Protocol for a feasibility study of group-based focused psychosocial support to improve the psychosocial well-being and functioning of adults affected by humanitarian crises in Nepal: Group Problem Management Plus (PM+)

Background The prevalence of common mental disorders increases in humanitarian emergencies while access to services to address them decreases. Problem Management Plus (PM+) is a brief five-session trans-diagnostic psychological WHO intervention employing empirically supported strategies that can be delivered by non-specialist lay-providers under specialist supervision to adults impaired by distress. Two recent randomized controlled trials in Pakistan and Kenya demonstrated the efficacy of individuallydelivered PM+. To make PM+ more scalable and acceptable in different contexts, it is important to develop a group version as well, with 6–8 participants in session. A study is needed to demonstrate the feasibility and acceptability of both the intervention in a new cultural context and the procedures to evaluate Group PM+ in a cluster randomized controlled trial. Go to: Methods This protocol describes a feasibility trial to Group PM+ in Sindhuli, Nepal. This study will evaluate procedures for a cluster randomized controlled trial (c-RCT) with Village Development Committees (VDCs), which are the second smallest unit of government administration, as the unit of randomization. Adults with high levels of psychological distress and functional impairment will receive either Group PM+ (n = 60) or enhanced usual care (EUC; n = 60). Psychological distress, functional impairment, depression symptoms, posttraumatic stress disorder (PTSD) symptoms, and perceived problems will be measured during screening, pre-treatment baseline, and 7–10 days after the intervention. Qualitative data will be collected from beneficiaries, their families, local stakeholders, and staff to support quantitative data and to identify themes reporting that those involved and/or effected by Group PM+ perceived it as being acceptable, feasible, and useful. The primary objective of this trial is to evaluate the acceptability and feasibility of the intervention; to identify issues around implementation of local adaptation methods, training, supervision, and outcomes measures; and to assure that procedures are adequate for a subsequent effectiveness c-RCT. Go to: Discussion Outcomes from this trial will contribute to optimizing feasibility and acceptability through cultural adaptation and contextualization of the intervention as well as refining the design for a c-RCT, which will evaluate the effectiveness of Group PM+ in Nepal. Go to: Trial registration ClinicalTrials.gov identifier: NCT03359486 Keywords: Low- and middle-income countries, Mental health, Non-specialists, Group interventions, Humanitarian emergencie

Participatory policy analysis in health policy and systems research: reflections from a study in Nepal.

Background Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country’s move to federalism on its health system, we reflect on the method’s strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach’s strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript. Main body We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues – especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants’ understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system. Conclusions PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders’ needs, it has great potential as a method in health policy and systems research

The impacts of decentralisation on health systems: a systematic review of reviews

Background: Despite decentralisation being a common mechanism through which health systems around the world have been reformed, a clear understanding of how decentralisation impacts health systems is lacking. Although both primary and secondary research exists, the evidence remains scattered. This review collected and synthesised evidence generated by previous reviews on the impact of decentralising health system governance on the six WHO (World Health Organization) health system building blocks. Methods: We systematically searched for reviews exploring the impact of decentralisation on the health system from five databases. Reviews, both systematic and non-systematic, published in the English language from 1990 to February 2022 were included. Quality assessment of the reviews was conducted using CASP for systematic reviews and SANRA for non-systematic reviews. Results: Nine reviews, each addressing slightly different questions, contexts and health system issues, were synthesised. They showed that devolution can have positive or negative impacts on the health system and its components. Moreover, impact assessments are significantly affected by complexities surrounding decentralisation and health system concepts: their dynamic mechanisms, inconsistent and often differently operationalized health system and health system component variables, and methodological challenges. For the WHO health system components, more negative than positive impacts were reported. The reviews highlight the importance of closely assessing (pre-)existing (political and non-political) characteristics of countries and their health systems to better understand impacts. Conclusions: Decentralisation can have a negative or a positive impact on the health system and its components; the impacts are shaped by pre-existing country contexts. Generating conclusive and generalisable evidence of the impacts of decentralisation on health systems is challenging. Whilst decentralisation may seek to enhance community engagement and improve the responsiveness of decision-making, it has the potential to create serious challenges to the health system, the manifestations of which are likely to be context-specific. Protocol Registration: PROSPERO CRD4202230201

Harnessing inter-disciplinary collaboration to improve emergency care in low- and middle-income countries (LMICs): results of research prioritisation setting exercise

