Community mental health care in the Asia‐Pacific region: using current best‐practice models to inform future policy

The reporting of child sexual abuse (CSA) and physician-patient sexual relationships (PPSR) are currently the focus of professional, legal and media attention in several countries. This paper briefly reviews mental health policies on these issues and reports on a WPA survey of them. While the WPA Madrid Declaration permits breaching confidentiality for mandatory reporting of CSA and clearly prohibits PPSR, it is not known how or to what extent these policies are implemented in WPA Member Societies’ countries. It is also not known whether policies or laws exist on these topics nationally or to what extent psychiatrists and the public are aware of them. Representatives of WPA Member Societies were e-mailed a survey about issues pertaining to CSA and PPSR. Fifty-one percent of 109 countries replied. All reporting countries had laws or policies regarding the reporting of CSA, but this was often voluntary (63%) and without protection for reporting psychiatrists either by law (29%) or by Member Societies (27%). A substantial number of psychiatric leaders did not know the law (27%) or their Society’s policy (11%) on these matters. With respect to PPSR, some reporting countries lacked laws or policies about PPSR with current (17%) or past (56%) patients. Fewer than half of responding representatives believed that their Society’s members or the public were well informed about the laws and policies pertaining to CSA or PPSR. There is clearly a wide range of laws, policies and practices about CSA and PPSR in WPA Member Societies’ countries. There is a need in some countries for laws or supplemental policies to facilitate the protection of vulnerable child and adult patients through clear, mandatory reporting policies for CSA and PPSR. Mechanisms to protect and support reporting psychiatrists should also be developed where they do not already exist. There is also a need in some countries to develop strategies to improve the education of psychiatrists, trainees, and the public on these issues.The Asia-Pacific region has close to half of the estimated 450 million people affected by mental illness globally 1.Based on international mental health care benchmarks, many Western health systems have established contemporary health policy and guidelines which include the provision of mental health care in the community. However, the delivery of quality and appropriate community mental health care remains an ongoing challenge for countries of both high and low socio-economic level. Difficulties and obstacles in implementation of comprehensive community service models include inadequate funding, availability of trained mental health workforce, integration with primary care services and community agencies, and collaboration between public and private health systems 2 - 3. As community mental health service system depends on sufficient workforce for service delivery, the critical shortage of adequately trained mental health staff continues to impede the progress of mental health reform.In response to such global trends, many countries in the Asia-Pacific region have begun to establish mental health policy and guidelines to move from institutional care to community mental health services. While these reforms are supported by recommendations from the World Health Organization (WHO) governing bodies, such as the Western Pacific Regional Mental Health Strategy 4, social, economic and cultural factors in Asia-Pacific countries often do not allow ready translation of Western community mental health models of care. Governments and service providers commonly face challenges in the development and implementation of locally appropriate community mental health care and services. Additionally, it would be unrealistic or undesirable to produce rigid recommendations for a singular community mental health care model, due to the diversity across the Asia-Pacific region. Hence, for constructive change to occur in the region, innovative, culturally appropriate and economically sustainable pathways for community treatment models need to be explored, developed and shared. Community mental health service reform appears to be gaining momentum in this region, despite the obstacles. Valuable lessons and inspiration for further development can be gained from both the successes and difficulties in reforming mental health systems and practices in the region.An emerging network of representatives from governments, peak bodies and key organizations is emerging in the Asia-Pacific region to build supportive relationships in order to facilitate the implementation of locally appropriate policy frameworks for community mental health service reform. The network is supported by the Asia-Pacific Community Mental Health Development (APCMHD) project, which involves 14 countries/regions in the Asia-Pacific region. Initiated in collaboration with the WHO Western Pacific Regional Office, the APCMHD project is led by Asia-Australia Mental Health, a consortium of the University of Melbourne Department of Psychiatry and Asialink, and St. Vincent’s Health, which is a part of the WHO Collaborating Centre for Mental Health (Melbourne). The project, which brought many key mental health organizations to work collaboratively, is consistent with the WHO Global Action Programme for Mental Health 5.The project aims are to promote best practice in community mental health care through exchange of knowledge and practical experience in the Asia-Pacific region. The key outcome is the documentation of the current status, strengths and needs of community mental health services in the region, in the hope to translate current understanding into practical changes in the future.     

