A qualitative evaluation of the use of Problem Management Plus (PM+) among Arabic-speaking migrants with psychological distress in France - The APEX study.

ABSTRACTBackground: Feasibility studies with non-French speaking migrants in France are needed to inform appropriate adaptation of psychosocial intervention procedures.Objective: To test the WHO Problem Management Plus (PM+) intervention protocol for Arabic-speaking migrants in the Paris metropolitan region.Methods: Between 2019 and 2021 we recruited participants from three accommodation centres receiving asylum seekers or migrants experiencing social and economic difficulties. Participants experiencing psychological distress underwent five PM + sessions with trained helpers. Feasibility was evaluated through 15 interviews with 8 participants, 4 helpers, and 3 study supervisors. Interview topics covered PM + implementation in general and for each component. We also sought to understand problems with delivery and gathered suggestions for improvement. Data were analysed thematically using a deductive approach.Results: We found implementation of PM + to be feasible, with predominantly positive reactions from participants, helpers and study staff. All intervention components were considered beneficial, with breathing exercises considered easy to implement and often sustained. Selection of problems and strategies to address them were described as challenging to execute. Psychosocial support from and rapport with helpers and the use of the native language were considered key strengths of the programme. However, we observed the need for complementary or higher intensity psychological support in some cases. Findings also highlighted the importance of addressing distress among non-specialist helpers delivering PM + . Finally, local guidance to social resources were suggested to be added in the protocol.Conclusion: PM + was well-liked and feasible, with cultural adjustments and increased access to community resources for migrants needed.

The World Health Organization Problem Management Plus (PM+) intervention was found to be a feasible and acceptable intervention for Arabic-speaking migrants in the Paris metropolitan region, with participants reporting improved mental health outcomes and satisfaction with the programme.The features of psychosocial support from and rapport with non-specialist helpers delivering PM + and the use of the native language were considered key strengths of the programme.The study documented perceived benefits of expanding PM + in scope and length, suggests the need for additional mental health services for non-specialist helpers, and highlights the importance of considering cultural and linguistic factors when providing mental health services to asylum seekers or migrants experiencing social and economic difficulties.

Suicidal ideation among Nepali widows: an exploratory study of risk factors and comorbid psychosocial problems.

PURPOSE: Suicide is a leading cause of death among Nepali women of reproductive age. Suicidal ideation has known associations with stressful life events, which Nepali widows disproportionately experience. We aimed to identify risk and protective factors that could lead to effective interventions for this population. METHODS: To study suicidal ideation in Nepali widows, we collected data from 204 women in urban, semi-urban, and rural areas whose husbands died at least one year prior. The questionnaire included sociodemographic information, the Hopkins Symptom Checklist-25, PTSD Checklist-Civilian Version, Somatic Symptom Scale-8, and the Multidimensional Scale of Perceived Social Support. Overall severity of prolonged grief was assessed by a counselor after completing a structured clinical interview. Using multivariate regression models, we assessed associations of sociodemographic and psychosocial indicators with past-year suicidal ideation. Latent profile analysis was also performed to estimate profiles of comorbidities. RESULTS: Past-year suicidality was high, with 16.2% (N = 33). Each year increase since husband's death was protective and reduced odds of ideation 8% (95% CI 0.85-0.98) and being educated and of older age also reduced the odds of ideation by 0.21 (95% CI 0.06-0.70), and 0.09 (95% CI 0.01-0.64), respectively. Depression (OR = 6.37, 95% CI 2.78-14.59), PTSD (OR = 3.84, 95% CI 2.15-6.86), prolonged grief (OR = 6.04, 95% CI 3.04-12.00) and anxiety (OR = 6.52, 95% CI 2.96-14.38) were highly associated with suicidality, and mapped onto the three profiles of increasing mental distress severity. CONCLUSION: Suicide remains a major issue among Nepali widows, showing high comorbidity with other mental disorders. Screening for depression, anxiety, and prolonged grief, may aid in identifying widows at increased risk of suicidal ideation.

The association of neck circumference with risk of metabolic syndrome and its components in adults: A systematic review and meta-analysis.

