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This paper reviews the mixed-methods studies from the last 2 years (2021-2022) into androgen use to highlight the most relevant developments within the field.The literature review found seven papers from 2021 to 2022. These seven cover a range of important considerations, including interventions to reduce androgen use, educational tools to increase professionals' knowledge, explorations on the comorbidity of use with other substances, motivations for use, potential risks factors for androgens' initiation, or risks of using androgens. Key findings include a greater understanding of motivations for use, particularly in females and older males; identification of potential risks for starting use/using androgens; benefits of including practical strength exercises in preventive intervention programmes and the efficacy of e-learning tools to increase professionals' knowledge of androgens use, as well as an increase in their confidence to support androgen users.The key implications for clinical practice are that we still need to support healthcare professionals to overcome the barriers for increasing their skills and knowledge around androgen use. A recognition that people who have become dependent on androgen use are potentially at risk of considerable harm, with further research needed into sub-groups of androgen users., http://links.lww.com/COE/A35.

Background The Middle East and North Africa (MENA) region continues to have the lowest prevalence of HIV (human immunodeficiency virus) in the world, less than 0.1%, yet new transmissions are increasing. Consistent condom use can reduce the probability of transmission by 90–95%, and its use remains as the staple prevention method; however, this isn’t the case for the MENA region, where condom use, knowledge of proper use, and accessibility are limited. Aims To conduct a systematic review on condom use, its use across different population groups, and its barriers and facilitators in countries that fall under the UNAIDS regional classification of MENA. Methods This systematic review was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines. The search included electronic databases: PubMed/MEDLINE, Academic Search Ultimate, COCHRANE, APA PsycINFO, ScienceDirect, CINAHL Complete, Scopus. There was no date restriction. Results Of the 471 records retrieved, 45 articles were appraised and included in the analysis. The reported barriers and facilitators are sub-divided into personal, social, and structural factors. Condom accessibility, partner objection, and their perceived ineffectiveness were key barriers, whereas availability, cost, and lack of awareness were rarely mentioned. Concerns of personal health and future financial security, as well as positive peer influence and delayed sexual experience, were identified as motivators. Conclusion Condom promotion in the region needs to incorporate gender-based power in relationships and the influence of religion, as well as the legal and structural factors. More investment and research are needed for women-initiated contraceptive and digital healthcare initiatives.

International migration is in an increasing trend globally; internal migration is also very common, particularly in low- and middle- income countries (LMICs). Little attention has been paid to the impact of men’s migration on non-migrating women’s health. Therefore, we undertook a systematic review to examine the impact of men's migration on the health of women who remain behind in LMICs. We searched five databases, CINAHL, Google Scholar, PsychINFO, PubMed and Scopus, for publications from 2005 to 2022 using key search terms 'left-behind', 'women' and 'migration'. Thirty-three peer-reviewed publications were included in the review. Findings suggest that left-behind women had increased access to healthcare due to better financial positions (via remittances) and experienced more empowerment/autonomy in the absence of their husbands. This resulted in increased (a) decision-making regarding their health and (b) freedom of mobility to seek healthcare. Remittances led to improved food and housing security, a critical wider determinant of health. However, some studies reported that in the longer term, the physical health of women who remain behind was negatively impacted. Almost all studies on mental health reported higher depressive symptoms among migrant wives compared to women co-habiting with their spouses. Left-behind women feared contracting sexually transmitted infections from their migrant partners. National and local policies should include support groups and counselling services at the local health centre for women who remain behind. We recommend further studies on the areas presented above as well as unexplored areas such as vulnerability to violence and impact of remittance on health and nutrition.

This is an editorial only.

The number of scientific articles published each year is rapidly growing and so is the number of academic journals. This makes it impossible for an individual practitioner or researcher to keep track of all research published in their own field or sub-discipline. With the growing amount of publications, it is also becoming more difficult to distinguish between similar papers published on the same topic, in the same journal, or by the same researchers (or research team). This perspective paper could support students and novice researchers, outlines the difference between the unique identifier for: (1) you as the researcher, (2) a specific paper; and (3) a specific journal. This paper further outlines the various numerical identifiers associated with academic publishing to help demystify academic publishing.

Worldwide there is a growing interest in multidisciplinary and interdisciplinary research. This overview paper addresses some of the pitfalls and barriers to being an interdisciplinary researcher. Being involved in interdisciplinary research is not an easy option for an individual discipline expert. It requires individual skills, ability to see beyond one’s discipline and perhaps personality characteristics such as a great team player. Interdisciplinary research may involve a mixed-methods approach underpinned by conflicting, and according to some incommensurable, research philosophies. The paper uses some examples from our own experiences of working in interdisciplinary teams to illustrate its potential.

Complex Innovative Trial Design (CID) offers several potential benefits for clinical research, including the use of novel statistical techniques such as adaptive designs and Bayesian methods that require computer simulation to determine operating characteristics. By leveraging these techniques, CID has the potential to increase the probability of success for clinical trials while simultaneously reducing the time and cost required for drug development.

