A balancing act: integrating the expertise of youth peer workers in child and adolescent mental health services.

The socio-relational focus of youth peer support workers (YPSWs) poses a challenge when YPSWs are embedded in medical oriented contexts common to child and adolescent mental health services (CAMHS); as it requires YPSWs to find a balance between being a peer on one hand, and adhering to professional boundaries and medical standards set out by CAMHS on the other. To create a suitable position for YPSWs in CAMHS, this study investigated the unique socio-relational contributions YPSWs can make to CAMHS in addition to clinicians, and identified how these contributions can be embedded within CAMHS. This study reports on 37 semi-structured interviews conducted in the Netherlands with youth (n = 10), YPSWs (n = 10), and clinicians (n = 17). Overall, the unique socio-relational contributions YPSWs can make include: their ability to build authentic trusting relationships with youth by providing empowerment, promoting autonomy, valuing stillness in recovery, reducing isolation, recognizing strengths, and navigating life inside and outside of (residential) mental healthcare and beyond classification. Moreover, prerequisites to safeguard the integration of YPSWs and these socio-relational contributions were also identified, including YPSWs achieving stability in recovery, recent lived experiences with mental health challenges, and organizational support in terms of suitable treatment climate, resources to enhance flexibility of YPSWs, and shared goals regarding youth peer support work. Overall, YPSWs view youth holistically and foster a connection with youth based on youthfulness and recent lived experience. Involving YPSWs is an important step forward to drive positive transformation in CAMHS.

Treating eating disorders by professionals with similar experiences: A systematic review.

OBJECTIVE: Although a significant number of professionals who provide eating disorder (ED) treatment have lived experience with an ED in the past, there is no consensus on whether these professionals should use these experiences in treatment. This review aims to evaluate current literature on recovered professionals with an ED past treating ED patients, unravelling advantages and disadvantages in treatment, the impact on professionals and their surroundings, and implications for practice. METHOD: A systematic literature search was conducted which included 10 articles. We analysed qualitative data through a systematic synthesis. Strength of evidence was calculated for each subtheme. RESULTS: Three themes and 14 subthemes were divided into categories. The category 'treatment (patient-professional interaction)' was divided into: advantages, disadvantages and other implications for treatment. Additionally, the category 'professionals themselves' included subthemes that directly impact or relate to ED professionals: recovery as a non-linear process, the significant role of self-care and adverse feelings of professionals. Finally, the category 'work settings' included: company culture and training, supervision and professional development. DISCUSSION: Recovered ED professionals are a promising addition to ED treatment due to the enhanced expertise of the professional. However, attention should be paid to the risk of distorted boundaries between patient and professional.

A systematic review exploring youth peer support for young people with mental health problems.

Youth peer support workers (YPSWs) are young adults with lived experience of mental illness during childhood or adolescence who support young people receiving treatment in mental health services. The contributions made by YPSWs are a promising development to facilitate consumer-centered and recovery-oriented care. Although the youth peer support workforce is expanding rapidly, structurally embedding YPSWs in practice is challenging. To overcome these challenges and thereby improve care for young people, insight into YPSW roles, barriers and facilitators for implementing and pursuing youth peer support (YPS) is a necessity. This systematic review examined the published literature to identify existing knowledge on YPSW roles in treatment settings, and the barriers and facilitators for implementing and pursuing YPS in practice. A total of 24 studies from a variety of youth serving contexts were included in this review. Thematic synthesis resulted in six YPSW roles and five themes with barriers and facilitators. The roles included the: engagement role, emotional support role, navigating and planning role, advocacy role, research role and the educational role. The themes explored the needs of YPSWs, experiences of YPSWs, relationships between service users and YPSWs, the collaboration process between YPSWs and non-peer staff, and organizational readiness. This review underlines that YPSWs likely are a valuable addition to numerous youth treatment contexts. Overall, the implementation of YPSWs is a multifaceted operation that requires careful planning. We recommend services to set clear and realistic expectations for YPSWs, to consider potential power imbalances between YPSWs and non-peer staff, to provide adequate resources to pursue YPS, and to approach the implementation of YPSWs with a growth mindset.

