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Millions of children and young people (CYP) in low‐ and middle‐income countries (LMICs) have no access to mental health care. This huge treatment gap is primarily due to limited availability of trained mental health professionals. We propose task‐sharing as a scalable strategy to expand access to child and adolescent mental health (CAMH) interventions in LMICs. Task‐sharing involves using the few mental health specialists in LMICs to train and supervise nonspecialists to provided CAMH interventions. There is strong evidence of clinical and cost effectiveness of task‐shared mental health interventions for adults in LMICs and promising evidence for CYP. To succeed, task‐shared programmes need to be embedded in a balanced system‐wide care setting that includes stakeholder involvement. The existing mental health specialists may require additional training in leadership, supervision, mentoring, service design and evaluation in order to meet the additional expectations of managing task‐sharing programmes. The nonspecialists to be trained would need assurances about workload, ongoing supervision, clinical back up for cases that exceed their expertise, certification for their training and career progression. CAMH task‐sharing offers good promise for increasing CYP's access to mental health interventions in LMICs. However, planners need to be aware of the important practical, ethical and contextual considerations necessary for success and sustainability. [ABSTRACT FROM AUTHOR]

Background: It is often difficult for clinicians in African low- and middle-income countries middle-income countries to access useful aggregated data to identify areas for quality improvement. The aim of this Delphi study was to develop a standardised perioperative dataset for use in a registry. Methods: A Delphi method was followed to achieve consensus on the data points to include in a minimum perioperative dataset. The study consisted of two electronic surveys, followed by an online discussion and a final electronic survey (four Rounds). Results: Forty-one members of the African Perioperative Research Group participated in the process. Forty data points were deemed important and feasible to include in a minimum dataset for electronic capturing during the perioperative workflow by clinicians. A smaller dataset consisting of eight variables to define risk-adjusted perioperative mortality rate was also described. Conclusions: The minimum perioperative dataset can be used in a collaborative effort to establish a resource accessible to African clinicians in improving quality of care. [ABSTRACT FROM AUTHOR]

Problem: Poor knowledge and stigmatizing attitudes of healthcare professionals constitute a significant barrier to child and adolescent mental health care worldwide. This study aimed to determine the effect of a training intervention on the knowledge and attitudes of pediatric nurses to child mental health problems at a Nigerian tertiary hospital. Methods: A two group pretest–posttest study design was undertaken. A total of 156 pediatric nurses were recruited, and participants in the intervention group received a brief child mental health training based on the World Health Organization's mhGAP training manual. Knowledge and attitudes to child mental health problems were obtained at baseline, and post intervention. Findings: There were no differences in knowledge or attitudes across the two groups at baseline. Post intervention, there was a significant increase in the mean post knowledge scores of the intervention group compared with the control group (t = 3.8, p <.001). The effect size of the intervention was 0.62. There were no significant differences in mean post attitude scores across groups. Conclusion: Incorporating children and adolescents mental health competencies into the training of nurses had a modest effect on their knowledge, but limited effect on their attitudes. [ABSTRACT FROM AUTHOR]

Purpose: Low contrast detectability (LCD) is a metric of fundamental importance in computed tomography (CT) imaging. In spite of this, its measurement is challenging in the context of nonlinear data processing. We introduce a new framework for objectively characterizing LCD with a single scan of a special‐purpose phantom and automated analysis software. The output of the analysis software is a "machine LCD" metric which is more representative of LCD than contrast‐noise ratio (CNR). It is not intended to replace human observer or model observer studies. Methods: Following preliminary simulations, we fabricated a phantom containing hundreds of low‐contrast beads. These beads are acrylic spheres (1.6 mm, net contrast ~10 HU) suspended and randomly dispersed in a background matrix of nylon pellets and isoattenuating saline. The task was to search for and localize the beads. A modified matched filter was used to automatically scan the reconstruction and select candidate bead localizations of varying confidence. These were compared to bead locations as determined from a high‐dose reference scan to produce free‐response ROC curves. We compared iterative reconstruction (IR) and filtered backpropagation (FBP) at multiple dose levels between 40 and 240 mAs. The scans at 60, 120, and 180 mAs were performed three times each to estimate uncertainty. Results: Experimental scans demonstrated the feasibility of our technique. Our metric for machine LCD was the area under the exponential transform of the FROC curve (AUC). AUC increased monotonically from 0.21 at 40 mAs to 0.84 at 240 mAs. The sample standard deviation of AUC was approximately 0.02. This measurement uncertainty in AUC corresponded to a change in tube current of 4% to 8%. Surprisingly, we found that AUCs for IR were slightly worse than AUCs for FBP. While the phantom was sufficient for these experiments, it contained small air bubbles and alternative fabrication methods will be necessary for widespread utilization. Conclusions: It is feasible to measure machine LCD using a search task on a phantom with hundreds of beads and to obtain tight error bars using only a single scan. Our method could facilitate routine quality assurance or possibly enable comparisons between different protocols and scanners. [ABSTRACT FROM AUTHOR]

