Depressive and anxiety disorders (common mental disorders) are the most common psychiatric condition encountered in primary healthcare.
To test the effectiveness of an intervention led by lay health ...counsellors in primary care settings (the MANAS intervention) to improve the outcomes of people with common mental disorders.
Twenty-four primary care facilities (12 public, 12 private) in Goa (India) were randomised to provide either collaborative stepped care or enhanced usual care to adults who screened positive for common mental disorders. Participants were assessed at 2, 6 and 12 months for presence of ICD-10 common mental disorders, the severity of symptoms of depression and anxiety, suicidal behaviour and disability levels. All analyses were intention to treat and carried out separately for private and public facilities and adjusted for the design. The trial has been registered with clinical trials.gov (NCT00446407).
A total of 2796 participants were recruited. In public facilities, the intervention was consistently associated with strong beneficial effects over the 12 months on all outcomes. There was a 30% decrease in the prevalence of common mental disorders among those with baseline ICD-10 diagnoses (risk ratio (RR) = 0.70, 95% CI 0.53-0.92); and a similar effect among the subgroup of participants with depression (RR = 0.76, 95% CI 0.59-0.98). Suicide attempts/plans showed a 36% reduction over 12 months (RR=0.64, 95% CI0.42–0.98) among baseline ICD-10 cases. Strong effects were observed on days out of work and psychological morbidity, and modest effects on overall disability corrected. In contrast, there was little evidence of impact of the intervention on any outcome among participants attending private facilities.
Trained lay counsellors working within a collaborative-care model can reduce prevalence of common mental disorders, suicidal behaviour, psychological morbidity and disability days among those attending public primary care facilities.
Summary Background Observational evidence suggests that community-based services for people with schizophrenia can be successfully provided by community health workers, when supervised by ...specialists, in low-income and middle-income countries. We did the COmmunity care for People with Schizophrenia in India (COPSI) trial to compare the effectiveness of a collaborative community-based care intervention with standard facility-based care. Methods We did a multicentre, parallel-group, randomised controlled trial at three sites in India between Jan 1, 2009 and Dec 31, 2010. Patients aged 16–60 years with a primary diagnosis of schizophrenia according to the tenth edition of the International Classification of Diseases, Diagnostic Criteria for Research (ICD-10-DCR) were randomly assigned (2:1), via a computer-generated randomisation list with block sizes of three, six, or nine, to receive either collaborative community-based care plus facility-based care or facility-based care alone. Randomisation was stratified by study site. Outcome assessors were masked to group allocation. The primary outcome was a change in symptoms and disabilities over 12 months, as measured by the positive and negative syndrome scale (PANSS) and the Indian disability evaluation and assessment scale (IDEAS). Analysis was by modified intention to treat. This study is registered as an International Standard Randomised Controlled Trial, number ISRCTN 56877013. Findings 187 participants were randomised to the collaborative community-based care plus facility-based care group and 95 were randomised to the facility-based care alone group; 253 (90%) participants completed follow-up to month 12. At 12 months, total PANSS and IDEAS scores were lower in patients in the intervention group than in those in the control group (PANSS adjusted mean difference −3·75, 95% CI −7·92 to 0·42; p=0·08; IDEAS −0·95, −1·68 to −0·23; p=0·01). However, no difference was shown in the proportion of participants who had a reduction of more than 20% in overall symptoms (PANSS 85 51% in the intervention group vs 44 51% in the control group; p=0·89; IDEAS 75 48% vs 28 35%). We noted a significant reduction in symptom and disability outcomes at the rural Tamil Nadu site (−9·29, −15·41 to −3·17; p=0·003). Two patients (one in each group) died by suicide during the study, and two patients died because of complications of a road traffic accident and pre-existing cardiac disease. 18 (73%) patients (17 in the intervention group) were admitted to hospital during the course of the trial, of whom seven were admitted because of physical health problems, such as acute gastritis and vomiting, road accident, high fever, or cardiovascular disease. Interpretation The collaborative community-based care plus facility-based care intervention is modestly more effective than facility-based care, especially for reducing disability and symptoms of psychosis. Our results show that the study intervention is best implemented as an initial service in settings where services are scarce, for example in rural areas. Funding Wellcome Trust.
