Suchergebnisse

Background Little is known about the state of mental health systems in Kenya. In 2010, Kenya promulgated a new constitution, which devolved national government and the national health system to 47 counties including Kilifi County. There is need to provide evidence from mental health systems research to identify priority areas in Kilifi's mental health system for informing county health sector decision making. We conducted an initial assessment of state of mental health systems in Kilifi County and documented resources, policy and legislation and spectrum of mental, neurological and substance use disorders. Methods This was a pilot study that used the brief version of the World Health Organization's Assessment Instrument for Mental Health Systems Version 2.2 to collect data. Data collection was based on the year 2014. Results Kilifi county has two public psychiatric outpatient units that are part of general hospitals. There is no standalone mental hospital in Kilifi. There are no inpatients or community based facilities for people with mental health problems. Although the psychiatric facilities in Kilifi have an essential drugs list, supply of drugs is erratic with frequent shortages. There is no psychiatrist or psychologist in Kilifi with only two psychiatric nurses for a population of approximately 1.2 million people. Schizophrenia was the commonest reason for visiting outpatient facilities (47.1%) while suicidal ideation was the least common (0.4%). Kenya's mental health policy, which is being used by Kilifi County, is outdated and does not cater for the current mental health needs of Kilifi. There is no specific legislation to protect the rights of people with mental health problems. No budget exists specifically for mental health care. There have been no efforts to integrate mental health care into primary care in Kilifi, and there is no empirical research work to evaluate its feasibility. Conclusion There is an urgent need to increase resources allocated for mental health in particular infrastructure and ...

Objective The present study compared the performance, workload, and stress associated with driver vigilance in two types of vehicle: a traditional, manually operated vehicle, and a partially automated vehicle. Background Drivers of partially automated vehicles must monitor for hazards that constitute automation failures and the need for human intervention, but recent research indicates that a driver's ability to do so declines as a function of time. That research lacked a comparison measure of driving without vehicle automation, so it is unknown to what degree these effects are specific symptoms of monitoring the roadway during an automated drive. Drivers in manual control of their vehicle must similarly monitor for hazards and may suffer similar vigilance decrements. Method Participants completed a simulated 40-minute drive while monitoring for hazards. Half of participants completed the drive with an automated driving system that maintained speed and lane position; the remaining half manually controlled the vehicle's speed and lane position. Results Driver sensitivity to hazards decreased and tendency to make false alarms increased over time in the automated control condition, but not in the manual control condition. Drivers in both conditions detected fewer hazards as the drive progressed. Ratings of workload and task-induced stress were elevated similarly in both conditions. Conclusion Partially automated driving appears to uniquely impair driver vigilance by reducing the ability to discriminate between benign and dangerous events in the driving environment as the drive progresses. Application Applied interventions should target improvements in driver sensitivity to hazardous situations that signal potential automation failures.

Objective: The current study investigated driver vigilance in partially automated vehicles to determine whether increased task demands reduce a driver's ability to monitor for automation failures and whether the vigilance decrement associated with hazard detections is due to driver overload. Background: Drivers of partially automated vehicles are expected to monitor for signs of automation failure. Previous research has shown that a driver's ability to perform this duty declines over time. One possible explanation for this vigilance decrement is that the extreme demands of vigilance causes overload and leads to depletion of limited attentional resources required for vigilance. Method: Participants completed a 40-min drive in a simulated partially automated vehicle and were tasked with monitoring for hazards that represented potential automation failures. Two factors were manipulated to test the impact of monitoring demands on performance: Spatial uncertainty and event rate. Results: As predicted, hazard detection performance was poorer when monitoring demands were increased, and performance declined as a function of time on task. Subjective reports also indicated high workload and task-induced stress. Conclusion: Drivers of partially automated vehicles are impaired by the vigilance decrement and elevated task demands, meaning that safe operation becomes less likely when the demands associated with monitoring automation increase and as a drive extends in duration. This study also supports the notion that vigilance performance in partially automated vehicles is likely due to driver overload. Application: Developers of automation technologies should consider countermeasures that attenuate a driver's cognitive load when tasked with monitoring automation.

Objective: The primary aim of the current study was to determine whether monitoring the roadway for hazards during automated driving results in a vigilance decrement. Background: Although automated vehicles are relatively novel, the nature of human-automation interaction within them has the classic hallmarks of a vigilance task. Drivers must maintain attention for prolonged periods of time to detect and respond to rare and unpredictable events, for example, roadway hazards that automation may be ill equipped to detect. Given the similarity with traditional vigilance tasks, we predicted that drivers of a simulated automated vehicle would demonstrate a vigilance decrement in hazard detection performance. Method: Participants "drove" a simulated automated vehicle for 40 minutes. During that time, their task was to monitor the roadway for roadway hazards. Results: As predicted, hazard detection rate declined precipitously, and reaction times slowed as the drive progressed. Further, subjective ratings of workload and task-related stress indicated that sustained monitoring is demanding and distressing and it is a challenge to maintain task engagement. Conclusion: Monitoring the roadway for potential hazards during automated driving results in workload, stress, and performance decrements similar to those observed in traditional vigilance tasks. Application: To the degree that vigilance is required of automated vehicle drivers, performance errors and associated safety risks are likely to occur as a function of time on task. Vigilance should be a focal safety concern in the development of vehicle automation.

BackgroundMany offenders with intellectual disabilities have substance use issues. Offending behaviour may be associated with substance use.Materials and MethodsPrisoners with and without intellectual disabilities were compared in terms of their substance use prior to imprisonment, the influence of substance use on offending, and their participation in alcohol and drug treatment programmes.ResultsSubstance use was similar in prisoners with and without intellectual disabilities in the year prior to their current prison terms. Prisoners with intellectual disabilities were much less likely to report that substance use was an antecedent to the offences leading to their imprisonment. The completion rate of alcohol and drug treatment programmes was much lower for those with intellectual disabilities.ConclusionsSubstance use may be as common in prisoners with intellectual disabilities as those without this condition. Services may need to reflect on whether their treatment programmes are meeting the needs of all prisoners.

The study presented here was a series of three experiments that examined the ability of blind individuals and individuals simulating the visual acuity of 20/400 to monitor the behaviors of a cane traveler in various environments and at distances between 10 feet and 25 feet.

A lack of research exists around the most common forms of sexual risk behaviors (SRB) among adolescents, including their underlying factors, in Sub Saharan Africa. Using an Ecological Model of Adolescent Behavior, we explore the perceptions of 85 young people and 10 stakeholders on SRB of adolescents in Kilifi County on the coast of Kenya. Our findings show that transactional sex, early sexual debut, coerced sex and multiple sexual partnerships are prevalent. An urgent need exists to develop measures to counter SRBs. The results contribute to understanding the range of risks and protective factors in differing contexts, tackling underlying issues at individual, family, local institutional, wider socioeconomic and political levels.

This paper reports findings from part of an evaluation study of the Communication Aids Project (CAP), a government-funded project in England which provided communication aids to school-aged children. The paper focuses on parents'views of the CAP process and the impact of the aid. Fourteen parents were interviewed twice over the telephone: once before or just as their children received communication aids and again six to eight weeks later. Parents expressed satisfaction with the impact of the aid on their children's lives and showed they had realistic expectations concerning potential short- and long-term benefits. They raised two main concerns regarding the provision of aids, namely the timescale involved and access to accurate information and advice.