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There is a dearth of psychological interventions for self-harm that have been tested and found acceptable by youth in low- and middle income countries. ĀTMAN (Sanskrit word meaning "self" or "self-existent essence") is one such contextually adapted psychological intervention developed in India. It has three key elements; problem-solving, emotion regulation, and social network strengthening skills. We delivered ATMAN in a series of young people who self-harm to optimize the content, structure and delivery mechanisms, and to assess their experiences of therapy and engagement. ATMAN was delivered sequentially by a psychiatrist and non-specialist counselor in 16 participants between 14 to 24 years who presented to a tertiary level public hospital in Mumbai with self-harm. Quantitative measurement tools included Beck's Scale for Suicidal Ideation (BSI), the Patient Health Questionnaire −9 (PHQ-9), Functional Assessment of Self-Mutilation, and session feedback form. Qualitative tools included PSYCHLOPS and exit interviews. Eight female and four male participants completed therapy with a mean of five sessions and an average duration of 50 min. There were no differences in module wise feedback ratings of the psychiatrist and counselor. There were significant differences in the pre- and post-therapy scores on BSI (mean difference (confidence interval)) (−16.8 (−20.2, −13.3)) and PHQ-9 (−10.8 (−14.5, −7.04)). Various content modifications were undertaken during this phase. ATMAN was acceptable to youth in India who self-harm. Modifications introduced during pilot trial phase make ATMAN better suited to the needs of the youth. ATMAN has the potential to be delivered by non- specialist counselors and to be integrated at all levels of health care settings including primary health care to reduce the burden of suicide in young people. However, an extended randomized controlled trial of ATMAN treatment with multiple counselors will help in identifying key competencies that should be developed during training and supervision, and various quality assurance measures that can be undertaken for effective implementation of ATMAN. [ABSTRACT FROM AUTHOR]

This article examines the vibrant presence of tantric religiosity in contemporary India through a case study of a Mumbai-based tāntrika, whom we call Ramji Pandit, and of the ways in which his Tantra is co-constitutive of contemporary business practices and global market economies. We show how Ramji's tantric ritual services – based firmly in mantras, yantras, and a "science" of vibrational resonance – trouble the conventional ways that religion and economy are often conceptualized as separate domains of value and practice , thought to act upon one another. At once mediating the contradictions of a market-forward liberal socio-economic order, subverting hegemonic forms of economic rationality, and reinforcing consumerist structures and values of late capitalism, Ramji's tantric practice is of a piece with today's global economy in ways that demand further exploration. By investigating the economic and spiritual value projects and goals in which Tantra is enlisted, this article explores the "value of Tantra" today in India and globally. [ABSTRACT FROM AUTHOR]

Background There is an urgent need for context-specific research leading to development of scalable interventions to address self-harm and suicide in low and middle-income countries (LMICs). Objective The current study was conducted to determine the contents of a psychological intervention to reduce recurrence of self-harm and improve functioning in youth who self-harm in India and finalise its delivery mechanisms. Methods A systematic, sequential approach was used to integrate available scientific evidence, expert service providers' knowledge and experience, and service users' lived experiences in the codesigning and development of a psychological intervention. The steps included: identifying prioritised outcomes for youth who self-harm as well as a selection of feasible and acceptable elements from self-harm interventions that have been trialled in LMICs, intervention development workshops with mental health professionals and youth to finalise elements, a review of relevant treatment manuals to decide on the treatment framework, and finalising the treatment structure and schedule in the second round of intervention development workshops. Findings We developed ATMAN treatment with three key elements; problem solving, emotion regulation and social network strengthening skills. The delivery schedule emphasises on the engagement elements, and allows for involvement of other stakeholders such as family members when acceptable to the clients. Conclusion and clinical implications ATMAN treatment could prove to be especially effective in reducing self-harm recurrence in youth in India due to its brief schedule, elements that have been selected in collaboration with the service users and its potential to be scaled up for delivery by non-specialist treatment providers. [ABSTRACT FROM AUTHOR]

