Technology-assisted cognitive-behavior therapy delivered by peers versus standard cognitive behavior therapy delivered by community health workers for perinatal depression: study protocol of a cluster randomized controlled non-inferiority trial

BACKGROUND

The lack of trained mental health professionals is a key barrier to scale-up of evidence-based psychological interventions in low and middle-income countries. We have developed an app that allows a peer with no prior experience of health-care delivery to deliver the cognitive therapy-based intervention for perinatal depression, the Thinking Healthy Programme (THP). This trial aims to assess the effectiveness and cost-effectiveness of this Technology-assisted peer-delivered THP versus standard face-to-face Thinking Healthy Programme delivered by trained health workers.

METHODS

We will employ a non-inferiority stratified cluster randomized controlled trial design comparing the two formats of intervention delivery. A total of 980 women in the second or third trimester of pregnancy with a diagnosis of Major Depressive Episode, evaluated with the Structured Clinical Interview for DSM-V Disorders (SCID), will be recruited into the trial. The unit of randomization will be 70 village clusters randomly allocated in a 1:1 ratio to the intervention and control arms. The primary outcome is defined as remission from major depressive episode at 3 months postnatal measured with the SCID. Data will also be collected on symptoms of anxiety, disability, quality of life, service use and costs, and infant-related outcomes such as exclusive breastfeeding and immunization rates. Data will be collected on the primary outcome and selected secondary outcomes (depression and anxiety scores, exclusive breastfeeding) at 6 months postnatal to evaluate if the improvements are sustained in the longer-term. We are especially interested in sustained improvement (recovery) from major depressive episode.

DISCUSSION

This trial will evaluate the effectiveness and cost-effectiveness of a technology-assisted peer-delivered cognitive behavioral therapy-based intervention in rural Pakistan. If shown to be effective, the novel delivery format could play a role in reducing the treatment gap for perinatal depression and other common mental disorders in LMIC.

TRIAL REGISTRATION

The trial was registered at Clinicaltrials.gov (NCT05353491) on 29 April 2022.

Arterial Versus Venous Blood Gas Analysis Comparisons, Appropriateness, and Alternatives in Different Acid/Base Clinical Settings: A Systematic Review

Arterial blood gases (ABGs) are routinely done in critical clinical settings to ascertain acid-base status. Due to difficulties and the potential side effects following arterial blood sampling, much research has been done to find the possibility of using venous samples as an alternative. However, this comparison needs to be evaluated in various contexts. Hence, this systematic review aims to explore the differences, appropriateness, and alternatives of arterial versus venous blood gas (VBG) analysis in different acid-base states. A comprehensive literature search was conducted through electronic databases using the terms "ABG," "VBG," "Arterial Blood Gas," "Venous Blood Gas," and "Gas analysis." Studies' qualities were assessed by using Newcastle - Ottawa Quality Assessment Scale. Of 531 articles, 22 were included in the study after title, abstract, and full-text screening. Based on the Newcastle - Ottawa Quality Assessment Scale, 23% of the studies had good quality (score ≥ 7), 77% fair quality (score 2-6), and none of the studies had poor quality (score ≤ 1). Moreover, 22.5% of the included articles found a strong correlation between ABG and VBG. 73% compared arterial and VBG parameters among patients with any clinical contexts, 22.5% in respiratory diseases, and 4.5% in metabolic conditions, and their results had a significant disparity. There was a considerable discrepancy among authors about the appropriateness and utilization of VBG as an alternative to ABG. Our findings suggest that those studies did not consider physiological differences between venous and arterial blood values and obviated the significance of sampling procedures.

Transcriptional profiling of human Vδ1 T cells reveals a pathogen-driven adaptive differentiation program

