Understanding mental health consequences and associated risk factors among adult injury survivors in Kenya

Background An elevated level of mental health burden has been reported among various injury populations in high-income settings, and such burden has been associated with decreased social functioning, return to work, and long-term impairment in functioning. Low- and middle-income countries (LMICs) have a much higher burden of injuries than high-income regions. However, there has been a lack of research on the mental health consequences among injury survivors in LMICs. The overall goal of this dissertation is to estimate the risk factors and trajectories of depressive, anxiety, and post-traumatic stress symptoms among adult injury survivors in Kenya, in terms of internationally applied mental health concepts as well as from the survivor’s perspective. Methods The dissertation applied an explanatory mixed method design. The quantitative analyses included chapters 4 and 5. Data for quantitative analyses came from a prospective cohort study on Health, Economic and Long-term Social Impact of Injuries (HEALS). The HEALS study participants were recruited at Kenyatta National Hospital. Chapter 4 examined the trajectories of depressive and anxiety symptoms between hospitalization and up to seven months after discharge and associated risk factors of the trajectories. Analyses of chapter 4 included 644 adult injury patients. Depressive and anxiety symptoms were assessed using Hopkins Symptoms Checklist at baseline and follow-ups. Latent growth curve analyses were used to model the trajectories of depressive and anxiety symptoms and their risk factors. Chapter 5 examined the trajectories of post-traumatic stress symptoms between one and up to seven months after discharge and the association with potentially traumatic events and other risk factors. Analyses of chapter 5 included 476 adult injury patients. Post-traumatic stress disorder symptoms were assessed using PTSD Checklist version 5 (PCL-5) at each follow-up and trauma history was assessed in the hospital using Brief Trauma Questionnaire. The level of disability was assessed at each follow-up interview. Latent growth curve analysis was conducted to estimate the trajectories of PTSD symptoms 4 to 7 months after hospital discharge. Risk factors and trauma history characteristics were preliminarily assessed using R3Step and subsequently included in multivariate logistic regression using manual BCH methods. Chapter 6 used a qualitative method to understand the different experiences and contributing factors of psychological distress and resilience among unintentional injury survivors in urban Kenya. In-depth interviews were conducted with 28 survivors of unintentional injuries in Nairobi and nearby area, four to eight months after the injury. Inductive thematic coding was performed on transcribed and translated interviews, after which the Conservation of Resources theory was adapted to identify the relationship between the resource losses, gains and psychological distress/resilience at the various stages of recovery, beginning with the injury event. Results In chapter 4, two trajectories of depressive and anxiety symptoms were found for the period between hospitalization and up to seven months after hospital discharge: elevated depressive and moderate anxiety symptoms (13%), and low depressive and anxiety symptoms (87%). The elevated depressive and moderate anxiety symptoms trajectory was associated with being female, residing in a rural area, prior trauma experience, longer hospitalization, worse self-rated health status while in the hospital, no household assets nor savings, and without monetary assistance during hospitalization. In chapter 5, two trajectories of post-traumatic stress symptoms were found between 1-month post-discharge and 4- to 7-months post-discharge: persistently elevated PTSD symptoms (9%), and low PTSD symptoms (91%). Having previously been exposed to potentially traumatic events and the number of types of trauma exposed were associated with an elevated PTSD symptom trajectory, but no longer associated after controlling for having depressive symptoms while in the hospital. Having previously witnessed killings or serious injuries was associated with elevated PTSD symptoms trajectory class, controlling for other risk factors and direct association with disability level at 4 to 7 months. Being female, having elevated depressive symptoms during hospitalization and having no household savings nor assets were associated with elevated PTSD symptoms trajectory. Chapter 6 found several types of resource loss described, including financial, property, condition, and physical health resources at different phases of recovery. Improvement in physical health, personal resources, social support through family, friends, neighbors and church members, and spirituality have contributed to the adaptation and resilience demonstrated among injury survivors. Conclusion These findings show the burden of depressive, anxiety, and post-traumatic stress symptoms several months after physical injury in a predominantly male, urban population in a lower-middle income country. This underscores the importance to identify patients who experienced worse psychosocial outcomes to provide preventive and early interventions through follow-up after hospital discharge. Potential interventions on providing social welfare and facilitating social network building may also help reduce distress and overall functioning

Regulating the sale of first-hand residential properties in Hong Kong : a study of policy and administrative dynamics

published_or_final_versionPolitics and Public AdministrationMasterMaster of Public Administratio

Effective Photodegradation of Methyl Orange Using Fluidized Bed Reactor Loaded with Cross-Linked Chitosan Embedded Nano-CdS Photocatalyst

