Making cities mental health friendly for adolescents and young adults.

Urban life shapes the mental health of city dwellers, and although cities provide access to health, education and economic gain, urban environments are often detrimental to mental health1,2. Increasing urbanization over the next three decades will be accompanied by a growing population of children and adolescents living in cities3. Shaping the aspects of urban life that influence youth mental health could have an enormous impact on adolescent well-being and adult trajectories4. We invited a multidisciplinary, global group of researchers, practitioners, advocates and young people to complete sequential surveys to identify and prioritize the characteristics of a mental health-friendly city for young people. Here we show a set of ranked characteristic statements, grouped by personal, interpersonal, community, organizational, policy and environmental domains of intervention. Life skills for personal development, valuing and accepting young people's ideas and choices, providing safe public space for social connection, employment and job security, centring youth input in urban planning and design, and addressing adverse social determinants were priorities by domain. We report the adversities that COVID-19 generated and link relevant actions to these data. Our findings highlight the need for intersectoral, multilevel intervention and for inclusive, equitable, participatory design of cities that support youth mental health.

Brain and other nervous system disorders across the lifespan - global challenges and opportunities.

This is an exciting time for scientific discovery that aims to reduce the frequency and impact of neurological, mental health and substance-use disorders. As it became increasingly clear that low- and middle-income countries have a disproportionate share of these disorders, and that many of the problems are best addressed by indigenous researchers who can seek context-sensitive solutions, the US National Institutes of Health and other research funders began to invest more in low- and middle-income country-focused research and research capacity-building to confront this significant public health challenge. In an effort to identify existing information, knowledge gaps, and emerging research and research capacity-building opportunities that are particularly relevant to low- and middle-income countries, in February 2014 the Center for Global Health Studies at the National Institutes of Health Fogarty International Center held a workshop to explore these issues with scientific experts from low- and middle-income countries and the United States. This evolved into the preparation of the Reviews in this supplement, which is designed to highlight opportunities and challenges associated with topical areas in brain-disorders research over the coming decade. This Introduction highlights some of the over-arching and intersecting priorities for addressing causes, prevention, treatment and rehabilitation as well as best practices to promote overall nervous system health. We review some brain disorders in low- and middle-income countries, while the Reviews describe relevant issues and the epidemiology of particular conditions in greater depth.

Introduction to collection: confronting the challenges of health research in humanitarian crises.

BACKGROUND: Humanitarian crises, such as armed conflict, forced displacement, natural disasters, and major disease outbreaks, take a staggering toll on human health, especially in low-resource settings. Yet there is a dearth of robust evidence to inform the governments, non-governmental organizations (NGOs), and other humanitarian organizations on how to best respond to them. The Fogarty International Center of the U.S. National Institutes of Health commissioned a collection of Research in Practice articles that highlights the experiences of scientists conducting research in the context of humanitarian crises. Unlike traditional research papers, the case analyses in this collection go beyond what research was completed and focus on why the research was important and how it was conducted in these extremely challenging settings. DISCUSSION: The papers selected for this collection span 27 countries, cover a broad range of humanitarian crises, and discuss a wide variety of disease and health risk factors. Of the 23 papers in the collection, 17 include an author from the affected country and five papers were authored by humanitarian NGOs. Throughout the collection, 43% of the authors were from low- and middle-income countries. Across the collection, some general themes emerged that are broadly applicable. Importantly, there is a clear need for more, high-quality research to address evidence gaps. Community engagement, already a key element to global health research, was highlighted as especially important for research involving populations dealing with severe trauma and disruption. Partnership with humanitarian actors, including local governments, local and international NGOs, and UN agencies, was found to be a critical strategy as well. CONCLUSION: A variety of audiences will find this collection useful. Global health educators can utilize papers to facilitate discussion around public health practice and equitable partnerships, among other topics. Humanitarian response organizations may use the collection to consider how research may inform and improve their work. Global health researchers, funders, and other stakeholders may use the collection to stimulate dialogue around key scientific research questions and better appreciate the importance of conducting research in humanitarian crises in the context of achieving broader global health goals.

Childhood obesity prevention across borders: A National Institutes of Health commentary.

