Community-based mental health care in Africa: mental health workers’ views

The World Health Organization (WHO) has for long proposed the development of community-based mental health services worldwide. However, the progress toward community mental health care in most African countries is still hampered by a lack of resources, with specialist psychiatric care essentially based in large, centrally located mental hospitals. It is again time to reconsider the direction of mental health care in Africa. Based on a small inquiry to a number of experienced mental health professionals in sub-Saharan Africa, we discuss what a community concept of mental health care might mean in Africa. There is a general agreement that mental health services should be integrated in primary health care. A critical issue for success of this model is perceived to be provision of appropriate supervision and continuing education for primary care workers. The importance of collaboration between modern medicine and traditional healers is stressed and the paper ends in a plea for WHO to take the initiative and develop mental health services according to the special needs and the socio-cultural conditions prevailing in sub-Saharan Africa.     

Work Ability of Health Care Shift Workers: What Matters?

This paper aims at identifying variables associated with inadequate work ability among nursing personnel at a public hospital, considering factors related to socio‐demographic, lifestyles, working conditions, and health outcomes. A cross‐sectional study was conducted in a university hospital in São Paulo, Brazil, as part of a larger research study on tolerance to 12 h night work. Nursing staff included registered nurses, nurse technicians, and nurse aides; in total, there were 996 healthcare workers (878 female; 118 male) at the time of the study. Some 696 workers (69.9%) of the population agreed to participate. Data collection (October 2004–July 2005) was based on a comprehensive questionnaire about living and working conditions (including incivility at work, work demands, work control, and support), mental and physical health symptoms (fatigue and sleep problems), and work ability. This report presents analyses of the adapted Brazilian version of the Work Ability Index (WAI) and associated variables. The study population worked one of the following shift schedules at this hospital: 12 h nights followed by 36 h off or 9 h or 6 h day (morning or afternoon) shifts. The mean age of the respondents was 34.9 (S.D.±10.4) years of age; 31.5% of the participants held two jobs. Statistical analyses using a hierarchical multiple logistic regression model were performed to evaluate the factors associated with inadequate (moderate and low scores) of the WAI. The significantly associated factors were socio‐demographic (income responsibility, sole breadwinner, raising kids, age group), working conditions (thermal discomfort, organization of the workplace, and verbal abuse), and health outcomes (high body mass index, obesity, sleep problems, and fatigue). In spite of limitations of the study design, results indicate that the nursing profession is associated with stressful working conditions, contributing to inadequate WAI. This is in addition to bad living conditions and precarious work. Intervention measures, either at the workplace or at individual levels, are necessary to prevent a decrease in work ability, even in this quite young working population.     

Recurrence of COVID-19 after recovery ? A case series in health care workers,France

We describe 3 cases of coronavirus disease 2019 in health care workers in France involving presumed clinical and microbiological recurrence after recovery. All patients were immunocompetent with clinical mild form. These cases highlight the possibility of coronavirus disease–recurrence.     

Would primary health care workers give appropriate dietary advice after cholesterol screening?

The purpose of this study was to obtain information on the dietary knowledge of primary health care workers and on their ability to apply this knowledge in practice. A total of 128 primary health care workers (53 general practitioners and 61 nurses) in 12 practices and 14 primary care facilitators were surveyed by questionnaire between December 1987 and June 1988. All of the practices were participating in a project to promote prevention in primary care and offered health checks designed to identify and deal with cardiovascular risk factors. The questionnaire focused on issues related to managing patients with moderate hypercholesterolaemia. The results of the study showed some important gaps in the health workers'' knowledge--for example, only 91 understood that dietary intake of polyunsaturated fatty acids as a proportion of total fat intake should be increased in a diet designed to reduce serum lipid concentrations. Appreciable gaps in their ability to give practical and appropriate dietary advice were also identified: 35 gave advice that would have led to the patient losing weight (although his history indicated that he was not overweight), and 27 gave only negative advice, offering no suggestions about substituting healthy foods for unhealthy ones. The demand for primary health care workers to give dietary advice is increasing and is likely to increase further if a national screening programme for hypercholesterolaemia is recommended. The results of this survey point to a need for improved nutritional education and training in dietary counselling for general practitioners, nurses, and primary care facilitators.     

Conflicts of interest in health care: who guards the guardians?

Conflicts of interest are rife in all areas of human endeavor, including medicine. Dealing with them is often difficult, because various disclosure remedies are sometimes too weak, while explicit prohibitions against participation in certain forms of research could block the needed synergies between scientists who work in universities, government, and industry. The situation is made still more difficult, because any effort to control one set of conflicts will necessarily generate another in its stead, as is well captured in Juvenal's famous question, "Who will guard the guardians?" That problem is more acute today, because many of our social watchdogs are in fact complex organizations that are rife with their own internal conflicts of interest. The problem is acute for the FDA, for example, which so fears the release of harmful drugs that it often keeps beneficial ones off the market. The problem can also arise in connection with the review of medical research by major journals, which is well illustrated by the recent effort of the New England Journal of Medicine to attack a Vioxx study it published in order to protect its own reputation.     

Can we consider medical residents as shift workers?