Purpose: An important challenge for deep learning models is generalizing to new datasets that may be acquired with acquisition protocols different from the training set. It is not always feasible to expand training data to the range encountered in clinical practice. We introduce a new technique, physics‐based data augmentation (PBDA), that can emulate new computed tomography (CT) data acquisition protocols. We demonstrate two forms of PBDA, emulating increases in slice thickness and reductions of dose, on the specific problem of false‐positive reduction in the automatic detection of lung nodules. Methods: We worked with CT images from the lung image database consortium (LIDC) collection. We employed a hybrid ensemble convolutional neural network (CNN), which consists of multiple CNN modules (VGG, DenseNet, ResNet), for a classification task of determining whether an image patch was a suspicious nodule or a false positive. To emulate a reduction in tube current, we injected noise by simulating forward projection, noise addition, and backprojection corresponding to 1.5 mAs (a "chest x‐ray" dose). To simulate thick slice CT scans from thin slice CT scans, we grouped and averaged spatially contiguous CT within thin slice data. The neural network was trained with 10% of the LIDC dataset that was selected to have either the highest tube current or the thinnest slices. The network was tested on the remaining data. We compared PBDA to a baseline with standard geometric augmentations (such as shifts and rotations) and Gaussian noise addition. Results: PBDA improved the performance of the networks when generalizing to the test dataset in a limited number of cases. We found that the best performance was obtained by applying augmentation at very low doses (1.5 mAs), about an order of magnitude less than most screening protocols. In the baseline augmentation, a comparable level of Gaussian noise was injected. For dose reduction PBDA, the average sensitivity of 0.931 for the hybrid ensemble network was not statistically different from the average sensitivity of 0.935 without PBDA. Similarly for slice thickness PBDA, the average sensitivity of 0.900 when augmenting with doubled simulated slice thicknesses was not statistically different from the average sensitivity of 0.895 without PBDA. While there were cases detailed in this paper in which we observed improvements, the overall picture was one that suggests PBDA may not be an effective data enrichment tool. Conclusions: PBDA is a newly proposed strategy for mitigating the performance loss of neural networks related to the variation of acquisition protocol between the training dataset and the data that is encountered in deployment or testing. We found that PBDA does not provide robust improvements with the four neural networks (three modules and the ensemble) tested and for the specific task of false‐positive reduction in nodule detection. [ABSTRACT FROM AUTHOR]

Background There is paucity of evidence-based psychological interventions for depressive disorders in Africa, more so among depressed children and adolescents. This study aimed to determine the effects of a school-based cognitive behavioural therapy programme ( CBT) on depressed adolescents in South West Nigeria. Methods Forty students who scored 18 or above on the Beck Depression Inventory ( BDI) were recruited from two schools (20 from each school). One school was designated intervention and the other a wait-list control school. Five weekly sessions of group CBT programme were conducted in the intervention school. Primary outcome measure was the Beck Depression Inventory, and secondary outcome measures were the Short Mood and Feelings Questionnaire and the Impact Supplement of the Strengths and Difficulties Questionnaire . Results Controlling for baseline scores and other confounders, the intervention group had significantly lower depressive symptoms scores on the BDI and SMFQ 1 week post intervention with large effect sizes. The intervention group maintained the treatment effect with significantly lower depression scores 16 weeks post intervention compared with their baseline scores. The effect sizes remained large. The intervention and control groups did not differ in their SDQ impact supplement scores post intervention, but the intervention group improved significantly on this measure at 16 weeks. Conclusions To our knowledge, this is the first study of a school-based group CBT programme for depressed adolescents in Africa. The programme showed good feasibility and promising effectiveness. [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study examined the influence of gender on undergraduate performance in psychiatry among final year medical students at the University College Hospital, Ibadan, Nigeria. METHODS: Results in all parts of the examination in psychiatry for the 2001 graduating class were obtained. In addition, performance scores were obtained for entrance examinations to medical school, preclinical subjects (anatomy, physiology and biochemistry) and clinical subjects (paediatrics, obstetrics and gynaecology, internal medicine and surgery). The mean marks according to gender, with 95% intervals, were calculated and tested for significance. RESULTS: A total of 234 students (160 men and 74 women) took the examinations in psychiatry. Women performed better than men in both the multiple choice questions (MCQ) examination (P = 0.0044) and the clinical assessment (P= 0.0000063). The women were significantly younger than the men (P = 0-0000007) and performance in both parts of the examination decreased with increasing age. There were no differences between the genders in entrance examination scores or preclinical scores but there were significant differences between the genders in performance in clinical subjects such as paediatrics, obstetrics and gynaecology and internal medicine. CONCLUSION: Women performed better than men in all parts of the psychiatry examination, with the difference being more marked in the clinical aspect. A superior performance on the part of women was noted in all clinical subjects. However, where an examination did not involve verbal interaction, there was no difference in performance between the genders. A direct correlation between increasing age and decreasing performance in examinations was also seen. [ABSTRACT FROM AUTHOR]

