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Holladay EE, Mudano AS, Xie F, Zhang J, Mikuls TR, LaMoreaux B, Padnick-Silver L, Curtis JR. Urate-lowering therapy, serum urate, inflammatory biomarkers, and renal function in patients with gout following pegloticase discontinuation. Arthritis Res Ther 2024; 26:86. [PMID: 38609967 PMCID: PMC11010378 DOI: 10.1186/s13075-024-03318-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/03/2024] [Indexed: 04/14/2024] Open
Abstract
BACKGROUND/PURPOSE Little is known about long-term clinical outcomes or urate-lowering (ULT) therapy use following pegloticase discontinuation. We examined ULT use, serum urate (SU), inflammatory biomarkers, and renal function following pegloticase discontinuation. METHODS We conducted a retrospective analysis of gout patients who discontinued pegloticase using the Rheumatology Informatics System for Effectiveness (RISE) registry from 1/2016 to 6/2022. We defined discontinuation as a gap ≥ 12 weeks after last infusion. We examined outcomes beginning two weeks after last dose and identified ULT therapy following pegloticase discontinuation. We evaluated changes in lab values (SU, eGFR, CRP and ESR), comparing on- treatment (≤ 15 days of the second pegloticase dose) to post-treatment. RESULTS Of the 375 gout patients discontinuing pegloticase, median (IQR) laboratory changes following discontinuation were: SU: +2.4 mg/dL (0.0,6.3); eGFR: -1.9 mL/min (- 8.7,3.7); CRP: -0.8 mg/L (-12.8,0.0); and ESR: -4.0 mm/hr (-13.0,0.0). Therapy post-discontinuation included oral ULTs (86.0%), restarting pegloticase (4.5%), and no documentation of ULT (9.5%), excluding patients with multiple same-day prescriptions (n = 17). Oral ULTs following pegloticase were: 62.7% allopurinol, 34.1% febuxostat. The median (IQR) time to starting/restarting ULT was 92.0 days (55.0,173.0). Following ULT prescribing (≥ 30 days), only 51.0% of patients had SU < 6 mg/dL. Patients restarting pegloticase achieved a median SU of 0.9 mg/dL (IQR:0.2,9.7) and 58.3% had an SU < 6 mg/dL. CONCLUSION Pegloticase treats uncontrolled gout in patients with failed response to xanthine oxidase inhibitors, but among patients who discontinue, optimal treatment is unclear. Based on this analysis, only half of those starting another ULT achieved target SU. Close follow-up is needed to optimize outcomes after pegloticase discontinuation.
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Affiliation(s)
- Emily E Holladay
- University of Alabama at Birmingham, 1825 University Blvd, Birmingham, AL, 35233, USA
| | - Amy S Mudano
- Foundation for Advancing Science, Technology, Education, and Research, Birmingham, AL, USA
| | - Fenglong Xie
- University of Alabama at Birmingham, 1825 University Blvd, Birmingham, AL, 35233, USA
| | - Jingyi Zhang
- University of Alabama at Birmingham, 1825 University Blvd, Birmingham, AL, 35233, USA
| | - Ted R Mikuls
- University of Nebraska Medical Center and the VA Nebraska-Western Iowa Health Care System, Omaha, NE, USA
| | - Brian LaMoreaux
- Horizon Therapeutics Plc (Now Amgen Inc.), Deerfield, IL, USA
| | | | - Jeffrey R Curtis
- University of Alabama at Birmingham, 1825 University Blvd, Birmingham, AL, 35233, USA.
- Foundation for Advancing Science, Technology, Education, and Research, Birmingham, AL, USA.
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Sawrikar V, Van Dyke C, Smith Slep AM. The Ws of Parental Help-Seeking: When, Where, and for What Do Parents Seek Help for Child Mental Health. Child Psychiatry Hum Dev 2024:10.1007/s10578-024-01683-5. [PMID: 38507021 DOI: 10.1007/s10578-024-01683-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2024] [Indexed: 03/22/2024]
Abstract
Parental help-seeking preferences may help explain the treatment gap in child mental health. This study examined mothers' and fathers' help-seeking behaviors for child mental health to further understand their individual preferences for treatment. A total of 394 mothers and fathers completed questionnaires assessing the types of help sought for mental health concerns for a target child (age 3-7 years), as well as measures representing illness profile, predisposing characteristics, and barriers/facilitators proposed to influence help-seeking. Parents often sought informal rather than professional help. Regression modelling indicated mothers' different help-seeking behaviors were significantly associated with illness profile (marital quality, child mental health, parental education), predisposing factors (parental attributions, child age), and family income, while fathers' different help-seeking behaviors were significantly associated with child demographics (age, gender). The results support expanding treatments into nonclinical settings and improving child mental health literacy to improve appropriate parental help-seeking for child mental health concerns.
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Affiliation(s)
- Vilas Sawrikar
- Centre for Applied Developmental Psychology, University of Edinburgh, Edinburgh, UK.
- Department of Clinical and Health Psychology, University of Edinburgh, Edinburgh, UK.
| | | | - Amy M Smith Slep
- Family Translational Research Group, New York University, New York, NY, USA
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de Bejczy A, Addolorato G, Aubin HJ, Guiraud J, Korpi ER, John Nutt D, Witkiewitz K, Söderpalm B. AUD in perspective. Int Rev Neurobiol 2024; 175:1-19. [PMID: 38555113 DOI: 10.1016/bs.irn.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/02/2024]
Abstract
Alcohol is a major cause of pre-mature death and individual suffering worldwide, and the importance of diagnosing and treating AUD cannot be overstated. Given the global burden and the high attributable factor of alcohol in a vast number of diseases, the need for additional interventions and the development of new medicines is considered a priority by the World Health Organization (WHO). As of today, AUD is severely under-treated with a treatment gap nearing 90%, strikingly higher than that for other psychiatric disorders. Patients often seek treatment late in the progress of the disease and even among those who seek treatment only a minority receive medication, mirroring the still-prevailing stigma of the disease, and a lack of access to effective treatments, as well as a reluctance to total abstinence. To increase adherence, treatment goals should focus not only on maintaining abstinence, but also on harm reduction and psychosocial functioning. A personalised approach to AUD treatment, with a holistic view, and tailored therapy has the potential to improve AUD treatment outcomes by targeting the heterogeneity in genetics and pathophysiology, as well as reason for, and reaction to drinking. Also, the psychiatric co-morbidity rates are high in AUD and dual diagnosis can worsen symptoms and influence treatment response and should be considered in the treatment strategies.
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Affiliation(s)
- Andrea de Bejczy
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Giovanni Addolorato
- Department of Medical and Surgical Sciences, Università Cattolica di Roma, Rome, Italy; Internal Medicine and Alcohol Related Disease Unit, Columbus-Gemelli Hospital, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Henri-Jean Aubin
- Université Paris-Saclay, Inserm, CESP, Villejuif, France; AP-HP, Université Paris Saclay, Villejuif, France
| | - Julien Guiraud
- Amsterdam UMC, Location Academic Medical Center, University of Amsterdam, Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, The Netherlands; Vergio, Clichy, France
| | - Esa R Korpi
- Department of Pharmacology, Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - David John Nutt
- Imperial College London and GABA Labs, London, United Kingdom
| | - Katie Witkiewitz
- Department of Psychology and Center on Alcohol, Substance Use, and Addictions, University of New Mexico, Albuquerque, New Mexico, United States
| | - Bo Söderpalm
- Addiction Biology Unit, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Addiction and Dependency, Sahlgrenska University Hospital, Gothenburg, Sweden
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Shakya P, Sood M, Mathur R, Prajapati N, Patil V. Pathways to care and barriers in treatment among patients with Dissociative disorders. Asian J Psychiatr 2024; 95:104000. [PMID: 38507864 DOI: 10.1016/j.ajp.2024.104000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 03/02/2024] [Accepted: 03/06/2024] [Indexed: 03/22/2024]
Abstract
INTRODUCTION Dissociative disorder patients often present with sudden and embarrassing symptoms, and it is difficult for the patient and care giver to understand initially, recognize the need for help and reach for appropriate treatment timely. This can result in high risk of engaging in dangerous behaviors such as self-harm and suicidal acts, impaired global functioning, and poor quality of life. Knowledge about the types of barriers which are there in treatment seeking, can help in planning strategies for their removal and to facilitate the treatment process. METHODS Cross-sectional study among patients (n=133) with Dissociative disorders which were recruited from January 2023 to June 2023 in a tertiary care hospital. Pathways to care and barriers in treatment for Dissociative disorders were assessed by interviewing patients using semi-structured proforma. The Dissociative Experience Scale and World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0)) were used to assess disease severity and impact of illness on various domains of life respectively. Group comparison was made to assess differences in social- clinical profile of patients choosing different modalities of treatment. RESULTS 133 patients of Dissociative disorders with mean age 29.6±9.2, showed their first-choice of help seeking from general practitioner/ neurologist (40.6%), traditional faith healers (35.3%), psychiatrist (18.1%) and 5.2% preferred alternative treatments. This trend changed with 2nd and 3rd contact of help seeking with greater preference for psychiatrist in their 2nd (n=45, 33.8%) and 3rd (n=69, 51.8%) contact. The median duration of untreated illness was 56 weeks (IQR 24-182 weeks). Social-clinical profile of patients varied with their choice of treatment, having lower education level (P = 0.013), longer duration of untreated illness (p=0.003), more severity of symptoms (p=0.032) and greater disability scores(p=0.002) in patients whose first treatment choice was traditional faith healers. More than 70% patients faced availability barriers, stigma, unawareness about mental illness and influence of others in treatment of choice as barriers in initiating and continuing treatment. CONCLUSION Patients with Dissociative disorders seek treatment from a multitude of healthcare providers including traditional faith healers, general physicians, and alternative medicine practitioners before reaching psychiatrist and undergoes various barriers in treatment. There is need to implement necessary measures for sensitization and awareness about Dissociative disorders to prevent prolonged and undue delays in initiation of appropriate management.
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Affiliation(s)
- Pooja Shakya
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Mamta Sood
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Rahul Mathur
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Nisha Prajapati
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
| | - Vaibhav Patil
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
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Falk SSI, Richter M, Schröder J, Böhme S, Mittlmeier T. Pre-existing osteoporosis and serum vitamin D levels in patients with distal radius fractures: are we missing something? Arch Orthop Trauma Surg 2024; 144:1281-1287. [PMID: 38305894 PMCID: PMC10896871 DOI: 10.1007/s00402-024-05199-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 12/30/2023] [Indexed: 02/03/2024]
Abstract
INTRODUCTION Given the significant therapeutic gap for osteoporosis, this study aims to investigate the most common osteoporosis-related fracture. The analysis will also consider patients' serum vitamin D levels and the indications for basic osteoporosis diagnostic tests and osteoporosis therapy prior to fracture. MATERIALS AND METHODS This prospective clinical trial included patients with distal radius fractures who underwent surgery at our hospital between 1 April 2021 and 7 April 2022. Blood samples were taken from all participants and existing risk factors for osteoporosis were recorded. In addition, the indication for a guideline-based osteoporosis diagnosis was assessed and the risk of another future fracture with FRAX® was calculated. This information was used to decide whether there was an indication for specific osteoporosis therapy. RESULTS A diagnosis gap of 53% and a treatment gap of 84% were identified among the 102 patients investigated. The patients' ages ranged from 46 to 91 years, with an average vitamin D level of 57 nmol/l, which was below the recommended level of 75 nmol/l. It was noted on a monthly basis that the vitamin D level (without substitution) never exceeded the recommended value of 75 nmol/l in any month. Three-quarters of patients had indications for a baseline osteoporosis diagnosis, yet less than 50% received one. According to FRAX® data, 57% of patients had indications for specific osteoporosis treatment before experiencing the fracture. CONCLUSION Even without a previous distal radius fracture, many patients are in need of osteoporosis diagnosis or treatment. Our research suggests that patients with distal radius fractures should have their vitamin D levels checked via a blood test and be evaluated for osteoporosis. As endogenous vitamin D levels are often inadequate, year-round vitamin D supplementation should be considered for the prevention of osteomalacia and as a basis for the treatment of osteoporosis. GERMAN CLINICAL TRIAL REGISTER ID DRKS00028085.
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Affiliation(s)
- Steffi S I Falk
- Clinic of Trauma, Hand and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18055, Rostock, Germany.
| | - Meike Richter
- Clinic of Trauma, Hand and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18055, Rostock, Germany
| | - Josephine Schröder
- Clinic of Trauma, Hand and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18055, Rostock, Germany
| | - Sina Böhme
- Clinic of Trauma, Hand and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18055, Rostock, Germany
| | - Thomas Mittlmeier
- Clinic of Trauma, Hand and Reconstructive Surgery, University of Rostock, Schillingallee 35, 18055, Rostock, Germany
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Rajan V, Behera P, Patra S, Singh AK, Patro BK. Prevalence of common mental disorders and treatment gap among patients with non-communicable diseases in the rural areas of East India. Soc Psychiatry Psychiatr Epidemiol 2024:10.1007/s00127-024-02618-0. [PMID: 38302776 DOI: 10.1007/s00127-024-02618-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 01/01/2024] [Indexed: 02/03/2024]
Abstract
BACKGROUND Mental and physical non-communicable diseases (NCDs) coexist, because they share common environmental and behavioral risk factors. The treatment gap for common mental disorders, such as depression, anxiety, and substance use, is large compared to other NCDs. OBJECTIVE To determine the prevalence and treatment gap of common mental disorders among patients with non-communicable diseases. METHODOLOGY The community-based cross-sectional study was conducted in the rural parts of East India, in people aged 30 years and older with NCDs. A simple random sample was chosen to select the villages and participants. Eligible participants administered with screening and diagnostic questionnaire for depression, anxiety, and substance use. Those diagnosed with mental disorders were again assessed for treatment status in the last 12 months. Non-receipt of treatment was considered as treatment gap. RESULTS A total of 515 participants were included in the analysis. The overall prevalence of common mental disorders among the study population was 46.4% (95% CI 42.0-50.8), and excluding substance use, the prevalence was 11.7% (95% CI 9.0-14.7). The treatment gap for common mental disorders among patients with non-communicable diseases, including and excluding substance use, was 98.3% (95% CI 95.8-99.5) and 93.3% (95% CI 83.8-98.2), respectively. CONCLUSION The prevalence and treatment gap of common mental disorders among persons with NCDs was high. Public health interventions need to be emphasized for the integration of mental health care into NCD care.
