Search

BackgroundPsychiatric diagnostic manuals recognise the importance of local expressions of distress in culturally diverse settings [i.e. idioms/cultural concepts of distress (CCDs)], yet there is a lack of consensus on how these should be incorporated into mental health related research.AimsTo perform a narrative synthesis and critical review of research exploring how idioms/CCDs have been integrated into assessment measures and interventions.MethodA systematic review was conducted in accordance with PRISMA guidelines. An adapted version of the COSMIN checklist was used to assess the quality of the linguistic translation of the idioms/CCDs.ResultsTwenty-nine papers were included in the final review. Primary qualitative research was the most common method of gathering information about idioms/CCDs. The majority of studies described integrating idioms/CCDs into assessment measures as opposed to interventions. Some studies used information relating to idioms/CCDs to develop novel assessment measures, while others adapted pre-existing assessment measures. The measures generated moderate to high levels of validity. Information relating to the linguistic translation conducted in the completion of the studies tended to be inadequately reported.ConclusionsIntegrating information about idioms/CCDs into assessment measures can enhance the validity of these assessments. Allocating greater research attention to idioms/CCDs can also promote more equitable exchanges of knowledge about mental health and wellbeing between the Global North and the Global South.

Background:The Boko Haram insurgency has brought turmoil and instability to Nigeria, generating a large number of internally displaced people and adding to the country's 17.5 million orphans and vulnerable children. Recently, steps have been taken to improve the mental healthcare infrastructure in Nigeria, including revamping national policies and initiating training of primary care providers in mental healthcare. In order for these efforts to succeed, they require means for community-based detection and linkage to care. A major gap preventing such efforts is the shortage of culturally appropriate, valid screening tools for identifying emotional and behavioral disorders among adolescents. In particular, studies have not conducted simultaneous validation of screening tools in multiple languages, to support screening and detection efforts in linguistically diverse populations. We aim to culturally adapt screening tools for emotional and behavioral disorders for use among adolescents in Nigeria, in order to facilitate future validation studies. Methods:We used a rigorous mixed-method process to culturally adapt the Depression Self Rating Scale, Child PTSD Symptom Scale, and Disruptive Behavior Disorders Rating Scale. We employed expert translations, focus group discussions (N = 24), and piloting with cognitive interviewing (N = 24) to achieve semantic, content, technical, and criterion equivalence of screening tool items. Results:We identified and adapted items that were conceptually difficult for adolescents to understand, conceptually non-equivalent across languages, considered unacceptable to discuss, or stigmatizing. Findings regarding problematic items largely align with existing literature regarding cross-cultural adaptation. Conclusions:Culturally adapting screening tools represents a vital first step toward improving community case detection.

Although resilience has been identified as an important mediator of negative mental health outcomes among refugee populations, there are few culturally specific measures of resilience among such communities and no such measure among Somalis. In this study we aimed to develop a culturally appropriate measure of resilience specific to Somali adults in San Diego, as an example of a vulnerable refugee community. A community-based, exploratory sequential mixed method investigation was conducted via focus group discussions ( n  = 4), cognitive interviews ( n  = 4), and iterative survey adaptation. Somali refugee adults in San Diego ( N  = 183) were surveyed with this novel scale, a standardized measure of resilience, and assessments of depression, anxiety, and PTSD. Results were analyzed via correlation coefficients and multivariate linear regression modeling. Qualitative findings supported the inclusion of items addressing both barriers and facilitators of good mental health, which resulted in the development of the Somali Distress and Resilience Survey (SDRS). Linear regression analysis revealed that the SDRS demonstrated significant associations with symptoms of depression and PTSD, while the standardized measure of resilience did not demonstrate associations with any of the mental health outcomes assessed. The SDRS identified obstacles to resilience among Somali individuals, placing them at risk of developing negative mental health outcomes. Our novel measure also demonstrated more robust relationships with these outcomes than a standardized measure of resilience, suggesting greater utility of the adapted scale. However, the SDRS's development raises larger questions about the limitations of developing and comprehensively evaluating novel resilience measures in a community-based setting., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Locus of control (LoC) refers to one's expectation that life outcomes and (mis)fortune are driven largely by one's own actions or abilities (internal LoC) or by external factors (e.g., powerful others, chance; external LoC). There is a large literature demonstrating an association between internal LoC and positive mental health outcomes. However, this research is conducted mostly in high-income, Global North settings, with limited consideration of cross-cultural variability. This short report explores how LoC relates to mental health when considered in a less-studied context: in a setting of stark structural violence and in relation to supernatural agents., Methods: I conducted a community-based survey in rural Haiti (n = 322) that assessed sent spirit-related locus of control (LoC-S) and mental health., Results: Among individuals experiencing higher levels of daily stressors, depressive and anxiety symptoms were high regardless of LoC-S. However, for individuals facing low-to-moderate daily stressors, external LoC-S (believing one does not have control in relation to sent spirits) was associated with lower depressive and anxiety symptoms, though this interaction did not hold for anxiety after controlling for covariates. Though initially a nonintuitive finding, I contextualize this outcome in relation to ethnographic work in Haiti, showing that the ability to explain misfortune via the supernatural world can serve as a form of blame displacement., Conclusion: In a context where extreme structural violence means that individuals realistically have little control over their lives, an external LoC better reflects lived experience, helping explain the association with better mental health outcomes., (© 2024 The Author(s). American Journal of Human Biology published by Wiley Periodicals LLC.)

Introduction: Children, adolescent, and young adult cancer survivors experience overall increased risks of infertility that are preventable through effective fertility preservation services prior to starting cancer treatment. Oncofertility care is the evidence-based practice of informing newly diagnosed cancer patients about their reproductive risks and supporting shared decision-making on fertility preservation services. Despite longstanding clinical guidelines, oncofertility care delivery continues to be limited and highly variable across adult and pediatric oncology settings., Materials and Methods: We describe the design of a stepped wedge cluster randomized clinical trial to evaluate the effectiveness of the multi-component Telehealth Oncofertility Care (TOC) intervention conducted in 20 adult and pediatric oncology clinics across three health systems in Southern California. Intervention components are: 1) electronic health record-based oncofertility needs screen and referral pathway to a virtual oncofertility hub; 2) telehealth oncofertility counseling through the hub; and 3) telehealth oncofertility financial navigation through the hub. We hypothesize the intervention condition will be associated with increased proportions of patients who engage in goal-concordant oncofertility care (i.e., engagement in reproductive risk counseling and fertility preservation services that meet the patient's fertility goals) and improved patient-reported outcomes, compared to the usual care control condition. We will also evaluate intervention implementation in a mixed-methods study guided by implementation science frameworks., Discussion: Our overall goal is to speed implementation of a scalable oncofertility care intervention at cancer diagnosis for children, adolescent and young adult cancer patients to improve their future fertility and quality of life., Trial Registration: Clinicaltrials.gov Identifier: NCT05443737., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: A myriad of federal, state, and organizational policies are designed to improve access to evidence-based healthcare, but the impact of these policies likely varies due to contextual determinants of, reinterpretations of, and poor compliance with policy requirements throughout implementation. Strategies enhancing implementation and compliance with policy intent can improve population health. Critically assessing the multi-level environments where health policies and their related health services are implemented is essential to designing effective policy-level implementation strategies. California passed a 2019 health insurance benefit mandate requiring coverage of fertility preservation services for individuals at risk of infertility due to medical treatments, in order to improve access to services that are otherwise cost prohibitive. Our objective was to document and understand the multi-level environment, relationships, and activities involved in using state benefit mandates to facilitate patient access to fertility preservation services., Methods: We conducted a mixed-methods study and used the policy-optimized exploration, preparation, implementation, and sustainment (EPIS) framework to analyze the implementation of California's fertility preservation benefit mandate (SB 600) at and between the state insurance regulator, insurer, and clinic levels., Results: Seventeen publicly available fertility preservation benefit mandate-relevant documents were reviewed. Interviews were conducted with four insurers; 25 financial, administrative, and provider participants from 16 oncology and fertility clinics; three fertility pharmaceutical representatives; and two patient advocates. The mandate and insurance regulator guidance represented two "Big P" (system level) policies that gave rise to a host of "little p" (organizational) policies by and between the regulator, insurers, clinics, and patients. Many little p policies were bridging factors to support implementation across levels and fertility preservation service access. Characterizing the mandate's functions (i.e., policy goals) and forms (i.e., ways that policies were enacted) led to identification of (1) intended and unintended implementation, service, and patient outcomes, (2) implementation processes by level and EPIS phase, (3) actor-delineated key processes and heterogeneity among them, and (4) inner and outer context determinants that drove adaptations., Conclusions: Following the midstream and downstream implementation of a state health insurance benefit mandate, data generated will enable development of policy-level implementation strategies, evaluation of determinants and important outcomes of effective implementation, and design of future mandates to improve fit and fidelity., (© 2024. The Author(s).)