Although medical residents are characterized by long working hours, night shifts and high levels of work load, it is unclear if their work schedule can be classified as shift work, or if it has a similar impact on residents' well-being. The present paper compared the profile of complaints about sleep or daytime functioning of medical residents to that of rotating shift workers and day workers, of similar ages. Sixty-one residents (aged: 32.2 +/- 2.2 years), after 2 years of residency, participated in the study. The two control groups with a similar age range (26-40 years) were chosen, and included 94 rotating shift workers and 146 day workers. All subjects completed self-administered questionnaires on their sleep habits, and their sleep-wake cycle was monitored by a wrist-worn actigraph. Ten percent of the residents complained about difficulties falling asleep, 34% complained about morning tiredness, 14% complained about mid-sleep awakening, and 20% about prolonged fatigue. The residents slept significantly less than the day workers, and their sleep efficiency was significantly higher. When examining their subjective complaints profile, residents complained more than day workers and their answers were more similar to those of rotating shift workers, therefore they can be considered to be characterized as shift workers.     

Are there health risks for travel among Tunisians? What type of medical care should be assured?

The present work aims to assess the importance of the international travels of Tunisians, their destinations, the risks they face as well as the means to reduce them. Therefore, data related to the period from 1989 to 1998, were collected from official organisms involved in this area. Results revealed an increase of the number of Tunisians travelling outside the country of 23% between 1989 and 1998, with a mean progress of 5.7% per year since 1993. Main destinations were Maghrebin countries (65.7%), Europe (30%) and Middle East (4%). The number of persons leaving to high risk destinations remains difficult to assess and shows the importance of implementing a surveillance system to insure an adequate medical follow-up of this category of travellers. The structures actually involved in the health management of Tunisian travellers have a weak recruitment which demonstrates the importance to strengthen the sensitization of general practitioners to this subject and the promotion of the immunization ward of "Institut Pasteur" to a national centre of travelling medicine.     

What is river health?

1. Traditionally the assessment of river water quality has been based solely on the measurement of physical, chemical and some biological characteristics. While these measurements may be efficient for regulating effluent discharges and protecting humans, they are not very useful for large-scale management of catchments or for assessing whether river ecosystems are being protected. 2. Measurements of aquatic biota, to identify structural or functional integrity of ecosystems, have recently gained acceptance for river assessment. Empirical evidence from studies of river ecosystems under stress suggests that a small group of biological ecosystem-level indicators can assess river condition. However, physical and chemical features of the environment affect these indicators, the structure and function of which may be changed by human activities. 3. The term ‘river health’, applied to the assessment of river condition, is often seen as being analogous with human health, giving many a sense of understanding. Unfortunately, the meaning of ‘river health’ remains obscure. It is not clear what aspects of river health sets of ecosystem-level indicators actually identify, nor how physical, chemical and biological characteristics may be integrated into measures rather than just observations of cause and effect. 4. Increased examination of relationships between environmental variables that affect aquatic biota, such as habitat structure, flow regime, energy sources, water quality and biotic interactions and biological condition, are required in the study of river health.     

Separation of housing and care: more or less care? Consequences for health care services utilization by the elderly

The Dutch policy for the care of the elderly has been mainly characterised by the aim to improve the possibility for elderly people to live independently for as long as possible. One measure that has been taken to achieve this goal is the separation of the financing of care from the accommodation in which care is given. Recent discussions have brought to light some possible positive and negative effects of this separation on the use of care. It is, however, largely unknown to what extent there are differences concerning the nature and intensity of care and the type of caregivers provided to dwellers of houses where care and housing are separated (so-called 'life-time houses') and the elderly who live in homes for residential care and nursing homes. To gain insight in this matter an explorative study was conducted in Rotterdam of the use of several health facilities by matching 35 dwellers of 'life-time houses' on the criteria age, health needs and social status with 35 dwellers of residential care homes and nursing homes. On the basis of interviews, questionnaires and patient records data were collected and analysed on the nature and amount of help that has been given (per minute per week) and the kind of caregiver. The main finding is that the use pattern differs between the research groups. Dwellers of 'life-time houses' generally make more use of some care facilities and make more use of different types of care and caregivers. These differences however do not seem to be exclusively caused by the separation of housing and care.     

Puma population limitation and regulation: What matters in puma management?

Wildlife managers require reliable information on factors that influence animal populations to develop successful management programs, including the puma (Puma concolor), in western North America. As puma populations have recovered in recent decades because of restrictions on human-caused mortality, managers need a clear understanding of the factors that limit or regulate puma populations and how those factors might be manipulated to achieve management objectives, including sustaining puma and other wildlife populations, providing hunting opportunity, and reducing puma interactions with people. I synthesized technical literature on puma populations, behavior, and relationships with prey that have contributed to hypotheses on puma population limitation and regulation. Current hypotheses on puma population limitation include the social limitation hypothesis and the food limitation hypothesis. Associated with each of those are 2 hypotheses on puma population regulation: the social regulation hypothesis and the competition regulation hypothesis. I organize the biological and ecological attributes of pumas reported in the literature under these hypotheses. I discuss the validity of these hypotheses based on the limits of the research associated with the hypotheses and the evolutionary processes theoretically underlying them. I review the management predictions as framed by these hypotheses as they pertain to puma hunting, puma-prey relationships, and human-puma interactions. The food limitation and competition regulation hypotheses explain more phenomena associated with puma and likely would guide more successful management outcomes. © 2019 The Wildlife Society.