bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving Access to Thrombolysis and Inhospital Management Times in Ischemic Stroke
Authors: Haesebaert Julie , Nighoghossian Norbert , Mercier Catherine , Termoz Anne , Porthault Sylvie , Derex Laurent , Gueugniaud Pierre-Yves , Bravant Estelle , Rabilloud Muriel , Schott Anne-Marie ,   on behalf of the AVC II Trial group*, Saligari Elisabeth , Cailler Samira , Hénniche Adeline , Prost Sylvain , Fournier Carole , Le Loch Jean-Baptiste , Roncoroni Cécile , Verbois Frédéric , Debas Olivier , Tesniere Marc , Bontemps Béatrice , Lavignon Jean-Pierre , Rimet Mathilde , Trinquet Patricia , Millot Thomas , Dumont Odile , Tabyaoui Samir , Ziade Elie , Detante Olivier , Giroud Maurice , Cakmak Serkan , Marcel Sébastien , Blanc-Lasserre Karine , Minier Dominique , Rodier Gilles , Philippeau Frédéric , Vallet Anne-Evelyne
Published: January 2018

Background and Purpose—

A suboptimal number of ischemic stroke patients eligible for thrombolysis actually receive it, partly because of extended inhospital delays. We developed a comprehensive program designed for emergency unit staff and evaluated its effectiveness for reducing intrahospital times and improving access to thrombolysis.

Methods—

We conducted a randomized stepped-wedge controlled trial in 18 emergency unit. The sequentially implemented training intervention, targeting emergency physicians and nurses, was based on specifically designed videos and interactive simulation workshops on intrahospital management optimization. The effectiveness was assessed on intrahospital times and thrombolysis proportion. During the study period, all consecutive patients with confirmed ischemic stroke and no contraindications to thrombolysis were included.

Results—

A total of 328 patients were enrolled in the control group and 363 in the intervention group. Mean age was 73.6 years. Overall thrombolysis proportion was 34.2% in the intervention group versus 25.6% in the control group (adjusted odds ratio, 1.42; 95% confidence interval, 1.01–2.01), thrombolysis proportion within 4 hours 30 minutes almost doubled (adjusted odds ratio, 1.9; 95% confidence interval, 1.32–2.73). Although imaging-to-stroke unit time was significantly decreased in the intervention group (39 versus 53 minutes;
P
=0.03), median door-to-imaging and door-to-needle times were not different between groups (
P
=0.70 and
P
=0.40, respectively).

Conclusions—

An interactive and multifaceted training program targeting emergency professionals was significantly associated with an increased access to thrombolysis, especially within 4 hours and 30 minutes.

Clinical Trial Registration—

URL:
https://www.clinicaltrials.gov
. Unique identifier: NCT02814760.
Neuroimaging Identifies Patients Most Likely to Respond to a Restorative Stroke Therapy
Authors: Cassidy Jessica M. , Tran George , Quinlan Erin B. , Cramer Steven C.
Published: January 2018

Background and Purpose—

Patient heterogeneity reduces statistical power in clinical trials of restorative therapies. Valid predictors of treatment responsiveness are needed, and several have been studied with a focus on corticospinal tract (CST) injury. We studied performance of 4 such measures for predicting behavioral gains in response to motor training therapy.

Methods—

Patients with subacute-chronic hemiparetic stroke (n=47) received standardized arm motor therapy, and change in arm Fugl-Meyer score was calculated from baseline to 1 month post-therapy. Injury measures calculated from baseline magnetic resonance imaging included (1) percent CST overlap with stroke, (2) CST-related atrophy (cerebral peduncle area), (3) CST integrity (fractional anisotropy) in the cerebral peduncle, and (4) CST integrity in the posterior limb of internal capsule.

Results—

Percent CST overlap with stroke, CST-related atrophy, and CST integrity did not correlate with one another, indicating that these 3 measures captured independent features of CST injury. Percent injury to CST significantly predicted treatment-related behavioral gains (
r
=−0.41;
P
=0.004). The other CST injury measures did not, neither did total infarct volume nor baseline behavioral deficits. When directly comparing patients with mild versus severe injury using the percent CST injury measure, the odds ratio was 15.0 (95% confidence interval, 1.54–147;
P
<0.005) for deriving clinically important treatment-related gains.

Conclusions—

Percent CST injury is useful for predicting motor gains in response to therapy in the setting of subacute-chronic stroke. This measure can be used as an entry criterion or a stratifying variable in restorative stroke trials to increase statistical power, reduce sample size, and reduce the cost of such trials.
Design and Evaluation of Agents that Sequence and Juxtapose Short Musical Patterns in Real Time
Authors: Martin Aengus , Jin Craig T. , Bown Oliver
Published: January 2018

