Publications by authors named "Rachel Jenkins"

160 Publications

"There's Just No Way to Help, and They Did." Parents Name Compassionate Care as a New Domain of Quality in Pediatric Home-Based Hospice and Palliative Care.

J Palliat Med 2020 06 27;23(6):767-776. Epub 2019 Dec 27.

Haslinger Family Pediatric Palliative Care Division and Rebecca C. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA.

To design high-quality home-based hospice and palliative care (HBHPC) systems, it is imperative to understand the perspectives of parents whose children enroll in HBHPC programs. The goal of this project was to identify and define parent/caregiver-prioritized domains of family-centered care in HBHPC by performing semistructured interviews of parents/caregivers ("parents") across Ohio whose children have received HBHPC. We hypothesized that the 10 provider-prioritized domains and their definitions, as identified in our previous research, would be modified and augmented by parents for application in the pediatric HBHPC setting. This was a qualitative study utilizing semistructured interviews of bereaved parents of children who were enrolled in a pediatric HBHPC program at the three sites from 2012 to 2016 and parents of children who were currently enrolled in these programs for at least a year. Parent-prioritized thematic codes mapped to 9 of the 10 provider-prioritized domains of quality HBHPC; none mapped to the domain "Ethical and Legal Aspects of Care." Although most of the provider-prioritized domains are pertinent to parents, parents defined these domains differently, deepening our understanding and perspective of quality within each domain. An 11th domain, Compassionate Care, was created and defined based on emergent themes. Parent/caregiver-prioritized domains of quality in pediatric HBHPC map closely to provider-prioritized domains, but parents define these domains differently. Parents also prioritize Compassionate Care as a new domain of quality in pediatric HBHPC. Measuring the quality of care provided in HBHPC programs through this broader perspective should enable the selection of measures which are truly patient- and family-centered.
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http://dx.doi.org/10.1089/jpm.2019.0418DOI Listing
June 2020

Welcome to the 16th volume of .

Future Oncol 2020 01 4;16(1):4247-4250. Epub 2019 Dec 4.

Future Science Group, Unitec House, 2 Albert Place, London N3 1QB, UK.

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http://dx.doi.org/10.2217/fon-2019-0741DOI Listing
January 2020

Data Resource Profile: Adult Psychiatric Morbidity Survey (APMS).

Int J Epidemiol 2020 04;49(2):361-362e

Department of Health Sciences, University of Leicester, UK.

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http://dx.doi.org/10.1093/ije/dyz224DOI Listing
April 2020

What could the future hold for treatment sequencing in cancer medicine? An interview with Angela Märten.

Future Oncol 2019 Sep 19;15(25):2891-2893. Epub 2019 Aug 19.

Unitec House, Albert Pl, Finchley, London, N3 1QB, UK.

Professor Angela Märten speaks to Rachel Jenkins, Commissioning Editor Angela Märten earned her PhD at Humboldt University of Berlin, Germany, in 2000, after working for several years as an oncology nurse. Upon completion of her PhD, she assumed responsibility for Phase I trials and translational research for the University Hospital of Bonn, Germany. In 2002, the University Hospital of Bonn appointed her as Assistant Professor for Experimental Haematology and Oncology. In 2003, she accepted a new position at the University of Heidelberg, Germany, heading the Immunotherapeutic Group and the Oncology Trial Department. The University of Heidelberg appointed her as Associate Professor in 2006 while she completed her Master of Sciences in Clinical Research in 2008. Professor Märten has been principal investigator of several clinical trials and has published more than 100 papers, with a particular focus on pancreatic carcinoma and lung cancer. She joined Boehringer Ingelheim in 2009, where she built up the German Medical Affairs Oncology team, before joining the Global Afatinib team in 2013. She is currently Global Senior Medical Advisor, Therapeutic Area of Oncology at Boehringer Ingelheim.
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http://dx.doi.org/10.2217/fon-2019-0176DOI Listing
September 2019

What could the future hold for treatment sequencing in cancer medicine? An interview with Angela Märten.

Future Oncol 2019 Sep 19;15(25):2891-2893. Epub 2019 Aug 19.

Unitec House, Albert Pl, Finchley, London, N3 1QB, UK.

