Quarantine alone or in combination with other public health measures to control COVID-19: A rapid Cochrane review.

In March 2020, the South African government implemented various non-pharmacological prevention and control measures (e.g. isolation, social distancing and quarantine) in response to the COVID-19 pandemic. We summarise evidence from a rapid Cochrane review on the effect of quarantine alone v. quarantine plus combination measures to prevent transmission of and mortality caused by COVID-19. The findings show that when started earlier, quarantine combined with other prevention and control measures can be more effective than quarantine alone, and cost less.

Adolescent girls and young women: Policy-to-implementation gaps for addressing sexual and reproductive health needs in South Africa.

Sexual and reproductive health (SRH) services for adolescent girls and young women (AGYW) remain inadequate - both globally and in South Africa (SA). We systematically scoped the available policies and guidelines for SRH-related policy for AGYW in SA. We found many available policies and guidelines to address issues of family planning, HIV prevention and care and antenatal and maternal care. Despite the wealth of guidance, SA's high rates of pregnancy and HIV transmission continue unabated. Our policy review and analysis identified issues for researchers and policymakers to consider when developing and implementing programmes to improve SRH services. We suggest that considering national policies alongside evidence of what is effective, as well as contextual barriers to and enablers of strategies to address AGYW needs for SRH, are among the key steps to addressing the policy-to-implementation gap.

Quarantine alone or in combination with other public health measures to control COVID-19: A rapid Cochrane review

In March 2020, the South African government implemented various non-pharmacological prevention and control measures (e.g. isolation, social distancing and quarantine) in response to the COVID-19 pandemic. We summarise evidence from a rapid Cochrane review on the effect of quarantine alone v. quarantine plus combination measures to prevent transmission of and mortality caused by COVID-19. The findings show that when started earlier, quarantine combined with other prevention and control measures can be more effective than quarantine alone, and cost less

Interventions for preventing unintended pregnancies among adolescents.

South Africa (SA) has an increasingly high rate of unintended pregnancies among adolescents, which are coupled with poor contraception knowledge. We highlight a systematic review that evaluated the effects of prevention interventions for unintended adolescent pregnancies, and provide implications for practice that are relevant to the SA context. The findings suggest the need for multifaceted interventions that are aligned with adolescent sexual and reproductive health best practices to address the unmet contraception knowledge gap, as well as unintended pregnancies among adolescents.

The burden of depression and anxiety among medical students in South Africa: A cross-sectional survey at the University of Cape Town.

BACKGROUND: Depressive and anxiety disorders occur at very high rates among medical students. For instance, an international review and meta-analysis estimated the overall pooled crude prevalence of depression or depressive symptoms at 27.2%. However, South African (SA) data are very limited. OBJECTIVES: To determine rates of depression and anxiety among medical students and to examine the associations with various sociodemographic variables (biological sex, gender identity, household income, ethnicity, and clinical v. pre-clinical students). We also examined whether the 'mini-semester' of 2017 resulting from the 2016 'Fees Must Fall' student protests was associated with increased depression/anxiety. METHODS: The study was a cross-sectional electronic survey conducted in the Faculty of Health Sciences, University of Cape Town, using an anonymous, self-administered online questionnaire. The questionnaire included basic sociodemographic questions, the Patient Health Questionnaire-9 and the Hospital Anxiety and Depression Scale. RESULTS: The sample consisted of 473 medical students, 333 (70.4%) female and 140 (29.6%) male. Based on ethnic self-identification, 165 (35.6%) were black, 144 (31.1%) white, 88 (19%) coloured, 52 (11.2%) Indian and 8 (1.7%) Asian. There were 239 pre-clinical students (50.5%) and 234 clinical students (49.5%). Of the sample, 36.4% were above the cut-off for major depressive disorder and 45.9% for anxiety disorder. Reported rates of disorders diagnosed by a health professional were 25.0% for depressive disorder and 20.5% for anxiety disorder, and 28.1% of all students were receiving psychotropic medication. Female sex was associated with both depression (prevalence ratio (PR) 3.7; p<0.001) and anxiety diagnoses (PR 4.7; p<0.001). None of the other sociodemographic characteristics showed significant associations. Interestingly, students who undertook the 2017 mini-semester showed an increased rate of depression (PR 2.1; p<0.05) and anxiety diagnoses (PR 2.1; p<0.05). CONCLUSIONS: Nearly one in four students reported depression/anxiety diagnoses and were on psychotropic medication, significantly more than age-based expectations. Even more screened positive for risk of depression/anxiety. Our findings indicate that medical students, particularly females, are at a significantly increased risk of depression and anxiety disorders. Results suggest that the 2016 student protests may have had a direct impact on the mental state of students. Multidisciplinary efforts should be targeted at initiatives to strengthen mental wellbeing and institutional culture around mental health. These efforts may help build resilience in the next generation of health professionals in SA ahead of work in an overburdened health and health education system.