Background More than half of deaths in low- and middle-income countries (LMICs) result from conditions that could be treated with emergency care - an integral component of universal health coverage (UHC) - through timely access to lifesaving interventions. Methods The World Health Organization (WHO) aims to extend UHC to a further 1 billion people by 2023, yet evidence supporting improved emergency care coverage is lacking. In this article, we explore four phases of a research prioritisation setting (RPS) exercise conducted by researchers and stakeholders from South Africa, Egypt, Nepal, Jamaica, Tanzania, Trinidad and Tobago, Tunisia, Colombia, Ethiopia, Iran, Jordan, Malaysia, South Korea and Phillipines, USA and UK as a key step in gathering evidence required by policy makers and practitioners for the strengthening of emergency care systems in limited-resource settings. Results The RPS proposed seven priority research questions addressing: identification of context-relevant emergency care indicators, barriers to effective emergency care; accuracy and impact of triage tools; potential quality improvement via registries; characteristics of people seeking emergency care; best practices for staff training and retention; and cost effectiveness of critical care – all within LMICs. Conclusions Convened by WHO and facilitated by the University of Sheffield, the Global Emergency Care Research Network project (GEM-CARN) brought together a coalition of 16 countries to identify research priorities for strengthening emergency care in LMICs. Our article further assesses the quality of the RPS exercise and reviews the current evidence supporting the identified priorities

Participatory policy analysis in health policy and systems research: reflections from a study in Nepal

Background Participatory policy analysis (PPA) as a method in health policy and system research remains underexplored. Using our experiences of conducting PPA workshops in Nepal to explore the impact of the country’s move to federalism on its health system, we reflect on the method’s strengths and challenges. We provide an account of the study context, the design and implementation of the workshops, and our reflections on the approach’s strengths and challenges. Findings on the impact of federalism on the health system are beyond the scope of this manuscript. Main body We conducted PPA workshops with a wide range of health system stakeholders (political, administrative and service-level workforce) at the local and provincial levels in Nepal. The workshops consisted of three activities: river of life, brainstorming and prioritization, and problem-tree analysis. Our experiences show that PPA workshops can be a valuable approach to explore health policy and system issues – especially in a context of widespread systemic change which impacts all stakeholders within the health system. Effective engagement of stakeholders and activities that encourage both individual- and system-level reflections and discussions not only help in generating rich qualitative data, but can also address gaps in participants’ understanding of practical, technical and political aspects of the health system, aid policy dissemination of research findings, and assist in identifying short- and long-term practice and policy issues that need to be addressed for better health system performance and outcomes. Conducting PPA workshops is, however, challenging for a number of reasons, including the influence of gatekeepers and power dynamics between stakeholders/participants. The role and skills of researchers/facilitators in navigating such challenges are vital for success. Although the long-term impact of such workshops needs further research, our study shows the usefulness of PPA workshops for researchers, for participants and for the wider health system. Conclusions PPA workshops can effectively generate and synthesize health policy and system evidence through collaborative engagement of health system stakeholders with varied roles. When designed with careful consideration for context and stakeholders’ needs, it has great potential as a method in health policy and systems research

Two-dimensional electrophoretic comparison of metastatic and non-metastatic human breast tumors using in vitro cultured epithelial cells derived from the cancer tissues

<p>Abstract</p> <p>Background</p> <p>Breast carcinomas represent a heterogeneous group of tumors diverse in behavior, outcome, and response to therapy. Identification of proteins resembling the tumor biology can improve the diagnosis, prediction, treatment selection, and targeting of therapy. Since the beginning of the post-genomic era, the focus of molecular biology gradually moved from genomes to proteins and proteomes and to their functionality. Proteomics can potentially capture dynamic changes in protein expression integrating both genetic and epigenetic influences.</p> <p>Methods</p> <p>We prepared primary cultures of epithelial cells from 23 breast cancer tissue samples and performed comparative proteomic analysis. Seven patients developed distant metastases within three-year follow-up. These samples were included into a metastase-positive group, the others formed a metastase-negative group. Two-dimensional electrophoretical (2-DE) gels in pH range 4–7 were prepared. Spot densities in 2-DE protein maps were subjected to statistical analyses (R/maanova package) and data-mining analysis (GUHA). For identification of proteins in selected spots, liquid chromatography-tandem mass spectrometry (LC-MS/MS) was employed.</p> <p>Results</p> <p>Three protein spots were significantly altered between the metastatic and non-metastatic groups. The correlations were proven at the 0.05 significance level. Nucleophosmin was increased in the group with metastases. The levels of 2,3-trans-enoyl-CoA isomerase and glutathione peroxidase 1 were decreased.</p> <p>Conclusion</p> <p>We have performed an extensive proteomic study of mammary epithelial cells from breast cancer patients. We have found differentially expressed proteins between the samples from metastase-positive and metastase-negative patient groups.</p

