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1.
Vet Parasitol ; 277: 109018, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31896020

RESUMO

Control of sheep gastrointestinal nematode (GIN) infections mostly relies on the use of anthelmintics. Refugia-based control strategies as targeted selective treatments (TST) can delay anthelmintic resistance development, but the optimal decision criteria for selecting individuals to be treated in subclinical infection scenarios remain unclear. The present study aimed to evaluate the suitability of body condition score (BCS) and faecal egg counts (FEC) as treatment indicators and to determine their optimized threshold values for treatment in TST by determining the relationships of BCS, FEC and anthelmintic treatment with several productive parameters in pre-mating and pre-partum periods at an individual level. Deworming in pre-mating period increased BCS gain, but its magnitude was directly associated with strongyle FEC before treatment. Deworming also increased fertility in ewes with BCS < 2.75 and the proportion of lambing ewes that got pregnant during the first ovulation cycle. Nevertheless, treatment did not yield productive benefits in ewes with higher BCS values. On the other hand, deworming in the pre-partum lowered lamb peri-partum mortality and increased lamb weight at birth and the growth of lambs during lactation, especially in lambs born from ewes with strongyle FEC > 400 epg before treatment. These results showed that FEC and especially BCS can be potential decision criteria for the implementation of TST in these types of scenarios. The TST scheme derived from the present results on the control of GIN infections should include anthelmintic treatment of ewes with BCS lower than ≈ 3 approximately five weeks before mating and lambing. In the pre-lambing period, treatment may be unnecessary if flock mean strongyle FEC is lower than ≈ 200 epg, as the proportion of ewes with individual FEC > 400 epg would be very low. The results suggest that implementation of this TST scheme would provide benefits, such as the improvement of productivity, a rational management of parasites in refugia, and preservation of future efficacy of anthelmintics, in comparison to traditional deworming schemes.


Assuntos
Gastroenteropatias/veterinária , Infecções por Nematoides/veterinária , Doenças dos Ovinos/tratamento farmacológico , Doenças dos Ovinos/prevenção & controle , Animais , Infecções Assintomáticas , Feminino , Gastroenteropatias/tratamento farmacológico , Gastroenteropatias/prevenção & controle , Infecções por Nematoides/tratamento farmacológico , Infecções por Nematoides/prevenção & controle , Gravidez , Ovinos
2.
Isr Med Assoc J ; 22(1): 27-31, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31927802

RESUMO

BACKGROUND: Congenital heart defects (CHD) may be associated with neurodevelopmental abnormalities mainly due to brain hypoperfusion. This defect is attributed to the major cardiac operations these children underwent, but also to hemodynamic instability during fetal life. Advances in imaging techniques have identified changes in brain magnetic resonance imaging (MRI)in children with CHD. OBJECTIVES: To examine the correlation between CHD and brain injury using fetal brain MRI. METHODS: We evaluated 46 fetuses diagnosed with CHD who underwent brain MRI. CHD was classified according to in situs anomalies, 4 chamber view (4CV), outflow tracts, arches, and veins as well as cyanotic or complex CHD. We compared MRI results of different classes of CHD and CHD fetuses to a control group of 113 healthy brain MRI examinations. RESULTS: No significant differences were found in brain pathologies among different classifications of CHD. The anteroposterior percentile of the vermis was significantly smaller in fetuses with abnormal 4CV. A significantly higher biparietal diameter was found in fetuses with abnormal arches. A significantly smaller transcerebellar diameter was found in fetuses with abnormal veins. Compared to the control group, significant differences were found in overall brain pathology in cortex abnormalities and in extra axial findings in the study group. Significantly higher rates of overall brain pathologies, ventricle pathologies, cortex pathologies, and biometrical parameters were found in the cyanotic group compared to the complex group and to the control group. CONCLUSIONS: Fetuses with CHD demonstrate findings in brain MRI that suggest an in utero pathogenesis of the neurological and cognitive anomalies found during child development.