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Affiliation(s)
- Varsha Rajan
- Department of Community Medicine and Family Medicine, Academic Block, AIIMS, Patrapada, Bhubaneswar, Odisha, India
| | - Priyamadhaba Behera
- Department of Community Medicine and Family Medicine, Academic Block, AIIMS, Patrapada, Bhubaneswar, Odisha, India
| | - Suravi Patra
- Department of Psychiatry, AIIMS, Bhubaneswar, Odisha, India
| | - Arvind Kumar Singh
- Department of Community Medicine and Family Medicine, Academic Block, AIIMS, Patrapada, Bhubaneswar, Odisha, India
| | - Binod Kumar Patro
- Department of Community Medicine and Family Medicine, Academic Block, AIIMS, Patrapada, Bhubaneswar, Odisha, India.
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Leone M, Berardelli A, Somse P, Padovani A, Guidotti G. The WHO-Intersectoral Global Action Plan (IGAP) on epilepsy and other neurologic disorders in sub-Saharan Africa: an Italian Society of Neurology intervention model. Neurol Sci 2024:10.1007/s10072-024-07338-6. [PMID: 38285325 DOI: 10.1007/s10072-024-07338-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 01/18/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Massimo Leone
- Department of Neuroalgology, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
- , .
- Drug Relief Through Excellent and Advanced Means (DREAM) program, Community of Sant'Egidio, Rome, Italy.
- Global Health Telemedicine, Rome, Italy.
| | - Alfredo Berardelli
- Department of Human Neurosciences, Policlinico Umberto I, Sapienza University, Rome, Italy
- IRCCS Neuromed, Isernia, Italy
| | - Pierre Somse
- Minister of Health, Bangui, Central African Republic
| | - Alessandro Padovani
- Dipartimento Di Scienze Cliniche Sperimentali, Clinica Neurologica, Università Degli Studi Di Brescia, UO Neurologia 2, ASST Spedali Civili, Policlinico Satellite, Brescia, Italy
| | - Giovanni Guidotti
- Drug Relief Through Excellent and Advanced Means (DREAM) program, Community of Sant'Egidio, Rome, Italy
- Health Department, Azienda Sanitaria Locale (ASL), Roma 1, Regione Lazio, , Rome, Italy
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Potočár L, Mladá K, Kučera M, Mohr P, Winkler P, Formánek T. Population mental health, help-seeking and associated barriers following the COVID-19 pandemic: Analysis of repeated nationally representative cross-sectional surveys in Czechia. Psychiatry Res 2024; 331:115641. [PMID: 38042095 DOI: 10.1016/j.psychres.2023.115641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 11/20/2023] [Accepted: 11/26/2023] [Indexed: 12/04/2023]
Abstract
This study investigated the Czech adults' mental health following the COVID-19 pandemic and the potential influence of data collection methodology on prevalence estimates. Separately, it investigated changes in help-seeking and associated barriers. Data from representative surveys on Czech adults, conducted in November 2017 (n = 3,306), in May (n = 3,021) and November 2020 (n = 3,000), and in November and December 2022 (n = 7,311), were used. Current mental disorders were assessed by the Mini International Neuropsychiatric Interview, and the treatment gap was established in individuals scoring positively. In help-seeking individuals, encountering barriers was investigated. In 2017 and 2022, 20.02 % and 27.22 % of individuals had at least one mental disorder, respectively. The 2022 panel sampling and online and telephone interviewing estimates (34.29 % and 26.7 %) were substantially higher than those from household sampling and personal interviewing (19.9 %). Prevalence rates based on household sampling and personal interviewing were broadly consistent in 2017 and 2022. The treatment gap was around 80 % from 2017 to 2022. More than 50 % of individuals encountered structural barriers in help-seeking in 2022. This study showed that prevalence rates were still elevated in 2022, but suggests that data collection methodology influenced the estimates. Separately, the treatment gap remained consistently very high, and encountering structural barriers in help-seeking was common.
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Affiliation(s)
- Libor Potočár
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; Department of Psychiatry, Faculty of Medicine in Pilsen, Charles University, Pilsen, Czech Republic
| | - Matěj Kučera
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Second Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Pavel Mohr
- Clinical Center, National Institute of Mental Health, Klecany, Czech Republic; Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom
| | - Tomáš Formánek
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czech Republic; Department of Psychiatry, University of Cambridge, Cambridge, United Kingdom.
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Elwakil W, El Gaafary M, El Miedany Y. Screening and management of osteoporosis: a survey of knowledge, attitude, and practice among healthcare professionals in Egypt-a study by the Egyptian Academy of Bone Health. Osteoporos Int 2024; 35:93-103. [PMID: 37721557 PMCID: PMC10786960 DOI: 10.1007/s00198-023-06914-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 09/05/2023] [Indexed: 09/19/2023]
Abstract
Secondary-level healthcare professionals, mainly rheumatologists and orthopedic surgeons, were invited to participate in an online survey questionnaire to assess knowledge and compliance with osteoporosis management guidelines and strategies, as well as self-reported quality of care. About 51% of the participants admit that they do not implement specific guidelines for the management of osteoporosis in their standard practice and depend on their experience and their clinical judgments. Moreover, although a good percentage (58%) had satisfactory knowledge levels in domains on the risk of osteoporotic fractures and investigations of osteoporosis, 47.5% of the participants did not score satisfactorily in questions on pharmacotherapy, especially for those patients at high risk for fractures. INTRODUCTION A recently published study demonstrated a treatment gap among those eligible for osteoporosis therapy in Egypt of about 82.1% in postmenopausal women and 100% in men. The current survey aimed to address some of the factors that may contribute to this wide gap. METHODS This was a cross-sectional study of secondary care healthcare professionals (both physicians and orthopedic surgeons) who were invited to complete an online questionnaire, which gathered information about physicians' socio-demographic data, knowledge, and compliance with osteoporosis management guidelines and strategies, as well as self-reported quality of care. Additionally, a knowledge score was calculated for all the participants. RESULTS A good percentage (58%) had a satisfactory knowledge level in domains on the risk of osteoporotic fractures and investigations of osteoporosis; however, 47.5% did not score satisfactorily in questions on pharmacotherapy, especially for those patients at high risk for fractures. CONCLUSIONS This work has identified some of the barriers to implementing guidelines for osteoporosis and fragility fracture management. In the meantime, it highlights the urgency of intensifying efforts to develop the knowledge and attitude of the healthcare professionals dealing with this condition in Egypt.
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Affiliation(s)
- Walaa Elwakil
- Rheumatology, Rehabilitation and Physical Medicine, Alexandria University, Alexandria, Egypt.
| | - Maha El Gaafary
- Community and Public Health, Ain Shams University, Cairo, Egypt
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Kim J, Ryu N, Chibanda D. Effectiveness of single-session therapy for adult common mental disorders: a systematic review. BMC Psychol 2023; 11:373. [PMID: 37936186 PMCID: PMC10631081 DOI: 10.1186/s40359-023-01410-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2023] [Accepted: 10/25/2023] [Indexed: 11/09/2023] Open
Abstract
BACKGROUND Common mental disorders (CMDs) impose significant socioeconomic impacts on the global community. Nevertheless, over 50% of individuals with CMDs do not receive proper treatment, indicating that the current treatment modalities do not adequately tackle this issue. Since single-session therapy (SST) is a potential method for reducing the treatment gap, it is crucial to evaluate its effectiveness. Therefore, this systematic review aimed to evaluate the effectiveness of SST on CMD symptoms in adults. METHODS This systematic review included randomised and non-randomised studies assessing the clinical effectiveness of SST on CMD symptoms in adults. English-written, peer-reviewed studies or dissertations were included, while grey literature was excluded. MEDLINE, Embase, PsycINFO, and Cochrane's CENTRAL were searched on December 13, 2022, from their inception dates. The risk of bias in the included studies was evaluated using RoB 2 and ROBINS-I. A narrative synthesis was performed. This systematic review was registered in the PROSPERO database on July 6, 2022 (CRD42022343925). RESULTS Six randomised and three non-randomised studies were included after screening 2,130 records. Three non-randomised studies with a "critical" or "serious" risk of bias were excluded from the synthesis. Therefore, six randomised trials involving 298 participants were included in the synthesis. Four out of six studies had a "high" risk of bias. The participants had non-severe symptoms at baseline, and three intervention types (behavioural activation, DBT, and solution-focused psychotherapy) were evaluated. Five of six studies showed positive results for depression, with only one reporting a positive result for anxiety. CONCLUSIONS SST may be effective in improving CMD symptoms in adults, particularly depression. However, there is a limit to deriving definite conclusions due to a high risk of bias in included studies, insufficient sample size and research volume. Further research exploring the characteristics of clients who can benefit from SST is required to facilitate its widespread use.
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Affiliation(s)
- Jongtae Kim
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
| | - Namgil Ryu
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dixon Chibanda
- Department of Population Health, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
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Sanza M, Monzio Compagnoni M, Caggiu G, Allevi L, Barbato A, Campa J, Carle F, D'avanzo B, Di Fiandra T, Ferrara L, Gaddini A, Saponaro A, Scondotto S, Tozzi VD, Lorusso S, Giordani C, Corrao G, Lora A. Assessing the quality of the care offer for people with personality disorders in Italy: the QUADIM project. A multicentre research based on the database of use of Mental Health services. Int J Ment Health Syst 2023; 17:31. [PMID: 37833745 PMCID: PMC10571410 DOI: 10.1186/s13033-023-00603-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 09/27/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Italy can be viewed as a laboratory to assess the quality of mental healthcare delivered in a community-oriented system, especially for severe mental disorders, such as personality disorders. Although initiatives based on clinical indicators for assessing the quality of mental healthcare have been developed by transnational-organisations, there is still no widespread practice of measuring the quality of care pathways delivered to patients with severe mental disorders in a community-oriented system, especially using administrative healthcare databases. The aim of the study is to evaluate the quality of care delivered to patients with personality disorders taken-in-care by mental health services of four Italian regions (Lombardy, Emilia-Romagna, Lazio, Sicily). METHODS A set of thirty-three clinical indicators, concerning accessibility, appropriateness, continuity, and safety of care, was implemented using regional healthcare utilization databases, containing data on mental health treatments and diagnosis, hospital admissions, outpatient interventions and exams and drug prescriptions. RESULTS 31,688 prevalent patients with personality disorders treated in 2015 were identified, of whom 2,331 newly taken-in-care. One-in-10 patients received a standardized assessment, the treatment discontinuity affected half of the cases. 12.7% of prevalent patients received at least one hospitalization, 10.6% in the newly taken-in-care cohort. 6-out-of-10 patients had contact with community-services within 14 days from hospital discharge. Access to psychotherapy and psychoeducational treatments was low and delivered with a low intensity. The median of psychosocial interventions per person-year was 19.1 and 9.4, respectively, in prevalent and newly taken-in-care cases. Nearly 50% of patients received pharmacological treatments. CONCLUSIONS Healthcare utilization databases were used to systematically evaluate and assess service delivery across regional mental health systems; suggesting that in Italy the public mental health services provide to individuals with personality disorders suboptimal treatment paths.
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Affiliation(s)
- Michele Sanza
- Department of Mental Health and Addiction Disorders Forlì-Cesena, AUSL Romagna, Cesena, Italy
| | - Matteo Monzio Compagnoni
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy.
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
| | - Giulia Caggiu
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | | | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | - Barbara D'avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Teresa Di Fiandra
- Psychologist, previously General Directorate for Health Prevention, Ministry of Health, Rome, Italy
| | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, CERGAS SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, CERGAS SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | - Stefano Lorusso
- Department of Health Planning, Italian Health Ministry, Rome, Italy
| | | | - Giovanni Corrao
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Milan, Italy
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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Carrino EA, Flatt RE, Pawar PS, Sanzari CM, Tregarthen JP, Argue S, Thornton LM, Bulik CM, Watson HJ. Sociodemographic and clinical characteristics of treated and untreated adults with bulimia nervosa or binge-eating disorder recruited for a large-scale research study. J Eat Disord 2023; 11:126. [PMID: 37525298 PMCID: PMC10391988 DOI: 10.1186/s40337-023-00846-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 07/17/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Eating disorders affect millions of people worldwide, but most never receive treatment. The majority of clinical research on eating disorders has focused on individuals recruited from treatment settings, which may not represent the broader population of people with eating disorders. This study aimed to identify potential differences in the characteristics of individuals with eating disorders based on whether they self-reported accessing treatment or not, in order to contribute to a better understanding of their diverse needs and experiences. METHODS The study population included 762 community-recruited individuals (85% female, M ± SD age = 30 ± 7 years) with bulimia nervosa or binge-eating disorder (BN/BED) enrolled in the Binge Eating Genetics Initiative (BEGIN) United States study arm. Participants completed self-report surveys on demographics, treatment history, past and current eating disorder symptoms, weight history, and their current mental health and gastrointestinal symptoms. Untreated participants (n = 291, 38%) were compared with treated participants (n = 471, 62%) who self-reported accessing BN/BED treatment at some point in their lives. RESULTS Untreated participants disproportionately self-identified as male and as a racial or ethnic minority compared with treated participants. Treated participants reported a more severe illness history, specifically, an earlier age at onset, more longstanding and frequent eating disorder symptoms over their lifetime, and greater body dissatisfaction and comorbid mental health symptoms (i.e., depression, anxiety, ADHD) at the time of the study. A history of anorexia nervosa was positively associated with treatment engagement. Individuals self-reporting a history of inpatient or residential treatment exhibited the most severe illness history, those with outpatient treatment had a less severe illness history, and untreated individuals had the mildest illness history. CONCLUSIONS Historically overlooked and marginalized populations self-reported lower treatment access rates, while those who accessed treatment reported more severe eating disorder and comorbid mental health symptoms, which may have motivated them to seek treatment. Clinic-based recruitment samples may not represent individuals with milder symptoms or racial and ethnic diversity, and males. Community-based recruitment is crucial for improving the ability to apply research findings to broader populations and reducing disparities in medical research. Trial Registration ClinicalTrials.gov NCT04162574 ( https://clinicaltrials.gov/ct2/show/NCT04162574 ).