In response to the increasing rates of childhood obesity, the United States and countries across Latin America have invested in research that tests innovative strategies and interventions. Despite this, progress has been slow, uneven, and sporadic, calling for increased knowledge exchange and research collaboration that accelerate the adaptation and implementation of promising childhood obesity interventions. To share research results, challenges, and proven intervention strategies among Latin American and US researchers, particularly those working with Latino and Latin American populations, the National Institutes of Health (NIH) convened researchers from the United States and Latin America to highlight synergies between research conducted in Latin America and among Latino populations in the United States with the goal of catalyzing new relationships and identifying common research questions and strategies. This article highlights the NIH's research and priorities in childhood obesity prevention as well as areas for future direction, including overarching NIH plans and NIH institutes, centers, and offices investments in specific areas related to childhood obesity prevention in Latin America and/or among Latino populations in the United States.

Strengthening research capacity in LMICs to address the global NCD burden.

The burden of noncommunicable diseases (NCDs) continues to rise across the globe, and the risk of dying prematurely from an NCD in a low- and middle-income country (LMIC) is almost double that in a high-income country. Confronting this crisis requires a critical mass of scientists who are well versed in regional health problems and understand the cultural, social, economic, and political contexts that influence the effectiveness of interventions to address NCDs. Investing in research capacity strengthening in LMICs is critical to effectively combating disease, and local researchers are best poised to address the health challenges in their home countries given their understanding of the unique culture and context in which they are working. The Fogarty International Center of the U.S. National Institutes of Health has a set of programs focused on building individual and institutional NCD research capacity in LMICs. The Programs provide models for sustainable scientific research capacity strengthening, innovative funding mechanisms and partnership-building approaches. Investing in the training and scientific capacity of LMIC individuals and institutions not only helps foster a research culture and solidify local ownership of research, but it also ensures that the most appropriate solutions are developed, increasing the likelihood that those solutions will sustain over time. In addition, the Programs' investigators have advanced the science across a range of NCDs and associated risk factors. This article describes key lessons and compelling cases from the Programs that can be harnessed by other health researchers and funders to further the global response to the NCD burden.

Emergency care research as a global health priority: key scientific opportunities and challenges.

Quality emergency medical care is critical to reducing the burden of disease in low-income and middle-income countries (LMICs) and protecting the health of populations during disasters and epidemics. However, conducting research in emergency care settings in LMIC settings entails unique methodological and operational challenges. Therefore, new approaches and strategies that address these challenges need to be developed and will require increased attention from scientists, academic institutions and the global health research funding community. Research priorities to address emergency care in LMICs have also not been well defined, resulting in limited research output from LMICs. This manuscript frames the efforts of four multidisciplinary working groups, which were established under the auspices of the Fogarty International Center as part of the Collaborative on Enhancing Emergency Care Research in LMICs and serves as an introduction to this series, which identifies challenges and solutions in the context of emergency care research in LMICs. The objective of this introductory paper is to articulate the need for emergency care research in LMICs and underscore its future promise. We present public health arguments for greater investment in emergency care research, identify barriers to develop and conduct research, and present a list of research priorities for community organizations, academic institutions and funding agencies. We conclude that advances in emergency care research will be critical to achieve national and global health targets, such as the Sustainable Development Goals (SDGs), and to ensure that evidence informs how such research is best conducted.

Health research in humanitarian crises: an urgent global imperative.

Globally, humanitarian crises-such as armed conflict, forced displacement, natural disasters and major disease outbreaks-affect more people today than at any point in recorded history. These crises have immense acute and long-term health impacts on hundreds of millions of people, predominantly in low and middle-income countries (LMIC), yet the evidence base that informs how humanitarian organisations respond to them is weak. Humanitarian crises are often treated as an outlier in global health. However, they are an increasingly common and widespread driver of health that should be integrated into comprehensive approaches and strategies, especially if we hope to achieve ambitious global health targets such as the Sustainable Development Goals. The academic research community can play an important role in addressing the evidence gap in humanitarian health. There are important scientific questions of high public health relevance that can only be addressed by conducting research in humanitarian settings. While working in these settings is uniquely challenging, there are effective strategies that can be employed, such as using flexible and adaptive research methodologies, partnering with non-governmental organisations and other humanitarian actors, and devoting greater attention to issues of research ethics, community engagement, local LMIC-based partners, building humanitarian research capacity and collaborating across disciplines.

Building on the HIV chronic care platform to address noncommunicable diseases in sub-Saharan Africa: a research agenda.

