Knowledge of Toxoplasmosis among Doctors and Nurses Who Provide Prenatal Care in an Endemic Region

Congenital toxoplasmosis is a potentially severe infection and its prevention is most often based on serological screening in pregnant women. Many cases could be prevented by simple precautions during pregnancy. Aiming to assess the knowledge about toxoplasmosis among professionals working in antenatal care in a high prevalent region, a questionnaire was administered to 118 obstetric nurses and physicians attending at primary care units and hospitals. The questionnaire was self-completed and included questions on diagnosis, clinical issues, and prevention. Only 44% of total answers were corrected. Lower scores were observed among those with over 10 years of graduation, working in primary care units, and nurses. Errors were mainly observed in questions of prevention and diagnosis. As congenital toxoplasmosis is a mother-to-child (MTC) transmitted disease, early diagnosis and treatment can prevent serious and irreversible fetal damage. Thus, doctors and nurses who provide prenatal care must be appropriately trained on prophylactic, diagnostic, and clinical aspects of toxoplasmosis. The authors suggest that measures should be taken for continuing education regarding toxoplasmosis in pregnancy

Measurement of the cosmic ray spectrum above 4×10184{\times}10^{18} eV using inclined events detected with the Pierre Auger Observatory

A measurement of the cosmic-ray spectrum for energies exceeding $4{\times}10^{18}$ eV is presented, which is based on the analysis of showers with zenith angles greater than $60^{\circ}$ detected with the Pierre Auger Observatory between 1 January 2004 and 31 December 2013. The measured spectrum confirms a flux suppression at the highest energies. Above $5.3{\times}10^{18}$ eV, the "ankle", the flux can be described by a power law $E^{-\gamma}$ with index $\gamma=2.70 \pm 0.02 \,\text{(stat)} \pm 0.1\,\text{(sys)}$ followed by a smooth suppression region. For the energy ($E_\text{s}$) at which the spectral flux has fallen to one-half of its extrapolated value in the absence of suppression, we find $E_\text{s}=(5.12\pm0.25\,\text{(stat)}^{+1.0}_{-1.2}\,\text{(sys)}){\times}10^{19}$ eV.Comment: Replaced with published version. Added journal reference and DO

Toxoplasmose em gestantes atendidas no IPEC - FIOCRUZ (2005-2007)Perfil clínico-soroepidemiológico e avaliação do conhecimento e comportamento relacionados à infecção por Toxoplasma gondii

