Transforming mental health systems globally: principles and policy recommendations.

A burgeoning mental health crisis is emerging globally, regardless of each country's human resources or spending. We argue that effectively responding to this crisis is impeded by the dominant framing of mental ill health through the prism of diagnostic categories, leading to an excessive reliance on interventions that are delivered by specialists; a scarcity of widespread promotive, preventive, and recovery-oriented strategies; and failure to leverage diverse resources within communities. Drawing upon a series of syntheses, we identify five principles to transform current practices; namely, address harmful social environments across the life course, particularly in the early years; ensure that care is not contingent on a categorical diagnosis but aligned with the staging model of mental illness; empower diverse front-line providers to deliver psychosocial interventions; embrace a rights-based approach that seeks to provide alternatives to violence and coercion in care; and centre people with lived experience in all aspects of care. We recommend four policy actions which can transform these principles into reality: a whole of society approach to prevention and care; a redesign of the architecture of care delivery to provide a seamless continuum of care, tailored to the severity of the mental health condition; investing more in what works to enhance the impact and value of the investments; and ensuring accountability through monitoring and acting upon a set of mental health indicators. All these actions are achievable, relying-for the most part-on resources already available to every community and country. What they do require is the acceptance that business as usual will fail and the solutions to transforming mental health-care systems are already present within existing resources.

Assessing capacities and resilience of health services during the COVID-19 pandemic: Lessons learned from use of rapid key informant surveys.

This article is part of the Research Topic: 'Health Systems Recovery in the Context of COVID-19 and Protracted Conflict.' Problem: Many countries lacked rapid and nimble data systems to track health service capacities to respond to COVID-19. They struggled to assess and monitor rapidly evolving service disruptions, health workforce capacities, health products availability, community needs and perspectives, and mitigation responses to maintain essential health services. Method: Building on established methodologies, the World Health Organization developed a suite of methods and tools to support countries to rapidly fill data gaps and guide decision-making during COVID-19. The tools included: (1) a national "pulse" survey on service disruptions and bottlenecks; (2) a phone-based facility survey on frontline service capacities; and (3) a phone-based community survey on demand-side challenges and health needs. Use: Three national pulse surveys revealed persisting service disruptions throughout 2020-2021 (97 countries responded to all three rounds). Results guided mitigation strategies and operational plans at country level, and informed investments and delivery of essential supplies at global level. Facility and community surveys in 22 countries found similar disruptions and limited frontline service capacities at a more granular level. Findings informed key actions to improve service delivery and responsiveness from local to national levels. Lessons learned: The rapid key informant surveys provided a low-resource way to collect action-oriented health services data to inform response and recovery from local to global levels. The approach fostered country ownership, stronger data capacities, and integration into operational planning. The surveys are being evaluated to inform integration into country data systems to bolster routine health services monitoring and serve as health services alert functions for the future.

Post-traumatic growth in PhD students during the COVID-19 pandemic.

Throughout the COVID-19 pandemic, graduate students have faced increased risk of mental health challenges. Research suggests that experiencing adversity may induce positive psychological changes, called post-traumatic growth (PTG). These changes can include improved relationships with others, perceptions of oneself, and enjoyment of life. Few existing studies have explored this phenomenon among graduate students. This secondary data analysis of a survey conducted in November 2020 among graduate students at a private R1 University in the northeast United States examined graduate students' levels and correlates of PTG during the COVID-19 pandemic. Students had a low level of PTG, with a mean score of 10.31 out of 50. Linear regression models showed significant positive relationships between anxiety and PTG and between a measure of self-reported impact of the pandemic and PTG. Non-White minorities also had significantly greater PTG than White participants. Experiencing more negative impact due to the pandemic and ruminating about the pandemic were correlated with greater PTG. These findings advance research on the patterns of PTG during the COVID-19 pandemic and can inform future studies of graduate students' coping mechanisms and support efforts to promote pandemic recovery and resilience.

Taking action on climate change: Testimonials and position statement from the International League Against Epilepsy Climate Change Commission.

