Prevalence of maternal depression and anxiety symptoms and associations with child mental health outcomes in rural Nepal.

OBJECTIVES: This study describes the prevalence, associated factors and child mental health outcomes related to symptoms of maternal depression and anxiety within 5 years after childbirth in a rural district in Nepal. This association is not well-understood in rural, community-based settings in low- and middle-income countries (LMIC). METHODS: A sample of 347 women with children under 5 years was recruited in September 2019 for a cross-sectional study in the rural Saptari district in Nepal. Multivariable logistic regression was used to investigate the association between maternal depressive or anxiety symptoms and children's experience and impact of emotional and behavioural difficulties. RESULTS: In total, 144 women (41.5%) had moderate or severe depression symptoms and 118 (34%) had anxiety symptoms. Mothers with a lower income were more likely to have anxiety symptoms than the highest income group (OR: 1.8, 95% CI: 1.1-3.0). An association existed between maternal depressive symptoms and the impact of emotional or behavioural difficulties in children (OR: 2.44, 95% CI: 1.02-5.84). In contrast, there was no association between maternal anxiety and child outcomes. CONCLUSIONS: Our findings suggest that the prevalence of probable maternal anxiety and depression symptoms was relatively high in this rural, low-resourced and community-based setting in Nepal. Maternal depressive symptoms were associated with the degree of impact on children's mental health post-infancy, emphasising the importance of improving maternal mental health in the early years of a child's life.

The investigation of bone fracture healing under intramembranous and endochondral ossification.

After trauma, fractured bone starts healing directly through bone union or indirectly through callus formation process. Intramembranous and endochondral ossification are two commonly known mechanisms of indirect healing. The present study investigated the bone fracture healing under intramembranous and endochondral ossification by developing theoretical models in conjunction with performing a series of animal experiments. Using experimentally determined mean bone densities in sheep tibia stabilized by the Locking Compression Plate (LCP) fixation system, the research outcomes showed that intramembranous and endochondral ossification can be described by Hill Function with two unique sets of function parameters in mechanical stimuli mediated fracture healing. Two different thresholds exist within the range of mechanical simulation index which could trigger significant intramembranous and endochondral ossification, with a relatively higher bone formation rate of endochondral ossification than that of intramembranous ossification. Furthermore, the increase of flexibility of the LCP system and the use of titanium LCP could potentially promote uniform bone formation across the fracture gap, ultimately better healing outcomes.

Effects of dynamic loading on fracture healing under different locking compression plate configurations: A finite element study.

The design of patient specific weight-bearing exercises after the surgical implementation of internal fixations is of critical importance for bone fracture healing. The purpose of this study is to theoretically investigate the effects of physiologically relevant dynamic loading on early stage of fracture healing under different locking compression plate (LCP) configurations. The finite element results show that dynamic loading enhanced transport of bone cells and growth factors in the fracture callus is much dependent on the flexibility of LCP. In comparison to free diffusion, a relatively flexible LCP together with dynamic loading could significantly enhance solute transport in callus. For example, a flexible LCP achieved by increasing WL (Working Length) and BPD (Bone Plate Distance) (e.g. WL=100 mm and BPD=2 mm) together with a 5-h 150 N@1 Hz dynamic loading could increase the uptake of chondrocytes by around 280% compared to free diffusion, osteoblasts by around 180%, osteogenic growth factors by around 120% and chondrogenic growth factors by around 220%. In addition, dynamic loading enhanced transport of cells and growth factors under LCP is spatially dependent with a relatively higher enhancement in far cortex zone than that in near cortex zone. The outcomes from present study could potentially assist orthopaedic surgeons to determine optimal loading regimes with consideration of patient specific LCP configurations.

Role of Dynamic Loading on Early Stage of Bone Fracture Healing.

After fracture, mesenchymal stem cells (MSCs) and growth factors migrate into the fracture callus to exert their biological actions. Previous studies have indicated that dynamic loading induced tissue deformation and interstitial fluid flow could produce a biomechanical environment which significantly affects the healing outcomes. However, the fundamental relationship between the various loading regimes and different healing outcomes has not still been fully understood. In this study, we present an integrated computational model to investigate the effect of dynamic loading on early stage of bone fracture healing. The model takes into account cell and growth factor transport under dynamic loading, and mechanical stimuli mediated MSC differentiation and tissue production. The developed model was firstly validated by the available experimental data, and then implemented to identify the loading regimes that produce the optimal healing outcomes. Our results demonstrated that dynamic loading enhances MSC and growth factor transport in a spatially dependent manner. For example, compared to free diffusion, dynamic loading could significantly increase MSCs concentration in endosteal zone; and chondrogenic growth factors in both cortical and periosteal zones in callus. Furthermore, there could be an optimal dynamic loading regime (e.g. 10% strain at 1 Hz) which could potentially significant enhance endochondral ossification.