Effect of counseling by paraprofessionals on depression, anxiety, somatization, and functioning in Indonesian torture survivors

The Indonesian population has faced political violence, victimization, and torture throughout the last 70 years. Due to the scarcity of mental health professionals in many low and middle-income countries, counseling programs are increasingly utilizing paraprofessionals to provide support to the affected population as a strategy of task shifting. In this article, we would like to examine the effectiveness of counseling services provided by such trained paraprofessionals. This study was part of program evaluation to determine whether the participants (torture survivors) improved after counseling services provided by trained paraprofessionals in Indonesia. Local communities were invited to join the psychosocial program created and implemented by an NGO in 2005. The 178 participants were recruited from Jakarta, Papua, and Aceh, Indonesia for the program, which aimed to help survivors of violence suffering from “heavy hearts.” The intervention lasted three months, and the follow-up intake was conducted after four months. The results indicated the participants’ anxiety symptoms, depressive symptoms, somatic symptoms, and functioning improved from the intake to the follow-up. The program appeared to have been effective in reducing the participants’ symptoms and impairment in functioning. This indicates that in countries where there is a scarcity of mental health professionals, working with paraprofessionals has the potential to help survivors of torture and violence

Factors supporting substance use improvement for Black Americans: A population health observational study

BACKGROUND: Black clients in substance use disorder (SUD) treatment are associated with the lowest successful completion and substance use reductions. More work is needed to identify specific factors that support successful recovery of Black clients. METHODS: Data from U.S. outpatient SUD treatment facilities receiving public funding from 2015 to 2019 were analyzed (N = 2239, 197). Primary analyses consisted of Black clients (n = 277, 726) reporting admission and discharge substance use frequency. Multiple logistic regression was used to predict substance use frequency improvement from Black client demographic, recovery capital, treatment characteristics, and state. Disparities were compared between Black and non-Black clients. RESULTS: The overall Black client improvement percentage was 46.95%. Mutual-help group attendance and Length of Stay demonstrated clinically meaningful effect sizes controlling for all other variables and state. Attending mutual-help groups 8-30 times per month (State aOR = 2.54, 95% CI = 2.43, 2.64) and outpatient treatment stays of 4 months or more (State aOR = 2.50, 95% CI = 2.44, 2.56) were factors supporting Black client improvement. Importantly, states are associated with disparate Black client risk differences and only South Dakota had greater Black improvement (RD = 6.35, 95% CI = 1.00, 11.71). CONCLUSIONS: Black client factors supporting substance use improvement include ancillary mutual-help group attendance and increased treatment retention. These factors may be more critical in states with larger Black improvement disparities. In general, treatment providers increasing access to mutual-help groups, and adjusting program inclusiveness and motivational factors for retention, would make strides in increasing improvement outcomes for Black clients

Village-Integrated Eye Worker trial (VIEW): rationale and design of a cluster-randomised trial to prevent corneal ulcers in resource-limited settings.

IntroductionCorneal opacity is a leading cause of blindness worldwide. In resource-limited settings, untreated traumatic corneal abrasions may result in infection and ultimately, opacity. Although antimicrobial treatment of corneal ulcers may successfully cure infections, the scarring that accompanies the resolution of infection can still result in visual impairment. Prevention may be the optimal approach for reducing corneal blindness. Studies have employed community health workers to provide prompt administration of antimicrobials after corneal abrasions to prevent infections, but these studies were not designed to determine the effectiveness of such a programme.Methods and analysisThe Village-Integrated Eye Worker trial (VIEW) is a cluster-randomised trial designed to assess the effectiveness of a community health worker intervention to prevent corneal ulcers. Twenty-four Village Development Committees (VDCs) in Nepal were randomised to receive a corneal ulcer prevention programme or to no intervention. Female Community Health Volunteers (FCHVs) in intervention VDCs are trained to diagnose corneal abrasions, provide antimicrobials and to refer participants when needed. An annual census is conducted over 3 years in all study VDCs to assess the incidence of corneal ulceration via corneal photography (primary outcome). Masked outcome assessors grade corneal photographs to determine the presence or absence of incident corneal opacities. The primary analysis is negative binomial regression to compare the incidence of corneal ulceration by study arm.Ethics and disseminationThe University of California San Francisco Committee on Human Research, Nepal Netra Jyoti Sangh and the Nepal Health Research Council have given ethical approval for the trial. The results of this trial will be presented at local and international meetings and submitted to peer-reviewed journals for publication.Trial registration numberNCT01969786; Pre-results

