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BACKGROUND: HIV among people who inject drugs (PWID) is a major public health challenge in India. This paper examines PWID in Delhi who also have male-to-male sex with a focus on overlapping HIV risk behaviours and the psychosocial correlates of a history of male-to-male anal sex. METHODS: We analysed data collected in April-May of 2012 from a community-based sample of 420 male PWID in Delhi obtained using time location sampling. RESULTS: One third (37%) of the men reported a history of anal sex with men, among whom just 16% used a condom at last anal sex. Almost all (93%) participants who had a history of anal sex with men also had sex with women. Chi-square tests revealed that a history of anal sex with men was associated with a higher number of female sexual partners and sharing of needles and syringes. Additionally, unprotected sex at last sex with a male partner was significantly associated with unprotected sex at last sex with regular and paid female partners. Multivariate binary logistic regression revealed that the psychosocial correlates of a history of anal sex with other men were: being aged 18-24 (OR = 2.4, p = 0.014), illiteracy (OR = 1.9, p = 0.033), having never been married (OR = 2.6, p = 0.007), a main source of income of crime/begging (OR = 3.1, p = 0.019), a duration of injecting drug use greater than 20 years (OR = 3.4, p = 0.035) and suicidal ideation (OR = 1.7, p = 0.048). CONCLUSION: Male-to-male sex was associated with psychosocial vulnerability, including a longer history of injecting drug use, suicidal ideation and socio-economic disadvantage. Given the extent of overlapping HIV risk behaviours, HIV programs for PWID would benefit from a strong focus on prevention of sexual HIV transmission, especially among male injectors who also have sex with other men.

This study evaluates the impacts of three well-established community arts programmes in Victoria, Australia, on the mental health and well-being outcomes of participants typically from disadvantaged backgrounds during 2006-07. It employs a theoretical framework that reconciles evidence-based practice in health and the phenomenological nature of community arts practice. Self-determination theory (SDT) was used to do this with SDT-derived psychometric instruments [arts climate and Basic Psychological Needs Scales (BPNS)]. Self-administered surveys using these instruments as well as a measure of social support were undertaken on two occasions. Two overlapping but distinct samples were defined and analysed cross-sectionally. These were a (pre-)survey at the commencement of rehearsals for the annual performance (n = 103) and a (post-)survey following the performance (n = 70). The most significant change (MSC) technique was used to study the arts-making process and how it contributes to outcomes. Using these mixed-methods approach, impacts on the climate of the arts organizations, participant access to supportive relationships and participant's mental health and well-being were studied. There were positive changes in the BPNS (p = 0.00), as well as its autonomy (p = 0.04) and relatedness (p = 0.00) subscales. Social support increased from 65.3% in the pre-survey to 82.4% in the post-survey (p = 0.03). MSC data indicated that the supportive, collaborative environment provided by the arts organizations was highly valued by participants and was perceived to have mental health benefits.Overall, the study demonstrated the potential health promoting effects of community arts programmes in disadvantaged populations. Its multi-method approach should be further studied in evaluating other community arts programmes.

Objective: Suicide is major public health problem in India. The objective of the analyses presented in this paper is to examine depressive and anxiety symptoms and socio-demographic indicators as correlates of suicidal ideation and attempts among people who inject drugs (PWID), a high-risk group for suicide. Method: We analysed data collected in April–May of 2012 from a community-based sample of 420 PWID in Delhi using time location sampling. Self-report symptom scales were used to measure the severity of symptoms of depression (PHQ-9) and anxiety (GAD-2) within the preceding 2 weeks. We assessed the presence of suicidal thoughts within the past 12 months. Results: Depressive and anxiety symptoms were associated with suicidal ideation, as were a range of social stressors including poor physical health, length of injecting drug use, housing insecurity, and experiences of violence and sexual abuse. However, depressive and anxiety symptoms were not associated with suicide attempts. Factors associated with suicide attempts among ideators were housing insecurity and relational dynamics including a poor relationship with family and, interestingly, being married. Conclusion: Suicide prevention interventions among this population should address not only individual mental health and addiction support needs but also the overwhelmingly poor psychosocial circumstances of this group.

