This proof-of-concept study evaluated an optimization strategy for the Community Case Detection Tool (CCDT) aimed at improving community-level mental health detection and help-seeking among children aged 6–18 years. The optimization strategy, CCDT+, combined data-driven supervision with motivational interviewing techniques and behavioural nudges for community gatekeepers using the CCDT. This mixed-methods study was conducted from January to May 2023 in Palorinya refugee settlement in Uganda. We evaluated (1) the added value of the CCDT+ in improving the accuracy of detection and mental health service utilization compared to standard CCDT, and (2) implementation outcomes of the CCDT+. Of the 1026 children detected, 801 (78%) sought help, with 656 needing mental health care (PPV = 0.82; 95% CI: 0.79, 0.84). The CCDT+ significantly increased detection accuracy, with 2.34 times higher odds compared to standard CCDT (95% CI: 1.41, 3.83). Additionally, areas using the CCDT+ had a 2.05-fold increase in mental health service utilization (95% CI: 1.09, 3.83). The CCDT+ shows promise as an embedded quality-optimization process for the detection of mental health problems among children and enhance help-seeking, potentially leading to more efficient use of mental health care resources.

Evidence on the effectiveness and implementation of mental health and psychosocial support (MHPSS) interventions for men in humanitarian settings is limited. Moreover, engagement and retention of men in such interventions has been challenging. Adaptations may therefore be required to improve the appropriateness and acceptability of these interventions for men. This study conducted formative research and examined the feasibility of combining an MHPSS intervention, Self-Help Plus, with a brief intervention to reduce harmful alcohol use among refugee men in Uganda. We conducted a cluster randomized feasibility trial comparing the combined alcohol intervention and Self-Help Plus, Self-Help Plus alone and enhanced usual care. Participants were 168 South Sudanese refugee men in Rhino Settlement who reported moderate or high levels of psychological distress. Session attendance was adequate: all sessions had at least 69% of participants present. Participant outcome measures, including symptoms of psychological distress, functional impairment, self-defined problems, depressive symptoms, post-traumatic stress symptoms, overall substance use risk, substance specific risk (alcohol, cannabis, stimulants and sedatives) and well-being, were sensitive to change. A combined approach to addressing mental health and alcohol use appears feasible among men in refugee settings, but further research is needed to examine the effectiveness of combined interventions among men.

Migrants and refugees face elevated risks for mental health problems but have limited access to services. This study compared two strategies for training and supervising nonspecialists to deliver a scalable psychological intervention, Group Problem Management Plus (gPM+), in northern Colombia. Adult women who reported elevated psychological distress and functional impairment were randomized to receive gPM+ delivered by nonspecialists who received training and supervision by: 1) a psychologist (specialized technical support); or 2) a nonspecialist who had been trained as a trainer/supervisor (nonspecialized technical support). We examined effectiveness and implementation outcomes using a mixed-methods approach. Thirteen nonspecialists were trained as gPM+ facilitators and three were trained-as-trainers. We enrolled 128 women to participate in gPM+ across the two conditions. Intervention attendance was higher in the specialized technical support condition. The nonspecialized technical support condition demonstrated higher fidelity to gPM+ and lower cost of implementation. Other indicators of effectiveness, adoption and implementation were comparable between the two implementation strategies. These results suggest it is feasible to implement mental health interventions, like gPM+, using lower-resource, community-embedded task sharing models, while maintaining safety and fidelity. Further evidence from fully powered trials is needed to make definitive conclusions about the relative cost of these implementation strategies.

As evidence supporting the effectiveness of mental health and psychosocial interventions grows, more research is needed to understand optimal strategies for improving their implementation in diverse contexts. We conducted a qualitative process evaluation of a multicomponent psychosocial intervention intended to promote well-being among refugee, migrant and host community women in three diverse contexts in Ecuador and Panamá. The objective of this study is to describe the relationships among implementation determinants, strategies and outcomes of this community-based psychosocial intervention. The five implementation strategies used in this study included stakeholder engagement, promoting intervention adaptability, group and community-based delivery format, task sharing and providing incentives. We identified 10 adaptations to the intervention and its implementation, most of which were made during pre-implementation. Participants (n = 77) and facilitators (n = 30) who completed qualitative interviews reported that these strategies largely improved the implementation of the intervention across key outcomes and aligned with the study’s intervention and implementation theory of change models. Participants and facilitators also proposed additional strategies for improving reach, implementation and maintenance of this community-based psychosocial intervention.