Leaf and fruit characteristics of Shea (Vitellaria paradoxa) in Northern Ghana

Leaf and fruit parameters of Vitellaria paradoxa populations in north-south gradientof the shea belt in the transitional and Guinea Savanna zones of Ghana were comparedduring the fruiting season between April to July, 2011. Leafmorphological traits studied include laminar width, petiole and laminar lengths. Fruitparameters measured include fruit and kernel widths, lengths, weights and pulp weight.Results showed variability for most of the characters determined. The leaves in Paga hadshorter petioles as compared to those of Nyankpala and Kawampe. The Nyankpala V. paradoxa has the smallest laminar width whilst Kawampe has longest leaf laminar ascompared to the rest. Values for fruit and kernel parameters were highest for samples fromPaga, followed by Kawampe and were significantly higher than those from Nyankpala.There were significant positive relationships between fresh fruit weight and both freshkernel weight (P < 0.001; R2 = 0.6925) and dry kernel weight (P < 0.001; R2 = 0.6532) for datapooled from all the three locations, however, the slopes and intercepts varied betweenlocations (P < 0.001). The result from the study provides opportunities and prospects forselection and breeding for V. paradoxa tree improvement in Ghana

Can REDD+ social safeguards reach the ‘right’ people? Lessons from Madagascar

AbstractThere is extensive debate about the potential impact of the climate mechanism REDD+ on the welfare of forest-dwelling people. To provide emission reductions, REDD+ must slow the rate of deforestation and forest degradation: such a change will tend to result in local opportunity cost to farmers at the forest frontier. Social safeguard processes to mitigate negative impacts of REDD+ are being developed and can learn from existing safeguard procedures such as those implemented by the World Bank. Madagascar has a number of REDD+ pilot projects with World Bank support including the Corridor Ankeniheny-Zahamena (CAZ). Nearly two thousand households around the corridor have been identified as ‘project affected persons’ (PAPs) and given compensation. We compare households identified as project affected persons with those not identified. We found households with more socio-political power locally, those with greater food security, and those that are more accessible were more likely to be identified as eligible for compensation while many people likely to be negatively impacted by the REDD+ project did not receive compensation. We identify three issues which make it difficult for a social safeguard assessment to effectively target the households for compensation: (a) poor information on location of communities and challenging access means that information does not reach remote households; (b) reluctance of people dependant on shifting agriculture to reveal this due to government sanctions; and (c) reliance by safeguard assessors on non-representative local institutions. We suggest that in cases where the majority of households are likely to bear costs and identification of affected households is challenging, the optimal, and principled, strategy may be blanket compensation offered to all the households in affected communities; avoiding the dead weight costs of ineffective safeguard assessments. The Paris Agreement in December 2015 recognised REDD+ as a key policy instrument for climate change mitigation and explicitly recognised the need to respect human rights in all climate actions. However, safeguards will be prone to failure unless those entitled to compensation are aware of their rights and enabled to seek redress where safeguards fail. This research shows that existing safeguard commitments are not always being fulfilled and those implementing social safeguards in REDD+ should not continue with business as usual

Stigma against mental health disorders in Nepal conceptualised with a 'what matters most' framework: a scoping review.

