The role of health systems and policy in producing behavior and social change to enhance child survival and development in low- and middle-income countries: an examination of the evidence.

Evidence-based behavior change interventions addressing health systems must be identified and disseminated to improve child health outcomes. Studies of the efficacy of such interventions were identified from systematic searches of the published literature. Two hundred twenty-nine of the initially identified references were judged to be relevant and were further reviewed for the quality and strength of the evidence. Studies were eligible if an intervention addressed policy or health systems interventions, measured relevant behavioral or health outcomes (e.g., nutrition, childhood immunization, malaria prevention and treatment), used at least a moderate quality research design, and were implemented in low- or middle-income countries. Policy or systems interventions able to produce behavior change reviewed included media (e.g., mass media, social media), community mobilization, educational programs (for caregivers, communities, or providers), social marketing, opinion leadership, economic incentives (for both caregiver and provider), health systems strengthening/policy/legislation, and others. Recommendations for policy, practice, and research are given based on fairly strong data across the areas of health service delivery, health workforce, health financing, governance and leadership, and research.

What risk do Brucella vaccines pose to humans? A systematic review of the scientific literature on occupational exposure.

BACKGROUND: Currently, vaccination of livestock with attenuated strains of Brucella remains an essential measure for controlling brucellosis, although these vaccines may be dangerous to humans. The aim of this study was to review the risk posed to humans by occupational exposure to vaccine strains and the measures that should be implemented to minimize this risk. METHODS: This article reviewed the scientific literature indexed in PubMed up to September 30, 2023, following "the PRISMA guidelines". Special emphasis was placed on the vaccine strain used and the route of exposure. Non-occupational exposure to vaccine strains, intentional human inoculation, publications on exposure to wild strains, and secondary scientific sources were excluded from the study. RESULTS: Nineteen primary reports were found and classified in three subgroups: safety accidents in vaccine factories that led to an outbreak (n = 2), survellaince studies on vaccine manufacturing workers with a serologic diagnosis of Brucella infection (n = 3), and publications of infection by vaccine strains during their administration, including case reports, records of occupational accidents and investigations of outbreaks in vaccination campaigns (n = 14). Although accidental exposure during vaccine manufacturing were uncommon, they could provoke large outbreaks through airborne spread with risk of spread to the neighboring population. Besides, despite strict protection measures, a percentage of vaccine manufacturing workers developed positive Brucella serology without clinical infection. The most frequent type of exposure with symptomatic infection was needle injury during vaccine administration. Prolonged contact with the pathogen, lack of information and a low adherence to personal protective equipment (PPE) use in the work environment were commonly associated with infection. CONCLUSIONS: Brucella vaccines pose occupational risk of contagion to humans from their production to their administration to livestock, although morbidity is low and deaths were not reported. Recommended protective measures and active surveillance of exposed workers appeared to reduce this risk. It would be advisable to carry out observational studies and/or systematic registries using solid diagnostic criteria.

Real-world effectiveness and safety of erenumab for the treatment of migraine: A systematic review and meta-analysis.

BACKGROUND: Migraine is a common and disabling primary headache disorder. Several drugs targeting calcitonin gene-related peptide (CGRP), such as erenumab (an anti-CGRP receptor mAb), have been developed recently. However, the real-world effects of erenumab are not well understood. OBJECTIVE: To assess the clinical effectiveness and safety of erenumab for reducing migraine intensity and frequency in the real world. METHODS: A systematic search of PubMed, Scopus, Web of Science and the Cochrane Library was conducted from inception to December 2023. Studies estimating the real-world effect of erenumab on monthly migraine days (MMD), monthly headache days (MHD), headache impact test (HIT-6), number of days in medication (NDM), acute monthly intake (AMI), pain intensity (PI) and safety outcomes were included. Meta-analyses of proportions or mean differences were performed. RESULTS: Fifty-three studies were included. At 3-months, the effect was -7.18 days for MMD, -6.89 days for MHD, -6.97 for HIT-6, -6.22 days for NDM, -15.75 for AMI, and -1.71 for PI. Generally, the effect at 6- and 12-months increased slightly and gradually. The MMD/MHD response rates revealed that approximately one-third of patients exhibited a response greater than 30%, while one-sixth demonstrated a response exceeding 50%. Additionally, 3-4% of patients achieved a response rate of 100%. Adverse event rates were 0.34 and 0.43 at 6- and 12-months, respectively. CONCLUSION: This study provides strong evidence of the effectiveness and safety of erenumab in the real world; to our knowledge, this is the first real-world meta-analysis specific to erenumab. Erenumab represents a solid therapeutic option for physicians.