The release of the 2021 Intergovernmental Panel on Climate Change (IPCC) report makes clear that human activities have resulted in significant alterations in global climate. There is no doubt that climate change is upon us; chronic global warming has been punctuated by more frequent extreme weather events. Humanity will have to mitigate climate change and adapt to these changing conditions or face dire consequences. One under-appreciated aspect of this global crisis is its impact on healthcare, particularly people with epilepsy and temperature-sensitive seizures. As members of the inaugural International League Against Epilepsy (ILAE) Climate Change Commission, we recount the personal motivations that have led each team member to decide to take action, in the hope that our journeys as ordinary clinicians and scientists will help persuade others that they too can act to foster change within their spheres of influence.

Informing the development of the coaching online and community health (COACH) program: a qualitative study of clubhouse members living with serious mental illness.

Health and wellness interventions addressing risk factors for early mortality among individuals with serious mental illness have demonstrated success and can be further augmented with digital technology. These programs may be suitable for delivery in psychosocial rehabilitation clubhouses, especially given many services have transitioned to digital platforms during the pandemic. This qualitative study aimed to: (a) explore clubhouse members' experiences engaging with the virtual clubhouse platform, and their preferences for accessing digital wellness and health promotion content; and, (b) gauge members' interest in an online peer-driven lifestyle intervention and their suggestions for program design. This study was guided by a community-based participatory action research framework. Ten focus groups were conducted with clubhouse members. Focus groups were coded and analyzed thematically by trained clubhouse members and the research team. Thirty-three members participated in the focus groups. Participants expressed the importance of having technical support from staff; that one-on-one support and consistent communication are important to keep them engaged in health and wellness programming; and described mixed views about use of the virtual platform, but generally were open to engaging in lifestyle intervention programming virtually. Participants who joined the clubhouse during the pandemic expressed feeling overwhelmed by in-person gatherings, and were especially interested in opportunities for remote participation. This study can inform health and wellness programming for delivery on the virtual clubhouse platform for members. The taxonomy of codes, created to generate a framework with recommendations, will inform the design of a virtual health and wellness intervention.

This study investigates people with mental illness's interest in an online program to improve their heart health and fitness through a clubhouse which they are a member of. Previous programs have had success improving the heart health and fitness of people with mental illness and adapting these programs to be accessible online can expand their impact. Thirty-three individuals participated in 10 focus groups and expressed the importance of having help from when accessing technology; that one-on-one support and communication would increase their participation in these programs; and described mixed views about use of online programs, but generally were open to an online program to increase heart health and fitness.

The Haunted House Experience: Developing a Home Health Assessment Training Utilizing an Interprofessional, Interinstitutional Virtual Simulation.

To meet the interprofessional education needs of students during the COVID-19 pandemic, universities transitioned to virtual options. For many universities, this transition was challenging and time-consuming. The Arkansas Interprofessional Education Consortium (ARIPEC) combined resources to create a novel learning experience for students with a focus on the skill of home assessment. An interinstitutional, interprofessional faculty project team was developed to create a learning experience, with each institution responsible for a portion of the virtual simulation development. This paper describes the process for creation and implementation of an interprofessional, interinstitutional virtual learning experience to support the growth of healthcare students across the state of Arkansas.

The burden of recording and reporting health data in primary health care facilities in five low- and lower-middle income countries.

BACKGROUND: Recording and reporting health data in facilities is the backbone of routine health information systems which provide data collected by health facility workers during service provision. Data is firstly collected in a register, to record patient health data and care process, and tallied into nationally designed reporting forms. While there is anecdotal evidence of large numbers of registers and reporting forms for primary health care (PHC) facilities, there are few systematic studies to document this potential burden on health workers. This multi-country study aimed to document the numbers of registers and reporting forms use at the PHC level and to estimate the time it requires for health workers to meet data demands. METHODS: In Cambodia, Ghana, Mozambique, Nigeria and Tanzania, a desk review was conducted to document registers and reporting forms mandated at the PHC level. In each country, visits to 16 randomly selected public PHC facilities followed to assess the time spent on paper-based recording and reporting. Information was collected through self-reports of estimated time use by health workers, and observation of 1360 provider-patient interactions. Data was primarily collected in outpatient care (OPD), antenatal care (ANC), immunization (EPI), family planning (FP), HIV and Tuberculosis (TB) services. RESULT: Cross-countries, the average number of registers was 34 (ranging between 16 and 48). Of those, 77% were verified in use and each register line had at least 20 cells to be completed per patient. The mean time spent on recording was about one-third the total consultation time for OPD, FP, ANC and EPI services combined. Cross-countries, the average number of monthly reporting forms was 35 (ranging between 19 and 52) of which 78% were verified in use. The estimated time to complete monthly reporting forms was 9 h (ranging between 4 to 15 h) per month per health worker. CONCLUSIONS: PHC facilities are mandated to use many registers and reporting forms pausing a considerable burden to health workers. Service delivery systems are expected to vary, however an imperative need remains to invest in international standards of facility-based registers and reporting forms, to ensure regular, comparable, quality-driven facility data collection and use.