Resource Use Efficiency of Maize Production with and Without Irrigation System in Kaski, Nepal

The study examined the resource use efficiency of maize production in rainfed and irrigated conditions in Kaski, Nepal. It focused specially on the production function of maize, resource use efficiency and socioeconomic characteristics of the farmers. A well-structured interview schedule was used in this study. Out of the 368 households interviewed, 165 farmers cultivated maize and a total of 157 farmers (59 from irrigated and 98 from rainfed) provided useful data. The data analysis was done by using Microsoft excel and SPSS. Cobb-Douglas production function was used to determine the resource use efficiency of maize production. &nbsp;Compared to rainfed system, maize productivity in irrigated system was higher despite the use of fewer input implying irrigation. Increase in seed use by 10% increased the yield by 1.9% in case of rainfed system and 0.05% in case of the irrigated system. The major implication for the study is that farmers should make proper utilization of their resources to achieve higher level of resource use efficiency

Bridging Yield Gap of Winter Maize Using Improved Agronomic Management Practices

Appropriate combinations of inputs determine the productivity of crops. A field experiment was carried out to evaluate the effect of different combinations of inputs on the yield of winter maize at National Maize Research Program (NMRP), Rampur, Chitwan. The experiment was laid out in randomized complete block design with four replications comprising of six treatments (T1= Hybrid (H) + recommended doses of NPK (RD) + irrigation (I) + high density (HD) (83333 plant ha-1) + improved weed management practice (IWMP), T2=Open pollinated variety (OPV)+RD+I+HD+IWMP, T3=OPV+ farmer's doses of NPK (FD)+I+HD+IWMP, T4= OPV+FD+rainfed (R)+HD+IWMP, T5=OPV+ FD+ R+low&nbsp; density (LD) (55555 plant ha-1) + IWMP, T6=OPV+FD+R+LD+ farmer's weed management practice (FWMP). The research result revealed significant variation on the grain yield among the different treatments. The highest grain yield (5357 kg ha-1) was obtained when hybrid maize was grown with recommended dose of fertilizer, higher density, irrigation and improved weed management practices. This treatment was followed by replacement of OPV in the above treatment (4410.77 kg ha-1). The decline in yield due to replacement of OPV from hybrid was 17.67 percent. The percent yield decline from full Package of practices (T1) were 23.01, 47.81, 36.66 and 35.95 when input combinations OPV+FD+I+ HD+IWMP, OPV + FD+R+HD+IWMP, OPV+FD+R+LD+IWMP and OPV+FD+R+LD+ FWMP respectively were used..The contrast for grain yield between hybrid vs. OPV, RD vs. FD and Irrigated vs. Rainfed were significant. Therefore, present investigation showed hybrid maize, recommended dose of fertilizer and irrigation were the most important inputs for improving maize productivity in winter season in Chitwan like climatic condition

Perceptions around COVID-19 and vaccine hesitancy: A qualitative study in Kaski district, Western Nepal

Burgeoning morbidity and mortality due to COVID-19 pandemic including the peaks in outbreaks due to different variants have attracted global attention. Although the development and rolling out of vaccines have been impressive, low- and middle-income countries suffer from a double burden: (1) lack of adequate vaccines; and (2) low vaccine uptake (vaccine hesitancy). The main objective of this study was to explore perceptions around COVID-19 and vaccine hesitancy among urban and rural population in Western Nepal. A qualitative study was conducted in six urban wards of Pokhara municipality and four rural municipalities in Kaski district of Nepal. A semi-structured interview guide was used to interview participants who were selected purposively to explore the perceived burden of COVID-19 pandemic, roles, and contributions of vaccine. Nineteen interviews were conducted by telephone following a government recommendation to avoid face-to-face meetings. Audio-recorded interviews were thematically analysed after transcription and translation into English. COVID-19 is a major (public) health concern and affects people at an individual, societal and national level. People dreaded its health hazards and consequences and seemed to be compliant with public health measures such as maintaining social distance, wearing masks and maintaining hygiene. Vaccine was considered to be a major intervention to fight the pandemic, nonetheless, the rationale and benefits of vaccines were blemished by the perceived lack of the vaccine’s effectiveness, duration of protection, and its potential side-events. Expedited development of vaccine was embraced with suspicion that vaccine may have incurred compromise in quality. Science and rationale behind vaccine were smeared by misinformation and clearly counteracting the misinformation were deemed critical. Providing information about vaccines through government entities (who are trusted) and respected individuals may engender trust and uptake of vaccine. Fighting off misinformation of COVID-19 is critical to curb the course of pandemic. Increased attention towards monitoring and investing in legitimacy of information and offering information through trusted sources can help improve the vaccine coverage