HealthRight International

In February 2022 Russia launched an invasion of Ukraine. National aid workers responded to the crisis, at the risk of their own wellbeing. This case study details the cocreation of a peer support intervention by a global public health non-profit working with national staff in Ukraine. As a first step in peer support wellbeing curriculum development, an online survey was developed and administered for 530 Ukrainian healthcare and humanitarian aid workers. The survey resulted in 300 valid responses, for a 57% response rate. Top stressors included: personal safety and security (43%), concerns for family and friends (32%), and financial hardships (29%). Just over one-third of respondents indicated that stress was interfering with their ability to do their job. Common forms of coping included distraction (73%), and use of alcohol or drugs (32%). Nearly all (97%) indicated interest in a peer support group intervention. In addition to interest in socializing with colleagues, top preferences for curriculum content included: coping skills, psychological preparedness, peer support facilitation skills, and healthy team dynamics. Survey results were used to develop a 6-module peer support group curriculum, refined through subsequent workshops. This participatory approach can be utilized to develop tailored wellbeing curriculum for workers of various types and across settings.

Background The relatively low universal health coverage (UHC) effective coverage indices in most African countries is a cause for concern. Some African countries have effective coverage indices as low as 25 when the global average is 44-48. Although several African countries have initiated UHC activities, their implementation paces and approaches vary. The aim of this systematic mapping study is to describe the publication frequencies on UHC-related activities across African countries. The revealed publication patterns can guide the enhancement of UHC research, implementation, and publication in Africa. Methods This systematic mapping study was conducted by first establishing a research scope. Then, relevant publications were identified from PubMed, Google Scholar, Google, WHO, and uhc2030 search engines. A classification scheme was developed to guide the systematic mapping of the selected 202 publications. This systematic mapping study describes the variations in UHC-related publication types, contributions, focus areas, and dimensions between 2013 and 2023 across African countries. Results Analyzing the publications based on the developed classification scheme revealed that WHO was the most frequent author with 17 publications. Secondly, primary research articles (28.2%, n = 57) were the commonest while legislation (0.5%, n = 1) were the rarest. Most of the publications were on the financing and performance of health systems. Conclusions Overall, publication numbers and evidence value increased as time progressed from 2013 to 2023. The generated systematic maps indicate opportunities for UHC-promoting publication activities. Supporting the development of legislation and authoring systematic reviews are some of the opportunities that stakeholders can leverage to steer UHC in Africa.

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.

Dr. Wright is from the Department of Obstetrics and Gynecology at Columbia University, New York, New York, and is the Editor-in-Chief of Obstetrics & Gynecology; email: [email protected]. Financial Disclosure Dr. Wright has received research funding from Merck and honoraria from UpToDate.

This paper proposes a framework for comprehensive, collaborative, and community-based care (C4) for accessible mental health services in low-resource settings. Because mental health conditions have many causes, this framework includes social, public health, wellness and clinical services. It accommodates integration of stand-alone mental health programs with health and non-health community-based services. It addresses gaps in previous models including lack of community-based psychotherapeutic and social services, difficulty in addressing comorbidity of mental and physical conditions, and how workers interact with respect to referral and coordination of care. The framework is based on task-shifting of services to non-specialized workers. While the framework draws on the World Health Organization’s Mental Health Gap Action Program and other global mental health models, there are important differences. The C4 Framework delineates types of workers based on their skills. Separate workers focus on: basic psychoeducation and information sharing; community-level, evidence-based psychotherapeutic counseling; and primary medical care and more advanced, specialized mental health services for more severe or complex cases. This paper is intended for individuals, organizations and governments interested in implementing mental health services. The primary aim is to provide a framework for the provision of widely accessible mental health care and services.

Alan Schulman and Stacey Lynn Schulman describe how generative AI can make classic, iconic musical styles feel new again, helping people to engage with artists who are gone, but not forgotten. This technology could fuel consumer engagement with brands that invest in musical cultures and branding.

IssuesDespite the large number of effective psychological interventions for alcohol use disorders (AUD), there is still a lack of clarity concerning the strategies that make these interventions effective.ApproachThe overall goal of this review was to identify, examine and synthesise the information about common strategies from evidence‐based psychological interventions for AUDs by conducting a review of systematic reviews, that is, a meta‐review. We isolated the relevant primary studies from eligible systematic reviews and extracted information about the interventions from these studies to understand the strategies used. Analysis was restricted to narrative summaries.Key FindingsThirteen reviews were eligible for inclusion in our meta‐review. Of these, eight demonstrated the effectiveness of a range of psychological interventions—behavioural couples therapy, cognitive behaviour therapy combined with motivational interviewing, brief interventions, contingency management, psychotherapy plus brief interventions, Alcoholics Anonymous and 12‐step treatment programs, family‐therapy or family‐involved treatment, and community reinforcement approach. The most commonly used component strategies in effective interventions for AUDs included assessment, personalised feedback, motivational interviewing, goal setting, setting and review of homework, problem solving skills and relapse prevention/management.ImplicationsEvidence about commonly used strategies in evidence‐based psychological interventions for AUDs offer the possibility of creating menu‐driven interventions that can be tailored to respond to individual client needs and preferences in different contexts.

Since 2014, a protracted armed conflict has afflicted eastern Ukraine, resulting in the displacement of over 1.4 million residents. The resulting humanitarian crisis has placed women, particularly displaced women, at greater risk of gender-based violence (GBV). In Ukraine, reports of GBV were higher following the start of the conflict (22.4% in 2014 vs. 18.3% in 2007), with displaced women suffering from GBV nearly three times more than non-displaced residents (15.2% vs. 5.3%). Many GBV incidents in Ukraine have been reported along the "contact line," the border separating government from non-government-controlled areas. This study compares types of GBV experienced by displaced and local (non-displaced) women receiving psychosocial support in order to identify the gaps in services during a time of conflict. Data was collected by mental healthcare providers from 11,826 women (25.5% displaced; 74.5% local) aged 15 to 69 receiving psychosocial services in five conflict-affected regions from February 2016 to June 2017. Group differences were assessed using Pearson's chi-squared or Fisher's exact tests for categorical variables and Wilcoxon rank-sum tests for continuous variables. Overall, almost half of the women experienced intimate partner violence and psychological abuse. Compared to residents, displaced women were more likely to report non-domestic GBV incidents involving sexual and economic violence. Almost 8% of violent incidents against displaced women occurred at checkpoints or at reception centers for internally displaced persons (IDP) and 20% were perpetrated by armed men. Consistent with the literature, this study suggests that displaced women are more vulnerable to attacks by persons outside the home and by armed groups. Our findings underscore the need to expand violence prevention programs to address the unique vulnerabilities of displaced women before, during, and after displacement. Programs should be tailored to prevent violence within and outside the home. Increased prevention efforts are needed in areas with high concentrations of armed men, along the contact line, and at IDP reception centers to protect displaced women. This is particularly urgent in the context of increased GBV due to COVID-19.