Professor Angela Märten speaks to Rachel Jenkins, Commissioning Editor Angela Märten earned her PhD at Humboldt University of Berlin, Germany, in 2000, after working for several years as an oncology nurse. Upon completion of her PhD, she assumed responsibility for Phase I trials and translational research for the University Hospital of Bonn, Germany. In 2002, the University Hospital of Bonn appointed her as Assistant Professor for Experimental Haematology and Oncology. In 2003, she accepted a new position at the University of Heidelberg, Germany, heading the Immunotherapeutic Group and the Oncology Trial Department. The University of Heidelberg appointed her as Associate Professor in 2006 while she completed her Master of Sciences in Clinical Research in 2008. Professor Märten has been principal investigator of several clinical trials and has published more than 100 papers, with a particular focus on pancreatic carcinoma and lung cancer. She joined Boehringer Ingelheim in 2009, where she built up the German Medical Affairs Oncology team, before joining the Global Afatinib team in 2013. She is currently Global Senior Medical Advisor, Therapeutic Area of Oncology at Boehringer Ingelheim.
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http://dx.doi.org/10.2217/fon-2019-0176DOI Listing
September 2019

Global mental health and sustainable development 2018.

Authors:
Rachel Jenkins

BJPsych Int 2019 May;16(2):34-37

Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK.

The Lancet Commission summarises some of the history of mental health concepts, recent developments in scientific understanding, mental health programmes and threats to progress, and proposes a way forward. Although ostensibly aiming to reframe global mental health within the paradigm of sustainable development, in practice it has taken a narrower academic perspective rather than a generic approach to health and social sector reform, leading to much less of an integrated implementation focus than would have been useful.
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http://dx.doi.org/10.1192/bji.2019.5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520536PMC
May 2019

Welcome to the 15th volume of Future Oncology.

Authors:
Rachel Jenkins

Future Oncol 2019 Jan;15(1):1-3

Future Science Group, Unitec House, 2 Albert Place, London N3 1QB, UK.

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http://dx.doi.org/10.2217/fon-2018-0782DOI Listing
January 2019

Malaria, mental disorders, immunity and their inter-relationships - A cross sectional study in a household population in a health and demographic surveillance site in Kenya.

EBioMedicine 2019 Jan 11;39:369-376. Epub 2018 Dec 11.

Kenya Medical Research Institute, Kenya.

Background: Both malaria and mental disorders are associated with immune changes. We have previously reported the associations between malaria and mental disorders. We now report associations between malaria, mental disorders and immunity.

Methods: A household survey of malaria, mental disorders and immunity was conducted in a health and demographic surveillance system's site of 70,000 population in an area endemic for malaria in western Kenya. A random sample of 1190 adults was selected and approached for consent, blood samples and structured interview.

Findings: We found marginally raised CD4/CD3 ratios of participants with malaria parasites, but no difference in CD4/CD3 ratios for participants with common mental disorder (CMD) or psychotic symptoms. People with psychotic symptoms had increased levels of IL-6, IL-8, and IL-10, and lower levels of IL-1beta. People with CMD had higher levels of IL-8 and IL-10. People with malaria had higher levels of IL-10 and lower levels of TNF-alpha. At the bivariate level, CMD was associated with log TNF-α levels using unadjusted odds ratios, but not after adjusting for malaria. Psychotic symptoms were associated with log IL-10 and log TNF-α levels at the bivariate level while in the adjusted analysis, log TNF-α levels remained highly significant..

Interpretation: This is the first population based study of immune markers in CMD and psychotic symptoms, and the first to examine the 3 way relationship with malaria. Our findings suggest that TNF-α may mediate the relationship between malaria and CMD. FUND: The study was funded by UK Aid, Department for International Development, Kenya office.
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http://dx.doi.org/10.1016/j.ebiom.2018.11.064DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355657PMC
January 2019

How primary care can contribute to good mental health in adults.

London J Prim Care (Abingdon) 2018 Jan 13;10(1):3-7. Epub 2017 Dec 13.

London Journal of Primary Care, London, UK.

The need for support for good mental health is enormous. General support for good mental health is needed for 100% of the population, and at all stages of life, from early childhood to end of life. Focused support is needed for the 17.6% of adults who have a mental disorder at any time, including those who also have a mental health problem amongst the 30% who report having a long-term condition of some kind. All sectors of society and all parts of the NHS need to play their part. Primary care cannot do this on its own. This paper describes how primary care practitioners can help stimulate such a grand alliance for health, by operating at four different levels - as individual practitioners, as organisations, as geographic clusters of organisations and as policy-makers.
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http://dx.doi.org/10.1080/17571472.2017.1410043DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5810155PMC
January 2018

Welcome to the 14th volume of Future Oncology.