We present and discuss the Agent Designer, a system that enables users of digital audio workstations to generate novel high-level structures for their compositions based on previous examples. The system uses variable-order Markov models and rule induction to learn both temporal relations and structural relations between parts in a piece of music. As is usual in machine learning, however, the quality of the learning can be improved greatly by users specifying relevant features. The Agent Designer therefore points to important design and human–computer interaction problems, as well as algorithmic challenges. We present a number of studies that help to understand how effective the Agent Designer is and how we might design a user interface that best enables users to obtain quality results from the system. We show that the Agent Designer is effective for certain musical styles, such as loop-based electronic music, and that we as expert users can design agents that produce the most effective results. We also note that it remains a challenge to automate this process fully.
Constructing an Identity Online: Logging-On as “Catholic”
Authors: Mullan Margaret
Published: January 2018

This article explores the nature of Catholic identity, as constructed in a Catholic social media site, PhatMass. This study, a month-long virtual ethnography of PhatMass, took place during the significant global Catholic event in February to March of 2013—the former Pope Benedict XVI’s resignation and the new Pope Francis’s election. James Carey’s (1989) ritual view of communication sheds light on PhatMass participant engagement with social media, popular culture, and Catholic identity during these online discussions.

The findings from this ethnography indicate that religion, media, and popular culture meet in the religious, media-using, culture participant who communicates, consumes, or creates meaning through daily ritual on technology. The blend of pop culture content and traditional Catholic beliefs on PhatMass reveals a broader Catholic identity emerging online. The PhatMass conversation provides details about how Catholic identity formation takes place in a world increasingly marked by online communication.
An annotated checklist of Brazilian sea spiders (Arthropoda: Pycnogonida)
Authors: LUCENA RUDÁ AMORIM , CHRISTOFFERSEN MARTIN LINDSEY
Published: January 2018

The Brazilian coast is over 7000 km long. It is comprised of diverse environments such as reef, lagoons and mangroves. These diverse habitats support great biological diversity but, due to the extension of the coast, knowledge of the pycnogonid fauna is poor and fragmented. Records from Brazil began with Krøyer in the 1840s. Collections from Brazilian waters by the "H.M.S. Challenger" and "Vettor Pisani" expeditions were published by Hoek (1881) and Schimkewitsch (1888). For almost 50 years there were no further publications, until Marcus (1940c) published his comprehensive paper on the South American fauna. Publications peaked between the 1940s and 1960s, with papers by Marcus, Sawaya, Mello-Leitão, Corrêa, Du Bois- Reymond Marcus, Hedgpeth and Stock. Approximately 40 papers based on material from Brazilian waters were published at this time, which recorded 65 species for Brazil. The aim of the present work is to provide a checklist of the Brazilian pycnogonids while providing a historical review and a full account of the corresponding literature.
A prototypical non-malignant epithelial model to study genome dynamics and concurrently monitor micro-RNAs and proteins in situ during oncogene-induced senescence
Authors: Komseli Eirini-Stavroula , Pateras Ioannis S. , Krejsgaard Thorbjørn , Stawiski Konrad , Rizou Sophia V. , Polyzos Alexander , Roumelioti Fani-Marlen , Chiourea Maria , Mourkioti Ioanna , Paparouna Eleni , Zampetidis Christos P. , Gumeni Sentiljana , Trougakos Ioannis P. , Pefani Dafni-Eleftheria , O’Neill Eric , Gagos Sarantis , Eliopoulos Aristides G. , Fendler Wojciech , Chowdhury Dipanjan , Bartek Jiri , Gorgoulis Vassilis G.
Published: January 2018

Background

Senescence is a fundamental biological process implicated in various pathologies, including cancer. Regarding carcinogenesis, senescence signifies, at least in its initial phases, an anti-tumor response that needs to be circumvented for cancer to progress. Micro-RNAs, a subclass of regulatory, non-coding RNAs, participate in senescence regulation. At the subcellular level micro-RNAs, similar to proteins, have been shown to traffic between organelles influencing cellular behavior. The differential function of micro-RNAs relative to their subcellular localization and their role in senescence biology raises concurrentin situanalysis of coding and non-coding gene products in senescent cells as a necessity. However, technical challenges have renderedin situco-detection unfeasible until now.

Methods

In the present report we describe a methodology that bypasses these technical limitations achieving for the first time simultaneous detection of both a micro-RNA and a protein in the biological context of cellular senescence, utilizing the new commercially available SenTraGorTMcompound. The method was applied in a prototypical human non-malignant epithelial model of oncogene-induced senescence that we generated for the purposes of the study. For the characterization of this novel system, we applied a wide range of cellular and molecular techniques, as well as high-throughput analysis of the transcriptome and micro-RNAs.

Results

This experimental setting has three advantages that are presented and discussed: i) it covers a “gap” in the molecular carcinogenesis field, as almost all correspondingin vitromodels are fibroblast-based, even though the majority of neoplasms have epithelial origin, ii) it recapitulates the precancerous and cancerous phases of epithelial tumorigenesis within a short time frame under the light of natural selection and iii) it uses as an oncogenic signal, the replication licensing factor CDC6, implicated in both DNA replication and transcription when over-expressed, a characteristic that can be exploited to monitor RNA dynamics.

