WHO ASSIST Research Articles

T148. FIRST EPISODE PSYCHOSIS, TRAUMA AND SUBSTANCE USE IN A HIGH HIV PREVALENCE SETTING IN SUB-SAHARAN AFRICA

BackgroundHIV, substance use and trauma are associated with more severe symptoms and poorer outcomes in psychosis. We aim to describe the profile of adults with first episode psychosis (FEP) and associations with substance use and trauma in a cohort of patients in a low resource, high HIV prevalence setting in South Africa.MethodsWe recruited all adult patients (18–45 years) presenting with FEP to five psychiatric units in the eThekwini Municipality, KwaZulu-Natal Province. Psychiatric diagnosis was made using the MINI. We used the PANSS for psychotic symptoms, WHO ASSIST for substance use and CTQ for early childhood trauma. HIV status was confirmed by ELISA.ResultsSixty participants were recruited, mean age 26 years (SD 8, IQR 19–33), 68% (n=41) were male. Mean age at presentation was 24 and 31 years for males and females respectively, with males being significantly younger than females (p=0.0003). Duration of untreated psychosis (DUP) was 12.5 months (IQR 1–10.3 months). Lifetime tobacco, alcohol and cannabis use was reported at 57%, 55%, and 47% respectively. Substance use was more prevalent among males compared to females, p=0.10, 0.13 and 0.0001 for tobacco, alcohol and cannabis respectively. Lifetime cannabis use was associated with higher negative PANSS scores (mean score 32, SD 10) compared to non-users (mean score 17, SD 7), p=0.05. Sixty eight percent (n=41) reported any traumatic event. Sixty-two percent (n=37) experienced trauma before 18 years and 35% (n=21) reported traumatic experiences in adulthood. Individuals who reported trauma in adulthood had higher hostility scores in the PANSS compared to those who experienced no trauma in adulthood (p=0.05).Fifteen (25%) of the cohort was HIV infected. Females were more likely to be HIV infected (58% HIV infected females compared to 9.8% HIV infection in males, p=0.0001).Eleven of the 15 HIV infected patients had been on antiretroviral treatment prior to the psychosis onset and four were newly diagnosed at the time of psychosis presentation. Of the 11 individuals on antiretroviral treatment, 6 (45%) were virologically suppressed.There was no significant difference in PANSS scores by HIV status (p=0.5) and childhood trauma (p=0.5).DiscussionThe study found participants with FEP had a high prevalence of HIV, particularly in females, and high prevalence of tobacco, alcohol and cannabis use. This suggests that these individuals are particularly vulnerable to the triple burden of psychosis, substance use and HIV. In addition, they had long DUP suggesting delay in accessing treatment, which all serve as poorer prognostic indicators in an already overwhelmed health care setting.The high rates of trauma (more than half the sample reporting childhood trauma) is another major public health concern as trauma exposure has been associated with poorer physical and mental health outcomes. In this study the lack of association between childhood trauma and psychosis severity is inconsistent with literature and needs to be further explored. The association between adult exposure to trauma and increased hostility scores suggests the need to include psychological treatment strategies to address the trauma exposure to improve outcomes.

TASKS AND EDUCATION RESOURCES OF ADOLESCENTS WHO ASSIST WITH CAREGIVING FOR A FAMILY MEMBER WITH DEMENTIA

An abundance of research involving adults who care for family members with dementia has guided the creation of supportive programs/services. Much less is known about adolescents who are dementia caregivers. This descriptive secondary analysis utilized data collected during a qualitative examination into the psychological well-being of adolescent dementia caregivers. Eleven adolescent/adult dyads who provided dementia care for a family member completed surveys prior to the adolescents’ participation in focus groups. Five male and six female adolescents ages 12 to 17 and eleven female adults were asked similar questions about caregiving tasks, education resources, and demographic information. Using descriptive statistics, the results of the surveys provide a snapshot of caregiving among a group of adolescents living in northwest Ohio and highlight differences reported by the dyads. Adult accounts of adolescent preparatory education were incongruent with the adolescents’ and did not report their use of books or online caregiving resources. Conversely, three adults (27%), but no adolescents, identified hands-on and observational opportunities as education resources. Adults reported greater adolescent involvement in ten activities of daily living (71%), especially related to bathing, shopping, transportation, and managing medication and finances. Adolescents reported helping with tasks such as eating and laundry more often than adults. While the sample size was small, these findings suggest a need for triangulation when seeking knowledge about adolescent caregiving. These results may inform researchers wishing to investigate the role of adolescent caregivers, as well as guide supportive agencies who provide education materials to families caring for individuals with dementia.

