The impact of helminths on the response to immunization and on the incidence of infection and disease in childhood in Uganda: design of a randomized, double-blind, placebo-controlled, factorial trial of deworming interventions delivered in pregnancy and early childhood [ISRCTN32849447]

BACKGROUND: Helminths have profound effects on the immune response, allowing long-term survival of parasites with minimal damage to the host. Some of these effects "spill-over", altering responses to non-helminth antigens or allergens. It is suggested that this may lead to impaired responses to immunizations and infections, while conferring benefits against inflammatory responses in allergic and autoimmune disease. These effects might develop in utero, through exposure to maternal helminth infections, or through direct exposure in later life. PURPOSE: To determine the effects of helminths and their treatment in pregnancy and in young children on immunological and disease outcomes in childhood. METHODS: The trial has three randomized, double-blind, placebo-controlled interventions at two times, in two people: a pregnant woman and her child. Pregnant women are randomized to albendazole or placebo and praziquantel or placebo. At age 15 months their children are randomized to three-monthly albendazole or placebo, to continue to age five years. The proposed designation for this sequence of interventions is a 2 x 2(x2) factorial design. Children are immunized with BCG and against polio, Diphtheria, tetanus, Pertussis, Haemophilus, hepatitis B and measles. Primary immunological outcomes are responses to BCG antigens and tetanus toxoid in whole blood cytokine assays and antibody assays at one, three and five years of age. Primary disease outcomes are incidence of malaria, pneumonia, diarrhoea, tuberculosis, measles, vertical HIV transmission, and atopic disease episodes, measured at clinic visits and twice-monthly home visits. Effects on anaemia, growth and intellectual development are also assessed. CONCLUSION: This trial, with a novel design comprising related interventions in pregnant women and their offspring, is the first to examine effects of helminths and their treatment in pregnancy and early childhood on immunological, infectious disease and allergic disease outcomes. The results will enhance understanding of both detrimental and beneficial effects of helminth infection and inform policy

A Randomized Controlled Trial of Folate Supplementation When Treating Malaria in Pregnancy with Sulfadoxine-Pyrimethamine

OBJECTIVES: Sulfadoxine-pyrimethamine (SP) is an antimalarial drug that acts on the folate metabolism of the malaria parasite. We investigated whether folate (FA) supplementation in a high or a low dose affects the efficacy of SP for the treatment of uncomplicated malaria in pregnant women. DESIGN: This was a randomized, placebo-controlled, double-blind trial. SETTING: The trial was carried out at three hospitals in western Kenya. PARTICIPANTS: The participants were 488 pregnant women presenting at their first antenatal visit with uncomplicated malaria parasitaemia (density of ≥ 500 parasites/μl), a haemoglobin level higher than 7 g/dl, a gestational age between 17 and 34 weeks, and no history of antimalarial or FA use, or sulfa allergy. A total of 415 women completed the study. INTERVENTIONS: All participants received SP and iron supplementation. They were randomized to the following arms: FA 5 mg, FA 0.4 mg, or FA placebo. After 14 days, all participants continued with FA 5 mg daily as per national guidelines. Participants were followed at days 2, 3, 7, 14, 21, and 28 or until treatment failure. OUTCOME MEASURES: The outcomes were SP failure rate and change in haemoglobin at day 14. RESULTS: The proportion of treatment failure at day 14 was 13.9% (19/137) in the placebo group, 14.5% (20/138) in the FA 0.4 mg arm (adjusted hazard ratio [AHR], 1.07; 98.7% confidence interval [CI], 0.48 to 2.37; p = 0.8), and 27.1% (38/140) in the FA 5 mg arm (AHR, 2.19; 98.7% CI, 1.09 to 4.40; p = 0.005). The haemoglobin levels at day 14 were not different relative to placebo (mean difference for FA 5 mg, 0.17 g/dl; 98.7% CI, −0.19 to 0.52; and for FA 0.4 mg, 0.14 g/dl; 98.7% CI, −0.21 to 0.49). CONCLUSIONS: Concomitant use of 5 mg FA supplementation compromises the efficacy of SP for the treatment of uncomplicated malaria in pregnant women. Countries that use SP for treatment or prevention of malaria in pregnancy need to evaluate their antenatal policy on timing or dose of FA supplementation