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Affiliation(s)
- Emily A. Carrino
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Rachael E. Flatt
- Department of Psychology and Neuroscience, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Pratiksha S. Pawar
- Department of Biotechnology, Dr D. Y. Patil Biotechnology and Bioinformatics Institute, Dr. D. Y. Patil Vidyapeeth, Pune, India
| | - Christina M. Sanzari
- Department of Psychology, State University of New York at Albany, Albany, NY USA
| | | | | | - Laura M. Thornton
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Cynthia M. Bulik
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Department of Nutrition, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Nobels Väg 12A, 171 65 Solna, Stockholm Sweden
| | - Hunna J. Watson
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
- Discipline of Psychology, School of Population Health, Curtin University, Perth, Australia
- Division of Paediatrics, School of Medicine, The University of Western Australia, Perth, Australia
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D'Avanzo B, Barbato A, Monzio Compagnoni M, Caggiu G, Allevi L, Carle F, Di Fiandra T, Ferrara L, Gaddini A, Sanza M, Saponaro A, Scondotto S, Tozzi VD, Giordani C, Corrao G, Lora A. The quality of mental health care for people with bipolar disorders in the Italian mental health system: the QUADIM project. BMC Psychiatry 2023; 23:424. [PMID: 37312076 PMCID: PMC10261835 DOI: 10.1186/s12888-023-04921-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 05/31/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND The assessment of the quality of care pathways delivered to people with severe mental disorders in a community-based system remains uncommon, especially using healthcare utilization databases. The aim of the study was to evaluate the quality of care provided to people with bipolar disorders taken-in-care by mental health services of four Italian areas (Lombardy, Emilia-Romagna, Lazio, province of Palermo). METHODS Thirty-six quality indicators were implemented to assess quality of mental health care for patients with bipolar disorders, according to three dimensions (accessibility and appropriateness, continuity, and safety). Data were retrieved from healthcare utilization (HCU) databases, which contain data on mental health treatments, hospital admissions, outpatient interventions, laboratory tests and drug prescriptions. RESULTS 29,242 prevalent and 752 incident cases taken-in-care by regional mental health services with a diagnosis of bipolar disorder in 2015 were identified. Age-standardized treated prevalence rate was 16.2 (per 10,000 adult residents) and treated incidence rate 1.3. In the year of evaluation, 97% of prevalent cases had ≥ 1 outpatient/day-care contacts and 88% had ≥ 1 psychiatric visits. The median of outpatient/day-care contacts was 9.3 interventions per-year. Psychoeducation was provided to 3.5% of patients and psychotherapy to 11.5%, with low intensity. 63% prevalent cases were treated with antipsychotics, 71.5% with mood stabilizers, 46.6% with antidepressants. Appropriate laboratory tests were conducted in less than one-third of prevalent patients with a prescription of antipsychotics; three quarters of those with a prescription of lithium. Lower proportions were observed for incident patients. In prevalent patients, the Standardized Mortality Ratio was 1.35 (95% CI: 1.26-1.44): 1.18 (1.07-1.29) in females, 1.60 (1.45-1.77) in males. Heterogeneity across areas was considerable in both cohorts. CONCLUSIONS We found a meaningful treatment gap in bipolar disorders in Italian mental health services, suggesting that the fact they are entirely community-based does not assure sufficient coverage by itself. Continuity of contacts was sufficient, but intensity of care was low, suggesting the risk of suboptimal treatment and low effectiveness. Care pathways were monitored and evaluated using administrative healthcare databases, adding evidence that such data may contribute to assess the quality of clinical pathways in mental health.
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Affiliation(s)
- Barbara D'Avanzo
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Angelo Barbato
- Department of Health Policy, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Matteo Monzio Compagnoni
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy.
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy.
| | - Giulia Caggiu
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Liliana Allevi
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
| | - Flavia Carle
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Center of Epidemiology and Biostatistics, Polytechnic University of Marche, Ancona, Italy
| | | | - Lucia Ferrara
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Michele Sanza
- Department of Mental Health and Substance Abuse, Local Health Trust of Romagna, Cesena, Italy
| | - Alessio Saponaro
- General Directorate of Health and Social Policies, Emilia-Romagna Region, Bologna, Italy
| | - Salvatore Scondotto
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Health Services and Epidemiological Observatory, Regional Health Authority, Sicily Region, Palermo, Italy
| | - Valeria D Tozzi
- Centre of Research on Health and Social Care Management, SDA Bocconi School of Management (Bocconi University, Milan, Italy
| | | | - Giovanni Corrao
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Unit of Biostatistics, Epidemiology and Public Health, Department of Statistics and Quantitative Methods, University of Milano-Bicocca, Street Bicocca degli Arcimboldi, 8, Building U7, Milan, 20126, Italy
| | - Antonio Lora
- National Centre for Healthcare Research and Pharmacoepidemiology, University of Milano-Bicocca, Milan, Italy
- Department of Mental Health and Addiction Services, ASST Lecco, Lecco, Italy
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El Miedany Y, El Gaafary M, Gadallah N, Mahran S, Fathi N, Abu Zaid MH, Tabra SAH, Hassan W, Elwakil W. Osteoporosis treatment gap in patients at risk of fracture in Egypt: a multi-center, cross-sectional observational study. Arch Osteoporos 2023; 18:58. [PMID: 37127804 DOI: 10.1007/s11657-023-01252-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Accepted: 04/19/2023] [Indexed: 05/03/2023]
Abstract
Despite the wide availability of a wide variety of approved osteoporosis medications and DXA scan centers in Egypt, only a minority of patients at high risk of sustaining a fragility fracture receive treatment, even after their first fracture. Such big "treatment gap" leaves the most high-risk individuals unprotected against fragility fractures. This study provides a benchmark to monitor national trends in osteoporosis management and service uptake. PURPOSE To assess the treatment gap among men and postmenopausal women presenting with a fragility fracture, and to analyze the characteristics and fracture risks of the patients presenting with an index fragility fracture. METHODS This was a multi-center, cross-sectional, observational study. Both men and postmenopausal women, admitted with an osteoporotic fracture (whether major osteoporosis or hip fracture), were consecutively recruited for this work. The fracture risk was assessed based on their FRAX calculation prior to the index fracture. All the patients were assessed for their falls and sarcopenia risks. Blood tests for bone profile as well as DXA scan were offered to all the patients. RESULTS Two hundred and thirty-six patients presenting with fragility fractures were included in this work. 70.8% were women and 29.2% were men. Mean age was 70.1 (SD = 9.2) years. Ten-year probability of fracture (without BMD) was high in 65.9% of the postmenopausal women and 40.3% of the men. 82.1% of the postmenopausal women and 100% in men identified to be eligible for osteoporosis therapy did not receive any form of osteoporosis therapy. FRAX score correlated significantly with bone mineral density assessment at both hip and spine. Falls, sarcopenia, and functional disability showed significant relation to the fracture risk. CONCLUSIONS There is a large treatment gap in Egyptian older adults. The recent guidelines for osteoporosis management in Egypt endorsed fracture centric approach to identify people at risk. The gap appears to be related to a low rate of osteoporosis diagnosis and lack of patient education.
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Affiliation(s)
- Yasser El Miedany
- Institute of Medical Sciences, Canterbury Christ Church University, Canterbury, England.
| | - Maha El Gaafary
- Community and Public Health, Ain Shams University, Cairo, Egypt
| | - Naglaa Gadallah
- Rheumatology and Rehabilitation, Ain Shams University, Cairo, Egypt
| | - Safaa Mahran
- Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | - Nihal Fathi
- Rheumatology and Rehabilitation, Assiut University, Assiut, Egypt
| | | | | | - Waleed Hassan
- Rheumatology and Rehabilitation, Benha University, Benha, Egypt
| | - Walaa Elwakil
- Rheumatology, Physcial Medicine and Rehabilitation, Alexandria University, Alexandria, Egypt
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Singh G, Singh MB, Ding D, Maulik P, Sander JW. Implementing WHO's Intersectoral Global Action Plan for epilepsy and other neurological disorders in Southeast Asia: a proposal. Lancet Reg Health Southeast Asia 2023; 10:100135. [PMID: 37197018 PMCID: PMC7614540 DOI: 10.1016/j.lansea.2022.100135] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/25/2022] [Accepted: 12/16/2022] [Indexed: 05/19/2023]
Abstract
The World Health Assembly approved the Intersectoral Global Action Plan for epilepsy and neurological disorders. Member states, including those in Southeast Asia, must now prepare to achieve IGAP's strategic targets by embracing novel approaches and strengthening existing policies and practices. We propose and present evidence to support four such processes. The opening course should engage all stakeholders to develop people-centric instead of outcome-centric approaches. Rather than caring for convulsive epilepsy alone, as currently done, primary care providers should also be skilled in diagnosing and treating focal and non-motor seizures. This could reduce the diagnostic gap as over half of epilepsies present with focal seizures. Currently, primary care providers lack knowledge and skills to manage focal seizures. Technology-enabled aids can help overcome this limitation. Lastly, there is need to add newer "easy to use" epilepsy medicines to Essential Medicines lists in light of emerging evidence for better tolerability, safety and user-friendliness.
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Affiliation(s)
- Gagandeep Singh
- Department of Neurology, Dayanand Medical College & Hospital, Ludhiana, India
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
| | - Mamta B. Singh
- Department of Neurology, All India Institute of Medical Sciences, New Delhi, India
| | - Ding Ding
- Institute of Neurology, Fudan University Hospital, Shanghai, China
| | - Pallab Maulik
- George Institute for Global Health, New Delhi, India
| | - Josemir W. Sander
- Department of Clinical & Experimental Epilepsy, UCL Queen Square Institute of Neurology, Queen Square, London, UK
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede 2103 SW, the Netherlands
- Neurology Department, West of China Hospital, Sichuan University, Chengdu 61004, China
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Samia P, Sahu JK, Ali A, Caraballo RH, Chan J, Coan AC, Fortini PS, Gwer S, Jocic-Jakubi B, Kissani N, Rivera Y, Sarfo FS, Singh MB, Trinka E, Yoo JY, Yu HY, Zelano J, Cross JH. Telemedicine for Individuals with epilepsy: Recommendations from International League Against Epilepsy Telemedicine Task Force. Seizure 2023; 106:85-91. [PMID: 36803864 DOI: 10.1016/j.seizure.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 02/05/2023] [Accepted: 02/06/2023] [Indexed: 02/12/2023] Open
Abstract
Worldwide, People with Epilepsy (PWE) are confronted with several barriers to face-to-face consultations. These obstacles hamper appropriate clinical follow-up and also increase the treatment gap for Epilepsy. Telemedicine holds the potential to enhance management as follow-up visits for PWE are focused on more on clinical history and counselling rather than physical examination. Besides consultation, telemedicine can also be used for remote EEG diagnostics and tele-neuropsychology assessments. In this article, the Telemedicine Task Force of the International League Against Epilepsy (ILAE) outlines recommendations regarding optimal practice in utilizing in the management of individuals with epilepsy. We formulated recommendations for minimum technical requirements, preparing for the first tele-consultation and the specificities for follow-up consultations. Special considerations are necessary for specific populations, including paediatric patients, patients who are not conversant with tele-medicine and those with intellectual disability. Telemedicine for individuals with epilepsy should be vigorously promoted with the aim of improving the quality of care and ultimately reduce the wide clinician access related treatment gap across several regions of the globe.
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Tarantino U, Greggi C, Visconti VV, Cariati I, Bonanni R, Gasperini B, Iundusi R, Gasbarra E, Tranquilli Leali P, Brandi ML. Fracture liaison service model: project design and accreditation. Osteoporos Int 2023; 34:339-348. [PMID: 36422656 PMCID: PMC9852196 DOI: 10.1007/s00198-022-06600-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
UNLABELLED Frailty fractures place a significant socioeconomic burden on the health care system. The Italian Society of Orthopaedics and Traumatology (SIOT) is proceeding to fracture liaison service (FLS) model accreditation in several Italian Fracture Units (FUs), which provides a multidisciplinary approach for the management of the fragility fracture patient. INTRODUCTION Osteoporosis and the resulting fragility fractures, particularly femoral fractures, place significant socioeconomic burdens on the health care system globally. In addition, there is a general lack of awareness of osteoporosis, resulting in underestimation of the associated risks and suboptimal treatment of the disease. The fracture liaison service (FLS) represents an exemplary model of post-fracture care that involves a multidisciplinary approach to the frail patient through the collaboration of multiple specialists. The purpose of this article is to highlight the path undertaken by the Italian Society of Orthopaedics and Traumatology (SIOT) for the purpose of certification of numerous FLS centers throughout Italy. METHODS SIOT is proceeding with international FLS accreditation in several Italian Fracture Units (FUs), following the creation of a model that provides specific operational and procedural steps for the management of fragility fractures throughout the country. FUs that decide to join the project and implement this model within their facility are then audited by an ACCREDIA-accredited medical certification body. RESULTS The drafted FLS model, thanks to the active involvement of a panel of experts appointed by SIOT, outlines a reference operational model that describes a fluid and articulated process that identifies the procedure of identification, description of diagnostic framing, and subsequent initiation of appropriate secondary prevention programs for fractures of individuals who have presented with a recent fragility fracture of the femur. CONCLUSION Accreditation of this prevention model will enable many facilities to take advantage of this dedicated diagnostic-therapeutic pathway for the purpose of fracture prevention and reduction of associated health and social costs.
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Affiliation(s)
- U Tarantino
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy.
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy.
| | - C Greggi
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - V V Visconti
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - I Cariati
- Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - R Bonanni
- Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - B Gasperini
- Department of Biomedicine and Prevention, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
| | - R Iundusi
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy
| | - E Gasbarra
- Department of Clinical Sciences and Translational Medicine, "Tor Vergata" University of Rome, Via Montpellier 1, 00133, Rome, Italy
- Department of Orthopaedics and Traumatology, "Policlinico Tor Vergata" Foundation, Viale Oxford 81, 00133, Rome, Italy
| | | | - M L Brandi
- FIRMO Foundation, Via San Gallo 123, 50100, Florence, Italy
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Abstract
The annual number of patients treated for osteoporosis between 1998 and 2018 in Switzerland increased until 2008 and steadily decreased thereafter. With a continuously growing population at fracture risk exceeding an intervention threshold, the treatment gap has increased and the incidence of hip fractures has stopped declining in the past decade. INTRODUCTION The existence of an osteoporosis treatment gap, defined as the percentage of patients at risk for osteoporotic fractures exceeding an intervention threshold but remaining untreated, is widely acknowledged. Between 1998 and 2018, new bone active substances (BAS) indicated for the treatment of osteoporosis became available. Whether and if so to what extent these new introductions have altered the treatment gap is unknown. METHODS The annual number of patients treated with a BAS was calculated starting from single-drug unit sales. The number of patients theoretically eligible for treatment with a BAS was estimated based on four scenarios corresponding to different intervention thresholds (one based solely on a bone mineral density T score threshold and three FRAX-based thresholds) and the resulting annual treatment gaps were calculated. RESULTS In Switzerland, the estimated number of patients on treatment with a BAS increased from 35,901 in year 1998 to 233,381 in year 2018. However, this number grew regularly since 1998, peaked in 2008, and steadily decreased thereafter, in timely coincidence with the launch of intravenous bisphosphonates and the RANKL inhibitor denosumab. When expressed in numbers of untreated persons at risk for osteoporotic fractures exceeding a given intervention threshold, the treatment gaps were of similar magnitude in 1998 (when the first BSAs just had become available) and 2018. There was a strong association, which does not imply causation, between the proportion of patients treated and hip fracture incidence. CONCLUSION In Switzerland, the osteoporosis treatment gap has increased over the past decade. The availability of new BAS has not contributed to its decrease.