Sociological and Psychological Factors on Prohibited Substances Abuse in Rehabilitation Centre of Medan City, Indonesia.

INTRODUCTION:Prohibited substances issue and their abuse have become a scourge for people in Indonesia. This situation creates concern for every level of society since this is very influential to damage and can even eliminate generations at a later time.AIM:This study aims to determine the characteristics of age, education, psychological and social problems related to substance dependence experienced by individuals with substance disorders who undergo rehabilitation in Medan, Indonesia.METHODS:This study is a cross-sectional analytic, in which the sample of this study was individuals who underwent rehabilitation in the Rehabilitation Center in Medan City who fulfilled the inclusion and exclusion criteria. A structured interview was carried out with the MINI ICD-10 on part M. disorders related to psychoactive substances. Furthermore, to see the level of dependence, WHO ASSIST questionnaire (The Alcohol, Smoking and Substance Involvement Screening Test) was used.RESULTS:This study discovered that subjects with age above 21 years were the most dominant of the prohibited substance users group as many as 87 people (69%), Batak tribe with 73 people (57.9%), residence originating from outside the city with 70 people (55.6%), Unmarried with 87 people (70.2%), education level is medium (junior high school) with 117 people (92.9%) and work as many as 77 people (61.1%). The study also found that the most dominant number of prohibited substances users were single users of methamphetamine and a combination of two substances, each of which was 49 people (38.9%). There is no relationship between social factors and patterns of prohibited substance use. Also, the most dominant users of prohibited substances who undergo rehabilitation are those based on family and police (involuntary admission). Finally, as many as 70 people used methamphetamine require intensive intervention.CONCLUSION:This study shows that social and demographic factors are not related to the pattern of prohibited substance use.

Tobacco use and HIV symptom severity in Chinese people living with HIV

ABSTRACTExposure to nicotine among people living with HIV (PLWH) may impact physical health as indicated by experienced symptoms. Yet, the empirical evidence documenting the relations between tobacco use and symptom experiences among PLWH remains limited. This study aims to assess the relationships between tobacco use and HIV symptoms through a cross-sectional survey conducted in Beijing and Shanghai. The WHO ASSIST screening test was used for frequency of tobacco use. Sixty-four items from the revised signs and symptoms checklist for persons with HIV disease (SSC-HIVrev) were used. “Total number of symptoms” was created by summing all the binary coded and “Maximal symptom severity” was created by taking the maximal severity level across all symptoms for each participant. After controlling for confounding variables, tobacco use was not associated with the total number of symptom, yet was associated with the maximal symptom severity. This study documents the link between tobacco use and experienced symptoms among PLWH by demonstrating that higher frequency of tobacco use is associated with greater odds of reporting more severe symptoms. Smoking cessation strategies should be integrated into symptom management interventions for PLWH to optimize their effectiveness.

Effect of Participatory Health Promotion Initiative on Tobacco Use among Adolescents: A School-Based Quasi-Experimental Pilot Study from Central India

Introduction: Prevalence of noncommunicable diseases (NCDs) is increasing rapidly in developing countries like India. The commonly attributable modifiable risk factors of NCDs include raised blood pressure (13%), tobacco use (9%), physical inactivity (6%), and obesity (5%). This quasi-experimental study with a pre-post design was conducted with an objective to assess the effect of Participatory Health Promotion initiative (PHPI) on tobacco use among adolescents. PHPI included distribution of personalized health card, tobacco-tar experiment demonstration, use of body mapping technique to emphasize hazards of tobacco on different body organs, and sensitization in small groups. Methods: Baseline tobacco use and health risk assessment were conducted by adapting WHO ASSIST tool among 200 students who were randomly selected from a secondary high school. All students in the school were then exposed to the PHPI. The postmeasurement was done among another 200 randomly selected students after 3 months. Results: The number of current tobacco users reduced from 29 (14.5%) in the baseline to 9 (4.5%) in the postmeasurement with a P

Outcome of a "modified brief intervention" program delivered at work place for a population with hazardous alcohol use.

