High mobility, low access thwarts interventions among seasonal workers in the Greater Mekong Sub-region: lessons from the malaria containment project

Background: During the process of malaria elimination in the Greater Mekong Sub-region, mobile and migrant populations (MMPs) have been identified as the most at-risk demographic. An important sub-group of MMPs are seasonal workers, and this paper presents an evaluation of the reach and effectiveness of interventions tailored towards this group and was carried out as part of the Containment Project from 2009-11. Methods: A mixed-methods study was conducted in Pailin Province in Western Cambodia. Three-hundred-and-four seasonal workers were surveyed using a structured questionnaire. Qualitative data were gathered through a total of eight focus group discussions and 14 in-depth interviews. Data triangulation of the qualitative and quantitative data was used during analysis. Results: High mobility and low access of the target population to the interventions, as well as lack of social and anthropological research that led to implementation oversights, resulted in under-exposure of seasonal workers to interventions. Consequently, their reach and impact were severely limited. Some services, particularly Mobile Malaria Workers, had the ability to significantly impact key factors, such as risky behaviours among those they did reach. Others, like Listening and Viewing Clubs and mass media campaigns, showed little impact. Conclusions: There is potential in two of the interventions assessed, but high mobility and inadequate exposure of seasonal workers to these interventions must be considered in the development and planning of future interventions to avoid investing in low-impact activities and ensure that all interventions perform according to their maximum potential. This will be critical in order for Cambodia to achieve its aim of malaria elimination. The lessons learned from this study can be extrapolated to other areas of health care in Cambodia and other countries in order to reduce the gap between healthcare provided to MMPs, especially seasonal workers, and to the general population

Feasibility of a randomised controlled trial of remotely delivered problem-solving cognitive behaviour therapy versus usual care for young people with depression and repeat self-harm: lessons learnt (e-DASH)

BackgroundSelf-harm and depression are strong risk factors for repeat self-harm and suicide. We aimed to investigate the feasibility of a randomised controlled trial (RCT) of remotely delivered problem-solving cognitive behaviour therapy (PSCBT) plus treatment as usual (TAU) versus TAU in young people with repeat self-harm and depression.MethodsSingle-blind multi-centre RCT with an internal pilot, pre-set stop-go criteria and qualitative semi-structured interviews. Eligible participants (aged 16–30 years) were recruited from 9 adult or child and adolescent self-harm and crisis services; had ≥ 2 lifetime self-harm episodes, one in the preceding 96 h; and Beck Depression Inventory-II (BDI-II) score ≥ 17. Participants were randomised (1:1) to either TAU or TAU and 10–12 sessions of PSCBT delivered by mobile phone or video-calling.ResultsTwenty-two participants were recruited (11 in each arm), 10 (46%) completed follow-up at 6 months, 9 (82%) started the PSCBT and 4 (36%) completed it. The study did not meet three of its four stop-go criteria, reflecting considerable barriers to recruitment and retention. Participants had severe depression symptoms: with mean BDI-II 38.9 in the PSCBT and 37.2 in TAU groups, respectively. Three (14%) unblindings occurred for immediate safety concerns. Barriers to recruitment and retention included lack of agency for participants, severity of depression, recency of crisis with burden for participants and clinicians who diagnosed depression according to pervasiveness.ConclusionsRCTs of PSCBT for young people with depression and self-harm are not feasible using recruitment through mental health services that conduct assessments following self-harm presentations. Clinician assessment following self-harm presentation mainly identifies those with severe rather than mild-moderate depression

A protocol for training group-housed rhesus macaques (Macaca mulatta) to cooperate with husbandry and research procedures using positive reinforcement

There has been increased recognition of the 3Rs in laboratory animal management over the last decade, including improvements in animal handling and housing. For example, positive reinforcement is now more widely used to encourage primates to cooperate with husbandry procedures, and improved enclosure design allows housing in social groups with opportunity to escape and avoid other primates and humans. Both practices have become gold standards in captive primate care resulting in improved health and behavioural outcomes. However, training individuals and social housing may be perceived as incompatible, and so it is important to share protocols, their outcomes and suggestions for planning and improvements for future uptake. Here we present a protocol with link to video for training rhesus macaques (Macaca mulatta) housed in single-male – multi-female breeding groups to sit at individual stations in the social enclosure. Our aim was that the monkeys could take part in welfare-related cognitive assessments without the need for removal from the group or interference by group members. To do this we required most individuals in a group to sit by individual stations at the same time. Most of the training was conducted by a single trainer with occasional assistance from a second trainer depending on availability. We successfully trained 61/65 monkeys housed in groups of up to nine adults (plus infants and juveniles) to sit by their individual stationing tools for >30 s. Males successfully trained on average within 30 min (2 training sessions); females trained on average in 1 h 52 min ± 13min (7.44 sessions), with rank (high, mid, low) affecting the number of sessions required. On average, dominant females trained in 1 h 26 min ± 16 min (5.7 sessions), mid ranked females in 1 h 52 min ± 20min (7.45 sessions), and subordinate females took 2 h 44 min ± 36 min (10.9 sessions). Age, group size, reproductive status, temperament, and early maternal separation did not influence the number of sessions a monkey required to reach criterion. We hope this protocol will be useful for facilities worldwide looking to house their animals in naturalistic social groups without impacting on animal husbandry and management