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Violence is a major public health problem globally, with the highest rates in low- and middle-income countries (LMICs) in the Americas and southern Africa. Parenting programmes in high-income countries can diminish risk for violence, by reducing risk factors such as child aggression and harsh parenting, and increasing protective factors such as child cognitive development and school readiness. However, there is critical need to identify low-cost programmes with replicable benefits that work in real-world LMICs contexts. A three-arm, randomised, single-blind trial evaluated effects of two low-cost, group-based parenting programmes recommended for LMICs (ACT: Raising Safe Kids; DBS: dialogic book-sharing) on child aggression (primary outcome), child development, parenting, maltreatment, and stress. Participants were 369 children with medium–high levels of aggression (mean age 3.1 years at baseline) in poor households. Interventions were implemented in city health and education services in southern Brazil. Maternal reports, filmed observations, child tasks, and hair cortisol were assessed at baseline, 1-month post-intervention, and 8-month follow-up. Intention-to-treat analyses compared each of ACT and DBS with a control group. Three hundred sixty-eight (99.7%) participants completed follow-up assessments 8 months after the interventions. There was no effect of ACT (standardised mean difference, SMD 0.11, 95% CI − 0.05, 0.27) or DBS (SMD 0.05, 95% CI − 0.11, 0.21) on the primary outcome of child aggression. ACT reduced harsh parenting behaviour post-intervention (SMD − 0.23; 95% CI − 0.46, − 0.01), but not at follow-up. DBS improved book-sharing practices at both time points (e.g., maternal sensitivity at follow-up SMD 0.33; 95% CI 0.08, 0.57). There were no benefits of either programme for other parenting, child development, or stress outcomes. Two parenting programmes in Brazil had small effects on parenting practices but did not reduce child aggression or several other important risk/protective factors for violence. Effective early interventions that reduce violence in real-world LMIC settings are highly desirable but may be challenging to achieve. [ABSTRACT FROM AUTHOR]

Sjögren's syndrome is an autoimmune disease characterized by inflammation of the exocrine glands. The disease can be primary or secondary (if it is associated with another autoimmune disease). In Barring symptom management, there is no established treatment. To evaluate the effectiveness and safety of abatacept as a treatment of primary Sjögren's syndrome over the course of 24 months. Eleven patients with primary Sjögren's syndrome from the Rheumatology Department of Universidade Santo Amaro, Sao Paulo, Brazil were enrolled for a prospective observational study. Eligible participants were diagnosed according to the 2002 American-European consensus criteria and had a score greater than 3 on the EULAR Sjögren's Syndrome Disease Activity Index (ESSDAI). Participants received intravenous abatacept for 24 months at a weight-adjusted dose of 500 mg for patients weighing < 60 kg and 750 mg for those weighing > 60 kg. The outcomes were ESSDAI activity index, non-stimulated salivary flow rate, ocular dryness (Schirmer test, tear film break-up time, and ocular staining score), SF-36 questionnaire, and Fatigue domain of the FACIT (Functional Assessment of Chronic Illness Therapy) index. There was a statistically significant reduction in ESSDAI index and improvement of salivary flow. One subscale of the SF-36 index—emotional role functioning—showed improvement. There was no change in ocular parameters or in the FACIT index. In this sample of 11 patients with primary Sjögren's syndrome, abatacept therapy improved xerostomia and systemic disease activity. Key Points • Abatacept is safe and effective for the treatment of primary Sjögren's syndrome. • Abatacept can improve salivary flow and ESSDAI index in this patient population. [ABSTRACT FROM AUTHOR]

The photosynthetic efficiency (PE) and potential of Phaeodactylum tricornutum for CO2 mitigation in industrial tubular photobioreactors (PBRs) of different volumes were evaluated. A preliminary assay was performed at lab-scale to optimize the salt concentration of the culture medium. Interestingly, salinity did not affect the growth of P. tricornutum at concentrations of 2.5, 5, 10, and 20 g L−1. Higher volumetric productivities were achieved in the 2.5-m3 tubular PBR (0.235 g L−1 day−1), followed by 35- and 10-m3 PBRs. Maximum areal productivities corresponded to 48.5, 45.0, and 12.8 g m−2 day−1 for the 35-, 10-, and 2.5-m3 PBRs, respectively. PE was thus higher in the 35- and 10-m3 PBRs (2.21 and 2.08%, respectively). The 10- and 35-m3 PBR showed CO2 mitigation efficiencies of 60 and 41%, respectively, of the CO2 introduced into the PBR, corresponding to 2.3 and 2.5 g of fixed CO2 per g of biomass. Overall, cultivation of P. tricornutum couples high PE and areal productivity when the industrial PBRs were used, particularly PBRs of larger volumes. This improved PE performance with larger PBR volumes strongly suggests that large-scale cultivation of this diatom holds great potential for industrial CO2 mitigation. [ABSTRACT FROM AUTHOR]

The prevalent policy is that 46, XX children born with congenital adrenal hyperplasia (CAH) should be assigned to the female sex given their potential reproductive capacity. The parsimonious argument is that the scarcity of long-term outcome studies with regard to gender identity and overall sexual health among these individuals does not warrant a moratorium to current medical practices. Nevertheless, new propositions suggest that clinical sex assignment at birth does not necessarily need to follow traditional biological criteria to define sex, such as karyotype, gonads, hormonal profile, and genital appearance. In agreement with a number of international organizations, the Caracas Consensus Group (2012) has taken the position that gender non-conformity among individuals born with genital variance can be an iatrogenic artifact. We present data on ten adolescent and adult 46, XX individuals with confirmed CAH diagnosis who were born, raised, and managed in Cuba or Puerto Rico. Given the lack of international agreement and based on long-term outcome data on gender expressions among 46, XX CAH individuals, we advocate for a Caribbean social policy that prioritizes the right to live gender as chosen by individuals born with genital variance. [ABSTRACT FROM AUTHOR]

The adipose tissue (AT) is severely affected by cachexia, a paraneoplastic syndrome, which increases the morbidity and mortality of cancer. There is, however, a heterogeneous response to the condition, according to the AT depot. As plasma leptin concentration has been often reported to vary in cachexia, we have measured (species specific radioimmunoassay) the local concentration of leptin in three AT depots: retroperitoneal (RPAT), epididymal (EAT) and mesenteric (MES) of Walker 256 tumour-bearing rats. A reduced concentration of leptin (P<0.0001) was found in all the depots and in the plasma of the cachectic rats, compared with controls already from day 4 after tumour cell injection. The presence of a cell infiltrate was observed in all AT obtained from the tumour-bearing animals. Ultrastructural analysis, along with immunocytochemistry for RT1B (indicating the presence of MHCII) and using antibody against mononuclear phagocytes, showed the cells to be macrophages. The profile of TNFa and PGE2 secretion by the infiltrate was investigated (commercial kits). There was increased production of both factors by the cells of all AT (P<0.05) compared with peritoneal macrophages obtained from the cachectic rats, while the cells isolated from MES showed the highest synthesis of TNFa. The results suggest a possible modulation of the chronic locally produced TNFa and PGE2 upon leptin synthesis by the AT of the cachectic rats. [ABSTRACT FROM AUTHOR]