γδ T cells are generally considered innate-like lymphocytes, however, an ‘‘adaptive-like’’ γδ compartment has now emerged. To understand transcriptional regulation of adaptive γδ T cell immunobiology, we combined single-cell transcriptomics, T cell receptor (TCR)-clonotype assignment, ATAC-seq, and immunophenotyping. We show that adult Vδ1⁺ T cells segregate into TCF7⁺LEF1⁺Granzyme B^neg (T_naive) or T-bet⁺Eomes⁺ BLIMP-1⁺Granzyme B⁺ (T_effector) transcriptional subtypes, with clonotypically expanded TCRs detected exclusively in T_effector cells. Transcriptional reprogramming mirrors changes within CD8⁺ αβ T cells following antigen-specific maturation and involves chromatin remodeling, enhancing cytokine production and cytotoxicity. Consistent with this, in vitro TCR engagement induces comparable BLIMP-1, Eomes, and T-bet expression in naive Vδ1⁺ and CD8⁺ T cells. Finally, both human cytomegalovirus and Plasmodium falciparum infection in vivo drive adaptive Vδ1 T cell differentiation from T_naive to T_effector transcriptional status, alongside clonotypic expansion. Contrastingly, semi-invariant Vγ9⁺Vδ2⁺ T cells exhibit a distinct ‘‘innate-effector’’ transcriptional program established by early childhood. In summary, adaptive-like γδ subsets undergo a pathogen-driven differentiation process analogous to conventional CD8⁺ T cells.

Using single-cell transcriptomics, TCR repertoire analysis, ATAC-seq, and immunophenotyping, McMurray et al. show naive Vδ1⁺ T cells can undergo transcriptional reprogramming to an effector state extremely similar to CD8 T_EMRA cells. Infections, including CMV and malaria, drive both clonotypic Vδ1⁺ T cell expansion and differentiation to this highly conserved effector program.

Simultaneous determination of nitrite and nitrate in meat and meat products using ion-exchange chromatography

Nitrite and nitrate salts are widely used as curing agents to preserve meat and meat products. Despite the benefits of using these salts in meat processing, it has some adverse health effects. The high concentration of these salts produces nitric oxide through various metabolic reactions followed by the generation of carcinogenic nitrosamines. In this study, a chromatographic method was developed for the simultaneous determination of nitrite and nitrate level in meat and meat products. Samples were collected from four different locations in Dhaka, Bangladesh and analysed by ion-exchange chromatography. Most relevant validation parameters were evaluated using the standard validation procedure. The linearity was more than 0.995 and recoveries for nitrite and nitrate were more than 96% and 97%, respectively. The Limit of detection (LOD) for nitrite and nitrate was 0.10 and 0.26 mg/L, respectively. Results showed that the highest nitrite and nitrate content was 66.04±0.55 and 55.02±1.4 mg/kg, respectively. However, nitrite and nitrate levels were lower than the prescribed value by international guidelines. Besides, temperaturebased recovery revealed that 80°C was the optimum temperature for recovering the nitrite and nitrate from meat and meat products. This developed method applying ion-exchange chromatography can monitor the content of nitrite and nitrate in meat and meat products to ensure food safety.

Explore the antiproliferative phytocompounds from ethanolic extracts of Citrus paradisi against liver cancer cell line by chemical analysis using TLC and FT-IR spectroscopy

The aim of the present study was to evaluate the in vitro antiproliferative activity of ethanolic extract of leaves and fruits Citrus paradisi plant on HepG-2 liver cell lines by MTT (3-(4, 5-dimethyl-2-thiazolyl)-2,5-diphenyl-2H-terazolium bromide) assay and to isolate and characterize the antiproliferative compounds by TLC (Thin layer chromatography) and FT-IR (Fourier transforms Infrared) spectroscopy. Qualitative phytochemical screening tests were performed to detect phytochemicals compounds from the crude extracts. Antioxidant activity of the plant extracts were characterized by using DPPH (2,2-Diphenyl-1-picrylhydrazyl) free radical scavenging method. The results showed that antioxidant activity using DPPH were found to be increased in a concentration dependent manner and decreased cell viability and cell growth inhibition in a dose dependent manner. The findings from this study indicated that fruit extract exhibited good antiproliferation and antioxidant potential. The seven functional groups of phytocompounds such as carboxylic acid, amine salt, aromatic compounds, cyclic alkene, aldehyde, fluoro compounds and alkene were detected by FT-IR which indicated that fruit extracts of Citrus paradisi possessed vast potential as a medicinal drug especially in liver cancer treatment.

