Steps,challenges and lessons in developing community mental health care

This paper summarises our own accumulated experience from developing community-orientated mental health services in England and Italy over the last 20-30 years. From this we have provisionally concluded that the following issues are central to the development of balanced mental health services: a) services need to reflect the priorities of service users and carers; b) evidence supports the need for both hospital and community services; c) services need to be provided close to home; d) some services need to be mobile rather than static; e) interventions need to address both symptoms and disabilities; and f) treatment has to be specific to individual needs. In this paper we consider ten key challenges that often face those trying to develop community-based mental health services: a) dealing with anxiety and uncertainty; b) compensating for a possible lack of structure in community services; c) learning how to initiate new developments; d) managing opposition to change within the mental health system; e) responding to opposition from neighbours; f) negotiating financial obstacles; g) avoiding system rigidities; h) bridging boundaries and barriers; i) maintaining staff morale; and j) creating locally relevant ser- vices rather than seeking “the right answer” from elsewhere.     

Biology and control of the fruit borer, Conopomorpha sinensis Bradley on litchi （Litchi chinensis Sonn.） in northern Thailand

Fruit and leaf shoot of litchi （Litchi chinensis） infestation by naturally occurring populations of the fruit bprer, Conopomorpha sinensis larvae and C. sinensis parasitization rates were determined in litchi orchards in northern Thailand at high （ca. 1 400 m ASL） and low （ca. 800 m ASL） elevations with different, non-overlapping fruiting seasons. In addition, spray applications of Bacillus thuringiensis var. aizawai, the natural compound spinosad and the chemical pesticide imidacloprid were conducted in the field to test the effects of these agents on C. sinensis fruit infestation rate. Fruit infestation rate and fruit growth, studied in a low elevation orchard, were sigmoidal and showed a highly significant positive correlation （P ≤ 0.01）. Leaf shoot infestation rate in the low elevation orchard decreased in the course of the fruiting season （March until May）, but increased in the high elevation orchard, where no fruits were present within the same period of time. Together, these results indicate that females of C. sinensis clearly prefer fruits over shoots for oviposition. If no fruits are available, which was the case in the high elevation orchard during that time, they are constrained to lay their eggs on shoots. The parasitization rate of C. sinensis larvae in untreated fruits was 54.3%. The parasitoid species were Chelonus chailini （90.8%） and Phanerotoma sp. （9.2%）. In the leaf shoots, C. sinensis was found to be parasitized by Phanerotoma sp. and Apanteles briareus. The applications of the different active agents had no significant effect on C. sinensis fruit infestation compared to the untreated control. Besides the cryptic life of the larvae, this is most probably explained by the fact that C. sinensis has several generations during the fruiting season. Because of the high parasitization rates recorded, an alternative and more effective control measure than the application of pesticides might be the augmentative release of parasitoids.     

Study of endophytic Xylariaceae in Thailand: diversity and taxonomy inferred from rDNA sequence analyses with saprobes forming fruit bodies in the field

A study of the diversity, taxonomy, and ecology of endophytic Xylariaceae (Ascomycota) was carried out. In this study, we obtained isolates of Xylariaceae from healthy, attached leaves and teleomorphic stromata on decayed plant materials in a permanent plot at Khao Yai National Park (Thailand). In addition, strains deposited beforehand were selected in which both endophytic strains isolated from living plant tissues and saprobic strains from fruit bodies were included. Consequently, 405 strains of Xylariaceae (273 endophytic and 132 saprobic strains, including identified strains) were studied to reveal the diversity and taxonomy of endophytes and the relationships between those endophytes and saprobic Xylariaceae in Thailand that have been recorded according to fruit-body formation on decayed plant materials. Analysis of 28S rDNA D1/D2 sequences revealed 21 xylariaceous species inhabiting tropical foliage at the site, and several species that are already known as saprobes appear to be among those isolated from living leaves. Furthermore, several clades that consisted of only endophytic strains were found, and some of these have no known matches in public DNA sequence banks.     