Authors:
Rachel Jenkins

Future Oncol 2018 Jan;14(1):1-3

Future Science Group, Unitec House, 2 Albert Place, London, N3 1QB, UK.

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http://dx.doi.org/10.2217/fon-2017-0591DOI Listing
January 2018

A Case of Bacteremia following Maggot Colonization.

Case Rep Infect Dis 2017 2;2017:3698124. Epub 2017 Nov 2.

University of Mississippi School of Pharmacy, Jackson, MS 39216, USA.

is a Gram-negative bacterium that is commonly associated with the larvae of flesh flies. is difficult to isolate in routine laboratory procedures but has been associated with neglected wounds infested with maggots, fever, elevated white blood count and C-reactive protein, and polymicrobial culture results. Other specific hematological/immunological changes are not known. We present a case of bacteremia and polymicrobial osteomyelitis resulting from infected decubitus ulcers. The patient improved after treatment with cefepime followed by levofloxacin.
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http://dx.doi.org/10.1155/2017/3698124DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5688256PMC
November 2017

Promoting Mental Health and Preventing Mental Illness in General Practice.

London J Prim Care (Abingdon) 2016 24;8(1):3-9. Epub 2016 Feb 24.

Public Health Barking and Dagenham Council and Greater London Authority.

This paper calls for the routine integration of mental health promotion and prevention into UK General Practice in order to reduce the burden of mental and physical disorders and the ensuing pressure on General Practice. The proposals & the resulting document (https://ethicscharity.files.wordpress.com/2015/09/rcgp_keymsg_150925_v5.pdf) arise from an expert 'Think Tank' convened by the London Journal of Primary Care, Educational Trust for Health Improvement through Cognitive Strategies (ETHICS Foundation) and the Royal College of General Practitioners. It makes 12 recommendations for General Practice: (1) Mental health promotion and prevention are too important to wait. (2) Work with your community to map risk factors, resources and assets. (3) Good health care, medicine and best practice are biopsychosocial rather than purely physical. (4) Integrate mental health promotion and prevention into your daily work. (5) Boost resilience in your community through approaches such as community development. (6) Identify people at increased risk of mental disorder for support and screening. (7) Support early intervention for people of all ages with signs of illness. (8) Maintain your biopsychosocial skills. (9) Ensure good communication, interdisciplinary team working and inter-sectoral working with other staff, teams and agencies. (10) Lead by example, taking action to promote the resilience of the general practice workforce. (11) Ensure mental health is appropriately included in the strategic agenda for your 'cluster' of General Practices, at the Clinical Commissioning Groups, and the Health and Wellbeing Board. (12) Be aware of national mental health strategies and localise them, including action to destigmatise mental illness within the context of community development.
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http://dx.doi.org/10.1080/17571472.2015.1135659DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5330334PMC
February 2016

Brain drain.

Authors:
Rachel Jenkins

BJPsych Int 2016 Aug 1;13(3):53-55. Epub 2016 Aug 1.

Professor Emeritus, Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK,

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5618874PMC
http://dx.doi.org/10.1192/s2056474000001215DOI Listing
August 2016

Prevalence and treatment of common mental disorders in the English national population, 1993-2007.

Br J Psychiatry 2016 08 9;209(2):150-6. Epub 2016 Jun 9.

Nicola Spiers, PhD, Department of Health Sciences, University of Leicester, Leicester, UK; Tarik Qassem, MD, Division of Mental Health and Well-being, University of Warwick, Coventry, UK, and Okasha Institute of Psychiatry, Ain Shams University, Cairo, Egypt, and Black Country Partnership NHS Foundation Trust, West Bromwich, UK; Paul Bebbington, PhD, FRCP, FRCPsych, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Sally McManus, MSc, NatCen for Social Research, London, UK; Michael King, PhD, Division of Psychiatry, Faculty of Brain Sciences, University College London, London, UK; Rachel Jenkins, FRCPsych, Institute of Psychiatry at Kings College, London, UK; Howard Meltzer (deceased), PhD, Department of Health Sciences, University of Leicester, Leicester; Traolach S. Brugha, FRCPsych, Department of Health Sciences, University of Leicester, Leciester; UK

Background: The National Psychiatric Morbidity Surveys include English cross-sectional household samples surveyed in 1993, 2000 and 2007.

Aims: To evaluate frequency of common mental disorders (CMDs), service contact and treatment.

Method: Common mental disorders were identified with the Clinical Interview Schedule - Revised (CIS-R). Service contact and treatment were established in structured interviews.

