Between 1989 and 2004, Liberia experienced a devastating civil war that resulted in widespread trauma with almost no mental health infrastructure to help citizens cope. In 2009, the Liberian Ministry of Health and Social Welfare collaborated with researchers from Massachusetts General Hospital to conduct a rapid needs assessment survey in Liberia with local key informants (n = 171) to examine the impact of war and post-war events on emotional and behavioral problems of, functional limitations of, and appropriate treatment settings for Liberian youth aged 5–22. War exposure and post-conflict sexual violence, poverty, infectious disease and parental death negatively impacted youth mental health. Key informants perceived that youth displayed internalizing and externalizing symptoms and mental health-related functional impairment at home, school, work and in relationships. Medical clinics were identified as the most appropriate setting for mental health services. Youth in Liberia continue to endure the harsh social, economic and material conditions of everyday life in a protracted post-conflict state, and have significant mental health needs. Their observed functional impairment due to mental health issues further limited their access to protective factors such as education, employment and positive social relationships. Results from this study informed Liberia's first post-conflict mental health policy.
Civil wars have been raging in regions of Africa, bringing tremendous emotional and physical mayhem and destruction to populations and infrastructures. Much attention has been given to descriptions of child soldiers and the war, but little is known about the circumstances of young Liberians in post-conflict situations. This study explores the ways in which young Liberians are surviving in the post-conflict Liberian context. We used qualitative data collected in Liberia using key informants focusing on individuals who work with young Liberians. We found that young Liberians are suffering from trauma and are engaging in violence, substance abuse, and sexual violence. They have also developed mechanisms for survival that include a high level of adultification, a phenomenon by which young people take on adult responsibilities. Key informants felt that young Liberians have problems respecting authority and accepting help. Furthermore, they are influenced by negative peers. These behaviors increase young Liberians' participation in high-risk behaviors, exacerbate existing trauma, and raise serious questions about the rebuilding of Liberia.
Background
General anaesthesia (GA) may be required to support the care of those seen in Special Care Dentistry (SCD) services for various reasons, such as enabling extensive dental care for people with severe learning disabilities or severe dental phobia. Guidance is needed for teams delivering SCD using GA due to the potential risks, implications, and costs of using GA to deliver dental care.
Aim
To present evidence‐based recommendations, where possible, for teams involved in providing GA for dental care for adults within SCD services.
Methods
A multidisciplinary working group, supported by a formal literature search and stakeholder involvement, iteratively produced and refined the recommendations presented.
Results
There was little evidence to inform the guidelines. Recommendations are therefore based mainly on the working group's expert consensus opinion. Clinical guidelines are presented as a set of overarching principles followed by six key sections reflecting patients' pathways from referral to dental services through to their care during and after GA.
Conclusion
Guidelines are presented to support those providing GA to provide SCD. The need for comprehensive and person‐centered assessment and planning is emphasized.
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