Psychometric Validation of the Multidimensional Scale of Perceived Social Support During Pregnancy in Rural Pakistan

Background: The Multidimensional Scale of Perceived Social Support (MSPSS) is a short and reliable instrument that assesses perceived social support from the social network of an individual. A previous study in Pakistan among postpartum women has demonstrated a unidimensional factor structure in contrast to the original three-factor structure. The emergence of a one-factor structure for postpartum women in Pakistan may be due to traditional postpartum practices unique to the women of the subcontinent. Building upon the previous evidence, this study aims to explore the psychometric properties of MSPSS among pregnant women in their third trimester in rural Pakistan.

Methods: A cross-sectional survey was conducted from October 2014 to February 2016, in rural Pakistan. A sample of 1,154 pregnant women (aged ≥ 18 years) in their third trimester who were registered with the local Lady Health Worker Program and were living in the north of the Punjab Province was included in this study. They were assessed using Urdu translated scales of Patient Health Questionnaire, MSPSS, Maternal Social Support Index, and Perceived Stress Scale. Principal Axis Factoring was used to assess the construct validity of the MSPSS.

Results: The MSPSS scale showed an excellent internal consistency, yielding a Cronbach's α-value of 0.933. The MSPSS scale exhibited an excellent construct validity, and confirmatory factor analysis retained three factors (family, friends, and significant others) for both the depressed and non-depressed samples. Internal reliability and construct validity were also established.

Conclusion: The psychometric findings suggest that the tridimensional structure of MSPSS is a valid and reliable measure of perceived social support among the Pakistani population with and without perinatal depression. The perceived social support is an important predictor of maternal mental well-being and psychopathologies, and the MSPSS can serve as a useful tool in mental health research in Pakistan.

Generation of Stable Isopentenyl Monophosphate Aryloxy Triester Phosphoramidates as Activators of Vγ9Vδ2 T Cells

Aryloxy triester phosphoramidate prodrugs of the monophosphate derivatives of isopentenyl pyrophosphate (IPP) and dimethylallyl pyrophosphate (DMAPP) were synthesized as lipophilic derivatives that can improve cell uptake. Despite the structural similarity of IPP and DMAPP, it was noted that their phosphoramidate prodrugs exhibited distinct stability profiles in aqueous environments, which we show is due to the position of the allyl bond in the backbones of the IPP and DMAPP monophosphates. As the IPP monophosphate aryloxy triester phosphoramidates showed favorable stability, they were subsequently investigated for their ability to activate Vγ9/Vδ2 T cells and they showed promising activation of this subset of T cells. Together, these findings represent the first report of IPP and DMAPP monophosphate prodrugs and the ability of IPP aryloxy triester phosphoramidate prodrugs to activate Vγ9/Vδ2 T cells highlighting their potential as possible immunotherapeutics.

Accuracy of Community Informant Led Detection of Maternal Depression in Rural Pakistan

Maternal depression is a global mental health and a public health priority. Despite the priority its active detection is still a challenge. We tested the accuracy of an adapted version of Community Informant Detection Tool for Maternal Depression (CIDT-MD) in rural settings of Pakistan. Using a single stage design, trained community informants (lady health workers and lay peers) identified women (pregnant and/or with children) with symptoms of probable depression using CIDT-MD. This was immediately followed by diagnostic interviews of all the women using the Structured Clinical Interview for the Diagnostic and Statistical Manual (SCID-V) for current major depressive episode by trained assessors, blinded to the outcome of CIDT-MD. Data were analyzed using Statistical Package for Social Sciences (Version 25.0, IBM Corp., Armonk, NY, USA) and FACTOR software (Version. 10.3.01, Virgili University, Tarragona, Spain). Descriptive statistics, factor analysis, validity, reliability and known group validity was conducted to evaluate the psychometric properties of the adapted CIDT-MD. In all, 425 women, with mean age of 28 years (SD = 4.7), participated. Nearly 10% were illiterate, while the rest (90%) had an education ranging from eight to 15 years of schooling. The majority (73.2%) of the participants had 1-3 children while only 17.4% had >3 children. The sensitivity and specificity of CIDT-MD in detecting depressive symptoms was 97.5% (95% CI: 94.2-99.1) and 82.4% (95% CI: 77.8-86.4) respectively. It's positive predictive value (PPV), 77.3% (95% CI: 72.9-81.2) and the negative predictive value (NPV) was 98.17% (95% CI: 95.7-99.2). While factor analysis revealed high inter-item correlation for most items (0.62-0.77) with an adequately fair Kaiser-Meyer-Olkin (KMO) sampling adequacy (0.73), significant Bartlett's test of sphericity (p < 0.001). Uni-dimensionality for the CIDT-MD based on one-dimensional congruence (0.97), explained common variance (0.85), excellent internal consistency (0.90), good criterion validity (Area Under Curve = 81%), tester-test reliability (0.87-0.89) and statistically significant known group analysis (p < 0.001). The adapted version of the Community Informant Detection Tool for Maternal Depression is a valid and a reliable tool for active case detection of maternal depression in rural settings of Pakistan.

