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Background As the field of global mental health grows, many psychotherapy trainees will work across cultures in low-resource settings in high-income countries or in low- and middle-income countries. Mentors and supervisors, including faculty members, may face several challenges in providing supervision for psychologists in low-resource settings. As such, there is a need to develop best practices for psychotherapy supervision in global mental health. We describe the common challenges and potential strategies in psychotherapy supervision based on our research, clinical, and academic partnerships between academic institutions, a nonprofit organization, and the Nepali government. The strategies and considerations we have found helpful include focusing on therapies with strong behavioral and interpersonal (rather than emotional or cognitive) components and using locally validated therapies or standard manuals that have been endorsed by the WHO for low-resource settings. Other strategies include providing psychotherapy training for local psychiatrists who may be in supervisory roles using the train-the trainer models to help them gain competence in navigating different expectations of social structures and family dynamics. Supervisors face many challenges while supporting trainees and early psychologists in global mental health settings. While ensuring local adaptation, key considerations can be developed into best practices to support supervisors, particularly psychiatrists and other faculty members based in high-income settings, and trainees based in low- and middle-income countries.

Background Postpartum contraceptive counseling and access are challenging in Nepal’s remote, hilly areas, driving a disproportionately high unmet need for contraception. Community health workers (CHWs) play an important role in delivering healthcare in difficult to reach places, but there is limited evidence from professionalized CHW models and their impact over time in Nepal. We implemented a pilot program in two rural districts in Nepal where full-time, salaried, and supervised CHWs delivered a bundled reproductive, maternal, newborn, and child health (RMNCH) intervention. This included contraceptive counseling adapted from the Balanced Counseling Strategy . Here we describe postpartum contraceptive outcomes associated with the integrated RMNCH intervention over a five-year period. Methods Applying a type 2 hybrid effectiveness-implementation approach, we conducted a non-randomized pre-post study with repeated measurements and nested qualitative data collection to study the intervention’s reach, effectiveness, adoption, implementation, and maintenance. Results Compared to the pre-intervention period, we observed higher ward-level post-intervention postpartum contraceptive prevalence, stratified by early postpartum (RR: 2.20; 95% CI: 1.96, 2.48) and late postpartum (RR: 1.70; 95% CI: 1.50, 1.93), after adjusting for district and intervention site. Lactational amenorrhea method (LAM) was the most common method during early postpartum in most intervention sites. The proportion of women who switched to other effective methods after LAM was relatively low. Qualitative data indicated that CHWs’ longitudinal engagement with participants helped facilitate contraceptive counseling and uptake despite challenges such as participants’ fear of side effects, limited autonomy for women, and peer influence. Conclusions Our findings suggest the integrated RMNCH intervention’s potential to increase modern contraceptive uptake in low-resource community settings and underscore CHWs’ ability to help drive longer-term change in their communities, especially around sensitive topics. This study contributes to the implementation research literature on community-based interventions to improve postpartum contraception use and may inform other CHW programs in similar contexts. Trial registration ClinicalTrials.gov Identifier: NCT03371186, registered 04 December 2017, retrospectively registered. Plain English Summary Women in Nepal’s remote, hilly areas often lack access to contraceptive counseling despite not wanting another pregnancy soon after giving birth. Community health workers (CHWs) play a key role in delivering healthcare in difficult to reach places. We tested out a program in two rural districts in Nepal where CHWs visited women in their homes to offer reproductive, maternal, newborn, and child health (RMNCH) care. The program included counseling individuals on contraception based on their family planning needs and values. We studied how modern contraception use changed in the area after this RMNCH program was introduced, compared to before. We found that, on average, the proportion of women who used a modern method of contraception increased in the local areas where CHWs visited women to provide RMNCH care. We also learned through conversations with CHWs, others involved in the program, and those who received care from CHWs, that CHWs’ regular visits helped them build relationships within their community, which likely helped women feel more comfortable being counseled and choose contraceptive methods. Women in the community hesitated to use modern contraceptives because they were afraid of side effects, were often unable to make decisions for themselves without their partners or families’ approval, or because the contraceptives they wanted were not available. We found that CHWs can help drive longer-term change in their communities, especially around sensitive topics like contraception.