First social impact bond for the SAMRC: A novel financing strategy to address the health and social challenges facing adolescent girls and young women in South Africa.

A social impact bond (SIB) is an innovative financing mechanism to attract investors to social programmes traditionally funded by governments. In this article, in celebration of the 50th anniversary of the South African Medical Research Council (SAMRC), the authors describe the SAMRC's first foray into this new world of financing through a SIB to improve the health and quality of life of adolescent girls and young women (AGYW). The AGYW SIB is in its preparatory phase and is scheduled for implementation in 2020. The authors describe the mechanism, including financial flows and the process of customising the SIB to meet the needs of AGYW, focusing on HIV prevention and treatment and the prevention and management of unintended pregnancies in schoolgoing AGYW. The authors outline an approach to designing the package of interventions, the metrics associated with such a programme and the business model. It is hypothesised that the proposed approach will lead to an improvement in programmatic outcomes, monitoring and evaluation tools and cost-effectiveness, and will develop key learning data for the future use of SIBs in health service delivery.

Measuring adolescent mental health around the globe: psychometric properties of the self-report Strengths and Difficulties Questionnaire in South Africa, and comparison with UK, Australian and Chinese data.

AIMS: This study evaluated the psychometric properties of the Strengths and Difficulties Questionnaire Self-Report (SDQ-S) in South African adolescents, and compared findings with data from the UK, Australia and China. METHODS: A sample of 3451 South African adolescents in grade 8, the first year of secondary school (Mage = 13.7 years), completed the SDQ-S in Afrikaans, English or isiXhosa. Means, group differences and internal consistency were analysed using SPSS V22, and confirmatory factor analyses were conducted using MPlus V7. RESULTS: In the South African sample, significant gender differences were found for four of the five sub-scale means and for total difficulties, but gender differences of alpha scores were negligible. The internal consistency for the total difficulties, prosocial behaviour and emotional symptoms sub-scales were fair. UK cut-off values for caseness (set to identify the top 10% of scores in a UK sample) led to a higher proportion of South African adolescents classified in the 'abnormal' range on emotional and peer difficulties and a lower proportion classified in the 'abnormal' range for hyperactivity. South African cut-offs were therefore generated. The cross-country comparison with UK, Australian and Chinese data showed that South African adolescent boys and girls had the highest mean scores on total difficulties as well as on the subscales of emotional symptoms and conduct problems. In contrast, South African boys and girls had the lowest mean scores for hyperactivity/inattention. The UK boys and girls had the highest mean scores for hyperactivity/inattention, while the Australian sample had the highest scores for prosocial behaviours. The Chinese boys had the highest peer problem mean scores and Chinese boys and girls had the lowest means on prosocial behaviours. Confirmatory factor analyses showed significant item loadings with loadings higher than 0.40 for the emotional and prosocial behaviour sub-scales on the five-factor model, but not for all relevant items on the other three domains. CONCLUSIONS: Findings support the potential usefulness of the SDQ-S in a South African setting, but suggest that the SDQ-S should not be used with UK cut-off values, and indicate the need for further validation and standardisation work in South African adolescents. We recommend that in-country cut-offs for 'caseness' should be used for clinical purposes in South Africa, that cross-country comparisons should be made with caution, and that further examination of naturalistic clusters and factors of the SDQ should be performed in culturally and contextually diverse settings.

Approximate eigensolutions of the attractive potential via parametric Nikiforov-Uvarov method.