With recent climatic changes, the reduced access to solar radiation has become an emerging threat to chickpeas' drought tolerance capacity under rainfed conditions. This study was conducted to assess, and understand the effects of reduced light intensity and quality on plant morphology, root development, and identifying resistant sources from a Sonali/PBA Slasher mapping population. We evaluated 180 genotypes, including recombinant inbred lines (RILs), parents, and commercial checks, using a split-block design with natural and low light treatments. Low light conditions, created by covering one of the two benches inside two growth chambers with a mosquito net, reduced natural light availability by approximately 70%. Light measurements encompassed photosynthetic photon flux density, as well as red, and far-red light readings taken at various stages of the experiment. The data, collected from plumule emergence to anthesis initiation, encompassed various indices relevant to root, shoot, and carbon gain (biomass). Statistical analysis examined variance, treatment effects, heritability, correlations, and principal components (PCs). Results demonstrated significant reductions in root biomass, shoot biomass, root/shoot ratio, and plant total dry biomass under suboptimal light conditions by 52.8%, 28.2%, 36.3%, and 38.4%, respectively. Plants also exhibited delayed progress, taking 9.2% longer to produce their first floral buds, and 19.2% longer to commence anthesis, accompanied by a 33.4% increase in internodal lengths. A significant genotype-by-environment interaction highlighted differing genotypic responses, particularly in traits with high heritability (> 77.0%), such as days to anthesis, days to first floral bud, plant height, and nodes per plant. These traits showed significant associations with drought tolerance indicators, like root, shoot, and plant total dry biomass. Genetic diversity, as depicted in a genotype-by-trait biplot, revealed contributions to PC1 and PC2 coefficients, allowing discrimination of low-light-tolerant RILs, such as 1_52, 1_73, 1_64, 1_245, 1_103, 1_248, and 1_269, with valuable variations in traits of interest. These RILs could be used to breed desirable chickpea cultivars for sustainable production under water-limited conditions. This study concludes that low light stress disrupts the balance between root and shoot morphology, diverting photosynthates to vegetative structures at the expense of root development. Our findings contribute to a better understanding of biomass partitioning under limited-light conditions, and inform breeding strategies for improved drought tolerance in chickpeas., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Naveed, Bansal and Kaiser.)

Purpose: Oncofertility counseling of female cancer patients lacks efficient access to tailored and valid infertility risk estimates to support shared decision-making on fertility preservation treatments. The objective was to develop, conduct user-centered design, and plan clinic-based implementation of the Cancer Related Infertility Score Predictor (CRISP), a web-based tool to support infertility risk counseling. Methods: Using a mixed methods design, literature review was undertaken to abstract data on infertility, primary ovarian insufficiency, and amenorrhea risks of common cancer treatments. The CRISP website was programmed to take user input about patient ages and cancer treatments and generate a risk summary. Using user experience methodology and semistructured interviews, usability testing and implementation assessment were conducted with 12 providers recruited from 5 medical centers in Southern California. Results: The web-based CRISP tool encompasses infertility risk data for 60 treatment regimens among 10 cancer types. Usability testing demonstrated that the tool is intuitive and informed minor modifications, including adding crowd-sourced submission of additional cancer treatments. Participants rated the tool as credible, advantageous over current provider methods to ascertain infertility risks, and useful for tailoring treatment planning and counseling patients. A key barrier was lack of information on some cancer treatments. Fit within clinical workflow was feasible, particularly with electronic health record integration. Conclusions: The novel, web-based CRISP tool is a feasible, acceptable, and appropriate tool to address provider knowledge gap about cancer related infertility risks and use for patient counseling. CRISP has significant potential to support tailored oncofertility counseling in the heterogeneous young cancer patient population.

Root systems of most land plants are colonised by arbuscular mycorrhiza fungi. The symbiosis supports nutrient acquisition strategies predominantly associated with plant access to inorganic phosphate. The nutrient acquisition is enhanced through an extensive network of external fungal hyphae that extends out into the soil, together with the development of fungal structures forming specialised interfaces with root cortical cells. Orthologs of the bHLHm1;1 transcription factor, previously described in soybean nodules (GmbHLHm1) and linked to the ammonium facilitator protein GmAMF1;3, have been identified in Medicago ( Medicago truncatula) roots colonised by AM fungi. Expression studies indicate that transcripts of both genes are also present in arbuscular containing root cortical cells and that the MtbHLHm1;1 shows affinity to the promoter of MtAMF1;3 . Both genes are induced by AM colonisation. Loss of Mtbhlhm1;1 expression disrupts AM arbuscule abundance and the expression of the ammonium transporter MtAMF1;3 . Disruption of Mtamf1;3 expression reduces both AM colonisation and arbuscule development. The respective activities of MtbHLHm1;1 and MtAMF1;3 highlight the conservation of putative ammonium regulators supporting both the rhizobial and AM fungal symbiosis in legumes.