Mobile genomics: tools and techniques for tackling transposons.

Next-generation sequencing approaches have fundamentally changed the types of questions that can be asked about gene function and regulation. With the goal of approaching truly genome-wide quantifications of all the interaction partners and downstream effects of particular genes, these quantitative assays have allowed for an unprecedented level of detail in exploring biological interactions. However, many challenges remain in our ability to accurately describe and quantify the interactions that take place in those hard to reach and extremely repetitive regions of our genome comprised mostly of transposable elements (TEs). Tools dedicated to TE-derived sequences have lagged behind, making the inclusion of these sequences in genome-wide analyses difficult. Recent improvements, both computational and experimental, allow for the better inclusion of TE sequences in genomic assays and a renewed appreciation for the importance of TE biology. This review will discuss the recent improvements that have been made in the computational analysis of TE-derived sequences as well as the areas where such analysis still proves difficult. This article is part of a discussion meeting issue 'Crossroads between transposons and gene regulation'.

Poor availability of essential medicines for women and children threatens progress towards Sustainable Development Goal 3 in Africa.

BACKGROUND: Most maternal and child deaths are preventable or treatable with proven, cost-effective interventions for infectious diseases and maternal and neonatal complications. In 2015 sub-Saharan Africa accounted for up to 66% of global maternal deaths and half of the under-five deaths. Access to essential medicines and commodities and trained healthcare workers to provide life-saving maternal, newborn and post-natal care are central to further reductions in maternal and child mortality. METHODS: Available data for 24 priority medicines for women and children were extracted from WHO service availability and readiness assessments conducted between 2012 and 2015 for eight countries in sub-Saharan Africa. The mean availability of medicines in facilities stating they provide services for women or children and differences by facility type, ownership and location are reported. RESULTS: The mean availability of 12 priority essential medicines for women ranged from 22% to 40% (median 33%; IQR 12%) and 12 priority medicines for children ranged from 28% to 57% (median 50%; IQR 14%). Few facilities (<1%) had all nominated medicines available. There was higher availability of priority medicines for women in hospitals than in primary care facilities: range 32%-80% (median 61%) versus 20%-39% (median 23%) and for children's medicines 31%-71% (median 58%) versus 27%-57% (median 48%). Availability was higher in public than private facilities: for women's medicines, range 21%-41% (median 34%) versus 4%-36% (median 27%) and for children's medicines 28%-58% (median 51%) versus 5%-58% (median 46%). Patterns were mixed for rural and urban location for the priority medicines for women, but similar for children's medicines. CONCLUSIONS: The survey results show unacceptably low availability of priority medicines for women and children in the eight countries. Governments should ensure the availability of medicines for mothers and children if they are to achieve the health sustainable development goals.

Generating statistics from health facility data: the state of routine health information systems in Eastern and Southern Africa.

Health facility data are a critical source of local and continuous health statistics. Countries have introduced web-based information systems that facilitate data management, analysis, use and visualisation of health facility data. Working with teams of Ministry of Health and country public health institutions analysts from 14 countries in Eastern and Southern Africa, we explored data quality using national-level and subnational-level (mostly district) data for the period 2013-2017. The focus was on endline analysis where reported health facility and other data are compiled, assessed and adjusted for data quality, primarily to inform planning and assessments of progress and performance. The analyses showed that although completeness of reporting was generally high, there were persistent data quality issues that were common across the 14 countries, especially at the subnational level. These included the presence of extreme outliers, lack of consistency of the reported data over time and between indicators (such as vaccination and antenatal care), and challenges related to projected target populations, which are used as denominators in the computation of coverage statistics. Continuous efforts to improve recording and reporting of events by health facilities, systematic examination and reporting of data quality issues, feedback and communication mechanisms between programme managers, care providers and data officers, and transparent corrections and adjustments will be critical to improve the quality of health statistics generated from health facility data.

