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To investigate the effectiveness of community-based mental health interventions by professionally trained, lay counsellors in low- and middle-income countries. We searched PubMed®, Cochrane Central Register of Controlled Trials, PROSPERO and EBSCO databases and professional section publications of the United States National Center for PTSD for randomized controlled trials of mental health interventions by professionally trained, lay counsellors in low- and middle-income countries published between 2000 and 2019. Studies of interventions by professional mental health workers, medical professionals or community health workers were excluded because there are shortages of these personnel in the study countries. Additional data were obtained from study authors. The primary outcomes were measures of post-traumatic stress disorder, depression, anxiety and alcohol use. To estimate effect size, we used a random-effects meta-analysis model. We identified 1072 studies, of which 19 (involving 20 trials and 5612 participants in total) met the inclusion criteria. Hedges' for the aggregate effect size of the interventions by professionally trained, lay counsellors compared with mostly either no intervention or usual care was -0.616 (95% confidence interval: -0.866 to -0.366). This result indicates a significant, medium-sized effect. There was no evidence of publication bias or any other form of bias across the studies and there were no extreme outliers among the study results. The use of professionally trained, lay counsellors to provide mental health interventions in low- and middle-income countries was associated with significant improvements in mental health symptoms across a range of settings.

We aimed to explore the effectiveness of a daily ten-minute teacher-led group thought field therapy stress-reduction intervention on middle-school adolescents residing in an area experiencing high levels of interpersonal and community violence. We hypothesized that it would lead to a reduction of trauma symptoms and improve grades in reading and math. In this double-masked feasibility study, adolescents in one school received a daily teacher-led thought field therapy intervention, and children in a different school served as an active waitlist group and received the same amount of time in a daily unguided drawing activity. The schools were geographically distant to prevent cross-contamination. Due to differences between groups in PTSD and academic performance prior to intervention, differences within each school's scores over time were calculated and compared to each other for indirect assessment of effect. PTSD scores at the treatment school showed no lasting change at five months, while the control school showed moderate improvement. Adolescents in the treatment group demonstrated large improvements in both reading and math. Adolescents in the control group demonstrated moderate decrease in math, and no change in reading. Preliminary evidence gained in this study suggests that a teacher-led ten-minute group thought field therapy exercise might assist adolescents' learning in reading and math. However, in an area experiencing ongoing interpersonal and community violence, a more multicomponent approach with longer periods of intervention, caretaker involvement and individual therapy for those who might benefit from it, may be needed. Study registration number: ISRCTN10548974.

To characterize the clinical features, associated disorders, and treatment of necrobiotic xanthogranuloma (NXG), a rare non-Langerhans cell histiocytosis, we conducted a retrospective review of pathologically confirmed NXG at Mayo Clinic Arizona from 1987 to June 2017. Data on clinical findings, laboratory findings, associated disorders, therapy, and response to therapy were extracted. Nineteen patients were identified. Mean age was 54 years (range, 17–84) with equal gender distribution. Median follow-up was 5.5 years (range, 1–18). Most patients had a detectable monoclonal protein (84%), and IgG kappa constituted 58%. The most common cutaneous lesions involved the periorbital region (53%). The majority of patients had extracutaneous manifestations, most commonly affecting the liver (32%) and the sinuses (21%). Hematologic malignancies were diagnosed in 26% of patients and included Hodgkin lymphoma, chronic lymphocytic leukemia (CLL), smoldering myeloma, and multiple myeloma. The most common treatment was chlorambucil with or without systemic corticosteroids. Response was seen in most patients (95%), and most patients received 1–3 lines of therapy (74%). NXG is a reactive histiocytic disorder that commonly involves multiple organ systems and requires a high degree of clinical suspicion for accurate diagnosis. Treatment decisions should be based on coexisting conditions and pattern of disease involvement.

Objectif Évaluer l'efficacité des interventions de santé mentale gérées au sein de la sphere communautaire par des conseillers non professionnels spécialement formés dans les pays a faibles et moyens revenus. Méthodes Nous avons mené nos recherches dans les bases de données de PubMed®, du Registre central Cochrane des essais contrôlés, de PROSPERO et d'EBSCO, ainsi que parmi les publications de la section professionnelle du Centre national américain du TSPT, afin d'en extraire des essais randomisés contrôlés portant sur des interventions de santé mentale gérées par des conseillers non professionnels spécialement formés dans les pays a faibles et moyens revenus, publiés entre 2000 et 2019. Les études consacrées aux interventions effectuées par des professionnels de la santé mentale, des membres du corps médical ou des agents de santé communautaires ont été écartées, car les pays observés manquent de personnel dans ce domaine. D'autres données ont été prélevées aupres des auteurs d'études. Les premiers résultats étaient des mesures relatives aux troubles de stress post-traumatique, a la dépression, a l'anxiété et a la consommation d'alcool. Nous avons employé un modele de méta-analyse a effets aléatoires pour évaluer les retombées. Résultats Nous avons identifié 1072 études; 19 d'entre elles (impliquant 20 essais et 5612 participants au total) correspondaient aux criteres d'inclusion. Le g de Hedges pour la taille de l'effet cumulé des interventions gérées par des conseillers non professionnels spécialement formés, comparé la plupart du temps avec l'absence d'intervention ou les soins habituels, s'élevait a -0,616 (intervalle de confiance de 95%: -0,866 a -0,366). Ce résultat témoigne d'un effet non négligeable, de taille moyenne. Il n'existait aucune preuve indiquant un biais de publication ou toute autre forme de biais dans les études, et les résultats ne laissaient transparaître aucune valeur extréme atypique. Conclusion Le recours a des conseillers non professionnels spécialement formés pour effectuer des interventions de santé mentale dans les pays a faibles et moyens revenus a entraíné une amélioration significative des symptômes dans de nombreuses situations.