Conclusions

Consequently, we demonstrate that our model is optimal for studying the molecular basis of epithelial carcinogenesis shedding light on the tumor-initiating events. The latter may reveal novel molecular targets with clinical benefit. Besides, since this method can be incorporated in a wide range of low, medium or high-throughput image-based approaches, we expect it to be broadly applicable.
Mental healthcare reform in the Republic of Moldova
Authors: Zinkler Martin , Boderscova Larisa , Chihai Jana
Published: January 2018

Mental healthcare in the countries of the former Soviet Union faces considerable challenges as result of the socio-economic transition. In this article we look at the changes in the Republic of Moldova. We identify weaknesses and strengths in the traditional hospital-based system and describe examples of the successful implementation of modern mental health services. We follow the reform process in mental health law and service provision in view of the recommendations from the Council of Europe (2004) for the protection of human rights of persons with mental disorder. Some of the information in this article was gathered during official visits to mental healthcare institutions in the Republic of Moldova in 2006.
Psychiatry in Ireland
Authors: Latif Zahid
Published: January 2018

Ireland is the third largest island in Europe and the twentieth largest island in the world, with an area of 86 576 km2; it has a total population of slightly under 6 million. It lies to the north-west of continental Europe and to the west of Great Britain. The Republic of Ireland covers five-sixths of the island; Northern Ireland, which is part of the United Kingdom, is in the north-east. Twenty-six of the 32 counties are in the Republic of Ireland, which has a population of 4.2 million, and its capital is Dublin. The other six counties are in Northern Ireland, which has a population of 1.75 million, and its capital is Belfast. In 1973 both parts of Ireland joined the European Economic Community. This article looks at psychiatry in the Republic of Ireland.
Correlates of lifetime alcohol abuse and dependence among older community residents in Brazil
Authors: Fillenbaum Gerda G. , Blay Sergio Luís , Andreoli Sergio Baxter , Gastal Fabio Leite
Published: January 2018

Misinterpretation in major surveys of alcohol use disorder as described by DSM-IV (Hasin et al, 2007) has raised serious questions regarding the extent of alcohol use disorder, and the relationship between alcohol abuse and alcohol dependence. While the adverse social, physical and mental effects of alcohol misuse are well known (Council on Scientific Affairs, 1996), there is little information on the determinants of alcohol abuse (societal impact) and alcohol dependence (physiological impact). We therefore examined their separate and combined associations with demographic, social and health characteristics in a representative community-resident sample aged 60 years and over. We hypothesised that, while for each of the three groups (those with alcohol abuse, those with alcohol dependence, and those with both) there would be associated demographic characteristics, abuse would be more closely associated with social characteristics, dependence with health characteristics, and the combined presence of abuse and dependence with both social and health characteristics.
Mental health services in the Republic of Niger
Authors: Eaton Julian , Maiga Djibo Douma , Pate Soumana
Published: January 2018

The Republic of Niger is a large, landlocked west African country. Around 80% of its vast land mass (1 300 000 km2) is in the Sahara Desert. Its neighbours are Mali, Algeria, Libya and Chad to the north, and Nigeria, Benin and Burkina Faso to the south. The country came under French rule in the 1890s and gained its independence in 1960, but development has been slowed by political instability, lack of natural resources and drought. In 1999, voters overwhelmingly approved a new constitution, allowing for multi-party elections, which were held later that year. An ongoing rebellion in the north makes access to much of the country difficult.
Psychiatry in Jamaica
Authors: Hickling Frederick W.
Published: January 2018

The intense historical relationship linking Jamaica and Britain to 300 years of the transatlantic slave trade and 200 years of colonialism has left 2.7 million souls living in Jamaica, 80% of African origin, 15% of mixed Creole background and 5% of Asian Indian, Chinese and European ancestry. With a per capita gross domestic product of US$4104 in 2007, one-third of the population is impoverished, the majority struggling for economic survival. The prevailing religion is Protestant, although the presence of African retentions such as Obeah and Pocomania are still widely and profoundly experienced, and the powerful Rastafarian movement emerged as a countercultural religious force after 1930. The paradox and contradictions of five centuries of Jamaican resistance to slavery and colonial oppression have spawned a tiny, resilient, creative, multicultural island people, who have achieved a worldwide philosophical, political and religious impact, phenomenal sporting prowess, astonishing musical and performing creativity, and a criminal underworld that has stunned by its propensity for violence.
The Mental Health needs of the UK's Chinese children
Authors: Cheng W. , Tiffin P. A.
Published: January 2018

Sir: In 2005, the Department of Health for England set a five-year action plan, Delivering Race Equality in Mental Health Care. The aim was to encourage the development of services that were more appropriate and responsive to the needs of both adults and children in Black and minority ethnic communities.
Mental illness and legal discrimination
Authors: Sugarman Philip
Published: January 2018

Sir: Tony Zigmond's editorial is categorical in condemning the detention of people who are competent but mentally ill (Zigmond, 2009). He notes that the driver for this is risk, in both UK and international legislation. He contrasts this with physical treatment, for which he, and the judicial authority he quotes, believe competency gives an absolute right to refuse.
Sweden
Authors: Silfverhielm Helena , Stefansson Claes Göran
Published: January 2018

