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There is a growing literature in support of the effectiveness of task-shared mental health interventions in resource-limited settings globally. However, despite evidence that effect sizes are greater in research studies than actual care, the literature is sparse on the impact of such interventions as delivered in routine care. In this paper, we examine the clinical outcomes of routine depression care in a task-shared mental health system established in rural Haiti by the international health care organization Partners In Health, in collaboration with the Haitian Ministry of Health, following the 2010 earthquake.
For patients seeking depression care betw|een January 2016 and December 2019, we conducted mixed-effects longitudinal regression to quantify the effect of depression visit dose on symptoms, incorporating interaction effects to examine the relationship between baseline severity and dose.
306 patients attended 2052 visits. Each visit was associated with an average reduction of 1.11 in depression score (range 0–39), controlling for sex, age, and days in treatment (95% CI −1.478 to −0.91; p < 0.001). Patients with more severe symptoms experienced greater improvement as a function of visits (p = 0.04). Psychotherapy was provided less frequently and medication more often than expected for patients with moderate symptoms.
Our findings support the potential positive impact of scaling up routine mental health services in low- and middle-income countries, despite greater than expected variability in service provision, as well as the importance of understanding potential barriers and facilitators to care as they occur in resource-limited settings.
'Birds have been to me the solace, the recreation, the passion of a lifetime.' So wrote Reginald Bosworth Smith (1839–1908), former Classics master at Harrow School. As a young man, he published his first book on birds while teaching at Oxford, and he continued to combine his lifelong love of birds with classical and literary teaching and research. He retired to a country house in Dorset and in 1905 published this book, based on a series of articles written in his retirement. Recording his own observations, some of many years before, and peppered with scholarly references to birds in literature, the essays cover individual birds such as the owl, the raven and the magpie, as well as bird-watching in Dorset and beyond. Imparting a love and respect for wildlife that remains inspiring, this book will be of great interest to the bird-lover and scholar of today.
We report evidence for graphene layer rearrangements in heavy ion interactions with carbon onions at 140 MeV and 70 MeV per nucleon kinetic energies. Graphene layer rearrangements have been recently predicted in spherical and cylindrical multi-layer graphene systems. The implications of graphene layer rearrangement on the tribological performance of multi-layer nano-carbons in extreme environments are discussed.