Background There are very few studies that have examined the effectiveness of psychological interventions (PIs) that have been developed and tested in high-income countries to reduce self- harm in low and middle-income countries. Objective To evaluate the perspectives and explanatory styles of youth with self-harm and their caregivers to inform the design of an evidence based PI in a non-Western cultural setting. An additional objective was to suggest ways of integrating local practices and traditions to enhance its acceptability. Methods We conducted 15 in- depth qualitative interviews with youth with self-harm and four interviews with the caregivers in the psychiatry department of a tertiary hospital located in Mumbai, India. Data were analysed using phenomenological thematic analysis. Findings Five themes were uncovered: (i) contextual factors related to self-harm including interpersonal factors, intrapersonal factors and socio-cultural factors; (ii) formulation and current feelings about the attempt (iii) family members and friends as the perceived supports and deterrents for future self-harm attempts; (iv) treatment related experiences with counselling, in- patient and outpatient treatment and barriers to treatment; and (v) coping strategies. Recommendations for key areas of adaptation include therapist adaptation, content adaptation to accommodate for cultural considerations and broader social context. Gender based socio-cultural norms, beliefs and stigma attached to self-harm need to be specifically addressed in South Asian setting. Interpersonal conflicts are the most common triggers. Conclusion and clinical implications To our knowledge this is the first study in the South Asian context evaluating explanatory styles of youth with self-harm and their caregivers to inform the design of an intervention to ensure its cultural congruence. Cultural adaptation of an evidence based PI results in competent delivery and ensures best results in diverse ethno-cultural populations. [ABSTRACT FROM AUTHOR]

Background: Strengthening Evidence base on scHool-based intErventions for pRomoting adolescent health (SEHER) is a multicomponent, whole-school health promotion intervention delivered by a lay counsellor or a teacher in government-run secondary schools in Bihar, India. The objective of this study is to examine the effects of the intervention after two years of follow-up and to evaluate the consistency of the findings observed over time.Methods and Findings: We conducted a cluster randomised trial in which 75 schools were randomised (1:1:1) to receive the SEHER intervention delivered by a lay counsellor (SEHER Mitra [SM]) or a teacher (Teacher as SEHER Mitra [TSM]), respectively, alongside a standardised, classroom-based life skills Adolescence Education Program (AEP), compared to AEP alone (control group). The trial design was a repeat cross-sectional study. Students enrolled in grade 9 (aged 13-15 years) in the 2015-2016 academic year were exposed to the intervention for two years and the outcome assessment was conducted at three time points─at baseline in June 2015; 8-months follow-up in March 2016, when the students were still in grade 9; and endpoint at 17-months follow-up in December 2016 (when the students were in grade 10), the results of which are presented in this paper. The primary outcome, school climate, was measured with the Beyond Blue School Climate Questionnaire (BBSCQ). Intervention effects were estimated using mixed-effects linear or logistic regression, including a random effect to adjust for within-school clustering, minimisation variables, baseline cluster-level score of the outcome, and sociodemographic characteristics. In total, 15,232 students participated in the 17-month survey. Compared with the control group, the participants in the SM intervention group reported improvements in school climate (adjusted mean difference [aMD] = 7.33; 95% CI: 6.60-8.06; p < 0.001) and most secondary outcomes (depression: aMD = -4.64; 95% CI: -5.83-3.45; p < 0.001; attitude towards gender equity: aMD = 1.02; 95% CI: 0.65-1.40; p < 0.001; frequency of bullying: aMD = -2.77; 95% CI: -3.40 to -2.14; p < 0.001; violence victimisation: odds ratio [OR] = 0.08; 95% CI: 0.04-0.14; p < 0.001; and violence perpetration: OR = 0.16; 95% CI: 0.09-0.29; p < 0.001). There was no evidence of an intervention effect in the TSM group compared with control group. The effects of the lay counsellor-delivered intervention were larger for most outcomes at 17-months follow-up compared with those at 8 months: school climate (effect size [ES; 95% CI] = 2.23 [1.97-2.50] versus 1.88 [1.44-2.32], p < 0.001); depression (ES [95% CI] = -1.19 [-1.56 to -0.82] versus -0.27 [-0.44 to -0.11], p < 0.001); attitude towards gender equity (ES [95% CI] = 0.53 [0.27-0.79] versus 0.23 [0.10-0.36], p < 0.001); bullying (ES [95% CI] = -2.22 [-2.84 to -1.60] versus -0.47 [-0.61 to -0.33], p < 0.001); violence victimisation (OR [95% CI] = 0.08 [0.04-0.14] versus 0.62 [0.46-0.84], p < 0.001); and violence perpetration (OR [95% CI] = 0.16 [0.09-0.29] versus 0.68 [0.48-0.96], p < 0.001), suggesting incremental benefits with an extended intervention. A limitation of the study is that 27% of baseline participants did not complete the 17-month outcome assessment.Conclusions: The trial showed that the second-year outcomes were similar to the first-year outcomes, with no effect of the teacher-led intervention and larger benefits on school climate and adolescent health accruing from extending lay counsellor-delivered intervention.Trial Registration: ClinicalTrials.gov NCT02907125. [ABSTRACT FROM AUTHOR]