Predictors of Prenatal Depression: A Cross-Sectional Study in Rural Pakistan

Objective: To determine the prevalence and association of prenatal depression with socioeconomic, demographic and personal factors among pregnant women living in Kallar Syedan, Rawalpindi, Pakistan. Methods: Five hundred women in the second and third trimester of pregnancy, living in Kallar Syedan, a rural area of district Rawalpindi Pakistan, were included in the study. Depression was assessed using "Patient health questionnaire" (PHQ9) in Urdu, with a cut-off score of 10. Multi-dimensional scale of perceived social support (MSPSS) was used to assess perceived social support. Life Events and Difficulties Schedule (LEDS) were used to measure stressful life events in past 1 year. Tool to assess intimate partner violence (IPV) was based on WHO Multi Country Study on "Women's Health and Domestic Violence against Women." Results: Prevalence of prenatal depression was found to be 27%. Number of pregnancies was significantly associated with prenatal depression (p < 0.01). Women living in a joint family and those who perceived themselves as moderately satisfied or not satisfied with their life in the next 4 years were found to be depressed (p < 0.01, OR 6.9, CI 1.77-26.73). Depressive symptomatology in women who experienced more than five stressful life events in last 1 year was three times higher (p < 0.001, OR 3.2, CI 1.68-5.98) than in women with 1-2 stressful events. Women who were supported by their significant others or their family members had 0.9 times (p < 0.01, OR 0.9, CI 0.85-0.96) less chance of getting depressed. Pregnant women who were psychologically abused by their partners were 1.5 times more depressed (p < 0.05 CI 1.12-2.51). Odds of having depression was also high in women who had less mean score of MSSI (p < 0.05, OR 1.1, CI 1.01-1.09). Women who had suitable accommodation had 0.5 times less chance of having depression than others (p < 0.05, OR 0.5, CI 0.27-0.92). Conclusion: Over a quarter of the women in the study population reported prenatal depression, which were predicted predominantly by psychosocial variables.

Aryloxy Diester Phosphonamidate Prodrugs of Phosphoantigens (ProPAgens) as Potent Activators of Vγ9/Vδ2 T-Cell Immune Responses

Vγ9/Vδ2 T-cells are activated by pyrophosphate-containing small molecules known as phosphoantigens (PAgs). The presence of the pyrophosphate group in these PAgs has limited their drug-like properties because of its instability and polar nature. In this work, we report a novel and short Grubbs olefin metathesis-mediated synthesis of methylene and difluoromethylene monophosphonate derivatives of the PAg (E)-4-hydroxy-3-methyl-but-2-enyl pyrophosphate (HMBP) as well as their aryloxy diester phosphonamidate prodrugs, termed ProPAgens. These prodrugs showed excellent stability in human serum (t_1/2 > 12 h) and potent activation of Vγ9/Vδ2 T-cells (EC₅₀ ranging from 5 fM to 73 nM), which translated into sub-nanomolar γδ T-cell-mediated eradication of bladder cancer cells in vitro. Additionally, a combination of in silico and in vitro enzymatic assays demonstrated the metabolism of these phosphonamidates to release the unmasked PAg monophosphonate species. Collectively, this work establishes HMBP monophosphonate ProPAgens as ideal candidates for further investigation as novel cancer immunotherapeutic agents.

Effectiveness of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal: a cluster randomised trial in Pakistan

BACKGROUND

Maternal depression has a recurring course that can influence offspring outcomes. Evidence on how to treat maternal depression to improve longer-term maternal outcomes and reduce intergenerational transmission of psychopathology is scarce, particularly for task-shifted, low-intensity, and scalable psychosocial interventions. We evaluated the effects of a peer-delivered, psychosocial intervention on maternal depression and child development at 3 years postnatal.