The aim of this study was to explore and identify the contribution of complex psychosocial factors to secondary risk prevention for Myocardial Infarction (MI) among adults under 55 years. Participants included 30 MI patients who were admitted to St. Vincent's Health in Melbourne. A repeated measures mixed measures methodology was used to examine demographic information, depressive symptomatology, physical and emotional wellbeing, and social functioning during hospitalization and at 3 and 6 months post discharge. Participants demonstrated severe depression at initial assessment but this reduced significantly post discharge. Depression at initial assessment aligned with reports of intense fear of increased mortality. The reduction in depression scores at 3 and 6 months aligned with emotional management of the crisis and improvements in general health, and physical and social functioning. The majority of patients did not participate in community rehabilitation, naming informal supports as the most significant. These results lend support to the use of crisis intervention and empowerment strategies as key elements of cardiac rehabilitation programs, to improve physical functioning and attend to depressive symptomatology in a proactive way, to improve secondary risk prevention among young patients who experience an MI event.

English: The aim of this study is to provide a taxonomic revision and molecular phylogenetic analysis of the eight Garuleum Cass. (Asteraceae) species of southern Africa. The taxonomic revision resulted in the construction of an identification key to the species, a revision of all type literature and nomenclature, clarification and designation of type specimens, compilation of morphological and micromorphological descriptions, distribution maps and ecological data for all Garuleum species. The molecular phylogenetic investigation resulted in the first complete phylogeny for the genus Garuleum, based on the nuclear gene region ITS and the chloroplast intergenic spacers trnT–trnF and psbA–trnH. All available type specimens related to Garuleum in southern Africa were studied. Where holotype specimens could not be located; lectotypes were designated from available isotypes or syntypes. In cases where only syntypes had been given by authors of species names, lectotypes were designated. Additional herbarium specimens on loan from several South African and European herbaria were investigated and additional material was collected in the field. These specimens were used to compile morphological descriptions and distribution maps. Micromorphological investigation of leaf surfaces, fruit, flowers and pollen was also completed. Garuleum species are aromatic, herbaceous shrubs with the inflorescence arranged in a capitulum composed of white or mauve coloured ray florets and yellow disc florets. The abaxial and adaxial leaf surfaces, leaf structure and involucral bract sizes are important for species identification. Garuleum is widely distributed over southern Africa, with the majority of the species found in the Eastern Cape. Some species, such as G. album, have restricted distribution ranges while others, such as G. bipinnatum, are very common and widely distributed. The annual precipitation of a specific region, in addition to altitude are possibly important factors influencin, Afrikaans: Die doel van hierdie studie is die samestelling van ‘n taksonomiese hersiening en molekulêre filogenetiese analise van die agt Garuleum Cass. (Asteraceae) spesies van Suider Afrika. Die taksonomiese hersiening het tot die konstruksie van ‘n identifikasiesleutel vir die spesies, ‘n hersiening van alle tipe literatuur en nomenklatuur, opklaring en aanwysing van tipe eksemplare, samestelling van morfologiese en mikromorfologiese beskrywings, verspreidingskaarte en ekologiese data oor al die Garuleum spesies gelei. Die molekulêre filogenetiese ondersoek het tot die eerste volledige filogenie vir die genus Garuleum, gelei en is gebaseer op die die kerngeenstreek ITS en chloroplast intergeniese spasiëerder geenstreke trnT–trnF en psbA–trnH. Alle beskikbare tipe-eksemplare met betrekking tot Garuleum in Suider Afrika is bestudeer. Waar geen holotipe eksemplare gevind is nie, is geskikte iso- of sintipes tot lektotipes verklaar. In gevalle waar slegs sintipes aangewys is deur outeurs van spesiename is lektotipes verklaar. Addisionele herbariumeksemplare op lening vanaf verskeie Suid Afrikaanse en Europese herbaria is bestudeer en addisionele materiaal is in die veld versamel. Hierdie eksemplare is gebruik vir die saamstel van morfologiese beskrywings en verspreidingskaarte. Mikromorfologiese studies van die blaar oppervlaktes, vrugte, blomme en stuifmeel is ook voltooi. Garuleum spesies is aromatiese, kruidagtige struike, met bloeiwyses wat in ‘n hofie gerangskik is en bestaan uit wit tot perskleurige lintblomme en geel buisblomme. Die boonste en onderste blaaroppervlaktes, blaarvorm en die groottes van die skutblare is belangrik vir spesie identifikasie. Garuleum het ‘n wye verspreiding oor Suider Afrika, maar die meerderheid van die spesies kom in die Oos-Kaap voor. Sommige spesies, soos G. album, het ‘n beperkte verspreiding terwyl ander spesies, soos G. bipinnatum, meer algemeen en wydverspreid voorkom. Die jaarlikse gemiddelde reënval van ‘n spesifieke gebie

