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Background and research aims: Cameroon hosts three species of pangolins and has recently been identified as a hub of pangolin trafficking. However, information on threats to pangolins needed to guide conservation efforts remains scarce, notably on consumption and trade patterns, and the prevalence of individuals trading pangolins. Local communities sharing the same habitats with pangolins can provide such information, which is useful to better target interventions. Methods: Based on a snowball sampling approach and using interview surveys in 20 villages surrounding Mbam et Djerem National Park, we investigated the consumption of pangolins and its drivers, parts sold, selling prices, places sold and buyers, and employed the nominative technique to estimate the percentage of people within the surveyed population engaged in selling pangolins. Results: Our results showed that both giant and white-bellied pangolins are locally consumed, mainly for their taste, and traded for meat and scales. Distance to the capital city Yaoundé, ethnolinguistic group, and education significantly affected the likelihood of consuming or trading white-bellied and giant pangolins. Selling and prices of giant pangolin meat and scales were significantly affected by distance to Yaoundé. The prevalence of people selling white-bellied and giant pangolins were higher in Tibati and Yoko compared to other municipalities. Implications for conservation: Overall, our study provided information necessary for effective law enforcement and research-oriented decision-making for pangolin conservation. We recommend the establishment of consumption reduction campaigns focusing on taste preference, investigation of the impacts of the newly constructed national road on pangolin supply chains and trafficking, and increasing the involvement of local communities in the management process of Mbam et Djerem National Park. [ABSTRACT FROM AUTHOR]

Information about the presence and population status of pangolins, and the threats they face, remains limited in many parts of Cameroon, a country that is home to three species of pangolin and considered to be a global hub of pangolin trafficking. Local communities living in rural areas can provide valuable information on species presence, local uses of wildlife, and possible threats, that is useful for prioritising conservation actions. Using interview surveys in 20 villages surrounding Mbam and Djerem National Park, we investigated local peoples' knowledge of pangolin presence, perceptions of population trends, cultural importance, consumptive and non-consumptive uses, and hunting of pangolins. Our results showed that most people recognised the white-bellied and giant pangolins, but only 10% recognised the black-bellied pangolin. Ethnolinguistic group significantly affected the likelihood of respondents recognising and having seen a pangolin before. Giant pangolin populations were perceived to be declining, particularly by older respondents. We found evidence of local use of pangolins for meat, but few respondents reported uses of scales. Cultural significance was reported by few respondents, but when it was reported it mostly referred to giant pangolin. White-bellied pangolins are reportedly hunted using bare hands for local consumption most frequently, whilst giant pangolins were mainly hunted for local consumption and income generation using wire snares. Overall, our study shows the possible value of local knowledge for planning and prioritising conservation actions for pangolins. We highlight the urgent need to monitor pangolin populations, and assess the possible impacts to pangolins from threats such as hunting. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Motor vehicle accident (MVA) fatalities are an important cause of death in young men. Psychiatric disorders have been shown to be risk factors for MVA, but only a few studies have investigated MVA fatalities.Method: A case-control study was carried out comparing 61 young male MVA fatalities in which the subject was the driver with an equal number of living male subjects matched for age (case by case with no more than 1 year's difference between case subjects and control subjects) with the accident group. We assessed both groups, using structured interviews and psychological autopsies.Results: Our results suggest that cluster B personality disorders (borderline and [or] antisocial) (OR 3.54; 95%CI, 1.38 to 16.01) and substance use disorders in the last 6 months (OR 4.33; 95%CI, 1.42 to 9.25) increased the risk of dying in MVAs. In addition, we observed an age effect, where differences in cluster B personality disorders and substance use disorders in the last 6 months were only significantly more prevalent in case subjects aged 26 years or over, compared with control subjects of the same age. Drivers under age 25 years appeared to be comparable with control subjects on all measures of psychopathology. Finally, this interaction between cluster B personality disorders and age over 26 years was the only significant predictor of car fatalities (adjusted OR 16.25; 95%CI, 1.67 to 158.10).Conclusion: Borderline and antisocial personality disorders in which impulsive-aggressive behaviours play a central role and substance use disorders appear to be risk factors for young male deaths in MVAs. Interestingly, this effect seems to be specific to MVA case subjects aged 26 years or over. [ABSTRACT FROM AUTHOR]

Focuses on the research determining the clinical skills of various psychiatrists in Canada. Assessment on the quality of medical services; Awareness on the needs of the patients; Creation of several mental health programs.

