Search

Heer Pater, komen alle mensen niet voort uit een vader Adam en Eva? Heb ik er kwaad aan gedaan dat ik twaalf van mijn broeders verlost heb van hun boeien die hun onrechtmatig waren aangedaan? Heer Pater, de Franse vrijheid is voor ons een kwelling geworden. Als iemand van ons gestraft werd, werd hem telkens gezegd: wil jij ook je vrijheid? Eens werd ik vastgebonden, ik riep zonder ophouden: genade voor een arme slaaf. Toen ik ten slotte losgemaakt werd, golfde het bloed uit mijn mond. Ik wierp mij op mijn knieën en riep tot God: is het dan Uw wil dat wij zo mishandeld worden? Ach Pater, men draagt meer zorg voor een beest; als een beest een been breekt, wordt het genezen.’ (Paula 1974). Deel van het betoog van Tula, leider van de grootste slavenopstand van Curaçao, in 1795, met de franciscaner pater Jacobus Schinck, openbaar gemaakt door de filosoof en socioloog A.F. Paula in 1974.

Chronic stress can produce reward system deficits (i.e., anhedonia) and other common symptoms associated with depressive disorders, as well as neural circuit hypofunction in the medial prefrontal cortex (mPFC). However, the molecular mechanisms by which chronic stress promotes depressive-like behavior and hypofrontality remain unclear. We show here that the neuronal activity-regulated transcription factor, NPAS4, in the mPFC is regulated by chronic social defeat stress (CSDS), and it is required in this brain region for CSDS-induced changes in sucrose preference and natural reward motivation in the mice. Interestingly, NPAS4 is not required for CSDS-induced social avoidance or anxiety-like behavior. We also find that mPFC NPAS4 is required for CSDS-induced reductions in pyramidal neuron dendritic spine density, excitatory synaptic transmission, and presynaptic function, revealing a relationship between perturbation in excitatory synaptic transmission and the expression of anhedonia-like behavior in the mice. Finally, analysis of the mice mPFC tissues revealed that NPAS4 regulates the expression of numerous genes linked to glutamatergic synapses and ribosomal function, the expression of upregulated genes in CSDS-susceptible animals, and differentially expressed genes in postmortem human brains of patients with common neuropsychiatric disorders, including depression. Together, our findings position NPAS4 as a key mediator of chronic stress-induced hypofrontal states and anhedonia-like behavior.

Pod-based electronic (e-) cigarettes more efficiently deliver nicotine using a protonated formulation. The cardiovascular effects associated with these devices are poorly understood. We evaluated whether pod-based e-liquids and their individual components impair endothelial cell function. We isolated endothelial cells from people who are pod users (n = 10), tobacco never users (n = 7), and combustible cigarette users (n = 6). After a structured use, pod users had lower acetylcholine-mediated endothelial nitric oxide synthase (eNOS) activation compared with never users and was similar to levels from combustible cigarette users (overall P = 0.008, P = 0.01 pod vs never; P = 0.96 pod vs combustible cigarette). The effects of pod-based e-cigarettes and their constituents on vascular cell function were further studied in commercially available human aortic endothelial cells (HAECs) incubated with flavored JUUL e-liquids or propylene glycol (PG):vegetable glycerol (VG) at 30:70 ratio with or without 60 mg/mL nicotine salt for 90 min. A progressive increase in cell death with JUUL e-liquid exposure was observed across 0.0001–1% dilutions; PG:VG vehicle with and without nicotine salt induced cell death. A23187-stimulated nitric oxide production was decreased with all JUUL e-liquid flavors, PG:VG and nicotine salt exposures. Aerosols generated by JUUL e-liquid heating similarly decreased stimulated nitric oxide production. Only mint flavored e-liquids increased inflammation and menthol flavored e-liquids enhanced oxidative stress in HAECs. In conclusion, pod e-liquids and their individual components appear to impair endothelial cell function. These findings indicate the potential harm of pod-based devices on endothelial cell function and thus may be relevant to cardiovascular injury in pod type e-cigarette users.

Advances in genetics has led to a better understanding of both genetic and environmental contributions to psychiatric mental health disorders. But psychiatric genetics research is predominantly Eurocentric, and individuals of non-European ancestry continue to be significantly underrepresented in research studies with potential to worsen existing mental health disparities. The objective of this study was to examine factors associated with genetic study participation in a schizophrenia sample. The study sample was extracted from the Clinical Antipsychotics Trial of Intervention Effectiveness (CATIE) schizophrenia study which enrolled 1493 patients with chronic schizophrenia between the ages of 18-65 years and incorporated an optional genetic sub-study. Using a logistic regression model (N = 1249), we examined sociodemographic and clinical variables that were independently associated with the outcome i.e., participation in the genetic sub-study. The genetic sub-study had a lower proportion of Black (30% in genetic vs 40% in CATIE overall) and other race (4% vs 6%) participants. Increased severity of psychopathology symptoms (odds ratio [OR] = 0.78, p = 0.004) decreased the odds whereas better reasoning scores (OR = 1.16, p = 0.036) increased the odds of genetic study participation. Compared to Black participants, White participants were significantly more likely to participate in the genetic sub-study (OR = 1.43, p = 0.009). Clinical factors in addition to race significantly impact genetic study participation of individuals with chronic schizophrenia. Our findings highlight the need for future research that examines the interactive effects of race and clinical factors such as symptom severity on psychiatrically ill individuals' choice to participate in genetics studies and to identify targeted strategies to increase equitable representation in psychiatric genetics research.

Introduction Nurses working in municipal long-term care face ethical challenges that can lead to moral distress and discomfort for the nurse and affect the quality of patient care. Tools and methods that contribute to increased ethical awareness and support for nurses dealing with moral issues are lacking. Technological innovations may be suitable for ethics work, but little research has been conducted on how such solutions could be designed or their potential benefit. Therefore, this study contributes knowledge about the development and testing of a digital tool for ethics support among nurses. Objective To investigate how digital ethical reflection can support ethics work among nurses working in long-term care. Methods A digital ethical reflection tool was designed and tested in nursing homes and home nursing care in collaboration with two Norwegian municipalities. The study used sequential explanatory mixed-methods design. Over a 6-week period, at the end of each shift, nurses digitally reported the ethical challenges they had experienced. Their responses and experiences were described using descriptive statistics. Additionally, focus group interviews were conducted and analyzed using reflexive thematic analysis (TA). Results During the study period, 17 nurses reported a total of 223 registrations, with 24.8% stating that they had been in an ethically difficult situation. The digital reporting was perceived as practically applicable and helped to increase nurses’ awareness of morally charged situations. The value of the registrations was found to depend on manager participation and the application of the obtained information. The participating nurses become aware that they lacked an arena for meaningful dialogue with and recognition from their manager. Conclusions Information obtained through digital reflection can form the basis for ethical reflections at the departmental level. Digital reflection has the potential to become a tool for managers in their support for employees facing ethical challenges when providing long-term care.

A novel Ni-I2 catalytic system was introduced for the synthesis of 2-arylimidazo[1,2-a]pyridines from readily available arylmethyl ketones and 2-aminopyridines as the starting materials. The method uses efficient and cost-effective NiCl2·6H2O catalyst and molecular iodine to provide a range of 2-arylimidazo[1,2-a]pyridines in moderate to good yields through the Ortoleva-King type protocol. The transformation is proposed to follow a sequence of α-iodination/Ortoleva-King type reaction/cyclization. The method was effectively utilized in the synthesis of Zolimidine, a gastroprotective drug.

