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The co-infection between visceral leishmaniasis (VL) and human immunodeficiency virus (HIV) has increased in several countries in the world. The current serological tests are not suitable since they present low sensitivity to detect the most of VL/HIV cases, and a more precise diagnosis should be performed. In this context, in the present study, an immunoproteomics approach was performed using Leishmania infantum antigenic extracts and VL, HIV and VL/HIV patients sera, besides healthy subjects samples; aiming to identify antigenic markers for these clinical conditions. Results showed that 43 spots were recognized by antibodies in VL and VL/HIV sera, and 26 proteins were identified by mass spectrometry. Between them, β-tubulin was expressed, purified and tested in ELISA experiments as a proof of concept for validation of our immunoproteomics findings and results showed high sensitivity and specificity values to detect VL and VL/HIV patients. In conclusion, the identified proteins in the present work could be considered as candidates for future studies aiming to improvement of the diagnosis of VL and VL/HIV co-infection.
Adenotonsillectomy is frequently performed for obstructive sleep apnoea, but is associated with post-operative respiratory morbidity. This study assessed the effect of paediatric Otrivine (0.05 per cent xylometazoline hydrochloride) on post-operative respiratory compromise.
Paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea were included. The control group (n = 24) received no intervention and the intervention group (n = 25) received intra-operative paediatric Otrivine during induction using a nasal patty. Post-operative outcomes included pain, respiratory distress signs and medical intervention level required (simple, intermediate and major).
Post-operative respiratory distress signs were exhibited by 4 per cent of the Otrivine group and 21 per cent of the control group. Sixty-eight per cent of the Otrivine group required simple medical interventions post-operatively, compared to 42 per cent of the control group. In the Otrivine group, 4 per cent required intermediate interventions; none required major interventions. In the control group, 12.5 per cent required both intermediate and major interventions. Fifty per cent of the control group reported pain post-operatively, compared with 40 per cent in the Otrivine group.
Intra-operative paediatric Otrivine may reduce post-operative respiratory compromise in paediatric patients undergoing adenotonsillectomy for obstructive sleep apnoea. A randomised controlled trial is required.
Graded exercises tests are performed in adult populations; nonetheless, the use of this type of assessment is greatly understudied in overweight and obese adolescents.
To investigate heart rate autonomic responses to submaximal aerobic exercise in obese and overweight adolescents.
We recruited 40 adolescents divided into two groups: (1) overweight group comprising 10 boys and 10 girls between Z-score +1 and +2 and (2) obese group comprising 10 boys and 10 girls above Z-score >+2. Heart rate variability was analysed before (T1) and after exercise (T2–T4) on treadmill at a slope of 0%, with 70% of the maximal estimated heart rate (220 – age) for 20 minutes.
Heart rate in the overweight group was: 93.2±10.52 bpm versus 120.8±13.49 bpm versus 94.6±11.65 bpm versus 93.0±9.23 bpm, and in the obese group was: 92.0±15.41 bpm versus 117.6±16.31 bpm versus 92.1±12.9 bpm versus 91.8±14.33 bpm. High frequency in the overweight group was: 640±633.1 ms2 versus 84±174.66 ms2 versus 603.5±655.31 ms2 versus 762.6±807.21 ms2, and in the obese group was: 628.4±779.81 ms2 versus 65.4±119.34 ms2 versus 506.2±482.70 ms2 versus 677.9±939.05 ms2; and root mean square of successive differences in the overweight group was: 37.9±18.81 ms versus 10.9±8.41 ms versus 32.8±24.07 ms versus 36.7±21.86 ms, and in the obese group was: 38.7±23.17 ms versus 11.5±8.62 ms versus 32.3±16.74 ms versus 37.3±24.21 ms. These values significantly changed during exercise compared with resting values in overweight and obese groups. Moreover, we also reported no significant difference of resting parasympathetic control of heart rate between obese and overweight adolescents.
There was no significant difference of autonomic responses elicited by submaximal aerobic exercise between overweight and obese adolescents.
The rate of deforestation in the Amazon is increasing. Predictive models estimate that as a result of agricultural expansion 40% of these forests will be lost by 2050. As a consequence the habitat of forest-dwelling species such as the Endangered black-faced black spider monkey Ateles chamek is being lost, particularly along the arc of deforestation in the Brazilian Amazon. We used species distribution modelling to (1) define the distribution of this spider monkey, using environmental predictors, (2) calculate the area of this distribution covered by the protected area network, and (3) calculate the expected loss of the species’ habitat under future scenarios of deforestation. We found that the species occupies only c. 28% of its extent of occurrence. Only 32% of the species’ area of occupancy is legally protected, and the modelling suggests that 31–40% of the species’ habitat will be lost by 2050. We highlight three unprotected regions with extensive forest cover that are predicted to become severely deforested by 2050 as priority regions for expanding the protected area network. We also propose landscape management and restoration in three human-modified regions. Our study provides an example of how species distribution modelling can be applied to assess threats to species and support decision makers in implementing conservation actions.