Comparison of the efficiency of the Onderstepoort- and Centres for Disease Control ultraviolet light traps for the collection of livestock associated Culicoides species in South Africa.

Comparative monitoring of the abundance and distribution of Culicoides biting midges (Diptera: Ceratopogonidae), the biological vectors of the causative agents of several diseases of global veterinary importance, will be crucial in determining the risk of disease outbreak and spread. Ultraviolet (UV) suction traps have become the most frequent method used for the monitoring of Culicoides diversity and abundance. The current study compared the trapping efficiency of the two most used UV suction light traps, i.e., the Onderstepoort (OP)- and the Centres for Disease Control trap, for the collection of livestock associated Culicoides species in South Africa. The study confirmed the superiority of the OP trap and indicated a correlation in species composition and age grading results as determine with the two trap types. Substantial variations in the comparative trap efficiency, as found between areas and sites within an area, suggest that a universal conversion factor between the two trap types may not be advisable as it is unclear to what extent species composition and environmental factors may influence the conversion factor. Light traps, independent of trap model, can be considered acceptable for determining the serial comparison of population numbers for seasonal fluctuation and species abundance in distribution surveys.

Evaluation of light emitting diode suction traps for the collection of livestock-associated Culicoides species in South Africa.

Risk analysis of pathogens transmitted by Culicoides (Diptera; Ceratopogonidae) depends on the ability to detect all potential vectors attacking livestock in an area. Onderstepoort 220-V ultraviolet (UV) down-draught light traps are considered the gold standard for this purpose. To improve the flexibility of this trap in the field, in the absence of 220-V power, the possibility of using low-energy light emitting diodes (LEDs) was assessed. The efficiency of a standard 220-V Onderstepoort trap (30 cm 8 W fluorescent UV light tube) was compared to that of 220-V Onderstepoort traps fitted with either two, four or eight individual white LEDs. The Onderstepoort 220-V trap was also compared to a 12-V Onderstepoort trap fitted with an 8 W fluorescent UV light tube, a 12-V Onderstepoort trap with 12 individual white LEDs and 12-V and 220-V Onderstepoort traps fitted with 12 individual UV LEDs. Higher numbers of Culicoides as well as species diversity were collected with a brighter light source. The use of UV LEDs in both the 12-V and 220-V combinations was comparable to the Onderstepoort 220-V light trap with ration to species diversity collected. The Onderstepoort 220-V light trap is recommended if large numbers of Culicoides need to be collected.

Assessment of the Hemotek® system for the in vitro feeding of field-collected Culicoides imicola (Diptera: Ceratopogonidae) in South Africa.

The optimising and standardisation of in vitro blood feeding protocols for field-collected Culicoides species (Diptera: Ceratopogonidae) will be of essence for the comparison of the vector competencies of various populations of viruses of veterinary importance and the establishment of laboratory colonies of putative vector species. A custom-made feeding chamber to accommodate the small size of Culicoides imicola Kieffer was designed for the commercially available Hemotek® system and compared to existing membrane and cotton pledge feeding methods. High feeding rates coupled to higher mean blood meal volume than that of the existing OVI device indicated that the Hemotek system will be suitable for the feeding of field-collected Culicoides. The Hemotek system was subsequently used to identify factors that may affect feeding success in the laboratory. Evaluated factors were the source (host) and temperature of the blood meal, time of the day of feeding, the position of the blood reservoir in relation to the midges and exposure time to the blood. While only feeding orientation and the temperature of the blood source seems to significantly affect the feeding rate, all the factors did influence the volume of blood consumed.

The applicability of spectrophotometry for the assessment of blood meal volume inartificially fed Culicoides imicola in South Africa.