With an area of 450 000 km2, Sweden is one of the largest countries in Western Europe. It is 1500 km from north to south. It has nearly 9 million inhabitants (20 per km2). It is a constitutional, hereditary monarchy with a parliamentary government. Sweden is highly dependent on international trade to maintain its high productivity and good living standards. Many public services are provided by Sweden's 289 municipalities and 21 county councils. Municipal responsibilities include schools, child care and care of the elderly, as well as social support for people with a chronic mental illness. The county councils are mainly responsible for healthcare, including psychiatric care, and public transport at the regional level. Sweden is characterised by an even distribution of incomes and wealth. This is partly a result of the comparatively large role of the public sector.
French psychiatry
Authors: Botbol Michel
Published: January 2018

French psychiatry is currently facing a period of profound change, as many of what were considered its most specific characteristics and traditions have been called into question. It is therefore difficult to draw a profile of French psychiatry, because it has to take into account a radical splitting between, on the one hand, what is still the common profile of most French psychiatrists and, on the other, the new model imposed by stakeholders and policy makers who want French psychiatry to take on a more Anglo-Saxon profile, with evidence-based practice coming to the fore, for instance.
Psychiatry in the Czech Republic
Authors: Raboch Jirí
Published: January 2018

The profound political, social and economic changes that occurred after the end of communist rule in Central Europe in 1989 had a profound influence on Czech psychiatry. In the socialist Czechoslovakia the healthcare system was fully owned, financed and organised by the state, in so-called regional institutes of healthcare. These had obligatory catchment areas of about 100 000 inhabitants and comprised in-patient as well as out-patient care facilities, including psychiatry. The main trends after 1989 were decentralisation of the healthcare system, rapid privatisation, especially of out-patient services, and financing through the newly established health insurance corporations.
Mental health in The Netherlands
Authors: Ten Doesschate R. J. A. , Hodiamont P. P. G.
Published: January 2018

The Netherlands borders the North Sea and is located between Belgium and Germany. Its total area is about 41 500 km2, nearly 34 000 km2 of which is land area. The country consists mostly of coastal lowland and land reclaimed from the sea (polders). An extensive system of dykes and dams protects nearly one-half of the total area from being flooded.
Psychiatry in Germany
Authors: Gaebel Wolfgang , Zielasek Jürgen , Müller Ulrich
Published: January 2018

Germany has an approximate area of 357 000 km2. Its population is 82.526 million. The life expectancy at birth is 75.6 years for men and 81.6 years for women (World Health Organization, 2005). The proportion of gross domestic product allocated to the health budget is 10.8%. The per capita total expenditure on health is $2820 (international dollars here and below) and the per capita government expenditure on health is $2113 (World Health Organization, 2005). A major factor in recent German history was reunification, which had a pronounced effect on the German healthcare system.
Intellectual disability: an Italian perspective
Authors: La Malfa Giampaolo , Cabras Pierluigi
Published: January 2018

Italy is a country that has a very long tradition, dating back to the Middle Ages, of offering assistance to people with all kinds of disabilities. The approach taken to intellectual disability in recent times can be divided into two periods: before and after the enactment of Law 180 in 1978. That law set in train a profound reform of Italy's public sector psychiatric care, which principally involved the closure of the psychiatric hospitals and the establishment of a system of community care.
Migration and psychiatric adjustment
Authors: Skuse David
Published: January 2018

With the extraordinarily large movements of populations from some of the former Soviet Union states into Western Europe, since their recent membership of the European Union, attention has been focused in recent years on how easy or otherwise it has been for these people to adjust to life in very different economic and social circumstances. It has been estimated that the UK has absorbed up to a million immigrants from Eastern European states since 2004, and an equivalent picture is seen elsewhere; for example, in Switzerland immigrants now comprise nearly a quarter of the population. We consider here the mental health issues faced by those moving to work in other countries, some of whom aim to become citizens, others to gain temporary economic advantage, and yet others to escape persecution and threats to their personal safety in their countries of origin.
Mental health among recent immigrants to Sweden from Eastern Europe and the former Soviet Union
Authors: Ekblad Solvig
Published: January 2018

Several European states such as Sweden have become transit countries for migrants, as well as reception countries for an increasing number of young migrants, not only asylum seekers and refugees from beyond Europe but also from the European Union's new members, after the dissolution of the Soviet bloc in 1989 and then the Soviet Union itself in 1991. Over 110000 immigrants from Eastern Europe and the former Soviet Union resided in Sweden in 2002, although the exact figure is difficult to estimate because of the varied legal status of the migrants. International migration is not a new phenomenon in this part of the world, of course: people have always moved in the search of greater personal safety, among other reasons. However, new groups with new psychosocial needs and demands on the healthcare systems of the host countries will be a challenge. The aim of this article is to give an overview of three sets of empirical data:

•

the prevalence of mental disorders among recent immigrants to Sweden from Eastern Europe and the former Soviet Union

•

their access to mental health and social care facilities arising from their legal status