Background: Scarce attention has been paid to establishing benchmarks for tertiary care for adults with severe mental disorders. Yet, the availability and efficient utilization of residential resources partly determines the capacity of a comprehensive system of care to avoid clogging ever-shrinking acute care bed facilities.Objectives: To describe the actual utilization of and projected needs for residential resources, one part of tertiary care, in the catchment area of a psychiatric hospital in east-end Montreal. To compare results obtained against actual utilization and projected needs evaluated in other Canadian provinces and in other countries, with a view to establishing national benchmarks.Methods: Two surveys were undertaken to establish the number of places in these facilities that were utilized and needed for adults aged 18 to 65 years with severe mental disorders, without a primary diagnosis of mental retardation or organic brain syndrome, and originally from the catchment area. A first survey ascertained the number of places utilized and of those needed for residential care among all long-stay inpatients and all adults in supervised residential facilities. A second survey identified the need for such long-stay hospitalization, nursing homes, and supervised facilities as an alternative or as a complement to hospitalization among acute care inpatients.Results: The actual ratio of places in long-stay hospital units, nursing homes, and supervised residential facilities was 150:100,000 inhabitants. The ideal ratio, according to estimated needs, is 171:100,000. The figure breakdown is as follows: 20:100,000 for long-stay hospital units, 20:100,000 for nursing homes, 40:100,000 for group homes, 40:100,000 for private hostels or foster families, and 51:100,000 for supervised apartments. The needs of this urban, blue-collar population for supervised residential places hovered in the upper range of utilization and standards for European countries and within the proposed standards for Canadian provinces.Discussion: Needs for long-stay hospitalization or for supervised residential facilities cannot be treated as absolute. For example, evaluation conducted in this hospital-led system of psychiatric care may produce higher estimates of institutional care. Comparing actual utilization and projected needs in this urban catchment area with current utilization in other jurisdictions in Canada and Europe should contribute to establishing sound national benchmarks within ranges.Conclusions: It is possible to establish benchmarks that guide the development of supervised residential settings to best meet the needs of the population of adults with severe and persistent mental disorders. The methods used here to assess needs should serve as guidelines for future research, because they were designed to contain the bias of over- or underprovision of care in the current utilization. [ABSTRACT FROM AUTHOR]

Explores the viability of the alternatives to acute psychiatric care in Montreal, Quebec. Issues on the cost of hospitalization; Arrays of alternative care; Significance of expanding community-based services.

Background: With the psychiatric deinstitutionalization movement in its fourth decade, questions are being raised concerning its relevance for long-stay inpatients with severe disabilities and the risk that those discharged into the community may be abandoned.Methods: A random sample taken in 1989 of long-stay inpatients at Louis-H Lafontaine Hospital made it possible to examine 96 pairs of patients. Each pair included 1 patient discharged between 1989 and 1998 and 1 patient hospitalized. Pairs were matched for sex, age, length of stay, and level of psychiatric care in 1989. Patients and staff were interviewed using standardized questionnaires, and case notes were reviewed to assess symptoms, daily living skills, residential status, quality of residential setting, and clinical and social problems and needs.Results: The investigation revealed that discharged patients moved to highly supervised settings, which included professionally supervised group homes, supervised hostels, and foster families. About 20% went to nursing homes owing to loss of autonomy from physical disorders. Only 4 discharged patients were lost to follow-up, of whom 2 were probable vagrants. Both those discharged and those remaining as inpatients presented with major clinical problems and daily living skill deficits. The care needs of discharged patients were generally met, and placement in the community was considered appropriate. Of those who had remained hospitalized, over one-half could be moved to supervised settings immediately, or after 1 to 2 years' preparation in a discharge unit, while 13% could be moved to nursing homes. Over 25% required intensive, individualized rehabilitation treatment targeting engagement, psychotic symptoms, withdrawal, and dangerous and socially embarrassing behaviours.Conclusion: Deinstitutionalization in the largest Canadian psychiatric hospital did not lead to patient abandonment in the community. [ABSTRACT FROM AUTHOR]

