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The rates of postnatal depression (PND) in British South Asian (BSA) women are higher than the general population. PND is known to cause disability and suffering in women and negative consequences for their infants and their family with huge costs to society. Due to linguistic and cultural barriers, BSA women do not access health care services.
To conduct an exploratory trial to test the feasibility and acceptability of a culturally adapted group Cognitive Behavioural Therapy (CBT) intervention (Positive Health Programme (PHP).
We aimed to determine if depressed BSA women receiving the PHP intervention will show significant improvements in terms of severity of depression, marital support, and social support as compared to the control group.
We used a two-arm pragmatic single-blind randomised controlled design. Women meeting the inclusion criteria were randomised either to the experimental group receiving PHP or treatment as usual (TAU) that is standard care usually provided by the GP.
A total of 615 mothers were screened for participation in the trial, of these 137 were assessed further to determine eligibility. Eighty-three mothers were randomized to receive either PHP (n = 42) or treatment as usual (TAU) (n = 41). Mothers found the intervention to be acceptable and felt an overall positive change in their attitudes, behaviour and confidence level.
The recruitment and retention figures (70%) highlight the ability of the research team to engage with the population. The findings suggest the acceptability of the culturally adapted PHP intervention for British South Asian women with postnatal depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
There is a scarcity of specialist trainers and supervisors for psychosocial interventions in low- and middle-income countries. A cascaded model of training and supervision was developed to sustain delivery of an evidence-based peer-delivered intervention for perinatal depression (the Thinking Healthy Programme) in rural Pakistan. The study aimed to evaluate the model.
Mixed methods were employed as part of a randomised controlled trial of the intervention. Quantitative data consisted of the peers' competencies assessed during field training and over the implementation phase of the intervention, using a specially developed checklist. Qualitative data were collected from peers and their trainers through 11 focus groups during the second and third year of intervention rollout.
Following training, 43 peers out of 45 (95%) achieved at least a ‘satisfactory’ level of competency (scores of ⩾70% on the Quality and Competency Checklist). Of the cohort of 45 peers initially recruited 34 (75%) were retained over 3 years and showed sustained or improved competencies over time. Qualitatively, the key factors contributing to peers' competency were use of interactive training and supervision techniques, the trainer–peer relationship, and their cultural similarity. The partnership with community health workers and use of primary health care facilities for training and supervision gave credibility to the peers in the community.
The study demonstrates that lay-workers such as peers can be trained and supervised to deliver a psychological intervention using a cascaded model, thus addressing the barrier of scarcity of specialist trainers and supervisors.
This study associated Human Papillomavirus (HPV) infection and other clinical parameters with five-year survival of oral squamous cell carcinoma patients at a tertiary care hospital in Karachi, Pakistan.
A total of 140 patients diagnosed with oral squamous cell carcinoma were enlisted. HPV status and subtypes were established through polymerase chain reaction performed in a previously published study. Clinical data including five-year survival were obtained through institutional medical records.
Ninety-five patients (67.9 per cent) were positive for HPV. Of these, 85 patients were HPV 16 positive while 2 patients were HPV 18 positive. The mean survival time for HPV positive patients was 44.3 months, whereas survival time for HPV negative patients was 46.9 months. Univariate analysis showed that HPV status in oral squamous cell carcinoma was not a statistically significant factor in determining five-year survival rate (p = 0.386).
There is a high prevalence of HPV positive oral squamous cell carcinoma in Pakistan; however, there is no difference in the five-year survival rate when compared to HPV negative oral squamous cell carcinoma.
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