•

their utilisation of health and social services
Helping each other help children — worldwide research networks in child and adolescent mental health
Authors: Ehrlich Stefan , Plener Paul L.
Published: January 2018

The International Congress of the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP) takes place every other year. It is an opportunity for specialists from around the world to meet, exchange ideas and plan new projects. Since 2006, the Donald J. Cohen (DJC) Travel Fellowship has been an integral part of the Congress. It aims to foster the professional development of ‘emerging leaders’ in child and adolescent mental health (Adler et al, 2007).
Psychiatry in Belgium
Authors: Baig Benjamin J. , Delvenne Veronique
Published: January 2018

The Kingdom of Belgium is a high-income country in northern Europe with an approximate area of 33 000 km2 and a population of 10.5 million. The proportion of the population under the age of 15 years is 17% and the proportion of the population above the age of 60 years is 22%. Life expectancy at birth is 75.2 years for males and 81.5 years for females. As a founding member of what is now the European Union, it hosts the headquarters of the European Commission and the European Parliament, as well as other major organisations, including NATO.
Mental health in Yemen: obstacles and challenges
Authors: Saleh Maan A. Bari Qasem , Makki Ahmed Mohamed
Published: January 2018

The Republic of Yemen, on the south-western coast of the Arabian Peninsula, was formed in 1990 when North and South Yemen united. Yemen covers 527 970 km2. The capital is Sana'a. The country is divided into 20 governorates and one municipality. It has an elected president, an elected House of Representatives, and an appointed Shura Council. The president is head of state, and the prime minister is head of government. Suffrage is universal for people aged 18 and older. The population of Yemen according to the 2004 census is about 20 million, but recent years have seen the arrival of many refugees.
First-episode psychosis: factors associated with delayed access to care in a rural Egyptian setting
Authors: El-Adl Mamdouh , El-Mahdy Mohammed , Anis Musheera
Published: January 2018

Over the past few decades there has been a growing interest in first-episode psychosis (FEP), help-seeking behaviour and pathways to care. Treating psychotic disorders in their earliest stages has become a key focus for research and clinical care (Yung & McGorry, 2007). FEP studies show that the average time between onset of symptoms and first effective treatment is often 1 year or more (McGlashan, 1987). This long duration of untreated psychosis (DUP) is undesirable. Early treatment helps minimise the risk of the serious consequences of untreated psychosis, in terms of changes in mental state and behaviour (Larsen et al, 1998; Wyatt et al, 1998) and can reduce suffering (Ho et al, 2003). Some early results suggested that an ‘early intervention in psychosis’ (EIP) service is more cost-effective than generic services (Mihalopoulos et al, 1999).
Bagh regrows - earthquake survivors as catalysts of community and personal reconstruction
Authors: Ansari Tanzeel R. , Ørner R. J.
Published: January 2018

In our age of frequent natural disasters in this increasingly interdependent world, there is a pressing need to understand better the processes of societal adjustment. The Kashmir earthquake of 8 October 2005 brought human suffering on a massive scale. High rates of psychiatric morbidity have been reported (Niaz et al, 2006; see also http://emdrpakistan.com). Whereas the relevance of the application of Western, secularised, psychological treatment models to this group is outside the scope of this paper, survivors have faced catastrophe and destruction of both their internal and external realities.
Training on the management of depression in primary care in Azerbaijan
Authors: Ismayilov Fuad , Asadova Sevil
Published: January 2018

In 2006, the Azerbaijan Ministry of Health and the World Bank launched the 6-year Health Sector Reform Project (HSRP). The principal goal of the Project is to prepare and implement a fundamental and comprehensive reform of the health system in Azerbaijan, including a major emphasis on strengthening the primary care system (Ministry of Health Project Implementation Unit, 2007). The project envisions the development of a new optimised system of services, with the integration of mental health into general healthcare. In the line of this process, the Public Health and Reform Centre (PHRC) of the Ministry of Health has developed evidence-based clinical practice guidelines on depression, for implementation within primary care (Ministry of Health, 2009). At the same time, representatives from the PHRC and the Departments of Psychiatry and Family Medicine of Azerbaijan Medical University, as well as the State Institute for Advanced Training of Physicians (in cooperation with the World Health Organization Country Office), formed a task force to carry out a survey to assess the need for education in mental health for primary care doctors. A total of 308 primary care doctors (see Table 1) working in 14 settings in different regions of the country were randomly selected and interviewed by the research team.
Global child mental health: what can we learn from countries with limited financial resources?
Authors: Skokauskas Norbert , Belfer Myron
Published: January 2018

In 1977 the World Health Organization recommended that every country throughout the world should have a national plan for child mental health. The United Nations Convention on the Rights of the Child has been another important stimulus for child mental health policies and services in many countries. Adopted unanimously by the United Nations General Assembly in 1989 and instituted as international law in 1990, the Convention is an agreement on the basic protections that should be accorded to children. Adopted in 1961, the European Social Charter is the major European treaty that secures children's rights. In 1996 the Charter was revised and expanded to include a list of core obligations of the contracting parties relating to the recognition of social, legal and economic rights for children and young persons.
Naturalistic study of crisis referrals to an Irish community adult mental health service
Authors: Apantaku-Olajide Tunde , Smyth Bobby P. , Gibbons Pat
Published: January 2018