TEsmall Identifies Small RNAs Associated With Targeted Inhibitor Resistance in Melanoma.

MicroRNAs (miRNAs) are small 21-22 nt RNAs that act to regulate the expression of mRNA target genes through direct binding to mRNA targets. While miRNAs typically dominate small RNA (sRNA) transcriptomes, many other classes are present including tRNAs, snoRNAs, snRNAs, Y-RNAs, piRNAs, and siRNAs. Interactions between processing machinery and targeting networks of these various sRNA classes remains unclear, largely because these sRNAs are typically analyzed separately. Here, we present TEsmall, a tool that allows for the simultaneous processing and analysis of sRNAs from each annotated class in a single integrated workflow. The pipeline begins with raw fastq reads and proceeds all the way to producing count tables formatted for differential expression analysis. Several interactive charts are also produced to look at overall distributions in length and annotation classes. We next applied the TEsmall pipeline to sRNA libraries generated from melanoma cells responding to targeted inhibitors of the MAPK pathway. Targeted oncogene inhibitors have emerged as way to tailor cancer therapies to the particular mutations present in a given tumor. While these targeted strategies are typically effective for short intervals, the emergence of resistance is extremely common, limiting the effectiveness of single-agent therapeutics and driving the need for a better understanding of resistance mechanisms. Using TEsmall, we identified several microRNAs and other sRNA classes that are enriched in inhibitor resistant melanoma cells in multiple melanoma cell lines and may be able to serve as markers of resistant populations more generally.

An evaluation of an interprofessional practice-based learning environment using student reflections.

The 12th Street Health and Wellness Center is an interprofessional, student-led, community-based clinic. Students from all University of Arkansas for Medical Sciences colleges work together to provide healthcare services for residents of an underserved community. Interprofessional student teams assess patients and present to an interprofessional preceptor team. At the conclusion of clinic, teams reflect on their experience. The objective of this study is to generate key themes from the end of clinic reflections to describe learning outcomes in an interprofessional practice environment. Student teams were asked to reflect on what they learned about patient care and interprofessional practice while volunteering at the clinic. Three hundred eighty reflection statements were assessed using the constant comparative approach with open coding by three researchers who identified and categorised themes by selecting key phrases from reflections. Eight themes emerged from this process which illuminated students' self-perceived development during practice-based learning and interprofessional collaboration. Key phrases were also coded to the four core Interprofessional Education Collaborative competency domains. These results suggest learners' perception that the Center is a practice-based environment that provides an opportunity to learn, integrate, and apply interprofessional curricular content.

The Role of Servant Leadership and Transformational Leadership in Academic Pharmacy.

A variety of changes are facing leaders in academic pharmacy. Servant and transformational leadership have attributes that provide guidance and inspiration through these changes. Servant leadership focuses on supporting and developing the individuals within an institution, while transformational leadership focuses on inspiring followers to work towards a common goal. This article discusses these leadership styles and how they may both be ideal for leaders in academic pharmacy.

Qualitative Analysis of Written Reflections during a Teaching Certificate Program.

OBJECTIVE: To evaluate the success of a teaching certificate program by qualitatively evaluating the content and extent of participants' reflections. METHODS: Two investigators independently identified themes within midpoint and final reflection essays across six program years. Each essay was evaluated to determine the extent of reflection in prompted teaching-related topic areas (strengths, weaknesses, assessment, feedback). RESULTS: Twenty-eight themes were identified within 132 essays. Common themes encompassed content delivery, student assessment, personal successes, and challenges encountered. Deep reflection was exhibited, with 48% of essays achieving the highest level of critical reflection. Extent of reflection trended higher from midpoint to final essays, with significant increases in the strengths and feedback areas. CONCLUSION: The teaching certificate program fostered critical reflection and self-reported positive behavior change in teaching, thus providing a high-quality professional development opportunity. Such programs should strongly consider emphasizing critical reflection through required reflective exercises at multiple points within program curricula.

