Adverse pregnancy outcomes in Toxoplasma gondii seropositive Hispanic women.

AIMS: Chronic Toxoplasma gondii infection is not thought to affect pregnancy or birth outcomes, but there are few prospective studies. The study aims were T. gondii immunoglobulin G measurement and relationship of chronic T. gondii infection with gestational age at birth and adverse pregnancy outcomes in 690 Hispanic women in Tampa, Florida. METHODS: Hispanic women, born either in the United States or in Latin America or the Caribbean had a venous blood sample drawn to measure T. gondii IgG and T. gondii serotype at the first prenatal visit, along with collection of demographic and health-related measures. Seropositive and seronegative women were followed throughout their pregnancy. Gestational age, infant weights, and adverse pregnancy outcomes (miscarriages, preterm births) were compared in the two groups. RESULTS: There were 740 women of self-reported Hispanic ethnicity screened and enrolled in Tampa, Florida, with 690 having birth data extracted from the electronic health record (538 T. gondii negative and 152 T. gondii seropositive). T. gondii seropositivity was 22.4% and the majority (83%) had high avidity titers, indicating chronic infection. Compared to T. gondii seronegative Hispanic women, seroseropositive women had more smaller for gestational age infants and higher prevalences of miscarriages and preterm birth. CONCLUSION: This is one of the largest longitudinal cohort studies of women with chronic T. gondii infection followed through pregnancy. There was a higher percentages of adverse pregnancy outcomes in this group compared to T. gondii seronegative controls. The mechanism for this is unknown and warrants reexamination of the dogma that chronic T. gondii infection in pregnant women has no significant clinical consequences.

Educational technologies for caregivers in the context of pediatric oncology hospital units: a scoping review / Tecnologías educativas para cuidadores en el contexto de unidades hospitalarias de oncología pediátrica: revisión de alcance / Tecnologias educacionais para cuidadores no contexto de unidades hospitalares de oncologia pediátrica: revisão de escopo

ABSTRACT Objective: mapping the scientific evidence about the use of educational technologies for caregivers in the context of Pediatric Oncology hospital units. Method: this is a scoping review based on the PRISMA-ScR recommendations and on the Joanna Briggs Institute methodology. The search was performed by two independent reviewers in 12 national and international data sources. Publications available in full and free of charge in electronic means were included, with no language or time restrictions. Abstracts were excluded, as well as letters to the editor, opinion articles, books, monographies, dissertations, theses, blog postings, and theoretical and reflection articles. Data analysis was descriptive, with elaboration of charts and absolute and relative frequency statistics. Results: the final sample was comprised by 15 studies published between 2010 and 2020 and mainly from developed countries. Apps and videos were the predominant educational technologies, followed by printed materials, contributing to increasing the caregivers' knowledge about the disease and cancer treatment, symptom management and side effects of the chemotherapy drugs. In addition, when compared to printed materials, the videos showed a reduction in the caregivers' anxiety levels. The professionals most involved with the technologies were nurses and physicians. Conclusion: it was possible to map that apps and videos are the main educational technologies that are being developed to instruct caregivers, addressing diagnosis and treatment of child-youth cancer, symptom management and self-care promotion.

RESUMEN Objetivo: mapear las evidencias científicas sobre el uso de tecnologías educativas para cuidadores en el contexto de unidades hospitalarias de Oncología Pediátrica. Método: se trata de una revisión de alcance basada en las recomendaciones PRISMA-ScR y en la metodología del Instituto Joanna Briggs. Dos revisores independientes realizaron la búsqueda en 12 fuentes de datos nacionales e internacionales. Se incluyeron publicaciones disponibles en su texto completo y en forma gratuita en medios electrónicos, sin restricciones de idiomas ni recorte temporal. Se excluyeron resúmenes, cartas al editor, artículos de opinión, libros, monografías, disertaciones, tesis, posts en blogs, y artículos teóricos y de reflexión. El análisis de los datos fue descriptivo, y se elaboraron cuadros y estadísticas con frecuencias absolutas y relativas. Resultados: muestra final de 15 estudios publicados entre 2010 y 2020 y principalmente realizados en países desarrollados. Las apps y los videos fueron las tecnologías educativas predominantes, seguidas por los materiales impresos, lo que contribuyó a aumentar el conocimiento de los cuidadores sobre la enfermedad y el tratamiento oncológico, el manejo de los síntomas y los efectos colaterales de los fármacos quimioterapéuticos. Además, los videos demostraron que reducen el nivel de ansiedad de los cuidadores en comparación con los materiales impresos. Los profesionales que más se involucraron con las tecnologías fueron los enfermeros y los médicos. Conclusión: fue posible mapear que las apps y los vídeos son las principales tecnologías educativas en actual desarrollo para orientar a los cuidadores, abordando el diagnóstico y tratamiento del cáncer infantojuvenil, el manejo de los síntomas y la promoción del autocuidado.