Despite large numbers of patients accessing antiretroviral treatment (ART) in Kenya, few studies have explored factors associated with virologic failure in Western Kenya, specifically. We undertook a study in Homa Bay County, Kenya to assess the extent of virologic treatment failure and factors associated with it. This was an observational retrospective study conducted from September 2020 to January 2021. Data were abstracted from the records of patients who had been on ART for at least six months at the time of data collection after systematic sampling stratified by age group at ART initiation (0–14 and 15+ years), using probability proportion to the numbers of patients attending the facility. Confirmed viral treatment failure was defined as viral load ≥1000 copies/ml based on two consecutive viral load measurements after at least three months of enhanced adherence counseling. Data were analyzed using descriptive statistics and Cox regression modeling. Of the 2,007 patients sampled, 160 (8.0%) had confirmed virologic treatment failure. Significantly higher virologic treatment failure rates were identified among male patients 78/830 (9.4%) and children 115/782 (14.7%). Factors associated with virologic treatment failure (VTF), were age 0–14 years, adjusted hazard ratio (AHR) 4.42, (95% Confidence Interval [CI], 3.12, 6.32), experience of treatment side effects AHD: 2.43, (95% CI, 1.76, 3.37), attending level 2/3 health facility, AHR: 1.87, (95% CI: 1.29, 2,72), and history of opportunistic infections (OIs), AHR: 1.81, (95% CI, 1.76, 3.37). Children, attendees of level 2/3 health facilities, patients with a history of OIs, and those experiencing treatment side-effects are at risk of VTF. Increased focus on children and adolescents on screening for drug resistance, administration of and adherence to medication, and on effective information and education on side-effects is critical. Additionally, there is need for increased training and support for health care workers at primary level care facilities.

O racismo institucional é o resultado do funcionamento das instituições que passam a atuar em uma dinâmica que confere ainda que indiretamente, desvantagens, privilégios com base na raça. A integralidade em saúde compõe uma categoria de análise dos estudos em saúde coletiva e descreve platôs crescentes de qualidade e acesso. Embora toda gestante tenha direito ao acesso e ao atendimento digno e de qualidade no decorrer da gestação, parto e puerpério e tenha havido melhoras na atenção ao pré-natal, diferentes fontes de informação demonstram que as mulheres negras continuam sendo as mais afetadas em relação ao acesso aos serviços de saúde. O objetivo desse estudo é analisar a influência da interseccionalidade dos marcadores sociais raça, cor, classe social, escolaridade no cuidado integral da gestante em atendimento no pré-natal a partir dos depoimentos das mulheres. A pesquisa foi realizada em dois bairros da cidade de Alvorada, na região metropolitana de Porto Alegre, Rio Grande do Sul (RS), a partir de relatos de mulheres em atendimento. A produção de dados foi realizada utilizando-se a entrevista semiestruturada, questionário sociodemográfico e caderno de campo. Para esse artigo foram selecionados os relatos de duas mulheres negras. Os dados foram analisados pela análise temática, com a construção de categorias teóricas e empíricas. As gestantes negras relataram sofrer racismo e violência obstétrica e medo em não poder ter acompanhante no parto devido à pandemia de COVID-19. Os depoimentos das mulheres encontram eco na literatura e demonstram uma face ainda mais perversa do racismo institucional: a produção de medo e vulnerabilidade mesmo nos atendimentos nos serviços públicos e privados de saúde, alertando o ensino da saúde para a produção de uma cultura que não tolere diferenças injustas no cuidado.

In this paper, we introduce a new iterative method that combines the inertial subgradient extragradient method and the modified Mann method for solving the pseudomonotone variational inequality problem and the fixed point of quasi-Bregman nonexpansive mapping in p-uniformly convex and uniformly smooth real Banach spaces. Under some standard assumptions imposed on cost operators, we prove a strong convergence theorem for our proposed method. Finally, we perform numerical experiments to validate the efficiency of our proposed method.

O objetivo deste artigo é destacar a presença de Paulo Freire como fundamentação teórica na produção científica do Grupo de Pesquisa Comunicação e Educação, ligado à Sociedade Brasileira de Estudos Interdisciplinares da Comunicação, entre os anos de 2001 e 2020. Para isso, foram analisados os 847 artigos apresentados em congressos nacionais neste período. Como resultado, a pesquisa aponta que em 41% dos textos há referências ao educador brasileiro – principalmente às obras Extensão ou comunicação?, Pedagogia do oprimido e Pedagogia da autonomia –, especialmente a conceitos como educação bancária, aprendizagem significativa, formação crítica, assim como reflexões sobre interação professor-aluno, diálogo e fundamentos da prática docente.

Abstract Background Concerted effort to control malaria has had a substantial impact on the transmission of the disease in the past two decades. In areas where reduced malaria transmission is being sustained through insecticide-based vector control interventions, primarily long-lasting insecticidal nets (LLINs) and indoor residual spraying (IRS), non-insecticidal complementary tools will likely be needed to push towards malaria elimination. Once interruption in local disease transmission is achieved, insecticide-based measures can be scaled down gradually and eventually phased out, saving on costs of sustaining control programs and mitigating any unintended negative health and environmental impacts posed by insecticides. These non-insecticidal methods could eventually replace insecticidal methods of vector control. House screening, a non-insecticidal method, has a long history in malaria control, but is still not widely adopted in sub-Saharan Africa. This study aims to add to the evidence base for this intervention in low transmission settings by assessing the efficacy, impact, and feasibility of house screening in areas where LLINs are conventionally used for malaria control. Methods A two-armed, household randomized clinical trial will be conducted in Mozambique, Zambia, and Zimbabwe to evaluate whether combined the use of house screens and LLINs affords better protection against clinical malaria in children between 6 months and 13 years compared to the sole use of LLINs. Eight hundred households will be enrolled in each study area, where 400 households will be randomly assigned the intervention, house screening, and LLINs while the control households will be provided with LLINs only. Clinical malaria incidence will be estimated by actively following up one child from each household for 6 months over the malaria transmission season. Cross-sectional parasite prevalence will be estimated by testing all participating children for malaria parasites at the beginning and end of each transmission season using rapid diagnostic tests. CDC light traps and pyrethrum spray catches (PSC) will be used to sample adult mosquitoes and evaluate the impact of house screening on indoor mosquito density, species distribution, and sporozoite rates. Discussion This study will contribute epidemiological data on the impact of house screening on malaria transmission and assess the feasibility of its implementation on a programmatic scale. Trial registration ClinicalTrials.gov PACTR202008524310568 . Registered on August 11, 2020.

Objetiva-se analisar os conhecimentos e as concepções e as práticas de professores do Município de Vitória, Espírito Santo sobre o processo de alfabetização da criança com Deficiência Intelectual. Trata-se de um estudo de natureza qualitativa do tipo exploratório, tendo Vigotski como principal interlocutor. Para tanto, foram realizadas entrevistas semiestruturadas. Os resultados produzidos evidenciam que o Município tem investido em formação para essas profissionais, todavia ainda parece incipiente essa formação ou necessita ser revista para atender as demandas da ação pedagógica, com vistas à garantia dos processos de alfabetização, principalmente, junto aos alunos público-alvo da educação especial com Deficiência Intelectual.

