The relative impact of barriers to care among military health services personnel: exploring differences using context specific scenarios.

BACKGROUND: Military health care providers often under access both physical and mental health care, yet research has predominantly focused on barriers to mental health care. This study explored a comprehensive set of barriers using hypothetical scenarios to quantify barrier impact on access to both mental and physical health care. METHODS: Canadian military health services personnel (N = 1033) completed one of two electronic surveys (assessing either physical health or other mental health barriers) that captured participant's demographics, health, endorsement of barriers, intent to seek care, and whether the respondent would access care in different health scenarios (pneumonia, back injury, depression and post-traumatic stress disorder). Logistic regression was used to calculate odds of not accessing care (versus accessing care) for each of the four health scenarios. RESULTS: All barrier factors independently predicted increased odds of not accessing care for all four scenarios. When entered into an adjusted model none of the barrier factors significantly predicted accessing care in the physical health scenarios. Staffing and workload resources and Treatment preferences (e.g., self-treat) were significant predictors of accessing care in the mental health scenarios. Weak general intentions to access care was the strongest predictors of not accessing care across all four scenarios. CONCLUSIONS: The impact of barriers on hypothetical care-seeking behaviour differs depending on the context for which one is accessing care, with access to resources and preference to self-treat driving mental health care seeking. Intent appears to be the most impactful predictor of accessing care potentially mediating the effect of other barrier types on care seeking.

Validation of a general mental health self-efficacy assessment tool.

The aim of this study was to assess the validity of a 14-item mental health self-efficacy scale developed to assess the effectiveness of the Road to Mental Readiness (R2MR) - a program aimed at improving the well-being and mental health of Canadian Armed Forces (CAF) personnel. The validity of the scale was assessed through an analysis of data collected as part of a pilot study and a larger group randomized control trial (GRCT) on the effectiveness of R2MR administered to CAF noncommissioned member recruits during basic training. Using data collected for the pilot study (N = 276), an initial review of items indicated a need to eliminate two redundant items and two items that were weakly correlated with other scale items. A parallel analysis and exploratory factor analysis (EFA) conducted on the resulting 10-item scale pointed to a one-factor model with all items loading satisfactorily. Using data from the GRCT (N = 1962), a confirmatory factor analysis (CFA) was conducted to further assess the revised scale. This CFA suggested good model fit (Root Mean Square Error of Approximation of .07 and Standardized Root Mean Square Residual of .06). The revised scale had an alpha of .88, was very strongly correlated with the full scale (r = .97, p < .001), and significantly predicted perceived control and self-efficacy regarding accessing mental health care and intention to access care.

Factor structure of a coping measure in the 2013 Canadian Forces Mental Health Survey.

BACKGROUND: Coping has been the subject of numerous studies over the past decades, yet significant debate remains regarding the structure of this construct. DATA AND METHODS: Exploratory and confirmatory factor analyses were conducted on 2013 Canadian Forces Mental Health Survey (CFMHS) data to examine the factor structure of coping items. A total of 6,696 Canadian Armed Forces (CAF) Regular Force members completed a coping inventory that assessed 14 coping strategies (e.g., problem solving, talking to others). RESULTS: Results indicated that coping among CAF Regular Force members was best represented by two factors: positive coping and negative coping. Coping strategies categorized as positive coping included active efforts to confront the stressor or improve one's well-being, whereas those categorized as negative coping reflected passive or avoidant efforts or behaviours that may compromise one's health. Positive coping factor scores were positively associated with perceptions of one's ability to handle difficult problems and day-to-day demands, while negative coping factor scores were negatively associated with such perceptions, suggesting that the factors had good concurrent validity. Additional analyses pointed to higher positive and negative coping scores among female Regular Force members compared with male Regular Force members. The additional analyses also showed generally less favourable coping scores among lower-ranking Regular Force members and those with a history of deployment to Afghanistan relative to their respective counterparts. Lastly, Regular Force members who received mental health training demonstrated higher positive coping scores. DISCUSSION: The report discusses implications for the use of coping indicators in future analyses involving the CFMHS.

