A user evaluation of speech/phrase recognition software in critically ill patients: a DECIDE-AI feasibility study.

OBJECTIVES: Evaluating effectiveness of speech/phrase recognition software in critically ill patients with speech impairments. DESIGN: Prospective study. SETTING: Tertiary hospital critical care unit in the northwest of England. PARTICIPANTS: 14 patients with tracheostomies, 3 female and 11 male. MAIN OUTCOME MEASURES: Evaluation of dynamic time warping (DTW) and deep neural networks (DNN) methods in a speech/phrase recognition application. Using speech/phrase recognition app for voice impaired (SRAVI), patients attempted mouthing various supported phrases with recordings evaluated by both DNN and DTW processing methods. Then, a trio of potential recognition phrases was displayed on the screen, ranked from first to third in order of likelihood. RESULTS: A total of 616 patient recordings were taken with 516 phrase identifiable recordings. The overall results revealed a total recognition accuracy across all three ranks of 86% using the DNN method. The rank 1 recognition accuracy of the DNN method was 75%. The DTW method had a total recognition accuracy of 74%, with a rank 1 accuracy of 48%. CONCLUSION: This feasibility evaluation of a novel speech/phrase recognition app using SRAVI demonstrated a good correlation between spoken phrases and app recognition. This suggests that speech/phrase recognition technology could be a therapeutic option to bridge the gap in communication in critically ill patients. WHAT IS ALREADY KNOWN ABOUT THIS TOPIC: Communication can be attempted using visual charts, eye gaze boards, alphabet boards, speech/phrase reading, gestures and speaking valves in critically ill patients with speech impairments. WHAT THIS STUDY ADDS: Deep neural networks and dynamic time warping methods can be used to analyse lip movements and identify intended phrases. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE AND POLICY: Our study shows that speech/phrase recognition software has a role to play in bridging the communication gap in speech impairment.

The correlation between occupation type and fibromyalgia severity.

BACKGROUND: Fibromyalgia (FM) is a chronic pain disorder associated with financial burden, decreased work productivity and absenteeism. Occupational stressors and specific employment factors may contribute to the severity of FM. AIMS: To determine if occupation type or employment status correlates with FM diagnostic and severity parameters, as assessed via validated instruments including tender points (TP), Widespread Pain Index (WPI), Symptom Severity (SS) and pain regions. METHODS: We performed a cross-sectional study of 200 adult patients diagnosed with FM at a single-centre FM clinic. Demographic and clinical data were extracted from the electronic medical records. Occupations were manually grouped in an iterative modified-Delphi approach and participants were grouped by employment status (Working, Not Working/Disabled or Retired) for analysis. RESULTS: In our cohort, 61% were employed and 24% were not working/disabled, while the remainder were students, homemakers or retired. SS score was significantly higher (P < 0.001) in not working/disabled patients compared to those employed. Business owners had the lowest TP count (median = 14) and the lowest median SS score (median = 7). WPI was highest for Others (Arts/Entertainment, Driver/Delivery and Housekeeper/Custodian workers; median=16) and the lowest for Retail/Sales/Wait Staff (median = 11). CONCLUSIONS: Work-related factors, occupation type and employment status correlate with diagnostic and severity parameters of FM. Employed participants had significantly lower SS scores suggesting that work loss correlates with SS. Participants employed in entry-level jobs or jobs with higher physical or financial stressors may experience greater FM symptoms. Further studies are required to explore work-related factors and their impact on the diagnostic and severity parameters of FM.

Dental enamel defects and dental caries of primary teeth among Indigenous children in Western Australia.

