Mental healthcare-seeking behavior during the perinatal period among women in rural Bangladesh.

INTRODUCTION: Mental health conditions are of rising concern due to their increased contribution to the global burden of disease. Mental health issues are inextricably linked with other socio-cultural and health dimensions, especially in the rural areas in developing countries. The complex relationship between mental health issues and socio-cultural settings may largely toll upon healthcare-seeking behavior. So, it urges to document the current status of mental healthcare-seeking behavior during the perinatal period among rural women in Bangladesh to develop a context-specific intervention in the future. METHODS: This study was carried out in one sub-district in Bangladesh from April 2017 to June 2018. We conducted 21 In-depth Interviews (IDIs) and seven Focus Group Discussions (FGDs) with different groups of purposively selected participants. After collecting the recorded interview and making the verbatim transcription, the data were coded through Atlasti 5.7.a. Data were analyzed thematically to interpret the findings. RESULTS: Two-thirds of the total respondents did not seek mental healthcare during the perinatal period at the community level. They also did not know about the mental health service provider or the facility to get set these services. Only one respondent out of twenty-one sought maternal mental healthcare from a gynecologist from a private hospital. Socio-cultural factors such as social stigma, traditional beliefs and practices, social and religious taboos, and social capital negatively influence healthcare-seeking behaviors. Besides, the community-level service providers were not found to be adequately trained and did not have proper guidelines regarding its management. CONCLUSION: The findings provide evidence that there is an urgent need to increase the awareness for service users and formulate a guideline for the community-level service provider to manage maternal mental problems during the perinatal period of women in rural Bangladesh.

Implementing a digital human resources management tool in the government health sector in Bangladesh: a policy content analysis.

INTRODUCTION: In Bangladesh, to address the challenges of ensuring adequate human resources for health (HRH), the government began implementing a digital tool for HRH management in 2017. However, evidence suggests institutionalizing such tools in low-and-middle-income countries is impeded by policy aspects like implementation strategy and poor regulatory framework. Therefore, we aimed to explore factors in the current policy landscape that might facilitate and challenge the implementation of the tool in Bangladesh. METHODS: We conducted a review of policies related to ICT implementation and human resources management in the health sector in Bangladesh using qualitative content analysis method. Ten policies have been identified, and extensive reading was done to ascertain common themes and patterns. A document analysis matrix was developed to synthesize and help interpret the findings. RESULTS: Regarding facilitators, strong upstream level commitments were reflected in the content of policies in terms of setting out specific objectives, targets, timelines, and budget allocation. However, the lack of explicit monitoring strategy and extent of stakeholders' engagement was not well-defined, ultimately creating chances for impeding downstream implementation. In addition, effective coordination among stakeholders and different HRH and ICT policies could be strengthened. DISCUSSION: Findings support the current discourse that national commitment plays a vital role in the integration of ICTs in health services. However, well-defined monitoring strategy and inter-ministry and intra-ministry policy coordination are crucial.

Effects of naproxen on immune responses in a colchicine-induced rat model of Alzheimer's disease.

BACKGROUND: The components of the immune system have been indicated to be linked with the neurotoxicity in Alzheimer's disease (AD). The participation of the immune system in the neurodegeneration in a rat model of colchicine-induced AD has not been explored. METHODS: In the present study, hippocampal neurodegeneration along with reactive oxygen species (ROS), nitrite and TNF-α in the hippocampus and some systemic immune responses were measured after 15 and 21 days of intracerebroventricular colchicine injection in rats and again after oral administration of different doses of the anti-inflammatory drug naproxen in AD rats. RESULTS: Chromatolysis and amyloid plaques were found along with higher ROS, nitrite and TNF-α levels in the hippocampus of colchicine-induced AD rats, and these changes were prevented by naproxen in a dose-dependent manner. Alterations in immunological parameters [increased phagocytic activity of white blood cells and splenic polymorphonuclear cells (PMN), increased cytotoxicity and decreased leucocyte adhesive inhibition index (LAI) of splenic mononuclear cells (MNC)] were also observed in colchicine-injected rats, which showed a dose-dependent recovery after oral administration of naproxen in AD rats. The number of plaques, chromatolysis of Nissl granules, TNF-α, nitrite and ROS levels in the hippocampus, phagocytic activity of splenic PMN and LAI of splenic MNC in AD rats showed greater changes in the 21- than in the 15-day study, and the recovery of these parameters after administration of naproxen differed between the two study durations. CONCLUSION: The present study shows that colchicine-induced neurodegeneration is time dependent and mediated by cyclooxygenase-induced neuroinflammation, which is reflected in the systemic immunological responses.

