Portugal and Angola: similarities and differences in Toxoplasma gondii seroprevalence and risk factors in pregnant women.

In this study we determined the presence of IgM/IgG antibodies to Toxoplasma gondii in sera of 155 and 300 pregnant women from Lisbon (Portugal) and Luanda (Angola), respectively, and evaluated the potential risk factors associated with this infection. DNA detection was performed by PCR assays targeting T. gondii regions (RE/B1). Overall, 21·9% (10·9% IgG, 10·9% IgG/IgM) of the Lisbon women and 27·3% (23·7%, IgG, 2% IgM, 1·7% IgG/IgM) of the Luanda women had antibodies to T. gondii. Single variable and binary logistic regression analyses were conducted. Based on the latter, contacts with cats (family/friends), and having more than two births were identified as risk factors for Toxoplasma infection in Lisbon women. In Luanda, the risk factors for T. gondii infection suggested by the single variable analysis (outdoor contact with cats and consumption of pasteurized milk/dairy products) were not confirmed by binary logistic regression. This study shows original data from Angola, and updated data from Portugal in the study of infection by T. gondii in pregnant women, indicating that the prevalence of anti-Toxoplasma antibodies is high enough to alert the government health authorities and implement appropriate measures to control this infection.

ESPR uroradiology task force and ESUR paediatric working group: imaging recommendations in paediatric uroradiology, part IV: Minutes of the ESPR uroradiology task force mini-symposium on imaging in childhood renal hypertension and imaging of renal trauma in children.

Two new recommendations of the European Society of Radiology task force and the European Society of Uroradiology workgroup on paediatric uroradiology are presented. One deals with diagnostic imaging in children after trauma to the urinary tract-renal trauma, in particular. The other concerns the evaluation of suspected renal hypertension. Available data in the paediatric literature are either unsatisfactory or controversial for both of these clinical settings. Therefore, the following consensus-based proposals aim at outlining effective imaging algorithms to reduce invasive imaging procedures while optimising diagnostic accuracy. The objective of following a more uniform imaging approach is to facilitate future meta-analysis as well as multicentre and other more evidence-based studies. The practise in paediatric radiology is typically based on local availability and on the limitations of professional expertise and equipment, balanced against the perceived needs of the individual child. Although this is unlikely to change in the near future, it does not release the physicians in charge of diagnostic imaging from their responsibility in choosing and providing state-of-the-art imaging and management protocols that are adapted specifically for use in children.

Occurrence of Cryptosporidium and Giardia genotypes and subtypes in raw and treated water in Portugal.

AIMS: Waterborne outbreaks of diarrhoeal illness reported worldwide are mostly associated with Cryptosporidium spp. and Giardia spp. Their presence in aquatic systems makes it essential to develop preventive strategies for water and food safety. This study was undertaken to monitor the presence of Cryptosporidium and Giardia in a total of 175 water samples, including raw and treated water from both surface and ground sources in Portugal. METHODS AND RESULTS: The samples were processed according to USEPA Method 1623 for immunomagnetic separation (IMS) of Cryptosporidium oocysts and Giardia cysts, followed by detection of oocysts/cysts by immunofluorecence (IFA) microscopy, PCR-based techniques were done on all water samples collected. Out of 175 samples, 81 (46.3%) were positive for Cryptosporidium and 67 (38.3%) for Giardia by IFA. Cryptosporidium spp. and G. duodenalis genotypes were identified by PCR in 37 (21.7%) and 9 (5.1%) water samples, respectively. C. parvum was the most common species (78.9%), followed by C. hominis (13.2%), C. andersoni (5.3%), and C. muris (2.6%). Subtype IdA15 was identified in all C. hominis-positive water samples. Subtyping revealed the presence of C. parvum subtypes IIaA15G2R1, IIaA16G2R1 and IIdA17G1. Giardia duodenalis subtype A1 was identified. CONCLUSIONS: The results of the present study suggest that Cryptosporidium spp. and Giardia spp. were widely distributed in source water and treated water in Portugal. Moreover, the results obtained indicate a high occurrence of human-pathogenic Cryptosporidium genotypes and subtypes in raw and treated water samples. SIGNIFICANCE AND IMPACT OF THE STUDY: Thus, water can be a potential vehicle in the transmission of cryptosporidiosis, and giardiasis of humans and animals in Portugal.

Grisel syndrome, acute otitis media, and temporo-mandibular reactive arthritis: A rare association.

We present a case report of a four-year-old boy with torcicollis and trismus after acute otitis media. Grisel Syndrome diagnosis in association with temporo-mandibular reactive arthritis was admitted, leading to early conservative treatment. GS should be suspected in a child presenting with torticollis after an upper respiratory tract infection or an ENT surgical procedure. The association with temporo-mandibular reactive findings is somehow rarer but not impossible, due to the close vascular communication between retropharyngeal and pterigoid spaces.

Mother-child interaction in the presence of maternal HIV infection.

