Association Between Mental Healthcare Shortages and Impact On Essential Community Resources

The present paper examines the use of dung for two essential human resources, fuel and fertilizer, in a highland community of southern Peru. The limited energy availability and the poor soils of the region, primarily the result of high-altitude climate and topography, necessitate this practice. Alternatives to dung use are costly or unavailable. Grazing herbivores transform the widely dispersed puna grasses into a compact and easily gathered source of energy and nutrients. Native choice among available dungs corresponds to their qualities: sheep dung, richest in nutrients, is applied as fertilizer; llama and cattle dungs, each with a high caloric value, are burned as fuels. Dung use is interpreted as an energetically efficient response to the highland environment and as central to the subsistence pattern in the area.

Consensus recommendations for essential vascular care in low- and middle-income countries

In the midst of the COVID-19 pandemic, farmers and farm workers have been deemed essential workers across the world. Yet, despite working in one of the most dangerous occupations, and despite being especially vulnerable to the virus (due to existing health risk factors and risk of infection stemming from difficulties adopting control measures), many farmers and farm workers in the United States have long lacked essential resources to ensure they can meet their health needs: affordable and accessible health insurance and health care. In this commentary, we draw on our own research focused on farm families and collective experiences to discuss three main challenges farm families have faced meeting their health needs: reliance on off-farm work for health insurance coverage, the need to forecast income when purchasing a plan on the health insurance marketplace, and barriers to health care in rural areas. As we discuss these challenges, we highlight the ways in which the COVID-19 pandemic is likely exacerbating these pressures. Recognizing that major crises in the past have led to major shifts in economic, social, and political systems, the disruptions brought on by COVID-19 could be leveraged to work toward increasing access to affordable and adequate health insurance and health care. As such, we conclude our commentary by outlining policy reforms and research efforts that are needed to ensure that those working in the farm sector have access to essential resources to preserve their health and safety.

Background: The integration of mental health services into primary health care (PHC) is considered a key strategy to improve access to care for people with common mental disorders (CMDs) in low- and middle-income countries (LMICs), yet mental health services remain largely unavailable at the PHC level. In Mexico, mental health services are only available at 30% of PHC clinics. Difficulties in translating research findings into routine health service delivery represent a major obstacle to integration of mental health care in PHC. This project investigated the barriers and facilitators to the implementation of mental health programmes integrated in PHC platforms in low-resource settings. Methods: I conducted a systematic review of the barriers and facilitators to the implementation of programmes for CMDs in primary care in LMICs. Then I conducted a mixed-methods case study of a mental health programme integrated in PHC clinics located in rural Mexico to examine implementation process and outcomes, and elicit potential barriers and facilitators to the programme implementation. First, I used mixed-methods to describe the programme implementation and examine outcomes. Subsequently, I used mixed-methods to explore factors related to non-attendance to mental health follow-up consultations. Finally, I used qualitative methods to elicit barriers and facilitators to implementation from the perspectives of service providers and service users. Results: Factors influencing programme implementation were identified through the systematic review including the organisation’s readiness for implementation, the attributes, knowledge and beliefs of service providers, complex service user needs, adaptability and perceived advantage of interventions, and the processes of planning and evaluating the implementation. The case study showed that implementation outcomes included: programme integration, and high levels of acceptability and feasibility enabled through support from the implementing organisation. Fidelity was limited due to the low provision of talk-based interventions. Providers identified that delivering talk-based interventions was unfeasible due to time constraints and limited specialist support to develop the skills needed to provide them. Non-attendance to mental health consultations was an important challenge to implementation fidelity. Main barriers to attendance included, long distance to the clinics, type of treatment, and waiting times; facilitators were the presence of a comorbidity, and perceived need of treatment. Experiences with providers or treatments were identified as both facilitators and barriers. Key facilitators to the programme implementation were the cultural adaptation and perceived advantage of interventions to deliver mental health care, the commitment of health providers, the availability of key resources, an organisational culture that promoted health care as a human right, and the presence of a strong programme leadership. Key barriers included the complexity of mental health interventions, low self-efficacy from health providers, insufficient availability of mentorship from specialists, and the complex needs and expectations of service users. Conclusions: Strengthening the health system is a necessary first step to implement mental health programmes in PHC to ensure ongoing capacity building mechanisms, essential resources, and specialist support are available. Moreover, to adequately address the health and social needs of service users in low-resource settings, locally relevant social interventions and intersectoral collaboration are essential.