Effects of vitamin C on the hypobaric hypoxia-induced immune changes in male rats.

Hypobaric hypoxia (HH) induces oxidative stress (OS) and is associated with the generation of reactive oxygen species (ROS). Vitamin C is an efficient antioxidant, and it is used in a high-altitude environment to reduce the OS. The present study explores the role of vitamin C on some HH-induced changes of immune parameters in rats which were exposed to HHc condition at 18,000 ft in a simulated chamber for 8 h/day for 6 days with and without vitamin C administration at three different doses (200, 400, and 600 mg/kg body wt). The phagocytic activity of circulating blood WBC was increased, and the cytotoxic activity of splenic mononuclear cell (MNC) and the delayed type of hypersensitivity (DTH) responses to bovine serum albumin (BSA) were decreased in rats exposed to HHc condition, but these immune changes were blocked after administration of vitamin C at 400 mg/kg body wt. The leukocyte adhesive inhibition index (LAI) was not altered either in HHc condition or after administration of vitamin C in HHc condition. The serum corticosterone (CORT) concentration was increased in rats exposed to HHc condition which was blocked after administration of vitamin C (400 mg/kg body wt). The immune parameters and serum CORT concentration, however, did not show any recovery after administration of vitamin C at the dose of 200 and 600 mg/kg body wt. The present study indicates that administration of vitamin C at a dose of 400 mg/kg body wt may prevent the HH-induced immunological changes but not at the lower dose (200 mg/kg body wt) or higher dose (600 mg/kg body wt) in rats.

Effects of naproxen on the hypobaric hypoxia-induced immune changes in male rats.

Some cell-mediated immune responses are altered in hypobaric hypoxic (HH) condition in rats. Prostaglandins (PGs) are increased in hypobaric hypoxia and non-steroidal anti-inflammatory drugs are used to facilitate acclimatization in high altitude by inhibiting PGs. The present study explores the role of PGs in hypobaric hypoxia-induced immune responses by inhibiting its synthesis with different doses of naproxen. The rats were exposed to HH condition at 18,000 ft in a simulated chamber for 8 h/day for 6 days. The phagocytic activity of circulating blood WBC, measured by fluorescein isothiocyanate-tagged bacterial cell, was increased in HH and this change was blocked after administration of naproxen. There was reduction of natural killer cell cytotoxicity of splenic mononuclear cell and delayed type of hypersensitivity responses to bovine serum albumin in rats exposed to HH condition but these immune responses were blocked after administration of naproxen in HH condition. The leukocytes adhesive inhibition index was not altered in HH condition and after administration of naproxen in HH condition. The serum corticosterone (CORT) concentration was increased in rats exposed to HH condition and this elevated CORT concentration was blocked after administration of naproxen in HH condition. The observed HH-induced immune changes are inhibited by naproxen in a dose-dependent manner. The study indicates that hypobaric hypoxia-induced immune changes are mediated by PGs.

Service coverage and health workforce allocation strategies for geriatric and palliative care in low- and middle-income countries: A protocol for a systematic review and meta-analysis.

BACKGROUND: Advances in medical science coupled with increased people's income results an elevated average of life expectancy even in the resource poor countries. The growing number of aged population, however, has drawn little attention in health system discourse of low- and Middle-Income Countries (LMICs). Nevertheless, ensuring availability of appropriate service and properly trained and skilled health workforce is an absolute necessity for a functional geriatric and palliative healthcare. Given the lack of specialist geriatricians in LMICs contexts, there are other health workforce strategies that might be effective in building a proper health system response to this growing demand. Therefore, we aimed to identify and synthesize evidence on the existing health workforce-related strategies taken to provide geriatric and palliative care in LMICs. METHODS: We will follow the recommendations provided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist. Following the PRISMA guidelines, we will search the Medline/PubMed, Scopus, Web of Science and Cochrane database from January 2011 to December 2021 using a comprehensive search strategy. Two independent reviewers will screen the title and abstracts text using the specified inclusion and exclusion criteria. For the finally included articles, full manuscripts will be retrieved, and reviewers will appraise and extract data using standardized form independently. The third reviewer will resolve any disagreements appear in the process. The findings of the review be synthesized using the narrative synthesis approach to analyse descriptive quantitative and qualitative data. Furthermore, meta-analysis will be done provided that the data meet certain requirement as per Cochrane guideline. Rayyan software will be used to manage and synthesize data. Revman software will be used to do meta-analysis, if data support. RESULTS: Findings of this review will be published in a peer-reviewed journal. CONCLUSION: This systematic review will identify the existing effective strategies taken to provide geriatric and palliative care, in LMICs.

