What happens when peer support workers are introduced as members of community-based clinical mental health service delivery teams: a qualitative study.

The insights of people who have experienced mental health issues are at the core of recovery frameworks. The inclusion of peer support workers in clinical care teams is crucial to a recovery-supportive focus. Peer support workers facilitate egalitarian spaces for non-peer staff and consumers to frankly discuss the lived experience of mental illness. This study was part of a larger evaluation study which aimed to explore the implementation of a newly formed community-based mental health team in South-East Queensland, Australia. The paper reports the role of peer support workers and answers two research questions: "How is peer support work constructed in an interprofessional clinical care team?" and (2) "How do interprofessional mental health clinical care teams respond to the inclusion of peer support workers as team members?" Three themes were identified: peer support worker' ability to navigate a legitimate place within care teams, their value to the team once they established legitimacy and their ability to traverse the care landscape. Ultimately, successful integration in interprofessional teams was dependent upon the ability of clinical staff to focus on unique strengths that peer support workers bring, in addition to lived experience with mental illness as a carer or consumer.

Spatially-resolved individual particle spectroscopy using photothermal modulation of Mie scattering.

We report a photothermal modulation of Mie scattering (PMMS) method that enables concurrent spatial and spectral discrimination of individual micron-sized particles. This approach provides a direct measurement of the "fingerprint" infrared absorption spectrum with the spatial resolution of visible light. Trace quantities (tens of picograms) of material were deposited onto an infrared-transparent substrate and simultaneously illuminated by a wavelength-tunable intensity-modulated quantum cascade pump laser and a continuous-wave 532 nm probe laser. Absorption of the pump laser by the particles results in direct modulation of the scatter field of the probe laser. The probe light scattered from the interrogated region is imaged onto a visible camera, enabling simultaneous probing of spatially-separated individual particles. By tuning the wavelength of the pump laser, the IR absorption spectrum is obtained. Using this approach, we measured the infrared absorption spectra of individual 3 µm PMMA and silica spheres. Experimental PMMS signal amplitudes agree with modeling using an extended version of the Mie scattering theory for particles on substrates, enabling the prediction of the PMMS signal magnitude based on the material and substrate properties.

Deep brain stimulation for obsessive-compulsive disorder: a systematic review and meta-analysis.

BACKGROUND: Deep brain stimulation (DBS) is increasingly being applied to psychiatric conditions such as obsessive-compulsive disorder (OCD), major depression and anorexia nervosa. Double-blind, randomized controlled trials (RCTs) of active versus sham treatment have been limited to small numbers. We therefore undertook a systematic review and meta-analysis of the effectiveness of DBS in psychiatric conditions to maximize study power. METHOD: We conducted a systematic literature search for double-blind, RCTs of active versus sham treatment using Pubmed/Medline and EMBASE up to April 2013. Where possible, we combined results from studies in a meta-analysis. We assessed differences in final values between the active and sham treatments for parallel-group studies and compared changes from baseline score for cross-over designs. RESULTS: Inclusion criteria were met by five studies, all of which were of OCD. Forty-four subjects provided data for the meta-analysis. The main outcome was a reduction in obsessive symptoms as measured by the Yale-Brown Obsessive Compulsive Scale (YBOCS). Patients on active, as opposed to sham, treatment had a significantly lower mean score [mean difference (MD) -8.93, 95% confidence interval (CI) -13.35 to -5.76, p < 0.001], representing partial remission. However, one-third of patients experienced significant adverse effects (n = 16). There were no differences between the two groups in terms of other outcomes. CONCLUSIONS: DBS may show promise for treatment-resistant OCD but there are insufficient randomized controlled data for other psychiatric conditions. DBS remains an experimental treatment in adults for severe, medically refractory conditions until further data are available.

Real-Time Suicide Surveillance: Comparison of International Surveillance Systems and Recommended Best Practice.

