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A substantial proportion of persons with mental disorders seek treatment from complementary and alternative medicine (CAM) professionals. However, data on how CAM contacts vary across countries, mental disorders and their severity, and health care settings is largely lacking. The aim was therefore to investigate the prevalence of contacts with CAM providers in a large cross-national sample of persons with 12-month mental disorders.
In the World Mental Health Surveys, the Composite International Diagnostic Interview was administered to determine the presence of past 12 month mental disorders in 138 801 participants aged 18–100 derived from representative general population samples. Participants were recruited between 2001 and 2012. Rates of self-reported CAM contacts for each of the 28 surveys across 25 countries and 12 mental disorder groups were calculated for all persons with past 12-month mental disorders. Mental disorders were grouped into mood disorders, anxiety disorders or behavioural disorders, and further divided by severity levels. Satisfaction with conventional care was also compared with CAM contact satisfaction.
An estimated 3.6% (standard error 0.2%) of persons with a past 12-month mental disorder reported a CAM contact, which was two times higher in high-income countries (4.6%; standard error 0.3%) than in low- and middle-income countries (2.3%; standard error 0.2%). CAM contacts were largely comparable for different disorder types, but particularly high in persons receiving conventional care (8.6–17.8%). CAM contacts increased with increasing mental disorder severity. Among persons receiving specialist mental health care, CAM contacts were reported by 14.0% for severe mood disorders, 16.2% for severe anxiety disorders and 22.5% for severe behavioural disorders. Satisfaction with care was comparable with respect to CAM contacts (78.3%) and conventional care (75.6%) in persons that received both.
CAM contacts are common in persons with severe mental disorders, in high-income countries, and in persons receiving conventional care. Our findings support the notion of CAM as largely complementary but are in contrast to suggestions that this concerns person with only mild, transient complaints. There was no indication that persons were less satisfied by CAM visits than by receiving conventional care. We encourage health care professionals in conventional settings to openly discuss the care patients are receiving, whether conventional or not, and their reasons for doing so.
The treatment gap between the number of people with mental disorders and the number treated represents a major public health challenge. We examine this gap by socio-economic status (SES; indicated by family income and respondent education) and service sector in a cross-national analysis of community epidemiological survey data.
Data come from 16 753 respondents with 12-month DSM-IV disorders from community surveys in 25 countries in the WHO World Mental Health Survey Initiative. DSM-IV anxiety, mood, or substance disorders and treatment of these disorders were assessed with the WHO Composite International Diagnostic Interview (CIDI).
Only 13.7% of 12-month DSM-IV/CIDI cases in lower-middle-income countries, 22.0% in upper-middle-income countries, and 36.8% in high-income countries received treatment. Highest-SES respondents were somewhat more likely to receive treatment, but this was true mostly for specialty mental health treatment, where the association was positive with education (highest treatment among respondents with the highest education and a weak association of education with treatment among other respondents) but non-monotonic with income (somewhat lower treatment rates among middle-income respondents and equivalent among those with high and low incomes).
The modest, but nonetheless stronger, an association of education than income with treatment raises questions about a financial barriers interpretation of the inverse association of SES with treatment, although future within-country analyses that consider contextual factors might document other important specifications. While beyond the scope of this report, such an expanded analysis could have important implications for designing interventions aimed at increasing mental disorder treatment among socio-economically disadvantaged people.
Niemann–Pick type C (NP-C) disease is a rare neurodegenerative lysosomal storage disorder. It is highly heterogeneous, and there is limited awareness of a substantial subgroup that has an attenuated adolescent/adult-onset disease. In these patients psychiatric features, often a psychosis, may dominate the initial impression, although often there is an associated ataxia and cognitive impairment. Typically, patients experience a substantial diagnostic delay. In this review we highlight the importance of early recognition and discuss the pathophysiology, neuropsychiatric presentation and recent changes in the investigation and work-up of these patients, and treatment options.
Palladium germanide thin films were investigated for infrared plasmonic applications. Palladium thin films were deposited onto amorphous germanium thin films and subsequently annealed at a range of temperatures. X-ray diffraction was used to identify stoichiometry, and Scanning Electron Micrographs, along with Energy Dispersive Spectroscopy (EDS) was used to characterize composition and film quality. Resistivity was also measured for analysis. Complex permittivity spectra were measured from 0.3 to 15 µm using IR ellipsometry. From this, surface plasmon polariton (SPP) characteristics such as propagation length and mode confinement were calculated and used to determine appropriate spectral windows for plasmonic applications with respect to film characteristics. Films were evaluated for use with on-chip plasmonic components.
In the final three decades of the twentieth century, the world's political economic framework underwent a far-reaching transformation from a state-centric to a neoliberal form (Sewell 2005). In the years following World War II, economies in all areas of the world had been governed by state-centered regulatory regimes. In the wealthy countries of North America, Western Europe, Japan, Australia, and New Zealand, economies were based on free markets and private property, but they were carefully steered and regulated by democratic Keynesian welfare states. In the communist countries, almost all economic activity took place in authoritarian state institutions. And in most of the major countries of Africa, Asia, and Latin America, governments imposed ambitious schemes of state-led development. Over the course of the 1970s, state-led regulatory regimes entered into crisis. By the 1990s, the communist regimes had fallen or had been thoroughly transformed from within by introducing markets and privatizing production. The advanced capitalist countries had dismantled or watered down their regulatory states by privatizing publicly owned enterprises, lifting capital controls, deregulating markets, and, more selectively, paring back welfare guarantees. And the vast majority of developing countries in Asia, Africa, and Latin America had abandoned important elements of their nationalist development strategies and opened their borders to global flows of capital and goods – some on their own volition and others under the coercive urging of the International Monetary Fund (IMF) and the World Bank. All of these countries had become part of a rapidly integrating world market regulated by global rules administered by economic governance institutions such as the World Trade Organization and disciplined by instantaneous global exchanges for currencies, securities, and bonds.