How rural and urban parents describe convenience in the context of school-based influenza vaccination: a qualitative study.

BACKGROUND: Seasonal influenza vaccine uptake among school-age children has been low, particularly among rural children, even in jurisdictions in Canada where this immunization is publicly funded. Providing this vaccination at school may be convenient for parents and might contribute to increased vaccine uptake, particularly among rural children. We explore the construct of convenience as an advantage of school based influenza vaccination. We also explore for rural urban differences in this construct. METHODS: Participants were parents of school-aged children from Alberta, Canada. We qualitatively analyzed focus group data from rural parents using a thematic template that emerged from prior work with urban parents. Both groups of parents had participated in focus groups to explore their perspectives on the acceptability of adding an annual influenza immunization to the immunization program that is currently delivered in Alberta schools. Data from within the theme of 'convenience' from both rural and urban parents were then further explored for sub-themes within convenience. RESULTS: Data were obtained from nine rural and nine urban focus groups. The template of themes that had arisen from prior analysis of the urban data applied to the rural data. Convenience was a third level theme under Advantages. Five fourth level themes emerged from within convenience. Four of the five sub-themes were common to both rural and urban participants: reduction of parental burden to schedule, reduction in parental lost time, decrease in parental stress and increase in physical access points for influenza immunization. The fifth subtheme, increases temporal access to influenza immunization, emerged uniquely from the rural data. CONCLUSIONS: Both rural and urban parents perceived that convenience would be an advantage of adding an annual influenza immunization to the vaccinations currently given to Alberta children at school. Improving temporal access to such immunization may be a more relevant aspect of convenience to rural than to urban parents.

Parasites of commercially important fish from Lake Naivasha, Rift Valley, Kenya.

In Lake Naivasha, the common carp Cyprinus carpio L. 1758 was accidentally introduced from fish farms adjacent to River Malewa in 1999 and now forms the bulk of the total fish caught. Since its introduction, no study has been made on its parasitic community nor are there any reports on ectoparasites from other fish species in this lake to the best of our knowledge. Therefore, the aim of this study was to describe the parasitic community of C. carpio and two other commercially important fish species: Oreochromis leucostictus and Tilapia zillii. Additionally, the abundant Barbus paludinosus was included in the study. A total of 286 fish (145C. carpio, 56 O. leucostictus, 18 T. zillii, and 67 B. paludinosus) were collected during the year 2011 and examined. Ten taxa of parasites were recovered from C. carpio dominated by the monogenean Dactylogyrus minutus, occurring with a prevalence (p) of 99.3%. Thirteen taxa of parasites were identified from O. leucostictus dominated by monogeneans Cichlidogyrus spp. (p = 91.1%). T. zillii harbored nine taxa of parasites with the digenean Tylodelphys sp. (p = 83.3%) being dominant and B. paludinosus harbored 11 taxa of parasites dominated by an unidentified monogenean of the genus Dactylogyrus (p = 83.6%). C. carpio had the lowest helminth species diversity and richness while monogenetic trematodes, which have never been reported from fish in Lake Naivasha, were the most prevalent parasites recovered.

Topical Treatment Is Effective and Safe for Acute Ankle Sprains: The Multi-Center Double-Blind Randomized Placebo-Controlled TRAUMED Trial.