The volume of the blood meal of haematophagous insects will determine the number of infective particles taken up during feeding and may as such denote the minimum dose needed to infect a competent vector. Culicoides midges resort among the smallest of haematophagous vectors and determining and comparing their blood meal volumes may be challenging. Collected Culicoides imicola females were fed on defibrinated bovine blood through a Parafilm® membrane using a Hemotek® system. After feeding, the weight of pools of 10 engorged females was compared to that of 10 unfed females to determine the volume of blood imbibed. After weighing, the pools were homogenized and their absorbance read at 410 nm. Spectrophotometer readings were then converted to blood meal volumes using calibration curves, obtained by the dilution of known volumes of blood used for feeding. Although the mean blood meal volumes determined spectrophotometrically (0.06 µL), differed significantly (P < 0.01) from those obtained by weighing (0.07 µL), the range in blood meal volumes determined spectrophotometrically (0.03-0.08 µL) and by weighing (0.01-0.11 µL) was positively correlated (r = 0.7; P < 0.01). Both methods can be used to determine the blood meal volume.

The efficiency of light-emitting diode suction traps for the collection of South African livestock-associated Culicoides species.

Culicoides biting midges (Diptera: Ceratopogonidae) are vectors of a range of orbiviruses that cause important veterinary diseases such as bluetongue and African horse sickness. The effective monitoring of Culicoides species diversity and abundance, both at livestock and near potential wildlife hosts, is essential for risk management. The Onderstepoort 220-V ultraviolet (UV) light trap is extensively used for this purpose. Reducing its power requirements by fitting low-energy light-emitting diodes (LEDs) can lead to greater flexibility in monitoring. A comparison of the efficiency of the 220-V Onderstepoort trap (8-W fluorescent UV light) with the efficiency of the 220-V or 12-V Onderstepoort traps fitted with red, white, blue or green LEDs or a 12-V fluorescent Onderstepoort trap demonstrated the 220-V Onderstepoort trap to be the most efficient. All the results showed nulliparous Culicoides imicola Kieffer females to be the dominant grouping. Despite the lower numbers collected, 12-V traps can be used in field situations to determine the most abundant species.

Evaluation of larviposition site selection of Glossina brevipalpis.

Tsetse species (Diptera: Glossinidae) are vectors of trypanosome parasites which cause disease in both humans and livestock. In South Africa Glossina austeni Newstead, 1912 and G. brevipalpis Newstead, 1911 are responsible for the cyclical transmission of animal trypanosomes causing African animal trypanosomiasis also referred to as nagana. Gravid tsetse females deposit a single larva in specific sites but little information is available on biotic and abiotic factors that govern site selection. This study therefore aimed to characterize some of the substrate conditions that may influence selection of larviposition sites. Colonised, gravid female G. brevipalpis were presented with a choice of four larviposition sites. Sites differed in qualities of pH (5, 7, 9), salinity (0, 1.3, 4g/L) and the presence of other tsetse pupae (G. brevipalpis or G. austeni). These trials indicated no significant selection by gravid females with regard to pH and salinity. Females selected significantly more often for sites with pupae (P<0.05), but also favored sites containing conspecific over heterospecific pupae (P<0.05). These results present the first indication of an aggregation effect of tsetse pupae in G. brevipalpis. This may imply that G. brevipalpis larvae produce a pheromone during pupation as seen in G. morsitans morsitans. Isolation of such semio-chemicals would allow the development of larviposition traps to attract gravid females.

Serotyping and genotyping of HIV-1 infection in residents of Khayelitsha, Cape Town, South Africa.