There is no agreed definition of a mental health crisis; however, a useful one is ‘a situation where mental health has deteriorated to an extent that the user is likely to be at risk of harm to self or others and is in need of urgent intensive specialist support and treatment’ (Minghella et al, 1998). Community-based care is the primary model of specialist mental healthcare in Ireland (Government of Ireland, 2006a). When clinically indicated, a patient with mental health crisis is referred to the community mental health team (CMHT) for an urgent assessment.
Mental health in the Plurinational State of Bolivia
Authors: Garcia Monica
Published: January 2018

Bolivia is a multicultural country located in the heart of South America. Neighbouring countries include Brazil, Peru, Argentina, Paraguay and Chile. It is a large nation, with an area of nearly 1100000 km2, although most of its territory was lost in wars. A particularly damaging loss was the sea coast, which was lost to Chile in the late 1800s. According to the constitution, Sucre is the capital city but La Paz is the seat of government and is often referred to as the capital.
The representation of low- and middle-income countries in the psychiatric research literature
Authors: Helal Muhammad Nabeel , Ahmed Uzair , Vostanis Panos
Published: January 2018

Despite the growing importance of mental health in international and national policies, the contribution to the psychiatric evidence base from non-Western countries is sparse. Such a gap in research output between high- and low-income countries constrains improvements in public health and mental health policy and practice in developing countries, where there is perhaps the greatest unmet need. If research is to inform local mental health policy and practice, it must reflect the diverse realities of local health systems and cultural factors.
Audit of ICD-10 diagnosis use at admission assessments and in discharge summaries by psychiatric trainees
Authors: Agboji Hezekiah , Moore Alan
Published: January 2018

Article 14 of the General and Specialist Medical Practice Order 2003 for specialties in psychiatry describes the specific conditions that a doctor must meet in order to be eligible as a specialist for the purposes of inclusion on the Specialist Register. The conditions as published by the Royal College of Psychiatrists (2003) include, among other requirements, that the psychiatrist shall demonstrate working knowledge of the epidemiology, aetiology, psychopathology, clinical features and natural history of the major psychiatric disorders in ICD-10 (World Health Organization, 1992), including age, gender and socio-cultural considerations, based upon the scientific literature. Familiarity with ICD-10 diagnostic criteria is therefore an important part of psychiatric training.
Reorienting health systems in South-East Asia to deliver care for mental and neurological disorders
Authors: Anwar Nazneen , Chandra Vijay , Kahandaliyanage Athula
Published: January 2018

Traditionally, care for mental and neurological disorders has been concentrated in tertiary care hospitals located in large cities. These custodial types of facility were designed to ‘protect’ the community from patients with a mental illness, as such persons were considered dangerous and a threat to the community. Given the state of medical knowledge in the 19th and 20th centuries, this mode of care was considered appropriate. However, in recent decades more humane and effective concepts of care have evolved. These concepts recognise the stigma attached to hospital-based care and also its limited outreach to the community, leaving out the vast majority of people living in rural and remote areas. Violation of human rights, sometimes seen in mental hospitals, has also been of concern.
The diagnostic validity of depression scales and clinical judgement in the Kurdistan region of Iraq
Authors: Al-salihy Zerak , Rahim Twana A. , Mahmud Mahmud Q. , Muhyaldin Asma S. , Mitchell Alex J.
Published: January 2018

We aimed to find the depression rating scale with the greatest accuracy when applied by psychiatrists in Iraqi Kurdistan. We recruited 200 patients with primary depression and 200 controls living in the Kurdistan region of Iraq. The Mini International Neuropsychiatry Inventory (MINI) was used as a gold standard for DSM-IV depression. We also used: the two-item and the nine-item versions of the Patient Health Questionnaire (PHQ2, PHQ9), the Hospital Anxiety and Depression Scale (HADS), the Calgary Depression Scale for Schizophrenia (CDSS) and the Centre for Epidemiological Studies Depression (CES-D) scale. Interviews were performed by psychiatrists who also rated their clinical judgement using the Clinical Global Impression (CGI) scale and other mental health practitioners. All scales and tools performed with high accuracy and reliability. The least accurate tool was the PHQ2; however, with only two items it was efficient. Sensitivity and specificity for all tools were above 90%. Clinicians using the CGI were accurate in their clinical judgement. The CDSS appeared to be the most accurate scale for DSM-IV major depression and the PHQ2 the most efficient. However, only the CDSS appeared to offer an advantage over psychiatrists' judgement.
Physical and mental illnesses: implications of similarities and differences for services and law
Authors: Roche Sean
Published: January 2018