Feasibility of using KardiaMobile-L6 for QT interval monitoring during the early phase of the COVID-19 pandemic in critical care patients.

The electrocardiogram (ECG) represents an essential tool to determine cardiac electrical abnormalities in COVID-19 patients, the effects of anti-SARS-CoV-2 drugs, and potential drug interactions. Smartphone-based heart monitors have increased the spectrum of ECG monitoring however, we are not aware of its reliability in critically ill COVID-19 patients. We aim to evaluate the feasibility and reliability of nurse-performed smartphone electrocardiography for QT interval monitoring in critically ill COVID-19 patients using KardiaMobile-6L compared with the standard 12-lead ECG. An observational comparative study was conducted comparing consecutive KardiaMobile-6L and 12-lead ECG recordings obtained from 20 patients admitted to the intensive care unit with SARS-CoV-2 infection and on invasive mechanical ventilation. The heart rate-corrected QT (QTc) intervals measured by KardiaMobile-6L and 12-lead ECG were compared. In 60 percent of the recordings, QTc intervals measured by KardiaMobile-6L matched those by 12-lead ECG. The QTc intervals measured by KardiaMobile-6 and 12-lead ECG were 428 ± 45 ms and 425 ± 35 ms (p = 0.82), respectively. The former demonstrated good agreement (bias = 2.9 ms; standard deviation of bias = 29.6 ms) with the latter, using the Bland-Altman method of measurement agreement. In all but one recording, KardiaMobile-6L demonstrated QTc prolongation. QTc interval monitoring with KardiaMobile-6L in critically ill COVID-19 patients was feasible and demonstrated reliability comparable to the standard 12-lead ECG.

A new acquisition protocol for conducting studies with children: The science camp research experience.

In the last 50 years, the study of brain development has brought major discoveries to education and medicine, changing the lives of millions of children and families. However, collecting behavioral and neurophysiological data from children has specific challenges, such as high rates of data loss and participant dropout. We have developed a science camp method to collect data from children using the benefits of positive peer interactions and interactive and engaging activities, to allow researchers to better collect data repeatedly and reliably from groups of children. A key advantage of this approach is that by increasing participant engagement, attention is also increased, thereby increasing data quality, reducing data loss, and lowering attrition rates. This protocol describes the step-by-step procedure for facilitation of a science camp, including behavioral, electrophysiological, and participatory engagement activities. As this method is robust but also flexible, we anticipate that it can also be applied to different demographics and research needs.

Atypical Associations between Functional Connectivity during Pragmatic and Semantic Language Processing and Cognitive Abilities in Children with Autism.

Autism Spectrum Disorder (ASD) is characterized by both atypical functional brain connectivity and cognitive challenges across multiple cognitive domains. The relationship between task-dependent brain connectivity and cognitive abilities, however, remains poorly understood. In this study, children with ASD and their typically developing (TD) peers engaged in semantic and pragmatic language tasks while their task-dependent brain connectivity was mapped and compared. A multivariate statistical approach revealed associations between connectivity and psychometric assessments of relevant cognitive abilities. While both groups exhibited brain-behavior correlations, the nature of these associations diverged, particularly in the directionality of overall correlations across various psychometric categories. Specifically, greater disparities in functional connectivity between the groups were linked to larger differences in Autism Questionnaire, BRIEF, MSCS, and SRS-2 scores but smaller differences in WASI, pragmatic language, and Theory of Mind scores. Our findings suggest that children with ASD utilize distinct neural communication patterns for language processing. Although networks recruited by children with ASD may appear less efficient than those typically engaged, they could serve as compensatory mechanisms for potential disruptions in conventional brain networks.

Children with autism spectrum disorder show atypical electroencephalographic response to processing contextual incongruencies.

Children with autism spectrum disorder (ASD) experience difficulties with social communication, making it challenging to interpret contextual information that aids in accurately interpreting language. To investigate how the brain processes the contextual information and how this is different in ASD, we compared event-related potentials (ERPs) in response to processing visual and auditory congruent and incongruent information. Two groups of children participated in the study: 37 typically developing children and 15 children with ASD (age range = 6 to 12). We applied a language task involving auditory sentences describing congruent or incongruent images. We investigated two ERP components associated with language processing: the N400 and P600. Our results showed how children with ASD present significant differences in their neural responses in comparison with the TD group, even when their reaction times and correct trials are not significantly different from the TD group.