Submitted by Gilvan Almeida ([email protected]) on 2017-01-02T12:12:56Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 72266.pdf: 1055677 bytes, checksum: 96b709bb8046fc48035b62cc75fa4bcd (MD5)Approved for entry into archive by Anderson Silva ([email protected]) on 2017-01-11T12:27:18Z (GMT) No. of bitstreams: 2 72266.pdf: 1055677 bytes, checksum: 96b709bb8046fc48035b62cc75fa4bcd (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5)Made available in DSpace on 2017-01-11T12:27:18Z (GMT). No. of bitstreams: 2 72266.pdf: 1055677 bytes, checksum: 96b709bb8046fc48035b62cc75fa4bcd (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2009Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro,RJ, BrasilToxoplasmose é causada por Toxoplasma gondii e freqüentemente cursa com infecção benigna, mas pode ocasionar desfechos trágicos ao feto e neonato quando a mulher adquire a primoinfecção durante a gestação. A profilaxia primária em indivíduos susceptíveis, o diagnóstico precoce e o tratamento específico das gestantes infectadas previnem ou atenuam a infecção fetal. Foi realizado estudo descritivo dos aspectos clínico-soroepidemiológicos de gestantes e conceptos com suspeita de toxoplasmose aguda e ainda, uma avaliação do conhecimento de aspectos gerais, fatores de risco, aspectos clínicos, profilaxia e comportamento das gestantes, frente à infecção por Toxoplasma gondii. Participaram gestantes encaminhadas com teste IgM anti-toxoplasma gondii reagente. As características predominantes foram o baixo nível de instrução, encaminhamento por unidades públicas de saúde da capital do Rio de Janeiro, em avançada idade gestacional. Os problemas identificados nos serviços de pré-natal foram: demora no diagnóstico sorológico, no encaminhamento e ausência de tratamento e disponibilidade do teste de avidez de IgG para 80% das gestantes. Foram avaliadas associações entre serviço de saúde público/privado, escolaridade, paridade, cidade de origem, demora no diagnóstico e tratamento da toxoplasmose. No Instituto de Pesquisa Clínica Evandro Chagas foram realizados testes sorológicos confirmatórios Foram identificadas 7% de gestantes com diagnóstico sorológico consistente de infecção recentemente adquirida e muitas apresentaram quadro compatível com infecção crônica; no entanto, houve impossibilidade de exclusão de infecção adquirida na gestação pela avançada idade gestacional no primeiro atendimento. Um grande percentual de testes sorológicos externos com resultado duvidoso foram observados pela confirmação de gestantes com IgM falso-reagente e IgG negativo, além do problema de descontinuidade no tratamento por metade das gestantes. Dentre as crianças acompanhadas, não foi identificada toxoplasmose congênita. A avaliação do conhecimento e do comportamento das gestantes, frente à infecção, demonstrou bom nível de conhecimento sobre a doença, uma vez que foram orientadas no prénatal após diagnóstico de suspeita de toxoplasmose. No entanto, o comportamento após o início da gestação não foi considerado preventivo e possibilitou a identificação de possíveis fatores de risco para a doença, relacionados em maioria por oocistos como fonte de infecção. A descrição dos aspectos sociais, clínicos e epidemiológicos da população atendida fundamentou a discussão de medidas para aprimoramento no atendimento de gestantes e crianças; enquanto a avaliação do conhecimento direcionou a possibilidade de elaboração de políticas para prevenção da toxoplasmose gestacional no Rio de Janeiro, como a parceria com um centro especializado de atendimento materno-infantil, a fim de permitir uma avaliação mais substancial do desfecho da infecção por Toxoplasma gondii nesta cidade, que até o momento é desconhecidoToxoplasmosis is caused for Toxoplasma gondii and often presents with benign infection but can lead to tragic outcomes fetus and newborn when a woman acquires first infection during pregnancy. The primary prevention in susceptible individuals, the early diagnosis and the specific treatment of infected pregnant women can prevent or relieve fetal infection. A descriptive study was conducted with clinical and seroepidemiological aspects of pregnant women with suspected acute toxoplasmosis and concepts, and an assessment of knowledge in general, risk factors, clinical aspects, prevention and behavior of pregnant women related to infection by T. gondii. Pregnant women referred to IPEC with test IgM reagent anti-T. gondii were included. The predominant characteristics of the participants were the low level of education, referral units for public health in the capital of Rio de Janeiro in advanced gestational age. The problems identified in prenatal services were: delay in the serological diagnosis, delay in the referral and lack of treatment and unavailability of testing for IgG avidity for 80% of pregnant women. Associations between health service public/private, education, parity, city of origin, delay in diagnosis and delay in treatment of toxoplasmosis were evaluated. In the IPEC were performed confirmatory serologic tests. Seven percent of pregnant women were identified with serological diagnosis consistent with recently acquired infection and many were compatible with chronic infection, however, was impossible the exclusion the infection prior to pregnancy by the advanced gestational age at the time of arrival at the center of reference A large percentage of external serological tests were observed with equivocal results, a fact evidenced by the confirmation of susceptible pregnant women, with false-reagent IgM and negative IgG, besides of the problem of discontinuity in the treatment of half pregnant women. Among the children followed was not identified congenital toxoplasmosis. The assessment of knowledge and behavior of pregnant women pointed to a good level of knowledge about the toxoplasmosis, but the conduct adopted after the beginning of pregnancy was not considered preventive, enabling the identification of possible risk factors for current infection, related in the majority with oocysts as a source of infection. The description of clinical epidemiological aspects of the population attended based the discussion of measures the care and monitoring of pregnant women and children, while the assessment of knowledge directs the development of policies for prevention of gestational toxoplasmosis. Partnership with a specialized center for maternal and child care is being implemented to enable a more substantial outcome of the infection by T. gondii in children of Rio de Janeiro, which until now is unknow