Introduction:At the population level, screening and brief intervention (BI) is the most cost-effective method to reduce the burden of disease due to hazardous alcohol use. In delivering BI at individual level, trained workforce as well as time is a limiting factor. Hence, a study was conducted to assess the outcome of a “modified brief intervention” program delivered at workplace in a group setting for the participants identified with hazardous alcohol use pattern, as a secondary prevention measure.Materials and Methods:Study was a pre- and post-intervention study without a control group. Following an educational lecture, conducted by a mental health team including a psychiatrist, participants were screened using the WHO ASSIST questionnaire, V3.0 version. Those screened positive for hazardous alcohol use were given “modified brief intervention” in a group setting at their workplace which consisted of two semi-structured sessions of 1-h duration each. The sessions were spaced in a month. First session was based on motivation enhancement measures along with gathering of current alcohol use details and second session focused on relapse prevention. Three months later, the outcomes were assessed using a semistructured questionnaire and ASSIST was reapplied. The analysis was done using the R-commander from R-software.Results:No significant difficulty was experienced in conducting the interventions. Fifty (55.6%) participants stayed alcohol abstinent following second session and another 22 (24.44%) had reduced both the quantity and frequency of use. Paired t-tests revealed statistically significant reduction in all secondary outcome parameters (ASSIST scores, usual dose in one sitting, maximum dose, and number of days of use in month). Eighty (88.89%) participants reported the program to be effective. Only 3 months of observation is a limitation.Conclusion:The study provides an efficient secondary prevention model to reduce hazardous drinking at the population level needing less workforce, cost, and time.

Proceedings of Contributed Presentations 10th World Federation of Chiropractic/Association of Chiropractic Colleges Education Conference

Proceedings of Contributed Presentations 10th World Federation of Chiropractic/Association of Chiropractic Colleges Education Conference

A study of substance abuse among male engineering students staying at hostels in a township near Kolkata

Background: Substance is being more common during college days, due to academic pressure, peer group effects, popularity and easy access to common substances. Men are more likely to engage in substance abuse. This was supposed to be more common in hostels. A study was carried out among male engineering students staying at hostels - with aims to find out the magnitude of substance abuse, to assess the potential risk of different substances abused and to find out a comparison between these two groups.Methods: Study was carried out with the help of two part questionnaire, one part containing alcohol, smoking and substance involvement screening test 8 item screening tool proposed by WHO (WHO-ASSIST). Other part contained socio demographic information. First 50 students, in each two colleges were enrolled in the study after getting their consent.Results: Ever use of tobacco product was found to be 66.0% and 22.0%, of alcoholic beverages: 72.0% and 26.0%, of cannabis: 46.0% and 14.0% - for students of government and private engineering college respectively. In the past 3 months, tobacco (36.0%) followed by cannabis (12.0%) were found to be the most commonly abused substances in government engineering college students while both (6.0%) cannabis and tobacco were the commonest substances of daily abuse among private engineering college students.Conclusions: High level of substance abuse was found to be present among male engineering students staying at hostels with higher level found among students of government engineering college.

Prevalence of nonmedical use of prescription-type opioids, methylphenidate, and sedative-hypnotics among university students in the south of Iran: a regression analysis.