METHODS

40 village clusters in Pakistan were randomly allocated using a computerised randomisation sequence to receive a group-based, psychosocial intervention and enhanced usual care for 36 months, or enhanced usual care alone. Pregnant women (≥18 years) were screened for moderate or severe symptoms of depression (patient health questionnaire-9 [PHQ-9] score ≥10) and were recruited into the trial (570 participants), and a cohort without depression (PHQ-9 score <10) was also enrolled (584 participants). Including the non-depressed dyads enabled us to determine how much of the excess risk due to maternal depression exposure the intervention could mitigate. Research teams responsible for identifying, obtaining consent, and recruiting trial participants were blind to the allocation status throughout the duration of the study, and principal investigators, site coordinators, statisticians, and members of the trial steering committee were also blinded to the allocation status until the analysis of 6-month data for the intervention. Primary outcomes were maternal depression symptoms and remission (PHQ-9 score <10) and child socioemotional skills (strengths and difficulties questionnaire [SDQ-TD]) at 36-months postnatal. Analyses were by intention to treat. This trial is registered with ClinicalTrials.gov, NCT02658994.

FINDINGS

From Oct 15, 2014 to Feb 25, 2016 46 village clusters were assessed for eligibility, of which 40 (including 1910 mothers were enrolled. After exclusions, 288 women were randomly assigned to the enhanced usual care group and 284 to the intervention group, and 1159 women were included in a group without prenatal depression. At 36-months postnatal, complete data were available from 889 mother-child dyads: 206 (72·5%) in the intervention group, 216 (75·3%) in the enhanced usual care group, and 467 (80·0%) women who did not have prenatal-depression. We did not observe significant outcome differences between the intervention group and the enhanced usual care group for the primary outcomes. The standardised mean difference of PHQ-9 total score was -0·13 (95% CI -0·33 to 0·07), relative risk of patient health questionnaire-9 remission was 1·00 (95% CI 0·88 to 1·14), and the SDQ-TD treatment estimate was -0·10 (95% CI -1·39 to 1·19).

INTERPRETATION

Reduced symptom severity and high remission rates were seen across both the intervention and enhanced usual care groups, possibly masking any effects of the intervention. A multi-year, psychosocial intervention can be task-shifted via peers but might be susceptible to reductions in fidelity and dosage over time (which were not among the outcomes of this trial). Early intervention efforts might need to rely on multiple models (eg, collaborative care), be of greater intensity, and potentially targeted at mothers who are at high risk for depression to reduce the intergenerational transmission of psychopathology from mothers to children.

FUNDING

National Institutes of Health.

AB0076 SPATIAL VARIATIONS OF BONE MICROARCHITECTURE AND MINERALIZATION IN HIP OSTEOARTHRITIS AND OSTEOPOROSIS

Background:

The pattern of changes in bone microarchitecture and mineralisation are distinctly different in osteoarthritis (OA) and osteoporosis (OP). However, the pathogenesis of OA is closely related with OP, making subchondral bone a promising target for OA treatment [1]. A detailed comparison of subchondral bone in OA and OP may help understand the relationship of the two diseases.

Objectives:

To carry out a comprehensive analysis of regional and compartmental variations in subchondral bone architecture and mineralisation in OA and OP.

Methods:

Femoral heads were collected from patients undergoing hip arthroplasty surgeries for hip OA (N=16) or osteoporotic fracture (N=7). For OP group, osteochondral plugs were collected from fixed sites: anterior, posterior and superior. For OA group, an optimised sampling procedure, based on a new macroscopic grading method and modified OARSI microscopic grading system, was used to collect plugs from regions with varying severity of cartilage degradation. Plugs were scanned by micro CT (voxel size 4.88µm). Regions of interest for cortical plate (Ct) and trabecular bone (Tb) were segmented from reconstructed images using semi-automatic approach. Densitometric (tissue and bone mineral density: TMD and BMD) and architectural parameters (cortical plate thickness (Ct.Th), trabecular bone volume fraction (BV/TV), trabecular thickness (Tb.Th), etc.) were measured using commercially available software. Unmatched inter-group regional comparisons were made between OA microscopic grades (1 to 4) and OP. Matched intra-sample regional analysis was made between ‘mild’ (Grade 1 and/or 2) and ‘severe’ (Grade 3 and/or 4) OA. TMD was also subjected to paired comparison between cortical (Ct.TMD) and trabecular (Tb.TMD) compartments. Correlations between densitometric and architectural parameters were also explored.