BACKGROUND: Teeth affected with enamel defects (EDs) are at an increased risk of dental caries. In spite of improving oral health status overall in Australia, Indigenous Australians still experience higher rates of dental caries than non-Indigenous Australians. This study reports on the prevalence of EDs and dental caries experience among Indigenous children in the Kimberley region of Western Australia. METHODS: Health status of all the primary teeth (ICDAS II criteria) and the presence of EDs on index teeth (modified Dental Defects of Enamel index; DDE) of young Indigenous children who participated in a 2-arm intervention trial was recorded. Generalized estimating equations were used to estimate the association between EDs and dental caries and effect estimates were presented as odds ratios and associated 95% confidence intervals. RESULTS: Person-level prevalence, from 237 children (mean age 3.6 years, standard deviation 1.7) assessed for EDs, was 58% and tooth-level prevalence was 24%. Teeth affected with demarcated or diffuse defects were associated with a twofold higher odds of having caries experience, odds ratio (OR) 2.5, 95% confidence interval (CI) 1.7-3.7 and OR 2.7, 95% CI 1.7-4.0 respectively. CONCLUSIONS: The presence of EDs among young Indigenous children was associated with a higher odds of caries experience among affected teeth.

Functional capacity and quality of life improvement in stable chronic obstructive pulmonary disease (COPD) patients following physical exercise and chicken egg white supplementation.

The pillars of comprehensive pulmonary rehabilitation program for chronic obstructive pulmonary disease (COPD) patients include physical exercise and good nutrition. The aim of this study was to evaluate the efficacy of pulmonary rehabilitation, which included physical exercise and chicken egg white supplementation, on the quality of life (QoL) and functional capacity among patients with stable COPD. The COPD patients were enrolled prospectively in this quasi-experimental study and completed a 12-week smartphone-guided home-based physical exercise program that comprised strength and resistance training three times per week for 30 minutes each session. Participants were divided into two groups: the control group who underwent physical exercise only, and the intervention group who had physical exercise and chicken egg white supplementation as a protein source. Patient characteristics including sex, age, nutritional status, comorbidities, smoking status, and obstruction severity, were evaluated. The COPD assessment test (CAT) score and six-minute walk test (6MWT) were used as the parameters to evaluate QoL and functional capacity, respectively. Of the total 50 patients included in the study, 12 were excluded due to follow-up and adherence problems. Our data indicated there were significant CAT score reduction and 6MWT improvement in both control and intervention groups after 12 weeks compared to baseline data. However, reduction of mean CAT score was higher in intervention compared to control group (-13.47±6.49 vs -5.42±5.07, p<0.001). In addition, the improvement of 6MWT was also higher in intervention group compared to control group (145.47±69.2 vs 32.42±17.3 meters, p<0.001). In conclusion, chicken egg white supplement to male patients with stable COPD who exercise with resistance and strength training could improve the QoL and functional capacity.

Effectiveness of adequate chicken egg white consumption on dyspnea degree and exacerbation incidence in stable COPD patients practicing strength and endurance exercises.

Lack of physical exercise and inadequate nutritional intake in chronic obstructive pulmonary disease (COPD) patients could lead to low muscle mass and function, which causes reduced respiratory function, increased incidence of exacerbations, exercise intolerance, increased visits to health facilities, and low health status. Therefore, physical exercise and good nutritional intake are the main foundations of a comprehensive pulmonary rehabilitation program for COPD patients. The aim of the study was to determine the effect of chicken egg white supplementation on dyspnea degree and the incidence of exacerbations in stable COPD patients who perform physical exercise independently at home. A quasi-experimental study was conducted in 38 stable COPD patients based on the Global Initiative for Chronic Lung Disease (GOLD) 2021 classification criteria. The patients were divided into two groups: the control group who did smartphone application-assisted physical exercises and the intervention group who did the same physical exercises plus chicken egg white supplementation for 12 weeks. Performed physical exercises included both strength and endurance training. The degree of dyspnea was assessed with modified Medical Research Council (mMRC) dyspnea scale and the incidence of exacerbations was assessed by direct interviews at the beginning and at the end of the intervention. A Fisher's exact test was used to assess the association between the intervention with dyspnea degree and exacerbation incidence. In the intervention group, chicken egg white supplementation for 12 weeks lowered the dyspnea degree by 3.16 times than the control (relative risk 3.16 with p=0.001). Furthermore, the incidence of exacerbations was also reduced by 1.8 times compared to the control group (relative risk 1.8, p=0.001). This study highlights a significant improvement in dyspnea degree and exacerbation incidence in COPD patients with the combination of protein supplementation and physical exercise. Therefore, adding chicken egg white intake could be beneficial for stable COPD patients practicing physical exercises.

