Health worker text messaging for blended learning, peer support, and mentoring in pediatric and adolescent HIV/AIDS care: a case study in Zimbabwe.

BACKGROUND: In sub-Saharan Africa, shortages of trained healthcare workers and limited resources necessitate innovative and cost-effective approaches for training, supervising, and mentoring. This qualitative case study describes participants' and trainers' perspectives and experiences with a text messaging component of a blended training course in HIV counseling and testing in Zimbabwe, using minimal resources in terms of staff time and equipment requirements. This component included a whole-group discussion forum as well as two-person partner discussions designed to promote reflection and analysis, teamwork, and active learning. CASE PRESENTATION: The Ministry of Health and Child Care (MoHCC) of Zimbabwe collaborated with the International Training and Education Center for Health (I-TECH) on adaptation of a 5-day in-service training in HIV Testing Services for Children and Adolescents. The new 7-week blended format included in-person sessions, tablet-based self-study, and discussions using the text messaging application, WhatsApp. Between August 2016 and January 2017, 11 cohorts (293 participants in total) were trained with this new curriculum, incorporating text messaging to support peer-to-peer and work-based education. Data collected included training participants' feedback, key informant interviews with the training team, and thematic analysis of WhatsApp messages from full-cohort discussions and a sampling of one-to-one partner discussions. A total of 293 healthcare workers from 233 health facilities across all provinces in Zimbabwe completed the blended learning course. Participants strongly endorsed using WhatsApp groups as part of the training. In the whole-group discussions, the combined cohorts generated over 6300 text messages. Several categories of communication emerged in analysis of group discussions: (1) participants' case experiences and questions; (2) feedback and recommendations for work issues raised; (3) inquiries, comments, and responses about course assignments and specific course content; (4) encouragement; and (5) technical challenges encountered using the blended learning methodology. Case discussions were complex, including patient history, symptoms, medications, and psychosocial issues-child abuse, adherence, and disclosure. CONCLUSIONS: Using text messaging in a communication platform that is an ongoing part of healthcare workers' daily lives can be an effective adjunct to in-service training, minimizing isolation and providing interactivity, supporting students' ability to fully integrate content into new skill attainment.

Childhood neglect and parental care perception in cocaine addicts: relation with psychiatric symptoms and biological correlates.

UNLABELLED: Childhood neglect and poor child-parent relationships have been reported to increase substance use disorders susceptibility. Stressful environmental factors, including emotional neglect, could affect individual personality traits and mental health, possibly inducing stable changes in hypothalamic-pituitary-adrenal (HPA) axis and brain mono-amine function, in turn involved in addictive behavior vulnerability. Therefore, we decided to investigate homovanillic (HVA) and prolactin (PRL) plasma levels, as expression of possible changes in dopamine function, ACTH and cortisol plasma levels, as measures of HPA axis function, and concomitant psychiatric symptoms profile in abstinent cocaine addicts, in relationship to their childhood history of neglect and poor parental care perception. METHODS: Fifty abstinent cocaine dependent patients, and 44 normal controls, matched for age and sex, were submitted to a detailed psychiatric assessment (DSM IV criteria). All patients and controls completed the Symptoms Check List-90 (SCL-90) and the Buss Durkee Hostility Inventory (BDHI), to evaluate psychiatric symptoms frequency and aggressiveness levels. The Childhood Experience of Care and Abuse-Questionnaire (CECA-Q) and Parental Bonding Instrument (PBI) have been used to retrospectively investigate parent-child relationships. Blood samples were collected to determine HVA, PRL, ACTH and cortisol basal plasma levels. RESULTS: Cocaine addicted individuals in general showed significantly lower HVA, and higher PRL, ACTH and cortisol basal levels respect to controls. In particular, neuroendocrine changes characterized cocaine addicts with childhood history of neglect and low perception of parental care. Obsessive-compulsive, depression and aggressiveness symptoms have been found related to poor parenting, inversely associated to HVA levels and directly associated to PRL, ACTH and cortisol levels. CONCLUSIONS: These findings suggest the possibility that childhood experience of neglect and poor parent-child attachment may partially contribute to a complex neurobiological derangement including HPA axis and dopamine system dysfunctions, playing a crucial role in addictive and affective disorders susceptibility.

Characterization and localization of 3H-arginine8-vasopressin binding to rat kidney and brain tissue.

Anatomic, behavioral and pharmacologic evidence suggests that arginine8-vasopressin (AVP) serves as a CNS neurotransmitter or neuromodulator. We have characterized AVP binding to membrane and tissue slice preparations from brain and kidney, and examined the anatomical distribution of these binding sites. Conditions for the binding assay were optimized using kidney medullary tissue. Binding of 3H-AVP (S.A. = 30-51 Ci/mmol, NEN) to brain and kidney membranes and tissue slices was saturable, temperature dependent, linearly related to protein concentration (or number of tissue slices), reversible, and specific since the ability of cold AVP to displace 3H-AVP from binding was greater than oxytocin and other related peptide fragments. Autoradiographic localization of 3H-AVP binding was restricted to kidney medullary tissue. In brain tissue, 3H-AVP binding was found to occur in concentrated foci. Brainstem areas such as the nucleus tractus solitarius (NTS) showed a high density of AVP binding sites. Since local injections of AVP into the NTS have been shown to influence blood pressure, the present study presents the first anatomical evidence for the presence of AVP specific binding sites which might mediate this effect.

