Chronic Pain Self-Management Strategies for Older Adults: An Integrative Review.

INTRODUCTION: Due to the complex nature of chronic pain, especially in older adults, a biopsychosocial approach is more effective than an isolated approach for its management. Furthermore, when patients are actively engaged in their pain management, they are more likely to be successful than relying totally on others. OBJECTIVE: To analyze the self-management strategies currently used by older adults with chronic pain. METHOD: An integrative review was conducted through seven online databases, searching for scientific studies on this topic published in the last 10 years. RESULTS AND CONCLUSION: Fifty-eight studies were included in the final sample. Research on chronic pain self-management for older adults has increased in recent years. Although a diversity of chronic physical painful conditions are being investigated, many conditions are still under-investigated. Online and in-person strategies are currently adopted, demonstrating similar results. Positive results are evidenced by strategies including health promotion, mind control, social participation and take-action fields. Major results come from a combination of strategies focusing on biopsychosocial aspects of pain management. Results include not only the reduction of pain itself, but increased self-efficacy, adoption of health behaviors and improvement of functionality, among others, i.e., improved QoL, despite pain.

Application of two- and multiway chemometric strategies for describing elementomic changes in pepper plants exposed to cadmium stress by multielement determination.

The objective of this work was to evaluate elemental changes in pepper exposed to Cd stress through different chemometric tools. For this purpose, pepper plants were grown under five different treatments with different Cd concentrations in the nutrient solution. Considering the hypothesis that pepper plants exposed to Cd stress during growth undergo changes in the macro- and microelemental distribution in leaves, stems, and roots, principal component analysis (PCA) and parallel factor (PARAFAC) analysis were applied to compare bidirectional and multivariate chemometric strategies to assess elemental changes in pepper plants. Since the number of variables and the data generated were large and complex, the application of chemometric tools was justified to facilitate the visualization and interpretation of results. The mineral composition, namely the Ca, Cd, Cu, Fe, K, Mg, Mn, N, and P contents, was assessed in 180 samples of leaves, stems, and roots of the cultivated peppers. Then, PCA and PARAFAC analysis were applied to compare bidirectional and multivariate chemometric strategies to assess elemental changes throughout pepper plants. The visualization of the trend on each sample and their intrinsic relationship with the variables were possible with the application of PCA. The use of PARAFAC analysis permitted the simultaneous study of all samples in a straightforward representation of the information that facilitated a quick and comprehensive understanding of the spatial distribution of elements in plants. Thus, macroelements (Ca, K, Mg, N, and P) that were found in higher concentrations in leaves did not present significant differences in the distribution along the plants under different treatment conditions. In contrast, a significant impact on the microelement (Cu, Fe, and Mn) distribution was produced between uncontaminated and contaminated samples. This analysis revealed a significant accumulation of Cd in roots and adverse effects on normal plant growth, demonstrating their level of phytotoxicity to pepper.

Description of the scientific method for the preparation and validation of educational technologies in digital format: a methodological study

Introduction: the use of digital technologies constitutes a process that allows the dynamization of the care process, based on aspects related to criticality and creativity. It is emphasized that the development of technologies must, therefore, be inserted in a context for changes and innovation in response to the population's health demand, and must follow a precise methodological path that goes from the construction to the validation of the appearance, content and effect . Objective: to describe the scientific method of elaboration and validation of educational technologies in digital format. Methods: methodological study, conducted according to the following steps: development of the research project and submission to the Research Ethics Committee; data collection; elaboration of the content, script, illustrations and layout of the booklet; and validation of educational technology. Results: the process of developing a technology requires methodological rigor, enabling coherence between theory and the purpose of the desired product, guaranteeing the internal quality of the developed technology. The use of educational technologies in health reinforces information, serving as a guide for guidelines regarding care and assisting in decision-making. Technological innovations in health, consists of a socio-technical process , permeated by professional and user reflections and experiences. Final considerations: educational technologies represent a potential resource for the development of health education practices, encouraging greater interaction between professionals and users, and an active attitude regarding self-care actions related to their health condition.