Introduction: Worldwide, cancer is the second major cause of death and is accountable for an approximately 9.6 million deaths in the year 2018. Cancer carries a stigma due to its link with death. This affects the health seeking behaviour of the cancer patients. Aim: To evaluate the effect of teaching intervention on cancer facts to reduce social stigma among rural adults. Materials and Methods: This quasi-experimental pretest posttest control group study was conducted from 5th January 2021 to 5th February 2021, in rural community at Mangalore, Karnataka, India. Hundred adults between 18-65 years of age were selected based on purposive sampling technique and randomly assigned to an experimental and control group. Data was collected using baseline proforma and self-designed cancer social stigma scale which is a 5-point rating scale, consisting of 20 statements. The total score of each participant was calculated and categorised as severe, moderate, mild and no social stigma. Individual teaching intervention was given on first day to the intervention group and post-test was conducted after seven days on both the groups. The data were analysed using the t-test and chisquare tests. Results: The total study population of 100 adults was divided into intervention group (mean age 33.34±4.46 years) and control group (mean age 36.22±4.07 years) of 50 subjects each. Before the teaching intervention, the mean and Standard Deviation (SD) of social stigma scores of intervention group and control group were 59.9±13.6 and 61.38±9.8, respectively. After the intervention, the score of the intervention group and control group were 30.62±4.5 and 61.44±10.8, respectively. Independent t-test showed that there was a significant difference in social stigma score between intervention group and control group after the intervention (p-value

Introdução e objetivo: Este estudo teve como objetivo verificar a relação entre composição corporal e VO2 máx em mulheres praticantes de corrida de rua. Materiais e Métodos: estudo observacional e transversal que avaliou 20 mulheres, praticantes de corrida de rua. Foi utilizado um questionário com questões sociodemográficas e sobre a prática de corrida de rua; a bioimpedância elétrica, e o teste de "vai e vem". Os dados foram analisados por meio dos testes Shapiro-Wilk, "U" de Mann-Whitney e correlação de Spearman (p

Postoperative Cognitive Dysfunction (POCD) adalah gangguan neurokognitif yang ditandai dengan penurunan kinerja kognitif setelah operasi dan anestesi. POCD ditandai dengan gangguan memori, penurunan proses informasi, berkurangnya perhatian, serta perubahan suasana hati dan kepribadian. Insidensi POCD pada pasien lanjut usia ( 60 tahun) sekitar 25,8% dalam tujuh hari setelah operasi dan 10% dalam tiga bulan setelah operasi. Faktor risiko dan etiologi yang menyebabkan POCD dapat dikurangi dengan edukasi pasien yang baik, perawatan pasien, dan sanitasi yang tepat sehingga dapat mencegah kecenderungan gejala POCD pada pasien tersebut. Pemeriksaan dapat dilakukan dengan tes pembelajaran kata, tes pembuatan Jejak, tes ketangkasan manual, dan tes kemampuan untuk mengingat urutan angka. Mini Mental State Examination (MMSE) sebagai tes untuk melakukan skrining demensia. MMSE terkadang digunakan untuk mengukur POCD. MMSE dapat digunakan dalam praktik klinis rutin untuk mengidentifikasi demensia subklinis pra operasi yang akan menempatkan pasien pada risiko yang lebih tinggi untuk berkembang menjadi POCD. Penatalaksanaan pada POCD meliputi dua pendekatan yaitu penegakkan diagnosis secara cepat dan pencegahan gejala POCD. Pencegahan dapat dilakukan dengan mengetahui faktor risiko preoperatif, intraoperatif, dan postoperatif. Pasien dengan POCD persisten mengalami dampak negatif pada kualitas hidup, kinerja memori subjektif, emosional, dan mungkin didapatkan konsekuensi kesehatan seperti demensia dan kematian dini. Post Operative Cognitive Dysfunction among Elderly Patients Abstract Postoperative Cognitive Dysfunction (POCD) is a neurocognitive disorder characterized by decreased cognitive performance after surgery and anesthesia. POCD is a complication characterized by memory impairment, decreased information processing and reduced attention, accompanied by changes in mood and personality. The incidence of POCD in elderly patients ( 60 years) was approximately 25.8% within seven days after surgery and 10% within three months after surgery. The risk factors and etiology that lead to POCD can be reduced by good patient education, patient care and proper sanitation can prevent the tendency of POCD symptoms in these patients. Examination can be done with the learning test, the word learning test, the tracing test, the manual dexterity test, the ability test to remember a sequence of numbers. Mini Mental Status Examination (MMSE) as a screening test for dementia. MMSE is sometimes used to measure POCD. MMSE can be used in routine clinical practice to identify preoperative subclinical dementia that would put patients at a higher risk of developing POCD. Management in POCD includes two approaches, namely rapid diagnosis and prevention of POCD symptoms. Prevention by knowing the risk factors preoperative, intraoperative and postoperative. In patients with persistent POCD, it has a negative impact on quality of life, subjective memory performance, emotional symptoms, and possible health consequences such as dementia and premature death.

Charcot-Marie-Tooth type 4B3 (CMT4B3) is a rare subtype of hereditary neuropathy associated with variants in the MTMR5/SBF1 gene. Herein, we report the generation and characterization of a hiPSC line from a 12-year-old Italian girl with early onset severe polyneuropathy with motor and axonal involvement, harboring biallelic variants in the MTMR5/SBF1 gene. Fibroblasts were reprogrammed using non-integrating episomal plasmids, and iPSCs successfully passed the stemness and pluripotency tests. Patient-specific hiPSCs were produced to obtain a disease model for the study of this rare condition.

O objetivo da pesquisa foi realizar um diagnóstico dos espaços de ação pública voltados para a garantia dos direitos da pessoa idosa no Estado do Pará. Buscou-se fazer um levantamento dos conselhos de direitos da pessoa idosa, existentes nos 144 municípios e compreender se os mesmos têm incidido na provisão das políticas públicas locais. Descreve-se os desafios e ações de enfrentamento realizadas por tais conselhos, examinou-se documentos de domínio público, demais fontes de informação e realizou-se entrevistas via Google Forms. O estudo, ainda que com resultado parcial, por fazer parte de uma pesquisa em andamento, conclui, que o Estado do Pará carece de política de fortalecimento dos conselhos. Contudo, pode inferir que os municípios cujos conselhos estão ativos conseguem empreender ações que buscam superar os desafios e limitações, possibilitando atendimento e garantias de direitos às pessoas idosas, mas que podem ser potencializadas com maior participação social e da gestão pública

This article explores intrapersonal and transpersonal communication as the principal derivatives of a subjective, inner reality. These levels relate to different states and levels of consciousness and corresponding levels of selfawareness. Since an exploration of the nature of the self and its possible confluence with states and levels of consciousness necessitates a multidisciplinary approach, theories and constructs in Psychology, the New Physics (Quantum Physics), Mysticism, and Philosophy are integrated with contemporary communication notions of the self and consciousness. Integration and inclusiveness consequently form the bedrock of this article.

Splenic marginal zone lymphoma is a mature B-cell neoplasm, as multiple myeloma; however, the coexistence of these two entities in the same patient is rare. We present the case of an 82-year-old older adult male with a history of prostatic hyperplasia and arterial hypertension, who at the time of consultation presented general syndrome, fever, abdominal discomfort, hypocolored mucous membranes and palpable spleen tip, without peripheral lymphadenopathy. After performing the paraclinical examinations and according to the result of the spleen biopsy, a splenic marginal zone lymphoma was diagnosed, with no clinical or laboratory evidence of multiple myeloma or Waldestrom's disease. Splenectomy was performed. Subsequently, the patient received six cycles of chemotherapy. He evolved favorably, the symptoms disappeared, the altered complementary symptoms returned to normal and it was decided to continue consultations according to protocol. After four years, in a follow-up consultation, he reported severe bone pain, especially at the level of spine and hips, as well as weight and appetite loss. A second hematologic malignancy, a stage IIIb multiple myeloma, was diagnosed. Treatment with a scheme of the elderly was carried out, based on the careful use of steroids, melphalan and bisphosphonates. Despite the delicate nature of the case, the patient had a 26-month survival after the second diagnosis.