OBJECTIVE: Some countries have implemented systems to monitor suicides in real-time. These systems differ because of the various ways in which suicides are identified and recorded. The main objective of this study was to conduct an international comparison of major real-time suicide mortality surveillance systems to identify joint strengths, challenges, and differences, and thereby inform best-practice criteria at local, national, and international levels. METHODS: Five major real-time suicide mortality surveillance systems of various coverage levels were identified and selected for review via an internet-based scoping exercise and prior knowledge of existing systems. Key information including the system components and practices was collated from those organizations that developed and operate each system using a structured template. The information was narratively and critically synthesized to determine similarities and differences between the systems. RESULTS: The comparative review of the five established real-time suicide surveillance systems revealed more commonalities than differences overall. Commonalities included rapid, routine surveillance based on minimal, provisional data to facilitate timely intervention and postvention efforts. Identified differences include the timeliness of case submission and system infrastructure. CONCLUSION: The recommended criteria could promote replicable components and practices in real-time suicide surveillance while offering flexibility in adapting to regional/local circumstances and resource availability.HIGHLIGHTSEvidence-informed recommendations for current best practice in real-time suicide surveillance.Proposed comprehensive framework can be adapted based on available resources and capacity.Real-time suicide mortality data facilitates rapid data-driven decision-making in suicide prevention.

Feeding behavior analysis of the soybean aphid (Hemiptera: Aphididae) on resistant soybean 'Dowling'.

Soybean aphid, Aphis glycines Matsumura (Hemiptera: Aphididae), is an exotic pest of soybean, Glycine max (L.) Merr., in North America. Plant resistance to the soybean aphid was recently discovered in 'Dowling' soybean in 2005. Dowling exhibits strong antibiotic effects on the soybean aphid by limiting colonization and effectively controlling aphid population development during all soybean growth stages. In addition, aphids feeding on Dowling experienced significantly reduced survival, longevity, and fecundity and increased developmental times. An assessment of soybean aphid feeding behavior was compared on Dowling and the susceptible check 'Glenwood' by using the electrical penetration graph technique. The effects of plant resistance on aphid feeding behavior were analyzed by comparing the amount of time soybean aphid spent feeding on various plant tissues on resistant and susceptible plants. There was no significant difference in the initial time for the aphid to begin probing on resistant and susceptible plants indicating no adverse effect of plant exterior on the soybean aphid attempting to feed. However the time from the beginning of plant penetration by the stylets to the first phloem sieve element phase was significantly different. In aphids that successfully reached phloem on Dowling, the time taken to reach this phase was triple the time of aphids reaching the phloem sieve element on the susceptible line. In addition, the total number of probing events and the duration of nonprobing were not significantly different between Dowling and Glenwood. When comparing feeding between lines, a greater proportion of aphids showed ingestion of xylem when feeding on Dowling, whereas successful feeding on phloem on Dowling was significantly shorter than when feeding on the susceptible line. Therefore, the antibiotic effect of Dowling resistance seems to reside at the level of the phloem sieve element, prohibiting the aphid from successfully exploiting phloem, and as a consequence the aphid abandons the Dowling plant or dies of inadequate nutritional intake.

Intervention for the control of soil-transmitted helminthiasis in the community.

The global strategy for the control of soil-transmitted helminthiasis, based on regular anthelminthic treatment, health education and improved sanitation standards, is reviewed. The reasons for the development of a control strategy based on population intervention rather than on individual treatment are explained. The evidence and experience from control programmes that created the basis for (i) the definition of the intervention package, (ii) the identification of the groups at risk, (iii) the standardization of the community diagnosis and (iv) the selection of the appropriate intervention for each category in the community are discussed. How to best deliver the appropriate intervention, the impact of the control measures on morbidity and on indicators such as school attendance, cognitive development and productivity are presented. The factors influencing the cost-benefits of helminth control are also considered. The recent progress on the control of soil-transmitted helminth infections is illustrated. Research needs are analysed in relation to the most recent perceptions from private-public partnerships involved in helminth control. The way forward for the control of soil-transmitted helminth infections is described as a multi-disease approach that goes beyond deworming and fosters a pro-poor strategy that supports the aims of the Millennium Development Goals.