Results: There were 8615, 6126 and 5385 participants aged 16-64. Prevalence of CMDs was consistent (1993: 14.3%; 2000: 16.0%; 2007: 16.0%), as was past-year primary care physician contact for psychological problems (1993: 11.3%; 2000: 12.0%; 2007: 11.7%). Antidepressant receipt in people with CMDs more than doubled between 1993 (5.7%) and 2000 (14.5%), with little further increase by 2007 (15.9%). Psychological treatments increased in successive surveys. Many with CMDs received no treatment.

Conclusions: Reduction in prevalence did not follow increased treatment uptake, and may require universal public health measures together with individual pharmacological, psychological and computer-based interventions.
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http://dx.doi.org/10.1192/bjp.bp.115.174979DOI Listing
August 2016

Collagen-derived matricryptins promote inhibitory nerve terminal formation in the developing neocortex.

J Cell Biol 2016 Mar;212(6):721-36

Virginia Tech Carilion Research Institute, Roanoke, VA 24016 Department of Biological Sciences, Virginia Polytechnic Institute and State University, Blacksburg, VA 24061

Inhibitory synapses comprise only ∼20% of the total synapses in the mammalian brain but play essential roles in controlling neuronal activity. In fact, perturbing inhibitory synapses is associated with complex brain disorders, such as schizophrenia and epilepsy. Although many types of inhibitory synapses exist, these disorders have been strongly linked to defects in inhibitory synapses formed by Parvalbumin-expressing interneurons. Here, we discovered a novel role for an unconventional collagen-collagen XIX-in the formation of Parvalbumin(+) inhibitory synapses. Loss of this collagen results not only in decreased inhibitory synapse number, but also in the acquisition of schizophrenia-related behaviors. Mechanistically, these studies reveal that a proteolytically released fragment of this collagen, termed a matricryptin, promotes the assembly of inhibitory nerve terminals through integrin receptors. Collectively, these studies not only identify roles for collagen-derived matricryptins in cortical circuit formation, but they also reveal a novel paracrine mechanism that regulates the assembly of these synapses.
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http://dx.doi.org/10.1083/jcb.201509085DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4792079PMC
March 2016

Common mental disorder in Nyanza province, Kenya in 2013 and its associated risk factors--an assessment of change since 2004, using a repeat household survey in a demographic surveillance site.

BMC Psychiatry 2015 Dec 9;15:309. Epub 2015 Dec 9.

Kenya Medical Research Institute, Kisumu, Kenya.

Background: Repeat household surveys are useful to assess change in prevalence over time, but there have been no repeat surveys of common mental disorder (CMD) in Kenya, or indeed sub-Saharan Africa. Therefore a repeat household survey of CMD and its associated risk factors was conducted in Maseno area, Kisumu county in Kenya, using a demographic surveillance site as the sample frame, in order to test the hypotheses that (a) the prevalence of CMD would increase between 2004 and 2013 due to the intervening political, social and economic pressures; (b) as in 2004, there would be no gender difference in prevalence of CMD.

Methods: One thousand one hundred ninety households were selected, and 1158 adult participants consented to be interviewed with a structured epidemiological assessment while 32 refused to participate in the study interviews, giving a response rate of 97.3%.

Results: The study found that the overall prevalence of CMD in 2013 was 10.3%. However, there were significantly higher rates of having any CMD in 2013 if one was female (OR 6.2, p < 0.001), divorced/widowed (OR 2.5, p < 0.003), aged over 60 (OR 2.3, p = 0.052), either self-employed (OR 3.3 p < 0.001) or employed (OR 3.3, p < 0.001), or belonged to the lowest asset quintile (OR 2.5, p = .0.004) after adjusting for other variables significant at the bivariate level. The overall prevalence in 2013 was consistent with that found in 2004, despite intervening political and community turbulence. However, this apparent consistency masks the development of a striking difference in prevalence between the genders. Over the decade 2004-13, the prevalence for men dropped from 10.9 to 3.8% (P = 0.001) and the prevalence for women increased from 10.8 to 17.5% (p = 0.001).

Conclusion: Common mental disorders continue to pose a significant public health burden in Kenya, and gender related vulnerability merits further research and is relevant for health worker training.
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http://dx.doi.org/10.1186/s12888-015-0693-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4673710PMC
December 2015

Community-oriented integrated care and health promotion - views from the street.

London J Prim Care (Abingdon) 2015 Sep 28;7(5):83-88. Epub 2015 Sep 28.