Adolescent girls in low- and middle-income countries continue to face poor sexual and reproductive health (SRH). In Nepal, early marriage and motherhood, gender-based violence, and unmet need for contraception remain pervasive. Adolescent girls in rural areas bear a disproportionate burden of poor reproductive health outcomes, but there are limited context-specific data. This is a qualitative study to identify factors that impact adolescent girls' utilisation of and access to SRH services in a rural district of Nepal. We conducted 21 individual interviews with adolescent girls aged 15-19 years, and three focus group discussions with community health workers. We used an inductive analytic approach to identify emergent and recurrent themes and present the themes using the social ecological model. Individual-level factors that contribute to low uptake of services among adolescent girls include lack of knowledge, self-perceived lack of need, low decision-making autonomy, and shyness. Interpersonal factors that impact access include unsupportive family norms, absence of open communication, and need for permission from family members to access care. At the community level, disparate gender norms, son preference, and judgment by community members affect adolescent SRH. Inadequate sex education, far travel distance to facilities, lack of female healthcare providers and teachers, and inability to access abortion services were identified as organisational and systems barriers. Stigma was a factor cross-cutting several levels. Our findings suggest the need for multi-level strategies to address these factors to improve adolescent girls' SRH.

Intimate partner violence (IPV) is a well-established driver of mental health problems, often doubling the prevalence of depression. In Nepal, approximately one in four women experience IPV, with young women disproportionately affected by mental health issues. Many women in Nepal reside with their mothers-in-law (MILs), who can influence violence and restrict women's mobility, highlighting the importance of including them in interventions targeting IPV. To address this, we developed a Multi-component family Intervention to Lower depression and Address intimate Partner violence (MILAP) and will conduct a randomized controlled trial (RCT) to evaluate its effectiveness in reducing IPV and depression. This RCT will enroll 300 family triads, each comprising a young married woman (aged 15-24), her husband, and her MIL. Blinded staff will conduct baseline assessments, after which each triad will be randomly assigned to either the MILAP or enhanced usual care (EUC). MILAP comprises nine sessions delivered by trained psychosocial counselors and focuses on strengthening the supportive relationship between MILs and daughters-in-law (DILs), providing behavioral couples therapy, and enhancing overall family dynamics. EUC includes standard care, such as individual and group counseling for IPV, enhanced with crisis counseling and referral support to ensure participant safety and access to additional resources. All participants, regardless of intervention allocation, will be assessed at baseline and at 1-, 3-, 6-, 9-, and 12-month follow-ups. These assessments will measure the following: primary outcomes (depression using Patient Health Questionnaire-9, IPV using Indian Family Violence and Control Scale); secondary outcome (post-traumatic stress disorder (PTSD) using PTSD CheckList-Civilian Version); and other outcomes. We will also conduct serial in-depth interviews to explore the mechanisms underlying MILAP's effectiveness and perform a cost-effectiveness analysis to assess its potential for scalable implementation. MILAP is a culturally adapted, family-based intervention designed to reduce IPV and depression among young Nepali women by improving communication, strengthening coping skills, and fostering supportive family relationships. This trial will assess MILAP's effectiveness, ethical rigor, cultural relevance, and scalability, with the goal of reducing IPV and improving family dynamics in low- and middle-income settings. This trial is registered in ClinicalTrials.gov with the National Clinical Trial (NCT) number: NCT06834867; first registered on February 24, 2025.

Exposure to particulate matter less than 2.5 µm in diameter (PM 2.5 ) is a cause of concern in cities and major emission regions of northern India. An intensive field campaign involving the states of Punjab, Haryana and Delhi national capital region (NCR) was conducted in 2022 using 29 Compact and Useful PM 2.5 Instrument with Gas sensors (CUPI-Gs). Continuous observations show that the PM 2.5 in the region increased gradually from < 60 µg m −3 in 6–10 October to up to 500 µg m −3 on 5–9 November, which subsequently decreased to about 100 µg m −3 in 20–30 November. Two distinct plumes of PM 2.5 over 500 µg m −3 are tracked from crop residue burning in Punjab to Delhi NCR on 2–3 November and 10–11 November with delays of 1 and 3 days, respectively. Experimental campaign demonstrates the advantages of source region observations to link agricultural waste burning and air pollution at local to regional scales.