It is estimated that between 5.5 and 6.1 million people are infected with HIV/acquired immunodeficiency syndrome (AIDS) in South Africa, with subtype C responsible for the majority of these infections. The Khayelitsha suburb of Cape Town has one of the highest HIV prevalence rates in South Africa. Overcrowding combined with unemployment and crime in parts of the area perpetuates high-risk sexual behavior, which increases exposure to infection by HIV. Against this background, the objective of this study was to characterize HIV-1 in residents confirmed to be seropositive. Serotyping was performed through a competitive enzyme-linked immunosorbent assay (cPEIA). Genotyping methods included RNA isolation followed by RT-PCR and sequencing of the gag p24, env gp41 immunodominant region (IDR), and env gp120 V3 genome regions of HIV-1. With the exception of a possible C/D recombinant strain, all HIV-1 strains were characterized as HIV-1 group M subtype C. One individual was shown to harbor multiple strains of HIV-1 subtype C. In Southern Africa, the focus has been to develop a subtype C candidate vaccine, as this is the major subtype found in this geographical area. Therefore, the spread of HIV-1 and its recombinant strains needs to be monitored closely.

The case of the red lingerie - chromhidrosis revisited.

Chromhidrosis or the production of coloured sweat is a rare clinical finding. A 26-year-old female presented with marked pink staining of her uniform and lingerie. Extractions of clothing, skin surface samples, eccrine sebum, urine and a fast food product were spectrophotometrically analysed to identify the pink staining pigment. Three water-soluble colouring agents have been identified. An eccrine route of excretion probably produced chromhidrosis. An overview is presented.

Evening primrose oil (Epogam) in the treatment of chronic hand dermatitis: disappointing therapeutic results.

BACKGROUND: Hand dermatitis is a common therapeutic challenge with limited and unsatisfactory therapy modules. A possible beneficial role of oral evening primrose oil needs to be investigated. OBJECTIVE: Pharmacological doses of gamma-linolenic acid (GLA) could improve the water permeability barrier of the epidermis in chronic hand dermatitis. Clinical improvement, changes in the lipogram and epidermal lipid composition could define functional improvement of the skin. Electron-microscopic evaluation of the epidermal lipid bilayer could underline the efficacy of essential fatty acids in chronic hand dermatitis. METHODS: Thirty-nine patients with chronic (> 1 year), stable hand dermatitis entered a 24-week double-blind placebo-controlled trial. Patch test with the European standard of allergens, haematogram and serum IgE values were determined before commencement of the study. Active therapy (600 mg/day of GLA) was administered to half the patient group. Medication was given for 16 weeks and observations continued for another 8 weeks. Patients were assessed clinically, using a visual analogue scale at 4-week intervals. Plasma and red blood cell lipograms, as well as skin biopsies, were taken before therapy, after the 16-week supplementation period and at week 24. Tissue was used for histological evaluation, electron-microscopic assessment and epidermal lipid analysis. RESULTS: Improvement in clinical parameters was present in the Epogam and placebo groups, but no statistical difference could be confirmed between the groups. Haematogram, blood and epidermal biochemistry were normal at baseline. No change in the lipid composition of plasma red cells or epidermis could be detected during the trail. Ultrastructurally skin specimens showed no change during the study period. CONCLUSION: The study indicates that the therapeutic value of orally administered GLA for chronic hand dermatitis is not superior to that of placebo.

The fine structure of ascospore shape and development in Ceratocystis fimbriata.

Ascospore development in Ceratocystis fimbriata Ell. & Halst. commenced in an eight-nucleate ascus. A single vesicle formed along the periphery of the ascus from fragments of ascospore delimiting membranes, surrounded all eight nuclei and eventually invaginated, first forming pouches with open ends, then finally enclosing each of the eight nuclei in a separate sac, thus delimiting ascospores. Pairing of the ascospores followed and brim formation occurred at the contact area between two ascospores. Osmiophilic bodies contributed to the formation of brim-like appendages by fusing to the ascospore walls. Additional brims were observed at opposite ends of the ascospores giving them a double-brimmed appearance.

Cadmium, lead, selenium, and zinc in semen of occupationally unexposed men.