RESUMO Objetivo: mapear as evidências científicas sobre o uso de tecnologias educacionais para cuidadores no contexto de unidades hospitalares de Oncologia Pediátrica. Método: trata-se de uma scoping review, com base nas recomendações PRISMA-ScR e metodologia do Instituto Joanna Briggs. A busca foi realizada em 12 fontes de dados nacionais e internacionais, por dois revisores independentes. Foram incluídas publicações disponíveis na íntegra e gratuitamente em meio eletrônico, sem restrição de idiomas e sem recorte temporal. Foram excluídos resumos, cartas ao editor, artigos de opinião, livros, monografias, dissertações, teses, postagens em blogs, artigos teóricos e de reflexão. A análise dos dados ocorreu de forma descritiva, sendo elaborados quadros e estatística com frequência absoluta e relativa. Resultados: a amostra final de 15 estudos, publicados entre os anos de 2010 e 2020 e oriundos, principalmente, de países desenvolvidos. Os aplicativos e vídeos foram às tecnologias educacionais predominantes, seguidos pelos materiais impressos, contribuindo para aumentar o conhecimento dos cuidadores sobre a doença e tratamento oncológico, manejo dos sintomas e efeitos colaterais dos quimioterápicos. Ademais, os vídeos demonstraram redução do nível de ansiedade dos cuidadores quando comparados com materiais impressos. Os profissionais que mais estiveram envolvidos com as tecnologias foram os enfermeiros e médicos. Conclusão: foi possível mapear que os aplicativos e vídeos são as principais tecnologias educacionais que estão sendo desenvolvidas para orientação dos cuidadores, abordando o diagnóstico e tratamento do câncer infantojuvenil, manejo dos sintomas e promoção do autocuidado.

Decreasing Tryptophan and Increasing Neopterin Plasma Levels During Pregnancy are Associated with High First Trimester Porphyromonas gingivalis K-Serotype IgG Serointensity in a Cohort of Hispanic Women.

BACKGROUND: Immune activation or high levels of stress may lead to increased metabolism of tryptophan during pregnancy. Porphyromonas gingivalis (Pg), the "keystone" periodontal pathogen, induces immune and indoleamine 2,3-dioxygenase (IDO) activation. Thus, we hypothesized that larger gestational decreases in tryptophan and elevations in neopterin and kynurenine would occur in pregnant women with elevated IgG antibodies to Pg capsular (K) serotypes. METHODS: Venous blood of 52 Hispanic pregnant women with a mean age (SD) of 31.8 (5.9) years was sampled once per trimester of pregnancy (V1, V2, V3), and plasma was obtained and stored. ELISAs were used to measure Pg capsular (K) serotype IgG serointensity (V1 only) and neopterin levels (V1-V3). Tryptophan and kynurenine (V1-V3) were measured with high-performance liquid chromatography. The participants having IgG serointensity for any of the seven Pg K serotypes in the highest quartile were defined as the "High PgK_IgG" group and those having IgG serointensity for all K serotypes in the lowest three quartiles were defined as the "Low PgK_IgG" group. Statistics included multivariable linear and nonparametric methods. RESULTS: Significant decreases in plasma tryptophan levels and increases in neopterin during gestation were found in "High PgK_IgG" women but not in "Low PgK_IgG" women. Kynurenine changes were not significantly different between the two groups. CONCLUSION: If replicated in larger studies and further characterized clinically, radiologically, and microbiologically, our results may potentially lead to novel interventional targets, as well as the development of more complete prognostic and predictive interactive biomarkers for adverse obstetrical outcomes and peripartum depression, and their prevention.

Correction: Yoo, J.Y., et al. Gut Microbiota and Immune System Interactions. Microorganisms 2020, 8, 1587.

Corrections have been made to "Gut Microbiota and Immune System Interactions" [...].

Comparative analysis of COVID-19 guidelines from six countries: a qualitative study on the US, China, South Korea, the UK, Brazil, and Haiti.