English: A taxonomic revision of Finlaysonia Wall. and Streptocaulon Wight and Arn. (Apocynaceae; Periplocoideaea) in Asia is presented. This revision comprises an investigation of the nomenclature of the two genera and their species, macromorphology of all plant parts; micromorphology of leaf epidermal surfaces, seed coat surfaces and translators, pollen wall architecture, geographical distribution, habitat preferences and phylogenetic relationships. The investigation resulted in the identification of characteristics for effective delimitation of the two genera and their respective species, identification keys for both genera and the species within each genus, correction of nomenclature, determination of inter-and intra-phylogenetic relationships and determination of their distribution patterns. Available type material was investigated, type literature was confirmed for all species and synonyms were declared where applicable. Lectotypes, selected from isotypes or syntypes, were declared where holotypes were not cited by authors or were not found in their collections or were destroyed or could not be located at all. Finlaysonia and Streptocaulon are closely related genera and have many characters in common. This includes the presence of colleters on the interpetiolar ridges, in leaf axils, on the leaf petiole and main vein, in the axils of inflorescences and at the inner bases of sepals. The flowers in both genera are rather similar with bowl-shaped, inverted corolla tubes and reflexed lobes, presence of only the primary corona which is divided into a foot and lobe, presence of interstaminal nectaries, translators and pollinia, two semi-inferior, apocarpous many ovuled-ovaries, a compound style, a gynostegium that is the result of fusion between stylar head and anthers, paired follicles and seeds with comas at the micropylar end except in F. obovata where the coma is replaced by a winged, fimbriate margin. Finlaysonia is characterized by trichomes on the outer or in, Afrikaans: ‘n Taksonomiese hersiening van Finlaysonia Wall. en Streptocaulon Wight & Arn.(Apocynaceae; Periplocoideae) in Asië word aangebied. Hierdie hersiening behels ‘n ondersoek van die nomenklatuur van die twee genera en hulle spesies, makromorfologie van alle plantdele; mikromorfologie van blaarepidermis- en saadhuidoppervlakke en translators, stuifmeelwandargitektuur, geografiese verspreiding, habitatsvoorkeure en filogenetiese verwantskappe. Die ondersoek het gelei tot die aanwysing van kenmerke vir doeltreffende omgrensing van die twee genera en hulle onderskeie spesies, opstel van identifiseringsleutels vir die twee genera en hulle afsonderlike spesies, regstelling van nomenklatuur, bepaling van inter- en intrafilogenetiese verwantskappe en die vasstelling van geografiese verspreidingspatrone. Beskikbare tipemateriaal is ondersoek, tipeliteratuur is vir al die spesies bevestig en sinonieme is, waar van toepassing, aangedui. Waar holotipes nie deur outeurs aangewys is nie, of nie in hul versamelings gevind is nie, of vernietig is, of geensins opgespoor kon word nie, is lektotipes uit isotipes of sintipes aangewys. FInlaysonia en Streptocaulon is naverwant en het verskeie kenmerke in gemeen. Dit sluit in die voorkoms van kolleters op die interpetiolêre riwwe, in die blaaroksels, op die blaarsteel en hoofaar, in die oksels van bloeiwyses en by die binnebasis van kelkblare. Daar is ‘n sterk ooreenkoms tussen die blomme van die twee genera, met bakvormige, omgebuigde kroonbuise en teruggebuigde kroonlobbe, teenwoordigheid van slegs die primêre bykroon wat verdeel is in ‘n voet en lob, die teenwoordigheid van nektarkliere tussen die meeldrade, translators en polliniums, twee halfonderstandige, onvergroeide vrugbeginsels met baie sade, ‘n saamgestelde styl, ginostegium gevorm uit die vergroeiing van stylkop en meeldrade, gepaarde kokervrugte en sade met vrugpluise aan die saadpoortjie se kant. Finlaysonia obovata is die uitsondering waar die saadpluis deur ‘n vle, The Department of Plant Sciences, University of the Free State

