Socio-cultural factors surrounding mental distress during the perinatal period in Zambia: a qualitative investigation.

BACKGROUND: The presence of mental distress during pregnancy and after childbirth imposes detrimental developmental and health consequences for families in all nations. In Zambia, the Ministry of Health (MoH) has proposed a more comprehensive approach towards mental health care, recognizing the importance of the mental health of women during the perinatal period. AIM: The study explores factors contributing to mental distress during the perinatal period of motherhood in Zambia. METHODS: A qualitative study was conducted in Lusaka, Zambia with nineteen focus groups comprising 149 women and men from primary health facilities and schools respectively. FINDINGS: There are high levels of mental distress in four domains: worry about HIV status and testing; uncertainty about survival from childbirth; lack of social support; and vulnerability/oppression. CONCLUSION: Identifying mental distress and prompt referral for interventions is critical to improving the mental health of the mother and prevent the effects of mental distress on the baby. RECOMMENDATION: Strategies should be put in place to ensure pregnant women are screened for possible perinatal mental health problems during their visit to antenatal clinic and referral made to qualified mental health professionals. In addition further research is recommended in order to facilitate evidence based mental health policy formulation and implementation in Zambia

Maximum tumor diameter is associated with event-free survival in PET-negative patients with stage I/IIA Hodgkin lymphoma.

Introduction: the high cure rates achieved in early-stage (ES) Hodgkin lymphoma (HL) are one of the great successes of hemato-oncology, but late treatment-related toxicity undermines long-term survival. Improving overall survival and quality of life further will require maintaining disease control while potentially de-escalating chemotherapy and/or omitting radiotherapy to reduce late toxicity. Accurate stratification of patients is required to facilitate individualized treatment approaches. Response assessment using 18F-fluorodeoxyglucose positron emission tomography (PET) is a powerful predictor of outcome in HL,1,2 and has been used in multiple studies, including the United Kingdom National Cancer Research Institute Randomised Phase III Trial to Determine the Role of FDG–PET Imaging in Clinical Stages IA/IIA Hodgkin’s Disease (UK NCRI RAPID) trial, to investigate whether patients achieving complete metabolic remission (CMR) can be treated with chemotherapy alone.3-5 These PET-adapted trials have demonstrated that omitting radiotherapy results in higher relapse rates, but without compromising overall survival.3-5 For the 75% of patients who achieved CMR in RAPID, neither baseline clinical risk stratification (favorable/unfavorable) nor PET (Deauville score 1/2) predicted disease relapse; additional biomarkers are needed.1 Tumor bulk has long been recognized as prognostic in HL,1,6 but there remains uncertainty about the significance and definition of bulk in the era of PET-adapted treatment.7 We performed a subsidiary analysis of RAPID to assess the prognostic value of baseline maximum tumor dimension (MTD) in patients achieving CMR. Methods: ee have previously reported the RAPID trial design, primary results, and outcomes according to pretreatment risk stratification and PET score.1,3 Patients were aged 16 to 75 years with untreated ES-HL and without B-symptoms or mediastinal bulk (mass > 1/3 internal mediastinal diameter at T5/6).6 Metabolic response after 3 cycles of ABVD chemotherapy (doxorubicin, bleomycin, vinblastine, and dacarbazine) was centrally assessed using PET (N = 562). Patients with CMR (ie, Deauville score 1-2) were randomly assigned to receive involved field radiotherapy (IFRT; n = 208) or no further therapy (NFT; n = 211). PET-positive patients (score, 3-5; n = 143) received a fourth cycle of ABVD and IFRT. Baseline disease assessment was performed by computed tomography, and bidimensional target lesion measurements were reported by local radiologists in millimeters. The association of baseline MTD with HL-related event-free survival (EFS: progression or HL-related death) and progression-free survival (PFS) (progression or any-cause death) was assessed using Kaplan-Meier and Cox regression analyses. Non-HL deaths were either related to primary treatment toxicity or occurred in HL remission.1 United Kingdom ethical approval for the RAPID trial was via the UK Multicentre Research ethics committee. Results and discussion: baseline patient characteristics have been previously described.1 Median age was 34 years (range, 16-75 years); 184 (37.4%) of 492 patients had unfavorable risk by European Organisation for Research and Treatment of Cancer criteria, and 155 (32.3%) of 480 by German Hodgkin Study Groupcriteria. Median MTD for patients achieving CMR was 3.0 cm (interquartile range, 2.0-4.0 cm) and 3.0 cm (interquartile range, 1.8-4.5 cm) in the NFT and IFRT groups, respectively, whereas PET-positive patients had a median MTD of 3.9 cm (interquartile range, 2.8-5.1 cm). After a median follow-up of 61.6 m, 44 HL progression events occurred: 21 NFT, 9 IFRT and 14 PET-positive. No patient received salvage treatment without documented progression. Only 5 HL-related deaths occurred (1 IFRT, 4 PET-positive), and 12 non-HL deaths (4 NFT, 6 IFRT, 2 PET-positive).1 For patients with CMR (N = 419), there was a strong association between MTD and EFS (hazard ratio [HR], 1.19; 95% confidence interval [CI], 1.02-1.39; P = .02), adjusting for treatment group, with an approximate 19% increase in HL risk per centimeter increase in MTD. The association was similar in both treatment groups (NFT HR, 1.20 [95% CI, 0.99-1.44; P = .06]; IFRT HR, 1.19 [95% CI, 0.92-1.55; P = .19]). The observed effect sizes did not markedly change after adjusting for baseline clinical risk factors, and similar results were observed for PFS (supplemental Table 1). In contrast, for PET-positive patients, there was no association between MTD and EFS (HR, 0.88; 95% CI, 0.70-1.11; P = .29) or PFS (HR, 0.87; 95% CI, 0.70-1.08; P = .21). In an exploratory analysis within the NFT group, MTD was dichotomized using increasing 1-cm intervals to investigate the relationship between MTD thresholds and EFS. The largest effect size was observed with an MTD threshold of ≥5 cm (Table 1). Similar results were observed for PFS; this threshold also performed best in time-dependent receiver operating characteristic curve analyses. It was not possible to assess MTD thresholds in the IFRT group with only 9 events. Among all randomized patients, 79 (18.9%) had MTD of ≥5 cm, the majority with mediastinal (n = 43), supraclavicular (n = 17), or cervical (n = 16) locations. Five-year EFS for patients with MTD of ≥5 cm randomly assigned to NFT and IFRT was 79.3% (n = 39; 95% CI, 66.6%-92.0%) and 94.9% (n = 40; 95% CI, 88.0%-100%), respectively (P = .03; Figure 1)

