bluuebunny/crossref_metadata_2025_split huggingface dataset:
Co-Development of a Bereavement Support Program for Parents With Lived Experience of Stillbirth or Neonatal Death in Pakistan
Authors: Naz Subia , Ali Tazeen , Chaudhry Nasim , Hussain Nusrat , Mills Tracey 
Published: August 2024

AimsRates of stillbirth and neonatal deaths are high in low- and middle-income countries including Pakistan and these are one of the most stressful life-events for parents and families. Society does not appropriately recognize perinatal loss and support from healthcare professionals is often very limited or non-existent in Pakistan. Therefore, we aimed to co-develop and assess the feasibility of a bereavement support program for parents who experienced stillbirth/neonatal death in a public health facility in Pakistan.MethodsThis study adopted a sequential mixed-method design. The first phase involved co-development of a bereavement support program through a consensus process involving multidisciplinary health professionals, stakeholders and parents with previous experience of perinatal death (n = 23) using the Nominal Group Technique. Phase 2 includes a feasibility assessment using before and after cohort design. Sixty women (30 per phase) with recent experience of stillbirth and/or neonatal death will be recruited, from a public hospital in Pakistan. The main outcome measures will include recruitment and retention and acceptability of the study processes and data collection.ResultsFollowing the consensus process, agreed intervention components included an educational workshop for healthcare staff, creation of a bereavement champion group of health workers in the facility and offering post-natal telephone peer support to bereaved mothers. The educational component for healthcare staff includes Advance Bereavement Care (ABC) workshop for all staff and bereavement champions (n = 15 healthcare workers) who later received one day's training and one-day training refresher. This component aims to improve care, act individually and as a group to identify areas for development, encourage good practice and support colleagues. The peer support component includes telephone support provided by women with previous experience of perinatal death (n = 7) trained by the research team. Supervision arrangements are in place for champions and peer supporters. The feasibility study is ongoing.ConclusionThe co-development process ensured the cultural relevance of both components of the bereavement support program. The process also contributed to improving the sense of ownership by healthcare facility. Feasibility study will confirm whether parents are willing to take part, acceptability and whether future research to assess the effectiveness of the intervention on improving care after SB/NND is feasible.
A Multicenter Randomized Controlled Trial of Measurement-Based Care for Major Depressive Disorder in Pakistan
Authors: Nigah Zahra , Chaudhry Nasim , Husain Nusrat , Chaudhry Imran , Husain Ishrat 
Published: August 2024

AimsA worldwide public health concern is major depressive disorder (MDD) with limited availability and access to evidence-based treatment in low- and middle-income countries (LMICs) such as Pakistan. Measurement-based care (MBC) is a low-cost strategy to improve clinical outcomes for people with MDD that involves the systematic administration of validated outcome measures to inform treatment decisions. However, research on MBC's effectiveness in LMICs is scarce. This paper aims to evaluate the feasibility and clinical effectiveness of MBC against standard care for patients with moderate to severe MDD in Pakistan.MethodsThis is a multicenter randomized control trial. Participants (n = 154) of 18 to 65 years of age recruited from psychiatric units of teaching and non-teaching hospitals and primary care settings such as General Physician (GP) clinics and Basic Health Units (BHUs) from 6 cities were randomised to receive MBC (guided by a schedule), or standard treatment (guided by clinicians’ judgement). Patients were prescribed by treating clinicians either with mirtazapine (7.5–45 mg/day) or paroxetine (10–60 mg/day) for a period of 12 weeks. All participants, regardless of their treatment arm, were followed-up till 24 weeks post-randomization and assessed for severity of depression. Side effects were regularly monitored using standard checklist. Outcome assessors were blind to treatment allocation.ResultsThe Pakistani National Bioethics Committee (NBC) has granted complete ethical approval. A total of 15 psychiatrists and 4 General Practitioners (GPs) were approached and invited to participate in the study and consent was given by 9 psychiatrists and 2 GPs. A total of 351 patients were screened against eligibility criteria and 177 were eligible to participate. A total of 154 eligible participants consented (87%) to participate and were recruited and randomized into the trial. A total of 131 randomized participants (85%) completed 24-month follow-up. Only two adverse events were reported during the trial period. Recruitment, retention and safety analysis indicates feasibility of the trial in Pakistani healthcare context. The data are being analyzed for effectiveness outcomes.ConclusionIt is essential to investigate the viability, usefulness, and efficacy of MBC for MDD in low-resource settings due to mounting data from high-income settings confirming its effectiveness. The planned trial's outcomes may help build a scalable, low-cost method for effectively improving outcomes for MDD patients in Pakistan.
Functions, Characteristics, and Experiences of Non-Suicidal Self-Injury: A Cross-Sectional Study of Youth and Adolescents in Singapore
Authors: Lin Xiaowen , Ling Neo Michelle Hui , Ong Jamie Jiehan , Fong Ying Jie , Chee Tji Tjian 
Published: August 2024

