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Smyth et al. use tissue microarrays from Alzheimer’s disease (AD) patient brains to show that PDGF-BB:PDGFRβ signalling components are reduced in AD. They then use primary human brain pericytes to elucidate a pathway by which PDGF-BB:PDGFRβ signalling in brain pericytes is disrupted in AD, thus impairing the blood brain barrier.

The study of microglia isolated from adult human brain tissue provides unique insight into the physiology of these brain immune cells and their role in adult human brain disorders. Reports of microglia in post-mortem adult human brain tissue show regional differences in microglial populations, however, these differences have not been fully explored in living microglia. In this study biopsy tissue was obtained from epileptic patients undergoing surgery and consisted of both cortical areas and neurogenic ventricular and hippocampal (Hp) areas. Microglia were concurrently isolated from both regions and compared by immunochemistry. Our initial observation was that a greater number of microglia resulted from isolation and culture of ventricular/Hp tissue than cortical tissue. This was found to be due to a greater proliferative capacity of microglia from ventricular/Hp regions compared to the cortex. Additionally, ventricular/Hp microglia had a greater proliferative response to the microglial mitogen Macrophage Colony-Stimulating Factor (M-CSF). This enhanced response was found to be associated with higher M-CSF receptor expression and higher expression of proteins involved in M-CSF signalling DAP12 and C/EBPβ. Microglia from the ventricular/Hp region also displayed higher expression of the receptor for Insulin-like Growth Factor-1, a molecule with some functional similarity to M-CSF. Compared to microglia isolated from the cortex, ventricular/Hp microglia showed increased HLA-DP, DQ, DR antigen presentation protein expression and a rounded morphology. These findings show that microglia from adult human brain neurogenic regions are more proliferative than cortical microglia and have a distinct protein expression profile. The data present a case for differential microglial phenotype and function in different regions of the adult human brain and suggest that microglia in adult neurogenic regions are “primed” to an activated state by their unique tissue environment.

Jansson et al. design a high content screening system to target inflammation in human brain cells of the blood–brain barrier (pericytes and endothelial cells) to identify inflammatory modifiers. They identify cardiac glycosides as powerful regulators of neuroinflammatory pathways in brain barrier tissues such as vasculature, meninges and choroid plexus.

Abstract Background Microglia play critical roles in the brain during homeostasis and pathological conditions. Understanding the molecular events underpinning microglial functions and activation states will further enable us to target these cells for the treatment of neurological disorders. The transcription factor PU.1 is critical in the development of myeloid cells and a major regulator of microglial gene expression. In the brain, PU.1 is specifically expressed in microglia and recent evidence from genome-wide association studies suggests that reductions in PU.1 contribute to a delayed onset of Alzheimer’s disease (AD), possibly through limiting neuroinflammatory responses. Methods To investigate how PU.1 contributes to immune activation in human microglia, microarray analysis was performed on primary human mixed glial cultures subjected to siRNA-mediated knockdown of PU.1. Microarray hits were confirmed by qRT-PCR and immunocytochemistry in both mixed glial cultures and isolated microglia following PU.1 knockdown. To identify attenuators of PU.1 expression in microglia, high throughput drug screening was undertaken using a compound library containing FDA-approved drugs. NanoString and immunohistochemistry was utilised to investigate the expression of PU.1 itself and PU.1-regulated mediators in primary human brain tissue derived from neurologically normal and clinically and pathologically confirmed cases of AD. Results Bioinformatic analysis of gene expression upon PU.1 silencing in mixed glial cultures revealed a network of modified AD-associated microglial genes involved in the innate and adaptive immune systems, particularly those involved in antigen presentation and phagocytosis. These gene changes were confirmed using isolated microglial cultures. Utilising high throughput screening of FDA-approved compounds in mixed glial cultures we identified the histone deacetylase inhibitor vorinostat as an effective attenuator of PU.1 expression in human microglia. Further characterisation of vorinostat in isolated microglial cultures revealed gene and protein changes partially recapitulating those seen following siRNA-mediated PU.1 knockdown. Lastly, we demonstrate that several of these PU.1-regulated genes are expressed by microglia in the human AD brain in situ. Conclusions Collectively, these results suggest that attenuating PU.1 may be a valid therapeutic approach to limit microglial-mediated inflammatory responses in AD and demonstrate utility of vorinostat for this purpose.

HEK293 cells have been used extensively to generate stable cell lines to study G protein-coupled receptors, such as muscarinic acetylcholine receptors (mAChRs). The activation of M1 mAChRs in various cell types in vitro has been shown to be protective. To further investigate M1 mAChR-mediated cell survival, we generated stable HEK293 cell-lines expressing the human M1 mAChR. M1 mAChRs were efficiently expressed at the cell surface and efficiently internalised within 1 h by carbachol. Carbachol also induced early signalling cascades similar to previous reports. Thus, ectopically expressed M1 receptors behaved in a similar fashion to the native receptor over short time periods of analysis. However, substantial cell death was observed in HEK293-M1 cells within 24 h after carbachol application. Death was only observed in HEK cells expressing M1 receptors and fully blocked by M1 antagonists. M1 mAChR-stimulation mediated prolonged activation of the MEK-ERK pathway and resulted in prolonged induction of the transcription factor EGR-1 (>24 h). Blockade of ERK signalling with U0126 did not reduce M1 mAChR-mediated cell-death significantly but inhibited the acute induction of EGR-1. We investigated the time-course of cell death using time-lapse microscopy and xCELLigence technology. Both revealed the M1 mAChR cytotoxicity occurs within several hours of M1 activation. The xCELLigence assay also confirmed that the ERK pathway was not involved in cell-death. Interestingly, the MEK blocker did reduce carbachol-mediated cleaved caspase 3 expression in HEK293-M1 cells. The HEK293 cell line is a widely used pharmacological tool for studying G-protein coupled receptors, including mAChRs. Our results highlight the importance of investigating the longer term fate of these cells in short term signalling studies. Identifying how and why activation of the M1 mAChR signals apoptosis in these cells may lead to a better understanding of how mAChRs regulate cell-fate decisions.