The paper examines the memory and hagiography of the important but little-researched late sixteenth-century bhakti saint Agradās. After introducing this influential Vaiṣṇava devotional poet and the Rām rasik tradition he is said to have founded, the paper explores the political realities and motivations behind the molding of Agradās's hagiography in particular ways in the nineteenth century and how his saintly authority has been drawn upon in modern times. Through a case study of Agradās, the paper makes an argument about the totemic function of the Hindu saint as a tangible expression of the intangible values and sentiments that bond and mobilize religious communities. [ABSTRACT FROM AUTHOR]

In order to investigate the possibility of a long-term paleoseismic history from offshore sedimentary records in Sumatra, we collected 144 deep-sea sediment cores in the trench and in lower slope piggyback basins of the Sumatra accretionary prism. We used multibeam bathymetry and seismic reflection data to develop an understanding of catchment basins, turbidity current pathways, and depositional styles, as well as to precisely locate our gravity cores, piston cores, Kasten cores, and multicores. We use detailed physical property data, including computed tomographic X-ray, gamma density, magnetic susceptibility, grain-size analysis, faunal analysis, and smear slides, to evaluate the turbidite stratigraphy and sedimentology at each site. We use radiocarbon age control for piggyback basin sites above the carbonate compensation depth, and use 210Pb and 137Cs to evaluate the timing of the most recent sedimentary deposits. Using well-log correlation methods and radiometric age control, we test for potential correlations between isolated sites in piggyback basins and the trench. We find evidence for very young surface turbidites along the northern Sumatra margin, most likely emplaced within the past few decades at the seafloor in both the 2004 and 2005 earthquake rupture zones, with no overlying hemipelagic sediment. Based on the young soupy deposits, lack of oxidation, and 210Pb and 14C age determinations, we interpret the uppermost turbidite in 21 cores within the 2004 rupture area to have been deposited within a few years of collection in 2007, and most likely as a result of the 2004 moment magnitude (Mw) ~9.2 earthquake. The likely 2004 turbidite has a distinctive stacked structure of three major fining-upward sequences observed at several basin and trench sites, similar to the pattern of moment release in the 2004 earthquake. We observe rapid die out of the 2004 and 2005 deposits with distance from the slip zones, from local sources of sediment supply, and in the segment boundary between the slip zones. Many individual turbidites show strong similarities between isolated sites, as well as having similar emplacement times. Based upon radiocarbon age control and lithostratigraphic correlations between isolated basin and trench core sites, we interpret that 43 turbidites can be linked spatially over a distance of ~230 km within the southern portion of the 2004 rupture zone. Sampling at deep-water sites isolated from terrestrial and shallow-water sediment sources, as well as potential storm or tsunami wave triggers, limits potential mechanisms for initiating turbidity currents to plate boundary, crustal, or slab earthquakes. Other potential triggers, such as tectonic oversteepening, random self-failures, gas hydrate destabilization, are unlikely to be correlative between any two isolated sites. The most probable explanation for the similarity of timing, turbidite sequences, and individual turbidite structure in isolated basin and trench stratigraphic sequences is a seismogenic origin. The mean emplacement time for turbidites (likely triggered by Great earthquakes, magnitude > ~8) in the 2004 rupture region for the past 6.6 ± 0.14 k.y. is 160 yr for 43 turbidites. The ages of 8 of the 10 uppermost turbidite deposits, spanning the past ~1500 yr, are largely consistent with the terrestrial paleoseismic and/or tsunami records in Thailand, Sumatra, India, and the Andaman Islands, suggesting either coincidence or a common origin. The mean interseismic time from the turbidite record for this same period is 170 yr, comparable to the ~210 yr recurrence for regional tsunami. The turbidite record, at 180 yr (6 events), compares reasonably well to the average for all events on northern Simeulue of 220 yr, and is identical to the tsunami interval of 180 yr for the same time period (6 events). Of the 43 correlated turbidites in the 2004 earthquake region, 13 are well correlated in our cores along strike lengths of 150 km or greater, and satisfy criteria for robustness; 24 turbidites correlated along a shorter strike distance may represent other plate boundary earthquakes of shorter spatial extent and may include turbidite beds sourced from crustal and slab earthquakes. [ABSTRACT FROM AUTHOR]