BACKGROUND & AIMS: Several prior studies suggested that neck circumference (NC) is a reliable diagnostic tool for risk of metabolic syndrome (MetS) and its features. However, not all studies support this view. Therefore, we aimed to perform a meta-analysis to summarize the association between NC with MetS and its components in adult populations. METHODS AND RESULTS: PubMed/Medline, Web of Knowledge, and Scopus electronic databases were searched until May 31, 2017 to find relevant English-language papers. We included studies that examined the association of NC with risk of MetS, or at minimum, one of its components as outcomes. Of 2628 publications identified, 19 papers met selection criteria. We found no association between NC and MetS (odd ratio (OR): 0.73; 95% CI: 0.003, 1.47). However, there was a positive association between NC and waist circumference (WC) (r = 0.85; 95%: 0.75, 0.95; I2: 98.2%; p = 0.0001), BMI: (r:0.88; 95% CI: 0.74, 0.91, I2:97.3%), triglycerides (TG) (OR: 1.87; 95% CI: 1.60, 2.19; I2:58.4%; p = 0.03), TC (r:0.14; 95%CI: 0.05, 0.23, I2:94.1%), LDL-C (r: 0.18; 95%CI: 0.07, 0.29, I2:94.3%), hypertension (OR: 1.94; 95% CI:1.43, 2.64, I2:87.3%), systolic (r: 0.21, 95%CI: 0.19, 0.23; I2:67.1%) and diastolic blood pressures (r: 0.20, 95%CI: 0.16, 0.23; I2:79.7%), low HDL-C (r:-0.21; 95% CI: -0.26, -0.15, I2 = 92.5%), as well as fasting blood sugar (FBS) concentrations (r: 0.20, 95%CI: 0.16, 0.24; I2:88.1%). CONCLUSION: Subjects with higher NC were at approximately two-fold higher risk for hypertriglyceridemia compared to those with lower NC. We found positive associations between NC, WC, BMI, hypertension, FBS, TC, LDL-C, SBP, DBP, and low HDL-C concentrations. However, heterogeneity was considerably high. Therefore, the findings should be taken with caution. Future studies using longitudinal designs are needed to further understand the association between NC and features of MetS.

Maternal depressive symptoms and early childhood cognitive development: a meta-analysis.

BACKGROUND: Previous findings have been mixed regarding the relationship between maternal depressive symptoms and child cognitive development. The objective of this study was to systematically review relevant literature and to perform a meta-analysis. METHOD: Three electronic databases (PubMed, EMBASE, PsycINFO) were searched. Initial screening was conducted independently by two reviewers. Studies selected for detailed review were read in full and included based on a set of criteria. Data from selected studies were abstracted onto a standardized form. Meta-analysis using the inverse variance approach and random-effects models was conducted. RESULTS: The univariate analysis of 14 studies revealed that maternal depressive symptoms are related to lower cognitive scores among children aged ⩽56 months (Cohen's d = -0.25, 95% CI -0.39 to -0.12). The synthesis of studies controlling for confounding variables showed that the mean cognitive score for children 6-8 weeks post-partum whose mothers had high depressive symptoms during the first few weeks postpartum was approximately 4.2 units lower on the Mental Developmental Index (MDI) of the Bayley Scales of Infant and Toddler Development (BSID) compared with children with non-symptomatic mothers (B̂ = -4.17, 95% CI -8.01 to -0.32). CONCLUSIONS: The results indicated that maternal depressive symptoms are related to lower cognitive scores in early infancy, after adjusting for confounding factors. An integrated approach for supporting child cognitive development may include program efforts that promote maternal mental health in addition to family economic wellbeing, responsive caregiving, and child nutrition.

Adherence to the Healthy Eating Index and Alternative Healthy Eating Index dietary patterns and mortality from all causes, cardiovascular disease and cancer: a meta-analysis of observational studies.

BACKGROUND: This meta-analysis investigated the association of diet quality indices, as assessed by HEI and AHEI, and the risk of all-cause, cardiovascular and cancer mortality. METHODS: We used PubMed, ISI Web of Science and Google Scholar to search for eligible articles published before July 2015. A total of 12 cohort studies (38 reports) and one cross-sectional study (three reports) met the inclusion criteria and were included in our meta-analysis. RESULTS: The highest level of adherence to the Healthy Eating Index (HEI) and Alternative Healthy Eating Index (AHEI) was significantly associated with a reduced risk of all-cause mortality [relative risk (RR) = 0.77, 95% confidence intterval (CI) = 0.76-0.78], cardiovascular mortality (RR = 0.77, 95% CI = 0.74-0.80) and cancer mortality (RR = 0.83, 95% CI = 0.81-0.86). Egger regression tests provided no evidence of publication bias. CONCLUSIONS: The present study indicates that high adherence to HEI and AHEI dietary patterns, indicating high diet quality, are associated with reduced risk of all-cause mortality (as well as cardiovascular mortality and cancer mortality).

Rice Bran Oil Decreases Total and LDL Cholesterol in Humans: A Systematic Review and Meta-Analysis of Randomized Controlled Clinical Trials.

