Screening programs for common maternal mental health disorders among perinatal women: report of the systematic review of evidence.

Postpartum depression and anxiety are highly prevalent worldwide. Fisher et al., estimated the prevalence of depression and anxiety at 15.6% during the antenatal and 19.8% during the postpartum period. Their impact on maternal and child health is well-recognized among the public health community, accounting for high societal costs. The public health impact of these conditions has highlighted the need to focus on the development and provision of effective prevention and treatment strategies.In recent decades, some advances have been made in the development of effective universal and targeted screening programmes for perinatal depression and anxiety disorders. Recent research has shown potential benefits of universal and targeted screening for perinatal depression, to identify and treat undiagnosed cases, and help thwart its deleterious consequences. Ethical implications, however, for these screening programmes, without the provision of treatment have often been emphasized.The present mixed-methods systematic review and meta-analysis was conducted to collate evidence for screening programmes for perinatal depression and anxiety. It aims to answer the following questions, in a global context: For women in the perinatal period, do screening programmes for perinatal depression and anxiety compared with no screening improve maternal mental health and infant outcomes?A series of meta-analyses reveal a reduction in perinatal depression and anxiety among perinatal women undergoing screening programmes. For the outcome of depressive disorder, meta-analysis indicates a positive impact in favour of the intervention group (OR = 0.55, 95% CI: 0.45 to 0.66, n = 9009), with moderate quality of evidence. A significant improvement (high quality) was also observed in symptoms of anxiety among perinatal women (SMD = - 0.18, 95% CI: - 0.25 to - 0.12, n = 3654).

Telemedicine to deliver diabetes care in low- and middle-income countries: a systematic review and meta-analysis.

OBJECTIVE: To determine the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. METHODS: We searched seven databases up to July 2020 for randomized controlled trials investigating the effectiveness of telemedicine in the delivery of diabetes care in low- and middle-income countries. We extracted data on the study characteristics, primary end-points and effect sizes of outcomes. Using random effects analyses, we ran a series of meta-analyses for both biochemical outcomes and related patient properties. FINDINGS: We included 31 interventions in our meta-analysis. We observed significant standardized mean differences of -0.38 for glycated haemoglobin (95% confidence interval, CI: -0.52 to -0.23; I 2 = 86.70%), -0.20 for fasting blood sugar (95% CI: -0.32 to -0.08; I 2 = 64.28%), 0.81 for adherence to treatment (95% CI: 0.19 to 1.42; I 2 = 93.75%), 0.55 for diabetes knowledge (95% CI: -0.10 to 1.20; I 2 = 92.65%) and 1.68 for self-efficacy (95% CI: 1.06 to 2.30; I 2 = 97.15%). We observed no significant treatment effects for other outcomes, with standardized mean differences of -0.04 for body mass index (95% CI: -0.13 to 0.05; I 2 = 35.94%), -0.06 for total cholesterol (95% CI: -0.16 to 0.04; I 2 = 59.93%) and -0.02 for triglycerides (95% CI: -0.12 to 0.09; I 2 = 0%). Interventions via telephone and short message service yielded the highest treatment effects compared with services based on telemetry and smartphone applications. CONCLUSION: Although we determined that telemedicine is effective in improving several diabetes-related outcomes, the certainty of evidence was very low due to substantial heterogeneity and risk of bias.

Prevention of common mental disorders among women in the perinatal period: a critical mixed-methods review and meta-analysis.

Perinatal depression and anxiety account for a high burden of perinatal morbidity and poor psychosocial functioning. There is a growing interest among mental health professionals, to devise interventions to prevent this condition. This review synthesizes evidence for the effectiveness of psychological and psychosocial interventions aimed at the prevention of perinatal depression and anxiety. We also explore qualitative evidence to understand the acceptability and feasibility of these interventions. Using a mixed-methods approach, data from a total of 21 studies were collated to inform the evidence for preventive interventions for perinatal depression and anxiety. Based on their theoretical orientations, these interventions were described by authors as cognitive-behavioral (n = 7); psychoeducational (n = 6); mindfulness (n = 2); and interpersonal psychotherapy (n = 2). These also included psychosocial approaches such as social support (n = 1) and multicomponent interventions (n = 3). For depressive symptoms, these interventions yielded moderate to strong effect sizes in favor of the intervention group [standardized mean difference (SMD) = -0.59; 95% confidence interval (CI) -0.95 to -0.23]. For anxiety symptoms, a strong effect size was estimated in favor of the intervention group (SMD = -1.43, 95% CI -2.22 to -0.65). Preventive interventions significantly reduce the severity of perinatal depressive and anxiety symptoms. These interventions are also acceptable and feasible in many settings.

Development and validation of Attitude Toward Nutrition Counselling Questionnaire for use among Kuwaiti healthcare professionals.