Assuntos
Lesões Encefálicas/embriologia , Feto/diagnóstico por imagem , Cardiopatias Congênitas/etiologia , Adulto , Encéfalo/diagnóstico por imagem , Encéfalo/embriologia , Encéfalo/patologia , Lesões Encefálicas/complicações , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/patologia , Estudos de Casos e Controles , Ecocardiografia , Feminino , Cardiopatias Congênitas/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Neuroimagem , Gravidez , Diagnóstico Pré-Natal/métodos
3.
Rev Med Liege ; 75(1): 6-9, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31920037

RESUMO

Velamentous cord insertion is a rare placental abnormality, that may be associated with vasa praevia, i.e. the presence of an umbilical vessel near the internal cervical orifice. In case of spontaneous rupture of the membranes, there is a major risk of fetal haemorrhage, which is often lethal for the unborn baby. The challenge of care is based on the prenatal diagnosis during the 2nd trimester ultrasound. In case a vasa praevia is confirmed during the 3rd trimester, elective caesarean section should be carried out prior to the onset of labour, between 34 and 36 weeks of pregnancy. Corticosteroid treatment for fetal lung maturation is recommended at 32 weeks of gestation because of the increased risk of preterm delivery. Velamentous cord insertion may be associated with other adverse pregnancy outcomes such as intrauterine growth restriction, death in utero, placental abnormalities.


Assuntos
Cesárea , Vasa Previa , Feminino , Humanos , Recém-Nascido , Gravidez , Resultado da Gravidez , Diagnóstico Pré-Natal , Ultrassonografia Pré-Natal , Vasa Previa/diagnóstico
4.
Rev Med Liege ; 75(1): 37-42, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31920042

RESUMO

OBJECTIVE: Perfluoroalkyl substances (PFAS) are chemicals widely employed in the industry. Long term consequences of the newborns' contamination by PFAS on thyroid function are of concern. The aim of this study is to assess the potential associations between PFAS contamination measured at birth and thyroid function assessed few months later. PFAS levels were previously determined in cord blood from a cohort of newborns recruited in Liege. METHOD: Parents of the children belonging to the first and the fifth quintiles of exposure to PFAS were contacted in order to measure the thyroid stimulating hormone (TSH) levels in their child few months after birth. Twenty-eight children participated in the study. Moreover, we performed a literature review about associations between pre- or perinatal exposure to persistent organic pollutants and thyroid function during early childhood. RESULT: No significant difference was highlighted between both groups of contamination (Mann-Whitney, p-value = 0.91). Literature review highlighted the critical need of new longitudinal data about this problematic. CONCLUSION: Our results suggest that the PFAS levels at birth are not associated with TSH levels later in life. Large scale studies are required to confirm our results.


Assuntos
Poluentes Ambientais , Fluorcarbonetos , Doenças da Glândula Tireoide , Glândula Tireoide , Criança , Estudos de Coortes , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Gravidez , Doenças da Glândula Tireoide/epidemiologia , Glândula Tireoide/fisiopatologia
5.
Rev Med Liege ; 75(1): 43-48, 2020 Jan.
Artigo em Francês | MEDLINE | ID: mdl-31920043

RESUMO

Ebstein's anomaly is a rare and complex congenital heart disease involving abnormal embryological development of the tricuspid valve. Its exact prevalence remains unknown given the under-diagnosis of minor forms and the broad clinical spectrum of this pathology resulting from the highly variable tricuspid morphology. Echocardiography plays an important role in diagnosis, assessment and prognostic evaluation of this condition. We present the case of a 6-year-old boy born from a twin pregnancy with a severe neonatal EA diagnosed by ultrasound at 29 weeks of gestation and we discuss the management on the light of the recent literature.


Assuntos
Anomalia de Ebstein , Criança , Anomalia de Ebstein/diagnóstico , Anomalia de Ebstein/cirurgia , Ecocardiografia , Feminino , Humanos , Masculino , Gravidez , Diagnóstico Pré-Natal , Valva Tricúspide
6.
Medicine (Baltimore) ; 99(1): e18673, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895835

RESUMO

The documents on the median effective concentration of local analgesic were many in primiparas during labor analgesia. However, the studies were fewer in multiparas. To explore the analgesic requirements in multiparas during epidural labor analgesia, we investigated the median effective concentration of ropivacaine with 2 µg/mL fentanyl for epidural labor analgesia in multiparas.Sixty-two women were recruited and assigned to the primipara group and multipara group in this prospective study. All the parturients received ropivacaine combined with 2 µg/mL fentanyl for epidural labor analgesia. The concentration of ropivacaine was determined by the up and down method and an initial concentration was set as 0.1% with a 0.01% interval. Effective analgesia was defined as the visual analog scale (VAS) ≤3 within 30 minutes after epidural administration when cervical dilatation is about 2 cm. The median effective concentration of ropivacaine was calculated by the up and down sequential method. The pain intensity was assessed using VAS. Hemodynamic parameters, the labor stages, and neonatal Apgar scores were recorded. Umbilical artery blood was drawn to analyze. The side effects, if any, were also recorded.The median effective concentration of ropivacaine was 0.057% (95% confidence interval [CI], 0.051-0.064%) in primiparas during epidural labor analgesia, and 0.068% (95% CI, 0.063-0.072%) in multiparas during epidural labor analgesia, there was significant difference between the groups (P = .02).This study indicated that the median effective concentration of ropivacaine with fentanyl for epidural labor analgesia was 0.068% (95% CI, 0.063-0.072%) and increased in multiparas compared with the primiparas (www.chictr.org.cn, registration number: ChiCTR-1800016486).