Behavioural and psychological symptoms of dementia in primary care: a survey of general practitioners in Ireland

Background Management of neuropsychiatric symptoms is a challenging task in primary care. Aims To assess self-reported confidence and knowledge of general practitioners (GPs) regarding the identification and management of behavioural and psychological symptoms of dementia (BPSD).Methods A self-designed two-page paper questionnaire was sent to a random sample of 160 GPs practising in north Dublin. They were asked to evaluate their confidence and knowledge on several aspects of diagnosis and management of BPSD.Results Completed questionnaires were returned from 109 GPs (response rate = 68%), of which 106 were usable. In general, GPs were somewhat critical of their self-reported skills in diagnosing (76.4%) and managing (77.4%) BPSD, as well as in discriminating BPSD from other behavioural disturbances (71.7%). Many of them (67.9%) also encountered difficulty accessing specialist services. There was no correlation between demographic characteristics of GPs or patient caseload with respect to their responses to questionnaire items. Although many GPs (92.5%) highly valued the important role of non-pharmacological interventions in BPSD, none of them reported recommending these in their daily practice.Conclusions Despite the fact that GPs have a wealth of knowledge about BPSD, they are largely critical of their knowledge and management skills of these symptoms. Efforts should be focused on supporting GPs by means of educational interventions that consider all aspects of dementia, but additionally highlight the more challenging neuropsychiatric components of the illness. Health services need to be structured in a way that promotes collaboration between GPs and mental health professionals for a seamless delivery of care.     

Health in exchange: teachers,doctors, and the strength of informal practices in Russia

This article explores teachers' and doctors' informal medical exchange practices in the context of the transforming health care system in post-Soviet Russia. Despite the advent of a medical marketplace, most Russians have low incomes and cannot buy the goods and services the market offers. Instead, they bypass the formal market mechanisms (such as obtaining cheaper medicine through personal connections) and official procedures (such as obtaining free or cheaper health care services despite the emergence of paid services) by using their social networks. This paper uses a network perspective to investigate how doctors' and teachers' mutual relations are formed and what resources form the basis of these informal exchange practices. Drawing on structured diary data and qualitative interviews with 20 teachers, in addition to interviews with eight doctors in St. Petersburg, the study goes beyond mere statistics on health care and attempts to depict from below the implications health and illness have for survival in contemporary Russia.     

Veterinary care of Asian timber elephants in India: Historical accounts and current observations

We discuss herein some of the historical factors that have influenced present day veterinary treatment and husbandry of Asian elephants used for timber extraction by Indian state forest departments. The British incorporated both indigenous and European practices into the veterinary management of timber elephants, and invested considerable time and energy to improve care and humane standards. The paper examines selected aspects of preventive and clinical treatment based on records from the Madras Presidency and present day Tamilnadu state. © 1995 Wiley-Liss, Inc.     

Species richness of the Cladocera (Branchiopoda: Anomopoda and Ctenopoda) in southern Thailand, and its complementarity with neighboring regions

Seventy-two cladoceran species from southern Thailand include eleven first records. Species accumulation curves were used to estimate the total number of species present, and Chaos estimator was used to extrapolate the species number observed in 212 samples to the total number present. This S*max amounted to 76.06 species, with a low ratio of variance/estimator. Cladoceran faunas were compared by a complementarity index at three levels: between habitat types, between different zones of Thailand, and between Thailand and other countries. The geographical gradient was quite strong, but because not all areas have been studied to the same degree and with the same taxonomic accuracy, some comparisons are robust while others are not.     

High concentrations of circulating interleukin-6 and monocyte chemotactic protein-1 with low concentrations of interleukin-8 were associated with severe chikungunya fever during the 2009-2010 outbreak in Thailand

The recent outbreak of Chikungunya virus in Thailand caused a rheumatic fever associated with considerable morbidity and fatalities. Thus, it is important to identify biomarker(s) of severe disease induced by this threatening arbovirus. Putative biomarkers in cases of chikungunya fever during an outbreak in the southern part of Thailand in 2009-2010 were identified. Sixty-two patients who had developed fever and myalgia, with or without arthralgia/arthritis, were enrolled and grouped into severe chikungunya fever (CHIKF) (n= 15), mild CHIKF (n= 20) and non-CHIKF (n= 27) to investigate circulating immunological mediators that might serve as markers of severity. Blood samples were taken at presentation (day 1) and 30 days later (day 30) and plasma concentrations of interleukin (IL)-1β, IL-6, IL-8, IL-17, tumor necrosis factor-alpha, monocyte chemotactic protein-1 (MCP-1), matrix metalloproteinase-1, tissue inhibitor of matrix metalloproteinase-1 and viral load were measured by ELISA. On day 1, severe CHIKF and mild CHIKF groups had viral loads of 10(8.5) and 10(8.3) of RNA copies/mL, respectively. At presentation, all CHIKF patients had circulating concentrations of IL-6 and MCP-1 higher than did non-CHIKF patients, whereas amongst the CHKF patients, the severe CHIKF patients had higher IL-6 concentrations than did mild CHIKF patients. Interestingly, severe CHIKF patients had significantly lower concentrations of circulating IL-8 than the other groups of patients, suggesting that high concentrations of IL-6 and MCP-1 with low concentrations of IL-8 may be a determinant of severe chikungunya virus infection.     