BACKGROUND: Topical NSAIDs are widely used to treat ankle sprains. Traumed (Tr14) gel is a multicomponent formulation, demonstrating inflammation-resolution properties. METHODS: This multicenter, double-blind trial investigated the efficacy and safety of Tr14 gel versus placebo gel and non-inferiority versus 1% diclofenac gel, applied 3×/day for 7 days after acute lateral ankle sprain (EudraCT Number: 2016-004792-50). The primary outcome was AUC for pain on passive movement, assessed by VAS from baseline to Days 4 and 7. RESULTS: The trial population included 625 patients aged 18 to 78 years. The AUC scores were 187.88 and 200.75 on Day 4 (p = 0.02) and 294.14 and 353.42 on Day 7 (p < 0.001) for Tr14 and placebo, respectively. For Tr14 compared to diclofenac, the AUC scores were 187.50 and 197.19 on Day 4 (p = 0.3804) and 293.85 and 327.93 on Day 7 (p = 0.0017), respectively. On the FAAM-ADL subscale, Tr14 was superior to placebo and non-inferior to diclofenac at all time points. Time to 50% pain improvement was lowest for Tr14 (6.0 days), compared to placebo (7.1 days) and diclofenac (7.0 days). Adverse events were uncommon and minor. CONCLUSIONS: Tr14 gel is effective and safe in acute ankle sprains, compared to placebo gel and diclofenac gel, and has faster pain resolution. TRIAL REGISTRATION: The trial was registered in clinicaltrialsregister.eu, EudraCT number 2016-004792-50 on 07.06.2017.

Direct and indirect barriers to hypothetical access to care among Canadian forces health services personnel.

BACKGROUND: Though research among Canadian Forces Health Services (CFHS) personnel is limited, the literature suggests formal healthcare is underused. Though much research has been conducted on particular barriers (e.g., stigma), examining a breadth of barriers could better inform behavioral interventions. Furthermore, work has yet to examine the indirect effects of barriers through their impact on intentions to access care. METHODS: CFHS participants were randomly assigned to complete either a mental health (N = 503) or physical health (N = 530) version of the survey. The survey included questions on the perceived impact of barriers, health-related information (e.g., past access to care), intention to seek care, and two hypothetical scenarios (i.e., pneumonia and back injury or post-traumatic stress disorder and depression) as a proxy of access to care. Multiple regressions using Hayes PROCESS macro were conducted to assess the direct and indirect effects (through intentions) of the barriers on hypothetical access to care. RESULTS: Results show conflict with career goals barriers were indirectly linked to all health outcomes, and directly linked to mental health outcomes. Treatment preference barriers were directly and indirectly linked to care seeking only for mental health, while resource barriers were directly linked to care seeking only for physical health. Knowledge and ability to access care barriers were directly linked to care seeking for depression and pneumonia. IMPLICATIONS: Interventions to improve treatment-seeking should be developed only after the behavioural antecedents are understood, and should focus on combining evidence-based techniques to simultaneously target multiple aspects of the behaviour.

Dynamics of single cell femtosecond laser printing.

In the present study, we investigated the dynamics of a femtosecond (fs) laser induced bio-printing with cell-free and cell-laden jets under the variation of laser pulse energy and focus depth, by using time-resolved imaging. By increasing the laser pulse energy or decreasing the focus depth thresholds for a first and second jet are exceeded and more laser pulse energy is converted to kinetic jet energy. With increasing jet velocity, the jet behavior changes from a well-defined laminar jet, to a curved jet and further to an undesired splashing jet. We quantified the observed jet forms with the dimensionless hydrodynamic Weber and Rayleigh numbers and identified the Rayleigh breakup regime as the preferred process window for single cell bioprinting. Herein, the best spatial printing resolution of 42 ± 3 µm and single cell positioning precision of 12.4 µm are reached, which is less than one single cell diameter about 15 µm.

A moderated-mediation analysis of pathways in the association between Veterans' health and their spouse's relationship satisfaction: The importance of social support.

