A pilot randomized controlled trial of a lay telephone coaching and web-based intervention for postpartum depression and anxiety: The MPOWER study.

Background: Mental health problems are frequent in the postpartum period, but accessible treatment options are lacking. The MPOWER study investigated whether the use of trained lay coaches could increase the uptake and effectiveness of a web-based intervention (WBI) for women with postpartum depression and/or anxiety. Objectives: First, to compare the feasibility and acceptability of a WBI for women with postpartum depression and anxiety, with and without the addition of telephone coaching calls. Second, to estimate the effectiveness of the WBI at decreasing symptoms of depression and anxiety at 6 months, with and without coaching calls. Methods: We conducted a pilot randomized controlled trial (RCT) that enrolled women who had recently given birth and had mild to moderate postpartum depression and/or anxiety. Study participants were provided access to the WBI. Women randomized to the intervention group also received up to 7 telephone coaching calls during the 6 months of follow up. We evaluated the feasibility of the intervention through participants' usage of the WBI, as well as the completion and fidelity of planned coach calls. We measured acceptability via two questionnaires on the usability of the WBI and participant satisfaction with the intervention. To determine the potential effectiveness of the intervention, the primary outcomes were defined as symptoms of depression and anxiety at 6 months and adjusted mean differences between groups for these outcomes were estimated using linear regression models. Results: We recruited 52 participants (25 intervention; 27 control). At 6 months, 88 % (22/25) of participants randomized to the intervention arm and 59 % (16/27) of participants randomized to the control arm remained in the study. The intervention group had an average of 11 (95 % CI: [5, 18]) more website logins than the control group. Intervention group participants completed a mean of 6.2 coaching calls with high fidelity. The estimates of the effect of the intervention on mental health outcomes at 6-months were imprecise but point estimates and confidence intervals were consistent with a moderate beneficial effect of the intervention on both symptoms of depression and anxiety (fully adjusted effects sizes: 0.51 (95 % CI: [-0.14, 1.17]) and 0.56 (95 % CI: [-0.09, 1.22]), respectively). Conclusions: WBIs with coaching are feasible, acceptable, and potentially effective treatment options for women with mild to moderate postpartum depression and/or anxiety. The addition of coaching calls markedly increased engagement with the WBI, but a larger RCT is needed to determine the effectiveness of such an intervention.

Perinatal Mental Healthcare Needs Among Women at a Community Hospital.

OBJECTIVE: Mental health problems affect up to 20% of women during pregnancy and the postpartum period. This study aimed to describe the mental health services and resources accessed by women with perinatal mental health problems (PMH) and to identify their unmet mental health care needs and preferences for support, as well as the barriers to accessing this support. METHODS: Participants were 18 years of age or older and spoke English or French. Consent was obtained 24 hours after delivery (T0) to screen for symptoms of depression and anxiety at 2 weeks postpartum (T1) using the Edinburgh Postnatal Depression Scale (EPDS) and the Generalized Anxiety Disorder Scale (GAD-7). Women with a positive screen (EPDS ≥10 or GAD-7 ≥10) were sent informational resources and were followed-up by telephone at 4 months postpartum (T2) to determine their use of these and other resources, their unmet needs, and their preferences for other resources or services. RESULTS: Seventy-three out of 344 participants (21.2%) screened positive, of whom 57 (78%) completed the T2 interview. Of those interviewed, 28% had used the informational resources provided by the study. Although 25% had consulted a health professional for mental health care, 37% had unmet mental health care needs. Preferences for additional support included web-based resources (30%), telephone support (28%), and booklets (25%). Lack of time (38%) and lack of childcare (23%) were the main barriers to seeking help. CONCLUSIONS: Web- and telephone-based approaches have the potential to address the most common barriers to access support for women experiencing perinatal mental health problems.

Over-the-Counter Drugs and Other Substances Used in Attempted Suicide Presented to Emergency Departments in Montreal, Canada.

Background: Over-the-counter (OTC) analgesics are frequently used in suicide attempts. Accessibility, toxicity, and unsupervised acquisition of large amounts may be facilitators. Aims: To identify patient characteristics associated with OTC drug use as a suicide attempt method among adults. Method: A cross-sectional study was conducted using chart review of all individuals who presented to the emergency department (ED) of two adult general hospitals following a suicide attempt during 2009-2010 in Montreal, Canada. Results: Among the 369 suicide attempters identified, 181 used overdosing, 47% of whom used OTC drugs. In logistic regression, women and those with medical comorbidity were more likely to use overdosing, while those with substance use disorders were less likely to do so. Among those who overdosed, women were more likely to use OTC drugs, while those who were Caucasian, had children, comorbidities, diagnoses with substance use disorders, and made attempts in the Fall were less likely to do so. Substances most frequently used were: acetaminophen among OTC drugs (30%); antidepressants (37%), anxiolytics (30%), opioids (10%), and anticonvulsants (9%) among prescription drugs; and cocaine (10%) among recreational drugs. Limitations: Reasons for the suicide method choice were not available. Conclusion: OTC drugs, in particular acetaminophen, are frequently used in suicide attempts. Accessibility to these drugs may be an important contributor.

"Free to Say No": Evoking freedom increased compliance in two field experiments.