Monitoring service delivery for universal health coverage: the Service Availability and Readiness Assessment.

OBJECTIVE: To describe the Service Availability and Readiness Assessment (SARA) and the results of its implementation in six countries across three continents. METHODS: The SARA is a comprehensive approach for assessing and monitoring health service availability and the readiness of facilities to deliver health-care interventions, with a standardized set of indicators that cover all main programmes. Standardized data-collection instruments are used to gather information on a defined set of selected tracer items from public and private health facilities through a facility sample survey or census. Results from assessments in six countries are shown. FINDINGS: The results highlight important gaps in service delivery that are obstacles to universal access to health services. Considerable variation was found within and across countries in the distribution of health facility infrastructure and workforce and in the types of services offered. Weaknesses in laboratory diagnostic capacities and gaps in essential medicines and commodities were common across all countries. CONCLUSION: The SARA fills an important information gap in monitoring health system performance and universal health coverage by providing objective and regular information on all major health programmes that feeds into country planning cycles.

An advanced pharmacy practice experience in application of evidence-based policy.

OBJECTIVE: To determine the impact of an advanced pharmacy practice experience (APPE) to develop skills needed to apply an evidence-based approach to population-level practice decisions. DESIGN: A 4-week evidence-based medicine APPE was implemented that included active-learning techniques and online learning modules, participation in state drug-policy committee meetings, and completion of an evidence-based medicine review for a specific drug agent or class. ASSESSMENT: Students' mean score on application of principles related to biostatistics and information mastery on posttests increased 15.8% from pretest to posttest. Students' mean score on a 22-question information mastery quiz was 90.8%. Mean scores for course evaluation components ranged from 4.8 to 5.0 on a 5-point Likert scale. All respondents indicated they would recommend the APPE to other students. CONCLUSIONS: An APPE that incorporated content from active drug-policy committees increased students' evidence-based medicine skills and enhanced their understanding of, appreciation for, and confidence in evidence-based practice.

TRPC1 and Orai1 interact with STIM1 and mediate capacitative Ca(2+) entry caused by acute hypoxia in mouse pulmonary arterial smooth muscle cells.

Previous studies in pulmonary artery smooth muscle cells (PASMCs) showed that acute hypoxia activates capacitative Ca(2+) entry (CCE) but the molecular candidate(s) mediating CCE caused by acute hypoxia remain unclear. The present study aimed to determine if transient receptor potential canonical 1 (TRPC1) and Orai1 interact with stromal interacting molecule 1 (STIM1) and mediate CCE caused by acute hypoxia in mouse PASMCs. In primary cultured PASMCs loaded with fura-2, acute hypoxia caused a transient followed by a sustained rise in intracellular Ca(2+) concentration ([Ca(2+)](i)). The transient but not sustained rise in [Ca(2+)](i) was partially inhibited by nifedipine. Acute hypoxia also increased the rate of Mn(2+) quench of fura-2 fluorescence that was inhibited by SKF 96365, Ni(2+), La(3+), and Gd(3+), exhibiting pharmacological properties characteristic of CCE. The nifedipine-insensitive rise in [Ca(2+)](i) and the increase in Mn(2+) quench rate were both inhibited in cells treated with TRPC1 antibody or TRPC1 small interfering (si)RNA, in STIM1 siRNA-transfected cells and in Orai1 siRNA-transfected cells. Moreover, overexpression of STIM1 resulted in a marked increase in [Ca(2+)](i) and Mn(2+) quench rate caused by acute hypoxia, and they were reduced in cells treated with TRPC1 antibody and in cells transfected with Orai1 siRNA. Furthermore, TRPC1 and Orai1 coimmunoprecipitated with STIM1 and the precipitation levels of TRPC1 and Orai1 were increased in cells exposed to acute hypoxia. Immunostaining showed colocalizations of TRPC1-STIM1 and Orai1-STIM1, and the colocalizations of these proteins were more apparent in acute hypoxia. These data provide direct evidence that TRPC1 and Orai1 channels mediate CCE through activation of STIM1 in acute hypoxic mouse PASMCs.