Background and aimNonmedical use of prescription drugs needs particular attention. The aim of this study was to determine the prevalence of prescription-type opioids, methylphenidate and sedative-hypnotics use, and related factors in university students.MethodsIn this cross-sectional study, 524 students of Hormozgan University of Medical Sciences were selected by multi-stage sampling in 2016. A self-report questionnaire had been used examining substance use, religious beliefs and parental support. The questions about substance use were prepared based on the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST). Religious beliefs were measured by Kendler’s general religiosity questionnaire. Parental support was measured by the Persian version of Aneshensel and Sucoff’s scale. All of the analysis was performed using Chi-square test, Fisher exact test, independent-samples t-test and binary logistic regression in SPSS 16 software. The level of significance was 0.05.ResultsThe last year prevalence of prescription-type opioids, methylphenidate and sedative-hypnotics use was 16.1%, 3.3%, and 10.3%, respectively. The final model of logistic regression indicated hookah use (OR=2.5), methylphenidate use (OR=4.5), sedative-hypnotics use (OR=2.7), and were associated with students’ prescription-type opioids use. The protective factor was familial support (OR=0.97) for prescription-type opioids use. Moreover, sedative-hypnotics use (OR=5.7) and illicit drug use (OR=27.6) were associated with methylphenidate use among students.ConclusionsThe results of this study showed that the prevalence of nonmedical use of prescription drugs is considerably high among students and is in need of interventions to reduce the prevalence of these drugs in universities.

A pilot replication of QUIT, a randomized controlled trial of a brief intervention for reducing risky drug use, among Latino primary care patients

BackgroundQUIT is the only primary care-based brief intervention that has previously shown efficacy for reducing risky drug use in the United States (Gelberg et al., 2015). This pilot study replicated the QUIT protocol in one of the five original QUIT clinics primarily serving Latinos. DesignSingle-blind, two-arm, randomized controlled trial of patients enrolled from March-October 2013 with 3-month follow-up. SettingPrimary care waiting room of a federally qualified health center (FQHC) in East Los Angeles. ParticipantsAdult patients with risky drug use (4–26 on the computerized WHO ASSIST): 65 patients (32 intervention, 33 control); 51 (78%) completed follow-up; mean age 30.8 years; 59% male; 94% Latino. Interventions and measuresIntervention patients received: 1) brief (typically 3–4minutes) clinician advice to quit/reduce their risky drug use, 2) video doctor message reinforcing the clinician’s advice, 3) health education booklet, and 4) up to two 20–30minute follow-up telephone drug use reduction coaching sessions. Control patients received usual care and cancer screening information. Primary outcome was reduction in number of days of drug use in past 30days of the highest scoring drug (HSD) on the baseline ASSIST, from baseline to 3-month follow-up. ResultsControls reported unchanged HSD use between baseline and 3-month follow-up whereas Intervention patients reported reducing their use by 40% (p<0.001). In an intent-to-treat linear regression analysis, intervention patients reduced past month HSD use by 4.5 more days than controls (p<0.042, 95% CI: 0.2, 8.7). Similar significant results were found using a complete sample regression analysis: 5.2 days (p<0.03, 95% CI: 0.5, 9.9). Additionally, on logistic regression analysis of test results from 47 urine samples at follow-up, intervention patients were less likely than controls to test HSD positive (p<0.05; OR: 0.10, 95% CI: 0.01, 0.99). ConclusionsFindings support the efficacy of the QUIT brief intervention for reducing risky drug use.

Identifying substance misuse in primary care: TAPS Tool compared to the WHO ASSIST

BackgroundThere is a need for screening and brief assessment instruments to identify primary care patients with substance use problems. This study's aim was to examine the performance of a two-step screening and brief assessment instrument, the TAPS Tool, compared to the WHO ASSIST. MethodsTwo thousand adult primary care patients recruited from five primary care clinics in four Eastern US states completed the TAPS Tool followed by the ASSIST. The ability of the TAPS Tool to identify moderate- and high-risk use scores on the ASSIST was examined using sensitivity and specificity analyses. ResultsThe interviewer and self-administered computer tablet versions of the TAPS Tool generated similar results. The interviewer-administered version (at cut-off of 2), had acceptable sensitivity and specificity for high-risk tobacco (0.90 and 0.77) and alcohol (0.87 and 0.80) use. For illicit drugs, sensitivities were >0.82 and specificities >0.92. The TAPS (at a cut-off of 1) had good sensitivity and specificity for moderate-risk tobacco use (0.83 and 0.97) and alcohol (0.83 and 0.74). Among illicit drugs, sensitivity was acceptable for moderate-risk of marijuana (0.71), while it was low for all other illicit drugs and non-medical use of prescription medications. Specificities were 0.97 or higher for all illicit drugs and prescription medications. ConclusionsThe TAPS Tool identified adult primary care patients with high-risk ASSIST scores for all substances as well moderate-risk users of tobacco, alcohol, and marijuana, although it did not perform well in identifying patients with moderate-risk use of other drugs or non-medical use of prescription medications. The advantages of the TAPS Tool over the ASSIST are its more limited number of items and focus solely on substance use in the past 3months.

