Sunglass tint does not impact the indoor catching performance of cricket fielders

Introduction

Sunglasses are worn by outdoor athletes such as cricketers for many reasons, including comfort and glare reduction, which may help to improve vision. Anecdotally they are purported to have performance-enhancing benefits, but there is a lack of evidence for this. Further, it appears that fielders are the only position in cricket who wear sunglasses. Therefore, this study aimed to compare the catching performance of fielders when wearing three different colour sunglasses tints during an indoor, laboratory-based experiment.

Methods

Twenty-one male cricketers currently playing for a university or amateur provincial teams in Makhanda, South Africa, who were non-habitual sunglass wearers, were recruited for this study. An optometrist administered pre-screening tests. Players had four testing sessions during which they wore a different colour tint at each session indoors (clear, blue, G30 (rose), and red). Players were required to catch 18 balls projected from a bowling machine. The number of balls caught, as well as the quality of the catch, was recorded. At the final session, they were asked which tint they thought was best.

Results

Pre-screening tests showed that the red lens was best for contrast sensitivity and stereopsis. During data collection, sunglass tint did not affect catching performance. The players perceived the red lens as the worst and the G30 as the best.

Discussion

It can be concluded that catching performance indoors is not affected by tint colour.

Impacts of Covid-19 on mental health service provision in the Western Cape, South Africa: The MASC study

In the context of an already large treatment gap in South Africa, this study aimed to examine how Covid-19 and the related lockdown measures affected the availability, accessibility, quality, and continuity of mental health services in the Western Cape province in South Africa. A mixed-methods design was employed, using narrative surveys, quantitative surveys, and qualitative semi-structured interviews, with 17 public mental health providers, and secondary data from the District Health Information System. We analysed and combined the data using descriptive statistics, template analysis and methodological triangulation. Results showed that Covid-19 and the lockdowns had negative impacts on mental health service provision at all levels of care, such as reduced access to services, increased stigma and discrimination, disrupted medication supply, increased workload and stress for providers, and the closure of psychosocial and therapeutic services. Innovations used by providers to mitigate these impacts included telehealth, online training, peer support groups, and community outreach. The study concludes that Covid-19 and the lockdowns exposed and exacerbated the existing gaps and challenges in mental health service provision in South Africa. Key recommendations for policy formation and response to future pandemics in the public mental health sector include: classifying psychological treatments as essential services, establishing an intersectoral mental health emergency response plan, involving mental health care users in the development of pandemic responses, creating policies for managing health emergencies in psychiatric facilities, and increasing resources for the mental health sector in South Africa. These recommendations are relevant for South Africa and other LMICs in ensuring adequate mental health care during public health emergencies.

Missed opportunities to address common mental disorders and risky alcohol use among people living with HIV in Zomba, Malawi: A cross sectional clinic survey

Common mental disorders (CMDs) and risky alcohol use are highly prevalent among people living with HIV, yet many do not receive treatment for these mental health problems. In Malawi, despite a mental health policy aiming to include mental healthcare into primary health care, many clients with HIV go unscreened and untreated for mental illnesses, indicating missed opportunities to offer mental health care to people living with HIV. The aim of this study was to determine the numbers and types of missed opportunities for screening and treatment of CMDs and risky alcohol use amongst a sample of people living with HIV attending anti-retroviral (ART) clinics in Zomba Malawi. A descriptive cross-sectional clinic survey was used, at three ART clinics in the Zomba district. Random sampling was conducted for all clients attending their ART clinics on specific days. The study surveyed 382 participants living with HIV. Of these participants, the majority were women (N = 247, 64.7%), and 87 (22.8%) screened positive for CMDs and/or alcohol misuse using the self-reporting questionnaire 20 (SRQ-20) and alcohol use disorder identification test (AUDIT). Of these, only 47 (54%) had been screened by health workers for CMDs or risky alcohol use in the past 12 months, and 66 (76%) wanted to receive treatment. Of the total sample of 382 participants, only 92 (24%) and 89 (23%) had been screened for CMDs or risky alcohol use by health workers. Failures by clinical officers and nurses to screen or treat CMDs and risky alcohol use in ART clinics represent missed opportunities to address the mental health of people living with HIV. Providing psychoeducation for staff, guidelines for screening and managing CMDs and alcohol use, increasing human resources, and accelerating implementation of the mental health policy in Malawi may be a few ways of improving mental health service provision at ART clinics in Malawi.

Implementation of a task-shared psychosocial intervention for perinatal depression in South Africa: A grounded theory process evaluation

Perinatal depression carries significant levels of disability for both women and their infants, but there is a large treatment gap for this condition in low and middle-income countries (LMICs). To address this gap, task-sharing using community health workers (CHWs) to provide psychosocial interventions for perinatal depression is increasingly common. Many of these interventions have shown significant positive effects on maternal mood, however not all have done so. This study used data from a task-shared psychosocial intervention for perinatal depression in Cape Town, South Africa, the 'Africa Focus on Intervention Research for Mental Health' (AFFIRM-SA) randomised controlled trial (RCT). It aimed to examine the processes that occurred within the delivery of the counselling intervention, and to use these findings to provide recommendations for psychosocial task sharing in LMICs. A grounded theory analysis was conducted of 234 counselling session transcripts from 39 randomly selected participants from the RCT. This revealed that the effectiveness of the intervention was compromised by the negative influence of participants' socio-economic context, and by counselling strategies that did not align with what was intended in the counselling manual. Despite this, participants provided spontaneous accounts of improvement in mood and cognition, and reasons for these improvements, interpreted as elements that were therapeutically effective for them. Most of these elements aligned with previously identified 'common elements' of therapy. Recommendations for future research and practice include conducting participatory formative research, using an iterative and responsive research design informed by implementation science, incorporating contextually appropriate strategies in interventions such as addressing social determinants of mental health, conducting intensive training and supervision, adopting a staged approach to managing depression, and using common elements of therapy as the basis for psychosocial interventions.