Accomplish Consultancy.

On the 1st and 2nd May 2015, participants at the RCGP London City Health Conference debated practical ways to achieve integrated care at community level. In five connected workshops, participants reviewed current work and identified ways to overcome some of the problems that had become apparent. In this paper, we summarise the conclusions of each workshop, and provide an overall comment. There are layers of complexity in community-oriented integrated care that are not apparent at first sight. The difficult thing is not persuading people that it matters, but finding ways to do it that are practical and sustainable. The dynamic and complex nature of the territory is bewildering. The expectation of silo-operating and linear thinking, and the language and models that encourage it, pervade health and social care. Comprehensive integration is possible, but the theory and practice are unfamiliar to many. Images, theories and models are needed to help people from all parts of the system to see big pictures and focused detail at the same time and oscillate between them to envision-integrated whole systems. Infrastructure needs to enable this, with coordination hubs, locality-based multidisciplinary meetings and cycles of inter-organisational improvement to nurture relationships across organisational boundaries.
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http://dx.doi.org/10.1080/17571472.2015.1082347DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4606821PMC
September 2015

Probable Post Traumatic Stress Disorder in Kenya and Its Associated Risk Factors: A Cross-Sectional Household Survey.

Int J Environ Res Public Health 2015 Oct 26;12(10):13494-509. Epub 2015 Oct 26.

Kenya Medical Research Institute, P.O. Box 54-40100 Kisumu, Kenya.

This study aimed to assess the prevalence of probable post-traumatic stress disorder (PTSD), and its associated risk factors in a general household population in Kenya. Data were drawn from a cross-sectional household survey of mental disorders and their associated risk factors. The participants received a structured epidemiological assessment of common mental disorders, and symptoms of PTSD, accompanied by additional sections on socio-demographic data, life events, social networks, social supports, disability/activities of daily living, quality of life, use of health services, and service use. The study found that 48% had experienced a severe trauma, and an overall prevalence rate of 10.6% of probable PTSD, defined as a score of six or more on the trauma screening questionnaire (TSQ). The conditional probability of PTSD was 0.26. Risk factors include being female, single, self-employed, having experienced recent life events, having a common mental disorder (CMD)and living in an institution before age 16. The study indicates that probable PTSD is prevalent in this rural area of Kenya. The findings are relevant for the training of front line health workers, their support and supervision, for health management information systems, and for mental health promotion in state boarding schools.
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http://dx.doi.org/10.3390/ijerph121013494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4627045PMC
October 2015

Alcohol consumption and hazardous drinking in western Kenya--a household survey in a health and demographic surveillance site.

BMC Psychiatry 2015 Sep 25;15:230. Epub 2015 Sep 25.

Kenya Medical Research Institute, Nairobi, Kenya.

Background: Alcohol use and hazardous drinking have been studied in school children and in urban areas of Kenya, but there has been no adult survey of these issues in a rural household population.

Methods: This study reports the prevalence of alcohol consumption and hazardous drinking in a household survey of a demographic surveillance site in rural Kenya. Information collected included demographic characteristics, socio-economic factors, recent life events and perceived social support. Alcohol consumption was assessed by questions about quantity and frequency. The Alcohol Use Disorders Identification Test (AUDIT) measured hazardous alcohol use. The Clinical Interview Schedule- Revised assessed common mental disorder, and the Psychosis Screening Questionnaire indicated the presence of psychotic symptoms.

Results: The study found that lifetime and current alcohol consumption were 10.8% and 9.2% respectively. Current alcohol consumption was significantly higher in men (OR 0.4, p < 0.001 for women) and in the self-employed (OR 1.8, p = 0.013), after adjustment for factors significant at the bivariate level. Hazardous drinking was significantly higher in men (OR 0.3, p < 0.001 for women), people living in larger households (OR 1.8, p = 0.021), people who were single (OR 1.7, p = 0.093), and in those who are self-employed (OR 1.8, p = 0.036), after adjustment for factors significant at the bivariate level.

Conclusion: This study suggests that alcohol consumption and hazardous drinking in the general population in a poor rural area in Nyanza Province is still relatively low. This represents an important public health educational opportunity to keep such rates low before increasing income and employment opportunities enable higher access to alcohol and other substances, and before the higher consumption found by studies on urban youth, especially neighbouring Kisumu town, spreads to the rural areas.
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http://dx.doi.org/10.1186/s12888-015-0603-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4582617PMC
September 2015

The role of global traditional and complementary systems of medicine in the treatment of mental health disorders.