Detailed description of the prevalence and sources of e-cigarettes among youth is needed to inform effective regulatory policies. We used the Youth Risk Behavior Surveillance System data (2015–2019) to assess trends in current (past-30-day-use) and frequent (≥10 days in past-30-days) e-cigarette use among United States high schoolers before the COVID-19 pandemic. First, we assessed trends overall and then stratified by participants’ sociodemographic characteristics, use of other tobacco products, and experiences of psychosocial stress. We also evaluated past year quit attempts and the changing sources of e-cigarettes.Our sample size was 41,021 (15,356–2015; 12,873–2017; 12,792–2019). The prevalence of current e-cigarette use increased from 24.0% (95%CI:21.9%–26.3%) in 2015 to 32.7% (30.4%–35.1%) in 2019. The proportion of current users who reported frequent use also increased significantly from 22.6% (20.4%–24.8%) to 45.4% (42.7%–48.2%). Thus, an increasing proportion of US high school students who use e-cigarettes reported frequent use, indicating greater nicotine dependence. The increase in current and frequent e-cigarette use was more pronounced in youth who reported other substance use and psychosocial stressors such as bullying. Between 2017 and 2019, there was a decline in the proportion of youth who bought e-cigarettes online (6.9% to 3.2%) or from convenience stores (22.0% to 16.6%). Conversely, there was an increase in the proportion who borrowed (34.5% to 40.1%) or purchased e-cigarettes through other people (10.7% to 18.0%), indicating that most youth are evading age-related restrictions by obtaining e-cigarettes from other people. Finally, a considerable proportion of youth tobacco users are making quit attempts; 47.6% (45.1%–50.1%) in 2019.

Abstract Background Data on the prevalence, genotypes and antibiotic resistance patterns of colonizing and infection-associated Staphylococcus aureus (S. aureus) strains both in humans and animals in Tanzania are scarce. Given the wide range of infections caused by S. aureus and the rise of methicillin-resistant S. aureus (MRSA) globally, this review aims at collecting published data on S. aureus bacterium to improve our understanding of its epidemiology in Tanzania. Main body We carried out a systematic review of scientific studies reporting on prevalence, antibiotic resistance and genotyping data pertaining to S. aureus in human and animal infection and colonization. The literature extracted from electronic databases such as PubMed and Google Scholar was screened for eligibility and relevant articles were included. The review is limited to manuscripts published in English language between the years 2010 and 2020. A total of 45 studies conducted in 7 of the 9 administrative zones in Tanzania were reviewed to gather data on S. aureus prevalence in humans and animals. Prevalence in humans ranged from 1 to 60%. Antibiotic resistance patterns of S. aureus isolated from colonized humans showed high resistance rates against co-trimoxazole (46%) and erythromycin (41%) as compared to reports from studies conducted outside Africa. The review suggests an increased MRSA prevalence of up to 26% as compared to 6–16% reported in previous years. Genotypic data reviewed suggested that MRSA predominantly belonged to ST88. The prevalence of S. aureus in animal studies ranged from 33 to 49%, with 4 to 35% of MRSA isolates. Most studies reported low antibiotic resistance levels, with the exception of penicillin (85%) and ampicillin (73%). Conclusion The prevalence of S. aureus and MRSA in Tanzania is rising, although clear variations between different geographic areas could be observed. Non-susceptibility to commonly prescribed antibiotics in community-associated S. aureus is of concern. Research strategies to ameliorate our knowledge on S. aureus epidemiology should employ regular antibiotic resistance surveillance, antimicrobial stewardship as well as genotypic characterization.

Abstract Background Preconditioning of the heart ameliorates doxorubicin (Dox)-induced cardiotoxicity. We tested whether pretreating cardiomyocytes by mitochondrial-targeted antioxidants, mitoquinone (MitoQ) or SKQ1, would provide better protection against Dox than co-treatment. Methods We investigated the dose-response relationship of MitoQ, SKQ1, and vitamin C on Dox-induced damage on H9c2 cardiomyoblasts when drugs were given concurrently with Dox (e.g., co-treatment) or 24 h prior to Dox (e.g., pretreatment). Moreover, their effects on intracellular and mitochondrial oxidative stress were evaluated by 2,7-dichlorofluorescin diacetate and MitoSOX, respectively. Results Dox (0.5–50 μM, n = 6) dose-dependently reduced cell viability. By contrast, co-treatment of MitoQ (0.05–10 μM, n = 6) and SKQ1 (0.05–10 μM, n = 6), but not vitamin C (1–2000 μM, n = 3), significantly improved cell viability only at intermediate doses (0.5–1 μM). MitoQ (1 μM) and SKQ1 (1 μM) significantly increased cell viability to 1.79 ± 0.12 and 1.59 ± 0.08 relative to Dox alone, respectively (both p

Background: The aim of this study was to explore the effectiveness of a Cognitive Orientation to daily Occupational Performance (CO-OP) intervention delivered in a group format in a 1-week summer day camp program for children referred for motor coordination difficulties. Transfer of learned skills to self-selected tasks not addressed in the group intervention was also explored. Method: A quasi-experimental one group pretest-posttest design with a 1-month follow-up was used. Changes in nine children’s self-selected occupational performance goals, as well as their sense of self-efficacy for these goals, were determined using nonparametric statistics. Results: Findings indicate a significant performance improvement at both posttest and follow-up, with large effect sizes. Self-efficacy also significantly changed across sessions on tasks directly addressed, with large effect sizes. No statistically significant changes for any of the measures were noted for the tasks that were not addressed during camp. Conclusion: The CO-OP in group format in an intensive 4-day summer day camp was effective in improving performance of self-selected camp goals, as well as self-efficacy, but less effective for transfer of learned skills to other tasks.

Introdução: O by-pass gástrico em y de Roux (BGYR) é a técnica cirúrgica mista mais utilizada no Brasil para o tratamento e controle da obesidade, sendo considerada a técnica mais efetiva para a perda ponderal de peso. Entretanto demanda cuidado nutricional contí­nuo, devido ao maior risco do paciente desenvolver deficiências nutricionais. Objetivo: realizar uma revisão sistemática sobre as principais deficiências de micronutrientes após o by-pass gástrico e determinar a importância da avaliação nutricional na prevenção das carências nutricionais. Materiais e métodos: a revisão foi realizada conforme a metodologia Preferred Repor Ting Items for Systematic Reviewaand Meta-analyses-PRISMA. Para tanto, foi consultada a produção cientifica de periódicos indexados nos bancos de dados Lilacs, Medline, Pubmed, Scielo, entre os anos de 2008 a julho de 2018. Resultados: a análise final contou com 25 artigos. Foi possí­vel observar que embora o by-pass gástrico em y de Roux melhore a qualidade de vida do paciente, está técnica pode causar deficiências de micronutrientes como das vitaminas do complexo B (B12, B9, B1) das vitaminas lipossolúveis (A, D) e de minerais como cálcio, zinco e ferro. Essas deficiências podem estar presentes no pré-operatório ou surgir e agravarem-se no pós-operatório. Conclusão: tendo em vista que as deficiências podem ocorrer tanto a curto, quanto a longo prazo é necessário acompanhamento nutricional e clí­nico dos pacientes para monitorização e prevenção destas deficiências por toda vida.