Chitosan-based photocatalyst composites containing CdS nanocrystals with and without glutaraldehyde or epichlorohydrin cross-linking treatments were investigated and the catalyzed photodegradation of methyl orange in aqueous solution was examined. In addition, the effects of catalyst dosage, initial dye concentration, and initial pH of the dye solution on the photodegradation kinetics were investigated. In this study, the effect of initial solution pH was more important than other factors. The photocatalyst composite could remove 99% dye in 80 minutes at pH 4. The catalyst composite was characterized by using X-ray diffraction (XRD), transmission electron microscopy (TEM), thermogravimetric analysis (TGA), fourier transform infrared (FT-IR), and visible reflectance spectroscopy. The dye removal mechanism of methyl orange involved an initial sorption process followed by photodegradation. The sorption process underwent the pseudo-second order kinetics, while photodegradation followed the Langmuir-Hinshelwood kinetics. Although the glutaraldehyde cross-linked chitosan enhanced the initial dye sorption, the epichlorohydrin cross-linked catalyst composite demonstrated a better overall dye removal performance, especially in the photodegradation step. Both chitosan encapsulated catalyst with and without epichlorohydrin cross-linking demonstrated the same pseudo-first order photodegradation kinetic constant of 0.026 min−1 and the same dye removal capacity. The catalyst composite could be reused but the photocatalytic activity dropped successively in each cycle

SARS-CoV-2 Transmission in Alberta, British Columbia, and Ontario, Canada, December 25, 2019, to December 1, 2020

Objective: This study aimed to investigate coronavirus disease (COVID-19) epidemiology in Alberta, British Columbia, and Ontario, Canada. Methods: Using data through December 1, 2020, we estimated time-varying reproduction number, R t , using EpiEstim package in R, and calculated incidence rate ratios (IRR) across the 3 provinces. Results: In Ontario, 76% (92 745/121 745) of cases were in Toronto, Peel, York, Ottawa, and Durham; in Alberta, 82% (49 878/61 169) in Calgary and Edmonton; in British Columbia, 90% (31 142/34 699) in Fraser and Vancouver Coastal. Across 3 provinces, R t dropped to ≤ 1 after April. In Ontario, R t would remain \u3c 1 in April if congregate-setting-associated cases were excluded. Over summer, R t maintained \u3c 1 in Ontario, ~1 in British Columbia, and ~1 in Alberta, except early July when R t was \u3e 1. In all 3 provinces, R t was \u3e 1, reflecting surges in case count from September through November. Compared with British Columbia (684.2 cases per 100 000), Alberta (IRR = 2.0; 1399.3 cases per 100 000) and Ontario (IRR = 1.2; 835.8 cases per 100 000) had a higher cumulative case count per 100 000 population. Conclusions: Alberta and Ontario had a higher incidence rate than British Columbia, but R t trajectories were similar across all 3 provinces

Adolescent and Young Adult Injuries in Developing Economies: A Comparative Analysis from Oman and Kenya

Background: Adolescence is a distinct period of rapid and dramatic biological, cognitive, psychological, and social development. The burden of injuries among young people (aged 10-24) is both substantial and maldistributed across regions and levels of economic development. Objectives: Our objective was to compare sociodemographic correlates of injury cause, intentionality, and mortality between Kenya and Oman, 2 countries with different levels of economic development and position in the demographic and epidemiologic transitions. Methods: Data on 566 patients in Oman and 5859 in Kenya between 10 and 24 years old were extracted from 2 separate multicenter trauma registries. Multivariable log binomial and Poisson regressions were used to evaluate social and demographic factors associated with injury cause, intentionality, and mortality. Literature on adolescent development was used to parameterize variables, and Akaike information criteria were used in the final model selections. Findings: The trauma registry data indicated a substantial burden of adolescent and young adult injury in both Oman and Kenya, particularly among males. The data indicated significant differences between countries ('P' interpersonal violence also resulting in severe injury across contexts. Both road traffic injuries and interpersonal violence were more common among older adolescents and young adults. Education and being in school were protective against injury, after controlling for gender, age category, occupation, and country. ConclusionsA rising burden of injuries among young people has been documented in every region of the world, irrespective on income status or level of development. Cost-effective injury control measures targeting this age group exist, including involvement in educational, vocational, and other prosocial activities; environmental alterations; and road safety measures

Adoption and Handling Information Communication Technology as Instrumental Activities of Daily Living for Aging-in-Place in Chinese Older Adults