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Affiliation(s)
- Kurt Lippuner
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Bita Yousefi Moghadam
- Department of Osteoporosis, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Patrick Schwab
- Swiss Federal Statistical Office, Neuchâtel, Switzerland
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Krawczyk N, Rivera BD, Jent V, Keyes KM, Jones CM, Cerdá M. Has the treatment gap for opioid use disorder narrowed in the U.S.?: A yearly assessment from 2010 to 2019". Int J Drug Policy 2022; 110:103786. [PMID: 35934583 DOI: 10.1016/j.drugpo.2022.103786] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/20/2022] [Accepted: 06/27/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The United States overdose crisis continues unabated. Despite efforts to increase capacity for treating opioid use disorder (OUD) in the U.S., how actual treatment receipt compares to need remains unclear. In this cross-sectional study, we estimate progress in addressing the gap between OUD prevalence and OUD treatment receipt at the national and state levels from 2010 to 2019. METHODS We estimated past-year OUD prevalence rates based on the U.S. National Survey on Drug Use and Health (NSDUH), using adjustment methods that attempt to account for OUD underestimation in national household surveys. We used data from specialty substance use treatment records and outpatient pharmacy claims to estimate the gap between OUD prevalence and number of persons receiving medications for opioid use disorder (MOUD) during the past decade. RESULTS Adjusted estimates suggest past-year OUD affected 7,631,804 individuals in the U.S. in (2,773 per 100,000 adults 12+), relative to only 1,023,959 individuals who received MOUD (365 per 100,000 adults 12+). This implies approximately 86.6% of individuals with OUD nationwide who may benefit from MOUD treatment do not receive it. MOUD receipt increased across states over the past decade, but most regions still experience wide gaps between OUD prevalence and MOUD receipt. CONCLUSIONS Despite some progress in expanding access to MOUD, a substantial gap between OUD prevalence and treatment receipt highlights the critical need to increase access to evidence-based services.
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Affiliation(s)
- Noa Krawczyk
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States.
| | - Bianca D Rivera
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Victoria Jent
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
| | - Katherine M Keyes
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, 10032, United States
| | - Christopher M Jones
- National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, NYU Grossman School of Medicine, New York, NY, United States
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Philip S, Chander KR, Varshney P, Patley R, Pandey P, Suhas S, Nirisha PL, Suchandra, Vinay B, Manjunatha N, Kumar CN, Math SB. The Legality and Ethical Issues of Certifying Laypersons as Mental Health Counselors in India. Indian J Psychol Med 2022; 44:537-543. [PMID: 36339686 PMCID: PMC9615441 DOI: 10.1177/02537176221074253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND The burden of mental health conditions and consequent disability impacts are felt most in low- and middle-income settings. These settings are constrained by the limited availability of resources to provide even essential aspects of mental health care (MHC). Task shifting and sharing interventions have shown promise in delivering community-based MHC across such low-resource settings. Some counseling tasks such as friendship bench interventions have been successfully shifted to laypersons. However, ethical and legal concerns regarding laypersons' incorporation in MHC delivery systems have not been examined. PURPOSE To examine the ethical and legal concerns surrounding the certification of laypersons as community-based mental health counselors. METHOD We undertook an academic review of various legislations pertinent to MHC service delivery and the certification of allied health care professionals to inform on acceptable and tenable strategies toward incorporating such a task-shifted intervention. CONCLUSION Scaling up the training of human resources to address access problems can be the first step in addressing the MHC access and treatment gaps. The certification of laypersons as community-based mental health counselors, although legally tenuous, can be pioneered by tertiary-level MHC institutions. This certification has sound ethical justification and is a progressive step toward realizing universal mental health coverage.
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Affiliation(s)
- Sharad Philip
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - K Rakesh Chander
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Prateek Varshney
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Rahul Patley
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Praveen Pandey
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Satish Suhas
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - P Lakshmi Nirisha
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Suchandra
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - B Vinay
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Narayana Manjunatha
- Telemedicine Centre, Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - C Naveen Kumar
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
| | - Suresh Bada Math
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, Karnataka, India
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Abstract
Osteoporosis care has evolved markedly over the last 50 years, such that there are now an established clinical definition, validated methods of fracture risk assessment, and a range of effective pharmacological agents. However, it is apparent that both in the context of primary and secondary fracture prevention, there is a considerable gap between the population at high fracture risk and those actually receiving appropriate antiosteoporosis treatment. In this narrative review article, we document recent work describing the burden of disease, approaches to management, and service provision across Europe, emerging data on gaps in care, and existing/new ways in which these gaps may be addressed at the level of healthcare systems and policy. We conclude that although the field has come a long way in recent decades, there is still a long way to go, and a concerted, integrated effort is now required from all of us involved in this field to address these urgent issues to ensure the best possible outcomes for our patients.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK; NIHR Oxford Biomedical Research Centre, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK.
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22
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Stelzle D, Kaducu J, Schmidt V, Welte TM, Ngowi BJ, Matuja W, Escheu G, Hauke P, Richter V, Ovuga E, Pfausler B, Schmutzhard E, Amos A, Harrison W, Keller L, Winkler AS. Characteristics of people with epilepsy in three Eastern African countries - a pooled analysis. BMC Neurol 2022; 22:321. [PMID: 36028820 PMCID: PMC9414166 DOI: 10.1186/s12883-022-02813-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Epilepsy is one of the most common neurological disorders worldwide. Yet, its treatment gap is large in some areas and especially in sub-Saharan Africa data on clinical, radiological and semiological characteristics, as well as on treatment of persons with epilepsy (PWE) are still scarce. METHODS We pooled data from four cross-sectional studies on epilepsy in eastern Africa. Two studies from Malawi and Uganda were community-based; two studies in Tanzania (urban Dar es Salaam and rural Haydom) were hospital-based. Clinical characteristics of PWE were assessed by the same questionnaire. Additionally, data on treatment were collected and computed tomography (CT) scans were performed. RESULTS Overall, 1179 PWE were included in our analysis (581 (49.3%) female, median age 22 years (IQR 15-32 years)). Up to 25% of the patients had focal onset seizures. Those showed a higher rate of remarkable CT scan findings, with especially post-ischaemic and neurocysticercosis-associated lesions, compared to PWE with generalized onset seizures (35.1% vs. 20%). The majority of the patients experienced tonic-clonic seizures (70-85%). Only 67-78% of PWE received anti-seizure medication (ASM) treatment in the community-based studies, mostly monotherapy with phenobarbital, phenytoin or carbamazepine. Yet, underdosage was frequent and a large proportion of PWE received alternative non-ASM treatment consisting of herbal treatment (up to 83%) and/or scarification (up to 20%). CONCLUSIONS Epilepsy is common in sub-Saharan Africa, often caused by neurocysticercosis or ischaemic strokes. PWE suffer from high seizure rates and subsequent injuries, as well as from socio-economic consequences due to insufficient ASM treatment. This pooled analysis illustrates the need for structural programmes for adequate identification, education, assessment and treatment of PWE in sub-Saharan Africa.
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Affiliation(s)
- Dominik Stelzle
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany
| | - Joyce Kaducu
- grid.415705.2Ministry of Health, Kampala, Republic of Uganda
| | - Veronika Schmidt
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.5510.10000 0004 1936 8921Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tamara M. Welte
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.411668.c0000 0000 9935 6525Department of Neurology, University Hospital Erlangen, Erlangen, Germany
| | - Bernard J. Ngowi
- grid.416716.30000 0004 0367 5636National Institute for Medical Research, Muhimbili Medical Research Centre, Dar es Salaam, Tanzania ,grid.8193.30000 0004 0648 0244University of Dar Es Salaam, Mbeya College of Health and Allied Sciences, Mbeya, Tanzania
| | - William Matuja
- grid.25867.3e0000 0001 1481 7466Department of Neurology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Gabrielle Escheu
- Department of Neurology, Kliniken Ostallgaeu-Kaufbeuren, Kaufbeuren, Germany
| | - Peter Hauke
- Department of Neurology, Kliniken Ostallgaeu-Kaufbeuren, Kaufbeuren, Germany
| | - Vivien Richter
- grid.411544.10000 0001 0196 8249Department of Radiology, University Hospital Tuebingen, Tuebingen, Germany
| | - Emilio Ovuga
- grid.442626.00000 0001 0750 0866Department of Mental Health, University of Gulu, Gulu, Uganda
| | - Bettina Pfausler
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Erich Schmutzhard
- grid.5361.10000 0000 8853 2677Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Action Amos
- National Epilepsy Association Malawi, International Bureau of Epilepsy, Lilongwe, Malawi
| | - Wendy Harrison
- grid.7445.20000 0001 2113 8111Department of Infectious Disease Epidemiology, Imperial College London, London, UK
| | - Luise Keller
- grid.6936.a0000000123222966Department of Neurology, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andrea S. Winkler
- grid.6936.a0000000123222966Center for Global Health, Department of Neurology, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675 Munich, Germany ,grid.5510.10000 0004 1936 8921Centre for Global Health, Institute of Health and Society, University of Oslo, Oslo, Norway
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Rens E, Michielsen J, Dom G, Remmen R, Van den Broeck K. Clinically assessed and perceived unmet mental health needs, health care use and barriers to care for mental health problems in a Belgian general population sample. BMC Psychiatry 2022; 22:455. [PMID: 35799153 PMCID: PMC9263045 DOI: 10.1186/s12888-022-04094-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/21/2022] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND Mental health problems often remain undetected and untreated. Prior research suggests that this is mainly due to a lack of need-perception and attitudinal barriers. The aim of this study is to examine unmet mental health needs using both a clinically assessed and a self-perceived approach in a Belgian province. METHODS A cross-sectional survey study with a weighted representative sample of 1208 individuals aged 15 - 80 years old was carried out in 2021 in the province of Antwerp (Belgium). Mental health needs were defined as a positive symptom screening for depression (PHQ-9), anxiety (GAD-7) or alcohol abuse (AUDIT-C and CAGE), combined with experiencing significant dysfunction in daily life. Also 12-month health care use for mental health problems, self-perceived unmet mental health needs and reasons for not seeking (extra) help were assessed. Logistic regression analyses were used to explore the predictors of mental health problems, health care use, and objective and subjective unmet mental health needs. RESULTS One in five participants had a positive screening on one of the scales, of whom half experienced dysfunction, leading to a prevalence of 10.4% mental health needs. Among those, only half used health care for their mental health, resulting in a population prevalence of 5.5% clinically assessed unmet mental health needs. Fourteen percent of the total sample perceived an unmet mental health need. However, more women and younger people perceived unmet needs, while clinically assessed unmet needs were higher among men and older people. One in six of the total sample used health care for their mental health, most of whom did not have a clinically assessed mental health need. Motivational reasons were most often endorsed for not seeking any help, while a financial barrier was the most important reason for not seeking extra help. CONCLUSIONS The prevalence of unmet mental health needs is high. Assessed and perceived (unmet) mental health needs are both relevant and complementary, but are predicted by different factors. More research is needed on this discrepancy.
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Affiliation(s)
- Eva Rens
- Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium. .,Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium. .,University of Antwerp, Gouverneur Kinsbergencentrum Room 00.56, Doornstraat 331, 2610, Wilrijk, Belgium.
| | - Joris Michielsen
- grid.11505.300000 0001 2153 5088Institute of Tropical Medicine (ITM), Antwerp, Belgium
| | - Geert Dom
- grid.5284.b0000 0001 0790 3681Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium
| | - Roy Remmen
- grid.5284.b0000 0001 0790 3681Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- grid.5284.b0000 0001 0790 3681Collaborative Antwerp Psychiatric Research Institute (CAPRI), University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681Family Medicine and Population Health (FAMPOP), University of Antwerp, Antwerp, Belgium
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Yavropoulou MP, Makras P, Athanasakis K, Bournia VK, Mathioudakis K, Tsolakidis A, Kassi E, Kaltsas G, Mitrou P, Sfikakis PP. Prevalence and patterns of anti-osteoporotic drug use based on 2019 real-world nationwide data in Greece. Arch Osteoporos 2022; 17:86. [PMID: 35761110 DOI: 10.1007/s11657-022-01126-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 06/07/2022] [Indexed: 02/03/2023]
Abstract
We used the Greek nationwide database to capture individuals on anti-osteoporotic treatment during 2019. From the estimated number of 683,679 osteoporotic individuals, only 42% were receiving treatment, with the total annual cost being almost one-tenth of the total cost of fractures. The treatment gap was significantly higher in males than in females. INTRODUCTION Based on the 2019 European scorecard (SCOPE), osteoporosis is diagnosed in an estimated 683,679 individuals in Greece, with the direct cost of incident fractures being €694.7 million, although further relevant real-world data are scarce. METHODS The e-Government Center for Social Security Services prescription database, which covers almost 100% of the Greek population, was used to capture all individuals on anti-osteoporotic treatment during 2019. RESULTS A total of 288,983 among 8,641,341 people, corresponding to 3.3% of the total adult Greek population, had filled at least one anti-osteoporotic prescription (6.0% and 0.36% for females and males, respectively). Prevalence of anti-osteoporotic treatment increased with age, from 0.15% in those younger than 50 to 8.6% in those older than 70 years. Oral bisphosphonates were more frequently prescribed (58.8%), followed by denosumab (39.4%). Alendronate was more frequently prescribed in males and in people younger than 60 years. Denosumab was more frequently prescribed in females and in people older than 60 years. Selective estrogen-receptor modulators, teriparatide, and parenteral bisphosphonates accounted for 1.1%, 1.0%, and 0.02% of all prescriptions, respectively. Orthopedic surgeons (39.6%), endocrinologists (19.6%), general practitioners (19%), and rheumatologists (9.3%) prescribed the vast majority of anti-osteoporotic regimens, with significant differences in prescription patterns. The annual cost of treatment per patient increased significantly with age, being on average €323.33. CONCLUSIONS Less than half of the estimated number of individuals with osteoporosis in 2019 in Greece received treatment, with the total annual cost being far less than the estimated cost of incident-fragility fractures. The impact of this undertreatment on related health care costs merits further investigation.