Acute kidney injury (AKI) is common in cirrhotic patients affecting almost 20% of these patients. While multiple etiologies can lead to AKI, pre-renal azotemia seems to be the most common cause of AKI. Irrespective of the cause, AKI is associated with worse survival with the poorest outcomes observed in those with hepatorenal syndrome (HRS) and acute tubular necrosis (ATN). In recent years, new definitions, and classifications of AKI in cirrhosis have emerged. More knowledge has also become available regarding the benefits and drawbacks of albumin and terlipressin use in these patients. Diagnostic tools such as urinary biomarkers and point-of-care ultrasound (POCUS) became available and they will be used in the near future to differentiate between different causes of AKI and direct management of AKI in these patients. In this update, we will review these new classifications, treatment recommendations, and diagnostic tools for AKI in cirrhotic patients.

In this work, impermeable and ultrathin surface nanomodifications for joint applications based on graphene oxide (GO) are assembled on CoCr surfaces via covalent immobilization between GO nanosheets and silane monolayers. Two silane curing temperatures, 45 °C for 24 h and 75 °C for 30 min, on CoCr surfaces and two incubation times for GO suspension, 12 h and 24 h, on silanized CoCr surfaces are prepared. Electrochemical characterization is performed using electrochemical impedance spectroscopy (EIS) in a 3 g/L hyaluronic acid solution. Results show that GO nanosheets immobilized with silane covalent bonding confer impermeability of sp2 networks on GO and strong interfacial adhesion of GO sheets anchored to silanized CoCr via organosilane chemistry, which prevents the permeation of oxidant species at the metal interface. At short GO incubation times (12 h), the Rs values decrease with the immersion time, indicating that small species, such as metal ions, are able to diffuse through the interlayer gaps of nanolayers. Longer GO incubation times (24 h) favor the formation of bonds between the GO and the silane, thus slowing downdiffusion and metal ion release into the medium. EIS data confirm the impermeability of GO nanocoatings with lengthening GO incubation time for medical application of metallic implants.

Resumo Fundamento Houve aumento expressivo na incidência de infecções relacionadas a dispositivos cardíacos eletrônicos implantáveis (DCEI) nos últimos anos, com impacto na mortalidade. Objetivos Verificar a proporção de pacientes com infecção de DCEI e analisar seu perfil clínico, as variáveis relacionadas com a infecção e sua evolução. Método Estudo retrospectivo, observacional e longitudinal com 123 pacientes com infecção de DCEI entre 6.406 procedimentos. Foram usados os testes paramétricos, e o nível de significância adotado na análise estatística foi de 5%. Resultados A idade média dos pacientes foi de 60,1 anos, e 71 eram homens. A média de internação foi de 35,3 dias, e houve remoção total do sistema em 105 pacientes. Identificaram-se endocardite infecciosa (EI) e sepse em 71 e 23 pacientes, respectivamente. A mortalidade intra-hospitalar foi 19,5%. Houve associação entre EI e extrusão do gerador (17,0% vs. 19,5% nos grupos com e sem EI, respectivamente, p = 0,04; associação inversa) e sepse (15,4% vs. 3,2%, p = 0,01). Houve associação entre morte intra-hospitalar e EI (83,3% vs. 52,0% com e sem morte, respectivamente, p = 0,005) e sepse (62,5% vs. 8,1%, p < 0,0001). Foi dada alta hospitalar a 99 pacientes. Durante a média de seguimento clínico de 43,8 meses, a taxa de mortalidade foi de 43%, e 65,2% dos pacientes com sepse faleceram (p < 0,0001). A curva de sobrevida de Kaplan-Meier não indicou associação significante com sexo, agente etiológico, fração de ejeção, EI e modalidade de tratamento. A taxa de mortalidade foi de 32,8% entre os pacientes submetidos a reimplante de eletrodos por via endocárdica e 52,2% entre aqueles por via epicárdica (p = 0,04). Não houve influência da etiologia chagásica, a qual correspondeu a 44,7% das cardiopatias de base, quanto às variáveis clínicas e laboratoriais ou à evolução. Conclusões A taxa de infecção foi de 1,9%, com predomínio em homens. Houve associação entre mortalidade intra-hospitalar e EI e sepse. Após a alta hospitalar, a taxa de mortalidade anual foi de 11,8%, com influência de sepse durante a internação e o implante epicárdico. (Arq Bras Cardiol. 2021; [online].ahead print, PP.0-0)

People Living with HIV (PLHIV) are at an increased risk of pneumococcal pneumonia than HIV-uninfected adults, but the reasons for this are still not well understood. We investigated whether alveolar macrophages (AM) mediated control of pneumococcal infection is impaired in PLHIV compared to HIV-uninfected adults. We assessed anti-bactericidal activity against Streptococcus pneumoniae of primary human AM obtained from PLHIV and HIV-uninfected adults. We found that pneumococcus survived intracellularly in AMs at least 24 hours post ex vivo infection, and this was more frequent in PLHIV than HIV-uninfected adults. Corroborating these findings, in vivo evidence showed that PLHIV had a higher propensity for harboring S. pneumoniae within their AMs than HIV-uninfected adults. Moreover, bacterial intracellular survival in AMs was associated with extracellular propagation of pneumococcal infection. Our data suggest that failure of AMs to eliminate S. pneumoniae intracellularly could contribute to the increased risk of pneumococcal pneumonia in PLHIV.

O projeto de extensão Informação Nutricional – Rotulagem de Alimentos teve seu início em 12 de maio de 2002 na Universidade Estadual do Oeste do Paraná - UNIOESTE, campus de Francisco Beltrão, portanto, completa 20 anos de atuação em 2022. Está vinculado ao Grupo de Estudo e de Pesquisa em Segurança Alimentar (GEPSA) a partir do ano de 2003. Tem por objetivo atender pequenos e médios produtores da agroindústria da região Oeste - Sudoeste do Paraná e Oeste de Santa Catarina, por meio da elaboração de cálculos para informações nutricionais obrigatórias em rótulos de alimentos embalados na ausência do consumidor. Dessa forma, o projeto contribui, ao longo de quase 20 anos, para a valorização dos produtos de pequenos produtores da região e auxilia no que diz respeito à Segurança Alimentar e Nutricional.

Background: Vasovagal syncope (VVS) is the most common cause of syncope. Some stages of its pathophysiological mechanisms remain unclear. Vasoactive substances such as nitric oxide metabolites (NOx) and endothelin (ET) may be involved during acute orthostatic stress. Objective: To analyze plasma changes in NOx and ET and heart rate variability (HRV) in the supine positions (T1) and during the head-up tilt test (HUTT) (T2), in patients with VVS (case group) and control group. Methods: Thirty-seven patients (17 in the case group and 20 in the control group), matched for age and sex (mean aged 31.8 years) underwent HUTT with simultaneous HRV recording and venipuncture. Blood samples were collected during phases T1 and T2 and the analysis was performed without knowledge of the HUTT result. Results: In the total sample, there was an increase in NOx values ( P = .014), however there was no increase in ET values from phase T1 to phase T2. Patients with VVS tended to increase plasma NOx values ( P = .057) and had significantly higher plasma values compared to ET ( P = .033) between phases T1 to T2. In the control group, there was no significant change in the values of these vasoactive substances. Regarding HRV, there were a decrease in the component HF (high frequency) and increased of the LF (low frequency)/HF ratio during HUTT. Conclusions: There was an increase in ET during HUTT occurred only in the case group. These patients are more likely to have an imbalance between antagonistic vasoactive biomarkers during orthostatic stress.