Assuntos
Analgesia Epidural , Analgesia Obstétrica , Anestésicos Locais/administração & dosagem , Paridade , Ropivacaina/administração & dosagem , Adulto , Feminino , Humanos , Gravidez
7.
Medicine (Baltimore) ; 99(1): e18695, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895838

RESUMO

RATIONALE: Jacobsen syndrome (JBS) is a rare chromosomal disorder with variable phenotypic expressivity, which is usually diagnosed in infancy and childhood based on clinical examination and hematological and cytogenetic findings. Prenatal diagnosis and fetal ultrasonographic findings of JBS are rare. PATIENT CONCERNS: A 38-year-old, gravida 3, para 1, pregnant woman underwent clinical ultrasound examination at 22 weeks of gestation. DIAGNOSES: Ultrasonographic findings indicated an interventricular septal defect, the presence of septal blood flow, dilation of the left renal pelvis, and a single umbilical artery. Amniocentesis was performed to evaluate possible genetic causes of this diagnosis by cytogenetic and single nucleotide polymorphism (SNP) array analysis. INTERVENTIONS: After genetic counseling and informed consent, the couple elected to terminate the pregnancy. OUTCOMES: Karyotype analysis showed that the fetal karyotype was 46,XX,del(11)(q23). The SNP array revealed a 6.118 Mb duplication of 11q23.2q23.3 and a 15.03 Mb deletion of 11q23.3q25. LESSONS: Ultrasonographic findings of fetal JBS, including an interventricular septal defect, dilation of the left renal pelvis, and a single umbilical artery, may be associated with a 15.03 Mb deletion of 11q23.3q25. Further cases correlating phenotype and genotype are required to predict the postnatal phenotype.


Assuntos
Síndrome da Deleção Distal 11q de Jacobsen/diagnóstico por imagem , Adulto , Feminino , Humanos , Cariótipo , Gravidez , Ultrassonografia Pré-Natal
8.
Orv Hetil ; 161(2): 43-49, 2020 Jan.
Artigo em Húngaro | MEDLINE | ID: mdl-31902235

RESUMO

Hormonal imprinting is a physiological process, which is a part of the receptor-hormone complex development. It determines the binding capacity of the receptors across the lifespan. It takes place perinatally in the critical period of hormone receptor development, when the developmental window for imprinting is open and permits the binding of hormone-like molecules (related or synthetic hormones, endocrine disruptors etc.) causing disturbances of the endocrine system, and the systems- influenced organs by it, for life. This is the faulty hormonal imprinting. However, studying the medical database, PubMed, a lot of data can be found on the harmful late (adult age) effects of medication in the critical period of development with non-hormonal molecules, which are manifested later in functional alterations or diseases. This could mean that in the process of faulty imprinting, the openness of the developmental window could be more important than the structural similarity of a molecule to hormones. As developmentally critical period for faulty imprinting by hormone-like molecules is not exclusively the perinatal one (this is justified in the case of faulty hormonal imprinting), the pubertal period was also studied from this aspect and similarities to the impact of perinatal use have been found (this could be called "Pubertal Origin of Health and Disease = POHaD). While in the case of hormonal faulty imprinting, the mechanism seems to be clear (considering the role of receptors), the mechanism of drug-provoked imprinting is presently uncleared (considering the variety of medications which cause late-manifested alterations). The medicaments-caused faulty imprinting conception calls attention to the dangers of medication in the perinatal as well as the pubertal periods. Orv Hetil. 2020; 161(2): 43-49.