This comparative study evaluated mother-child interaction in southeastern U.S. mother-child dyads where the mother was HIV positive and determined if the presence of maternal HIV infection was associated with differences in the quality of the mother-child interaction. A comparison was made between two groups of mother-child dyads, one where the mother was HIV positive (N = 25) and one where the mother was not HIV positive (N = 25). The Barnard model of mother-infant interaction guided this study. The quality of interaction within the dyads was assessed using the Nursing Child Assessment Teaching Scales (NCATS). Associated maternal, child, and environmental factors were described using an interview form, Centers for Epidemiologic Studies Depression Scale, and the Bayley Infant Neurodevelopmental Screener. The quality of mother-child interaction in the two groups was compared using chi square and paired t tests. Findings from this research showed no statistically significant difference in mother-child interaction (measured by NCATS) between the HIV-positive and HIV-negative groups. Although maternal symptoms of depression were noted in more of the HIV-positive mothers, covariant analysis failed to show this factor had any significant influence on mother-child interaction scores between the groups. It was noted that total sample (N = 50) group mean scores on NCATS maternal subscale and total interaction were significantly lower than published population norms. As the mother-child interaction has critical implications for the child, strategies to improve reciprocity need to be developed in this population, and attention must be paid to mental health needs of HIV-positive women.

Code books--a critical link in the research process.

There is no one right way to construct a code book; however, it is critical that all the elements needed to understand and work with the data be present. By constructing a comprehensive code book before the data are collected, the investigator is assured of preparing for all aspects of data analysis. It is important to remember that one cannot be too compulsive in planning for data analysis. The findings of the study are discovered through the analysis of the data. The purpose of the study is to be able to describe the findings in a cogent manner. If the data are not systematically organized, they will be useless to the investigator.

Parent and student preferences for services in a school-based clinic.

As a component of program planning for a school-based clinic in a suburban high school, a sample of 199 students and 196 parents were surveyed about preferences for health services. Parents and students were asked about health services desired and level of interest. Student overall interest in health services was less than parent interest, although both groups indicated at least a moderate level of interest. Both students and parents reported interest in availability of comprehensive services, including general health services, reproductive health services, and counseling services. The process of polling parents and students serves dual purposes of informing the population about school-based clinics, as well as gathering information to attempt to match the health services offered with needs identified.

Behavioral and physiological response during feeding in infants with congenital heart disease: a naturalistic study.

Twenty mother-infant dyads, ten with congenital heart disease (CHD) and ten controls, were studied during a naturally occurring feeding episode. Heart and respiratory rate data from a Hewlett Packard Infant Monitor were recorded on a computer while the feeding was videotaped for later scoring. No significant relationship was found between potent disengagement cues and changes in either heart or respiratory rate during feeding. However, the presentation of subtle disengagement cues were observed to be significantly more frequent among infants with CHD. A wide range of individual differences were noted in presentation of disengagement cues and heart and respiratory rates in both groups. No discernable pattern of heart rate or respiratory rate increase or decrease related to subtle or potent disengagement cures was found in either the infants with CHD or the healthy controls.

Observation: a valuable data collection strategy for research with children.

This study introduces the basic concepts of observational research by defining the terms and discussing some of the critical issues specific to observational research. Observational methods signify a systematic approach to quantifying behavior. A discussion of the major concerns in observational research is presented. These concerns include defining the coding categories; identifying the unit of measurement, the method of recording the observation, and deciding on a sampling strategy; training of observers; and interrater and intrarater reliability.

Parent-infant interaction during feeding when the infant has congenital heart disease.

This article examines parent-infant interaction (PII) during feeding when the infant has congenital heart disease (CHD) using the Nursing Child Assessment Feeding Scale (NCAFS) and compares the NCAFS scores of the infants with CHD with those of healthy controls. Twenty mother-infant dyads, 10 with CHD and 10 controls, were studied. Infants with CHD scored significantly lower than controls on both infant subscales, Responsiveness to Caregiver and Clarity of Cues, of the NCAFS. Mothers of CHD infants scored significantly lower on the Social Emotional Growth Fostering subscale. These findings suggest specific behavioral differences in infants with CHD during feeding and support the need for more information about feeding interactions in infants with CHD.

Case study of a high-risk neonate failing to thrive post-extracorporeal membrane oxygenation and post-necrotizing enterocolitis.

Infants discharged from neonatal intensive care units (NICUs) often face a long journey of chronic illness, family stresses, and financial burdens. Health care professionals involved in acute care need to be aware of the far-reaching repercussions of neonatal illness. This report presents a case study of a low-income, single mother from a rural community and her son, a neonatal intensive care unit (NICU) graduate post-extracorporeal membrane oxygenation (ECMO) and post-necrotizing enterocolitis (NEC) discharged with a gastronomy tube (g-tube) and failure to thrive (FTT), from his birth to 10 months of age. Family-focused interventions aimed at improving growth and developmental delays and providing family support will be discussed.