Effects of electrolytic lesion of medial septum on some immune responses in rats.

BACKGROUND/AIM: Considering the modulatory role of medial septum (MS) on behavioral and autonomic activities, and its neural connections with other brain areas having effects on the immune system, the role of MS on some immune responses has been investigated. METHODS: Hyperreactivity scores, total count and differential count of WBC, phagocytic activity of blood WBC, leukocyte adhesive inhibition index (LAI), delayed type of hypersensitive (DTH) reaction and serum corticosterone (CORT) concentration were measured in MS-lesioned, sham-operated and control rats after 2 and 3 weeks of operation. The results of MS-lesioned rats were compared to those in the control and sham-operated rats. RESULTS: The hyperreactivity score was not changed in the MS-lesioned rats. The phagocytic activity of blood WBC was increased but the DTH reaction and percentage of LAI were decreased in the MS-lesioned rats compared to the control and sham-operated rats 2 weeks after surgery. The serum CORT concentration was increased in the MS-lesioned rats compared to the control and sham-operated rats 2 weeks after surgery. After 3 weeks of MS lesion these immunological parameters and CORT concentration returned back to the normal values indicating a transient change of these parameters. CONCLUSION: This study concludes a complex and differential regulatory role of MS in the immune functions which are not linked with the hyperreactive behavior in rats. This immunoregulation of MS appears to be different from that of the lateral septum like their dissimilar modulatory roles in some behaviors.

Effects of stimulation of muscarinic acetylcholine receptors in medial septum on some immune responses in rats.

OBJECTIVES: Though the immunomodulatory role of medial septum (MS) has been indicated, but the contribution of the muscarinic acetylcholine (mAch) receptors presented in the internal network of the neurons of MS in this regard is not known. The aim of the present study is to assess the contribution of mAch receptors of MS on some immunological parameters. METHODS: Different immunological parameters i.e. phagocytic activity of peripheral leukocytes, adhesibility and cytotoxicity of splenic mononuclear cells (MNC), delayed type of hypersensitivity (DTH) responses, Total Count (TC) and Differential Count (DC) of WBC with serum corticosterone (CORT) concentration have been measured after stimulation and blocking of mAch receptors of MS in rats. Ach or atropine has been micro infused into MS of separate groups of rats for stimulating or blocking of the mAch receptors respectively. RESULTS: In Ach or atropine microinfused rats, the TC of WBC remained unaltered in the present study. The percentage of neutrophil has increased and the percentage of lymphocyte has decreased in Ach microinfused rats, but these parameters remain unaltered in atropine microinfused rats. The observed immunological parameters have increased after microinfusion of 0.60µM and 0.12µM of Ach and serum CORT concentration has decreased in those animals. These immunological parameters have decreased and serum CORT has increased after microinfusion of atropine (2 and 4mM) in MS of rats. CONCLUSION: It appears that the Ach receptors in MS can modulate the observed immunological parameters, and serum CORT plays an important role for these immune changes.

Naproxen, a Nonsteroidal Anti-Inflammatory Drug, Can Affect Daily Hypobaric Hypoxia-Induced Alterations of Monoamine Levels in Different Areas of the Brain in Male Rats.