NOTES ON THE APPLICATION OF THE FLUORINEDATING METHOD TO THE DATING OF SOME FOSSIL HUMAN REMAINS OF CHINA

Several new finds of fossilized human remains have been made in Chinaduring the last few years.As most of the materials were incidentally discover-ed and collected by amateur collectors,the stratigraphical position of thefossils and their relation with the associating vertebrate fossils were mostlyunknown or doubtful.     

中国南海栉水母类初志

(一)从作者此次在广东沿海的采集经验看来,我国南海最常见的栉水母类有三种,即球栉水母[Pleurobrachia globosa Moser]、瓜水母[Beroe cucumis Fabricius]和蝶水母[Ocyropsis crystallina(Rang)],其中以球栉水母产量最多,最为常见。 (二)本文对球栉水母的消化和运动方面作了较详细的报道。食物的消化,主要是在口道内进行的,口道内有一对口道囊(stomodael pouches),这对小囊在平时体积很小,口缘皱缩,因此很不容易识别,当摄食以後,此囊即扩大三四倍以上,其中充满消化液,较小的食物(如蟹的溞状幼体)可储於口道囊内,进行消化,较大的食物(如幼鱼)则在口道内消化。食物经消化後,沿着胃和各种水管分布於全身。不能消化的食物残馀,则仍由口排出。就作者所知,球栉水母的口道囊过去还没有人报道过,一般教科书称之为口道嵴(stomodael ridge)或口道褶(stomodael fold),显系观察的谬误,这里必须予以指出的。球栉水母的运动方法有三种:(1)利用栉毛不断的鼓动,结果口端朝前游动;(2)触手收缩,栉毛停止摆动,利用本身的比重比海水为大...     

中国的内囊霉科菌根真菌

本文报道了25种采集于我国广州、昆明、武汉、北京和哈尔滨等地农业土壤中的内囊霉科真菌。其中球内囊霉属(Glonus)16种,无柄内囊霉属(Acaulospora)4种,楯孢内囊霉属(Scutellospora)3种,巨孢内囊霉属(Giga-spora)1种,内养内囊霉属(Entrophospora)1种。此外还发现了硬内囊霉属(Sc-kerocystis)的孢子果。其中20种和除球内囊霉属外的另外5属为我国的新记录。     

几种楝科植物种核油对褐稻虱的拒食作用试验

某些楝科种核油对褐稻虱具有特殊的作用,它与常规的化学杀虫剂不同,并不直接杀死害虫,而是引起褐稻虱对使用种核油的水稻产生拒食或避忌,对褐稻虱重要天敌蜘蛛类并不伤害。     

武昌东湖软体动物的生态分布及种群密度

本文报道1963年4—5月和10—11月两度在东湖101个采样点上进行软体动物定量采集的结果。软体动物计41种,隶10科、20属,其中腹足类的种类多,生物量也大,瓣鳃类则全系小型种类主要为河蚬(Corbicula fluminea),个体数及生物量都很低。根据10—11月的调查结果,全湖软体动物平均生物量为30.5克/平方米(平均个体数为134个/平方米),其中以铜锈环稜螺(Bellamya aerginosa)生物量最大(15.5克),其次为纹沼螺(Parafossarudus striatulus)(5.8克)和长角涵螺(Alocinma longicornis)(6.4克),这3种腹足类占全部软体动物生物量的90%以上,是东湖中的优势种类。它们的分布型式属大小不等的核心分布,其实际分布概率,符合P-E 分布的理论概率。环境分析表明铜锈环稜螺的分布主要取决于水深(r=-0.257;d.f.=99;p0.01);长角涵螺数量的多寡受制于水草的有无(均数比较:d.f.=99时,t′=7.656;t0.01≈2.641);而纹沼螺的分布则与水深有关(r=-0.697;d.f.=99;p0.01),又与水草的有无有关(平均数比较:d.f.=99时,t′=6.93;t0.01≈2.641)。       