Background: The COVID-19 pandemic disrupted essential health services (EHS) delivery worldwide; however, there are limited data for healthcare facility (HCF)–level EHS disruptions in low- and middle-income countries. We surveyed HCFs in 3 counties in Kenya to understand the extent of and reasons for EHS disruptions occurring during February 2020–May 2021. Methods: We included 3 counties in Kenya with high burden of COVID-19 at the time of study initiation. Stratified sampling of HCFs occurred by HCF level. HCF administrators were interviewed to collect information on types of EHS disruptions that occurred and reasons for disruptions, including those related to infection prevention and control (IPC). Analyses included descriptive statistics with proportions for categorical variables and median with interquartile range (IQR) for continuous variables. Results: In total, 59 HCFs in Kenya provided complete data. All 59 HCFs (100%) reported EHS disruptions due to COVID-19. Among all HCFs, limiting patient volumes was the most common disruption reported (97%), while 56% of HCFs reduced staffing of EHS and 52% suspended EHS. Median duration of disruptions ranged from 7 weeks (IQR, 0–15) for inpatient ward closures to 25 weeks (IQR, 14–37) for limiting patient volumes accessing EHS. Among HCFs that reported disruptions, the most cited reason (ie, 95% of HCFs) was fewer patients receiving services. The most common IPC-related reason for disruption was diversion of resources to accommodate physical distancing measures (76%) followed by COVID-19 outbreaks among patients or staff (34%); staff shortages due to COVID-19 illness (25%) or perceived infection risk (19%); and lack of adequate personal protective equipment (20%). Conclusions: Most HCFs reported disruptions to EHS during the pandemic, including many that were related to IPC. Some disruptions may be mitigated by strengthening IPC infrastructure and practices, including protecting healthcare personnel to prevent staffing shortages.

This special issue of JASEd offers insights to current research and practice pertaining to decolonizing perspectives of arts education. As the editors of this special issue, we each come from distinct positionalities, geographical locations, and contextual understandings. We found common ground in the need to discuss and share around the theme of decolonizing arts education. Spurred on by the seismic shifts of power, politics, and polarization that the world is currently experiencing, we noted an urgency to address what this might all mean in and for arts education.

Abstract Eswatini was the first country in sub-Saharan Africa to pass a National Malaria Elimination Policy in 2011, and later set a target for elimination by the year 2020. This case study aimed to review the malaria surveillance data of Eswatini collected over 8 years between 2012 and 2019 to evaluate the country’s efforts that targeted malaria elimination by 2020. Coverage of indoor residual spraying (IRS) for vector control and data on malaria cases were provided by the National Malaria Programme (NMP) of Eswatini. The data included all cases treated for malaria in all health facilities. The data was analysed descriptively. Over the 8 years, a total of 5511 patients reported to the health facilities with malaria symptoms. The case investigation rate through the routine surveillance system increased from 50% in 2012 to 84% in 2019. Incidence per 1000 population at risk fluctuated over the years, but in general increased from 0.70 in 2012 to 1.65 in 2019, with the highest incidence of 3.19 reported in 2017. IRS data showed inconsistency in spraying over the 8 years. Most of the cases were diagnosed by rapid diagnostic test (RDT) kits in government (87.6%), mission (89.1%), private (87%) and company/industry-owned facilities (84.3%), either singly or in combination with microscopy. Eswatini has fallen short of achieving malaria elimination by 2020. Malaria cases are still consistently reported, albeit at low rates, with occasional localized outbreaks. To achieve elimination, it is critical to optimize timely and well-targeted IRS and to consider rational expansion of tools for an integrated malaria control approach in Eswatini by including tools such as larval source management, long-lasting insecticidal nets (LLINs), screening of mosquito house entry points, and chemoprophylaxis. The establishment of rigorous routine entomological surveillance should also be prioritized to determine the local malaria vectors’ ecology, potential species diversity, the role of secondary vectors and insecticide resistance.

Abstract Background HIV testing among adolescents is significantly lower than among adults and many adolescents living with HIV do not know their status. Adolescent perceptions of HIV testing are poorly understood and may negatively affect testing uptake. Using a qualitative design, this study sought to explore perceptions about HIV testing and treatment among adolescents living with HIV and adolescents of unknown HIV status in Lusaka, Zambia and Kenya. Methods Study participants were adolescents aged 15–19 years old. The adolescents living with HIV were recruited from HIV support groups at health facilities. Adolescents of unknown HIV status were recruited from existing adolescent groups within the community. In both Zambia and Kenya, four focus group discussions (FGDs) were conducted with adolescents living with HIV and four FGDs were conducted with adolescents whose HIV status was unknown, for a total of 16 FDGs. FGDs consisted of 6–12 participants, a moderator, and a note-taker. FGDs were audio-recorded, transcribed, and translated into transcripts. Transcripts were coded in the qualitative analysis software program MAXQDA v. 12. Data reduction and summary tables were generated to help identify themes across the two study population groups. Data were interpreted within the health belief model. Results Adolescents discussed the challenges of facing a positive HIV test result, including fear of a positive result and need to change their lifestyle, fear of social isolation, and perception of the lost opportunity to achieve future dreams. Most adolescents of unknown status were not as aware of the benefits of learning their HIV status, nor were they aware of the ability to live a long and healthy life on ART. HIV-positive adolescents reported that the messages targeted towards adolescents focus on the need to remain HIV-negative, as opposed to the benefits of knowing one’s status. Adolescents described age and requirements for parental permission as a significant limitation in their ability to access HIV testing. Conclusions Adolescents require more information about the benefits of testing early and the ability to live a long and healthy life on ART. Educating adolescents that HIV testing is a normative behavior among their peers could strengthen HIV testing among adolescents.

Background: Silicone oil (SO) is an important adjunct for internal tamponade, especially in eyes with proliferative vitreoretinopathy, diabetic tractional retinal detachments, and traumatic retinal detachments. SO has been associated with complications, such as cataract, keratopathy, and glaucoma. Secondary glaucoma has been reported to occur at any time in the postoperative period with a wide range of intraocular pressures (IOPs) and vision loss. Aim: The aim of this study is to assess the incidence and clinical profile of SO-induced ocular hypertension (SOIOH) at our institution, after pars plana vitrectomy (PPV) and silicone oil tamponade (SOT) in patient requiring the procedure. Materials and Methods: This is a prospective study of patients who attended Minto Ophthalmic Hospital, Regional Institute of Ophthalmology, Bengaluru from November 2017 to October 2020 who were requiring SOT for various vitreoretinal pathology. Preoperative complete ophthalmic evaluation was done, starting from visual acuity recording using Snellen's chart, slit-lamp examination, IOP measurement using Goldmann's applanation tonometry, gonioscopy, and dilated fundus examination. A standard three-port PPV with SO injection was performed. SOIOH was defined as IOP >21 mmHg after a period of 3 weeks postoperative, which required either medical or surgical therapy. Patients who developed SOIOH were compared to those who did not develop SOIOH (SOIOH free group), in terms of age, length of SOT, presence of retained SO in anterior chamber and angle, and IOP outcomes. Results: Among 26 patients who met our inclusion criteria were evaluated. Among them, 19 (73%) were male and 7 (27%) were female. The mean average age of all the patients was 36.88 (standard deviation [SD] 17.53) ranging from 10 years to 63 years. The mean average IOP of all patients preoperatively was 13.77 mm of hg (SD 3.45 mm of hg). It increased postoperatively showing a mean average postoperative IOP of all patients as 26.08 mm of hg (SD 11.2 mm of hg). The mean overall increase in IOP postoperatively was 12.31 mm of hg (P = 0.001). The mean average preoperative IOP was 12.2 mm of hg and mean postoperative IOP was 15.4 mm of hg in the SOIOH free group, with a mean average IOP spike postoperatively was 3.2 mm of hg (P = 0.061). In the SIOH group, the postoperatively average IOP spike was 15.75 mm Hg with values ranging from 14.75 mm hg preoperative to 30.5 mm hg postoperative (P = 0.001). Interpretation and Conclusions: Patients who underwent PPV with SOT should be followed up for longer period and those who have retained SO in anterior chamber or angles should be followed up more frequently as chances of development of SOIOH is more in them as proved by this study.

