Prevalence of Mental Disorders among Older People in Nepal: A Systematic Review.

Background There has been limited research into the prevalence of mental disorders amongst older adults in developing countries. Developing countries such as Nepal are undergoing significant demographic changes with an increasing number and proportion of older persons. Objective This systematic review reports the prevalence of mental health disorders amongst the elderly in Nepal. Method Databases searched were PubMed, CINAHL, Scopus and PsycINFO. A hand search for relevant articles appearing in reference lists and previously identified research was also undertaken. Result Of the 26 studies (32 articles) included most were community and aged-care home -based studies measuring depression. The prevalence of depressive symptom cases ranged from 25.5% to 60.6% in the community, 17.3% to 89.1% in aged-care facilities and 53.2% to 57.1% in hospital settings. The prevalence of depressive disorders in similar settings varied between 4.4% (in community) to 53.2% (in hospital). The prevalence of anxiety symptom cases ranged from 21.7% to 32.3%. Psychosis, alcohol dependence and dementia were other identified disorders amongst the elderly. Disordered symptom cases are more prevalent in aged-care facilities than in community settings and mental disorders are higher for hospital-based studies compared to community settings. Conclusion This review identified a higher prevalence of depression amongst the elderly in Nepal compared to studies conducted in developed countries. The high rates of reported prevalence among the elderly warrant the need to develop more effective public health and welfare approaches to prevent, treat and manage the mental disorders among this vulnerable population.

Critical care polyneuropathy in burn injuries: An integrative review.

Polyneuropathy is a debilitating condition which may be associated with large burns. The aim of this integrative review is to identify factors that contribute to the development of critical care polyneuropathy in patients admitted to an intensive care unit with a severe burn injury. PubMed, Scopus, CINHAL and EMBASE were searched up until July 2016. Studies/case reports focusing on critical care polyneuropathy for burn injured patients were included. The ten studies, included a total of 2755 burns subjects and identified 128 critical care polyneuropathy patients with an incidence of 4.4%. Three case reports identified prolonged ventilation and development of critical care neuropathy. Overall, factors identified as contributing to the development of critical care polyneuropathy in burn injured patients included prolonged ventilation (>7 days), large and deep total body surface area burns (mean TBSA 40%), and sepsis. Critical care polyneuropathy in burn patients remains challenging to diagnose and treat. To date, there is a lack of long term studies describing the impact of critical care polyneuropathy on functional performance or participation in activities of daily living in the burns population and this is consistent with the general literature addressing the lack of follow up assessments and long term consequences of persistent muscle weakness.

Burns in Israel, comparative study: Demographic, etiologic and clinical trends 1997-2003 vs. 2004-2010.

OBJECTIVES: To review hospitalised burn patients from 2004 to 2010 admitted to Israeli burn units and compare these result with data from 1997 to 2003. METHODS: Retrospectively, data was collected from the Israeli Trauma Registry (ITR) encompassing all burn admissions to Israeli burn units from 2004-2010 and compared to 1997-2003. RESULTS: Of the 5269 burn patients admitted from 2004 to 2010, 39.8% were non-Jewish. Infants under two years were the prominent age group (24.1%). Second to third degree burns 1-9% TBSA/first degree burns were 71%, second to third degree burns 10-19% TBSA were 16% and those 20%>TBSA consisted of 13%. Only 2.7% involved an inhalation injury. The average length of stay was 11.67 days and mortality rate 3.72%. All data was compared to the previous year's 1997-2003 and trends were identified. CONCLUSIONS: Within Israel, high risk populations remain infants under two years of age, males and those from non-Jewish populations. National prevention strategies and campaigns are warranted to inform and educated parents of young children and those at risk of burns. Of note, advances in burn care and procedures might have contributed to a decrease in the length of hospital stay (LOS).

Inpatient peer support for adult burn survivors-a valuable resource: a phenomenological analysis of the Australian experience.