BackgroundBariatric surgery presently is the best possible intervention for treatment of severe obesity and its related conditions. This study presents retrospective data on the pregnancy outcomes of Indian patients who underwent bariatric surgery before conception.MethodologyThis is a single-centre retrospective, observational study. Data on demographics, pre-surgery weight, body mass index (BMI), types of bariatric surgery, weight at conception, weight gain during pregnancy, type of delivery and the health of the baby were collected and analysed to study the weight loss pattern and pregnancy outcomes in female patients of childbearing potential.ResultsThe study included 34 women of childbearing potential (BMI>30 kg/m2) who underwent bariatric surgery. The study population was followed up from the time of surgery until 1-year post-delivery of the baby. The mean weight gain during the pregnancy was 14.9±5.4 kg. Twenty-three underwent LSCS, and the rest had normal delivery with mean baby weight of 2.5±0.4 kg. Six babies required neonatal intensive care. In our series, only 4 of 35 cohorts that are only 11% had substantial weight retention (range 5–13 kg) at the end of 12 months which is significantly lower than the normal cohorts who did not undergo bariatric surgery.ConclusionBariatric surgery improves fertility with safe pregnancy and its outcomes in terms of preeclampsia, eclampsia, gestational diabetes, premature rupture of the membranes (PROM), postpartum haemorrhage (PPH) and puerperal sepsis in women with childbearing potential and safe for offspring in terms of shoulder dystocia, macrosomia, birth asphyxia and perinatal mortality. However, they should be well aware of the risks associated with bariatric surgery especially the mal-absorptive procedures.

Impairment in ventricular relaxation and preserved left ventricular ejection fraction are the two main features of heart failure with preserved ejection fraction (HFpEF) a difficult clinical condition. Therapeutic choices for HFpEF patients are still scarce despite its rising frequency and negative effects on morbidity and mortality, necessitating creative methods to enhance results. The increased thromboembolic risk seen in these individuals raises questions about the relevance of anticoagulation in the therapy of HFpEF. Although anticoagulation has been shown to be beneficial in heart failure with decreased ejection fraction (HFrEF) and other high-risk cardiovascular disorders, its efficacy and safety in HFpEF present a challenging therapeutic challenge. Anticoagulants have been the subject of clinical trials in HFpEF, but the results have been conflicting, giving clinicians only a little information with which to make decisions. The decision-making process is made more difficult by worries about potential bleeding hazards, particularly in susceptible elderly HFpEF patients with other comorbidities. The link between heart failure and anticoagulant medication in HFpEF is thoroughly analyzed in this narrative review. In HFpEF, cardiac fibrosis and endothelial dysfunction create a prothrombotic milieu, as is highlighted in this passage. Also covered are recent developments in innovative biomarker research and cutting-edge imaging techniques, which may provide ways to spot HFpEF patients who might benefit from anticoagulation. This therapeutic conundrum may be resolved by using precision medicine strategies based on risk classification and individualized therapy choices. This review emphasizes the need for more research to establish the best use of anticoagulation in HFpEF within the framework of personalized therapy and shared decision-making. To successfully manage thromboembolic risk and reduce bleeding consequences in HFpEF patients, it is essential to perform well-designed clinical studies and advance our understanding of the pathophysiology of HFpEF. These developments may ultimately improve the prognosis and quality of life for people who suffer from this difficult and mysterious ailment.

PurposeTo detail the methodology for a novel ocular trauma registry and utilize the registry to determine the demographics, nature of injury, and associations of severe visual loss for open globe injuries (OGI).MethodsThirteen hospitals in 7 countries used International Globe and Adnexal Trauma Epidemiology Study (IGATES) platform. Patients presenting between April 2009 and 2020 with OGI (with or without) adnexal involvement or intraocular foreign body (IOFB) were included.ResultsAnalyses of presenting and final VA, using “severe vision loss” (VA ≤ 6/60) and “no severe loss” (VA > 6/60), were performed. Four hundred fifty-four (64%) patients had VA < 6/60 at presentation and 327 (44.8%) at final follow-up, with a highly significant association between presenting and final VA (p < 0.0001). From the cohort of 746 patients, 37 were missing VA at presentation and 16 at follow-up and complete clinical data was available for 354 patients. The male to female ratio is 6:1, and mean age 36.0 ± 20.0 years old. Relative afferent pupillary defect (RAPD), zone III injury, IOFB, and eyelid injury at presentation were recorded in 50 (6.7%), 55 (7.8%), 97 (13%), and 87 (11.7%) patients, respectively, and were significantly associated with VA < 6/60 at follow-up. Older age, ≥ 61 years, was associated with 3.39 times (95% CI: 1.95–5.89) higher risk than ≤20-year-old patients (p < 0.0001) and males 0.424 times (95% CI: 0.27–0.70) lower risk than female (p = 0.0001) of severe vision loss (SVL).ConclusionIn OGIs from 13 hospitals, female gender, older age, zone III injury, eyelid injury, and IOFB were associated with higher risk of visual outcome of SVL.

