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Prevalence and Correlates of Alcohol Dependence Disorder among TB and HIV Infected Patients in Zambia  [PDF]
Rebecca O’Connell, Nathaniel Chishinga, Eugene Kinyanda, Vikram Patel, Helen Ayles, Helen A. Weiss, Soraya Seedat
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0074406
Abstract: Objectives To determine the prevalence and correlates of alcohol dependence disorders in persons receiving treatment for HIV and Tuberculosis (TB) at 16 Primary Health Care centres (PHC) across Zambia. Methods 649 adult patients receiving treatment for HIV and/or TB at PHCs in Zambia (363 males, 286 females) were recruited between 1st December 2009 and 31st January 2010. Data on socio-demographic variables, clinical disease features (TB and HIV), and psychopathological status were collected. The Mini International Neuropsychiatric Interview (MINI) was used to diagnose alcohol dependence disorder. Correlates of alcohol dependence were analyzed for men only, due to low prevalence in women. Univariable and multivariable logistic regression models were used to estimate odds ratios (OR) and 95% confidence intervals (CI), using general estimating equations to allow for within-PHC clustering. Results The prevalence of alcohol dependence was 27.2% (95%CI: 17.7-39.5%) for men and 3.9% (95%CI: 1.4-0.1%) for women. Factors associated with alcohol dependence disorder in men included being single, divorced or widowed compared with married (adjusted OR = 1.47, 95%CI: 1.00-2.14) and being unemployed (adjusted OR=1.30, 95%CI: 1.01-1.67). The highest prevalence of alcohol dependence was among HIV-test unknown TB patients (34.7%), and lowest was among HIV positive patients on treatment but without TB (14.1%), although the difference was not statistically significant (p=0.38). Conclusions Male TB/HIV patients in this population have high prevalence of alcohol dependence disorder, and prevalence differs by HIV/TB status. Further work is needed to explore interventions to reduce harmful drinking in this population.
A Brief History of Kafue National Park, Zambia.
H.K. Mwima
Koedoe : African Protected Area Conservation and Science , 2001, DOI: 10.4102/koedoe.v44i1.186
Abstract: This paper presents the first documentation of the history of Zambia's oldest and largest national park: Kafue National Park. The movement of people out of the park is systematically presented. Furthermore, access and resource use and exploitation rights granted to people who lived inside the park are summarised. The paper looks at park administration, wildlife management, tourism and briefly presents areas for future studies.
ZAMSTAR, The Zambia South Africa TB and HIV Reduction study: Design of a 2 × 2 factorial community randomized trial
Helen M Ayles, Charalambos Sismanidis, Nulda Beyers, Richard J Hayes, Peter Godfrey-Faussett
Trials , 2008, DOI: 10.1186/1745-6215-9-63
Abstract: The interaction between TB and HIV is reviewed and possible interventions that could reduce the prevalence of TB in HIV-endemic populations are discussed. Two of these interventions are described in detail and the design of a 2 × 2 factorial community randomised trial to test these interventions is presented. The limitations and challenges of the design are identified and discussed.There is an urgent need to reduce the prevalence of TB in communities highly affected by HIV. Potential interventions are complex and require innovative trial designs to provide the rigorous evidence needed to inform health policy makers and to ensure that resources are used optimally.Number: ISRCTN36729271Tuberculosis (TB) incidence is increasing in much of sub-Saharan Africa, largely due to the high prevalence of HIV infection. International TB control strategies rely on self-presentation of cases to the health services, diagnosis by sputum smear microscopy and the use of a 6–8 month course of multi-drug therapy to cure the disease[1]. However these strategies are currently failing to control TB in high HIV prevalence settings, due both to the massive