The approximate analytical solutions of the non-relativistic SchrÓ§dinger equation for the Attractive potential model with the centrifugal term are investigated using the elegant methodology of the parametric Nikiforov-Uvarov. The energy equation and the corresponding un-normalized radial wave functions are obtained in a close and compact form after a proper Greene-Aldrich approximation scheme is applied. By changing the numerical values of some potential strengths, special cases of the Attractive potential are investigated in detail. The effects of the potential strengths and potential range respectively on the energy are also studied. The energy is found to be very sensitive to each of the potential parameters. Some theoretic quantities such as information energy, Renyi entropy and Tsallis entropy.

[Atomoxetine for the treatment of attention-deficit/hyperactivity disorder]. / Atomoxetin in der Behandlung der Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Kindern und Erwachsenen.

Atomoxetine is a selective noradrenaline reuptake inhibitor that has been studied for use in the treatment of attention-deficit/hyperactivity disorder (ADHD). In vitro, ex vivo and in vivo studies have shown that atomoxetine is a highly selective antagonist of the presynaptic norepinephrine transporter with little or no affinity for other noradrenergic receptors or other neurotransmitter transporters or receptors. So far, two open-label and seven randomised, double-blind, placebo-controlled, clinical trials have been published, six in youths and three in adults. Each of these trials has shown a positive response as measured by the primary efficacy measures, the ADHD-IV Rating Scale (ADHD RS) or the Conners Adult ADHD Rating Scale (CAARS). Atomoxetine has generally been well tolerated. The most common treatment-related adverse event was decreased appetite. Atomoxetine shows no abuse potential and is not a controlled substance in the US. In November of 2002 the FDA approved atomoxetine for use in the US for the treatment of ADHD in children, adolescents and adults. Atomoxetine is the first nonstimulant approved by the FDA for the treatment of ADHD and the first medication approved for the treatment of adult ADHD.

[Aripiprazole: a new atypical antipsychotic drug]. / Aripiprazol - Pharmakologie eines neuen atypischen Antipsychotikums.

Aripiprazole is an atypical antipsychotic agent with an intrinsic dopamineagonist activity of 30 %. Aripiprazole exerts additional partial agonist action on 5-HT (1A) receptors and has antagonist properties at 5-HT (2A) receptors. Controlled studies demonstrated an effectiveness in acute relapse of schizophrenic psychosis, chronical schizophrenic and schizoaffective disorders. Aripiprazole was effective in the treatment of productive psychotic and negative symptoms. Compared to other antipsychotics aripiprazole demonstrated a favourable profile of side effects: only slight changes of body weight, mild extrapyramidal symptoms, no prolactin elevation and no significant changes in QTc interval. The efficacy in the long term treatment of schizophrenia seems to be similar to other antipsychotics (e. g. olanzapine). The first evaluations of studies with patients with bipolar disorders showed a significant efficacy in the treatment of mania.

[Analysis of a special consultation for attention deficit/hyperactivity disorder in adults]. / Analyse einer Spezialsprechstunde für die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen.

It is increasingly recognised that one-third to one-half of children diagnosed as having attention deficit/hyperactivity disorder (ADHD) continue to exhibit symptoms of the disorder into adulthood. The purpose of this study was to report on the demographic and clinical profile of 85 adults (50 men, 35 women) who presented with adult ADHD and meet DSM-IV criteria for the disorder. Patients underwent a diagnostic work-up consisting of medical, psychiatric and demographic evaluation. Deficits in educational and social competence could be demonstrated in more than one third of the patients. Male patients consulted the out-patient service on the average earlier than female patients. Only a small percentage of the population was pretreated in childhood or adolesence. Highest degrees of comorbidity were found for substance abuse and mood disorders. Anxiety disorders and personality disorders were also frequently present in ADHD patients. Patients remained predominantly in the special out-patient service, transfer to GPs was inhibited by the currently off-label use of the prescribed drugs. Guidelines need to be drawn up to establish handover from paediatric to adult ADHD care.

[Life events and contact behaviour in drug-related death]. / Kontaktverhalten und Lebensereignisse: Untersuchung zur Vorphase des Drogentodes.

The purpose of the study was to analyse influencing factors on drug-related death. Contact behaviour and life events in the forefield of drug-related death were of special interest. During a period of 5 years 189 drug-related deaths were investigated in the German town Essen (inhabitants about 600,000). 53.4 % of 189 people with drug-related death had contact to specialised institutes for drug addicts during lifetime. However, only about 15 % of this group contacted these institutes over the period of the last three months. Additionally, 26 of the 189 persons had a psychiatric comorbid diagnosis, and this subgroup also demonstrated a restricted contact behaviour. Life events during lifetime and especially during the last 3 months seemed to be of influence upon the circumstances of drug-related death. According to this study, there seems to exist a turning away from professional institutions towards the end of the drug career which makes the documentation of influencing factors on drug-related death more difficult. Turning away from the help system is not the reason for drug-related death, but an important attendant circumstance.