Lancet Psychiatry 2015 Feb 28;2(2):168-77. Epub 2015 Jan 28.

Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK.

Traditional and complementary systems of medicine include a broad range of practices, which are commonly embedded in cultural milieus and reflect community beliefs, experiences, religion, and spirituality. Two major components of this system are discernible: complementary alternative medicine and traditional medicine, with different clientele and correlates of patronage. Evidence from around the world suggests that a traditional or complementary system of medicine is commonly used by a large number of people with mental illness. Practitioners of traditional medicine in low-income and middle-income countries fill a major gap in mental health service delivery. Although some overlap exists in the diagnostic approaches of traditional and complementary systems of medicine and conventional biomedicine, some major differences exist, largely in the understanding of the nature and cause of mental disorders. Treatments used by providers of traditional and complementary systems of medicine, especially traditional and faith healers in low-income and middle-income countries, might sometimes fail to meet widespread understandings of human rights and humane care. Nevertheless, collaborative engagement between traditional and complementary systems of medicine and conventional biomedicine might be possible in the care of people with mental illness. The best model to bring about that collaboration will need to be established by the needs of the extant mental health system in a country. Research is needed to provide an empirical basis for the feasibility of such collaboration, to clearly delineate its boundaries, and to test its effectiveness in bringing about improved patient outcomes.
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http://dx.doi.org/10.1016/S2215-0366(15)00013-9DOI Listing
February 2015

The role of global traditional and complementary systems of medicine in the treatment of mental health disorders.

Lancet Psychiatry 2015 Feb 28;2(2):168-77. Epub 2015 Jan 28.

Health Service and Population Research Department, Institute of Psychiatry, King's College, London, UK.

Traditional and complementary systems of medicine include a broad range of practices, which are commonly embedded in cultural milieus and reflect community beliefs, experiences, religion, and spirituality. Two major components of this system are discernible: complementary alternative medicine and traditional medicine, with different clientele and correlates of patronage. Evidence from around the world suggests that a traditional or complementary system of medicine is commonly used by a large number of people with mental illness. Practitioners of traditional medicine in low-income and middle-income countries fill a major gap in mental health service delivery. Although some overlap exists in the diagnostic approaches of traditional and complementary systems of medicine and conventional biomedicine, some major differences exist, largely in the understanding of the nature and cause of mental disorders. Treatments used by providers of traditional and complementary systems of medicine, especially traditional and faith healers in low-income and middle-income countries, might sometimes fail to meet widespread understandings of human rights and humane care. Nevertheless, collaborative engagement between traditional and complementary systems of medicine and conventional biomedicine might be possible in the care of people with mental illness. The best model to bring about that collaboration will need to be established by the needs of the extant mental health system in a country. Research is needed to provide an empirical basis for the feasibility of such collaboration, to clearly delineate its boundaries, and to test its effectiveness in bringing about improved patient outcomes.
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http://dx.doi.org/10.1016/S2215-0366(15)00013-9DOI Listing
February 2015

Prevalence of malaria parasites in adults and its determinants in malaria endemic area of Kisumu County, Kenya.

Malar J 2015 Jul 8;14:263. Epub 2015 Jul 8.

Kenya Medical Research Institute, Nairobi, Kenya.

Background: The prevalence of malaria parasites in adults in Africa is less well researched than in children. Therefore, a demographic surveillance site was used to conduct a household survey of adults in the malaria endemic area of Maseno division in Kisumu County near Lake Victoria.

Methods: A random survey of 1,190 adults living in a demographic health surveillance site in a malaria endemic area of 70,805 population size was conducted, measuring presence of malaria parasites by slide microscopy. Data were analysed using STATA to calculate the prevalence of malaria and associated risk factors.

Results: The adult prevalence of presence of malaria parasites in Maseno was 28% (95% CI: 25.4-31.0%). Gender was a significant sociodemographic risk factor in both univariate (OR 1.5, p = 0.005) and multivariate (OR 1.4, p = 0.019) analyses. Females were 50% more likely to have malaria than men.

Conclusions: Presence of malaria parasites is common in the adult population of this endemic area, and the rate is greatly increased in women. The presence of such an adult pool of malaria parasites represents a key reservoir factor in transmission of parasites to children, and is relevant for plans to eradicate malaria.
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http://dx.doi.org/10.1186/s12936-015-0781-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495611PMC
July 2015

The role of global traditional and complementary systems of medicine in treating mental health problems.

