Mental and substance use disorders in sub-saharan Africa: predictions of epidemiological changes and mental health workforce requirements for the next 40 years

The world is undergoing a rapid health transition, with an ageing population and disease burden increasingly defined by disability. In Sub-Saharan Africa the next 40 years are predicted to see reduced mortality, signalling a surge in the impact of chronic diseases. We modelled these epidemiological changes and associated mental health workforce requirements. Years lived with a disability (YLD) predictions for mental and substance use disorders for each decade from 2010 to 2050 for four Sub-Saharan African regions were calculated using Global Burden of Disease 2010 study (GBD 2010) data and UN population forecasts. Predicted mental health workforce requirements for 2010 and 2050, by region and for selected countries, were modelled using GBD 2010 prevalence estimates and recommended packages of care and staffing ratios for low- and middle-income countries, and compared to current staffing from the WHO Mental Health Atlas. Significant population growth and ageing will result in an estimated 130% increase in the burden of mental and substance use disorders in Sub-Saharan Africa by 2050, to 45 million YLDs. As a result, the required mental health workforce will increase by 216,600 full time equivalent staff from 2010 to 2050, and far more compared to the existing workforce. The growth in mental and substance use disorders by 2050 is likely to significantly affect health and productivity in Sub-Saharan Africa. To reduce this burden, packages of care for key mental disorders should be provided through increasing the mental health workforce towards targets outlined in this paper. This requires a shift from current practice in most African countries, involving substantial investment in the training of primary care practitioners, supported by district based mental health specialist teams using a task sharing model that mobilises local community resources, with the expansion of inpatient psychiatric units based in district and regional general hospitals

The impact of LASPO on routes to justice

This research underlines the emotional, social, financial and mental health impacts for individuals who have attempted to resolve their legal problems without legal aid, following the implementation of the Legal Aid, Sentencing and Punishment of Offenders Act (LASPO) in 2013. LASPO introduced funding cuts to legal aid and narrowed the scope and financial eligibility criteria, with the result that fewer people could access legal advice and representation for problems in areas such as family, employment and welfare benefits law. We interviewed over 100 people in the Liverpool City Region, with problems in at least one of these areas of law, to understand how LASPO had affected their options for resolving those issues. We also interviewed a number of advice providers and legal aid practitioners, and analysed national data from Citizens Advice. Many participants reported significant financial deprivation as a result of trying but not being able to resolve their legal issues. Some were unable to afford food, adequate housing or other essentials. A lack of preventive legal help led to delays in resolution, which often made problems worse. There was also evidence that costs were passed to other parts of the public sector, including an increased reliance on welfare benefits as a result of unresolved employment issues. Family law • The high cost of legal fees is a key barrier to justice. Some participants who paid for legal advice or representation reported going into debt as a result. • People’s inability to pay for expert or specialist evidence without legal aid may have led to courts making decisions on the basis of insufficient information. • Cuts to legal aid have had a negative impact on children’s lives, especially in relation to child contact cases. Employment law • The main barriers to justice are the high cost of legal representation, the difficulty of navigating the tribunal process without support and a low level of knowledge about employment rights. • Many participants reported that the costs of bringing their claims to tribunal were disproportionate to the value of the claims. This deterred them from bringing claims and made it harder to find a solicitor willing to take their case. • Participants had fewer options for accessing third-sector specialist advice and representation. Those participants who went to tribunal had to represent themselves as a result, and in general they lacked the skills or experience to do this competently. Welfare benefits law • LASPO has significantly reduced the capacity of voluntary sector organisations to provide welfare law advice. There is almost no specialist advice left to provide support to appeal benefits decisions. • The removal of welfare benefits law from the scope of legal aid has exacerbated the impact of recent welfare reforms, which is likely to have affected disabled people disproportionately. Most participants tried multiple routes to resolve a single issue: attempting to resolve problems on their own, trying to access free advice and taking steps to get paid advice or representation before courts or tribunals. But without legal aid, almost all the participants struggled to solve their problems

Recombination Rate Coefficients for KLL Di-electronic Satellite Lines of Fe XXV and Ni XXVII

The unified method for total electron-ion recombination is extended to study the dielectronic satellite (DES) lines. These lines, formed from radiative decay of autoionizing states, are highly sensitive temperature diagnostics of astrophysical and laboratory plasma sources. The computation of the unified recombination rates is based on the relativistic Breit-Pauli R-matrix method and close coupling approximation. Extending the theoretical formulation developed earlier we present recombination rate coefficients for the 22 satellite lines of KLL complexes of helium-like Fe XXV and Ni XXVII. The isolated resonance approximation, commonly used throughout plasma modeling, treats these resonances essentially as bound features except for dielectronic capture into, and autoionization out of, these levels. A line profile or cross section shape is often assumed. On the other hand, by including the coupling between the autoionizing and continuum channels, the unified method gives the intrinsic spectrum of DES lines which includes not only the energies and strengths, but also the natural line or cross section shapes. A formulation is presented to derive autoionization rates from unified resonance strengths and enable correspondence with the isolated resonance approximation. While the rates compare very well with existing rates for the strong lines to <20%, the differences for weaker DES lines are larger. We also illustrate the application of the present results to the analysis of K ALPHA complexes observed in high-temperature X-ray emission spectra of Fe XXV and Ni XXVII. There are considerable differences with previous results in the total KLL intensity for Fe XXV at temperatures below the temperature of maximum abundance in coronal equilibrium. (Abbreviated Abstract)Comment: 21 pages, 5 figures, to appear in Physica Script

A novel role for syndecan-3 in angiogenesis.