Evaluation of an Advocacy Programme for Mental Health Care Users in South Africa: A Mixed Methods Study

This study evaluates the implementation of a national advocacy programme for mental health care users, conducted by the South African National Department of Health and the South African Federation for Mental Health. Semi-structured interviews were conducted with care users (n = 18), service providers (n = 9), support persons (n = 6), NGO directors (n = 4), and programme managers in the DoH (n = 4). Although informational benefits were highlighted from programme empowerment sessions, very few advocacy groups were subsequently established. Barriers to establishing and conducting advocacy groups included a lack of follow-up support, pervasive stigma from communities and health care workers, low self-confidence, and a lack of financial resources. Facilitators for establishment of groups included conducting empowerment sessions and identifying 'mental health champions' at clinics, improving mental health training for health workers, dispensing psychiatric medication to patients on the same day, providing funding for non-governmental organisations, conducting national awareness campaigns, and establishing holistic rehabilitation centres for care users.

Post-Partum Spontaneous Coronary Artery Dissection with Occluded Left Anterior Descending Artery

Presentation We present a case of spontaneous coronary artery dissection (SCAD) in a 35-year-old lady who was 4 months post-partum. Despite a lack of typical risk factors, initial presentation and investigations were strongly suggestive of ACS. Diagnosis Coronary angiography revealed an occluded proximal left anterior descending (LAD) artery with TIMI 0 flow. Angiographic appearances and intravascular ultrasound (IVUS) were consistent with SCAD. Treatment A single drug-eluting stent was deployed, successfully restoring good flow, without extending the dissection flap. Discussion SCAD should be considered as an important and underdiagnosed cause of ACS, predominantly in young women without other apparent risk factors.

Experiences and Perceived Benefits of a Youth Skateboarding Program in South Africa: From the Physical to Emotional and Beyond

This study aimed to assess the mental health needs and risk behaviors of adolescents attending an afterschool life-skills skateboarding program, to evaluate the perceived benefits of the program, and to identify potential modifications required to meet the identified needs. Program participants were from three gang- and poverty-affected urban communities in Cape Town, South Africa. Seventy-six adolescents aged between 10 and 19 years old (83% male) completed a self-report survey, and 24 adolescents and 19 key influencers participated in in-depth interviews and focus groups. Descriptive analyses were conducted on survey data and a framework approach was used to analyze qualitative data. 72% of the adolescents reported symptoms of moderate to severe anxiety and/or depressive symptoms, 66% had experienced food insecurity, 45% had been physically abused at home, 47% had been bullied, and 59% had used alcohol. Benefits of the program included experiencing a sense of belonging to a skateboarding subculture, protection from gang recruitment and community violence, physical and emotional benefits of exercise, mentors as positive role models, and learning life skills. Recommendations to improve the program were to include information on depression, anxiety, suicidal thoughts and grief, and to include stress management and emotion regulation skills.

Urine Concentration Does Not Affect Biochemical Testing for Non-adherence

Hypertension is one of the most important modifiable risk factor causing cardiovascular disease. Unfortunately, non-adherence to antihypertensive medications is frequently observed in hypertensive patients and can lead to an increase in morbidity and mortality. Until recently, there was no robust clinical method to objectively diagnose non-adherence. Recently, the detection of medications in urine or blood by mass spectrometry techniques such as liquid chromatography-tandem mass spectrometry (LC–MS-MS) has been accepted as the diagnostic method of choice for the detection of non-adherence. Despite this, it is unclear whether the concentration of urine can affect the detection of medications in urine. Therefore, this study aimed to assess the effect of urine concentration on detection of antihypertensive medications by LC–MS-MS in which urine creatinine is used as an independent marker of urine concentration. Biochemical adherence results for 22 different medications (1,709 prescriptions) in 463 different subjects were converted to an adherence score. The adherence score was defined as the ratio of the total number of subjects in which the drug was detected to the total number of subjects to whom the drug was prescribed. The adherence scores for each medication were correlated with urine creatinine concentration for each medication. Non-adherence was observed in 47.1% of samples with a mean urine creatinine concentration of these samples of 9.4 ± 7.1 mmol/L. There was no significant difference between the urine creatinine concentrations in the detected vs non-detected groups for each of the 22 medications. Furthermore, there are no differences in adherence scores across the urine creatinine concentration. This is the first study to demonstrate that urine creatinine concentration does not affect the results of the adherence screening by LC–MS-MS.

Adaptation and validation of a structured version of the Hamilton Depression Rating Scale for use by non-clinicians in South Africa (AFFIRM-HDRS)

RATIONALE, AIMS AND OBJECTIVES

The Hamilton depression rating scale (HDRS) is seen as an international gold standard for the measurement of depression. High rates of untreated depression, including perinatal depression, support the rationale to adapt and validate a structured version of the HDRS to be used by non-clinicians in low-income settings.