Introdução: o uso de tecnologias digitais constitui como um processo que permite a dinamização no processo de cuidar, pautada nos aspectos relacionados a criticidade e criatividade. Enfatiza-se, que o desenvolvimento de tecnologias deve, portanto, insere-se em um contexto por mudanças e inovação em resposta a demanda de saúde da população devendo seguir um percurso metodológico preciso que vai desde a construção à validação da aparência, conteúdo e efeito. Objetivo: descrever o método científico de elaboração e validação de tecnologias educativas no formato digital. Método: estudo metodológico, conduzido de acordo com as seguintes etapas: elaboração do projeto de pesquisa e submissão ao Comitê de Ética em Pesquisa; levantamento dos dados; elaboração do conteúdo, roteiro, ilustrações e diagramação da cartilha; e validação da tecnologia educacional. Resultados: o processo de elaboração de uma tecnologia requer rigor metodológico, possibilitando coerência entre teoria e finalidade do produto desejado, garantindo qualidade interna da tecnologia elaborada. O uso de tecnologias educativas em saúde reforça informações, servindo como guia para orientações quanto ao cuidado e auxiliando nas tomadas de decisões. Inovações tecnológicas em saúde, consiste em um processo sócio-técnico, permeado por reflexões e experiências profissionais e usuários. Considerações finais: tecnologias educacionais representam um recurso potencializador para o desenvolvimento de práticas de educação em saúde, estimulando maior interação entre profissionais e usuários, e uma postura ativa quanto a ações de autocuidado relacionado a sua condição de saúde.

Alternative additives associated in the feeding of laying hens: performance, biometrics, bone traits, and economic evaluation-an unsupervised machine learning approach.

Given the current bans on the use of some growth promoting antibiotics in poultry nutrition, the need to use alternative additives which could replace traditional promoters in diets has arisen. The objective of this study was to evaluate the effect of alternative additives, associated or not, in replacing the antibiotic growth promoter in the diets of laying hens on performance, egg quality, biometry, bone characteristics, and economic viability. A total of 378 birds at 97 weeks of age, weighing 1691 ± 80g with an average production of 79.96 ± 4.9%, were randomly distributed and submitted to different diets: negative control - NC (no additive); positive control - PC, conventional growth promoter (Enramycin); associated organic acids (OA); symbiotic (S); Essential oil (EO); OA + S; and S+EO. The diet did not influence (P > 0.05) performance, egg quality, biometry, and bone traits. However, the use of alternative additives and their associations with the exception of S+OA, provided better economic indices when compared to NC and CP. The first component showed a negative relationship between feed conversion per mass and dozen eggs with gut length, Seedor index, egg production, and egg mass; the second component showed a positive relationship between yolk, pancreas, proventriculus, and gizzard; and, finally, the third component showed that feed consumption has a negative relationship with bone strength and deformity. The first two canonical functions were significant and discriminated 100% of the differences between the diets. Moreover, 50% of the birds were correctly classified in their group of origin, in which the positive control group (83.3%) and OA+S presented the highest rates of correct responses (66.7%). Bone deformity and bowel length were the only two variables with discriminatory power. Natural growth promoters alone or in association do not harm performance, egg quality, digestive organs biometry or bird bone characteristics, in addition to promoting greater economic return. Thus, they can be considered possible substitutes for traditional antibiotics. Finally, unsupervised machine learning methods are useful statistical techniques to study the relationship of variables and point out the main biomarkers of poultry production.

COVID-19 in the municipalities of Botucatu and Serrana, São Paulo, Brazil, the effects of lethality and mortality / COVID-19 nos municípios de Botucatu e Serrana, São Paulo, Brasil, os efeitos da letalidade e mortalidade

Introduction: In 2019, the proliferation of a virus identified as SARS-CoV-2 emerged in the city of Wuhan, a district in China, quickly spread throughout the world, gaining pandemic status and less than 1 year, its repercussions and magnitude caused scientists, governments and society to adopt severe measures to combat this disease. Objective: To analyze mortality, incidence and mortality from COVID-19 in the municipalities of Botucatu and Serrana, São Paulo, Brazil. Methods: This is an ecological study with a time series design with secondary data. All registered cases and deaths registered by COVID-19 from April 2020 to August 2021 in the municipalities of Botucatu and Serrana, São Paulo, Brazil were considered. The incidence, mortality and lethality rate were used. The monthly and/or weekly percentage variation and their respective 95% confidence intervals were estimated.Results: It identified that 12.88% of the residents of the city of Botucatu were infected with COVID-19 and 8.61% of the population of the municipality of Serrana was infected. There was a stationary trend of mortality and incidence in the period between April 2020 and May 2021 and decreasing in both sexes in the mortality rate in the municipality of Serrana, in the city of Botucatu there was a trend of increasing mortality and incidence in the same period observed. Conclusion: The mass vaccination strategy of citizens in the cities of Botucatu and Serrana present robust data to consider that immunization has a decreasing effect on the number of cases and deaths from COVID-19, which effectively contributes to fighting the pandemic and reduces the contamination and progression of the disease to more severe cases.