Introduction: Military personnel and Veterans are at increased risk of mental and physical health conditions, which can impact their families. Spouses often perform a vital role in caring for service members and Veterans facing illness or injury, which can lead to caregiver burden. In turn, this may contribute to relationship issues. Research suggests that ensuring that spouses are well supported can alleviate some of these negative effects. The current study examined whether social support received by spouses of newly released Veterans buffers the impact of Veterans' health on caregiver burden, subsequently impacting spouses' relationship satisfaction. Methods: Data were collected as part of the Canadian Armed Forces Transition and Well-being Survey. The sample included N = 595 spouses of Regular Force Veterans who released in 2016 with at least 2 years of service. We examined Veterans' mental and physical health and spouses' caregiver burden, social support, and relationship satisfaction. A moderated mediation model was tested using structural equation modeling. Results: There was a significant indirect association between Veterans' health (both physical and mental) and spouses' relationship satisfaction through caregiver burden. Furthermore, social support moderated the association, as evidenced by a weaker association between Veterans' health and caregiver burden at low levels (-1SD) of social support compared to high levels (+1SD). Implications: Findings suggest additional efforts should be made to ensure sufficient support is provided to spouses, especially when they are caring for a service member or Veteran facing illness or injury, to strengthen their families' well-being.

Trials and tribulations among members of Canada's Defence Team early in the pandemic: key insights from the COVID-19 Defence Team Survey. / Les défis auxquels ont fait face les membres de l'Équipe de la Défense du Canada au début de la pandémie : principales conclusions du sondage de l'Équipe de la Défense sur la COVID-19.

INTRODUCTION: Due to the unprecedented impact of COVID-19, there is a need for research assessing pandemic-related challenges and stressors. The current study aimed to assess key concerns and general well-being among members of Canada's Defence Team, including Canadian Armed Forces personnel and members of the Department of National Defence (DND) Public Service. METHODS: The COVID-19 Defence Team Survey was administered electronically to Defence Team staff in April and May of 2020 and was completed by 13 688 Regular Force, 5985 Reserve Force and 7487 civilian DND Public Service personnel. Along with demographic information, the survey included assessments of work arrangement, pandemic-related concerns, general well-being and social and organizational support. Weighted data (to ensure representation) were used in all analyses. RESULTS: The majority of respondents were working from home, with a small minority unable to work due to restrictions. Though many concerns were endorsed by a substantial proportion of respondents, the most prevalent concerns were related to the health and well-being of loved ones. The majority of respondents reported their partner, family, supervisors, friends, colleagues and children provided general support. Half of the civilian defence staff and one-third of military respondents reported a decline in mental health. Women, younger respondents, those with dependents and, in some cases, those who were single without children were at risk of lower well-being. CONCLUSION: The pandemic has negatively impacted a substantial portion of the Defence Team. When responding to future crises, it is recommended that leaders of organizations provide additional supports to higher-risk groups and to supervisors who are ideally positioned to support employees during challenging times.

Enhanced Glutamate Synthesis and Export by the Thermotolerant Emerging Industrial Workhorse Bacillus methanolicus in Response to High Osmolarity.

The thermotolerant methylotroph Bacillus methanolicus MGA3 was originally isolated from freshwater marsh soil. Due to its ability to use methanol as sole carbon and energy source, B. methanolicus is increasingly explored as a cell factory for the production of amino acids, fine chemicals, and proteins of biotechnological interest. During high cell density fermentation in industrial settings with the membrane-permeable methanol as the feed, the excretion of low molecular weight products synthesized from it will increase the osmotic pressure of the medium. This in turn will impair cell growth and productivity of the overall biotechnological production process. With this in mind, we have analyzed the core of the physiological adjustment process of B. methanolicus MGA3 to sustained high osmolarity surroundings. Through growth assays, we found that B. methanolicus MGA3 possesses only a restricted ability to cope with sustained osmotic stress. This finding is consistent with the ecophysiological conditions in the habitat from which it was originally isolated. None of the externally provided compatible solutes and proline-containing peptides affording osmostress protection for Bacillus subtilis were able to stimulate growth of B. methanolicus MGA3 at high salinity. B. methanolicus MGA3 synthesized the moderately effective compatible solute L-glutamate in a pattern such that the cellular pool increased concomitantly with increases in the external osmolarity. Counterintuitively, a large portion of the newly synthesized L-glutamate was excreted. The expression of the genes (gltAB and gltA2) for two L-glutamate synthases were upregulated in response to high salinity along with that of the gltC regulatory gene. Such a regulatory pattern of the system(s) for L-glutamate synthesis in Bacilli is new. Our findings might thus be generally relevant to understand the production of the osmostress protectant L-glutamate by those Bacilli that exclusively rely on this compatible solute for their physiological adjustment to high osmolarity surroundings.

