Academic literature on the topic 'Mental illness $z Australia $x Prevention'

Objective: To discuss the prevalence of blood-borne viral and sexually transmissible infections among psychiatric populations, as well as current treatment approaches, both locally and internationally. Method: In this paper, we outline available epidemiological data, as well as interventions designed to target infectious disease risk among those with serious mental illness. Results: Within Australia, the prevalence of blood-borne viral and sexually transmissible infections among at-risk populations remains unacceptably high despite a number of successful harm reduction and prevention strategies. Although the highest rates of new infections occur among young people aged 15–29 years, recent research suggests that psychiatric populations are also at significant risk. However, despite increased rates, there is currently no coordinated strategy to educate, test and reduce disease risk among people suffering with mental illness within Australia. Conclusions: Although further epidemiological research at a local level is needed, interventions specifically targeting psychiatric populations and younger cohorts in particular, are essential. This will require multidisciplinary, collaborative service development, incorporating mental health, substance use and infectious disease specialists.

Aim: The aim of this study was to identify factors associated with deaths by hanging among young people in Queensland, Australia. Method: An examination of coroner's reports for all deaths by hanging of people under 25 years of age that occurred in Queensland in the years 1995 and 1996. Results: All cases were recorded as suicides. Most were males and a quarter were indigenous persons. Half the deaths occurred in regional or rural areas. Unemployment, the experience of personal loss, psychiatric illness and alcohol use were possible precipitating agents. Early warning signs were the onset of uncharacteristic behaviours and threats of suicide. Conclusions: The private nature of hanging means that there are rarely opportunities to prevent it in the period immediately before the fatal event. Earlier interventions will have to be considered. To prevent hanging as a means of suicide, we need to understand more about the difficulties experienced by some young men who are living in rural areas. We need more information about the cultural problems experienced by indigenous youths in their teenage years. Young people in the justice system may need personal support. There is a pressing need to determine if young people, especially in rural areas, have adequate access to the professional expertise needed to diagnose and treat mental disorders.

Objective: To identify characteristics that could distinguish males who completed suicide by hanging from males who completed suicide by firearms and non-domestic gas, and to suggest suicide prevention strategies targeted at hanging. Method: Using the psychological autopsy design, males who used hanging, firearms and non-domestic gas were compared on a range of variables covering social, psychological, and health related factors and aspects of the suicide incident. The sample consisted of 950 males who suicided in Queensland, Australia, between 1994 and 1996. Results: Compared with males who used firearms and non-domestic gas, males who used hanging were significantly younger, less likely to have left a suicide note, and more likely to have been diagnosed with a psychotic disorder. Compared with males who used firearms, males who used hanging were significantly more likely to have made prior suicide attempts and have had no physical illness. Compared with males who used non-domestic gas, males who used hanging were significantly more likely to have lived with others, have had prior legal trouble, and have suicided at their residence. Conclusions: The results are discussed in terms of the availability and socio-cultural acceptability of methods. The authors suggest a possible relationship between impulsive traits and method choice. This proposition requires further investigation using alternative methodologies. Some suicide prevention measures targeting hanging suicides are discussed in light of the results.

Bullying behaviour can have a negative impact on a child's physical and psychological health. Bullying in the classroom is a challenge for early-childhood educators. Preschool is the first place outside the home where children face social challenges when interacting with their classmates. Child-Friendly Class is the first step and part of the Children Friendly School (CSF) as a UNICEF program and an important Indonesian government policy to prevent the emergence of child bullying behaviour. This study aims to identify needs in the process of developing a Child-Friendly Classroom Management model to anticipate bullying behaviour. This research and development method uses an adaptation of the Rowntree model which includes three stages of the process and data collection techniques using interviews, questionnaires, and observation. The results of this study indicate that the preparation of an effective classroom management guidebook to create child-friendly classes needs to be followed up immediately. Several findings related to teachers' perceptions of classroom management, and child-friendly classes prove that child-friendly classes have not been implemented properly in PAUD institutions, with bullying behaviour still appearing in early childhood in PAUD institutions. PAUD teachers understand that it is important to implement classroom management but so far there has been no manual on how to manage effective classrooms as well as training related to the implementation of effective classroom management. The creation of child-friendly classes is believed to be able to help teachers suppress the emergence of bullying behaviour in early childhood. Keywords: Child-Friendly Classroom Management, Bullying Prevention, Early Childhood Education References: Allday, R. A., Hinkson-Lee, K., Hudson, T. M., Neilsen-Gatti, S., Kleinke, A., & Russel, C. S. (2012). Training General Educators to Increase Behavior-Specific Praise: Effects on Students with EBD. Behavioral Disorders, 37, 87–98. Alsaker, F. D., & Valkanover, S. (2012). The Bernese Program against Victimization in Kindergarten and Elementary School. New Directions for Youth Development, 2012(133), 15–28. https://doi.org/10.1002/yd.20004 Arseneault, L., Walsh, E., Trzesniewski, K., Newcombe, R., Caspi, A., & Moffitt, T. E. (2006). Bullying Victimization Uniquely Contributes to Adjustment Problems in Young Children: A Nationally Representative Cohort Study. PEDIATRICS, 118(1), 130–138. https://doi.org/10.1542/peds.2005-2388 Benedict, E., Horner, R. H., & Squires, J. (2007). Assessment and Implementation of Positive Behavior Support in Preschools. Topics in Early Childhood Special Education, 27, 174–192. Boz, Y. (2008). Turkish student teachers’ concerns about teaching. European Journal of Teacher Education, 31(4), 367–377. https://doi.org/10.1080/02619760802420693 Bradshaw, C. P., & Johnson, R. M. (2011). The Social Context of Bullying and Peer Victimization: An Introduction to the Special Issue. Journal of School Violence, 10(2), 107–114. https://doi.org/10.1080/15388220.2011.557145 Bradshaw, C. P., Sawyer, A. L., & O’Brennan, L. M. (2009). A Social Disorganization Perspective on Bullying-Related Attitudes and Behaviors: The Influence of School Context. American Journal of Community Psychology, 43(3–4), 204–220. https://doi.org/10.1007/s10464-009-9240-1 Bullock, J. R. (2002). Bullying among Children. Childhood Education, 78(3), 130–133. https://doi.org/10.1080/00094056.2002.10522721 Çobanoğlu, F., Ayvaz-Tuncel, Z., & Ordu, A. (2018). Child-friendly Schools: An Assessment of Secondary Schools. Universal Journal of Educational Research, 6(3), 466–477. https://doi.org/10.13189/ujer.2018.060313 Cothran, D. J., Kulinna, P. H., & Garrahy, D. A. (2003). “This is kind of giving a secret away...”: Students’ perspectives on effective class management. Teaching and Teacher Education, 19(4), 435–444. https://doi.org/10.1016/S0742-051X(03)00027-1 Cross, D., Monks, H., Hall, M., Shaw, T., Pintabona, Y., Erceg, E., Hamilton, G., Roberts, C., Waters, S., & Lester, L. (2011). Three‐year results of the Friendly Schools whole‐of‐school intervention on children’s bullying behaviour. British Educational Research Journal, 37(1), 105–129. https://doi.org/10.1080/01411920903420024 Cross, D., Pintabona, Y., Hall, M., Hamilton, G., & Erceg, E. (2004). Validated Guidelines for School-Based Bullying Prevention and Management. International Journal of Mental Health Promotion, 6(3), 34–42. https://doi.org/10.1080/14623730.2004.9721937 Cross, D., Runions, K. C., Shaw, T., Wong, J. W. Y., Campbell, M., Pearce, N., Burns, S., Lester, L., Barnes, A., & Resnicow, K. (2019). Friendly Schools Universal Bullying Prevention Intervention: Effectiveness with Secondary School Students. International Journal of Bullying Prevention, 1(1), 45–57. https://doi.org/10.1007/s42380-018-0004-z Evertson, C. M., & Weinstein, C. S. (2012). Handbook of Classroom Management: Research, Practice, and Contemporary Issues. Fox, B. H., Farrington, D. P., & Ttofi, M. M. (2012). Successful Bullying Prevention Programs: Influence of Research Design, Implementation Features, and Program Components. Research Design, 6, 10. Georgiou, S. N. (2008). Bullying and victimization at school: The role of mothers. The British Journal of Educational Psychology, 78 Pt 1, 109–125. Hammarberg, T. (1998). A School for Children with Rights. UNICEF International Child Development Centre. Hymel, S., & Swearer, S. M. (2015). Four decades of research on school bullying: An introduction. American Psychologist, 70(4), 293–299. https://doi.org/10.1037/a0038928 Johansen, A., Little, S. G., & Akin-Little, A. (2011). An Examination of New Zealand Teachers’ Attributions and Perceptions of Behaviour, Classroom Management, and the Level of Formal Teacher Training Received in Behaviour Management. King, E. (2020). Implications for the child friendly schools policy within Cambodia’s cultural and primary school context. Asia-Pacific Journal of Teacher Education, 48(4), 375–388. https://doi.org/10.1080/1359866X.2019.1645811 Kirves, L., & Sajaniemi, N. (2012). Bullying in early educational settings. Early Child Development and Care,182(3–4), 383–400. https://doi.org/10.1080/03004430.2011.646724 MacSuga, A. S., & Simonsen, B. (2011). Increasing Teachers’ Use of Evidence-Based Classroom Management Strategies through Consultation: Overview and Case Studies. Beyond Behavior, 20, 4–12. Maida, P. (2006). Child-Friendly-School-Manual. UNICEF. Modipane, M., & Themane, M. (2014). Teachers’ social capital as a resource for curriculum development: Lessons learnt in the implementation of a Child-Friendly Schools programme. South African Journal of Education, 34(4), 1–8. https://doi.org/10.15700/201412052105 Monks, C. P., Smith, P. K., & Swettenham, J. (2005). Psychological correlates of peer victimisation in preschool: Social cognitive skills, executive function and attachment profiles. Aggressive Behavior, 31(6), 571–588. https://doi.org/10.1002/ab.20099 Olweus, D. (1994). Bullying at School: Basic Facts and Effects of a School Based Intervention Program. Journal of Child Psychology and Psychiatry, 35(7), 1171–1190. https://doi.org/10.1111/j.1469-7610.1994.tb01229.x O’Neill, S. C., & Stephenson, J. (2011). Classroom behaviour management preparation in undergraduate primary teacher education in Australia: A web-based investigation. Australian Journal of Teacher Education, 36(10). https://doi.org/10.14221/ajte.2011v36n10.3 O’Neill, S., & Stephenson, J. (2012). Does classroom management coursework influence pre-service teachers’ perceived preparedness or confidence? Teaching and Teacher Education, 28(8), 1131–1143. https://doi.org/10.1016/j.tate.2012.06.008 Osher, D., Kelly, D. L., Tolani-Brown, N., Shors, L., & Chen, C.-S. (2009). American Institutes for Research 1000 Thomas Jefferson Street , NW Washington, DC 20007-3835. 13. Perren, S., Stadelmann, S., & Von Klitzing, K. (2009). Child and family characteristics as risk factors for peer victimization in kindergarten. Swiss Journal of Educational Research, 36(1), 13–32. https://doi.org/10.24452/sjer.36.1.4806 Reinke, W. M., Lewis-Palmer, T., & Merrell, K. (2008). The Classroom Check-up: A Classwide Teacher Consultation Model for Increasing Praise and Decreasing Disruptive Behavior. School Psychology Review, 37(3), 315–332. PubMed. Repo, L., & Sajaniemi, N. (2015). Prevention of bullying in early educational settings: Pedagogical and organisational factors related to bullying. European Early Childhood Education Research Journal, 23(4), 461–475. https://doi.org/10.1080/1350293X.2015.1087150 Rigby, K. (2003). Consequences of Bullying in Schools. The Canadian Journal of Psychiatry, 48(9), 583–590. https://doi.org/10.1177/070674370304800904 Rowntree, D. (1994). Preparing Materials for Open, Distance and Flexible Learning: An Action Guide for Teachers and Trainers. Kogan Page. https://books.google.com.jm/books?id=6Tf1kH6MQZ0C Sainio, M., Veenstra, R., Huitsing, G., & Salmivalli, C. (2011). Victims and their defenders: A dyadic approach. International Journal of Behavioral Development, 35(2), 144–151. https://doi.org/10.1177/0165025410378068 Salmivalli, C. (2002). Is there an age decline in victimization by peers at school? Educational Research, 44(3), 269–277. https://doi.org/10.1080/00131880210135331 Saracho, O. (2016). Contemporary Perspectives on Research on Bullying and Victimization in Early Childhood Education. Information Age Publishing, Incorporated. https://books.google.co.id/books?id=dalCDQAAQBAJ Saracho, O. N. (2017). Bullying Prevention Strategies in Early Childhood Education. Early Childhood Education Journal, 45(4), 453–460. https://doi.org/10.1007/s10643-016-0793-y Sempowicz, T., & Hudson, P. (2011). Analysing Mentoring Dialogues for Developing a Preservice Teacher’s Classroom Management Practices. Australian Journal of Teacher Education, 36(8). https://doi.org/10.14221/ajte.2011v36n8.4 Smith, J. D., Schneider, B. H., Smith, P. K., & Ananiadou, K. (2004). The Effectiveness of Whole-School Antibullying Programs: A Synthesis of Evaluation Research. School Psychology Review, 33, 