Risk factors for inadequate prenatal care use in the metropolitan area of Aracaju, Northeast Brazil

Abstract Background The aim of prenatal care is to promote good maternal and foetal health and to identify risk factors for adverse pregnancy outcomes in an attempt to promptly manage and solve them. Although high prenatal care attendance is reported in most areas in Brazil, perinatal and neonatal mortalities are disproportionally high, raising doubts about the quality and performance of the care provided. The objective of the present study was to evaluate the adequacy of prenatal care use and the risk factors involved in inadequate prenatal care utilization in the metropolitan area of Aracaju, Northeast Brazil. Methods A survey was carried out with puerperal women who delivered singleton liveborns in all four maternity hospitals of Aracaju. A total of 4552 singleton liveborns were studied. The Adequacy of Prenatal Care Utilization Index, modified according to the guidelines of the Prenatal Care and Birth Humanization Programme, was applied. Socioeconomic, demographic, biological, life style and health service factors were evaluated by multiple logistic regression. Results: Prenatal care coverage in Aracaju was high (98.3%), with a mean number of 6.24 visits. Prenatal care was considered to be adequate or intensive in 66.1% of cases, while 33.9% were considered to have inadequate usage. Age < 18 to 34 years at delivery, low maternal schooling, low family income, two or more previous deliveries, maternal smoking during pregnancy, having no partner and prenatal care obtained outside Aracaju were associated with inadequate prenatal care use. In contrast, private service attendance protected from inadequate prenatal care use. Conclusion Prenatal care coverage was high. However, a significant number of women still had inadequate prenatal care use. Socioeconomic inequalities, demographic factors and behavioural risk factors are still important factors associated with inadequate prenatal care use.

Cellular and humoral immune responses against the Plasmodium vivax MSP-119 malaria vaccine candidate in individuals living in an endemic area in north-eastern Amazon region of Brazil

Abstract Background Plasmodium vivax merozoite surface protein-1 (MSP-1) is an antigen considered to be one of the leading malaria vaccine candidates. PvMSP-1 is highly immunogenic and evidences suggest that it is target for protective immunity against asexual blood stages of malaria parasites. Thus, this study aims to evaluate the acquired cellular and antibody immune responses against PvMSP-1 in individuals naturally exposed to malaria infections in a malaria-endemic area in the north-eastern Amazon region of Brazil. Methods The study was carried out in Paragominas, Pará State, in the Brazilian Amazon. Blood samples were collected from 35 individuals with uncomplicated malaria. Peripheral blood mononuclear cells were isolated and the cellular proliferation and activation was analysed in presence of 19 kDa fragment of MSP-1 (PvMSP-119) and Plasmodium falciparum PSS1 crude antigen. Antibodies IgE, IgM, IgG and IgG subclass and the levels of TNF, IFN-γ and IL-10 were measured by enzyme-linked immunosorbent assay. Results The prevalence of activated CD4+ was greater than CD8+ T cells, in both ex-vivo and in 96 h culture in presence of PvMSP-119 and PSS1 antigen. A low proliferative response against PvMSP-119 and PSS1 crude antigen after 96 h culture was observed. High plasmatic levels of IFN-γ and IL-10 as well as lower TNF levels were also detected in malaria patients. However, in the 96 h supernatant culture, the dynamics of cytokine responses differed from those depicted on plasma assays; in presence of PvMSP-119 stimulus, higher levels of TNF were noted in supernatant 96 h culture of malaria patient’s cells while low levels of IFN-γ and IL-10 were verified. High frequency of malaria patients presenting antibodies against PvMSP-119 was evidenced, regardless class or IgG subclass.PvMSP-119-induced antibodies were predominantly on non-cytophilic subclasses. Conclusions The results presented here shows that PvMSP-119 was able to induce a high cellular activation, leading to production of TNF and emphasizes the high immunogenicity of PvMSP-119 in naturally exposed individuals and, therefore, its potential as a malaria vaccine candidate.

Hip-hop and Construction of Group Identity in a Stigmatized Area. : A Field Study regarding Cultural Capital among Roma Youths in Konik, Montenegro.

This research aimed for an extended knowledge and understanding of young people in stigmatized areas and their construction of group identity. With a focus on Roma youths in Konik, Montenegro, and their involvement in hip-hop we wanted to explore what this culture meant to them in relation to their context. An ethnographic approach was used in collecting the empirical data through observations, interpreting music lyrics and conducting qualitative semi-structured interviews. Five young Roma boys from Konik, all involved in hip-hop, were interviewed. Theoretical perspectives on identity, youth culture and stigmatization were central. In addition, Bourdieu’s theory regarding cultural capital was emphasized and connected to youths and hip-hop. The empirical material showed that involvement in hip-hop provided the Roma youths with a group identity that they referred to in positive terms. Contextual factors of stigmatization excluded the Roma group from the majority population and the engagement in hip-hop created a possibility for the youths to be someone. The cultural capital gained through hip-hop was not used to verify and legitimate an authentic Roma identity. It was rather a way for them to create boundaries towards the negative elements in their community.

CLIL materials in Secondary Education: focusing on the language of instruction in the subject area of Mathematics

[EN]Applying a CLIL methodological approach marks a shift in emphasis from language learning based on linguistic form and grammatical progression to a more ‘language acquisition’ one which takes account language functions. In this article we will study the elements of the “language of instruction” of the area of Maths in Secondary Education, by focusing on the analysis of the communicative functions, and the lexical and the cultural items present in the textbook in use. Our aim is to present the CLIL teacher with the linguistic and didactic implications that he or she should take into consideration when implementing the bilingual syllabuses with their students. In order to do that, we will present our conclusions emphasizing the need for coordination in different content areas, linguistic and communicative contents, between the foreign language teacher and the CLIL subject one.