An Association Study of the COMT and GABA Gene Variants with Alcohol Dependence

Alcohol dependence (AD), associated with high mortality and morbidity is caused due to involvement of both environmental and genetic factors. Behavioral effects of alcohol including cognitive impairment, motor incoordination, tolerance and dependence are likely due to its effect on the multiple brain proteins including neurotransmitters. Dysfunction in these neurotransmitter systems may be at the level of enzymes involved in metabolic degradation, or receptors involved in neurotransmission like dopamine, Gamma-amino butyric acid (GABA), serotonin etc. Genetic polymorphisms in these neurotransmitter systems are implicated in conferring susceptibility to AD. Aim: To identify association of single nucleotide polymorphisms (SNPs) in COMT (rs4680 and rs2075507) and GABAA receptor genes (rs13172914 and rs211014) with AD. Method: A total of 100 AD patients diagnosed on the basis of DSM IV criteria from the outpatient clinic of the National Drug Dependence Treatment Centre (NDDTC) of All India Institute of Medical Sciences (AIIMS), and 100 healthy individuals from the general population were recruited. A detailed history including pattern of drug use and demographic details with pedigree information was noted. Genomic DNA from peripheral blood samples was processed for PCR amplification followed by restriction digestion to screen for the presence of polymorphisms. Genotype and allele frequencies were evaluated and correlated with alcohol use parameters including duration of alcohol use, age at onset of alcohol use, quantity of alcohol consumed (gms/day) and WHO ASSIST score and levels of liver function enzymes (SGPT and SGOT). Statistical analysis was performed using SPSS v21.0. Results: Genetic analysis of the study group revealed COMT rs4680 to be significantly associated with AD (p=0.03), while the other COMT SNP rs2075507 showed an association with increased levels of SGPT in the patients. GABAA receptor gene polymorphisms showed no association with AD. Conclusion: The study suggests a role of COMT gene polymorphism rs4680 in conferring susceptibility to AD.

Substance Abuse among College Students: Prevalence, Predictors, and Prevention of Students Substance Use

Substance abuse among college students has become a subject of concern all over the world. Growing substance abuse and its crash on physical and psychosocial health is a global public health concern. Particularly disturbing fact is that the age of commencement of abuse is gradually falling. To plan effective interventions, it is essential to have information on the extent and type of substance abuse among students and their attitude towards its control. The current study was carried out to find out the prevalence of substance abuse among college students from urban areas in Bangalore and Mysore, data was collected from students in degree level (n=40), using the WHO ASSIST. This study aimed to show the prevalence of substance abuse among college students and also to understand the influence of legal and soft drugs on the future use of dangerous and hard drugs. Results of current study revealed that the prevalence of substance abuse among college students is high and causes significant physical and psychological problem in this population. A large proportion of those using drugs reported serious adverse effect, raising the necessity of targeted intervention to reduce the risk of subsequent substance and other deleterious consequence.

An Association Study on the Glutamate Pathway GRIN2A Gene Polymorphisms with Heroin Dependence