Claudia Palacio,1 Lourdes Fernández De Ortega,2 Francisco R Bustos,3 Eduardo Chávez,4 Aldo A Oregon-Miranda,5 Arieh R Mercado-Sesma5 1Anterior Segment Department, Fundación Hospital Nuestra Señora de la Luz, México City, México; 2Anterior Segment Department, Asociación Para Evitar la Ceguera en México, Hospital Dr Luis Sánchez Bulnes, México; 3Anterior Segment Department, Antiguo Hospital Civil de Guadalajara Fray Antonio Alcalde, Guadalajara, Jalisco, México; 4Anterior Segment Department, Instituto de Oftalmología, Fundación de Asistencia Privada Conde de Valenciana, IAP, México; 5Clinical Research Department, Laboratorios Sophia, SA de CV, Zapopan, Jalisco, México Purpose: The purpose of this study was to evaluate the aqueous humor bioavailability and clinical efficacy of bromfenac 0.09% vs nepafenac on the presence of cystoid macular edema (CME) after phacoemulsification.Material and methods: A Phase II, double-blind, masked, active-controlled, multicenter, clinical trial of 139 subjects, randomized to either a bromfenac 0.09% ophthalmic solution (n=69) or nepafenac 0.1% (n=70). Subjects instilled a drop three times a day for a period of 30 days. Follow-up visits were on days 2, 7, 15, 30, and 60. Biomicroscopy, clinical ocular signs, and assessment of posterior segment were performed. The primary efficacy endpoints included the presence of CME evaluated by optical coherence tomography. Safety evaluation included intraocular pressure, transaminase enzymes, lissamine green, and fluorescein stain.Results: The demographic and efficacy variables were similar between groups at baseline. The presence of pain, photophobia, conjunctival hyperemia, chemosis, cellularity, and corneal edema disappeared by day 30 in both groups. The central retinal thickness did not show significant changes after treatment when compared to baseline as follows: in the bromfenac group (247.2±32.9 vs 252.0±24.9 µm; P=0.958) and in nepafenac group (250.8±34 vs 264.0±34.1 µm; P=0.137), respectively. A statistically significant difference was observed between bromfenac and nepafenac group: (252.0±24.9 vs 264.0±34.1 µm; P=0.022), at day 30, respectively; even though there was no clinical relevance in the presentation of CME. There were no significant alterations in intraocular pressure, either lissamine green or fluorescein stains. The adverse events were not related to the interventions. Conclusion: Bromfenac 0.09% ophthalmic solution showed similar clinical efficacy to reduce the presentation of CME after phacoemulsification compared to nepafenac 0.01%. Keywords: bromfenac, ocular NSAID, cystoid macular edema, OCT

According to the life course perspective (LCP), optimal human development and healthy aging are key goals that must start preconceptionally and continue later in life. However, older adult health and family health across generations have received very little attention in maternal and child health (MCH). Community-based participatory research (CBPR) is an important strategy for putting the LCP into action by engaging those communities most affected by health disparities. We conducted six CBPR focus groups using the LCP as the theoretical framework to capture community members' perspectives of risk and protective factors for older adult health. Perceived protective factors for older adults included socialization, support systems, and practicing wellness. Perceived risk factors included caretaking responsibilities, isolation, medical issues, and lack of support. The identified risk and protective factors for older adult health must be considered when developing public health interventions that promote health equity in aging and MCH., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

DNA and RNA nucleobase modifications are biologically relevant and valuable in fundamental biochemical and biophysical investigations of nucleic acids. However, directly introducing site-specific nucleobase modifications into long unprotected oligonucleotides is a substantial challenge. In this study, we used in vitro selection to identify DNAzymes that site-specifically N-alkylate the exocyclic nucleobase amines of particular cytidine, guanosine, and adenosine (C, G and A) nucleotides in DNA substrates, by reductive amination using a 5'-benzaldehyde oligonucleotide as the reaction partner. The new DNAzymes each require one or more of Mg2+, Mn2+, and Zn2+ as metal ion cofactors and have kobs from 0.04 to 0.3 h-1, with rate enhancement as high as ∼104 above the splinted background reaction. Several of the new DNAzymes are catalytically active when an RNA substrate is provided in place of DNA. Similarly, several new DNAzymes function when a small-molecule benzaldehyde compound replaces the 5'-benzaldehyde oligonucleotide. These findings expand the scope of DNAzyme catalysis to include nucleobase N-alkylation by reductive amination. Further development of this new class of DNAzymes is anticipated to facilitate practical covalent modification and labeling of DNA and RNA substrates., (© The Author(s) 2024. Published by Oxford University Press on behalf of Nucleic Acids Research.)

Oxygen is a vital but often overlooked variable in tissue culture experiments. Physiologically relevant oxygen tensions range from partial pressures of 100 mmHg at the alveolar-capillary interface in the lung to less than 7.6 mmHg in the hypoxic regions of solid tumors. These values are markedly lower than the partial oxygen pressure of ambient air, which is standard experimental practice. Physiologically relevant culture environments are needed to better predict cellular and tissue-level responses to drugs or potential toxins. Three commonly used methods to regulate in vitro oxygen tension involve placing cells in 1) a hypoxia chamber, 2) setups that rely on mass transport-limited microenvironments, and 3) microfabricated devices. Hypoxia chambers have the lowest barrier to entry, as they do not require laboratories to change their tissue culture setups. Here, we present a gas-regulation system for a three-zone hypoxia chamber. Each zone can maintain independent environments, with partial pressure compositions of 1-21 % O 2 and 1-10 % CO 2 . The design incorporates small-scale fabrication techniques (e.g., laser cutting and 3D printing) and off-the-shelf electronic components for simple assembly. The hypoxia chambers are significantly lower in cost than the commercial counterparts: $1,400 for the control system or $4,100 for a complete three-zone chamber system ., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Author(s).)

Background: Adolescents with autism spectrum disorder (ASD) are at an increased risk of overweight/obesity and adverse childhood experiences (ACEs)., Objective: This study examined whether ACEs increased the odds of overweight/obesity in adolescents with ASD., Methods: This cross-sectional study used National Survey of Children's Health (NSCH) 2018-2019 data (N = 31,533 children ages 10-17 years, including n = 480 children with mild ASD and n = 423 children with moderate/severe ASD with normal or overweight/obese BMI). Parent-reported body mass index (BMI) was coded as overweight/obesity vs. normal weight. The independent variable was the count of nine ACEs. Binary logistic regression was conducted, controlling for social ecological factors., Results: The odds of overweight/obesity in adolescents with ASD with 1-2 ACEs (OR 1.3, CI 1.1-1.4) and 3+ ACEs (OR 1.6, CI 1.3-2.0) were higher than those with 0 ACEs; odds increased with higher counts of ACEs. Household income level was the most significant sociodemographic influence on odds of obesity in adolescents with ASD (0-99 % Federal Poverty Level: OR 1.9, CI 1.6-2.3). Adolescents with moderate/severe ASD (OR 1.7, CI 1.2-2.5) and mild ASD (OR 1.6, CI 1.0-2.4) had higher odds of overweight/obesity after accounting for ACEs, race/ethnicity, sex, household income, and physical activity., Conclusion: Findings indicated ACEs are associated with ASD, which calls for integration of ACEs information within trauma-informed care practices for obesity prevention and intervention for adolescents with ASD. Persistent disparities of overweight/obesity exist by race/ethnicity, sex, and household income within this population, which indicates the need for tailoring trauma-informed approaches to the unique needs of this population., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Introduction: MCH training programs in schools of public health provide specialized training to develop culturally competent and skilled MCH leaders who will play key roles in public health infrastructure. Previous literature has reported on the effectiveness of MCH training programs (e.g., number of trainees, improvement in knowledge/skills); less attention has been devoted to understanding factors influencing program implementation during times of rapid change, while considering internal and external contexts (e.g., global pandemic, social unrest, uncertainty of funding, mental health issues, and other crises)., Purpose: This article describes a graduate-level MCH leadership training program and illustrates how an implementation science framework can inform the identification of determinants and lessons learned during one year of implementation of a multi-year program., Assessment: Findings reveal how CFIR can be applicable to a MCH training program and highlight how constructs across domains can interact and represent determinants that serve as both a barrier and facilitator. Key lessons learned included the value of accountability, flexibility, learner-centeredness, and partnerships., Conclusion: Findings may apply to other programs and settings and could advance innovative training efforts that necessitate attention to the multi-level stakeholder needs (e.g., student, program, institution, community, and local/regional/national levels). Applying CFIR could be useful when interpreting process and outcome evaluation data and transferring findings and lessons learned to other organizations and settings. Integrating implementation science specifically into MCH training programs could contribute to the rigor, adaptability, and dissemination efforts that are critical when learning and sharing best practices to expand leadership capacity efforts that aim to eliminate MCH disparities across systems., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Syndemic Theory (ST) provides a framework to examine mutually enhancing diseases/health issues under conditions of social inequality and inequity. ST has been used in multiple disciplines to address interacting infectious diseases, noncommunicable diseases, and mental health conditions. The theory has been critiqued for its inability to measure disease interactions and their individual and combined health outcomes. This article reviews literature that strongly suggests a syndemic between food insecurity (FI) and diet-related chronic diseases (DRCDs), and proposes a model to measure the extent of such interaction. The article seeks to: (1) examine the potential syndemic between FI and DRCDs; (2) illustrate how the incorporation of Life History Theory (LHT), into a syndemic framework can help to highlight critical lifeperiods when FI-DRCD interactions result in adverse health outcomes; (3) discuss the use of mixed methods to identify and measure syndemics to enhance the precision and predictive power of ST; and (4) propose an analytical model for the examination of the FI-DRCD syndemic through the life course. The proposed model is more relevant now given the significant increase in FI globally as a result of the ongoing COVID-19 pandemic. The differential impact that the pandemic appears to have among various age groups and by other demographic factors (e.g., race, gender, income) offers an opportunity to examine the potential FI-DRCD syndemic under the lens of LHT., (Published by Elsevier Ltd.)

