31 results
Developing knowledge-based psychotherapeutic competencies in non-specialist providers: A pre-post study with a nested randomised controlled trial of a coach-supported versus self-guided digital training course for a problem-solving psychological intervention in India
- Sonal Mathur, Helen A. Weiss, Melissa Neuman, Baptiste Leurent, Andy P. Field, Tejaswi Shetty, James E. J., Pooja Nair, Rhea Mathews, Kanika Malik, Daniel Michelson, Vikram Patel
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- Journal:
- Cambridge Prisms: Global Mental Health / Volume 10 / 2023
- Published online by Cambridge University Press:
- 29 November 2023, e87
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We evaluated a digital learning programme for non-specialists to develop knowledge-based competencies in a problem-solving intervention for adolescents to examine the overall impact of training on knowledge-based competencies among learners; and to compare the effects of two training conditions (self-guided digital training with or without coaching) in a nested parallel, two-arm, individually randomised controlled trial. Eligible participants were 18 or older; fluent in Hindi or English; able to access digital training; and had no prior experience of delivering structured psychotherapies. 277 participants were enrolled from 31 March 2022 to 19 June 2022 of which 230 (83%) completed the study. There was a significant increase in competency score from pre-training (Mean = 7.01, SD = 3.29) to post-training (Mean = 8.88, SD = 3.80), 6 weeks after the pre-training assessment. Knowledge competency scores showed larger increase among participants randomised to the coaching arm (AMD = 1.09, 95% CI 0.26–1.92, p = 0.01) with an effect size (d) of 0.33 (95% CI 0.08–0.58). More participants completed training in the coaching arm (n = 96, 69.6%) compared to the self-guided training arm (n = 56, 40.3%). In conclusion, a coach-supported remote digital training intervention is associated with enhanced participation by learners and increased psychotherapeutic knowledge competencies.
Community-based rehabilitation intervention for people with schizophrenia in Ethiopia (RISE) cluster-randomised controlled trial: An exploratory analysis of impact on food insecurity, underweight, alcohol use disorder and depressive symptoms
- Laura Asher, Rahel Birhane, Helen A. Weiss, Girmay Medhin, Medhin Selamu, Vikram Patel, Mary De Silva, Charlotte Hanlon, Abebaw Fekadu
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- Cambridge Prisms: Global Mental Health / Volume 10 / 2023
- Published online by Cambridge University Press:
- 25 October 2023, e70
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We evaluated the effectiveness of community-based rehabilitation (CBR) in reducing depressive symptoms, alcohol use disorder, food insecurity and underweight in people with schizophrenia. This cluster-randomised controlled trial was conducted in a rural district of Ethiopia. Fifty-four sub-districts were allocated in a 1:1 ratio to the facility-based care [FBC] plus CBR arm and the FBC alone arm. Lay workers delivered CBR over 12 months. We assessed food insecurity (self-reported hunger), underweight (BMI< 18.5 kg/m2), depressive symptoms (PHQ-9) and alcohol use disorder (AUDIT ≥ 8) at 6 and 12 months. Seventy-nine participants with schizophrenia in 24 sub-districts were assigned to CBR plus FBC and 87 participants in 24 sub-districts were assigned to FBC only. There was no evidence of an intervention effect on food insecurity (aOR 0.52, 95% CI 0.16–1.67; p = 0.27), underweight (aOR 0.44, 95% CI 0.17–1.12; p = 0.08), alcohol use disorder (aOR 0.82, 95% CI 0.24–2.74; p = 0.74) or depressive symptoms (adjusted mean difference − 0.06, 95% CI −1.35, 1.22; p = 0.92). Psychosocial interventions in low-resource settings should support access to treatment amongst people with schizophrenia, and further research should explore how impacts on economic, physical and mental health outcomes can be achieved.
Predictors of spontaneous remission and recovery among women with untreated perinatal depression in India and Pakistan
- Daniela C. Fuhr, Siham Sikander, Fiona Vanobberghen, Benedict Weobong, Atif Rahman, Helen A. Weiss
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- Cambridge Prisms: Global Mental Health / Volume 10 / 2023
- Published online by Cambridge University Press:
- 23 June 2023, e34
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Background
Mothers with perinatal depression can show different symptom trajectories and may spontaneously remit from depression, however, the latter is poorly understood. This is the first study which sought to investigate predictors of spontaneous remission and longer-term recovery among untreated women with perinatal depression.
MethodsWe analysed data from two randomised controlled trials in women with perinatal depression in India and Pakistan. Analyses were restricted to women in the control groups who did not receive active treatment. Generalised estimating equations and logistic regressions were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs), adjusting for within-person correlation.