Background: Heroin dependence (HD) is a complex disorder characterized by disruption in particular circuits of the brain and influenced by environmental and genetic factors. Glutamate pathway plays a role in normal brain functions including learning, memory, and cognition. Disturbances in Glutamate pathways are implicated in many psychiatric disorders, including heroin dependence, and polymorphisms present in these pathway genes are reported to increase the risk of developing heroin dependence. Aim: To identify association of single nucleotide polymorphisms (SNPs) of Glutamate pathway genes with heroin dependence and correlate with heroin use parameters. Method: A total of 103 HD patients were recruited as per DSM IV criteria from the Department of Psychiatry, and 100 healthy volunteers from the general population. Genomic DNA from peripheral blood samples was processed for PCR followed by restriction digestion to screen for presence of GRIN2A polymorphisms in the glutamate pathway. GRIN2A SNPs i.e. rs11866328, rs1071502, rs1375067, rs1530669, rs12325652, rs16966381, rs1104068, rs16966448, rs9927871 and rs1366076 were selected based on the Hap Map project and Tagger program (r2 ≥ 0.8). Genotype and allele frequencies were estimated and the difference between patient and control groups were assessed by chi-square test of significance and the results correlated with duration, age at onset of heroin use, the quantity of heroin consumed and WHO ASSIST score. Statistical analysis was done using Haploview v4.1 and SPSSv21.0. Results: Haplotype analyses revealed three SNPs (rs1071502-rs1366076-rs1104068) with alleles A-T-A to confer risk while the haplotypes A-T-G had a protective effect on HD. Another haplotype (rs1530669-rs9927871) was also found significantly associated with heroin dependence (p=0.039). Conclusion: The study reports for the first time, a possible association of GRIN2A SNPs with age at onset of heroin use, duration and quantity of use, and also suggests an important role in severity of heroin dependence.

Study on Prevalence and It’s Contributing Factors of Psychoactive Substance Abuse among Homeless Children

Homeless children are those who live alone on the street. UNICEF estimated that India has 18 million homeless children which is the largest population in the world. Use of psychoactive substance is particularly high in street children as seen in 40-70% of street children across various Indian cities are substance abusers. The study was conducted at District Ludhiana, Punjab. 60 Homeless children of age group 6-18 years were selected by snowball sampling. WHO Assist V 3.0 and a structured questionnaire were used to collect data. Findings reveals that 55 (91.7%) of the homeless children were psychoactive substance abusers with 14.95 ± 02.50 years as mean age of initiation of the substance abuse. Major factors to initiate substance abuse were enjoyment and peer pressure. Age (p=0.02), Male gender (p=0.43), Illiteracy (p=43) were associated with substance abuse among homeless children.

Capabilities for Clinical Management of Radiation Injuries of the Nikiforov Russian Center of Emergency and Radiation Medicine (EMERCOM of Russia)

This article presents an overview of the capabilities for clinical management of radiation injuries available at the Nikiforov Russian Center of Emergency and Radiation Medicine (NRCERM) of the Ministry of the Russian Federation for Civil Defense, Emergencies and Elimination of Consequences of Natural Disasters (EMERCOM). NRCERM is a federal state budgetary institution and the Russian Federation's head organization for providing medical assistance for persons overexposed to ionizing radiation, responders to radiation emergencies and people evacuated from radiation contaminated areas. As the WHO Collaborating Center for Treatment and Rehabilitation of Accident Recovery Workers of Nuclear and Other Disasters and a member of the WHO Radiation Emergency Medical Preparedness and Assistance Network (REMPAN), NRCERM is prepared to provide assistance and technical support in case of a radiation accident. For this purpose, NRCERM hospitals are equipped with technologically advanced facilities and possess well-trained specialist staff.

Taiwan's Health Aid: A Call for Transparency

Taiwan has experienced rapid progress on multiple indices of economic and human development over the past century, resulting in its recognition as one of the “four Asian tigers” and being among an elite group of “high-income economies ” [1,2]. Although there are a number of factors explaining this rapid development, the role of WHO and other international assistance cannot be ignored [3,4]. With this rapid development, Taiwan has transformed from aid recipient to donor. Yet today Taiwan’s Official Development Assistance (ODA) as a proportion of gross domestic product is believed to be both low in absolute and relative terms [1,4]. ODA includes both bilateral and multilateral aid through grants, low-interest loans, or in-kind assistance. For 2008, the last figures for which we have data, Taiwan ODA amounted to approximately $430 million or 0.11% of gross national income (GNI), far below a United Nations standard of 0.7% [4]. Compared to Organisation for Economic Cooperation and Development (OECD) countries, Taiwan would rank at the bottom on this index, below Greece, Italy, and South Korea, and its value is both low in relative and absolute terms (see Table 1). But without the latest figures for

GHSI EMERGENCY RADIONUCLIDE BIOASSAY LABORATORY NETWORK - SUMMARY OF THE SECOND EXERCISE.