Transmission of the Ambystoma tigrinum virus to alternative hosts.

Ambystoma tigrinum virus (ATV) is a lethal virus originally isolated from Sonora tiger salamanders Ambystoma tigrinum stebbinsi in the San Rafael Valley in southern Arizona. USA. ATV is implicated in several salamander epizootics. We attempted to transmit ATV experimentally to fish and amphibians by injection, water bath exposure, or feeding to test whether ATV can cause clinical signs of infection or be recovered from exposed individuals that do not show clinical signs. Cell culture and polymerase chain reaction of the viral major capsid protein gene were used for viral detection. Salamanders and newts became infected with ATV and the virus was recovered from these animals, but virus could not be recovered from any of the frogs or fish tested. These results suggest that ATV may only infect urodeles and that fish and frogs may not be susceptible to ATV infection.

[Evaluation of standardized training for the "Positive and Negative Syndrome Scale" (PANSS)]. / Evaluation eines standardisierten Trainings für die "Positive and Negative Syndrome Scale" (PANSS).

The present analysis comprises 3 studies on the interrater reliability of the Positive and Negative Syndrome Scale for Schizophrenia (PANSS; German version). To our knowledge this is the first empirical report on interrater reliability and on results of rater training of the German version of the PANSS despite the widespread use of the scale. In a total of 47 training participants with different clinical experience standardized PANSS rater training was carried out and subsequently evaluated. Therefore, concordance rates with an expert standard (C) and weighted coefficients kappa (kappa W) were calculated. As a main outcome of the studies, at least 3 training sessions were necessary but also sufficient to reach acceptable interrater reliability of the PANSS (C > 80%, kw > 0.60). In training participants with low psychiatric experience the level of interrater reliability of schizophrenic negative symptoms did not reach the results of positive symptoms after the training. Despite some conceptual limitations with respect to negative symptoms, the German version of the PANSS seems highly suitable to assess a broad spectrum of schizophrenic psychopathology in a reliable and economic manner. The present results also underline the practicability of our recommendations for conducting PANSS rater training in the clinical and scientific field as part of quality control and quality assurance in psychopathological assessment.

Growth hormone response to placebo, apomorphine and growth hormone releasing hormone in abstinent alcoholics and control subjects.

Abstinent alcoholics and control subjects were challenged with placebo (saline), growth hormone releasing hormone (GHRH) and apomorphine (APO). While both groups did not differ in their growth hormone response (HGH) to placebo and GHRH, the alcoholics revealed a significant lower HGH response to dopamine receptor stimulation with APO. These findings provide no evidence that in abstinent alcoholics HGH blunting after dopamine receptor stimulation could be related to an alteration at the pituitary level but they give neuroendocrinological support to the hypothesis of a lower dopamine receptor sensitivity in abstinent alcoholics.

[Psychopharmacotherapy in pregnancy and breast feeding]. / Psychopharmakotherapie in Schwangerschaft und Stillzeit.

The primary purpose of this article is to review critically the literature on the use of psychotropic medications in pregnancy and during breast feeding in order to suggest strategies for the clinical management of these periods. Use of psychotropic medications during pregnancy may cause three complications: 1. teratogenicity, 2. perinatal syndromes (neonatal toxicity), and 3. postnatal behavioural sequelae (behavioural toxicity). The literature features few well-controlled studies concerning these points, so that the available information allows only few conclusions. Exposure to certain psychotropic drugs in utero may increase the risk for some specific congenital anomalies; there is mostly no strong evidence for behavioural toxicity in children exposed to psychotropic medications. Use of psychotropic drugs during pregnancy and breast feeding may be appropriate in many clinical situations and should include thoughtful weighing of risk of pre- and postnatal exposure versus risk of relapse following drug discontinuation. The authors try to present disorder-based guidelines for psychotropic drug use during pregnancy and breast feeding and for psychiatrically ill women who wish to conceive.