Concentrations of cadmium, lead, selenium, and zinc were determined in semen and seminal plasma of 22 volunteers by atomic absorption spectrometry. Additionally conventional semen parameters and, by means of computer videomicrography, motion parameters of spermatozoa were evaluated. Concentrations of Cd, Pb, and Zn determined in semen were not significantly different from those measured in seminal plasma. However, selenium levels were significantly higher in semen (53.8 +/- 22.9 micrograms l-1) than in seminal plasma (40.4 +/- 15.5 micrograms l-1, P < 0.01). The investigated semen samples on average contained low levels of Cd (0.4 +/- 0.23 micrograms l-1) and Pb (9.8 +/- 6.5 micrograms l-1). Studies on the intra-individual variability revealed the following average coefficients of variation (%) for element concentrations: Pb (70), Cd (53), Se (27), and Zn (23); and for semen parameters: total sperm count (46), sperm concentration (37), motility (22), ejaculate volume (21), linearity (19), linear velocity (11), curvilinear velocity (10), and percentage of normally formed sperm (9). Significant positive correlations were detected between semen selenium levels and sperm concentration (r = 0.51, P < 0.05), and percentage of normally formed sperm (r = 0.46, P < 0.05), respectively. Sperm motility (r = 0.53, P < 0.02), linear (r = 0.76, P < 0.001) and curvilinear velocity (r = 0.64, P < 0.002) were significantly correlated with semen cadmium levels.

Viewing primary mental health care at a time of social transition in South Africa.

As South Africa shifts from a social structure based on the principles of apartheid to a democratic society, social policies must be developed that are consonant with the ideals of the "new" society. These must, however, take into account the current realities of the South African context. This article suggests that the application of the principles of primary mental health care is the approach most likely to meet mental health needs in the future South Africa, but that difficulties are likely to arise in the transition to this approach. These difficulties must be identified and dealt with. The authors discuss the problems in providing competent curative care to all and in shifting emphasis to prevention and promotion in mental health care. The discussion covers both practical and political complications. The authors conclude that though the process to primary mental health care will be a long one, the problems are unlikely to be insurmountable.

Private health care in South Africa: should the unions intervene?

The South African state's policy of privatization of health services has led to deterioration of public-sector health care and increased costs of access to this sector. This has generated an increasing demand for private health insurance among the predominantly black organized working class. These demands pose a dilemma for the progressive trade unions; negotiation of private-sector health insurance will have deleterious consequences for the equity and efficiency of the health services in general. Current trends in the private health sector also indicate that rapid cost increases will make most regular insurance packages unaffordable to the majority of workers within a few years. On the other hand, trade unions are obliged to meet the material demands of their members, and to intervene to stem the flow of individual workers to the private health sector. This article describes these trends, and the authors argue the case for intervention in this process by trade unions, in the form of union-negotiated and union-controlled "managed care" schemes. Such schemes will allow for the delivery of an adequate and appropriate package of health services at affordable rates. Union control will also allow for such structures to become the building blocks of a future national health service, and for incorporation into that service. Finally, the political implications of such interventions are addressed. The authors argue that the potential for undermining broader political campaigns and for creating divisions within the working class are important problems, but that many of these may be overcome through appropriate interventions.

The private health sector in South Africa--current trends and future developments.

The private health sector is experiencing a crisis of spiralling costs, with average annual cost increases of between 13% and 32% over the decade 1978-1988. This trend is partly explained by the high utilisation rates that result from the combination of the 'fee-for-service' system and the 'third-party' payment structure of the sector. Medical schemes have responded by promoting the idea of 'flexible packages', and have won the right to 'risk-rate' prospective members. It is argued that these measures will undermine the principle of equity in health care, and will not solve the problems of the private sector. Instead, a more significant restructuring of the sector is likely to emerge. This may take the form of 'managed care' structures, along the lines of the health maintenance organisation model from the USA. The principles, advantages and problems of 'managed care' structures are described. These are shown to be potentially more rational and efficient than the current structure of the private sector. Although some resistance to 'managed care' structures can be expected, the convergence of interests of large employers and trade unions in containing health care costs suggests that their emergence is a likely development.