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To explore the factors affecting intra-household food allocation practices to inform the development of interventions to prevent low birth weight in rural plains of Nepal.
Qualitative methodology using purposive sampling to explore the barriers and facilitating factors to improved maternal nutrition.
Rural Dhanusha District, Nepal.
We purposively sampled twenty-five young daughters-in-law from marginalised groups living in extended families and conducted semi-structured interviews with them. We also conducted one focus group discussion with men and one with female community health volunteers who were mothers-in-law.
Gender and age hierarchies were important in household decision making. The mother-in-law was responsible for ensuring that a meal was provided to productive household members. The youngest daughter-in-law usually cooked last and ate less than other family members, and showed respect for other family members by cooking only when permitted and deferring to others’ choice of food. There were limited opportunities for these women to snack between main meals. Daughters-in-law’ movement outside the household was restricted and therefore family members perceived that their nutritional need was less. Poverty affected food choice and families considered cost before nutritional value.
It is important to work with the whole household, particularly mothers-in-law, to improve maternal nutrition. We present five barriers to behaviour change: poverty; lack of knowledge about cheap nutritional food, the value of snacking, and cheap nutritional food that does not require cooking; sharing food; lack of self-confidence; and deference to household guardians. We discuss how we have targeted our interventions to develop knowledge, discuss strategies to overcome barriers, engage mothers-in-law, and build the confidence and social support networks of pregnant women.
To outline the development of a smartphone-based tool to collect thrice-repeated 24 h dietary recall data in rural Nepal, and to describe energy intakes, common errors and researchers’ experiences using the tool.
We designed a novel tool to collect multi-pass 24 h dietary recalls in rural Nepal by combining the use of a CommCare questionnaire on smartphones, a paper form, a QR (quick response)-coded list of foods and a photographic atlas of portion sizes. Twenty interviewers collected dietary data on three non-consecutive days per respondent, with three respondents per household. Intakes were converted into nutrients using databases on nutritional composition of foods, recipes and portion sizes.
Dhanusha and Mahottari districts, Nepal.
Pregnant women, their mothers-in-law and male household heads. Energy intakes assessed in 150 households; data corrections and our experiences reported from 805 households and 6765 individual recalls.
Dietary intake estimates gave plausible values, with male household heads appearing to have higher energy intakes (median (25th–75th centile): 12 079 (9293–14 108) kJ/d) than female members (8979 (7234–11 042) kJ/d for pregnant women). Manual editing of data was required when interviewers mistook portions for food codes and for coding items not on the food list. Smartphones enabled quick monitoring of data and interviewer performance, but we initially faced technical challenges with CommCare forms crashing.
With sufficient time dedicated to development and pre-testing, this novel smartphone-based tool provides a useful method to collect data. Future work is needed to further validate this tool and adapt it for other contexts.
Recent studies point to overlap between neuropsychiatric disorders in symptomatology and genetic aetiology.
To systematically investigate genomics overlap between childhood and adult attention-deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and major depressive disorder (MDD).
Analysis of whole-genome blood gene expression and genetic risk scores of 318 individuals. Participants included individuals affected with adult ADHD (n = 93), childhood ADHD (n = 17), MDD (n = 63), ASD (n = 51), childhood dual diagnosis of ADHD–ASD (n = 16) and healthy controls (n = 78).
Weighted gene co-expression analysis results reveal disorder-specific signatures for childhood ADHD and MDD, and also highlight two immune-related gene co-expression modules correlating inversely with MDD and adult ADHD disease status. We find no significant relationship between polygenic risk scores and gene expression signatures.
Our results reveal disorder overlap and specificity at the genetic and gene expression level. They suggest new pathways contributing to distinct pathophysiology in psychiatric disorders and shed light on potential shared genomic risk factors.
To develop and validate a photographic food atlas of common foods for dietary assessment in southern Nepal.
We created a life-sized photographic atlas of forty locally prepared foods. Between March and June 2014, data collectors weighed portion sizes that respondents consumed during one mealtime and then a different data collector revisited the household the next day to record respondents’ estimations of their previous day’s intakes using the atlas. Validity was assessed by percentage error, Cohen’s weighted kappa (κw) and Bland–Altman limits of agreement.
Dhanusha and Mahottari districts in southern Nepal.
A random sample of ninety-five adults in forty-eight rural households with a pregnant woman.
Overall, respondents underestimated their intakes (mean error =−4·5 %). Rice and dal (spiced lentil soup) intakes were underestimated (−14·1 % and −34·5 %, respectively), but vegetable curry intake was overestimated (+20·8 %). Rice and vegetable curry portion size images were significantly reliably selected (Cohen’s κw (se): rice=0·391 (0·105); vegetable curry=0·430 (0·139)), whereas dal images were not. Energy intake over one mealtime was under-reported by an average of 569 kJ (136 kcal; 4·5 % error) using recall compared with the weighing method.