ResultsIn multivariable analyses, remission was associated with a husband who is not working (adjusted OR, aOR = 2.04, 95% CI 1.02–4.11), lower Patient Health Questionnaire-9 score at baseline (aOR = 0.43, 95% CI 0.20–0.90 for score of ≥20 vs. 10–14) and better social support at baseline (aOR = 2.37, 95% CI 1.32–4.27 for high vs. low social support).
ConclusionsWomen with low baseline severity may remit from perinatal depression with adequate social support from family and friends. These factors are important contributors to the management of perinatal depression and the prevention of clinical worsening, and should be considered when designing low-threshold psychological interventions.
Cannabis use and psychotic disorders in diverse settings in the Global South: findings from INTREPID II
- Joni Lee Pow, Casswina Donald, Marta di Forti, Tessa Roberts, Helen A. Weiss, Olatunde Ayinde, Sujit John, Bola Olley, Akin Ojagbemi, Georgina Miguel Esponda, Joseph Lam, Paramasivam Poornachandrika, Paola Dazzan, Fiona Gaughran, Palaniyandi Ponnusamy Kannan, Selvaraju Sudhakar, Jonathan Burns, Bonginkosi Chiliza, INTREPID Group, Alex Cohen, Oye Gureje, Rangaswamy Thara, Robin M. Murray, Craig Morgan, Gerard Hutchinson
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- Psychological Medicine / Volume 53 / Issue 15 / November 2023
- Published online by Cambridge University Press:
- 23 March 2023, pp. 7062-7069
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Background
Cannabis use has been linked to psychotic disorders but this association has been primarily observed in the Global North. This study investigates patterns of cannabis use and associations with psychoses in three Global South (regions within Latin America, Asia, Africa and Oceania) settings.
MethodsCase–control study within the International Programme of Research on Psychotic Disorders (INTREPID) II conducted between May 2018 and September 2020. In each setting, we recruited over 200 individuals with an untreated psychosis and individually-matched controls (Kancheepuram India; Ibadan, Nigeria; northern Trinidad). Controls, with no past or current psychotic disorder, were individually-matched to cases by 5-year age group, sex and neighbourhood. Presence of psychotic disorder assessed using the Schedules for Clinical Assessment in Neuropsychiatry and cannabis exposure measured by the World Health Organisation Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).
ResultsCases reported higher lifetime and frequent cannabis use than controls in each setting. In Trinidad, cannabis use was associated with increased odds of psychotic disorder: lifetime cannabis use (adj. OR 1.58, 95% CI 0.99–2.53); frequent cannabis use (adj. OR 1.99, 95% CI 1.10–3.60); cannabis dependency (as measured by high ASSIST score) (adj. OR 4.70, 95% CI 1.77–12.47), early age of first use (adj. OR 1.83, 95% CI 1.03–3.27). Cannabis use in the other two settings was too rare to examine associations.
ConclusionsIn line with previous studies, we found associations between cannabis use and the occurrence and age of onset of psychoses in Trinidad. These findings have implications for strategies for prevention of psychosis.
Urbanicity and rates of untreated psychotic disorders in three diverse settings in the Global South
- Tessa Roberts, Ezra Susser, Joni Lee Pow, Casswina Donald, Sujit John, Vijaya Raghavan, Olatunde Ayinde, Bola Olley, Georgina Miguel Esponda, Joseph Lam, Robin M. Murray, Alex Cohen, Helen A. Weiss, Gerard Hutchinson, Rangaswamy Thara, Oye Gureje, Jonathan Burns, INTREPID Group, Craig Morgan
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- Journal:
- Psychological Medicine / Volume 53 / Issue 14 / October 2023
- Published online by Cambridge University Press:
- 16 January 2023, pp. 6459-6467
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Background
Extensive evidence indicates that rates of psychotic disorder are elevated in more urban compared with less urban areas, but this evidence largely originates from Northern Europe. It is unclear whether the same association holds globally. This study examined the association between urban residence and rates of psychotic disorder in catchment areas in India (Kancheepuram, Tamil Nadu), Nigeria (Ibadan, Oyo), and Northern Trinidad.
MethodsComprehensive case detection systems were developed based on extensive pilot work to identify individuals aged 18–64 with previously untreated psychotic disorders residing in each catchment area (May 2018–April/May/July 2020). Area of residence and basic demographic details were collected for eligible cases. We compared rates of psychotic disorder in the more v. less urban administrative areas within each catchment area, based on all cases detected, and repeated these analyses while restricting to recent onset cases (<2 years/<5 years).
