Maternal educational level and risk of gestational hypertension: the Generation R Study.

We examined whether maternal educational level as an indicator of socioeconomic status is associated with gestational hypertension. We also examined the extent to which the effect of education is mediated by maternal substance use (that is smoking, alcohol consumption and illegal drug use), pre-existing diabetes, anthropometrics (that is height and body mass index (BMI)) and blood pressure at enrolment. This was studied in 3262 Dutch pregnant women participating in the Generation R Study, a population-based cohort study. Level of maternal education was established by questionnaire at enrolment, and categorized into high, mid-high, mid-low and low. Diagnosis of gestational hypertension was retrieved from medical records using standard criteria. Odds ratios (OR) of gestational hypertension for educational levels were calculated, adjusted for potential confounders and additionally adjusted for potential mediators. Adjusted for age and gravidity, women with mid-low (OR: 1.52; 95% CI: 1.02, 2.27) and low education (OR: 1.30; 95% CI: 0.80, 2.12) had a higher risk of gestational hypertension than women with high education. Additional adjustment for substance use, pre-existing diabetes, anthropometrics and blood pressure at enrolment attenuated these ORs to 1.09 (95% CI: 0.70, 1.69) and 0.89 (95% CI: 0.50, 1.58), respectively. These attenuations were largely due to the effects of BMI and blood pressure at enrolment. Women with relatively low educational levels have a higher risk of gestational hypertension, which is largely due to higher BMI and blood pressure levels from early pregnancy. The higher risk of gestational hypertension in these women is probably caused by pre-existing hypertensive tendencies that manifested themselves during pregnancy

Endothelial dysfunction in pregnancy metabolic disorders

In recent years, the vascular endothelium has gained attention as a key player in the initiation and development of pregnancy disorders. Endothelium acts as an endocrine organ that preserves the homeostatic balance by responding to changes in metabolic status. However, in metabolic disorders, endothelial cells adopt a dysfunctional function, losing their normal responsiveness. During pregnancy, several metabolic changes occur, in which endothelial function decisively participates. Similarly, when pregnancy metabolic disorders occur, endothelial dysfunction plays a key role in pathogenesis. This review outlines the main findings regarding endothelial dysfunction in three main metabolic pathological conditions observed during pregnancy: gestational diabetes, hypertensive disorders, and obesity and hyperlipidemia. Organ, histological and cellular characteristics were thoroughly described. Also, we focused in discussing the underlying molecular mechanisms involved in the cellular signaling pathways that mediate responses in these pathological conditions

An investigation of the perception of factors associated with daily living activities of comprehensive psychiatric rehabilitation consumers

[ACCESS RESTRICTED TO THE UNIVERSITY OF MISSOURI AT REQUEST OF AUTHOR.] For the last 60 years, there has been an increasing number of American adults identified as suffering from one or more severe diagnosable mental disorders that reduce an individual's ability to perform living and working tasks. Many of these consumers participate in services through comprehensive psychiatric rehabilitation (CPR) programs throughout the United States. CPR services attempt to meet the needs of individuals with severe psychiatric disabilities (Barton, 1999). Informed by ecological systems theory (EST) (Bronfenbrenner,1979) and empowerment theory (ET; Perkins and Zimmermen,1995; Rappaport, 1981; Rappaport 1990), this study utilized a survey in which CPR consumers rated numerous demographic and study variables regarding how helpful each was to their daily living activities. At the end of six-weeks of data collection, 122 consumers' surveys had been collected for data analysis. Descriptive statistics and linear regression analysis were employed to address four research questions. Half of the participants were 45 years of age or younger and half were 46 years of age or older. Most of the participants were female and identified as white. More than half of the participants lived on their own in the community, with most of the remaining living in an RCF (residential care facility) and a few living in a group setting with family or with friends. Most of the participants reported that their parents were married or divorced, that their parents are still living and that they have contact with their parents. Most of the participants had siblings and reported having contact with their siblings. Most of the participants reporting having weekly contact with their Community Support Specialist. Results of the regression analyses with the demographic variables and each of the system variables revealed several microsystem variables and several mezzo-system variables as strong predictors of DLA-20 scores; however, no macro-system variables met significance to be considered predictive of DLA-20 scores. The regression analysis, with the demographic variables and the system variables combined, found significant predictors of DLA-20 that came from all three system variables: micro-, mezzo-, and macro-system variables. The results of this study can be used to support the implementation of individual treatment plans, through the SMART (specific, measurable, attainable, relevant, and time-limited) goals and treatment approach in CPR programs so that the services provided to CPR consumers truly help them successfully complete their activities of daily living.Includes bibliographical references

Differences in concussion knowledge between parents and their children in a multidisciplinary concussion clinic sample.