Effect of Supplementation with Zinc and Other Micronutrients on Malaria in Tanzanian Children: A Randomised Trial

Hans Verhoef and colleagues report findings from a randomized trial conducted among Tanzanian children at high risk for malaria. Children in the trial received either daily oral supplementation with either zinc alone, multi-nutrients without zinc, multi-nutrients with zinc, or placebo. The investigators did not find evidence from this study that zinc or multi-nutrients protected against malaria episodes

The effect of a school-based iron intervention on the haemoglobin concentration of school children in north-west Pakistan

This article was published in the European Journal of Clinical Nutrition [Nature Publishing Group © the authors] and the definitive version is available at: http://dx.doi.org/10.1038/ejcn.2013.160Objective: To assess the effectiveness of iron supplements administered to school children through a longitudinal school health intervention in terms of child haemoglobin concentration and anaemia prevalence. Subjects and Methods: Children and adolescents aged 5-17 years were selected from 30 schools in north-west Pakistan for a longitudinal iron supplement intervention. Children received once-weekly iron supplements (200mg ferrous sulphate containing 63mg of elemental iron) for 24 weeks (n=352); or the same supplements twice-weekly for 12 weeks (n=298) or received no tablets (n=298). Haemoglobin concentration was estimated in finger-prick blood samples at baseline, 12 and 24 weeks. Follow-up samples were taken at 36 weeks. Results: A non-significant increase in haemoglobin concentration was observed in children receiving iron supplements after 12 weeks (mean 1.4 g/l SD 15.0 g/l in once-weekly vs 2.5 g/l SD 14.5 g/l in twice-weekly) compared with the group receiving no iron supplements. There was no significant reduction in the prevalence of anaemia in the once-weekly or twice-weekly group compared with the unsupplemented group. The prevalence of anaemia increased in all three groups during the follow-up period (24 to 36 weeks). Conclusion: Once-weekly and twice-weekly iron supplements were not associated with significant increases in haemoglobin concentration compared with unsupplemented children. In all groups, baseline haemoglobin concentration was the strongest predictor of haemoglobin increase. The lack of improvement may stem from the moderate baseline prevalence of anaemia (33%); other micronutrient deficiencies; variable compliance, or the worsening of haemoglobin status due to seasonal changes in dietary iron and other nutrients

Effects of iron supplementation and anthelmintic treatment on motor and language development of preschool children in Zanzibar: double blind, placebo controlled study

To measure the effects of iron supplementation and anthelmintic treatment on iron status, anaemia, growth, morbidity, and development of children aged 6-59 months.

Undergraduate College Students\u27 Perceptions of Psychologists

We surveyed undergraduate students\u27 perceptions of professional psychologists\u27 characteristics as well as their competency. Overall, psychologists were viewed positively on dimensions surveyed and students perceived psychologists generally as being competent. Treating psychiatric disorders and conducting assessments were said to be among psychologists\u27 overall strong suits. Confusion between psychologists and psychiatrists seemed to exist in students\u27 thinking on some issues. We believe stereotyping also may be an issue that impacts students\u27 constructs regarding professional psychologists

Undergraduate College Students\u27 Perceptions of Psychiatric Nurses

We surveyed undergraduate students\u27 perceptions of psychi­atric nurses\u27 effectiveness and analyzed other sources of data. Stu­dents reported that psychiatric nurses\u27 strengths include helping in situations that involve psychiatric symptoms, mental health evaluation, and drug abuse. Psychiatric nurses also were said to be effective when helping an individual with psychiatric symptoms, such as delusions and hallucinations. Friends or associates, common knowledge, school and education, and movies are some sources bv which students learn about psychiatric nurses. Sources that provided less influential information include insurance carriers, newspapers, and personal experience