Background: A key question in implementation science is how to balance adaptation and fidelity in translating interventions to new settings. There is growing consensus regarding the importance of planned adaptations to deliver interventions in contextually sensitive ways. However, less research has examined ad-hoc adaptations, or those that occur spontaneously in the course of intervention delivery. A key question is whether ad-hoc adaptations ultimately contribute to or detract from intervention goals. This study aimed to (a) identify ad-hoc adaptations made during delivery of a family therapy intervention and (b) assess whether they promoted or interrupted intervention goals., Methods: Tuko Pamoja (Swahili: "We are Together") is an evidence-informed family therapy intervention aiming to improve family dynamics and mental health in Kenya. Tuko Pamoja employs a task-shifting model, delivered by lay counselors who are afforded a degree of flexibility in presenting content and in practices they use in sessions. We used transcripts of therapy sessions with 14 families to examine ad-hoc adaptations used by counselors. We first identified and characterized ad-hoc adaptations through a team-based code development, coding, and code description process. Then, we evaluated to what extent ad-hoc adaptations promoted the principles and strategies of the intervention ("TP-promoting"), disrupted them ("TP-interrupting"), or neither ("TP-neutral"). To do this, we first established inter-coder agreement on application of these categories with verification by the intervention developer. Then, coders categorized ad-hoc adaptation text segments as TP-promoting, TP-interrupting, or TP-neutral., Results: Ad-hoc adaptations were frequent and included (in decreasing order): incorporation of religious content, exemplars/role models, community dynamics and resources, self-disclosure, and metaphors/proverbs. Ad-hoc adaptations were largely TP-promoting (49%) or neutral (39%), but practices were TP-interrupting 12% of the time. TP-interrupting practices most often occurred within religious content and exemplars/role models, which were also the most common practices overall., Conclusion: Extra attention is needed during planned adaptation, training, and supervision to promote intervention-aligned use of common ad-hoc adaptation practices. Discussing them in trainings can provide guidance for lay providers on how best to incorporate ad-hoc adaptations during delivery. Future research should evaluate whether well-aligned ad-hoc adaptations improve therapeutic outcomes., Trial Registration: Pilot trial registered at clinicaltrials.gov (C0058)., (© 2023. BioMed Central Ltd.)

Introduction: From diagnosis to post-treatment, many young breast cancer survivors (YBCS) experience infertility, limited contraception choices, concern about pregnancy safety, and menopausal symptoms. Clinical guidelines recommend oncofertility care (counseling and/or clinical services that meet fertility, contraception, pregnancy health and/or menopausal symptom management needs) throughout the cancer care continuum. However, significant oncofertility care gaps exist in rural, community oncology settings., Materials and Methods: We describe the design of an interrupted time series, effectiveness-implementation hybrid clinical trial that evaluates a multi-component intervention to improve YBCS engagement in oncofertility care. The intervention is comprised of 1) oncology clinic-based oncofertility needs screen; 2) a women's health survivorship care plan in Spanish and English; 3) remote patient navigation; and 4) telehealth oncofertility consultation. During the pre-intervention period (12 months), usual care will be delivered. During the intervention period (15 months), the multi-component intervention will be implemented at two rural oncology clinics with largely Latina, Spanish-speaking populations. The primary outcome of YBCS (n = 135) engagement in oncofertility care will be collected from medical record review. We will also collect validated patient-reported outcomes. Informed by the Exploration Preparation Implementation Sustainment (EPIS) implementation science framework, we will integrate qualitative and quantitative data to explore whether and how the intervention was effective, acceptable, appropriate, and delivered with fidelity., Discussion: Our overall goal is to speed implementation of a scalable oncofertility care intervention for YBCS in underserved areas to reduce disparities and improve reproductive health and quality of life., Trial Registration: Clinicaltrials.gov Identifier: NCT05414812., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Main Conclusion: Legumes manage both symbiotic (indirect) and non-symbiotic (direct) nitrogen acquisition pathways. Understanding and optimising the direct pathway for nitrate uptake will support greater legume growth and seed yields. Legumes have multiple pathways to acquire reduced nitrogen to grow and set seed. Apart from the symbiotic N 2 -fixation pathway involving soil-borne rhizobia bacteria, the acquisition of nitrate and ammonia from the soil can also be an important secondary nitrogen source to meet plant N demand. The balance in N delivery between symbiotic N (indirect) and inorganic N uptake (direct) remains less clear over the growing cycle and with the type of legume under cultivation. In fertile, pH balanced agricultural soils, NO 3 - is often the predominant form of reduced N available to crop plants and will be a major contributor to whole plant N supply if provided at sufficient levels. The transport processes for NO 3 - uptake into legume root cells and its transport between root and shoot tissues involves both high and low-affinity transport systems called HATS and LATS, respectively. These proteins are regulated by external NO 3 - availability and by the N status of the cell. Other proteins also play a role in NO 3 - transport, including the voltage dependent chloride/nitrate channel family (CLC) and the S-type anion channels of the SLAC/SLAH family. CLC's are linked to NO 3 - transport across the tonoplast of vacuoles and the SLAC/SLAH's with NO 3 - efflux across the plasma membrane and out of the cell. An important step in managing the N requirements of a plant are the mechanisms involved in root N uptake and the subsequent cellular distribution within the plant. In this review, we will present the current knowledge of these proteins and what is understood on how they function in key model legumes (Lotus japonicus, Medicago truncatula and Glycine sp.). The review will examine their regulation and role in N signalling, discuss how post-translational modification affects NO 3 - transport in roots and aerial tissues and its translocation to vegetative tissues and storage/remobilization in reproductive tissues. Lastly, we will present how NO 3 - influences the autoregulation of nodulation and nitrogen fixation and its role in mitigating salt and other abiotic stresses., (© 2023. The Author(s).)

The cyanogenic glucoside, dhurrin, present in Sorghum bicolor is thought to have multiple functions, including in defence against herbivory. The hormone methyl jasmonate (MeJA) is also induced by herbivory and is key to instigating defence processes in plants. To investigate whether dhurrin is induced in response to herbivore attack and also to the associated presence of MeJA, sorghum plants were either wounded or exogenous MeJA was applied. We show that specific wounding (pin board and perforation) and the application of MeJA increases dhurrin concentration in leaves and sheath tissue 12 h after treatment. Quantitative PCR shows that the expression of two genes, SbCYP79A1 and SbUGT85B1, involved in the synthesis of dhurrin are significantly induced by exogenous MeJA and by wounding. Analysis of 2 kb of sequence upstream of the start codon of SbCYP79A1 identifies several cis-acting elements that have been linked to MeJA induction. A promoter deletion series, coupled to GFP, and transiently expressed in Nicotiana benthamiana suggests that there are potentially three sequence motifs (~-925 to -976) involved in the binding of transcription factors that result in increased expression of SbCYP79A1 and the synthesis of dhurrin in response to MeJA., (© 2023 The Authors. Plant Biology published by John Wiley & Sons Ltd on behalf of German Society for Plant Sciences, Royal Botanical Society of the Netherlands.)

Chickpea is the second-most-cultivated legume globally, with India and Australia being the two largest producers. In both of these locations, the crop is sown on residual summer soil moisture and left to grow on progressively depleting water content, finally maturing under terminal drought conditions. The metabolic profile of plants is commonly, correlatively associated with performance or stress responses, e.g., the accumulation of osmoprotective metabolites during cold stress. In animals and humans, metabolites are also prognostically used to predict the likelihood of an event (usually a disease) before it occurs, e.g., blood cholesterol and heart disease. We sought to discover metabolic biomarkers in chickpea that could be used to predict grain yield traits under terminal drought, from the leaf tissue of young, watered, healthy plants. The metabolic profile (GC-MS and enzyme assays) of field-grown chickpea leaves was analysed over two growing seasons, and then predictive modelling was applied to associate the most strongly correlated metabolites with the final seed number plant -1 . Pinitol (negatively), sucrose (negatively) and GABA (positively) were significantly correlated with seed number in both years of study. The feature selection algorithm of the model selected a larger range of metabolites including carbohydrates, sugar alcohols and GABA. The correlation between the predicted seed number and actual seed number was R 2 adj = 0.62, demonstrating that the metabolic profile could be used to predict a complex trait with a high degree of accuracy. A previously unknown association between D-pinitol and hundred-kernel weight was also discovered and may provide a single metabolic marker with which to predict large seeded chickpea varieties from new crosses. The use of metabolic biomarkers could be used by breeders to identify superior-performing genotypes before maturity is reached.