ResultsWe found evidence of higher overall rates of psychosis in more urban areas within the Trinidadian catchment area (IRR: 3.24, 95% CI 2.68–3.91), an inverse association in the Nigerian catchment area (IRR: 0.68, 95% CI 0.51–0.91) and no association in the Indian catchment area (IRR: 1.18, 95% CI 0.93–1.52). When restricting to recent onset cases, we found a modest positive association in the Indian catchment area.
ConclusionsThis study suggests that urbanicity is associated with higher rates of psychotic disorder in some but not all contexts outside of Northern Europe. Future studies should test candidate mechanisms that may underlie the associations observed, such as exposure to violence.
Pilot randomised controlled trial of a remotely delivered online intervention for adolescent mental health problems in India: lessons learned about low acceptability and feasibility during the COVID-19 pandemic
- Pattie P. Gonsalves, Bhargav Bhat, Rhea Sharma, Abhijeet Jambhale, Bindiya Chodankar, Mamta Verma, Eleanor Hodgson, Helen A. Weiss, Baptiste Leurent, Kate Cavanagh, Christopher G. Fairburn, Pim Cuijpers, Daniel Michelson, Vikram Patel
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- BJPsych Open / Volume 9 / Issue 1 / January 2023
- Published online by Cambridge University Press:
- 27 December 2022, e7
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Background
‘POD Adventures’ is a gamified problem-solving intervention delivered via smartphone app, and supported by non-specialist counsellors for a target population of secondary school students in India during the COVID-19 pandemic.
AimsTo evaluate the feasibility and acceptability of undertaking a randomised controlled trial of POD Adventures when delivered online with telephone support from counsellors.
MethodWe conducted a parallel, two-arm, individually randomised pilot-controlled trial with 11 secondary schools in Goa, India. Participants received either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes were assessed at two timepoints: baseline and 6 weeks post-randomisation.
ResultsSeventy-nine classroom sensitisation sessions reaching a total of 1575 students were conducted. Ninety-two self-initiated study referrals (5.8%) were received, but only 11 participants enrolled in the study. No intervention arm participants completed the intervention. Outcomes at 6 weeks were not available for intervention arm participants (n = 5), and only four control arm participants completed outcomes. No qualitative interviews or participant satisfaction measures were completed because participants could not be reached by the study team.
ConclusionsDespite modifications to address barriers arising from COVID-19 restrictions, online delivery was not feasible in the study context. Low recruitment and missing feasibility and acceptability data make it difficult to draw conclusions about intervention engagement and indicative clinical outcomes. Prior findings showing high uptake, adherence and engagement with POD Adventures when delivered in a school-based context suggest that an online study and delivery posed the biggest barriers to study participation and engagement.
Life events and psychosis: case–control study from India, Nigeria, and Trinidad and Tobago
- Ibidunni O. Oloniniyi, Helen A. Weiss, Sujit John, Oluyomi Esan, Maia Hibben, Vikram Patel, Robin M. Murray, Alex Cohen, Gerard Hutchinson, Oye Gureje, Rangaswamy Thara, Craig Morgan, Tessa Roberts
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- BJPsych Open / Volume 8 / Issue 5 / September 2022
- Published online by Cambridge University Press:
- 16 September 2022, e168
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Background
There is evidence of an association between life events and psychosis in Europe, North America and Australasia, but few studies have examined this association in the rest of the world.
AimsTo test the association between exposure to life events and psychosis in catchment areas in India, Nigeria, and Trinidad and Tobago.
MethodWe conducted a population-based, matched case–control study of 194 participants in India, Nigeria, and Trinidad and Tobago. Cases were recruited through comprehensive population-based, case-finding strategies. The Harvard Trauma Questionnaire was used to measure life events. The Screening Schedule for Psychosis was used to screen for psychotic symptoms. The association between psychosis and having experienced life events (experienced or witnessed) was estimated by conditional logistic regression.
ResultsThere was no overall evidence of an association between psychosis and having experienced or witnessed life events (adjusted odds ratio 1.19, 95% CI 0.62–2.28). We found evidence of effect modification by site (P = 0.002), with stronger evidence of an association in India (adjusted odds ratio 1.56, 95% CI 1.03–2.34), inconclusive evidence in Nigeria (adjusted odds ratio 1.17, 95% CI 0.95–1.45) and evidence of an inverse association in Trinidad and Tobago (adjusted odds ratio 0.66, 95% CI 0.44–0.97).
ConclusionsThis study found no overall evidence of an association between witnessing or experiencing life events and psychotic disorder across three culturally and economically diverse countries. There was preliminary evidence that the association varies between settings.