Background: The cost-effectiveness of the eventual deinstitutionalization of patients with severe and persistent mental disorders who are currently, hospitalized in tong-term care remains a controversial matter.Methods: A retrospective cohort of 96 pairs of psychiatric hospital patients with 1 member deinstitutionalized between 1989 and 1998 was followed up for nearly 10 years. All use of medical and social services was documented. Patients were evaluated at the start and end of the study on various clinical and social dimensions, as well as on quality of life.Results: On several dimensions, deinstitutionalized patients scored more positively than did those patients still hospitalized. The lower daily cost of living accommodations for deinstitutionalized patients easily offsets the cost of services required for treatment in the community.Conclusion: Deinstitutionalization, as implemented in the hospital studied, remains for many patients a less costly option than continued hospitalization and is likely to improve their mental state and well-being.(Can J Psychiatry 2000;45:533-538)Key Words: economic evaluation, deinstitutionalization, cost-effectiveness [ABSTRACT FROM AUTHOR]

Objective: Epidemiologic research has demonstrated that the majority of mental illness in the community is not treated. Primary care physicians and the specialty mental health sector each have an important role in the provision of mental health services. Our goal is to clarify the extent of undertreatment of selected mental illnesses in Ontario and to examine how treatment is divided between the primary care and specialty sectors. In particular, we are interested in both the relative numbers and the types—based on sociodemographic and severity indicators—of patients found in each sector, as well as in confirming the key role of primary care in the provision of mental health services. Method: Data were taken from the Mental Health Supplement to the Ontario Health Survey, a community survey of 9953 individuals. All subjects who met DSM-III-R criteria for a past year diagnosis of mood, anxiety, substance abuse, bulimic, or antisocial personality disorders were categorized by their use of mental health services in the preceding year—into nonusers, primary care only patients, specialty only patients, and both sector patients. The 3 groups utilizing services were then compared by demographic, clinical, and disability characteristics. Results: Only 20.8% of subjects with a psychiatric diagnosis reported use of mental health services, but 82.9% of these same individuals used primary care physicians for general health problems. Among those who used mental health services, 38.2% used family physicians only for psychiatric treatment, compared with 35.8% who used only specialty mental health providers, and 26.0% who used both sectors. The 3 groups of users showed only modest differences on sociodemographic characteristics. Patients in the specialty only sector reported significantly higher rates of sexual and physical abuse. On specific disability measures, all 3 groups were similar. Conclusion: The vast majority of individuals with an untreated psychiatric disorder are using the primary care sector for general health treatment, allowing an opportunity for identification and intervention. Primary care physicians also treat the majority of those seeking mental health services, and individuals seen only by these primary care physicians are probably as ill as those seen exclusively in the specialty mental health sector. From a public health perspective, future policy interventions should aim to improve collaboration between the 2 sectors and enhance the ability of primary care physicians to deliver psychiatric services. [ABSTRACT FROM AUTHOR]

Copyright of Canadian Journal of Psychiatry is the property of Sage Publications Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Italian statistics indicate that fewer people are living alone than in Great Britain. Psychiatric Case Register figures show that the treated prevalences are nearly half those found in British Case Register areas. The level of staffing in good practice areas like South-Verona or Trieste is at least similar and at times higher than British or American counterparts. The clinical caseload of Italian clinical teams is therefore lower. The Italian patients may have a greater social network's availability by the mere fact of living in the same household of relatives. It is hypothesized that these elements affect a clinical team's availability to offer alternatives to hospitalisation. A ratio caseload/staff should be taken into account in assessing the Italian psychiatric reform and alternatives to hospitalisation. [ABSTRACT FROM PUBLISHER]

This article examines the role of psychiatrists in preventing suicide in Australia. It is noted that psychiatrists can help both in populations and in their patients but they cannot do it alone. It is recommended that primary care physicians need more training and education so that they can detect, engage in treatment and treat in collaboration patients with depression and substance abuse. Here again, psychiatrists can play a role through shared care models. Second, insufficient coordination between psychiatric services and addiction services was found in more than one-third of cases.

A letter to the editor is presented in response to commentaries on the article "Mental health treatments in Ontario: Selective comparisons between primary care and specialty sectors," published in the Volume 42 of the "Canadian Journal of Psychiatry."