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Ageing and care related issues : a focus on IndiaAgeing is a process and it does not start at a particular chronological age. Although most people enjoy this period of life, many still face multiple challenges related to ill health, disabilities and care related issues. Multi morbidity is common in this age group, and the need for routine and emergency health care is more frequent. There are concerns related to availability, access and affordability of quality care for the elderly. Considering the proportion of older adults in India, the magnitude of the care needs is extremely high. Despite the general progress of health infrastructure, policies and legal framework, specific support and care for the elderly are still at an alarmingly low level. Specifically, it is the care and support at the individual level which requires more attention. While personal planning and preparation for old age is essential, multilevel support systems should be available and be more robust. These should be able to cater to person-specific needs and care fairly at different socioeconomic strata.
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Cognitive behavioral therapy for the treatment of post-traumatic stress disorder : a reviewBackground: Post-traumatic stress disorder (PTSD) is a psychiatric sequel to a stressful event or situation of an exceptionally threatening or catastrophic nature. Cognitive behavioral therapy (CBT) has been used in the management of PTSD for many years. This paper reviews the effectiveness of CBT for the treatment of PTSD following various types of trauma, its potential to prevent PTSD, methods used in CBT, and reflects on the mechanisms of action of CBT in PTSD. Methods: Electronic databases, including PubMed, were searched for articles on CBT and PTSD. Manual searches were conducted for cross-references in the relevant journal sites. Results: The current literature reveals robust evidence that CBT is a safe and effective intervention for both acute and chronic PTSD following a range of traumatic experiences in adults, children, and adolescents. However, nonresponse to CBT by PTSD can be as high as 50%, contributed to by various factors, including comorbidity and the nature of the study population. CBT has been validated and used across many cultures, and has been used successfully by community therapists following brief training in individual and group settings. There has been effective use of Internet-based CBT in PTSD. CBT has been found to have a preventive role in some studies, but evidence for definitive recommendations is inadequate. The effect of CBT has been mediated mostly by the change in maladaptive cognitive distortions associated with PTSD. Many studies also report physiological, functional neuroimaging, and electroencephalographic changes correlating with response to CBT. Conclusion: There is scope for further research on implementation of CBT following major disasters, its preventive potential following various traumas, and the neuropsychological mechanisms of action.
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Women's health inequalities in 15 Muslim-populated countries : evidence from population and mortality statisticsIn this study, we examined health inequalities and the status of women as evidenced in the patterns of population and mortality statistics in fifteen Muslim-populated countries. Based on WHO data, female-to-male ratios were calculated to determine differential gender ratios of population and mortality, using Western gender patterns as a baseline. The socioeconomic contexts of the analysis were the percentage of women in parliaments data by OECD and the Gross National Income Per Capita PPP by the World Bank. The study results indicate that former USSR countries had fewer girls, suggesting gender selection, whilst fewer adult women in the Gulf States population indicate health inequalities. Female children’s mortality was under-reported, inferring under-valuing girls. Higher female adult deaths in Egypt, Iran, and the Gulf States show greater discrimination. Women in the richest Muslim countries face more inequalities and less representation in Parliament. The implications of the study are discussed.
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Association of cannabis, cannabidiol and synthetic cannabinoid use with mental health in UK adolescentsBackground: Cannabis has been associated with poorer mental health, but little is known of the effect of synthetic cannabinoids or cannabidiol (often referred to as CBD). Aims: To investigate associations of cannabis, synthetic cannabinoids and cannabidiol with mental health in adolescence. Method: We conducted a cross-sectional analysis with 13- to 14-year-old adolescents across England and Wales in 2019-2020. Multilevel logistic regression was used to examine the association of lifetime use of cannabis, synthetic cannabinoids and cannabidiol with self-reported symptoms of probable depression, anxiety, conduct disorder and auditory hallucinations. Results: Of the 6672 adolescents who participated, 5.2% reported using of cannabis, 1.9% reported using cannabidiol and 0.6% reported using synthetic cannabinoids. After correction for multiple testing, adolescents who had used these substances were significantly more likely to report a probable depressive, anxiety or conduct disorder, as well as auditory hallucinations, than those who had not. Adjustment for socioeconomic disadvantage had little effect on associations, but weekly tobacco use resulted in marked attenuation of associations. The association of cannabis use with probable anxiety and depressive disorders was weaker in those who reported using cannabidiol than those who did not. There was little evidence of an interaction between synthetic cannabinoids and cannabidiol. Conclusions: To our knowledge, this study provides the first general population evidence that synthetic cannabinoids and cannabidiol are associated with probable mental health disorders in adolescence. These associations require replication, ideally with prospective cohorts and stronger study designs. Keywords: Anxiety or fear-related disorders; conduct disorders; depressive disorders; psychotic disorders/schizophrenia; substance use disorders.