Critical ethnographers have long challenged positivist notions of research objectivity and the presumed unbiased observer, arguing that one's theoretical lens and positionality influence research design, access, and experiences in the field. Scholars of color have further pointed out the need to examine people's lived experiences through an intersectional framework, acknowledging the ways in which people's lives are situated within larger structures of power and forms of oppression. In this paper, I use critical ethnography as an intersectional methodological approach to examine the lived experiences of mixed-status families and situate them within a larger political-economic context of restrictive immigration policies and neoliberal globalization. Critical ethnography is a useful methodology when interrogating larger questions of structure and agency, positionality, and social justice scholarship. I use critical ethnography to challenge the rigidity of ethnographic borders by proposing a concept of "ethnographic crossings" as moments in time and space when the roles of researchers and participants become blurred and intertwined. I draw on ethnographic examples to show the evolution of my project-from gaining access to immigrant families and following them across two countries to the close relationships developed during fieldwork that crossed emotional boundaries., (© The Author(s), under exclusive licence to Springer Nature Limited 2022.)

Intimate partner violence (IPV) is a significant public health issue with detrimental consequences for women's reproductive, mental, and physical health. In Haiti, IPV is a major obstacle to women's development. Yet, the determinants of IPV victimization are still not well understood. In this study, we utilized the 2016-2017 Haiti Demographic and Health Survey to determine the prevalence of IPV victimization and its subtypes (emotional, physical, and sexual abuse) among married or cohabiting women ( N = 3,805) of reproductive age (15-49) by their current husband/partner. Logistic regression was conducted to explore the association between IPV and household, individual, husband/partner, and relationship characteristics. The prevalence of IPV victimization was 32.5% with the majority reporting emotional (24.7%) followed by physical (16.8%) and sexual (10.5%) violence. Increased odds of IPV victimization were found among women with children in the household (adjusted odds ratio [AOR] = 1.45, 95% confidence interval [CI] = [1.03, 2.02]), with attitudinal acceptance of wife-beating (AOR = 1.45, 95% CI = [1.05, 2.02]), and those who witnessed their father beating their mother (AOR = 1.49, 95% CI = [1.18, 2.67]). Higher odds of reporting IPV victimization were also found among women whose partner drank alcohol (AOR = 2.89, 95% CI = [2.29, 3.65]), who were in a polygynous relationship (AOR = 1.76, 95% CI = [1.23, 2.40]), and displayed one or more controlling behaviors (AOR = 1.92, 95% CI = [1.42, 2.59]). Women who reported being afraid of their partner had greater odds of IPV victimization (AOR = 16.22, 95% CI = [8.38, 31.39]). Decreased odds of reporting IPV were associated with women living in rural areas (AOR = 0.73, 95% CI = [0.53, 1.00]) and those unmarried, but living with their partner (AOR = 0.62, 95% CI = [0.43, 0.90]). Our findings identify subgroups of women in Haiti that may be vulnerable to IPV victimization. Thus, we recommend a differentiated approach to IPV prevention strategies and interventions that consider women's family structure in the household as well as individual, partner, and relationship characteristics.

Background: Nonalcoholic fatty liver disease (NAFLD) is a major cause of liver disease worldwide. The diagnosis of nonalcoholic steatohepatitis (NASH), the most severe form of NAFLD, is crucial and has prognostic and therapeutic implications. However, currently this diagnosis is based on liver biopsy and has several limitations., Aim: To evaluate the performance of gadoxetic acid-enhanced magnetic resonance imaging (GA-MRI) in differentiating isolated steatosis from NASH in patients with NAFLD., Methods: In this prospective study, 56 patients with NAFLD (18 with isolated steatosis and 38 with NASH) underwent GA-MRI. The contrast enhancement index (CEI) was calculated as the rate of increase of the liver-to-muscle signal intensity ratio from before and 20 min after intravenous GA administration. Between-group differences in mean CEI were examined using Student's t test. The area under the receiver operator characteristic curve and the diagnostic performance of gadoxetic acid-enhanced magnetic resonance imaging were evaluated., Results: The mean CEI for all subjects was 1.82 ± 0.19. The mean CEI was significantly lower in patients with NASH than in those with isolated steatosis ( P = 0.008). Two CEI cut-off points were used: < 1.66 (94% specificity) to characterize NASH and > 2.00 (89% sensitivity) to characterize isolated steatosis. CEI values between 1.66 and 2.00 indicated liver biopsy, and the procedure could be avoided in 40% of patients with NAFLD., Conclusion: GA-MRI is an effective noninvasive method that may be useful for the differentiation of NASH from isolated steatosis, and could help to avoid liver biopsy in patients with NAFLD., (©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.)

Objective: An examination of the synergistic effects of maternal obesity and macrosomia on the risk of stillbirth is lacking. The purpose of this study was to determine the association between fetal macrosomia, maternal obesity, and the risk of stillbirth., Methods: This retrospective cross-sectional study used the CDC's Birth Data and Fetal Death Data files for 2014-2017 [n = 10,043,398‬ total births; including 48,799 stillbirths]. The exposure was fetal macrosomia stratified by obesity subtypes (I-III). The outcome was the risk of stillbirth. We also controlled for potential and known confounding factors in adjusted models. Adjusted Relative Risks (ARR) were estimated with log-binomial regression models., Results: The rate of stillbirth was higher among macrosomic infants born to mothers with obesity compared to those without (6.55 vs. 0.54 per 1000 total births). After controlling for confounding, women with obesity types II and III were at increased risk for stillbirth [Obesity II ARR = 2.37 (2.07-2.72); Obesity III ARR = 9.06 (7.61-10.78)]., Conclusions for Practice: Obesity-related fetal overgrowth is a significant risk factor for stillbirth, especially among women with type II and type III obesity. This finding highlights the need for more effective clinical and public health strategies to address pre-pregnancy obesity and to optimize gestational weight gain., Competing Interests: Declaration of Competing Interest The authors have no financial disclosures to declare and no conflicts of interest to report., (Copyright © 2020 Elsevier B.V. All rights reserved.)