The evoking freedom or "but you are free" (BYAF) technique is a social influence tactic that offers recipients the freedom to accept or decline a request. This research tested the effectiveness of the evoking freedom technique in two field experiments. Participants were asked either to complete a survey (Experiment 1) or to allow a stranger to borrow their mobile phone to make a call (Experiment 2) on an urban university campus. Half of the requests involved language that evoked freedom, and half of the requests were direct. In both experiments, results showed significantly greater compliance in the evoking freedom condition. This research extends previous work by demonstrating the effectiveness of the technique using a high-stakes request and in a culture other than that of France, where the majority of evoking freedom studies have been conducted.

Sero-Negative Systemic Sclerosis: A Rare Presentation.

Systemic Sclerosis is a multisystem disease associated with progressive fibrosis of skin and internal organs. It is diagnosed by presence of characteristic clinical findings and is supported by specific serologic abnormalities. ANA is positive in case of systemic sclerosis in 90 percent of cases. We report a rare case of this rare disease where patient was ANA, Antitopoisomerase I (anti-Scl-70), Anticenteromere antibody negative.

Attempted Suicide Among Students and Young Adults in Montreal, Quebec, Canada: A Retrospective Cross-Sectional Study of Hospitalized and Nonhospitalized Suicide Attempts Based on Chart Review.

OBJECTIVE: We conducted a chart review to identify postsecondary students and nonstudents in the same age range who presented to the emergency department following a suicide attempt to (1) compare demographic characteristics and suicide risk factors and (2) determine factors associated with more serious attempts requiring hospitalizations. METHOD: The study was conducted in 1 tertiary trauma hospital and 1 community hospital affiliated with McGill University, Montreal, Quebec, Canada, between January 1, 2009, and March 31, 2010. Charts of patients with potential suicide attempts were identified from medical records using ICD-10 codes that indicated traumatic injury, intentional self-harm, poisoning, and psychiatric or perception/cognition disorders and from the emergency department triage file using keywords that indicated suicidality or self-harm at presentation. RESULTS: In multivariable logistic regression models (odds ratio, 95% CI), students were younger (per 5-year increase: 0.22, 0.12-0.41), less likely to be born in Canada (0.17, 0.06-0.44), and more likely to use less violent methods (laceration, poisoning, other, multiple methods) versus more violent methods (collision, jump, fire burns, firearm, hanging) in their attempt. Fewer students had a history of substance abuse (0.12, 0.02-0.94) but were not different from nonstudents on history of other mental disorders. Less students attempted suicide in the winter/spring (January-April) versus fall (September-December) semester (0.32, 0.11-0.91). Students who attempted suicide were more likely to have family/social support. Those who attempted suicide in the previous year were more likely to require hospitalization for their current suicide attempt. CONCLUSIONS: Knowledge of specific factors associated with suicide attempts in young people can help inform and guide suicide prevention efforts in both academic and community settings. Specific to the findings of this study regarding the method of suicide attempt used, for example, limiting access to dangerous substances or large quantities of medications may help prevent or reduce suicide attempts in this population.

Recurrent severe anaemia: a rare presentation of parvovirus b19 infection.

Secondary pure red cell aplasia is usually seen in immunocompromised hosts or patients who have chronic haemolytic anaemia, which is caused by blood transfusion related transmission. The present patient, a 30-year-old immunocompetent female, presented several times with recurrent severe anaemia, over a period of one and half years. Her history, clinical examination and investigations did not reveal any indigenous drug intake, previous blood transfusions, haemolytic disorders, myeloproliferative disorders, pregnancies, autoimmune diseases or thymoma. She was found to have a thalassaemia minor trait, on the basis of which severity and recurrence of anaemia could not be explained, and on further evaluation, she was diagnosed to have acute aplastic crisis caused by Parvovirus B19 induced, acquired pure red cell aplasia. The co- existence of these two haematological disorders in an immunocompetent, non-transfusion dependent individual is rare, which makes our case report unique.

Peripheral arterial disease and digital gangrene: a rare presentation of diabetic hand syndrome.

Digital gangrene in upper limbs may be due to systemic sclerosis, trauma, connective tissue disorders, vasculitic disorders and various myeloproliferative disorders or as a part of tropical diabetes hand syndrome which follows trauma. Peripheral arterial disease in diabetics commonly involves lower limbs. The present case, 45-year-old diabetic, presented with dry gangrene in fingertips of both hands for last two weeks without any history of trauma or lower limb gangrene. On examination and workup of the patient was found to have bilateral upper limb arterio-occlusive disease involving ulnar vessels as a macrovascular complication of diabetes mellitus. This presentation of diabetic hand syndrome is very, very rare, hence being reported.

[Confusion Assessment Method. Validation of a French-language version]. / Confusion Assessment Method. Validation d'une version française.

There is no systematic or standardized approach to assessing higher mental functions in hospitalized elderly patients, despite the constant presence of nursing staff. The Confusion Assessment Method (CAM) is the only valid and reliable clinical tool for detecting symptoms of delirium easily and quickly, even by health professionals with no specialized training in psychiatry. The CAM has been translated into eight languages, but no validated French-language version has been published as yet. It was in response to this need that the researchers took the first steps in validating a French-language version of the CAM and the diagnostic algorithm, and enhanced the description in French of symptoms of delirium and the criteria of the diagnostic algorithm. The validation process was based on the first two steps in the transcultural validation method for psychological questionnaires suggested by Vallerand. The availability of a French-language version of this instrument will lead to greater professional autonomy and help to simplify the recognition of symptoms of delirium and ensure that the appropriate action is taken sooner.