Summary Background Depression and anxiety disorders are common mental disorders worldwide. The MANAS trial aimed to test the effectiveness of an intervention led by lay health counsellors in primary ...care settings to improve outcomes of people with these disorders. Methods In this cluster randomised trial, primary care facilities in Goa, India, were assigned (1:1) by computer-generated randomised sequence to intervention or control (enhanced usual care) groups. All adults who screened positive for common mental disorders were eligible. The collaborative stepped-care intervention offered case management and psychosocial interventions, provided by a trained lay health counsellor, supplemented by antidepressant drugs by the primary care physician and supervision by a mental health specialist. The research assessor was masked. The primary outcome was recovery from common mental disorders as defined by the International Statistical Classification of Diseases and Related Health Problems—10th revision (ICD-10) at 6 months. This study is registered with ClinicalTrials.gov , number NCT00446407. Findings 24 study clusters, with an equal proportion of public and private facilities, were randomised equally between groups. 1160 of 1360 (85%) patients in the intervention group and 1269 of 1436 (88%) in the control group completed the outcome assessment. Patients with ICD-10-confirmed common mental disorders in the intervention group were more likely to have recovered at 6 months than were those in the control group (n=620 65·0% vs 553 52·9%; risk ratio 1·22, 95% CI 1·00–1·47; risk difference=12·1%, 95% CI 1·6%–22·5%). The intervention had strong evidence of an effect in public facility attenders (369 65·9% vs 267 42·5%, risk ratio 1·55, 95% CI 1·02–2·35) but no evidence for an effect in private facility attenders (251 64·1% vs 286 65·9%, risk ratio 0·95, 0·74–1·22). There were three deaths and four suicide attempts in the collaborative stepped-care group and six deaths and six suicide attempts in the enhanced usual care group. None of the deaths were from suicide. Interpretation A trained lay counsellor-led collaborative care intervention can lead to an improvement in recovery from CMD among patients attending public primary care facilities. Funding The Wellcome Trust.
Background: Post-operative surgical site infection (SSI) is the most commonly reported nosocomial infection which constitutes a major public health care problem worldwide. SSI are the one of the most ...common complication after caesarean section (C-sec) and results in maternal morbidity and mortality, increased length of the hospital stays and economic burden. The aim of the study is to determine the incidence and risk factors of SSI in women undergoing C-sec. Methods: The prospective observational study carried out in department of Obstetrics and Gynaecology in Goa medical college, Bambolim Goa from 1st November 2017 to 30th May 2019. Collection of data was carried using predesigned and pretested proforma. SSI was examined for association of different risk factors and its distribution. Results: During this study period, 2106 patients underwent C-sec, out of which 103 patients developed post-operative SSI with the incidence rate being 4.89%. The incidence rate was found higher in emergency cases (6.55%) as compared to that of elective (1.21%) and median time to SSI was the 6th post-operative day. Majority of SSI, i.e., 102 out of 103 (99.08%) were superficial SSI, 1 (0.98%) were deep SSI and no organ/space SSI. The highest rate of SSI was found in 21-34 years of age group (84.47%). The common risk factors associated are anaemia, diabetes, hypertension and obesity. Conclusions: SSI results from multiple risk factors which include modifiable and non-modifiable factors and thorough analysis of these factors can help prevent SSI. The medical staff should focus on some of the modifiable risk factors can be eliminated by strict antisepsis, timely prophylactic antibiotic and maintaining normothermia as well as optimal glucose level. Keywords: SSI, C-sec, Deep SSI, Superficial SSI
The monsoonal signal dominates most climate records from the Indian Ocean. As a consequence, conventional stable isotope tracers have not been effective at tracking ocean circulation in the Indian ...Ocean and distinguishing between monsoonal and ocean circulation changes in the Bay of Bengal. Here we present a deglacial through Holocene Nd isotope record of seawater in the central Bay of Bengal, spanning the last 16 kyr. Comparison with a published record from the deep equatorial Indian Ocean (Piotrowski et al., , https://doi.org/10.1016/j.epsl.2009.06.007 shows that Nd isotope ratios of these cores were similar until ~8 ka (ƐNd = −7 to −8 until ~13 ka, and −8.5 to −9.5 between ~13 and 8 ka), after which the Bay of Bengal record diverges to lower values (ƐNd = ~ −10.5). We interpret the Nd isotope record until ~8 ka in both cores to represent the influence of the global overturning ocean circulation. The divergence of the record in the Bay of Bengal since ~8 ka to lower ƐNd values is coincident with a major increase in the strength of the rain‐bearing southwest monsoon and a high sediment load from the Ganga‐Brahmaputra Rivers to the Bengal Fan that reflects major impacts from the intensified monsoon. Thus, the Nd isotopes are sensitive recorders of the changes in monsoon intensity in the Bay of Bengal.
Key Points
Nd isotopes are used as a water mass tracer in the Bay of Bengal
The global overturning circulation controlled the deep circulation in the Bay of Bengal for the major portion of the last deglaciation
After 8‐7 ka, the weathering signal due to enhanced monsoon activity has overwhelmed the deep ocean circulation signal
The Movement for Global Mental Health Patel, Vikram; Collins, Pamela Y.; Copeland, John ...
British journal of psychiatry,
02/2011, Letnik:
198, Številka:
2
Journal Article
Recenzirano
Odprti dostop
The Movement for Global Mental Health is a coalition of individuals and
institutions committed to collective actions that aim to close the treatment
gap for people living with mental disorders ...worldwide, based on two
fundamental principles: evidence on effective treatments and the human
rights of people with mental disorders.
