A qualitative phenomenological exploration of prolonged grief in New Delhi, India.

Prolonged grief disorder (PGD) is a condition characterized by difficulty in coping effectively with the loss of loved ones. The proposed diagnostic criteria for PGD have been based predominantly on research from developed Western nations. The cultural variations associated with experience and expression of grief and associated mourning rituals have not been considered comprehensively. The current study aimed to understand the experience of prolonged grief in India through a qualitative enquiry with mental health professionals (focus group discussions) and affected individuals (key informant interviews). Several novel findings diverging from the current understanding of manifestation and narratives of PGD emerged from the study, including differences in the social contexts of bereavement and culture-specific magico-religious beliefs and idioms of distress. The findings point to limitations of existing diagnostic systems for PGD. The results of this study suggest that the assumption of content equivalence for psychiatric disorders across cultures may not be justified and that there is a need to develop culturally sensitive diagnostic criteria and assessment scales for PGD.

Baseline situational analysis in Bangladesh, Jordan, Paraguay, the Philippines, Ukraine, and Zimbabwe for the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health.

INTRODUCTION: Mental, neurological and substance use conditions lead to tremendous suffering, yet globally access to effective care is limited. In line with the 13th General Programme of Work (GPW 13), in 2019 the World Health Organization (WHO) launched the WHO Special Initiative for Mental Health: Universal Health Coverage for Mental Health to advance mental health policies, advocacy, and human rights and to scale up access to quality and affordable care for people living with mental health conditions. Six countries were selected as 'early-adopter' countries for the WHO Special Initiative for Mental Health in the initial phase. Our objective was to rapidly and comprehensively assess the strength of mental health systems in each country with the goal of informing national priority-setting at the outset of the Initiative. METHODS: We used a modified version of the Program for Improving Mental Health Care (PRIME) situational analysis tool. We used a participatory process to document national demographic and population health characteristics; environmental, sociopolitical, and health-related threats; the status of mental health policies and plans; the prevalence of mental disorders and treatment coverage; and the availability of resources for mental health. RESULTS: Each country had distinct needs, though several common themes emerged. Most were dealing with crises with serious implications for population mental health. None had sufficient mental health services to meet their needs. All aimed to decentralize and deinstitutionalize mental health services, to integrate mental health care into primary health care, and to devote more financial and human resources to mental health systems. All cited insufficient and inequitably distributed specialist human resources for mental health as a major impediment. CONCLUSIONS: This rapid assessment facilitated priority-setting for mental health system strengthening by national stakeholders. Next steps include convening design workshops in each country and initiating monitoring and evaluation procedures.

Prevalence of epilepsy in Bangladesh: Results from a national household survey.

OBJECTIVE: To determine the prevalence and types of epilepsy in Bangladesh. METHODS: We conducted a nationwide population-based cross-sectional survey among Bangladeshi population of all ages, except children under one month. We surveyed 9839 participants (urban, 4918; rural, 4920) recruited at their households using multistage cluster sampling. Trained physicians with neurology background confirmed the diagnosis of suspected epilepsy cases identified by interviewer-administered questionnaires. We reported the overall and sex, residence, and age groups-specific prevalence of epilepsy per 1000 populations with 95% confidence interval. RESULTS: The national prevalence of epilepsy per 1000 was 8.4 (95% CI 5.6-11.1), urban 8.0 (4.6-11.4), and rural 8.5 (5.60-11.5). The prevalence in adult males and females was 9.2 (5.7-12.6) and 7.7 (3.6-11.7), respectively. The prevalence in children aged <18 years (8.2, 3.4-13.0 was similar to adults (8.5 (5.4-11.4). Among all epilepsy cases, 65.1% had active epilepsy. Their (active epilepsy) prevalence was 5.8 (3.5-8.1). Of them, 63.4% were not receiving treatment. Moreover, those who received allopathy treatment, 72.5% had low adherence leading to a high treatment gap. SIGNIFICANCE: Our findings out of this first-ever national survey were similar to other Asian countries. However, the prevalence of active epilepsy and treatment gap were considerably higher. This study serves useful evidence for tailoring interventions aimed to reduce the burden of epilepsy-primarily through targeted community awareness program-and access to antiepileptic treatment in health facilities in Bangladesh.

BehavioR: a digital platform for prevention and management of behavioural addictions.

Behavioural addictions have been identified as an emerging public health problem. The unprecedented pace of the digital revolution, resulting in an ever-increasing use of internet-based technologies, provides the opportunity to create a unique resource to assist in offering public health interventions in the World Health Organization South-East Asia Region. The ability to deliver evidence-based treatment and preventive programmes that can be accessed by mobile phones, for example, increases access to a wide range of populations, including hidden or hard-to-reach populations. BehavioR (the Behavioral addictions Resource hub) has been established with the aim of offering a one-stop resource centre for behavioural addictions. The expected end-users of this digital platform include patients, caregivers, the general public, health-care providers, academics, researchers and policy-makers. The platform can be used to offer digital health interventions to patients; strengthen the capacity of health-care providers for early detection of, screening for, intervention in and management of behavioural addictions; and serve as an online repository for reliable information on behavioural addictions for the general public.

Depression and physical noncommunicable diseases: The need for an integrated approach.

