Low Resource Settings

There  is  a  high  burden  of  mental  illness  in  low‐resource  areas  within  the  United  States  and  in  low‐  and  middle‐income  countries.  Significant  challenges  in  implementing focal treatments in these settings call for a shift toward alternative treatment approaches  that  have  a  greater  public  health  impact.  We  use  Glasgow  et  al’s. 
(American  Journal  of  Public  Health, 89, 1999,  1322)  RE‐AIM  framework,  which prioritizes  not  only  intervention  effectiveness,  but  also  the  dimensions  of  reach,  adoption,  implementation,  and  maintenance.  We  suggest  that  transdiagnostic  approaches,  specifically  those  that  are  multiproblem,  modular,  flexible  and  of  lower complexity, offer several advantages in low‐resource settings. We review their background, evidence, and specific characteristics that may advance RE‐AIM dimensions in low‐resource settings. We conclude with future directions to increase the public health impact of our mental health interventions.

Background. People with HIV-1 (PWH) exhibit a high fall incidence and increased fracture risk. As little is known about fall frequency and associated factors in PWH residing in lower-middle-income countries (LMIC), we investigated fall frequency, bone quality, and factors associated with fall history in a South African cohort. Methods. Fifty PWH without obvious predisposing factors for mobility impairments attending 2 public primary care clinics in the Western Cape region participated. Demographic, clinical, and physical performance data were collected. Falls were assessed retrospectively over 12 months. Mobility and balance were evaluated using a physical performance battery. Bone mineral density was screened using quantitative ultrasound (QUS). Associations between variables and falls grouping were analyzed using chi-square tests, t tests, and Mann-Whitney U tests, and effect sizes (ES) were calculated. Results. Thirty-four percent of PWH (median age, 36.6 years) reported falling during the past year, and 41.2% of fallers reported multiple falls. Fallers had more mobility problems (P = .013), higher fear of falling (P = .007), higher fracture history (P = .003), worse balance performance (P < .001), higher proportions of detectable viral loads (P = .021), and poorer bone quality (P = .040). Differences were of medium to large ES. Conclusions. This exploratory study is the first to show that relatively young South African PWH without obvious predisposing factors for gait and balance impairments experience falls. The observed fall-associated factors warrant further research using larger samples and longitudinal designs to ascertain fall predictors within this population.

https://www.morressier.com/article/pasung-forms-physical-restraint-critical-review-treatment-gap-severe-mental-illness-lowresource-settings/5c643dc89ae8fb00131f8c55
Physical restraint has been used widely in institutions or by caregiver worldwide. The typical case in Indonesia is pasung or physical restraint, a form of chaining or isolating mentally ill individuals, particularly in case of schizophrenia. This practice happens in other settings as well, in the way of inpatient restraint within a mental health hospital. Exposure to pasung and other physical restraints for the patients are related to barriers in mental health services, which is a concrete form of treatment gap, the proportion of those who do need treatment but does not receive any. The analysis aims at developing recommendations for optimising community resource to minimise treatment gap and reduce the rate of physical restraint.

We report a case of human immunodeficiency virus-associated pericardial tuberculosis complicated by cardiac tamponade. Emergency management and subsequent therapeutic interventions are described and then discussed with particular focus on resource-limited settings. The paucity of evidence to support clinical decisions is emphasized and the need for well designed diagnostic and therapeutic studies is highlighted.