Understanding cohort differences in appraisals of reconstruction priorities of mental health systems in postconflict Liberia

Objective: This study analyzes the relationship between informants’ age and their assessment of mental health needs in postconflict society and examines if mental health needs assessment priorities differ depending upon whether or not the informant was exposed to the Liberian civil war.Method: A cross-sectional survey was conducted in March 2009 to obtain data on mental health needs of Liberian children, adolescents and young adults. A total of 171 individuals were interviewed. The data were analyzed using a two- way ANOVA.Results: Elder respondents expressed a preference for young adults to receive services in a church/mosque (F = 4.020, p < .05); for adolescents in volunteer programs (F = 3.987, p < .05) and for children in sports programs (F = 4.396, p < .05). Experiencing conflict did exert some influence on treatment setting preferences. Those who resided outside Liberia during the conflict cited a preference for traditional healers and medical clinics. However, this preference was for the children and young adult age categories. Those who experienced the civil war reported significantly higher preferences for adolescent services to be located in medical clinics, with traditional healers, and in churches/mosques.Conclusion: This study provides additional support for the premise that the utilization of psychiatric services needs to be viewed from the perspective of Liberians and that there are differences in preferences across groups. Our results suggest that service providers and policy makers take into account the age of the patient when deciding where to locate treatment settings for the population.Keywords: Mental Health; Liberia; Treatment Settings; Elders; Needs AssessmentAfrican Journal of Psychiatry • November 2013, 16(6

Assessment of the needs of vulnerable youth populations in post-conflict Liberia

Objective: The study examined key informants’ perceptions of the emotional impact of traumatic events, major problems, functional limitations and appropriate treatment settings for children, adolescents, and young adults in post-conflict Liberia.Method: This research is a based on cross-sectional survey conducted between March 30, 2009 and April 30, 2009 in Liberia with 171 local key Liberian informants. Analysis was conducted using mixed methods. The findings we will report were collected in the qualitative portion of the survey. Results: We found that while different interventions were preferred for different types of young people, some interventions were mentioned for all youth and by all age and gender groups of key informants. These includedcounseling, education, and skills training. Also frequently chosen were housing, community reintegration, recreation, and medical care. In general, key informants reported similar concerns regardless of their ages or genders. Notable exceptions to this were in interventions for youth who joined fighting forces. Men over 50 were the only ones to recommend apology and reparations. Similarly, in recommendations for criminals and violent youth, a number of men mentioned prison, whereas the women did not.Conclusion: Our findings suggest that the needs of post-conflict Liberian youth span a variety of domains, including physical, emotional, medical, psychological, and educational. These findings can be used to guide the development of treatment programs for these young people.Keywords: Post-Conflict Liberia; Mental Health Needs Assessment; Children and Adolescent

Local perceptions of the relative contributions of enclave tourism and agritourism to community well-being: The case of Mauritius

To date, limited attention has been paid to the contribution of tourism to the well-being of island residents in general and to whether such well-being varies according to the nature of tourism development in particular. Specifically, island tourism is frequently manifested in resort-based enclave development, a form of tourism that is often criticised for its assumed limited benefits to the wider community. As a consequence, alternative approaches such as agritourism, are increasingly proposed as a means of enhancing community development and well-being yet the relative merits of enclave and agritourism have not been explored within an island tourism context. This paper addresses this notable gap in the literature. Drawing on a questionnaire-based survey in Mauritius, it considers and compares the perceptions of local people of the extent to which enclave tourism and agritourism contribute to their well-being. The results reveal that both types of tourism development contribute both positively and negatively to community well-being although enclave tourism is perceived to have fewer positive outcomes. On the one hand, enclave tourism provides valuable cultural opportunities but damages the environment, restricts entrepreneurship and favours local elites; on the other hand, agritourism, although not yet well-established in Mauritius, is perceived to positively enhance the cultural and social spheres of community life whilst supporting entrepreneurship

Understanding and reducing sexual prejudice in Jamaica: Theoretical and practical insights from a severely anti-gay society

Jamaica has earned an international reputation for severe sexual prejudice: perhaps disproportionately so compared to other severely anti-LGBT societies. Until recently, however, no quantitative empirical research had investigated Jamaica’s sexual prejudice, leaving the prejudice poorly understood and methods of reducing it unclear. This article reviews the past 15 years of empirical research on Jamaican anti-LGBT prejudice. It situates Jamaica within the global context, explains the current understanding of the severity and nature of the problem, evaluates solutions currently being explored and suggests promising strategies based on available evidence. Importantly, this article also reflects on lessons learned from Jamaica that are relevant for other severely anti-LGBT societies

Advancing data collection of hospital-related harms: Validity of the new ICD-11 Quality & Safety Use Case

Introduction The beta version of the new ICD-11 includes a 3-part model for coding hospital acquired conditions (harms) to enhance adverse event descriptions. This method includes code clusters for detail each condition/event (e.g. bleed), cause (e.g. anticoagulant drug), and mode (over-dose). Objectives and Approach To compare the proportion of adverse events captured in ICD-11 to clinical chart review. A large field trial of 3000 inpatient charts are being coded with ICD-11 and chart review. Hospital admissions were randomly selected between January- June 2015 for adults at 3 Calgary hospitals. Chart reviewers were nurses trained to identify 11 categories of harms. Six coding specialists were trained to code with the ICD-11 3-part model for harm description. Coding decision trees and case examples of hospital-related harms were reviewed extensively by both teams. Coding training focused on new codes, code clustering, and extension codes for cause and mode of the harm. Results Of the 1,009 records reviewed and coded using ICD-11 to date, chart reviewers and coding specialists accurately identified 49 (37%) of the same charts with documented hospital harms. Both correctly identified 797 (91\%) of cases with no harm. Detailed analysis will follow. Study case examples will demonstrate advanced features of ICD-11 and the coding rules being collaboratively developed by our team, CIHI, and and WHO representatives. Conclusion/Implications Identification of hospital-related harms was consistent between coding specialists using ICD-11 principles and clinical chart reviewers. Variation existed in determining the cause and the mode of the harm. Case examples exemplify the new 3-part model for ICD-11 description of hospital-related harms