Purpose: Oncofertility care for pediatric, adolescent, and young adult cancer patients remains under-implemented across adult and pediatric oncology settings. We pilot tested an electronic health record (EHR)-enabled multicomponent oncofertility intervention (including screening, referral, and fertility consult) in an adult academic oncology program and systematically assessed intervention fit to pediatric and community oncology programs. Methods: Using surveys ( n  = 33), audits ( n  = 143), and interviews ( n  = 21) guided by implementation science frameworks, we pilot tested the EHR-enabled intervention for oncofertility care in young cancer patients at an adult oncology program and evaluated implementation outcomes. We interviewed health care providers from seven regional oncology and fertility programs about intervention fit to their clinical contexts. Results: We recruited 33 health care providers from an adult oncology setting and 15 health care providers from seven additional oncology and fertility settings. At the adult oncology setting, the intervention was found to be appropriate, acceptable, and feasible and improved the screening of fertility needs (from 30% pre- to 51% post-intervention); yet, some patients did not receive appropriate referrals to fertility consults. Providers across all settings suggested content and context modifications, such as adding options to the intervention or allowing the screening component to pop up at a second visit, to improve and adapt the intervention to better fit their clinical care contexts. Conclusions: We found that the EHR-enabled intervention increased the rate of goal-concordant oncofertility care delivery at an adult oncology program. We also identified facilitators, barriers, and needed adaptations to the intervention required for implementation and scaling-up across diverse oncology settings.

Background: Community Advisory Boards (CABs) have been frequently used to engage diverse partners to inform research projects. Yet, evaluating the quality of engagement has not been routine. We describe a multi-method ethnographic approach documenting and assessing partner engagement in two "virtual" CABs, for which we conducted all meetings remotely., Methods: Two research projects for increasing equitable COVID-19 testing, vaccination, and clinical trial participation for underserved communities involved remote CAB meetings. Thirty-three partners representing 17 community groups participated in 15 sessions across the two CABs facilitated by a social change organization. We developed ethnographic documentation forms to assess multiple aspects of CAB member engagement (e.g., time spent speaking, modality used, types of interactions). Documenters were trained to observe CAB sub-groups via virtual sessions. Debriefing with the documentation team after CAB meetings supported quality assurance and process refinement. CAB members completed a brief validated survey after each meeting to assess the quality and frequency of engagement. Content and rapid thematic analysis were used to analyze documentation data. Quantitative data were summarized as frequencies and means. Qualitative and quantitative findings were triangulated., Results: A total of 4,540 interactions were identified across 15 meetings. The most frequent interaction was providing information (44%), followed by responding (37-38%). The quality and frequency of stakeholder engagement were rated favorably (average 4.7 of 5). Most CAB members (96%) reported good/excellent engagement. Specific comments included appreciation for the diversity of perspectives represented by the CAB members and suggestions for improved live interpretation. Debriefing sessions led to several methodological refinements for the documentation process and forms., Conclusion: We highlight key strategies for documenting and assessing community engagement. Our methods allowed for rich ethnographic data collection that refined our work with community partners. We recommend ongoing trainings, including debriefing sessions and routinely reviewed assessment of data to strengthen meaningful community engagement., (© 2023. The Author(s).)

Background: With growing global recognition of the need to address mental health, a key challenge is determining who needs mental health services. Most self-report screening tools were developed in English-speaking high-income settings, and this cultural milieu influences the types and content of items, the manner in which items are asked, and the options for responding to items. Approaches have been developed for transcultural translation and validation. However, these approaches are typically applied in one language at a time, which is of limited utility in linguistically diverse settings., Methods: To address challenges in cross-cultural validation, we undertook a unique process of simultaneously validating tools in two languages in Nigeria. Through this dual-language validation, we explored how cultural and contextual differences may influence what is considered valid for a mental health tool. We validated the Depression Self Rating Scale, Child PTSD Symptom Scale (CPSS), and Disruptive Behavior Disorders Rating Scale with a community sample of 330 adolescents aged 12-17. Validity was assessed in Hausa and Pidgin, two languages commonly spoken in Nigeria. Clinical psychologists used the Kiddie-Schedule for Affective Disorders and Schizophrenia to establish caseness., Results: Most items had good discriminant validity, except on the CPSS, on which only 8 of 17 items discriminated by caseness. Findings indicate the influence of culture (e.g., linguistic differences in translatability of items) and context (e.g., items that reflect experiences of hunger or foodborne illness; different PTSD caseness by language might reflect differential trauma exposure between populations). We also identified items that operated differently between languages., Conclusion: We identified shortcomings in cross-cultural validation procedures with regard to determining whether language, context, or or other differences influence performance of items. For future validation efforts, we recommend systematically collecting information on context and stressful/traumatic exposures as a way to contextualize interpretation of the validity findings., Acronyms: Depression Self Rating Scale (DSRS), Child PTSD Symptom Scale (CPSS), Disruptive Behavior Disorders Rating Scale (DBDRS), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), Area Under the Curve (AUC), Diagnostic Odds Ratio (DOR), Low- and Middle-Income Countries (LMICs), Posttraumatic Stress Disorder (PTSD)., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

To increase cultural relevance and maximize access for historically underserved populations, there is a need to explore mechanisms underlying treatment outcomes during piloting. We developed a mixed-method approach, Integrated Clinical and Implementation Mapping (ICIM), to explore clinical and implementation mechanisms to inform improvements in content and delivery. We applied ICIM in a pilot of Tuko Pamoja, a lay counselor-delivered family intervention in Kenya (10 families with adolescents ages 12-17). ICIM is a 3-phase process to triangulate data sources to analyze how and why change occurs within individual cases and across cases. We synthesized data from session and supervision transcripts, fidelity and clinical skills ratings, surveys, and interviews. Outputs included a comprehensive narrative and visual map depicting how content and implementation factors influenced change. For Tuko Pamoja, ICIM results showed common presenting problems, including financial strain and caregivers' distress, triggering negative interactions and adolescent distress. ICIM demonstrated that active treatment ingredients included communication skills and facilitated, prescribed time together. Families improved communication, empathy, and hope, facilitated improved family functioning and mental health. Key implementation mechanisms included provider clinical competencies, alliance-building, treatment-aligned adaptations, and consistent attendance. Results guided manual and training refinements and generated hypotheses about mechanisms to test in larger trials., Competing Interests: Declaration of competing interest None., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: There are increasing initiatives to reduce mental illness stigma among primary care providers (PCPs) being trained in mental health services. However, there is a gap in understanding how stigma reduction initiatives for PCPs produce changes in attitudes and clinical practices. We conducted a pilot randomized controlled trial of a stigma reduction intervention in Nepal: REducing Stigma among HealthcAre Providers (RESHAPE). In a previous analysis of this pilot, we described differences in stigmatizing attitudes and clinical behaviors between PCPs receiving a standard mental health training (mental health Gap Action Program, mhGAP) vs. those receiving an mhGAP plus RESHAPE training. The goal of this analysis is to use qualitative interview data to explain the quantitative differences in stigma outcomes identified between the trial arms., Methods: PCPs were randomized to either standard mental health training using mhGAP led by mental health specialists or the experimental condition (RESHAPE) in which service users living with mental illness shared photographic recovery narratives and participated in facilitated social contact. Qualitative interviews were conducted with PCPs five months post-training (n = 8, standard mhGAP training; n = 20, RESHAPE). Stigmatizing attitudes and clinical practices before and after training were qualitatively explored to identify mechanisms of change., Results: PCPs in both training arms described changes in knowledge, skills, and confidence in providing mental healthcare. PCPs in both arms described a positive feedback loop, in which discussing mental health with patients encouraged more patients to seek treatment and open up about their illness, which demonstrated for PCPs that mental illness can be treated and boosted their clinical confidence. Importantly, PCPs in the RESHAPE arm were more likely to describe a willingness to treat mental health patients and attributed this in part to social contact with service users during the training., Conclusions: Our qualitative research identified testable mechanisms of action for stigma reduction and improving clinical behavior: specifically, recovery stories from service users and social engagement led to greater willingness to engage with patients about mental illness, triggering a feedback loop of more positive experiences with patients who benefit from mental healthcare, which further reinforces willingness to deliver mental healthcare. Trial registration ClinicalTrials.gov identifier, NCT02793271., (© 2022. The Author(s).)