547–560. Sourander, A., Ronning, J., Brunstein-Klomek, A., Gyllenberg, D., Kumpulainen, K., Niemelä, S., Helenius, H., Sillanmäki, L., Ristkari, T., Tamminen, T., Moilanen, I., Piha, J., & Almqvist, F. (2009). Childhood Bullying Behavior and Later Psychiatric Hospital and Psychopharmacologic Treatment. ARCH GEN PSYCHIATRY, 66(9), 9. Tauber, R. T. (2007). Classroom Management: Sound Theory and Effective Practice. Praeger Publishers. https://books.google.la/books?id=XiQFyR41kysC Ttofi, M. M., & Farrington, D. P. (2011). Effectiveness of school-based programs to reduce bullying: A systematic and meta-analytic review. Journal of Experimental Criminology, 7(1), 27–56. https://doi.org/10.1007/s11292-010-9109-1 Ttofi, M. M., & Farrington, D. P. (2012). Bullying prevention programs: The importance of peer intervention, disciplinary methods and age variations. Journal of Experimental Criminology, 8(4), 443–462. https://doi.org/10.1007/s11292-012-9161-0 Unal, Z., & Unal, A. (2012). The Impact of Years of Teaching Experience on the Classroom Management Approaches of Elementary School Teachers. International Journal of Instruction, 5, 41–60. UNICEF. (2007). Implementation Handbook for The Convention on The Rights of The Child (3th Edition). UNICEF. Vaillancourt, T., McDougall, P., Hymel, S., Krygsman, A., Miller, J., Stiver, K., & Davis, C. (2008). Bullying: Are researchers and children/youth talking about the same thing? International Journal of Behavioral Development, 32(6), 486–495. https://doi.org/10.1177/0165025408095553 Vlachou, M., Andreou, E., Botsoglou, K., & Didaskalou, E. (2011). Bully/Victim Problems Among Preschool Children: A Review of Current Research Evidence. Educational Psychology Review, 23(3), 329–358. https://doi.org/10.1007/s10648-011-9153-z Vlachou, M., Botsoglou, K., & Andreou, E. (2014). Bullying/Victimization in Preschool Children. https://doi.org/10.13140/2.1.5086.1764 Vreeman, R. C., & Carroll, A. E. (2007). A systematic review of school-based interventions to prevent bullying. Archives of Pediatrics & Adolescent Medicine, 161 1, 78–88. Witvliet, M., Olthof, T., Hoeksma, J. B., Goossens, F. A., Smits, M. S. I., & Koot, H. M. (2010). 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<p><strong>List of abstracts and authors:</strong></p><p><strong>1. Bipolar disorder not otherwise specified -overdiagnosed or underdiagnosed?</strong></p><p>E Allers</p><p><strong>2. The prognosis of major depression untreated and treated: Does the data reflect the true picture of the prognosis of this very common disorder?</strong></p><p>E Allers</p><p><strong>3. Can we prolong our patients' life expectancy? Providing a better quality of life for patients with severe mental illness</strong></p><p>O A Betencourt</p><p><strong>4. The scope of ECT practice in South Africa</strong></p><p>J Benson-Martin, P Milligan</p><p><strong>5. Biomarkers for schizophrenia: Can we evolve like cancer therapeutics?</strong></p><p>P Buckley<strong></strong></p><p><strong>6. Relapse in schizophrenis: Major challenges in prediction and prevention</strong></p><p>P Buckley</p><p><strong>7. Informed consent in biological treatments: The right to know the duty to inform</strong></p><p><strong></strong>I Chetty</p><p><strong>8. Effectiveness of a long-acting injectable antipsychotic plus an assertive monitoring programme in first-episode schizophrenia</strong></p><p><strong></strong>B Chiliza, L Asmal, O Esan, A Ojagbemi, O Gureje, R Emsley</p><p><strong>9. Name, shame, fame</strong></p><p>P Cilliers</p><p><strong>10. Can we manage the increasing incidence of violent raging children? We have to!</strong></p><p>H Clark</p><p><strong>11. Serotonin, depression and antidepressant action</strong></p><p>P Cowen</p><p><strong>12. Prevalence and correlates of comorbid psychiatris illness in patients with heroin use disorder admitted to Stikland Opioid Detoxification Unit</strong></p><p>L Dannatt, K J Cloete, M Kidd, L Weich</p><p><strong>13. Investigating the association between diabetes mellitus, depression and psychological distress in a cohort of South African teachers</strong></p><p>A K Domingo, S Seedat, T M Esterhuizen, C Laurence, J Volmink, L Asmal</p><p><strong>14. Neuropeptide S -emerging evidence for a role in anxiety</strong></p><p>K Domschke</p><p><strong>15. Pathogenetics of anxiety</strong></p><p>K Domschke</p><p><strong>16. The effects of HIV on the fronto-striatal system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>17. Effects of acute antipsychotic treatment on brain morphology in schizophrenia</strong></p><p>R Emsley, L Asmal, B Chiliza, S du Plessis, J Carr, A Goosen, M Kidd, M Vink, R Kahn</p><p><strong>18. Development of a genetic database resource for monitoring of breast cancer patients at risk of physical and psychological complications</strong></p><p>K Grant, F J Cronje, K Botha, J P Apffelstaedt, M J Kotze</p><p><strong>19. Unipolar mania reconsidered: Evidence from a South African study</strong></p><p><strong></strong>C Grobler</p><p><strong>20. Antipsychotic-induced movement disorders: Occurence and management</strong></p><p>P Haddad</p><p><strong>21. The place of observational studies in assessing the effectiveness of long-acting injectable antipsychotics</strong></p><p>P Haddad</p><p><strong>22. Molecular mechanisms of d-cycloserine in fear extinction: Insights from RNS sequencing</strong></p><p>S Hemmings, S Malan-Muller, L Fairbairn, M Jalali, E J Oakeley, J Gamieldien, M Kidd, S Seedat</p><p><strong>23. Schizophrenia: The role of inflammation</strong></p><p>DC Henderson</p><p><strong>24. Addictions: Emergent trends and innovations</strong></p><p>V Hitzeroth</p><p><strong>25. The socio-cultural-religious context of biological psychiatric practice</strong></p><p>B Janse van Rensburg</p><p><strong>26. Biochemical markers for identifying risk factors for disability progression in multiple sclerosis</strong></p><p><strong></strong>S Janse van Rensburg, M J Kotze, F J Cronje, W Davis, K Moremi, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>27. Alcohol-induced psychotic disorder: Brain perfusion and psychopathology - before and after antipsychotic treatment</strong></p><p>G Jordaan, J M Warwick, D G Nel, R Hewlett, R Emsley</p><p><strong>28.'Pump and dump': Harm reduction strategies for breastfeeding while using substances</strong></p><p>L Kramer</p><p><strong>29. Adolescent neuropsychiatry - an emerging field in South African adolescent psychiatric services</strong></p><p>A Lachman</p><p><strong>30. Recovery versus remission, or what it means to be healthy for a psychiatric patient?</strong></p><p>B Latecki</p><p><strong>31. Holistic methods utilised to normalise behaviours in youth diagnosed with neuro-biochemical disorders</strong></p><p>P Macqueen</p><p><strong>32. Candidate genes and novel polymorphisms for anxiety disorder in a South African cohort</strong></p><p>N McGregor, J Dimatelis, S M J Hemmings, C J Kinnear, D Stein, V Russel, C Lochner</p><p><strong>33. Higher visual functioning</strong></p><p>A Moodley</p><p><strong>34. The effects of prenatal methylmercury exposure on trace element and antioxidant levels in rat offspring following 6-hydroxydopamine-induced neuronal insult</strong></p><p>Z M Moosa, W M U Daniels, M V Mabandla</p><p><strong>35. Paediatric neuropsychiatric movement disorders</strong></p><p>L Mubaiwa</p><p><strong>36. The South African national female offenders study</strong></p><p>M Nagdee, L Artz, C de Clercq, P de Wet, H Erlacher, S Kaliski, C Kotze, L Kowalski, J Naidoo, S Naidoo, J Pretorius, M Roffey, F Sokudela, U Subramaney</p><p><strong>37. Neurobiological consequences of child abuse</strong></p><p>C Nemeroff</p><p><strong>38. What do Stellenbosch Unviversity medical students think about psychiatry - and why should we care?