Stigma related to mental disorders is a barrier to quality mental healthcare. This scoping review aimed to synthesise literature on stigma related to mental disorders in Nepal to understand stigma processes. The anthropological concept of 'what matters most' to understand culture and stigma was used to frame the literature on explanatory models, manifestations, consequences, structural facilitators and mitigators, and interventions. We conducted a scoping review with screening guided by the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews (PRISMA-ScR). A structured search was done using three international databases (PsycINFO, Medline and Web of Science), one Nepali database (NepJol) and cross-referencing for publications from 1 January 2000 through 24 June 2020. The search was repeated to include structural stigma-related terms. Quality of quantitative studies was assessed using the Systematic Assessment of Quality in Observational Research (SAQOR) tool. The review was registered through the Open Science Framework (OSF) (osf.io/u8jhn). The searches yielded 57 studies over a 20-year period: 19 quantitative, 19 qualitative, nine mixed methods, five review articles, two ethnographies and three other types of studies. The review identified nine stigma measures used in Nepal, one stigma intervention, and no studies focused on adolescent and child mental health stigma. The findings suggest that 'what matters most' in Nepali culture for service users, caregivers, community members and health workers include prestige, productivity, privacy, acceptance, marriage and resources. Cultural values related to 'what matters most' are reflected in structural barriers and facilitators including lack of policies, programme planning and resources. Most studies using quantitative tools to assess stigma did not describe cultural adaptation or validation processes, and 15 out of the 18 quantitative studies were 'low-quality' on the SAQOR quality rating. The review revealed clear gaps in implementation and evaluation of stigma interventions in Nepal with only one intervention reported, and most stigma measures not culturally adapted for use. As stigma processes are complex and interlinked in their influence on 'what matters most' and structural barriers and facilitators, more studies are required to understand this complexity and establish effective interventions targeting multiple domains. We suggest that stigma researchers should clarify conceptual models to inform study design and interpretations. There is a need to develop procedures for the systematic cultural adaptation of stigma assessment tools. Research should be conducted to understand the forms and drivers of structural stigma and to expand intervention research to evaluate strategies for stigma reduction

Review of the mechanisms of debris-flow impact against barriers

Our limited understanding of the mechanisms pertaining to the force exerted by debris flows on barriers makes it difficult to ascertain whether a design is inadequate, adequate, or over-designed. The main scientific challenge is because flow-type landslides impacting a rigid barrier is rarely captured in the field, and no systematic, physical experimental data is available to reveal the impact mechanisms. An important consideration in flow-structure interaction is that the impact dynamics can differ radically depending on the composition of the flow. Currently, no framework exists that can characterize the impact behavior for a wide range of flow compositions. This review paper examines recent works on debris-flow structure interactions and the limitations of commonly used approaches to estimate the impact load for the design of barriers. Key challenges faced in this area and outlook for further research are discussed

The induction of microRNA-16 in colon cancer cells by protein arginine deiminase inhibition causes a p53-dependent cell cycle arrest.

Protein Arginine Deiminases (PADs) catalyze the post-translational conversion of peptidyl-Arginine to peptidyl-Citrulline in a calcium-dependent, irreversible reaction. Evidence is emerging that PADs play a role in carcinogenesis. To determine the cancer-associated functional implications of PADs, we designed a small molecule PAD inhibitor (called Chor-amidine or Cl-amidine), and tested the impact of this drug on the cell cycle. Data derived from experiments in colon cancer cells indicate that Cl-amidine causes a G1 arrest, and that this was p53-dependent. In a separate set of experiments, we found that Cl-amidine caused a significant increase in microRNA-16 (miRNA-16), and that this increase was also p53-dependent. Because miRNA-16 is a putative tumor suppressor miRNA, and others have found that miRNA-16 suppresses proliferation, we hypothesized that the p53-dependent G1 arrest associated with PAD inhibition was, in turn, dependent on miRNA-16 expression. Results are consistent with this hypothesis. As well, we found the G1 arrest is at least in part due to the ability of Cl-amidine-mediated expression of miRNA-16 to suppress its\u27 G1-associated targets: cyclins D1, D2, D3, E1, and cdk6. Our study sheds light into the mechanisms by which PAD inhibition can protect against or treat colon cancer

Prevalence and risk factors associated with chronic kidney disease in Nepal: evidence from a nationally representative population-based cross-sectional study.