Research on mental health in specific communities requires careful attention to cultural context and language. Studies on global mental health have increasingly analyzed idioms of distress, or culturally situated ways of conceptualizing, experiencing, and expressing distress. This study examines how idioms of distress are used and understood in Arcahaie, Haiti. The goal was to enrich current understanding of mental health conceptualization and communication by exploring the heterogeneity of common idioms of distress. Interviews with community members ( N  = 47) explored meanings and perceived causations of 13 idioms of distress. Major themes included pervasiveness of poverty, ruminative thinking, effects of Vodou and Christian belief systems, embodied distress, and the behavior of "crazy" people ( moun fou ). The findings suggest some specific pathways for potential community engagement projects, including training lay-leaders in cognitive behavioral therapy using existing socioreligious infrastructure and expanding access to social engagement activities. This research contributes to a small but growing body of literature on mental illness in Haiti and to methods for studying idioms of distress.

Background: In 2016, the California Department of Healthcare Services (DHCS) released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage among Medicaid beneficiaries. However, implementation remains poor. We apply the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to identify barriers and facilitators to fidelity to APL 16-014 across California Medicaid MCPs., Methods: We assessed fidelity through semi-structured interviews with MCP health educators ( N  = 24). Interviews were recorded, transcribed, and reviewed to develop initial themes regarding barriers and facilitators to implementation. Initial thematic summaries were discussed and mapped onto EPIS constructs., Results: The APL (Innovation) was described as lacking clarity and specificity in its guidelines, hindering implementation. Related to the Inner Context, MCPs described the APL as beyond the scope of their resources, pointing to their own lack of educational materials, human resources, and poor technological infrastructure as implementation barriers. In the Outer Context, MCPs identified a lack of incentives for providers and beneficiaries to offer and participate in tobacco-cessation programs, respectively. A lack of communication, educational materials, and training resources between the state and MCPs (missing Bridging Factors) were barriers to preventing MCPs from identifying smoking rates or gauging success of tobacco-cessation efforts. Facilitators included several MCPs collaborating with each other and using external resources to promote tobacco cessation. Additionally, a few MCPs used fidelity monitoring staff as Bridging Factors to facilitate provider training, track providers' identification of smokers, and follow-up with beneficiaries participating in tobacco-cessation programs., Conclusions: The release of the evidence-based APL 16-014 by California's DHCS was an important step forward in promoting tobacco-cessation services for Medicaid MCP beneficiaries. Improved communication on implementation in different environments and improved Bridging Factors such as incentives for providers and patients are needed to fully realize policy goals., Plan Language Summary: In 2016, the California Department of Healthcare Services (DHCS) in California released an "All Plan Letter" (APL 16-014) to its Medicaid managed care plans (MCPs) providing guidance on implementing tobacco-cessation coverage to address tobacco use among Medicaid beneficiaries. We conducted semi-structured interviews with health educators in California Medicaid MCPs to explore the barriers and facilitators to implementing the APL using the Exploration, Preparation, Implementation, Sustainment framework. According to MCPs, barriers included a lack of clarity in the APL guidelines; a lack of resources, including educational materials, infrastructure to identify smokers, and human resources; and a lack of incentives or penalties for providers to provide tobacco-cessation materials to beneficiaries. Facilitators included collaboration between MCPs and state and/or national public health programs. Overall, our findings can provide avenues for improving the implementation of tobacco-cessation services within Medicaid MCPs., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

In their response to our article (both in this issue), DeYoung and colleagues did not sufficiently address three fundamental flaws with the Hierarchical Taxonomy of Psychopathology (HiTOP). First, HiTOP was created using a simple-structure factor-analytic approach, which does not adequately represent the dimensional space of the symptoms of psychopathology. Consequently, HiTOP is not the empirical structure of psychopathology. Second, factor analysis and dimensional ratings do not fix the problems inherent to descriptive (folk) classification; self-reported symptoms are still the basis on which clinical judgments about people are made. Finally, HiTOP is not ready to use in real-world clinical settings. There is currently no empirical evidence demonstrating that clinicians who use HiTOP have better clinical outcomes than those who use the Diagnostic and Statistical Manual of Mental Disorders ( DSM ). In sum, HiTOP is a factor-analytic variation of the DSM that does not get the field closer to a more valid and useful taxonomy., Competing Interests: Declaration of Conflicting Interests The author(s) declared that there were no conflicts of interest with respect to the authorship or the publication of this article.

Anthropologists have long emphasized the social significance of foods and the contexts in which they are consumed. Expanding on this idea, we define the context of consumption as the non-eating behaviors that surround eating, such as the manner of food preparation, food sharing, and dietary patterns. In this study, we used cultural consensus analysis to assess whether there exist consistently shared, normative ideas about preferable context of food consumption in three diverse research sites: urban Ethiopia, rural Brazil, and rural Haiti. Our analysis demonstrates that in all three communities, there are distinct sets of behaviors that people identified as non-preferable because they reliably associate them with poverty and food insecurity, and behaviors that people identify as preferable because they reliably associate them with wealth and food security. Across the settings, there was little variation in agreement about behaviors across household composition, age, gender, and food security status. These findings suggest that people do indeed share culturally specific ideas about the context in which foods should be prepared and consumed, beyond the actual content of one's diet. Exploring these cultural models elucidates the social consequences of food insecurity, enabling researchers to better examine the relationship between food insecurity, social context, and well-being.

The Hierarchical Taxonomy of Psychopathology (HiTOP) uses factor analysis to group people with similar self-reported symptoms (i.e., like-goes-with-like). It is hailed as a significant improvement over other diagnostic taxonomies. However, the purported advantages and fundamental assumptions of HiTOP have received little, if any scientific scrutiny. We critically evaluated five fundamental claims about HiTOP. We conclude that HiTOP does not demonstrate a high degree of verisimilitude and has the potential to hinder progress on understanding the etiology of psychopathology. It does not lend itself to theory-building or taxonomic evolution, and it cannot account for multifinality, equifinality, or developmental and etiological processes. In its current form, HiTOP is not ready to use in clinical settings and may result in algorithmic bias against underrepresented groups. We recommend a bifurcation strategy moving forward in which the DSM is used in clinical settings while researchers focus on developing a falsifiable theory-based classification system.