Introdução: em 2019, surgiu na cidade de Wuhan, um distrito na região da China a proliferação com a infecção de um vírus identificado como SARS-CoV-2, rapidamente espalhou-se pelo mundo ganhando status de pandemia em menos de 1 ano, suas repercussões e magnitude fizeram que os cientistas, governos e sociedade adotarem medidas severas para o combate a esta enfermidade. Objetivo: analisar a mortalidade, incidência e letalidade por COVID-19 nos municípios de Botucatu e Serrana, São Paulo, Brasil. Método: trata-se de um estudo ecológico com delineamento de série temporal com dados secundários. Foram consideradas todos os casos registrados e óbitos registrados por COVID-19 no período de abril de 2020 a agosto de 2021, nos municípios de Botucatu e Serrana, São Paulo, Brasil. Foi utilizado a taxa de incidência, mortalidade e letalidade. Estimou-se a variação percentual mensal e/ou semanal e seus respectivos intervalos de 95% de confiança. Resultados: identificou que e 12,88% dos munícipes da cidade de Botucatu foram infectados com COVID-19 e 8,61% da população do município de Serrana foi infectada. Observou-se uma tendência estacionária de mortalidade e incidência no período entre abril 2020 a maio 2021 e decrescente em ambos os sexos na taxa de letalidade no município de Serrana, na cidade de Botucatu houve tendência de mortalidade e incidência crescentes no mesmo período observado. Conclusão: a estratégia de vacinação em massa dos munícipes das cidades de Botucatu e Serrana apresentam dados robustos para considerar que a imunização tem efeito de queda no número de casos e óbitos por COVID-19, o que contribui efetivamente no combate a pandemia e reduz a contaminação e evolução da doença para casos mais graves.

Application of multivariate analysis to assess stress by Cd, Pb and Al in basil (Ocimum basilicum L.) using caffeic acid, rosmarinic acid, total phenolics, total flavonoids and total dry mass in response.

Basil is an edible, aromatic plant, which makes the study of the ecotoxicity of metals in plant metabolism relevant. Given the above, the objective of this study was to evaluate the effects of metals, aluminum, lead, and cadmium, in the synthesis of phenolic compounds and in the dry mass of basil plants (O. basilicum L.) grown in a hydroponic system. The plants were subjected to four different concentrations of cadmium (0.2, 0.6, 1.2, and 1.8 mmol L-1), lead and aluminum (0.04, 0.08, 0.12, and 0.16 mmol L-1), and compared with the control. After desiccation of the plant material, the total dry mass was obtained and then, hydroethanolic extracts (43% distilled water and 57% ethanol) were made for biochemical analyzes, which consisted of the determination of caffeic acid (CA) and rosmarinic acid (RA) by high performance liquid chromatography analysis with a diode detector (HPLC-DAD); total phenolics (TP) and total flavonoids (TF) by spectrophotometry. The data were submitted to analysis of variance and multivariate analysis (principal component analysis-PCA and hierarchical cluster analysis-HCA) was applied for data association. The phenolic compounds showed a high positive correlation with each other, and the total dry mass showed low and negative correlations with the analyzed variables. The results showed that the metals aluminum, lead, and cadmium promoted a stress condition in basil plants, which resulted in the reduction of the dry matter mass and an increase in the synthesis of phenolic compounds, according to the type and concentration of the metal.

Magnesium in the water of Japanese quails kept under comfort zone and under thermal stress / Magnésio na água de codornas japonesas mantidas em zona de conforto e sob estresse térmico

The objective was to evaluate the increasing levels of magnesium in the water supplied to laying quails (Coturnix coturnix japonica), kept in climatic chambers under thermoneutral temperature and thermal stress, on their performance and morphometry of their organs. The birds were distributed in a completely randomized design, 2x4 factorial arrangement, 2 temperatures (24 and 32 ºC) and 4 levels of magnesium in the water (50, 150, 250 and 350 mg L-1), with six replicates and eight birds per experimental unit. The data were subjected to analysis of variance and the means compared by the Tukey test at 5% probability level. The magnesium levels in the water did not affect (P > 0.05) the production performance and morphometry of the organs, with less water consumption at the magnesium level of 150 mg L-1, and birds kept at 32 °C had a reduction in feed consumption and feed conversion, but without affecting organ morphometry. Japanese quails in the production phase can consume water with magnesium levels up to 350 mg L-1 without having their production performance and morphometry of organs affected and raised in an environment with temperatures of up to 32 °C.(AU)