Dietary brewer's spent yeast enhances growth, hematological parameters, and innate immune responses at reducing fishmeal concentration in the diet of climbing perch, Anabas testudineus fingerlings.

A 60-day feeding trial was conducted to optimally reduce the fishmeal level in climbing perch (Anabas testudineus) fingerling diet using a dietary brewer's spent yeast biomass (BSY) based diet. In this study, five isonitrogenous (35% CP) and isocaloric (19.15 MJ/Kg) feeds were prepared by replacing 0 (BSY0), 25% (BSY25), 50% (BSY50), 75% (BSY75) and 100% (BSY100) of fishmeal protein using BSY protein. A total of 225 numbers of uniform-sized climbing perch fingerlings (3.29 ± 0.09 g) were randomly stocked in the 15 rectangular FRP (Fiber-reinforced plastic) tanks (150 L capacity). The experimental fish were fed twice daily at 4% BW for the first fortnight and later reduced to 3% BW based on satiation. At the end of the feeding trial, the weight gain (WG) of fish increased with the increasing BSY incorporation rates corresponding to fishmeal content and peaked at 77.88%, and beyond that, WG decreased. Food conversion ratios decreased as dietary BSY levels increased and peaked at 76.28%. All other growth and feed utilization parameters followed a similar trend of weight gain. Hepatosomatic index (HSI) and viscerosomatic index (VSI), A:G ratio, serum catalase activity, and monocytes were unaffected and the total serum protein, albumin, globulin, alanine aminotransferase (ALT), aspartate aminotransferase (AST), respiratory burst activity, lysozyme levels, myeloperoxidase activity, hemoglobulin, red blood cells, white blood cells, neutrophils, eosinophils, lymphocytes, and gut protease activities were increased significantly (P < 0.05) with the increasing replacement levels and peaked between 25 and 75%. The serum SOD activity and total platelets were decreased, whereas the serum uric acid and gut amylase activities were increased significantly to the increasing levels of FM replacement in the diets (P < 0.05). Among treatments, the BSY100 resulted in an overall poor growth response combined with relatively reduced values in nearly all biochemical parameters. The whole-body composition was nearly unaffected. The integrated biomarker response of various biochemical indicators from the different treatments has shown that the 50% fishmeal protein can be optimally replaced by BSY, which would cause an 18% reduction in the Economic conversion ratio (ECR) and -270.28 gCO2e- reduction in carbon footprint value per kg of climbing perch fingerlings production.

Atraumatic Restorative Treatments in Australian Aboriginal Communities: A Cluster-randomized Trial.