O processo de profissionalização dos Osteopatas em Portugal: as forças e as debilidades de uma profissão em construção

Sendo certo que os profissionais de saúde têm suscitado enorme interesse junto dos sociólogos que se interessam pela problemática das profissões, não será despiciendo afirmar que as áreas das medicinas alternativas ou não convencionais estão ainda muito pouco estudadas entre nós. Assim sendo, o objectivo principal deste artigo será o de dar a conhecer os aspectos mais marcantes do processo de profissionalização dos Osteopatas em Portugal, tendo como referencial teórico de base o paradigma do poder na análise das profissões. Segundo Mike Saks (2000), o facto de existir um elevado número de profissionais da medicina alternativa e complementar, tal não significa que as práticas alternativas estejam consolidadas no quadro das ofertas dos sistemas de saúde europeus. Entre nós, a inserção no mercado de trabalho dos profissionais em Osteopatia é ainda relativamente recente e revela algumas especificidades, ao aceitar pessoas sem qualquer formação estruturada e consolidada, ou reconhecimento profissional acreditado pelo Estado. Sabendo que a qualidade da inserção no mercado de trabalho dos profissionais em Osteopatia pode determinar em grande medida a qualidade da carreira a ser construída, o objectivo deste trabalho consistiu em analisar o processo de profissionalização e de formação identitária dos actuais Osteopatas que trabalham em Portugal. Tendo por base a caracterização do conceito de profissão apresentado por E. Freidson e a partir de um conjunto de entrevistas realizadas junto de indivíduos de ambos os sexos a trabalhar em Portugal e assumindo diferentes experiências e formações ditas Osteopáticas, tanto a nível nacional como internacional, foi possível concluir que sem a regulamentação da profissão por parte do Estado e sem a formação de cursos a tempo inteiro devidamente estruturados e oficialmente reconhecidos, dificilmente será possível ultrapassar uma imagem muito débil de percepcionar o que é a Osteopatia e qual o seu verdadeiro “métier”. Desta forma poder-se-á estar a criar um problema de natureza e formação identitária entre os profissionais e na imagem que estes transmitem para a opinião pública. O poder profissional desta classe apresentar-se-á debilitado e enfraquecido por falta de uma consolidação da profissão, ao gerar valores e formas muito diferenciadas de apropriação da profissão e das suas actividades de trabalho

A locked immunometabolic switch underlies TREM2 R47H loss of function in human iPSC-derived microglia

Loss‐of‐function genetic variants of triggering receptor expressed on myeloid cells 2 (TREM2) are linked with an enhanced risk of developing dementias. Microglia, the resident immune cell of the brain, express TREM2, and microglial responses are implicated in dementia pathways. In a normal surveillance state, microglia use oxidative phosphorylation for their energy supply, but rely on the ability to undergo a metabolic switch to glycolysis to allow them to perform rapid plastic responses. We investigated the role of TREM2 on the microglial metabolic function in human patient iPSC‐derived microglia expressing loss of function variants in TREM2. We show that these TREM2 variant iPSC‐microglia, including the Alzheimer's disease R47H risk variant, exhibit significant metabolic deficits including a reduced mitochondrial respiratory capacity and an inability to perform a glycolytic immunometabolic switch. We determined that dysregulated PPARγ/p38MAPK signaling underlies the observed phenotypic deficits in TREM2 variants and that activation of these pathways can ameliorate the metabolic deficit in these cells and consequently rescue critical microglial cellular function such as β‐Amyloid phagocytosis. These findings have ramifications for microglial focussed‐treatments in AD