</strong></p><p>G Nortje, S Suliman, K Seed, G Lydall, S Seedat</p><p><strong>39. Neurological soft skins in Nigerian Africans with first episode schizophrenia: Factor structure and clinical correlates</strong></p><p><strong></strong>A Ojagbemi, O Esan, O Gureje, R Emsley</p><p><strong>40. Should psychiatric patients know their MTHFR status?</strong></p><p>E Peter</p><p><strong>41. Clinical and functional outcome of treatment refractory first-episode schizophrenia</strong></p><p>L Phahladira, R Emsley, L Asmal, B Chiliza</p><p><strong>42. Bioethics by case discussion</strong></p><p>W Pienaar</p><p><strong>43. Reviewing our social contract pertaining to psychiatric research in children, research in developing countries and distributive justice in pharmacy</strong></p><p>W Pienaar</p><p><strong>44. The performance of the MMSE in a heterogenous elderly South African population</strong></p><p>S Ramlall, J Chipps, A I Bhigjee, B J Pillay</p><p><strong>45. Biological basis addiction (alocohol and drug addiction)</strong></p><p>S Rataemane</p><p><strong>46. Volumetric brain changes in prenatal methamphetamine-exposed children compared with healthy unexposed controls</strong></p><p><strong></strong>A Roos, K Donald, G Jones, D J Stein</p><p><strong>47. Single voxel proton magnetic resonance spectroscopy of the amygdala in social anxiety disorder in the context of early developmental trauma</strong></p><p>D Rosenstein, A Hess, S Seedat, E Meintjies</p><p><strong>48. Discussion of HDAC inhibitors, with specific reference to supliride and its use during breastfeeding</strong></p><p>J Roux</p><p><strong>49. Prevalence and clinical correlates of police contact prior to a first diagnosis of schizophrenia</strong></p><p>C Schumann, L Asmal, K Cloete, B Chiliza, R Emsley</p><p><strong>50. Are dreams meaningless?</strong></p><p>M Solms</p><p><strong>51. The conscious id</strong></p><p>M Solms<strong></strong></p><p><strong>52. Depression and resilience in HIV-infected women with early life stress: Does trauma play a mediating role?</strong></p><p>G Spies, S Seedat</p><p><strong>53. State of affairs analysis for forensic psychiatry in SA</strong></p><p>U Subramaney</p><p><strong>54. Escitalopram in the prevention of post-traumatic stress disorder: A pilot randomised controlled trial</strong></p><p>S Suliman, S Seedat, J Pingo, T Sutherland, J Zohar, D J Stein</p><p><strong>55. Epigenetic consequences of adverse early social experiences in primates</strong></p><p>S Suomi</p><p><strong>56. Risk, resilience, and gene x environment interactions in primates</strong></p><p>S Suomi</p><p><strong>57. Biological aspects of anorexia nervosa</strong></p><p>C Szabo</p><p><strong>58. Agents used and profiles of non-fatal suicidal behaviour in East London</strong></p><p>H Uys</p><p><strong>59. The contributions of G-protein coupled receptor signalling to opioid dependence</strong></p><p>J van Tonder</p><p><strong>60. Emerging trend and innovation in PTSD and OCD</strong></p><p>J Zohar</p><p><strong>61. Making the SASOP treatment guidelines operational</strong></p><p>E Allers</p><p><strong>Poster Presentations</strong></p><p><strong>62. Neuropsychological deficits in social anxiety disorder in the context of early developmental trauma</strong></p><p><strong></strong>S Bakelaar, D Rosenstein, S Seedat</p><p><strong>63.Social anxiety disorder in patients with or without early childhood trauma: Relationship to behavioral inhibition and activation and quality of life</strong></p><p><strong></strong>S Bakelaar, C Bruijnen, A Sambeth, S Seedat</p><p><strong>64. Exploring altered affective processing in obssessive compulsive disorder symptom subtypes</strong></p><p>E Breet, J Ipser, D Stein, C Lochner<strong><br /></strong></p><p><strong>65. To investigate the bias toward recognising the facial expression of disgust in obsessive compulsive disorder as well as the effect of escitalopram</strong></p><p>E Breet, J Ipser, D Stein, C Lochner</p><p><strong>66. A fatal-case of nevirapine-induced Stevens-Johnson's syndrome in HIV mania</strong></p><p>A Bronkhorst, Z Zingela, W M Qwesha, B P Magigaba<strong></strong></p><p><strong>67. Association of the COMT G472A (met/met) genotype with lower disability in people diagnosed with multiple sclerosis</strong></p><p>W Davis, S J van Rensburg, L Fisher, F J Cronje, D Geiger, M J Kotze</p><p><strong>68. Homocycsteine levels are associated with the fat mass and obesity associated gene FTO(intron 1 T&gt;A) polymorphism in MS patients</strong></p><p>W Davis, S J Van Rensburg, M J Kotze, L Fisher, M Jalali, F J Cronje, K Moremi, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus</p><p><strong>69. Analysis of the COMT 472 G&gt;A (rs4680) polymorphism in relation to environmental influences as contributing factors in patients with schizophrenia</strong></p><p>D de Klerk, S J van Rensburg, R A Emsley, D Geiger, M Rensburg, R T Erasmus, M J Kotze</p><p><strong>70. Dietary folate intake, homocysteine levels and MTHFR mutation detection in South African patients with depression: Test development for clinical application </strong></p><p>D Delport, N vand der Merwe, R Schoeman, M J Kotze</p><p><strong>71. The use ofexome sequencing for antipsychotic pharmacogenomic applications in South African schizophrenia patients</strong></p><p>B Drogmoller, D Niehaus, G Wright, B Chiliza, L Asmal, R Emsley, L Warnich</p><p><strong>72. The effects of HIV on the ventral-striatal reward system</strong></p><p>S du Plessis, M Vink, J Joska, E Koutsilieri, C Scheller, B Spottiswoode, D Stein, R Emsley</p><p><strong>73. Xenomelia relates to asymmetrical insular activity: A case study of fMRI</strong></p><p>S du Plessis, M Vink, L Asmal</p><p><strong>74. Maternal mental helath: A prospective naturalistic study of the outcome of pregancy in women with major psychiatric disorders in an African country</strong></p><p>E du Toit, L Koen, D Niehaus, B Vythilingum, E Jordaan, J Leppanen</p><p><strong>75. Prefrontal cortical thinning and subcortical volume decrease in HIV-positive children with encephalopathy</strong></p><p>J P Fouche, B Spottiswoode, K Donald, D Stein, J Hoare</p><p><strong>76. H-magnetic resonance spectroscopy metabolites in schizophrenia</strong></p><p>F Howells, J Hsieh, H Temmingh, D J Stein</p><p><strong>77. Hypothesis for the development of persistent methamphetamine-induced psychosis</strong></p><p><strong></strong> J Hsieh, D J Stein, F M Howells</p><p><strong>78. Culture, religion, spirituality and psychiatric practice: The SASOP Spirituality and Psychiatry Special Interest Group Action Plan for 2012-2014</strong></p><p>B Janse van Rensburg</p><p><strong>79. Cocaine reduces the efficiency of dopamine uptake in a rodent model of attention-deficit/hyperactivity disorder: An <em>in vivo</em> electrochemical study</strong></p><p><strong></strong>L Kellaway, J S Womersley, D J Stein, G A Gerhardt, V A Russell</p><p><strong>80. Kleine-Levin syndrome: Case in an adolescent psychiatric unit</strong></p><p>A Lachman</p><p><strong>81. Increased inflammatory stress specific clinical, lifestyle and therapeutic variables in patients receiving treatment for stress, anxiety or depressive symptoms</strong></p><p>H Luckhoff, M Kotze, S Janse van Rensburg, D Geiger</p><p><strong>82. Catatonia: An eight-case series report</strong></p><p>M Mabenge, Z Zingela, S van Wyk</p><p><strong>83. Relationship between anxiety sensitivity and childhood trauma in a random sample of adolescents from secondary schools in Cape Town</strong></p><p>L Martin, M Viljoen, S Seedat</p><p><strong>84. 