Dificuldades observadas em um centro de referência no diagnóstico e manejo de gestantes com toxoplasmose

Submitted by Gilvan Almeida ([email protected]) on 2017-01-18T16:35:22Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Difficulties.pdf: 417174 bytes, checksum: c43d1c331c12f413c5e65d8d1aa829cc (MD5)Approved for entry into archive by Fátima Lopes ([email protected]) on 2018-04-26T16:26:08Z (GMT) No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Difficulties.pdf: 417174 bytes, checksum: c43d1c331c12f413c5e65d8d1aa829cc (MD5)Made available in DSpace on 2018-04-26T16:26:08Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Difficulties.pdf: 417174 bytes, checksum: c43d1c331c12f413c5e65d8d1aa829cc (MD5) Previous issue date: 2010Fundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto de Pesquisa Clínica Evandro Chagas. Rio de Janeiro, RJ, BrasilObjetivos: avaliar as dificuldades encontradas no atendimento de gestantes com diagnóstico de toxoplasmose por parte de serviços de atendimento pré-natal. Métodos: estudo longitudinal, prospectivo, com 262 gestantes encaminhadas ao Ambulatório de Toxoplasmose do Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, entre janeiro de 2005 e julho de 2009. Resultados: a maioria das gestantes foram encaminhadas no segundo ou terceiro trimestre de gestação (91,2%) e por serviços públicos de saúde (81,3%). O tempo médio de demora na coleta de sangue para os testes sorológicos no pré-natal foi de 113,4 dias. Houve demora média de 52,1 dias para o encaminhamento e 160,6 dias para o início do tratamento. Mulheres mais jovens (P=0,03) e aquelas provenientes do sistema público de saúde (P<0,000) foram encaminhadas mais tardiamente. O tratamento foi iniciado na origem em apenas 16% das gestantes, e 5% destas não receberam a dose preconizada de espiramicina. No Centro de Referência houve baixa confirmação dos testes sorológicos realizados nos serviços de saúde de origem. Constatou-se que 12,6% das gestantes com diagnóstico inicial de toxoplasmose aguda eram suscetíveis à infecção por Toxoplasma gondii, sendo os testes considerados falso-positivos. Conclusões: este estudo destaca dificuldades observadas no manejo de gestantes com toxoplasmose por parte do atendimento pré-natal da rede básica de saúde, incluindo a atenção quanto à qualidade dos testes diagnósticos e a necessidade de maior ênfase na educação continuada dos profissionais de saúdeAims: To evaluate the difficulties met in the care of pregnant women with toxoplasmosis diagnosis in antenatal care services. Methods: Longitudinal prospective study with 262 pregnant women referred to the Toxoplasmosis Clinic at Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, between January 2005 and July 2009. Results: Most women (91.2%) were in the second and third trimesters of pregnancy, and 81.3% were referred by public health services. The average delay was 113.4 days in the collection of the first sample for serological tests in antenatal care, 52.1 days for referral and 160.6 days in starting treatment. Younger women (P=0.03) and those from the public health system were referred later (P<0.05). Treatment was initiated at the origin for only 16% of the pregnant women, and 5% of these did not receive the recommended dose of spiramycin. At the Reference Center there was a low rate of confirmation of the serological tests performed in the health services of origin. It was found that 12.6% of pregnant women with an initial diagnosis of acute toxoplasmosis were susceptible to infection by Toxoplasma gondii . These tests were considered false positives. Conclusions: This study highlights the difficulties met in the management of pregnant women with toxoplasmosis in the antenatal care, including the quality of diagnostic tests and the need for greater emphasis on continuing education of health professional

Difficulties observed in a reference center in the diagnosis and management of pregnant women with toxoplasmosis