INTRODUCTION: The management of early childhood caries (ECC) is challenging. OBJECTIVES: A model of care based on Atraumatic Restorative Treatment and the Hall Technique (ART-HT) to manage ECC was evaluated among remote Aboriginal communities in Australia. METHODS: Aboriginal communities in the North-West of Western Australia were invited to participate and consenting communities were randomized into early or delayed intervention for the management of ECC. Children were examined at baseline and at the 11-mo follow-up. The early intervention group (test) was provided with the ART-based dental care at baseline while the delayed intervention group (control) was advised to seek care through the usual care options available within the community. At follow-up, both groups were examined by calibrated examiners, and were offered care using the ART-HT approach. Changes from baseline to follow-up in caries experience were tested using paired tests. Multivariate analysis after multiple imputation of missing data used generalised estimating equation (GEE) controlling for clustering within communities. RESULTS: A total of 25 communities and 338 children (mean age = 3.6 y, SD 1.7) participated in the study (test = 177). At follow-up, 231 children were examined (68% retention, test = 125). At follow-up, children in the test group had more filled teeth (test filled teeth = 1.2, control filled teeth = 0.2, P < 0.001) and decreased levels of decayed teeth (mean test = 0.7 fewer teeth with decay, mean control = 1.0 more tooth with decay, P < 0.001). GEE analysis controlled for baseline caries experience, age, sex, and community water fluoride levels found increased rates of untreated decayed teeth (RR = 1.4, P = 0.02) and decreased rates of filled teeth (RR = 0.2, P < 0.001) at follow-up among the control group. CONCLUSION: A model of care relying on the principles of minimally invasive atraumatic approaches enabled the delivery of effective dental services to young children (<6 y) in remote Aboriginal Australian communities resulting in increased levels of care and improved oral health. KNOWLEDGE TRANSFER STATEMENT: This cluster-randomized trial tested a multi-component model of dental care to young children with ECC in remote Aboriginal communities in Australia. The intervention, based on the atraumatic approaches using minimally invasive techniques encompassing preventive care, Atraumatic Restorative Treatment and the Hall Technique (ART-HT), delivered more restorative care and reduced the incidence of caries. This model of care was more effective than available standard care and should be incorporated into mainstream service delivery programs.

Dermatology consultation service at a large metropolitan hospital system serving minority populations.

BACKGROUND: Dermatology consultations in the inpatient hospital setting can improve diagnostic accuracy and management. OBJECTIVE: Characterize dermatologic diagnostic and treatment trends in the hospital setting and identify variables that may affect patient care. METHODS: Retrospective chart review from 1 January 2012 to 31 December 2017 at Jackson Memorial Hospital (JMH) (Miami, Florida, USA), an academic non-profit tertiary care centre affiliated with University of Miami Miller School of Medicine, was performed. Patients who received dermatology consultations in the emergency department (ED) or inpatient settings were included. Patient demographics, admission information, provisional diagnosis and management plans by primary teams, final diagnosis, management plans and testing recommendations by the dermatology consults team, and follow-up information were collected. Analysis using Microsoft Excel of how time to consultation, admission length, inpatient versus ED setting and primary team affected diagnostic accuracy was also performed. RESULTS: The 1004 consultations for 812 patients (n = 812) were reviewed (359 women, 453 men). Most patients were Hispanic (n = 359; 44.2%) or African American (n = 273; 33.6%). Mean admission length was 20.6 days (range 0-439; median 6). The most common consulting service was internal medicine (n = 452). In 387 cases (47.6%), primary teams did not give a provisional diagnosis. The most common provisional diagnoses were bacterial infection (n = 93), viral infection (n = 49) and drug reaction (n = 44). The most common diagnoses by dermatology were viral infection (n = 93), bacterial infection (n = 90) and drug reaction (n = 80). Dermatology consultation changed the provisional diagnosis in 55.7% of cases, more often in cases where consultation took place ≥2 days after admission (P < 0.05). Primary teams followed dermatology treatment recommendations in 85.2% of cases. CONCLUSION: Dermatology consultation improves diagnostic accuracy in skin disorders in the hospital setting and serves as a valuable resource for inpatient care. A notable aspect of data from this study is the unique patient population, predominantly comprised of underrepresented racial and ethnic minorities including Hispanics and African Americans.

Rifled carotid: Internal carotid artery thrombosis from prolonged carrying of a military rifle.

BACKGROUND: Traumatic carotid artery thrombosis is uncommon and it usually results from penetrating injuries and less commonly secondary to blunt trauma. It can lead to delayed clinical presentation, which leads to delay in the diagnosis. Soldiers in combat scenario also can present with such an illness, which results from varied modes of injuries. Our case illustrates an unusual cause of carotid thrombosis. CASE PRESENTATION: Our patient is a 37-year-old soldier who developed neck pain and headache following a 5 km training run with rifle on the shoulder and subsequently developed left upper limb weakness and evaluation revealed extracranial right internal carotid thrombosis. He was managed with anticoagulants and antiplatelets with complete resolution of the thrombosis and complete recovery of the weakness. CONCLUSION: Blunt trauma to the neck in the form of carrying a rifle for a prolonged duration can result in injury to the carotid vessels leading to delayed neurological presentation. Educating the troops regarding such a mode of illness will prevent such a catastrophic nature of vascular injury resulting in ischaemic stroke.