'Making ethics real'. An overview of an ethics course presented by Fraser Health Ethics Services, BC, Canada</strong></p><p>JJ McCallaghan</p><p><strong>85. Clozapine discontinuation rates in a public healthcare setting</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>86. Retrospective review of clozapine monitoring in a publica sector psychiatric hospital and associated clinics</strong></p><p>M Moolman, W Esterhuysen, R Joubert, J C Lamprecht, M S Lubbe</p><p><strong>87. Association of an iron-related TMPRSS6 genetic variant c.2007 C&gt;7 (rs855791) with functional iron deficiency and its effect on multiple sclerosis risk in the South African population</strong></p><p>K Moremi, S J van Rensburg, L R Fisher, W Davis, F J Cronje, M Jalali Sefid Dashti, J Gamieldien, D Geiger, M Rensburg, R van Toorn, M J de Klerk, G M Hon, T Matsha, S Hassan, R T Erasmus, M Kidd, M J Kotze</p><p><strong>88. Identifying molecular mechanisms of apormophine-induced addictive behaviours</strong></p><p>Z Ndlazi, W Daniels, M Mabandla</p><p><strong>89. Effects of lifestyle factors and biochemistry on the major neck blood vessels in patients with mutiple sclerosis</strong></p><p>M Nelson, S J van Rensburg, M J Kotze, F Isaacs, S Hassan</p><p><strong>90. Nicotine protects against dopamine neurodegenration and improves motor deficits in a Parkinsonian rat model</strong></p><p>N Ngema, P Ngema, M Mabandla, W Daniels</p><p><strong>91. Cognition: Probing anatomical substrates</strong></p><p>H Nowbath</p><p><strong>92. Chronic exposure to light reverses the effects of maternal separation on the rat prefrontal cortex</strong></p><p>V Russel, J Dimatelis</p><p><strong>93. Evaluating a new drug to combat Alzheimer's disease</strong></p><p>S Sibiya, W M U Daniels, M V Mabandla</p><p><strong>94. Structural brain changes in HIV-infected women with and without childhood trauma</strong></p><p>G Spies, F Ahmed, C Fennema-Notestine, S Archibald, S Seedat</p><p><strong>95. Nicotine-stimulated release of hippocampal norepinephrine is reduced in an animal model of attention-deficit/ hyperactivity disorder: the spontaneously hypertensive rat</strong></p><p>T Sterley</p><p><strong>96. Brain-derive neurotrophic factor (BDNF) protein levels in anxiety disorders: Systematic review and meta-regression analysis</strong></p><p>S Suliman, S M J Hemmings, S Seedat</p><p><strong>97. A 12-month retrospective audit of the demographic and clinical profile of mental healthcare users admitted to a district level hospital in the Western Cape, South Africa</strong></p><p>E Thomas, K J Cloete, M Kidd, H Lategan</p><p><strong>98. Magnesium recurarization: A comparison between reversal of neuromuscular block with sugammadex v. neostigmine/ glycopyrrolate in an <em>in vivo</em> rat model</strong></p><p><strong></strong>M van den Berg, M F M James, L A Kellaway</p><p><strong>99. Identification of breast cancer patients at increased risk of 'chemobrain': Case study and review of the literature</strong></p><p>N van der Merwe, R Pienaar, S J van Rensburg, J Bezuidenhout, M J Kotze</p><p><strong>100. The protective role of HAART and NAZA in HIV Tat protein-induced hippocampal cell death</strong></p><p>S Zulu, W M U Daniels, M V Mabandla</p>

ObjectiveTo assess evidence for public health impact of syndromic surveillance.IntroductionSystematic syndromic surveillance is undergoing a transition. Building on traditional roots in bioterrorism and situational awareness, proponents are demonstrating the timeliness and informative power of syndromic surveillance data to supplement other surveillance data.MethodsWe used PubMed and Google Scholar to identify articles published since 2007 using key words of interest (e.g., syndromic surveillance in combinations with emergency, evaluation, quality assurance, alerting). The following guiding questions were used to abstract impact measures of syndromic surveillance: 1) what was the public health impact; what decisions or actions occurred because of use of syndromic surveillance data?, 2) were there specific interventions or performance measures for this impact?, and 3) how, and by whom, was this information used?ResultsThirty-five papers were included. Almost all articles (n=33) remarked on the ability of syndromic surveillance to improve public health because of timeliness and/or accuracy of data. Thirty-four articles mentioned that syndromic surveillance data was used or could be useful. However, evidence of health impact directly attributable to syndromic surveillance efforts were lacking. Two articles described how syndromic data were used for decision-making. One article measured the effect of data utilization.ConclusionsWithin the syndromic surveillance literature instances of a conceptual shift from detection to practical response are plentiful. As the field of syndromic surveillance continues to evolve and is used by public health institutions, further evaluation of data utility and impact is needed.ReferencesAyala, A., Berisha, V., Goodin, K., Pogreba-Brown, K., Levy, C., McKinney, B., Koski, L., & Imholte, S. (2016). Public health surveillance strategies for mass gatherings: Super Bowl XLIX and related events, Maricopa County, Arizona, 2015. Health Security, 14(3), 173-84. doi: 10.1089/hs.2016.0029.Bermis, K., Frias, M., Patel, M.T., & Christiansen, D. (2017). Using an Emergency Department Syndromic Surveillance System to Evaluate Reporting of Potential Rabies Exposures, Illinois, 2013-2015. Public Health Reports 132(Supplement 1) 59S-64S."Borroto, R., Williamson, B., Pitcher, P., Ballester, L., Smith, W., Soetebier, K., & Drenzek, C. (2016). Using Syndromic Surveillance Alert Protocols for Epidemiologic Response in Georgia. Online Journal of Public Health Informatics 9(1):e123. doi:10.5210/ojphi.v9i1.7707."Daly, E.R., Dufault, K., Swenson, D.J., Lakevicius, P., Metcalf, E., & Chan, B.P. (2017). Use of emergency department data to monitor and respond to an increase in opioid overdoses in New Hampshire 2011-2015. 