Ophthalmic trauma is a leading cause of preventable monocular blindness worldwide. The prevalence of ophthalmic trauma varies considerably based on geographic location, socio-economic status, age groups, occupation, and cultural practices such as firework celebrations. Clinical registries are known to be valuable in guiding the diagnosis, management, and prognostication of complex diseases. However, there is currently a lack of a centralized international data repository for ophthalmic trauma. We draw lessons from past and existing clinical registries related to ophthalmology and propose a new suitable international multicenter clinical registry for ophthalmic trauma: the International Globe and Adnexal Trauma Epidemiology Study (IGATES). IGATES is hosted on a secure web-based platform which exhibits user-friendly smart features, an integrated Ocular Trauma Score (OTS) prognosis calculator, efficient data collection points, and schematic graphical software. IGATES currently has 37 participating centers globally. The data collected through IGATES will be primarily used to develop a more robust and improved ophthalmic trauma prognostic classification system, the Ocular Trauma Score-2 (OTS-2), which builds on previous systems such as the Birmingham Eye Trauma Terminology System (BETTS) and Ocular Trauma Score (OTS). Furthermore, IGATES will act as a springboard for further research into the epidemiology, diagnosis, and management of ophthalmic trauma. Ultimately, IGATES serves to advance the field of ophthalmic trauma and improve the care that patients with ophthalmic trauma receive.

The ongoing pandemic of the novel Corona Virus Disease 2019 (COVID-19) is an unprecedented challenge to global health, never experienced before. This study aims to describe the clinical characteristics and outcomes of patients with COVID-19 admitted to Mercy Hospitals. Retrospective, observational cohort study designed to include every COVID-19 subject aged 18 years or older admitted to Mercy Saint (St) Vincent, Mercy St Charles, and Mercy St Anne's hospital in Toledo, Ohio from January 1, 2020 through June 15th, 2020. Primary Outcome Measure was mortality in the emergency department or as an in-patient. 470 subjects including 224 males and 246 females met the inclusion criteria for the study. Subjects with the following characteristics had higher odds (OR) of death: Older age [OR 8.3 (95% CI 1.1-63.1, p = 0.04)] for subjects age 70 or more compared to subjects age 18-29); Hypertension [OR 3.6 (95% CI 1.6-7.8, p = 0.001)]; Diabetes [OR 3.1 (95% CI 1.7-5.6, p<0.001)]; COPD [OR 3.4 (95% CI 1.8-6.3, p<0.001)] and CKD stage 2 or greater [OR 2.5 (95% CI 1.3-4.9, p = 0.006)]. Combining all age groups, subjects with hypertension had significantly greater odds of the following adverse outcomes: requiring hospital admission (OR 2.2, 95% CI 1.4-3.4, p<0.001); needing respiratory support in 24 hours (OR 2.5, 95% CI: 1.7-3.7, p<0.001); ICU admission (OR 2.7, 95% CI 1.7-4.4, p<0.001); and death (OR 3.6, 95% CI 1.6-7.8, p = 0.001). Hypertension was not associated with needing vent in 24 hours (p = 0.07). Age and hypertension were associated with significant comorbidity and mortality in Covid-19 Positive patients. Furthermore, people who were older than 70, and had hypertension, diabetes, COPD, or CKD had higher odds of dying from the disease as compared to patients who hadn't. Subjects with hypertension also had significantly greater odds of other adverse outcomes.