This article explores bhakti attitudes towards Tantra in early modern north India by focusing specifically on the figure of the tantric yogī as healer in bhakti poems and hagiographies. A phenomenal rise of devotional (bhakti) literature and communities occurred in Mughal India and scholarship has neglected to examine how bhakti’s ascent took place in conjunction with, and even depended on, the marginalisation of formerly dominant tantric religious paradigms. This article aims to shed some light on this historical development by demonstrating the way in which early modern north Indian bhakti literature marked the utter powerlessness of the tantric yogīs’ tantra-mantra against either the snake of viraha (love in separation from the Divine) or the snake of māyā (that worldly delusion and desire that bind us in suffering and prevent liberation). We’ve been bitten, my friend, by a dark, black snake, and no one—no one but the Lord of the Yadus—can take the poison away. SūrdāsAgainst the snake of passionate desire, no mantra nor magic avails. Raidās [ABSTRACT FROM PUBLISHER]

The article explores Bhakti, an ancient Sanskrit religion in India. It notes that this ancient religion depicts the loving devotion performed by various social classes. In addition, the said religion is also known as Bhakti Movement, where most of the ancient people are devoting for the social reform in the country during the ancient times.

What do metaphor, simile, and analogy look like before the explicit tradition of Sanskrit poetics? How such formulations might be understood in the midst of the multiple contexts of early India, and how they might be relevant to a larger field of hermeneutics? The study of metaphor has been a staple of the broader pursuit of hermeneutics for some time now (see Dilthey and Jameson 1972; Ricoeur 1974, 1975; Calinescu 1979; Johnson Sheehan 1999, just to name a few works dealing with this topic). If Gadamer (1975: p. 430) is right that a fusion of horizons between text and interpreter is one of the primary acts of interpretation, then metaphors can be viewed as vehicles for that fusion, as well as verbal constructions that move between different points of view within the text that keep both similarity and difference in play.1 [ABSTRACT FROM PUBLISHER]

Focuses on several Jewish works in an Indian setting. Screening of the film 'True Love' in India; Overview of the novel 'Marianne of the Snow,' by Hadassah Ashdot; Discussion of book 'Salted Children,' by Shani Mitzafon.

Discusses the commentarial practice of worshiping the rising sun in India with the Rg-Vedic hymn 1.50 which is destructive of heart disease and conducive to excellent health. Philosophical and intellectual emphasis in the study of Indian commentarial practice; Terminology of magic in the commentarial practice; Framework of commentarial practice.

The article offers the authors' insight on the article by Shaza Fadel and colleagues on mid-childhood mortality in middle-income countries including India, China, and Brazil. They say that the study reveal that main causes of deaths include communicable or nutritional disease, road traffic injuries and drowning, and non-communicable diseases. They also discuss limitations of the study, the need of multisectoral actions to reduce death rates, and collection of more accurate data on death causes.

Background: Schools can play an important role in health promotion by improving students’ health literacy, attitudes, health-related behaviours, social connection and self-efficacy. These interventions can be particularly valuable in low- and middle-income countries with low health literacy and high burden of disease. However, the existing literature provides poor guidance for the implementation of school-based interventions in low-resource settings. This paper describes the development and pilot testing of a multicomponent school-based health promotion intervention for adolescents in 75 government-run secondary schools in Bihar, India. Method: The intervention was developed in three stages: evidence review of the content and delivery of effective school health interventions; formative research to contextualize the proposed content and delivery, involving intervention development workshops with experts, teachers and students and content analysis of intervention manuals; and pilot testingin situto optimize its feasibility and acceptability. Results: The three-stage process defined the intervention elements, refining their content and format of delivery. This intervention focused on promoting social skills among adolescents, engaging adolescents in school decision making, providing factual information, and enhancing their problem-solving skills. Specific intervention strategies were delivered at three levels (whole school, student group, and individual counselling) by either a trained teacher or a lay counsellor. The pilot study, in 50 schools, demonstrated generally good acceptability and feasibility of the intervention, though the coverage of intervention activities was lower in the teacher delivery schools due to competing teaching commitments, the participation of male students was lower than that of females, and one school dropped out because of concerns regarding the reproductive and sexual health content of the intervention. Conclusion: This SEHER approach provides a framework for adolescent health promotion in secondary schools in low-resource settings. We are now using a cluster-randomized trial to evaluate its effectiveness and cost-effectiveness. [ABSTRACT FROM PUBLISHER]