METHODS

Using previous structured versions of the HDRS as a foundation, the tool was adapted, translated, and then validated with an isiXhosa speaking perinatal population in South Africa (n = 187), using cognitive testing, test-retest reliability, and inter-rater assessments. The AFFIRM-HDRS was compared with the Edinburgh postnatal depression scale (EPDS) using the non-parametric Spearman Rho test to assess concurrent validity. Internal consistency was examined using Cronbach's Alpha, and inter-rater and test-retest reliability were assessed with the intra-class coefficient (ICC). Cohen's Kappa was used to assess the overall percentage agreement for each individual item of the AFFIRM-HDRS.

RESULTS

The AFFIRM-HDRS showed good construct and content validity had significant associations with the EPDS (Rho = 0.60 and 0.43, P < .001), and acceptable internal consistency (Cronbach's alpha = 0.74.). Inter-rater reliability and test-retest scores were excellent, with intraclass correlations ranging from 0.97 (0.94-0.99) to 0.98 (0.97-0.99) between raters, and test-retest reliability being 0.90 (95% CI: 0.86-0.93). The tool performed similarly to previous structured versions. Individual item-rest correlations suggest that the items "Weight loss or gain," "Insight," and "Libido" did not fit well with the overall instrument, but that the rest of the items performed well.

CONCLUSION

The AFFIRM-HDRS is adequately structured to be used by non-clinicians in an isiXhosa speaking perinatal population. It is hoped that this structured tool can be used to assist with identification and referral of these at-risk populations by non-clinicians in resource-constrained environments, thereby playing a role in addressing the treatment gap for perinatal depression in LMICs.

Task-sharing of psychological treatment for antenatal depression in Khayelitsha, South Africa: Effects on antenatal and postnatal outcomes in an individual randomised controlled trial

The study's objective was to determine the effectiveness of a task-sharing psychological treatment for perinatal depression using non-specialist community health workers. A double-blind individual randomised controlled trial was conducted in two antenatal clinics in the peri-urban settlement of Khayelitsha, Cape Town. Adult pregnant women who scored 13 or above on the Edinburgh Postnatal Depression rating Scale (EPDS) were randomised into the intervention arm (structured six-session psychological treatment) or the control arm (routine antenatal health care and three monthly phone calls). The primary outcome was response on the Hamilton Depression Rating Scale (HDRS) at three months postpartum (minimum 40% score reduction from baseline) among participants who did not experience pregnancy or infant loss (modified intention-to-treat population) (registered on Clinical Trials: NCT01977326). Of 2187 eligible women approached, 425 (19.4%) screened positive on the EPDS and were randomised; 384 were included in the modified intention-to-treat analysis (control: n = 200; intervention: n = 184). There were no significant differences in response on the HDRS at three months postpartum between the intervention and control arm. A task-sharing psychological treatment was not effective in treating depression among women living in Khayelitsha, South Africa. The findings give cause for reflection on the strategy of task-sharing in low-resource settings.

Epidemiology of paediatric gastrointestinal colonisation by extended spectrum cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolates in north-west Cambodia

Background

Extended-spectrum cephalosporin resistance (ESC-R) in Escherichia coli and Klebsiella pneumoniae is a healthcare threat; high gastrointestinal carriage rates are reported from South-east Asia. Colonisation prevalence data in Cambodia are lacking. The aim of this study was to determine gastrointestinal colonisation prevalence of ESC-resistant E. coli (ESC-R-EC) and K. pneumoniae (ESC-R-KP) in Cambodian children/adolescents and associated socio-demographic risk factors; and to characterise relevant resistance genes, their genetic contexts, and the genetic relatedness of ESC-R strains using whole genome sequencing (WGS).

Results

Faeces and questionnaire data were obtained from individuals < 16 years in north-western Cambodia, 2012. WGS of cultured ESC-R-EC/KP was performed (Illumina). Maximum likelihood phylogenies were used to characterise relatedness of isolates; ESC-R-associated resistance genes and their genetic contexts were identified from de novo assemblies using BLASTn and automated/manual annotation. 82/148 (55%) of children/adolescents were ESC-R-EC/KP colonised; 12/148 (8%) were co-colonised with both species. Independent risk factors for colonisation were hospitalisation (OR: 3.12, 95% CI [1.52–6.38]) and intestinal parasites (OR: 3.11 [1.29–7.51]); school attendance conferred decreased risk (OR: 0.44 [0.21–0.92]. ESC-R strains were diverse; the commonest ESC-R mechanisms were bla_CTX-M 1 and 9 sub-family variants. Structures flanking these genes were highly variable, and for bla_{CTX-M-15, − 55 and − 27} frequently involved IS26. Chromosomal bla_CTX-M integration was common in E. coli.

Conclusions

Gastrointestinal ESC-R-EC/KP colonisation is widespread in Cambodian children/adolescents; hospital admission and intestinal parasites are independent risk factors. The genetic contexts of bla_CTX-M are highly mosaic, consistent with rapid horizontal exchange. Chromosomal integration of bla_CTX-M may result in stable propagation in these community-associated pathogens.

Electronic supplementary material

The online version of this article (10.1186/s12866-019-1431-9) contains supplementary material, which is available to authorized users.