OBJECTIVE: This study aims to report the developmental processes and validation of Attitude Toward Nutrition Questionnaire in Arabic language. RESULTS: A total of 173 (response rate = 86.93%) participants responded to the survey. There were a total of 92 (53.2%) nutritionists and 81(46.8%) doctors/surgeons. Principal component analyses revealed followed by visualization of Cattell's scree plot, suggested a four-factor solution for the 36-item Attitude Toward Nutrition Counselling Questionnaire. It was found to have an acceptable validity. These four factors cumulatively explained 37.9% of the variance in the factor structure of the ATNQ. Cronbach's alpha revealed an acceptable level of reliability for each subscale of the ATNQ. The first subscale named "Factual knowledge about nutrition" comprised of nine items. It yielded a Cronbach's alpha value of 0.78. The second subscale "knowledge about nutrition in morbidities" comprised of seven items and yielded a Cronbach's alpha value of 0.71. The third subscale "counselling of patients" comprised of 11 items and yielded a Cronbach's alpha of 0.68. The fourth subscale comprising nine items yielded a Cronbach's alpha value of 0.64 and was named, "Dietary programs and supplementation".

Psychosocial predictors of antenatal stress in Pakistan: perspectives from a developing country.

OBJECTIVE: Antenatal stress is highly prevalent globally and is associated with adverse physical and psychiatric morbidities and adverse neonatal outcomes. However, the burden of antenatal stress and its psychosocial predicators have not been explored in context of the Pakistani sociocultural environment. The present study explores the prevalence of antenatal stress and its association with gender of offspring, socioeconomic background, cultural beliefs, and access to healthcare in the province of Punjab, Pakistan. RESULTS: There was a total of 516 pregnant women. Antenatal stress was measured by the Perceived Stress Scale (PSS). The mean score of the respondents on the Perceived Stress Scale was 7.55 (3.43). A total of 218 (42.2%) respondents reported higher stress levels. Logistic regression analysis (backward method) yielded a significant model predicting high stress levels. According to it, low family income, unplanned pregnancy, increasing number of children, less autonomy in decision making, marital problems, harassment, desire to have a male offspring, and the history of birth complications, attended by midwives were associated with high stress levels.

Validity and reliability of the Urdu version of the Hospital Anxiety & Depression Scale for assessing antenatal anxiety and depression in Pakistan.

This study aims to elucidate the appropriate factor structure for Hospital Anxiety & Depression Scale (HADS) for assessment of anxiety and depression symptoms during pregnancy among Pakistani women. This cross-sectional study was conducted during a 5 month period (2014) in four teaching hospitals of Lahore, Pakistan. Convenience sampling was done to recruit pregnant women availing obstetrics and gynecology services for routine prenatal or perinatal care in the respective departments of the four institutes. Trained interviewers interviewed the consenting participants using a pre-tested scale. All data were analyzed using SPSS v.20. Factor structure of the HADS was explored using Principal Axis Factoring (PAF) method. Goodness of fit of the factor structure was assessed using the Confirmatory Factor Analysis (CFA). Cronbach's alpha value for whole scale was good (α = 0.81). Sensitivity analysis involving assessment of Cronbach's alpha value after removal of each item, did not reveal any major deviations in overall internal consistency of the HADS. Parallel analysis suggested one factor solution to be viable. When one factor was extracted as a uni-dimensional measure of anxiety and depression: item 11 (I feel restless as I have to be on the move) and 14 (I can enjoy a good book or radio or TV program) were deemed problematic for having low communalities and factor loading values.

Gender of children and social provisions as predictors of unplanned pregnancies in Pakistan: a cross-sectional survey.

OBJECTIVE: Previous research indicates that attitudes to pregnancy and motherhood are influenced by social values, culture and religion. This study explores the relationship between social support and unwanted pregnancy among Pakistani women. This cross-sectional study was conducted at four teaching hospitals in Lahore in 2014. RESULTS: A total of 500 pregnant women who visited the hospitals' obstetrics and gynecology departments were asked to respond to a questionnaire consisting of respondents' characteristics and the Social Provisions Scale (SPS). Logistic regression analyzed the predictors of unplanned pregnancy. Unwanted pregnancies were more likely to occur among pregnant women from rural areas, with low scores on the SPS 'reassurance of worth' sub-scale, no history of contraceptive use, and who already had at least one son than those with no sons.

Exploring Symptoms of Post-traumatic Stress Disorders and Perceived Social Support among Patients with Burn Injury.

Introduction Burns are a serious public health problem globally, causing an estimated 265,000 deaths per year. Although the association of burn injuries with mortality and morbidity rates has been well established, data on their psychological consequences are scarce. The present study explores the frequency of post-traumatic stress disorder (PTSD) and perceived social support among patients with burn injuries in Pakistan. Methods This cross-sectional study was conducted at two teaching hospitals in Lahore, Pakistan from May 2015 to July 2015. Eighty patients with burn injuries were included by convenience sampling and interviewed with a specifically designed questionnaire with items on demographics, and the Impact of Events Scale-Revised (IES-R) and Multidimensional Scale of Perceived Social Support (MSPSS) instruments. Results Data were analyzed for a total of 80 participants: 56 women (70.0%) and 24 men (30.0%). Mean age was 35.74 (11.15) years. A high proportion of participants perceived highest social support from friends, reported high ego resiliency levels, had more severe symptoms of avoidance and intrusion, and had high overall PTSD scores. There were no differences between groups in the proportions of respondents who reported high perceived social support from significant others or family, overall social support or symptoms of hyperarousal. Conclusion The findings reflect a high frequency of PTSD symptomatology and poor social support among Pakistani patients with burn injuries in our sample. These factors can exacerbate the patient's physical injury, delaying both their physical and mental rehabilitation.