Each day, children in Chicago are cheated out of a challenging, meaningful, or even an adequate education. Chicago public school students, overwhelmingly children of color (56% are African American, 29% are Latino) and children of the poor (79% qualify for federal lunch programs) are the victims. Despite the well-publicized crime rate in Chicago's poor neighborhoods, the greatest robbery is not in the streets, but in the schools. For example:* Of the 39,000 freshman who entered Chicago high schools in 1980, only 18,500 graduated in 1984.* Less than a third of those students could read at or above the 12th-grade level as measured by a national standardized test.* During the decade of the 1980s, between 40% and 50% of students who entered Chicago high schools dropped out, and many dropped out before beginning high school.* Reading scores in almost half of Chicago's schools are in the lowest 1% of the nation.In the past several years, a massive social movement has coalesced around reforming Chicago's schools. It has become a movement to fight this crime against children, a movement that is in profound ways a continuation of the African American freedom struggle, and a movement that may yet derail on issues of race and racism. This, then, is a story of conflict and contradiction, of a restless sea of social forces.If the flim-flam in Chicago is thought of as simple stealing, then over time Chicagoans witness not merely a stick-up, but grand larceny indeed, towering, extravagant theft. The following is an explanation of how this flim-flam works.INEQUITABLE DISTRIBUTION OF EDUCATIONAL RESOURCESChicago schools are at the lower end of the resource-distribution curve, and they lack the most basic, essential resources needed to do the job they are asked to do. Eighty percent o the children in Illinois who speak something other than English as their first language attend Chicago public schools, and half of the poorest children in the state are served in these schools. Chicago children need more, and yet they receive less.Chicago spends about 15% less per student than surrounding districts. This is partly because the city can raise only about $1,500 per student per year on its property tax base, less than half that raised by the average suburban district. For example, within a few miles of Chicago, one district raises $12,000 per child; another $14,000 per child. State aid to Chicago schools is based on the notion that only 22.6% of the students are from poor families, yet the federal census declares that 45% of Chicago's students are poor and that 79% are eligible for the federal reduced-price lunch program. This artificial limit in the state aid formula costs Chicago schools over $120 million a year.Money is only one aspect of the resource equation. Aging and inadequate physical plants, overcrowded spaces, a disastrous public transportation system, deteriorating local services including parks and libraries, poor access to the resources of the wider community and city, the inaccessibility of school buildings to students during nonschool hours, and the questionable standards for certifying teachers--each of these factors is a matter of resources, and on each measure, Chicago children need the most and get the least.Chicago schools are increasingly poor, African American, and Latino; and the political struggle over state funding of the city's schools is intense. While surveys of suburban and downstate voters have indicated an unwillingness on their part to adequately fund Chicago schools, a glimmer of hope was seen last spring when 56% of Illinois voters supported a state constitutional amendment that would have raised taxes to support more equitable school funding. The amendment was defeated (60% of the vote was needed to pass), but it out-polled both presidential contender Bill Clinton and senatorial candidate Carol Moseley-Braun.In 1988, Illinois's then-governor James Thompson agitated a wide range of racial tensions when, in arguing against adequate funding for Chicago schools, he quipped that he did not want to throw money into a Black Hole. …

The study of the interrelationship between productivity and biodiversity is a major research field in ecology. Theory predicts that if essential resources are heterogeneously distributed across a metacommunity, single species may dominate productivity in individual metacommunity patches, but a mixture of species will maximize productivity across the whole metacommunity. It also predicts that a balanced supply of resources within local patches should favor species coexistence, whereas resource imbalance would favor the dominance of one species. We performed an experiment with five freshwater algal species to study the effects of total supply of resources, their ratios, and species richness on biovolume production and evenness at the scale of both local patches and metacommunities. Generally, algal biovolume increased, whereas algal resource use efficiency (RUE) and evenness decreased with increasing total supply of resources in mixed communities containing all five species. In contrast to predictions for biovolume production, the species mixtures did not outperform all monocultures at the scale of metacommunities. In other words, we observed no general transgressive overyielding. However, RUE was always higher in mixtures than predicted from monocultures, and analyses indicate that resource partitioning or facilitation in mixtures resulted in higher-than-expected productivity at high resource supply. Contrasting our predictions for the local scale, balanced supply of resources did not generally favor higher local evenness, however lowest evenness was confined to patches with the most imbalanced supply. Thus, our study provides mixed support for recent theoretical advancements to understand biodiversity-productivity relationships.

Looking beyond the coronavirus: lessons and principles.