Longitudinal experiences and risk factors for common mental health problems and suicidal behaviours among female sex workers in Nairobi, Kenya
- Alicja Beksinska, Pooja Shah, Mary Kungu, Rhoda Kabuti, Hellen Babu, Zaina Jama, Mamtuti Panneh, Emily Nyariki, Chrispo Nyabuto, Monica Okumu, Pauline Ngurukiri, Erastus Irungu, Rupert Kaul, Janet Seeley, Mitzy Gafos, Tara S. Beattie, Helen A. Weiss, Joshua Kimani
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- Global Mental Health / Volume 9 / 2022
- Published online by Cambridge University Press:
- 18 August 2022, pp. 401-415
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Background
Female sex workers (FSWs) are at high risk of mental health problems and suicide risk. Few longitudinal studies have examined risk factors for poor mental health among FSWs.
MethodsMaisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme clinics across Nairobi. Behavioural-biological survey data were collected at baseline (n = 1003, June–December 2019), midline (n = 366) (Jan–March 2020) and endline (n = 877) (June 2020–Jan 2021). Women reporting mental health problems were offered counselling services. Multivariable mixed logistic regression models were used to examine factors associated with mental health problems and suicidal behaviours.
ResultsThere was a decline in the proportion of women reporting any mental health problem (depression and/or anxiety and/or PTSD) (baseline: 29.9%, midline: 13.3%, endline: 11.8%). There was strong evidence that any mental health problem was associated with recent hunger (aOR 1.99; 95% CI 1.37–2.88) and recent violence from non-intimate partners (2.23; 95% CI 1.55–3.19). Recent suicidal behaviour prevalence was similar across survey rounds (baseline: 10.2%; midline: 10.2%; endline: 10.4%), and was associated with recent violence from non-intimate partners (aOR 1.96; 95% CI 1.31–2.95), recent hunger (aOR 1.69; 95% CI 1.15–2.47) and having an additional employment to sex work (aOR 1.50; 95% CI 1.00–2.23).
ConclusionsOur study found a decline in mental health problems but high levels of persistent suicidal behaviours among FSWs. Syndemic risk factors including food insecurity and violence were longitudinally associated with mental health problems and recent suicidal behaviours. There is a need for accessible mental health services for FSWs, alongside structural interventions addressing poverty and violence.
Prevalence and correlates of common mental health problems and recent suicidal behaviour among female sex workers in Nairobi, Kenya: findings from the Maisha Fiti study
- Alicja Beksinska, Zaina Jama, Rhoda Kabuti, Mary Kungu, Hellen Babu, Emily Nyakiri, Pooja Shah, Chrispo Nyabuto, Monica Okumu, Anne Mahero, Pauline Ngurukiri, Erastus Irungu, Wendy Adhiambo, Peter Muthoga, Rupert Kaul, Janet Seeley, Tara S Beattie, Joshua Kimani, Helen Weiss
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- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S238
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Aims
Adverse childhood experiences (ACEs), poverty, violence and harmful alcohol/substance are associated with poor mental health outcomes in the general population. These risks are likely to be exacerbated among Female Sex Workers (FSWs), however there are few studies examining risks factors for mental health problems among FSWs. We examine the prevalence and correlates of common mental health problems including suicidal behaviour among FSWs in Kenya.
MethodMaisha Fiti is a longitudinal study among FSWs randomly selected from Sex Worker Outreach Programme (SWOP) clinics across Nairobi. Baseline data were collected from June-December 2019. Mental health problems were assessed using the Patient Health Questionnaire (PHQ-9) for depression, the Generalised Anxiety Disorder tool (GAD-7) for anxiety, and the Harvard Trauma Questionnaire (HTQ-17) for Post-Traumatic Stress Disorder (PTSD). Recent suicidal behaviour was defined as reported suicide attempt or suicidal ideation in the past 30 days. Other measurement tools included the WHO Adverse Childhood Experiences (ACE) score, WHO Violence Against Women questionnaire, and the WHO ASSIST tool (to measure harmful alcohol/substance use in the past 3 months). Descriptive statistics and multivariable logistic regression were conducted in Stata 16.1.
ResultOf 1039 eligible FSWs, 1003 FSWs took part in the study (response rate: 96%) with a mean age of 33.7 years. The prevalence of moderate/severe depression was 23.2% (95%CI: 20.7–25.9%), moderate/severe anxiety 11.0% (95%CI: 9.3–13.1%), PTSD 14.0% (95% CI: 12.2–16.5%) and recent suicidal behaviour 10.2% (95%CI: 8.5–12.2%) (2.6% suicide attempt; 10.0% suicidal ideation). Among women with any mental health problem 63.0% also had a harmful alcohol/substance use problem. One in four women (25%; 95%CI: 22.5–27.8%) had depression and/or anxiety and this was independently associated with higher ACE scores, hunger (skipped a meal in last week due to financial difficulties), death of a child, perceived sex work stigma and recent sexual/physical violence. PTSD was associated with higher ACE scores, hunger, increased STI prevalence (chlamydia trachomatis) and recent violence. Recent suicidal behaviour was associated with higher ACE scores, low literacy, hunger, and recent violence. Mental health problems and suicidal behaviour were less prevalent among women reporting social support.
