RESUMEN
Toxoplasma gondii is a parasitic infection that can be transmitted in utero, resulting in fetal chorioretinitis and other long-term neurological outcomes. If diagnosed early, pregnancy-safe chemotherapeutics can prevent vertical transmission. Unfortunately, diagnosis of acute, primary infection among pregnant women remains neglected, particularly in low-and-middle-income countries. Clinically actionable diagnosis is complex due to the commonality of infection during childhood and early adulthood which spawn long-last antibody titers and historically unreliable direct molecular diagnostics. The current study employed a cross-sectional T. gondii perinatal surveillance study using digital PCR, a next generation molecular diagnostic platform, and a maternal-fetal outcomes survey to ascertain the risk of vertical toxoplasmosis transmission in the Western Region of El Salvador. Of 198 enrolled mothers at the time of childbirth, 6.6% had evidence of recent T. gondii infection-85% of these cases were identified using digital PCR. Neonates born to these acutely infected mothers were significantly more likely to meconium aspiration syndrome and mothers were more likely to experience labor and delivery complications. Multivariable logistic regression found higher maternal T. gondii infection odds were associated with the presence of pet cats, the definitive T. gondii host. In closing, this study provides evidence of maternal T. gondii infection, vertical transmission and deleterious fetal outcomes in a vulnerable population near the El Salvador-Guatemala border. Further, this is the first published study to show clinical utility potential of digital PCR for accurate diagnosis of congenital toxoplasmosis cases.
Asunto(s)
Transmisión Vertical de Enfermedad Infecciosa , Reacción en Cadena de la Polimerasa , Toxoplasma , Toxoplasmosis , Humanos , Estudios Transversales , Femenino , El Salvador/epidemiología , Embarazo , Toxoplasma/genética , Toxoplasma/inmunología , Toxoplasma/aislamiento & purificación , Adulto , Recién Nacido , Reacción en Cadena de la Polimerasa/métodos , Toxoplasmosis/diagnóstico , Toxoplasmosis/epidemiología , Toxoplasmosis/transmisión , Toxoplasmosis/parasitología , Adulto Joven , Gatos , Complicaciones Parasitarias del Embarazo/diagnóstico , Complicaciones Parasitarias del Embarazo/epidemiología , Complicaciones Parasitarias del Embarazo/parasitología , Animales , Toxoplasmosis Congénita/diagnóstico , Toxoplasmosis Congénita/epidemiología , MasculinoRESUMEN
Congenital Chagas disease is a growing concern, prioritized by the World Health Organization for public health action. El Salvador is home to some of the highest Chagas disease (Trypanosoma cruzi infection) burdens in the Americas, yet pregnancy screening remains neglected. This pilot investigation performed a maternal T. cruzi surveillance study in Western El Salvador among women presenting for labor and delivery. From 198 consented and enrolled pregnant women, 6% were T. cruzi positive by serology or molecular diagnosis. Half of the infants born to T. cruzi-positive women were admitted to the NICU for neonatal complications. Geospatial statistical clustering of cases was noted in the municipality of Jujutla. Older women and those knowing an infected relative or close friend were significantly more likely to test positive for T. cruzi infection at the time of parturition. In closing, maternal T. cruzi infections were significantly higher than national HIV or syphilis maternal rates, creating an urgent need to add T. cruzi to mandatory pregnancy screening programs.
RESUMEN
Neglected bacterial zoonoses are a group of Neglected Tropical Diseases (NTDs) that are commonly underdiagnosed and underreported due to their undifferentiated febrile illness symptomology. Spotted fever group rickettsioses (SFGR), a subset of tick-borne bacterial zoonoses, belong in this group. There is a dichotomy in the reporting and recognition of these pathogens in Central America: countries with reduced human development scores-like El Salvador-have little to no research or surveillance dedicated to these pathogens and the diseases they cause. This was the third-ever tick survey in El Salvador, highlighting the knowledge gap in this country. A total of 253 ticks were collected from 11 animals at two farm sites and one veterinary office. Standard and quantitative PCR were used to detect presence of SFGR, Ehrlichia, and Anaplasma sp. pathogens in ticks. Ehrlichia sp. were detected in 2.4% of all collected ticks and Anaplasma sp. were detected in 5.5% of all ticks. Rickettsia rickettsii was amplified in 18.2% of ticks, and amplicons similar to R. parkeri, and R. felis were found in 0.8% and 0.4%, of collected ticks, respectively. This is the first report of these pathogenic bacterial species in El Salvador. This study emphasizes the need for further surveillance and research including incorporating additional human seroprevalence and testing to understand the public health burden in this country.