OBJECTIVES: To evaluate the difficulties met in the care of pregnant women with toxoplasmosis diagnosis in antenatal care services. METHODS: Longitudinal prospective study with 262 pregnant women referred to the Toxoplasmosis Clinic at Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, between January 2005 and July 2009. RESULTS: Most women (91.2%) were in the second and third trimesters of pregnancy, and 81.3% were referred by public health services. The average delay was 113.4 days in the collection of the first sample for serological tests in antenatal care, 52.1 days for referral and 160.6 days in starting treatment. Younger women and those from the public health system were referred later. Treatment was initiated at the origin for only 16% of the pregnant women, and 5% of these did not receive the recommended dose of spiramycin. At the Reference Center there was a low rate of confirmation of the serological tests performed in the health services of origin. It was found that 12.6% of pregnant women with an initial diagnosis of acute toxoplasmosis were susceptible to infection by Toxoplasma gondii. These tests were considered false positives. CONCLUSIONS: This study highlights the difficulties met in the management of pregnant women with toxoplasmosis in the antenatal care, including the quality of diagnostic tests and the need for greater emphasis on continuing education of health professionals.OBJETIVOS: avaliar as dificuldades encontradas no atendimento de gestantes com diagnóstico de toxoplasmose por parte de serviços de atendimento pré-natal. MÉTODOS: estudo longitudinal, prospectivo, com 262 gestantes encaminhadas ao Ambulatório de Toxoplasmose do Instituto de Pesquisa Clínica Evandro Chagas-Fundação Oswaldo Cruz, entre janeiro de 2005 e julho de 2009. RESULTADOS: a maioria das gestantes foram encaminhadas no segundo ou terceiro trimestre de gestação (91,2%) e por serviços públicos de saúde (81,3%). O tempo médio de demora na coleta de sangue para os testes sorológicos no pré-natal foi de 113,4 dias. Houve demora média de 52,1 dias para o encaminhamento e 160,6 dias para o início do tratamento. Mulheres mais jovens e aquelas provenientes do sistema público de saúde foram encaminhadas mais tardiamente. O tratamento foi iniciado na origem em apenas 16% das gestantes, e 5% destas não receberam a dose preconizada de espiramicina. No Centro de Referência houve baixa confirmação dos testes sorológicos realizados nos serviços de saúde de origem. Constatou-se que 12,6% das gestantes com diagnóstico inicial de toxoplasmose aguda eram suscetíveis à infecção por Toxoplasma gondii, sendo os testes considerados falso-positivos. CONCLUSÕES: este estudo destaca dificuldades observadas no manejo de gestantes com toxoplasmose por parte do atendimento pré-natal da rede básica de saúde, incluindo a atenção quanto à qualidade dos testes diagnósticos e a necessidade de maior ênfase na educação continuada dos profissionais de saúde

Genetic polymorphism for IFNγ +874T/A in patients with acute toxoplasmosis

INTRODUCTION: A single nucleotide polymorphism (SNP) in the gene encoding gamma interferon influences its production and is associated with severity of infectious diseases. This study aimed to evaluate the association of IFNγ+874T/A SNP with duration of disease, morbidity, and development of retinochoroiditis in acute toxoplasmosis. METHODS: A case-control study was conducted among 30 patients and 90 controls. RESULTS: Although statistical associations were not confirmed, A-allele was more common among retinochoroiditis cases and prolonged illness, while T-allele was more frequent in severe disease. CONCLUSIONS: Despite few cases, the results could indicate a relation between IFNγ+874T/A single nucleotide polymorphism and clinical manifestations of toxoplasmosis

Käytännön kosteikkosuunnittelu

Maatalouden vesiensuojelua edistetään monin tavoin. Ravinteita ja eroosioainesta sisältäviä valumavesiä pyritään puhdistamaan erilaisissa kosteikoissa. Tämä opas on kirjoitettu avuksi pienimuotoisten kosteikkojen perustamiseen. Oppaassa esitetään käytännönläheisesti kosteikon toteuttamisen eri vaiheet paikan valinnasta suunnitteluun ja rakentamiseen. Vuonna 2010 julkaistun painoksen tiedot on saatettu ajantasalle. Julkaisu on toteutettu osana Tehoa maatalouden vesiensuojeluun (TEHO) -hanketta ja päivitetty TEHO Plus -hankkeen toimesta. Oppaan toivotaan lisäävän kiinnostusta kosteikkojen suunnitteluun ja edelleen niiden rakentamiseen