OBJECTIVE: The remarkable progress made in confronting the global HIV epidemic offers a unique opportunity to address the increasing threat of noncommunicable diseases (NCDs). However, questions remain about how to enhance the HIV platforms to deliver integrated HIV and NCD care to people living with HIV (PLHIV) in sub-Saharan Africa (SSA). We aimed to develop a priority research agenda to advance this effort. METHODS: Researchers, policymakers, and implementers from the United States and SSA conducted three scoping reviews on HIV/NCD prevention and care focused on clinical, health system, and community levels. Based on the review findings and expert inputs, we conducted iterative consensus-development activities to generate a prioritized research agenda. RESULTS: Population-level data on NCD prevalence among PLHIV in SSA are sparse. The review identified NCD screening and management approaches that could be integrated into HIV programs in SSA. However, few studies focused on the effectiveness, cost, and best practices for integrated chronic care platforms, making it difficult to derive policy recommendations. To address these gaps, we propose a prioritized research agenda focused on developing evidence-based service delivery models, increasing human capacity through workforce education, generating data through informatics platforms and research, managing the medication supply chain, developing new financing and sustainability models, advancing research-informed policy, and addressing other crosscutting health system issues. CONCLUSION: Based on collaborative, interdisciplinary efforts, a research agenda was developed to provide guidance that advances efforts to adapt the current health system to deliver integrated chronic care for PLHIV and the population at large.

Prevención transfronteriza de la obesidad infantil: comentario de los National Institutes of Health.

En respuesta al aumento de las tasas de obesidad infantil, Estados Unidos y algunos países de Latinoamérica han financiado numerosos estudios que analizan estrategias e intervenciones innovadoras. A pesar de ello, los avances han sido lentos, irregulares y esporádicos, lo cual demuestra la necesidad de intensificar el intercambio de conocimientos y la colaboración en la investigación para acelerar la adaptación e implementación de intervenciones prometedoras en el campo de la obesidad infantil. Con la intención de compartir resultados de estudios, problemas y estrategias de intervención de probada eficacia entre los investigadores latinoamericanos y estadounidenses (especialmente los que trabajan con poblaciones latinas y latinoamericanas), los National Institutes of Health (NIH) reunieron a investigadores de Estados Unidos y Latinoamérica para destacar las sinergias entre los estudios de Latinoamérica y los realizados en poblaciones latinas de Estados Unidos. El fin último de esta iniciativa fue catalizar nuevas relaciones e identificar preguntas y estrategias comunes para la investigación. Este artículo se centra en la investigación y las prioridades de los NIH en materia de prevención de la obesidad infantil, así como en las áreas para futuras acciones, incluidos los planes generales de los NIH y las inversiones de sus institutos, centros y oficinas en áreas concretas relacionadas con la prevención de la obesidad infantil en Latinoamérica y en las poblaciones latinas de Estados Unidos.

HIV and noncommunicable disease comorbidities in the era of antiretroviral therapy: a vital agenda for research in low- and middle-income country settings.

In this special 2014 issue of JAIDS, international investigator teams review a host of noncommunicable diseases (NCDs) that are often reported among people living and aging with HIV in sub-Saharan Africa. With the longer lifespans that antiretroviral therapy programs have made possible, NCDs are occurring due to a mix of chronic immune activation, medication side effects, coinfections, and the aging process itself. Cancer; cardiovascular and pulmonary diseases; metabolic, body, and bone disorders; gastrointestinal, hepatic, and nutritional aspects; mental, neurological, and substance use disorders; and renal and genitourinary diseases are discussed. Cost-effectiveness, key research methods, and issues of special importance in Asia, Latin America, and the Caribbean are also addressed. In this introduction, we present some of the challenges and opportunities for addressing HIV and NCD comorbidities in low- and middle-income countries, and preview the research agenda that emerges from the articles that follow.

A multi-disciplinary approach to implementation science: the NIH-PEPFAR PMTCT implementation science alliance.

