Testing the effects of the Shamiri Intervention and its components on anxiety, depression, wellbeing, and academic functioning in Kenyan adolescents: study protocol for a five-arm randomized controlled trial

BACKGROUND

Treatments for youth mental disorders are a public health priority, especially in sub-Saharan Africa (SSA), where treatment options remain limited due to high cost, elevated stigma, and lack of trained mental health professionals. Brief, accessible, and non-stigmatizing community-based interventions delivered by lay providers may help address treatment needs in SSA. One such intervention, the Shamiri Intervention, consisting of three elements (growth mindset, gratitude, and value affirmation) has been tested in randomized controlled trials with school-going Kenyan adolescents. This three-element Shamiri Intervention has been shown to significantly reduce depression and anxiety symptoms and improve social support and academic performance relative to a control group. In this trial, we aim to investigate the effects of each element of the Shamiri Intervention.

METHODS

In this five-arm randomized controlled trial, we will test each of the intervention components (growth mindset, gratitude, and value affirmation) against the full Shamiri Intervention and against a study skills control intervention. Students (Nplanned = 1288) at participating secondary schools who are interested in participating in this universal intervention will be randomized in equal numbers into the five groups. The students will meet in groups of 8-15 students led by local high school graduate lay providers. These lay providers will receive a brief training, plus expert supervision once a week throughout the intervention delivery. Multi-level models will be used to compare trajectories over time of the primary outcomes (depressive symptoms, anxiety symptoms, academic performance, and wellness) and secondary outcomes in each intervention group to the control group. Multi-level models will also be used to compare trajectories over time of the primary outcomes (depressive symptoms, anxiety symptoms, academic performance, and wellness) and secondary outcomes of participants in the single-element interventions compared to the full Shamiri Intervention. Finally, effect sizes (calculated as mean gain scores) will be used to compare all groups on all measures.

DISCUSSION

This trial will shed light on the mechanisms and outcomes targeted by each individual intervention, helping prioritize which mental health interventions are most important to disseminate.

TRIAL REGISTRATION

PACTR Trial ID: PACTR202104716135752 . Approved on 4/19/2021.

Nuclear progesterone receptor regulates ptger4b and PLA2G4A expression in zebrafish (Danio rerio) ovulation

Previous studies have implicated the nuclear progesterone receptor (Pgr or nPR) as being critical to ovulation in fishes. This study investigated the expression of Pgr in zebrafish ovarian follicles throughout development as well as putative downstream targets of Pgr by searching the promoter regions of selected genes for specific DNA sequences to which Pgr binds and acts as a transcription factor. Expression of Pgr mRNA increases dramatically as follicles grow and mature. In silico analysis of selected genes linked to ovulation showed that the prostaglandin receptors ptger4a and ptger4b contained the progesterone responsive element (PRE) GRCCGGA in their promoter regions. Studies using full-grown follicles incubated in vitro revealed that ptger4b was upregulated in response to 17,20β-P. Our studies also showed that the expression of phospholipase A2 (PLA2G4A) mRNA and protein, a key enzyme in prostaglandin synthesis, was upregulated in response to 17,20β-P treatment. pla2g4a was not found to contain a PRE, indicating that it is regulated indirectly by 17,20β-P or that it may contain an as-of-yet unidentified PRE in its promoter region. Collectively, these studies provide further evidence of the importance of Pgr during the periovulatory periods through its involvement in prostaglandin production and function by controlling expression of PLA2G4A and the receptor EP4b and that these genes appear to be regulated through the actions of 17,20β-P.

Identical and Nonidentical Twins: Risk and Factors Involved in Development of Islet Autoimmunity and Type 1 Diabetes

OBJECTIVE

There are variable reports of risk of concordance for progression to islet autoantibodies and type 1 diabetes in identical twins after one twin is diagnosed. We examined development of positive autoantibodies and type 1 diabetes and the effects of genetic factors and common environment on autoantibody positivity in identical twins, nonidentical twins, and full siblings.