Assuntos
Disruptores Endócrinos/efeitos adversos , Impressão Genômica/efeitos dos fármacos , Hormônios/metabolismo , Sistema Endócrino , Feminino , Fertilização , Humanos , Gravidez , Efeitos Tardios da Exposição Pré-Natal/fisiopatologia
9.
Medicine (Baltimore) ; 99(1): e16791, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895764

RESUMO

The present study aimed to investigate the feasibility of vaginal delivery combined with vaginal tightening surgery and perineal body repair.From January 2017 to April 2017, 5 cases underwent vaginal delivery combined with vaginal tightening surgery and perineal body repair. We retrospectively analyzed the clinical data.The incisions of 5 cases were all primary healing; vulva form was improved, and there were no postoperative hematoma, infection or vaginal mucosa prolapse. Sexual function was improved to different degrees. The pelvic muscle force test showed that both the type I and type II myofiber scores were increased.It is feasible to perform vaginal delivery combined with vaginal tightening surgery and perineal body repair, which is a safe and effective method for improving sex life and pelvic floor function.


Assuntos
Parto Obstétrico/efeitos adversos , Vagina/cirurgia , Adulto , Feminino , Humanos , Lacerações/etiologia , Lacerações/cirurgia , Diafragma da Pelve/fisiopatologia , Diafragma da Pelve/cirurgia , Períneo/lesões , Períneo/cirurgia , Gravidez , Qualidade de Vida , Vagina/fisiopatologia , Vulva/cirurgia
10.
Medicine (Baltimore) ; 99(1): e18136, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895766

RESUMO

RATIONALE: Despite the fact that treatment of paraquat poisoning in pregnant women and their fetuses is challenging and raises ethical issues, it is rarely reported in the literature. We report the case of a pregnant woman who took paraquat intentionally. PATIENT CONCERNS: A 36-year-old woman at 38 weeks gestational age, in an apparent suicide attempt, drank 1 mouthful (about 20 ml) of paraquat solution. Ten hours later, her urine dithionate test showed light blue color with a plasma paraquat concentration of 0.547 µg/ml. Six hours after admission, a male infant, whose plasma paraquat concentration was 0.761 µg/ml, together with 0.673 µg/ml in the amniotic fluid measured by high-performance liquid chromatography, was delivered but the woman's lung, liver, and kidney function declined rapidly. DIAGNOSIS: INTERVENTIONS:: Because of placenta previa and multiple organ failure, emergency cesarean section, and panhysterectomy were performed for the pregnant woman. Intravenous injection of antibiotic to prevent infection and dexamethasone 30 mg once a day were administered. Mechanical ventilation was performed for the infant and meropenem and penicillin injection was administered. OUTCOMES: The infant died 33 hours after birth while the mother died on the 3rd day after ingestion. LESSONS: Paraquat can enter the fetus through the placenta and the amniotic fluid via fluid exchange. The pathological changes of fetal organs may relate to gestational age, and the prognosis was very poor in both the mother and the fetus.


Assuntos
Feto/efeitos dos fármacos , Herbicidas/envenenamento , Paraquat/envenenamento , Morte Perinatal , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Masculino , Morte Materna , Gravidez , Tentativa de Suicídio
11.
Medicine (Baltimore) ; 99(1): e18298, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895768

RESUMO

INTRODUCTION: Leptomeningeal dissemination due to HER2-overexpressing breast cancer is a rare and hard to treat complication with short-term dismal prognosis. PATIENT CONCERNS: A 34-year-old female previously treated because of HER2+ breast cancer is admitted to the Neurology Department in December 2016 due to sensory-motor neurological semiology. DIAGNOSIS: A wide set of diagnostic tests is performed and finally cytologic findings after repeated CSF confirm leptomeningeal infiltration by breast carcinoma (panCK+, GATA3+). INTERVENTIONS: Weekly intrathecal triple therapy with methotrexate, cytarabine and hydrocortisone plus trastuzumab is carried out during 4 months. OUTCOMES: Clinical and pathological response that lasts more than 24 months. CONCLUSION: Leptomeningeal carcinomatosis is an oncological situation where conventional therapies have limited activity. In HER2+ advanced breast cancer patients, intrathecal therapy with anti-HER2 therapy (trastuzumab) is feasible and may reach long-term disease control, especially in cases of low-tumor burden.