ConclusionThe high burden of mental problems among FSWs indicates a need for accessible services tailored for FSWs alongside broader structural interventions addressing poverty, harmful alcohol/substance use and violence. High rates of ACEs among this population indicates the need to consider early childhood and family interventions to prevent poor mental health outcomes.
Funding: Medical Research Council and the UK Department of International Development
Effectiveness of a peer-led adolescent mental health intervention on HIV virological suppression and mental health in Zimbabwe: protocol of a cluster-randomised trial
- Silindweyinkosi Chinoda, Abigail Mutsinze, Victoria Simms, Rhulani Beji-Chauke, Ruth Verhey, Joanna Robinson, Taryn Barker, Owen Mugurungi, Tsitsi Apollo, Epiphany Munetsi, Dorcas Sithole, Helen A. Weiss, Dixon Chibanda, Nicola Willis
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- Global Mental Health / Volume 7 / 2020
- Published online by Cambridge University Press:
- 28 August 2020, e23
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Background
Adolescents living with HIV (ALHIV) experience a high burden of mental health disorder which is a barrier to antiretroviral therapy adherence. In Zimbabwe, trained, mentored peer supporters living with HIV (Community Adolescent Treatment Supporters – CATS) have been found to improve adherence, viral suppression and psychosocial well-being among ALHIV. The Friendship Bench is the largest integrated mental health programme in Africa. We hypothesise that combining the CATS programme and Friendship Bench will improve mental health and virological suppression among ALHIV compared with the CATS programme alone.
MethodsWe will conduct a cluster-randomised controlled trial in 60 clinics randomised 1:1 in five provinces. ALHIV attending the control arm clinics will receive standard CATS support and clinic support following the Ministry of Health guidelines. Those attending the intervention arm clinics will receive Friendship Bench problem-solving therapy, delivered by trained CATS. Participants with the signs of psychological distress will be referred to the clinic for further assessment and management. The primary outcome is HIV virological failure (≥1000 copies/ml) or death at 48 weeks. Secondary outcomes include the proportion of adolescents with common mental disorder symptoms (defined as Shona Symptom Questionnaire (SSQ-14) score ≥8), proportion with depression symptoms (defined as Patient Health Questionnaire (PHQ-9) score ≥11), symptom severity (mean SSQ-14 and PHQ-9 scores) and EQ-5D score for health-related quality of life.
ConclusionsThis trial evaluates the effectiveness of peer-delivery of mental health care on mental health and HIV viral load among ALHIV. If effective this intervention has the potential to be scaled-up to improve these outcomes.
Trial registration: PACTR201810756862405. 08 October 2018.
Mental health research capacity building in sub-Saharan Africa: the African Mental Health Research Initiative
- Dixon Chibanda, Melanie Abas, Rosemary Musesengwa, Chris Merritt, Katherine Sorsdahl, Walter Mangezi, Chiwoza Bandawe, Frances Cowan, Ricardo Araya, Exnevia Gomo, Lorna Gibson, Helen Weiss, Charlotte Hanlon, Crick Lund
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- Global Mental Health / Volume 7 / 2020
- Published online by Cambridge University Press:
- 03 March 2020, e8
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Mental, neurological and substance use (MNS) disorders are a leading, but neglected, cause of morbidity and mortality in sub-Saharan Africa. The treatment gap for MNS is vast with only 10% of people with MNS disorders in low-income countries accessing evidence-based treatments. Reasons for this include low awareness of the burden of MNS disorders and limited evidence to support development, adaptation and implementation of effective and feasible treatments. The overall goal of the African Mental Health Research Initiative (AMARI) is to build an African-led network of MNS researchers in Ethiopia, Malawi, South Africa and Zimbabwe, who are equipped to lead high quality mental health research programs that meet the needs of their countries, and to establish a sustainable career pipeline for these researchers with an emphasis on integrating MNS research into existing programs such as HIV/AIDS. This paper describes the process leading to the development of AMARI's objectives through a theory of change workshop, successes and challenges that have been faced by the consortium in the last 4 years, and the future role that AMARI could play in further building MNS research capacity by brining on board more institutions from low- and middle-income countries with an emphasis on developing an evidence-based training curriculum and a research-driven care service.