Objectives: To evaluate the association between macrosomia and stillbirth over the previous four decades and to determine the consistency of the relationship., Methods: This was a population-based retrospective cohort study using United States Natality and Fetal Death Data from 1982 to 2017 and restricted to the gestational age range of 37-41 weeks inclusive. Macrosomia was defined as birthweight ≥4000 g and subdivided into its grades as previously recommended: grade 1 (4000-4499 g), grade 2 (4500-4999 g), and grade 3 (≥5000 g). We calculated temporal trends of stillbirth among fetuses with macrosomia over the years using joinpoint regression. We generated odds ratios from adjusted binomial logistic regression models to examine the association between macrosomia and risk of stillbirth stratified by grades using normal-weight infants (2500-3999 g) as referent., Results: Within the fetal macrosomia group, the rate of stillbirth declined from 2.04/1000 in 1982 to 1.05/1000 by the end of the study period (2017), representing a drop of about 48.5%. For the normal-weight fetuses, stillbirth rate declined from 1.95/1000 to 0.83/1000, equivalent to a decline of 57.4%. Macrosomia was significantly associated with elevated risk for stillbirth: grade 2 (OR = 1.27; 95% CI = 1.22-1.32) and grade 3 (OR = 5.97; 95% CI = 5.69-6.22)., Conclusions: Fetal macrosomia is a significant risk factor for fetal demise with the worst intrauterine survival observed among those classified as grade 3. Fetal macrosomia is a heterogeneous rather than a homogeneous entity in terms of risk profiles, and this needs to be considered in future policy guidelines., (© 2020 Wiley Periodicals, Inc.)

Purpose: Studies have reported a surge in the prevalence of obesity among various demographic groups including pregnant women in the U.S. Given the association between maternal obesity and risk of fetal macrosomia, we hypothesized that the incidence of fetal macrosomia will be on the rise in the U.S. We examined trends in fetal macrosomia and macrosomia phenotypes in the U.S. among singleton live births within the gestational age of 28-42 weeks inclusive., Methods: This was a retrospective cohort study covering the period 1971-2017 using U.S. Natality Data files. We applied Joinpoint regression models to derive the average annual percentage change in the outcome. We measured incidence and trends of fetal macrosomia which was defined as birth weight ≥ 4000 g. We further subdivided macrosomia into its phenotypes as previously recommended: Grade 1 (4000-4499 g), Grade 2 (4500-4999 g) and Grade 3 (≥ 5000 g)., Results: A total of 147,331,305 singleton births over the entire study period of 47 years were analyzed. From a baseline incidence of 8.84%, the rate of fetal macrosomia declined to 8.07% by the end of the study representing a drop of 8.70% in relative terms. The greatest drop was among infants with Grade 3 macrosomia, the most severe and lethal phenotype. The most impactful factors were maternal age and gestational weight gain., Conclusion: This study is the largest population-based study conducted regarding fetal macrosomia. The rate of fetal macrosomia declined over the previous 5 decades with the most substantial drop observed in the phenotype with the worst prognosis.

The life course perspective (LCP), a valuable theoretical framework for investigating racial disparities in birth outcomes, examines the cumulative exposure of risk and protective factors throughout the life span. Although risk and protective exposures are equally vital to health, most studies have focused solely on the risk factor exposures faced by vulnerable populations. In clear contrast to the traditional public health approach, which emphasizes a deficit model, strengths-based approaches focus on protective factors and fostering resilience. These approaches view communities as valuable assets that have the capacity to fully engage themselves and their residents to achieve optimal health. Participatory action research methods are well suited to apply a strengths-based approach to understand health disparities. Our study aimed to explore maternal and child health protective factors from community residents' perspective. A group of researchers, including active members in the community with a long history of grassroots development work, conducted ten community-based participatory focus groups with community residents in Tampa, FL, using the LCP framework. A total of 78 residents participated in ten focus groups. Perceived protective factors during pregnancy included self-esteem, spirituality, pregnancy support, good nutrition, prenatal care, and community resources. Protective factors for non-pregnant women were self-esteem, spirituality, social support, health literacy, community support and community resources, and societal factors. For children and adolescents, relevant protective factors were self-esteem, positive role models, nutrition and physical activity, and community support. The identified factors are community assets or strengths that mitigate or eliminate maternal and child health risks in families and communities residing in low-income neighborhoods, which must be considered in developing effective maternal and child health interventions.

There is a paucity of information on the intermediate behavioral pathways linking exposure to racial discrimination with negative health outcomes among racial and ethnic minority populations in low income settings. This study examined the association between experiences of discrimination and the number of unhealthy days due to physical or mental illness and whether alcohol use influenced the association. A community needs assessment was conducted from 2013-2014 within a low-income community in Florida. Structural equation modeling was performed using maximum likelihood estimation with robust standard errors. In a total of 201 observations, path analyses uncovered significant positive indirect associations (p<0.05) between perceived discrimination and unhealthy days through perceived stress, sleep disturbances, and chronic illness. Although a maladaptive mechanism, alcohol use was a strong buffer on the effects of racism on stress., Competing Interests: Conflicts of Interest: The authors report no conflict of interest., (Copyright © 2020 Salihu et al.)

Bryozoa is a phylum of aquatic invertebrates widely distributed around the world, including harbor areas. They have association to artificial structures as main mechanism of dispersal, including ships, which facilitates their introduction to new environments. The detection of exotic species is important to prevent new introductions and to propose management strategies of marine areas. Thus, after analyzing and discussing local and global criteria of exotic species, an account of exotic bryozoans from Brazil is presented, including 12 classified as exotic (six established and six detected) and 17 classified as potentially exotic (cryptogenic). Three species have been reported causing economic or environmental impacts worldwide. Of those, Membraniporopsis tubigera is known to cause economic impacts on the Brazilian coast. Hull fouling is the main dispersal mechanism for exotic bryozoans. The lacking of reliable data did not allow inferring on the exotic status on some fouling bryozoan species in Brazil., (Copyright © 2018 Elsevier Ltd. All rights reserved.)

Purpose: The purpose of this study was to evaluate the clinical efficacy and safety of a novel ophthalmic solution of pazufloxacin on the ocular surface of patients with bacterial conjunctivitis after 7 days of intervention., Methods: This is a phase 2, double-blind, controlled, multicenter, clinical trial of 300 subjects, randomized to either a 3 dosing regimen of pazufloxacin 0.6% ophthalmic solution (twice a day [BID], n = 90; 3 times a day [TID], n = 76; 4 times a day [QID], n = 68), moxifloxacin 0.3% TID (n = 82), or gatifloxacin 0.5% TID (n = 72). Follow-up was set on days 0, 3, and 7. Assessments of ocular signs were performed, both anterior and posterior segments. The primary outcome measures included conjunctival culture and clinical signs. Safety variables included adverse events (AEs), lisamine green, fluorescein ocular surface stains, and clinical signs of tolerability., Results: After intervention, bacterial eradication was reported in all groups: pazufloxacin BID 79%, pazufloxacin TID 84%, pazufloxacin QID 84%, moxifloxacin 80%, and gatifloxacin 82%. There were no significant differences between treatments. Similar results were reported in clinical remission: pazufloxacin BID 89%, pazufloxacin TID 98%, pazufloxacin QID 92%, moxifloxacin 91%, and gatifloxacin 92% (P = 0.03 comparing pazufloxacin BID vs. TID). There were no differences between female and male responses. The AEs were not related to the interventions., Conclusions: A simplified dosing regimen was selected to follow the development of ophthalmic pazufloxacin based on its efficacy and safety profile. Pazufloxacin, 1 drop 3 times daily, showed similar rates of bacterial eradication and clinical remission compared with other fluoroquinolones.