To carry out an economic evaluation of a task-shifting intervention for the treatment of depressive and anxiety disorders in primary-care settings in Goa, India.
Cost-utility and cost-effectiveness ...analyses based on generalized linear models were performed within a trial set in 24 public and private primary-care facilities. Subjects were randomly assigned to an intervention or a control arm. Eligible subjects in the intervention arm were given psycho-education, case management, interpersonal psychotherapy and/or antidepressants by lay health workers. Subjects in the control arm were treated by physicians. The use of health-care resources, the disability of each subject and degree of psychiatric morbidity, as measured by the Revised Clinical Interview Schedule, were determined at 2, 6 and 12 months.
Complete data, from all three follow-ups, were collected from 1243 (75.4%) and 938 (81.7%) of the subjects enrolled in the study facilities from the public and private sectors, respectively. Within the public facilities, subjects in the intervention arm showed greater improvement in all the health outcomes investigated than those in the control arm. Time costs were also significantly lower in the intervention arm than in the control arm, whereas health system costs in the two arms were similar. Within the private facilities, however, the effectiveness and costs recorded in the two arms were similar.
Within public primary-care facilities in Goa, the use of lay health workers in the care of subjects with common mental disorders was not only cost-effective but also cost-saving.
It is generally accepted view that the ventilation of Southern Ocean during the last deglaciation was the key factor in atmospheric CO
2
rise. Further, other sites were identified, like the western ...equatorial Pacific, the Sub-Antarctic Atlantic and the eastern equatorial Pacific. Now there are evidences that CO
2
was also released from the eastern Arabian Sea. The Arabian Sea is unique in characteristic, being land locked from the North and affected by monsoon winds and seasonal reversing circulations. Furthermore, the CO
2
outgassing noticed during deglaciation makes it an interesting region to understand if the outgassing occurred from the deeper waters and hence led to any rise in deepwater
C
O
3
2
−
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Background
There is a priority need to make community-based care widely available for people living with schizophrenia (PLwS) in low- and middle-income countries. An innovative approach for ...increasing access could be to integrate clinical services available in tertiary care hospitals with community-based care through a task-sharing approach. We describe such an integrated intervention that was implemented at Tezpur in northeast India in collaboration with the Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH).
Method
The objectives of the study were to illustrate the feasibility of integrating and implementing the intervention and to describe its individual, systemic, and public health impacts. Due to the limited resources available, we conducted a pragmatic single-arm longitudinal evaluation of the intervention cohort over 24 months.
Results
Of the 239 PLwS enrolled in the intervention, 198 (83%) were followed up for 24 months, with nearly three-quarters reporting a >70% reduction in disabilities, most notably between 6 and 18 months. There was a marked reduction in unmet needs across multiple domains, and at 24 months, 62% of the cohort was engaged in individual jobs or other market-linked livelihood opportunities. There was greater uptake and retention with outpatient contacts at the LGBRIMH, and PLwS experienced a marked (82%) reduction in inpatient admissions rates, as compared to before enrolment. Over a period of 24 months, primary caregivers reported that their families experienced significantly fewer social difficulties such as unemployment, interpersonal conflicts, and social isolation. The intervention had a significant public health impact, with an estimated 51.8% effective treatment coverage rate for the integrated intervention.
Conclusion
Our findings provide preliminary evidence of the feasibility of implementing the integrated intervention and its effectiveness. We believe that there is merit in further in-depth refinement and exploration of this implementation-related research and cost analysis while replicating the intervention in other tertiary care institutions.
Plain Language Summary
In low- and middle-income countries such as India, integrating clinical services available at tertiary mental health hospitals with community-based care through a task-sharing approach is an innovative way to make community-based care widely available for people living with schizophrenia (PLwS). The purpose of our study was to investigate the feasibility of implementing such an intervention in a community in Tezpur, northeastern India, in collaboration with a Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH), and to describe the individual, systemic, and public health effects of the intervention. Our findings suggest that integrating the intervention is feasible, has significant impacts on individuals and public health, and is an effective way to expand access to community-based care for PLwS through partnerships with existing tertiary care institutions.
Determination of propellant formulation by ballistic requirement is an important area of research in recent times. In this study, a theoretical method for the design of gun propellant formulation ...using primary data of ingredients and necessary thermochemical properties of the resultant propellant was established. The employed method is based on a mathematical model of thermochemical properties of the propellant by optimizing the heat of explosion of the propellant using the fmincon tool in MATLAB. A graphical user interface (GUI) based code was generated and developed for the formulation design of solid gun propellants. The designed code was verified by available data in the literature. Such code will be useful to the researchers working in the area of high energy materials for the design of unknown propellant compositions. Further, it can be extended to redesign the existing propellant formulation in order to enhance the ballistic performance.
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