ObjectivesWe aimed to explore the effectiveness of a daily ten-minute teacher-led group thought field therapy stress-reduction intervention on middle-school adolescents residing in an area experiencing high levels of interpersonal and community violence. We hypothesized that it would lead to a reduction of trauma symptoms and improve grades in reading and math.MethodsIn this double-masked feasibility study, adolescents in one school received a daily teacher-led thought field therapy intervention, and children in a different school served as an active waitlist group and received the same amount of time in a daily unguided drawing activity. The schools were geographically distant to prevent cross-contamination.ResultsDue to differences between groups in PTSD and academic performance prior to intervention, differences within each school's scores over time were calculated and compared to each other for indirect assessment of effect. PTSD scores at the treatment school showed no lasting change at five months, while the control school showed moderate improvement. Adolescents in the treatment group demonstrated large improvements in both reading and math. Adolescents in the control group demonstrated moderate decrease in math, and no change in reading.ConclusionsPreliminary evidence gained in this study suggests that a teacher-led ten-minute group thought field therapy exercise might assist adolescents' learning in reading and math. However, in an area experiencing ongoing interpersonal and community violence, a more multicomponent approach with longer periods of intervention, caretaker involvement and individual therapy for those who might benefit from it, may be needed. Study registration number: ISRCTN10548974.

Postpartum weight retention is commonly considered an important precursor to long-term weight gain, with existing research suggesting that failure to lose weight in postpartum has significant future health implications. While postpartum has been identified as a possible ‘window of opportunity’ for women to make health behaviour change and manage their weight, it remains unclear how mothers, and in particular ‘large’ (BMI ≥ 40 kg/m2) mothers, experience health and engage with health-related behaviours at this particular point in the life course. Existing research has done little to enhance our understandings of the lived, embodied and practical realities of caring for an infant and, crucially, how this impacts health and weight management during the postpartum period. In addition, qualitative research focusing on postpartum has largely ignored the temporal dimensions of this period and, instead, has tended to focus attentions on a single ‘snapshot’ in time. To address these gaps in the literature, this study employed longitudinal qualitative methodology to explore 15 ‘large’ (BMI ≥ 40 kg/m2) women’s lived experience of health and weight management over the first six months following childbirth. Participants were recruited from a specialist antenatal metabolic clinic based in Edinburgh, Scotland. When possible, three in-depth semi-structured interviews were carried out with each participant: the first at six weeks postpartum, the second at three months and, the third at six months postpartum. Both six weeks and six months have consistently been identified in the literature as important markers for postpartum women. Hence, it was hoped that by interviewing at these and an intervening time point (i.e. three months) it would be possible to capture and understand processes of change with regards to weight management in the postpartum period. The analysis revealed that accounts of health and weight were far from straightforward and seemed to be heavily influenced by the wider social context, which routinely pathologises, demonises and stigmatises ‘fatness’. Challenging contemporary discourses of the ‘obesity epidemic’ which frame the large body as a direct consequence of individual lifestyle, participants principally drew upon lay notions of inheritance and implicated a genetic predisposition to resist individual responsibility for weight and body size. The analysis suggests that concerns for health were largely predicated on subjective experiences and, in the absence of tangible and embodied experiences of ill-health, participants expressed little if any impetus to engage in weight management for the purpose of improving their health. In short, the idea that their weight was an indicator of poor health, or future health risk, was not a view shared by participants. Instead, they expressed more complex understandings of their weight, and their responsibilities to engage in health changing behaviour. Despite articulating often strong desires to engage in weight management ‘for the baby’, the longitudinal focus revealed a disjuncture between these intentions and the reality of those engagements. Influential in this discordance was the transition from an intensely medicalised and closely monitored pregnancy, to a period of minimal or no follow up in postpartum. The lack of ‘surveillance’ appeared to have a notable impact on participants’ engagements with health-related behaviours once at home and going about the day-to-day tasks of caring for their infant. Dominant discourses around ‘good’ mothering also made it difficult for participants to prioritise their own needs (such as weight management) ahead of those of their children and other family members. When participants reflected on their experiences of mothering they frequently drew upon understandings of themselves as relational beings and, at times, positioned themselves as phenomenologically inseparable from their baby. This relationality was often experienced as a diminishing of individual autonomy, as the body of the mother and the baby became inter-embodied and bounded. Consequently, my analysis serves to problematise the individualised expectation surrounding a mother’s ability to act autonomously and engage in health-related behaviours in postpartum. These findings also call for a stronger appreciation to be developed of the complexities surrounding engagements with health-related behaviours at this particular point in the life course. In particular this research demonstrates the importance and utility of adopting a more embodied approach, which in turn has some notable implications for public health policy and practice.