OBJECTIVE: This study aimed to determine population-based prevalence of chronic kidney disease (CKD) and its associated factors in Nepal. STUDY DESIGN: The study was a nationwide population-based cross-sectional study. SETTING AND PARTICIPANTS: Cross-sectional survey conducted in a nationally representative sample of 12 109 Nepalese adult from 2016 to 2018 on selected chronic non-communicable diseases was examined. Multistage cluster sampling with a mix of probability proportionate to size and systematic random sampling was used for the selection of individuals aged 20 years and above. PRIMARY AND SECONDARY OUTCOME MEASURES: Primary outcome in this study was population-based prevalence of CKD in Nepal. A participant was considered to have CKD if the urine albumin-to-creatinine ratio was greater than or equal to 30 mg/g and/or estimated glomerular filtration rate is less than 60 mL/min/1.73 m2 at baseline and in follow-up using modification of diet in renal disease study equations. The secondary outcome measure was factors associated with CKD in Nepal. The covariate adjusted association of risk factors and CKD was calculated using multivariable binary logistic regression. RESULTS: The overall prevalence of CKD in Nepal was 6.0% (95% CI 5.5 to 6.6). Factors independently associated with CKD included older age (adjusted OR (AOR) 2.6, 95% CI 1.9 to 3.6), Dalit caste (AOR 1.6, 95% CI 1.1 to 2.3), hypertension (AOR 2.4, 95% CI 2.0 to 3.0), diabetes mellitus (AOR 3.2, 95% CI 2.5 to 4.1), raised total cholesterol (AOR 1.3, 95% CI 1.0 to 1.6) and increased waist-to-hip ratio (AOR 1.6, 95% CI 1.2 to 2.3). CONCLUSION: This nationally representative study shows that the prevalence of CKD in the adult population of Nepal is substantial, and it is independently associated with several cardiometabolic traits. These findings warrant longitudinal studies to identify the causes of CKD in Nepal and effective strategies to prevent it

Determinants of institutional birth among women in rural Nepal: a mixed-methods cross-sectional study

Background: Encouraging institutional birth is an important component of reducing maternal mortality in low-resource settings. This study aims to identify and understand the determinants of persistently low institutional birth in rural Nepal, with the goal of informing future interventions to reduce high rates of maternal mortality. Methods: Postpartum women giving birth in the catchment area population of a district-level hospital in the Far-Western Development Region of Nepal were invited to complete a cross-sectional survey in 2012 about their recent birth experience. Quantitative and qualitative methods were used to determine the institutional birth rate, social and demographic predictors of institutional birth, and barriers to institutional birth. Results: The institutional birth rate for the hospital's catchment area population was calculated to be 0.30 (54 home births, 23 facility births). Institutional birth was more likely as age decreased (ORs in the range of 0.20-0.28) and as income increased (ORs in the range of 1.38-1.45). Institutional birth among women who owned land was less likely (OR = 0.82 [0.71, 0.92]). Ninety percent of participants in the institutional birth group identified safety and good care as the most important factors determining location of birth, whereas 60 % of participants in the home birth group reported distance from hospital as a key determinant of location of birth. Qualitative analysis elucidated the importance of social support, financial resources, birth planning, awareness of services, perception of safety, and referral capacity in achieving an institutional birth. Conclusion: Age, income, and land ownership, but not patient preference, were key predictors of institutional birth. Most women believed that birth at the hospital was safer regardless of where they gave birth. Future interventions to increase rates of institutional birth should address structural barriers including differences in socioeconomic status, social support, transportation resources, and birth preparedness