Immigrants are often considered a vulnerable population. Paradoxically, some researchers have reported lower risk of pregnancy-related hypertension (PRH) among immigrants when compared to their non-immigrant counterparts. The lack of consistency and the absence of a synthesis of studies investigating the associations between immigration status and PRH represent a gap in our understanding of socioecological roots of PRH. Of studies published in during the study period, 16 met the inclusion criteria. For each study, we computed relative risks that compared PRH risk by migrant status. The pooled estimate of the relative risk of PRH represented a statistically significantly lower risk among immigrants (RR = 0.74; 95 % CI 0.67, 0.82). The body of evidence indicates that immigrant status is generally associated with reduced risk of PRH. However the strength of this association could vary by country of origin of immigrants.

Little is known about the patterns of risk factors experienced by communities of color and how diverse community contexts shape the health trajectory of women from the early childhood period to the time of their pregnancies. Thus, we conducted a focus group study to identify social risks over the life course that contribute to maternal and child health from the perspective of community members residing in low income urban areas. Ten community-based participatory focus groups were conducted with residents from selected communities in Tampa, Florida, from September to November 2013. We used the life course perspective to illuminate and explain the experiences reported by the interviewees. A total of 78 residents participated in the focus groups. Children and adolescents' health risks were childhood obesity, lack of physical activity, and low self-esteem. Women's health risks were low self-esteem, low educational level, low health literacy, inadequate parenting skills, and financial problems. Risks during pregnancy included stress, low self-esteem, inadequate eating patterns, lack of physical activity, healthcare issues, lack of social support, and lack of father involvement during pregnancy. Multiple risk factors contribute to maternal and child health in low income communities in Tampa Bay. The intersection of risk factors in different life periods suggest possible pathways, cumulative, and latent effects, which must be considered in future longitudinal studies and when developing effective maternal and child health programs and policies.

Background: Dry eye disease (DED) is multifactorial, affecting 5-34 % of the global adult population and reducing quality of life. The artificial tears or lubricants are the therapy most used for the treatment of DED, due to their low side effect profile, which attempt to modify the properties of the tear film. The aim of the present study was to evaluate the clinical efficacy of a fixed combination of xanthan gum and chondroitin sulfate preservative free on the ocular surface of patients with dry eye disease during 60 days of intervention., Methods: A phase III, double-blind, masked, controlled, multicenter, clinical trial of 148 subjects, randomized to either a fixed combination of xanthan gum 0.09 % and chondroitin sulfate 0.1 % (XG/CS) ophthalmic solution (n = 76) or a fixed combination of polyethylene glycol 400 0.4 % and propylene glycol 0.3 % (PEG/PG) (n = 72). Subjects self-dosed four times daily during 60 days. Follow-up was set on days 2, 7, 15, 30 and 60. Assessments of anterior/posterior segment ocular signs were performed. The outcome measures included Schirmer test, tear film break-up time and OSDI score. Security variables included intraocular pressure, lisamine green and fluorescein ocular surface stains., Results: The primary efficacy endpoints were similar between groups at baseline. After intervention time Schirmer test increased in both groups compared to baseline, XG/CS (6.4 ± 2.2 vs 11.0 ± 6.6; p = 0.002) and PEG/PG (6.5 ± 2.5 vs 10.5 ± 5.6; p = 0.019) respectively. Similar results were reported in the tear film break-up time in XG/CS (5.5 ± 2.1 vs 7.4 ± 2.9; p = 0.027) and PEG/PG (5.2 ± 2.0 vs 7.4 ± 2.7; p = 0.046) respectively. The OSDI score decreased to normal values in both groups, XG/CS (19.3 ± 7.4 vs 7.3 ± 5.9; p = 0.001) and PEG/PG (19.3 ± 7.5 vs 7.9 ± 8.2; p = 0.001) respectively. There was no significant difference between treatments for any parameter. Moreover, both groups decreased the presence of burning sensation, tearing, foreign body sensation, conjunctival hyperemia and photophobia. The adverse events were not related to the interventions., Conclusions: Xanthan gum/chondroitin sulfate preservative free showed similar clinical efficacy, evaluated with OSDI score, TBUT and Schirmer test compared to polyethylene glycol/propylene glycol in the treatment of dry eye disease., Trial Registration: ClinicalTrials.gov: NCT01657253 . Date of registration May 19, 2014.

Purpose: To compare the profiles of postoperative photorefractive keratectomy (PRK) pain between both eyes under the same conditions and to verify the preoperative predictors of pain such as gender, anxiety, knowledge of the procedure, and spherical equivalent refractive error (SERE)., Methods: This prospective study included 86 eyes of 43 patients with myopia who underwent PRK in both eyes at an interval of 14 days between the procedures. Before surgery, subjects answered the State Anxiety Inventory. After surgery, usual PRK pain treatment was given. Subjects answered the Visual Analog Scale, the Brief Pain Inventory (BPI), and the McGill Pain Questionnaire at 1, 24, 48, 72, and 96 hours after surgery. Pain scores and anxiety were compared between each eye using the Wald test and paired Student t test, respectively. The Wald test was performed for gender and SERE for each eye separately., Results: There were no statistically significant differences between both eyes for all time points regarding the Visual Analog Scale, BPI, and McGill Pain Questionnaire-Pain Rating Index pain scores. Subjects were less anxious on average before the second surgery compared with before the first surgery (P < 0.001); however, it was not related to pain ratings after surgery. Gender did not significantly affect any scale of pain, and the SERE between -3 diopters (D) and -5 D (P = 0.035) revealed effects on the BPI., Conclusions: The profiles of postoperative pain after PRK were similar between both eyes under the same conditions. In this study, a high SERE was the only predictor for increased pain after PRK.

Purpose: To evaluate ocular straylight before and after photorefractive keratectomy (PRK) for low myopia with and without topical mitomycin (MMC) treatment., Methods: Patients who underwent PRK for low myopia were enrolled into the study. PRK without MMC was performed in 21 eyes (12 patients), whereas PRK with topical 0.02% MMC was performed in 25 eyes (14 patients). Both groups were treated using the NIDEK EC5000 excimer laser. Measurements were performed using the C-Quant straylight meter preoperatively and at two and four months postoperatively., Results: The mean patient age was 30 ± 4 years, and the mean spherical equivalent refractive error was -2.2 ± 0.75 D. The mean preoperative intraocular straylight values were 1.07 ± 0.10 in the PRK without MMC group and 1.07 ± 0.11 log(s) in the PRK with topical MMC group. At two months after surgery, there was a decrease in mean intraocular straylight values in both groups. However, a significant difference was only reached in the PRK with MMC group [0.98 ± 0.09 log(s), p=0.002] compared with preoperative values, which was likely due to a greater scatter of measurements in the PRK without MMC group [1.03 ± 0.13 log(s), p=0.082]. At four months postoperatively, ocular straylight values were not significantly different compared with those at baseline in either the PRK without MMC group [1.02 ± 0.14 log(s), p=0.26] or in the PRK with topical MMC group [1.02 ± 0.11 log(s), p=0.13]., Conclusion: PRK for low myopia decreases ocular straylight, and MMC application further reduces straylight in the early postoperative period. However, ocular straylight values do not significantly differ at four months after surgery compared with those at baseline.

