What about lay counselors' experiences of task-shifting mental health interventions? Example from a family-based intervention in Kenya.

Background:A key focus of health systems strengthening in low- and middle-income countries is increasing reach and access through task-shifting. As such models become more common, it is critical to understand the experiences of lay providers because they are on the forefront for delivering care services. A greater understanding would improve lay provider support and help them provide high-quality care. This is especially the case for those providing mental health services, as providing psychological care may pose unique stressors. We sought to understand experiences of lay counselors, focusing on identity, motivation, self-efficacy, stress, and burnout. The goal was to understand how taking on a new provider role influences their lives beyond simply assuming a new task, which would in turn help identify actionable steps to improve interventions with task-shifting components. Methods:Semi-structured interviews (n = 20) and focus group discussions (n = 3) were conducted with three lay counselor groups with varying levels of experience delivering a community-based family therapy intervention in Eldoret, Kenya. Thematic analysis was conducted, including intercoder reliability checks. A Stress Map was created to visualize stress profiles using free-listing and pile-sorting data collected during interviews and focus group discussions. Results:Counselors described high intrinsic motivation to become counselors and high self-efficacy after training. They reported positive experiences in the counselor role, with new skills improving their counseling and personal lives. As challenges arose, including client engagement difficulties and balancing many responsibilities, stress and burnout increased, dampening motivation and self-efficacy. In response, counselors described coping strategies, including seeking peer and supervisor support, that restored their motivation to persevere. At case completion, they again experienced high self-efficacy and a desire to continue. Conclusions:Findings informed suggestions for ways to incorporate support for lay providers into task-shifting interventions at initiation, during training, and throughout implementation. These include acknowledging and preparing counselors for challenges during training, increasing explicit attention to counselor stress in supervision, fostering peer support among lay providers, and ensuring a fair balance between workload and compensation. Improving and building an evidence base around practices for supporting lay providers will improve the effectiveness and sustainability of lay provider-delivered interventions

Medicinal and ethnoveterinary remedies of hunters in Trinidad

BACKGROUND: Ethnomedicines are used by hunters for themselves and their hunting dogs in Trinidad. Plants are used for snakebites, scorpion stings, for injuries and mange of dogs and to facilitate hunting success. RESULTS: Plants used include Piper hispidum, Pithecelobium unguis-cati, Bauhinia excisa, Bauhinia cumanensis, Cecropia peltata, Aframomum melegueta, Aristolochia rugosa, Aristolochia trilobata, Jatropha curcas, Jatropha gossypifolia, Nicotiana tabacum, Vernonia scorpioides, Petiveria alliacea, Renealmia alpinia, Justicia secunda, Phyllanthus urinaria,Phyllanthus niruri,Momordica charantia, Xiphidium caeruleum, Ottonia ovata, Lepianthes peltata, Capsicum frutescens, Costus scaber, Dendropanax arboreus, Siparuma guianensis, Syngonium podophyllum, Monstera dubia, Solanum species, Eclipta prostrata, Spiranthes acaulis, Croton gossypifolius, Barleria lupulina, Cola nitida, Acrocomia ierensis (tentative ID). CONCLUSION: Plant use is based on odour, and plant morphological characteristics and is embedded in a complex cultural context based on indigenous Amerindian beliefs. It is suggested that the medicinal plants exerted a physiological action on the hunter or his dog. Some of the plants mentioned contain chemicals that may explain the ethnomedicinal and ethnoveterinary use. For instance some of the plants influence the immune system or are effective against internal and external parasites. Plant baths may contribute to the health and well being of the hunting dogs

Assessing ad-hoc adaptations alignment with therapeutic goals: a qualitative study of lay counselor-delivered family therapy in Eldoret, Kenya.