AimsNon-Suicidal Self-Injury (NSSI) occurs when direct, deliberate harm is caused to one's physical body without intention of suicide. Approximately 22.1% of youth worldwide would engage in NSSI in their lifetimes. Due to the increased risk of harm and future suicide attempts, NSSI is a behaviour that warrants attention and has been identified as a condition in need of further study. While some studies have examined the prevalence and experiences of NSSI in Singapore, there is a lack of detailed studies on the presentation and overall phenomenology of NSSI in the local context. This study aims to assess the characteristics of NSSI using the Non-Suicidal Self-Injury – Assessment Tool (NSSI-AT) in a cross-sectional design. We investigated the functions, characteristics, and personal experiences of local youths who engage in NSSI for the development and improvement of patient-centred care.Methods121 youths between 12 and 25 years old were recruited from the National University Health System. The study included patients seeking treatment for mood disorders and have self-reported NSSI behaviours such as cutting, hitting, and scratching prior to or at the time of visit. Outcomes for the NSSI–AT, including the actions, functions, frequency, age of onset, initial motivations, severity, practice patterns, disclosure, and treatment experiences of self-harm, were reported using descriptive analysis. Personal reflections were analysed using thematic analysis.ResultsParticipants were mostly female (n = 86, 71.1%) with a mean age of 16.2 years (SD = 2.33). Many participants engaged in NSSI actions such as cutting, scratching, and banging on objects, to manage high-pressure agitating and low-pressure depressive emotional states. Most participants started engaging in NSSI in early adolescence (mean = 13.0 years old, SD = 2.37, range = 7–23) and have hurt themselves more severely than intended (n = 79, 65.3%). When reflecting on overall NSSI experiences, participants had similar levels of ambivalence toward NSSI and growth due to NSSI. Participants also gave encouragement to others going through similar experiences and reported the negative aspects of self-harm.ConclusionFindings support emotional regulation as a function of NSSI in the local population, where self-harm was not generally used for social communication purposes. Findings also suggest that youths may be more vulnerable to NSSI during early adolescence, corresponding to a time of substantial life changes. This study also demonstrated the individuality of NSSI experiences among the local youth, highlighting the importance of having a person-centred approach in NSSI treatment. Taken together, this highlights the need to develop interventions that can effectively serve this age group and their specific challenges.
A Comparison of the Use of Handheld KardiaMobile ECG Devices With 12-Lead ECGs in an Older Adult Psychiatric Setting
Authors: Cross Ben , Leadbetter Jane , Richman Anna 
Published: August 2024