Purpose: Postoperative pain remains an important limiting factor to the selection of photorefractive keratectomy (PRK). There is a consensus in neurology pain research that pain should be evaluated as a multidimensional concept, which differs from current practice in ophthalmology. The purpose of this paper was to validate the use of multidimensional questionnaires, such as the Brief Pain Inventory (BPI) and the McGill Pain Questionnaire (MPQ), to provide an improved analysis of pain after PRK and to better describe its temporal profile., Methods: This prospective study included 43 eyes of 43 myopic patients who underwent unilateral PRK. After surgery, usual pain treatment was administered. All of the participants responded to the Visual Analogue Scale (VAS), the BPI and the MPQ 1, 24, 48, 72, and 96 hours after surgery. The internal consistency was evaluated, different postoperative periods were compared, and convergent validity was assessed using correlation testing., Results: The Cronbach alpha test showed high internal consistency for each of the questionnaire subscales. Patients reported higher postoperative pain values at the first measurement of the VAS (4.93 ± 2.38), MPQ-pain rating index (26.95 ± 10.58), BPI-pain severity index (14.53 ± 7.36), and BPI-pain interference index (22.30 ± 15.13). Almost all of the scales and subscales showed a statistically significant direct correlation with the VAS at all of the evaluation periods., Conclusions: This study validated the utility of multidimensional questionnaires to expand the assessment of the PRK postoperative pain profile, including intensity and other qualitative aspects.

Background: Adverse childhood experiences (ACE) have been previously linked to quality of life, health conditions, and life expectancy in adulthood. Less is known about the potential mechanisms which mediate these associations. This study examined how ACE influences adult health-related quality of life (HRQoL) in a low-income community in Florida., Methods: A community-based participatory needs assessment was conducted from November 2013 to March 2014 with 201 residents of Tampa, Florida, USA. HRQoL was measured by an excessive number of unhealthy days experienced during the previous 30-day window. Mediation analyses for dichotomous outcomes were conducted with logistic regression. Bootstrapped confidence intervals were generated for both total and specific indirect effects., Results: Most participants reported 'good to excellent health' (76%) and about a fourth reported 'fair to poor health' (24%). The mean of total unhealthy days was 9 days per month (SD ± 10.5). Controlling for demographic and neighborhood covariates, excessive unhealthy days was associated with ACE (AOR = 1.23; 95% CI: 1.06, 1.43), perceived stress (AOR = 1.07; 95% CI: 1.03, 1.10), and sleep disturbance (AOR = 8.86; 3.61, 21.77). Mediated effects were significant for stress (β = 0.08) and sleep disturbances (β = 0.11) as they related to the relationship between ACE and excessive unhealthy days., Conclusion: ACE is linked to adult HRQoL. Stress and sleep disturbances may represent later consequences of childhood adversity that modulate adult quality of life.

Objective: To describe the use of a clinically enhanced maternal and child health (MCH) database to strengthen community-engaged research activities, and to support the sustainability of data infrastructure initiatives., Data Sources/study Setting: Population-based, longitudinal database covering over 2.3 million mother-infant dyads during a 12-year period (1998-2009) in Florida., Setting: A community-based participatory research (CBPR) project in a socioeconomically disadvantaged community in central Tampa, Florida., Study Design: Case study of the use of an enhanced state database for supporting CBPR activities., Principal Findings: A federal data infrastructure award resulted in the creation of an MCH database in which over 92 percent of all birth certificate records for infants born between 1998 and 2009 were linked to maternal and infant hospital encounter-level data. The population-based, longitudinal database was used to supplement data collected from focus groups and community surveys with epidemiological and health care cost data on important MCH disparity issues in the target community. Data were used to facilitate a community-driven, decision-making process in which the most important priorities for intervention were identified., Conclusions: Integrating statewide all-payer, hospital-based databases into CBPR can empower underserved communities with a reliable source of health data, and it can promote the sustainability of newly developed data systems., (© Health Research and Educational Trust.)

Background: Providing practitioners with an intuitive measure for priority setting that can be combined with diverse data collection methods is a necessary step to foster accountability of the decision-making process in community settings. Yet, there is a lack of easy-to-use, but methodologically robust measures, that can be feasibly implemented for reliable decision-making in community settings. To address this important gap in community based participatory research (CBPR), the purpose of this study was to demonstrate the utility, applicability, and validation of a community priority index in a community-based participatory research setting., Design and Methods: Mixed-method study that combined focus groups findings, nominal group technique with six key informants, and the generation of a Community Priority Index (CPI) that integrated community importance, changeability, and target populations. Bootstrapping and simulation were performed for validation., Results: For pregnant mothers, the top three highly important and highly changeable priorities were: stress (CPI=0.85; 95%CI: 0.70, 1.00), lack of affection (CPI=0.87; 95%CI: 0.69, 1.00), and nutritional issues (CPI=0.78; 95%CI: 0.48, 1.00). For non-pregnant women, top priorities were: low health literacy (CPI=0.87; 95%CI: 0.69, 1.00), low educational attainment (CPI=0.78; 95%CI: 0.48, 1.00), and lack of self-esteem (CPI=0.72; 95%CI: 0.44, 1.00). For children and adolescents, the top three priorities were: obesity (CPI=0.88; 95%CI: 0.69, 1.00), low self-esteem (CPI=0.81; 95%CI: 0.69, 0.94), and negative attitudes toward education (CPI=0.75; 95%CI: 0.50, 0.94)., Conclusions: This study demonstrates the applicability of the CPI as a simple and intuitive measure for priority setting in CBPR. Significance for public healthCommunity-based participatory research (CBPR) has been credited to be a promising approach for the reduction of health disparities and as an effective way to create sustainable community outcomes. Priority setting is an essential decision-making step in community-based participatory research. Issue prioritization must be driven not just by the importance of the issue, but also what realistically can be changed with available funds. However, there is little guidance on how to approach priority setting with objective and subjective measures while implementing CBPR. This study depicts the invention of a Community Priority Index (CPI), which can be used to prioritize community health issues by combining subjective and objective markers into a single measure. The CPI shown in this study represents a viable systematic approach to improve the objectivity and reliability of community-based decision-making.

