Possible Health

Intimate partner violence (IPV) and mental health (MH) issues among women in Nepal are deeply influenced by complex intergenerational family dynamics and power hierarchies. The traditional power hierarchies often place mothers-in-law (MILs) in authoritative roles over daughters-in-law (DILs), limiting the latter's autonomy and decision-making power. We designed a multi-component family intervention called MILAP to lower depression and address intimate partner violence by improving communication, promoting gender equity, and improving family relationships. This paper explores the perceptions and experiences of DILs who received the MILAP intervention. A total of 61 families participated in a pilot study of the MILAP intervention. Of these, 8 families (comprising triads of daughter-in-law, mother-in-law, and husband) were purposively selected for in-depth interviews (IDIs). All interviews were conducted immediately after the intervention and at the 6-month follow-up to assess MILAP's sustainability and impact. A thematic approach was used to analyze the data, utilizing Dedoose data management software. Four major themes were identified: (1) Enhanced communication within the family, (2) Strengthened DIL's empowerment, (3) Improved relationship quality, and (4) Increased DIL's freedom of movement. Participants reported improvement in communication among family members, particularly by using active listening skills which in turn contributed to conflict reduction and a more harmonious family environment. DILs experienced increased empowerment. They were more involved in family decision-making as the family unit adopted more equitable gender norms. The intervention strengthened spousal relationship improved MIL-DIL interactions, facilitated mutual understanding, and reduced household stress. Additionally, MILAP enabled DILs to move more freely outside the home. This increased mobility expanded their social networks, as DILs participated in community events, visited natal families, and accessed health services. However, some participants expressed concerns about the long-term sustainability of these changes, highlighting the need for continued reinforcement. Our study underscores the importance of a family-based intervention in improving relationship quality and promoting autonomy among DILs experiencing IPV. The positive shifts perceived within families suggest promise for MILAP to strengthen support structures and address factors that may influence DIL's mental health. However, ongoing follow-up and reinforcement strategies are recommended to maintain the gains achieved from the intervention.

Traditional assessment methods struggle to authentically capture the practical application of competencies in complex learning environments such as SEL (Social-Emotional Learning) and CTE (Career and Technical Education). These fields require tools that go beyond self-reports or structured written assessments, which often miss the nuanced, context-driven ways students demonstrate skills. ZoneSight leverages generative AI to perform deep contextual analysis on unstructured data like audio and video, allowing for a richer, more flexible assessment of competencies that more closely reflect the authentic learning, while also introducing more objectivity and scalability to assessments in these fields. This paper presents early progress and preliminary results from ZoneSight, a tool designed to address this challenge by analyzing real interactions to extract insights into nuanced competencies, beginning with SEL. ZoneSight's scalable, psychometrically sound assessments align with the dynamic nature of SEL (current focus) and hold future potential for application in CTE environments.

Men who have sex with men (MSM) have an elevated risk of adverse health outcomes associated with alcohol use and smoking. Although substantial studies have been conducted globally, little is known about alcohol use and smoking among MSM in Nepal. Therefore, the present study aimed to examine the prevalence and patterns of alcohol use and daily smoking among MSM in Nepal. A cross-sectional respondent-driven survey was conducted among MSM in Kathmandu, Nepal, between October and December 2022. Bivariate and multivariate logistic regression analyses were used to evaluate independent correlates of alcohol use in the past 12 months and daily smoking. Among 250 participants (mean age 27.6 ± 8.9 years), 71.6% had consumed alcohol in the past 12 months, and 42% smoked daily in the last 30 days. MSM who had an income of less than NRs 20,000 (aOR: 2.1; 95% CI: 1.1-3.8), were single (aOR: 2.0; 95% CI: 1.1-3.8), employed (aOR: 2.1; 95% CI: 1.1-4.1), engaged in sex work (aOR: 3.5; 95% CI: 1.1-11.1), ever smoked (aOR: 5.1; 95% CI: 2.6-9.7), and who did not engage in condomless sex (aOR: 2.1; 95% CI: 1.1-4.5) were more likely to use alcohol in the past 12 months. Similarly, participants who were born in Bagmati province (aOR: 3.7; 95% CI: 1.8-7.6), and had a history of drug use (aOR: 2.8; 95% CI: 1.3-5.7), and police detention (aOR: 3.2; 95% CI: 1.3-9.2) were more likely to be involved in daily smoking. The findings underscore the necessity of MSM-specific alcohol and smoking cessation programs in Nepal.

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. Faculty members and mentors 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 and gaining 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 psychiatrists, supervisors, and trainees based in low- and middle-income countries.

