Understanding the clinical spectrum of complicated Plasmodium vivax malaria: a systematic review on the contributions of the Brazilian literature

The resurgence of the malaria eradication agenda and the increasing number of severe manifestation reports has contributed to a renewed interested in the Plasmodium vivax infection. It is the most geographically widespread parasite causing human malaria, with around 2.85 billion people living under risk of infection. The Brazilian Amazon region reports more than 50% of the malaria cases in Latin America and since 1990 there is a marked predominance of this species, responsible for 85% of cases in 2009. However, only a few complicated cases of P. vivax have been reported from this region. A systematic review of the Brazilian indexed and non-indexed literature on complicated cases of vivax malaria was performed including published articles, masters' dissertations, doctoral theses and national congresses' abstracts. The following information was retrieved: patient characteristics (demographic, presence of co-morbidities and, whenever possible, associated genetic disorders); description of each major clinical manifestation. As a result, 27 articles, 28 abstracts from scientific events' annals and 13 theses/dissertations were found, only after 1987. Most of the reported information was described in small case series and case reports of patients from all the Amazonian states, and also in travellers from Brazilian non-endemic areas. The more relevant clinical complications were anaemia, thrombocytopaenia, jaundice and acute respiratory distress syndrome, present in all age groups, in addition to other more rare clinical pictures. Complications in pregnant women were also reported. Acute and chronic co-morbidities were frequent, however death was occasional. Clinical atypical cases of malaria are more frequent than published in the indexed literature, probably due to a publication bias. In the Brazilian Amazon (considered to be a low to moderate intensity area of transmission), clinical data are in accordance with the recent findings of severity described in diverse P. vivax endemic areas (especially anaemia in Southeast Asia), however in this region both children and adults are affected. Finally, gaps of knowledge and areas for future research are opportunely pointed out

Development of Externalizing Behaviors in the Context of Family and non-Family Relationships

A longitudinal model was presented, that included reciprocal associations between physically harsh parenting by the mother, child externalizing problems, and support from the father, the extended family, and the neighbors. This transactional process was estimated for the years preceding school entry. The data were from a 4-years longitudinal and nationally representative study of 1009 children and their mothers in Turkey. The results indicated that concurrently, physically harsh parenting and child externalizing problems were strongly associated. Controlling for their within domain stability and cross-domain concurrent correlation, changes in harsh parenting and changes in child externalizing behaviors had significant reciprocal effects in early childhood, although these effects were small. These reciprocal effects were smaller for observer reported harsh parenting than maternal reports. There was a role of the mesosystem in this developmental process. Increases in the support from the father, and the extended family and the neighbors predicted declines in the child externalizing behaviors subsequently. Reciprocally, high child externalizing and maternal physically harsh parenting predicted subsequent declines in the support from these sources. These results were consistent with the hypotheses that negative mother–child relationships could spill over to the other relationships of the mothers, and that positive and supportive relationships of the mother could constitute positive role models for the child.This research was funded by a grant from the Turkish Institute for Scientific and Technological Research (106K347 and 109K525) and received generous support from Koc Universit