BACKGROUND: In late January, a worldwide crisis known as COVID-19 was declared a Public Health Emergency of International Concern by the WHO. Within only a few weeks, the outbreak took on pandemic proportions, affecting over 100 countries. It was a significant issue to prevent and control COVID-19 on both national and global scales due to the dramatic increase in confirmed cases worldwide. Government guidelines provide a fundamental resource for communities, as they guide citizens on how to protect themselves against COVID-19, however, they also provide critical guidance for policy makers and healthcare professionals on how to take action to decrease the spread of COVID-19. We aimed to identify the differences and similarities between six different countries' (US, China, South Korea, UK, Brazil and Haiti) government-provided community and healthcare system guidelines, and to explore the relationship between guideline issue dates and the prevalence/incidence of COVID-19 cases. METHODS: To make these comparisons, this exploratory qualitative study used document analysis of government guidelines issued to the general public and to healthcare professionals. Documents were purposively sampled (N = 55) and analyzed using content analysis. RESULTS: The major differences in the evaluation and testing criteria in the guidelines across the six countries centered around the priority of testing for COVID-19 in the general population, which was strongly dependent on each country's healthcare capacity. However, the most similar guidelines pertained to the clinical signs and symptoms of COVID-19, and methods to prevent its contraction. CONCLUSION: In the initial stages of the outbreak, certain strategies were universally employed to control the deadly virus's spread, including quarantining the sick, contact tracing, and social distancing. However, each country dealt with differing healthcare capacities, risks, threats, political and socioeconomic challenges, and distinct healthcare systems and infrastructure. Acknowledging these differences highlights the importance of examining the various countries' response to the COVID-19 pandemic with a nuanced view, as each of these factors shaped the government guidelines distributed to each country's communities and healthcare systems.

Gut Microbiota and Immune System Interactions.

Dynamic interactions between gut microbiota and a host's innate and adaptive immune systems play key roles in maintaining intestinal homeostasis and inhibiting inflammation. The gut microbiota metabolizes proteins and complex carbohydrates, synthesize vitamins, and produce an enormous number of metabolic products that can mediate cross-talk between gut epithelial and immune cells. As a defense mechanism, gut epithelial cells produce a mucosal barrier to segregate microbiota from host immune cells and reduce intestinal permeability. An impaired interaction between gut microbiota and the mucosal immune system can lead to an increased abundance of potentially pathogenic gram-negative bacteria and their associated metabolic changes, disrupting the epithelial barrier and increasing susceptibility to infections. Gut dysbiosis, or negative alterations in gut microbial composition, can also dysregulate immune responses, causing inflammation, oxidative stress, and insulin resistance. Over time, chronic dysbiosis and the translocation of bacteria and their metabolic products across the mucosal barrier may increase prevalence of type 2 diabetes, cardiovascular disease, inflammatory bowel disease, autoimmune disease, and a variety of cancers. In this paper, we highlight the pivotal role gut microbiota and their metabolites (short-chain fatty acids (SCFAs)) play in mucosal immunity.

Novel method of measuring chronic stress for preterm infants: Skin cortisol.

BACKGROUND AND OBJECTIVES: Infants who begin life in the medicalized environment of the neonatal intensive care unit (NICU) do so under stressful conditions. Environmental exposures are often abrasive to vulnerable infants, while invasive and noninvasive lifesaving interventions provide additional pain and/or stress. The most commonly selected biomarker to measure stress is cortisol. The skin is the barrier between the external environment and communicates with our neurological, endocrine and immune regulatory networks. To examine if skin cortisol may be a reliable biomarker of stress, NICU stress exposure and repeated measurements of skin cortisol in very preterm infants were examined retrospectively during the first 6 weeks of life. The temporal relationship between skin cortisol and NICU stress exposure was also analyzed. MATERIALS AND METHODS: Participants included 82 preterm infants born weighing less than 1500 g, admitted to a level III NICU, with a mean gestational age of 28.5 weeks. Infants were studied from birth through 6 weeks of life. NICU stress data was collected using the Neonatal Infant Stressor Scale. Skin samples were collected using d-squame tape as soon after birth as possible and every two weeks thereafter. RESULTS: On average, infants experienced approximately 43 stressful events per day during the first 6 weeks of life in the NICU. Stress level and cortisol reactivity varied by gestation age. Higher stress resulted in higher cortisol for infant >28 weeks; lower stress scores were associated with higher stress for infants <28 weeks. Stress exposure during 7 days prior to cortisol sampling yielded the highest AUC for the 2 groups. A statistically significant interaction was identified between gestational age and stress exposure during the previous 7 days (p < 0.01). CONCLUSION: This is the first study to demonstrate skin cortisol as a preterm infant biomarker of chronic stress exposure. For infants with appropriate skin maturation, this non-invasive sampling method provides several benefits. Importantly, this method may be less intrusive and disruptive for preterm infants.

