Some implications of a community mental health model for developing countries

The aim of this paper is to call attention to certain problems facing many developing countries which are bound to lead to further difficulties in psychosocial adjustment. Almost all these problems are inherent in the process of socioeconomic change, urbanization, and industrialization. These changes may not only lead to an increase in the rate of mental illness, but because of their impact on the basic family structure and living conditions, will result in a reduced tolerance of deviation on the part of the community. Moreover, the spread of public education and mass media is also likely to lead to a change in the expectations and attitudes of developing nations making it no longer possible to endure psychological suffering as part of one's destiny. Even the improvement of public health services leading to reduction of infant mortality and a rise in life expectancy may lead to a gross increase in demands for mental health services by the very young and the aged sections of the population. It is the contention of this paper that a community mental health model, with certain modifications to fit the local culture, will best serve the increasing mental health needs of developing nations. Of particular relevance are such aspects of the model as population and prevention orientation, community involvement, extension of prefessional resources through consultation, utilization of non-professional manpower, continuity and comprehensiveness of care as well as an open systems conceptualization of the whole process of the organization and delivery of mental health services. The latter approach will help bring about an integration of mental health services within the wider framework of human service agencies, e.g., public health, general and adult education, family planning, and community development.     

Update on punctal plugs

Punctal plugs have offered a safe and often reversible treatment for aqueous-deficient dry eye for over three decades. However, they represent only one tool in our armamentrarium to help patients with dry eyes, and plugs do have limitations. This article briefly reviews the history of occlusive treatments for aqueous tear deficiency and provides an update of recent advancements in punctal and canalicular occlusive materials and techniques.     

Periodic lateralized epileptiform discharges associated with subdural hematoma.

A case presenting with headaches, organic dysfunction with visual hallucinations, and incontinence of urine, all of two days' duration is described here. EEG obtained on the fourth hospital day showed right-sided PLEDS and on the fifth hospital day a generalized seizure occurred. The other clinical and laboratory data led to a diagnosis of bilateral subdural hematomas. The patient recovered following surgical treatment. No etiologic factor other than the subdural hematomas was found to explain the PLEDS. Possible mechanisms of pathophysiology are discussed.     

The role of user charges and structural attributes of quality on the use of maternal health services in Morocco

Health care decision makers in settings with low levels of utilization of primary services are faced with the challenge of balancing the sometimes competing goals of increasing coverage and utilization of maternity services, particularly among the poor, with that of ensuring the financial viability of the health system. Morocco is a case in point where this policy dilemma is currently being played out. This study examines the role of household out-of-pocket costs and structural attributes of quality on the use of maternity care in Morocco using empirical data collected from both households and health care facilities. A nested logit model is estimated, and the coefficient estimates are used to carry out policy simulations of the impact of changes in the levels of out-of-pocket fees and structural attributes of quality in order to help guide policy makers responsible for the design of pending social insurance programs. The results of the paper suggest that social insurance strategies that involve increases in out-of-pocket charges in the form of copayments could be implemented without untoward effects on appropriate use of maternity care for non-poor women, but would be contraindicated for poorer and rural households.     

The association between bladder-emptying methods and health-related quality of life among Iranian individuals with spinal cord injury

Objectives: In this study, we compared the health-related quality of life (HRQoL) among patients with spinal cord injury (SCI) using different bladder emptying methods including normal spontaneous micturition (NSM), micturition with assisted maneuvers (MAM), aseptic intermittent catheterization by patient (IC-P), aseptic IC by an attendant/caregiver (IC-A) and indwelling catheterization.

Design: Cross-sectional.

Setting: Tertiary rehabilitation center.

Participants: Patients referred to Brain and Spinal Cord Injury Research Center between 2012 and 2014.

Outcome measures: HRQoL was assessed by Short Form Health Survey (SF-36). Hierarchical regression analysis with adjustment for probable confounders (demographic and injury-related variables) was performed to assess the relationship between bladder-emptying method and total SF-36 score.

Results: Patients with injury at cervical sections had significantly lower scores in domain of physical functioning (PF), physical component summary (PCS) and total score (P: 0.001, <0.0001 and 0.027, respectively). Longer time since injury was associated with better scores of PCS, Mental component summary (MCS) and total score (P: 0.002, <0.0001 and 0.003, respectively). Regression analysis showed that the effect of bladder-emptying method on total score of SF-36 was significant (P < 0.0001) and this relationship remained significant after adjustment for probable confounders in the second step of hierarchical regression analysis (R: 0.923, R²: 0.852, Adjusted R²: 0.847, P?<?0.0001). Patients with NSM had the highest scores in SF-36 instrument and individuals with indwelling catheterization had the poorest HRQoL in all domains.

Conclusion: This study shows that the type of bladder management method affects HRQoL significantly in patients with SCI. Intermittent catheterization are recommended to be administered instead of indwelling catheterization to improve HRQoL.