Facing Adversity and Factors Affecting Resilience: A Qualitative Analysis of the Lived Experiences of Canadian Special Operations Forces.

Special Operations Forces (SOF) personnel are required to withstand considerable physical and psychological hardship. Research examining resilience and mental health among SOF personnel is limited and has provided mixed results; in addition, minimal research has been undertaken on the subjective experiences of adversity and the process of resilience among SOF personnel. This unique qualitative study describes the lived experience of Canadian SOF personnel, the challenges they face, and the factors they believe impact their resilience. Seventy Canadian SOF personnel participated in in-depth, semistructured interviews. A thematic analysis of the interviews revealed that operational demands, paired with an organizational culture of performance, were important stressors for most participants, negatively affecting both themselves and their families. SOF organizations select members with resilient characteristics; however, the same characteristics that make these members resilient also lead to self-imposed pressure to perform and avoid taking time for proper recovery. Team members were reported to help such members process difficult or traumatic experiences and facilitate their seeking care. Findings provide insight into the adverse experiences that participants encountered while serving in an SOF organization and the intertwined individual, social, and organizational factors affecting their resilience. Results point to the importance of managing and mitigating the impact of high operational tempo and a culture of performance to protect the health and wellness of SOF personnel and their families.

Pharmacodynamic interaction between 4-aminoquinolines and retinol in Plasmodium falciparum in vitro.

The pharmacodynamic interaction between retinol and 4-aminoquinolines has been investigated in 29 fresh isolates of Plasmodium falciparum. Although the parasites were highly resistant against 4-aminoquinolines, significant synergism was observed between chloroquine and retinol as well as amodiaquine and retinol, the latter at physiological concentrations. Combination with retinol reduced the geometric mean concentrations effecting complete inhibition (GMCOC) by chloroquine from 14425 nM to 8943 nM in CHL-RET low, 7042 nM in CHL-RET medium, and 4920 nM in CHL-RET high. Synergism between amodiaquine and retinol was greater, with strong and highly significant reductions of the GMCOC, from 2520 nM for amodiaquine to 1092 nM for AMO-RET low, 800 nM for AMO-RET medium, and 745 nM for AMO-RET high. While it is obviously too late for making practical use of the activity enhancement for chloroquine, the situation is different for amodiaquine, where supplementation with retinol may extend the usefulness of the medicament.

Stigma doesn't discriminate: physical and mental health and stigma in Canadian military personnel and Canadian civilians.

BACKGROUND: Illness-related stigma has been identified as an important public health concern. Past research suggests there is a disproportionate risk of mental-health stigma in the military, but this same finding has not yet been established for physical-health stigma. The current study aimed to assess the independent contribution of mental and physical health on both enacted stigma (discriminatory behaviour) and felt stigma (feelings of embarrassment) and to determine whether these associations were stronger for military personnel than civilians. METHODS: Data were obtained from the 2002 Canadian Community Health Survey - Mental Health and Well-being and its corresponding Canadian Forces Supplement. Logistic regressions were used to examine a potential interaction between population (military [N = 1900] versus civilian [N = 2960]), mental health, and physical health in predicting both enacted and felt stigma, with adjustments made for socio-demographic information, mental health characteristics, and disability. RESULTS: Mental health did not predict enacted or felt stigma as a main effect nor in an interaction. There was a strong link between physical health and enacted and felt stigma, where worse physical health was associated with an increased likelihood of experiencing both facets of stigma. The link between physical health and enacted stigma was significantly stronger for military personnel than for civilians. CONCLUSIONS: Physical health stigma appears to be present for both civilians and military personnel, but more so for military personnel. Elements of military culture (e.g., the way care is sought, culture of toughness, strict fitness requirements) as well as the physical demands of the job could be potential predictors of group differences.