PURPOSE: This study assessed concussion knowledge in concussed youth and parents treated at a multi-disciplinary concussion center. METHODS: Youth (n = 50) and parents (n = 36) were approached at the beginning of a clinical visit. Participants completed a 22-item, previously published concussion knowledge survey before the visit. RESULTS: Responses were compared with previously collected, published data from adolescents in a high school setting (n = 500). The patient group was divided into those with one (n = 23) vs. two or more concussions (n = 27). Chi-square analyses compared total correct responses between youth, parents, and the high school sample. T-tests assessed differences in knowledge based on prior concussions, age, and gender. All groups showed high accuracy for return-to-play guidelines (\u3e90%) and similar knowledge of concussion-related symptoms (72.3% vs. 68.6%). Significant knowledge gaps about diagnosis, neurological consequences, and long-term risks were present across groups (19% to 68% accuracy). The patient group more often misattributed neck symptoms to concussion (X2  \u3c  0.005). Prior concussion and gender were not significant predictors of concussion knowledge (p \u3e  0.5). CONCLUSION: Community and clinically-based educational techniques may not be effectively communicating knowledge about concussion diagnosis, symptoms, long-term risks, and neurological implications of concussion. Educational tools need to be tailored to specific settings and populations

CTX-M-65 Extended-Spectrum β-Lactamase–Producing Salmonella enterica Serotype Infantis, United States

Extended-spectrum β-lactamases (ESBLs) confer resistance to clinically important third-generation cephalosporins, which are often used to treat invasive salmonellosis. In the United States, ESBLs are rarely found in Salmonella. However, in 2014, the US Food and Drug Administration found blaCTX-M-65 ESBL-producing Salmonella enterica serotype Infantis in retail chicken meat. The isolate had a rare pulsed-field gel electrophoresis pattern. To clarify the sources and potential effects on human health, we examined isolates with this pattern obtained from human surveillance and associated metadata. Using broth microdilution for antimicrobial susceptibility testing and whole-genome sequencing, we characterized the isolates. Of 34 isolates, 29 carried the blaCTX-M-65 gene with <9 additional resistance genes on 1 plasmid. Of 19 patients with travel information available, 12 (63%) reported recent travel to South America. Genetically, isolates from travelers, nontravelers, and retail chicken meat were similar. Expanded surveillance is needed to determine domestic sources and potentially prevent spread of this ESBL-containing plasmid

Evolutionary adaptations to pre-eclampsia/eclampsia in humans: Low fecundability rate, loss of oestrus, prohibitions of incest and systematic polyandry

The definitive version is available at www.blackwell-synergy.comGestational-hypertension/pre-eclampsia occurs in approximately 10% of human pregnancies. This persistent complication of pregnancy has been reported to occur more frequently in couples conceiving very shortly after the beginning of their sexual relationship and/or after a change in paternity. Primipaternity may be the leading cause of pre-eclampsia in women under 30 years of age when genetic susceptibility to cardio-vascular disease has not yet been expressed, especially in women before their twenties, who for the last 40,000 years have perhaps comprised the age group when the majority of parturients classified as Homo sapiens sapiens initiated their reproductive life. In terms of evolution, the prevalence of pre-eclampsia represents a distinct reproductive disadvantage in humans as compared with other mammals. Indeed, pre-eclampsia is a consequence of the defect of the normal human-specific deep endovascular invasion of the trophoblast. The large size of the human fetal brain imposing this deep trophoblastic invasion induced the need for major immunogenetic compromises in terms of paternal–maternal tissue tolerance. The price that mankind has had to pay to adapt to the pre-eclampsia risk is a low fecundability rate and therefore loss of oestrus, possibly a step in the deviation between apes and hominids. Further, pre-eclampsia risk may be a contributing factor leading to the rejection of systematic polyandry in human societies and have influenced prohibition of incest.Pierre-Yves Robillard, Gustaaf A. Dekker, Thomas C. Hulse