Background: Brazil, Russia, India, China, and South Africa (BRICS) are emerging economies making up almost half the global population. We analyzed trends in cardiovascular disease (CVD) mortality across the BRICS and associations with age, period, and birth cohort.Methods: Mortality estimates were derived from the Global Burden of Disease Study 2017. We used age-period-cohort modeling to estimate cohort and period effects in CVD between 1992 and 2016. Period was defined as survey year, and period effects reflect population-wide exposure at a circumscribed point in time. Cohort effects are defined as differences in risks across birth cohort. Net drift (overall annual percentage change), local drift (annual percentage change in each age group), longitudinal age curves (expected longitudinal age-specific rate), and period (cohort) relative risks were calculated.Results: In 2016, there were 8.4 million CVD deaths across the BRICS. Between 1992 and 2016, the reduction in CVD age-standardized mortality rate in BRICS (-17%) was less than in North America (-39%). Eighty-eight percent of the increased number of all-cause deaths resulted from the increase in CVD deaths. The age-standardized mortality rate from stroke and hypertensive heart disease declined by approximately one-third across the BRICS, whereas ischemic heart disease increased slightly (2%). Brazil had the largest age-standardized mortality rate reductions across all CVD categories, with improvement both over time and in recent birth cohorts. South Africa was the only country where the CVD age-standardized mortality rate increased. Different age-related CVD mortality was seen in those ≥50 years of age in China, ≤40 years of age in Russia, 35 to 60 years of age in India, and ≥55 years of age in South Africa. Improving period and cohort risks for CVD mortality were generally found across countries, except for worsening period effects in India and greater risks for ischemic heart disease in Chinese cohorts born in the 1950s and 1960s.Conclusions: Except for Brazil, reductions of CVD mortality across the BRICS have been less than that in North America, such that China, India, and South Africa contribute an increasing proportion of global CVD deaths. Brazil's example suggests that prevention policies can both reduce the risks for younger birth cohorts and shift the risks for all age groups over time. [ABSTRACT FROM AUTHOR]