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McCloskey E, Rathi J, Heijmans S, Blagden M, Cortet B, Czerwinski E, Hadji P, Payer J, Palmer K, Stad R, O'Kelly J, Papapoulos S. Prevalence of FRAX risk factors and the osteoporosis treatment gap among women ≥ 70 years of age in routine primary care across 8 countries in Europe. Arch Osteoporos 2022; 17:20. [PMID: 35064844 PMCID: PMC8783912 DOI: 10.1007/s11657-021-01048-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 12/06/2021] [Indexed: 02/03/2023]
Abstract
We studied whether elderly women at risk for fractures receive primary care treatment to prevent fracture. We found that across Europe, women at risk are often not identified, and less than half of such women receive appropriate treatment. Finally, women diagnosed with osteoporosis are much more likely to receive treatment. PURPOSE To examine the relationship between risk factors for fragility fracture (FF) and osteoporosis (OP) treatment gap in elderly women across Europe, and compare the prevalence of risk factors between countries. METHODS Demographic and clinical information was collected from women ≥ 70 years visiting primary care physicians in Belgium, France, Germany, Ireland, Poland, Slovakia, Switzerland, and the UK. Increased risk of FF was defined by the presence of 1 or more criteria (history of fracture, 10-year fracture probability, or T-score ≤ - 2.5). RESULTS There were 3798 women in total. Treatment gap (proportion at increased risk of FF not receiving treatment for OP) varied from 53.1 to 90.8% across countries, and the proportion of patients at increased risk of FF varied from 41.2 to 76.1%. Across countries, less than 50% of patients with increased risk of FF had a diagnosis of OP. Previous fracture was the most common risk factor, with similar prevalence across most countries; other risk factors varied widely. The treatment gap was reduced in patients with an OP diagnosis in all countries, but this reduction varied from 36.5 to 79.4%. The countries with the lowest rates of bone densitometry scans (Poland, France, and Germany; 8.3-12.3%) also had the highest treatment gap (82.2 to 90.8%). CONCLUSIONS This study highlights differences across Europe in clinical risk factors for fracture, rates of densitometry scanning, and the rates of OP diagnosis. More emphasis is needed on risk assessment to improve the identification and treatment of elderly women at risk for fracture.
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Affiliation(s)
- Eugene McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | | | | | | | - Bernard Cortet
- Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
| | - Edward Czerwinski
- Department of Bone and Joint Diseases, FHS, Jagiellonian University Medical College, Kopernika 32, 31-501, Krakow, Poland
| | - Peyman Hadji
- Frankfurt Center of Bone Health, Frankfurt, Germany.,Philipps-University of Marburg, Marburg, Germany
| | - Juraj Payer
- Faculty of Medicine, 5th Department of Internal Medicine in University Hospital Bratislava, Comenius University, Bratislava, Slovakia
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Jadnanansing R, de Beurs E, Etwaroo K, Blankers M, Dwarkasing R, Peen J, Lumsden V, Bipat R, Dekker J. A survey of depression and anxiety disorders in urban and rural Suriname. BMC Public Health 2022; 22:51. [PMID: 34998381 PMCID: PMC8742324 DOI: 10.1186/s12889-021-12454-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 12/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suriname is a Low-middle income country consisting of diverse population groups. Epidemiological studies concerning mental disorders like depression and anxiety had not been conducted until 2015. The treatment gap for mental disorders in Low and middle-income countries (LMICs) may reach 76-80% as treatment is not always readily available. In this study, we estimate and compare the prevalence of potential cases of depression and anxiety, as well as the size of the treatment gap in a rural (Nickerie) and urban (Paramaribo) region of Suriname, a lower middle-income country. METHODS Subjects were selected by a specific sampling method of the national census bureau. The Center for Epidemiological Studies-Depression (CES-D) was used to assess depression. Generalized anxiety disorder was assessed with the Generalized Anxiety Disorder 7 (GAD-7) and The Agoraphobic Cognitions Questionnaire (ACQ), the Body Sensations Questionnaire (BSQ) were used to assess Panic disorder. The treatment gap was calculated by estimating the percentage of subjects with depression or anxiety that did not seek out professional help. RESULTS About 18% of the respondents from Nickerie and 16% from Paramaribo were at risk of depression and the established cut-off values of the instruments used indicate that about 3-4% in both regions may suffer from Generalized Anxiety Disorder. Women in both samples were most at risk of high anxiety about body sensations and maladaptive thoughts about panic. The treatment gap varies between 78 and 100% for the two disorders. CONCLUSIONS A high depression rate has been found in both areas, especially among young females. In addition, a high treatment gap is noted which insinuates that more therapeutic strategies are required to tackle depression and anxiety in Suriname.
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Affiliation(s)
- Raj Jadnanansing
- Center for Psychiatry in Suriname and Faculty of Social Science, Anton de Kom University of Suriname, Letitia Vriesdelaan 1 - 3, Paramaribo, Suriname.
| | - Edwin de Beurs
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands.,Department of Clinical Psychology, Faculty of Social Sciences, Leiden University, Leiden, The Netherlands
| | - Kajal Etwaroo
- Center for Psychiatry in Suriname and Faculty of Social Science, Anton de Kom University of Suriname, Letitia Vriesdelaan 1 - 3, Paramaribo, Suriname
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Rudi Dwarkasing
- Center for Psychiatry in Suriname and Department of Psychiatry, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Jaap Peen
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Vincent Lumsden
- Center for Psychiatry in Suriname and Department of Psychiatry, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Robbert Bipat
- Department of Physiology, Faculty of Medicine, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands.,Department of Clinical Psychology, VU University Amsterdam, Amsterdam, The Netherlands
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Mekonen T, Chan GCK, Connor JP, Hides L, Leung J. Estimating the global treatment rates for depression: A systematic review and meta-analysis. J Affect Disord 2021; 295:1234-42. [PMID: 34665135 DOI: 10.1016/j.jad.2021.09.038] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/02/2021] [Accepted: 09/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Depression is considered a global crisis due to its high prevalence and associated disabilities. The burden posed by depression could be reduced by increasing access to timely treatment. Limited information is available on treatment rates of depression, particularly in low- and middle-income countries. This study aimed to estimate the treatment rates for depression in the general adult population by World Bank income classification. METHODS We searched PubMed, EMBASE, PsycINFO, and CINAHL, supplemented with hand-search of reference lists to identify community-based studies. The overall treatment rate for depression was estimated from studies that reported any treatment (behavioral or pharmacological treatments) in healthcare or informal non-healthcare settings. Data were pooled using a random-effects meta-analysis model. Subgroup analyses by income classification were completed. Meta-regression was conducted by study characteristics. The protocol was pre-registered at PROSPERO (CRD42020161683). RESULTS We included 65 studies comprising 1.1 million participants from 79 countries and territories. The global 12-month/lifetime pooled treatment rate was 34.8% (95% confidence interval: 29.9, 39.9%). The treatment rates were 48.3% (43.0, 53.6%) in high-income countries, 21.4% (15.1, 27.7%) in middle-income countries, and 16.8% (11.3, 23.0%) in low-income countries. Among the treated samples, 12-month minimally adequate treatment was estimated to be 40%. LIMITATION We reported a substantial level of between-study heterogeneity, which was partially explained by study characteristics in the meta-regression. CONCLUSION Globally, approximately one-third of people with depression receive treatment. Three in five treated people with depression did not receive minimally adequate treatment. Depression treatment rates are considerably lower in low-and middle-income countries.
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Arshad F, MM S, Paplikar A, Rajendran S, Kalkonde Y, Alladi S. Vascular cognitive impairment in India: Challenges and opportunities for prevention and treatment. Cereb Circ Cogn Behav 2021; 3:100034. [PMID: 36324418 PMCID: PMC9616277 DOI: 10.1016/j.cccb.2021.100034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 10/22/2021] [Accepted: 11/23/2021] [Indexed: 06/16/2023]
Abstract
The burden of vascular contribution to cognitive impairment and dementia is substantially high in India. There are approximately 5.3 million dementia patients in India and nearly 40% are estimated to be due to vascular dementia. Several factors pose unique challenges to reducing the burden of vascular dementia and vascular cognitive impairment (VCI) in India. Wide heterogeneity in vascular risk factor profile, diversity in socioeconomic, ethnic and dietary factors, as well as regional and rural-urban differences impact uniform implementation of preventive and therapeutic strategies. There is limited evidence on the natural history of vascular disease from longitudinal cohorts in India. Additionally, the lack of advanced brain imaging and genetic information pose challenges to understanding pathophysiology and treatment response to VCI in India. Efforts are now being made to implement programmes to reduce cardiovascular risk and VCI at the population level. Cognitive and functional measures appropriate to the diverse linguistic and educational context have been developed to diagnose VCI across India. Multicentric clinical and research cohorts of stroke are also being established. Filling research gaps and developing intervention strategies for the Indian context are crucial to address the growing burden of VCI.
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Affiliation(s)
- Faheem Arshad
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Samim MM
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Avanthi Paplikar
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Srijithesh Rajendran
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | - Suvarna Alladi
- Department of Neurology, National Institute of Mental Health and Neurosciences, Bengaluru, India
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Srivastava K, Agarwal E, Rajadhyaksha S, Deshmukh R, Kulkarni V, Doke P, Narula A, Gothankar J, Patil A, Gadgil M. Significant treatment gap and co-morbidities identified in an epidemiological survey of pediatric epilepsy in rural suburbs of India. Seizure 2021; 91:417-424. [PMID: 34311203 DOI: 10.1016/j.seizure.2021.07.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 07/10/2021] [Accepted: 07/13/2021] [Indexed: 11/26/2022] Open
Abstract
PURPOSE A cross-sectional epidemiological survey of children was conducted in two rural clusters to estimate the point prevalence and study various aspects of childhood epilepsy. MATERIAL AND METHODS In the first stage, a house-to-house survey was conducted by health workers using a screening questionnaire, which was pre-validated in a pilot study. All screen positive houses were visited by pediatric neurologist for detailed evaluation. Children with a clinical diagnosis of epilepsy underwent EEG and were evaluated for type of seizure, epilepsy syndrome, etiology, co-morbidities and treatment gap. Knowledge, attitude and practice regarding epilepsy was assessed amongst caregivers of the affected children. RESULTS A total population of 75,455 population was screened, 19,181 children aged 2 months to 18 years were identified. Out of 355 screen positive children, 66 were diagnosed with epilepsy. The point prevalence of pediatric epilepsy was 3.44 per 1000 children. 53% had focal epilepsy, 31.8% had an identifiable epilepsy syndrome, 44% had at least one comorbidity. The etiology was identified in 68%, the commonest being perinatal brain insult. The magnitude of treatment gap was 45.45%, with significant deficits in knowledge. CONCLUSION There are significant deficits in diagnosis and treatment of pediatric epilepsy among the rural population of India. The existing rural health care facilities need to be augmented to facilitate the timely diagnosis and optimum care of these children, including care of associated co-morbidities.
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Affiliation(s)
- Kavita Srivastava
- Pediatric neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India.
| | - Ekta Agarwal
- Pediatric neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Surekha Rajadhyaksha
- Pediatric neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Ruturaj Deshmukh
- Pediatric neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Vishwanath Kulkarni
- Pediatric neurology Unit, Department of Pediatrics, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Prakash Doke
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Aps Narula
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Jayashree Gothankar
- Department of Community Medicine, Bharati Vidyapeeth Deemed University Medical College, Pune, India
| | - Archana Patil
- State Health Systems Resource Center, Pune, Maharashtra, India
| | - Mukta Gadgil
- State Health Systems Resource Center, Pune, Maharashtra, India
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Gaiha SM, Gulfam FR, Siddiqui I, Kishore R, Krishnan S. Pilot Community Mental Health Awareness Campaign Improves Service Coverage in India. Community Ment Health J 2021; 57:814-27. [PMID: 33052548 DOI: 10.1007/s10597-020-00714-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 09/19/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Low community awareness of mental health problems negatively impacts treatment-seeking for such problems. Despite a shortage of mental health providers, there is scope to improve coverage of mental health services in India. In this study, we examined the impact of a multi-state community-based awareness campaign on knowledge, attitude, treatment-seeking behavior and acceptability. METHODS Campaign activities included educational materials, public meetings, musical announcements, quizzes, and street plays, followed by a mental health screening camp. A rapid, real-world evaluation was conducted using post-intervention surveys (n = 693), field notes and telephonic interviews in five states. RESULTS The campaign, implemented as a public-private partnership between government service providers and community-based organizations, reached ~ 3000 people in 20 new locations across five states. As a result of the campaign, 1,176 persons sought treatment services for mental disorders and 66% received a preliminary diagnosis. Collectively, campaign activities were the first time that ~ 75% of participants reported learning about mental health problems. Participants expressed knowledge that mental disorders are treatable, listed common symptoms and location of available mental health services and attitudes supporting people with mental health problems. CONCLUSION The campaign enabled improved coverage for mental health services, potentially by enhancing knowledge, attitude and treatment-seeking behavior. Future research may develop a quasi-experimental evaluation of the current campaign methodology.
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Rubeis G. E-mental health applications for depression: an evidence-based ethical analysis. Eur Arch Psychiatry Clin Neurosci 2021; 271:549-55. [PMID: 31894391 DOI: 10.1007/s00406-019-01093-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/18/2019] [Indexed: 12/23/2022]
Abstract
E-mental health applications (apps) are an increasingly important factor for the treatment of depression. To assess the risks and benefits for patients, an in-depth ethical analysis is necessary. The objective of this paper is to determine the ethical implications of app-based treatment for depression. An evidence-based ethical analysis was conducted. The material was meta-reviews and randomized control studies (RCTs) on app-based treatment. Based on the empirical data, an ethical analysis was conducted using the 3-ACES-approach by Thornicroft and Tansella. Apps may empower autonomy, offer an uninterrupted series of contacts over a period of time, show evidence-based benefits for patients with subclinical and mild-to-moderate-symptoms, are easily accessible, may be used for coordinating information and services within an episode of care, and are on the whole cost-effective. Their risks are that they are not suitable for the whole range of severity of mental illnesses and patient characteristics, show severe deficits in the data privacy policy, and a big variability in quality standards. The use of apps in depression treatment can be beneficial for patients as long as (1) the usefulness of an app-based treatment is assessed for each individual patient, (2) apps are chosen according to symptom severity as well as characteristics like the patient's level of self-reliance, their e-literacy, and their openness vis-à-vis apps, (3) manufacturers improve their privacy policies and the quality of apps.