Early diagnosis of HIV infected and the availability of antiretroviral therapy (ART) has helped HIV infected person to receive appropriate and timely treatment. HIV infected individuals on ART continue to stay at home till such time until hospitalization becomes absolutely necessary. The Informal caregivers (ICGs) who provide care and support out of sense of duty or love, who are neither trained in healthcare nor compensated for their services, are expected to provide a helping hand to the formal caregivers in matters of monitoring drugs, health hygiene, providing nutritious diet and providing emotional support. Care of HIV infected persons require a lot of physical and mental energy. The impact of HIV caregiving leads to psychological distress which results in symptoms of depression and anxiety. Besides, as HIV is considered as a self-inflicted medical condition, compassion and emotional support from other family members, relatives, and friends is practically zero. In addition, stigma and discrimination heightens the psychological distress experienced by the ICGs. A few researchers have focused on the psychological distress faced by ICGs. Thus, very little has been done to understand or develop one of the most essential resources: the ICGs of people infected with HIV.Depression refers to an array of phenomena, ranging from the normal expression of a sad mood to the impaired emotional state of a clinical depression (Teri & Wagner, 1992). Negative emotions form the heart of depressive syndrome, but many other symptoms such as reduced appetite, insomnia and lack energy may also appear (Weiten & Lloyd, 2003). Among the psychological disorders, anxiety disorders are the common. Moreover, anxiety is one of the most prevalent problems promoting the need for medical and mental services. Many recent studies have frequently found that anxiety disorders more often precede rather than follow depression (e.g., Alloy et al., 1990; Brown & Barlow, 1992; Rohde et al., 1991). These findings may lend support to recent theories that conceptualize anxiety and depression as similar constructs falling in different points of helplessness-hopelessness continuum (Barlow, 1991 ).Yoga, an ancient Eastern philosophy incorporates stress-reduction techniques that include regulated breathing, relaxation as well as various postures (Cohen et al., 2004). Yoga can be considered as active coping strategy which helps in managing negative emotions experienced in caregiving and enhances positive thinking. Besides, Yoga helps in managing their own distress by bestowing greater powers of concentration and self-control. Increasing attention is being focused on non pharmacological therapy and relaxation techniques in meeting the demands of clinicians and patients' nowadays (Sahasi et al., 1991 ). It has under gone changes from its original form tailored by individual yoga practitioners to attract more followers. Yoga has often been perceived as a method of stress management tool that can assist in alleviating depression, anxiety and physical disorders. The aim of the study was to provide valuable information on the psychological impact on HIV/AIDS caregivers and also give an insight into the efficacy of therapeutic intervention at the level of primary care.MethodParticipantsPurposive sampling was used as the aim was to investigate a specific pre-defmed group - the ICGs of people living with HIV/AIDS. To be eligible for the study, ICGs had to be the primary caregiver of the HIV infected person (adult or child) who have the diagnosis of sero-positive status for a minimum of one month. The sample consisted of 35 ICGs fromNGOs catering to people infected with HIV/AIDS in Mumbai.InstrumentsBeck's Depression Inventory (Beck, 1971): Beck's Depression Inventory consists of 21 items and there are four possible responses to each item namely 'Always', 'Often' 'Sometimes' and 'Never'. The Subjects were asked to tick () any one, which applies to them most. …

Evidence-Based Medicine: A New Paradigm for the Teaching and Practice of Medicine

Technology assessment can lead to the rapid application of essential diagnostic technologies and prevent the wide diffusion of marginally useful methods. In both of these ways, it can increase quality of care and decrease the cost of health care. This comprehensive monograph carefully explores methods of and barriers to diagnostic technology assessment and describes both the rationale and the guidelines for meaningful evaluation. While proposing a multi-institutional approach, it emphasizes some of the problems involved and defines a mechanism for improving the evaluation and use of medical technology and essential resources needed to enhance patient care.

Two West African countries, Benin and Guinea, have been reorganizing their peripheral health systems since 1986, with the goal of improving access to primary health care (PHC). A comprehensive approach evolve, based on improving effectiveness, optimizing efficiency, ensuring financial variability and promoting equity. These strategies were launched as the Bamako Initiative by the World Health Organization's Regional Assembly in 1987. This is the first in a series of five articles on the Bamako Initiative in Benin and Guinea. The strategies implemented in these two countries are discussed. Subsequent articles discuss the improved health indicators, impact on service costs efficiency, and community empowerment through local cost recovery and equity implications. The health center is the basis for a revitalized primary care system. From here, an integrated minimum health care package is readily accessible to meet basic community health needs. Through the Bamako Initiative program, drugs and other essential resources are always available, regular contract between the community health service providers and communities has increased, and the quality of care has improved while also becoming more efficient. Community health resources are managed locally through joint microplanning and monitoring, involving health personnel and village committees. Community ownership, fostered by local budgeting and decision making, is an essential pillar for the success of the system.