5 - Diamonds and the Mantle Geodynamics of Carbon
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- By Steven B. Shirey, Karen V. Smit, D. Graham Pearson, Michael J. Walter, Sonja Aulbach, Frank E. Brenker, Hélène Bureau, Antony D. Burnham, Pierre Cartigny, Thomas Chacko, Daniel J. Frost, Erik H. Hauri, Dorrit E. Jacob, Steven D. Jacobsen, Simon C. Kohn, Robert W. Luth, Sami Mikhail, Oded Navon, Fabrizio Nestola, Paolo Nimis, Mederic Palot, Evan M. Smith, Thomas Stachel, Vincenzo Stagno, Andrew Steele, Richard A. Stern, Emilie Thomassot, Andrew R. Thomson, Yaakov Weiss
- Edited by Beth N. Orcutt, Isabelle Daniel, Université Claude-Bernard Lyon I, Rajdeep Dasgupta, Rice University, Houston
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- Deep Carbon
- Published online:
- 03 October 2019
- Print publication:
- 17 October 2019, pp 89-128
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Summary
The science of studying diamond inclusions for understanding Earth history has developed significantly over the past decades, with new instrumentation and techniques applied to diamond sample archives revealing the stories contained within diamond inclusions. This chapter reviews what diamonds can tell us about the deep carbon cycle over the course of Earth’s history. It reviews how the geochemistry of diamonds and their inclusions inform us about the deep carbon cycle, the origin of the diamonds in Earth’s mantle, and the evolution of diamonds through time.
Delay in Motor Development of Twins in Africa: A Prospective Cohort Study
- Tessa Goetghebuer, Martin O. C. Ota, Bunja Kebbeh, Malick John, Dolly Jackson-Sillah, Johan Vekemans, Arnaud Marchant, Melanie Newport, Helen A. Weiss
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- Twin Research / Volume 6 / Issue 4 / 01 August 2003
- Published online by Cambridge University Press:
- 21 February 2012, pp. 279-284
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Twins are prone to developmental delay due to prematurity and low birthweight. However it is unknown if twinning is an independent risk factor for developmental delay. The objective of this study was to compare the attainment of a set of gross motor milestones in a cohort of twins and singletons in The Gambia. Eighty-four pairs of twins and 72 singletons were enrolled at birth and followed up until 18 months of age. The mean age at achieving milestones was higher in twins for each development outcome and the difference between twins and singletons was significant after adjustment for confounders for maintaining head, sitting without support and walking. In twins, we found a highly significant correlation within pairs for most milestones. When monozygotic and dizygotic twins were compared, a significant heritability was observed for crawling, sitting, standing and walking, with over 90% of population variance observed due to genetic factors rather than environmental factors. There was little evidence for a genetic contribution towards very early milestones. In conclusion, our data suggest that twinning is an independent risk factor for developmental delay in early life in The Gambia, and that genetic factors contribute strongly to certain motor development outcomes.
Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months
- Vikram Patel, Helen A. Weiss, Neerja Chowdhary, Smita Naik, Sulochana Pednekar, Sudipto Chatterjee, Bhargav Bhat, Ricardo Araya, Michael King, Gregory Simon, Helena Verdeli, Betty R. Kirkwood
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- Journal:
- The British Journal of Psychiatry / Volume 199 / Issue 6 / December 2011
- Published online by Cambridge University Press:
- 02 January 2018, pp. 459-466
- Print publication:
- December 2011
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Background
Depressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare.
AimsTo test the effectiveness of an intervention led by lay health counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders.
MethodTwenty-four primary care facilities (12 public, 12 private) in Goa (India) were randomised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders. Participants were assessed at 2, 6 and 12 months for presence of ICD-10 common mental disorders, the severity of symptoms of depression and anxiety, suicidal behaviour and disability levels. All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design. The trial has been registered with clinicaltrials.gov (NCT00446407).
ResultsA total of 2796 participants were recruited. In public facilities, the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes. There was a 30% decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses (risk ratio (RR) = 0.70, 95% CI 0.53–0.92); and a similar effect among the subgroup of participants with depression (RR = 0.76, 95% CI 0.59–0.98). Suicide attempts/plans showed a 36% reduction over 12 months (RR = 0.64, 95% CI 0.42–0.98) among baseline ICD-10 cases. Strong effects were observed on days out of work and psychological morbidity, and modest effects on overall disability. In contrast, there was little evidence of impact of the intervention on any outcome among participants attending private facilities.
