Recent research activities in WHO's mental health programme

The mental health programme of WHO has been formulated through a process of consultation within WHO, with other United Nations bodies, with Governments, with the scientific community and with various non-governmental organizations (Sartorius, 1978; WHO, 1983 a; Lambo & Sartorius, in the press

Risk factor assessment in South African Black patients presenting with acute myocardial infarction at R.K. Khan Hospital, Durban

Objective: To assess various risk factors in Black South African patients presenting with acute myocardial infarction (AMI) to the Coronary Care Unit (CCU) at R.K. Khan Hospital, Durban, South Africa. Methods and results: The study population was recruited from consecutive patients from a multi-ethnic background with a diagnosis of AMI over a 4 year period (2008 - 2012). Only patients who were of Black South African origin (n=94) were eligible for analysis. Demographic data stored in an electronic database were extracted from all patients. The mean age of the participantswas 54.3 ± 11.0 years of whom 85% were males. The majority presented with ST elevation myocardial infarction (STEMI) (83%) whilst 17% had Non ST elevation myocardial infarction (NSTEMI). Smoking (48%) and hypertension (46%) were the most commonly observed risk factors. Thirty six percent of patients developed one or more major adverse cardiac events (MACE). Recurrence of infarction and death occurred more frequently in females compared to males (14% vs. 2%, p=0.04). No signifi cant difference in MACE was found between patients who were human immunodefi ciency virus (HIV) positive (18%) compared to those who were HIV negative (82%). Metabolic syndrome, as defi ned by the International Diabetes Federation (IDF) criteria, was found in 35 (45%) of patients. The number of patients presenting with hypertension and diabetes was signifi -cantly higher in our study compared to the INTERHEART Africa study (73% vs. 50%, p<0.01; and 40% vs. 24%, p<0.01). Conclusion: South African Blacks have multiple risk factors, similar to other ethnic groups in the country, which contribute to the development of AMI. Recurrence of infarction and death occurred more frequently in females compared to males. In addition to conventional risk factors for CAD, an increased heart rate, STEMI, obesity, family history of cerebrovascular disease and hyperuricaemia are strongly associated with the presence of MACE

Two-year follow-up of the patients included in the WHO International Pilot Study of Schizophrenia

Over 90% of the 1202 patients investigated in the 9 centres collaborating in the International Pilot Study of Schizophrenia were traced 2 years after the initial examination and on the average over 75% of them were re-examined, using standardized instruments and methods. Results indicate that patients diagnosed as schizophrenic on the basis of standardized assessments and clearly specified diagnostic criteria demonstrated very marked variations of course and outcome over a 2-year period. Schizophrenic patients in the centres in developing countries had considerably better course and outcome than schizophrenic patients in the centres in developed countrie

The costs of delivering human papillomavirus vaccination to Grade 4 learners in KwaZulu-Natal, South Africa

Background. The national human papillomavirus (HPV) vaccination roll-out in South Africa provides two doses of Cervarix to all female Grade 4 learners in state schools. This study estimated the costs of vaccinating all learners in KwaZulu-Natal Province (females or males and females) using either the two- or three-dose strategies for both the bivalent and quadrivalent vaccines.Objective. To determine costs of the HPV vaccination programme in KwaZulu Natal.Methods. Costs were determined adapting World Health Organization vaccination costing guidelines.Results. The 2014 current cost of delivering three doses of Gardasil was ZAR510 per learner. The projected cost of delivering Cervarix to female learners at two or three doses over the period 2014 - 2018, adjusted for inflation, was ZAR172 717 342 and ZAR250 048 426, respectively. Similarly, the cost for Gardasil at these doses was ZAR197 482 200 and ZAR287 194 361, respectively. For male and female learners the cost for Cervarix over this period at two or three doses was ZAR337 101 132 and ZAR540 150 713, respectively. Similarly, the cost for Gardasil at these doses was ZAR426 597 971 and ZAR620 392 784, respectively. Accounting for population variation for females over 5 years, the cost of two doses of Cervarix ranged from ZAR168 888 677 to ZAR 176 545 977 at the lower and upper 95% confidence intervals (CIs), respectively. For three doses the cost ranged from ZAR244 505 544 to ZAR255 591 263 at the lower and upper 95% CIs, respectively. Similarly, the cost for two doses of Gardasil ranged from ZAR193 104 566 to ZAR201 859 798. For three doses the cost ranged from ZAR280 828 057 to ZAR293 560 614.Conclusion. This study gives decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the HPV vaccination programme

Schizophrenia succeeded by affective illness: catamnestic study and statistical enquiry

On the basis of data derived from a long-term follow-up of 12 cases and a 2-year follow-up of the International Pilot Study of Schizophrenia it is suggested that some patients with remitting schizophrenic illnesses can subsequently present clear-cut affective disorders. The implications of these findings are discusse

WHO International Pilot Study of Schizophrenia

The results are described of a transcultural psychiatric study of schizophrenia undertaken by WHO in nine countries. The study proved that such a collaboration was feasible, that it was possible to develop research procedures for international use, and that similar types of schizophrenia could be found in each of the countries involved. One thousand two hundred and two patients were studied and over 2 million items of information obtaine

The International Pilot Study of Schizophrenia: five-year follow-up findings

A five-year follow-up of the patients initially included in the International Pilot Study of Schizophrenia was conducted in eight of the nine centres. Adequate information was obtained for 807 patients, representing 76% of the initial cohort. Clinical and social outcomes were significantly better for patients in Agra and Ibadan than for those in the centres in developed countries. In Cali, only social outcome was significantly bette

Reported stigma and discrimination by people with a diagnosis of schizophrenia

Aims. This article examines the extent of stigma and discrimination as reported by people with a diagnosis of schizophrenia. The hypothesis is that when people express in their own words the discrimination they experience such discrimination will be found to be widespread. Methods. Seventy-five people with a diagnosis of schizophrenia from 15 different countries were interviewed with a mixed methods instrument to assess reported discrimination. The data were analysed for frequency counts and then a thematic analysis was performed. A conceptual map is provided. Results. The study was a cross-cultural one but, contrary to expectations, few transnational differences were found. The main hypothesis was supported. Conversely, we found that when participants reported ‘positive discrimination', this could as easily be conceptualised as being treated similarly to how others in society would expect to be treated. Conclusion. Negative discrimination is ubiquitous and sometimes connotatively very strong, with reports of humiliation and abuse. ‘Positive discrimination' conversely indicates that people with a mental illness diagnosis expect discrimination and are grateful when it does not occur. The literature on self-stigma is discussed and found wanting. Similarly, the theory that contact with mentally ill people reduces stigma and discrimination is not fully supported by our result