Design and study protocol of the maternal smoking cessation during pregnancy study, (M-SCOPE)

<p>Abstract</p> <p>Background</p> <p>Maternal smoking is the most significant cause of preventable complications during pregnancy, with smoking cessation during pregnancy shown to increase birth weight and reduce preterm birth among pregnant women who quit smoking. Taking into account the fact that the number of women who smoke in Greece has increased steadily throughout the previous decade and that the prevalence of smoking among Greek females is one of the highest in the world, smoking cessation should be a top priority among Greek health care professionals.</p> <p>Methods/Design</p> <p>The Maternal Smoking Cessation during Pregnancy Study (M-SCOPE), is a Randomized Control Trial (RCT) that aims to test whether offering Greek pregnant smokers a high intensity intervention increases smoking cessation during the third trimester of pregnancy, when compared to a low intensity intervention. Prospective participants will be pregnant smokers of more than 5 cigarettes per week, recruited up to the second trimester of pregnancy. Urine samples for biomarker analysis of cotinine will be collected at three time points: at baseline, at around the 32^ndweek of gestation and at six months post partum. The control group/low intensity intervention will include: brief advice for 5 minutes and a short leaflet, while the experimental group/intensive intervention will include: 30 minutes of individualized cognitive-behavioural intervention provided by a trained health professional and a self-help manual especially tailored for smoking cessation during pregnancy, while counselling will be based on the ''5 As.'' After childbirth, the infants' birth weight, gestational age and any other health related complications during pregnancy will be recorded. A six months post-partum a follow up will be performed in order to re-assess the quitters smoking status.</p> <p>Discussion</p> <p>If offering pregnant smokers a high intensity intervention for smoking cessation increases the rate of smoking cessation in comparison to a usual care low intensity intervention in Greek pregnant smokers, such a scheme if beneficial could be implemented successfully within clinical practice in Greece.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov Identifier <a href="http://www.clinicaltrials.gov/ct2/show/NCT01210118">NCT01210118</a></p

The feasibility of a role for community health workers in integrated mental health care for perinatal depression: a qualitative study from Surabaya, Indonesia.

BACKGROUND: Indonesian maternal health policies state that community health workers (CHWs) are responsible for detection and referral of pregnant women and postpartum mothers who might suffer from mental health problems (task-sharing). The documents have been published for a while, however reports on the implementation are hardly found which possibly resulted from feasibility issue within the health system. AIMS: To examine the feasibility of task-sharing in integrated mental health care to identify perinatal depression in Surabaya, Indonesia. METHODS: Semi-structured interviews were conducted with 62 participants representing four stakeholder groups in primary health care: program managers from the health office and the community, health workers and CHWs, mental health specialists, and service users. Questions on the feasibility were supported by vignettes about perinatal depression. WHO's health systems framework was applied to analyse the data using framework analysis. RESULTS: Findings indicated the policy initiative is feasible to the district health system. A strong basis within the health system for task-sharing in maternal mental health rests on health leadership and governance that open an opportunity for training and supervision, financing, and intersectoral collaboration. The infrastructure and resources in the city provide potential for a continuity of care. Nevertheless, feasibility is challenged by gaps between policy and practices, inadequate support system in technologies and information system, assigning the workforce and strategies to be applied, and the lack of practical guidelines to guide the implementation. CONCLUSION: The health system and resources in Surabaya provide opportunities for task-sharing to detect and refer cases of perinatal depression in an integrated mental health care system. Participation of informal workforce might facilitate in closing the gap in the provision of information on perinatal mental health

Perbedaan Respon Hematologi dan Perkembangan Kognitif pada Anak Anemia Defisiensi Besi Usia Sekolah Dasar yang Mendapat Terapi Besi Satu Kali dan Tiga kali Sehari

Latar belakang. Anemia defisiensi besi (ADB) dapat menyebabkan gangguan belajar dan mental dalam jangka panjang, bahkan dapat menetap. Tingkat kepatuhan pengobatan yang diberikan tiga kali sehari masih rendah. Hal ini dapat ditingkatkan dengan pemberian satu kali sehari sehingga diharapkan pengobatan akan berhasil. Tujuan. Membandingkan respon pengobatan pada pemberian sulfas frosus satu kali sehari dengan 3 kali sehari pada anak usia sekolah yang menderita anemia defisiensi besi. Metode. Penelitian dilakukan di Kecamatan Bilah Hulu, Kabupaten Rantau Prapat terhadap murid sekolah dasar. Anak dengan Hb 13 dan RDW index >220 diikutsertakan dalam penelitian. Fungsi kognitif dinilai dengan Weschler Intelligence Scale for Children. Sampel secara random dibagi menjadi 2 kelompok yang mendapat sulfas ferosus 3 kali sehari dan satu kali sehari dengan dosis yang sama (besi elemental 5 mg/kgBB/hari). Hasil. Lima puluh anak dinilai dengan WISC, didapati rerata Full IQ 83,80 (SD=13,14), Performance IQ 81,08 (SD=14,58) dan Verbal IQ 88,10 (SD=14,20). Didapatkan skor aritmatika yang rendah (7+3,23). Tingkat IQ didapati average 36%, dull normal 28%, borderline 24%, dan mental defective 10%. Konsentrasi yang rendah dijumpai pada 44% dan sangat rendah 10%. Terdapat peningkatan bermakna kadar hemoglobin pada kedua kelompok setelah pemberian terapi besi (p<0,05), namun tidak dijumpai perbedaan bermakna peningkatan Hb antar kedua kelompok (p=0,29). Kesimpulan. Full IQ anak sekolah dasar yang menderita anemia defisiensi besi tidak melebihi tingkat average, didapati gangguan konsentrasi dan fungsi kognitif, terutama dalam matematika. Tidak didapati perbedaan bermakna antara kelompok terapi besi tiga kali sehari dibandingkan satu kali sehari dalam peningkatan Hb