Developmental Differences in Neuromagnetic Cortical Activation and Phase Synchrony Elicited by Scenes with Faces during Movie Watching.

The neural underpinnings of humans' ability to process faces and how it changes over typical development have been extensively studied using paradigms where face stimuli are oversimplified, isolated, and decontextualized. The prevalence of this approach, however, has resulted in limited knowledge of face processing in ecologically valid situations, in which faces are accompanied by contextual information at multiple time scales. In the present study, we use a naturalistic movie paradigm to investigate how neuromagnetic activation and phase synchronization elicited by faces from movie scenes in humans differ between children and adults. We used MEG data from 22 adults (6 females, 3 left handed; mean age, 27.7 ± 5.28 years) and 20 children (7 females, 1 left handed; mean age, 9.5 ± 1.52 years) collected during movie viewing. We investigated neuromagnetic time-locked activation and phase synchronization elicited by movie scenes containing faces in contrast to other movie scenes. Statistical differences between groups were tested using a multivariate data-driven approach. Our results revealed lower face-elicited activation and theta/alpha phase synchrony between 120 and 330 ms in children compared with adults. Reduced connectivity in children was observed between the primary visual areas as well as their connections with higher-order frontal and parietal cortical areas. This is the first study to map neuromagnetic developmental changes in face processing in a time-locked manner using a naturalistic movie paradigm. It supports and extends the existing evidence of core face-processing network maturation accompanied by the development of an extended system of higher-order cortical areas engaged in face processing.

The Safety and Efficacy of Calcitonin Gene-Related Peptide (CGRP) Monoclonal Antibodies for the Preventive Treatment of Migraine: A Protocol for Multiple-Treatment Systematic Review and Meta-Analysis.

BACKGROUND: Migraine is a common and disabling primary headache disorder, associated with many medical comorbidities, highly prevalent, with complex treatment and management. Currently, monoclonal antibodies targeting the trigeminal sensory neuropeptide, calcitonin gene-related peptide (CGRP), are available. The aim of this protocol is to provide a review comparing the effects and safety profile of different monoclonal antibodies in migraine patients. METHODS: The literature search will be performed through the MEDLINE, Embase, CENTRAL, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP), Web of Science and Scopus databases, following the PICO strategy. Real World studies and randomized clinical trials assessing the effect of monoclonal antibodies against CGRP interventions (erenumab, eptinezumab, fremanezumab and galcanezumab) on monthly migraine days (MMD), monthly headache days (MHD), headache impact test (HIT-6) and triptan days of use (TriD) will be included. In Real World studies, the DerSimonian and Laird method will be used to calculate pooled estimates of the mean change difference and in randomized clinical trials, a network meta-analysis will be performed to estimate the comparative effects of different monoclonal antibodies against CGRP. RESULTS: The findings of this study will be reported in a peer-reviewed journal. CONCLUSIONS: This study will provide evidence to health professionals on the efficacy and safety of different monoclonal antibodies against CGRP on the outcomes studied.

CDH1 and SNAI1 are regulated by E7 from human papillomavirus types 16 and 18.

A common characteristic of cancer types associated with viruses is the dysregulated expression of the CDH1 gene, which encodes E­cadherin, in general by activation of DNA methyltransferases (Dnmts). In cervical cancer, E7 protein from high risk human papillomaviruses (HPVs) has been demonstrated to interact with Dnmt1 and histone deacetylase type 1 (HDAC1). The present study proposed that E7 may regulate the expression of CDH1 through two pathways: i) Epigenetic, including DNA methylation; and ii) Epigenetic­independent, including the induction of negative regulators of CDH1 expression, such as Snail family transcriptional repressor Snai1 and Snai2. To test this hypothesis, HPV16­ and HPV18­positive cell lines were used to determine the methylation pattern of the CDH1 promoter and its expression in association with its negative regulators. Different methylation frequencies were identified in the CDH1 promoter in HeLa (88.24%) compared with SiHa (17.65%) and Ca Ski (0%) cell lines. Significant differences in the expression of SNAI1 were observed between these cell lines, and an inverse association was identified between the expression levels of SNAI1 and CDH1. In addition, suppressing E7 not only increased the expression of CDH1, but notably decreased the expression of SNAI1 and modified the methylation pattern of the CDH1 promoter. These results suggested that the expression of CDH1 was dependent on the expression of SNAI1 and was inversely associated with the expression of E7. The present results indicated that E7 from HPV16/18 regulated the expression of CDH1 by the two following pathways in which Snai1 is involved: i) Hypermethylation of the CDH1 promoter region and increasing expression of SNAI1, as observed in HeLa; and ii) Hypomethylation of the CDH1 promoter region and expression of SNAI1, as observed in SiHa. Therefore, the suppression of CDH1 and expression of SNAI1 may be considered to be biomarkers of metastasis in uterine cervical cancer.