(Background) The use of information communication technology and smartphone application are crucial to individuals’ functional independence of community living. Previous studies did not reveal how older adults’ in applying the information communication technology will affect their aging-in-place in our contemporary community. (Methods) This study aimed at developing the psychometric properties of the instrument named Advanced Instrumental Activities of Daily Living (AIADL), and to explore the adoption and handling information communication technology in instrumental activities of daily living for aging-in-place of older adults. 100 home-living participants who are functionally and socially independent, 100 hostel-living participants who are functionally independent but need social assistance, and 100 care-and-attention home living participants who need environment support and assistance in daily functioning were recruited for this study. (Results) AIADL showed good test-retest reliability and good-to-excellent internal consistency. Exploratory factor analysis revealed a two-factor structure with “home living and management” and “community living”. Validity analysis with the known-groups method showed a high overall accuracy of prediction of individuals’ capability of independent living in the community. (Conclusions) AIADL is a valid and reliable instrument to assess older adults’ ability in handling contemporary instrumental activities in their daily life. This instrument can serve as a reference in measuring individuals’ ability of aging-in-place

A Large Population Histology Study Showing the Lack of Association between ALT Elevation and Significant Fibrosis in Chronic Hepatitis B

OBJECTIVE: We determined the association between various clinical parameters and significant liver injury in both hepatitis B e antigen (HBeAg)-positive and HBeAg-negative patients. METHODS: From 1994 to 2008, liver biopsy was performed on 319 treatment-naive CHB patients. Histologic assessment was based on the Knodell histologic activity index for necroinflammation and the Ishak fibrosis staging for fibrosis. RESULTS: 211 HBeAg-positive and 108 HBeAg-negative patients were recruited, with a median age of 31 and 46 years respectively. 9 out of 40 (22.5%) HBeAg-positive patients with normal ALT had significant histologic abnormalities (necroinflammation grading >/= 7 or fibrosis score >/= 3). There was a significant difference in fibrosis scores among HBeAg-positive patients with an ALT level within the Prati criteria (30 U/L for men, 19 U/L for women) and patients with a normal ALT but exceeding the Prati criteria (p = 0.024). Age, aspartate aminotransferase and platelet count were independent predictors of significant fibrosis in HBeAg-positive patients with an elevated ALT by multivariate analysis (p = 0.007, 0.047 and 0.045 respectively). HBV DNA and platelet count were predictors of significant fibrosis in HBeAg-negative disease (p = 0.020 and 0.015 respectively). An elevated ALT was not predictive of significant fibrosis for HBeAg-positive (p = 0.345) and -negative (p = 0.544) disease. There was no significant difference in fibrosis staging among ALT 1-2 x upper limit of normal (ULN) and > x 2 ULN for both HBeAg-positive (p = 0.098) and -negative (p = 0.838) disease. CONCLUSION: An elevated ALT does not accurately predict significant liver injury. Decisions on commencing antiviral therapy should not be heavily based on a particular ALT threshold.published_or_final_versio

Immunoregulatory Protein Profiles of Necrotizing Enterocolitis versus Spontaneous Intestinal Perforation in Preterm Infants

Necrotizing enterocolitis (NEC) and spontaneous intestinal perforation (SIP) are the most common acute surgical emergencies associated with high morbidity and mortality in preterm infants. We aimed to compare the profiles of immunoregulatory proteins and identify novel mediators in plasma of NEC and SIP infants. We also investigated the expression of target genes in resected intestinal tissues and an enterocyte cell line. Using Cytokine Antibody Array assay, we reported the first comparative profiles of immunoregulatory proteins in plasma of NEC and SIP infants, and showed that dysregulated proteins belonged to functionally diversified categories, including pro- and anti-inflammation, angiogenesis, cell growth, wound healing, anti-apoptosis, cell adhesion and extracellular matrix reorganization. Validation by ELISA confirmed significantly higher concentrations of interleukin (IL)-6, angiopoietin (Ang)-2, soluble type II interleukin-1 receptor (sIL-1RII), and soluble urokinase-type plasminogen activator receptor (suPAR) in NEC infants compared with gestational age-matched control, and a lower level of an epidermal growth factor receptor, secreted form of receptor tyrosine-protein kinase ErbB3 (sErbB3), compared with SIP infants. mRNA expressions of IL1-RII and uPAR were up-regulated in resected bowel tissues from NEC infants, indicating that immunoregulation also occurred at the cellular level. In FHs-74 Int cells, Ang-2, IL1-RII and uPAR mRNA expressions were significantly induced by the combined treatment with lipopolysaccharide (LPS) and platelet activating factor (PAF). Our study provided plasmatic signatures of immunoregulatory proteins in NEC and SIP infants, and demonstrated involvement of multiple functional pathways. The magnitude of changes in these proteins was significantly more extensive in NEC infants, reflecting the different nature of injury and/or severity of inflammation. We speculate that dysregulation of IL-6, Ang-2, IL-1RII and uPAR occurred at both systemic and cellular levels, and probably mediated via LPS and endogeneous PAF signals. Such exaggerated immunologic responses may account for the high morbidity and mortality in NEC compared with SIP patients