A qualitative analysis of adolescent motherhood within the broader family context in Peru.

Objective: The purpose of this study was to characterize the impact of adolescent pregnancy on families and describe the needs of adolescent mothers and their infants in order to assess the need for intervention and identify potential intervention targets. Background: Adolescent mothers and their offspring face an increased risk of mental health problems. Adolescent mothers and their families also face significant resource constraints; 95% live in low- and middle-income countries (LMICs). Cost-effective interventions are needed to improve outcomes for this vulnerable group. Method: This qualitative study conducted in Lima, Peru, consisted of four clinician focus groups and 18 in-depth interviews with adolescent mothers and their family members. Data were coded thematically, and direct content analysis was employed. Results: The study identified the following issues facing adolescent parents: the transition to parenthood, the need for family support, difficulty accessing support, the difficulty for family members of providing support, and ideas about responsibility and adolescent autonomy. Conclusion: Overall, these findings demonstrate the need for interventions that engage families and address barriers to accessing support, including relationship conflict and differing beliefs about responsibility and autonomy. Implications: Interventions are needed for adolescent mothers in LMICs that mobilize family support. Clinicians who care for these patients need to be aware of the family context and the resources available where they practice.

Childhood Leukemia Survival in the US-Mexico Border: Building Sustainable Leukemia Care Using Health Systems Strengthening Models.

PURPOSE: Pediatric leukemia outcomes are poor in most low- and middle-income countries (LMICs) and exacerbated by health care systems ill equipped to manage cancer. Effective leukemia management in LMICs involves curating epidemiologic data; providing health care workforce specialty training; developing evidence-based treatments and supportive care programs; safeguarding access to medications and equipment; providing patient and family psychosocial, financial, and nutritional support; partnering with nongovernmental organizations, and ensuring treatment adherence. METHODS: In 2013, through a partnership between North-American and Mexican institutions, we used the WHO Framework for Action, a health systems strengthening model to implement a leukemia care sustainable program aimed at improving acute lymphoblastic leukemia (ALL) outcomes at a public hospital in Mexico. We prospectively assessed clinical features, risk classification, and survival outcomes in children with ALL at Hospital General-Tijuana from 2008 to 2012 (preimplementation) and from 2013 to 2017 (postimplementation). We also evaluated program sustainability indicators. RESULTS: Our approach led to a fully-staffed leukemia service, sustainable training programs, evidence-based and data-driven projects to improve clinical outcomes, and funding for medications, supplies, and personnel through local partnerships. Preimplementation and postimplementation 5-year overall survival for the entire cohort of children with ALL, children with standard-risk ALL, and children with high-risk ALL improved from 59% to 65% (P = .023), 73% to 100% (P < .001), and 48% to 55% (P = .031), respectively. All sustainability indicators improved between 2013 and 2017. CONCLUSION: Using the health systems strengthening WHO Framework for Action model, we improved leukemia care and survival in a public hospital in Mexico across the US-Mexico border. We provide a model for the development of similar programs in LMICs to sustainably improve leukemia and other cancer outcomes.

Manifestations of Intergenerational Trauma During the Perinatal Period Among Adolescent Mothers in Lima, Peru: A Qualitative Analysis.

Adverse childhood experiences have a lasting impact on health across the life course. The perinatal period offers a unique opportunity to rework problematic dynamics in families experiencing intergenerational trauma. This study explores the family dynamics that are activated during the perinatal period and considers the potential for intervention with adolescent parents and their families in Lima, Peru. This narrative analysis was part of a broader study that included focus groups and in-depth interviews. Of the ten adolescent mothers interviewed, four narratives were selected for presentation in this manuscript. These particular narratives were selected to illustrate the diversity of the experiences among this group and for the exceptional level of detail provided about their life experiences and family relationships. Narrative excerpts were analyzed in the context of the entire interview and the aggregate content of other interviews in order to explore both explicit and implicit meanings. This study identified critical relational shifts among adolescent parents and their families during the perinatal period. In one instance, adolescent parenthood created an opportunity for the family to come together. In the other cases, conflict escalated, relations grew distant, or both. These narrative data demonstrate that intergenerational trauma can interfere with family relationships in the context of adolescent pregnancy and prevent adolescent parents from accessing needed support from their families. Intervention with families could address the impact of trauma and improve communication and collaboration.

The Transcription Factor Pdr802 Regulates Titan Cell Formation and Pathogenicity of Cryptococcus neoformans.