Objective: The aim of this study is to describe national trends for opioid use among pregnancy-related hospitalizations from 1998 to 2009., Study Design: Using the Nationwide Inpatient Sample, we identified hospital discharge records associated with the diagnoses codes for the use of opioids for all eligible pregnancy-related inpatient admissions between 1998 and 2009. Joinpoint regression modeling was used to describe changes in trend of pregnancy-related opioid use. The main outcome measure was the annual percent change for opioids use among pregnancy-related hospitalizations., Results: From 1998 to 2009, opioid use was documented in 138,224 of 55,781,966 pregnancy-related inpatient hospitalizations (25 cases per 10,000 discharges). A statistically significant downward trend occurred from 1998 to 2001, whereas from 2002 to 2009 there was a statistically significant upward trend. The increasing trend in opioid use from 2002 to 2009 is notably higher for whites compared with blacks and Hispanics., Conclusions: Our findings highlight the continuous need to monitor opioids use and to revise prescription guidelines, practices, and regulatory mechanisms to curtail the progression of the increasing opioids use during pregnancy. It is critical that health care providers weight the benefits of these medications along with their potential risks when discussing analgesic treatment options with pregnant women., (Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.)

This paper outlines how to compute community priority indices in the context of multicriteria decision making in community settings. A simple R function was developed and validated with community needs assessment data. Particularly, the first part of this paper briefly overviews the existing methods for priority setting and reviews the utility of a multicriteria decision-making approach for community-based prioritization. The second part illustrates how community priority indices can be calculated using the freely available R program to handle community data by showing the computational and mathematical steps of CPI (Community Priority Index) with bootstrapped 95% confidence intervals.

Introduction: Although hookah smoking is becoming a source of tobacco use among college students in the United States, little is known of the students' knowledge, attitudes, and practices regarding hookah use. This cross-sectional study was aimed at determining the prevalence of hookah use and describing social and behavioral factors associated with hookah smoking among university students in a large urban university in Florida., Methods: A convenience sample of 478 undergraduate and graduate students was recruited. Lifetime use and current use was evaluated. Logistic regression modeling was used to assess the independent association between study covariates and hookah use., Results: Prevalence among students of having ever used hookah during their lifetime was 54.4%. Hookah use within the past 30 days was 16.3%. Hookah use was significantly associated with cigarette smoking (odds ratio [OR], 4.52; 95% confidence interval [CI], 2.13-9.60) and hookah ownership (OR, 10.67; 95% CI, 4.83-23.66) but not with alcohol use (OR, 1.73; 95% CI, 0.74-4.04). Findings also suggest hookah is perceived as a safer alternative to cigarette smoking. Almost 30% of those who never smoked hookah reported they would consider smoking hookah in the future., Conclusion: Hookah smoking is popular among college students. Misperceptions associated with hookah use indicate a starting point for developing health behavior change interventions. Future studies should investigate social and behavioral determinants of hookah use and determine the incidence of hookah use among college and high school students. Tobacco control activities should include prevention of hookah tobacco use in university settings.

Objective: To evaluate a patient-centered medical training curriculum, the SELECT program, through perceptions of the inaugural student cohort., Methods: Data were collected from two focus groups conducted in the university setting, comprised of fifteen first-year medical students who participated in the SELECT program during its inaugural year. A questioning protocol was used to guide the focus group discussion, which was transcribed and hand-coded through thematic analyses., Results: Various themes related to patient-centered care were identified. Students noted changes in their attitudes towards interacting with patients in an empowering and educative manner as a result of communication and motivational interviewing exercises. Additionally, they recognized certain external, structural barriers as well as internal conflict between pragmatism and emotional intelligence that could potentially hinder patient-centered care. The impact of family dynamics and social support on quality of life and health outcomes was acknowledged. Students also emphasized the value of collaborating with multiple health professionals. Lastly, students provided suggestions for program improvement, namely additional simulations, more education regarding other healthcare professionals' roles, more standardized experiences, and application of principles to acute and primary care., Conclusions: Upon completion of the first year of the SELECT program, students gained an appreciation for patient-centered care and various factors and skills that facilitate such care. Additionally, they experienced a dissonance between didactic concepts from the curriculum and observed medical practices. This study highlights the educational benefits of a patient-centered medical curriculum and provides suggestions for future improvement.

Objective: The purpose of this study was to investigate the views of medical students and residents regarding the practice of professionalism, their perceived challenges, and ideas for the development of a new curriculum in medical professionalism., Methods: Data were collected from four focus groups comprised of 27 residents and medical students recruited from the University of South Florida Morsani School of Medicine and Residency Programs between January and March 2012. A questioning protocol was used to guide the focus group discussion. Data were transcribed for thematic analysis., Results: Learners expressed beliefs regarding key attributes of professional behaviors, factors perceived to be associated with lapses of professional behavior, skills that need to be taught, and strategies to teach professionalism from the learners' perspective. Learners perceived that the values of professionalism are often disconnected from the reality evidenced in clinical training due to a myriad of personal and contextual challenges., Conclusions: Residents and students need help in negotiating some of the challenges to medical professionalism that are encountered in clinical settings. We recommend a learner's centered model of curriculum development in medical professionalism that takes into consideration perceived challenges and strategies for modeling and reinforcing medical professionalism.

Purpose: To quantify ocular symptoms, goblet cells (GC) and mucin 5AC (MUC5AC) gene expression on the conjunctiva of healthy subjects exposed to ambient levels of traffic-derived air pollution and to estimate its correlation with NO2 and particulate matter smaller than 2.5 μm (PM2.5) levels., Methods: Twenty-one taxi drivers or traffic controllers were assessed with the Ocular Surface Disease Index (OSDI) questionnaire and conjunctival impression cytology. MUC5AC mRNA levels were determined based on the cytology of the right eye, and GC density was assessed based on the cytology of the left eye. Mean individual levels of 24-h NO2 and PM2.5 exposure were assessed the day before examination. Possible associations between NO2 or PM2.5 levels, OSDI scores, GC densities and MUC5AC mRNA levels were verified., Results: The subjects were exposed to mean PM2.5 levels of 35±12 μg/m(3) and mean NO2 levels of 189±47 μg/m(3). OSDI scores were low (7.4±8) and GC densities were 521±257 and 782±322 cell/mm(2) on the bulbar and tarsal conjunctivas, respectively. The mean GC-derived MUC5AC mRNA expression was 14±7 fM/μg of total RNA. A significant and positive correlation was observed between MUC5AC mRNA levels and tarsal GC density (p=0.018). A trend toward association between PM2.5 levels and tarsal GC cell density (p=0.052) was found., Conclusion: Exposure to ambient levels of air pollution impacts conjunctival GC density. An increase in MUC5AC mRNA levels may be part of an adaptive ocular surface response to long-term exposure to air pollution., (Copyright © 2014 Elsevier Inc. All rights reserved.)

Evidence of successful models for promoting early childhood development and for effectively addressing developmental delays is available, yet the adoption of evidence-based strategies is limited in low-income countries. Nicaragua, a low-income country on the Central American isthmus, faces policy-, organizational-, and community-level obstacles which prevent families from receiving the benefits of early child development programs as well as other necessary services for children at risk of or with developmental delays. Failing to address developmental delays in a timely manner leads to detrimental social and economic consequences for families and society at large. In this article, we examine existing information on early childhood development in Nicaragua and discuss some programmatic implications for the recognition and early intervention of developmental delays in Nicaragua.