昆虫保幼激素类似物对棉蚜形态和不育的效应

认识昆虫保幼激素对昆虫生长发育所起的调节作用已有较长时期,而探索用人工合成昆虫保幼激素类似物防治害虫还是近一、二十年的事。近年来,一些试验结果证明ZR-777等对蚜虫有很高的生理活性;Nassar(1973),Tamaki(1973),Benskin(1973),Kubr(1973)及广东农林学院(1976)等都有报道,但对不育类型,不育个体的不育程度与寿命,尤其是对胚胎发育影响,尚未见系统报道。本文比较系统地讨论这一问题。在室内和田间试验基础上,还初步提出该类化合物对蚜虫活性测定程序和鉴定指标。     

The Effect of Segment Length on Conductance Measurements in Lonicera fragrantissima

The effect of stem segment length on conductance measurementswas determined by repeatedly shortening the transport distancein isolated stem segments of Lonicera fragrantissima. If vesselends limit water flow, shorter segment lengths could resultin higher readings of K_h (hydraulic conductance per unit pressuregradient). The mean K_h in the successively shortened segmentsshowed no statistically significant change when shortened from20 to 2 cm, even though maximum vessel lengths ranged from 6to 14 cm. This suggests vessel ends may be less limiting towater flow than are vessel lumens. There was a statisticallysignificant drop in K_h (19%, s.e.=0·29%) when segmentswere shortened from 2 to 1 cm, regardless of the position ofthe segment within the branch. The K_h remained constant withapplied pressure in 2 cm segments while it was more variablewith applied pressure in 1 cm segments. Based on the paint-infusionmethod mean vessel lengths were from 0·6 to 1·2cm. The consistently lower K_h in 1 cm segments might be dueto an end effect in segments with a high percentage of cut openvessels. Within a branch, distal and proximal stem segmentshad lower K_h values than segments from intermediate positions,but nodes had no measurable impact on K_h. Longer segments allowfor more accurate and consistent measurements of K_h since theyintegrate localized variation in K_h while minimizing the segmentend effect. Key words: Vessel length, vessel end, hydraulic conductance, paint-infusion method, Lonicera fragrantissima     

Influence of typhoons on annual CO2 flux from a subtropical, humic lake

The Intergovernmental Panel on Climate Change predicts dramatic changes in precipitation patterns over the next century. One potential method for inferring how these changes in annual precipitation and intensity of storm events will influence aquatic ecosystems is to study and model present-day lakes that share climatic characteristics with future climate scenarios. A small lake in north-central Taiwan provided an excellent opportunity to explore the influence of intense meteorological events on CO₂ exchange between surface waters and the atmosphere. Each year Yuan Yang Lake (YYL) is influenced by multiple typhoons that pass near the island of Taiwan. This lake has been instrumented with a sensor network that monitors water column and meteorological parameters at a high temporal resolution (2–10 min intervals). Using this high-resolution data and manually collected CO₂ samples, a mass-balance model of CO₂ dynamics in YYL was developed. In addition, a generalized simulation model was used to explore how typhoon frequency, intensity, and timing impact CO₂ efflux to the atmosphere. Our findings suggest that increased annual precipitation and frequency of storm events results in greater epilimnetic interaction with the watershed and hypolimnion. These interactions resulted in elevated epilimetic CO₂ concentrations and therefore greater evasion of CO₂ to the atmosphere.     

Seasonal dynamics,typhoons and the regulation of lake metabolism in a subtropical humic lake

1. We used high‐frequency in situ dissolved oxygen measurements to investigate the seasonal variability and factors regulating metabolism in a subtropical alpine lake in Taiwan between May 2004 and October 2005, specifically exploring how the typhoon season (from June or July to October) affects lake metabolism. 2. Gross primary production (GPP) and ecosystem respiration (R) both peaked in early summer and mid‐autumn but dropped during the typhoon season and winter. Yuan‐Yang Lake is a net heterotrophic ecosystem (annual mean net ecosystem production ?39.6 μmole O₂ m^?3). 3. Compared to the summer peaks, seasonal averages of GPP and R decreased by approximately 50% and 25%, respectively, during the typhoon season. Ecosystem respiration was more resistant to external disturbances than GPP and showed strong daily variation during typhoon seasons. 4. Changes in the quality and quantity of dissolved organic carbon controlled the temporal dynamics and metabolic regulation. External disturbances (typhoons) caused increased allochthony, increasing DOC and water colour and influencing lake metabolism. 5. Seasonal winter mixing and typhoon‐induced water mixing in summer and autumn play a key role in determining the extent to which the lake is a seasonal carbon sink or source to the atmosphere.