RESEARCH DESIGN AND METHODS

Subjects from the TrialNet Pathway to Prevention Study (N = 48,026) were screened from 2004 to 2015 for islet autoantibodies (GAD antibody [GADA], insulinoma-associated antigen 2 [IA-2A], and autoantibodies against insulin [IAA]). Of these subjects, 17,226 (157 identical twins, 283 nonidentical twins, and 16,786 full siblings) were followed for autoantibody positivity or type 1 diabetes for a median of 2.1 years.

RESULTS

At screening, identical twins were more likely to have positive GADA, IA-2A, and IAA than nonidentical twins or full siblings (all P < 0.0001). Younger age, male sex, and genetic factors were significant factors for expression of IA-2A, IAA, one or more positive autoantibodies, and two or more positive autoantibodies (all P ≤ 0.03). Initially autoantibody-positive identical twins had a 69% risk of diabetes by 3 years compared with 1.5% for initially autoantibody-negative identical twins. In nonidentical twins, type 1 diabetes risk by 3 years was 72% for initially multiple autoantibody-positive, 13% for single autoantibody-positive, and 0% for initially autoantibody-negative nonidentical twins. Full siblings had a 3-year type 1 diabetes risk of 47% for multiple autoantibody-positive, 12% for single autoantibody-positive, and 0.5% for initially autoantibody-negative subjects.

CONCLUSIONS

Risk of type 1 diabetes at 3 years is high for initially multiple and single autoantibody-positive identical twins and multiple autoantibody-positive nonidentical twins. Genetic predisposition, age, and male sex are significant risk factors for development of positive autoantibodies in twins.

Likelihood of natural conception following treatment by IVF

PURPOSE

To predict the ongoing likelihood of natural conception, when a couple has ceased to try to conceive by assisted conception.

METHODS

A postal questionnaire survey obtained information on further attempts to conceive and have a baby, either without treatment or by treatment elsewhere.

RESULTS

From a response rate of 44%, there were 116 couples who fulfilled the study criteria. The data presented are based on this group. The overall likelihood of conception was 18%. Cumulative results were analysed up to 3 years following treatment. Univariate analysis showed that likelihood of conception was affected by infertility diagnosis (p = 0.024), woman's age (> 38 years; p < 0.005) (negatively) and duration of infertility (< 3 years; p < 0.005) (positively), while primary infertility did not. Effects of diagnosis and infertility duration were confirmed by multivariable analysis, controlling for age and primary infertility. These latter variables had no independent effect.

CONCLUSION

The likelihood of natural conception following IVF treatment was determined by duration of infertility and diagnosis; tubal disease in particular was associated with a very poor likelihood of natural conception.

Guidelines for counselling in infertility: outline version

The Guidelines for Counselling in Infertility describe the purpose, objectives, typical issues and communication skills involved in providing psychosocial care to individuals using fertility services. The Guidelines are presented in six sections. The first section describes how infertility consultations differ from other medical consultations in obstetrics and gynaecology, whereas the second section addresses fundamental issues in counselling, such as what is counselling in infertility, who should counsel and who is likely to need counselling. Section 3 focuses on how to integrate patient-centred care and counselling into routine medical treatment and section 4 highlights some of the special situations which can provoke the need for counselling (e.g. facing the end of treatment, sexual problems). Section 5 deals exclusively with third party reproduction and the psychosocial implications of gamete donation, surrogacy and adoption for heterosexual and gay couples and single women without partners. The final section of the Guidelines is concerned with psychosocial services that can be used to supplement counselling services in fertility clinics: written psychosocial information, telephone counselling, self-help groups and professionally facilitated group work. This paper summarizes the different sections of the Guidelines and describes how to obtain the complete text of the Guidelines for Counselling in Infertility.

Protein kinase C isoform expression in CD45RA+ and CD45RO+ T lymphocytes

Differences in levels of specific enzymes utilized in intracellular signalling could be a factor in the distinct signalling properties observed in memory and naive T cells. We have studied the expression of both classical and non-classical protein kinase of C (PKC) isoenzymes in CD45RA and CD45RO cells using a combination of Western blot and flow cytometric analysis. These data indicate that CD45RA cells express higher levels of PKC alpha, PKC beta and PKC delta than CD45RO cells. In addition, CD45RA+ cells show greater proliferative activity when stimulated with phorbol myristate acetate (PMA) and calcium ionophore than their CD45RO+ counterparts. Variations in the levels of these isoenzymes could be implicated in functional differences, such as proliferation and cytokine production, in these cell subsets.

