Psychological and relational meanings of the experience of motherhood with toxoplasmosis / Significados psicológicos e relacionais da experiência da maternidade com toxoplasmose / Significados psicológicos y relacionales de la experiencia de la maternidad con toxoplasmosis

With the purpose of understanding the psychological and relational meanings of the experience of motherhood in the face of toxoplasmosis, a clinical-qualitative study was carried out performing semi-directed interviews with five mothers of babies with toxoplasmosis. The information was submitted to Content Analysis, and the results demonstrated that the psychological meanings include both the presence of difficulties and suffering and the potentiality of the babies and the establishment of emotional mother-baby bonds. Relative to the relational meanings, the importance of support networks was identified, emphasizing the role of family members, health services, and religiosity as sources of support in facing difficulties. However, it was identified that the care is provided primordially to the babies, with the emotional assistance to mothers being insufficient. In conclusion, it stands out that each mother experienced toxoplasmosis from their possibilities and available support network, which affected the establishment of the mother-baby bond. (AU)

Com o objetivo de compreender os significados psicológicos e relacionais da experiência da maternidade diante da toxoplasmose, realizou-se uma pesquisa clínico-qualitativa, em que foram realizadas entrevistas semidirigidas com cinco mães de bebês com toxoplasmose. As informações foram submetidas à análise de conteúdo e os resultados demonstraram que os significados psicológicos incluem tanto a presença de dificuldades e sofrimento, quanto de potencialidade dos bebês e do estabelecimento de vínculo emocional mãe-bebê. Com relação aos significados relacionais, identificou-se a importância das redes de apoio, destacando-se o papel de familiares, serviços de saúde e da religiosidade como fonte de suporte para o enfrentamento das dificuldades. Contudo, identificou-se que a atenção é dispensada primordialmente aos bebês, sendo insuficiente a assistência emocional para as mães. Em conclusão, destaca-se que cada mãe experienciou a toxoplasmose a partir das suas possibilidades e das redes de apoio disponíveis, o que afetou no estabelecimento da vinculação mãe-bebê. (AU)

Para comprender los significados psicológicos y relacionales de la maternidad frente a la toxoplasmosis, se realizó una investigación clínico-cualitativa, en la que se realizaron entrevistas semiestructuradas con cinco madres de bebés con toxoplasmosis. La información fue sometida a Análisis de Contenido y los resultados demostraron que los significados psicológicos incluyen tanto la presencia de dificultades y sufrimiento, como la potencialidad de los bebés para el establecimiento de un vínculo emocional con sus madres. Considerando los significados relacionales, se identificó la importancia de las redes de apoyo, destacando el papel de la familia, los servicios de salud y la religiosidad como soporte frente a las dificultades. Sin embargo, se identificó que la atención se presta principalmente a los bebés, con asistencia emocional insuficiente para las madres. Como conclusión, se enfatiza que cada madre ha experimentado toxoplasmosis en función de sus posibilidades y de las redes de apoyo disponibles, lo que ha afectado el establecimiento de la conexión madre-bebé. (AU)

O laço mãe-bebê e o desenvolvimento infantil frente à toxoplasmose: um estudo de casos múltiplos / El vínculomadre-bebé y el desarrollo del niño frente a la toxoplasmosis: un estudio de caso múltiple / The mother-baby bondand child development in the context of toxoplasmosis: a multiple case study / Le lien mère-bébé et le développement de l'enfant face à la toxoplasmose: une étude de cas multiples

Este estudo objetivou compreender as implicações da toxoplasmose congênita e pós-natal no laço mãe-bebê e no desenvolvimento do bebê. Realizou-se um estudo de casos múltiplos com duas díades de mães e bebês diagnosticados com toxoplasmose congênita ou pós-natal, através de entrevistas semiestruturadas com as mães e observação dos Indicadores Clínicos de Referência para o Desenvolvimento Infantil (IRDIs). O primeiro caso apresentou todos os indicadores presentes, revelando que o processo de desenvolvimento do bebê estava em andamento. O segundo caso teve dois indicadores ausentes, sinalizando um alerta frente a dificuldades na relação da díade. Destaca-se que a presença de intercorrências orgânicas pode afetar a constituição do laço mãe-bebê e o desenvolvimento do bebê, mas não implica, necessariamente, em consequências negativas, visto que se tratam de processos complexos, dinâmicos e multifatoriais