Syndecan-3 is one of the four members of the syndecan family of heparan sulphate proteoglycans and has been shown to interact with numerous growth factors via its heparan sulphate chains. The extracellular core proteins of syndecan-1,-2 and -4 all possess adhesion regulatory motifs and we hypothesized that syndecan-3 may also possess such characteristics. Here we show that a bacterially expressed GST fusion protein consisting of the entire mature syndecan-3 ectodomain has anti-angiogenic properties and acts via modulating endothelial cell migration. This work identifies syndecan-3 as a possible therapeutic target for anti-angiogenic therapy.This work was funded by Arthritis Research-UK (Grant No. 19207) and funds from the William Harvey Research Foundation both to JRW

Spatial variations in snowpack chemistry, isotopic composition of NO3− and nitrogen deposition from the ice sheet margin to the coast of western Greenland

The relative roles of anthropogenic nitrogen (N) deposition and climate change in causing ecological change in remote Arctic ecosystems, especially lakes, have been the subject of debate over the last decade. Some palaeoecological studies have cited isotopic signals (δ(15N)) preserved in lake sediments as evidence linking N deposition with ecological change, but a key limitation has been the lack of co-located data on both deposition input fluxes and isotopic composition of deposited nitrate (NO3−). In Arctic lakes, including those in western Greenland, previous palaeolimnological studies have indicated a spatial variation in δ(15N) trends in lake sediments but data are lacking for deposition chemistry, input fluxes and stable isotope composition of NO3−. In the present study, snowpack chemistry, NO3− stable isotopes and net deposition fluxes for the largest ice-free region in Greenland were investigated to determine whether there are spatial gradients from the ice sheet margin to the coast linked to a gradient in precipitation. Late-season snowpack was sampled in March 2011 at eight locations within three lake catchments in each of three regions (ice sheet margin in the east, the central area near Kelly Ville and the coastal zone to the west). At the coast, snowpack accumulation averaged 181 mm snow water equivalent (SWE) compared with 36 mm SWE by the ice sheet. Coastal snowpack showed significantly greater concentrations of marine salts (Na+, Cl−, other major cations), ammonium (NH4+; regional means 1.4–2.7 µmol L−1), total and non-sea-salt sulfate (SO42−; total 1.8–7.7, non-sea-salt 1.0–1.8 µmol L−1) than the two inland regions. Nitrate (1.5–2.4 µmol L−1) showed significantly lower concentrations at the coast. Despite lower concentrations, higher precipitation at the coast results in greater net deposition for NO3− as well as NH4+ and non-sea-salt sulfate (nss-SO42−) relative to the inland regions (lowest at Kelly Ville 6, 4 and 3; highest at coast 9, 17 and 11 mol ha−1 a−1 of NO3−, NH4+ and nss-SO42− respectively). The δ(15N) of snowpack NO3− shows a significant decrease from inland regions (−5.7 ‰ at Kelly Ville) to the coast (−11.3 ‰). We attribute the spatial patterns of δ(15N) in western Greenland to post-depositional processing rather than differing sources because of (1) spatial relationships with precipitation and sublimation, (2) within-catchment isotopic differences between terrestrial snowpack and lake ice snowpack, and (3) similarities between fresh snow (rather than accumulated snowpack) at Kelly Ville and the coast. Hence the δ(15N) of coastal snowpack is most representative of snowfall in western Greenland, but after deposition the effects of photolysis, volatilization and sublimation lead to enrichment of the remaining snowpack with the greatest effect in inland areas of low precipitation and high sublimation losses

The hidden burden of eating disorders : an extension of estimates from the Global Burden of Disease Study 2019