Background: School environments affect health and academic outcomes. With increasing secondary school retention in low-income and middle-income countries, promoting quality school social environments could offer a scalable opportunity to improve adolescent health and wellbeing.Methods: We did a cluster-randomised trial to assess the effectiveness of a multi-component whole-school health promotion intervention (SEHER) with integrated economic and process evaluations in grade 9 students (aged 13-14 years) at government-run secondary schools in the Nalanda district of Bihar state, India. Schools were randomly assigned (1:1:1) to three groups: the SEHER intervention delivered by a lay counsellor (the SEHER Mitra [SM] group), the SEHER intervention delivered by a teacher (teacher as SEHER Mitra [TSM] group), and a control group in which only the standard government-run classroom-based life-skills Adolescence Education Program was implemented. The primary outcome was school climate measured with the Beyond Blue School Climate Questionnaire (BBSCQ). Students were assessed at the start of the academic year (June, 2015) and again 8 months later at the end of the academic year (March, 2016) via self-completed questionnaires. This study is registered with ClinicalTrials.gov, number NCT02484014.Findings: Of the 112 eligible schools in the Nalanda district, 75 were randomly selected to participate in the trial. We randomly assigned 25 schools to each of the three groups. One school subsequently dropped out of the TSM group, leaving 24 schools in this group. The baseline survey included a total of 13 035 participants, and the endpoint survey included 14 414 participants. Participants in the SM-delivered intervention schools had substantially higher school climate scores at endpoint survey than those in the control group (BBSCQ baseline-adjusted mean difference [aMD] 7·57 [95% CI 6·11-9·03]; effect size 1·88 [95% CI 1·44-2·32], p<0·0001) and the TSM-delivered intervention (aMD 7·57 [95% CI 6·06-9·08]; effect size 1·88 [95% CI 1·43-2·34], p<0·0001). There was no effect of the TSM-delivered intervention compared with control (aMD -0·009 [95% CI -1·53 to 1·51], effect size 0·00 [95% CI -0·45 to 0·44], p=0·99). Compared with the control group, participants in the SM-delivered intervention schools had moderate to large improvements in the secondary outcomes of depression (aMD -1·23 [95% CI -1·89 to -0·57]), bullying (aMD -0·91 [95% CI -1·15 to -0·66]), violence victimisation (odds ratio [OR] 0·62 [95% CI 0·46-0·84]), violence perpetration (OR 0·68 [95% CI 0·48-0·96]), attitude towards gender equity (aMD 0·41 [95% CI 0·21-0·61]), and knowledge of reproductive and sexual health (aMD 0·29 [95% CI 0·06-0·53]). Similar results for these secondary outcomes were noted for the comparison between SM-delivered intervention schools and TSM-delivered intervention schools (depression: aMD -1·23 [95% CI -1·91 to -0·55]; bullying: aMD -0·83 [95% CI -1·08 to -0·57]; violence victimisation: OR 0·49 [95% CI 0·35-0·67]; violence perpetration: OR 0·49 [95% CI 0·34-0·71]; attitude towards gender equity: aMD 0·23 [95% CI 0·02-0·44]; and knowledge of reproductive and sexual health: aMD 0·22 [95% CI -0·02 to 0·47]). However, no effects on these secondary outcomes were observed for the TSM-delivered intervention schools compared with the control group (depression: aMD -0·03 [95% CI -0·70 to 0·65]; bullying: aMD -0·08 [95% CI -0·34 to 0·18]; violence victimisation: OR 1·27 [95% CI 0·93-1·73]; violence perpetration: OR 1·37 [95% CI 0·95-1·95]; attitude towards gender equity: aMD 0·17 [95% CI -0·09 to 0·38]; and knowledge of reproductive and sexual health: aMD 0·06 [95% CI -0·18 to 0·32]).Interpretation: The multi-component whole-school SEHER health promotion intervention had substantial beneficial effects on school climate and health-related outcomes when delivered by lay counsellors, but no effects when delivered by teachers. Future research should focus on the evaluation of the scaling up of the SEHER intervention in diverse contexts and delivery agents.Funding: John D. and Catherine T. MacArthur Foundation, USA and the United Nations Population Fund India Office. [ABSTRACT FROM AUTHOR]

Background: The present study compares depressive symptoms in adolescents from three countries: Mumbai, India; Seattle, United States; and Melbourne, Australia measured using the Short Moods and Feelings Questionnaire (SMFQ). The study cross nationally compares SMFQ depressive symptom responses by age and gender.Methods: Data from a cross-nationally matched survey were used to compare factorial and measurement characteristics from samples of students from Grade 7 and 9 in Mumbai, India (n=3268) with the equivalent cohorts in the Washington State, USA (n=1907) and Victoria, Australia (n=1900). Exploratory Structural Equation Modelling (ESEM) was used to cross-nationally examine factor structure and measurement invariance.Results: A number of reports suggesting that SMFQ is uni-dimensional were not supported in findings from any country. A model with two factors was a better fit and suggested a first factor clustering symptoms that were affective and physiologically based symptoms and a second factor of self-critical, cognitive symptoms. The two-factor model showed convincing cross national configural invariance and acceptable measurement invariance. The present findings revealed that adolescents in Mumbai, India, reported substantially higher depressive symptoms in both factors, but particularly for the self-critical dimension, as compared to their peers in Australia and the USA and that males in Mumbai report high levels of depressive symptoms than females in Mumbai.Limitations: the cross sectional study collected data for adolescents in Melbourne and Seattle in 2002 and the data for adolescents in Mumbai was obtained in 2010-2011 CONCLUSIONS: These findings suggest that previous findings in developed nations of higher depressive symptoms amongst females compared to males may have an important cultural component and cannot be generalised as a universal feature of adolescent development. [ABSTRACT FROM AUTHOR]