Introduction: This article presents research into the professionalisation of midwifery in Slovenia. Since recognition by related occupations is important for professions, this comparative study asked doctors and nurses in Slovenia about their perceptions of the status of midwifery. Method: A questionnaire survey was conducted with 300 Slovenian midwives, 666 nurses and 416 obstetricians. The questionnaire included statements covering traditional sociological notions of the profession (ethics, theory, power), and three notions based on new elements of professionalism (reflective practice, interdisciplinary working and partnership with clients). Results: Results suggest that nurses perceived themselves to be less autonomous than midwives, and this partly explains why most nurses thought that midwifery should be a specialised course of study, after the general nursing diploma. Obstetricians claimed to support midwives, however they did not give midwives credit for basic midwifery competencies and did not feel midwifery to be equal to their profession. Midwives revealed not to feel autonomous; they felt that nursing and obstetrics is jeopardizing independent midwifery practice. Discussion with conclusion: Slovenian midwifery was poorly evaluated in some attributes of professionalism, especially knowledge and autonomy. Even midwives themselves consider midwifery more occupation than profession. The autonomy of midwifery will be hard to achieve in the institutions of medical dominance. The study revealed that participants of all three groups are in a competitive relation and are poorly aware of the roles and competencies of other two professions. Therefore, partially joined education might be beneficial in order to promote interprofessional collaboration in the future.

Caesarean section (CS) rate is rising dramatically worldwide. WHO recommended CS rate of 10-15% at populational level would not be the ideal rate at the hospitals level due to the differences on population they have been serving. At the hospital level, a perfectly effective system is necessary to understand the trends and causes of rising trends of CS as well as to implement effective measures where necessary to control the same. Hence, WHO recommended the Robson classification, which is also called the 10-group classification of CS (TGCS) as a global standard tool to assess, monitor and compare CS rates within healthcare facilities over time, and between health facilities. The Robson classification, proposed by Dr Michael Robson in 2001, is a system that classifies all women at admission at a specific health facility for childbirth into 10 groups based on five basic obstetric characteristics (parity, gestational age, onset of labour, foetal presentation and number of foetuses). This classification is easy and simple and mutually exclusive, highly reproducible, easily applicable, and useful to change clinical practice. It has many strengths such as simplicity, flexibility (further subdivisions can be made to increase homogeneity within groups). This classification helps to identify and analyse the contribution of each group to overall CS rates. It also allows distinguishing the main group of women who contributes most and least to the overall CS rates; so that the CS rates can be monitored in a meaningful, reliable, and action-oriented manner in each health facilities for optimal use of CS.

Introduction: To date, there is no comprehensive systematic review and meta-analysis to assess the suitability of COVID-19 vaccines for mass immunization. The current systematic review and meta-analysis was conducted to evaluate the safety and immunogenicity of novel COVID-19 vaccine candidates under clinical trial evaluation and present a contemporary update on the development and implementation of a potential vaccines. Methods: For this study PubMed, MEDLINE, and Embase electronic databases were used to search for eligible studies on the interface between novel coronavirus and vaccine design until December 31, 2020. Results: We have included fourteen non-randomized and randomized controlled phase I-III trials. Implementation of a universal vaccination program with proven safety and efficacy through robust clinical evaluation is the long-term goal for preventing COVID-19. The immunization program must be cost-effective for mass production and accessibility. Despite pioneering techniques for the fast-track development of the vaccine in the current global emergency, mass production and availability of an effective COVID-19 vaccine could take some more time. Conclusions: Our findings invited a revisit to the reported solicited and unsolicited SAE for COVID-19 candidate vaccines. Hence, it is alarming to judiciously expose thousands of participants to COVID-19 candidate vaccines at Phase-3 trials that have adverse events and insufficient evidence on safety and effectiveness that necessitates further justification.

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The paper explores how COVID-19-related moral panics have led to fear and oth-ering practices among returnee Nepalese migrants from India and Muslims living in Nepal. This qualitative study included in-depth interviews with returnee migrants (n=15), Muslims (n=15) from Kapilvastu and Banke districts of Nepal, and eight inter-views with media and health professionals, and representatives from migration organ-isations. Four themes emerged from our data analysis: 1) rumours & mis/disinformation; 2) impact of rumours on marginalised groups (with three sub-themes: i) perceived fear; ii) othering practices; iii) health & social impact); 3) re-sistance; and 4) institutional response against rumours.\ud Citation: Lastname, F.; Lastname, F.; Lastname, F. Title. Sustainability 2022, 14, x. https://doi.org/10.3390/xxxxx\ud Academic Editor: Firstname Last-name\ud Received: date\ud Accepted: date\ud Published: date\ud Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and insti-tutional affiliations.\ud \ud Copyright: © 2022 by the authors. Submitted for possible open access publication under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).\ud Findings suggest that rumours and misinformation were fuelled by various media platforms, especially social media (e.g. Facebook & YouTube) during the initial months of the lockdown. This created a moral panic which led to returnee migrants and Mus-lim populations experiencing fear and social isolation. Resistance and effective institu-tional responses to dispel rumours were limited. A key contribution of the paper is to highlight the lived experiences of COVID- 19 related rumors on marginalised groups. The paper argues that there is a need for clear government action using health promo-tion messages to tackle rumours (health-related or otherwise), mis/disinformation and mitigating the consequences (hatred and tensions) at the community level.