Background Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy). Methods A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. Results 40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved

BACKGROUND: There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined. METHODS/DESIGN: Patients (and their primary carers, if available) are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy. DISCUSSION: The results of this trial will assist with the development of a model for community-based rehabilitation management f

Background: There is much discourse in healthcare about the importance of client-centred rehabilitation, however in the realm of community-based therapy post-stroke there has been little investigation into the efficacy of goal-directed practice that reflects patients' valued activities. In addition, the effect of active involvement of carers in such a rehabilitation process and their subsequent contribution to functional and emotional recovery post-stroke is unclear. In community based rehabilitation, interventions based on patients' perceived needs may be more likely to alter such outcomes. In this paper, we describe the methodology of a randomised controlled trial of an integrated approach to facilitating patient goal achievement in the first year post-stroke. The effectiveness of this intervention in reducing the severity of post-stroke depression, improving participation status and health-related quality of life is examined. The impact on carers is also examined.Methods/Design: Patients (and their primary carers, if available) are randomly allocated to an intervention or control arm of the study. The intervention is multimodal and aims to screen for adverse stroke sequelae and address ways to enhance participation in patient-valued activities. Intervention methods include: telephone contacts, written information provision, home visitation, and contact with treating health professionals, with further relevant health service referrals as required. The control involves treatment as usual, as determined by inpatient and community rehabilitation treating teams. Formal blinded assessments are conducted at discharge from inpatient rehabilitation, and at six and twelve months post-stroke. The primary outcome is depression. Secondary outcome measures include participation and activity status, health-related quality of life, and self-efficacy.Discussion: The results of this trial will assist with the development of a model for community-based rehabilitation management for

Purpose. To conduct a systematic review to explore the effectiveness of community-based rehabilitation interventions delivered by allied health professionals and/or nursing staff in reducing depression, facilitating participation and improving health-related quality of life (HRQoL) post-inpatient stroke rehabilitation. Method. A search was conducted in the databases of MEDLINE, PEDro, CINAHL and the Cochrane Library. Publications were classified into categories based on the type of the interventions. Best evidence synthesis and meta-analysis were utilised to determine the level of evidence. Results. Fifty-four studies were included in the review, and divided into nine broad intervention categories. Meta-analysis demonstrated significant reduction in depression with exercise interventions (n = 137; effect estimate SMD: −2.03, 95%CI: −3.22, −0.85). Community-based interventions targeting participation and leisure domains showed moderate evidence for improvement in global participation measures and HRQoL. Comprehensive rehabilitation demonstrated limited evidence for depression and participation, and strong evidence for HRQoL. Conclusions. There is limited to moderate evidence supporting some rehabilitation interventions in affecting the outcomes of depression, participation and HRQoL post-stroke. Heterogeneity of the studies made evidence synthesis difficult. Further consideration needs to be given to the type and timing of outcome measures selected to represent the domains of participation and HRQoL.

BACKGROUND: Broad community access to high quality evidence-based primary mental health care is an ongoing challenge around the world. In Australia one approach has been to broaden access to care by funding psychologists and other allied health care professionals to deliver brief psychological treatments to general practitioners' patients. To date, there has been a scarcity of studies assessing the efficacy of social worker delivered psychological strategies. This study aims to build the evidence base by evaluating the impact of a brief educational intervention on social workers' competence in delivering cognitive behavioural strategies (strategies derived from cognitive behavioural therapy). METHODS: A randomised controlled trial design was undertaken with baseline and one-week follow-up measurement of both objective and self-perceived competence. Simulated consultations with standardised depressed patients were recorded on videotape and objective competence was assessed by blinded reviewers using the Cognitive Therapy Scale. Questionnaires completed by participants were used to measure self-perceived competence. The training intervention was a 15 hour face-to-face course involving presentations, video example consultations, written materials and rehearsal of skills in pairs. RESULTS: 40 Melbourne-based (Australia) social workers enrolled and were randomised and 9 of these withdrew from the study before the pre training simulated consultation. 30 of the remaining 31 social workers (97%) completed all phases of the intervention and evaluation protocol (16 from intervention and 14 from control group). The intervention group showed significantly greater improvements than the control group in objective competence (mean improvement of 14.2 (7.38-21.02) on the 66 point Cognitive Therapy Scale) and in subjective confidence (mean improvement of 1.28 (0.84-1.72) on a 5 point Likert scale). On average, the intervention group improved from below to above the base competency t