Can mental health treatments help prevent or reduce intimate partner violence in low- and middle-income countries? A systematic review

Background

Epidemiological research suggests an interrelationship between mental health problems and the (re)occurrence of intimate partner violence (IPV). However, little is known about the impact of mental health treatments on IPV victimization or perpetration, especially in low- and middle-income countries (LMIC).

Methods

We conducted a systematic review to identify prospective, controlled studies of mental health treatments in LMIC. We defined ‘mental health treatment’ as an intervention for individuals experiencing mental ill health (including substance misuse) including a substantial psychosocial or pharmacological component. Studies had to measure a mental health and IPV outcome. We searched across multi-disciplinary databases using a structured search strategy. Screening of title/abstracts and full-text eligibility assessments were conducted by two researchers independently, data were extracted using a piloted spreadsheet, and a narrative synthesis was generated.

Results

We identified seven studies reported in 11 papers conducted in five middle-income countries. With the exception of blinding, studies overall showed acceptable levels of risk of bias. Four of the seven studies focused on dedicated mental health treatments in various populations, including: common mental disorders in earthquake survivors; depression in primary care; alcohol misuse in men; and alcohol misuse in female adult sex workers. The dedicated mental health treatments targeting depression or alcohol misuse consistently reduced levels of these outcomes. The two studies targeting depression also reduced short-term IPV, but no IPV benefits were identified in the two alcohol-focused studies. The other three studies evaluated integrated interventions, in which a focus on substance misuse was part of efforts to reduce HIV/AIDS and violence against particularly vulnerable women. In contrast to the dedicated mental health interventions, the integrated interventions did not consistently reduce mental ill health or alcohol misuse compared to control conditions.

Conclusions

Too few studies have been conducted to judge whether mental health treatments may provide a beneficial strategy to prevent or reduce IPV in LMIC. Key future research questions include: whether promising initial evidence on the effects of depression interventions on reducing IPV hold more broadly, the required intensity of mental health components in integrated interventions, and the identification of mechanisms of IPV that are amenable to mental health intervention.

Electronic supplementary material

The online version of this article (10.1186/s12905-019-0728-z) contains supplementary material, which is available to authorized users.

Patterns of intimate partner violence among perinatal women with depression symptoms in Khayelitsha, South Africa: a longitudinal analysis

BACKGROUND

A combination of intimate partner violence (IPV) and depression is a common feature of the perinatal period globally. Understanding this association can provide indications of how IPV can be addressed or prevented during pregnancy. This paper aims to determine the prevalence and correlates of IPV among pregnant low-income women with depressive symptoms in Khayelitsha, South Africa, and changes in IPV reports during the course of the perinatal period.

METHODS

This study is a secondary analysis of data collected as part of a randomised controlled trial testing a psychosocial intervention for antenatal depression. IPV, socio-demographic measures, depression and other mental health measures were collected at recruitment (first antenatal visit), 8 months gestation, and 3 and 12 months postpartum. IPV was defined as a sexual or physical violence perpetrated by the participant's partner in the past 3 months. Descriptive statistics are reported.

RESULTS

Of 425 recruited depressed participants, 59 (13.9%) reported IPV at baseline, with physical IPV being the most frequently reported (69.5%). Reported IPV was associated with greater emotional distress, potentially higher food insecurity and higher rates of alcohol abuse. There were clear longitudinal trends in reported IPV with the majority of women no longer reporting IPV postpartum. However, some women reported IPV at later assessment points after not reporting IPV at baseline.

CONCLUSIONS

There is a strong association between IPV and depression in pregnancy. IPV reports remit over time for the women in this study, although the reason for this reduction is not clear and requires further investigation.

The Last Laugh - Reversible myeloneuropathy induced by chronic nitrous oxide use

A previously fit and well 19 year old male presents with a progressive ataxic - sensory neuropathy worsening over 2 - 3 weeks. History and investigations revealed extensive recreational use of nitrous oxide resulting in functional B12 deficiency and consequent subacute combined degeneration of the cord. Abstinence and B12 supplementation resulted in a rapid and full neurological recovery. This case report highlights the importance of considering nitrous oxide abuse in the differential diagnosis of atypical neurological symptoms and signs, and emphasizes the possibility of good clinical outcomes with treatment.

Review article: the role of the microcirculation in liver cirrhosis

BACKGROUND

Intrahepatic microvascular derangements and microcirculatory dysfunction are key in the development of liver cirrhosis and its associated complications. While much has been documented relating to cirrhosis and the dysfunction of the microcirculation in the liver parenchyma, far less is known about the state of the extrahepatic microcirculation and the role this may have in the pathogenesis of multiple organ failure in end stage liver cirrhosis.

AIM

To provide an update on the role of the microcirculation in the pathophysiology of cirrhosis and its associated complications and briefly discuss some of the imaging techniques which may be used to directly investigate the microcirculation.

METHODS

A Medline literature search was conducted using the following search terms: 'cirrhosis', 'microcirculation', 'circulation', 'systemic', 'inflammation', 'peripheral', 'hepatorenal' and 'hepatopulmonary'.

RESULTS

Significant heterogeneous microvascular alterations exist in patients with cirrhosis. Data suggest that the systemic inflammation, associated with advanced cirrhosis, induces microcirculatory dysregulation and contributes to haemodynamic derangement. The resultant vasoconstriction and hypoperfusion in the systemic extrahepatic microvasculature, is likely to be instrumental in the pathophysiology of organ failure in decompensated cirrhosis, however the mechanistic action of vasoactive agents used to correct the circulatory disturbance of advanced cirrhosis is poorly understood.