Background: Anorexia nervosa and bulimia nervosa are the only eating disorders included in the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019, yet binge-eating disorder and other specified feeding or eating disorder (OSFED) are more prevalent. This study sought to estimate the prevalence and burden of binge-eating disorder and OSFED globally and present a case for their inclusion in GBD. Methods: We sourced studies from the GBD 2019 anorexia nervosa and bulimia nervosa epidemiological databases, two systematic reviews that included studies with epidemiological estimates of binge-eating disorder and OSFED, and experts in the field. Studies, published between Jan 1, 1998, and March 1, 2019, were included if they reported non-zero prevalence of two or more eating disorders (anorexia nervosa, bulimia nervosa, binge-eating disorder, or OSFED) and diagnosed cases according to DSM-IV or DSM-5. The proportions of total eating disorder cases that met diagnostic criteria for each individual eating disorder were estimated via network meta-regression and simulation using studies reporting eating disorder prevalence. The global cases unrepresented in GBD 2019 were estimated using the proportions from the simulation and the GBD 2019 eating disorder prevalence. Disability weights for binge-eating disorder and OSFED were then estimated along with disability-adjusted life-years (DALYs). Estimates are presented with 95% uncertainty intervals (UIs). Findings: 54 studies, of which 36 were from high-income countries, were included in the analysis. The number of global eating disorder cases in 2019 that were unrepresented in GBD 2019 was 41·9 million (95% UI 27·9–59·0), and consisted of 17·3 million (11·3–24·9) people with binge-eating disorder and 24·6 million (14·7–39·7) people with OSFED (vs 13·6 million [10·2–17·5] people with eating disorders in GBD 2019). Together, binge-eating disorder and OSFED caused 3·7 million (95% UI 2·0–6·5) DALYs globally, bringing the total eating disorder DALYs to 6·6 million (3·8–10·6) in 2019. Interpretation: Binge-eating disorder and OSFED accounted for the majority of eating disorder cases and DALYs globally. These findings warrant the inclusion of binge-eating disorder and OSFED in future iterations of GBD, which will bring the burden experienced by people living with these disorders to the attention of policy makers with the means to target this burden. Funding: Queensland Health, Australian National Health and Medical Research Council, and Bill & Melinda Gates Foundation

Atomic data from the IRON Project. I. Electron-impact scattering of Fe17+ using <I>R</I>-matrix theory with intermediate coupling

We present results for electron-impact excitation of F-like Fe calculated using R-matrix theory where an intermediate-coupling frame transformation (ICFT) is used to obtain level-resolved collision strengths. Two such calculations are performed, the first expands the target using 2s2 2p5, 2s 2p6, 2s2 2p4 3l, 2s 2p5 3l, and 2p6 3l configurations while the second calculation includes the 2s2 2p4 4l, 2s 2p5 4l, and 2p6 4l configurations as well. The effect of the additional structure in the latter calculation on the n=3 resonances is explored and compared with previous calculations. We find strong resonant enhancement of the effective collision strengths to the 2s2 2p4 3s levels. A comparison with a Chandra X-ray observation of Capella shows that the n=4 R-matrix calculation leads to good agreement with observation</p

The National Food Consumption Survey (NFCS): South Africa, 1999

Objective: The aim of the National Food Consumption Survey (NFCS) in South Africa was to determine the nutrient intakes and anthropometric status of children (1-9 years old), as well as factors that influence their dietary intake. Design: This was a cross-sectional survey of a nationally representative sample of all children aged 1-9 years in South Africa. A nationally representative sample with provincial representation was selected using 1996 Census information. Subjects: Of the 3120 children who were originally sampled data were obtained from 2894, a response rate of 93%. Methods: The sociodemographic status of each household was assessed by a questionnaire. Dietary intake was assessed by means of a 24-hour recall and a food-frequency questionnaire from the caregivers of the children. Food purchasing practices were determined by means of a food procurement questionnaire. Hunger was assessed by a modified hunger scale questionnaire. Nutritional status was determined by means of anthropometric measurements: height, weight, head circumference and arm circumference. Results: At the national level, stunting (height-for-age below minus two standard deviations (&lt; -2SD) from the reference median) was by far the most common nutritional disorder, affecting nearly one in five children. The children least affected (17%) were those living in urban areas. Even with regard to the latter, however, children living in informal urban areas were more severely affected (20%) compared with those living in formal urban areas (16%). A similar pattern emerged for the prevalence of underweight (weight-for-age &lt; -2SD), with one in 10 children being affected at the national level. Furthermore, one in 10 (13%) and one in four (26%) children aged 1-3 years had an energy intake less than half and less than two-thirds of their daily energy needs, respectively. For South African children as a whole, the intakes of energy, calcium, iron, zinc, selenium, vitamins A, D, C and E, riboflavin, niacin, vitamin B6 and folic acid were below two-thirds of the Recommended Dietary Allowances. At the national level, data from the 24-hour recalls indicated that the most commonly consumed food items were maize, sugar, tea, whole milk and brown bread. For South African children overall, one in two households (52%) experienced hunger, one in four (23%) were at risk of hunger and only one in four households (25%) appeared food-secure. Conclusion: The NFCS indicated that a large majority of households were food-insecure and that energy deficit and micronutrient deficiencies were common, resulting in a high prevalence of stunting. These results were used as motivation for the introduction of mandatory fortification in South Africa. © The Authors 2005.Conference Pape