The Global Health Security Initiative (GHSI) established a laboratory network within the GHSI community to develop collective surge capacity for radionuclide bioassay in response to a radiological or nuclear emergency as a means of enhancing response capability, health outcomes and community resilience. GHSI partners conducted an exercise in collaboration with the WHO Radiation Emergency Medical Preparedness and Assistance Network and the IAEA Response and Assistance Network, to test the participating laboratories (18) for their capabilities in in vitro assay of biological samples, using a urine sample spiked with multiple high-risk radionuclides (90Sr, 106Ru, 137Cs, and 239Pu). Laboratories were required to submit their reports within 72 h following receipt of the sample, using a pre-formatted template, on the procedures, methods and techniques used to identify and quantify the radionuclides in the sample, as well as the bioassay results with a 95% confidence interval. All of the participating laboratories identified and measured all or some of the radionuclides in the sample. However, gaps were identified in both the procedures used to assay multiple radionuclides in one sample, as well as in the methods or techniques used to assay specific radionuclides in urine. Two-third of the participating laboratories had difficulties in determining all the radionuclides in the sample. Results from this exercise indicate that challenges remain with respect to ensuring that results are delivered in a timely, consistent and reliable manner to support medical interventions. Laboratories within the networks are encouraged to work together to develop and maintain collective capabilities and capacity for emergency bioassay, which is an important component of radiation emergency response.

Clinical correlates of first episode early onset psychosis in KwaZulu-Natal, South Africa

Background: The study of first episode early onset psychosis can yield many clues to understanding the early development of psychosis and guide interventions to decrease psychosis risk and improve outcome. The aim of the study was to investigate the socio-demographic profile and clinical correlates in early onset psychosis.Method: Forty-five adolescents with first episode early onset psychosis were assessed by a clinical interview, socio-demographic questionnaire, the Positive and Negative Syndrome Scale (PANSS), Symptom Onset in Schizophrenia (SOS) score, the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (WHO ASSIST) questionnaire for substance misuse and a urine cannabis level.Results: The mean age of the respondents was 15.9 years (SD 1.8, range 10–18 years). Thirty-one (69%) were male. There was a poor recognition of the prodromal period in 22 (49%) patients and caregivers. The mean duration of untreated psychosis (DUP) was 27.2 weeks (SD 56.7). There was a negative correlation between DUP and age of onset (p<0.05). Mean age at onset of psychosis (males 15.7 years, SD 2.2, and females 15.3 years, SD 2.6) and mean age of presentation (males 16.0 years, SD 1.8, and females 15.5 years, SD 1.7) was slightly younger in the females than males, but not statistically significant. A total of 25 (56%) adolescents reported lifetime cannabis use and 24 (96%) were male.Conclusion: Symptoms of the prodromal period were poorly recognised. The mean DUP suggests a significant delay in treatment and younger children had a longer DUP. The gender differences in presentation (marginal) and substance use (highly significant) suggests that there may be different environmental risk factors for males and females in early onset psychosis or that early onset psychosis is more genetically homogenous and less dependent on environmental triggers.

First Evidence of Comorbidity of Problem Gambling and Other Psychiatric Problems in a Representative Urban Sample of South Africa.

We investigate the extent to which problem gambling in a recent South African sample, as measured by the Problem Gambling Severity Index (PGSI), is comorbid with depression, anxiety and substance abuse. Data are from the 2010 South African National Urban Prevalence Study of Gambling Behavior. A representative sample of the urban adult population in South Africa (N = 3,000). Responses to the 9-item PGSI and ratings on the Beck Depression Index, the Beck Anxiety Inventory, and the World Health Organization Alcohol, Smoking and Substance Involvement Screening Tool (WHO ASSIST). Cross tabulations and Chi square analyses along with logistic regression analyses with and without controls for socio-demographic and/or socio-economic variables were used to identify comorbidities. The prevalence of depression, anxiety, alcohol and substance use were clearly higher among the sample at risk for problem gambling. Black African racial status and living in areas characterized by migrant mining workers was associated with increased risk of problem gambling and comorbidities. There is strong evidence that findings of comorbidities between pathological gambling and depression, anxiety and substance abuse in developed countries generalize to the developing country of South Africa. Historical context, however, gives those comorbidities a unique demographic distribution.