CONCLUSIONS

Further research into the role of the microcirculation in patients with liver cirrhosis, will improve physicians understanding of the pathophysiology of cirrhosis, and may provide a platform for real time evaluation of an individual's microcirculatory response to vasoactive mediators, thus guiding their therapy.

Validation of the 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) in Zulu, Xhosa and Afrikaans populations in South Africa

BACKGROUND

The 10-item Centre for Epidemiological Studies Depression Scale (CES-D-10) is a depression screening tool that has been used in the South African National Income Dynamics Study (NIDS), a national household panel study. This screening tool has not yet been validated in South Africa. This study aimed to establish the reliability and validity of the CES-D-10 in Zulu, Xhosa and Afrikaans. The CES-D-10's psychometric properties were also compared to the Patient Health Questionnaire (PHQ-9), a depression screening tool already validated in South Africa.

METHODS

Stratified random samples of Xhosa, Afrikaans and Zulu-speaking participants aged 15 years or older (N = 944) were recruited from Cape Town Metro and Ethekwini districts. Face-to-face interviews included socio-demographic questions, the CES-D-10, Patient Health Questionnaire (PHQ-9), and WHO Disability Assessment Schedule 2.0 (WHODAS). Major depression was determined using the Mini International Neuropsychiatric Interview. All instruments were translated and back-translated to English. Construct validity was examined using exploratory factor analysis with varimax rotation. Receiver Operating Characteristics (ROC) curves were used to investigate the CES-D-10 and PHQ-9's criterion validity, and compared using the DeLong method.

RESULTS

Overall, 6.6, 18.0 and 6.9% of the Zulu, Afrikaans and Xhosa samples were diagnosed with depression, respectively. The CES-D-10 had acceptable internal consistency across samples (α = 0.69-0.89), and adequate concurrent validity, when compared to the PHQ-9 and WHODAS. The CES-D-10 area under the Receiver Operator Characteristic curve was good to excellent: 0.81 (95% CI 0.71-0.90) for Zulu, 0.93 (95% CI 0.90-0.96) for Afrikaans, and 0.94 (95% CI 0.89-0.99) for Xhosa. A cut-off of 12, 11 and 13 for Zulu, Afrikaans and Xhosa, respectively, generated the most balanced sensitivity, specificity and positive predictive value (Zulu: 71.4, 72.6% and 16.1%; Afrikaans: 84.6%, 84.0%, 53.7%; Xhosa: 81.0%, 95.0%, 54.8%). These were slightly higher than those generated for the PHQ-9. The CES-D-10 and PHQ-9 otherwise performed similarly across samples.

CONCLUSIONS

The CES-D-10 is a valid, reliable screening tool for depression in Zulu, Xhosa and coloured Afrikaans populations.

"The sun has set even though it is morning": Experiences and explanations of perinatal depression in an urban township, Cape Town

This study examined experiences and explanations of depression amongst Xhosa-speaking pregnant women, mothers, and health workers in an urban township in Cape Town, South Africa. The study was conducted as part of formative research for a randomised controlled trial to develop and evaluate a task-sharing counselling intervention for maternal depression in this setting. We conducted qualitative semi-structured interviews with 12 depressed and 9 nondepressed pregnant women and mothers of young babies, and 13 health care providers. We employed an in-depth framework analysis approach to explore the idioms, descriptions, and perceived causes of depression particular to these women, and compared these with the ICD-10 and DSM-5 criteria for major depression. We found that symptoms of major depression are similar in this township to those described in international criteria (withdrawal, sadness, and poor concentration), but that local descriptions of these symptoms vary. In addition, all the symptoms described by participants were directly related to stressors occurring in the women's lives. These stressors included poverty, unemployment, lack of support from partners, abuse, and death of loved ones, and were exacerbated by unwanted or unplanned pregnancies and the discovery of HIV positive status at antenatal appointments. The study calls attention to the need for specifically designed counselling interventions for perinatal depression that are responsive to the lived experiences of these women and grounded in the broader context of poor socioeconomic conditions and living environments in South Africa, all of which have a direct impact on mental health.

Filling the treatment gap: developing a task sharing counselling intervention for perinatal depression in Khayelitsha, South Africa

BACKGROUND

Perinatal depression is a major public health issue especially in low income settings in South Africa, where there is a shortage of mental health professionals. New psychological interventions delivered by non-specialists are needed to fill the treatment gap. This paper describes the process of developing a manual based task sharing counselling intervention for perinatal depression in Khayelitsha, Cape Town.

METHODS

Qualitative semi-structured interviews were conducted with 26 participants, including service providers and service users at a clinic in Khayelitsha in order to explore the feasibility, acceptability and content of a task sharing counselling intervention. The interviews were recorded, translated and transcribed. Themes were identified using the framework analysis approach and were coded and analysed using NVivo v10. After the semi-structured interviews, a workshop was conducted with mental health experts on evidence-based psychological interventions for depression, together with a document review of counselling manuals for community health workers in South Africa.

RESULTS

The findings indicate that a task sharing counselling intervention was acceptable and feasible for depressed women in Khayelitsha, under the following conditions: (1) respondents preferred a female counsellor and felt that clinic based individual sessions should be provided at least once a month by an experienced Xhosa speaking counsellor from the community; and (2) the content of a counselling intervention should include psycho-education on cognitive and behavioural effects of depression, how to cope with interpersonal problems, and financial stressors. Based on these conditions, the review of manuals and expert consultation, key components of the counselling intervention were identified as: psycho-education, problem solving, healthy thinking and behaviour activation. These were included in the final counselling manual.