The effect of halving the standard dose of cryopreserved semen for donor insemination: a controlled study of conception rates

Employing a common standard technique of intra-cervical insemination from straws of cryopreserved donor semen, a volume of 0.25 ml of 0.5 ml was inseminated in alternate cycles to determine if the lower volume could be used without a decrease in the conception rate. A total of 177 women were recruited and received a median of four cycles of treatment. Of these, 90 women became pregnant, 47 with 0.5 ml and 43 with 0.25 ml inseminations. The conception rates were identical for both volumes in the first nine cycles of treatment and the cumulative rates were 57.7 and 59.3%, respectively. Subsequently more pregnancies were achieved with 0.5 ml than 0.25 ml semen (nine pregnancies in 73 further cycles versus three pregnancies in 68 cycles, respectively), although the difference was not statistically significant. There were no significant differences in the women's ages, luteinizing hormone, follicle stimulating hormone, progesterone, mucus quality, mucus pH, parity or partner's diagnosis between those women who became pregnant and those who failed to conceive with either insemination dose. We conclude that the volume of semen inseminated into the cervical canal without a cervical cap can be decreased to 0.25 ml without an adverse effect on the conception rate at least in the first 9 months of treatment. This will allow more effective use to be made of valuable screened and quarantined cryopreserved semen.

Oestrogen and androgen states in oligo-amenorrhoeic women with polycystic ovaries

Oestrogen and androgen states have been studied in relation to ovarian morphology defined by ultrasonography in 65 women with oligo-amenorrhoea. Of the 48 women with polycystic ovaries (PCO), 44 (92%) had a withdrawal bleed following progestogen challenge (indicating oestrogenization) compared with just three (18%) of the 17 with non-PCO (P less than 0.001). Median serum concentrations of oestradiol and oestrone were statistically significantly higher in the PCO group but the ranges overlapped widely. Of the four women with PCO but oestrogen deficiency, two were hirsute and had evidence of a severe form of the disorder. The other two were not hirsute and appeared to have hypothalamic dysfunction associated with weight loss overriding the disorder due to pre-existing PCO. Compared with the non-PCO group, the PCO subgroup without hirsutism (n = 31) had statistically significantly higher median values of LH, testosterone, androstenedione, and dehydroepiandrosterone sulphate concentrations, and free androgen index. Concentrations of androgen, but not LH, were significantly higher still in the PCO subgroup with hirsutism (n = 17).

The diagnosis of polycystic ovaries in women with oligo-amenorrhoea: predictive power of endocrine tests

The ability of several endocrine tests to distinguish between women with and without polycystic ovaries (PCO) has been studied prospectively in a series of 65 patients with functional oligo-amenorrhoea using ultrasonography as a reference test. In terms of overall diagnostic accuracy, the free androgen index (FAI) (94%) and the progestogen challenge (89%) gave similar results (Cl = -5 to 15%) but both were significantly better than all the other tests including measurement of serum LH (69%), total testosterone (71%) and androstenedione (74%) (minimum Cl = 6 to 23%). The FAI together with LH measurement was the most accurate of the combinations (97%) but this was not significantly better than the best of the combinations incorporating the progestogen challenge (92%; Cl = -3% to 13%). Given the limited availability of the assay for SHBG, these results show that assessment of oestrogen state is a useful method for categorizing patients with functional oligo-amenorrhoea.