Lancet Psychiatry 2015 Feb;2(2):168-177

Health Service and Population Research Department, Institute of Psychiatry, King's College, London.

Traditional and complementary systems of medicine (TCM) encompass a broad range of practices which are commonly embedded within contextual cultural milieu, reflecting community beliefs, experiences, religion and spirituality. Evidence from across the world, especially from low- and middle-income countries (LMIC), suggests that TCM is commonly used by a large number of persons with mental illness. Even though some overlap exists between the diagnostic approaches of TCM and conventional biomedicine (CB), there are major differences, largely reflecting differences in the understanding of the nature and etiology of mental disorders. However, treatment modalities employed by providers of TCM may sometimes fail to meet common understandings of human rights and humane care. Still, there are possibilities for collaboration between TCM and CB in the care of persons with mental illness. Research is required to clearly delineate the boundaries of such collaboration and to test its effectiveness in bringing about improved patient outcomes.
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http://dx.doi.org/10.1016/S2215-0366(15)00013-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456435PMC
February 2015

Adult psychotic symptoms, their associated risk factors and changes in prevalence in men and women over a decade in a poor rural district of Kenya.

Int J Environ Res Public Health 2015 May 19;12(5):5310-28. Epub 2015 May 19.

Kenya Medical Research Institute, Nairobi, P.O. Box 54840-00200, Kenya.

There have been no repeat surveys of psychotic symptoms in Kenya or indeed subSaharan Africa. A mental health epidemiological survey was therefore conducted in a demographic surveillance site of a Kenyan household population in 2013 to test the hypothesis that the prevalence of psychotic symptoms would be similar to that found in an earlier sample drawn from the same sample frame in 2004, using the same overall methodology and instruments. This 2013 study found that the prevalence of one or more psychotic symptoms was 13.9% with one or more symptoms and 3.8% with two or more symptoms, while the 2004 study had found that the prevalence of single psychotic symptoms in rural Kenya was 8% of the adult population, but only 0.6% had two symptoms and none had three or more psychotic symptoms. This change was accounted for by a striking increase in psychotic symptoms in women (17.8% in 2013 compared with 6.9% in 2004, p < 0.001), whereas there was no significant change in men (10.6% in 2013 compared with 9.4% in 2004, p = 0.582). Potential reasons for this increase in rate of psychotic symptoms in women are explored.
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http://dx.doi.org/10.3390/ijerph120505310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4454969PMC
May 2015

Whither mental health policy-where does it come from and does it go anywhere useful?: Comment on "Cross-national diffusion of mental health policy".

Authors:
Rachel Jenkins

Int J Health Policy Manag 2015 Apr 23;4(4):249-51. Epub 2015 Feb 23.

King's College London, London, UK.

Factors influencing cross-national diffusion of mental health policy are important to understand but complex to research. This commentary discusses Shen's research study on cross-national diffusion of mental health policy; examines the extent to which the three questions researched by Shen (whether countries are more likely to have a mental health policy (a) the earlier a country becomes a member of World Health Organization (WHO), (b) the more international aid a country receives, and (c) the more neighbouring countries already have a mental health policy) are in fact able to assess WHO's impact on cross-national diffusion of mental health policy. The commentary then suggests a range of more specific questions which may be used to further elucidate the impact of WHO on an individual country, and considers the relative value of published mental health policy compared with the integration of mental health into national health sector strategies and other sector reforms, and concludes with a call for more integration of mental health across all WHO activities at international, regional and country levels.
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http://dx.doi.org/10.15171/ijhpm.2015.40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380569PMC
April 2015

Whither mental health policy-where does it come from and does it go anywhere useful?: Comment on "Cross-national diffusion of mental health policy".

Authors:
Rachel Jenkins

Int J Health Policy Manag 2015 Apr 23;4(4):249-51. Epub 2015 Feb 23.

King's College London, London, UK.

Factors influencing cross-national diffusion of mental health policy are important to understand but complex to research. This commentary discusses Shen's research study on cross-national diffusion of mental health policy; examines the extent to which the three questions researched by Shen (whether countries are more likely to have a mental health policy (a) the earlier a country becomes a member of World Health Organization (WHO), (b) the more international aid a country receives, and (c) the more neighbouring countries already have a mental health policy) are in fact able to assess WHO's impact on cross-national diffusion of mental health policy. The commentary then suggests a range of more specific questions which may be used to further elucidate the impact of WHO on an individual country, and considers the relative value of published mental health policy compared with the integration of mental health into national health sector strategies and other sector reforms, and concludes with a call for more integration of mental health across all WHO activities at international, regional and country levels.
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http://dx.doi.org/10.15171/ijhpm.2015.40DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4380569PMC
April 2015

Erratum to: Feelings of loneliness among adults with mental disorder.

