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Schools are important settings for increasing reach and uptake of adolescent mental health interventions. There is limited consensus on the focus and content of school-based mental health services (SBMHSs), particularly in low-resource settings. This study elicited the views of diverse stakeholders in two urban settings in India about their priorities and preferences for SBMHSs.
We completed semi-structured interviews and focus group discussions with adolescents (n = 191), parents (n = 9), teachers (n = 78), school counsellors (n = 15), clinical psychologists/psychiatrists (n = 7) in two urban sites in India (Delhi and Goa). Qualitative data were obtained on prioritized outcomes, preferred content and delivery methods, and indicated barriers.
All stakeholders indicated the need for and acceptability of SBMHSs. Adolescents prioritized resolution of life problems and exhibited a preference for practical guidance. Parents and teachers emphasized functional outcomes and preferred to be involved in interventions. In contrast, adolescents' favored limited involvement from parents and teachers, was related to widespread concerns about confidentiality. Face-to-face counselling was deemed to be the most acceptable delivery format; self-help was less frequently endorsed but was relatively more acceptable if blended with guidance or delivered using digital technology. Structured sensitization was recommended to promote adolescent's engagement. Providers endorsed a stepped care approach to address different levels of mental health need among adolescents.
SBMHSs are desired by adolescents and adult stakeholders in this setting where few such services exist. Sensitization activities are required to support implementation. School counsellors have an important role in identifying and treating adolescents with different levels of mental health needs, and a suite of interventions is needed to target these needs effectively and efficiently.
There is limited evidence of the safety and impact of task-shared care for people with severe mental illnesses (SMI; psychotic disorders and bipolar disorder) in low-income countries. The aim of this study was to evaluate the safety and impact of a district-level plan for task-shared mental health care on 6 and 12-month clinical and social outcomes of people with SMI in rural southern Ethiopia.
In the Programme for Improving Mental health carE, we conducted an intervention cohort study. Trained primary healthcare (PHC) workers assessed community referrals, diagnosed SMI and initiated treatment, with independent research diagnostic assessments by psychiatric nurses. Primary outcomes were symptom severity and disability. Secondary outcomes included discrimination and restraint.
Almost all (94.5%) PHC worker diagnoses of SMI were verified by psychiatric nurses. All prescribing was within recommended dose limits. A total of 245 (81.7%) people with SMI were re-assessed at 12 months. Minimally adequate treatment was received by 29.8%. All clinical and social outcomes improved significantly. The impact on disability (standardised mean difference 0.50; 95% confidence interval (CI) 0.35–0.65) was greater than impact on symptom severity (standardised mean difference 0.28; 95% CI 0.13–0.44). Being restrained in the previous 12 months reduced from 25.3 to 10.6%, and discrimination scores reduced significantly.
An integrated district level mental health care plan employing task-sharing safely addressed the large treatment gap for people with SMI in a rural, low-income country setting. Randomised controlled trials of differing models of task-shared care for people with SMI are warranted.
In recent years, research into novel plant protection strategies with endophytic entomopathogenic fungi has increased markedly. However, current applications of these fungi are mostly not supported by targeted formulation strategies which should enhance fungal establishment in close proximity to plant tissue and promote endophytism. Further drawbacks are low stability of fungal propagules during drying and storage, difficult handling as well as high dosages and costs per hectare. Formulation has the potential to substantially improve all of these characteristics to come closer to implementation of these fungi in integrated pest management. This chapter reviews the currently available literature on application of formulated endophytic entomopathogenic fungi via sprays, seed treatments, and sowing of granules and beads. It further addresses future trends in formulation science to overcome current challenges of endophytic entomopathogenic fungi regarding consistent efficacy particularly under field conditions.
Focused and results-based, this important board review title covers everything that residents need to know when preparing for their Anesthesiology BASIC exam. Written by residents familiar with the exam, its use of bullet points and illustrations enables effective learning and efficient exam preparation. Providing a comprehensive review of all exam topics, the guide uses a clear and focused note-taking style to present 'high-yield' information, enabling efficient study techniques. Bullet points and short paragraphs feature to help rapid understanding, with margin space provided to annotate and add further notes. The helpful format ensures that all exam preparation, including notes from question banks, can be kept in this 'one-stop' review book. Mirroring the BASIC exam requirements, this book covers clinical anesthetic practice, pharmacology, physiology, anatomy, and anesthesia equipment and monitoring. Written by residents for residents, it is an essential preparation resource for the Anesthesiology BASIC exam.