It appears self-evident that psychiatry should be classified as a particular specialty within the broader field of medicine. Psychiatrists, being first and foremost doctors, have undertaken an identical basic training to their physician and surgical peers and, as in general medicine and surgery, the biomedical model is a central pillar of psychiatric practice. Within psychiatry, signs and symptoms are elicited, diagnoses made and very often physical interventions (in the form of psychotropic agents) are employed. However, familiar institutional conventions can conceal the fact that psychiatry suffers from greater uncertainty regarding its conceptual foundations than other fields of medicine. In fact, the conceptual challenges arising within psychiatry are reflected in its thriving field of philosophy, and although there exists a dedicated philosophy of medicine, no other specialty is equal to psychiatry's breadth of conceptual debate.
The cross-cultural sensitivity of the Strengths and Difficulties Questionnaire (SDQ): a comparative analysis of Gujarati and British children
Authors: Kumar Manasi , Fonagy Peter
Published: January 2018

The purpose of this study was to investigate whether the Strengths and Difficulties Questionnaire (SDQ) may be considered a reliable measure of child behaviour, social functioning and adjustment in an Indian Gujarati context. The sample comprised 351 children who were classified as coming from a ‘poverty’ or ‘non-poverty’ background. The means and standard deviations for the SDQ total and five behavioural scales, as rated by children themselves, were first calculated for the entire Gujarati sample, then for the poverty and non-poverty subgroups. The SDQ did prove to be an appropriate measure for behavioural assessment. Its cross-cultural sensitivity was ascertained by comparing it against a British normative population. Small effect sizes were seen in the Emotional subscale scores and scores for total difficulties, and medium and large effect sizes on the Prosocial and Peer subscales, respectively, with greater difficulties experienced by the Indian Gujarati sample than their British counterparts.
The Addiction Severity Index (ASI) and the attitudes of staff to the use of care outcome measurement in Saudi Arabia
Authors: Ahmed Abdelaal
Published: January 2018

Several years ago, Al Amal Hospital began to use the Addiction Severity Index (ASI) for the assessment and measurement of the outcome of care provided for persons with addiction problems. Clinical staff have been sceptical about the usefulness of this tool in clinical practice. We conducted a survey of staff to record their opinions of the ASI and other outcome measurement tools. Participants highlighted factors that would encourage the use of such tools in daily practice. In order to achieve the desired goals, an outcome measurement tool should be concise, adapted to culture and suitable for use in treatment planning and follow-up by clinicians.
Persistent negative symptoms in schizophrenia: survey of Canadian psychiatrists
Authors: Lutgens Danyael , Lepage Martin , Manchanda Rahul , Malla Ashok
Published: January 2018

A sample of 206 Canadian psychiatrists who routinely treat patients with psychotic disorders were randomly surveyed regarding their knowledge and practice in relation to persistent negative symptoms of schizophrenia. Large majorities reported observing a high prevalence of persistent negative symptoms that do not respond to available treatments (83%), have a profound impact on functional outcomes (96.5%) and contribute to family burden. Almost half the sample (43%) recognised the importance of formally assessing persistent symptoms and nearly a third (30%) indicated that this was a part of their usual practice. These survey results correspond with recent consensus and highlight the importance and challenge of treating persistent negative symptoms in schizophrenia.
Psychosocial research with children in Iraq: current health practice and policy in a context of armed conflict
Authors: Al Obaidi Abdul Kareem , Corcoran Tim , Scarth Leslie
Published: January 2018

There is a need to show how psychosocial issues affect children in conflict areas like Iraq. Raising knowledge and awareness of children's mental health status in Iraq has been difficult and the knowledge base has been limited by the shortage of resources, international sanctions and the isolation of Iraqi scholars. Many obstacles to research in Iraq exist but an agenda should be developed emphasising the need for high-quality contextualised psychosocial research. Health researchers in the country need to clarify basic population parameters and to provide culturally appropriate, evidence-based interventions for practitioners.
Prevalence of post-traumatic stress disorder among the survivors of two suicide bombings in Iraq
Authors: Abbas Mohammed J. , Al Haidary Amir Fadhil , Alghanimy Sabah
Published: January 2018

The prevalence rates of post-traumatic stress disorder (PTSD) and subthreshold PTSD (SPTSD) were measured in 258 survivors of two suicide bombings in Karbala, Iraq, 2 months after the incidents. Of the total sample, 112 (43.4%) had PTSD and 59 (22.9%) had SPTSD. PTSD was more prevalent after the incident that was associated with more civilian deaths.
The need to reform mental health legislation in Commonwealth countries
Authors: Pathare Soumitra , Shields Laura , Sagade Jaya , Nardodkar Renuka
Published: January 2018

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) serves as a comprehensive and legally binding framework for the rights of persons with mental illness. The extent to which countries have adapted their mental health legislation to reflect the binding provisions outlined in the CRPD is unclear. This paper reviews the situation across the Commonwealth.
Innovations in mental health training – the Kintampo Project, Ghana
Authors: Roberts Mark , Adjase Emmanuel Teye , Crabb Jim
Published: January 2018