Across the globe, the implementation of quality improvement science and collaborative learning has positively affected the care and outcomes for children born with CHD. These efforts have advanced the collective expertise and performance of inter-professional healthcare teams. In this review, we highlight selected quality improvement initiatives and strategies impacting the field of cardiovascular care and describe implications for future practice and research. The continued leveraging of technology, commitment to data transparency, focus on team-based practice, and recognition of cultural norms and preferences ensure the success of sustainable models of global collaboration.
Animal and human studies suggest that individual differences in maternal parenting behaviour are transmitted from one generation to the next.
This study aimed to examine potential psychosocial mechanisms underlying an intergenerational transmission of conceptualization of parenting, including affect, cognition, and parental support.
In a subsample of 201 first-time mothers participating in the Maternal Adversity, Vulnerability and Neurodevelopment (MAVAN) project, we assessed maternal childhood rearing experiences, using the Parental Bonding Instrument and the Childhood Trauma Questionnaire. At 6 months postpartum, mothers completed questionnaires on parenting stress, symptoms of depression, internalization of maternal care regulation and current relationship with mother and father.
We found significant direct associations of maltreatment and rearing by the grandmother with parenting stress at 6 months. These associations were mediated through distinct psychosocial pathways: the association of maltreatment on higher parenting stress was fully mediated through more maternal symptoms of depression (z = 2.297; P = 022). The association between sub-optimal rearing provided by the mother and higher parenting stress was mediated through lower internalization of maternal care regulation (z = -2.155; P = 031) and to a lesser degree through more symptoms of depression (z = -1.842; P = 065). Finally, higher quality rearing by the grandfather was indirectly related to lower parenting stress through positive current relationship with the father (z = -2.617; P = 009).
There are distinct pathways by which early experiences manifest in parenting stress. By understanding the structure of dysregulated parenting, clinicians will have practical information to specifically target maternal motivation, social supports, and depressed mood to disrupt maladaptive parenting cognitions and practices.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Transition into parenthood is a demanding phase in life and exposes the becoming parents to vulnerability for depression, anxiety and stress. Perinatal mental health problems are a major public health issue and many women suffering from depression during their first year after delivery. High levels of stress during pregnancy are associated with adverse psychological and physiological outcomes for the infant and parents. There seems to be an intergenerational transmission of mental health from parent to infant. The current study evaluated the effectiveness of mindfulness intervention during pregnancy in reducing depression symptoms, anxiety and perceived stress in parents-to-be.
Assess whether the mindfulness will improve interaction between mother-infant at 12 months.
Perceived stress scale and Edinburgh postnatal depression scale used to measure stress and depression during pregnancy. Parent child early relational assessment assessed mother-infant interaction.
Inhibited parent-infant relationships were more common in the control group comparing to the mindfulness intervention group. This is in line with previous research on periantal depression, anxiety, and stress, showing more dysfunctional dyads. A depressed mother has reduced capability to be alert to her baby's signals, which is necessary for appropriate parent-infant relationship to occur. The cumulative effect of impaired parent-infant relationship is a “depressed dyad” of mother and infant.
Mindfulness intervention reduced depressive symptoms, anxiety, and perceived stress in pregnant women. At 12 months mother-infant relationship assessment, the mindfulness intervention group dyads showed a more attuned mother-infant interaction.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Critical to the development of improved HIV elimination efforts is a greater understanding of how social networks and their dynamics are related to HIV risk and prevention. In this paper, we examine network stability of confidant and sexual networks among young black men who have sex with men (YBMSM). We use data from uConnect (2013–2016), a population-based, longitudinal cohort study. We use an innovative approach to measure both sexual and confidant network stability at three time points, and examine the relationship between each type of stability and HIV risk and prevention behaviors. This approach is consistent with a co-evolutionary perspective in which behavior is not only affected by static properties of an individual's network, but may also be associated with changes in the topology of his or her egocentric network. Our results indicate that although confidant and sexual network stability are moderately correlated, their dynamics are distinct with different predictors and differing associations with behavior. Both types of stability are associated with lower rates of risk behaviors, and both are reduced among those who have spent time in jail. Public health awareness and engagement with both types of networks may provide new opportunities for HIV prevention interventions.
There is limited information published on the specific financial costs of completed and/or attempted suicide in bipolar patients. In the last 15 years, only 6 studies were published. Their results vary considerably due to differences in methods used. Also, information on cost for pure manic versus mixed episodes is lacking. This is surprising, since studies have shown that suicidal behaviour is more common among patients with depressive symptoms than with pure mania, and this difference increases considerably when the mixed-features specifier is applied.
We conducted a registry study with the aim to expand the epidemiological information on suicidal behaviour by episode type in bipolar disorder, and its associated costs.