Suicidal thoughts and behaviors (STBs) are prevalent within the Lesbian, Gay, Bisexual, Transgender, and Queers (LGBTQ) community, often exacerbated by challenges in accessing care and the perceived stigma and discrimination tied to disclosing one's identity. Digital health interventions that offer psychosocial self-help present a promising platform to reach individuals at risk of STBs, especially those who may not engage with conventional health services. This review aimed to assess the role of digital-based intervention in reducing STBs among LGBTQ individuals. We conducted a systematic literature search from three databases, PsycINFO, PubMed, and CINHAL, from 1st Jan 1990 to 31st December 2023. The review encompassed studies investigating the feasibility, acceptability, and impact of digital interventions on STBs, employing randomized control trials (RCTs), pseudo-RCTs, observational pre-posttest designs, and qualitative studies. Potential bias was evaluated using the McGill Mixed Methods Appraisal Tool (MMAT). Five non-overlapping studies were included, reporting data from 777 participants. The studies featured diverse types of digital interventions, including videos, online writing, and mobile applications. The studies included three RCTs, and two qualitative studies. Across most of these studies, notable enhancements or reductions in the proportion of participants reporting STBs were observed post-intervention, alongside improvements in help-seeking intentions. The findings underscored that the applications used in the studies were engaging, acceptable, and deemed feasible in effectively addressing suicide prevention among the LGBTQ community. Overall, digital interventions were found to be feasible and acceptable in suicide prevention among LGBTQ communities, demonstrating preliminary efficacy in increasing help-seeking behavior when experiencing suicidal thoughts and in reducing STBs. Therefore, advocating for widespread promotion and dissemination of digital health interventions is crucial, particularly in low- and middle-income countries (LMICs) with limited access to health services and heightened barriers to obtaining such services. Further research using fully powered RCT is imperative to assess the efficacy of these interventions.

A Fobia Social, também conhecida como Transtorno de Ansiedade Social, está entre os transtornos psiquiátricos com maior incidência e comum na população mundial. O transtorno da Fobia Social caracteriza-se pela experiência de medo ou ansiedade avultados em circunstâncias sociais, quando a pessoa precisa de maneira explícita estar sob avaliação de outras pessoas. A pandemia da Covid-19 desencadeou uma das maiores conturbações que a humanidade pôde vivenciar. A quarentena e as medidas de distanciamento social, propiciaram um aumento significativo nos sintomas da Fobia Social. Este artigo tem como objetivo descrever as técnicas da Terapia Cognitivo-Comportamental (TCC) aplicadas ao transtorno da Fobia Social. O método utilizado foi da pesquisa e revisão bibliográfica, com base em materiais científicos já publicados. Nos resultados encontrados foi perceptível que a pandemia da Covid-19 trouxe um acréscimo aos transtornos mentais menores, dentre eles está a Fobia Social. Para quem apresentava o transtorno da Fobia Social, o isolamento provocado pela pandemia, foi uma forma de alívio, uma evitação favorável. No entanto, no decorrer do isolamento, foram detectados dois efeitos referentes à ansiedade social: a diminuição da percepção de ansiedade social, uma vez que as pessoas estavam menos expostas socialmente e o desenvolvimento de ansiedade social. Dessa forma as técnicas da TCC, como a Reestruturação Cognitiva, Técnica de Exposição, Técnica de Relaxamento e Treino de Habilidades Sociais, ajudam o paciente a construir um repertório de habilidades sociais, a fim, de lidar com os problemas de medo e ansiedade de exposições.

Le dialogue entre Pauline L. Boulba et Marisa Hayes s’attache aux résonances artistiques des écrits de Jill Johnston : la transition devient une entreprise de traduction. D’une langue à une autre, d’une écriture journalistique, brève et régulière, au projet d’un livre augmenté d’un film et d’une performance, il est question des médiums d’expression d’une pensée de la danse.

BackgroundTimely tracking of health outcomes is difficult in low- and middle-income countries without comprehensive vital registration systems. Community health workers (CHWs) are increasingly collecting vital events data while delivering routine care in low-resource settings. It is necessary, however, to assess whether routine programmatic data collected by CHWs are sufficiently reliable for timely monitoring and evaluation of health interventions. To study this, we assessed the consistency of vital events data recorded by CHWs using two methodologies—routine data collected while delivering an integrated maternal and child health intervention, and data from a birth history census approach at the same site in rural Nepal.MethodsWe linked individual records from routine programmatic data from June 2017 to May 2018 with those from census data, both collected by CHWs at the same site using a mobile platform. We categorized each vital event over a one-year period as ‘recorded by both methods,’ ‘census alone,’ or ‘programmatic alone.’ We further assessed whether vital events data recorded by both methods were classified consistently.ResultsFrom June 2017 to May 2018, we identified a total of 713 unique births collectively from the census (birth history) and programmatic maternal ‘post-delivery’ data. Three-fourths of these births (n = 526) were identified by both. There was high consistency in birth location classification among the 526 births identified by both methods. Upon including additional programmatic ‘child registry’ data, we identified 746 total births, of which 572 births were identified by both census and programmatic methods. Programmatic data (maternal ‘post-delivery’ and ‘child registry’ combined) captured more births than census data (723 vs. 595). Both methods consistently classified most infants as ‘living,’ while infant deaths and stillbirths were largely classified inconsistently or recorded by only one method. Programmatic data identified five infant deaths and five stillbirths not recorded in census data.ConclusionsOur findings suggest that data collected by CHWs from routinely tracking pregnancies, births, and deaths are promising for timely program monitoring and evaluation. Despite some limitations, programmatic data may be more sensitive in detecting vital events than cross-sectional census surveys asking women to recall these events.

This paper offers a review of some Christian authors who used Virgil as a pagan model with the purpose of portraying Christ’s life as a classical hero. Our working hypothesis is that Juvencus and Proba made the allusions and references to Aeneas’ heroic qualities to announce the victorious new archetype of Christ as the only example of virtue. This process defined as ‘Virgilisation of Christ’s life’ was fundamental for Prudentius’ poetic task.