Objective: Pro re nata (as needed) medications are widely used among older patients in long-term care. Current knowledge of healthcare providers’ administration of these medications and the decisions involving these medications is scarce and mainly relies on data from nursing homes. This study aims to explore how healthcare providers who work in sheltered housing for older people, experience pro re nata decision-making. Design, setting and subjects: This study used qualitative interviews of healthcare providers working in sheltered housing in mid- and eastern Norway (n=8). Data analysis was based on qualitative, latent, content analysis. Results: The analysis showed that the main experiences of the informants in the study involved the challenge of making decisions that give the professionals a good feeling about their decision, the main theme being Searching for comfort when making pro re nata medication decisions. Three sub-themes were identified within this theme: Taking, sharing and shifting responsibility, striving between resident autonomy and appropriate medication use, and struggling with and/or embracing the system. Conclusions: The healthcare providers in this study experienced PRNM decision-making differently. The informants experienced this decision-making to sometimes be challenging, due to the informants wanting to make decisions that are acceptable to both the residents and themselves.

Thorough understanding of the role of CD4 T cells in immunity can be greatly assisted by the study of responses to defined specificities. This requires knowledge of Plasmodium-derived immunogenic epitopes, of which only a few have been identified, especially for the mouse C57BL/6 background. We recently developed a TCR transgenic mouse line, termed PbT-II, that produces CD4+ T cells specific for an MHC class II (I-Ab)-restricted Plasmodium epitope and is responsive to both sporozoites and blood-stage P. berghei. Here, we identify a peptide within the P. berghei heat shock protein 90 as the cognate epitope recognised by PbT-II cells. We show that C57BL/6 mice infected with P. berghei blood-stage induce an endogenous CD4 T cell response specific for this epitope, indicating cells of similar specificity to PbT-II cells are present in the naïve repertoire. Adoptive transfer of in vitro activated TH1-, or particularly TH2-polarised PbT-II cells improved control of P. berghei parasitemia in C57BL/6 mice and drastically reduced the onset of experimental cerebral malaria. Our results identify a versatile, potentially protective MHC-II restricted epitope useful for exploration of CD4 T cell-mediated immunity and vaccination strategies against malaria.

Bakgrunn: Forskinga er tydeleg på at sosial støtte er avgjerande for god psykisk helse. Denne artikkelen handlar om folk sine erfaringar med forhold som fremjar og hemjar sosial støtte i psykisk helsearbeid. Artikkelen har som mål å utforske forhold som påverkar sosial støtte i vår tid, spesielt relatert til korleis vi opplever støtte i kjensleliv og praktisk kvardag når vi går gjennom langvarige psykiske helsevanskar. Metodologi: Inspirert av poesi som metode har vi reanalysert delar av datamaterialet etter gjennomførte fokusgruppeintervju og deltakande observasjon. Metodedelen tek føre seg kvifor poesi som analysemetode og verktøy kan vere relevant, både i analyseprosess og i presentasjon av data. To av forfattarane har erfaringar med psykiske helsevanskar. Funn: Funna er presentert gjennom to poetiske hovudtema: I: det som blomstrar og II: det som visnar. Funna beskriv kva betyding estetikk, økonomi, strukturelle tilhøve og haldningar kan ha for opplevinga av sosial støtte. Originalitet: Artikkelen løftar fram nokre av sosial støtte sine vilkår ved hjelp av poetisk analyse og formidling, og inviterer til innsikter som tradisjonelt format ikkje alltid kan gje.

Background: Caring for children with Autism Spectrum Disorder (ASD) is demanding, especially where access to services and support are inadequate. The present study aimed to systematically review the challenges associated with the caregivers whose children have autism. Materials and Methods: A systematic review design was utilized. The searches were conducted from February 2019 to January 2020. A qualitative analysis that was based on meta-aggregation approach and thematic analysis was used. Thereafter, data was presented into themes. The quality of all included studies was assessed using the Critical Appraisal Skills Program (CASP). Results: The search generated 909 articles of which only 9 met the inclusion criteria. The main findings were discussed under the following three thematic domains: 1) Stigma, 2) Financial burden, and 3) Caregiving burden. Conclusions: Evidence from the data reviewed showed financial burden faced by the caregivers whose children are diagnosed with ASD. This was manifested through both direct and indirect cost of treatment. Another key finding was that majority of the caregivers faced stigma from the community. This implies the low level of awareness of the ASD within the community. The present study calls for more programs on the present research problem within the community so as to increase awareness. Furthermore, the current advocacy of Universal Health Coverage programs in the country should incorporate ASD children.

Abstract Background Serological screening is a common method to monitor antibody response to pathogen exposure, but results could vary due to several factors. This study aimed to quantify animal and management related factors associated with variation in antibody levels in finisher pigs at slaughter, in an Irish farrow-to-finish farm endemically infected with Actinobacillus pleuropneumonia (App), Mycoplasma hyopneumoniae (Mhyo) and swine influenza virus (SIV). A second objective was to estimate differences in antibody levels in pigs presenting pluck lesions. This was an observational study whereby pigs were managed as per routine farm practice. Data on sow parity, number of born alive (NBA) pigs per litter, cross-fostering status, birth and weaning body weight were recorded from 1016 pigs born from one farrowing batch. At slaughter, blood samples were collected for serological analysis and pigs were inspected for presence of enzootic pneumonia (EP)-like lesions, pleurisy, pericarditis and heart condemnations. Pigs were retrospectively classified into three production flows, depending on time spent in each production stage: flow 1 (F1; pigs followed the normal production flow); flow 2 (F2; pigs which were delayed by 1 week from advancing forward); and flow 3 (F3; pigs delayed by > 1 week from advancing forward). A nested case-control design was applied by matching pigs from each flow by sow parity, birth weight and NBA. Results Pigs born from primiparous sows had higher antibody levels for App than those born to parity ≥5 sows (P 0.05). Pigs in F1 had lower antibody levels for App but higher antibody levels for SIV than F2 and F3 pigs (P 0.05), except for increased antibody levels for Mhyo when EP-like lesions were present (P = 0.006). Conclusion Results indicate that offspring from primiparous sows develop higher antibody levels for App IV toxin when exposed to this disease and that enforcement of a strict all-in/all-out production system would reduce on-farm disease circulation. A high percentage of pigs were affected with EP-like lesions which were associated with higher antibody levels for Mhyo.

