Results from a large clinical trial funded by the National Institutes of Health show that an intervention for anxiety provided to pregnant women living in Pakistan significantly reduced the likelihood of the women developing moderate-to-severe anxiety, depression, or both six weeks after birth. The unique intervention was administered by non-specialized providers who had the equivalent of a bachelor’s degree in psychology-but no clinical experience. The results suggest this intervention could be an effective way to prevent the development of postpartum mental health challenges in women living in low-resource settings.

“In low resource settings, it can be challenging for women to access mental health care due to a global shortage of trained mental health specialists,” said Joshua A. Gordon, M.D., Ph.D., Director of the National Institute of Mental Health, part of NIH. “This study shows that non-specialists could help to fill this gap, providing care to more women during this critical period.”

Led by Pamela J. Surkan, Ph.D., Sc.D., of Johns Hopkins Bloomberg School of Public Health, Baltimore, the study was conducted in the Punjab Province of Pakistan between April 2019 and January 2022. Pregnant women with symptoms of at least mild anxiety were randomly assigned to receive either routine pregnancy care or a cognitive behavioral therapy (CBT)-based intervention called Happy Mother-Healthy Baby. The researchers assessed the participants (380 women in the CBT group and 375 women in the routine care group) for anxiety and depression six weeks after the birth of their child.

The researchers found that 9% of women in the intervention group developed moderate-to-severe anxiety compared with 27% of women in the routine care group. Additionally, 12% percent of women in the intervention group developed depression compared with 41% of women in the routine care group.

“Postpartum depression not only harms mothers, it is also associated with poorer physical growth and delayed cognitive development in their children,” said Dr. Surkan. “The link between maternal and child health highlights the critical importance of developing effective ways to address postpartum anxiety and depression.”

The Happy Mother-Healthy Baby intervention was created using input from pregnant women in a hospital in Rawalpindi, Pakistan. Pregnant women took part in six intervention sessions where they learned to identify anxious thoughts and behaviors, such as thoughts about possible miscarriage, and to practice replacing them with helpful thoughts and behaviors. The first five sessions were conducted in early to mid-pregnancy, and the sixth session occurred in the third trimester.

Prior research suggests that up to 30% of women in the Global South, which includes South America, Africa, and most of southern Asia, report experiencing anxiety during pregnancy. Anxiety during pregnancy predicts the development of anxiety and depression after birth, making the prenatal period a prime target for intervention. However, it can be challenging for women living in low-resource settings to access trained clinical care. The findings from this study demonstrate that an intervention such as Happy Mother-Healthy Baby could be an effective way to help prevent the development of postpartum depression and anxiety in settings where specialist clinical care may be hard to access.

“In the future, we can build on these findings through implementation research. Having identified an intervention that works, the next step is to figure out the best ways to deliver effective treatment to the people who need it, bridging the gap between science and practice,” said Dr. Surkan.

Reference:

Surkan, P. J., Malik, A., Perin, J., Atif, N., Rowther, A., Zaidi, A., & Rahman, A. (2024). Anxiety-focused cognitive behavioral therapy delivered by non-specialists to prevent postnatal depression: A randomized, phase 3 trial. Nature Medicine. https://www.nature.com/articles/s41591-024-02809-x.

Recently published multicentre prospective observational study was conducted to investigate the incidence, patient characteristics, diagnostic pathway, management, and outcome of acute mesenteric ischaemia (AMI). The study included adult patients with clinical suspicion of AMI admitted or transferred to 32 participating hospitals worldwide. It was found that AMI occurred in 0.038% of adult admissions in participating acute care hospitals, with a total of 705 included patients, of which 418 patients had confirmed AMI. The study revealed that occlusive arterial AMI was the most common type diagnosed, followed by venous AMI and non-occlusive AMI (NOMI).

Management and Outcome of Acute Mesenteric Ischaemia (AMI)

In 69% of cases, AMI was the primary reason for hospital admission, and in 31% of cases, AMI occurred after being admitted with another diagnosis. The median time from onset of symptoms to hospital admission was 24 hours, and the time from admission to diagnosis was 6 hours. Initial management involved surgery in 58% of patients, with 24.4% undergoing revascularization. The overall in-hospital and 90-day mortality rates for AMI were 49% and 53.3%, respectively, with the highest mortality seen in the NOMI subtype (72.7% and 74.5%).

Variability and Need for Standardization in Management of Acute Mesenteric Ischaemia (AMI)

The study also highlighted the variability between participating sites for most variables studied, indicating a lack of standardized management internationally. Furthermore, the findings suggest a need for greater awareness of AMI, better guidance in diagnosis and management, and emphasize the importance of computed tomography angiography and immediate surgical treatment in patients with suspected AMI. The study provided valuable insights into the incidence, characteristics, diagnostic pathways, management, and outcomes of AMI, but also highlighted the need for further research and consensus processes to improve the understanding and management of this condition.

Reference –

Reintam Blaser, A., Mändul, M., Björck, M. et al. Incidence, diagnosis, management and outcome of acute mesenteric ischaemia: a prospective, multicentre observational study (AMESI Study). Crit Care 28, 32 (2024). https://doi.org/10.1186/s13054-024-04807-4

India: A recent study published in the Indian Heart Journal has shed light on the trends in the epidemiology of dyslipidemias in India.

Chronic constipation is a common gastrointestinal issue among individuals with Parkinson’s disease (PD), significantly impacting their quality of life. Elobixibat, an ileal bile acid transporter inhibitor, has shown potential in improving bowel movements and stool consistency in patients with chronic constipation.

Raipur: Three nurses were dismissed from service for allegedly filming reels in the operation theatre of a Dau Kalyan Singh PG Institute and Research Centre in Raipur in Chhattisgarh and sharing them on social media. 

The services of Pushpa Sahu, Tripti Dasar and Tej Kumari, who were daily wage staff nurses at Dau Kalyan Singh PG Institute and Research Centre Raipur, were terminated on February 23 after a complaint was received against them, said facility deputy superintendent Dr Hemant Sharma. 

Also Read:Wrong blood transfusion on pregnant woman: Two doctors terminated, staff nurse suspended

On February 5, reels shot by the trio inside the operation theatre of the burn and plastic surgery unit came to the notice of the Assistant Nursing Superintendent following which higher authorities were informed, he said.

“Clicking pictures and making reels inside operation theatres is against rules. The nurses are also seen wearing shoes and sandals that they usually wear outside the OT. They allegedly misbehaved with the ward incharge when she objected to their act,” he said.

In one of the two reels shared by the hospital management, the three nurses, wearing green dresses used in operation theatres, are seen dancing holding surgical items to songs like ‘first rahu mai dar badar’ and ‘why this kolaveri di’.

Speaking to media persons, Hemant Sharma posted as the deputy superintendent of the hospital said that as soon the video went viral, a complaint was lodged against them, and they were terminated soon after, reports HT.

 Also Read:3 doctors served notices, Nurse suspended over swapping of newborn bodies at Indore Hospital