CONCLUSION

The development of task sharing counselling interventions for perinatal depression should be informed by the views and needs of local service users and service providers. The study illustrates the manner in which these views can be incorporated for the development of evidence-based psychological interventions, within a task sharing framework in low and middle-income countries.

Evaluating the effectiveness of a home-based exercise programme delivered through a tablet computer for preventing falls in older community-dwelling people over 2 years: study protocol for the Standing Tall randomised controlled trial

INTRODUCTION

In order to prevent falls, older people should exercise for at least 2 h per week for 6 months, with a strong focus on balance exercises. This article describes the design of a randomised controlled trial to evaluate the effectiveness of a home-based exercise programme delivered through a tablet computer to prevent falls in older people.

METHODS AND ANALYSIS

Participants aged 70 years or older, living in the community in Sydney will be recruited and randomly allocated to an intervention or control group. The intervention consists of a tailored, home-based balance training delivered through a tablet computer. Intervention participants will be asked to complete 2 h of exercises per week for 2 years. Both groups will receive an education programme focused on health-related information relevant to older adults, delivered through the tablet computer via weekly fact sheets. Primary outcome measures include number of fallers and falls rate recorded in weekly fall diaries at 12 months. A sample size of 500 will be necessary to see an effect on falls rate. Secondary outcome measures include concern about falling, depressive symptoms, health-related quality of life and physical activity levels (in all 500 participants); and physiological fall risk, balance, functional mobility, gait, stepping and cognitive performance (in a subsample of 200 participants). Adherence, acceptability, usability and enjoyment will be recorded in intervention group participants over 2 years. Data will be analysed using the intention-to-treat principle. Secondary analyses are planned in people with greater adherence. Economic analyses will be assessed from a health and community care provider perspective.

ETHICS AND DISSEMINATION

Ethical approval was obtained from UNSW Ethics Committee in December 2014 (ref number HC#14/266). Outcomes will be disseminated through publication in peer-reviewed journals and presentations at international conferences.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry (ACTRN)12615000138583.

Making assessment locally relevant: measuring functioning for maternal depression in Khayelitsha, Cape Town

PURPOSE

We developed a locally relevant functioning assessment instrument (FAI) for pregnant women and mothers of young babies to complement a widely validated instrument-the World Health Organization's Disability Assessment Schedule (WHODAS) 12-item version. The FAI is an outcome measure in a randomised controlled trial on the effectiveness of a lay counsellor administered intervention for distressed pregnant women in Khayelitsha, Cape Town.

METHODS

Nine items most commonly reported by 40 pregnant women or mothers with young babies in qualitative interviews were selected for the instrument, with a 10th item 'Other'. The FAI was validated with 142 pregnant women and mothers in Khayelitsha. Analysis was conducted to assess internal reliability, exploratory factor analysis and convergent validity.

RESULTS

The FAI had good internal reliability (Cronbach's alpha = 0.77) and the explanatory factor analysis showed a clear 3-factor solution, relating to domestic, childcare and social activities. The FAI scores showed floor effects, but were positively correlated with the two measures of functioning (WHODAS 2.0 and Washington Group Short Set). The FAI scores also correlated with the measure of depression (Edinburgh Postnatal Depression Scale-EPDS), reflecting increased functional limitations associated with increased depressive symptoms.

CONCLUSION

The results show that the FAI has good internal reliability, and good convergent and construct validity as a measure of functioning for this context. This paper reports on the process of developing an instrument and highlights the importance of using instruments that are locally relevant to ensure accurate measurement of functional status.

Task sharing of a psychological intervention for maternal depression in Khayelitsha, South Africa: study protocol for a randomized controlled trial

BACKGROUND

Maternal depression carries a major public health burden for mothers and their infants, yet there is a substantial treatment gap for this condition in low-resourced regions such as sub-Saharan Africa. To address this treatment gap, the strategy of "task sharing" has been proposed, involving the delivery of interventions by non-specialist health workers trained and supervised by specialists in routine healthcare delivery systems. Several psychological interventions have shown benefit in treating maternal depression, but few have been rigorously evaluated using a task sharing approach. The proposed trial will be the first randomised controlled trial (RCT) evaluating a task sharing model of delivering care for women with maternal depression in sub-Saharan Africa. The objective of this RCT is to determine the effectiveness and cost-effectiveness of a task sharing counseling intervention for maternal depression in South Africa.

METHODS/DESIGN

The study is an individual-level two-arm RCT. A total of 420 depressed pregnant women will be recruited from two ante-natal clinics in a low-income township area of Cape Town, using the Edinburgh Postnatal Depression Scale to screen for depression; 210 women will be randomly allocated to each of the intervention and control arms. The intervention group will be given six sessions of basic counseling over a period of 3 to 4 months, provided by trained community health workers (CHW)s. The control group will receive three monthly phone calls from a CHW trained to conduct phone calls but not basic counseling. The primary outcome measure is the 17-Item Hamilton Depression Rating Scale (HDRS-17). The outcome measures will be applied at the baseline assessment, and at three follow-up points: 1 month before delivery, and 3 and 12 months after delivery. The primary analysis will be by intention-to-treat and secondary analyses will be on a per protocol population. The primary outcome measure will be analyzed using linear regression adjusting for baseline symptom severity measured using the HDRS-17.