Peer support has long been recognised as an essential component of a supportive network for people facing adversity. In particular, burn survivor peer support is a valuable and credible resource available to those rehabilitating from a severe burn. The aim of this study was to explore burn survivors' experiences of providing and receiving inpatient peer support to develop an in-depth understanding of the influence during the rehabilitation journey. In 2011, twenty-one burn survivors were recruited from four severe burn units across Australia. A qualitative phenomenological methodology was used to construct themes depicting survivors' experiences. Participants were selected through purposeful sampling, and data collected through in-depth individual semi-structured interviews. Data were analysed using Colaizzi's phenomenological method of data analysis. Central to burn rehabilitation was the notion of peer support having a significant impact on burn survivors' psychosocial rehabilitation. The emergent theme 'Burn Survivor Peer Support' identified five cluster themes: (1) Encouragement, inspiration and hope (2) Reassurance (3) The Importance of Timing (4) The Same Skin (5) Appropriate Matching. These findings demonstrate that peer support assists with fostering reassurance, hope and motivation in burn rehabilitation. A national network based on a clinician led inpatient burn survivor peer support programme could provide burn survivors across Australia, and in particular remote access locations, with the benefits of peer support necessary to endure the rehabilitation journey.

Coming to terms with it all: adult burn survivors' 'lived experience' of acknowledgement and acceptance during rehabilitation.

Although studies have explored the 'lived experience' of burn survivors, little is known about their experiences encountered during rehabilitation. A descriptive phenomenological study was conducted to gain an in-depth insight into burn survivors' experiences' of acknowledgement and acceptance of their injury and the challenges experienced during their rehabilitation journey. A descriptive phenomenological methodology was used to construct themes depicting how burn survivors endeavoured to acknowledge and accept their injury and subsequent altered body image. Twenty men and one woman up to eight years after-burn within Australia were selected through purposeful sampling, and data were collected through in-depth individual interviews conducted in 2011 (N = 21). Interviews were analysed using Colaizzi's method of data analysis. The emergent theme acknowledgement identified four cluster themes that represented how burn survivors came to terms with their injury and an altered body image: (1) reasoning (2) humour (3) the challenge of acceptance (4) self-awareness. Coming to terms with a severe burn is a challenging experience. Reasoning and humour are strategies utilised by burn survivors that facilitate with acknowledgement and acceptance. Understanding these concepts through the burn survivors' perspective will, potentially, facilitate a better understanding of how to best provide for this cohort of patients.

Adult burn survivors' personal experiences of rehabilitation: an integrative review.

Burn rehabilitation is a lengthy process associated with physical and psychosocial problems. As a critical area in burn care, the aim was to systematically synthesise the literature focussing on personal perceptions and experiences of adult burn survivors' rehabilitation and to identify factors that influence their rehabilitation. Studies were identified through an electronic search using the databases: PubMed, CINAHL, EMBASE, Scopus, PsycINFO and Trove of peer reviewed research published between 2002 and 2012 limited to English-language research with search terms developed to reflect burn rehabilitation. From the 378 papers identified, 14 research papers met the inclusion criteria. Across all studies, there were 184 participants conducted in eight different countries. The reported mean age was 41 years with a mean total body surface area (TBSA) burn of 34% and the length of stay ranging from one day to 68 months. Significant factors identified as influential in burn rehabilitation were the impact of support, coping and acceptance, the importance of work, physical changes and limitations. This review suggests there is a necessity for appropriate knowledge and education based programmes for burn survivors with consideration given to the timing and delivery of education to facilitate the rehabilitation journey.

Arizona outreach program meets with success.

PIP: On overview is provided of a 9-month outreach program in family planning (FP) for poor Spanish-speaking families in Maricopa County, Arizona. Arizona does not provide any public FP services. A network of bilingual outreach workers provided educational sessions to individuals, to groups in homes and schools, during neighborhood meetings, and at work places. The tasks involved presenting information, advocating FP, transporting people to medical appointments, and guidance through the health care system. More than 600 people received FP information during this period. 77 asked for FP referrals, and 89 requested referrals for sterilization. Literature in Spanish and English was field-tested. The costs of voluntary sterilization were underwritten by a small fund from the Arizona FP Council (AFPC) and by donations from private providers and clinics. The outreach effort was successful because of consistent follow-up until services were rendered. This persistence was necessary in order for many clients to navigate the English-speaking system and satisfy their needs. The need for FP services was documented. Lists were generated of persons waiting for sterilization. A recent development was the availability of public funds for those qualifying for state assistance in order to obtain voluntary sterilizations. An independent evaluator commended the program for breaking down barriers which confront low income, Hispanic, minorities and recommended that it be adopted to other special populations needing FP services.^ieng