Ontogenetic changes in vasopressin binding site distribution in rat brain: an autoradiographic study.

Binding sites for [3H]vasopressin were identified in brains of neonatal (days 0-23) and adult (90 day) Long-Evans and Brattleboro rats, using a technique of in vitro receptor autoradiography. Results indicate that the regional distribution of binding sites for [3H]vasopressin in the brain changes markedly during postnatal development. Binding sites in the septum proliferated slowly to attain adult distribution in the dorsal and lateral septum, while in other regions, such as the caudate, hippocampus and cingulate gyrus, intense labeling appeared early in development but disappeared by adulthood. In the amygdala, binding did not change during postnatal development. Binding sites in the septum appeared before vasopressinergic fibers are present. Also, binding was present for vasopressin in regions which have not yet been reported to receive vasopressinergic innervation. Therefore, it is proposed that the presence of binding sites for vasopressin is independent of the presence of vasopressin itself. This hypothesis is supported by labeling in the Brattleboro rat which was comparable to that in the Long-Evans.

Somatic and behavioral ontogeny in three rat strains: preliminary observations of dopamine-mediated behaviors and brain D-1 receptors.

1. The acquisition of developmental milestones and maturational motor reflexes were compared in three rat strains (culled to 8 pups/litter), F344, Buff and SD. 2. Open field behavior on postnatal day 21 was scored for locomotor activity, rears and center entries. 3. F344 rats, which model ADHD, were the slowest of the three strains in acquiring a number of developmental milestones and in gaining weight; but they were intermediate in their scores for locomotor activity and rearing during open field testing at postnatal day 21. 4. Preliminary autoradiographic data using the D-1 specific ligand [3H]SCH 23390 are included which suggest that D-1 receptors, which display age-dependent changes in concentration and distribution, are relevant to day 21 open field behavior. 5. F344 rats demonstrate developmental "dysmaturation" which is consistent with that observed in children with ADHD in that somatic growth is disproportionately delayed in comparison to neurological and motor maturation.

Somatic and central nervous system growth in artificially reared rat pups.

Rearing preweanling rat pups away from their mothers by feeding through chronic intragastric cannulas has been shown to result in alterations in the growth of specific organs. In the present study, artificially reared (AR) rats and their normally reared (NR) siblings were sacrificed at various ages during this procedure to determine the time course of these alterations. Brain growth deficits were detected within 24 hours, peaked after 8 days of artificial rearing and showed some recovery by the end of the study. By day 18, the livers, kidneys and spleens of the AR pups were significantly larger than those of their NR siblings. The spleens showed an initial decrease in weight compared to the spleens of the NR pups. However, by day 18, the spleens of the AR group were significantly larger than those of the NR group.

Localization and measurement of neurotransmitter receptors in rat and human brain by quantitative autoradiography.

Receptors for neurotransmitters can be visualized and characterized using in vitro tissue slice binding techniques and quantitative autoradiography. In this article, the general methods used in studies of this type are outlined and specific application to the study of catecholamine and neuropeptide receptors in rat and human brain tissue are described. Receptor autoradiography is used to examine regulation of dopamine receptor density in response to denervation and replacement of dopamine using brain transplants. Morphological and pharmacological aspects of vasopressin receptor ontogeny in the rat brain are examined. Finally, autoradiographic data on catecholamine receptor localization and characterization in the human hypothalamus, locus coeruleus, and frontal cortex are presented and discussed with reference to their applications in the study of neuropsychiatric disorders such as schizophrenia and senile dementia of the Alzheimer's type.

A new method to assess skin treatments for lowering the impedance and noise of individual gelled Ag-AgCl electrodes.

A model-based new procedure for measuring the single electrode-gel-skin impedance (ZEGS) is presented. The method is suitable for monitoring the contact impedance of the electrodes of a large array with limited modifications of the hardware and without removing or disconnecting the array from the amplifier. The procedure is based on multiple measurements between electrode pairs and is particularly suitable for electrode arrays. It has been applied to study the effectiveness of three skin treatments, with respect to no treatment, for reducing the electrode-gel-skin impedance (ZEGS) and noise: (i) rubbing with alcohol; (ii) rubbing with abrasive conductive paste; (iii) stripping with adhesive tape. The complex impedances ZEGS of the individual electrodes were measured by applying this procedure to disposable commercial Ag-AgCl gelled electrode arrays (4  ×  1) with a 5 mm(2) contact area. The impedance unbalance ΔZ = ZEGS1 - ZEGS2 and the RMS noise (VRMS) were measured between pairs of electrodes. The tissue impedance ZT was also obtained, as a collateral result. Measurements were repeated at t0 = 0 min and at t30 = 30 min from the electrode application. Mixed linear models and linear regression analysis applied to ZEGS, ΔZ and noise VRMS for the skin treatment factor demonstrated (a) that skin rubbing with abrasive conductive paste is more effective in lowering ZEGS, ΔZ and VRMS (p < 0.01) than the other treatments or no treatment, and (b) a statistically significant decrement (p < 0.01), between t0 and t30, of magnitude and phase of ZEGS.Rubbing with abrasive conductive paste significantly decreased the noise VRMS with respect to other treatments or no treatment.