DISCUSSION

The findings of this trial can provide policy makers with evidence regarding the effectiveness and cost-effectiveness of structured psychological interventions for maternal depression delivered by appropriately trained and supervised non-specialist CHWs in sub-Saharan Africa.

TRIAL REGISTRATION

Clinical Trials (ClinicalTrials.gov): NCT01977326, registered on 24/10/2013; Pan African Clinical Trials Registry (http://www.pactr.org): PACTR201403000676264, registered on 11/10/2013.

Essential regional nerve blocks for the dermatologist: Part 2

Following on from Part 1 of the series (regional nerve blocks for the face and scalp), we guide the clinician through the anatomy and cutaneous innervation of the digits, wrist and ankle, providing a practical step-by-step guide to regional nerve blockade of these areas.

An innovative repair for a re-recurrence of an incarcerated inguinal hernia

A patient presented with a recurrent incarcerated inguinoscrotal hernia requiring urgent surgery. The defect was through the gap in the mesh left originally for the cord structures. As a result, a modified funnel repair was performed. An innovative approach was adopted that was best suited to tackling and reducing the risk of recurrence.

Essential regional nerve blocks for the dermatologist: part 1

The aim of this two-part series is to provide an up-to-date review of essential regional nerve blocks for dermatological practice. In Part 1, we give a concise overview of local anaesthetics and their potential complications, as well as the relevant anatomy and cutaneous innervation of the face and scalp. This culminates in a step-by-step practical guide to performing each nerve block.

Errors in anti-D immunoglobulin administration: retrospective analysis of 15 years of reports to the UK confidential haemovigilance scheme

OBJECTIVE

To highlight the errors associated with the use of anti-D immunoglobulin in RhD antigen-negative women, and their resultant clinical impact during and after pregnancy, and to suggest strategies to reduce these errors.

DESIGN

Retrospective review of cumulative reporting to the UK confidential haemovigilance scheme, Serious Hazards of Transfusion (SHOT), between 1996 and 2011.

SETTING

Obstetric departments in the UK.

POPULATION

Mothers who require anti-D immunoglobulin to prevent RhD sensitisation during pregnancy or after birth.

METHODS

Hospital transfusion teams reported adverse events to the SHOT database.

MAIN OUTCOME MEASURES

Reported number of events and their causes, and morbidity and mortality associated with errors.

RESULTS

In 15 years of reporting, SHOT haemovigilance has shown a total of 1211 errors related to the administration of anti-D immunoglobulin, particularly regarding omission or late administration (157/249 or 63% reported in 2011). Anti-D immunoglobulin errors comprised 13.7% (249/1815) of all SHOT reports in 2011. Failure to recognise women who already have RhD sensitisation occurred in 19 cases, and was followed by suboptimal monitoring of the pregnancy. Nine of the infants suffered haemolytic disease of the fetus and newborn (HDFN): one resulted in neonatal death and three required red cell transfusion.

CONCLUSIONS

Babies as well as their mothers remain at risk from avoidable errors. More active attention at national and local levels to further education and training, particularly for midwives, is an absolute necessity. We recommend the use of a SHOT-devised anti-D administration flowchart, adapted locally into a checklist, to help reduce errors.

Search for R-parity violating decays of sneutrinos to eμ, μτ, and eτ pairs in pp collisions at square root s = 1.96 TeV

We present a search for supersymmetric neutrino ν production using the Tevatron pp collision data collected with the CDF II detector and corresponding to an integrated luminosity of 1 fb-1. We focus on the scenarios predicted by the R-parity violating (RPV) supersymmetric models in which sneutrinos decay to two charged leptons of different flavor. With the data consistent with the standard model expectations, we set upper limits on σ(pp→ν)×BR(ν→eμ,μτ,eτ) and use these results to constrain the RPV couplings as a function of the sneutrino mass.

Search for new physics with a dijet plus missing E(T) signature in pp collisions at √s=1.96 TeV

We present results of a signature-based search for new physics using a dijet plus missing transverse energy (E(T)) data sample collected in 2  fb⁻¹ of pp collisions at √s=1.96  TeV with the CDF II detector at the Fermilab Tevatron. We observe no significant event excess with respect to the standard model prediction and extract a 95% C.L. upper limit on the cross section times acceptance for a potential contribution from a nonstandard model process. The search is made by using novel, data-driven techniques for estimating backgrounds that are applicable to first searches at the LHC.

Exclusion of an exotic top quark with -4/3 electric charge using soft lepton tagging

We present a measurement of the electric charge of the top quark using pp collisions corresponding to an integrated luminosity of 2.7 fb(-1) at the CDF II detector. We reconstruct tt events in the lepton + jets final state. We use soft lepton taggers to determine the flavor of the b jets, which we use to reconstruct the top quark's electric charge and exclude an exotic top quark with -4/3 charge at 95% confidence level. This is the strongest exclusion of the exotic charge scenario and the first to use soft leptons for this purpose.