burden of disease and the inadequacy of existing health systems to find and cure infectious cases coupled with the continuing stigma and denial that surround HIV and TB[2].The Zambia/South Africa TB and AIDS Reduction (ZAMSTAR) study aims to use existing tools for diagnosis and treatment but to test new approaches to the delivery of TB control strategies to determine whether these can reduce the prevalence of TB and HIV at community level.The first mechanism by which prevalence of TB could be reduced is through more efficient detection and treatment of infectious cases of TB. Prior to the HIV epidemic, a large body of work provided the backbone for the DOTS strategy, which uses passive case-finding to detect TB cases[3]. Recent work highlights the importance of case-finding and the need to adapt the existing approach to incorporate a more
Brief major depressive episode as an essential predictor of the Bipolar Spectrum Disorder  [cached]
Amir Shabani,Fatemeh Zolfigol,Mehdi Akbari
Journal of Research in Medical Sciences , 2009,
Abstract: BACKGROUND: A bipolar spectrum definition presented to help the designation of more appropriate diagnostic criteria for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-V) is Ghaemi et al. Bipolar Spectrum Disorder (BSD). The present study evaluates the BSD frequency among inpatients with major depressive disorder (MDD) and tries to elucidate the contribution of second degree diagnostic items of BSD in the BSD definition. METHODS: One hundred individuals aged 18-65 with current MDD consecutive admitted in three university affiliated psychiatric center were clinically interviewed. The patients with mental retardation or the history of substance dependence/ abuse were excluded. The interviews were carried out by a trained general practitioner according to an 11-item checklist comprised of criteria C (2 items) and D (9 items) of Ghaemi et al. BSD. RESULTS: Fifty three males and 47 females entered the study. Patients' mean age was 34.16 ± 9.58. Thirty eight patients (39.2%: 18 males and 20 females) met the complete diagnostic criteria of BSD. Early-onset depression (53.0%), recurrent depression (40.0%) and treatment resistant depression (38.8%) were the most frequent accessory items of BSD, but using logistic regression three items -recurrent major depressive episodes (MDEs), treatment resistant depression, and brief MDE- had the significant weight to predict the BSD. Then, three mentioned items were simultaneously entered the logistic regression model: brif MDE (β = 1.5, EXP (β) = 4.52, p = 0.007), treatment resistant depression (β = 1.28, EXP (β) = 3.62, p = 0.01), and recurrent MDEs (β = 1.28, EXP (β) = 3.62, p = 0.01) had the highest strength in predicting BSD and account for 21-30% of BSD diagnosis variance in sum. CONCLUSIONS: Regarding the greater diagnostic strength of some accessory items – especially brief MDE – to predict the BSD, it is suggested that these items were considered as the main ones in the BSD criterion C. KEY WORDS: Bipolar spectrum disorder, brief depressive episode, recurrent depression, treatment resistant depression.
The Impact of Tuberculosis on Zambia and the Zambian Nursing Workforce
Dorothy Chanda,Davina J. Gosnell
Online Journal of Issues in Nursing , 2006,
Abstract: In Zambia, the incidence of tuberculosis (TB) has greatly increased in the last 10 years. This article describes Zambia and highlights the country’s use of the United Nations Millennium Development Goals as a framework to guide TB treatment programmes. An overview of TB in Zambia is provided. Data related to TB cases at the county’s main referral hospital, the University Teaching Hospital (UTH), is discussed. Treatment policies and barriers are described. Zambian nurses have been greatly affected by the rise in the morbidity and mortality of nurses with TB. This article explains the impact of TB on the Zambian nursing workforce. Review of Zambian government programmes designed to address this health crisis and targeted interventions to reduce TB among nurses are offered.