There is increasing evidence supporting the effectiveness of psychological interventions in low- and middle-income countries. However, primary care providers (PCPs) may prefer treating patients with medication. A secondary exploratory analysis of a pilot cluster randomized controlled trial was conducted to evaluate psychological vs. pharmacological treatment preferences among PCPs. Thirty-four health facilities, including 205 PCPs, participated in the study, with PCPs in 17 facilities assigned to a standard version of the mental health Gap Action Programme (mhGAP) training delivered by mental health specialists. PCPs in the other 17 facilities received mhGAP instruction delivered by specialists and people with lived experience of mental illness (PWLE), using a training strategy entitled Reducing Stigma among HealthcAre ProvidErs (RESHAPE). Pre- and post- intervention attitudes were measured through quantitative and qualitative tools. Qualitative interviews with 49 participants revealed that PCPs in both arms endorsed counseling's benefits and collaboration within the health system to provide counseling. In the RESHAPE arm, PCPs were more likely to increase endorsement of statements such as "depression improves without medication" ( F = 9.83, p < 0.001), "not all people with depression must be treated with antidepressants" ( χ 2 = 17.62, p < 0.001), and "providing counseling to people who have alcohol abuse problems is effective" ( χ 2 = 26.20, p < 0.001). These mixed-method secondary findings from a pilot trial suggest that in-person participation of PWLE in training PCPs may not only reduce stigma but also increase PCPs' support of psychological interventions. This requires further investigation in a full-scale trial.

Syndemics theory has provided insight into the ways that disease states and social adversity interact in marginalized populations to further disempower these groups. Yet, until recently, scholars have not identified how we might actually recognize and measure a syndemic, as opposed to a situation where there are multiple but non-interacting diseases present in a population. As researchers like those included in this special issue develop new methods for assessing syndemic interactions in diverse global populations, this short communication argues for the value of locally relevant measures. Poverty, mental health, food insecurity, and type 2 diabetes are used to illustrate the assessment of a potential syndemic from a locally grounded perspective. The discussion emphasizes the insights locally adapted measures can add and what information would be lost without their use., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Objective: To review empirical studies that assess saturation in qualitative research in order to identify sample sizes for saturation, strategies used to assess saturation, and guidance we can draw from these studies., Methods: We conducted a systematic review of four databases to identify studies empirically assessing sample sizes for saturation in qualitative research, supplemented by searching citing articles and reference lists., Results: We identified 23 articles that used empirical data (n = 17) or statistical modeling (n = 6) to assess saturation. Studies using empirical data reached saturation within a narrow range of interviews (9-17) or focus group discussions (4-8), particularly those with relatively homogenous study populations and narrowly defined objectives. Most studies had a relatively homogenous study population and assessed code saturation; the few outliers (e.g., multi-country research, meta-themes, "code meaning" saturation) needed larger samples for saturation., Conclusions: Despite varied research topics and approaches to assessing saturation, studies converged on a relatively consistent sample size for saturation for commonly used qualitative research methods. However, these findings apply to certain types of studies (e.g., those with homogenous study populations). These results provide strong empirical guidance on effective sample sizes for qualitative research, which can be used in conjunction with the characteristics of individual studies to estimate an appropriate sample size prior to data collection. This synthesis also provides an important resource for researchers, academic journals, journal reviewers, ethical review boards, and funding agencies to facilitate greater transparency in justifying and reporting sample sizes in qualitative research. Future empirical research is needed to explore how various parameters affect sample sizes for saturation., (Copyright © 2021. Published by Elsevier Ltd.)

Importance: Multiple US states recently passed laws mandating health insurance coverage for fertility preservation (FP) services to improve access to care for patients with cancer, for whom FP service expenses can be prohibitive. Key unanswered questions include how heterogeneous benefit mandate laws and regulations are and how this variation may affect implementation, access, and utilization., Objective: To describe the design of state-level FP health insurance benefit mandate laws and regulations and derive guidance on best practices and implementation needs., Design, Setting, and Population: Legal mapping and implementation science framework-guided analyses were conducted on 11 US state laws that mandate health insurance benefit coverage for FP services for patients at risk of iatrogenic infertility from medical treatments and on related insurer regulations. Design features of laws and regulations and the implementation process were summarized by themes (eg, coverage specification)., Exposures: State jurisdiction., Main Outcomes and Measures: Main outcomes were the scope and specificity of mandated FP insurance coverage and the role of clinical practice guidelines and insurer regulations in implementation., Results: Between June 2017 and March 2021, 11 states passed FP benefit mandate laws. States took a median (range) of 283 (0-640) days to implement mandates, and a majority issued regulatory guidance after the law was in effect. While standard-of-care procedures such as embryo cryopreservation require medical evaluation, medications, ultrasonography and laboratory monitoring, oocyte retrieval, embryo derivation, cryopreservation, and storage, there was variation in which services were specified for inclusion or exclusion in the laws and/or regulator guidance. The majority of state laws and regulator guidance reference medical society clinical practice guidelines and federal policies (Affordable Care Act and Health Insurance Portability and Accountability Act)., Conclusions and Relevance: In this qualitative assessment of 11 state-level FP benefit mandates, variation that may influence patient access was identified in the design and implementation of the mandates. As clinical stakeholders aim to understand and/or shape these laws and their implementation, key considerations included specificity and flexibility of benefit design to be clinically meaningful, expansion of clinical practice guidelines to inform benefit coverage, inclusion of publicly insured and self-insured populations for universal access, and consistency between state and federal policies.

Lay-counselors have become a key human resource in the field of global mental health, aiming to address the estimated one-million-person shortage of mental healthcare providers. However, the role of lay-counselors is ambiguous and in tension: their role is quasi-professional, with specific training and skills that set them apart within communities, yet their role is also defined in contrast to professional mental healthcare providers. We explore how these tensions manifest through the material technologies for protocolizing and evaluating lay-counselor roles. We draw on our ethnographic fieldwork within two global mental health interventions that represent different ends of the spectrum of lay-counselor involvement, in order to explore the possibilities and limitations of such material technologies. Thinking Healthy Program-Peer delivered is a cognitive behavioral therapy-based intervention for women with perinatal depression delivered in Goa, India, and Tuko Pamoja (Swahili: "We are Together") is a family therapy intervention to improve mental health and family functioning in Eldoret, Kenya. First, we explore how intervention manuals - the step-by-step protocols that guide therapy delivery - can both constrain counselors to a script and enable their novel contributions to therapeutic encounters. Then, we examine assessment tools used to evaluate interventions writ large and lay-counselors specifically. We describe how, even where lay-counselors are encouraged to bring their own expertise into therapy delivery, this expertise is not often reflected in evaluation tools. Instead, the focus tends toward fidelity checklists, which require adherence to the manualized intervention and can penalize counselors for "going off book." Even though lay-counselors are often recruited specifically because of their existing roles and "local expertise," we argue that the material technologies of interventions can at times limit how their expertise is enabled and valued. We offer recommendations for global mental health programs to facilitate greater recognition and valuing of lay-counselor expertise., Competing Interests: Declaration of competing interest The authors report no conflicts of interest.

