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Wietse Tol and colleagues discuss some of the key challenges for implementation of new WHO guidelines for stress-related mental health disorders in low- and middle-income countries. Please see later in the article for the Editors' Summary.

Exposure to adversity, particularly in early childhood, can lead to lifelong struggles with learning and adverse physical and mental health. Mental health promotion and prevention, care services and psychosocial approaches can play an important role in mitigating these adversities and improving a range of developmental outcomes for children - including learning, relational and social skills, and health and nutrition. This study explores effective mental health and psychosocial support (MHPSS) programming integrated within education in emergencies (EiE). Core actions developed through a participatory consultation with multisectoral actors are outlined to address the common challenges and barriers associated with MHPSS programming in emergency education. Targeted approaches, resources and case studies from humanitarian settings are highlighted and provide detail on how to address planning, coordination and implementation barriers to effective MHPSS integration. This study explores the social and psychological foundations of MHPSS programming in EiE and how caregivers, teachers and communities can meaningfully participate in creating safe and healing learning environments, forming the critical safety net for children's wellbeing in situations of adversity.

In low- and middle-income countries (LMICs), children and families face a multitude of risk factors for mental health and well-being. These risks are even further exacerbated in humanitarian emergencies. However, access to effective mental health services in such settings is severely limited, leading to a large mental health treatment gap. Middle childhood (5–12 years) is a crucial period for human development during which symptoms of emotional distress often emerge, with one in three mental disorders developing prior to age 14. However, there is little evidence of effective psychological interventions for children in this developmental stage, and suitable for implementation within LMICs and humanitarian emergencies. We conducted this evidence review to inform the development of a new intervention package based on existing best practice for this age group, drawing insights from both global and LMIC resources. Our review synthesizes the findings of 52 intervention studies from LMICs and humanitarian settings; 53 existing systematic reviews and meta-analyses covering both LMICs and high-income countries, and 15 technical guidelines. Overall, there is limited high-quality evidence from which to draw recommendations for this age group; however, some promising intervention approaches were identified for children experiencing externalizing and internalizing symptoms, traumatic stress and a combination of difficulties. Several effective interventions utilize cognitive-behavioral techniques for children, in either group or individual format, and incorporate caregiver skills training into treatment, although the findings are mixed. Most evaluated interventions use specialists as delivery agents and are lengthy, which poses challenges for scale-up in settings where financial and human resources are scarce. These findings will inform the development of new psychological interventions for children in this age group with emotional and behavioral difficulties.

Background: migraine can negatively affect students' health, well-being, and physical, mental, and cognitive functions. Aims: This study aims to (i) compare the health-related QoL of students with and without migraines, (ii) assess the association between higher QoL scores and the general characteristics of the students, and (iii) evaluate the predictors of higher QoL. Methods: A cross-sectional study was conducted over four months between November 2019 and April 2020, targeting 1095 students from the public university campus faculties. Data were collected using a validated tool (SF-8) through face-to-face interviews performed by four pharmacy students. Results: Cases had significantly lower scores in all the physical domains compared to controls, with an overall total score of 62.0 (16.7) compared to 73.1 (18.4) (pO.OOl). Similarly, lower overall scores for the mental domains were noted for cases (61.3 (16.7)). Caffeine consumption affected mental scores, where 71.9% of non-consmners had significantly higher scores than others (54.5%; p=0.015). Moreover, the higher the academic satisfaction, the better the QoL, with 61.2% of students who reported high satisfaction having higher scores in the mental domains compared to only 34.2% of those reporting low academic satisfaction (p=0.008). On the other hand, 62.6% of male students without migraine had significantly higher PC scores than females (48.2%; p<0.001), and those in their last academic years had substantially higher PC scores compared to those in their first two years (p=0.004). Cigarette and waterpipe smokers had lower PC scores among controls (p=0.042 and 0.012, respectively), and around 60% of those practicing sports had higher PC and MC scores (pO.OOl). Conclusion: Migraine adversely affected students on both physical and psychological aspects, translated by lower QoL scores. The predictors of a better QoL should be considered when developing treatment plans and supporting those affected by this condition.