Analysis of a cDNA from the neurologically active locus shaking-B (Passover) of Drosophila melanogaster.

We have isolated and sequenced a cDNA from the shaking-B locus of Drosophila melanogaster. The cDNA contains an open reading frame with extensive homology to another D. melanogaster gene, l(1)ogre. This suggests the existence of a new family of proteins required for the development and maintenance of the D. melanogaster nervous system.

Lactose maldigestion in Ascaris-infected preschool children.

Two studies were conducted to investigate the contribution of Ascaris lumbricoides to lactose maldigestion in preschool children in two different communities in Panama where milk is available as a source of nutrients and the prevalence of Ascaris is known to be high. Both Ascaris-infected and uninfected children were given a standard lactose load and lactose absorption was studied by measuring the rise in plasma glucose in study 1 and by determination of breath hydrogen concentrations at regular intervals after ingestion of the test dose in study 2. All children were tested before anthelmintic treatment with levamisole and 3 wk after therapy. The mean rise in blood glucose from infected (n = 13) children 40 min after the ingestion of lactose was about half of that of the controls (n = 21). After deworming, lactose digestion improved in previously infected children. In study 2, significant differences in breath hydrogen concentrations postmilk ingestion were observed between the Ascaris-infected (n = 47) and the uninfected children (n = 35) before treatment. There was a substantial reduction of breath hydrogen after milk ingestion in the previously infected children after therapy. No differences were observed in breath hydrogen content of the uninfected children during the pre- and posttreatment phases of the study in the lactose tolerance test. These studies provide evidence that infection with Ascaris lumbricoides impairs lactose digestion in preschool children.

Worker productivity and the nutritional status of Kenyan road construction laborers.

The effects of energy supplementation (group I received 200 kcal/day and group II received 1000/kcal day) were examined on road workers in Kenya. Anthropometric, dietary, worker productivity, clinical hematology, and parasitology data were collected from 224 workers of both sexes or, subsamples of these workers at base-line, midpoint, and final measurement periods. Sixty-seven percent of the work force was less than 85% of weight for height. Females tended to be better nourished than males. Multiple regression analysis showed that increases in arm circumference and Hb levels were associated with significant productivity gains of about 4%. At the midpoint, group II males gained 1.10 kg (p less than 0.0003) while group I males showed no change. Weight loss during the latter part of the study resulted in no significant final weight change for males. "Successful" supplementation was weakly associated with a productivity increase for group II workers of 12.5% (p less than 0.10).

Relationships between Ascaris infection and growth of malnourished preschool children in Kenya.

A longitudinal study in Ascaris-infected and noninfected children was conducted in two Kenyan villages. Anthropometric, clinical, and stool exams were performed three times at 14-week intervals. All children received an anthelmintic drug (levamisole) at the second examination. In the 14 weeks before deworming, children with Ascaris (n = 61) did not differ from controls (n = 125) in percentage expected weight gain. In the 14 weeks after deworming, previously infected children showed higher percentage expected weight gain than controls. Before deworming, there was a statistically significant (P less than 0.0005) decrease in triceps skinfold thickness in Ascaris-infected children versus controls. After deworming, skinfold increased significantly (P less than 0.0005) in previously infected children versus controls. Multiple regression analysis showed that Ascaris infection was by far the most important variable of those studied explaining decrease in skinfold thickness before and increase after deworming. It appears that even light Ascaris infections might adversely influence nutritional status, and deworming might enhance growth.

Ascaris and ascariasis.