Homovanillic acid (HVA) plasma levels inversely correlate with attention deficit-hyperactivity and childhood neglect measures in addicted patients.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) seems to be a risk condition for substance use disorders, possibly in relationship to common neurobiological changes, underlying both addictive and externalising behaviour susceptibility. Although this vulnerability has been primarily attributed to gene variants, previous studies suggest that also adverse childhood experiences may influence neurotransmission, affecting in particular brain dopamine (DA) system and possibly concurring to the development of behavioural disorders. Therefore, we decided to investigate ADHD symptoms and plasma concentrations of the DA metabolite homovanillic acid (HVA) in abstinent addicted patients, in comparison with healthy control subjects, evaluating whether ADHD scores were related with HVA levels, as expression of DA turnover, and whether HVA values, in turn, were associated with childhood emotional neglect. METHODS: Eighty-two abstinent drug dependent patients, and 44 normal controls, matched for age and sex, completed the Wender Utah Rating Scale (WURS), measuring ADHD symptoms, and the Childhood Experience of Care and Abuse Questionnaire (CECA-Q). Blood samples were collected to determine HVA plasma levels. RESULTS: Addicted individuals showed significantly higher ADHD scores and lower HVA levels respect to control subjects. ADHD scores at WURS in addicted patients negatively correlated with plasma HVA values. In turn, plasma HVA levels were inversely associated with childhood neglect measures, reaching statistical significance with "mother-antipathy" and "mother neglect" scores. CONCLUSIONS: These findings suggest the possibility that childhood experience of neglect and poor mother-child attachment may have an effect on central dopamine function as an adult, in turn contributing to both ADHD and substance abuse neurobiological vulnerability.

A microwave-hyperthermia model of febrile convulsions.

While convulsions associated with fever represent a serious problem in pediatric medicine, conventional animal models of febrile convulsions suffer numerous technical limitations. A microwave-hyperthermia model that eliminates these problems was tested. Microwave energy was used to increase the core temperature of 13- and 17-day-old rats, resulting in convulsions similar to febrile convulsions in human infants. Rats were irradiated for 10 min in circularly polarized waveguides at 918 MHz, CW (average SAR = 9.4 W/kg at 13 days and 18.0 W/kg at 17 days as determined by twin-well calorimetry). Day 17 irradiated rats were less susceptible to convulsions that were day 13 irradiated rats, indicating an age-dependent decline in susceptibility. Contrary to findings of earlier models using infrared or hot-oven heating, convulsions induced with microwave hyperthermia impaired neither brain growth nor subsequent performance during behavioral testing. Simultaneous measurement of brain and rectal temperatures during microwave irradiation revealed differential heating rates that favor thermal homeostasis in brain tissue.

Artificial rearing of rat pups with a protein-enriched formula.

Neonatal Long-Evans hooded rat pups were assigned to one of three groups: 1) pups normally reared, 2) pups implanted with intragastric cannulas and artificially reared with a common milk replacement formula, 3) pups implanted with intragastric cannulas and artificially reared with a protein-enriched milk formula. Daily body weights were recorded, as were the ontogeny of various reflexes. On day 18, the animals were behaviorally tested and then killed. There were no differences among the three groups in daily body weights, nor in the ontogeny of reflexive behavior. There were no differences in the wet weights of caudal brain sections, but the normally reared animals had significantly larger rostral brain sections than either artificially reared group. While cerebella of normally reared animals were significantly larger than those of the two artificially reared groups, there was a significant trend towards more normal cerebellar weights with the addition of protein in the formula of artificially reared animals. Behavioral tests indicated that the animals artificially reared have significantly different behavior than normally reared animals. However, compared to animals artificially reared using a common milk formula, animals artificially reared with additional protein in their formula behave more like normally reared animals.

Localization and characterization of vasopressin-binding sites in the amygdala of the rat brain.

Putative receptors for arginine-vasopressin (AVP) in rat brain were localized and characterized using autoradiographic and radioligand-binding techniques. When brain slices were incubated with tritium-labeled vasopressin, an intense concentration of binding sites was identified which included the medial aspects of the amygdala. Binding of labeled AVP to membrane preparations from this brain region was saturable, specific, reversible, and of high affinity. An antagonist of the peripheral pressor activity of vasopressin was found to be a potent competitor for binding to this site.