Detection, treatment and prevention programs for gestational diabetes mellitus: The St Carlos experience.

Gestational diabetes mellitus (GDM) increases the risk of adverse events in pregnancy and jeopardizes long-term health of the mother and offspring. There is currently no consensus as to what screening strategies improve the efficiency of GDM diagnosis. Which criteria should be used? Is the one-step or two-step procedure better? There is no agreement as to what the best dietary approach in the treatment of GDM is. In addition, different nutritional interventions have been studied in the prevention of GDM. The Mediterranean diet seems to be effective in preventing GDM and other maternofoetal outcomes. We review herein our experience using the one-step criteria for GDM screening; the treatment and prevention strategies used; and the overall impact of nutrition on maternofoetal health.

Reduction of periprosthetic Staphylococcus aureus infection by preoperative screening and decolonization of nasal carriers undergoing total knee arthroplasty.

OBJECTIVE: The aim of this study was to evaluate whether the establishment of a preoperative screening and decolonization protocol for Staphylococcus aureus carriers undergoing total knee arthroplasty (TKA) could decrease the incidence of periprosthetic joint infection (PJI) caused by this microorganism. METHODS: We conducted a retrospective study comparing a control group comprising 400 patients (134 men, and 266 women; mean age: 72.2 ± 6.8 years) who went through surgery between January 2009 and December 2013, with a second intervention group of 403 patients (125 men, and 278 women; mean age: 72.4 ± 6.9 years) in which the protocol of screening and decolonization of S. aureus nasal carriers was applied between January 2014 and December 2016. During this latter period patients were preoperatively screened and, if positive, treated with mupirocin nasal ointment and chlorhexidine soap, for 5 days prior to surgery. RESULTS: In the control group, 17 of 400 patients (4.2%) had a SSI, 8 (2%) of them caused by S. aureus and 9 (2.2%) by other microorganisms. In the intervention group 20.6% of patients had a positive S. aureus nasal swab and were treated according to the protocol. 5 of 403 patients (1.2%) in this group had a SSI, 1 (0.2%) due to S. aureus and 4 (1%) to other microorganisms. When comparing surgical-site infection (SSI) rates between the two groups, we found a statistically significant reduction in both global SSI (p = 0.009) and specifically S. aureus SSI (p = 0.02), in the intervention group. No decolonized S. aureus nasal carrier presented a SSI. DISCUSSION: In patients undergoing TKA a preoperative screening and decolonization protocol for S. aureus nasal carriers, using mupirocin nasal ointment and chlorhexidine soap, is an effective measure to reduce the rate of SSI caused by this microorganism. LEVEL OF EVIDENCE: Level III; Therapeutic Study.

Psychometric properties of the Brief Symptoms Inventory-18 (Bsi-18) in a Spanish sample of outpatients with psychiatric disorders.

This study analyzes the psychometric and structural properties of the BSI-18 in a sample of Spanish outpatients with psychiatric disorders (N = 200), with three basic objectives: (a) to study the structural validity of the instrument; (b) to analyse reliability (internal consistency and test-retest stability) and validity (convergent and discriminant) of the instrument, and (c) to evaluate sensitivity to change in a therapeutic context. Using confirmatory factor analysis, two models were tested: the three-dimensional theoretical model proposed by its authors, and the empirical four-factor model obtained by the same authors through exploratory factor analysis. Our results showed that the best structure was a four-dimensional model, with the General Distress index and Somatization, Depression, General Anxiety and Panic scores. These four scales showed good internal consistency, test-retest reliability, validity and sensitivity to therapeutic change. The BSI-18 has been shown to be a reliable and useful tool for psychiatric assessment of patients, with the added advantage provided by its simplicity and ease of application.

[The implementation process of a new model of intensive rehabilitation in a hospital setting: the development of an innovative practice within the context of integration of settings, services and treatment models]. / Le processus d'implantation d'un nouveau modèle de réhabilitation intensive en milieu hospitalier: le développement d'une pratique novatrice dans le contexte de l'intégration des milieux, des services, et des modèles de soins.