O objetivo foi avaliar os níveis crescentes de magnésio na água fornecida a codornas (Coturnix coturnix japonica) em postura, mantidas em câmaras climáticas sob temperatura termoneutra e estresse térmico, sobre o desempenho e morfometria dos órgãos das aves. As aves foram distribuídas em delineamento inteiramente casualizado, arranjo fatorial 2x4, 2 temperaturas (24 e 32 ºC) e 4 níveis de magnésio na água (50, 150, 250 e 350 mg L-1), com seis repetições e oito aves por unidade experimental e os dados submetidos à análise de variância e as médias comparadas pelo teste de Tukey a 5% de probabilidade. Os níveis de magnésio na água não afetaram (P > 0,05) o desempenho produtivo e a morfometria dos órgãos, com menor consumo de água ao nível de 150 mg L-1 de magnésio e, as aves mantidas a 32 °C tiveram uma redução no consumo de ração e conversão alimentar, mas sem afetar a morfometria dos órgãos. Codornas japonesas em fase de produção podem consumir água com níveis de magnésio de até 350 mg L-1 sem ter o desempenho produtivo e a morfometria dos órgãos afetados e criados em ambiente com temperatura de até 32 °C.(AU)

Physiological, nutritional, and biochemical indicators of lead tolerance in sunflower genotypes / Indicadores fisiológicos, nutricionais e bioquímicos de tolerância ao chumbo em genótipos de girassol

This study aimed to select and classify sunflower genotypes tolerant to lead (Pb) stress and evaluate their capacity of phytoextraction based on physiological, nutritional, and biochemical responses. Two experiments were carried out under lead stress. In the first experiment, out of 21 genotypes studied three showed higher relative biomass yield and were characterized as Pb-tolerant and five showed lower relative biomass production and were considered Pb-sensitive. In the second experiment, one Pb-tolerant (BRS-G27) and two Pb-sensitive (H251 and AG963) genotypes were studied. In this experiment, Pb stress reduced the growth and contents photosynthetic pigments in all genotypes, but more pronouncedly in sensitive genotypes. There were no substantial changes in micronutrient levels in the leaves and stem, but the levels of Cu and Mn in the stressed roots of sensitive genotypes were much lower than in BRS-G27. The contents of organic solutes in the roots suggest that sensitive genotypes have higher energy costs for osmoregulation by carbohydrates and amino acids synthesis. However, the accumulation of proline may be related to a greater Pb tolerance. Considering the results of dry mass yield, transfer coefficient, translocation factor, and tolerance index, the BRS-G27 genotype can be recommended for use in phytoremediation of Pb-contaminated soils.(AU)

Este estudo teve como objetivo selecionar e classificar genótipos de girassol tolerantes ao estresse por chumbo (Pb) e avaliar sua capacidade de fitoextração com base nas respostas fisiológicas, nutricionais e bioquímicas. Dois experimentos foram realizados sob estresse de Pb. No primeiro experimento, dos 21 genótipos estudados, três apresentaram maior produção relativa de biomassa e foram caracterizados como tolerantes ao Pb e cinco apresentaram menor produção relativa de biomassa e foram considerados sensíveis ao Pb. No segundo experimento foram estudados um genótipo tolerante ao Pb (BRS-G27) e dois sensíveis ao Pb (H251 e AG963). Neste experimento, o estresse por Pb reduziu o crescimento e os teores de pigmentos fotossintéticos em todos os genótipos, porém, mais pronunciado em genótipos sensíveis. Não houve mudanças substanciais nos níveis de micronutrientes nas folhas e no caule, mas os níveis de Cu e Mn nas raízes estressadas de genótipos sensíveis foram muito mais baixos do que o BRS-G27. Os conteúdos de solutos orgânicos nas raízes sugerem que genótipos sensíveis apresentam maiores custos energéticos para osmorregulação por carboidratos e síntese de aminoácidos. No entanto, o acúmulo de prolina pode estar relacionado a uma maior tolerância ao Pb. Considerando os resultados de produção de massa seca, coeficiente de transferência, fator de translocação e índice de tolerância, o genótipo BRS-G27 pode ser recomendado para uso em fitorremediação de solos contaminados com Pb.(AU)

Exploratory analysis in the evaluation of stress due to aluminum presence in Physalis angulata L. and multielement determination by microwave-induced plasma optical emission spectrometry (MIP OES).