BACKGROUND: A key question in implementation science is how to balance adaptation and fidelity in translating interventions to new settings. There is growing consensus regarding the importance of planned adaptations to deliver interventions in contextually sensitive ways. However, less research has examined ad-hoc adaptations, or those that occur spontaneously in the course of intervention delivery. A key question is whether ad-hoc adaptations ultimately contribute to or detract from intervention goals. This study aimed to (a) identify ad-hoc adaptations made during delivery of a family therapy intervention and (b) assess whether they promoted or interrupted intervention goals. METHODS: Tuko Pamoja (Swahili: We are Together) is an evidence-informed family therapy intervention aiming to improve family dynamics and mental health in Kenya. Tuko Pamoja employs a task-shifting model, delivered by lay counselors who are afforded a degree of flexibility in presenting content and in practices they use in sessions. We used transcripts of therapy sessions with 14 families to examine ad-hoc adaptations used by counselors. We first identified and characterized ad-hoc adaptations through a team-based code development, coding, and code description process. Then, we evaluated to what extent ad-hoc adaptations promoted the principles and strategies of the intervention (TP-promoting), disrupted them (TP-interrupting), or neither (TP-neutral). To do this, we first established inter-coder agreement on application of these categories with verification by the intervention developer. Then, coders categorized ad-hoc adaptation text segments as TP-promoting, TP-interrupting, or TP-neutral. RESULTS: Ad-hoc adaptations were frequent and included (in decreasing order): incorporation of religious content, exemplars/role models, community dynamics and resources, self-disclosure, and metaphors/proverbs. Ad-hoc adaptations were largely TP-promoting (49%) or neutral (39%), but practices were TP-interrupting 12% of the time. TP-interrupting practices most often occurred within religious content and exemplars/role models, which were also the most common practices overall. CONCLUSION: Extra attention is needed during planned adaptation, training, and supervision to promote intervention-aligned use of common ad-hoc adaptation practices. Discussing them in trainings can provide guidance for lay providers on how best to incorporate ad-hoc adaptations during delivery. Future research should evaluate whether well-aligned ad-hoc adaptations improve therapeutic outcomes. TRIAL REGISTRATION: Pilot trial registered at clinicaltrials.gov (C0058)

MS1 induces a spontaneous formation of free-floating insulin-positive PIs.

<p><b><i>A.</i></b> Light and phase contrast microscopy showing the formation of βTC3 PIs over 8 d. <b><i>B.</i></b> IF staining of βTC3 monolayers. Blue- DAPI, Red- Insulin and merge. <b><i>C.</i></b> 3-D reconstruction of z-stack confocal images of a representative PI. Blue- DAPI, Red- Insulin and merge.</p

Col-IV and laminin are detected in and around the PI.

<p><b><i>A.</i></b> IF staining of MS1 cells. Blue-DAPI, Green-CD31, Red-BS1 and merge. White/Yellow represents double positive cells. <b><i>B.</i></b> RT-PCR for laminin β1 and col-IV in MS1, whole murine islet preps, and βTC3 cells. Laminin α1 and α2 were not detected (data not shown). <b><i>C.</i></b> IF staining of MS1 cells. Blue- DAPI, Green- col-IV, White-Laminin, and merge. <b><i>D.</i></b> 3-D reconstruction of z-stack imaging of an 8 d old PI. <b><i>E.</i></b> Non-consecutive z-stack confocal images of a PI. Blue- DAPI, Red- Insulin, Green- col-IV, White- laminin.</p

Baseline and glucose stimulated insulin expression and secretion are enhanced in MS1-induced PIs.

<p><b><i>A.</i></b> FACS staining for proinsulin expression in monolayers (dotted line) and PIs (solid line). Grey histogram- isotype control. MFI: mono = 6579, PIs = 7486 <b><i>B.</i></b> Quantitative RT-PCR analysis of insulin 1 expression in βTC3 monolayers (closed bars) or PIs (opened bars). Data represents an average of 3 independent experiments. *<i>p<0.025</i>. Monolayers and PIs were cultured for 8 d, washed with media lacking glucose, and incubated with escalating glucose levels for 6 h. <b><i>C.</i></b> Insulin ELISA analysis of supernatant from βTC3 monolayers and PIs. Experiment represents three independent repeats. N = 3 per group. Two-way ANOVA analysis<b>.</b> <i>^†p<0.001, *p<0.0001.</i></p

Evaluation of β cell loss in MS1-induced PIs.

<p><b><i>A.</i></b> FACS staining for 7-AAD viability dye of monolayers (dotted line) and PIs (solid line). Grey histogram unstained control. Black arrow show 7-AAD positive cells. <b><i>B.</i></b> Non-consecutive z-stack confocal images of a 14 d old PI. Blue- DAPI, Red- Insulin, Green- cleaved caspase-3. White arrows point to caspase-3 positive cells.</p