AimsTo establish the usability and tolerability, as well as accuracy of measurements of a handheld KardiaMobile ECG device in an inpatient older adult dementia ward.MethodsBetween February 2023 and April 2023, KardiaMobile ECGs and 12-lead ECGs were taken for patients admitted within a dementia ward in Liverpool. The standard 12-lead ECGs were analysed as per current practice, by Broomwell Health Watch. The KardiaMobile ECGs were read manually, by two independent raters, for heart rate and QTc. The user-rated tolerability was measured out of 5, 5 being the most tolerable, and was measured for both KardiaMobile and 12-lead ECGs, allowing comparison. The QTc and heart rate were calculated for both methods, and then compared. QTc was calculated using Bazett's formula.Results13 inpatients had a 12-lead ECG, and a KardiaMobile ECG performed. Both were tolerated by all patients, except one who tolerated neither, leaving 12 ECGs for comparison. KardiaMobile ECGs were quicker to obtain, more well tolerated, and easy to use. However, manual calculation of QTc, versus expert and computer analysis for 12-lead ECGs, led to some variability between QTc measurements. Inter-rater reliability between raters for the KardiaMobile QTc was poor, however, when both were combined, correlation with 12-lead ECG QTc was moderate. KardiaMobile ECGs were harder to obtain in those with tremors, and the lack of computerised readings made interpretation more difficult. 12-lead ECGs also offer reassurance in the form of a fully interpreted, more detailed ECG.ConclusionKardiaMobile devices are faster to use and as/more tolerable in a dementia ward setting than 12-lead ECGs. The ECG trace is fed back instantly to the mobile device, however, automatic interpretation is limited and QTc calculation relies on the operator. Visual inspection of QTc can be difficult, and unreliable. However, the combination of two different raters led to more reliable results. The device has potential for use in this setting, however, an increase in automatic interpretation, or interpretation by a third party such as with Broomwell Health Watch, would increase its usability.
Youth Group Wellbeing Project for Adolescents Impacted by the March 15 Attacks – Protocol for a Pilot Randomised Waitlist-Controlled Trial
Authors: Donovan Katherine , Dean Shaystah 
Published: August 2024

AimsPsychological distress is common in adolescence; even more so following traumatic events. On 15 March 2019, two mosques in Christchurch were targeted in an act of terrorism. This has had widespread repercussions in the Muslim and wider community in Christchurch and New Zealand. This protocol offers an integrated group treatment based on an indigenous Islamic Psychology framework incorporating components of established transdiagnostic interventions for increasing wellbeing and reducing psychological distress in teenagers. We aim to measure the effect size of the treatment effect on total difficulties, emotional difficulties, trauma symptoms, somatic symptoms and functional impairment in adolescents self-identifying as impacted by the terror attack. We will measure the degree of parental distress and somatic symptoms to explore whether an intervention for adolescents has an impact on parental wellbeing. We will determine the feasibility and acceptability of this approach to inform supports for similar populations and as an example of cultural adaptation of mental health services.MethodsThis is a randomised controlled trial with a waitlist-controlled design to measure the size of treatment effects on clinical outcomes, and the feasibility of this protocol. We aim to recruit 64 participant families. A 6-week group programme will be offered to teenage participants randomised to the study group and offered to the waitlist group following the study. The study will be community-based in one site. We will assess clinical outcomes including emotional difficulties and somatic symptoms in teenagers (aged 12–19) and parents at baseline, end of treatment and at 3-month follow-up, and measure the project's acceptability with participants and parents. Individuals’ experiences of the programme will be examined using qualitative analysis of participant interviews at the end of the programme. Statistical analysis will be a mixed method design including effect size difference calculations, quantitative measures of acceptability and qualitative analysis. Treatment data from participants randomised to the waitlist first will not be included in statistical comparison of treatment effects but will be used for the assessment of feasibility.ResultsThis study will inform whether this unique approach is feasible and easily accessible for adolescents impacted by traumatic events. Its design has been driven by community engagement and stakeholder consultation to consider recruitment, relational safety, screening, and risk management. The project has an emphasis on widening access to mental health supports in a minority faith community by maintaining cultural sensitivity and reducing stigma associated with mental illness.ConclusionTrial registration: ClinicalTrials.gov, NCT05030909. Registered on 8 September 2021.
Integrated Parenting Intervention for Depressed Fathers of Young Children: A Nested Qualitative Study From Pakistan
Authors: Sattar Rabia , Chaudhry Nasim , Kiran Tayyeba , Husain Nusrat , Husain Ishrat 
Published: August 2024