The present work aimed to analyze the mineral nutrition of Physalis angulata L. under stress by aluminum in the nutrient solution. The treatments consisted of five different concentrations of aluminum in the nutrient solution (0, 0.04, 0.08, 0.12, and 0.16 mmol L-1) in the AlCl3 form. The plants were exposed to Al for 30 days. Subsequently, nutritional and aluminum analyses were performed on plant tissue. The data were submitted to analysis of variance (p < 0.05), and, in case of significance, the regression study was performed as well as hierarchical cluster analysis (HCA) and principal component analysis (PCA) were used. The formation of four groups occurred, where we can observe the similarity and differences in the treatments between them. The separation of the treatments into groups reflected the heterogeneity of the treatments about the aluminum levels in the nutrient solution, evidencing its phytotoxicity level in Physalis angulata plants. Among the analyzed variables, P, K, Ca, Mg, Fe, Mo, and Zn were the most influential ones demonstrated by principal component analysis (PCA). The stress of 0.16 mmol L-1 of Al increased the phosphorus contents in the stems and roots and the potassium, copper, and molybdenum contents in all parts of the plants. In contrast, Al reduced the levels of calcium, magnesium, iron, and zinc in P. angulata plants. Iron being the micronutrient that showed the largest reduction, followed by zinc in the leaves. The highest levels of aluminum were found in the roots.

Thermoregulatory, behavioral and productive responses of laying hens supplemented with different types and dosages of phytases raised in a hot environment: An integrative approach.

This study had the following objectives: (i) to evaluate the thermoregulatory and behavioral responses of light laying hens supplemented with different types and dosages of phytases in the two day shifts; and (ii) to integrate the thermoregulatory and behavioral responses with performance of these birds raised in a hot environment. 270 light laying hens of the Hy-Line White lineage, with a body weight of 1.60 ± 0.092 kg were distributed in a completely randomized design in a 2 × 2 + 1 factorial model with two types of phytases (bacterial and fungal) and two dosages (450 and 900 FTU), and a control diet. The day shift (morning and afternoon) was considered as a fixed effect in the factorial arrangement. Principal component analysis (PCA), correspondence analysis (CA) and canonical discriminant analysis (CDA) were used. There was no interaction (P > 0.05) between phytases and dosages for thermoregulatory responses. Respiratory rate (RR), cloacal temperature (CT), and surface temperature with feathers (STWF) and featherless (STF) were higher (P < 0.001) in the afternoon. Birds show different thermoregulatory and behavioral responses in the two shifts of the day. We also observed that birds supplemented with bacterial and fungal phytase showed similar thermoregulatory and behavioral responses to the control group in both day shifts. Expression of the "eating" activity was greater in the morning, while the birds remained sitting longer in the afternoon. Egg production was higher (P < 0.001) in birds supplemented with bacterial phytase. The phytase dosages had no effect on thermoregulatory, behavioral or performance responses. Egg production, feed conversion per dozen eggs corresponded to 81.1% of the differences between bacterial and fungal phytase supplementation and group control. Thus, we conclude that: (i) phytase dietary supplementation has no effect on the thermoregulatory responses of laying hens reared in a hot environment; (ii) birds supplemented with bacterial phytase showed higher egg production; and (iii) phytases (450 and 900 FTU) do not interfere with productive, behavioral and thermoregulatory responses.

Educação Permanente em Saúde e atenção psicossocial: a experiência do Projeto Rede Sampa / Permanent Health Education and psychosocial care: the experience of the Projeto Rede Sampa

RESUMO Este artigo relata uma experiência de formação em saúde mental desenvolvida no município de São Paulo entre os anos de 2013 e 2016. Denominado Projeto Rede Sampa - Saúde Mental Paulistana, direcionou-se a trabalhadores de diversas categorias profissionais e diferentes pontos da Rede de Atenção Psicossocial, tendo sido elaborado e executado utilizando estratégias que garantiram a participação dos distintos atores na construção de conteúdos de aprendizagem, a abordagem da singularidade das redes territoriais e o registro do percurso formativo das turmas. A partir da metodologia construcionista social, procurou-se discutir a relevância das interações dialógicas para o fortalecimento do trabalho em rede e a importância do alinhamento com a atenção psicossocial como modelo ético de cuidado.