Experiments in no-impact control of dingoes: Comment on Allen et al. 2013

There has been much recent debate in Australia over whether lethal control of dingoes incurs environmental costs, particularly by allowing increase of populations of mesopredators such as red foxes and feral cats. Allen et al. (2013) claim to show in their recent study that suppression of dingo activity by poison baiting does not lead to mesopredator release, because mesopredators are also suppressed by poisoning. We show that this claim is not supported by the data and analysis reported in Allen et al.'s paper. © 2014 Johnson et al.; licensee BioMed Central Ltd

A systematic review of adaptive wildlife management for the control of invasive, non-native mammals, and other human–wildlife conflicts

1.We are entering an era where species declines are occurring at their fastest ever rate, and the increased spread of non-native species is among the top causes. High uncertainty in biological processes makes the accurate prediction of the outcomes of management interventions very challenging. Adaptive management (AM) offers solutions to reduce uncertainty and improve predictability so that the outcomes of interventions can continuously improve. 2.We quantitatively assess the extent to which AM is used for managing vertebrates, with a focus on invasive non-native species (INNS). Using the Web of Science, we evaluated 3992 articles returned by the search terms ‘adaptive management’ or ‘adaptive harvest management’ against seven recommended elements of AM (engagement with stakeholders, defining objectives, forecasting and estimating uncertainty, implementing management, monitoring populations, adjusting management in response to monitoring, and improving forecasting and reducing uncertainty in response to monitoring populations). 3.The use of AM for vertebrates was reported in 56 (1%) of the evaluated studies; including four for managing INNS. Of these, ten studies excluding INNS and no studies of INNS management implemented all seven recommended elements of AM. Those elements infrequently implemented were: the use of analysis or models to forecast and represent uncertainty (44%) and the feedback of monitoring data to improve forecasting and reduce uncertainty (25%). 4.Complete active AM has rarely been implemented and reported for managing INNS, despite the significant advantages it offers. Among studies purporting to have implemented AM, most did not use analyses or models to forecast and represent uncertainty, while most defined objectives, implemented management, and monitored populations.5.Improvements to ongoing control programmes and much broader adoption of the AM approach are required to increase the efficiency and success of INNS management campaigns and reduce their negative impacts on native species

In the best interests of the deceased: A possible justification for organ removal without consent?

Opt-out systems of postmortem organ procurement are often supposed to be justifiable by presumed consent, but this justification turns out to depend on a mistaken mental state conception of consent. A promising alternative justification appeals to the analogical situation that occurs when an emergency decision has to be made about medical treatment for a patient who is unable to give or withhold his consent. In such cases, the decision should be made in the best interests of the patient. The analogous suggestion to be considered, then, is, if the potential donor has not registered either his willingness or his refusal to donate, the probabilities that he would or would not have preferred the removal of his organs need to be weighed. And in some actual cases the probability of the first alternative may be greater. This article considers whether the analogy to which this argument appeals is cogent, and concludes that there are important differences between the emergency and the organ removal cases, both as regards the nature of the interests involved and the nature of the right not to be treated without one’s consent. Rather, if opt-out systems are to be justified, the needs of patients with organ failure and/or the possibility of tacit consent should be considered

Infant cortex responds to other humans from shortly after birth

A significant feature of the adult human brain is its ability to selectively process information about conspecifics. Much debate has centred on whether this specialization is primarily a result of phylogenetic adaptation, or whether the brain acquires expertise in processing social stimuli as a result of its being born into an intensely social environment. Here we study the haemodynamic response in cortical areas of newborns (1–5 days old) while they passively viewed dynamic human or mechanical action videos. We observed activation selective to a dynamic face stimulus over bilateral posterior temporal cortex, but no activation in response to a moving human arm. This selective activation to the social stimulus correlated with age in hours over the first few days post partum. Thus, even very limited experience of face-to-face interaction with other humans may be sufficient to elicit social stimulus activation of relevant cortical regions

Phenotypic microarrays suggest Escherichia coli ST131 is not a metabolically distinct lineage of extra-intestinal pathogenic E. coli

Extraintestinal pathogenic E. coli (ExPEC) are the major aetiological agent of urinary tract infections (UTIs) in humans. The emergence of the CTX-M producing clone E. coli ST131 represents a major challenge to public health worldwide. A recent study on the metabolic potential of E. coli isolates demonstrated an association between the E. coli ST131 clone and enhanced utilisation of a panel of metabolic substrates. The studies presented here investigated the metabolic potential of ST131 and other major ExPEC ST isolates using 120 API test reagents and found that ST131 isolates demonstrated a lower metabolic activity for 5 of 120 biochemical tests in comparison to non-ST131 ExPEC isolates. Furthermore, comparative phenotypic microarray analysis showed a lack of specific metabolic profile for ST131 isolates countering the suggestion that these bacteria are metabolically fitter and therefore more successful human pathogens