In recent years much new information has been obtained about the epidemiology, population biology and public health significance of infections of Ascaris lumbricoides in humans. Results from experimental infections of A. suum in pigs have helped to elucidate the observations made in the community on human ascariasis. The main purpose of the review is to see how new information may contribute to further acceptance of ascariasis as a serious contributor to ill-health and so to the design and implementation of sustainable control programmes intended to reduce the morbidity due to infection with A. lumbricoides. Eradication is neither a realistic nor prudent aim given the current shortage of appropriate sanitation in many countries where ascariasis is endemic. A substantial body of evidence shows that for the four common species of soil-transmitted nematode, including A. lumbricoides, regular administration of broad-spectrum anthelminthic drugs to children attending primary schools is a cost-effective means of controlling the infections. Anthelminthic drugs must be of proven quality and efficacy and health professionals should be prepared to detect and manage drug resistance should that emerge. Despite a deeper understanding of the immune response of a variety of hosts to infections with either A. lumbricoides or A. suum there is at present little prospect of an effective vaccine against ascariasis. The relationship between A. lumbricoides and A. suum is addressed, particularly since both species, if they are indeed separate species, occur in people and their pigs in many communities.

Control strategies for human intestinal nematode infections.

In recent years significant progress has been made in understanding the ecology, epidemiology and related morbidity and development of new tools for the control of soil-transmitted helminths. Such knowledge has recognized the impact of helminth infections on the health of infected groups and has created a rational basis for their control. Schoolchildren harbour some of the most intense helminthic infections, which produce adverse effects on health, growth and scholastic performance. However, although great effort has been put into targeting school-age children, women of child-bearing age and pre-school children are two other groups at high risk of morbidity due to intestinal nematode infections. Highly effective and safety-tested, single-dose anthelminthic drugs are now available, permitting periodical deworming of schoolchildren and other high-risk groups at affordable prices. Four anthelminthics against all intestinal nematodes are included in the WHO Essential Drug List (albendazole, levamisole, mebendazole and pyrantel). Recently ivermectin has also been registered for use against Strongyloides stercoralis in humans. Several well-monitored country experiences have shown that chemotherapy-based control of morbidity due to soil-transmitted helminths is possible and highly cost-effective.

Relationships of Schistosoma haematobium, hookworm and malarial infections and metrifonate treatment to growth of Kenyan school children.

Relationships of S. haematobium, hookworm and malarial infections to growth 6 months after metrifonate treatment were studied in Kenyan primary school children in an area where poor growth, S. haematobium and hookworm were common and malaria was endemic. All children with light-moderate S. haematobium infections (1-500 eggs/10 ml adj) in 4 schools were examined (Exam 1), allocated at random to either placebo (MIP, n = 198) or metrifonate treatment (MIT, n = 201) groups, treated, and examined again 6 months later (Exam 2). An additional 19 heavily infected children (HIT group greater than 500 eggs/10 ml adj) were treated immediately after Exam 1 and also followed. The MIT and HIT groups exhibited more rapid growth between Exam 1 and 2 than did the placebo group. The MIT group gained significantly (P less than 0.001) more than the MIP group in weight (0.8 kg), percent weight for age (2.3 percentage points), weight for height squared (0.04 units), arm circumference (0.4 cm), percent arm circumference for age (1.7 percentage points) and in triceps and subscapular skinfold thicknesses. In addition, the placebo group showed statistically significant decreases between exams in percentage weight for age, percent arm circumference for age, both skinfold thicknesses for age and no significant increase in percent height for age while the MIT group exhibited highly significant increases in all anthropometric parameters.(ABSTRACT TRUNCATED AT 250 WORDS)

Relationships of Schistosoma hematobium, hookworm and malarial infections and metrifonate treatment to hemoglobin level in Kenyan school children.