Web-based tools can be used reliably to detect patients with major depressive disorder and subsyndromal depressive symptoms
Chao-Cheng Lin, Ya-Mei Bai, Chia-Yih Liu, Mei-Chun Hsiao, Jen-Yeu Chen, Shih-Jen Tsai, Wen-Chen Ouyang, Chia-hsuan Wu, Yu-Chuan Li
BMC Psychiatry , 2007, DOI: 10.1186/1471-244x-7-12
Abstract: The ISP-D to screen for major depressive disorder (MDD), minor depressive disorder (MinD), and subsyndromal depressive symptoms (SSD) was developed in traditional Chinese. Volunteers, 18 years and older, were recruited via the Internet and then assessed twice on the online ISP-D system to investigate the test-retest reliability of the test. They were subsequently prompted to schedule face-to-face interviews. The interviews were performed by the research psychiatrists using the Mini-International Neuropsychiatric Interview and the diagnoses made according to DSM-IV diagnostic criteria were used for the statistics of criterion validity. Kappa (κ) values were calculated to assess test-retest reliability.A total of 579 volunteer subjects were administered the test. Most of the subjects were young (mean age: 26.2 ± 6.6 years), female (77.7%), single (81.6%), and well educated (61.9% college or higher). The distributions of MDD, MinD, SSD and no depression specified were 30.9%, 7.4%, 15.2%, and 46.5%, respectively. The mean time to complete the ISP-D was 8.89 ± 6.77 min. One hundred and eighty-four of the respondents completed the retest (response rate: 31.8%). Our analysis revealed that the 2-week test-retest reliability for ISP-D was excellent (weighted κ = 0.801). Fifty-five participants completed the face-to-face interview for the validity study. The sensitivity, specificity, positive, and negative predictive values for major depressive disorder were 81.8% and 72.7%, 66.7%, and 85.7% respectively. The overall accuracy was 76.4%.The evidence indicates the ISP-D is a reliable and valid online tool for assessing depression. Further studies should test the ISP-D in clinical settings to increase its applications in clinical environments with different populations and in a larger sample size.Clinical depression is a highly prevalent mental illness. The World Health Organization Global Burden of Disease study in 1997 predicted that clinical depression will be the second most
Translation and validation of brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients  [cached]
Kochhar P,Rajadhyaksha S,Suvarna V
Journal of Postgraduate Medicine , 2007,
Abstract: Context: Depression is frequently encountered in the primary care setting but is often unrecognized and hence untreated. There is a need for a uniform user-friendly screening instrument for depression for primary healthcare personnel in India. Aims: Translation and validation of the brief patient health questionnaire (BPHQ) as a screening tool for depression in major Indian languages. Materials and Methods: This was a prospective study conducted at 18 sites, in psychiatric and general clinics. The English version of the BPHQ was translated into 11 Indian languages. The translations were reviewed by experts and volunteers and proofread for the final translated BPHQ. The validation exercise included more than 3000 subjects. A psychiatrist and a psychiatry social worker / coordinator conducted the study under the supervision of the principal investigator. For each language, the presence or absence of major depressive disorder (MDD) as diagnosed with the help of a patient-completed BPHQ and the psychiatrist DSM-IV diagnosis was matched. The kappa coefficient was used as a measure of inter-observer agreement between the two diagnostic methods. Results: Seven languages failed the primary validation exercise. These translations were reviewed and the updated versions, after proofreading were re-run for validation. The self-administered BPHQ was successfully translated and validated for diagnosis of MDD against DSM-IV diagnosis made by a psychiatrist, in English, Hindi, Marathi, Oriya, Malayalam, Assamese, Gujarati, Kannada, Telugu, Bengali and Tamil. Conclusions: BPHQ is a simple, quick and reliable instrument, which facilitates rapid and accurate diagnosis of depression in the primary care setting in our country.
Brief Treatment of Co-Occurring Post-Traumatic Stress and Depressive Symptoms by Use of Accelerated Resolution Therapy?  [PDF]
Kevin E. Kip,Frank A. Kozel,Amy Shuman,Sue Ann Girling,David M. Diamond
Frontiers in Psychiatry , 2013, DOI: 10.3389/fpsyt.2013.00011
Abstract: This uncontrolled prospective cohort study evaluated the use of accelerated resolution therapy (ART) for treatment of comorbid symptoms of post-traumatic stress disorder (PTSD) and major depressive disorder. Twenty-eight adult subjects, mean age of 41 years (79% female, 36% Hispanic), received a mean of 3.7 ± 1.1 ART treatment sessions (range 1–5). ART is a new exposure-based psychotherapy that makes use of eye movements. Subjects completed a range of self-report psychological measures before and after treatment with ART including the 17-item PCL-C checklist (symptoms of PTSD) and 20-item Center for Epidemiologic Studies Depression Scale (CES-D). For the PCL-C, the pre-ART mean (±standard deviation) was 62.5 (8.8) with mean reductions of ?29.6 (12.5), ?30.1 (13.1), and ?31.4 (14.04) at post-ART, 2-month, and 4-month follow-up, respectively (p < 0.0001 for comparisons to pre-ART score). Compared to pre-ART status, this corresponded to standardized effect sizes of 2.37, 2.30, and 3.01, respectively. For the CES-D, the pre-ART mean was 35.1 (8.8) with mean reductions of ?20.6 (11.0), ?18.1 (11.5), and ?15.6 (14.4) at post-ART, 2-month, and 4-month follow-up, respectively (p ≤ 0.0001 compared to Pre-ART score). This corresponded to standardized effect sizes of 1.88, 1.58, and 1.09, respectively. Strong correlations were observed at 2-month and 4-month follow-up for post-treatment changes in PTSD and depression symptom scores (r = 0.79, r = 0.76, respectively, p ≤ 0.0002). No serious treatment-related adverse effects were reported. In summary, ART appears to be a promising brief, safe, and effective treatment for adults with clinically significant comorbid symptoms of PTSD and depression. Future controlled and mechanistic studies with this emerging therapy are warranted, particularly given its short treatment duration, and in light of current heightened emphasis on health care cost constraints.