Depression is globally the third-leading cause of disability in terms of disability-adjusted life-years. Depression in patients with diseases such as cancer, diabetes mellitus, stroke or cardiovascular disease is 2-4-fold more prevalent than in people who do not have physical noncommunicable diseases, and may have a more prolonged course. The significant burden due to depression that is comorbid with chronic physical disease, coupled with limited resources, makes it a major public health challenge for low- and middle-income countries. Given the bidirectional relation between depression and chronic physical disease, the clear way forward in managing this population of patients is via a system in which mental health care is integrated with primary care. Central to this integrated approach is the Collaborative Care Model, adapted to the local sociocultural context. In this model, care is jointly led by the primary care physician, supported by a case manager and a mental health professional. Various successful initiatives in low- and middle-income countries may be used as templates for collaborative care in other low-resource settings. The model involves a range of interwoven components, such as capacity-building, task-sharing, task-shifting, developing good referral and linkage systems, anti-stigma initiatives and lifestyle modifications. Policies based on adoption of this approach would not only directly address depression that is comorbid with physical noncommunicable disease but also facilitate achievement of Sustainable Development Goal 3, to "ensure healthy lives and promote well-being for all at all ages".

Post-disaster mental health and psychosocial support: Experience from the 2015 Nepal earthquake.

On 25 April 2015, an earthquake of magnitude 7.8 struck Nepal, which, along with the subsequent aftershocks, killed 8897 people, injured 22 303 and left 2.8 million homeless. Previous efforts to provide services for mental health and psychological support (MHPSS) in humanitarian settings in Nepal have been largely considered inadequate and poorly coordinated. Immediately after the earthquake, the Government of Nepal declared a state of emergency and the health sector started to respond. The immediate response to the earthquake was coordinated following the Inter-Agency Standing Committee (IASC) cluster approach. One month after the disaster, integrated MHPSS subclusters were initiated to coordinate the activities of many national and international, governmental and nongovernmental, partners. These activities were largely conducted on an ad-hoc basis, owing to lack of focus on MHPSS in the health sector's contingency plan for emergencies. The mental health subcluster attempted to implement a mental health response according to World Health Organization and IASC guidelines. The MHPSS response highlighted many strengths and weaknesses of Nepal's mental health system. This provides an opportunity to "build back better" through reform of mental health services. A strategic response to the lessons of the 2015 earthquake will deliver both improved population mental health and increased preparedness for the future.

Pattern and predictors of dyslipidemia in patients with type 2 diabetes mellitus.

Dyslipidemia is a major risk factor for macro-vascular complications in patients with type 2 diabetes mellitus (T2DM). Present study explored pattern and predictors of dyslipidemia in Bangladeshi T2DM patients. The cross-sectional study is conducted among 366 consecutive eligible T2DM patients aged >30 years, BIRDEM diabetic hospital, during July-to-December 2010. Physical examination, diabetic profile, lipid profile and serum createnine was performed. Adjusted odds ratio and confidence limit were generated through binary logistic regression. Most frequent form (59.3%) of dyslipidemia is low HDL. Duration of T2DM is significantly correlated with TC (P<0.05), HDL (P<0.05) and LDL (P<0.05) in both male and female. Glycemic control in terms of HbA1c >7% appeared as predictor of dyslipidemia (P<0.01). Duration T2DM is associated with increased risk of having higher TC (P<0.05), LDL (P<0.05) and lower HDL (P<0.01) and does not seem to affect triglyceride (P>0.05). T2DM with comorbid hypertension seems to predict hyper tri-glyceridemia and lower HDL. Both TC-HDL ratio and LDL-HDL ratio appeared as good predictor of all four parameters of dyslipidemia (P<0.01). The characteristic features of diabetic dyslipidemia are low HDL, high triglyceride and LDL cholesterol level. Low HDL level is the most frequent type of abnormality. Poor glycemic control, prolonged duration, coexisting hypertension predicts dyslipidemia in T2DM.

Climatic factors influencing dengue cases in Dhaka city: a model for dengue prediction.

BACKGROUND & OBJECTIVES: Transmission of dengue virus depends on the presence of Aedes mosquito. Mosquito generation and development is known to be influenced by the climate. This study was carried out to examine whether the climatic factors data can be used to predict yearly dengue cases of Dhaka city, Bangladesh. METHODS: Monthly reported dengue cases and climate data for the years 2000-2008 were obtained from the Directorate General of Health Services (DGHS) and Meteorological Department of Dhaka, Bangladesh, respectively. Data for the period 2000 to 2007 were used for development of a model through multiple linear regressions. Retrospective validation of the model was done with 2001, 2003, 2005 and 2008 data. Log transformation of the dependent variable was done to normalize data for linear regression. Average monthly humidity, rainfall, minimum and maximum temperature were used as independent variables and number of dengue cases reported monthly was used as dependent variable. Accuracy of the model for predicting outbreak was assessed through receiver operative characteristics (ROC) curve. RESULTS: Climatic factors, i.e. rainfall, maximum temperature and relative humidity were significantly correlated with monthly reported dengue cases. The model incorporating climatic data of two-lag month explained 61 per cent of variation in number of reported dengue cases and this model was found to predict dengue outbreak (≥ 200 cases) with considerable accuracy [area under ROC curve = 0.89, 95%CI = (0.89-0.98)]. INTERPRETATION & CONCLUSIONS: Our results showed that the climate had a major effect on the occurrence of dengue infection in Dhaka city. Though the prediction model had some limitations in predicting the monthly number of dengue cases, it could forecast possible outbreak two months in advance with considerable accuracy.

Reorienting health systems in South-East Asia to deliver care for mental and neurological disorders.

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.