Discussions on oral health care among elderly Chinese immigrants in Melbourne and Vancouver

doi: 10.1111/j.1741‐2358.2011.00568.x Discussions on oral health care among elderly Chinese immigrants in Melbourne and Vancouver Background: This study explored how elderly Chinese immigrants value and relate to how acculturation influences oral health and subsequent service use. Methods: Elders who had immigrated to Melbourne and Vancouver within the previous 15 years were recruited from local community centres and assigned to focus groups of 5–7 participants in Vancouver (4 groups) or Melbourne (5 groups). Results: Following an iterative process of thematic analysis, the discussions revealed that immigrants care about the comfort and appearance of their teeth, and they value Western dentistry as a supplement to traditional remedies, but they have difficulty getting culturally sensitive information about oral health care. Accessing dentistry, they explained, is distressing because of language problems and financial costs that impose on their children. Consequently, many immigrants obtain dental treatment in China when they return for occasional visits. They felt that separation of dentistry from national health care programmes in Canada and Australia disregards natural links between oral health and general health. Conclusions: The similarity of concerns in both cities suggests that dissemination of information and availability of services are the important themes influencing oral health, and that, beliefs developed over a lifetime play an important role in interpreting oral health in the host country.     

Socioeconomic Metabolism and Colonization of Natural Processes in SangSaeng Village: Material and Energy Flows, Land Use, and Cultural Change in Northeast Thailand

Conceptualizing environmental problems as sustainability problems contributing to local and global environmental change requires an understanding of how societies cope with their natural environment. Indicators for society–nature interactions are fairly well developed for national-level analyses. This study adapts some of these indicators to the local level and relates them to a qualitative assessment of economic and cultural change in a single community. Indicators are derived from material and energy flow accounting methods and address two major objectives: Firstly, to identify mutual influences between the global and the local level. Secondly, to assess future potentials of environmental pressures and impacts that can be expected to occur as such communities follow a path of further modernization. This study of a small rice-farming community in Northeast Thailand deals with physical as well as sociocultural aspects in order to produce a broad picture of society–nature relations. The indicators developed portray a society in the midst of transition and rapid modernization. This becomes apparent when comparing the results to those of similar studies in traditional and industrial societies. What we see is a community struggling to adapt to global influences, while at the same time maintaining subsistence with traditional coping mechanisms.     

In the Shadows of Medicine and Modernity: Medical Integration and Secular Histories of Religious Healing in Turkey

Building upon the World Health Organization's recent publication WHO Strategy for Traditional Medicine (WHO 2002), this paper examines the historical position of "traditional medicines" at their intersection with the development and modernization of a biomedically based health care system in Turkey. This paper considers how the historical development of Turkey's health care system, as a prominent site for the articulation of the state's broader modernization project, sustained particular formulations of subjectivity and citizenship that were defined in opposition to a set of cultural practices and modes of religious-political authority represented by "traditional medicines." Consequently, projects and policies seeking to formally integrate "complementary" or "alternative" therapies directly confront this past and the various ways in which it is reenacted in constituting the present.     

Oral vaccination against classical swine fever with a chimeric <Emphasis Type="Italic">Pestivirus</Emphasis>: comparative investigations of liquid and lyophilized virus

The goal of this study was to evaluate the efficacy of the chimeric marker vaccine candidate CP7_E2alf in different formulations for oral immunization against classical swine fever (CSF). In the first experiment, three wild boars were vaccinated orally with the liquid chimeric virus CP7_E2alf, whereas in the second experiment, four wild boars and four domestic pigs were immunized with the lyophilized chimera administered in gelatine capsules and new baits. The chimera was safe for wild boars and domestic pigs. All animals vaccinated orally with the liquid chimera were seropositive 21 days after vaccination, and neither viraemia nor virus shedding were observed after challenge with a highly virulent CSF virus. At necropsy, viral genome of the challenge virus was detected in some organs of all surviving wild boars. Lyophilized chimera administered orally did not protect the animals. The reasons for the inefficacy of the lyophilized vaccine virus are discussed. Irrespective of the negative result with lyophilized virus, the study and previous experiences (Reimann et al., Virology, 307:213–227, 2004) suggest that the chimera CP7_E2alf is a potential CSF marker vaccine candidate.     