Most family violence research has been conducted in high-income countries, although family violence rates are higher in low- and middle-income countries (LMICs), and outcomes more severe. Given the strong associations of family violence with substance use and mental illness, the aim of this systematic review was to examine interventions that targeted familial violence and at least one other condition of substance use or mental illness to determine effective treatments in LMICs. We conducted a systematic review of interventions that addressed family violence and mental illness or substance use. A committee of three researchers independently screened titles and abstracts and conducted full-text eligibility assessments. Two researchers conducted a risk of bias assessment. Data were extracted using a structured spreadsheet and narratively synthesized. Our search identified 29 articles produced from 19 studies conducted in 13 LMICs. Most (n = 15) studies randomized to study condition. Lack of blinding was the most common threat. The external validity of studies was generally poor. Fourteen studies had a primary intervention target of family violence, mental health, substance use, economic improvement, or HIV. None of the studies showed improvements in all intervention areas. Child maltreatment was less likely to be addressed than intimate partner violence (IPV). Targeted interventions for substance and mental health mostly improved primary outcomes, although they were less effective in reducing IPV. Evidence-based treatments must be rigorously evaluated before innovations in implementation can occur. Interventions overwhelmingly addressed IPV victimization and should consider how to work with couples and include men and children.

Trauma exposure is prevalent globally and is a defining event for the development of posttraumatic stress disorder (PTSD), characterised by intrusive thoughts, avoidance behaviours, hypervigilance and negative alterations in cognition and mood. Exposure to trauma elicits a range of physiological responses which can interact with environmental factors to confer relative risk or resilience for PTSD. This systematic review summarises the findings of longitudinal studies examining biological correlates predictive of PTSD symptomology. Databases (Pubmed, Scopus and Web of Science) were systematically searched using relevant keywords for studies published between 1 January 2021 and 31 December 2022. English language studies were included if they were original research manuscripts or meta-analyses of cohort investigations that assessed longitudinal relationships between one or more molecular-level measures and either PTSD status or symptoms. Eighteen of the 1,042 records identified were included. Studies primarily included military veterans/personnel, individuals admitted to hospitals after acute traumatic injury, and women exposed to interpersonal violence or rape. Genomic, inflammation and endocrine measures were the most commonly assessed molecular markers and highlighted processes related to inflammation, stress responding, and learning and memory. Quality assessments were done using the Systematic Appraisal of Quality in Observational Research, and the majority of studies were rated as being of high quality, with the remainder of moderate quality. Studies were predominantly conducted in upper-income countries. Those performed in low- and middle-income countries were not broadly representative in terms of demographic, trauma type and geographic profiles, with three out of the four studies conducted assessing only female participants, rape exposure and South Africa, respectively. They also did not generate multimodal data or use machine learning or multilevel modelling, potentially reflecting greater resource limitations in LMICs. Research examining molecular contributions to PTSD does not adequately reflect the global burden of the disorder.

Community-based psychosocial interventions are key elements of mental health and psychosocial support; yet evidence regarding their effectiveness and implementation in humanitarian settings is limited. This study aimed to assess the appropriateness, acceptability, feasibility and safety of conducting a cluster randomized trial evaluating two versions of a group psychosocial intervention. Nine community clusters in Ecuador and Panamá were randomized to receive the standard version of the Entre Nosotras intervention, a community-based group psychosocial intervention co-designed with community members, or an enhanced version of Entre Nosotras that integrated a stress management component. In a sample of 225 refugees, migrants and host community women, we found that both versions were safe, acceptable and appropriate. Training lay facilitators to deliver the intervention was feasible. Challenges included slow recruitment related to delays caused by the COVID-19 pandemic, high attrition due to population mobility and other competing priorities, and mixed psychometric performance of psychosocial outcome measures. Although the intervention appeared promising, a definitive cluster randomized comparative effectiveness trial requires further adaptations to the research protocol. Within this pilot study we identified strategies to overcome these challenges that may inform adaptations. This comparative effectiveness design may be a model for identifying effective components of psychosocial interventions.

Much of the research on posttraumatic stress disorder (PTSD) and alcohol use disorder (AUD) has been conducted in high-income countries (HICs). However, PTSD and AUD commonly co-occur (PTSD + AUD) are both associated with high global burden of disease, and disproportionately impact those in low- and middle-income countries (LMICs). This narrative review attempts to synthesize the research on prevalence, impact, etiological models, and treatment of PTSD + AUD drawing from research conducted in HICs and discussing the research that has been conducted to date in LMICs. The review also discusses overall limitations in the field, including a lack of research on PTSD + AUD outside of HICs, issues with measurement of key constructs, and limitations in sampling strategies across comorbidity studies. Future directions are discussed, including a need for rigorous research studies conducted in LMICs that focus on both etiological mechanisms and on treatment approaches.

Nutrition education and policy, systems and environmental (PSE) change interventions may be able to address food insecurity and obesity, conditions which are disproportionately experienced by African Americans. Work that seeks to address these disparities and advance social justice should uplift and learn from participant voices, particularly from marginalised groups. This scoping review aimed to summarise the available literature describing African Americans’ perceptions of and experiences participating in nutrition interventions. We conducted an electronic literature search with the assistance of a research librarian which encompassed six databases (MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses) and identified thirty-five sources meeting our inclusion criteria. The majority of studies assessing African Americans’ satisfaction with interventions examined educational interventions alone, and about half of the included studies assessed satisfaction through quantitative methods alone. The only studies which found participants to be dissatisfied with interventions used qualitative methods and examined interventions providing education alone. Future work should evaluate African Americans’ experience with nutrition-focused PSE changes, interventions which may be better able to address racial disparities in obesity and food insecurity. Nutrition educators working with African Americans should also consider evaluating future interventions using qualitative inquiry, to obtain an in-depth understanding of participant experiences with interventions.