Este estudio buscó comprender las implicaciones de toxoplasmosis congénita y postnatal en el vínculo madre-bebé y en el desarrollo del bebé. Se realizó un estudio de caso múltiple con dos díadas de madres y bebés diagnosticados con toxoplasmosis congénita o posnatal, mediante entrevistas semiestructuradas con las madres y observación de los Indicadores Clínicos de Referencia para el Desarrollo Infantil (IRDIs). El primer caso presentó todos indicadores presentes, revelando que el proceso de desarrollo del bebé estaba en curso. El segundo caso tenía dos indicadores ausentes, indicando una alerta ante las dificultades en la relación madre-bebé. Se destaca que la presencia de complicaciones orgánicas puede afectar la constitución del vínculo madre-bebé y el desarrollo del bebé, pero no necesariamente implica consecuencias negativas, por tratarse de procesos complejos, dinámicos y multifactoriales

This study aimed to understand the implications of congenital and postnatal toxoplasmosis in the mother-baby bond and in baby's development. A multiple case study was carried out with two dyads of mothers and babies diagnosed with congenital or postnatal toxoplasmosis, through semi-structured interviews with the mothers and observation of the Clinical Reference Indicators for Child Development (IRDIs). The first case presented all the indicators present, revealing that the baby's development process was in progress. The second case had two indicators absent, signaling an alert in the face of difficulties in the dyad's relationship. It is noteworthy that the presence of organic complications can affect the constitution of the mother-infant bond and the baby's development, but it does not necessarily imply negative consequences, as these are complex, dynamic and multifactorial processes

Cette étude a visé à comprendre les implications de la toxoplasmose congénitale et le postnatal pour le lien mère-bébé et le développement de bébé. Une étude de multiples cas a été realizé avec deux dyades des mères et bébés diagnostiqués avec toxoplasmose congénitale ou postnatal, à travers de interviews semi-structurés aves des méres et observation des Indicateurs Cliniques de Risque pour le Développement de l'Infant (IRDIs). Le premier cas présentait tous les indicateurs présents, révélant que le processus de développement du bébé était en cours. Le deuxième cas avait deux indicateurs absents, signalant une alerte sur la difficulté dans la relation de dyade. Il est souligné que la présence de complications organiques affecte la constitution du lien mère-bébé et le développement du bébé, mais n'implique pas, nécessairement, en conséquences négatives ou préjudice,car ce sont des processus complexes, dynamiques et multifactoriels qui sont considerés

Evaluation of the level of awareness of congenital toxoplasmosis and associated practices among pregnant women and health workers in Tanzania's Temeke district in Dar es Salaam.

BACKGROUND: Toxoplasmosis caused by the obligate intracellular coccidian protozoan Toxoplasma gondii (T. gondii) infects all warm-blooded animals including humans. This parasite may develop in both immune-compromised and immunocompetent hosts but usually the disease manifestations strongly differ according to immune status. Immunocompromised hosts develop more severe disease than immunocompetent hosts. Infections in pregnancy carry the risk of foetal involvement and can lead to serious clinical outcomes including psychomotor and ocular disorders in congenitally infected foetuses and children. OBJECTIVE: To assess the level of awareness and practices towards congenital toxoplasmosis among health workers and pregnant women in Tanzania's Temeke municipality. METHODS: This was a cross-sectional study involving 371 pregnant women and 22 health workers from six healthcare facilities in Temeke municipality of Dar es Salaam, Tanzania. A structured questionnaire and review of prenatal screening forms were used to collect information. The questionnaire focused on knowledge of disease aetiology, signs and symptoms, modes of transmission, treatment and management. RESULTS: Of the pregnant women, 96% (95% CI: 0. 94-0.98) were unaware of the disease, had never heard, read or seen any information regarding toxoplasmosis. The majority of respondents including those who had heard, read or seen information concerning toxoplasmosis were unaware of the disease aetiology, signs and symptoms. However, 90% (95% CI: 0.86-0.93) of respondents unknowingly observed preventive practices towards the disease including avoiding eating raw, cured or rare meat. There was a significant statistical relationship between practices towards toxoplasmosis and age of pregnant women, such that for every increase in age by ten years the risk practices towards toxoplasmosis increased by 41% (OR=1.41, 95%, C.I. 1.05-1.90). Preventive practices towards toxoplasmosis decreased significantly by 74% and 78% for the age of 19-25 and 26-35 years old pregnant women respectively, as compared to those < 19 years. No significant difference was observed for those aged > 35 years. Multigravidae was associated with at-risk practices towards toxoplasmosis (OR=2.65, CI: 1.38-5.08). Of the 22 health workers who participated in the study, 36% (95% CI: 0.15-0.58) were aware of the congenital toxoplasmosis and its clinical outcomes. None of them had diagnosed the disease before. CONCLUSION: Due to general lack of awareness towards toxoplasmosis observed among both health workers and pregnant women in Temeke Municipality, we recommend health policy on maternal and child healthcare to address prenatal screening that is aimed at providing early diagnosis for any possible congenital toxoplasmosis as well as diseases that are currently screened in Tanzania such as HIV, syphilis and malaria. Integrating a One Health approach in educating medical professionals and the vulnerable population of pregnant women on the importance of congenital zoonoses will promote awareness and preventive practices towards the disease.