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32
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Sebela A, Byatt N, Formanek T, Winkler P. Prevalence of mental disorders and treatment gap among Czech women during paid maternity or parental leave. Arch Womens Ment Health 2021; 24:335-338. [PMID: 32691155 DOI: 10.1007/s00737-020-01052-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 07/16/2020] [Indexed: 10/23/2022]
Abstract
We performed a secondary analysis of the data from Czech epidemiological study on mental health to determine the prevalence of mental disorders among Czech women on maternity or parental leave and to assess the present treatment gap. Any mental disorder was present in 17.6% (n = 21) of the total sample of 119 women. The treatment gap was present among 76% (n = 16) of them. In conclusion, most women on maternity or parental leave facing a mental disorder were not receiving treatment. The present study is the first of its kind in the region of Central and Eastern Europe.
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Affiliation(s)
- A Sebela
- Department of Diagnostics and Treatment of Mental Disorders, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czechia.
| | - N Byatt
- UMass Memorial Health Care, University of Massachusetts Medical School, 55 North Lake Ave, Worcester, MA, 01655, USA
| | - T Formanek
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czechia
| | - P Winkler
- Department of Public Mental Health, National Institute of Mental Health, Topolová 748, 250 67, Klecany, Czechia
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Narasimha VL, Mathew Y, Anil S, Murthy P. A study to evaluate availability of tobacco cessation services in Bengaluru, India. Asian J Psychiatr 2021; 58:102600. [PMID: 33607349 DOI: 10.1016/j.ajp.2021.102600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 01/25/2021] [Accepted: 02/07/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND In India, 28.6 % of the population use tobacco products. OBJECTIVE AND METHODS To evaluate the availability of tobacco cessation services in 101 hospitals in Bengaluru. RESULTS Only 4 out of 101 hospitals evaluated had a separate Tobacco Cessation Clinic; 24 % provided minimal services for people with addiction related problems; 28 % had at least one resident counsellor; additional 10 % had a visiting counsellor. All four of them provided counselling and medication. CONCLUSIONS Availability of tobacco cessation services in Bengaluru is minimal. It is important to upscale availability of cessation services both for tobacco and other substance use.
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Affiliation(s)
- Venkata Lakshmi Narasimha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
| | - Yohann Mathew
- BSc Biotechnology, Ramnarain Ruia Autonomous college, Mumbai, Intern Cipla Health Ltd, India.
| | | | - Pratima Murthy
- Professor and Head of the Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, 560029, India.
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Fuggle NR, Curtis B, Clynes M, Zhang J, Ward K, Javaid MK, Harvey NC, Dennison E, Cooper C. The treatment gap: The missed opportunities for osteoporosis therapy. Bone 2021; 144:115833. [PMID: 33359889 PMCID: PMC7116600 DOI: 10.1016/j.bone.2020.115833] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 12/18/2020] [Accepted: 12/19/2020] [Indexed: 02/07/2023]
Abstract
Despite substantial advances in delineation of the epidemiology, pathophysiology, risk assessment and treatment of osteoporosis over the last three decades, a substantial proportion of men and women at high risk of fracture remain untreated - the so-called "treatment gap". This review summarises the important patient-, physician- and policyrelated causes of this treatment gap, before discussing in greater detail: (a) the evidence base for the efficacy of bisphosphonates in osteoporosis; (b) recent evidence relating to the adverse effects of this widely used therapeutic class, most notably atypical femoral fracture and osteonecrosis of the jaw; (c) available strategies to improve both secondary and primary prevention pathways for the management of this disorder.
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Affiliation(s)
- Nicholas R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Beth Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Michael Clynes
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Jean Zhang
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Kate Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Muhammad Kassim Javaid
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK; NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospitals Southampton NHS Foundation Trust, Southampton, UK; NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK.
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Ibrahim FA, Nirisha L, Barikar M, Kumar CN, Chand PK, Manjunatha N, Math SB, Thirthalli J, Manjappa AA, Parthasarathy R, Reddy S, Arora S. Identification of Psychiatric Disorders by Rural Grass-Root Health Workers: Case Series & Implications for the National Mental Health Program of India. Psychiatr Q 2021; 92:389-395. [PMID: 32772306 PMCID: PMC10035070 DOI: 10.1007/s11126-020-09807-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Auxiliary Nurse Midwife (ANMs) and Accredited Social Health Activists (ASHAs) are well suited to cater to the mental health needs of the communities. Integrating primary mental health care into the general healthcare is one of the important objectives of the District Mental Health Program (DMHP) to reduce the treatment gap. As a part of an ICMR funded trial to evaluate the effectiveness of NIMHANS-ECHO blended training program, the ASHAs and ANMs were trained to identify and refer cases from the community. We aim to describe a series of cases identified by those workers from the community, highlighting their importance in our health care system.
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Affiliation(s)
- Ferose Azeez Ibrahim
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Lakshmi Nirisha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Malathesh Barikar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India.
| | - Prabhat Kumar Chand
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Narayana Manjunatha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Suresh Bada Math
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Adarsha Alur Manjappa
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, Karnataka, India
| | - Rajani Parthasarathy
- Department of Health and Family Welfare, Government of Karnataka, Bengaluru, Karnataka, India
| | - Shanivaram Reddy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, 560029, India
| | - Sanjeev Arora
- The ECHO Institute, University of New Mexico, Albuquerque, NM, USA
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Jadnanansing R, Blankers M, Dwarkasing R, Etwaroo K, Lumsden V, Dekker J, Bipat R. Prevalence of substance use disorders in an urban and a rural area in Suriname. Trop Med Health 2021; 49:12. [PMID: 33526098 PMCID: PMC7852200 DOI: 10.1186/s41182-021-00301-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 01/21/2021] [Indexed: 11/24/2022] Open
Abstract
Background Alcohol use disorders (AUD) have the worst impact in low-middle-income countries (LMICs), where the disease burden per liter of alcohol consumed is higher than in wealthy populations. Furthermore, the median treatment gap for AUDs in LMICs is 78.1%. The highest prevalence of AUDs worldwide in 2004 was found in the western Pacific region, Southeast Asia, and the Americas. The main aim of this study was to estimate and compare the prevalence of risky alcohol use and the extent of the treatment gap in a rural (Nickerie) and in an urban (Paramaribo) area in Suriname, a LMICs country with a wide variety of ethnic groups. Methods The respondents were randomly recruited using a specific sampling method of the National Census Bureau. The final samples were 1837 households for Paramaribo and 1026 for Nickerie, reflecting the populations in both regions. The Alcohol Use Disorder Identification Test (AUDIT) and the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) were used to assess the likelihood of the presence of alcohol use disorder. A score of > 7 for the AUDIT implies risky alcohol use. Results The results indicated that 2% of the women and 15% of the men in the rural area scored 8 or higher on the AUDIT. In the urban area, these numbers were 3% and 17%, respectively. In both samples, the men had the highest addiction risk at about 16% compared with 2% for females. Married persons are significantly less likely to become alcoholic than singles and other groups in Paramaribo. In both areas, higher education was associated with a lower probability of alcohol abuse and dependence, while handymen showed a higher odd. A treatment gap of 50% was found for alcohol use disorders in the rural area. The corresponding gap in the urban area was 64%. Conclusions Surinamese men show a high prevalence of the likelihood of AUD. In addition, the treatment gap for these possible patients is large. It is therefore of paramount importance to develop therapeutic strategies with the aim of tackling this physically and mentally disabling disorder. Tailored E-health programs may be of benefit.
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Affiliation(s)
- Raj Jadnanansing
- Center for Psychiatry in Suriname and Department of Psychology Anton de Kom University of Suriname, Paramaribo, Suriname.
| | - Matthijs Blankers
- Research Department, Arkin Mental Health Institute, Amsterdam, The Netherlands
| | - Rudi Dwarkasing
- Center for Psychiatry in Suriname and Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Kajal Etwaroo
- Center for Psychiatry in Suriname and Department of Psychology Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Vincent Lumsden
- Center for Psychiatry in Suriname and Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname
| | - Jack Dekker
- Research Department, Arkin Mental Health Institute Amsterdam and Department of Clinical Psychology, VU University, Amsterdam, The Netherlands
| | - Robbert Bipat
- Department of Physiology, Faculty of Medical Science, Anton de Kom University of Suriname, Paramaribo, Suriname
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McCloskey E, Rathi J, Heijmans S, Blagden M, Cortet B, Czerwinski E, Hadji P, Payer J, Palmer K, Stad R, O'Kelly J, Papapoulos S. The osteoporosis treatment gap in patients at risk of fracture in European primary care: a multi-country cross-sectional observational study. Osteoporos Int 2021; 32:251-259. [PMID: 32829471 PMCID: PMC7838133 DOI: 10.1007/s00198-020-05557-z] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Accepted: 07/21/2020] [Indexed: 01/15/2023]
Abstract
UNLABELLED This study in 8 countries across Europe found that about 75% of elderly women seen in primary care who were at high risk of osteoporosis-related fractures were not receiving appropriate medication. Lack of osteoporosis diagnosis appeared to be an important contributing factor. INTRODUCTION Treatment rates in osteoporosis are documented to be low. We wished to assess the osteoporosis treatment gap in women ≥ 70 years in routine primary care across Europe. METHODS This cross-sectional observational study in 8 European countries collected data from women 70 years or older visiting their general practitioner. The primary outcome was treatment gap: the proportion who were not receiving any osteoporosis medication among those at increased risk of fragility fracture (using history of fracture, 10-year probability of fracture above country-specific Fracture Risk Assessment Tool [FRAX] thresholds, T-score ≤ - 2.5). RESULTS Median 10-year probability of fracture (without bone mineral density [BMD]) for the 3798 enrolled patients was 7.2% (hip) and 16.6% (major osteoporotic). Overall, 2077 women (55%) met one or more definitions for increased risk of fragility fracture: 1200 had a prior fracture, 1814 exceeded the FRAX threshold, and 318 had a T-score ≤ - 2.5 (only 944 received a dual-energy x-ray absorptiometry [DXA] scan). In those at increased fracture risk, the median 10-year probability of hip and major osteoporotic fracture was 11.2% and 22.8%, vs 4.1% and 11.5% in those deemed not at risk. An osteoporosis diagnosis was recorded in 804 patients (21.2%); most (79.7%) of these were at increased fracture risk. The treatment gap was 74.6%, varying from 53% in Ireland to 91% in Germany. Patients with an osteoporosis diagnosis were found to have a lower treatment gap than those without a diagnosis, with an absolute reduction of 63%. CONCLUSIONS There is a large treatment gap in women aged ≥ 70 years at increased risk of fragility fracture in routine primary care across Europe. The gap appears to be related to a low rate of osteoporosis diagnosis.
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Affiliation(s)
- E McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield, Sheffield, UK.
| | - J Rathi
- Carrig Medical Centre, Cork, Ireland
| | | | - M Blagden
- Ashgate Medical Practice, Chesterfield, UK
| | - B Cortet
- Department of Rheumatology and EA 4490, University-Hospital of Lille, Lille, France
| | - E Czerwinski
- Department of Bone and Joint Diseases, FHS, Jagiellonian University Medical College, Kopernika 32, 31-501, Krakow, Poland
| | - P Hadji
- Frankfurt Center of Bone Health, Frankfurt, Germany
- Philipps-University of Marburg, Marburg, Germany
| | - J Payer
- Faculty of Medicine, 5th Department of Internal Medicine in University Hospital Bratislava, Comenius University, Bratislava, Slovakia
| | | | - R Stad
- Amgen Europe GmbH, Rotkreuz, Switzerland
| | | | - S Papapoulos
- Leiden University Medical Center, Leiden, Netherlands
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Bounlu M, Auditeau E, Vorachit S, Chivorakoun P, Souvong V, Soukhasem T, Sannikone S, Preux PM, Boumediene F. Management of epilepsy in Laos: Perceptions of healthcare professionals from Vientiane Capital province and traditional healers in Southern Laos. J Tradit Complement Med 2021; 11:46-52. [PMID: 33511061 PMCID: PMC7817710 DOI: 10.1016/j.jtcme.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 12/21/2019] [Accepted: 12/26/2019] [Indexed: 11/03/2022] Open
Abstract
Background and aim Traditional practices are deeply rooted in Lao people's perceptions and beliefs about health and illness.The objective of the study was to understand the perceptions of healthcare professionals and traditional healers regarding the management of epilepsy in Laos, and their reciprocal views. Experimental procedure An observational study was carried out in two areas of Laos from February to May 2017. Semi directive questionnaires were used to collect quantitative and qualitative data. Semiotic square was carried out to highlight relationships between attitudes of traditional healers and healthcare professionals. For quantitative approach, the proportions were reported, and the test used was Fisher's test for nominal variables. The mean and standard deviation expressed the continuous variables and the Student's t-test was used. Results and conclusion Epilepsy was cited by 90.9% of traditional healers as a convulsive disease with saliva or urine, and herbal medicines were predominantly used (86.4%) to treat it. Few healthcare professionals (26.5%) pointed out that they knew remedies to treat epilepsy other than antiepileptic drugs (AEDs), and 76.5% of healthcare professionals mentioned that epilepsy was a disease which only AEDs could treat. On the other hand, 54.5% of traditional healers confirmed a traditional remedy could cure completely epilepsy through long-term use. Ninety percent of traditional healers said the collaboration with healthcare professionals was a good idea and 44.1% of the healthcare professionals group said was complicated.The combination of these medicines for the management of epilepsy needs to be adapted to Lao's medical context.