Aged abuse can manifest as physical harm, sexual assault, intimidation, blackmail, and social deprivation, misappropriation of funds or property, and neglect. The extent of the problem is difficult to assess in health settings due to underreporting and the fragility and reluctance of the elderly in being able to discuss the issue with health care providers. This appears to be related to the fact that perpetrators are frequently family members with resulting issues of aged dependency, family loyalty, and fear of the consequences of reporting. Of equal importance is a general lack of community understanding of aged abuse, including health professionals who frequently lack the confidence in screening and management to respond appropriately when aged abuse is suspected. Staff knowledge and skills emerge as a deficit in the detection of elder abuse and staff education has been identified as an effective means of improving the recognition of the abused elderly person in acute hospital settings. In addition, there remains a need for effective screening protocols. The aim of this study was to explore the recognition of aged abuse in an acute and subacute hospital setting. This has implications for effective management and community linkage as well as strengthening the knowledge base of issues related to this vulnerable group. The study included a survey and interview with hospital staff to explore their response to aged abuse over a retrospective twelve-month period.

Background: Depressive symptoms occur in approximately one-third of stroke patients. We sought to evaluate whether an integrated model of stroke care and secondary prevention reduced depressive symptomatology in stroke survivors. Methods: The integrated care (IC) model is a multifaceted program that provides ongoing collaboration between a specialist stroke service and primary care physicians, using telephone tracking, a bi-directional information feedback loop, management of vascular risk factors, and regular screening for depressive symptoms. Results: Patients exposed to the IC model exhibited significantly fewer depressive symptoms than controls at 12 months post stroke (as measured by the PHQ-9 screening tool; p = 0.006). At 12 months, 30/91 (33%) of the treatment group had depressive symptoms, compared to 52/95 (55%) of the control group (p = 0.003). With other variables adjusted for, the major associates of being depressed at 12 months were group allocation and physical disability. Conclusion: The integrated care approach provides a framework for detecting and monitoring depressive symptoms, and appears to be protective against post-stroke depression. Copyright © 2008 S. Karger AG.

This column presents the Consultation-Liaison in Primary-Care Psychiatry model, which was developed in Australia. This model is a structured approach to collaborative care of people with mental illnesses between primary care services and specialist mental health services. The first component of the model is a consultation, liaison, and education service provided by psychiatric consultants at participating general practices. The second component involves transferring selected patients from community mental health services into general practitioner-based collaborative care. In the final component a clinical case-register and reminder system managed by the specialist services is used to actively promote follow-up for transferred clients. The column also offers some evidentiary support for this care model that suggests a best-practices model for maintaining adequacy of care for patients.

Biofilm cells differ phenotypically from their free-floating counterparts. Differential growth rates in biofilms are often referred to, particularly in response to limited diffusion of oxygen and nutrients. We observed growth rates of attached Pseudomonas sp. strain CT07 cells that were notably higher than the maximum specific growth rate measured in batch culture. Despite dilution rates in continuous flow cells that exceeded the maximum planktonic specific growth rate by 58 times, sampling of the effluent revealed > 10(9) cells ml(-1), suggesting that biofilms function as a source of planktonic cells through high cell yield and detachment. Further investigation demonstrated considerable planktonic cell yield from biofilms as young as 6 h, indicating that detachment is not limited to established biofilms. These biofilm-detached cells were more sensitive to a commercial biocide than associated biofilm- and chemostat-cultivated populations, implying that detached biofilm cells exhibit a character that is distinct from that of attached and planktonic cell populations