Goswami, Ananda Raj, Goutam Dutta, and Tusharkanti Ghosh. Naproxen, a nonsteroidal anti-inflammatory drug can affect daily hypobaric hypoxia-induced alterations of monoamine levels in different areas of the brain in male rats. High Alt Med Biol. 17:133-140, 2016.-The oxidative stress (OS)-induced prostaglandin (PG) release, in hypobaric hypoxic (HHc) condition, may be linked with the changes of brain monoamines. The present study intends to explore the changes of monoamines in hypothalamus (H), cerebral cortex (CC), and cerebellum (CB) along with the motor activity in rats after exposing them to simulated hypobaric condition and the role of PGs on the daily hypobaric hypoxia (DHH)-induced alteration of brain monoamines by administering, an inhibitor of PG synthesis, naproxen. The rats were exposed to a decompression chamber at 18,000 ft for 8 hours per day for 6 days after administration of vehicle or naproxen (18 mg/kg body wt.). The monoamine levels (epinephrine, E; norepinephrine, NE; dopamine, DA; and 5-hydroxytryptamine, 5-HT) in CC, CB, and H were assayed by high-performance liquid chromatography (HPLC) with electrochemical detection, and the locomotor behavior was measured by open field test. The NE and DA levels were decreased in CC, CB, and H of the rat brain in HHc condition. The E and 5-HT levels were decreased in CC, but in H and CB, they remained unaltered in HHc condition. These DHH-induced changes of monoamines in brain areas were prevented after administration of naproxen in HHc condition. The locomotor behavior remained unaltered in HHc condition and after administration of naproxen in HHc condition. The DHH-induced changes of monoamines in the brain in HHc condition are probably linked with PGs that may be induced by OS.

Effects of stimulation of glutamate receptors in medial septum on some immune responses in rats.

The immunomodulatory role of medial septum (MS) has been explored so far only in MS lesioned rats. But in MS lesioned rats, all the nerve cells and fibres of the lesioned area are damaged and the specific role of the neural circuits of MS on immunomodulation cannot be assessed from the lesion of MS. Considering the presence of a large number of glutamate receptors in MS, the specific role of glutamate receptors stimulation on some immune responses has been investigated in the present study. Hyperreactive behaviour, TC and DC of WBC, phagocytic activity of peripheral leukocytes, adhesibility and cytotoxicity of splenic mononuclear cells (MNC), delayed type of hypersensitivity (DTH) responses and the serum corticosterone (CORT) were measured after microinfusion of glutamate into MS of rats. To ascertain the specific role of those glutamate receptors, the parameters were also measured after microinfusion of glutamate receptor blocker 6, 7-dinitroquinoxaline-2, 3-dione (DNQX). The hyperreactive behaviour, TC and DC of WBC remained unaltered after stimulation or blocking of glutamate receptors. The phagocytic activity, adhesibility and cytotoxicity of splenic MNC, and DTH responses were increased after infusion of 0.25 and 0.5µM glutamate. But after infusion of higher dose of glutamate (1µM), the phagocytic activity and the adhesibility of splenic MNC were decreased and other parameters remained unaltered in that condition. After infusion of 4 and 8mM DNQX all the observed immunological parameters were decreased. The CORT concentration was decreased after infusion of 0.25 and 0.5µM of glutamate but it was increased after infusion of 1µM glutamate or 4 and 8mM DNQX. Results indicate that the medial septal glutamate receptors play an important role in the modulation of some immune responses.

Anticonvulsant effect of Marsilea quadrifolia Linn. on pentylenetetrazole induced seizure: a behavioral and EEG study in rats.

ETHNOPHARMACOLOGICAL RELEVANCE: Marsilea quadrifolia Linn (MQ) extract has been used traditionally as sedative and antiepileptic drug in India. AIM OF THIS STUDY: To investigate the anticonvulsive potential of MQ extracts by using behavior and electroencephalographic (EEG) analysis on pentylenetetrazole (PTZ) induced seizure model in rats. MATERIALS AND METHODS: For anticonvulsant effect, 60minutes after administration of MQ, behavior and EEG were analyzed during PTZ (60mg/kg) induced seizures. Changes of EEG power, latency of onset of seizure, seizure severity score, and duration of epileptic seizure were determined. RESULTS: Both the water and ethanol extract of MQ increased the latency of seizure but also decreased duration of epileptic seizure and seizure severity score. This reduction of seizure severity was also observed in EEG recording and EEG power analysis. The effectiveness of MQ ethanol extract is better than MQ water extract. CONCLUSION: Both water and ethanol extract of MQ were effective in reducing the severity of behavioral and EEG seizures induced by PTZ in rats. This study justifies the traditional use of this plant in epilepsy.