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Background: The Royal Australian and New Zealand College of Psychiatrists is coordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority. This paper presents CPGs for schizophrenia and related disorders. Over the past decade schizophrenia has become more treatable than ever before. A new generation of drug therapies, a renaissance of psychological and psychosocial interventions and a first generation of reform within the specialist mental health system have combined to create an evidence-based climate of realistic optimism. Progressive neuroscientific advances hold out the strong possibility of more definitive biological treatments in the near future. However, this improved potential for better outcomes and quality of life for people with schizophrenia has not been translated into reality in Australia. The efficacy-effectiveness gap is wider for schizophrenia than any other serious medical disorder. Therapeutic nihilism, under-resourcing of services and a stalling of the service reform process, poor morale within specialist mental health services, a lack of broad-based recovery and life support programs, and a climate of tenacious stigma and consequent lack of concern for people with schizophrenia are the contributory causes for this failure to effectively treat. These guidelines therefore tackle only one element in the endeavour to reduce the impact of schizophrenia. They distil the current evidence-base and make recommendations based on the best available knowledge. Method: A comprehensive literature review (1990–2003) was conducted, including all Cochrane schizophrenia reviews and all relevant meta-analyses, and a number of recent international clinical practice guidelines were consulted. A series of drafts were refined by the expert committee and enhanced through a bi-national consultation process. Treatment recommendations: This guideline provides evidence-based recommendations for the management of schizophrenia by treatment type and by phase of illness. The essential features of the guidelines are: (i) Early detection and comprehensive treatment of first episode cases is a priority since the psychosocial and possibly the biological impact of illness can be minimized and outcome improved. An optimistic attitude on the part of health professionals is an essential ingredient from the outset and across all phases of illness. (ii) Comprehensive and sustained intervention should be assured during the initial 3–5 years following diagnosis since course of illness is strongly influenced by what occurs in this ‘critical period’. Patients should not have to ‘prove chronicity’ before they gain consistent access and tenure to specialist mental health services. (iii) Antipsychotic medication is the cornerstone of treatment. These medicines have improved in quality and tolerability, yet should be used cautiously and in a more targeted manner than in the past. The treatment of choice for most patients is now the novel antipsychotic medications because of their superior tolerability and, in particular, the reduced risk of tardive dyskinesia. This is particularly so for the first episode patient where, due to superior tolerability, novel agents are the first, second and third line choice. These novel agents are nevertheless associated with potentially serious medium to long-term side-effects of their own for which patients must be carefully monitored. Conventional antipsychotic medications in low dosage may still have a role in a small proportion of patients, where there has been full remission and good tolerability; however, the indications are shrinking progressively. These principles are now accepted in most developed countries. (vi) Clozapine should be used early in the course, as soon as treatment resistance to at leasttwo antipsychotics has been demonstrated. This usually means incomplete remission of positive symptomatology, but clozapine may also be considered where there are pervasive negative symptoms or significant or persistent suicidal risk is present. (v) Comprehensive psychosocial interventions should be routinely available to all patients and their families, and provided by appropriately trained mental health professionals with time to devote to the task. This includes family interventions, cognitive-behaviour therapy, vocational rehabilitation and other forms of therapy, especially for comorbid conditions, such as substance abuse, depression and anxiety. (vi) The social and cultural environment of people with schizophrenia is an essential arena for intervention. Adequate shelter, financial security, access to meaningful social roles and availability of social support are essential components of recovery and quality of life. (vii) Interventions should be carefully tailored to phase and stage of illness, and to gender and cultural background. (viii) Genuine involvement of consumers and relatives in service development and provision should be standard. (ix) Maintenance of good physical health and prevention and early treatment of serious medical illness has been seriously neglected in the management of schizophrenia, and results in premature death and widespread morbidity. Quality of medical care for people with schizophrenia should be equivalent to the general community standard. (x) General practitioners (GPs)s should always be closely involved in the care of people with schizophrenia. However, this should be truly shared care, and sole care by a GP with minimal or no specialist involvement, while very common, is not regarded as an acceptable standard of care. Optimal treatment of schizophrenia requires a multidisciplinary team approach with a consultant psychiatrist centrally involved.

Neural tube defects (NTDs), such as spinal cord and brain defects, are due to abnormal embryonic development of the neural tube and associated with increased fetal and infant mortality, morbidity, lifelong disability, and high economic costs. Globally, more than 260,000 pregnancies are estimated to be affected by NTDs, and 75% of the NTD live births result in under-5 deaths.1 Majority of NTDs are folic acid-sensitive; with much of the NTD burden preventable through consumption of folic acid before and during early pregnancy (periconception). An association between low folate status of women of reproductive age (WRA) and risk of NTD-affected pregnancy was first proposed in 1965 by Hibbard et al.2 and was subsequently substantiated in several randomized controlled trials which demonstrated the effectiveness of folic acid supplementation during periconception in preventing the first occurrence of NTDs.3 These findings resulted in a recommendation in 1992 by the U.S. Public Health Service that WTA consume 400 μg of folic acid daily to prevent occurrence of an NTD-affected pregnancy.4 This recommendation together with other large-scale, global intervention studies demonstrated the efficacy of a daily periconceptional supplement of 400 μg in preventing a large percentage of NTDs.5 Folic acid is a synthetic, oxidized form of folate that acts as a coenzyme in the biosynthesis of DNA and RNA. With 4 mg folic acid daily, it may take 20 weeks to reach red-blood-cell folate levels between 1050 and 1340 nmol/L, which is optimal for reduction of the neural tube defect risk. Therefore, folic acid supplementation should be started 5–6 months before conception. The residual risk with optimal red-blood-cell folate levels is reportedly 4.5 per 10,000 total births whereas the residual risk in pooled data from countries with mandatory folic acid fortification is 7.5 per 10,000 pregnancies, regardless of pre-fortification rates.6 In one study, the optimal RBC folate level was achieved in 80.4% of women who started FA 400 μg 4–8 weeks before their last menstrual period (LMP) compared to only 53.6% in women who started 4–8 weeks after their LMP (P < 0.001). 