The photographic atlas is a useful tool for field estimation of dietary intake. Average errors were low, and there was ‘modest’ agreement between weighed and recalled portion size image selection of rice and vegetable curry food items. Error in energy estimation was low but with wide limits of agreement, suggesting that there is scope for future work to reduce error further.
A cost-effectiveness study compared visual laser ablation of the prostate (VLAP) with transurethral resection (TURP). Achieving equivalent outcomes, VLAP was more expensive than TURP. The result was sensitive to various assumptions, suggesting that VLAP might prove to be the preferred technology. Problems inherent in economic evaluation of emerging technologies are discussed.
Services for people with intellectual disabilities, in the UK as elsewhere, have changed dramatically over the last 30 years; deinstitutionalisation has probably been the largest experiment in social policy in our time. The vast majority of people with intellectual disabilities, their families and carers have benefited from having a better quality of life as a result of deinstitutionalisation. However, much still needs to be done to integrate this population more into society and to ensure they are offered the appropriate supports to meet their needs.
Caroline Mohr, Consultant Clinical Psychologist, Centre for Developmental Psychiatry and Psychology, Monash University, Melbourne, Victoria, Australia,
Helen Costello, Senior Researcher, King's College London
Assessing the presence of mental health problems in individuals with intellectual disabilities (ID) is a complex process. Increased clinical and research attention in recent years has resulted in the development of a range of assessment instruments aimed at improving the identification and diagnosis of psychiatric and behavioural disorders in this population. The routine use of valid and reliable assessment and monitoring tools may make a significant contribution to improving the quality of care. Yet, currently there is no consensus about which assessment instruments should be used.
The aim of this chapter is to provide an overview of the characteristics and psychometric properties of what the authors consider to be the best available assessment and monitoring tools. The chapter describes the approaches employed for the development of assessment instruments, describes the key features of six checklists and rating scales and summarizes evidence about their validity and reliability. In doing so, the strengths and limitations of available assessment instruments are highlighted, and recommendations for using assessment and monitoring tools are made.
Developing assessment and monitoring tools
While the precise function of instruments may vary, the central aim of assessment and monitoring tools is to increase the validity and reliability with which the presence and severity of the signs, or symptoms, of mental health problems are measured over a given period. Standardized instruments help to ensure that individuals referred to mental health services receive a comprehensive and objective assessment, less subject to factors such as ‘diagnostic overshadowing’ (Reiss et al., 1982) and variations in the opinions of individual carers and clinicians (Einfeld & Tonge, 1992).
Helen Costello, Senior Researcher, King's College London, The Institute of Psychiatry, Estia Centre – Guy's Hospital,
Geraldine Holt, Consultant Psychiatrist, Estia Centre, York Clinic – Guy's Hospital, London,
Nancy Cain, Associate Clinical Professor of Psychiatry, 300 Crittenden Blvd, Rochester, NY 14642, USA,
Elspeth Bradley, Associate Professor, Department of Psychiatry, University of Toronto, CANADA,
Jennifer Torr, Senior Lecturer in Mental Health, Monash University,
Robert Davis, Associate Professor, Department of General Practice Monash University,
Niki Edwards, Clinical Coordinator and Lecturer, The University of Queensland,
Nick Lennox, Associate Professor, Queensland Centre for Intellectual & Developmental Disability School of Population Health The University of Queensland,
Germain Weber, Professor of Psychology, Department of Clinical, Biological and Differential Psychology, Faculty of Psychology, University of Vienna
Life in the community for individuals with intellectual disabilities (ID) implies new roles and responsibilities for professionals providing mental health care to this population. A diverse range of mental health service models have emerged both nationally and internationally to meet these needs. In some cases, emphasis is on the provision of generic mainstream services to individuals with ID, while in others specialist services have been developed, either working independently of or in tandem with generic teams. This variability implies that a variety of professional groups require specialist knowledge for assessing, treating and managing mental health problems in individuals with ID. Very little is written about the education of professionals providing mental health care for this group and there is a lack of recognition of the need for formalized training in mental health and ID from a national and international perspective. Many training programmes appear ad hoc, with the availability and content of most educational initiatives being largely determined by the specific interests of those individuals providing and undergoing training. This chapter reviews the training programmes of three groups of health care professionals (psychiatrists, psychologists and primary care physicians) available in five countries (UK, USA, Canada, Australia and Austria) in relation to mental health problems in individuals with ID. The role of specific institutions and key individuals in increasing the profile of mental health problems in this population is highlighted, factors hindering the development of professional training are identified and recent innovations in curricula are described.
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