Reforma psiquiátrica e transtornos mentais na estratégia saude da familia: opinião de familiares e profissionais / Psychiatric reform and mental disorders in the family health strategy: family ans professional opinion

Estudo caracterizado como pesquisa operacional ou Investigação em Sistemas de Saúde (ISS) com caráter descritivo e quantitativo que objetivou analisar opinião de familiares e profissionais sobre a Reforma Psiquiátrica e os principais transtornos mentais na estratégia saúde da família. Investigou-se280 sujeitos dos quais 126 eram profissionais de saúde e 154 familiares de portadores de transtornos mentais que responderam a Escala de Medida de Opinião (EMO). Os dados digitados e tabulados foram submetidos ao software Epi Info, versão 6.04. O estudo encontrou diferenças de gênero em relação aos principais transtornos mentais identificados pelos familiares no município de Parnamirim/RN, donde 45% (29) são mulheres com diagnóstico de portadoras detranstornos do humor, enquanto a maioria dos homens, 62%(55), apresentam transtornos decorrentes do uso de substâncias psicoativas. Em relação à Reforma Psiquiátrica a opinião dos familiares e profissionais reflete ainda as dúvidas e a descrença na Reforma Psiquiátrica Brasileira. Ademais, a realidade traz um contingente crescente de pessoas com o transtorno mental e comportamental o que exige uma prática profissional qualificada em consonância aos preceitos do processo de Reforma Psiquiátrica no país.

The study is characterized as an operational research or Health System Research (HSR) with a descriptive and quantitative character which aimed to analyze the opinion of families and professionals about the psychiatric reform and major mental disorders in care in the family health strategy. 280 subjects were investigated of which 126 were health professionals and 154 relatives of patients with mental disorders, who responded to the Measurement Scale of Opinion (MSO). The typed data and tabulated were submitted to Epi Info software, version 6.04. The study found gender differences in relation to major mental disorders identified by family members in the municipality of Parnamirim/RN, where 45% (29) are women diagnosed with mood disorders while most men, 62% (55), presented disorders arise from the use of psychoactive substances. Regarding the Psychiatric Reform, the family and professionals opinions reflect the doubts and disbelief in the Brazilian Psychiatric Reform. Besides, the reality brings a growing contingent of people with mental and behavioral disorder that requires a qualified professional practice according to the precepts of the Psychiatric Reform in the country.

Opinião dos familiares na estratégia saúde da família sobre doença mental, doente e família / Opinión de los familiares en la estrategia salud de la familia sobre enfermedad mental, enfermo y familia / The opinion of family members in the family health strategy about the mental illness, the patient and the family

Analisar a opinião dos familiares na Estratégia Saúde da Família sobre o doente, a doença mental e a família. Método: Pesquisa operacional ou Investigação em Sistemas de Saúde, descritiva e quantitativa, realizada com 154 familiares através da Escala de Medida de Opinião. Aprovado pelo protocolo nº 001/11CEP-UFRN, CAAE -0003.0.051.000-11. Resultados: 68% dos familiares discordam totalmente de que alcoolismo é doença mental; 50% discordam pouco como diferenciar um doente mental de uma pessoa normal; 30 % dos familiares concordam pouco de ser agressivo; 32% concordam totalmente como lugar do louco no hospício; 75% discordam totalmente que internar uma pessoa em hospital psiquiátrico significa rejeição da família; e 82% concordam totalmente em dar suporte à família para cuidar. Conclusão: Reflete uma aparente novidade nos modos de cuidar e perplexidade ao assumir este protagonismo, embora, sejam cuidadores habituais dos portadores.

Se analizó la opinión de los familiares en la Estrategia Salud de la Familia sobre el enfermo, la enfermedad mental y la familia. Método: Pesquisa operacional o Investigación en Sistemas de Salud, de carácter descriptivo cuantitativo, realizada con 154 familiares a través de la Escala de Medida de Opinión. Aprobado el protocolo 001/11 CEP-UFRN, CAAE - 0003.0.051.000-11. Resultados: Enfermedad Mental - 68% de los familiares discuerdan totalmente de que alcoholismo es enfermedad mental y 50% discuerdan poco como diferenciar un enfermo mental de una persona normal. Enfermo Mental - 30 % de los familiares concuerdan poco de ser agresivo y 32% concuerdan totalmente como lugar de loco es en el manicomio. Familia - 75% discuerdan totalmente que internar una persona en hospital psiquiátrico significa rechazo de la familia y 82% concuerdan totalmente en dar soporte a la familia para cuidar. Conclusión: Refleja un modo nuevos de la atención y perplejidad para asumir este papel, sin embargo, son los cuidadores de los pacientes.

Objective: To analyze the opinion of family members in the Family Health Strategy about the patient, the family, and the mental illness. Method: This Operations Research or Health System Research has a descriptive quantitative nature and involved 154 families through the Measurement Scale of Opinion. Trial registration number 001/11, CAAE -0003.0.051.000-11. Results: 68% of family members disagrees strongly that alcoholism is a mental illness; 50% somewhat disagrees about differences between a mental patient and normal people; 30% agrees somewhat that it is aggressive; 32% agrees totally that the insane should be in sanatorium; 75% totally disagrees that hospitalization into a sanatorium means rejection by family; 82% agrees fully about the family support to care for patient. Conclusion: It reveals apparent new models of care and perplexity to assume this role, even though they are the usual caregivers.