Fluctuations in T helper subpopulations in relapsing-remitting multiple sclerosis

Patients with active multiple sclerosis (MS) have been reported to have a depletion of CD4+ CD45R+ cells, the immature resting CD4+ subpopulation. Using Leu 3a(anti-CD4) and Leu 18(anti-CD45R), the frequencies and absolute numbers of CD4+ CD45R+ and CD4+ CD45R- subsets were measured in 30 patients with MS and 17 healthy controls. These subsets were monitored every 6 weeks over a 6 month period. CD4+ CD45R- cells were found to be increased in relapse compared to remission (p less than 0.005) while CD4+ CD45R+ levels were not significantly altered in relapse. However, the CD4+ subset ratio (CD4+ CD45R-/CD4+ CD45R+) was significantly higher in relapse compared with remission (p less than 0.002). Furthermore, these findings were upheld when data from the same 6 patients in relapse and remission was compared. Increased disease activity was not associated with changes in any of the other parameters measured (total T cells, total CD4+ cells, suppressor cells or activated T cells). These results suggest that relapse in MS is accompanied by the conversion of CD4+ CD45R+ resting cells to CD4+ CD45R- primed cells.

Norethisterone treatment to control timing of the IVF cycle

The use of norethisterone to control the timing of the preceding menstrual cycle and in consequence the timing of the in-vitro fertilization (IVF) cycle has been evaluated in a therapeutic IVF programme in which oocyte recovery was limited to 2 days each week. A consecutive series of 181 cycles after norethisterone and 29 untreated controls were compared. Menstruation occurred 2-3 days after norethisterone as planned in 82% of patients overall and in 87% of patients whose menstrual cycle length varied by no more than 2 days about the median. Norethisterone treatment did not significantly affect the outcome of IVF treatment compared with the controls in respect to cycles abandoned (12 versus 0%, respectively), peak follicular diameter (mean 18.1 mm versus 18.3 mm 48 h before laparoscopy), oocyte recovery rate (4.6 versus 4.5 per patient), oocyte morphology (63% versus 52% mature), or fertilization rate (72 versus 65% of mature oocytes). Clinical pregnancies were too few for comparison (rates 27 versus 9% per laparoscopy) but the overall rate (23%) indicated effectiveness of the methods. Prior norethisterone treatment appears to be an effective and useful means of controlling the timing of the oocyte recovery in IVF treatment.

Use of nonsustained ventricular tachycardia as a guide to antiarrhythmic drug therapy in patients with malignant ventricular arrhythmia

From a population of 260 patients with malignant ventricular arrhythmia (ventricular fibrillation or ventricular tachycardia with syncope) we identified 52 (20%) who had infrequent ventricular premature beats during exercise testing and 48 hours of ambulatory monitoring. These patients underwent invasive electrophysiologic study utilizing programmed premature stimulation with up to three extrastimuli at currents of twice and three times middiastolic threshold. The end point for testing was nonsustained ventricular tachycardia (NSVT), defined as 3 to 20 propagated responses resulting from the last premature stimulus. A multiple response was obtained in 45 patients consisting of reproducible NSVT in 36 and sustained ventricular tachycardia in nine. The 36 patients with NSVT underwent 540 electrophysiologic tests with 18 antiarrhythmic agents. Suppression of the repetitive response was achieved in 31 of the 36 patients (86.1%). After an average follow-up of 21 months, one of 31 patients in whom the repetitive response had been abolished had recurrent arrhythmia. This contrasted with recurrence in two of the five patients in whom NSVT was still provoked. During the extensive testing, ventricular fibrillation was not induced. Sustained ventricular tachycardia occurred in 27 of the 540 tests (5.0%), but cardioversion was required in only 12 (2.2%). We conclude that NSVT constitutes a safe electrophysiologic end point for selecting an effective antiarrhythmic program in patients who have experienced malignant ventricular arrhythmia but in whom monitoring and exercise testing are inadequate to guide therapy.

Epistaxis and hypertension

The status of nose bleeding as a symptom of high blood pressure has been studied in patients admitted because of epistaxis. Twenty-six patients with a factor predisposing to nasal bleeding had age- and sex-adjusted systolic and diastolic scores similar to those of the general population. One hundred and sixty-eight patients with no such factor formed a different population with significantly higher age- and sex-adjusted systolic and diastolic scores. It is concluded that epistaxis is a true symptom of hypertension.