Culturally adapted psychosocial interventions (CaPSI) for early psychosis in a low-resource setting: study protocol for a large multi-center RCT.

BACKGROUND: Psychosis treatment guidelines recommend cognitive behaviour therapy (CBT) and family intervention (FI), for all patients with first episode psychosis (FEP), though guidance borrows heavily from literature in adults from high income countries. To our knowledge, there are few randomized controlled trials (RCTs) examining the comparative effect of these commonly endorsed psychosocial interventions in individuals with early psychosis from high-income countries and no such trials from low and middle-income countries (LMICs). The present study aims to confirm the clinical-efficacy and cost-effectiveness of delivering culturally adapted CBT (CaCBT) and culturally adapted FI (CulFI) to individuals with FEP in Pakistan. METHOD: A multi-centre, three-arm RCT of CaCBT, CulFI, and treatment as usual (TAU) for individuals with FEP (n = 390), recruited from major centres across Pakistan. Reducing overall symptoms of FEP will be the primary outcome. Additional aims will include improving patient and carer outcomes and estimating the economic impact of delivering culturally appropriate psychosocial interventions in low-resource settings. This trial will assess the clinical-efficacy and cost-effectiveness of CaCBT and CulFI compared with TAU in improving patient (positive and negative symptoms of psychosis, general psychopathology, depressive symptoms, quality of life, cognition, general functioning, and insight) and carer related outcomes (carer experience, wellbeing, illness attitudes and symptoms of depression and anxiety). CONCLUSIONS: A successful trial may inform the rapid scale up of these interventions not only in Pakistan but other low-resource settings, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority groups with FEP. TRIAL REGISTRATION: NCT05814913.

Evaluation of two resin based fissure sealants: a comparative clinical study.

OBJECTIVE: To evaluate retention of two resin based fissure sealants (Embrace and Delton FS+) for a period of twelve months. MATERIALS AND METHODS: Sixty eight first permanent molars were sealed for seventeen healthy children in the age group of six-eight years. According to random selection, the first permanent molars on the right side of both arches were sealed with Embrace (Group A) and on the left side of both arches were sealed with Delton FS+ (Group B). RESULTS: The total retention of Embrace was 23.50% and for Delton FS+ was 17.60% at one year. CONCLUSION: At one year the total retention of Embrace was 23.50% and for Delton FS+ was 17.60%, however the results were statistically insignificant.

Willingness to pay for treated mosquito nets in Surat, India: the design and descriptive analysis of a household survey.

For willingness to pay (WTP) studies to have an appropriate impact on policy making, it is essential that the design and analysis are undertaken carefully. This paper aims to describe and justify the design of the survey tool used to assess hypothetical WTP for treated mosquito nets (TMN) in rural Surat, India and report its findings. Results from qualitative work were used as an input for developing the WTP questionnaire. A total of 1200 households belonging to 80 villages in rural Surat were selected for the study. A bidding format was used to elicit WTP values, using three different starting bids. The scenario was constructed in a way to reduce the possibility of respondents acting strategically. The response rate was 100%. About 79% of the respondents were willing to buy TMNs and the mean WTP was Rs57. Descriptive results of economic and other taste and preference variables are also presented, which include preventive measures used by households and treatment seeking behaviour for malaria. It is observed that WTP as well as demographic variables and prevention methods differ significantly across arms of the trial. This paper suggests that policy-makers could use the evidence following further analysis, along with information on costs of implementation, to ascertain the levels of subsidy that may be needed at different levels of coverage.

Environmental impact on crew of armoured vehicles: effects of 24 h combat exercise in a hot desert.

A field study was undertaken to investigate the effects of combined noise, vibration and heat stress on the physiological functions of the crew of armoured vehicles during prolonged combat exercise in a desert. The sound pressure level of noise was measured with a sound level meter and accelerations by vibration analyser. The thermal load on the crew was evaluated by calculating the wet bulb globe temperature index. The physiological responses of the subjects (n = 9), included significant increases in the heart rate, 24 h water intake and urinary catecholamine concentration. A significant decrease was recorded in body mass, peak expiratory flow rate and 24 h urinary output. The high heat load on the crew resulted in a hypohydration of 3% body mass and appeared to be the dominant factor in producing the physiological strain.