African Americans experience high rates of obesity and food insecurity in part due to structural racism, or overlapping discriminatory systems and practices in housing, education, employment, health care and other settings. Nutrition education and nutrition-focused policy, systems and environmental changes may be able to address structural racism in the food environment. This scoping review aimed to summarise the available literature regarding nutrition interventions for African Americans that address structural racism in the food environment and compare them with the ‘Getting to Equity in Obesity Prevention’ framework of suggested interventions. An electronic literature search was conducted with the assistance of a research librarian encompassing six databases: MEDLINE, PyscINFO, Agricola, ERIC, SocINDEX and ProQuest Dissertations & Theses. A total of thirty sources were identified detailing interventions addressing structural barriers to healthy eating. The majority of nutrition interventions addressing structural racism consisted of policy, systems and/or environmental changes in combination with nutrition education, strategies focused on proximal causes of racial health disparities. Only two articles each targeted the ‘reduce deterrents’ and ‘improve social and economic resources’ aspects of the framework, interventions which may be better suited to addressing structural racism in the food environment. Because African Americans experience high rates of obesity and food insecurity and encounter structural barriers to healthy eating in the food environment, researchers and public health professionals should address this gap in the literature.

The second BIALL Law Firm Library Survey was launched in December 2019. The aim of the survey is to understand standard practice across the law firm library sector and to allow firms to benchmark certain aspects of the library's service against industry averages. This article contains a summary of the results with comparisons, where possible, to results from the previous survey (2015/16). The full survey results can be found on the BIALL website.

Anecdotal evidence suggests the use of bolus tube feeding is increasing in the long-term home enteral tube feed (HETF) patients. A cross-sectional survey to assess the prevalence of bolus tube feeding and to characterise these patients was undertaken. Dietitians from ten centres across the UK collected data on all adult HETF patients on the dietetic caseload receiving bolus tube feeding (n 604, 60 % male, age 58 years). Demographic data, reasons for tube and bolus feeding, tube and equipment types, feeding method and patients’ complete tube feeding regimens were recorded. Over a third of patients receiving HETF used bolus feeding (37 %). Patients were long-term tube fed (4·1 years tube feeding, 3·5 years bolus tube feeding), living at home (71 %) and sedentary (70 %). The majority were head and neck cancer patients (22 %) who were significantly more active (79 %) and lived at home (97 %), while those with cerebral palsy (12 %) were typically younger (age 31 years) but sedentary (94 %). Most patients used bolus feeding as their sole feeding method (46 %), because it was quick and easy to use, as a top-up to oral diet or to mimic mealtimes. Importantly, oral nutritional supplements (ONS) were used for bolus feeding in 85 % of patients, with 51 % of these being compact-style ONS (2·4 kcal (10·0 kJ)/ml, 125 ml). This survey shows that bolus tube feeding is common among UK HETF patients, is used by a wide variety of patient groups and can be adapted to meet the needs of a variety of patients, clinical conditions, nutritional requirements and lifestyles.

The discovery of the ubiquity of filaments in the interstellar medium in the last two decades has begged the question: “What role do filaments play in star formation?” Here we describe how our automated filament finding algorithms can combine with both magnetic field measurements and high-resolution observations of dense cores in these filaments, to provide a statistically large sample to investigate the effect of filaments on star formation. We find that filaments are likely actively accreting mass from the interstellar medium, explaining why some 60% of stars, and all massive stars, form “on-filament”.

The study is aimed to better understand how post-acute-care services help persons with acquired brain injury (ABI) and their families following acute-care discharge. Participants included 21 primary family caregivers of persons with ABI. Participants reported their level of satisfaction with 14 different post-acute-care ABI services following discharge from an acute-care ABI facility in a large south-western city in the United States. Participants completed a survey following the discharge (on average 8.1 months) of their family member from acute-care services. Surveys included both quantitative and open-ended questions. The present study focused on participant satisfaction ratings and perceptions of helpfulness among the 14 different service areas. The average satisfaction rating across the 14 service areas was 73.4%. Professional consultation and assessment (81.8%) received the highest satisfaction rating, followed by therapy and intervention (77.9%), and peer support (51.9%). Open-ended question responses on the helpfulness of post-acute-care services focused on (a) therapy and intervention and (b) professional consultation and assessment. Study findings highlight the need to track the use of ABI services from the acute-phase through long-term community adjustment. Findings also underscore the importance of targeting interventions and services specific to the post-acute phase of ABI rehabilitation.