Peer review is key in academic publishing, and rejection (or at least being asked to resubmit your paper to the journal), is a not uncommon occurrence. However, receiving such rejection and having to reply to it can be hard for the early-career researcher. In this paper, we first highlight the role of the peer reviewer, followed by some of the less friendly reviewers’ comments to our own submitted papers in four case studies. We conclude with several suggestions of ways to deal with less than positive reviews.

Anabolic Androgenic Steroids (AAS) are commonly used for their anabolic effects and potential detrimental consequences are well documented. Most studies focus on the motivations of increased muscle development and report increased libido as a secondary motivation. This paper aims to explore users’ reports of libido as a motivator for starting and restarting AAS use. This mixed-methods study comprised questionnaires with 133 adult male AAS users (38% of selected increased libido as motivation for using), and 23 semi-structured interviews with a sub-sample. Thematic analysis identified four interlinked themes: increased libido as a motivation for starting/re-starting AAS; increased libido/sexual performance as a beneficial effect; mixed experiences with physicians regarding libido changes and hypogonadism and reduced sexual functioning and fertility after AAS cessation. Increased libido was identified as a benefit by 90% but motivations for use changed over time. Reasons for AAS use included mitigating the effects of aging particularly linked to the concept of virility. AAS as self-medication for low testosterone needs further investigation as does the idea of hegemonic masculinity as a reinforcing driver for AAS use. This study highlights the need to consider how AAS users’ views of medical support impact on self-medication choices.

Handwashing is effective at preventing several infectious diseases. The study aims to find out the role of wealth status in establishing handwashing stations in the households of Nepal. This study used secondary data from Nepal Demographic Health Survey (NDHS) 2016 to assess the association between households' wealth status to handwashing stations. The findings displayed significant association between age of the household head, residence place, ecological zone, province, wealth status, having of mosquito net, having a radio, and TV at respondents household to fixed handwashing stations at their households at p=

Not applicable as this is an editorial.

Background: This study explores food beliefs among poor mothers related to feeding their offspring. Mothers’ misconception of a healthy diet is one of the major causes of nutritional problems in preschool-aged children in Nepal and these beliefs and attitudes can result in the inappropriate feeding of young children. Objectives: The main objectives of this study were:• identify major barriers for recommending healthy food that are associated with existing cultures, religions and ethnic divisions;• assess the knowledge, attitudes, and beliefs about nutritious food amongst mothers;• assess health-seeking behaviour for children of low socio-economic status. Methods: Study used a qualitative focus group discussion. Fifty participants took part in seven focus groups to explore their food beliefs. The qualitative focus groups aimed to collect in-depth information around food beliefs and data were thematically analysed. Results: The study identified six key themes: (a) poverty; (b) knowledge; (c) policy; (d) beliefs about breastfeeding; (e) food beliefs: and (f) health-seeking behaviours/cultural influences. Many participants thought that illiterate and underserved populations are generally exposed due to financial scarcity, poor knowledge and strongly rooted in cultural practices, and beliefs. This study found ‘diversified views’ as a major barrier to food and health-seeking behaviours. Some groups recognised the negative effects of existing beliefs and taboos. However, the spiritual healers highlighted the importance of linking beliefs with cultural and religious norms and values. They showed the complex relationships between food and health-seeking behaviours and food recommendations with financial status and the perceived cultural practices of society. Conclusions: This study suggests that a public health approach is needed to address nutrition problems associated with behaviour and revealed major barriers which were associated with poverty, resources, and mothers’ education level.

The growth in information technology and computer capacity has opened up opportunities to deal with much and much larger data sets than even a decade ago. There has been a technological revolution of big data and Artificial Intelligence (AI). Perhaps many readers would immediately think about robotic surgery or self-driving cars, but there is much more to AI. This Short Communication starts with an overview of the key terms, including AI, machine learning, deep learning and Big Data. This Short Communication highlights so developments of AI in health that could benefit a low-income country like Nepal and stresses the need for Nepal’s health and education systems to track such developments and apply them locally. Moreover, Nepal needs to start growing its own AI expertise to help develop national or South Asian solutions. This would require investing in local resources such as access to computer power/capacity as well as training young Nepali to work in AI.

The sudden outbreak of Coronavirus-19 disease (COVID-19) is transforming the psychology and interpersonal relationships of millions across the globe. In Nepal, there is a need for national mental health surveys post COVID-19. This pandemic can cause traumatic experiences to the patients, caregivers, those quarantined and frontline healthcare providers which may lead to PTSD. Special attention should be focused on high-risk individuals, including policies to implement regular screening of PTSD symptoms.

This paper illustrates the growing importance of mixed-methods research to a wide range of health disciplines ranging from nursing to epidemiology. Mixed-methods approaches requires not only the skills of the individual quantitative and qualitative methods but also a skill set to bring two methods/datasets/findings together in the most appropriate way. Health researchers need to pay careful attention to the ‘best’ approach to designing, implementing, analysing, integrating both quantitative (number) and qualitative (word) information and writing this up in a way that enhances its applicability and broadens the evidence-based practice. This paper highlights the strengths and weaknesses of mixed-methods approaches as well as some of the common mistakes made by researchers applying mixed-methods for the first time.

Many traditional scientific journals carry an editorial at the start of each issue or perhaps in most issues. The more recently established online journals seemed to have discontinued this tradition, for example there is no editorial in Sociological Research Online or many of the online journals in the BMC stable, such as BMC Pregnancy & Childbirth or BMC Public Health. Over the past two decades we have published close to fifty editorials between us. We would like to highlight some of their specific features to offer advice and encouragement to would-be editorial writers, and, more generally, promote the writing and publishing of editorials. This paper includes an overview of the eight most recent editorials, all focusing on the hot topic of COVID-19, published in this scientific journal.

Online communication tools are increasingly being used by qualitative researchers; hence it is timely to reflect on the differences when using a broad range of data collection methods. Using a case study with a potentially hard-to-reach substance-using population who are often distrustful of researchers, this article explores the use of a variety of different platforms for interviews. It highlights both the advantages and disadvantages of each method. Face-to-face interviews and online videos offer more opportunity to build rapport, but lack anonymity. Live Webchat and audio-only interviews offer a high level of anonymity, but both may incur a loss of non-verbal communication, and in the Webchat a potential loss of personal narrative. This article is intended for sociologists who wish to broaden their methods for conducting research interviews.

Academic writing, especially in the health field, is usually an interdisciplinary team effort. This paper highlights some of the trials, tribulations, and benefits of working with co-authors. This includes collaborations and co-authorship between academics from different disciplines, academics of different level of careers, and authors from countries of varying economies i.e., high-income countries (HICs) and from low-and middle-income countries (LMICs). This paper also provides advice in the form of several useful tips to lead authors and co-authors to support collaborative working.

Female labour migration from the global south to the Middle East has increased in recent times. The rights and health of these women are often severely affected during and post migration. The aim of this study was to provide a clearer understanding of the process and context of female labour migration from Nepal. This included reasons for female labour migration, the risks, benefits, health impacts and measures to better support and protect women before, during and post migration.Data in this paper is based on semi-structured interviews conducted with ten key stakeholders (staff working with support organisations, policy-makers and researchers in the field) all with a professional interest in female labour migration from Nepal.It was found that government restrictions on female labour migrants working in the domestic sector increased undocumented migration through India, increasing the risk of trafficking and exploitation. Despite these risks, migration is attractive to many Nepalese women as it offers an opportunity to improve livelihood for them and their family. In addition, it can provide a ‘window to empowerment’. The study concludes that restricted migration, implemented in the name of protection, has undermined the rights, security and health of many Nepalese women.

Background Maternal health programmes that focus on the woman alone are limiting in LMICs as pregnant women often relate to maternity services through a complex social web that reflects power struggles within the kinship and the community. Methods A scoping review was conducted to explore the rationale for male involvement in maternal health in LMICs. This review was guided by the question: What is the current state of knowledge regarding the inclusion of men in maternal health services in LMICs? The literature search was conducted using mySearch, Bournemouth University`s iteration of the EBSCO Discovery Service (EDS) tool. The review process used the Preferred Reporting Items for Systematic Reviews to select papers for inclusion. Findings Thirty three studies met the inclusion criteria. Findings describe the rationale for involving men in maternity care, alongside the criticisms and challenges inherent in engaging with men in maternal health. Involving men in maternity services can improve health outcomes for women and infants. Health strategies aimed at educating men are relevant in equipping men with knowledge and skills that help men to be supportive of women`s wellbeing during pregnancy and childbirth. Conclusion Men can serve as advocates for women and reinforce their partner`s choices in accessing skilled care and infant feeding. Further research is required to examine the effect of male involvement on women`s autonomy and to assess health education interventions aimed at mitigating harmful outcomes of involving men in maternity services.

Across the globe, there can be confusion about the difference between the concepts of health education, health promotion and, often also, public health. This confusion does not limit itself to the individual terms but also to how these terms relate to each other. Some use terms such as health education and health promotion interchangeably; others see them clearly as different concepts. In this theoretical overview paper, we have first of all outlined our understanding of these individual terms. We suggest how the five principles of health promotion as outlined by the World Health Organization (WHO, 1984) fit into Tannahill’s (2009) model of three overlapping areas: (a) health education; (b) prevention of ill health; and (c) health protection. Our schematic overview places health education within health promotion and health promotion itself in the center of the overarching disciplines of education and public health. We hope our representation helps reduce confusion among all those interested in our discipline, including students, educators, journalists, practitioners, policymakers, politicians, and researchers.

Background: Anecdotal reports suggest an increasing prevalence of kidney problems in returnee Nepali migrant workers from the Gulf countries and Malaysia. Aims and Objectives: This study aims to (a) explore the magnitude of the kidney health-related problems in returnee Nepali migrant workers; and, (b) assess the need for further scientific investigations. Materials and Methods: This was a self-administered survey of practicing nephrologists in Nepal. All 51 nephrologists working in Nepal (at the time of this study) were approached by email for anonymous participation using an online survey platform. Data were collected between December 2019 and February 2020. Descriptive statistics were generated for data analysis. Results: A total of 38 nephrologists completed the survey. Almost all their migrant patients were: younger than 40 years, males, from rural areas of Nepal, and had worked in Gulf countries or Malaysia. Most (92.1%) of the respondents reported that the causes behind kidney-related problems of returnee migrant workers were of unknown etiology and less likely to be linked to traditional risk factors. Chronic kidney disease and glomerulonephritis were the most common kidney health-related problems. The vast majority of respondents (76.3%) thought that the returnee migrant workers are at a higher risk of kidney-related problems than the general Nepali population. Conclusion: Nepali labor migrants in the countries of the Gulf and Malaysia could be at a higher risk of kidney health-related problems than the general Nepali population. Further rigorous scientific investigation is warranted to examine the kidney-health-related risk of Nepali migrant workers

Background Over the past 20 years, Nepal has seen major improvements in childhood and maternal survival. In 2015, the Nepalese government introduced a new federal political structure. It is unclear how this has affected the health system, and particularly, maternal and child health care. Hence, this study aims to describe and analyse health facility preparedness in the light of the federalization process with regards to providing appropriate and timely maternal and neonatal health services. Methods A descriptive cross-sectional study was conducted in Jumla district, Nepal in 2019 covering all 31 state health facilities (HF) to assess the availability of maternal and neonatal health services including appropriate workforce and access to essential medicines. Tests of association between demographic factors and the probability of a facility experiencing a shortage of essential medicine within the last 3 months were also conducted as exploratory procedures. Results Out ot 31 HFs, more than 90% of them had all their staff positions filled. Most facilities (n = 21) had experienced shortages of essential medicines within the past 3 months. The most common out of stock medicine were: Amoxicillin (n = 10); paracetamol (n = 10); Vitamin A (n = 7); and Metronidazole (n = 5). Twenty-two HFs had referred maternal and newborn cases to a higher centre within the past 12 months. However, more worryingly, twenty HFs or their catchment communities did not have emergency ambulance transport for women and newborns. Conclusion HFs reported better staffing levels than levels of available drugs. HFs should be supported to meet required minimal standards such as availability of essential medicines and the provision of emergency ambulance transport for women and newborns.

Purpose Mental health disparities exist among Black, Asian and Minority Ethnics (BAME) populations. This paper aims to provide an overview of mental health services designed for the BAME population in the UK, both established BAME communities and refugee/asylum-seekers. Design/methodology/approach A range of electronic databases were searched for peer-reviewed studies conducted within the past decade in the UK. Using the Arksey and O’Malley methodology, data were extracted, analysed and summarised. Findings A total of 13 papers were identified, mostly non-randomised community-based. Studies were very heterogeneous in terms of their sample and service provided. After the initial appraisal, the authors presented a narrative synthesis. Overall, all studies reported positive mental health outcomes and beneficial effects. Research limitations/implications Because of the time limitations and quality of the papers, the authors only included peer-reviewed journal papers. Practical implications Mental health services provided for BAME people, both established and refugee/asylum-seekers are feasible and improve engagement with the services and mental health outcomes. Initiatives are required to facilitate the integration of these targeted services within mental health and community services for BAME in the UK. Originality/value This scoping review is a snapshot of the mental health services designed for BAME people in the UK, either established or refugee/asylum-seekers in the past 10 years and adds to the evidence-based knowledge from these studies.

Background/Aims: Uncertainty in illness is a well-known concept in health care literature. A considerable volume of research has investigated how people adapt to different health conditions and how the concept of uncertainty in illness relates to those populations. The aim of this article is to explore the concept of uncertainty in illness among mental health nurses and to provide an understanding of its relevance to people living with mental ill health. Method: A focus group was conducted with mental health nurses at an international psychiatric nursing conference. The focus group discussion was recorded and then transcribed and thematically analysed. Results: Uncertainty in illness among people living with mental ill health exists and manifests itself in various ways: uncertainty in the context of loss, uncertainty as a stimulus for change, and uncertainty as an integral part of the human experience and existence. Conclusions: Even though contemporary approaches in mental health nursing do not directly address uncertainty, the concept and its implications need to be considered and raised further among mental health professionals in order to improve support for people living with mental ill health in their process of personal recovery.

Background Since Nepali cross-border migrants can freely enter, work and stay in India, they are largely undocumented. The majority is involved in semi-skilled or unskilled jobs with limited labour rights and social security, a fact which predisposes them to psychological distress. We aimed to assess the prevalence of and factors associated with psychological morbidity among Nepali migrants upon their return from India. Methods A community based cross-sectional study was conducted in six districts of Nepal between September 2017 and February 2018. A total of 751 participants who had worked at least six months in India and returned to Nepal were interviewed from 24 randomly selected clusters. The General Health Questionnaire (GHQ)-12 was used to measure the psychological morbidity. Data were analysed using Poisson regression analysis. Results The majority was younger than 35 years (64.1%), male (96.7%), married (81.8%), had at least a primary education (66.6%), and belonged to Dalit, Janajati and religious minorities (53.7%). The prevalence of psychological morbidity was 13.5% (CI: 11.2–16.1%). Participants aged 45 years and above (adjusted prevalence ratio (aPR) = 2.74), from the Terai (aPR = 3.29), a religious minority (aPR = 3.64), who received no sick leave (aPR = 2.4), with existing health problems (aPR = 2.0) and having difficulty in accessing health care (aPR = 1.88) were more likely than others to exhibit a psychological morbidity. Conclusion This study demonstrated that psychological morbidity was prevalent in the study participants and varied significantly with individual characteristics, work conditions and health. Multifaceted approaches including psychological counselling for returnees and protection of labour and health rights in the workplace are recommended to help reduce psychological morbidity.

Background Despite breastfeeding providing maximum health benefits to mother and baby, many women in the United Kingdom do not breastfeed, or do so briefly. Purpose Using tenets of ethnography, this study aimed to explore the everyday experiences of first time breastfeeding mothers in the early weeks following birth. Methods Using a camcorder, five mothers in the United Kingdom captured their real-time experiences in a video diary, until they perceived their infant feeding was established. Using a multidimensional approach to analysis, we examined how five mothers interacted with the camcorder as they shared their emotions, feelings, thoughts and actions in real-time. Findings Mothers recorded 294 video clips, total recording time exceeded 43 h. This paper focuses on one theme, the therapeutic role of the camcorder in qualitative research. Four subthemes are discussed highlighting the therapeutic impact of talking to the camcorder: personifying the camcorder; using the camcorder as a confidante; a sounding board; and a mirror and motivator. Conclusion Frequent opportunities to relieve tension by talking to “someone” without interruption, judgement or advice can be therapeutic. Further research needs to explore how the video diary method can be integrated into standard postnatal care to provide benefits for a wider population.

Globally, frequent flooding causes higher magnitude of disaster among the developing and developed nations. Particularly, the Indian subcontinent is considered as highly vulnerable area for natural disaster and is affected most because of limited resources and coping strategies for post-disaster rehabilitation. Apart from the great impact on human health, floods have considerable impact on mental health. The most frequently diagnosed psychological illness in flood affected population is post-traumatic stress disorder (PTSD). In India, the incidence of PTSD in major natural disasters varies considerably depending upon the magnitude of event, with the highest rates reported of around 70%. Studies conducted during initial few months post-disaster, showed a higher occurrence of psychiatric manifestations. On the other hand, some reports suggested contrary results under similar circumstances. Notably, extreme age (children and elderly), female gender, socioeconomic status, pre-existing mental health issues and financial crisis post-disaster are the potential predisposing factors influencing the vulnerability of PTSD. In Indian context, the variability in the magnitude of psychiatric illness is mainly attributed to the ethnic diversity (vulnerable population), severity and type of flood event and social support. Still there is more to explore regarding the long-term sequelae of catastrophic floods on physical and mental trauma on disaster-affected populations.

Mental health in Black Asian and Minority Ethnic (BAME) communities is a rising public health concern in the UK, with key challenges around accessing mental health services. Our understanding of mental health issues in the growing Nepali and Iranian communities in the UK is very limited. Therefore, this study aims to explore the major factors affecting access to, and engagement with NHS mental health services. This study used a qualitative approach comprising in-depth interviews with seven Nepali, eight Iranians and six community mental health workers in the south of England. The data were analysed using a thematic approach. Six themes were identified: (1) stigma and fear; (2) gender; (3) language; (4) tradition and culture; (5) family involvement; and (6) lack of cultural awareness in health workers, all appearing to be major issues. This study contributes to a shared understanding of mental illness within two given cultural contexts to promote early interventions in UK mental health services. Developing cross-cultural perspectives in health care should be a priority in practice.

Traditionally the role of the external examiners in UK universities or more formally Higher Education Institutions (HEIs) is that of quality assurance (QA). Typically, an experienced academic who is not affiliated with the HEI (i.e., someone from another university) is invited to act as an external examiner for a particular course or a module. The external examiner’s primary role is to provide impartial and independent advice to ensure academic standards are upheld for a degree program; and that the degree is comparable with similar programs across the country and that the achievements of students are also comparable with students on courses at other universities. This primary role makes external examiners highly valued people in UK universities, and as a result, their views are nearly always taken seriously. Over and above this recognized primary role of QA, external examiners can also be engaged by the host university in other ways. These additional roles or tasks of the external examiner can help enhance teaching and learning in higher education. This chapter will reflect on the range of roles, including the ones that go beyond QA.

The caste system is social stratification system that has been used over the last 3 millennia. This review aims to investigate caste-based inequity in health care utilization in South Asia, particularly focusing those at the bottom of the caste hierarchy, commonly known as Dalit communities. A systematic methodology was followed; key databases (including CINAHL, Medline, SocINDEX, PubMed, Nepjol, JSTOR, and ASSIA) were searched for relevant articles published before October 2019, using comprehensive search strategy in accordance with the PRISMA guidelines. In total 15,109 papers were found, and from these, nine selected papers were included in the review. The papers focused on studies in both India (n = 7) and Nepal (n = 2) and utilized a range of methods including qualitative (n = 2), quantitative (n = 3), and mixed methods (n = 4) approaches. The review identified four main themes: stigma, poverty, cultures and beliefs, and health care. Caste-based inequity impacts upon all aspects of an individual’s well-being including violence and everyday life risks. Caste also impacts upon individuals’ opportunities to access education, employment, and health care. Dalits appear to experience this more significantly due to both poverty and their caste status, which increases their vulnerability to health risks.

With the growing UK Nepali community, understanding their health and social care needs is an essential to reduce health and social care inequalities. However, very little is known about the health, wellbeing and utilisation of health and social care services among the Nepali population in the UK. Therefore, this study set out to identify health and social care needs of Nepali community. The mixed-methods study was conducted with the Nepali population living in London. It consists of a semi-structured survey (N = 345); three focus group discussions and three key informant interviews. The mean age of the participants was 40.6 (± 17.6). About 28% of our sample reported having chronic health problems. About 60% currently consume alcohol and 21% were smokers. Male participants (35%) more likely to be physically active than females (21%). Registration with a family doctor/general practitioner (GP) was high (96%). However, uptake of disease screening was very low (28%). In the preceding year, 17% had experienced poor mental or emotional health. The findings also suggest language is a key barrier to utilise health and social care among UK Nepali. We suggest removing the language barrier is essential step to improve access to available health and social care services. A culturally sensitive educational initiative creating awareness about the structure of UK health and social care services is required to offer to this community.

Roles of PhD supervisors are diverse, ranging from providing in-depth discipline-specific Public Health knowledge and technical (e.g., methodological) support to the students, encouraging them towards publications or conference presentations, offering pastoral support for student wellbeing, and finally preparing them to defend their thesis by conducting a mock viva. Effective supervision plays a vital role in a PhD journey reflecting on the quality of the PhD work, positive PhD experience, and supervisor-student relationship. While some student-supervisors team may encounter conflicting and challenging relationships, many relationships between PhD supervisor(s) and students progress into mentorship through joint publications and grant applications, career advice, and support establishing wider collaborative networks. Drawing from the wider experiences of the authors, this article highlights the responsibilities, opportunities, and sometimes the challenging nature of being a PhD supervisor. This reflection will inform good practices for PhD supervisors in countries including Nepal, where the numbers of PhD students in the field of Public Health is steadily increasing.

The novel coronavirus or COVID-19 is a new highly infectious virus affecting a large population across the globe. There is no specific therapeutic drug available against covid-19 hence the most effective public health measures need to strictly be adhered to without delay. Range of issues were reported to fight against COVID-19 in the current health system of Nepal which should be addressed and strengthened the full spectrum of the health system for its effective and sustainable response. It is crucial to understand the current health system at the local and provincial level and strictly adhere the federal government policies and plan as per the protocol for maintaining minimum infection prevention and control measures with having preventive and safety measures to both service providers and community people. To tackle those daily increasing number of COVID-19 cases, it provides an opportunity for the three tires of governments to reprioritize the health service in the national agenda for the effective prevention and response it. Although National health policy 2019 clearly articulated the need for equitable access and quality of health care services to all. Evidence shows that Nepal is in risk zone because of comparably weak health system that should be aware of all three tires of governments of Nepal and strengthen and control the present threat posed the daily increasing cases of pandemic.

This short guest article outlines the important role the discipline of health promotion can, and should, play in a global pandemic like the one we are experiencing now with COVID-19. The authors outline some of the key aspects of health promotion related to the prevention of the spread of COVID-19, but also the effects of lockdown on the population and the empowerment of affected populations

Patient and public involvement/engagement (PPI/E) in public health research and health technology assessment (HTA) in high-income countries (HICs) have significantly increased over the past decade. PPI/E helps to improve research and HTA, ultimately benefitting patients and service users. PPI/E is a very new concept in many low- and middle-income countries (LMICs). This paper considers the importance of PPI in public health research and HTA in the development and implementation of technology in the health sector in South Asia. Currently, in this region, health technology is frequently adopted from HICs without local research and HTA. It also discusses the importance of local co-creation of technology to reflect the needs of users within a culturally appropriate setting. It is important for LMIC-based researchers to understand the potential of PPI/E and how it can contribute to it to improve health care and research, especially perhaps in the era of COVID-19.

