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.

Alleviation of halitosis by use of probiotics and their protective mechanisms in the oral cavity.

Regarding the relation of halitosis with oral infections and its effects on social relations between humans, the present study investigated the positive effects of probiotics on prevention or treatment of halitosis. The causative agents of halitosis are volatile sulphur compounds (VSCs), and halitosis is divided into oral and non-oral types according to the source of the VSCs. H2S and CH3SH are two main halitosis metabolites-produced following the degradation of proteins by bacteria in the mouth-however, CH3SCH3 has a non-oral origin, and is a blood neutral molecule. Just as much as halitosis is important in medicine, its psychological aspects are also considered, which can even lead to suicide. Today, the use of probiotics as a new therapeutic in many roles is in progress. Most probiotics are used for the treatment of gastrointestinal tract disorders, but various studies on the alleviation of halitosis by use of probiotics have reported satisfactory results. The genera Lactobacillus, Streptococcus and Weissella are among the most useful probiotics for the prevention or treatment of halitosis in the oral cavity.

Occupational dose assessment and National Dose Registry System in Iran.

This report presents status of external and internal dose assessment of workers and introducing the structure of National Dose Registry System of Iran (NDRSI). As well as types of individual dosemeters in use, techniques for internal dose assessment are presented. Results obtained from the International Atomic Energy Agency intercomparison programme on measurement of personal dose equivalent H(p) (10) and consistency of the measured doses with the delivered doses are shown. Also, implementation of dosimetry standards, establishment of quality management system, authorisation and approval procedure of dosimetry service providers are discussed.

Outcome of living kidney transplant: pediatric in comparison to adults.

BACKGROUND: Renal transplantation is the most optimal way to manage children with end-stage renal disease. Despite its benefits, pediatric renal transplantation is a challenge for several transplantation centers in terms of achieving a satisfactory outcome. We sought to compare the long-term outcome of pediatric versus adult recipients who underwent renal transplantation. METHOD: We examined, 2631 recipients of a first kidney from a living donor between 1982 and 2002. The two groups were matched for immunosuppressive therapy and number of HLA mismatches. The patients were divided into a pediatric (n=301; age 18 years) to compare 5-year patient and graft survivals. RESULTS: The mean ages of the pediatric and adult groups were 40 +/- 13 and 14 +/- 13 years, respectively. The 5-year graft survival was lower among the pediatric versus the adult group (56% vs 68%; P=.015) with no difference in patient survival (88% vs 86%; P>.05). CONCLUSION: The poorer graft survival in pediatric transplantation may be due to the nature of pediatric transplantation, in terms of inconsistent adherence to medication regimens, worse side effects of medications, higher rate of graft rejection due to recurrent disease, and more intense immunoreactivity of children.

Prevalence of asthma and related symptoms in junior high school children in Isfahan, Iran.

Asthma is the most common chronic disease in children. There are scattered epidemiological data concerning the prevalence of this disorder in developing countries. From October 1998 to May 1999 we studied 4069 randomly selected, junior high-school children in urban areas of Isfahan for asthma and related symptoms. The ages were expected to be 12-15 years. The children completed a questionnaire, and 3924 completed questionnaires were returned (response rate = 96.4%). Pupils with chronic respiratory symptoms were interviewed, physically examined at hospital and 1710 of them also underwent post exercise spirometry. The overall prevalence of asthma ever in life was 9.5%, with a male to female ratio of 2/1. The frequencies of current asthma, wheezing ever in life and exercise induced wheezy breathing were 7.3%, 19.1% and 14.2% respectively. Wheeze was heard on chest auscultation in 4.1% of the children. Pulmonary function tests revealed forced expiratory volume in 1 sec (FEV1) < 80% in 5.9%, forced mid-expiratory flow (FEF25-75) < 70%, in 9.7% and FEF75 < 70% in 20.6% of the tested children. All of the later findings strongly correlate with history of asthma. Parental smoking, similar illness in parents and/or siblings, lower levels of parental education and presence of cats, cockroaches and chicken in the household were significant risk factors. The prevalence of asthma in the students of the junior high schools of Isfahan is not far less than the average rates reported in many parts of the world, and it seems necessary to pay more attention to poorly controlled air pollution in Isfahan as an industrial city.

Prevalence of asthma and related symptoms in primary school children of Isfahan, Iran, in 1998.

As developing countries adopt an industrialized style of living, an increase in asthma prevalence can be expected. A cross sectional study was undertaken to evaluate the prevalence rates of asthma and related symptoms and clinical findings in Isfahan, Iran. A randomly selected population of Isfahan primary school children, consisting of 3,982 children aged 6 to 11 was enrolled in the study. Parents completed a Persian questionnaire modified from ISAAC and ECRHS questionnaires. The returned 3,828 (96.1%) questionnaires were reviewed and 686 children suffering from asthma or any of the related symptoms were invited for further evaluations. In this stage 655 children (95.5%) underwent a medical interview and physical examinations, of which 415, underwent post exercise spirometry and body-plethysmography. The prevalence rates for previously diagnosed asthma, dyspnea and wheezing ever, dyspnea and wheezing in the last 12 months and frequently recurring dyspneal attacks were 0.71%, 7.6%, 3.9% and 1.6%, respectively. Wheezing was heard upon auscultation of the chests of 70 children (10.7%). Forced expiratory volume in 1st second (FEV1) < 80% of prediction was recorded in 3.1% of the children, other findings included reduced peak expiratory flow rate (PEF), mean expiratory flow 25 to 75 percent (FEF 25-75), forced expiratory flow at 75% of FVC (FEF 75), and increased residual volume (RV) and air-ways resistance in 4.3%, 10.6%, 21.2%, 30.1% and 63.2% of the pupils, respectively. We conclude that asthma screening programs employing clinical methods should be encouraged, but measurement of airway resistance is not a suitable tool for epidemiologic studies.

Understanding individual differences in word recognition skills of ESL children.

This paper focuses on the extent to which the development of ESL (English as a Second Language) word recognition skills mimics similar trajectories in same-aged EL1 (English as a First Language) children, and the extent to which phonological processing skills and rapid naming can be used to predict word recognition performance in ESL children. Two cohorts of Grade 1 ESL and EL1 primary-level children were followed for two consecutive years. Results indicated that vocabulary knowledge, a measure of language proficiency, and nonverbal intelligence were not significant predictors of word recognition in either group. Yet, by considering individual differences in phonological awareness and rapid naming, it was possible to predict substantial amounts of variance on word recognition performance six months and one year later in both language groups. Commonality analyses indicated that phonological awareness and rapid naming contributed unique variance to word recognition performance. Moreover, the profiles of not at-risk children in the EL1 and ESL groups were similar on all but the oral language measure, where EL1 children had the advantage. In addition, EL1 and ESL profiles of children who had word-recognition difficulty were similar, with low performance on rapid naming and phonological awareness. Results indicate that these measures are reliable indicators of potential reading disability among ESL children.