Background: Thalassemia is a common inherited hemoglobin disorder in Southeast Asia. Severe thalassemia can lead to significant morbidity for patients and economic strain for under-resourced health systems. Thailand's thalassemia prevention and control program has successfully utilized prenatal screening and diagnosis to reduce the incidence of severe thalassemia in Thai populations, but migrant populations are excluded despite having high thalassemia prevalence. We sought to identify key barriers to and facilitators of thalassemia screening and to develop tailored recommendations for providing migrants with access to thalassemia prevention and control., Methods: We conducted 28 in-depth interviews and 4 focus group discussions (FGDs) in Chonburi, Thailand with Myanmar and Cambodian migrants, Thai healthcare providers, Thai parents of children affected by thalassemia, and migrant agents., Results: Participant narratives revealed that migrants' lack of knowledge about the prevalence, manifestations, severity, and inherited nature of thalassemia led to misconceptions, fear, or indifference toward thalassemia and screening. Negative perceptions of pregnancy termination were based in religious beliefs but compounded by other sociocultural factors, presenting a key obstacle to migrant uptake of prenatal screening. Additionally, structural barriers included legal status, competing work demands, lack of health insurance, and language barriers. Participants recommended delivering public thalassemia education in migrants' native languages, implementing carrier screening, and offering thalassemia screening in convenient settings., Conclusions: An effective thalassemia prevention and control program should offer migrants targeted thalassemia education and outreach, universal coverage for thalassemia screening and prenatal care, and options for carrier screening, providing a comprehensive strategy for reducing the incidence of severe thalassemia in Thailand and establishing an inclusive model for regional thalassemia prevention and control., (© 2021. The Author(s).)

Purpose: Oncofertility care at cancer diagnosis remains underimplemented across oncology and fertility care settings, with limited tools to scale up effective implementation strategies. Using implementation science theory, we systematically assessed factors that influence oncofertility care implementation and mapped scalable strategies, particularly electronic health record (EHR)-enabled ones, that fit adult and pediatric oncology care contexts. Methods: Using purposeful sampling, we recruited health care providers and female, reproductive-aged survivors of adolescent and young adult (AYA) cancers (AYA survivors) from a comprehensive cancer center and a freestanding children's hospital to semistructured interviews and focus groups. Using thematic analysis combining inductive codes with deductive codes using the Consolidated Framework for Implementation Research (CFIR), we characterized barriers and facilitators to care and designed responsive strategies. Two coders independently coded each transcript. Results: We recruited 19 oncology and fertility providers and 9 cancer survivors. We identified barriers and facilitators to oncofertility care in the CFIR domains of individual, inner setting, outer setting, and process, allowing us to conceptualize oncofertility care to encompass three core components (screening, referral, and fertility preservation counseling) and map five strategies to these components that fit an adult and a children's context and bridge oncology and fertility practices. The strategies were screening using a best practice advisory, referral order, telehealth fertility counseling, provider audit and feedback, and provider education. All but provider education were EHR tools with embedded efficiencies. Conclusion: An implementation science approach systematically assessed oncofertility care and mapped strategies to provide a theory-based approach and scalable EHR tools to support wider dissemination.

Despite extensive ethnographic and qualitative research on traditional healers in Nepal, the role of traditional healers in relation to mental health has not been synthesized. We focused on the following clinically based research question, "What are the processes by which Nepali traditional healers address mental well-being?" We adopted a scoping review methodology to maximize the available literature base and conducted a modified thematic analysis rooted in grounded theory, ethnography, and phenomenology. We searched five databases using terms related to traditional healers and mental health. We contacted key authors and reviewed references for additional literature. Our scoping review yielded 86 eligible studies, 65 of which relied solely on classical qualitative study designs. The reviewed literature suggests that traditional healers use a wide range of interventions that utilize magico-religious explanatory models to invoke symbolic transference, manipulation of local illness narratives, roles, and relationships, cognitive restructuring, meaning-making, and catharsis. Traditional healers' perceived impact appears greatest for mild to moderate forms of psychological distress. However, the methodological and sample heterogeneity preclude uniform conclusions about traditional healing. Further research should employ methods which are both empirically sound and culturally adapted to explore the role of traditional healers in mental health.

Family-based interventions offer a promising avenue for addressing chronic negative family interactions that contribute to lasting consequences, including family violence and the onset and maintenance of mental health disorders. The purpose of this study was to conduct a mixed-methods, single group pre-post pilot trial of a family therapy intervention ( N = 10) delivered by lay counselors in Kenya. Results show that both caregivers and children reported reductions in family dysfunction and improved mental health after the intervention. Point estimates represent change of more than two standard deviations from baseline for the majority of primary outcomes. Treated families also reported a decrease in harsh discipline, intimate partner violence, and alcohol-related problems. These results were corroborated by findings from an observational measure of family functioning and in-depth qualitative interviews. This study presents preliminary evidence of pre-post improvements following a family therapy intervention consisting of streamlined, evidence-informed family therapy strategies to target family dysfunction and mental health., Competing Interests: Conflict of Interest The authors declare that they have no conflict of interest.

Objective: This pilot study assessed the efficacy of personalised, printed and mobile-accessible discharge instructions for pain relief for patients discharged from the ED., Methods: Patients presenting with pain caused by acute musculoskeletal or visceral complaints not requiring admission were eligible. Both groups received usual pain relief discharge advice, the intervention group received additional personalised printed and mobile-accessible discharge instructions. Numerical Rating Scale pain scores were measured at ED visit. Pain scores, Patient Global Impression of Change scale improvement scores, satisfaction with instructions, recall of pain relief advice, receipt of side effects advice and unscheduled visits were measured at 5 days., Results: A total of 80 patients, recruited over 14 days, were randomly allocated to the intervention or control group. Two patients were excluded and 81% (n = 65) were followed up at 5 days. There was no significant difference in change of pain scores or improvement scores between groups from visit to 5 day follow up. The intervention group showed significantly higher odds of being 'very satisfied' compared to the control group (odds ratio [OR] 7.14, 95% confidence interval [CI] 1.18-50.00), significantly higher odds of full recall of pain relief medication advice (OR 20.00, 95% CI 1.56-100.00) and significantly higher odds of receiving information on medication side effects (OR 6.25, 95% CI 1.67-20.00)., Conclusions: Patients who received personalised printed and mobile-accessible ED discharge instructions for pain relief reported higher levels of satisfaction with their instructions, had better recall of their pain relief medications advice and received more information on medication side-effects., (© 2020 Australasian College for Emergency Medicine.)