Abstract Background Respiratory disease is one of the most important factors impacting pig production worldwide. There is no available information on the prevalence of key pathogens implicated in Irish pig production. The objective of this study was to describe the prevalence of pleurisy, pneumonia, lung abscesses, pericarditis and liver milk spots in finisher pigs of a cohort of Irish pig farms, and to describe the seroprevalence of: influenza A virus (IAV), porcine reproductive and respiratory syndrome virus (PRRSv), Mycoplasma hyopneumoniae (Mhyo) and Actinobacillus pleuropneumoniae (APP). Results In brief, 56 farrow-to-finish farms (29% of the Irish breeding herd) were enrolled in the study in 2017. Data on lungs, heart, and liver lesions were assessed for each farm at slaughter. An average of 417 (range 129–1154) plucks per farm were assessed for pleurisy, pneumonia, lung abscesses, pericarditis, and liver milk spots. Blood samples from 32 finisher pigs were collected at slaughter for each farm. The observed prevalence of pleurisy and pneumonia was one of the lowest reported in similar studies in Europe (13 and 11% estimated average within farm, respectively). Pleurisy lesions were mostly moderate and severe. Pneumonia lesions affected a low level of lung surface (5.8%). Prevalence of pericarditis was mid-high (8%) and the prevalence of liver milk spots was high, with an average of 29% of the livers affected. For serology, 78.6% of the farms were positive for IAV, 50% were positive for PRRSv, 71.4% were positive for Mhyo, and 98.2% were positive for APP. Influenza virus was the main pathogen associated with pleurisy (P

Abstract Background Free carnitine has been measured in the Dutch newborn screening (NBS) program since 2007 with a referral threshold of ≤5 μmol/L, regardless of gestational age or birthweight. However, several studies suggest that carnitine concentrations may depend on gestational age and birthweight. We evaluated differences in postnatal day‐to‐day carnitine concentrations in newborns based on gestational age (GA) and/or weight for GA (WfGA). Methods A retrospective study was performed using data from the Dutch NBS. Dried blood spot (DBS) carnitine concentrations, collected between the 3rd and 10th day of life, of nearly 2 million newborns were included. Individuals were grouped based on GA and WfGA. Median carnitine concentrations were calculated for each group. Mann‐Whitney U tests, and chi‐square tests were applied to test for significant differences between groups. Results Preterm, postterm, and small for GA (SGA) newborns have higher carnitine concentrations at the third day of life compared to term newborns. The median carnitine concentration of preterm newborns declines from day 3 onwards, and approximates that of term newborns at the sixth day of life, while median concentrations of postterm and SGA newborns remain elevated at least throughout the first 10 days of life. Carnitine concentrations ≤5 μmol/L were found less frequently in SGA newborns and newborns born between 32 and 37 weeks of gestation, compared to term newborns. Conclusions Median carnitine concentrations in NBS DBS vary with day of sampling, GA, and WfGA. It is important to take these variables into account when interpreting NBS results..

ABSTRACT Oubjective: To assess the implications of changing the cutoff level of TSH from 10 to 6 mIU/L. Subjects and methods: The study population was constituted by 74.123 children screened for congenital hypothyroidism by the National Screening Program in Santa Catarina, from March 2011 to February 2012. The cutoff of TSH was 6 mIU/L. If TSH between 6-10 mIU/L, the newborn was recalled for a second TSH measurement on filter paper. If TSH > 6 mIU/L in the second sample, the child was sent for medical evaluation. In children with normal topic thyroid, levothyroxine was suspended for 1 month at the age of 3 years for identification of the etiology and evaluation of the need to continue treatment. Results: Among the children screened, 435 were recalled for presenting TSH between 6 and 10 mIU/L in the first sample, 28 remained TSH > 6 mIU/L in the second sample. Among these, 11 had a final diagnosis of dyshormonogenesis, two of ectopic thyroid, two of thyroid hypoplasia and one of transient hypothyroidism. Ten children presented normal TSH levels on the first medical evaluation and two lost follow-up. Conclusion: A decrease in the TSH cutoff level from 10 to 6 mIU/L in a neonatal screening program for congenital hypothyroidism reduced the number of false-negative results, increasing the sensitivity of the test, but increased the number of false-positive results and recalls. Since a TSH cutoff level of 6 mIU/L detects thyroid function abnormalities requiring treatment, the adoption of this cutoff level is justified.

Abstract Peripartum deaths remain significantly high in low- and middle-income countries, including Kenya. The COVID-19 pandemic has disrupted essential services, which could lead to an increase in maternal and neonatal mortality and morbidity. Furthermore, the lockdowns, curfews, and increased risk for contracting COVID-19 may affect how women access health facilities. SARS-CoV-2 is a novel coronavirus that requires a community-centred response, not just hospital-based interventions. In this prolonged health crisis, pregnant women deserve a safe and humanised birth that prioritises the physical and emotional safety of the mother and the baby. There is an urgent need for innovative strategies to prevent the deterioration of maternal and child outcomes in an already strained health system. We propose strengthening community-based midwifery to avoid unnecessary movements, decrease the burden on hospitals, and minimise the risk of COVID-19 infection among women and their newborns.

Introdução e objetivo: O presente estudo investigou o nível de ansiedade, resiliência e coesão de grupo de atletas de uma equipe de futsal do sexo feminino uma competição de curta duração. Materiais e Métodos: Estudo transversal, o qual fizeram parte da pesquisa 12 jogadoras de futsal de uma equipe que disputou os Jogos Universitários Brasileiros no ano de 2017. Como instrumento foi utilizado o questionário de ansiedade pré-competitiva (CSAI-2R), a resiliência foi avaliada pela Escala de Resiliência de Connor-Davidson (CD-RISC10) e a coesão de grupo foi avaliada pelo Questionário de Ambiente de Grupo (GEQ). A análise de dados foi realizada por meio dos testes de Shapiro-Wilk, o teste de anova de medida repetidas foi utilizado para comparar os níveis de ansiedade nos jogos e o coeficiente de correlação de Spearman para verificar a correlação entre as variáveis, a significância adotada foi (p

Introduction: By the time they complete breast cancer therapy, many young patients are still of childbearing age. We aim to estimate the incidence of pregnancies in women who completed treatment and examine the percentage of patients who received fertility counseling before initiation of therapy. Material and methods: Electronic health records of breast cancer patients between 2008 and 2014 at AUBMC were screened for exclusion criteria of having metastatic disease or known infertility, still receiving therapy, and being above 42 years at diagnosis. Data about therapy and tumor characteristics was obtained for the included survivors who were interviewed as well via telephone for information about fertility preservation counseling, pregnancy occurrence, and delivery. Results: 451 breast cancer patients were identified. 39 patients remained after application of exclusion criteria. 30.76% (n = 12) wanted more children at the time of diagnosis. 10.25% (n = 4) of all 39 patients treated for breast cancer achieved one or more pregnancy after a median time of 3.83 years after completion of therapy. 25% (n = 3) of women who wanted more children at diagnosis (n = 12) were able to conceive. 23.07% (n = 9) of patients discussed fertility with their primary oncologist prior to treatment initiation. 35.89% (n = 14) of patients were aware of fertility preservation technique availability, but none of these patients used one. Conclusions: The observed rate of pregnancy is comparable to the literature. There is a lack in fertility counseling of breast cancer patients, and the rate of use of fertility preservation techniques is very low despite prior knowledge about their availability.

Abstract Background Residents living in sheltered housing depend on help from healthcare personnel (HCP) with medication management, regarding regular long-term and pro re nata (PRN) medication. The HCP assess the need for PRN medication prior to administration to the residents. The purpose of this study was to describe HCP’s perceptions of factors affecting PRN medication management in sheltered housing for older adults. Method This was a qualitative study with five focus-group interviews with 22 HCP working in sheltered housing for older adults. The HCP were heterogenous regarding scholarly education and experiences, working in four different municipalities in mid-Norway, representing urban, sub-urban and rural districts. The analysis was inductive, based on qualitative, manifest, content analysis. The main outcome was HCP perceptions of the factors affecting PRN medication management in sheltered housing. Results Four main factors affecting the PRN medication management were identified in the data and were related to either: 1) the medication; 2) the resident; 3) the HCP; or 4) the organisation. These categories included 14 subcategories. Overall, the HCP described the management of PRN medication as a complex process, where the above factors all have impact on the residents’ health and safety. Conclusion HCP working in sheltered housing describe that PRN medication management is affected by numerous human factors, that consequently may affect patient outcomes and safety. HCP involved in PRN medication management should be aware of factors that affect their decision-making, and safe management requires a professional practice built on medicines competence, practical skills and experience.