Focal Cortical Dysplasia and Refractory Epilepsy: Role of Multimodality Imaging and Outcome of Surgery.

BACKGROUND AND PURPOSE: Focal cortical dysplasia (FCD) is one of the most common causes of drug resistant epilepsy. Our aim was to evaluate the role of presurgical noninvasive multimodality imaging techniques in selecting patients with refractory epilepsy and focal cortical dysplasia for epilepsy surgery and the influence of the imaging modalities on long-term seizure freedom. MATERIALS AND METHODS: We performed a retrospective analysis of data of 188 consecutive patients with FCD and refractory epilepsy with at least 2 years of postsurgery follow-up. Predictors of seizure freedom and the sensitivity of neuroimaging modalities were analyzed. RESULTS: MR imaging showed clear-cut FCD in 136 (72.3%) patients. Interictal FDG-PET showed focal hypo-/hypermetabolism in 144 (76.6%); in 110 patients in whom ictal SPECT was performed, focal hyperperfusion was noted in 77 (70.3%). Focal resection was the most common surgery performed in 112 (59.6%). Histopathology revealed FCD type I in 102 (54.3%) patients. At last follow-up, 124 (66.0%) were seizure-free. Complete resection of FCD and type II FCD were predictors of seizure freedom. Localization of FCD on either MR imaging or PET or ictal SPECT had the highest sensitivity for seizure freedom at 97.5%. Among individual modalities, FDG-PET had the highest sensitivity (78.2%), followed by MR imaging (75.8%) and ictal SPECT (71.8%). The sensitivity of MR imaging to localize type I FCD (60.8%) was significantly lower than that for type II FCD (84.8%, P < .001). Among 37 patients with subtle MR imaging findings and a focal FDG-PET pattern, 30 patients had type I FCD. CONCLUSIONS: During presurgical multimodality evaluation, localization of the extent of the epileptogenic zone in at least 2 imaging modalities helps achieve seizure freedom in about two-thirds of patients with refractory epilepsy due to FCD. FDG-PET is the most sensitive imaging modality for seizure freedom, especially in patients with type I FCD.

Quality protein maize based muffins: influence of non-gluten proteins on batter and muffin characteristics.

Quality protein maize (QPM) is nutritionally improved maize which has twice the amount of lysine and tryptophan than normal maize. The present study evaluated the effect of different proteins namely egg white proteins (EWP), casein, whey protein isolate, soy protein isolate (SPI) on characteristics of gluten free QPM based muffins. QPM muffins without any added protein served as control and muffins prepared using wheat and EWP served as reference. Effect of addition of different proteins on pasting properties revealed that the thermal stability of QPM flour increased as indicated by decrease in breakdown viscosity. The effect of added proteins on QPM muffin-making properties was evaluated for rheology of batter and physicochemical, texture, color and sensory characteristics of muffins. Dynamic rheology showed that storage modulus (G') and loss modulus (G″) of batter with SPI was the highest while batter with EWP showed lowest value. QPM-EWP muffins were softer, chewy and springier and had more specific volume than control muffins and were comparable to reference muffins. Inclusion of all proteins increased L* values (lightness) and decreased a* (redness/greenness) and b* (yellow/blueness) values of QPM based muffins. Sensory analysis revealed that gluten free QPM muffin prepared from EWP were acceptable with a sensory score of 7.97 which was comparable to reference muffins (8.03).

Co-extrusion of food grains-banana pulp for nutritious snacks: optimization of process variables.