Cardiovascular disease (CVD) has become a concerning health problem because of its increasing prevalence. Vegetable oils such as rice bran oil may improve blood lipids, risk factors for CVD. We performed a systematic review and meta-analysis to identify and quantify the effects of rice bran oil on lipid profiles in humans. Literature databases (Pubmed, Scopus, Science Direct, Proquest, Ovid, and Google Scholar) were systematically searched until the end of November 2015, with no restrictions regarding study design, time, or language. The variables extracted for the meta-analysis included low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triacylglycerol (TAG), VLDL-C, apoA, apoB, Lp(a), TC/HDL-C, and LDL-C/HDL-C. From 415 identified articles, 11 randomized controlled trials met the eligibility criteria and were included in our review. Rice bran oil consumption resulted in a significant decrease in concentrations of LDL-C (-6.91 mg/dl, 95% CI, -10.24 to -3.57; p<0.001) and TC (-12.65 mg/dl; 95% CI, -18.04 to -7.27; p<0.001). The increase in HDL-C levels were considerable only in men (6.65 mg/dl; 95% CI, 2.38-10.92; p=0.002). Results of our meta-analysis provided no evidence of a significant effekt of rice bran oil on other lipid profile components. In conclusion, consumption of rice bran oil can reduce LDL-C and TC concentrations, which may lead to prevention and control of CVD. It also has favorable effects on HDL-C concentrations in men. However, changes related to other lipid profile components are not considerable.

The Impact of a Low Glycemic Index Diet on Inflammatory Markers and Serum Adiponectin Concentration in Adolescent Overweight and Obese Girls: A Randomized Clinical Trial.

Although the effects of dietary glycemic index (GI) on insulin resistance are well documented in adults, the complex interaction among glucose intolerance, inflammatory markers, and adipokine concentration has not been well studied, especially among adolescents. We investigated the effect of a low glycemic index (LGI) diet on insulin concentration, fasting blood sugar (FBS), inflammatory markers, and serum adiponectin concentration among healthy obese/overweight adolescent females. In this parallel randomized clinical trial, 2 different diets, an LGI diet and a healthy nutritional recommendation diet (HNRD) with similar macronutrient composition were prescribed to 50 obese and overweight adolescent girls with the same pubertal status. Biochemical markers FBS, serum insulin concentration, high sensitivity C-reactive protein (hs-CRP), interleukin 6 (IL-6), and adiponectin were measured before and after a 10 week intervention. Using an intention-to-treat analysis, data from 50 subjects were analyzed. According to a dietary assessment, GI in the LGI group was 43.22±0.54. While the mean for FBS, serum insulin concentration, the homeostasis model assessment (HOMA), the quantitative insulin sensitivity check index (QUICKI), and adiponectin concentration did not differ significantly within each group, the average hs-CRP and IL-6 decreased significantly in the LGI diet group after the 10 week intervention (p=0.009 and p=0.001; respectively). Comparing percent changes, we found a marginally significant decrease in hs-CRP in the LGI group compared with the HNRD group after adjusting for confounders. Compliance with an LGI diet may have favorable effect on inflammation among overweight and obese adolescent girls.

Low-income African-American adults share weight status, food-related psychosocial factors and behaviours with their children.

OBJECTIVE: This study aims to examine the extent to which low-income African-American children's weight status, psychosocial characteristics and food-related behaviours are associated with that of their adult caregivers. METHODS: Cross-sectional data from baseline evaluation of B'More Healthy Communities for Kids obesity prevention trial were used. Outcomes of interest were children's overweight and/or obesity status, food-related self-efficacy, knowledge, intentions and healthier/less healthy food acquisition scores. The primary exposures were adult caregiver's overweight and/or obesity status, their psychosocial factors and food acquisition scores. Multiple logistic regression analyses were used to assess associations. RESULTS: Children had higher odds of overweight or obesity if they had an overweight/obese caregiver (odds ratio [OR] 4.04, 95% confidence interval [95%CI] 1.59-10.28) or an obese caregiver (OR 2.50, 95%CI 1.39-4.51). Having a caregiver in the highest quartile of self-efficacy, food intentions and healthy food acquisition patterns was associated with higher odds of their child also having a higher score on these factors (self-efficacy: OR 3.77 [95%CI 1.76-8.04]; food intentions: OR 1.13 [95%CI 1.01-1.27]; and healthy food acquisition: OR 2.19 [95%CI 1.05-4.54]). CONCLUSIONS: Child and adult caregiver weight status and psychosocial characteristics were positively associated in this low-income, urban population. These findings may help inform obesity treatment or prevention programmes and interventions aimed at parents and families.

Is there a relationship between red or processed meat intake and obesity? A systematic review and meta-analysis of observational studies.