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Positive impact and its relationship to wellbeing in parents of children with intellectual disability: a literature reviewAim: This review focuses on parent carers of children with an intellectual disability. The aim of the review is to assess the relationship between positive impact and parental well-being and the factors that affect this relationship, including challenging behaviour, syndrome type and gender of parent. Method: A structured search was conducted in the databases of Psycinfo and Ovid Medline and 16 articles were included in the review. Results: A relationship between positive impact and parental well-being was found, however this was affected by extraneous variables including partner well-being, challenging behaviour and syndrome characteristics. Other variables that affected this relationship were type of coping strategies employed and individual parent characteristics including self esteem and optimism. Conclusions: A relationship between positive impact and well-being exists but remains unclear due to the number of extraneous variables that may affect this relationship and that require further research, including cultural influence and socio economic position. This relationship has relevance when designing interventions for families as focusing on increasing positive impacts and reducing the influence of variables that interact negatively with positive impact and well-being may increase parental well-being and therefore capacity for coping
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Improving care for families where children and parents have concurrent mental health problemsBackground: When mental illness affects children and parents within the same family there is a need for close professional collaboration between the respective psychiatric teams. However, there is no nationally established precedence for this, and the area has not been investigated within the published literature. Method: Retrospective case note study of 322 child psychiatric patients to estimate the prevalence of parental mental illness and analyse the degree of professional liaison taking place. Results: Twenty-eight children had parents with concurrent mental health problems. Only four of these cases (14.2%) contained evidence of ongoing professional liaison between child and adult mental health teams. Conclusion: Inadequate liaison between child and adult services is a problem within the UK mental health system and detrimental to patient care. Recent national interest in establishing a more integrated family-focused service is encouraging, but will take time to implement and will not replace the need for separate specialist services. Efficient clinical collaboration must be developed at local levels to create a more comprehensive management strategy for children and parents with concurrent mental health problems.
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A short guide to understanding behavioural difficultiesAn approach to behaviour problems presenting in a paediatric context is described. This model aims to generate a form of understanding that is not only accessible but can also generate management strategies.
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Understanding the effectiveness of school-based interventions to prevent suicide: a realist reviewBackground: Schools appear an obvious place to deliver suicide prevention interventions for children and adolescents. The complexity of suicide interventions lead to a paucity of good quality evidence. An alternate approach of information gathering is needed to identify and collate evidence from existing interventions. Scope: We completed a realist review of school-based suicide interventions. This is a novel method of understanding complex interventions that uses an iterative approach. In this review, we attempt to clarify and lay out what type of suicide intervention programme might be useful in schools, based on the local needs and context. Conclusion: It is possible to develop and implement an evidence-based suicide intervention in schools by understanding the different processes that can contribute to success or failure of these interventions in a real-world setting.
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Deterioration and recovery of DAP IQ scores in the repeated assessment of the Naglieri draw-a-person (DAP) test in 6- to 12-year-old childrenThe study investigated whether mental age in children, as assessed by the IQ in the Draw-A-Person (DAP) test (Naglieri, 1988), can be improved by practice. In addition, it was tested whether children needed novel content to keep up their performance level during test repetition. The DAP test was given to 6-, 8-, 10-, and 12-year-old children (N = 80) 3 times. In addition, they drew a police figure 3 times, with task sequence counterbalanced. Repeated drawings resulted in significant omission of detail and deterioration of scores, but the novel task instruction temporarily recovered the IQ scores. This did not occur in the reverse sequence of the tasks, with the less specified DAP instruction given in the 2nd half of the drawing series. Furthermore, structural regressions in the human figure drawing could be observed in individual cases. However, 12-year-olds did not need the external introduction of novel content to maintain their IQ score. Correlations showed that this age group redefined their drawing plan on each repetition, and often created unique figures on each occasion, even if the instruction had stayed the same.
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Prevalence of child abuse in Kerala, India: an ICAST-CH based surveyBackground: Child abuse is a major concern in India with frequent reports of extreme maltreatment and fatalities. A dearth of robust and methodologically sound studies has resulted in ambiguity regarding the extent of child abuse in the general population. Objectives: To estimate the one-year and lifelong prevalence of exposure to violence, physical abuse, emotional abuse, sexual abuse, and neglect using a validated instrument-the International Society for the Prevention of Child Abuse and Neglect (ISPCAN) Child Abuse Screening Tool - Child, Home Version (ICAST-CH). Participants and setting: Adolescents (n = 6957) attending randomly selected schools in one city in Kerala, India. Methods: Cross-sectional survey using self-report instrument. Results: The one-year prevalence of any abuse was 89.9% (95% CI: 89.1-90.7) suggesting that child maltreatment was widespread. Physical and emotional abuses were also very common. Although sexual abuse was least common, a considerable proportion of adolescents reported it; one-year prevalence of sexual abuse was 16.7% and lifetime prevalence was 19.9%. Boys reported more abuse than girls across all the categories of abuse (including sexual abuse). Abuse was more frequent in the higher age groups and classes at school. Abuse was also more frequent in nuclear families and families that reported alcohol use. Children who reported an abusive experience usually faced more than one category of abuse; abuse in one category was significantly associated with abuse in other categories. Conclusions: Abuse of children is alarmingly common. There is an urgent need for improving the awareness surrounding this issue as it is a major public health challenge faced by the country. The priority should be on setting up easily accessible support services for children.