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The COVID-19 pandemic had an unprecedented impact on global mental health and well-being, including across the Asia-Pacific. Efforts to mitigate virus spread led to far-reaching disruption in the delivery of health and social services. In response, there was a rapid shift to the use of digital mental health (DMH) approaches. Though these technologies helped to improve access to care for many, there was also substantial risk of access barriers leading to increased inequities in access to mental health care, particularly among at-risk and equity-deserving populations. The objective of this study was to conduct a needs assessment and identify priorities related to equitable DMH access among at-risk and equity-deserving populations in the Asia Pacific region during the first year of the COVID-19 pandemic. The study consisted of a modified Delphi consensus methodology including two rounds of online surveys and online consultations with stakeholders from across the region. Study participants included policy makers, clinicians and service providers, and people with lived experience of mental health conditions. Results demonstrate that vulnerabilities to negative mental health impacts and access barriers were compounded during the pandemic. Access barriers included a lack of linguistically and culturally appropriate DMH options, low mental health literacy and poor access to technological infrastructure and devices, low levels of awareness and trust of DMH options, and lack of policies and guidelines to support effective and equitable delivery of DMH. Recommendations to improve equitable access include ensuring that diverse people with lived experience are engaged in research, co-design and policy development, the development and implementation of evidence-based and equity-informed guidelines and frameworks, clear communication about DMH evidence and availability, and the integration of DMH into broader health systems. Study results can inform the development and implementat

Despite Vietnam's overall progress on maternal health indicators, marginalized ethnic minorities in remote areas face lower access to antenatal care and higher maternal mortality rates relative to the Kinh (majority ethnic group). Last year, we conducted fieldwork for 2 qualitative research projects that aimed to address maternal health inequities among pregnant ethnic minority women in rural Northern Vietnam. Although not the focus of our research, the use of ultrasonography services at for-profit private clinics was ubiquitous in participants' healthcare-seeking accounts. Ultrasound scans from for-profit clinics were a major component of ethnic minority women's antenatal care: many purchased 8 to 10 scans during pregnancy at $6.15 US dollars per scan, despite their limited agricultural income of $120 to $205 per month. Women were unaware of how many scans were recommended and their medically indicated scheduling, but purchased frequent scans to assuage pregnancy anxieties and access what they experienced as the highest-quality antenatal service. In tandem, for-profit ultrasonography providers offered broader opening hours, immediate results, and rich technological scans, which seemed to deliver poor families the most tangible "value" for their hard-earned money. Previous literature documented the concerning overuse of ultrasonography among Kinh women in urban Vietnam: What are the implications of this trend extending to affect rural-dwelling ethnic minority women who face lower education, economic marginalization, and a 4-fold higher maternal mortality rate? Our findings raise concerns related to safety, financial vulnerability and provider-induced demand, and broader health policy questions regarding healthcare commodities in low-resource settings. Critically, there is no evidence of the effect of obstetrical ultrasound on reducing maternal mortality in low- and middle-income countries, and its excess use could burden available resources and detract from evidence

This article considers how a First Nations Voice to Parliament, if carefully designed, could strengthen the land-based sovereignty and autonomy of First Peoples in Australia. It critiques the proposals presented in the Indigenous Voice Co-design Process' Interim Report released January 2021 for its emphasis on the role of government and existing structures. It responds to Indigenous critiques of the Uluru Statement from the Heart, while arguing for a constitutionally enshrined Voice to Parliament that respects and defers to First Nations' Country-based authority.

Policy engagement is essential for the implementation and scale-up of global mental health innovations, but the process of policy engagement can be challenging and unpredictable. The Mental Health in Adults and Children-Frugal Innovations (MAC-FI) project, taking place in Vietnam, is a successful and novel partnership between policy makers and researchers that emerged from a history of collaboration on mental health policy engagement with partners in Canada, Australia, and Vietnam. Policy engagement takes place within dynamic contexts and changes in the internal and external policy environment may pose challenges to policy engagement. Alignment with government policy priorities, the support of policy champions, and building on existing relationships, however, have facilitated policy engagement in the MAC-FI study and have led to opportunities for ongoing collaboration. Though the Vietnam policy context is unique, lessons learned from the MAC-FI study may be helpful for other global mental health initiatives seeking to navigate the process of policy engagement.

BACKGROUND: While depression is a leading contributor to burden of disease in Vietnam, there is a critical gap in depression care due to the shortage of mental health specialists and extremely limited mental health services in general health care settings. We have previously reported the effectiveness of a supported self-management (SSM) task-sharing intervention for depression, delivered by social collaborators (lay social workers). The purpose of this study was to identify factors influencing the effectiveness of delivery of SSM by social collaborators and delineate areas for further attention that are relevant for scale-up. METHODS: A hundred and ten (110) key informant interviews were conducted with three stakeholder groups (patients, social collaborators, experts) from eight provinces in Vietnam. Participants were identified through records from a recently completed randomized trial that showed the effectiveness of SSM in community-based settings in Vietnam. Qualitative descriptive methods and thematic analysis were used to examine the interviews. A coding framework and corresponding themes were developed deductively, based on the findings from the randomized trial and the literature, and through inductive analysis, to describe the contextual factors that impacted the social collaborators' role in successfully implementing the SSM intervention. RESULTS: Our analysis identified the following benefits of working with social collaborators: (1) increased awareness of mental health in the family and community; (2) reduced stigma; (3) a better understanding that depression is treatable; (4) increased help-seeking; and (5) improved access to care. There were also significant challenges, including social collaborator characteristics (age, education, pre-existing training and skills) and contextual factors influencing their work (roles and responsibilities, training, compensation, support from government). CONCLUSIONS: Engaging social collaborators in the delivery of SS

Dysregulated mitochondrial function is a hallmark of immune-mediated inflammatory diseases. Cytochrome c oxidase (CcO), which mediates the rate-limiting step in mitochondrial respiration, is remodeled during development and in response to changes of oxygen availability, but there has been little study of CcO remodeling during inflammation. Here, we describe an elegant molecular switch mediated by the bifunctional transcript C15orf48, which orchestrates the substitution of the CcO subunit NDUFA4 by its paralog C15ORF48 in primary macrophages. Expression of C15orf48 is a conserved response to inflammatory signals and occurs in many immune-related pathologies. In rheumatoid arthritis, C15orf48 mRNA is elevated in peripheral monocytes and proinflammatory synovial tissue macrophages, and its expression positively correlates with disease severity and declines in remission. C15orf48 is also expressed by pathogenic macrophages in severe coronavirus disease 2019 (COVID-19). Study of a rare metabolic disease syndrome provides evidence that loss of the NDUFA4 subunit supports proinflammatory macrophage functions.