Deployment-related trauma and post-traumatic stress disorder: does gender matter?

Objective: Military research has attempted to identify whether women have an increased vulnerability to mental health issues following deployment-related trauma, but findings have been mixed. Most studies have controlled for childhood abuse, but not other non-deployment trauma (e.g. life-threatening illness), which may partly explain previous mixed results. This study assessed gender differences in the association between deployment-related trauma and post-traumatic stress disorder (PTSD) while controlling for non-deployment trauma. Methods: Data came from the 2013 Canadian Forces Mental Health Survey. Regular or reserve personnel who had been deployed at least once were included in this study (n = 5980). Logistic regression was used to examine the interaction between gender and deployment-related trauma in predicting lifetime PTSD. Results: After controlling for non-deployment trauma, the association of gender with PTSD went from being significant to being marginally significant. The interaction between gender and deployment-related trauma was not significant. Conclusion: Though controlling for non-deployment trauma did not completely dissipate gender differences in PTSD, such differences were greatly reduced, indicating that these may be partly related to traumatic experiences outside deployment. As gender did not moderate the link between deployment-related trauma and PTSD, the findings suggest that trauma experienced while on deployment does not disproportionately affect women compared to their male counterparts.

Objetivo: La investigación militar ha intentado identificar si las mujeres tienen una mayor vulnerabilidad a los problemas de salud mental después del trauma relacionado con el despliegue militar, pero los hallazgos han sido mixtos. La mayoría de los estudios han controlado el abuso infantil, pero no otros traumas no relacionados con el despliegue (p. Ej., Enfermedad potencialmente mortal), lo cual puede explicar parcialmente los resultados mixtos anteriores. Este estudio evaluó las diferencias de género en la asociación entre el trauma relacionado con el despliegue militar y el trastorno de estrés postraumático, al mismo tiempo que se controlaba los traumas no relacionados con despliegue militar.Métodos: Los datos provienen de la Encuesta de Salud Mental de las Fuerzas Armadas Canadienses de 2013. El personal regular o de reserva que se había desplegado al menos una vez se incluyeron en este estudio (n = 5980). Se Utilizó regresión logística para examinar la interacción entre el género y el trauma relacionado con el despliegue en la predicción del TEPT a lo largo de la vida.Resultados: Después de controlar por trauma no relacionado con el despliegue, la asociación de género con TEPT paso de ser significativa a solo marginalmente significativa. La interacción entre el género y el trauma relacionado con el despliegue no fue significativa.Conclusión: Aunque el controlar por traumas no relacionados con el despliegue militar no disipó por completo las diferencias de género en el TEPT, tales diferencias se redujeron sustancialmente, lo que indica que pueden estar parcialmente relacionadas con experiencias traumáticas fuera del despliegue. Dado que el género no moderó la relación entre el trauma relacionado con el despliegue y el TEPT, los hallazgos sugieren que el trauma experimentado durante el despliegue no afecta en forma desproporcionada a las mujeres en comparación con sus pares masculinos.

RAB27A, RAB27B and VPS36 are downregulated in advanced prostate cancer and show functional relevance in prostate cancer cells.