AimsDepression is a leading cause of disability, contributing to the global burden of disease. Low- and middle-income countries (LMICs) carry over 80% of this disease burden. There are high rates of depression in men in Pakistan. Paternal depression is often overlooked and is an under-researched area. Fathers are at risk of depression particularly if their partner is depressed. There is a need for integrated partner inclusive interventions to improve both parent and child outcomes including overall child development. Therefore, this nested qualitative study aims to identify barriers in transition to scale up an innovative low-cost partner inclusive culturally adapted psychosocial intervention for depressed fathers through a process evaluation from the perspective of fathers.MethodsThis qualitative study was nested within a cluster randomized controlled trial, with depressed fathers of young children (0–3 years) recruited from 18 towns in Karachi, Pakistan. Face to face or digitally audio-recorded interviews were conducted with depressed fathers (N = 24) from the intervention arm of the trial at end of intervention period (i.e., 4-month post-baseline). The intervention involved twelve sessions of a parenting intervention called Learning Through Play integrated with group Cognitive Behaviour Therapy and manual content from “Focus on Fathers”. Interviews were guided by a semi-structured topic guide to explore perceived usefulness of the intervention with particular focus on exploring any additional benefits or challenges of engaging partners into the intervention. Interviews lasted approximately an hour. Data were analysed using the principles of Framework Analysis. A concurrent analysis of initial interviews directed towards further interviews until data saturation.ResultsAnalysis highlighted perceived usefulness of the intervention such as improvement in mood, engagement in routine tasks, healthy thinking patterns, increased attachment with child, improved relationship with the family, improvement in parenting knowledge and more positive attitudes towards child development, supporting partners in household chores, and recommendation to promote this partner inclusive parenting program throughout the country.ConclusionAddressing depression in parents is hugely important due to its adverse impact on both parents and children. This low-cost parenting program supported fathers in their parenting role along with improvement in psychological well-being. This has also informed barriers and facilitators to implement the LTP plus parenting program and the possibilities to roll out the intervention at national level.
Prevalence and Interrelation of Irritable Bowel Syndrome With Generalized Anxiety Disorder Among Sudanese Medical Students, 2020
Authors: Heamid Samah H. , Ibrahim Danya 
Published: August 2024

AimsThis study aimed to determine the prevalence of irritable bowel syndrome (IBS) among medical students at Khartoum University and to examine its association with generalized anxiety disorder (GAD).MethodsThis cross-sectional study was conducted between December 2020 and February 2021, using the Rome IV criteria to diagnose IBS and a 7-item generalized anxiety disorder (GAD-7) scale to assess GAD. A total of 395 self-administered questionnaires were distributed using proportional allocation based on percentages of students in each academic year and their gender. Simple random sampling was used to select participants. The analysis was done using SPSS, and a p-value of <0.05 was considered significant.ResultsWe included 325 medical students with a mean age of 21.4 ± 2.2 years, and 69.5% females and 30.5% males. The overall prevalence of IBS was 16.6%, with the most common subtype being IBS-M (35%), followed by IBS-D (31%), IBS-C (28%), and IBS-U (6%). The prevalence of GAD was 22.8%, and anxiety was detected in 54.5% of students. 7.7% of students had both IBS and GAD, and there was a statistically significant relationship between IBS and GAD (Chi-square = 20.385; p < 0.001).ConclusionThe study findings aligned with previous literature underscoring the prevalence of IBS and GAD among medical students at Khartoum University. Also, sheds light on a substantial association between them. Providing psychological support and stress management programs to medical students is paramount and key to a favorable prognosis.
A Systematic Review of Virtual Reality vs. Standard Social Skills Training for Improving Social Interaction Skills and Reducing Social Anxiety in Children With Autism Spectrum Disorder (ASD)
Authors: Idowu Oluwatobi , Aderinto Nicholas , Olatunji Gbolahan , Kokori Emmanuel 
Published: August 2024