Case study of the home health management of a child with congenital anomalies associated with prenatal cocaine abuse.

The presence of a history of poor parental upbringing, poverty, and substance abuse within a family stresses its capacity to cope with the needs of a child with congenital anomalies. Nursing has a key role to play in providing specific information, practical assistance, and support in these circumstances. A case study of a child in such a family is presented in this article, and the multiple nursing interventions provided to facilitate the family's coping skills are discussed.

Current knowledge in the management of children and adolescents with sickle cell disease: Part 1, Physiological issues.

This article reviews the current state of the knowledge in the management of children and adolescents with sickle cell disease (SCD). A thorough review of the literature concerning physiological issues including the clinical manifestations of SCD as well as current treatment modalities is included. Therapeutic management of health and illness for a child with SCD is discussed in relation to primary, secondary, and tertiary prevention. Recommendations for nursing practice and research are made.

Perspectives in transplantation immunology 1991.

The clinical success of organ transplantation depends to a large degree on the immunological acceptance of the grafted organ. This paper summarizes from an immunological point of view the recent progress that has been made to improve graft acceptance, and discusses some future aspects in the field. Over the last few years, major emphasis has been put on the development of new immunosuppressive drugs, including FK 506, rapamycin, and Deoxyspergualin. Together with monoclonal antibodies against defined T-cell surface antigens, there are now new and effective means available to prevent or treat rejection episodes. Progress has also been made in the field of HLA typing, where the introduction of molecular biology-based methods significantly increased the accuracy of HLA class II typing. The ultimate goal of transplantation immunology is the induction of (donor-) specific tolerance. While some protocols are effective in inducing peripheral tolerance in experimental animals, these regimens are at present not yet applicable in the clinical situation. To overcome the shortage of donor organs, alternative strategies are currently being considered. Among these, xenotransplantation may eventually prove successful, despite the massive immunological problems such as, e.g., the presence of preformed xenoreactive antibodies.

Failure to thrive: a parent-infant interaction perspective.

The purpose of this study was to prospectively study inpatients admitted for failure to thrive during their first year of life. Twelve infants with failure to thrive were studied and compared with 17 healthy controls. Mothers and infants with nonorganic failure to thrive scored lower on the Nursing Child Assessment Feeding Scale, reported more change in their lives, and less social support. The need for further research is discussed and suggestions for beginning level interventions are made.

Human cytotoxic lymphocytes. V. Frequency and specificity of gamma delta+ cytotoxic lymphocyte precursors activated by allogeneic or autologous stimulator cells.

We have investigated the frequency and specificity of gamma delta+ cytotoxic lymphocyte precursors (CLP) under limiting dilution culture conditions. E rosette separated total T cells and CD3+CD4-CD8-TCR alpha beta- double-negative (DN) T cells were cocultured with allogeneic or autologous PBMC stimulator cells, and frequencies of alloreactive and autoreactive CLP were determined after 12 to 14 days against Con A blast target cells. Freshly isolated DN cells consisting of 82.3 +/- 8.2% gamma delta+ T cells did not exert cytolytic activity against K562 or anti-TCR gamma delta mAb-producing hybridoma cells. In striking contrast to E+ cells, the vast majority of alloantigen-stimulated clonally developing DN CLP did not show specificity for stimulator-derived target cells. Thus, frequencies of alloreactive and autoreactive CLP after alloantigenic stimulation were in the range of 1/100 to 1/4800 and 1/450 to 1/5000, respectively. After coculture with autologous stimulator cells, frequencies of autoreactive and alloreactive DN CLP were 1/700 to 1/2700 and 1/1360 to 1/4500, respectively. Split culture analysis revealed that most proliferating DN colonies selected for high probability of clonality simultaneously killed both autologous and HLA-mismatched allogeneic targets. The majority of the DN cells expressed the CD3+/TCR gamma delta+ phenotype after culture, and thus were not CD2+CD3- NK cells. Taken together, our results show that 1) freshly isolated peripheral blood gamma delta+ T cells lack cytotoxic activity, and 2) most cytotoxic gamma delta+ T cells activated by autologous or allogeneic stimulator cells under limiting dilution conditions do not discriminate between autologous and allogeneic targets.

"High-tech" home care for children with chronic health conditions: a pilot study.

The purposes of this study were to pilot test the instrument and methods for a major study of caregivers of children who are technology dependent and to test constructs proposed for the major study in a discrete sample. The major study will be implemented in 13 cities in the United States. The pilot was conducted in three small- to moderate-size metropolitan areas in the Southeast and Midwest. Seventy-three primary caregivers provided data during a structured telephone interviews. The children represented four groups of children dependent on technology as defined by the Office of Technology Assessment (OTA) (1987). The findings supported the methodology and the viability of the instrument. Analysis suggests that caring for a child who is technology dependent affects family functioning and increases family stress levels in some families. The financial burden is also significant. It is suggested that nurses can be a critical source of support and information to these families.