Delivering the Thinking Healthy Programme for perinatal depression through volunteer peers: a cluster randomised controlled trial in Pakistan

BACKGROUND

The Thinking Healthy Programme (THP), which is endorsed by WHO, is an evidence-based intervention for perinatal depression. We adapted THP for delivery by volunteer peers (laywomen from the community) to address the human resource needs in bridging the treatment gap, and we aimed to assess its effectiveness and cost-effectiveness in Rawalpindi, Pakistan.

METHODS

In this cluster randomised controlled trial, we randomly assigned 40 village clusters (1:1) to provide either THP peer-delivered (THPP) and enhanced usual care (EUC; intervention group) or EUC only (control group) to the participants within clusters. These villages were randomly selected from eligible villages by an independent researcher. The participants were pregnant women aged 18 years or older who had scored at least 10 on the Patient Health Questionnaire-9 (PHQ-9), who we recruited from households within communities in Rawalpindi, Pakistan. The research teams who were responsible for recruiting trial participants were masked to treatment allocations. Participants attended follow-up visits at 3 and 6 months after childbirth. The primary outcomes were the severity of depressive symptoms (assessed by PHQ-9 score) and the prevalence of remission (defined as a PHQ-9 score of less than 5) in participants with available data 6 months after childbirth, which was assessed by researchers who were masked to treatment allocations. We analysed outcomes by intention to treat, adjusting for covariates that were defined a priori or that showed imbalance at baseline. The trial was registered with ClinicalTrials.gov, number NCT02111915.

FINDINGS

Between April 15 and July 30, 2014, we randomly selected 40 of 46 eligible village clusters for assessment, as per sample size calculations. Between Oct 15, 2014, and Feb 25, 2016, we identified and screened 971 women from 20 village clusters that had been randomly assigned to the THPP and EUC group and 939 women from 20 village clusters that had been randomly assigned to the EUC only group. In the intervention group, 79 women were ineligible for inclusion, 11 women refused screening, 597 women screened negative on the PHQ-9, and one woman did not consent to participate. In the control group, 75 women were ineligible for inclusion, 14 women refused screening, 562 women screened negative on the PHQ-9, and one woman did not consent to participate. We enrolled 283 (29%) women in the intervention group and 287 (31%) women in the control group. At 6 months after childbirth, 227 (80%) women in the THPP and EUC group and 226 (79%) women in the EUC only group were assessed for the primary outcome. The severity of depression (assessed by PHQ-9 scores; standardised mean difference -0·13, 95% CI -0·31 to 0·06; p=0·07) and prevalence of remission (49% in the intervention group vs 45% in the control group; prevalence ratio 1·12, 95% CI 0·95 to 1·29; p=0·14) did not significantly differ between the groups 6 months after childbirth. There was no evidence of significant differences in serious adverse events between the groups.

INTERPRETATION

THPP had no effect on symptom severity or remission from perinatal depression at 6 months after childbirth, but we found that it was beneficial on some other metrics of severity and disability and that it was cost-effective. THPP could be a step towards use of an unused human resource to address the treatment gap in perinatal depression.

FUNDING

National Institute of Mental Health (USA).

Models of osteoarthritis: the good, the bad and the promising

Osteoarthritis (OA) is a chronic degenerative disease of diarthrodial joints most commonly affecting people over the age of forty. The causes of OA are still unknown and there is much debate in the literature as to the exact sequence of events that trigger the onset of the heterogeneous disease we recognise as OA. There is currently no consensus model for OA that naturally reflects human disease. Existing ex-vivo models do not incorporate the important inter-tissue communication between joint components required for disease progression and differences in size, anatomy, histology and biomechanics between different animal models makes translation to the human model very difficult. This narrative review highlights the advantages and disadvantages of the current models used to study OA. It discusses the challenges of producing a more reliable OA-model and proposes a direction for the development of a consensus model that reflects the natural environment of human OA. We suggest that a human osteochondral plug-based model may overcome many of the fundamental limitations associated with animal and in-vitro models based on isolated cells. Such a model will also provide a platform for the development and testing of targeted treatment and validation of novel OA markers directly on human tissues.

Charged compact objects in f(R,T) gravity

This paper analyzes the effects of charge on the nature of relativistic compact star candidates with anisotropic distribution in the framework of [Formula: see text] gravity. For this purpose, we consider Krori–Barua solutions and obtain the values of unknown constants as well as charge using observational data of Her X-1, 4U1820-30 and SAX J 1808.4-3658 star models. For three viable [Formula: see text] models, we investigate the behavior of energy density, transverse as well as radial pressures in the interior geometry of these stars. The validity of energy conditions, effect of anisotropic factor and stability of these stellar models are also examined. We conclude that the effect of charge leads to more stable structures of relativistic compact objects.