7 A worldwide survey of folic acid supplementation in WRA showed inadequate compliance to folic acid intake.8 A systematic review and meta-analysis of pooled prevalence estimates of folic acid compliance showed 32–51% in North America, 9–78% in Europe, 21–46% in Asia, 4–34% in the Middle East, 32–39% in Australia/New Zealand, and 0% in Africa. Poor compliance was secondary to many factors. In the United States, the recommendation of 400 μg supplemental intake of folic acid daily has limitations as many pregnancies, including up to 50% of all pregnancies are unplanned.9 In many countries, particularly among low- and middle-income countries, many barriers exist for the access of WRA to folic acid supplements, such as procurement of the micronutrients in a relatively costly prepackaged form and ineffective distribution system. An evaluation of NTD trends in multiple countries indicated that, regardless of form, timing, or intended target, issuing recommendations on folic acid use alone, in the absence of fortification, had no detectable impact on NTD incidence. Thus, food fortification with folic acid has been a component of national public health strategies; in particular, where folate status is insufficient and a fortifiable food vehicle, processed by a centralized industry is consumed regularly by WRA.10,11 Other factors associated with poor compliance in folic acid intake include low income, smoking during pregnancy, alcohol consumption, multiple pregnancy, geographic location, and religious beliefs. On the other hand, preconception counselling, previous infertility therapy, multivitamin intake before pregnancy, older age planned pregnancy, previous infertility therapy, and multivitamin intake before pregnancy increased compliance.12-16 Women who also believed that they had good general and obstetric health (e.g., no history of illness or miscarriage) had attitudes of not being susceptible to the health consequences of not taking folic acid supplements and were the low users of folic acid supplement.17 In the Philippines, although WRA are advised to consume 320 ug dietary folate equivalent per day,18 about 0.9 % (around 1 in 5) are folate-deficient based on red cell folate count, while 38.7% (around 2 in 5) are folate-deficient based on serum folate.19 Congenital malformations including NTDs remain in the top ten leading causes of infant mortality from 1960 to 2005.20 In the index paper of Bernardo21 a cross-sectional, cluster sampling survey of 184 healthy, pregnant women, of age 15–49 years was conducted in the Batangas province from May to July 2017 to assess the level of knowledge, attitude, and perceived practice among the subjects on the importance of folate periconceptionally. A pretested interview questionnaire was used. The mean scores were 77% (moderate level) for knowledge, 82% for positive attitude, and 71% for positive perceived practice. The scores in the survey were related to patient’s age, civil status and to some extent, education. The study suggested that while respondents knew about folate (70%), they had low knowledge of the effect of its deficiency especially as it can lead to infant death. Knowledge had significant and positive moderate correlation with attitude (r = 0.7) and perceived practice (r = 0.5), but there was a weak positive correlation between attitude and perceived practice (r = 0.4). This likely indicates failure to emphasize the translation of knowledge and awareness properly and sufficiently into actual practice. As recommended by the author, education is the principal means to achieve the desired outcome. However, it is not clear in the study whether some amount of educational intervention besides determination of prevalence was included. As in any prevalence study, the golden opportunity to improve health outcomes is to accompany the survey with educational intervention, which in many instances, is required by the institutional board review. Some regression analysis of the data may also have been useful to determine which factors contributed most to the outcome measures. Enrique M. Ostrea, Jr., MD Wayne State University Hutzel Women’s Hospital Children’s Hospital of Michigan Detroit, Michigan, United States of America; National Institutes of Health University of the Philippines, Manila REFERENCES Blencowe H, Kancherla V, Moorthie S, Darlison D, Modell B. Estimates of global and regional prevalence of neural tube defects for 2015: a systematic analysis. Ann NY Acad Sci. 2018; 1414:31-46. Hibbard B, Hibbard E, Jeffcoate J. Folic acid and reproduction. 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Geographical variations and determinants of iron and folic acid supplementation during pregnancy in Ethiopia: Analysis of 2019 mini demographic and health survey. BMC Pregnancy Childbirth. 2022; 22:127. De Santis M, Quattrocchi T, Mappa I, Spagnuolo T, Licameli A, Chiaradia G, De Luca C. Folic acid use in planned pregnancy: an Italian survey. Matern Child Health J. 2013; 17:661-6. Felipe-Dimog E, Yu C, Ho C, Liang F. Factors influencing the compliance of pregnant women with iron and folic acid supplementation in the Philippines. 2017 Philippine Demographic and Health Survey Analysis. Nutrients. 2021; 13: 3060.1-9. Toivonen K, Lacroix E, Flynn M, Ronksley P, Oinonen K, Metcalfe A, et al. Folic acid supplementation during the preconception period: A systematic review and meta-analysis. Prev Med. 2018; 114:1-17. Fulford B, Macklon N, Boivin J. Mental models of pregnancy may explain low adherence to folic acid supplementation guidelines: a cross-sectional international survey. Eur J Obstet Gynecol Reprod Biol. 2014 May; 176:99-103. Philippine Dietary and Reference Intakes. Food and Nutrition Research Institute - Department of Science and Technology (FNRIDOST). 2015. DOST Complex, FNRI Bldg., Bicutan, Taguig City, Metro Manila Philippines. Available from: https://www.fnri.dost.gov.ph/images/images/news/PDRI-2018.pdf. Desnacido JA, Cheong RL, Madriaga JR, Perlas IA & Marcos JM. Folate status of Filipino women of childbearing age: Philippines 2008. [Internet]. [cited 2019 May]. Available from: http://122.53.86.125/Seminar%20Series/38th/folate%20status_filipino%20women.pdf. David-Padilla C, Cutiongco-dela Paz E, Cavan BC, Abarquez C, Sur ALD, Sale RI, et al. Establishment of the Philippine Birth Defects Surveillance. Acta Med Philipp. 2011; 45 (4). [Internet]. [cited 2019 May]. Available from: https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source. Bernardo A. Assessment of knowledge, attitude, and perceived practices on the importance of folate among Filipino women of child-bearing age in the province of Batangas. Acta Med Philipp. May 2021, doi:10.47895/amp.vi0.1462.