This study examined the influence of gender on undergraduate performance in psychiatry among final year medical students at the University College Hospital, Ibadan, Nigeria. Results in all parts of the examination in psychiatry for the 2001 graduating class were obtained. In addition, performance scores were obtained for entrance examinations to medical school, preclinical subjects (anatomy, physiology and biochemistry) and clinical subjects (paediatrics, obstetrics and gynaecology, internal medicine and surgery). The mean marks according to gender, with 95% intervals, were calculated and tested for significance. A total of 234 students (160 men and 74 women) took the examinations in psychiatry. Women performed better than men in both the multiple choice questions (MCQ) examination ( P = 0·0044) and the clinical assessment ( P = 0·0000063). The women were significantly younger than the men ( P = 0·0000007) and performance in both parts of the examination decreased with increasing age. There were no differences between the genders in entrance examination scores or preclinical scores but there were significant differences between the genders in performance in clinical subjects such as paediatrics, obstetrics and gynaecology and internal medicine. Women performed better than men in all parts of the psychiatry examination, with the difference being more marked in the clinical aspect. A superior performance on the part of women was noted in all clinical subjects. However, where an examination did not involve verbal interaction, there was no difference in performance between the genders. A direct correlation between increasing age and decreasing performance in examinations was also seen. [ABSTRACT FROM AUTHOR]

Aims: To test the accuracy of risk of malignancy index (RMI) in preoperative prediction of malignancy and treatment of adnexal masses. Methods: A total of 302 women with ultrasound diagnosed adnexal masses, and serum measurement of cancer-associated antigen CA-125 levels, were studied. They all had surgical exploration between October 2001 and September 2005 at the Friedrich-Alexander University Women's Hospital, Erlangen, Germany. The RMI was based on menopausal status, ultrasound morphology of adnexal masses and absolute level of serum CA-125. A cut-off of 250 was chosen as the threshold for determining the type of surgical operations (laparotomy versus laparoscopy) and the skill of the surgeons (gynecological oncologist versus general gynecologist). The data obtained were analyzed for baseline characteristics using χ2 test and analysis of variance (ANOVA). P < 0.05 were statistically significant. The various testing methods were evaluated for sensitivity, specificity, positive and negative predictive values. Results: The best individual performance was found in RMI at a cut-off of 250 with a sensitivity of 88.2%, specificity of 74.3%, positive predictive value of 71.3% and negative predictive value of 90%. When RMI was used to triage patient treatment, 81.5% of patients who had laparoscopy had histological diagnosis of benign ovarian tumor and 7.5% had malignant tumor. In contrast, 74.4% of patients who had laparotomy had histological diagnosis of malignant ovarian tumor and 16% had benign tumor. Conclusion: Risk of malignant index is a reliable, cheap, readily available and cost-effective method of preoperative discrimination of benign from malignant adnexal masses. It is also helpful in triaging patients to different treatment groups. [ABSTRACT FROM AUTHOR]

Aim: To assess the effectiveness of oral misoprostol compared with methylergometrine in the prevention of primary post-partum hemorrhage during the third stage of labor. Methods: This was a randomized controlled trial of 864 singleton low-risk pregnant women. The outcomes were total blood loss, duration of the third stage of labor and peripartal change in hematocrit. Comparisons were by the χ2-test and Student t-test. Relative risks were calculated for side-effects profile. A P-value of less than 0.05 was statistically significant. Results: The biodata of all the participants were similar. The mean blood loss for the misoprostol and methylergometrine groups was 191.6 ± 134.5 mL and 246.0 ± 175.5 mL, respectively (95% CI: −79.3 to −39.5 mL). The mean duration of the third stage of labor was 19.6 ± 2.4 min and 9.4 ± 3.3 min in the misoprostol and methylergometrine groups, respectively (95% CI: 9.82–10.58 min). More subjects had blood loss >500 mL, 42 (9.7%) versus 6 (1.4%), and peripartal hematocrit change greater than 10%, 38 (8.8%) versus 5 (1.2%), in the methylergometrine group than in the misoprostol group, respectively. Also, more subjects received additional oxytocic in the methylergometrine group, compared to the misoprostol group (80 [18.5%] versus 33 [7.6%] patients, respectively). Conclusions: Orally administered misoprostol was more effective in reducing blood loss during the third stage of labor than intramuscular methylergometrine. However, there were more subjects in the misoprostol group in whom duration of the third stage of labor was greater than 15 min and who also had manual placental removal than in the methylergometrine group. [ABSTRACT FROM AUTHOR]

There is no organised training and service for CAMH in Nigeria. A 3-day course in child mental health aimed at multidisciplinary health professionals was developed and evaluated to inform future training. Developing the course involved multi-professional consultation. Course evaluation involved the completion of questionnaires by delegates (present from 5 of the 6 geopolitical zones of Nigeria) before and after the training. Training needs expressed include skills to manage CAMH problems in their own context, greater understanding of normal child development and strategies to train others. Most participants reported that their expectations were met and would affect their practice especially with regard to collaboration. [ABSTRACT FROM AUTHOR]