ConclusionsTrained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.
Contributors
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- By Rose Teteki Abbey, K. C. Abraham, David Tuesday Adamo, LeRoy H. Aden, Efrain Agosto, Victor Aguilan, Gillian T. W. Ahlgren, Charanjit Kaur AjitSingh, Dorothy B E A Akoto, Giuseppe Alberigo, Daniel E. Albrecht, Ruth Albrecht, Daniel O. Aleshire, Urs Altermatt, Anand Amaladass, Michael Amaladoss, James N. Amanze, Lesley G. Anderson, Thomas C. Anderson, Victor Anderson, Hope S. Antone, María Pilar Aquino, Paula Arai, Victorio Araya Guillén, S. Wesley Ariarajah, Ellen T. Armour, Brett Gregory Armstrong, Atsuhiro Asano, Naim Stifan Ateek, Mahmoud Ayoub, John Alembillah Azumah, Mercedes L. García Bachmann, Irena Backus, J. Wayne Baker, Mieke Bal, Lewis V. Baldwin, William Barbieri, António Barbosa da Silva, David Basinger, Bolaji Olukemi Bateye, Oswald Bayer, Daniel H. Bays, Rosalie Beck, Nancy Elizabeth Bedford, Guy-Thomas Bedouelle, Chorbishop Seely Beggiani, Wolfgang Behringer, Christopher M. Bellitto, Byard Bennett, Harold V. Bennett, Teresa Berger, Miguel A. Bernad, Henley Bernard, Alan E. Bernstein, Jon L. Berquist, Johannes Beutler, Ana María Bidegain, Matthew P. Binkewicz, Jennifer Bird, Joseph Blenkinsopp, Dmytro Bondarenko, Paulo Bonfatti, Riet en Pim Bons-Storm, Jessica A. Boon, Marcus J. Borg, Mark Bosco, Peter C. Bouteneff, François Bovon, William D. Bowman, Paul S. Boyer, David Brakke, Richard E. Brantley, Marcus Braybrooke, Ian Breward, Ênio José da Costa Brito, Jewel Spears Brooker, Johannes Brosseder, Nicholas Canfield Read Brown, Robert F. Brown, Pamela K. Brubaker, Walter Brueggemann, Bishop Colin O. Buchanan, Stanley M. Burgess, Amy Nelson Burnett, J. Patout Burns, David B. Burrell, David Buttrick, James P. Byrd, Lavinia Byrne, Gerado Caetano, Marcos Caldas, Alkiviadis Calivas, William J. Callahan, Salvatore Calomino, Euan K. Cameron, William S. Campbell, Marcelo Ayres Camurça, Daniel F. Caner, Paul E. Capetz, Carlos F. Cardoza-Orlandi, Patrick W. Carey, Barbara Carvill, Hal Cauthron, Subhadra Mitra Channa, Mark D. 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Yee, Viktor Yelensky, Yeo Khiok-Khng, Gustav K. K. Yeung, Angela Yiu, Amos Yong, Yong Ting Jin, You Bin, Youhanna Nessim Youssef, Eliana Yunes, Robert Michael Zaller, Valarie H. Ziegler, Barbara Brown Zikmund, Joyce Ann Zimmerman, Aurora Zlotnik, Zhuo Xinping
- Edited by Daniel Patte, Vanderbilt University, Tennessee
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- The Cambridge Dictionary of Christianity
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- 05 August 2012
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- 20 September 2010, pp xi-xliv
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Non-traditional lifestyles and prevalence of mental disorders in adolescents in Goa, India
- Aravind Pillai, Vikram Patel, Percy Cardozo, Robert Goodman, Helen A. Weiss, Gracy Andrew
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- Journal:
- The British Journal of Psychiatry / Volume 192 / Issue 1 / January 2008
- Published online by Cambridge University Press:
- 02 January 2018, pp. 45-51
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- January 2008
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Background
Adolescents comprise a fifth of the population of India, but there is little research on their mental health. We conducted an epidemiological study in the state of Goa to describe the current prevalence of mental disorders and its correlates among adolescents aged between 12 and 16 years.
AimsTo estimate the prevalence and correlates of mental disorders in adolescents.
MethodPopulation-based survey of all eligible adolescents from six urban wards and four rural communities which were randomly selected. We used a Konkani translation of the Development and Well-Being Assessment to diagnose current DSM-IV emotional and behavioural disorders. All adolescents were also interviewed on socio-economic factors, education, neighbourhood, parental relations, peer and sexual relationships, violence and substance use.