A Review of Tuberculosis in Ndola District of Zambia  [PDF]
Ngula Monde, Musso Munyeme, Sydney Malama
Journal of Tuberculosis Research (JTR) , 2016, DOI: 10.4236/jtr.2016.41001
Abstract: Background: Tuberculosis (TB) remains the most frequent and important infectious disease causing morbidity and mortality globally. The World Health Organization estimates the incidence of all forms of TB in Zambia at 444/100,000. Tuberculosis case notification rates have increased eightfold over the past two decades and this is largely due to the concurrent Human Immunodeficiency Virus epidemic. The cornerstone of Tuberculosis control is early case detection and treatment which is promoted by Direct Observed Treatment-Short course strategy. This paper reviews the available information in English on TB situation in Ndola district of Zambia with the purpose of assessing successes recorded over the reviewed period. Results: This review has noted a reduction in the number of new cases of TB recorded, improved diagnosis and treatment success of TB in Ndola district over the reviewed period. Conclusion: This review has observed a reduction in the number of new cases of TB recorded in Ndola district over a period of ten years due to the strategies put up by the National TB Program as well as the effective implementation of the strategies by the District Medical team. These strategies included the Directly Observed Therapy Short course (DOTS).
Pre-post changes in psychosocial functioning among relatives of patients with depressive disorders after Brief Multifamily Psychoeducation: A pilot study
Fujika Katsuki, Hiroshi Takeuchi, Mizuho Konishi, Megumi Sasaki, Yuka Murase, Atsuko Naito, Hiroko Toyoda, Masako Suzuki, Nao Shiraishi, Yosuke Kubota, Yoshiko Yoshimatsu, Toshiaki A Furukawa
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-56
Abstract: Thirty-two relatives of patients with major depressive disorder participated in an open study testing the effectiveness of brief multifamily psychoeducation. The intervention consisted of four sessions over the course of 6 weeks. Outcome measures focused on emotional distress, care burden and Expressed Emotion (EE).The emotional distress, care burden and EE of the family all showed statistically significant improvements from baseline to after the family intervention. The proportion of relatives scoring 9 or more on K6, which indicates possible depressive or anxiety disorder, decreased from sixteen relatives (50.0%) at baseline, to only 3 relatives (9.3%) after the intervention.This study suggests that brief multifamily psychoeducation is a useful intervention to reduce the psychosocial burden of the relatives of patients with depressive disorder. Further evaluation of family psychoeducation for relatives of patients with depressive disorder is warranted.Major depressive disorder (MDD) is a long-lasting illness with significant effects on the patient's family, social, and work life [1,2]. Treatment failure results in a low recovery rate and frequent relapses [3]. According to studies on the naturalistic course of MDD, a prospective study in Japan showed that 10-20% of patients entering treatment remain chronically depressed without recovery up to 1 or even 2 years [4]. Once recovered, the cumulative probability of remaining well without subthreshold symptoms was 57% at 1 year, 47% at 2 years and 35% at 5 years [5]. Additionally, individuals with MDD have a higher level of divorce [6] and severe financial strain [7].It is easy to imagine that relatives of these patients with MDD are fraught with heavy psychosocial burden and show increased rates of depression and anxiety [8,9]. Research suggests that approximately 40% of caregivers of patients with chronic psychiatric disorder have mental disturbance [10,11]. Among relatives of patients with MDD, the patient's behavio
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