Present study was undertaken to optimize the process conditions for development of food grains (maize, defatted soy flour, sesame seed)-banana based nutritious expanded snacks using extrusion processing. Experiments were designed using Box-Behnken design with banana pulp (8-24 g), screw speed (300-350 rpm) and feed moisture (14-16% w.b.). Seven responses viz. expansion ratio (ER), bulk density (BD), water absorption index (WAI), protein, minerals, iron and sensory acceptability were considered for optimizing independent parameters. ER, BD, WAI, protein content, total minerals, iron content, and overall acceptability ranged 2.69-3.36, 153.43-238.83 kg/m3, 4.56-4.88 g/g, 15.19-15.52%, 2.06-2.27%, 4.39-4.67 mg/100 g (w.b.) and 6.76-7.36, respectively. ER was significantly affected by all three process variables while BD was influenced by banana pulp and screw speed only. Studied process variables did not affected colour quality except 'a' value with banana pulp and screw speed. Banana pulp had positive correlation with water solubility index, total minerals and iron content and negative with WAI, protein and overall acceptability. Based upon multiple response analysis, optimized conditions were 8 g banana pulp, 350 rpm screw speed and 14% feed moisture indicating the protein, calorie, iron content and overall sensory acceptability in sample as 15.46%, 401 kcal/100 g, 4.48 mg/100 g and 7.6 respectively.

Markers of obesity and growth in preeclamptic and normotensive pregnant women.

The objective of the study was to analyse leptin, IGF-1, Apo A, lipoproteins, haem oxygenase-1 (HO-1) in maternal sera and venous umbilical cord sera of newborn babies of 25 preeclamptics (group II), and 25 normotensive pregnant women (group I) as markers of obesity and growth in preeclamptic and normotensive pregnant women. Apo A I and II levels were estimated by competitive immunoassay using direct chemiluminiscence technology. Haem oxygenase-1 (HO-1), leptin and IGF-1 were analysed by ELISA. Maternal and cord blood levels of homocysteine, folic acid, lipid profile (namely, total cholesterol, triglycerides, LDL-C, VLDL-C and HDL-C), Haem oxygenase 1 were higher in preeclamptic women as compared to normotensive pregnant women. Serum and cord blood Apo A-I and Apo B, leptin levels, IGF-I were lower in preeclamptic women as compared to normotensive pregnant. The findings of high serum HO-1 levels in maternal and cord blood in preeclampsia supports the role of oxidative stress and excessive inflammatory response in the pathogenesis of preeclampsia. It seems likely that IGF-1 and leptin play a central role in controlling foetal growth. There is increasing evidence that the foundations of life-long health are, in part, laid in the uterus. Findings of present study suggest that alterations in biochemical markers of growth and obesity occur in mothers and foetuses and modifications of uterine environment can be of help to prevent future cardiovascular risk. Impact statement Preeclampsia has been reported to be associated with an increased risk of later life cardiovascular disease. However, information regarding how obesity increases the risk of preeclampsia is limited. Atherogenic milieu occurring during pregnancy persists into adulthood and foetal growth retardation is strongly associated with adult atherosclerosis. There is conflicting evidence regarding alterations of IGFs in preeclamptic pregnancies and deficit in circulating and cord blood IGF-1 levels in intrauterine growth restricted newborns and a correlation between IGF-1 levels and birth weight have been reported. Leptin is a predictor of cardiovascular risk independent of insulin resistance. Emerging evidence supports an important role for the haem oxygenase system (HO-1) in the maintenance of a healthy pregnancy, especially during pathological challenge. Conflicting data are available regarding HO-1, leptin and IGF -1 in preeclamptic mothers. The extent to which they mediate foetal growth and developmental abnormalities remains to be clarified. Serum IGF-1 levels were significantly decreased in preeclamptics and maternal IGF-1 showed a strong inverse correlation with leptin levels. High serum HO-1 levels in maternal and cord blood in preeclampsia were observed in the present study. Findings of the present study suggest that alterations in biochemical markers of growth and obesity occur in mothers and foetuses and modifications of the uterine environment can be of help to prevent future cardiovascular risk.