A body of literature exists regarding the association of red and processed meats with obesity; however, the nature and extent of this relation has not been clearly established. The aim of this study is to conduct a systematic review and meta-analysis of the relationship between red and processed meat intake and obesity. We searched multiple electronic databases for observational studies on the relationship between red and processed meat intake and obesity published until July 2013. Odds ratios (ORs) and means for obesity-related indices and for variables that may contribute to heterogeneity were calculated. A systematic review and a meta-analysis were conducted with 21 and 18 studies, respectively (n = 1,135,661). The meta-analysis (n = 113,477) showed that consumption of higher quantities of red and processed meats was a risk factor for obesity (OR: 1.37; 95% CI: 1.14-1.64). Pooled mean body mass index (BMI) and waist circumference (WC) trends showed that in comparison to those in the lowest ntile, subjects in the highest ntile of red and processed meat consumption had higher BMI (mean difference: 1.37; 95% CI: 0.90-1.84 for red meat; mean difference: 1.32; 95% CI: 0.64-2.00 for processed meat) and WC (mean difference: 2.79; 95% CI: 1.86-3.70 for red meat; mean difference: 2.77; 95% CI: 1.87-2.66 for processed meat). The current analysis revealed that red and processed meat intake is directly associated with risk of obesity, and higher BMI and WC. However, the heterogeneity among studies is significant. These findings suggest a decrease in red and processed meat intake.

Beneficial effects of zinc supplementation on head circumference of Nepalese infants and toddlers: a randomized controlled trial.

BACKGROUND/OBJECTIVE: To assess the effects of micronutrient supplementation on head circumference of rural Nepali infants and children. SUBJECTS/METHODS: We used a randomized controlled trial to assess the effects of micronutrient supplementation on head circumference in 569 rural Nepali infants and children aged 4-17 months. Children were randomized to: (1) zinc, (2) iron-folic acid, (3) zinc plus iron-folic acid or (4) a placebo group. Data on head circumference were collected during five visits at ∼3 month intervals over the course of a year. We calculated change in head circumference in treatment groups receiving zinc and iron comparing the first and fifth visits as well as used generalized estimating equations (GEE) to take advantage of data from all points in time. Models were adjusted for covariates unbalanced in the randomization and for baseline head circumference. RESULTS: Estimating differences in head circumference between baseline and visit 5, children in the zinc treatment group showed smaller decreases in head circumference z-score compared with placebo (adjusted ß=0.13, 95% confidence interval (CI): 0.03 to 0.23). Using GEE, zinc treatment was associated with 0.11 (95% CI: 0.05 to 0.17) decrease in the rate of decline in head circumference z-score across visits as compared with placebo. Iron-folic acid supplementation was not associated with head circumference z-scores when comparing visits 1 with 5 or including data across all visits in adjusted models. CONCLUSION: Our results suggest that zinc supplementation confers a beneficial effect on the rate of head growth in Nepali infants.

Perceptions of a mental health questionnaire: the ethics of using population-based controls.

Mental health surveys are used extensively in epidemiological research worldwide. The ethical questions that arise regarding their risk of causing psychological distress or other potential harm have not been studied in the general population. We have investigated how study participants serving as controls in a population-based study perceived an anonymous postal questionnaire focusing on mental health and wellbeing. Parents were contacted from the Swedish Census Bureau as part of a larger follow-up study on palliative care conducted in 2001. Eligible parents had a child of the same gender, year of birth and were from the same counties in Sweden as parents who had lost a child to cancer. Five percent reported being negatively affected. The principle negative effect on participants was that self-reflection reminded them of their difficulties. Of the 418 respondents, 52% reported that they were positively affected by study participation and 95% perceived the inquiry as valuable. These findings support the use of population-based controls in future research.

Childhood overweight and maternal depressive symptoms.

AIM: Given the rising global prevalence of overweight associated with the nutrition transition, the objective of this study was to evaluate whether maternal depressive symptoms are related to overweight in infants aged 6-24 months. METHODS: Participants in this cross-sectional study included 589 mother-child dyads from low-income urban communities in Teresina, Piauí, northeast Brazil. While adjusting for sociodemographic and biological determinants of child growth, the study assessed the relationship between mothers' depressive symptom scores, measured with the Center for Epidemiologic Studies Depression Scale and child weight-for-height using multivariable logistic regression. Child overweight was calculated with the World Health Organization growth curves using 85th and 95th percentile cutoffs of the weight-for-height z-score (WHZ). RESULTS: Children of mothers with high depressive symptoms had 1.7 and 2.3 higher odds of being over WHZ cutoffs for the 85th and 95th percentile, respectively. Child age between 18 and 24 months (compared with children 6-12 months old), being low birth weight, not receiving the Family Health Programme and breastfeeding between 6 and 12 months (compared with <6 months) were other factors inversely related to at least one of the overweight indicators (odds ratio (OR) range 0.3 to 0.6). Having a mother with fewer than 8 years of education was positively associated with child overweight (OR 1.4, 95% CI 1.0 to 2.1, for WHZ >85th%). CONCLUSION: Results suggest that maternal depressive symptoms are related to overweight in children aged 6-24 months.