On the stability of Einstein universe in f(R, T, Rμν Tμν) gravity

This paper investigates the existence and stability of Einstein universe in the context of f(R, T, Q) gravity, where Q = R[Formula: see text] T[Formula: see text]. Considering linear homogeneous perturbations around scale factor and energy density, we formulate static as well as perturbed field equations. We parametrize the stability regions corresponding to conserved as well as non-conserved energy–momentum tensor using linear equation of state parameter for particular models of this gravity. The graphical analysis concludes that for a suitable choice of parameters, stable regions of the Einstein universe are obtained which indicates that the big bang singularity can be avoided successfully by the emergent mechanism in non-minimal matter-curvature coupled gravity.

Effect of distillery yeast sludge on growth performance, nutrient digestibility and slaughter parameters in Japanese quails

This study was planned to evaluate the effect of distillery yeast sludge (DYS) as a protein source on growth performance, nutrient digestibility and slaughtering parameters in Japanese quail birds. For this purpose, six hundred day-old quails were randomly distributed into six dietary treatments. These dietary treatments were; G₁ (Control Group) fed a basal diet (CP 24%, ME 2900 kcal/kg) without DYS, while other dietary treatments were G₂, G₃, G₄, G₅ and G₆ fed basal diet containing DYS @ 1.5, 3.0, 4.5, 6.0 and 7.5%, respectively. It was observed that feed intake and weight gain tended to increase (P < 0.05) up to 3% DYS. Better (P < 0.05) feed conversion ratio (FCR) was observed in birds fed diet containing DYS at the level of 1.5 and 3%. Dry matter and crude protein digestibility decreased with increasing levels of DYS (P < 0.05). Cost of production per 100 g of weight gain was also less in birds fed diet containing 3% DYS. Study revealed that inclusion of distillery yeast sludge in the diet of Japanese quails up to 3% improves the growth performance and economics efficacy.

Stability Analysis of Bulk Viscous Cosmology

In this paper, we study phase space analysis of FRW universe model by taking a power-law model for bulk viscosity coefficient. An autonomous system of equations is developed by defining normalized dimensionless variables. We find corresponding critical points for di.erent values of the parameters to investigate stability of the system. It is found that the presence of power-law model of bulk viscosity appears as an e.ective ingredient to enhance the stability of the respective universe model.

MCE domain proteins: conserved inner membrane lipid-binding proteins required for outer membrane homeostasis

Bacterial proteins with MCE domains were first described as being important for Mammalian Cell Entry. More recent evidence suggests they are components of lipid ABC transporters. In Escherichia coli, the single-domain protein MlaD is known to be part of an inner membrane transporter that is important for maintenance of outer membrane lipid asymmetry. Here we describe two multi MCE domain-containing proteins in Escherichia coli, PqiB and YebT, the latter of which is an orthologue of MAM-7 that was previously reported to be an outer membrane protein. We show that all three MCE domain-containing proteins localise to the inner membrane. Bioinformatic analyses revealed that MCE domains are widely distributed across bacterial phyla but multi MCE domain-containing proteins evolved in Proteobacteria from single-domain proteins. Mutants defective in mlaD, pqiAB and yebST were shown to have distinct but partially overlapping phenotypes, but the primary functions of PqiB and YebT differ from MlaD. Complementing our previous findings that all three proteins bind phospholipids, results presented here indicate that multi-domain proteins evolved in Proteobacteria for specific functions in maintaining cell envelope homeostasis.