Asunto(s)
Rickettsia , Enfermedades por Picaduras de Garrapatas , Garrapatas , Animales , Humanos , Rickettsia/genética , Ehrlichia/genética , Garrapatas/microbiología , Anaplasma/genética , Zoonosis Bacterianas , El Salvador , Estudios Seroepidemiológicos , Enfermedades por Picaduras de Garrapatas/epidemiologíaRESUMEN
BACKGROUND: Malaria elimination in Brazil poses several challenges, including the control of Plasmodium falciparum foci and the hidden burden of Plasmodium vivax in pregnancy. Maternal malaria and fetal health outcomes were investigated with a perinatal surveillance study in the municipality of Cruzeiro do Sul, Acre state, Brazilian Amazon. The research questions are: what are the causal effects of low birth weight on low Apgar at 5-min and of perinatal anaemia on stillbirth? METHODS: From November 2018 to October 2019, pregnant women of ≥ 22 weeks or puerperal mothers, who delivered at the referral maternity hospital (Juruá Women and Children's Hospital), were recruited to participate in a malaria surveillance study. Clinical information was obtained from a questionnaire and abstracted from medical reports. Haemoglobin level and presence of malarial parasites were tested by haematology counter and light microscopy, respectively. Low Apgar at 5-min and stillbirth were the outcomes analysed in function of clinical data and epidemiologic risk factors for maternal malaria infection using both a model of additive and independent effects and a causal model with control of confounders and use of mediation. RESULTS: In total, 202 (7.2%; N = 2807) women had malaria during pregnancy. Nearly half of malaria infections during pregnancy (n = 94) were P. falciparum. A total of 27 women (1.03%; N = 2632) had perinatal malaria (19 P. vivax and 8 P. falciparum). Perinatal anaemia was demonstrated in 1144 women (41.2%; N = 2779) and low birth weight occurred in 212 newborns (3.1%; N = 2807). A total of 75 newborns (2.7%; N = 2807) had low (< 7) Apgar scores at 5-min., and stillbirth occurred in 23 instances (30.7%; n = 75). Low birth weight resulted in 7.1 higher odds of low Apgar at 5-min (OR = 7.05, 95% CI 3.86-12.88, p < 0.001) modulated by living in rural conditions, malaria during pregnancy, perinatal malaria, and perinatal anaemia. Stillbirth was associated with perinatal anaemia (OR = 2.56, 95% CI 1.02-6.42, p = 0.0444) modulated by living in rural conditions, falciparum malaria during pregnancy, perinatal malaria, and perinatal fever. CONCLUSIONS: While Brazil continues its path towards malaria elimination, the population still faces major structural problems, including substandard living conditions. Here malaria infections on pregnant women were observed having indirect effects on fetal outcomes, contributing to low Apgar at 5-min and stillbirth. Finally, the utility of employing multiple statistical analysis methods to validate consistent trends is vital to ensure optimal public health intervention designs.