Assuntos
Antineoplásicos Imunológicos/uso terapêutico , Neoplasias da Mama/patologia , Carcinoma Ductal/patologia , Carcinomatose Meníngea/tratamento farmacológico , Carcinomatose Meníngea/secundário , Trastuzumab/uso terapêutico , Adulto , Neoplasias da Mama/tratamento farmacológico , Carcinoma Ductal/tratamento farmacológico , Feminino , Humanos , Carcinomatose Meníngea/patologia , Gravidez , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Complicações Neoplásicas na Gravidez/patologia , Receptor ErbB-2
12.
Medicine (Baltimore) ; 99(1): e18447, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895773

RESUMO

Prenatal examination is a pivotal measure to prevent high-risk pregnancy and to ensure the safety of both mother and infant. However, pregnant women in Linzhi Prefecture in the Tibet Autonomous Region (TAR) often cannot obtain regular prenatal examinations due to limited accessibility of healthcare facilities, shortage of medical staff, and lack of medical equipment. Health education is an important approach to solve this ever-growing issue of pregnant women in rural Tibet.To evaluate the efficacy of flexible methods of health education programs on improving compliance among pregnant women from Tibet, China.In May to November of 2018, a total of 168 pregnant women receiving prenatal examination in a tertiary referral hospital in Linzhi Prefecture were recruited and randomly assigned to a control (n = 85) and intervention group (n = 83). All pregnant women were followed up until delivery. The pregnant women in the control group received regular prenatal examination and health education programs. Other than receiving routine prenatal care, participants of the interventional group also voluntarily joined the WeChat Social Messaging platform. Online resources posted by the maternity schools provided convenience and flexibility for the pregnant woman. The number of prenatal examinations was statistically significant between the 2 groups. The effect of flexible patterns of health education programs on improving the compliance of pregnant women in Tibet was assessed.The number of prenatal examinations in the intervention group was 2.646 times, which was higher than that in the control group (P < .01). Multivariate analysis demonstrated that interventional measures and ethnicity were the influencing factors of the number of prenatal examinations for pregnant women in Linzhi after the adjustment of age, history of adverse pregnancy, education level, ethnicity, multiparity, gestational complications, and medical history. The number of prenatal examinations for the pregnant Tibetan women was 0.535 times lower compared with that of the pregnant Han women (95% CI: -0.089, 1.157, P = .091).Flexible forms of health education during the antenatal period can effectively increase the compliance of pregnant women in Tibet.


Assuntos
Educação em Saúde/métodos , Cooperação do Paciente , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Feminino , Humanos , Gravidez , Rede Social , Tibet
13.
Medicine (Baltimore) ; 99(1): e18489, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895782

RESUMO

BACKGROUND: In a multitude of previous studies, Chlamydia trachomatis (CT) plays an important role in the occurrence of ectopic pregnancy (EP). However, the predictive value of CT infections in the occurrence of EP has not been estimated worldwide. We thus evaluated, by means of a meta-analysis, the current status of the association between CT infections with EP and the potential predictive value of CT infections in EP. METHODS: We evaluated studies performed between the database construction time and August 2018 published in PubMed, the Cochrane Library, EMBASE, and the Web of Science (SCI). The relationship between CT and EP was calculated based upon the predetermined entry criteria for control group selection and the original data. The related articles were analyzed using a random-effects model, and the heterogeneity of the studies was assessed using the I index. Data were analyzed with the STATA 12.0 software. RESULTS: Twenty-five studies that recruited 11960 patients were included in the present meta-analysis, and the relation of CT infections with EP were assessed. The association between CT infections and EP risk showed an odds ratio (OR) of 3.03, with a 95% confidence interval (CI) of 2.37 to 3.89. Our results showed that there was a statistically significant difference between the intervention and control groups. The prevalence of CT infections in EP was then calculated by a subgroup analysis: African (OR, 2.22; 95% CI, 1.14-4.31), European (OR, 3.16; 95% CI, 2.10-4.47), North American (OR, 3.07; 95% CI, 1.78-5.31), and Asian (OR, 3.39; 95% CI, 1.95-5.90). CONCLUSIONS: From the results of numerous studies conducted on different continents, this meta-analysis showed a clear association between EP and prior CT infections, that is, CT infections increase the risk of EP occurrence.