Search for the production of scalar bottom quarks in pp collisions at square root(s) = 1.96 TeV

We report on a search for direct scalar bottom quark (sbottom) pair production in pp collisions at square root(s) = 1.96 TeV, in events with large missing transverse energy and two jets of hadrons in the final state, where at least one of the jets is required to be identified as originating from a b quark. The study uses a collider detector at Fermilab Run II data sample corresponding to 2.65 fb(-1) of integrated luminosity. The data are in agreement with the standard model. In an R-parity conserving minimal supersymmetric scenario, and assuming that the sbottom decays exclusively into a bottom quark and a neutralino, 95% confidence-level upper limits on the sbottom pair production cross section of 0.1 pb are obtained. For neutralino masses below 70 GeV/c2, sbottom masses up to 230 GeV/c2 are excluded at 95% confidence level.

When and why is blood crossmatched? A prospective survey of transfusion laboratory practice in two regions in the north of England

BACKGROUND AND OBJECTIVES

This study was undertaken to provide data relating to the timing of laboratory crossmatch procedures, and the source of requests for out of hours crossmatch, to support interpretation of error reports originating in the transfusion laboratory, received by the Serious Hazards of Transfusion haemovigilance scheme.

MATERIALS AND METHODS

Data on the timing, origin and urgency of all crossmatch requests were collected in 34 hospitals in northern England over a 7-day period in 2008. Additional data on clinical urgency were collected on crossmatches that were performed out of hours.

RESULTS

Data were obtained on 2423 crossmatches, including 610 (25.2%) performed outside core hours. 30.3% of out of hours crossmatch requests were for transfusions that were set up outside 4 h of completion of the crossmatch.

CONCLUSION

2008 Serious Hazards of Transfusion data showed that 29/39 (74%) of laboratory errors resulting in 'wrong blood' occurred out of hours whilst our audit shows that only 25% of crossmatch requests are made in that time period, suggesting that crossmatching performed outside core hours carries increased risks. The reason for increased risk of error needs further research, but 25 laboratories had only one member of staff working out of hours, often combining blood transfusion, haematology and coagulation work. A total of 25% of out of hours requests were not clinically urgent. Hospitals should develop policies to define indications for out of hours transfusion testing, empower laboratory staff to challenge inappropriate requests and ensure that staffing and expertise is appropriate for the workload at all times.

Measurement of W-boson polarization in Top-Quark Decay in pp collisions at sqrt[s]=1.96 TeV

We report measurements of the polarization of W bosons from top-quark decays using 2.7 fb{-1} of pp collisions collected by the CDF II detector. Assuming a top-quark mass of 175  GeV/c{2}, three measurements are performed. A simultaneous measurement of the fraction of longitudinal (f{0}) and right-handed (f{+}) W bosons yields the model-independent results f{0}=0.88±0.11(stat)±0.06(syst) and f{+}=-0.15±0.07(stat)±0.06(syst) with a correlation coefficient of -0.59. A measurement of f{0} [f{+}] constraining f{+} [f{0}] to its standard model value of 0.0 [0.7] yields f{0}=0.70±0.07(stat)±0.04(syst) [f{+}=-0.01±0.02(stat)±0.05(syst)]. All these results are consistent with standard model expectations. We achieve the single most precise measurements of f{0} for both the model-independent and model-dependent determinations.

Measurement of the ratio σ{tt}/σ{Z/γ{*}→ll} and precise extraction of the tt cross section

We report a measurement of the ratio of the tt to Z/γ{*} production cross sections in sqrt[s]=1.96  TeV pp collisions using data corresponding to an integrated luminosity of up to 4.6  fb{-1}, collected by the CDF II detector. The tt cross section ratio is measured using two complementary methods, a b-jet tagging measurement and a topological approach. By multiplying the ratios by the well-known theoretical Z/γ{*}→ll cross section predicted by the standard model, the extracted tt cross sections are effectively insensitive to the uncertainty on luminosity. A best linear unbiased estimate is used to combine both measurements with the result σ{tt}=7.70±0.52  pb, for a top-quark mass of 172.5  GeV/c{2}.

Search for pair production of supersymmetric top quarks in dilepton events from pp collisions at sqrt[s]=1.96 TeV

We present the results of a search for pair production of the supersymmetric partner of the top quark (the top squark t{1}) decaying to a b quark and a chargino χ{1}{±} with a subsequent χ{1}{±} decay into a neutralino χ{1}{0}, lepton ℓ, and neutrino ν. Using a data sample corresponding to 2.7  fb{-1} of integrated luminosity of pp collisions at sqrt[s]=1.96  TeV collected by the CDF II detector, we reconstruct the mass of top squark candidate events and fit the observed mass spectrum to a combination of standard model processes and t{1}t{1} signal. We find no evidence for t{1}t{1} production and set 95% C.L. limits on the masses of the top squark and the neutralino for several values of the chargino mass and the branching ratio B(χ{1}{±}→χ{1}{0}ℓ{±}ν).

Search for WW and WZ resonances decaying to electron, missing E(T), and two jets in pp collisions at square root(s) = 1.96 TeV

Using data from 2.9  fb(-1) of integrated luminosity collected with the CDF II detector at the Tevatron, we search for resonances decaying into a pair of on-shell gauge bosons, WW or WZ, where one W decays into an electron and a neutrino, and the other boson decays into two jets. We observed no statistically significant excess above the expected standard model background, and we set cross section limits at 95% confidence level on G* (Randall-Sundrum graviton), Z', and W' bosons. By comparing these limits to theoretical cross sections, mass exclusion regions for the three particles are derived. The mass exclusion regions for Z' and W' are further evaluated as a function of their gauge coupling strength.