Integration of mental health into primary care and community health working in Kenya: context, rationale, coverage and sustainability.

Integration of mental health into primary care is essential to meet population needs yet faces many challenges if such projects are to achieve impact and be sustainable in low income countries alongside other competing priorities. This paper describes the rationale and progress of a collaborative project in Kenya to train primary care and community health workers about mental health and integrate mental health into their routine work, Within a health systems strengthening approach. So far 1877 health workers have been trained.

Anesthetic considerations for the neonate with tracheoesophageal fistula.

Tracheoesophageal fistula (TEF) and associated esophageal atresia (EA) in the neonate, presents during the first week of life. This congenital defect can be complicated by aspiration, respiratory distress, and other congenital anomalies. The knowledge and ability of the anesthesiologist to anticipate the challenges in managing neonates presenting for repair, plays an important role in their treatment and survival.

Virtual patient training to improve reproductive health care for women with intellectual disabilities.

A multimedia virtual patient module, involving the case of a young woman with mild intellectual disabilities with a complaint of diffuse abdominal pain, was developed as a clinical training tool for students in health care professions. Primary objectives following use of the module included improved knowledge and reduced perception of difficulty in treating women's health patients with intellectual disabilities. The module was developed using an iterative, collaborative process of a core development team that included medical professionals, multimedia specialists, the parent of a child with intellectual disability, and a disability advocate.

Dynamical tunneling in mushroom billiards.

We study the fundamental question of dynamical tunneling in generic two-dimensional Hamiltonian systems by considering regular-to-chaotic tunneling rates. Experimentally, we use microwave spectra to investigate a mushroom billiard with adjustable foot height. Numerically, we obtain tunneling rates from high precision eigenvalues using the improved method of particular solutions.

Regular-to-chaotic tunneling rates using a fictitious integrable system.

We derive a formula predicting dynamical tunneling rates from regular states to the chaotic sea in systems with a mixed phase space. Our approach is based on the introduction of a fictitious integrable system that resembles the regular dynamics within the island. For the standard map and other kicked systems we find agreement with numerical results for all regular states in a regime where resonance-assisted tunneling is not relevant.

Longitudinal test of a multiple domain model of adolescent condom use.

A comprehensive multiple domain model (MDM) to understand condom use in adolescents was proposed and tested using structural equation modeling of data at three time points. The proposed model integrates social psychological theory, demographic and personality factors, social environment, and situational/contextual variables. Adolescents who were sexually active at time 2 (6 months after baseline) and time 3 (1 year after time 2) and completed surveys at all three time points were included in the analyses (N = 511).

Qualitative research on adolescent pregnancy: a descriptive review and analysis.

This study examined qualitative research on adolescent pregnancy to determine designs and methods used and to discover emergent themes across studies. Most of the 22 studies reviewed were described as qualitative or phenomenological by design and included samples comprising either African-American and Caucasian participants or African-Americans exclusively. Based on analysis of the collective primary findings of the sample articles, four themes were identified: (a) factors influencing pregnancy; (a) pregnancy resolution; (c) meaning of pregnancy and life transitions; and (d) parenting and motherhood.

A convenient procedure for bismuth-mediated Barbier-type allylation of aldehydes in water containing fluoride ions.

A new and convenient procedure for synthesis of homoallylic alcohols in generally good to excellent yields has been developed. The bismuth-mediated Barbier-type allylation of aldehydes (aromatic, aliphatic, alicyclic and heterocyclic) with allyl bromide has been carried out smoothly in water in the presence of fluoride ions.

A feasibility study of remote monitoring of asthmatic patients.

We assessed the feasibility of a remote monitoring system for asthmatic patients to use in their own homes. Eighty-four patients were invited to participate following discharge from hospital after an acute exacerbation of their asthma. We remotely monitored 33 patients from two hospitals for two weeks.

Evidence-based practice and the advanced practice nurse: a curriculum for the future.

The concept of evidence-based practice has gained increased attention throughout the 1990s as a strategy for linking the best scientific findings with clinical judgment to improve health outcomes. Because the concept implies finding, evaluating, summarizing, and using research results, a high level of clinical reasoning skills is required. Effective evidence-based practice also requires the incorporation of new practices into clinical and organizational settings, thereby demanding advanced leadership skills.

Supporting Partners of People with Aphasia in Relationships and Cconversation (SPPARC).

This paper reviews new theoretical and practical developments in working with partners of people with aphasia and describes the development of a clinician's resource entitled 'SPPARC: Supporting Partners of People with Aphasia in Relationships and Conversation'. It focuses particularly on one part of that resource: the SPPARC Conversation Training Programme, which adapts conversation analysis for clinical use. The paper describes the stages involved in assessing and working on conversation in everyday life.

Therapy using conversation analysis: helping couples adapt to aphasia in conversation.

This study focuses on the assessment and treatment of the conversations of a couple where one partner has aphasia. The assessment and treatment, informed by conversation analysis, are described, and some implications for the relation between language and psychosocial issues discussed.

Communication of sexual risk behavior among late adolescents.

A grounded theory approach was used to describe how males and females in late adolescence communicate with their sexual partners about sexual risk behaviors. Interviews were audiotaped with 18 women and 15 men from a university in the southeastern United States. Verbatim transcripts were analyzed using constant comparative analysis.

The importance of timing of surgery for hemodialysis vascular access thrombectomy.

The effect of delay in thrombectomy of occluded hemodialysis accesses was examined to determine whether a critical period exists during which a salvage procedure was more likely to be successful. A total of 1,126 vascular access surgeries between January 1, 1989, and December 31, 1994, were analyzed. No period of delay in thrombectomy was found when it was possible to say with certainty that an access could not be salvaged, although success was greatest in the first 48 h.

Double-blind, placebo-controlled study of cyclosporin A as a corticosteroid-sparing agent in corticosteroid-dependent asthma.

Patients with severe asthma who require long-term oral corticosteroid therapy are at risk of unwanted effects. Several immunosuppressive drugs have been assessed as corticosteroid-sparing agents in chronic asthma. We previously showed that cyclosporin A (CsA) administered for 12 wk improved lung function in corticosteroid-dependent patients.