Assuntos
Infecções por Chlamydia/epidemiologia , Gravidez Ectópica/epidemiologia , Adulto , Chlamydia trachomatis , Feminino , Humanos , Razão de Chances , Gravidez , Gravidez Ectópica/etiologia , Prevalência , Fatores de Risco , Sensibilidade e Especificidade
14.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 21-36, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914565

RESUMO

Influenza virus infection is a respiratory infectious disease. The World Health Organization (WHO) estimated that seasonal influenza epidemics have caused an annual 3 to 5 million severe cases, and 290 000 to 650 000 deaths globally. Seasonal influenza vaccination is the most effective way to prevent influenza virus infection and complications from infection. Currently, China has licensed trivalent inactivated influenza vaccine (IIV3) and quadrivalent inactivated influenza vaccine (IIV4). In 2018, the Chinese Center for Disease Control and Prevention issued the "Technical Guidelines for Seasonal Influenza Vaccination in China (2018-2019)" ( "Guide 2018" for short). To strengthen the technical guidance for prevention and control of influenza and operational research on influenza vaccination in China, the National Immunization Advisory Committee (NIAC) Influenza Vaccination Technical Working Group (TWG), updated the 2018 technical guidelines and compiled the "Technical guidelines for seasonal influenza vaccination in China (2019-2020)" . The main updates in this version include the following: First, new research evidences especially studies of China, including disease burden, effectiveness, Vaccine-avoidable disease burden, vaccine safety monitoring, and cost-effectiveness and cost-benefit. Second, policies and measures for influenza prevention and control issued by National Health Commission (PRC) in the past year. Thirdly, new type seasonal influenza vaccine licensed and issued in 2019-2020 in China. Fourth, northern hemisphere influenza vaccination composition for the 2019-2020 season which included trivalent and quadrivalent influenza vaccine. The recommendations described in this report include the following: Points of Vaccination clinics (PoVs) should provide influenza vaccination to all persons aged 6 months and above who are willing to be vaccinated and do not have contraindications. No preferential recommendation is made for one influenza vaccine product over another for persons for whom more than one licensed, recommended, and appropriate product is available. To decrease the risk of severe infections and complications due to influenza virus infection among high risk groups, the recommendations prioritize seasonal influenza vaccination for children aged 6-59 months, adults ≥60 years of age, persons with specific chronic diseases, healthcare workers, the family members and caregivers of infants <6 months of age, and pregnant women or women who plan to become pregnant during the influenza season. Children aged 6 months through 8 years require 2 doses of influenza vaccine administered a minimum of 4 weeks apart during their first season of vaccination for optimal protection. If they were vaccinated in 2018-2019 influenza season or a prior season, 1 dose is recommended. People more than 8 years old require 1 dose of influenza vaccine. It is recommended that people receive their influenza vaccination by the end of October. Influenza vaccination should be offered as soon as the vaccination is available. For the people unable to be vaccinated before the end of October, influenza vaccination will continue to be offered for the whole season. Influenza vaccine is also recommended for use in pregnant women during any trimester. These guidelines are intended for use by staff members of the Centers for Disease Control and Prevention at all levels who work on influenza control and prevention, PoVs staff members, healthcare workers from the departments of pediatrics, internal medicine, and infectious diseases, and staff members of maternity and child care institutions at all levels. These guidelines will be updated periodically as new evidence becomes available.


Assuntos
Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Vacinação/normas , Adolescente , Adulto , Criança , Pré-Escolar , China , Feminino , Humanos , Esquemas de Imunização , Lactente , Pessoa de Meia-Idade , Gravidez , Estações do Ano , Adulto Jovem
17.
MMWR Morb Mortal Wkly Rep ; 69(1): 1-5, 2020 Jan 10.
Artigo em Inglês | MEDLINE | ID: mdl-31917782