The World Health Organization (WHO) declared a COVID-19 pandemic last March 11, 2020.1,2 According to the WHO Director General, “In the past two weeks, the number of cases of COVID-19 outside China has increased 13-fold, and the number of affected countries has tripled. There are now more than 118,000 cases in 114 countries, and 4,291 people have lost their lives. Thousands more are fighting for their lives in hospitals.” Soon after, Metro Manila was placed on a complete lockdown which started on March 15, 2020 and continues up to the time of this writing.2 So, what exactly is this COVID-19 pandemic? Will it be changing how we live our lives as healthcare professionals? What will be our role in taking care of patients with COVID-19? These and many other related questions require immediate answers as we face the threat of COVID-19. The WHO was first informed of cases of pneumonia of unknown cause in Wuhan City, China near the end of 2019. A novel coronavirus was identified as the cause by Chinese authorities and was initially named 2019-nCoV.3,4 This was later revised to COVID-19 (coronavirus disease of 2019) and the virus that causes it called SARS-CoV-2 (severe acute respiratory syndrome-coronavirus 2). In the first global epidemic caused by the “first” SARS coronavirus in 2003, the Philippines had a total of only eight confirmed patients. All the cases had contact with a nurse aide who had returned from Toronto, Canada where she got it. The index case and her father eventually died from SARS while the rest recovered.5 But, with COVID-19, at the time of writing this editorial, there were approximately 1,611 weekly cases with 112 weekly deaths in the Philippines and appears to be an increasing trend.6,7 By mid-March 2020, the WHO European Region had become the epicenter of the epidemic, reporting over 40% of globally confirmed cases. As of 28 April 2020, 63% of global mortality from the virus was from the Region, according to the WHO.3 There is much that we need to know about SARS-CoV-2, the virus that causes COVID-19. It belongs to the same family of coronavirus that causes SARS, MERS (Middle East Respiratory Syndrome), and even the common cold.3 Early studies report that SARS-CoV-2 was most often detected in respiratory samples from patients in China. However, live virus was also found in feces.8 It is thought that transmission mainly occurs through the respiratory route, probably as droplets, but extra respiratory sources may also be important. Risk factors for severe illness remain uncertain but old age and comorbidities such as cardiovascular disease, liver disease, kidney disease or malignant tumors, have emerged as likely important factors. There are no proven effective specific treatment strategies, and the risk-benefit ratio for commonly used treatments such as corticosteroids is not clear.7,8 COVID-19 may also cause damage to other organs such as the heart, the liver, and the kidneys, as well as to organ systems such as the blood and the immune system. Patients die of multiple organ failure, shock, acute respiratory distress syndrome, heart failure, arrhythmias, and renal failure.9,10 Among the WHO’s current recommendations, people with mild respiratory symptoms should be encouraged to isolate themselves, and social distancing is emphasized, and these recommendations apply even to countries with no reported cases.3,11 However, such measures could drastically affect the economy with impact on work practices as well as commercial establishments which depend on people’s patronage.12,13 Moreover, the psychological and mental burden that isolation and quarantine can bring about should also be considered. 14,15 For those in the academe, adjustments and quick transition to online learning strategies will need to be made.16 This will also affect how scientific research is done, particularly as we try to learn more about COVID-19.17 The longer the pandemic lasts, and the longer these measures need to be implemented, the more significant will the effects be on the economic and mental well-being of the people. There has certainly been a rush to get more information about COVID-19.18 Although well-intended in most cases, this has resulted into an “infodemic” with some erroneous or unscientific information about COVID-19. 19-21 Even mainstream scientific publications have not been spared by such faulty information. 22,23 Health professionals, therefore, who will be using the information found in these publications will need to be more vigilant in making sure that the data are properly collected and interpreted. We need to constantly update ourselves as new information becomes available.24-26 As in many viral diseases, the best way to combat COVID-19 could be vaccination. Based on the experience with developing vaccines for the other coronaviruses such as the ones causing SARS, MERS and even the common colds, the development of an effective vaccine against COVID-19 may be challenging.27-30 Even if one were to be quickly developed, having the resources needed to make enough vaccines for potentially all inhabitants of our planet are also staggering. And then of course, once a vaccine is available, each country would have to device its own vaccination strategy and all of its accompanying logistic considerations. And then there is the cost of such a vaccine. As a third world country, would the Philippines be able to afford enough vaccines for its citizens? Pending availability of an effective vaccine, one would need to look at actual treatment of COVID-19 patients. In the short-term, it may be possible to repurpose some of the currently available drugs we use for treating other viruses.31-33 In order to help address these, some wide-ranging initiatives have been set up. In March 2020, the UK Research and Innovation (UKRI) Medical Research Council and the UK National Institute of Health Research (NIHR) started the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial.34,35 It is the world’s largest clinical trial into treatments for COVID-19, with more than 40,000 participants across 185 trials sites in the UK. It is led by the University of Oxford. At about the same time, the WHO also announced the start of an international randomized and adaptive clinical trial SOLIDARITY which will also be looking at potential treatments for COVID-19. 36,37 The Philippines is set to participate in the SOLIDARITY trial.38 Use of personal protective equipment (PPEs) similar to how we have used them against Ebola and other viruses could also be beneficial.39 But similar to developing capacity for making enough vaccines, the ability to make enough PPEs, especially the disposable ones and bring these to where they are needed could also be additional challenges. In the Philippines, as in many other parts of the world, many healthcare workers report insufficient availability of PPEs which puts them at risk of getting COVID-19 from their patients.40,41 There are many more questions needing answers that we will need to deal with as we confront COVID-19. And, most likely, there will also be new challenges that can arise as the pandemic evolves. The combined efforts of the scientific and political communities will need to be engaged if we hope to successfully deal with this emergency. Joven Jeremius Q. Tanchuco, MD, MHA Professor, Department of Biochemistry and Molecular Biology, College of Medicine, University of the Philippines Manila Clinical Professor, Division of Pulmonary Medicine, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila REFERENCES WHO Director-General's opening remarks at the media briefing on COVID-19 [Internet]. 11 March 2020 [cited 2020 Apr 15]. Available from: https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020. Metro Manila to be placed on 'lockdown' due to COVID-19 [Internet]. [cited 2020 Apr 15]. Available from: https://cnnphilippines.com/news/2020/3/12/COVID-19-Metro-Manila-restrictions-Philippines.html Cucinotta D, Vanelli M. WHO Declares COVID-19 a Pandemic. Acta Biomed. 2020;91(1):157-160. doi:10.23750/abm. v91i1.9397 Coronavirus disease (COVID-19) pandemic [Internet]. [cited 2020 Apr 15]. Available from: https://www.euro.who.int/en/health-topics/health-emergencies/coronavirus-covid-19/novel-coronavirus-2019-ncov World Health Organization. SARS outbreak in the Philippines = Flambée de SRAS aux Philippines. Weekly Epidemiological Record = Relevé épidémiologique hebdomadaire. 2003;78(22):189-192. https://apps.who.int/iris/handle/10665/232177 COVID-19 Dashboard by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University ( JHU) [Internet]. [cited 2020 Apr 19]. Available from: https://www.arcgis. com/apps/dashboards/bda7594740fd40299423467b48e9ecf6. Dong E, Du H, Gardner L. An interactive web-based dashboard to track COVID-19 in real time [published correction appears in Lancet Infect Dis. 2020;20(9):e215]. 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New Microbes New Infect. 2020;35:100679. doi:10.1016/j.nmni.2020.100679 The RECOVERY trial [Internet]. [cited 2020 Apr 15]. Available from: https://www.ukri.org/our-work/tackling-the-impact-of-covid-19/vaccines-and-treatments/recovery-trial-identifies-covid-19-treatments/ RECOVERY [Internet]. [cited 2020 Apr 15]. Available from: https://www.recoverytrial.net/ UN health chief announces global ‘solidarity trial’ to jumpstart search for COVID-19 treatment [Internet]. [cited 2020 Apr 15]. Available ftom: https://news.un.org/en/story/2020/03/1059722 WHO COVID-19 Solidarity Therapeutics Trial [Internet]. [cited 2020 Apr 15]. Available from: https://www.who.int/emergencies/diseases/novel-coronavirus-2019/global-research-on-novel-coronavirus-2019-ncov/solidarity-clinical-trial-for-covid-19-treatments PH Solidarity trial for COVID-19 treatments receives green light from ethics review body [Internet]. [cited 2020 Apr 22]. Available from: https://www.who.int/philippines/news/detail/22-04-2020-ph-solidarity-trial-for-covid-19-treatments-receives-green-light-from-ethics-review-body Balachandar V, Mahalaxmi I, Kaavya J, Vivekanandhan G, Ajithkumar S, Arul N, et al.COVID-19: emerging protective measures. Eur Rev Med Pharmacol Sci. 2020;24(6):3422-3425. doi:10.26355/eurrev_202003_20713 Philippines: Country faces health and human rights crisis one year into the COVID-19 pandemic [Internet]. [cited 2020 Apr 28]. Available from: https://www.amnesty.org/en/latest/press-release/2021/04/philippines-faces-health-human-rights-crisis-covid/. Shortage of personal protective equipment endangering health workers worldwide [Internet].[cited 2020 Apr 15]. Available from: https://www.who.int/news/item/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide.