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Depression is common during pregnancy and is associated with reduced adherence to HIV-related care, though little is known about perinatal trajectories of depression and viral suppression among women living with HIV (WLHV) in sub-Saharan Africa. We sought to assess any association between perinatal depressive symptoms and viral non-suppression among WLWH. Depressive symptomatology and viral load data were collected every 6 months from WLWH enrolled in the African Cohort Study (AFRICOS; January 2013-February 2020). Generalized estimating equations modeled associations between depressive symptoms [Center for Epidemiological Studies Depression (CES-D) ≥ 16] and viral non-suppression. Of 1722 WLWH, 248 (14.4%) had at least one pregnancy (291 total) and for 61 pregnancies (21.0%), women reported depressive symptoms (13.4% pre-conception, 7.6% pregnancy, 5.5% one-year postpartum). Depressive symptomatology was associated with increased odds of viral non-suppression (aOR 2.2; 95% CI 1.2-4.0, p = 0.011). Identification and treatment of depression among women with HIV may improve HIV outcomes for mothers.

Mobile devices offer a scalable opportunity to collect longitudinal data that facilitate advances in mental health treatment to address the burden of mental health conditions in young people. Sharing these data with the research community is critical to gaining maximal value from rich data of this nature. However, the highly personal nature of the data necessitates understanding the conditions under which young people are willing to share them. To answer this question, we developed the MindKind Study, a multinational, mixed methods study that solicits young people's preferences for how their data are governed and quantifies potential participants' willingness to join under different conditions. We employed a community-based participatory approach, involving young people as stakeholders and co-researchers. At sites in India, South Africa, and the UK, we enrolled 3575 participants ages 16-24 in the mobile app-mediated quantitative study and 143 participants in the public deliberation-based qualitative study. We found that while youth participants have strong preferences for data governance, these preferences did not translate into (un)willingness to join the smartphone-based study. Participants grappled with the risks and benefits of participation as well as their desire that the "right people" access their data. Throughout the study, we recognized young people's commitment to finding solutions and co-producing research architectures to allow for more open sharing of mental health data to accelerate and derive maximal benefit from research.

Background: Asthma is one of the leading causes of school absenteeism. Schools can play an important role in coordinating asthma care. The purpose of this study was to assess the implementation of asthma-related school health policies and practices across states and how they have changed over time. Methods: Data were analyzed from 36 states that conducted School Health Profiles surveys during 2008 to 2018. Trends in 6 topics were analyzed by logistic regression and JointPoint trend test. Results: Trends in efforts to identify and track students with asthma and improve students' and parents' knowledge about asthma were stable or increased. Interest among lead health education teachers in receiving professional development on asthma trended downward in 35 of 36 states. Conclusions: Stable to upward trends suggest that a majority of schools have maintained or improved their efforts to identify and track students with asthma and increase the knowledge of students and parents about asthma. However, further improvement is needed in referral of students with asthma to health care professionals and encouraging asthma-related professional development of lead health education teachers.

The 2022 Russian invasion of Ukraine has caused serious challenges for healthcare workers (HCWs) and HIV-related healthcare services. This study assessed the effects of the invasion on HCWs wellbeing and on continuity of HIV services, using in-depth interviews with HCWs from facilities offering HIV antiretroviral therapy (ART) and pre-exposure prophylaxis (PrEP) services in the Donetsk region of Eastern Ukraine. A directed content analysis, with both inductive and deductive approaches, was conducted. Ten HCWs (6 [60%] doctors, 4 [40%] nurses; 9 [90%] female) were interviewed. Six respondents were displaced from their homes and worksites, and all described stress and threats to emotional wellbeing. HCWs used online consultations, encrypted mobile communication, and multi-month dispensing to support continuity of ART and PrEP services. They noted immediate needs for psychological and financial support, and access to laptop computers and mobile communications to ensure continuity of HIV services. Priorities for restoration of services include repair of health facilities, restoration of laboratory services and supply chains, and return of personnel and patients. HCWs made innovative, rapid adaptations to HIV services to keep ART and PrEP services running, demonstrating the resolve of Ukrainian HCWs to maintain continuity of HIV services despite the disruptions of war. [ABSTRACT FROM AUTHOR]

Application of hydraulic fracturing to produce "unconventional" oil and gas from shale formations and other low-permeability geological units has raised concerns about the potential environmental impacts, including potential adverse effects of fracturing fluids (FF) on groundwater. In this study, laboratory batch test experiments and new analytical methods were developed to analyze FF chemicals as potential indicators (tracers) to detect impacts of fracturing fluids on groundwater. The tests, conducted over 101–196 days, included FF with synthetic chemicals (~40,000–4,000,000 µg/L), placed in batches with groundwater and sediment at 5° and 25 °C, along with sterile controls. Using the new methods, measurable concentrations of the FF chemicals were many orders in magnitude lower (~3000 to 3,000,000 X) compared to their concentrations in synthetic fracturing fluids, indicating that these chemicals are excellent candidates as indicators of FF contamination in groundwater, if they are relatively persistent, and not prone to extensive loss by sorption during migration in the subsurface. Variable sorption and degradation of the chemicals was observed in both batch and column tests. Sorption was negligible (sorption coefficient, Kd~0.0) for some synthetic chemicals (polyethylene glycol, ethanolamines, isopropanol, and ethyl hexanol) in some tests. At the other extreme, strong sorption was observed for some of the higher molecular weight cocamido propyl betaine (max Kd = 1.17) and polyethylene glycol (max Kd = 1.12) components, and triethanolamine (max Kd = 0.47) in other tests. Apparent loss by degradation was observed for each chemical in some tests, but negligible in others. The shortest apparent half-lives were for isopropanol and ethyl hexanol at 25 °C (t½ < 11 days), and the most persistent synthetic chemicals were polyethylene glycols (t½ ≥ 182 d) and the ethanolamines (t½ ≥ 212 d). Of the potentially diagnostic FF chemicals investigated, the relatively hydrophilic and persistent lower molecular weight polyethylene glycols are some of the most promising as potential indicators of contamination of groundwater by FF. [ABSTRACT FROM AUTHOR]

Introduction: While sexual assault may have particularly adverse emotional effects compared with other forms of trauma, it remains unclear which emotional outcome dimensions are impacted, whether cannabis outcomes are similarly impacted, and whether gender differences exist in sexual assault's links with these outcomes. Methods: N = 100 cannabis users with trauma histories (M age = 33.1) completed standardized measures of demographics, trauma exposure, posttraumatic stress (PTS) and depressive symptoms, hopelessness, and cannabis outcomes (frequency, medicinal prescription, motives, and craving). Results: Sexual assault was experienced more often by women (83.9%) than men (31.8%). A series of 2 × 2 analyses of variance [gender: women (n = 56) vs. men (n = 44) × trauma type: sexual assault (n = 61) vs. other (n = 39)] and logistic regression revealed that sexual assault survivors scored higher than other trauma survivors on re-experiencing and hyperarousal PTS symptoms (DSM-5 Clusters B and E), cognitive depressive symptoms, hopelessness, cannabis use frequency, medicinal cannabis prescription, cannabis use to cope with psychological symptoms, and compulsivity craving; and lower on social and enhancement cannabis use motives. In terms of gender main effects, women scored higher than men on cannabis use to cope with negative emotions. In terms of interactions for PTS Cluster D symptoms (negative alterations in mood/cognitions), among men only, sexual assault survivors scored higher than other trauma survivors; and for cannabis enhancement motives and purposefulness cannabis craving, among sexual assault survivors only, women scored higher than men. Discussion: Across many different trauma, women survivors' use of cannabis to cope with negative affect should be a specific therapeutic focus. Moreover, we identified specific emotional and cannabis use outcomes that should be of specific clinical concern among sexual assault survivors regardless of gender. Finally, in terms of gender differences of clinical interest among sexual assault survivors, while PTS Cluster D symptoms should be specific treatment targets in men, cannabis enhancement motives and purposefulness craving should be treatment targets in women. [ABSTRACT FROM AUTHOR]

Background The treatment coverage for major depressive disorder (MDD) is low in many parts of the world despite MDD being a major contributor to disability globally. Most existing reviews of MDD treatment coverage do not account for potential sources of study-level heterogeneity that contribute to variation in reported treatment rates. This study aims to provide a comprehensive review of the evidence and analytically quantify sources of heterogeneity to report updated estimates of MDD treatment coverage and gaps by location and treatment type between 2000 and 2019. Methods and findings A systematic review of the literature was conducted to identify relevant studies that provided data on treatment rates for MDD between January 1, 2000, and November 26, 2021, from 2 online scholarly databases PubMed and Embase. Cohort and cross-sectional studies were included if treatment rates pertaining to the last 12 months or less were reported directly or if sufficient information was available to calculate this along with 95% uncertainty intervals (UIs). Studies were included if they made use of population-based surveys that were representative of communities, countries, or regions under study. Studies were included if they used established diagnostic criteria to diagnose cases of MDD. Sample and methodological characteristics were extracted from selected studies. Treatment rates were modeled using a Bayesian meta-regression approach and adjusted for select covariates that quantified heterogeneity in the data. These covariates included age, sex, treatment type, location, and choice of MDD assessment tool. A total of 149 studies were included for quantitative analysis. Treatment coverage for health service use ranged from 51% [95% UI 20%, 82%] in high-income locations to 20% [95% UI 1%, 53%] in low- and lower middle-income locations. Treatment coverage for mental health service use ranged from 33% [95% UI 8%, 66%] in high-income locations to 8% [95% UI Conclusions In this study, we observed that the treatment coverage for MDD continues to be low in many parts of the world and in particular in low- and lower middle-income countries. There is a continued need for routine data collection that will help obtain more accurate estimates of treatment coverage globally., Author(s): Modhurima Moitra 1,2, Damian Santomauro 1,3,4, Pamela Y. Collins 2,5, Theo Vos 1, Harvey Whiteford 1,3,4, Shekhar Saxena 6, Alize J. Ferrari 1,3,4,* Introduction Depressive disorders are highly prevalent [...]

Background: In West Africa, healers greatly outnumber trained mental health professionals. People with serious mental illness (SMI) are often seen by healers in "prayer camps" where they may also experience human rights abuses. We developed "M&M," an 8-week-long dual-pronged intervention involving (1) a smartphone-delivered toolkit designed to expose healers to brief psychosocial interventions and encourage them to preserve human rights (M-Healer app), and (2) a visiting nurse who provides medications to their patients (Mobile Nurse). Objective: We examined the feasibility, acceptability, safety, and preliminary effectiveness of the M&M intervention in real-world prayer camp settings. Methods: We conducted a single-arm field trial of M&M with people with SMI and healers at a prayer camp in Ghana. Healers were provided smartphones with M-Healer installed and were trained by practice facilitators to use the digital toolkit. In parallel, a study nurse visited their prayer camp to administer medications to their patients. Clinical assessors administered study measures to participants with SMI at pretreatment (baseline), midtreatment (4 weeks) and post treatment (8 weeks). Results: Seventeen participants were enrolled and most (n=15, 88.3%) were retained. Participants had an average age of 44.3 (SD 13.9) years and 59% (n=10) of them were male. Fourteen (82%) participants had a diagnosis of schizophrenia and 2 (18%) were diagnosed with bipolar disorder. Four healers were trained to use M-Healer. On average, they self-initiated app use 31.9 (SD 28.9) times per week. Healers watched an average of 19.1 (SD 21.2) videos, responded to 1.5 (SD 2.4) prompts, and used the app for 5.3 (SD 2.7) days weekly. Pre-post analyses revealed a significant and clinically meaningful reduction in psychiatric symptom severity (Brief Psychiatric Rating Scale score range 52.3 to 30.9; Brief Symptom Inventory score range 76.4 to 27.9), psychological distress (Talbieh Brief Distress Inventory score range 37.7 to 16.9), shame (Other as Shamer Scale score range 41.9 to 28.5), and stigma (Brief Internalized Stigma of Mental Illness Scale score range 11.8 to 10.3). We recorded a significant reduction in days chained (1.6 to 0.5) and a promising trend for reduction in the days of forced fasting (2.6 to 0.0, P=.06). We did not identify significant pre-post changes in patient-reported working alliance with healers (Working Alliance Inventory), depressive symptom severity (Patient Health Questionnaire-9), quality of life (Lehman Quality of Life Interview for the Mentally Ill), beliefs about medication (Beliefs about Medications Questionnaire--General Harm subscale), or other human rights abuses. No major side effects, health and safety violations, or serious adverse events occurred over the course of the trial. Conclusions: The M&M intervention proved to be feasible, acceptable, safe, and clinically promising. Preliminary findings suggest that the M-Healer toolkit may have shifted healers' behaviors at the prayer camp so that they commit fewer human rights abuses. [ABSTRACT FROM AUTHOR]

Background: In 2010, the Louisiana Asthma Management and Prevention Program (LAMP) implemented the Asthma-Friendly Schools Initiative in high-risk Louisiana populations. The social ecological model (SEM) was used as a framework for an asthma program implemented in 70 state K-12 public schools over 2 years. Methods: Activities included a needs assessment, identification of students with asthma, individualized asthma action plans (AAP), staff trainings, environmental quality improvement, and school system policy changes to address the asthma burden. Results: There were 522 new or existing asthma cases recognized. Asthma knowledge/awareness was measurably improved among school personnel. School indoor air quality was improved across all locations. School-level polices were adopted that improved AAP collection, compliance to bus-idling restrictions, and asthma medication self-carry. Conclusions: The SEM framework can be used for school-based programs to address successfully and improve asthma-related issues from the individual through policy levels.