Results:

Regional analysis showed that Tb.TMD in OA Grade 3 and 4 was significantly lower than in OP and Grade 1 and 2, while Tb.TMD in OP was not significantly different from OA Grade 1 and 2 (Fig 1A, F). Ct.TMD in OA Grade 4 was significantly lower than in OP, but no difference was found in other comparisons (Fig 1B, G). For BMD of trabecular bone (Tb.BMD) and architectural parameters including BV/TV and Ct.Th, values for OA Grade 3 and/or 4 were significantly higher than OP and Grade 1 and/or 2, but the difference between OP and Grade 1 and 2 was not significant (Fig 1C-E, H-J). Compartmental analysis showed that Ct.TMD was significantly lower than Tb.TMD in all groups (Table I). Tb.TMD was inversely correlated with Tb.BMD and BV/TV in both OA and OP; Ct.TMD and Tb.TMD were inversely associated with Ct.Th and Tb.Th respectively in OA (Table II).

Conclusion:

In both OA and OP, material density (TMD) of cortical plate was lower than trabecular bone. In hip OA, densitometric and architectural changes of subchondral cortical and trabecular bone were related to severity of cartilage degradation. In OA trabecular bone, the decrease in material density was compensated by increased bone volume, leading to higher apparent density (BMD); while in OP, loss of bone volume was correlated with, but not compensated by increased mineralisation, leading to lower apparent density.

References:

[1]Castaneda, S., et al. Biochem. Pharmacol., 2012

Table 1.

Compartmental comparison of TMD

OPOA Grade1234Ct.TMD1.19±0.071.18±0.091.15±0.061.16±0.061.12±0.07Tb.TMD1.34±0.06****1.37±0.10****1.33±0.07****1.22±0.06*1.19±0.09*Table 2.

Correlation analysis

OPOAPR2SlopePR2SlopeTb.TMD - BV/TV< 0.00010.69-0.01< 0.00010.84-0.01Tb.BMD - BV/TV< 0.00010.950.02< 0.00010.960.01Tb.BMD - Tb.TMD< 0.00010.60-1.25< 0.00010.81-1.37Ct.TMD - Ct.Thns0.00090.19-0.33Tb.TMD - Tb.Thns< 0.00010.55-1.97

Acknowledgments:

China Scholarship Council

Disclosure of Interests:

None declared

AB1248 MOLECULAR MARKERS OF PAIN AND OTHER SYMPTOMS IN KNEE OSTEOARTHRITIS

Background:

Osteoarthritis (OA) is one of the leading causes for disability in adults. The diagnosis of OA is generally based on patient reported pain, other symptoms and radiographic changes which occur in late stages. There have been extensive research over the last 30 years to identify and validate molecular markers for early diagnosis of OA and a large range of potential biomarkers has been identified[1, 2]. However, most of these biomarkers are markers of structural and metabolic changes, and have poor correlation with pain and stiffness in knee OA. The publicly available data from the National Institute of Health Osteoarthritis Initiative (OAI) provides an opportunity to search for clinically useful biomarkers associated with the main symptoms in OA.

Objectives:

To identify molecular biomarkers which are associated with the main symptoms of knee OA.

Methods:

600 participants from 4791 men and women aged 45 to 79 who were Kellgren & Lawrence grade 1 or more were identified with biochemical markers data, radiographic and clinical features of OA. Nineteen biochemical markers measured in serum and/or urine were analysed for their association with primary clinical features of OA: Knee injury and Osteoarthritis Outcome Score (KOOS) pain and symptoms, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and stiffness score. Patient level analysis was carried out based on the worst affected knee. The association of molecular biomarkers with KOOS and WOMAC scores were assessed using univariate and multivariate linear and logistic regression, and receiving operator characteristic curves (ROC). Area under the curve (AUC) was calculated in order to determine if a combination of the biomarkers improve the associations with the outcome variables.