Health data were retrieved from the Swedish Patient Register. Data covered the period 1990–2014 and included the number of discharged patients with bipolar diagnosis, hospital re-admissions, and attempted and/or completed suicides. Moreover, we retrieved data on suicide and cause of death from the Swedish Cause of Death register. Analyses were done for the whole sample and stratified by subtypes (mania, depression and mixed forms).
First results will be presented at the EPA meeting.
This is a nation-wide Swedish study of completed and attempted suicide in bipolar patients. The hypothesis we will test is that there is a substantial variation between different bipolar disorder subtypes, and that most of the expenditures due to suicidal behaviour in bipolar disorder are linked to mixed forms, mania in combination with depression.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their central line-associated bloodstream infection (CLABSI) prevention efforts. This document updates “Strategies to Prevent Central Line-Associated Bloodstream Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint
Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
Since the publication of “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals” in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention(CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).
Since the publication of “A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals” in 2008, prevention of healthcare-associated infections (HAIs) has become a national priority. Despite improvements, preventable HAIs continue to occur. The 2014 updates to the Compendium were created to provide acute care hospitals with up-to-date, practical, expert guidance to assist in prioritizing and implementing their HAI prevention efforts. They are the product of a highly collaborative effort led by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise, including the Centers for Disease Control and Prevention (CDC), the Institute for Healthcare Improvement (IHI), the Pediatric Infectious Diseases Society (PIDS), the Society for Critical Care Medicine (SCCM), the Society for Hospital Medicine (SHM), and the Surgical Infection Society (SIS).
To identify current outpatient parenteral antibiotic therapy practice patterns and complications.
We administered an 11-question survey to adult infectious disease physicians participating in the Emerging Infections Network (EIN), a Centers for Disease Control and Prevention–sponsored sentinel event surveillance network in North America. The survey was distributed electronically or via facsimile in November and December 2012. Respondent demographic characteristics were obtained from EIN enrollment data.
Overall, 555 (44.6%) of EIN members responded to the survey, with 450 (81%) indicating that they treated 1 or more patients with outpatient parenteral antimicrobial therapy (OPAT) during an average month. Infectious diseases consultation was reported to be required for a patient to be discharged with OPAT by 99 respondents (22%). Inpatient (282 [63%] of 449) and outpatient (232 [52%] of 449) infectious diseases physicians were frequently identified as being responsible for monitoring laboratory results. Only 26% (118 of 448) had dedicated OPAT teams at their clinical site. Few infectious diseases physicians have systems to track errors, adverse events, or “near misses” associated with OPAT (97 [22%] of 449). OPAT-associated complications were perceived to be rare. Among respondents, 80% reported line occlusion or clotting as the most common complication (occurring in 6% of patients or more), followed by nephrotoxicity and rash (each reported by 61%). Weekly laboratory monitoring of patients who received vancomycin was reported by 77% of respondents (343 of 445), whereas 19% of respondents (84 of 445) reported twice weekly laboratory monitoring for these patients.
Although use of OPAT is common, there is significant variation in practice patterns. More uniform OPAT practices may enhance patient safety.
In 2012, three architectural competitions were held as part of the strategic programme ‘Living Well, Growing Old’, launched by the Swedish government in 2010. The intention was to use the innovative quality of the architectural competition in order to conceive future-oriented built environments for the ageing Swedish society. In Sweden, several architectural competitions with a focus on space for dependent and frail older people have been organised over the past century. Architectural design has been incorporated into reforms for social care of older people. This study focuses on the relationship between architecture and socio-political visions in three architectural competitions, realised in 1907, 1948 and 1979. The study demonstrates that architectural competitions within this field are more than a list of functional and spatial requirements for architects to respect. Instead, they are socio-political statements that define spatial frameworks within an ideological view on how ethically to provide care for dependent and frail older people in a welfare regime.
In the global ‘North-West’, liberal democracy is regarded as the universally valid model of political rule that is to be promoted globally via foreign and development policies. Democracy promotion, however, is frequently challenged by justice-related claims. Whereas external democracy promoters claim to help enforce universal individual rights, those resisting democracy promotion point to the collective entitlement to a self-determined political evolution. ‘North-Western’ governments see liberal democracy as the only embodiment of a just political order, but in those countries that are the targets of democracy promotion different understandings of appropriate norms and institutions may exist. Contestation of democracy promotion has, therefore, a crucial normative dimension that can be conceptualized as a series of conflicts over justice. If we conceive of external democracy promotion as a process of interaction instead of unidirectional export or socialization, such justice conflicts constitute a major normative challenge to democracy promoters. The paper argues for an alternative perspective on ‘democracy promotion as interaction’ and presents a typology of justice conflicts that will, in future research, enable us to empirically analyse the normative challenges brought about by the interactive nature of democracy promotion.