Every year around 1000 Nepali migrant workers die abroad. Every one in three females and one in ten males commit suicide, reflecting a high mental health risk among Nepali migrant workers. This study aims to identify triggers of mental ill-health among Nepali migrant workers and their perceptions on the need of mental health components in the pre-departure orientation programme. We conducted five focus group discussions (FGD) and seven in-depth interviews with Nepali migrant workers and eight semi-structured interviews with stakeholders working for migrants. Participants were invited at Kathmandu’s international airport on return from abroad, at hotels or bus stations near the airport, through organisations working for migrants, and participants’ network. All FGD and interviews were conducted in Kathmandu and audio recorded, transcribed and translated into English. Data were analyzed thematically. High expectations from families back home, an unfair treatment at work, poor arrangements of accommodation, loneliness and poor social life abroad were frequently reported factors for poor mental health. Access to mental health services abroad by Nepali migrant was also poor. We found little on mental health in the pre-departure orientation. We need to improve our knowledge of mental health risks to provide better, more focused and more up-to-date pre-departure training to new migrant workers leaving Nepal.

Background Migration to India is a common livelihood strategy for poor people in remote Western Nepal. To date, little research has explored the degree and nature of healthcare access among Nepali migrant workers in India. This study explores the experiences of returnee Nepali migrants with regard to accessing healthcare and the perspectives of stakeholders in the government, support organizations, and health providers working with migrant workers in India. Methods Six focus group discussions (FGDs) and 12 in-depth interviews with returnee migrants were conducted by trained moderators in six districts in Western Nepal in late 2017. A further 12 stakeholders working in the health and education sector were also interviewed. With the consent of the participants, FGDs and interviews were audio-recorded. They were then transcribed and translated into English and the data were analysed thematically. Results The interviewed returnee migrants worked in 15 of India’s 29 states, most as daily-wage labourers. Most were from among the lowest castes so called-Dalits. Most migrants had had difficulty accessing healthcare services in India. The major barriers to access were the lack of insurance, low wages, not having an Indian identification card tied to individual biometrics so called: Aadhaar card. Other barriers were unsupportive employers, discrimination at healthcare facilities and limited information about the locations of healthcare services. Conclusions Nepali migrants experience difficulties in accessing healthcare in India. Partnerships between the Nepali and Indian governments, migrant support organizations and relevant stakeholders such as healthcare providers, government agencies and employers should be strengthened so that this vulnerable population can access the healthcare they are entitled to.

The year 2020, will forever be marked by the Global pandemic, COVID-19. According to The Department of Health in South Africa until September 15, 2020 3,940,217 tests have been conducted. 651,521 positive cases have been identified, 583,126 recoveries have been reported and there has been a total of 15641 deaths. The South African government have introduced a range of parameters and laws in order to curb the spread of the virus whilst simultaneously endorsing programs to spearhead the preparedness of the healthcare system for the various waves of COVID-19 cases that have been forecast. In conjunction with the new laws and regulations, the South African Government has exercised lockdown and restriction of movement policies. South Africa’s unique, multifaceted and strategic method of combatting the coronavirus has proven to be effective in using existing resources and redirecting both manpower and personnel, thus being of great benefit to all stakeholders and citizens within the country. The prohibition of alcohol is a unique method employed by the government, the full extent to which this policy reform has benefitted the country, its government and its citizens is yet to be fully calculated and projected as South Africa’s Coronavirus cases are still increasing on a daily basis. This policy reform will likely find itself becoming a popular trend with crisis management protocols of other countries if the long-term benefits thereof are proven to be true.

Introduction There are many mobile telephone apps to help women self-monitor aspects of pregnancy and maternal health. This literature review aims to understand midwives' perspectives on women self-monitoring their pregnancy using eHealth and mHealth, and establish gaps in research. Methods MEDLINE, PubMed, Scopus, CINAHL and PsycINFO were systematically searched on midwifery, eHealth/mHealth and perspectives. Qualitative, quantitative and mixed-methods studies published in English were considered for inclusion in the review, without geographical limitations. Relevant articles were critically appraised and narrative synthesis was conducted. Results Twelve relevant papers covering midwives' perspectives of the use of eHealth and mHealth by pregnant women were obtained for inclusion in this review. Seven of these publications focused on midwives' views of eHealth, and five on their perspectives of mHealth interventions. The studies included demonstrate that midwives generally hold ambivalent views towards the use of eHealth and mHealth technologies in antenatal care. Often, midwives acknowledged the potential benefits of such technologies, such as their ability to modernise antenatal care and to help women make more informed decisions about their pregnancy. However, midwives were quick to point out the risks and limitations of these, such as the accuracy of conveyed information, and negative impacts on the patient-professional relationship. Conclusions Post-COVID-19, where technology is continuously developing, there is a compelling need for studies that investigate the role of eHealth and mHealth in self-monitoring pregnancy, and the consequences this has for pregnant women, health professionals and organisations, as well as midwifery curricula.