Between 2022 and 2024, Somalia's ongoing drought claimed more than 70 000 lives, with nearly 40% of these deaths among children under 5. This tragic loss highlights the urgent need for action to address the disproportionate impact of the drought on Somalia's most vulnerable populations. The 2022 drought, which affected nearly half of the country's population, brought Somalia to the brink of famine, leaving many families without essential resources and health care, particularly in the southern-central regions like Banadir, Bay, and Lower Shabelle. Despite narrowly avoiding famine through the efforts of the Somali government and international partners, the consequences of the drought continue to devastate communities. The study "From Insight to Action: An Update on Mortality Patterns in Somalia" reveals that most excess deaths were children, presenting not only a tragedy for families but also a long-term social and economic setback for the nation. WHO and UNICEF stress the need for a long-term approach to address Somalia's vulnerabilities, emphasizing the importance of building resilient health systems, investing in climate-resilient agriculture, and empowering communities. The international community must also commit to supporting Somalia's development to break the cycle of disaster and ensure a brighter future for the nation's children.

Acute Care Nurse Practitioner-Led Extracorporeal Membrane Oxygenation Simulation Training.

BackgroundIt is estimated that 287,000 women worldwide die annually from pregnancy and childbirth-related conditions, and 6.9 million under-five children die each year, of which about 3 million are newborns. Most of these deaths occur in sub-Saharan Africa. The maternal health situation in Tanzania mainland and Zanzibar is similar to other sub-Saharan countries. This study assessed the availability, accessibility and quality of emergency obstetric care services and essential resources available for maternal and child health services in Zanzibar.MethodsFrom October and November 2012, a cross-sectional health facility survey was conducted in 79 health facilities in Zanzibar. The health facility tools developed by the Averting Maternal Death and Disability program were adapted for local use.ResultsOnly 7.6 % of the health facilities qualified as functioning basic EmONC (Emergency Obstetric and Neonatal Care) facilities and 9 % were comprehensive EmONC facilities. Twenty-eight percent were partially performing basic EmONC and the remaining 55.7 % were not providing EmONC. Neonatal resuscitation was performed in 80 % of the hospitals and only 17.4 % of the other health facilities that were surveyed. Based on World Health Organisation (WHO) criteria, the study revealed a gap of 20 % for minimum provision of EmONC facilities per 500,000 population. The met need at national level (proportion of women with major direct obstetric complications treated in a health facility providing EmONC) was only 33.1 % in the 12 months preceding the survey. The study found that there was limited availability of human resources in all visited health facilities, particularly for the higher cadres, as per Zanzibar minimum staff requirements.ConclusionThere is a need to strengthen human resource capacity at primary health facilities through training of health care providers to improve EmONC services, as well as provision of necessary equipment and supplies to reduce workload at the higher referral health facilities and increase geographic access.

To explore the experiences of providers from two community behavioral health agencies involved in the implementation of Certified Community Behavioral Health Clinics (CCBHCs). This qualitative study was conducted as part of a larger evaluation of CCBHC implementation outcomes in two community-based behavioral health agencies. Ninety-one participants, including case managers, counselors, care coordinators, and leadership teams from both agencies, participated in focus group discussions to share their experiences regarding the implementation of the CCBHC model within their organizations. Three rounds of focus group discussions were held between 2021 and 2023. A total of 24 focus groups were audio-recorded and transcribed by one of the researchers. Qualitative data was analyzed by two researchers using the systematic text condensation method. Six themes emerged from the focus groups reflecting both positive impacts and implementation challenges. Providers reported the implementation of CCBHCs improved service accessibility and effective care coordination; however, staff noted difficulties connecting clients with essential community resources, including housing and transportation. Both agencies underwent significant organizational transformation, although communication strategies varied by agency size. Finally, providers observed improved communication, client benefits (e.g., reduced hospitalizations), and positive organizational change. Despite these successes, agencies expressed significant concerns about long-term program viability due to reliance on temporary grant funding. The CCBHC model of integrated care has expanded significantly in recent years. Most participants reported a positive cultural shift within their agencies following CCBHC implementation. However, limited community resources continue to restrict agencies' ability to address clients' basic needs. Since the CCBHC model was implemented through temporary grant funding, sustainability remains a concern. Both issues underscore the need for policies that increase the availability of community resources and ensure the long-term viability of CCBHCs.