ResultsOut of 2684 eligible adolescents, 2048 completed the study. The current prevalence of any DSM-IV diagnosis was 1.81%; 95% CI 1.27–2.48. The most common diagnoses were anxiety disorders (1.0%), depressive disorder (0.5%), behavioural disorder (0.4%) and attention-deficit hyperactivity disorder (0.2%). Adolescents from urban areas and girls who faced gender discrimination had higher prevalence. The final multivariate model found an independent association of mental disorders with an outgoing ‘non-traditional’ lifestyle (frequent partying, going to the cinema, shopping for fun and having a boyfriend or girlfriend), difficulties with studies, lack of safety in the neighbourhood, a history of physical or verbal abuse and tobacco use. Having one's family as the primary source of social support was associated with lower prevalence of mental disorders.
ConclusionsThe current prevalence of mental disorders in adolescents in our study was very low compared with studies in other countries. Strong family support was a critical factor associated with low prevalence of mental disorders, while factors indicative of adoption of a non-traditional lifestyle were associated with an increased prevalence.
Dedication
- Edited by Rosalind Field, Rosalind Field was formerly Reader in Medieval Literature at Royal Holloway, University of London. [Retired], Alison Wiggins, Alison Wiggins is Lecturer in English Language at the University of Glasgow.
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- Guy of Warwick: Icon and Ancestor
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- Boydell & Brewer
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- 24 October 2017
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- 19 July 2007, pp xiii-xiv
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Appendix: Synopsis of the Guy of Warwick narrative
- Edited by Rosalind Field, Rosalind Field was formerly Reader in Medieval Literature at Royal Holloway, University of London. [Retired], Alison Wiggins, Alison Wiggins is Lecturer in English Language at the University of Glasgow.
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- Guy of Warwick: Icon and Ancestor
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- Boydell & Brewer
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- 24 October 2017
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Summary
Short summary
Guy, the son of the steward of Earl Rohaud of Warwick, falls helplessly in love with the Earl's daughter Felice. Felice will grant him her love once he has proved himself as a knight. Guy travels to France with his companions, including Herhaud of Ardern. He distinguishes himself in a tournament at Rouen and as a prize is offered the love of Blancheflour, the daughter of the German Emperor Reiner. Guy returns to England to claim the love of Felice [E 209–1054; Auchinleck 235–1130; CUL 177–792].
On his return, Felice tells Guy that she will grant him her love only when he has proved himself the best of all knights. Guy travels abroad again and distinguishes himself in a series of tournaments. His adventures include: the ambush at the orders of Duke Otes (whom he had earlier wounded at Rouen) and the battle for the Duke of Louvain against the Emperor Reiner. The Emperor Reiner's champion is Tirri. Otes is also fighting on his side and violently opposes the reconciliation that Guy finally effects between the two former enemies. Guy next travels to Constantinople. He frees the land of the Emperor Hernis from the forces of the Sultan and is offered his daughter in return. However, Guy is hated by the Emperor's jealous steward Morgadour, who slanders him and kills his pet lion. At this, Guy kills Morgadour, refuses to marry the daughter, and leaves. In Lorraine Guy rescues Tirri (who has become his sworn brother) and his mistress Oisel and then helps Albri (Tirri's father) against Loher (Oisel's father) and Otes (now Oisel's intended husband). After rescuing Tirri from prison Guy kills Otes. Then, whilst hunting Guy kills a young knight and has to fight with the vassals of Florentin, the knight's father. Guy returns to England and kills a dragon that is devastating Northumberland. He returns to Warwick, marries Felice, and conceives a child [E 1055–7562; Auchinleck 1131–7306, stanzas 3–19; CUL 793–7116].
A fortnight after the marriage, Guy repents that he has so long neglected God through his excessive devotion to Felice and sets out on a pilgrimage of atonement. After visiting Jerusalem and Bethlehem, he successfully fights for King Triamour against the Sultan's gigantic champion, Amoraunt.
Contents
- Edited by Rosalind Field, Rosalind Field was formerly Reader in Medieval Literature at Royal Holloway, University of London. [Retired], Alison Wiggins, Alison Wiggins is Lecturer in English Language at the University of Glasgow.
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- Guy of Warwick: Icon and Ancestor
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- Boydell & Brewer
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- 24 October 2017
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- 19 July 2007, pp v-vi
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Frontmatter
- Edited by Rosalind Field, Rosalind Field was formerly Reader in Medieval Literature at Royal Holloway, University of London. [Retired], Alison Wiggins, Alison Wiggins is Lecturer in English Language at the University of Glasgow.
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- Book:
- Guy of Warwick: Icon and Ancestor
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- Boydell & Brewer
- Published online:
- 24 October 2017
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- 19 July 2007, pp i-iv
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