Paracrine and long-range signaling via extracellular vesicles, such as exosomes and microvesicles, is deemed crucial for tumorigenesis, invasion and spread of solid tumors. The ESCRT machinery (endosomal sorting complexes required for transport) and Rab-proteins act as key players in vesicular trafficking and secretion. Yet, their role in prostate cancer (PCa) is unknown. Therefore, this study aimed to elucidate the relevance of these components in PCa. In silico reanalysis of genes with known involvement in vesicular trafficking and secretion in an existing microarray dataset revealed low expression of RAB27A, RAB27B and VPS36 to be predictive for reduced BCR-free survival in patients with localized PCa (p=0.033, 0.025 and 0.005). In the same microarray dataset underexpression of RAB27A, RAB27B and VPS36 was seen in distant metastases (p<0.001; p=0.003; p<0.001). This was consistent in two further microarray datasets. qRT-PCR-validation in two independent cohorts of PCa specimens (n=90) showed low expression of VPS36 in PCa tissue (p=0.023), especially in castration-resistant tumors (p=0.002). In all five datasets there were significant correlations between the expression of at least two of the candidates. Upon knockdown of VPS36 an increase of RAB27A and RAB27B expression, but not vice versa, was observed in both prostate and breast cancer cells (PC3, MDA-MB­231). In PC3 cell knockdown of RAB27B and VPS36 dramatically reduced colony formation (-52.2%, p<0.001; -71.1%, p<0.001) and, controversial to reports in other tumor entities, increased the release of extracellular particles (+25.3%, p=0.014; +45.6%, p<0.001). Taken together RAB27A, RAB27B and VPS36 are frequently underexpressed in advanced PCa and are inversely correlated with PCa outcome. There seems to be a close relationship in the expression of RAB27A, RAB27B and VPS36, with RAB27A and RAB27B being dependent on VPS36. Changes in colony formation and particle release upon RNAi indicate an involvement in paracrine cell-cell communication.

An adolescent with significant emotional and medically unexplained complaints: case report and proposal of an intervention.

BACKGROUND: Ethiopia is a country in which child and adolescent mental health needs are often not met. In order to promote capacity building, a Collaborative International Exchange Programme has been established between Jimma University at Jimma, Ethiopia, and Ludwig-Maximilian University in Munich, Germany. The programme focuses on training non-physician health professionals in mental health speciality. One of the courses in the training programme, child psychiatry, involves a child psychiatrist and a children's nurse supporting the management of a patient described in this case report. Its conceptual framework is based on the section "significant emotional and medically unexplained complaints" of the "WHO mental health GAP intervention guide for mental, neurological and substance use disorders in non-specialized health settings". OBJECTIVE: The purpose of this case report is to promote confidence in mental health professionals when managing patients with similar conditions, and to stimulate further evaluation of the conceptual approach in developing countries. PATIENT: The subject of this case report is a 14-year-old adolescent girl admitted to the psychiatric clinic at Jimma University Teaching Hospital. She was admitted for intractable retching, inability to eat, weight loss, and inability to walk. Challenges included the combination of medical and psychiatric symptoms, and the significant impairment of functioning in this adolescent. The first aim in the management of this patient was to guarantee vital functions. In a problem-oriented approach, different domains were addressed to restore nutritional, social, emotional, and motor functions. Treatment consisted of various elements of psychosocial interventions. The patient improved in 2 weeks and the final diagnosis was conversion disorder. CONCLUSION: Psychosocial interventions can be developed in cooperation, and applied in a setting where little child mental health expertise is available. Case-based learning relying on local expertise is suitable in meeting local needs and in developing mental health services for children and adolescents.

Financial strain, social capital, and perceived health during economic recession: a longitudinal survey in rural Canada.

Although the health consequences of financial strain are well documented, less is understood about the health-protective role of social capital. Social capital refers to a sense of community embeddedness, which is in part reflected by group membership, civic participation, and perceptions of trust, cohesion, and engagement. We investigated whether perceptions of social capital moderate the relation between financial strain and health, both mental and physical. This longitudinal study surveyed adults in two communities in rural Ontario where significant job losses recently occurred. Data were collected on financial strain, social capital, perceived stress, symptoms of anxiety and depression, and physical health on three occasions over 18 months (N's = 355, 317, and 300). As expected, financial strain positively related to perceived stress, poor physical health and symptoms of anxiety and depression, whereas social capital related to less stress, better physical health, and fewer symptoms of anxiety and depression. Effects of financial strain on perceived stress and depressive symptoms were moderated by social capital such that financial strain related more closely to perceived stress and depressive symptoms when social capital was lower. The findings underscore the health-protective role of community associations among adults during difficult economic times.