Relationships between hemoglobin level and S. hematobium, hookworm, and malarial infection before and six months after metrifonate treatment were studied in Kenyan primary school children in an area where anemia, S. hematobium and hookworm are common (prevalences 61%, 46%, and 95%, respectively) and malaria is holoendemic. The mean hemoglobin level in children from one school, both with and without S. hematobium infection (n = 250), was significantly lower in children with higher S. hematobium egg counts, heavier hookworm infections, positive Plasmodium slides, and larger spleens. All children with light-moderate S. hematobium infection (1-500 eggs/10 ml adj) in four schools were examined (Exam 1), allocated at random to either placebo (MIP, n = 198) or metrifonate treatment (MIT, n = 202) groups, treated, and examined again six months later (Exam 2). Hemoglobin levels rose significantly in both groups between exams, but the rise in the MIT group was 30% higher than in the MIP group (1.3 vs. 1.0 g/dl, P less than 0.014). The increase in hemoglobin level in the MIT group was significantly and positively correlated with decreases between exams in S. hematobium and hookworm egg counts and with higher malarial parasite counts at Exam 1 (Pearson r's 0.21, 0.20, 0.20, respectively, P less than 0.01). A stepwise multiple regression equation using hemoglobin rise between exams as the dependent variable showed that decreases in S. hematobium and hookworm egg counts were equally important determinants of hemoglobin rise and that malarial parasite count was almost as important as the changes in intensities of the helminth infections. These results show that treatment for S. hematobium with metrifonate can increase hemoglobin levels in children in an area where S. hematobium and anemia are common. They also emphasize the importance of measuring multiple parasitic infections and using multivariate statistical techniques such as multiple regression analysis in order to define the relationships between parasitic infections and morbidity.

Nutritional aspects of infection.

Current knowledge is examined about the means whereby ascariasis, hookworm disease, strongyloidiasis and trichuriasis may contribute to the aetiology of human malnutrition. Results from experiments with related parasites in the laboratory have demonstrated the role of gastrointestinal helminthiases in animal malnutrition. Some evidence shows that in children, infection with the intestinal stages of Ascaris lumbricoides is associated with reduced growth rate, disturbed nitrogen balance, malabsorption of vitamin A, abnormal fat digestion, lactose maldigestion and an increased intestinal transit time. The main impact of hookworm infection is its relationship with iron-deficiency anaemia which may have effects at the community level as regards work and productivity in adults and learning and school performance in children. More research is needed to extend knowledge of the nutritional impact of ascariasis and hookworm disease in order to establish their public health significance. Research is needed also to identify the range of nutritional effects on man that occur as a result of trichuriasis and strongyloidiasis. The significance of less prevalent and more localized gastrointestinal helminthiases should not be ignored.

Haemoglobin concentrations and concomitant infections of hookworm and Trichuris trichiura in Panamanian primary schoolchildren.

The blood haemoglobin concentrations and intestinal helminth infections were surveyed in 658 children aged between 6 and 12 years attending 4 primary schools in Coclé Province, Panama, in November 1987. 147 (22.3%) of the children were judged to have haemoglobin concentrations indicative of iron-deficiency anaemia. Blood haemoglobin concentrations were significantly lower in children with heavier Trichuris trichiura infections (> 5000 eggs/g) (P = 0.014), and in children with dual infections of both hookworm and T. trichiura (P = 0.005). Children with concomitant T. trichiura and hookworm infections were also significantly more likely to have blood haemoglobin levels indicative of anaemia than children who were uninfected or had single infections with either of these helminths (P < 0.005). In a longitudinal study involving 171 children selected from the original 658, blood haemoglobin concentrations were measured again in November 1988. Children who were considered to show an improvement in both hookworm and T. trichiura infections over this 12 month period showed a significantly greater increase in blood haemoglobin concentrations than children who had remained uninfected with either of these helminths throughout the study period (P < 0.05).

Intestinal parasitic infections of men in four regions of rural Kenya.

Faecal samples were obtained from 906 men living in four different regions of rural Kenya: the cool Highlands, the humid coastal lowlands, the equatorial Lake Victoria basin and the arid marginal highlands. The prevalence of intestinal parasitic infections is reported and compared, contrasted and discussed in terms of the typical environmental conditions in each region. Almost 70% of men appeared to be infected with intestinal helminths; hookworm was most common. The regional prevalence of hookworm infections appeared to be related to relative humidity.