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Puntaje de Apgar , Malaria Falciparum/epidemiología , Salud Materna/estadística & datos numéricos , Atención Perinatal/estadística & datos numéricos , Complicaciones Parasitarias del Embarazo/epidemiología , Mortinato/epidemiología , Adolescente , Adulto , Brasil/epidemiología , Femenino , Humanos , Malaria Falciparum/parasitología , Malaria Vivax/epidemiología , Persona de Mediana Edad , Embarazo , Complicaciones Parasitarias del Embarazo/parasitología , Prevalencia , Adulto JovenRESUMEN
By 2050, Mexican Americans (MAs) will become the largest aged minority subgroup in the United States. Although older MAs often depend on family for care, no standard instrument is available to scale the motive for filial obligation. Building on previous work, the purpose of this study is to establish psychometric properties of the bilingual Mutuality Scale (MS) for use with MA family caregivers of older adults. A methodological design with a convenience sample is used. Through Principal Axis Factoring with Oblimin(©) rotation, a two-factor structure emerge--interaction between the caregiving dyad and reaction from the care recipient--which accounted for 63% of the variance in MS scores. Cronbach's alphas are .87 in both cases and test-retest estimates across three weeks are r = .93 and .94, respectively. Despite needing further refinement, the MS shows potential to measure the motive involved in older adult care, which may be useful in designing culturally relevant interventions for the MA population.
Asunto(s)
Cuidadores/psicología , Americanos Mexicanos , Motivación , Encuestas y Cuestionarios , Anciano , Familia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Análisis de Componente Principal , Psicometría , Reproducibilidad de los Resultados , Factores Sexuales , Estados UnidosRESUMEN
Given the fast-growing Mexican American (MA) population, it is common for investigators to be pressured into using Spanish translated instruments developed for English-speaking populations. However, these translated instruments may have limited relevance for data collection without adequate assessment and vetting. The purpose of this paper is to present lessons learned from the pilot testing of instruments designed for use with Mexican Americans. Pilot testing of two instruments was conducted with 22 Mexican American family caregivers of older adults. Issues that emerged were classified into three categories-instrumentation, methodology, and demographic data. Within the area of instrumentation, six issues were identified-level of abstraction, concreteness, pronoun use, clarity, exclusiveness, and response format. Methodological concerns were focused on test-retest administration and inclusion criteria. Issues within the demographic data were concerned with marital status, country of birth, household size and income, and validity of self-rated scales. By addressing those concerns, investigators may be more likely to have culturally sensitive measures and greater generalization to relevant MA populations.
Asunto(s)
Hijos Adultos/psicología , Cuidadores/psicología , Relaciones Intergeneracionales , Americanos Mexicanos/psicología , Hijos Adultos/etnología , Anciano , Características Culturales , Demografía , Femenino , Humanos , Relaciones Intergeneracionales/etnología , Masculino , Americanos Mexicanos/etnología , Persona de Mediana Edad , Proyectos Piloto , Reproducibilidad de los Resultados , TraducciónRESUMEN
AIMS AND OBJECTIVES: This study builds on earlier work on medication administration hassles, minor daily irritants experienced by family caregivers of older relatives, by investigating the feasibility of using the Family Caregiver Medication Administration Hassles Scale (FCMAHS) for use with Mexican American caregivers. BACKGROUND: Appropriate medication administration is a critical factor in the effective management of chronic illness. When medication regimens are managed on behalf of an older care recipient, especially those with numerous medications for a variety of conditions, the caregiving task is even more complex. Relying on family support is common for older Mexican Americans. Despite this, there is little known about how Mexican Americans are handling their caregiving duties at home. DESIGN: A non-experimental methodological design was used to assess the psychometric properties of the FCMAHS with Mexican Americans, chosen because they are a rapidly growing population in the US. METHODS: A purposive sample of 239 Mexican American adult caregivers, recruited in Dallas and San Diego, completed a brief biographical survey and the version of the FCMAHS created for Mexican Americans, i.e., the FCMAHS-MA. RESULTS: Principal axis factoring with orthogonal rotation was used to extract six factors which accounted for 53% of the variance in total scores - initial information seeking, safety issues, advanced information acquisition, scheduling, daily routine and prescription filling. Reliability estimates for the factors (alpha) ranged from 0.70-0.90. Test-retest reliability across a three-week interval was r = 0.64. CONCLUSIONS: The FCMAHC-MA shows promise as a guide for future caregiving intervention studies on family medication management for older relatives; however, it would benefit from refinement in future studies. RELEVANCE TO CLINICAL PRACTICE: Understanding family caregivers' hassles with medication administration is important because these hassles can accumulate and lead to caregiver strain. Culturally relevant intervention depends on accurate measurement of the hassles experienced by these caregivers.