Neuropsychiatric manifestations of latent toxoplasmosis on mothers and their offspring.

Toxoplasmosis is one of the most common parasitic diseases worldwide. It is estimated that approximately one-third of the world's population is latently infected. Infection generally occurs via oral the route and maternal transmission. Damage of the central nervous system is one of the most serious consequences of congenital toxoplasmosis. Moreover, recent investigations proposed that acute and sub-acute congenital toxoplasmosis as well as latent toxoplasmosis during pregnancy; play various roles in the etiology of different neuropsychiatric disorders in mothers and their offspring. This paper reviews new findings about the role of latent toxoplasmosis in the etiology of various neuropsychiatric disorders in mothers and their offspring.

Toxoplasma infection and later development of schizophrenia in mothers.

OBJECTIVE: Several studies based on clinical samples have found an association between Toxoplasma gondii infection and schizophrenia, and a case-control study among U.S. military personnel with specimens available from both before and after diagnosis found a positive association between T. gondii immunoglobulin G (IgG) antibody level and schizophrenia. These findings have never been replicated in a prospective cohort study. The purpose of this study was to determine whether mothers infected with T. gondii have an elevated risk of schizophrenia or related disorders and whether the risk depends on IgG antibody level. METHOD: In a register-based prospective cohort study of 45,609 women born in Denmark, the level of T. gondii-specific IgG antibodies was measured in connection with childbirth between 1992 and 1995. Women were followed up from the date of delivery until 2008. RESULTS: A significant positive association between T. gondii IgG antibody level and schizophrenia spectrum disorders was found. Mothers with the highest IgG level had a relative risk of 1.73 (95% confidence interval [CI]=1.12-2.62) compared with mothers with the lowest IgG level. For schizophrenia, the relative risk was 1.68 (95% CI=0.77-3.46). When the mothers were classified according to IgG level, only those with the highest IgG levels had a significantly higher risk of schizophrenia spectrum disorders. CONCLUSIONS: Women with high levels of T. gondii-specific IgG antibodies have a significantly elevated risk of developing schizophrenia spectrum disorders.

Prenatal screening and diagnosis of congenital toxoplasmosis: a review of safety issues and psychological consequences for women who undergo screening.

As part of the EUROTOXO initiative, this review focuses on the potential risks associated with prenatal testing for congenital toxoplasmosis. We first review the evidence on the risks of adverse events associated with amniocentesis, which is required for definitive diagnosis of toxoplasmosis infection in the fetus, and for which the most important risk is fetal loss. To date, there has been only one randomized trial to document risks associated with amniocentesis. This trial, which was conducted in 1986, reported a procedure-related rate of fetal loss of 1.0% (95% CI, 0.3-1.5). However, evidence from available controlled studies suggests that the pregnancy loss associated with mid-trimester amniocentesis may be lower. Potential psychological consequences of prenatal testing for congenital toxoplasmosis include parental anxiety due to false positive results and uncertainties related to prognosis of children with a prenatal diagnosis of congenital toxoplasmosis. Parental anxiety may be particularly important in screening strategies that include more frequent screenings, which may in turn entail substantial, and at times unnecessary, anxiety or other negative consequences for women and their families. These negative psychological outcomes should be balanced against the benefits of testing, which can allow women to make an informed choice regarding the pregnancy.

Impact of visual impairment on measures of cognitive function for children with congenital toxoplasmosis: implications for compensatory intervention strategies.