AimsAutism Spectrum Disorder (ASD) poses unique challenges for social interaction and communication skills development in children. Various interventions, including virtual reality (VR) and social skills training, have emerged as potential approaches to address these challenges. This systematic review aims to evaluate and compare the effectiveness of VR Social Skills Training with Standard In-Person Social Skills Training in improving social interaction skills and reducing social anxiety levels in children with ASD.MethodsA search was conducted across electronic databases (PubMed, PsycINFO, Cochrane Library and Scopus) for relevant studies published from 2000 to December 2023. Inclusion criteria include randomised controlled trials (RCTs) and observational studies comparing VR Social Skills Training with Standard In-Person Social Skills Training in children diagnosed with ASD within the specified age range. Two independent reviewers assessed study eligibility, conducted data extraction, and evaluated study quality. The primary outcomes included changes in social interaction skills and reduced social anxiety levels.ResultsFrom 1,239 studies initially identified, 25 met inclusion criteria post-screening. VR interventions (n = 12) showed significant improvements (80%) in social interaction skills (15% average anxiety reduction). Varied platforms were utilised, including virtual social scenarios. Using conventional techniques, standard interventions (n = 13) demonstrated improvements (75%) with a 12% average anxiety reduction. Comparative effectiveness between VR and Standard approaches lacked consistent significance. Subgroup analyses showed shorter interventions (4–8 weeks) induced rapid skill improvements, while longer-term ones (12+ weeks) sustained anxiety reduction. Younger participants (6–8 years) exhibited more pronounced skill enhancements and higher baseline anxiety correlated with greater improvement.ConclusionThis review provides an overview of the current evidence on the comparative effectiveness of VR Social Skills Training and Standard In-Person Social Skills Training for children with ASD. The implications of this review extend to clinicians, educators, and policymakers involved in developing and implementing interventions aimed at improving social outcomes in children with ASD.
Dementia in the United Arab Emirates: Factors Affecting the Time From Symptom Emergence to Formal Diagnosis
Authors: Javaid Syed Fahad , Shebani Zubaida , Andrade Gabriel 
Published: August 2024

AimsDementia is a debilitating neurodegenerative disorder that can negatively impact the lives of those affected and their families. Providing safe and person-centered care for individuals living with dementia is a global need with particular emphasis on providing individuals and their families with a rapid diagnosis of their condition following the commencement of symptoms. This study aimed to establish the mean duration of cognitive symptoms before a formal diagnosis of dementia is given in the United Arab Emirates (UAE). We also studied demographic and symptom-specific factors affecting the time for dementia to be formally diagnosed. Our study examined a global issue through a more localized lens to identify areas for improvement.MethodsThe study involved extracting and analyzing anonymous data from the electronic medical records of dementia patients at Al-Ain Hospital, UAE. Following ethical approval, the data for individuals diagnosed with any form of dementia from 01/01/2010 to 31/12/2019 were extracted using a set of related diagnostic codes. A short questionnaire was completed for every record that matched the search criteria. Demographic information was collected in addition to details of diagnosis, presenting symptoms, comorbidities, and medications.A two-tailed independent t-test was conducted to assess the effect of demographic characteristics (gender, nationality, and age) on the time to receive a diagnosis of dementia. A one-way ANOVA was conducted to assess the effect of initial symptoms, including forgetfulness, agitation/aggression, and hallucinations, on the time taken to receive a diagnosis.ResultsOut of the total sample of 825, 442 (53.6%) were females, with 518 (63%) being Emirati citizens. The mean age of the studied sample at the time of diagnosis was 78 years (SD = 11.1). Alzheimer's dementia, 335 (40.6%), was the most common subtype diagnosed. The mean duration of symptoms (DUS) before formal diagnosis was 34.6 months (SD = 28.8). A statistically significant relationship was found between age and DUS, with those over 70 years of age at the time of diagnosis more likely to have a longer DUS (p < 0.001). There was a statistically significant mean difference in the DUS and some initial symptoms, namely agitation/aggression(p < 0.001), lability (p < 0.003), disinhibition (p < 0.001), and hallucinations (p < 0.001).ConclusionTo our knowledge, this is the first study of its kind in the UAE. Future investigation in this area is much needed, and this study will provide the foundations for dementia awareness campaigns encouraging early presentation to the services.No financial sponsorship has been received for this study.