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Affiliation(s)
- Mayoura Bounlu
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Emilie Auditeau
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Somchit Vorachit
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Phetvongsinh Chivorakoun
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Vimalay Souvong
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Thidachanh Soukhasem
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Sonesimmaly Sannikone
- Association for Patient with Epilepsy in Laos (Lao APE), Vientiane, Lao People's Democratic Republic
| | - Pierre-Marie Preux
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
| | - Farid Boumediene
- INSERM U1094, Univ. Limoges, CHU Limoges, IRD, U1094, Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France
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Fuller AT, Almojuela A, Kaddumukasa MN, Chakraborty P, Smith PJ, Kolls BJ, Van Belleghem F, Muhumuza C, Nshemerirwe S, Kaddumukasa M, Nakasujja N, Nakku J, Kakooza-Mwesige A, Haglund MM, Koltai DC. Hospital-based epilepsy care in Uganda: A prospective study of three major public referral hospitals. Epilepsy Behav 2021; 114:107301. [PMID: 32861671 DOI: 10.1016/j.yebeh.2020.107301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/23/2020] [Accepted: 06/28/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study sets out to describe the current demographics of people with epilepsy (PWE) attending hospital-based care in Uganda and the epilepsy treatment practices within three of the largest Ugandan public referral hospitals. METHODS In a six-month prospective cohort study, 626 children and adults attending epilepsy clinics at Mulago National Referral Hospital, Butabika National Referral Mental Hospital and Mbarara Regional Referral Hospital were enrolled. Using a study questionnaire, data were collected at baseline and at 3 weeks, 3 months, and 6 months following enrollment. Specific data surrounding individual patient demographics, clinical characteristics and severity of epilepsy, and treatment of epilepsy with antiepileptic drugs (AEDs) were collected. RESULTS Female patients totaled to 50.8%, with a nearly equal gender distribution at each hospital. There was no statistical difference in gender or age between sites. The majority of PWE had completed primary school, with less than 15% of patients completing more than a secondary education. Seizure severity was high, with most patients having multiple seizures per week at the initial onset of epilepsy, and greater than 90% of patients reporting a loss of consciousness with seizures. The majority of patients (54.95%) also reported a developmental or learning delay. Most patients were on 1 AED (46.01%) or 2 AEDs (36.90%), with carbamazepine being the most frequently prescribed AED. There was a trend towards improved seizure severity over the follow-up period, as assessed by the corresponding Personal Impact of Epilepsy Scale (PIES) subscale. CONCLUSIONS People with epilepsy attending hospital-based care in Uganda tend to have severe forms of epilepsy requiring management with AEDs. Current hospital-based practices show a positive trend for seizure burden and quality of life of PWE in Uganda. Further interventions to improve overall access to biomedical care are required to continue to advance the management of PWE across all communities. This article is part of the Special Issue "The Intersection of Culture, Resources, and Disease: Epilepsy Care in Uganda".
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Affiliation(s)
- Anthony T Fuller
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Alysa Almojuela
- Section of Neurosurgery, Rady Faculty of Health Sciences, University of Manitoba, GB1-820 Sherbrook Street, Health Sciences Centre, Winnipeg, MB R3A 1R9, Canada
| | - Martin N Kaddumukasa
- Department of Medicine, Mulago National Referral Hospital, Neurology Unit, Kampala, Uganda; School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Payal Chakraborty
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA
| | - Patrick J Smith
- Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA
| | - Brad J Kolls
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA; Duke Clinical Research Institute, Neuroscience Medicine, 300 W Morgan St, Durham, NC 27701, USA
| | - Florence Van Belleghem
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Department of Medicine, Group Biomedical Sciences, KU Leuven, Belgium
| | - Christine Muhumuza
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Makerere University School of Public Health, Department of Epidemiology and Biostatistics, Mulago Complex, P.O. Box 7072, Kampala, Uganda
| | - Sylvia Nshemerirwe
- Butabika National Referral Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Mark Kaddumukasa
- School of Medicine, College of Health Sciences, Makerere University, P.O. Box 7072, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, School of Medicine, Makerere University College of Health Sciences, P.O. Box 7072, Kampala, Uganda
| | - Juliet Nakku
- Butabika National Referral Mental Hospital, P.O. Box 7017, Kampala, Uganda
| | - Angelina Kakooza-Mwesige
- Department of Paediatrics and Child Health, Makerere University College of Health Sciences, Mulago Hill Road, P.O. Box 7072, Kampala, Uganda; Department of Paediatrics and Child Health, Mulago National Referral Hospital, Pediatric Neurology Unit, Kampala, Uganda
| | - Michael M Haglund
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke Global Health Institute, 310 Trent Dr, Durham, NC 27710, USA; Duke University, School of Medicine, Durham, NC, USA
| | - Deborah C Koltai
- Duke Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Box 3807 Duke University Medical Center, Durham, NC 27705, USA; Duke University School of Medicine, Department of Psychiatry and Behavioral Sciences, DUMC Box 3119, Trent Drive, Durham, NC, USA; Duke University School of Medicine, Department of Neurology, Durham, NC, USA.
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Kanis JA, Norton N, Harvey NC, Jacobson T, Johansson H, Lorentzon M, McCloskey EV, Willers C, Borgström F. SCOPE 2021: a new scorecard for osteoporosis in Europe. Arch Osteoporos 2021; 16:82. [PMID: 34080059 PMCID: PMC8172408 DOI: 10.1007/s11657-020-00871-9] [Citation(s) in RCA: 181] [Impact Index Per Article: 60.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 12/18/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED This scorecard summarises key indicators of the burden of osteoporosis and its management in the 27 member states of the European Union, as well as the UK and Switzerland. The resulting scorecard elements, assembled on a single sheet, provide a unique overview of osteoporosis in Europe. INTRODUCTION The scorecard for osteoporosis in Europe (SCOPE) is a project of the International Osteoporosis Foundation (IOF) that seeks to raise awareness of osteoporosis care in Europe. The aim of this project was to develop a scorecard and background documents to draw attention to gaps and inequalities in the provision of primary and secondary prevention of fractures due to osteoporosis. METHODS The SCOPE panel reviewed the information available on osteoporosis and the resulting fractures for each of the 27 countries of the European Union plus the UK and Switzerland (termed EU27+2). The information obtained covered four domains: background information (e.g. the burden of osteoporosis and fractures), policy framework, service provision and service uptake, e.g. the proportion of men and women at high risk that do not receive treatment (the treatment gap). RESULTS There was a marked difference in fracture risk among the EU27+2 countries. Of concern was the marked heterogeneity in the policy framework, service provision and service uptake for osteoporotic fracture that bore little relation to the fracture burden. For example, despite the wide availability of treatments to prevent fractures, in the majority of the EU27+2, only a minority of patients at high risk receive treatment even after their first fracture. The elements of each domain in each country were scored and coded using a traffic light system (red, orange, green) and used to synthesise a scorecard. The resulting scorecard elements, assembled on a single sheet, provide a unique overview of osteoporosis in Europe. CONCLUSIONS The scorecard enables healthcare professionals and policy makers to assess their country's general approach to the disease and provide indicators to inform the future provision of healthcare.
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Affiliation(s)
- John A. Kanis
- grid.411958.00000 0001 2194 1270Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ,grid.11835.3e0000 0004 1936 9262Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Nicholas Norton
- grid.512444.20000 0004 7413 3148Quantify Research, Stockholm, Sweden
| | - Nicholas C. Harvey
- grid.5491.90000 0004 1936 9297MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK ,grid.430506.40000 0004 0465 4079NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Trolle Jacobson
- grid.512444.20000 0004 7413 3148Quantify Research, Stockholm, Sweden
| | - Helena Johansson
- grid.411958.00000 0001 2194 1270Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ,grid.11835.3e0000 0004 1936 9262Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK
| | - Mattias Lorentzon
- grid.411958.00000 0001 2194 1270Mary McKillop Institute for Health Research, Australian Catholic University, Melbourne, Australia ,grid.8761.80000 0000 9919 9582Geriatric Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eugene V. McCloskey
- grid.11835.3e0000 0004 1936 9262Centre for Metabolic Bone Diseases, University of Sheffield Medical School, University of Sheffield, Beech Hill Road, Sheffield, S10 2RX UK ,grid.11835.3e0000 0004 1936 9262MRC Versus Arthritis Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Carl Willers
- grid.512444.20000 0004 7413 3148Quantify Research, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Fredrik Borgström
- grid.512444.20000 0004 7413 3148Quantify Research, Stockholm, Sweden ,grid.4714.60000 0004 1937 0626Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Haverkamp D, van der Vis HM, Lee J, Achan P, Sierevelt IN, Ramachandran M. Two-year clinical results of a novel load redistribution device for the treatment of medial knee OA. Arch Orthop Trauma Surg 2020; 140:1873-1881. [PMID: 32128630 DOI: 10.1007/s00402-020-03390-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE A potential method to relieve the pain from medial osteoarthritis of the knee is to offload the medial compartment. The Latella™ Knee Implant is a novel device designed to offload the medial compartment. The objective of the Cotera-1 study was to evaluate the preliminary safety and feasibility of the Latella implant to treat patients with medial OA of the knee, by a 2-year follow-up of a prospective multicenter feasibility study (Cotera-1) performed in the Netherlands and UK METHODS: In this first-in-man study, 11 participants received the Latella implant and were followed for 2 years, documenting physician assessment, Patient-Reported Outcome (PRO) scoring (KOOS, IKDC, Kujala, SF-36); Patient Global Assessment (PGA), radiographic analysis and MRI analysis, complications, reoperation rate and hip-knee-ankle axis. RESULTS The Latella Knee Implant system proved to be well tolerated and demonstrated a low-risk safety profile up to 24 months post-treatment. A responder analysis was performed of the subjects who still had the Latella implanted at 24-month time point (n = 9). Based on a MCID of eight for KOOS pain sub-scale, 78% of the subjects at the 24 month time point would be considered as responders. Similarly, based on improvement in the medial knee pain compared to baseline using the NRS scale of 1-10, 89% of the subjects at the 24-month time point would be considered as responders. Two patients were revised during follow-up: one for arthrofibrosis and one converted to TKA for progression of OA. CONCLUSIONS The early clinical experience with the Latella Knee Implant in this pilot feasibility study has been encouraging. It appears to be a safe implant with possible effect on medial OA. Additional studies need to be performed to assess the safety and efficacy of the procedure in a larger patient population. LEVEL OF EVIDENCE II.
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Affiliation(s)
- D Haverkamp
- Xpert Orthopedie, Laarderhoogtweg 12, 1101 AE, Amsterdam, The Netherlands.
| | - H M van der Vis
- Xpert Orthopedie, Laarderhoogtweg 12, 1101 AE, Amsterdam, The Netherlands
| | - J Lee
- Barts Health NHS Trust, London, UK.,The Royal London Hospital, Whitechapel, London, E1 1BB, UK
| | - P Achan
- Barts Health NHS Trust, London, UK.,The Royal London Hospital, Whitechapel, London, E1 1BB, UK
| | - I N Sierevelt
- Xpert Orthopedie, Laarderhoogtweg 12, 1101 AE, Amsterdam, The Netherlands
| | - M Ramachandran
- Barts Health NHS Trust, London, UK.,The Royal London Hospital, Whitechapel, London, E1 1BB, UK
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Rens E, Dom G, Remmen R, Michielsen J, Van den Broeck K. Unmet mental health needs in the general population: perspectives of Belgian health and social care professionals. Int J Equity Health 2020; 19:169. [PMID: 32993667 DOI: 10.1186/s12939-020-01287-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/23/2020] [Indexed: 11/21/2022] Open
Abstract
Background An unmet mental health need exists when someone has a mental health problem but doesn’t receive formal care, or when the care received is insufficient or inadequate. Epidemiological research has identified both structural and attitudinal barriers to care which lead to unmet mental health needs, but reviewed literature has shown gaps in qualitative research on unmet mental health needs. This study aimed to explore unmet mental health needs in the general population from the perspective of professionals working with vulnerable groups. Methods Four focus group discussions and two interviews with 34 participants were conducted from October 2019 to January 2020. Participants’ professional backgrounds encompassed social work, mental health care and primary care in one rural and one urban primary care zone in Antwerp, Belgium. A topic guide was used to prompt discussions about which groups have high unmet mental health needs and why. Transcripts were coded using thematic analysis. Results Five themes emerged, which are subdivided in several subthemes: (1) socio-demographic determinants and disorder characteristics associated with unmet mental health needs; (2) demand-side barriers; (3) supply-side barriers; (4) consequences of unmet mental health needs; and (5) suggested improvements for meeting unmet mental health needs. Conclusions Findings of epidemiological research were largely corroborated. Some additional groups with high unmet needs were identified. Professionals argued that they are often confronted with cases which are too complex for regular psychiatric care and highlighted the problem of care avoidance. Important system-level factors include waiting times of subsidized services and cost of non-subsidized services. Feelings of burden and powerlessness are common among professionals who are often confronted with unmet needs. Professionals discussed future directions for an equitable mental health care provision, which should be accessible and targeted at those in the greatest need. Further research is needed to include the patients’ perspective of unmet mental health needs.
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Kokdere F, Tirrell E, Fukuda AM, Gobin AP, Kavanaugh BC, Price LH, Carpenter LL. Do deviations from the 5 sessions per week schedule impact outcomes of transcranial magnetic stimulation for major depressive disorder? Brain Stimul 2020; 13:1491-1493. [PMID: 32768691 DOI: 10.1016/j.brs.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/29/2020] [Accepted: 08/04/2020] [Indexed: 10/23/2022] Open
Affiliation(s)
- Fatih Kokdere
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Eric Tirrell
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA
| | - Andrew M Fukuda
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Asi Polly Gobin
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA
| | - Brian C Kavanaugh
- Emma Pendleton Bradley Hospital, Riverside, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Lawrence H Price
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Linda L Carpenter
- Butler Hospital TMS Clinic and Neuromodulation Research Facility, Providence, RI, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
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Clarke BL, Shoback DM. A bridge too far? Attempting to bridge the treatment gap in osteoporosis. Endocrine 2020; 69:241-243. [PMID: 32441027 PMCID: PMC8832363 DOI: 10.1007/s12020-020-02346-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Bart L Clarke
- Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Dolores M Shoback
- San Francisco, Endocrine Research Unit-111N, San Francisco Department of Veterans Affairs Medical Center, University of California, 1700 Owens Street, 3rd Floor, Room 369, San Francisco, CA, 94158, USA.