Patterns of Biomarkers in Cord Blood During Pregnancy and Preeclampsia.

BACKGROUND: Umbilical cord blood (UCB) is in contact with all the fetal tissues and can reflect the state of fetus and UCB can be compared with maternal blood. Inflammatory, metabolic and immunological disorders during pregnancy can affect the environment in which the fetus is developing and may produce various alterations. OBJECTIVE: To analyze different biochemical parameters in maternal venous blood and new born umbilical cord blood from healthy normotensive pregnant and preeclamptic women. MATERIALS AND METHODS: Homocysteine, folate, B12, heme oxygenase-1 (HO-1), endoglin, leptin, cholinesterase, IGF-1, Apo A, lipoproteins, TSH, fT3, fT4 were analyzed in maternal sera and venous umbilical cord sera of newborns of twenty five preeclamptics (group II) and twenty five normotensive pregnant women (group I). Homocysteine, folic acid, vitamin B12, Apo A I & II, TSH, fT3, fT4 levels were estimated by competitive immunoassay using direct chemiluminiscence technology. Heme oxygenase-1 (HO-1), endoglin, leptin, cholinesterase, IGF-1 were analyzed by ELISA. RESULTS: Maternal and cord blood levels of homocysteine, folic acid, lipid profile (namely, total cholesterol, triglycerides, LDL-C, VLDL-C and HDL-C), TSH, heme oxygenase 1, were higher in preeclamptic women as compared to normotensive pregnant women. Endoglin levels were significantly lower in cord blood of preeclamptic mother as compared to normotensive mothers. Serum and cord blood vitamin B12, Apo A-I and Apo B l, cholinesterase, leptin levels, IGF-I were lower in preeclamptic women as compared to normotensive pregnant. CONCLUSION: Findings of the present study suggest that biochemical alterations occur in mothers and fetuses and modifications of uterine environment (in terms of thyroxine and folate and vitamin B12 supplementation) can be of help.

Scaling-up services for psychosis, depression and epilepsy in sub-Saharan Africa and South Asia: development and application of a mental health systems planning tool (OneHealth).

BACKGROUND: Although financing represents a critical component of health system strengthening and also a defining concern of efforts to move towards universal health coverage, many countries lack the tools and capacity to plan effectively for service scale-up. As part of a multi-country collaborative study (the Emerald project), we set out to develop, test and apply a fully integrated health systems resource planning and health impact tool for mental, neurological and substance use (MNS) disorders. METHODS: A new module of the existing UN strategic planning OneHealth Tool was developed, which identifies health system resources required to scale-up a range of specified interventions for MNS disorders and also projects expected health gains at the population level. We conducted local capacity-building in its use, as well as stakeholder consultations, then tested and calibrated all model parameters, and applied the tool to three priority mental and neurological disorders (psychosis, depression and epilepsy) in six low- and middle-income countries. RESULTS: Resource needs for scaling-up mental health services to reach desired coverage goals are substantial compared with the current allocation of resources in the six represented countries but are not large in absolute terms. In four of the Emerald study countries (Ethiopia, India, Nepal and Uganda), the cost of delivering key interventions for psychosis, depression and epilepsy at existing treatment coverage is estimated at US$ 0.06-0.33 per capita of total population per year (in Nigeria and South Africa it is US$ 1.36-1.92). By comparison, the projected cost per capita at target levels of coverage approaches US$ 5 per capita in Nigeria and South Africa, and ranges from US$ 0.14-1.27 in the other four countries. Implementation of such a package of care at target levels of coverage is expected to yield between 291 and 947 healthy life years per one million populations, which represents a substantial health gain for the currently neglected and underserved sub-populations suffering from psychosis, depression and epilepsy. CONCLUSIONS: This newly developed and validated module of OneHealth tool can be used, especially within the context of integrated health planning at the national level, to generate contextualised estimates of the resource needs, costs and health impacts of scaled-up mental health service delivery.