Cryptococcus neoformans is a ubiquitous, opportunistic fungal pathogen that kills almost 200,000 people worldwide each year. It is acquired when mammalian hosts inhale the infectious propagules; these are deposited in the lung and, in the context of immunocompromise, may disseminate to the brain and cause lethal meningoencephalitis. Once inside the host, C. neoformans undergoes a variety of adaptive processes, including secretion of virulence factors, expansion of a polysaccharide capsule that impedes phagocytosis, and the production of giant (Titan) cells. The transcription factor Pdr802 is one regulator of these responses to the host environment. Expression of the corresponding gene is highly induced under host-like conditions in vitro and is critical for C. neoformans dissemination and virulence in a mouse model of infection. Direct targets of Pdr802 include the quorum sensing proteins Pqp1, Opt1, and Liv3; the transcription factors Stb4, Zfc3, and Bzp4, which regulate cryptococcal brain infectivity and capsule thickness; the calcineurin targets Had1 and Crz1, important for cell wall remodeling and C. neoformans virulence; and additional genes related to resistance to host temperature and oxidative stress, and to urease activity. Notably, cryptococci engineered to lack Pdr802 showed a dramatic increase in Titan cells, which are not phagocytosed and have diminished ability to directly cross biological barriers. This explains the limited dissemination of pdr802 mutant cells to the central nervous system and the consequently reduced virulence of this strain. The role of Pdr802 as a negative regulator of Titan cell formation is thus critical for cryptococcal pathogenicity.IMPORTANCE The pathogenic yeast Cryptococcus neoformans presents a worldwide threat to human health, especially in the context of immunocompromise, and current antifungal therapy is hindered by cost, limited availability, and inadequate efficacy. After the infectious particle is inhaled, C. neoformans initiates a complex transcriptional program that integrates cellular responses and enables adaptation to the host lung environment. Here, we describe the role of the transcription factor Pdr802 in the response to host conditions and its impact on C. neoformans virulence. We identified direct targets of Pdr802 and also discovered that it regulates cellular features that influence movement of this pathogen from the lung to the brain, where it causes fatal disease. These findings significantly advance our understanding of a serious disease.

A Qualitative Study of Child Nutrition and Oral Health in El Salvador.

The nutrition transition from traditional diets to processed snacks and sugary beverages has contributed to a higher burden of child malnutrition, obesity, and tooth decay. While child health interventions typically promote nutritious eating, they rarely promote oral health. Mothers' motivations for child nutrition and oral health practices need to be better understood. A convenience sample of 102 mothers in eight rural Salvadoran communities participated in focus groups addressing child nutrition and oral health. Focus groups were transcribed and coded using qualitative content analysis. Primary themes included generational changes in health environments; health knowledge, attitudes, and practices; and access and barriers to health services. Mothers noted general improvements in awareness of oral hygiene but poorer child oral health, which they attributed to widespread sales of unhealthy snacks and beverages near schools. Distance and cost limited families' access to dental services. Knowledge gaps included the belief that oral iron supplements cause tooth decay, uncertainty regarding when to start tooth brushing, and until when parents should help children brush. Maternal-child health programs should emphasize the adverse health consequences of feeding young children processed snacks and sugary drinks, and promote dental care access and regulations to ensure health-promoting environments surrounding schools.

Heavy metals extractability in a soil amended with sewage sludge

Few investigations have been carried out about the comparison of desorption rate and amount of heavy metals extracted successively by organic acid mixtures mimicking the rhizosphere and routine extractants in sewage sludge-amended soils. Extractions of Zn, Cd, Ni, Cr, and Cu were performed in samples of a sewage sludge-amended soil using seven extractants: four organic acid mixtures and three routine extractants (DTPA, Mehlich-I, and ammonium acetate). Results from single pass extractions, in which the extractable metal contents were determined by simply extracting the soil a single time, as well as from 15 successive extractions, in which the solid residues of the first extraction was successively extracted 14 additional times, of heavy metals were analyzed. The extractability of heavy metals in a single pass extraction was, in general, as follows: Mehlich-I > DTPA > organic acids > NH4OAc. The highest rates of extraction followed the general order: DTPA > Mehlich-I > organic acids > NH4OAc. While Mehlich-I presented the highest extractability of heavy metals among studied extractants, DTPA showed a high extractability of Zn, Cd, Ni, and Cu in a single extraction as well as the highest rates of extraction among the studied extractants. The transfer of heavy metals from soil to organic acid solutions is slower than to DTPA and Mehlich-I extractants.