This article describes the process of implementation of an internal intensive rehabilitation program at Douglas hospital for people with severe mental disorders. A discussion of contemporary paradigms of rehabilitation implies the integration of biological and psychosocial perspectives in the characterization and treatment of the pathology. The discussion of the reorganization of the entire rehabilitation services of the Program for severe mental disorders leads to specifying the organizational and regional context of the implementation. The axes of implementation in priority are the following : analysis of needs, training, reorganization of work and modification of the setting of care. These activities are implemented in reference to scientific developments that are empirically relevant and assessed regularly. Future challenges include the pursuit of integration of treatment models, of settings and services within the context of the hierarchy of mental health care in Québec.

Effects of storage on vis-NIR-SWIR reflectance spectra of Mombasa grass leaf samples / Efeitos do armazenamento no espectro de reflectância vis-NIR-SWIR de amostras foliares de capim Mombaça

ABSTRACT: Vis-NIR-SWIR reflectance spectra of leaf samples, collected in the laboratory, allow the calibration of predictive models to quantify their physicochemical attributes in a practical manner and without producing chemical residues. This technique should enable the development of management strategies for intensification of pasture use. However, spectral analysis performed in the laboratory may be affected by the deterioration of plant material during transport from the field to the lab, so storage methods are necessary. This research aimed to evaluate the effects of different storage methods on the spectral response of Mombasa grass leaves. Three methods were evaluated: (i) artificially refrigerated environment, (ii) humid environment, and (iii) without microenvironment control. These methods were tested in five different storage times: 2 hours, 4 hours, 8 hours, 24 hours and 48 hours. The spectral behavior of the leaves still inserted in the plant was used as a quality reference. Results showed notable changes at the earliest storage time for the treatment without microenvironment control. Both methods with microenvironment control stabilized the occurrence of spectral changes over 48 hours of the samples storage, thus both were suggested for this species.

RESUMO: Espectros de reflectância vis-NIR-SWIR de amostras foliares, coletados em laboratório, permitem a calibração de modelos preditivos para quantificação de seus atributos físico-químicos de maneira prática e sem produção de resíduos químicos. Esta técnica permite o desenvolvimento de estratégias de manejo para a intensificação do uso de pastagens. Contudo, análises espectrais realizadas em laboratório podem ser afetadas pela deterioração do material vegetal durante o transporte do campo ao laboratório, fazendo-se necessário a utilização de métodos de armazenamento. O presente trabalho objetivou avaliar o efeito de diferentes métodos de armazenamento na resposta espectral de folhas de capim Mombaça. Avaliou-se três métodos: (i) ambiente refrigerado artificialmente; (ii) ambiente úmido; e (iii) ao ar livre, sem controle do microambiente; assim como, cinco diferentes tempos de armazenamento: 2 horas, 4 horas, 8 horas, 24 horas e 48 horas. O comportamento espectral das folhas ainda inseridas na planta foi utilizado como referência de qualidade. Os resultados mostraram alterações pronunciadas para o armazenamento ao ar livre já nos primeiros intervalos de tempo. Ambos métodos com controle de microambiente permitiram estabilizar a ocorrência de alterações espectrais ao longo das 48h de armazenamento das amostras, sendo ambos sugeridos para esta espécie.

Highly sensitive detection of Pseudomonas savastanoi pv. savastanoi in asymptomatic olive plants by nested-PCR in a single closed tube.

A nested-polymerase chain reaction (PCR) has been set up to be performed in a single closed tube for the detection of Pseudomonas savastanoi pv. savastanoi. Nested-PCR coupled with dot-blot hybridization was able to detect up to one cell of the target per ml of olive extract, showing the greatest sensitivity compared with all previously reported detection assays. Validation of the developed procedure for diagnosis and epidemiological purposes was achieved by testing ca. 240 asymptomatic plant samples from olive trees. When performing the other previously reported techniques (bacterial isolation and single PCR), P. savastanoi was detected in 50 of the analyzed samples, while with the new developed nested-PCR assay, the bacterium was detected in 82 samples.

Conditions facilitating knowledge exchange between rehabilitation and research teams--a study.

This paper describes an experience in the exchange of information between researchers and practitioners, where conditions favorable to knowledge exchange were systematically documented. Conditions related to the organization proved to be the most determining, as did the quality and intensity of communication between the actors. This communication process is enhanced by characteristics related to practitioners and researchers. However, the well-established boundaries between the practitioners and the researchers, fueled by distinctive rules of practice, remain a major issue. Knowledge brokerage, effective reporting skills, and adapted, well-focused feedback could help to bring together the researchers and their partners.