In resource-limited countries, interventions to prevent mother-to-child HIV transmission (PMTCT) have not yet realized their full potential health impact, illustrating the common gap between the scientific proof of an intervention's efficacy and effectiveness and its successful implementation at scale into routine health services. For PMTCT, this gap results, in part, from inadequate adaptation of PMTCT interventions to the realities of the implementation environment, including client and health care worker behaviors and preferences, health care policies and systems, and infrastructure and resource constraints. Elimination of mother-to-child HIV transmission can only be achieved through understanding of key implementation barriers and successful adaptation of scientifically proven interventions to the local environment. Central to such efforts is implementation science (IS), which aims to investigate and address major bottlenecks that impede effective implementation and to test new approaches to identifying, understanding, and overcoming barriers to the adoption, adaptation, integration, scale-up, and sustainability of evidence-based interventions. Advancing IS will require deliberate and strategic efforts to facilitate collaboration, communication, and relationship-building among researchers, implementers, and policy-makers. To speed the translation of effective PMTCT interventions into practice and advance IS more broadly, the US National Institutes of Health, in collaboration with the President's Emergency Plan for AIDS Relief launched the National Institutes of Health/President's Emergency Plan for AIDS Relief PMTCT IS Alliance, comprised of IS researchers, PMTCT program implementers, and policy-makers as an innovative platform for interaction and coordination.

Effect of shatapushpa taila matra basti and pathadi kwatha on poly cystic ovarian disease.

Poly Cystic Ovarian Disease (PCOD) is a complex disorder affecting 5-15% women in their reproductive age and related to ovarian dysfunction, characterized by menstrual irregularities, hyperandrogonism, obesity, and infertility. In Ayurveda, these symptoms are found under various conditions, caused by vitiated Vata and Kapha. Pathadi Kwatha and Shatapushpa Taila Matra Basti were studied in the current attempt to evaluate their comparative efficacy in cases of PCOD. Total 34 patients of PCOD were registered among which, 32 had completed the treatment of 2 months. They were randomly divided in to three groups. In group A Pathadi Kwatha (10 g, bid) and Shatapushpa Taila Matra Basti (60 ml for 7 days after cessation of menses for 2 consecutive cycles) were administered. In group B only Basti, whereas in group C capsules of roosted wheat flour were administered. Better results were obtained in group A especially in menstrual irregularities, achieving follicular growth and in weight reduction.

Comparison of combinations of ciprofloxacin-metronidazole and ceftriaxone-metronidazole in controlling operative site infections in obstetrics and gynecological surgeries: A retrospective study.

OBJECTIVE: To compare the effectiveness of the ciprofloxacin-metronidazole (CIP-MET) regimen with the ceftriaxone-metronidazole (CEF-MET) regimen for operative site infection control in women undergoing obstetrical and gynecological surgeries. MATERIALS AND METHODS: One thousand and eighty-four case records of women who had undergone various obstetrical and gynecological surgeries who were given CIP-MET regimen and CEF-MET regimen were analyzed in predesigned and pretested proforma. Patients who were given CIP-MET regimen and CEF-MET regimen were classified as Group 1 and Group 2 respectively. The mode of administration of both the regimens was noted. Numbers of wound infections were recorded in the respective groups. Socioeconomic status and hemoglobin level of the patients were noted. Other data such as hospital stay, duration of operation were also noted. RESULTS: Out of a total of 1084 case records, 31 (5.8%) and eight (0.7%) patients contracted wound infections in Group 1 and Group 2 respectively (P = 0.0001). CONCLUSION: The CEF-MET regimen was found superior to the CIP-MET regimen to control operative site infection in obstetrical and gynecological surgeries.

The globalization of health research: harnessing the scientific diaspora.

The scientific diaspora is a unique resource for U.S. universities. By drawing on the expertise, experience, and catalytic potential of diaspora scientists, universities can capitalize more fully on their diverse intellectual resources to make lasting contributions to global health. This article examines the unique contributions of the diaspora in international research collaborations, advantages of harnessing the diaspora and benefits to U.S. universities of fostering these collaborations, challenges faced by scientists who want to work with their home countries, examples of scientists engaging with their home countries, and specific strategies U.S. universities and donors can implement to catalyze these collaborations. The contributions of the diaspora to the United States are immense: International students enrolled in academic year 2007-2008 contributed an estimated $15 billion to the U.S. economy. As scientific research becomes increasingly global, the percentage of scientific publications with authors from foreign countries has grown from 8% in 1988 to 20% in 2005. Diaspora scientists can help build trusting relationships with scientists abroad, and international collaborations may improve the health of underserved populations at home. Although opportunities for diaspora networks are increasing, most home countries often lack enabling policies, infrastructure, and resources to effectively utilize their diaspora communities abroad. This article examines how some governments have successfully mobilized their scientific diaspora to become increasingly engaged in their national research agendas. Recommendations include specific strategies, including those that encourage U.S. universities to promote mini-sabbaticals and provide seed funding and flexible time frames.