Results:

Only 3 of the 19 biomarkers investigated were associated with clinical symptoms. Serum cartilage oligomeric matrix protein (COMP) and chondroitin sulphate 846 (CS846) were associated with WOMAC pain and stiffness respectively, while, urinary C-terminal crosslinked telopeptide of type II collagen (CTXII) appeared to be highly associated with WOMAC stiffness, KOOS pain and symptoms (Table 1 / 2). The AUC from the univariate model for the association of biomarkers with WOMAC pain and stiffness were 0.5 (Table 1), while the AUC for unadjusted and adjusted multivariate model for the 3 biomarkers combined were 0.56 and 0.67 respectively (Figure 1).

Table 1.

Univariate logistic regression model.

WOMAC PainWOMAC StiffnessBiomarkersOR (95%)AUC (p-value)OR (95%)AUC (p-value)sCS8461.0026 (0.9996, 1.0056)0.5200 (0.088)1.0047 (1.0013, 1.0081)0.5399 (0.007)sCOMP0.9419 (0.8912, 0.9954)0.5462 (0.034)1.0424 (0.9843, 1.1039)0.5317 (0.156)uCTXII1.0077 (0.9990, 1.0165)0.5300 (0.083)1.0099 (1.0005, 1.0194)0.5489 (0.039)

Conclusion:

Serum COMP and urinary CTXII are associated with pain in knee OA, while serum CS846 and urinary CTXII are associated with joint stiffness. The multivariate logistic regression model shows good discrimination for the association of biomarkers with clinical symptoms of OA. The data from the multivariate model suggests that a clinically useful biomarker may be created using AUC values for better specificity and sensitivity.

References:

[1]Lotz, M., et al. Annals of the Rheumatic Diseases, 2013. 72(11)

[2]Kraus, V.B., et al. Annals of the Rheumatic Diseases, 2017. 76(1)

Table 2.

Univariate and multivariate linear regression model. Confounders such as age, body mass index, gender and race were adjusted in the multivariate model.

BiomarkersKOOS PainKOOS SymptomsUnivariateMultivariateUnivariateMultivariateCoefficient (95%)p-valueCoefficient (95%)p-valueCoefficient (95%)p-valueCoefficient (95%)p-valuesMMP30.057 (-0.024, 0.138)0.1650.019 (-0.074, 0.111)0.6960.092 (0.022, 0.162)0.0100.059 (-0.021, 0.140)0.147uCTXII-0.678 (-0.124, -0.012)0.017-0.086 (-0.152, -0.021)0.010-0.730 (-0.121, -0.025)0.003-0.091 (-0.148, -0.034)0.002

Acknowledgments

Disclosure of Interests:

None declared

Effectiveness of the Thinking Healthy Programme for perinatal depression delivered through peers: Pooled analysis of two randomized controlled trials in India and Pakistan

BACKGROUND

The Thinking Healthy Programme (THP) is recommended to treat perinatal depression in resource-limited settings, but scale-up is hampered by a paucity of community health workers. THP was adapted for peer-delivery (THPP) and evaluated in two randomized controlled trials in India and Pakistan. Our aim was to estimate the effectiveness of THPP on maternal outcomes across these two settings, and evaluate effect-modification by country and other pre-defined covariates.

METHODS

Participants were pregnant women aged≥18 years with depression (Patient Health Questionnaire (PHQ-9) score≥10), randomized to THPP plus enhanced usual care (EUC) or EUC-only. Primary outcomes were symptom severity and remission (PHQ-9 score<5) 6 months post-childbirth. Secondary outcomes included further measures of depression, disability and social support at 3 and 6 months post-childbirth.

RESULTS

Among 850 women (280 India; 570 Pakistan), 704 (83%) attended 6-month follow-up. Participants in the intervention arm had lower symptom severity (PHQ-9 score adjusted mean difference -0.78 (95% confidence interval -1.47,-0.09)) and higher odds of remission (adjusted odds ratio 1.35 (1.02,1.78)) versus EUC-only. There was a greater intervention effect on remission among women with short chronicity of depression, and those primiparous. There were beneficial intervention effects across multiple secondary outcomes.

LIMITATIONS

The trials were not powered to assess effect-modifications. 10-20% of participants were missing outcome data.

CONCLUSIONS

This pooled analysis demonstrates the effectiveness, acceptability and feasibility of THPP, which can be scaled-up within a stepped-care approach by engaging with the existing health care systems and the communities to address the treatment gap for perinatal depression in resource-limited settings.