The landscape of some low- and middle-income countries is sadly all too often littered with the remains of well intentioned health development projects that have failed. The Kintampo Project in Ghana is an education intervention that is set to achieve the most elusive of outcomes in development work, namely genuine sustainability. This article focuses on the challenges faced by the project and the factors that have allowed it to reach its targets.
Mental health law reforms in Uganda: lessons learnt
Authors: Ssebunnya Joshua , Ndyanabangi Sheila , Kigozi Fred
Published: January 2018

Ugandan mental health legislation, which dates from 1964, principally aims to remove persons with mental disorders from the community but also to protect their safety, by keeping them in confinement, although this has been without consideration for clinical care. In response to criticism from various stakeholders and advocates and the need to reflect modern clinical care, Uganda undertook to review and amend the mental health legislation, as part of the Mental Health and Poverty Project (MHaPP). We report on work in progress advancing new legislation.
‘Freedom is more important than health’: Thomas Szasz and the problem of paternalism
Authors: Moncrieff Joanna
Published: January 2018

When Thomas Szasz summed up his philosophical principles at the Royal College of Psychiatrists' annual meeting in Edinburgh in 2010, he declared that ‘freedom is more important than health’. Psychiatry is the arena in which the conflict between freedom and health comes most sharply into focus, according to Szasz. This paper proposes some parallels with medicine in low-income countries for pointers towards a resolution of this conflict.
Canada's mental health legislation
Authors: O'Reilly Richard L. , Gray John E.
Published: January 2018

In Canada the ten provinces and three territories are responsible for their own health laws and services. The 13 mental health acts have core similarities, but there are clinically significant differences. In most Canadian jurisdictions legislation is based on common law; in Quebec, it is based on a civil code. Canadian jurisdictions favour voluntary admission and sometimes make this explicit in their mental health acts. For involuntary admission or compulsory in-patient or community treatment to be valid, three elements must be applied correctly: the process, the criteria and the rights procedures. These are reviewed in this paper.
Mental health law in Peru: work in progress
Authors: Jimenez David , Eguiguren Christina Alejandrina , Dougall Dominic , Pliszka Bartłomiej , Hall Ian
Published: January 2018

Mental health law in Peru is developing. The Peruvian Constitution enshrines important human rights principles in relation to people with mental health problems but the enactment of such principles into national legislation is very patchy. This means that people with mental health problems, especially those admitted to hospital, may not receive optimum care and may be at risk of having their human rights breached. In this article we consider how far the current national legislation meets these constitutional rights and what the legislation that is in development may ultimately achieve.
Gambling addiction in China: a survey of Chinese psychiatrists
Authors: Huang Xiuqin , Shijun Du , George Sanju
Published: January 2018

We studied Chinese psychiatrists' understanding of gambling addiction, as well as their experiences of and confidence in assessing and treating these patients. To this end, we carried out a postal questionnaire survey of 110 psychiatrists working in China. A majority had seen people with gambling addiction in their practice but only 1 of the 110 psychiatrists had ever received any training in the management of the condition. A large majority of psychiatrists indicated that gambling addiction was an important public health problem and 71.8% said they would like to be more involved in its management. Much more needs to be done to improve the identification and treatment of gambling addiction in China.
An experience of provision of psychiatric services in the earthquake-affected area of Kashmir in India
Authors: Chadda R. K. , Malhotra A.
Published: January 2018

Developing psychiatric services for disaster-affected populations in a place with meagre resources is a challenge, especially if the place is remote and offers limited access, and the weather conditions are harsh. The earthquake in October 2005 posed just such a challenge (Makhdum & Javed, 2005). Massive damage was reported from Pakistan, as the epicentre was in Muzaffarabad, in Pakistani-controlled Kashmir. There was also extensive damage to life and property in some areas of Kashmir in India. The road and communication network had been completely destroyed in many of the affected areas.
Malawi
Authors: Kauye Felix , Mafuta Chitsanzo
Published: January 2018

Malawi is a country with an approximate area of 118 000 km2. Its population is estimated at 13 million and the gender ratio (men per hundred women) is 98. The proportion of the population under the age of 15 years is 47% and the proportion above the age of 60 years is 5%. The literacy rate is 75.5% for men and 48.7% for women (World Health Organization, 2005).
Mental healthcare in Singapore
Authors: Chong Siow-Ann
Published: January 2018

Singapore is a modern city state and the smallest nation (land area of 699 km2) in South East Asia. Its population of over 4 million is multiracial, with the Chinese (76.8%) constituting the majority of the population, followed by the Malays (13.9%) and the Indians (7.9%). The present health system is one that stresses individual responsibility, based on a system of compulsory medical saving accounts and on market mechanisms for the allocation of scarce healthcare resources. There are both public and private healthcare sectors. Since 1985, every public sector hospital has been ‘restructured’ — to grant some degree of autonomy in operational matters, with the intention of creating competition and financial discipline, although the government still retains 100% ownership of the hospitals.
Austria
Authors: Weber Germain
Published: January 2018

In the past two decades, national as well as regional policy agendas for people with disabilities and especially people with intellectual disabilities have followed strategies of inclusion and rights, with the promotion of a community-based approach.