The objective of this paper is to review observational studies that addressed the survival of pre-viable gestations in the United States. We searched PubMed, Ovid, CINAHL, and Web of Knowledge for studies reporting survival of infants born at <24 gestational weeks and/or <500g in the United States and published between January 2003 and January 2013. The full texts of 70 articles were examined and a total of 15 studies qualified and were selected. We analyzed fixed-effect and random-effects models for eight studies on survival to discharge. Pooled survival to discharge in the random-effects model was 45.9% (95% CI: 41.1-51.7) and 39.7% in the fixed-effect model (95% CI: 38.8-40.7). Studies differed by pre-viable survival measures and epochs (1985-2009). Protective factors included antenatal corticosteroids, neonatal resuscitation, and intensive care. The current survival threshold for pre-viable infants warrants reconsideration of the limits of viability. Protective factors that enhance survival should be considered in the management of these infants., (Copyright © 2013 Elsevier Inc. All rights reserved.)

Visual acuity is the measurement of an individual's ability to recognize details of an object in a space. Visual function measurements in clinical ophthalmology are limited by factors such as maximum contrast and so it might not adequately reflect the real vision conditions at that moment as well as the subjective aspects of the world perception by the patient. The objective of a successful vision-restoring surgery lies not only in gaining visual acuity lines, but also in vision quality. Therefore, refractive and cataract surgeries have the responsibility of achieving quality results. It is difficult to define quality of vision by a single parameter, and the main functional-vision tests are: contrast sensitivity, disability glare, intraocular stray light and aberrometry. In the current review the different components of the visual function are explained and the several available methods to assess the vision quality are described.

Background: Fluorescein angiography has been fundamental for the understanding and description of vascular disorders affecting the retina and choroid. The aim of this report is to assess the early anatomic retinal changes visible with angiography, and their relation with the clinical findings of retinopathy of prematurity., Methods: Ten babies were included in the study, the initial examination being at 2 weeks after birth. Two cycles of tropicamide 0.8 % and phenylephrine 5 % eye drops were instilled into both eyes 30 min before examination. A RetCam II was used to obtain digital retinal images, after instilling topical anesthesia (tetracain 0.5 %) and using a contact gel. Fluorescein angiography was undertaken following administration of an intravenous bolus of 0.1 ml/kg saline fluorescein 10 % followed by a 3.0-ml isotonic saline flush, with the assistance of the neonatologist; the right and left eyes were imaged., Results: We observed that some of the vascular abnormalities described for threshold disease by Lepore were already present at the second week of life, preceding the diagnosis of threshold disease by 3-4 weeks in two cases. The main findings in our cases were arterio-venous shunts, surrounded by areas of capillary non-perfusion, rosary-bead-like hyper-fluorescence, tortuosity and leakage from distal arterioles, none of which were detectable in the digital fundus pictures., Conclusions: Early ROP screening at the NICU that includes FA is a safe procedure, and gives the examiner details of vascular changes that are not detectable by indirect ophthalmoscopy, which could predict the progression to threshold disease, and provide an alert about the need of therapeutic interventions.

Objective: This study aimed to review studies that addressed the impact of previous reproductive cancer diagnosis on selected fetal birth outcomes., Materials and Methods: We searched PubMed and Web of Knowledge to identify peer-reviewed articles published from January 1992 to December 2012, investigating the association between reproductive cancer and birth outcomes. After applying exclusion criteria, 49 articles were identified for full review, and 36 articles were finally selected for this systematic review. The quality of the studies was assessed by independent reviewers., Results: We found 13 cervical cancer studies, 16 ovarian cancer studies, and 7 corpus uteri cancers that reported subsequent pregnancies (n = 688 pregnancies in 477 women). Of these, 489 pregnancies reached third trimester. Among viable pregnancies, only 416 pregnancies had information on maturity status based on gestational age and/or birth weight. For those with cervical cancer, the preterm birth (PTB) rate was 48.5%. For those with ovarian cancer, there were no cases of PTB. For those with corpus uteri cancers, the PTB was 7.7%. All studies had small sample sizes, and there was considerable heterogeneity of results. Abortions, ectopic pregnancies, and terminations were also reported., Conclusions: Reproductive cancers may be associated to subsequent adverse fetal birth outcomes; however, the quality of evidence is still insufficient to infer a relationship between reproductive cancers treated conservatively and adverse fetal birth outcomes in subsequent pregnancies.

Quality of life has emerged as an essential health component that broadens the traditionally narrow concerns focused on only morbidity and life expectancy. Although a growing number of tools to measure quality of life are in circulation, there is a lack of guidelines as well as rigorous assessment for their use with pregnant and postpartum populations. It is also unclear whether these instruments could validly be employed to measure patient-reported outcomes in comparative effectiveness research of maternal care interventions. This paper reviews articles cited in CINAHL, COCHRANE, EMBASE, PSYCINFO, and PUBMED that addressed quality of life in pregnant and postpartum populations. Instruments used to measure quality of life in selected articles were assessed for their adherence to international guidelines for health outcomes instrument development and validation. The authors identified 129 articles that addressed quality of life in pregnant and/or postpartum women. Out of these, only 64 quality (generic and specific) scales were judged relevant to be included in this study. Analysis of measurement scales used in the pregnant and/or postpartum populations revealed important validity, reliability and psychometric inadequacies that negate their use in comparative effectiveness analysis in pregnant and post-partum populations. Valid, reliable, and responsive instruments to measure patient-reported outcomes in pregnant and postpartum populations are lacking. To demonstrate the effectiveness of various treatment and prevention programs, future research to develop and validate a robust and responsive quality of life measurement scale in pregnant and postpartum populations is needed.

A critical mass of public health practitioners with expertise in analytic techniques and best practices in comparative effectiveness research is needed to fuel informed decisions and improve the quality of health care. The purpose of this case study is to describe the development and formative evaluation of a technology-enhanced comparative effectiveness research learning curriculum and to assess its potential utility to improve core comparative effectiveness research competencies among the public health workforce. Selected public health experts formed a multidisciplinary research collaborative and participated in the development and evaluation of a blended 15-week comprehensive e-comparative effectiveness research training program, which incorporated an array of health informatics technologies. Results indicate that research-based organizations can use a systematic, flexible, and rapid means of instructing their workforce using technology-enhanced authoring tools, learning management systems, survey research software, online communities of practice, and mobile communication for effective and creative comparative effectiveness research training of the public health workforce.

The silicosis is the pneumoconiosis more frequent, resulting from the inhalation of silica or silicates containing mineral dust, mainly characterized by irreversible lung fibrosis. It is associated with the development of other diseases, including pulmonary tuberculosis, lung cancer and autoimmune diseases. The connective tissue disease after exposure to silica occurs usually after 15 years of initial exposure.The Erasmus syndrome describes the association of systemic sclerosis following exposure to silica with or without silicosis. The authors report two cases of patients with diagnosis of silicosis who developed systemic sclerosis.

Ankylosing spondylitis (AS) is a chronic inflammatory disease that affects mainly the axial skeletal system, causing pain and functional incapacity. The peripheral joint involvement occurs in 30 to 40% of cases. Osteomyelitis of the mandible was relatively common before the advent of preventive antibiotic therapy and restorative dentistry. Currently, the infection of the facial bones is a rare condition, being the odontogenic infection the most responsible for cases with mandibular involvement. The authors report the case of a EA patient, with severe peripheral involvement, which progressed to osteomyelitis of the jaw, secondary to the odontogenic infection due to delay in diagnosis and treatment.