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Iconaru L, Smeys C, Baleanu F, Kinnard V, Moreau M, Cappelle S, Surquin M, Rubinstein M, Rozenberg S, Paesmans M, Karmali R, Bergmann P, Body JJ. Osteoporosis treatment gap in a prospective cohort of volunteer women. Osteoporos Int 2020; 31:1377-1382. [PMID: 32128600 DOI: 10.1007/s00198-020-05339-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 02/06/2020] [Indexed: 12/11/2022]
Abstract
UNLABELLED Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture. The high treatment gap in our cohort consisted of unselected volunteer patients highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment. INTRODUCTION Despite the availability of efficient drugs to prevent osteoporotic fractures, only a minority of women receives osteoporosis therapy after a fracture, with a treatment gap around 80%. This can have dramatic consequences for patients and the healthcare systems. METHODS In this study based on longitudinal data from the FRISBEE (Fracture RIsk Brussels Epidemiological Enquiry) cohort of 3560 volunteer women aged 60 to 85 years, we evaluated the 1-year treatment gap after a first major incident fragility fracture. RESULTS There were 386 first validated fragility fractures, 285 major osteoporotic fractures (MOF) and 101 "other major" fractures. The rate of untreated patients was 85.0% (82.8% for MOF versus 91.0 % for "other major" fracture sites) (p = 0.04), with a lower rate for spine (70.5%) and hip (72.5%) versus shoulder (91.6%) and wrist (94.1%) (p < 0.0001). More specifically, the treatment gap for patients with osteoporosis, defined by a T-score < - 2.5 SD was 74.6% versus 76.5% for patients with osteoporosis defined by the presence of hip, shoulder, or spine fractures, independently of DXA results. When considering age groups, the rate of untreated women was 87.9% for women 60-70 years old, 88.2% between 70 and 80 years and 77.8% above 80 years (p = 0.03), with a greater difference between women who were younger or older than 80 years at inclusion: 88.1% versus 77.8% (p = 0.009). A diagnosis of osteoporosis (p = 0.01) and age (p = 0.03) were the only clinical risk factors (CRFs) significantly associated with treatment initiation. CONCLUSIONS This study highlights the urgent need of additional education, especially for the medical profession, regarding the risk-benefit balance of treatment.
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Affiliation(s)
- L Iconaru
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium.
| | - C Smeys
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - F Baleanu
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - V Kinnard
- Department of Internal Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Moreau
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Cappelle
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Surquin
- Department of Geriatrics, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - M Rubinstein
- Department of Nuclear Medicine, Ixelles Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - S Rozenberg
- Department of Gynecology, CHU St Pierre, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - M Paesmans
- Data Centre, Inst. J. Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - R Karmali
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - P Bergmann
- Department of Nuclear Medicine, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
| | - J J Body
- Department of Endocrinology, CHU Brugmann, Université Libre de Bruxelles, Brussels, Belgium
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Chaulagain A, Pacione L, Abdulmalik J, Hughes P, Oksana K, Chumak S, Mendoza J, Avetisyan K, Ghazaryan G, Gasparyan K, Chkonia E, Servili C, Chowdhury N, Pinchuk I, Belfar M, Guerrero A, Panteleeva L, Skokauskas N. WHO Mental Health Gap Action Programme Intervention Guide (mhGAP-IG): the first pre-service training study. Int J Ment Health Syst 2020; 14:47. [PMID: 32612675 PMCID: PMC7325034 DOI: 10.1186/s13033-020-00379-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/17/2020] [Indexed: 01/21/2023] Open
Abstract
Background Despite the increasing burden of mental, neurological, and substance use (MNS) disorders, a significant treatment gap for these disorders continues to exist across the world, and especially in low- and middle-income countries. To bridge the treatment gap, the World Health Organization developed and launched the Mental Health Gap Action Programme (mhGAP) and the mhGAP Intervention Guide (mhGAP-IG) to help train non-specialists to deliver care. Although the mhGAP-IG has been used in more than 100 countries for in-service training, its implementation in pre-service training, that is, training prior to entering caregiver roles, is very limited. Aim of the study The aim of this study was to collect and present information about the global experience of academic institutions that have integrated WHO’s mhGAP-IG into pre-service training. Methods A descriptive cross-sectional study was conducted using an electronic questionnaire, from December 2018 to June 2019. Results Altogether, eleven academic institutions across nine countries (Mexico, Nigeria, Liberia, Sierra Leone, Somaliland, Armenia, Georgia, Ukraine and Kyrgyzstan) participated in this study. Five of the institutions have introduced the mhGAP-IG by revising existing curricula, three by developing new training programmes, and three have used both approaches. A lack of financial resources, a lack of support from institutional leadership, and resistance from some faculty members were the main obstacles to introducing this programme. Most of the institutions have used the mhGAP-IG to train medical students, while some have used it to train medical interns and residents (in neurology or family medicine) and nursing students. Use of the mhGAP-IG in pre-service training has led to improved knowledge and skills to manage mental health conditions. A majority of students and teaching instructors were highly satisfied with the mhGAP-IG. Conclusions This study, for the first time, has collected evidence about the use of WHO’s mhGAP-IG in pre-service training in several countries. It demonstrates that the mhGAP-IG can be successfully implemented to train a future cadre of medical doctors and health nurses.
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Affiliation(s)
- Ashmita Chaulagain
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Laura Pacione
- Department of Psychiatry, Division of Child and Youth Mental Health, University of Toronto, Toronto, Canada
| | | | - Peter Hughes
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Kopchak Oksana
- Department of Neurology, Psychiatry, Kyiv Medical University, Kiev, Ukraine
| | - Stanislav Chumak
- Department of Psychiatry, Psychotherapy and Medical Psychology, P.L. Shupyk National Medical Academy of Postgraduate Education, Kiev, Ukraine
| | - José Mendoza
- Department of Psychiatry, National Autonomous University of Mexico, Mexico City, Mexico
| | - Kristine Avetisyan
- Department of Clinical Psychology, Yerevan State Medical University, Yerevan, Armenia
| | - Gayane Ghazaryan
- Department of Clinical Psychology, Yerevan State Medical University, Yerevan, Armenia
| | - Khachatur Gasparyan
- Department of Clinical Psychology, Yerevan State Medical University, Yerevan, Armenia
| | - Eka Chkonia
- Department of Psychiatry, Tbilisi State Medical University, Tbilisi, Georgia
| | - Chiara Servili
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Neerja Chowdhury
- Department of Mental Health and Substance Abuse, World Health Organization, Geneva, Switzerland
| | - Iryna Pinchuk
- Research Institute of Psychiatry and Drug Abuse, Ministry of Health, Kiev, Ukraine
| | - Myron Belfar
- Department of Psychiatry, Harvard Medical School, Boston, USA
| | - Anthony Guerrero
- Child and Adolescent Psychiatry Division, University of Hawai'i at Mānoa John A. Burns School of Medicine, Honolulu, USA
| | - Lilya Panteleeva
- Department of Psychiatry, Kyrgyz-Russian Slavic University, Bishkek, Kyrgyzstan
| | - Norbert Skokauskas
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.,Helse Midt-Norge RHF, Trondheim, Norway
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Brouwers EPM. Social stigma is an underestimated contributing factor to unemployment in people with mental illness or mental health issues: position paper and future directions. BMC Psychol 2020; 8:36. [PMID: 32317023 PMCID: PMC7171845 DOI: 10.1186/s40359-020-00399-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 03/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background As yet, little is known about the effects of mental health stigma on sustainable employment. This is surprising, as mental health stigma is common, and because people with severe and common mental disorders are 7 and 3 times more likely to be unemployed, respectively, than people with no disorders. As the global lifetime prevalence of mental disorders is 29%, the high unemployment rates of people with these health problems constitute an important and urgent public health inequality problem that needs to be addressed. Main text The aim of this position paper is to illustrate the assumption that stigma contributes to the unemployment of people with mental illness and mental health issues with evidence from recent scientific studies on four problem areas, and to provide directions for future research. These four problem areas indicate that: (1) employers and line managers hold negative attitudes towards people with mental illness or mental health issues, which decreases the chances of people with these health problems being hired or supported; (2) both the disclosure and non-disclosure of mental illness or mental health issues can lead to job loss; (3) anticipated discrimination, self-stigma and the ‘Why Try’ effect can lead to insufficient motivation and effort to keep or find employment and can result in unemployment; and (4) stigma is a barrier to seeking healthcare, which can lead to untreated and worsened health conditions and subsequently to adverse occupational outcomes (e.g. sick leave, job loss). Conclusions The paper concludes that stigma in the work context is a considerable and complex problem, and that there is an important knowledge gap especially regarding the long-term effects of stigma on unemployment. To prevent and decrease adverse occupational outcomes in people with mental illness or mental health issues there is an urgent need for high quality and longitudinal research on stigma related consequences for employment. In addition, more validated measures specifically for the employment setting, as well as destigmatizing intervention studies are needed.
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Affiliation(s)
- Evelien P M Brouwers
- Scientific Center for Care and Wellbeing, Tilburg School of Social and Behavioral Sciences, Tilburg University, P.O. Box 90153, 5000 LE, Tilburg, The Netherlands.
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Abstract
PURPOSE OF REVIEW The assessment of fracture risk and use of antiosteoporosis medications have increased greatly over the last 20-30 years. However, despite this, osteoporosis care remains suboptimal worldwide. Even in patients who have sustained a fragility fracture, fewer than 20% actually receive appropriate antiosteoporosis therapy in the year following the fracture. There is also evidence that treatment rates have declined substantially in the last 5-10 years, in many countries. The goal of this article is to consider the causes for this decline and consider how this situation could be remedied. RECENT FINDINGS A number of possible reasons, including the lack of prioritisation of osteoporosis therapy in ageing populations with multimorbidity, disproportionate concerns regarding the rare side effects of anti-resorptives and adverse changes in reimbursement in the USA, have been identified as contributing factors in poor osteoporosis care. Improved secondary prevention strategies; screening measures (primary prevention) and appropriate, cost-effective guideline and treatment threshold development could support the optimisation of osteoporosis care and prevention of future fractures.
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Affiliation(s)
- Elizabeth M Curtis
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK.
| | - Stephen Woolford
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
| | - Claire Holmes
- Rheumatology Department, University Hospitals Southampton NHS Foundation Trust, Southampton, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Oxford Biomedical Research Unit, University of Oxford, Oxford, UK
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
| | - Nicholas C Harvey
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, UK
- NIHR Southampton Biomedical Research Centre, University Hospitals Southampton NHS Foundation Trust, University of Southampton, Southampton, UK
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Mogal Z, Aziz H. Epilepsy treatment gap and stigma reduction in Pakistan: A tested public awareness model. Epilepsy Behav 2020; 102:106637. [PMID: 31805506 DOI: 10.1016/j.yebeh.2019.106637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 09/28/2019] [Accepted: 10/01/2019] [Indexed: 10/25/2022]
Abstract
High epilepsy treatment gap (ETG) and stigma remain a major issue globally. Addressing the basic problems is necessary, for advances in management to be effective. According to the 1987 population-based study, prevalence of active epilepsy in Pakistan is 0.98% with 98.1% ETG in rural and 72.5% in urban population and the presence of stigma. These dismal figures were a stimulus for our reported activities. Recognizing the problems faced by 2.2 million people with epilepsy (PWE) in the country, a group of volunteers mostly from the medical community has attempted to address these issues with an ongoing sustained awareness program over the last 18 years, working within the constraints of prevailing healthcare system, with gratifying results. In 2001, under a nongovernmental organization (NGO), the Comprehensive Epilepsy Control Programme of Pakistan (CECP) was launched to address the various paucities in knowledge, attitude, and practice about epilepsy; especially ETG and stigma. The CECP has two primary components: Epilepsy Support Pakistan (CECP-ESP) for awareness and mass education and National Epilepsy Centre (CECP-NEC) for holistic management of PWE, professional education, and research. Both work in tandem, and there is an overlap of their activities. This article only evaluates the outcome of sustained awareness activities of the CECP-ESP, through direct and indirect measures after 5 years of its initiation. A significant reduction in ETG and stigma exclusively through public awareness has been possible. This model can be easily replicated by any country, with involvement of the local population.
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Affiliation(s)
- Zarine Mogal
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan.
| | - Hasan Aziz
- National Epilepsy Centre, Jinnah Postgraduate Medical Centre, Rafiqui Shaheed Road, Karachi 75510, Pakistan
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Borgström F, Karlsson L, Ortsäter G, Norton N, Halbout P, Cooper C, Lorentzon M, McCloskey EV, Harvey NC, Javaid MK, Kanis JA. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos 2020; 15:59. [PMID: 32306163 PMCID: PMC7166207 DOI: 10.1007/s11657-020-0706-y] [Citation(s) in RCA: 307] [Impact Index Per Article: 76.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Accepted: 01/28/2020] [Indexed: 02/06/2023]
Abstract
UNLABELLED This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five countries of the European Union plus Sweden (EU6). In 2017, new fragility fractures in the EU6 are estimated at 2.7 million with an associated annual cost of €37.5 billion and a loss of 1.0 million quality-adjusted life years. INTRODUCTION Osteoporosis is characterized by reduced bone mass and strength, which increases the risk of fragility fractures, which in turn, represent the main consequence of the disease. This report provides an overview and a comparison of the burden and management of fragility fractures in the largest five EU countries and Sweden (designated the EU6). METHODS A series of metrics describing the burden and management of fragility fractures were defined by a scientific steering committee. A working group performed the data collection and analysis. Data were collected from current literature, available retrospective data and public sources. Different methods were applied (e.g. standard statistics and health economic modelling), where appropriate, to perform the analysis for each metric. RESULTS Total fragility fractures in the EU6 are estimated to increase from 2.7 million in 2017 to 3.3 million in 2030; a 23% increase. The resulting annual fracture-related costs (€37.5 billion in 2017) are expected to increase by 27%. An estimated 1.0 million quality-adjusted life years (QALYs) were lost in 2017 due to fragility fractures. The current disability-adjusted life years (DALYs) per 1000 individuals age 50 years or more were estimated at 21 years, which is higher than the estimates for stroke or chronic obstructive pulmonary disease. The treatment gap (percentage of eligible individuals not receiving treatment with osteoporosis drugs) in the EU6 is estimated to be 73% for women and 63% for men; an increase of 17% since 2010. If all patients who fracture in the EU6 were enrolled into fracture liaison services, at least 19,000 fractures every year might be avoided. CONCLUSIONS Fracture-related burden is expected to increase over the coming decades. Given the substantial treatment gap and proven cost-effectiveness of fracture prevention schemes such as fracture liaison services, urgent action is needed to ensure that all individuals at high risk of fragility fracture are appropriately assessed and treated.
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Affiliation(s)
- Fredrik Borgström
- Medical Management Centre, Department of Learning Informatics, Management and Ethics, Karolinska Institute, Solna, Sweden ,Quantify Research, Stockholm, Sweden
| | | | | | | | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK ,National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Mattias Lorentzon
- Mary MacKillop Health Institute, Catholic University of Australia, Melbourne, Australia ,Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine and Clinical Nutrition, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Eugene V. McCloskey
- Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX UK ,MRC and Arthritis Research UK Centre for Integrated Research in Musculoskeletal Ageing, Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK
| | - Nicholas C. Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Muhamamd K. Javaid
- National Institute for Health Research (NIHR) Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - John A. Kanis
- Mary MacKillop Health Institute, Catholic University of Australia, Melbourne, Australia ,Centre for Metabolic Bone Diseases, University of Sheffield Medical School, Beech Hill Road, Sheffield, S10 2RX UK
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