School-based influenza vaccination: parents' perspectives.

BACKGROUND: School-age children are important drivers of annual influenza epidemics yet influenza vaccination coverage of this population is low despite universal publicly funded influenza vaccination in Alberta, Canada. Immunizing children at school may potentially increase vaccine uptake. As parents are a key stakeholder group for such a program, it is important to consider their concerns. PURPOSE: We explored parents' perspectives on the acceptability of adding an annual influenza immunization to the immunization program that is currently delivered in Alberta schools, and obtained suggestions for structuring such a program. PARTICIPANTS: Forty-eight parents of children aged 5-18 years participated in 9 focus groups. Participants lived in urban areas of the Alberta Health Services Calgary Zone. FINDINGS: Three major themes emerged: Advantages of school-based influenza vaccination (SBIV), Disadvantages of SBIV, and Implications for program design & delivery. Advantages were perceived to occur for different populations: children (e.g. emotional support), families (e.g. convenience), the community (e.g. benefits for school and multicultural communities), the health sector (e.g. reductions in costs due to burden of illness) and to society at large (e.g. indirect conduit of information about health services, building structure for pandemic preparedness, building healthy lifestyles). Disadvantages, however, might also occur for children (e.g. older children less likely to be immunized), families (e.g. communication challenges, perceived loss of parental control over information, choices and decisions) and the education sector (loss of instructional time). Nine second-level themes emerged within the major theme of Implications for program design & delivery: program goals/objectives, consent process, stakeholder consultation, age-appropriate program, education, communication, logistics, immunizing agent, and clinic process. CONCLUSIONS: Parents perceived advantages and disadvantages to delivering annual seasonal influenza immunizations to children at school. Their input gives a framework of issues to address in order to construct robust, acceptable programs for delivering influenza or other vaccines in schools.

Parasite communities of the elongate tigerfish Hydrocynus forskahlii (Cuvier 1819) and redbelly tilapia Tilapia zillii (Gervais 1848) from Lake Turkana, Kenya: influence of host sex and size.

Fish is an important food source for an estimated 300,000 people inhabiting the shores of Lake Turkana, Kenya. Despite its large size (7560 km2) and importance, the lake remains one of the least studied in the Great Lakes Region of Africa. This study describes the parasite community of the elongate tigerfish Hydrocynus forskahlii (Cuvier, 1819) and the redbelly tilapia Tilapia zillii (Gervais, 1848). A total of 87 individuals (43 H. forskahlii and 44 T. zillii) were dissected and examined for parasites. Two taxa infected H. forskahlii, the dominant one being an anisakid nematode Contracaecum sp. (L3) (P = 83.7%, mean intensity (MI) = 46.0, abundance (A) = 38.5). Twelve parasite taxa were recovered from T. zillii, with metacestodes of the gryporhynchid cestode Amirthalingamia macracantha being dominant (P = 79.5, MI = 10.3, A = 8.2). This was the first report of a mixture of merocercoids and plerocercoids in the same host. Fish size was positively correlated with the major parasite infection levels, but, the prevalence of Contracaecum sp. in H. forskahlii was negatively correlated with size, probably reflecting ontogenetic shifts in habitats and diets with age. Fish sex was not a significant influencing factor, with the exception of Contracaecum sp. in H. forskahlii, where prevalence differed significantly between sexes (p<0.05), with the females having a higher prevalence than the males. We conclude that H. forskahlii had a poor parasitic community but that the infection levels with Contracaecum sp. were high. T. zillii had a rich parasite fauna, although, most parasites occurred at low intensities.