Soc Psychiatry Psychiatr Epidemiol 2015 Mar;50(3):503-4

Department of Health Sciences, College of Medicine, Biological Sciences and Psychology, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.

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http://dx.doi.org/10.1007/s00127-014-0977-yDOI Listing
March 2015

Prevalence of psychosis in black ethnic minorities in Britain: analysis based on three national surveys.

Soc Psychiatry Psychiatr Epidemiol 2015 Jul 11;50(7):1057-64. Epub 2014 Sep 11.

Division of Psychiatry, Faculty of Brain Sciences, University College London, Charles Bell House, 67-73 Riding House Street, London, W1W 7EH, UK.

Purpose: A considerable excess of psychosis in black ethnic minorities is apparent from clinical studies, in Britain, as in other developed economies with white majority populations. This excess is not so marked in population surveys. Equitable health service provision should be informed by the best estimates of the excess. We used national survey data to establish the difference in the prevalence of psychosis between black ethnic groups and the white majority in the British general population.

Methods: Analysis of the combined datasets (N = 26,091) from the British national mental health surveys of 1993, 2000 and 2007. Cases of psychosis were determined either by the use of the Schedules for Clinical Assessment in Neuropsychiatry (SCAN), or from a combination of screening items. We controlled for sex, age, social class, unemployment, design features and other putative confounders, using a Disease Risk Score.

Results: People from black ethnic minorities had an excess prevalence rate of psychosis compared with the white majority population. The OR, weighted for study design and response rate, was 2.72 (95 % CI 1.3-5.6, p = 0.002). This was marginally increased after controlling for potential confounders (OR = 2.90, 95 % CI 1.4-6.2, p = 0.006).

Conclusions: The excess of psychosis in black ethnic minority groups was similar to that in two previous British community surveys, and less than that based on clinical studies. Even so it confirms a considerable need for increased mental health service resources in areas with high proportions of black ethnic minority inhabitants.
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http://dx.doi.org/10.1007/s00127-014-0960-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4464643PMC
July 2015

A randomised controlled trial to assess the effectiveness of a nurse-led palliative care intervention for HIV positive patients on antiretroviral therapy: recruitment, refusal, randomisation and missing data.

BMC Res Notes 2014 Sep 3;7:600. Epub 2014 Sep 3.

Department of Palliative Care and Rehabilitation, Cicely Saunders Institute, King's College London, Bessemer Road, London SE5 9PJ, UK.

Background: Despite the life threatening nature of an HIV diagnosis and the multidimensional problems experienced by this patient population during antiretroviral therapy, the effectiveness of a palliative care approach for HIV positive patients on ART is as yet unknown.

Findings: A randomised controlled trial (RCT) was conducted in a sample of 120 HIV positive patients on ART in an urban clinic in Mombasa, Kenya. The intervention was a minimum of seven sessions of multidimensional, person-centred care, given by HIV nurses trained in the palliative care approach over a period of 5 months. Rates of recruitment and refusal, the effectiveness of the randomisation procedure, trial follow-up and attrition and extent of missing data are reported.120 patients (60 randomised to control arm, 60 randomised to intervention arm) were recruited over 5.5 months, with a refusal rate of 55.7%. During the study period, three participants died from cancer, three withdrew (two moved away and one withdrew due to time constraints). All of these patients were in the intervention arm: details are reported. There were five additional missing monthly interviews in both the control and intervention study arm, bringing the total of missing data to 26 data points (4.3%).

Discussion: The quality and implications of these data are discussed extensively and openly, including the effect of full and ethical consent procedures, respondent burden, HIV stigma, accurate randomisation, patient safety and the impact of the intervention. Data on recruitment randomisation, attrition and missing data in clinical trials should be routinely reported, in conjunction with the now established practice of publishing study protocols to enhance research integrity, transparency and quality. Transparency is especially important in cross cultural settings, in which the sources of funding and trial design are often not based in the country of data collection. Findings reported can be used to inform future RCTs in this area.

Trial Registration: Clinicaltrials.gov NCT01608802.
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http://dx.doi.org/10.1186/1756-0500-7-600DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4161861PMC
September 2014