ABSTRACT This article reports on a training experience in mental health developed in the city of São Paulo between 2013 and 2016. Named Projeto Rede Sampa - Saúde Mental Paulistana, it was aimed at workers from different professional categories and different points of the Psychosocial Care Network, having been elaborated and executed using strategies that ensured the participation of the different actors in the construction of learning contents, the approach to the singularity of territorial networks and the registration of the training path of the classes. Based on the social constructionist methodology, we sought to discuss the relevance of dialogical interactions for the strengthening of networking and the importance of alignment with psychosocial care as an ethical model of care.

Organic minerals with different chemical characteristics in diets for Hy-Line White laying hens: performance, biometry of digestive organs, and bone quality

Two trials were carried out to evaluate the effect of groups of organic minerals with different chemical characteristics on the performance, egg quality, biometry of digestive organs, and bone quality of laying hens in the first and second laying cycles. In the first cycle, 180 layers at 72 weeks were used in a completely randomized design (CRD) with four treatments and five replicates with nine birds each. In the second cycle, 216 layers at 94 weeks of age were used in a CRD with four treatments and six replicates with nine birds each. Birds were fed the following diets: treatment 1 - basal diet (inorganic minerals); treatment 2 - basal diet + amino acid chelated minerals (Cu, Fe, Mn, and Zn) + selenium yeast; treatment 3 - basal diet + mineral-amino acid complex (Mn, Zn, and Cu); and treatment 4 - basal diet + metal chelate (Mn, Zn, and Cu) + methionine hydroxy analogue. The following performance variables were evaluated: feed intake (g/bird/day), egg production (%), egg weight (g), egg mass (g/bird/day), conversion per mass (kg/kg), and conversion per dozen eggs (kg/dz). In the egg, the percentages of albumen, yolk, and shell; eggshell thickness (mm); and specific gravity (g/cm3) were determined. The relative weights (%) of the proventriculus, gizzard, liver, pancreas, and intestines were also measured. Lastly, in the tibiae, the weight (g), length (mm), resistance (kgf/cm2), deformity (mm), Seedor index (mg/mm), and mineral matter content (g/kg) were measured. The variables were not influenced by the groups of organic minerals used. Groups of organic minerals with different chemical characteristics can be used in layer diets without affecting their performance, egg quality, digestive organs, or bone quality.(AU)

Enteroaggregative Escherichia coli Subclinical Infection and Coinfections and Impaired Child Growth in the MAL-ED Cohort Study.

OBJECTIVE: We evaluated the impact of subclinical enteroaggregative Escherichia coli (EAEC) infection alone and in combination with other pathogens in the first 6 months of life on child growth. METHODS: Nondiarrheal samples from 1684 children across 8 Multisite Birth Cohort Study, Malnutrition and Enteric Diseases (MAL-ED) sites in Asia, Africa, and Latin America were tested monthly; more than 90% of children were followed-up twice weekly for the first 6 months of life. RESULTS: Children with subclinical EAEC infection did not show altered growth between enrollment and 6 months. Conversely, EAEC coinfection with any other pathogen was negatively associated with delta weight-for-length (P < 0.05) and weight-for-age (P > 0.05) z scores between 0 and 6 months. The presence of 2 or more pathogens without EAEC was not significantly associated with delta weight-for-length and weight-for-age. The most frequent EAEC coinfections included Campylobacter spp, heat-labile toxin-producing enterotoxigenic E coli, Cryptosporidium spp, and atypical enteropathogenic E coli. Myeloperoxidase levels were increased with EAEC coinfection (P < 0.05). EAEC pathogen codetection was associated with lower neopterin levels compared to those of no-pathogen control children (P < 0.05). Mothers of children with EAEC coinfections had lower levels of education, poorer hygiene and sanitation, lower socioeconomic status, and lower breast-feeding rates compared to mothers of children in whom no pathogen was detected (P < 0.05). CONCLUSIONS: These data emphasize the public health importance of subclinical EAEC infection in early infancy in association with other pathogens and the need for improved maternal and child care, hygiene, sanitation, and socioeconomic factors.