OBJECTIVES: The purpose of this work was to determine whether visual impairment caused by toxoplasmic chorioretinitis is associated with impaired performance of specific tasks on standardized tests of cognitive function. If so, then we worked to determine whether there are patterns in these difficulties that provide a logical basis for development of measures of cognitive function independent of visual impairment and compensatory intervention strategies to facilitate learning for such children. METHODS: Sixty-four children with congenital toxoplasmosis with intelligence quotient scores > or = 50 and visual acuity sufficient to cooperate with all of the intelligence quotient subscales had assessments of their vision, appearance of their retinas, and cognitive testing performed between 3.5 and 5 years of age. These evaluations took place between 1981 and 1998 as part of a longitudinal study to determine outcome of congenital toxoplasmosis. Children were evaluated at 3.5 or 5 (37 children) or both 3.5 and 5 (27 children) years of age. Cognitive function was measured using the Wechsler Preschool and Primary Scale of Intelligence-Revised. Wechsler Preschool and Primary Scale of Intelligence-Revised scale scores were compared for children grouped as those children who had normal visual acuity in their best eye (group 1), and those who had impaired vision in their best eye (acuity < 20/40) because of macular disease (group 2). Demographic characteristics were compared for children in the 2 groups. Test scores were compared between groups using all of the 3.5-year-old visits, all of the 5-year-old visits, and using each child's "last" visit (ie, using the 5-year-old test results when a child was tested at both 3.5 and 5 years of age or only at 5 years, otherwise using the 3.5-year-old test results). The results were similar and, therefore, only the results from the last analysis are reported here. RESULTS: There were 48 children with normal visual acuity in their best eye (group 1) and 16 children with impaired vision because of macular involvement in their best eye (group 2). Ethnicity and socioeconomic scores were similar. There was a significantly greater proportion of males in group 2 compared with group 1 (81% vs 46%). There was no significant diminution in Wechsler Preschool and Primary Scale of Intelligence-Revised test scores between 3.5 and 5 years of age for the 27 children tested at both of these ages. Verbal intelligence quotient, performance intelligence quotient, full-scale intelligence quotient scores, and all of the scaled scores except arithmetic and block design were significantly lower for children in group 2 compared with group 1. The majority of the differences remained statistically significant or borderline significant after adjusting for gender. However, the difference in overall verbal scores does not remain statistically significant. Mean +/- SD verbal (98 +/- 20) and performance (95 +/- 17) intelligence quotients were not significantly different for children in group 1. However, verbal (88 +/- 13) and performance intelligence quotients (78 +/- 17) were significantly different for children in group 2. For children in group 2, their lowest scale scores were in object assembly, geometric design, mazes, and picture completion, all timed tests that involved visual discrimination of linear forms with small intersecting lines. In the 2 scales scored that did not differ between groups 1 and 2, arithmetic and block design, timing and vision but not linear forms were components of the tasks. Children with monocular and binocular normal visual acuity did not differ in verbal, performance, or full-scale intelligence quotients or any of the subscale tests. Difficulty with sight or concomitant neurologic involvement also seemed to impact the ability to acquire information, comprehension skills, and vocabulary and performance in similarities testing. After controlling for gender, however, these differences were diminished, and there were no longer differences in overall verbal scores. As noted above, results were generally similar when all of the tests for 3.5-year-olds or 5-year-olds were analyzed separately. At the 3.5-year visit there were fewer significant differences between the 2 groups for the verbal components than at the 5-year visit. CONCLUSIONS: In children with congenital toxoplasmosis and bilateral macular disease (group 2) because of toxoplasmic chorioretinitis, scaled scores were lowest on timed tests that require discrimination of fine intersecting lines. Although the severity of ocular and neurologic involvement is often congruent in children with congenital toxoplasmosis, ophthalmologic involvement seems to account for certain specific limitations on tests of cognitive function. Children with such visual impairment compensate with higher verbal skills, but their verbal scores are still less than those of children with normal vision, and in some cases significantly so, indicating that vision impairment might affect other aspects of cognitive testing. Patterns of difficulties noted in the subscales indicate that certain compensatory intervention strategies to facilitate learning and performance may be particularly helpful for children with these impairments. These patterns also provide a basis for the development of measures of cognitive function independent of visual impairment.

Attitude towards serological tests for infection during pregnancy.

In anticipation of systematic prenatal screening at the antenatal clinic of Gasthuisberg University Hospital, Leuven, Belgium, the attitude of 500 successive pregnant women towards testing for rubella, toxoplasmosis, hepatitis B virus, HIV and syphilis was studied by means of written questionnaires. All tests were well accepted, toxoplasmosis and rubella being most (92 and 91%), syphilis and HIV being least (79 and 82%) favoured. Refusal was generally associated with lower education, but refusal for syphilis and HIV was associated with high education. Ninety-four percent wanted to be informed of the results of the tests. Only one woman (0.2%) of those who agreed with testing did not want to know her HIV test result. Pregnant doctors were more reluctant about screening, in particular for sexually transmitted diseases, whereas nurses were in favour of it. Written information failed to increase the acceptance rate, but lowered the number of women without an opinion.

[Clinico-functional correlations in the evaluation of the development of children with perinatal lesions of the central nervous system during the first 6 months of life]. / Kliniko-funktsional'nye korreliatsii v otsenke razvitiia detei pervogo polugodiia zhizni s perinatal'nym porazheniem TsNS.

The purpose of the work was to design a model of the screening estimation of the psychomotor development of the child with perinatal CNS derangement seen in the first half-year of life since the neonatal period. Use was made of noninvasive diagnostic methods, available for examination both under in- and outpatient conditions. Complex analysis of the health status of the child with perinatal CNS pathology made every month of life according to the screening program allows one to decide the problem of the intensity of morphofunctional disorders of the brain and of the methods of choosing treatment and corrective measures.