RESUMO

In May 2018, a study of birth defects in infants born to women with diagnosed human immunodeficiency virus (HIV) infection in Botswana reported an eightfold increased risk for neural tube defects (NTDs) among births with periconceptional exposure to antiretroviral therapy (ART) that included the integrase inhibitor dolutegravir (DTG) compared with other ART regimens (1). The World Health Organization* (WHO) and the U.S. Department of Health and Human Services† (HHS) promptly issued interim guidance limiting the initiation of DTG during early pregnancy and in women of childbearing age with HIV who desire pregnancy or are sexually active and not using effective contraception. On the basis of additional data, WHO now recommends DTG as a preferred treatment option for all populations, including women of childbearing age and pregnant women. Similarly, the U.S. recommendations currently state that DTG is a preferred antiretroviral drug throughout pregnancy (with provider-patient counseling) and as an alternative antiretroviral drug in women who are trying to conceive.§ Since 1981 and 1994, CDC has supported separate surveillance programs for HIV/acquired immunodeficiency syndrome (AIDS) (2) and birth defects (3) in state health departments. These two surveillance programs can inform public health programs and policy, linkage to care, and research activities. Because birth defects surveillance programs do not collect HIV status, and HIV surveillance programs do not routinely collect data on occurrence of birth defects, the related data have not been used by CDC to characterize birth defects in births to women with HIV. Data from these two programs were linked to estimate overall prevalence of NTDs and prevalence of NTDs in HIV-exposed pregnancies during 2013-2017 for 15 participating jurisdictions. Prevalence of NTDs in pregnancies among women with diagnosed HIV infection was 7.0 per 10,000 live births, similar to that among the general population in these 15 jurisdictions, and the U.S. estimate based on data from 24 states. Successful linking of data from birth defects and HIV/AIDS surveillance programs for pregnancies among women with diagnosed HIV infection suggests that similar data linkages might be used to characterize possible associations between maternal diseases or maternal use of medications, such as integrase strand transfer inhibitors used to manage HIV, and pregnancy outcomes. Although no difference in NTD prevalence in HIV-exposed pregnancies was found, data on the use of integrase strand transfer inhibitors in pregnancy are needed to understand the safety and risks of these drugs during pregnancy.


Assuntos
Infecções por HIV/diagnóstico , Defeitos do Tubo Neural/epidemiologia , Complicações Infecciosas na Gravidez/diagnóstico , Adolescente , Adulto , Antirretrovirais/efeitos adversos , Antirretrovirais/uso terapêutico , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Recém-Nascido , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Estados Unidos/epidemiologia , Adulto Jovem
18.
N C Med J ; 81(1): 5-13, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908325

RESUMO

BACKGROUND In 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program to provide 5 local health departments (LHDs) with financial resources and technical assistance to address 3 aims: improve birth outcomes, reduce infant mortality, and improve health for children from birth to 5 years.METHOD: State legislation established an academic-practice partnership between NCDPH and the University of North Carolina at Chapel Hill (UNC) to provide program evaluation and implementation coaching to LHDs. ICO4MCH used a collective impact framework, principles of implementation science, and a health equity approach to implement evidence-based strategies to address the program's aims.RESULTS: A shared measurement system was developed by an evaluation stakeholders group led by the NCDPH and UNC in which LHDs reported data on a quarterly basis and the evaluators returned reports to drive improvements. Structured assessments and technical assistance provided by implementation coaches helped grantees address barriers to implementation including cultivating and sustaining a diverse community action team, addressing staff turnover, and using data to drive improvements.LIMITATIONS: It was challenging for grantees to balance community needs and build partnerships in the first year while integrating data from multiple assessments into action plans to meet the performance measures. It was necessary to streamline assessments and reduce indicators to make data more actionable.CONCLUSION: An academic-practice partnership was integral to successful implementation of the ICO4MCH program and may serve as a model for moving evidence-based maternal child health programs to practice in LHDs.


Assuntos
Saúde da Criança , Promoção da Saúde/organização & administração , Relações Interinstitucionais , Saúde Materna , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , North Carolina , Gravidez , Avaliação de Programas e Projetos de Saúde
19.
N C Med J ; 81(1): 14-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908326

RESUMO

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Doença Relacionada a Viagens , Infecção por Zika virus/etnologia , Estudos Transversais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , North Carolina , Gravidez , Fatores de Risco , Serviços de Saúde Rural
20.
N C Med J ; 81(1): 24-27, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908328

RESUMO

In working to improve the health of North Carolinians, a critical focus starts with our mothers and infants and their surrounding communities. North Carolina's perinatal outcomes, as evidenced by maternal morbidity and mortality, infant mortality, preterm births, and the larger context of lifelong physical and mental health of our citizens, offer areas for improvement and policy implications. In addition, the unacceptable disparities that remain despite some overall improvement in outcomes warrant full attention. This issue of the NCMJ highlights the state of perinatal health in North Carolina; the importance of a risk-appropriate perinatal system of care; the opportunities for supporting our parents, children, and families; and how we as a state and as a community can come together to improve the safety and experience of giving birth in North Carolina and beyond.


Assuntos
Saúde do Lactente/estatística & dados numéricos , Saúde Materna/estatística & dados numéricos , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Recém-Nascido , Mortalidade Materna/tendências , North Carolina/epidemiologia , Gravidez , Nascimento Prematuro/epidemiologia
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