Poucos trabalhos têm sido realizados sobre a comparação da taxa de dessorção e da quantidade de metais extraídos sucessivamente por misturas de ácidos orgânicos que imitam a composição da rizosfera e por extratores usados na rotina em amostras de solo tratado com lodo de esgoto. Extrações de Zn, Cd, Ni, Cr e Cu foram realizadas em amostras de um solo de carga variável tratado com lodo de esgoto usando-se sete extratores: quatro misturas com ácidos orgânicos e três extratores usados na rotina (DTPA, Mehlich-I e acetato de amônio). Os resultados para uma única extração, em que o conteúdo de metais extraíveis foi determinado simplesmente extraindo-os do solo uma única vez, bem como após 15 extrações sucessivas, em que o resíduo sólido da primeira extração foi extraído sucessivamente por mais 14 vezes, foram analisados. A extractabilidade dos metais em uma extração simples foi, em geral, como segue: Mehlich-I > DTPA > ácidos orgânicos > NH4OAc. As mais elevadas taxas de extração seguiram a ordem: DTPA > Mehlich-I > ácidos orgânicos > NH4OAc. A maior extração de metais foi obtida com Mehlich-I, enquanto, o DTPA também extraiu alta quantidade de Zn, Cd, Ni e Cu em uma extração simples, bem como obteve as mais altas taxas de extração entre os extratores estudados. A transferência de metais do solo para as soluções de ácidos orgânicos foi mais lenta que para os extratores DTPA e Mehlich-I.

Heavy metals extractability in a soil amended with sewage sludge

Few investigations have been carried out about the comparison of desorption rate and amount of heavy metals extracted successively by organic acid mixtures mimicking the rhizosphere and routine extractants in sewage sludge-amended soils. Extractions of Zn, Cd, Ni, Cr, and Cu were performed in samples of a sewage sludge-amended soil using seven extractants: four organic acid mixtures and three routine extractants (DTPA, Mehlich-I, and ammonium acetate). Results from single pass extractions, in which the extractable metal contents were determined by simply extracting the soil a single time, as well as from 15 successive extractions, in which the solid residues of the first extraction was successively extracted 14 additional times, of heavy metals were analyzed. The extractability of heavy metals in a single pass extraction was, in general, as follows: Mehlich-I > DTPA > organic acids > NH4OAc. The highest rates of extraction followed the general order: DTPA > Mehlich-I > organic acids > NH4OAc. While Mehlich-I presented the highest extractability of heavy metals among studied extractants, DTPA showed a high extractability of Zn, Cd, Ni, and Cu in a single extraction as well as the highest rates of extraction among the studied extractants. The transfer of heavy metals from soil to organic acid solutions is slower than to DTPA and Mehlich-I extractants.

Poucos trabalhos têm sido realizados sobre a comparação da taxa de dessorção e da quantidade de metais extraídos sucessivamente por misturas de ácidos orgânicos que imitam a composição da rizosfera e por extratores usados na rotina em amostras de solo tratado com lodo de esgoto. Extrações de Zn, Cd, Ni, Cr e Cu foram realizadas em amostras de um solo de carga variável tratado com lodo de esgoto usando-se sete extratores: quatro misturas com ácidos orgânicos e três extratores usados na rotina (DTPA, Mehlich-I e acetato de amônio). Os resultados para uma única extração, em que o conteúdo de metais extraíveis foi determinado simplesmente extraindo-os do solo uma única vez, bem como após 15 extrações sucessivas, em que o resíduo sólido da primeira extração foi extraído sucessivamente por mais 14 vezes, foram analisados. A extractabilidade dos metais em uma extração simples foi, em geral, como segue: Mehlich-I > DTPA > ácidos orgânicos > NH4OAc. As mais elevadas taxas de extração seguiram a ordem: DTPA > Mehlich-I > ácidos orgânicos > NH4OAc. A maior extração de metais foi obtida com Mehlich-I, enquanto, o DTPA também extraiu alta quantidade de Zn, Cd, Ni e Cu em uma extração simples, bem como obteve as mais altas taxas de extração entre os extratores estudados. A transferência de metais do solo para as soluções de ácidos orgânicos foi mais lenta que para os extratores DTPA e Mehlich-I.

Disposal of domestic sludge and sludge ash on volcanic soils.

Column leaching experiments were conducted to test the ability of Chilean volcanic soils in retaining the mineral constituents and metals in sewage sludge and sludge ash that were incorporated into the soils. Small or negligible amounts of the total content of Pb, Fe, Cr, Mn, Cd, and Zn (0 to <2%), and more significant amounts of mineral constituents such as Na (7-9%), Ca (7-13%), PO4 (4-10%), and SO4 (39-46%) in the sludge and sludge ash were readily soluble. When they were incorporated on the surface layer of the soils and leached with 12 pore volumes of water over a 3 month period of time, less than 0.1% of the total amount of heavy metals and PO4 in the sludge and sludge ash were collected in the drainage water. Cation exchange selectivity, specific anion adsorption and solubility are the processes that cause the reduction of leaching. The volcanic soils were capable of retaining the mineral constituents, P, and metals in applied sewage sludge and sludge ash and gradually released them as nutrients for plant growth.