Sero-prevalence and epidemiology of peste des petits ruminants in Libya

We conducted a cross-sectional study during 2013 to quantify the serological prevalence of peste des petits ruminants (PPR) infection and to investigate host factors associated with PPR infection in small ruminants in Libya. A two-stage sampling design was carried out. A total number of 148 flocks owning at least 100 heads each were randomly selected. Sixteen to forty-eight samples were collected from each selected flock. A total number of 3,508 serum samples from unvaccinated animals were collected and analysed at IZSLER Brescia, Italy, by using competitive ELISA, IDvet innovative diagnostics (IDvet 310, France). The overall serological prevalence among SR was 33% (95% CI: 31.4-34.5). Significant differences between the prevalence in the geographical branches were observed. The lowest prevalence level was observed in Zawiyah branch (16.1%), whereas the highest value was obtained for the Sabha branch (56.8%). Considering the age, a serological prevalence of 24.7%, 31.5% and 42.1% was observed in SR <1 year, between 1 and 2 years and more than 2 years, respectively. Statistically significant differences (p < .001) in the sero-prevalence levels were also observed between the age groups. Our findings suggest that the southern part of Libya could be more exposed to the infections coming from the neighbouring countries and this should be better investigated to correctly identify wherever specific entry points can be considered at higher risk than others. The results also confirmed the endemic status of PPR in Libya, with a constant exposure to the infection of the animals during their life. In the framework of the global strategy for control and eradication of PPR, our results, even if obtained by a preliminary study, can contribute to the assessment of the epidemiological situation of PPR in Libya as required by the Stage 1 of the plan.

Effect of graded levels of dietary corn steep liquor on growth performance, nutrient digestibility, haematology and histopathology of broilers

This experiment was conducted to assess nutritional potential of corn steep liquor (CSL) as an alternative protein source in broiler's diet. A total of 280-day-old unsexed broiler chicks were randomly distributed into four experimental groups in a simple randomised experimental design (each group had seven replicates; 10 birds per each). Four iso-nitrogenous and iso-caloric broiler starter and finisher diets (C, LCSL, MCSL and HCSL) were formulated containing 0%, 5%, 10% and 15% CSL respectively. Results revealed that chicks fed MCSL diet had significantly (p ≤ .05) the heaviest Body weight, highest Body weight gain and the lowest feed conversion ratio followed by those fed HCSL diet. In the starter period, LCSL and MCSL diets resulted in better (p ≤ .05) dry matter (DM) (89.57%) and crude protein (67.67%) digestibilities respectively. In the finisher period, DM, crude fibre and fat digestibilities were not affected by CSL inclusion levels; while crude protein digestibility was significantly (p ≤ .05) high in the groups fed LCSL and HCSL diets. The CSL inclusion had no effect on blood haematology except serum uric acid, which tended to increase with increasing CSL levels. No microscopic changes were exhibited on liver, heart, kidneys and intestine of birds across all dietary treatments. However, crops in birds fed HCSL diet showed moderate to severe hypertrophy and hyperplasia of the mucosal lining. The study showed that CSL could be added up to 15% in broiler's diet without any adverse effect on bird's performance.

Physical behavior of anisotropic compact stars in f(R, T, RμνTμν) gravity

This paper investigates the behavior of anisotropic compact stars in the background of R + αRμνTμν gravity model. For this purpose, we use Krori–Barua metric solutions where constants are calculated using masses and radii of compact stars like Her X-1, SAX J 1808.4–3658, and 4U1820–30. We analyze regular behavior of effective energy density, and radial and transverse pressures in the interior of compact stars. We also discuss energy conditions, effect of anisotropic factor, and stability criteria of these stars. It is concluded that the considered compact star models satisfy all the energy conditions and remain stable against the anisotropic effect in this gravity.

Application of multiplex PCR for the simultaneous detection of Taenia spp. from domestic dogs in the north of Iran

The family Taeniidae is of great importance in the medical and veterinary fields, particularly in the tropics and subtropics. Identification of eggs of different Taenia spp. in the final host by morphological examination is difficult owing to their similarity. Therefore, a multiplex polymerase chain reaction (PCR) targeting a mitochondrial gene was applied to identify morphologically indistinguishable eggs. Fecal samples from 100 domestic dogs, from the Mazandaran province in Iran, were examined using the flotation/sieving method followed by multiplex PCR. Taeniid eggs were observed in 24 % samples, of which 12 %, 10 %, and 2 % were infected with Echinococcus granulosus, Taenia spp., and both E. granulosus and Taenia spp., respectively. E. multilocularis was absent in these samples. The prevalence of E. granulosus in the examined domestic dogs as definitive hosts in north of Iran was high (14 %). Therefore, people living in this region of Iran are in danger of acquiring hydatid cyst, which is a serious public health problem.

HIV diagnosis in a patient presenting with vasculitis

A patient with digital ischaemia and gangrene was treated with iloprost and antiplatelets for two weeks. His vasculitic screen was negative except for a positive HIV test. His vasculitis improved three weeks after treatment with antiretroviral medications. Though vasculitis is well known to be associated with HIV infection, very few cases of HIV present as vasculitis.