From traditional definitions of stigma, we have developed four main components to consider in this report: self-stigma (or internalised stigma), which occurs when people with mental health conditions are aware of the negative stereotypes of others, agree with them, and turn them against themselves; stigma by association, which refers to the attribution of negative stereotypes and discrimination directed against family members (eg, parents, spouses, or siblings) or to mental health staff; public and interpersonal stigma, which refer to the forms of knowledge and stereotypes, negative attitudes (prejudice), and negative behaviour (discrimination) by members of society towards people with mental health conditions; and structural (systemic or institutional) stigma, which refers to policies and practices that work to the disadvantage of the stigmatised group, whether intentionally or unintentionally. Stigma and discrimination contravene basic human rights and have severe, toxic effects on people with mental health conditions that exacerbate marginalisation and social exclusion, for example by reducing access to mental and physical health care and diminishing educational and employment opportunities [...]provisions that support the social inclusion of people with disabilities should be applied equally whether they arise from physical or mental health conditions. [...]health and care provision should be equitable regardless of whether people have a physical or mental health condition.

During ischemia and reperfusion injury (IRI), mitochondria may release mitochondrial DNA (mtDNA). mtDNA can serve as a propagator of further injury but in specific settings has anti-inflammatory capacities as well. Therefore, the aim of this study was to study the perioperative dynamics of plasma mtDNA during living donor kidney transplantation (LDKT) and its potential as a marker of graft outcome. Fifty-six donor–recipient couples from the Volatile Anesthetic Protection of Renal Transplants-1 (VAPOR-1) trial were included. Systemic venous, systemic arterial, and renal venous samples were taken at multiple timepoints during and after LDKT. Levels of mtDNA genes changed over time and between vascular compartments. Several donor, recipient, and transplantation-related variables significantly explained the course of mtDNA genes over time. mtDNA genes predicted 1-month and 24-month estimated glomerular filtration rate (eGFR) and acute rejection episodes in the two-year follow-up period. To conclude, mtDNA is released in plasma during the process of LDKT, either from the kidney or from the whole body in response to transplantation. While circulating mtDNA levels positively and negatively predict post-transplantation outcomes, the exact mechanisms and difference between mtDNA genes are not yet understood and need further exploration.

Background Coronary artery disease (CAD) is the major leading cause of death worldwide. The national practice guidelines from the American College of Cardiology (ACC) and American Heart Association (AHA) promote the use of several medical therapies for secondary prevention for patients with CAD. The purpose of this study was to evaluate whether ACS patients, admitted into two tertiary referral medical centers in Beirut, Lebanon, are discharged on optimal medical therapy based on the current AHA/ACC guidelines. Methods We reviewed the medical records of all patients with ACS who were admitted to the coronary care units (CCU) of two hospitals in Beirut, Lebanon between May and August 2012. Discharge prescriptions were reviewed and rating for the appropriateness of discharge cardiac medications was based on the AHA/ACC guidelines. We assessed whether patients were discharged on antiplatelet therapy, β-blockers, angiotensin converting enzymes inhibitors (ACEIs) or angiotensin receptor blockers (ARBs), statins, and nitrates, unless contraindicated or not tolerated. In addition, we assessed whether patients and/or their caregivers were counseled about their disease(s) and discharge medications. Results 186 patients with a mean age of 63 ± 11.78 years, 70.4% of which were males, were admitted with ACS and were included in the study. Fifty three (28.5%) patients had ST elevation MI (STEMI), 64 (34.4%) had non-ST-elevation myocardial infarction (NSTEMI) and 69 (37.1%) had unstable angina (USA). Sixty two patients (33.3%) were treated with medical therapy and 124 patients (66.7%) underwent percutaneous coronary intervention (PCI). Among eligible patients, 98.9% were discharged on aspirin, 89.1% on dual antiplatelet therapy (aspirin + thienopyridine or ticagrelor), 90.5% on a β-blocker, 81.9% on an ACEI or ARB, 89.8% on a statin, and 19.4% on nitroglycerin. Overall, 62.9% of the patients received the optimal cardiovascular drug therapy (the combination of dual antiplatelet therapy, a β-blocker, an ACEIs or an ARB, and a statin), 55.1% were counseled on their disease state(s) and drug therapy, and 92.2% and 55.9% were counseled on smoking cessation and life style changes, respectively. Conclusion In patients admitted with ACS, discharge cardiac medications are prescribed at suboptimal rates. Education of healthcare providers and implementation of ACS discharge protocols may help improve compliance with ACC/AHA guidelines. In addition, clinicians should be encouraged to provide adequate patient counseling.