Social isolation and loneliness in family caregivers of people with severe mental illness: A scoping review

Family caregivers of people with severe mental illness (SMI) have been increasingly observed to experience social isolation and/or loneliness (SI/L) which are risk factors for ill health. This scoping review aimed to map existing evidence and identify knowledge gaps in studies on SI/L in this population using the Arksey and O'Malley's framework. Parallel searches (2011–2021) conducted in 10 databases identified 51 publications from 18 countries fully meeting the inclusion criteria. Over half of the included studies were quantitative. We found that the definition of loneliness reached a consensus, while the definition of social isolation varied across studies. Risk factors and correlates of SI/L were grouped into sociodemographic factors, illness-related factors, health and wellbeing, and stigma. The evidence showed a lack of comprehensive measurements assessing SI/L, few longitudinal studies, and little knowledge of interventions specifically addressing SI/L. Future studies are recommended to address these knowledge gaps and explore effective interventions on SI/L in family caregivers of people with SMI

The lung in progressive systemic sclerosis (scleroderma)

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Reconstructing Tuberculosis Services after Major Conflict: Experiences and Lessons Learned in East Timor

BACKGROUND: Tuberculosis (TB) is a major public health problem in developing countries. Following the disruption to health services in East Timor due to violent political conflict in 1999, the National Tuberculosis Control Program was established, with a local non-government organisation as the lead agency. Within a few months, the TB program was operational in all districts. METHODS AND FINDINGS: Using the East Timor TB program as a case study, we have examined the enabling factors for the implementation of this type of communicable disease control program in a post-conflict setting. Stakeholder analysis was undertaken, and semi-structured interviews were conducted in 2003 with 24 key local and international stakeholders. Coordination, cooperation, and collaboration were identified as major contributors to the success of the TB program. The existing local structure and experience of the local non-government organisation, the commitment among local personnel and international advisors to establishing an effective program, and the willingness of international advisers and local counterparts to be flexible in their approach were also important factors. This success was achieved despite major impediments, including mass population displacement, lack of infrastructure, and the competing interests of organisations working in the health sector. CONCLUSIONS: Five years after the conflict, the TB program continues to operate in all districts with high notification rates, although the lack of a feeling of ownership by government health workers remains a challenge. Lessons learned in East Timor may be applicable to other post-conflict settings where TB is highly prevalent, and may have relevance to other disease control programs

World report on violence and health

This report examines the types of violence that are present worldwide, in the everyday lives of people, and that constitute the bulk of the health burden imposed by violence. Accordingly, the information has been arranged in nine chapters, covering the following topics: 1. Violence – a global public health problem 2. Youth violence 3. Child abuse and neglect by parents and other caregivers 4. Violence by intimate partners 5. Abuse of the elderly 6. Sexual violence 7. Self-directed violence 8. Collective violence 9. The way forward: recommendations for action; Because it is impossible to cover all types of violence fully and adequately in a single document, each chapter has a specific focus. For example, the chapter on youth violence examines interpersonal violence among adolescents and young adults in the community. The chapter on child abuse discusses physical, sexual and psychological abuse, as well as neglect by parents and other caregivers; other forms of maltreatment of children, such as child prostitution and the use of children as soldiers, are covered in other parts of the report. The chapter on abuse of the elderly focuses on abuse by caregivers in domestic and institutional settings, while that on collective violence discusses violent conflict. The chapters on intimate partner violence and sexual violence focus primarily on violence against women, though some discussion of violence directed at men and boys is included in the chapter on sexual violence. The chapter on self-directed violence focuses primarily on suicidal behaviour. The chapter is included in the report because suicidal behaviour is one of the external causes of injury and is often the product of many of the same underlying social, psychological and environmental factors as other types of violence. The chapters follow a similar structure. Each begins with a brief discussion of definitions for the specific type of violence covered in the chapter, followed by a summary of current knowledge about the extent of the problem in different regions of the world. Where possible, country-level data are presented, as well as findings from a range of research studies. The chapters then describe the causes and consequences of violence, provide summaries of the interventions and policy responses that have been tried, and make recommendations for future research and action. Tables, figures and boxes are included to highlight specific epidemiological patterns and findings, illustrate examples of prevention activities, and draw attention to specific issues. The report concludes with two additional sections: a statistical annex and a list of Internet resources. The statistical annex contains global, regional and country data derived from the WHO mortality and morbidity database and from Version 1 of the WHO Global Burden of Disease project for 2000. A description of data sources and methods is provided in the annex to explain how these data were collected and analysed. The list of Internet resources includes web site addresses for organizations involved in violence research, prevention and advocacy. The list includes metasites (each site offers access to hundreds of organizations involved in violence research, prevention and advocacy), web sites that focus on specific types of violence, web sites that address broader contextual issues related to violence, and web sites that offer surveillance tools for improving the understanding of violence

Parameterized Inapproximability of Target Set Selection and Generalizations

In this paper, we consider the Target Set Selection problem: given a graph and a threshold value $thr(v)$ for any vertex $v$ of the graph, find a minimum size vertex-subset to "activate" s.t. all the vertices of the graph are activated at the end of the propagation process. A vertex $v$ is activated during the propagation process if at least $thr(v)$ of its neighbors are activated. This problem models several practical issues like faults in distributed networks or word-to-mouth recommendations in social networks. We show that for any functions $f$ and $\rho$ this problem cannot be approximated within a factor of $\rho(k)$ in $f(k) \cdot n^{O(1)}$ time, unless FPT = W[P], even for restricted thresholds (namely constant and majority thresholds). We also study the cardinality constraint maximization and minimization versions of the problem for which we prove similar hardness results

Malaria control in Timor-Leste during a period of political instability: what lessons can be learned?

<p>Abstract</p> <p>Background</p> <p>Malaria is a major global health problem, often exacerbated by political instability, conflict, and forced migration.</p> <p>Objectives</p> <p>To examine the impact of political upheaval and population displacement in Timor-Leste (2006) on malaria in the country.</p> <p>Method</p> <p>Case study approach drawing on both qualitative and quantitative methods including document reviews, in-depth interviews, focus group discussions, site visits and analysis of routinely collected data.</p> <p>Findings</p> <p>The conflict had its most profound impact on Dili, the capital city, in which tens of thousands of people were displaced from their homes. The conflict interrupted routine malaria service programs and training, but did not lead to an increase in malaria incidence. Interventions covering treatment, insecticide treated nets (ITN) distribution, vector control, surveillance and health promotion were promptly organized for internally displaced people (IDPs) and routine health services were maintained. Vector control interventions were focused on IDP camps in the city rather than on the whole community. The crisis contributed to policy change with the introduction of Rapid Diagnostic Tests and artemether-lumefantrine for treatment.</p> <p>Conclusions</p> <p>Although the political crisis affected malaria programs there were no outbreaks of malaria. Emergency responses were quickly organized and beneficial long term changes in treatment and diagnosis were facilitated.</p