Integration of mental health into primary care and community health working in Kenya: context, rationale, coverage and sustainability

Integration of mental health into primary care is essential to meet population needs yet faces many challenges if such projects are to achieve impact and be sustainable in low income countries alongside other competing priorities. This paper describes the rationale and progress of a collaborative project in Kenya to train primary care and community health workers about mental health and integrate mental health into their routine work, Within a health systems strengthening approach. So far 1877 health workers have been trained. The paper describes the multiple challenges faced by the project, and reviews the mechanisms deployed which have strengthened its impact and sustainability to date.     

Corolla herbivory, pollination success and fruit predation in complex flowers: an experimental study with Linaria lilacina (Scrophulariaceae)

BACKGROUND AND AIMS: Herbivory on floral structures has been postulated to influence the evolution of floral traits in some plant species, and may also be an important factor influencing the occurrence and outcome of subsequent biotic interactions related to floral display. In particular, corolla herbivory may affect structures differentially involved in flower selection by pollinators and fruit predators (specifically, those ovopositing in ovaries prior to fruit development); hence floral herbivores may influence the relationships between these mutualistic and antagonistic agents. METHODS: The effects of corolla herbivory in Linaria lilacina (Scrophulariaceae), a plant species with complex flowers, were considered in relation to plant interactions with pollinators and fruit predators. Tests were made as to whether experimentally created differences in flower structure (resembling those occurring naturally) may translate into differences in reproductive output in terms of fruit or seed production. KEY RESULTS: Flowers with modified corollas, particularly those with lower lips removed, were less likely to be selected by pollinators than control flowers, and were less likely to be successfully visited and pollinated. As a consequence, fruit production was also less likely in these modified flowers. However, none of the experimental treatments affected the likelihood of visitation by fruit predators. CONCLUSIONS: Since floral herbivory may affect pollinator visitation rates and reduce seed production, differences among plants in the proportion of flowers affected by herbivory and in the intensity of the damage inflicted on affected flowers may result in different opportunities for reproduction for plants in different seasons.     

Wound response in passion fruit (<Emphasis Type="Italic">Passiflora</Emphasis> f. <Emphasis Type="Italic">edulis flavicarpa</Emphasis>) plants: gene characterization of a novel chloroplast-targeted allene oxide synthase up-regulated by mechanical injury and methyl jasmonate

The induction of a chloroplast-localized 13-lipoxygenase (13-LOX) in passion fruit leaves in response to methyl jasmonate (MeJa) was previously reported. Since allene oxide synthase (AOS) is a key cytochrome P450 enzyme in the oxylipin pathway leading to AOS-derived jasmonates, the results above led in turn to an investigation of AOS in our model plant. Spectrophotometric assays showed that 24 h exposure of MeJa caused a high increase in 13-hydroperoxy linolenic acid (13-HPOT) metabolizing activity in leaf tissue. Western analysis using polyclonal antibodies against tomato AOS strongly indicate that, at least a part of the 13-HPOT metabolizing capacity can be attributed to AOS activity. We cloned the cDNA from a novel AOS encoding gene from passion fruit, named PfAOS. The 1,512 bp open reading frame of the AOS–cDNA codes a putative protein of 504 amino acid residues containing a chloroplast target sequence. Database comparisons of the deduced amino acid sequence showed highest similarity with dicot AOSs. Immunocytochemistry analysis showed the compartmentalization of AOS in chloroplasts of MeJa treated leaves, corroborating the predicted subcellular localization. Northern analysis showed that AOS gene expression is induced in leaf tissue in response to mechanical wounding and exposure to MeJa. In addition, such treatments caused an increase in papain inhibitor(s) in leaf tissue. Taken together, these results indicate that PfAOS may play an important role in systemic wound response against chewing insect attack. Furthermore, it can be useful as a tool for understanding the regulation of jasmonates biosynthesis in passion fruit.