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Introduction: Acceptance and commitment therapy (ACT) has a rapidly developing evidence base, with few studies in the developing world or humanitarian context. A recent trial of a guided self-help intervention derived from ACT reported significant positive findings, but the extent to which the central principles of this intervention were maintained and implemented have not been explored.Objective: To examine the role of psychological flexibility as a potential mediator in the relationship between involvement in a guided self-help intervention, Self Help Plus, and psychological distress in a sample of South Sudanese refugee women living in northern Uganda.Methods: We conducted secondary analysis of data from a cluster randomized controlled trial conducted in 2018. We used multilevel mediation modeling to explore the relationship of psychological flexibility, as measured by the Acceptance and Action Questionnaire (AAQ-II), as a mediating factor in the relationship between Self Help Plus involvement and general psychological distress as measured by the Kessler-6 (K6).Results: We found strong multilevel mediation of decreased K6 scores in the treatment group by AAQ-II scores (multilevel b = -3.28). A more pronounced mediation effect was discovered immediately post intervention (b = -1.09) compared to 3-month follow-up (b = -0.84). This is in line with the current literature that demonstrates the role of psychological flexibility as a primary mechanism of change in ACT-based interventions.Conclusions: Psychological flexibility is a contributing component in the theory of change for this ACT-based intervention. Identifying the core components of interventions allows for more effective adaptation and implementation of relevant services, especially in low-resource contexts.

Introduction The pattern of intimate partner violence has not been studied in-depth in Sri Lanka. The aim of this study was to investigate the weapons use among women exposed to intimate partner violence (IPV) and to compare with community violence (CV). Method A retrospective, comparative cross-sectional study of women who have undergone medico-legal examination after reporting IPV or CV to a tertiary care hospital, in Colombo, Sri Lanka years from January 2011 to December 2012 was conducted. Of 9000 Medico-Legal Examination Forms, women above 18 years who had reported IPV and CV were studied. Results The prevalence of reported cases of IPV was 2.8%and CV was 5%. Of them, 255 (36%) IPV and 449 (64%) CV were reported. IPV was common among young, married, unemployed women (p 0.05). Assault with a weapon was common at home in the morning and resulted in severe injuries (p Conclusions Women exposed to IPV were young, married and unemployed. Most assaults were due to manhandling while sexual violence reports were fewer than expected. Weapon assaults are common at home in the morning and result in severe injuries but not associated with alcohol abuse. There were many similarities between IPV and CV assaults which indicate that both groups take their basis in a gender-unequal society that breeds violence. The victim knew the abuser, not only in the IPV group as expected but also in the CV group.CV occurs outside the home by known perpetrators using ‘occasional weapons’. CV in Sri Lanka and worldwide is an almost unexplored area that needs to be further investigated in order to develop evidence-based intervention programmes.

Objectives To investigate, in a retrospective study, the expression of erythropoietin (Epo) in human renal cell carcinoma (RCC) and its correlation with overall survival, as Epo (an haematopoietic cytokine that regulates the production of red blood cells), with its receptor, was recently localized in non-haematopoietic tissues, e.g. liver, uterus, central nervous system, vascular endothelial cells and solid tumours. Patients and methods We used data from 113 patients who had radical nephrectomy for RCC between 1990 and 2000, taking sections from formalin-fixed and paraffin wax-embedded tissue blocks. The association between Epo staining and the patients’ characteristics was assessed by either chi-squared tests (for categorical variables) or two-sample independent t-tests (for continuous variables). Results Tissue from 37 patients (33%) was positive for cytoplasmic Epo expression; 76 (67%) samples were negative. Univariate hazard ratio analysis confirmed that those with positive Epo staining were more than twice as likely to die as those with negative staining (hazard ratio 2.34, 95% confidence interval 1.27-4.3). Conclusion This study shows that the expression of Epo in RCC is adversely associated with overall survival. This is the first report of such an association, and might be explained by the loss of Von Hippel-Lindau protein function in clear cell RCC. The expression of Epo might have potential use in clinical trials when stratifying high-risk patients for adjuvant therapy after nephrectomy.