Impacts of mid- to later childhood body build, social circumstance and blood pressure on early-adult arterial stiffness in different ethnic groups

OBJECTIVE: Arterial stiffness, measured as aortic pulse wave velocity [PWV], is a powerful prognostic indicator for cardiovascular events, displacing blood pressure (BP). Little is known of its determinants. We tested how factors measured twice previously in childhood in the MRC ‘DASH’ study, particularly body mass (BMI) components and BP, affected PWV in young adults. DESIGN AND METHODS: Of 6643 London children, aged 11-13y, from 51 schools in samples of about 1000 in 6 ethnic groups, 4785 (72% of the cohort), were seen again at 14-16y. In 2013, 666 (97% of invited) took part in a young-adult pilot (21-23y). With psychosocial, anthropometric and BP measures, PWV was recorded via an upper arm cuff on the calibrated Arteriograph device. RESULTS: PWV reproducibility was excellent, with mean differences across 3 x 6-8 cardiac cycles each of -0.06, 0.03 and 0.06 m/sec. Unadjusted PWVs in Caribbean-origin and White UK young men were similar (mean+SD 7.9+0.3 vs 7.6 +0.4 m/sec) and lower in other groups at similar SBPs (120mmHg), BMIs (24.6kg/m2) and waists (84.3cm). In full regression models, while Caribbean (higher BMIs and waists), African and Indian young women had lower PWV (by 0.5-0.8, 95%CI 0.1-1.1,m/sec) than did white UK women (6.9+0.2), values were still increased by age, BP, a powerful impact from waist/height, with a racism effect (+0.4m/sec) in women. Childhood effects of waist/hip were also detectable. CONCLUSION: Even by young adulthood, increased waist/height ratios, BP and psychosocial variables such as perceived racism were independent determinants of arterial stiffness, likely to increase with age.

Mental health research in Ghana: a literature review.

CONTEXT/BACKGROUND: Mental health is a neglected area in health care in Ghana. With few clinicians and trained researchers in the field, research has been limited both in quantity and quality. METHOD: A search of the available literature revealed 98 articles published between 1955 and 2009. Sixty-six are reviewed in this paper. RESULTS: Topics covered included hospital and community-based prevalence studies, psychosis, depression, substance misuse, self-harm, and help-seeking. Much of the research was small in scale and thus largely speculative in its conclusions. Epidemiological data is scarce and unreliable and no large-scale studies have been published. There are very few studies of clinical practice in mental health. CONCLUSIONS: The existing literature suggests several important areas for future research to inform the development of targeted and effective interventions in mental health care in Ghana.

From mental health policy development in Ghana to implementation: what are the barriers?

OBJECTIVE: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. METHOD: The study used both quantitative and qualitative methods. Quantitatively, the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the content of mental health policy, plans and legislation in Ghana. Qualitative data was gathered using in-depth interviews and focus group discussions with key stakeholders in mental health at the macro, meso and micro levels. These were used to identify barriers to the implementation of mental health policy, and steps to overcoming these. RESULTS: Barriers to mental health policy implementation identified by participants include: low priority and lack of political commitment to mental health; limited human and financial resources: lack of intersectoral collaboration and consultation; inadequate policy dissemination; and an absence of research-based evidence to inform mental health policy. Suggested steps to overcoming the barriers include: revision of mental health policy and legislation; training and capacity development and wider consultation. CONCLUSION: These results call for well-articulated plans to address the barriers to the implementation of mental health policy in Ghana to reduce the burden associated with mental disorders.

A situation analysis of mental health services and legislation in Ghana: challenges for transformation.

OBJECTIVE: To conduct a situation analysis of the status of mental health care in Ghana and to propose options for scaling up the provision of mental health care. METHOD: A survey of the existing mental health system in Ghana was conducted using the WHO Assessment Instrument for Mental Health Systems. Documentary analysis was undertaken of mental health legislation, utilizing the WHO Legislation checklists. Semi-structured interviews and focus group discussions were conducted with a broad range of mental health stakeholders (n=122) at the national, regional and district levels. RESULTS: There are shortfalls in the provision of mental health care including insufficient numbers of mental health professionals, aging infrastructure, widespread stigma, inadequate funding and an inequitable geographical distribution of services. CONCLUSION: Community-based services need to be delivered in the primary care setting to provide accessible and humane mental health care. There is an urgent need for legislation reform, to improve mental health care delivery and protect human rights.

From mental health policy development in Ghana to implementation: what are the barriers?

Objective: This paper identifies the key barriers to mental health policy implementation in Ghana and suggests ways of overcoming them. Method: The study used both quantitative and qualitative methods. Quantitatively; the WHO Mental Health Policy and Plan Checklist and the WHO Mental Health Legislation Checklist were employed to analyse the content of mental health policy; plans and legislation in Ghana. Qualitative data was gathered using in-depth interviews and focus group discussions with key stakeholders in mental health at the macro; meso and micro levels. These were used to identify barriers to the implementation of mental health policy; and steps to overcoming these. Results: Barriers to mental health policy implementation identified by participants include: low priority and lack of political commitment to mental health; limited human and financial resources; lack of intersectoral collaboration and consultation; inadequate policy dissemination; and an absence of research-based evidence to inform mental health policy. Suggested steps to overcoming the barriers include: revision of mental health policy and legislation; training and capacity development and wider consultation. Conclusion: These results call for well-articulated plans to address the barriers to the implementation of mental health policy in Ghana to reduce the burden associated with mental disorders