Objective: The engagement of peers and service users is increasingly emphasized in mental health clinical, educational, and research activities. A core means of engagement is via the sharing of recovery narratives, through which service users present their personal history of moving from psychiatric disability to recovery. We critically examine the range of contexts and purposes for which recovery narratives are elicited in global mental health., Method: We present 4 case studies that represent the variability in recovery narrative elicitation, purpose, and geography: a mental health Gap Action Programme clinician training program in Nepal, an inpatient clinical service in Indian-controlled Kashmir, a recovery-oriented care program in urban Australia, and an undergraduate education program in the rural United States. In each case study, we explore the context, purpose, process of elicitation, content, and implications of incorporating recovery narratives., Results: Within each context, organizations engaging service users had a specific intention of what "recovery" should constitute. This was influenced by the anticipated audience for the recovery stories. These expectations influenced the types of service users included, narrative content, and training provided for service users to prepare and share narratives. Our cases illustrate the benefit of these coconstructed narratives and potential negative impacts on service users in some contexts, especially when used as a prerequisite for accessing or being discharged from clinical care., Conclusions and Implications for Practice: Recovery narratives have the potential to be used productively across purposes and contexts when there is adequate identification of and responses to potential risks and challenges. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

With the growing burden of mental health disorders worldwide, alongside efforts to expand availability of evidence-based interventions, strategies are needed to ensure accurate identification of individuals suffering from mental disorders. Efforts to locally validate mental health assessments are of particular value, yet gold-standard clinical validation is costly, time-intensive, and reliant on available professionals. This study aimed to validate assessment items for mental distress in Kenya, using an innovative gold standard and a combination of culturally adapted and locally developed items. The mixed-method study drew on surveys and semi-structured interviews, conducted by lay interviewers, with 48 caregivers. Interviews were used to designate mental health "cases" or "non-cases" based on emotional health problems, identified through a collaborative clinical rating process with local input. Individual mental health survey items were evaluated for their ability to discriminate between cases and non-cases. Discriminant survey items included 23 items adapted from existing mental health assessment tools, as well as 6 new items developed for the specific cultural context. When items were combined into a scale, results showed good psychometric properties. The use of clinically rated semi-structured interviews provides a promising alternative gold standard that can help address the challenges of conducting diagnostic clinical validation in low-resource settings., (© 2019 International Union of Psychological Science.)

Background: The soil environment is responsible for sustaining most terrestrial plant life, yet we know surprisingly little about the important functions carried out by diverse microbial communities in soil. Soil microbes that inhabit the channels of decaying root systems, the detritusphere, are likely to be essential for plant growth and health, as these channels are the preferred locations of new root growth. Understanding the microbial metagenome of the detritusphere, and how it responds to agricultural management such as crop rotations and soil tillage, is vital for improving global food production., Results: This study establishes an in-depth soil microbial gene catalogue based on the living-decaying rhizosphere niches in a cropping soil. The detritusphere microbiome regulates the composition and function of the rhizosphere microbiome to a greater extent than plant type: rhizosphere microbiomes of wheat and chickpea were homogenous (65-87% similarity) in the presence of decaying root (DR) systems but were heterogeneous (3-24% similarity) where DR was disrupted by tillage. When the microbiomes of the rhizosphere and the detritusphere interact in the presence of DR, there is significant degradation of plant root exudates by the rhizosphere microbiome, and genes associated with membrane transporters, carbohydrate and amino acid metabolism are enriched., Conclusions: The study describes the diversity and functional capacity of a high-quality soil microbial metagenome. The results demonstrate the contribution of the detritusphere microbiome in determining the metagenome of developing root systems. Modifications in root microbial function through soil management can ultimately govern plant health, productivity and food security.

Mental healthcare is largely unavailable throughout Haiti, particularly in rural areas. The aim of the current study is to explore perceived feasibility, acceptability, and effectiveness of potential culturally adapted interventions to improve mental health among Haitian women. The study used focus group discussions (n = 12) to explore five potential interventions to promote mental health: individual counseling, income-generating skills training, peer support groups, reproductive health education, and couples' communication training. Findings indicate that individual counseling, support group, and skills training components were generally anticipated to be effective, acceptable, and feasible by both male and female participants. That being said, participants expressed doubts regarding the acceptability of the couples' communication training and reproductive health education due to: a perceived lack of male interest, traditional male and female gender roles, lack of female autonomy, and misconceptions about family planning. Additionally, the feasibility, effectiveness, and acceptability of the components were described as dependent on cost, proximity to participants, and inclusion of a female health promoter that is known in the community. Given the lack of research on intervention approaches in Haiti, particularly those targeting mental health, this study provides a foundation for developing prevention and treatment approaches for mental distress among Haitian women.

Since 2013, the Boko Haram insurgency in Nigeria has left almost 2 million people displaced and 10 million in need of life-saving services. While the humanitarian response has focused on provision of food, shelter, and physical health needs, mental health needs remain largely overlooked. This mixed-methods project explored the mental health and psychosocial (MHPS) burden, existing resources and coping mechanisms, and remaining needs among internally displaced persons (IDPs) and host communities in Borno State, Nigeria. Survey findings reveal a high burden of mental health needs: 60% of participants strongly endorsed at least one mental health symptom, and 75% endorsed functional impairment associated with mental health symptoms. Unexpectedly, we found that adult men had the highest rates of symptom burden, suggesting that typical approaches focusing on women and children would miss this vulnerable population. Qualitative findings (free lists, interviews, focus group discussions) reflect MHPS needs that could be addressed through solutions-focused approaches, although tailored interventions would be needed to support stigmatised and vulnerable groups such as drug users and rape victims. Finally, participants emphasised the breakdown of community and political leadership structures, as well as of economic and livelihood activities, suggesting that MHPS interventions should focus on restoring these key resources.

Nitrogen availability and ontogeny both affect the relative growth rate (RGR) of plants. In this study of barley (Hordeum vulgare L.) we determined which growth parameters are affected by nitrate (N) availability, and whether these were confounded by differences in plant size, reflecting differences in growth. Plants were hydroponically grown on six different nitrate (N) concentrations for 28 days, and nine harvests were performed to assess the effect of N on growth parameters. Most growth parameters showed similar patterns of responses to N supply whether compared at common time points or common plant sizes. N had a significant effect on the biomass allocation: increasing N increased leaf mass ratio (LMR) and decreased root mass ratio (RMR). Specific leaf area (SLA) was not significantly affected by N. RGR increased with increasing N supply up to 1 mM, associated with increases in both LMR and net assimilation rate (NAR). Increases in N supply above 1 mM did not increase RGR as increases in LMR were offset by decreases in NAR. The high RGR at suboptimal N supply suggest a higher nitrogen use efficiency (biomass/N supply). The reasons for the homeostasis of growth under suboptimal N levels are discussed.

Objectives: Lack of wealth (poverty) impacts almost every aspect of human biology. Accordingly, many studies include its assessment. In almost all cases, approaches to assessing poverty are based on lack of success within cash economies (eg, lack of income, employment). However, this operationalization deflects attention from alternative forms of poverty that may have the most substantial influence on human wellbeing. We test how a multidimensional measure of poverty that considers agricultural assets expands the explanatory power of the construct of household poverty by associating it with one key aspect of wellbeing: symptoms of mental health., Methods: We used the case of three highly vulnerable but distinctive communities in Haiti-urban, town with a rural hinterland, and rural. Based on survey responses from adults in 4055 geographically sampled households, linear regression models were used to predict depression and anxiety symptom levels controlling for a wide range of covariates related to detailed measures of material poverty, including cash-economy and agricultural assets, income, financial stress, and food insecurity., Results: Household assets related to the cash economy were significantly associated with lower (ie, better) depression scores (-0.7, [95% CI: -1.2 to, -0.1]) but unrelated to anxiety scores (-0.3 [95% CI: -0.8 to 0.3]). Agricultural wealth was significantly-and more strongly-associated with both reductions in depression symptoms (-1.4 [95% CI: -2.2 to -0.7]) and anxiety symptoms (-1.8 [95% CI: -2.6 to -1.0]). These associations were consistent across the three sites, except in the fully urban site in Port-au-Prince where level of depression symptoms was not significantly associated with household agricultural wealth., Conclusions: Standard measures of poverty based on success in the cash economy can mask important associations between poverty and wellbeing, in this case related to household-level subsistence capacity and crucial food-producing household assets., (© 2019 Wiley Periodicals, Inc.)