Prediction of body volume by a stepwise linear regression technique.

Body volume and 35 anthropometric measurements were obtained from 88 active soldiers using standard techniques. These anthropometric measurements were examined for their possible relationships to body volume using stepwise linear regression analysis. Four measurements (Body weight, anterior thigh skinfold thickness, subscapular skinfold thickness and suprailiac skinfold thickness) accounted for 99.7% of the variation in body volume and the introduction of each of these measurements in the equation was significant. The regression equation for predicting body volume from these 4 anthropometric measurements had a multiple correlation coefficient of 0.9987 (P less than 0.001). Body weight alone was correlated with body volume to the extent of 0.9966. An attempt has therefore been made to develop a multiple linear regression equation without incorporation of body weight in the regression analysis. Nine measurements were selected by stepwise linear regression analysis for predicting body volume. These nine measurements accounted for 97.1% of the variation in body volume. These equations have been validated on another small sample of 22 soldiers. The analysis has also revealed that a direct regression of body density from the anthropometric variables gives more accurate results than when estimated body volumes are utilized for calculating body density.

Relationship of body density and lean body mass to body measurements: application to Indian soldiers of relationships developed for people of European descent.

Body density was measured directly in 90 young Indian soldiers from the Gurkha, Rajput and South Indian regiments. Body density was also predicted on the same subjects using skinfold thicknesses as well as other anthropometric measurements. Validity of the regression equations of Pascale, Grossman, Sloan and Frankel (1956), Sloan (1967) and Wilmore and Behnke (1969) was also tested on these Indian soldiers. Lean body mass was estimated directly from another equation of Wilmore and Behnke (1969), where skinfold thicknesses were not involved. The results indicate that all the body density predicting equations underestimate the measured body density, with the equation of Sloan (1967) approximately more closely to the actual value in these ethnic groups. The equation of Wilmore and Behnke (1969) regresses lean body weight from body measurement satisfactorily in all the ethnic groups of this study.

Effect of chronic and acute exposure to noise on physiological functions in man.

Physiological parameters have been compared in 75 normal healthy individuals exposed to occupational noise of 88-107 dB(A) (6-8h/day) for 10-15 years and in 36 normal non-exposed subjects. Blood pressure, both systolic (P less than 0.01) and diastolic (P less than 0.001), and heart rate (P less than 0.05) were found to be significantly higher in the exposed subjects. Irregularity in cardiac rhythm, both in amplitude and duration, was found in 18% of the exposed subjects as against 6% in the non-exposed group. Variation in the heart rate during acute noise exposure of 90 dB(A) has been shown to be related with the preponderance of tonicity of sympathetics and parasympathetics. Measurement of hand blood flow during the same exposure showed a lesser degree of vasoconstriction and a slower recovery rate in the exposed group. Altered observations in the exposed group could be attributed to changes in the mechanical property of blood vessels.

Estimation of body density and lean body weight from body measurements at high altitude.

Body density and other anthropometric data were obtained on 101 Indian soldiers who were continously staying at high altitude (3920 m) for more than 10 months. Use was made of a human body volumeter, and body density was calculated from observed body weight and volume. Measurements were taken on the body using standard techniques. A stepwise linear regression analysis was performed to establish possible relationships of 36 body measurements with density and lean body weight. Thigh anterior, juxta-nipple skin folds and forearm and ankle circumference were selected in the regression equation predicting body density. Multiple correlation coefficient (R) equal to 0.765 was obtained for this equation. For the predicted lean body weight, R equalled 0.930. The regression equations included body weight, thigh, anterior and juxta-nipple skin fold thicknesses, and forearm circumference. Contribution of other body measurements in the regression of these parameters was not significant. The analysis also revealed that a new set of coefficients is required for the measurements included in the published regression equations.