Inflammatory and haematological markers in the maternal, umbilical cord and infant circulation in histological chorioamnionitis

BACKGROUND: The relationship between histological chorioamnionitis and haematological and biochemical markers in mothers and infants at delivery, and in infants postnatally, is incompletely characterised. These markers are widely used in the diagnosis of maternal and neonatal infection. Our objective was to investigate the effects of histological chorioamnionitis (HCA) on haematological and biochemical inflammatory markers in mothers and infants at delivery, and in infants post-delivery. METHODS: Two hundred and forty seven mothers, delivering 325 infants, were recruited at the only tertiary perinatal centre in Western Australia. Placentae were assessed for evidence of HCA using a semi-quantitative scoring system. Maternal high sensitivity C-reactive protein (hsCRP), procalcitonin, and umbilical cord hsCRP, procalcitonin, white cell count and absolute neutrophil count were measured at delivery. In infants where sepsis was clinically suspected, postnatal CRP, white cell count and absolute neutrophil count were measured up to 48 hours of age. The effect of HCA on maternal, cord and neonatal markers was evaluated by multivariable regression analysis. RESULTS: The median gestational age was 34 weeks and HCA was present in 26 of 247 (10.5%) placentae. Mothers whose pregnancies were complicated by HCA had higher hsCRP (median 26 (range 2-107) versus 5.6 (0-108) mg/L; P<0.001). Histological chorioamnionitis was associated with higher umbilical cord hsCRP (75(th) percentile 2.91 mg/L (range 0-63.9) versus 75(th) percentile 0 mg/L (0-45.6); P<0.001) and procalcitonin (median 0.293 (range 0.05-27.37) versus median 0.064 (range 0.01-5.24) ug/L; P<0.001), with a sustained increase in neonatal absolute neutrophil count (median 4.5 (0.1-26.4)x10(9)/L versus 3.0 (0.1-17.8)x10(9)/L), and CRP up to 48 hours post-partum (median 10 versus 6.5 mg/L) (P<0.05 for each). CONCLUSION: Histological chorioamnionitis is associated with modest systemic inflammation in maternal and cord blood. These systemic changes may increase postnatally, potentially undermining their utility in the diagnosis of early-onset neonatal infection

Correction to: Cluster identification, selection, and description in Cluster randomized crossover trials: the PREP-IT trials

An amendment to this paper has been published and can be accessed via the original article

La formación del educador infantil y la deserción escolar en territorios de conflicto armado en Colombia

La deserción en el ámbito educativo se refiere al abandono progresivo o determinado antes del tiempo de culminación establecido; situación que preocupa instituciones educativas y entidades gubernamentales. Se han desarrollado diversas investigaciones que permiten conocer porcentajes, motivos y principales causas de la deserción. El abandono escolar es una problemática multifactorial relacionada con el contexto; a diferencia del sector urbano, en las zonas rurales los índices de deserción suelen ser altos, con mayor acentuación en territorios de conflicto armado. El objetivo del presente trabajo fue analizar la pertinencia de la formación en Licenciatura en Pedagogía Infantil, su aporte para la comprensión y mitigación del fenómeno de deserción escolar en territorios con incidencia de conflicto armado en Colombia. Para ello, se indagó sobre la realidad de los estudiantes en el contexto rural colombiano, la normativa asociada a poblaciones desertoras rurales y el análisis de la conveniencia de los programas de formación en educación inicial de algunas Instituciones Educativas del Valle del Cauca, frente a la comprensión del fenómeno y posible contribución, para contrarrestar las tasas de deserción de acuerdo al contexto y necesidades de la población.Dropout in the educational field refers to the gradual or decided abandonment before the established completion time; situation that worries educational and governmental institutions. Various investigations have been carried out that reveal percentages, reasons and main causes of desertion. School dropout is a multifactorial problem related to the context; Unlike the urban sector, in rural areas desertion rates tend to be high, with a greater accentuation in territories of armed conflict. The aim this work was to analyze the relevance of the Bachelor's Degree in Early Childhood Education, its contribution to the understanding and mitigation of the phenomenon of school dropout in territories with an incidence of armed conflict in Colombia. To do this, the reality of students in the rural Colombian context was investigated, the regulations associated with rural populations in school dropout and the analysis of the convenience of training programs in initial education of Educational Institution's Valle del Cauca, opposite to the understanding of the phenomenon and possible contribution, to counteract the dropout rates according to the context and the needs of the population.PregradoLicenciado(a) en Educación Infanti

Implementing stakeholder engagement to explore alternative models of consent: An example from the PREP-IT trials

Introduction: Cluster randomized crossover trials are often faced with a dilemma when selecting an optimal model of consent, as the traditional model of obtaining informed consent from participant's before initiating any trial related activities may not be suitable. We describe our experience of engaging patient advisors to identify an optimal model of consent for the PREP-IT trials. This paper also examines surrogate measures of success for the selected model of consent. Methods: The PREP-IT program consists of two multi-center cluster randomized crossover trials that engaged patient advisors to determine an optimal model of consent. Patient advisors and stakeholders met regularly and reached consensus on decisions related to the trial design including the model for consent. Patient advisors provided valuable insight on how key decisions on trial design and conduct would be received by participants and the impact these decisions will have. Results: Patient advisors, together with stakeholders, reviewed the pros and cons and the requirements for the traditional model of consent, deferred consent, and waiver of consent. Collectively, they agreed upon a deferred consent model, in which patients may be approached for consent after their fracture surgery and prior to data collection. The consent rate in PREP-IT is 80.7%, and 0.67% of participants have withdrawn consent for participation. Discussion: Involvement of patient advisors in the development of an optimal model of consent has been successful. Engagement of patient advisors is recommended for other large trials where the traditional model of consent may not be optimal