Lymphogranuloma venereum: a new face for an old disease. Our experience in the Bologna area.

Lymphogranuloma venereum (LGV) is a sexual transmitted infection due to Clamydia trachomatis biovar L, endemic in part of Africa, Asia, South America and the Caribbean, but rare in industrialized countries up to 10 years ago. In 2003, a cluster of cases of LGV among men who have sex with men (MSM) was reported in Rotterdam. Since then, several reports of LGV have been reported in the largest cities in Europe, the United States and Australia. They have usually occurred with an anorectal syndrome. The purpose of this study is to summarize the expertise provided by the international literature about the new LGV outbreaks and to offer the first data collected on the presence of this disease in the Bologna area. In fact, we examine 5 cases of LGV proctitis diagnosed and treated at the Clinic of Sexually Transmitted Disease (STD) of the Dermatology Section at Sant’Orsola-Malpighi Hospital, Bologna. Particular attention will be paid to the laboratory method that allows identification and typing of the microorganism C. trachomatis serovar L1, L2, L3, leading to an etiologic diagnosis of certainty. The diagnosed cases of LGV will be described and compared with the international literature, trying to assess the risk factors, the most effective diagnostic and therapeutic procedure and the best approach to the patient.

High-resolution reconstruction of Holocene climate variability and environmental changes in the North Pacific using bivalve shells

Bivalve mollusk shells are useful tools for multi-species and multi-proxy paleoenvironmental reconstructions with a high temporal and spatial resolution. Past environmental conditions can be reconstructed from shell growth and stable oxygen and carbon isotope ratios, which present an archive for temperature, freshwater fluxes and primary productivity. The purpose of this thesis is the reconstruction of Holocene climate and environmental variations in the North Pacific with a high spatial and temporal resolution using marine bivalve shells. This thesis focuses on several different Holocene time periods and multiple regions in the North Pacific, including: Japan, Alaska (AK), British Columbia (BC) and Washington State, which are affected by the monsoon, Pacific Decadal Oscillation (PDO) and El Niño/Southern Oscillation (ENSO). Such high-resolution proxy data from the marine realm of mid- and high-latitudes are still rare. Therefore, this study contributes to the optimization and verification of climate models. However, before using bivalves for environmental reconstructions and seasonality studies, life history traits must be well studied to temporally align and interpret the geochemical record. These calibration studies are essential to ascertain the usefulness of selected bivalve species as paleoclimate proxy archives. This work focuses on two bivalve species, the short-lived Saxidomus gigantea and the long-lived Panopea abrupta. Sclerochronology and oxygen isotope ratios of different shell layers of P. abrupta were studied in order to test the reliability of this species as a climate archive. The annual increments are clearly discernable in umbonal shell portions and the increments widths should be measured in these shell portions. A reliable reconstruction of paleotemperatures may only be achieved by exclusively sampling the outer shell layer of multiple contemporaneous specimens. Life history traits (e.g., timing of growth line formation, duration of the growing season and growth rates) and stable isotope ratios of recent S. gigantea from AK and BC were analyzed in detail. Furthermore, a growth-temperature model based on S. gigantea shells from Alaska was established, which provides a better understanding of the hydrological changes related to the Alaska Coastal Current (ACC). This approach allows the independent measurement of water temperature and salinity from variations in the width of lunar daily growth increments of S. gigantea. Temperature explains 70% of the variability in shell growth. The model was calibrated and tested with modern shells and then applied to archaeological specimens. The time period between 988 and 1447 cal yrs BP was characterized by colder (~1-2°C) and much drier (2-5 PSU) summers, and a likely much slower flowing ACC than at present. In contrast, the summers during the time interval of 599-1014 cal yrs BP were colder (up to 3°C) and fresher (1-2 PSU) than today. The Aleutian Low may have been stronger and the ACC was probably flowing faster during this time.

Relationships between plant diversity and environmental heterogeneity in rupicolous grasslands on gypsum. The case study of Alysso-Sedion albi (Habitat 6110).

Plant communities on weathered rock and outcrops are characterized by high values in species richness (Dengler 2006) and often persist on small and fragmented surfaces. Yet very few studies have examined the relationships between heterogeneity and plant diversity at small scales, in particular in poor-nutrient and low productive environment (Shmida and Wilson 1985, Lundholm 2003). In order to assess these relationships both in space and time in relationship, two different approaches were employed in the present study, in two gypsum outcrops of Northern Apennine. Diachronic and synchronic samplings from April 2012 to March 2013 were performed. A 50x50 cm plot was used in both samplings such as the sampling unit base. The diachronic survey aims to investigate seasonal patterning of plant diversity by the use of images analysis techniques integrated with field data and considering also seasonal climatic trend, the substrate quality and its variation in time. The purpose of the further, synchronic sampling was to describe plant diversity pattern as a function of the environmental heterogeneity meaning in substrate typologies, soil depth and topographic features. Results showed that responses of diversity pattern depend both on the resources availability, environmental heterogeneity and the manner in which the different taxonomic group access to them during the year. Species richness and Shannon diversity were positively affected by increasing in substrate heterogeneity. Furthermore a good turnover in seasonal species occurrence was detected. This vegetation may be described by the coexistence of three groups of species which created a gradient from early colonization stages, characterized by greater slope and predominance of bare rock, gradually to situation of more developed soil.

Divergence patterns in Fucus seaweeds (Phaeophyceae) in the northern Baltic Sea and in the Tjongspollen area

To be able to interpret patterns of biodiversity it is important to understand the processes by which new species evolve and how closely related species remain reproductively isolated and ecologically differentiated. Divergence and differentiation can vary during speciation and it can be seen in different stages. Groups of closely related taxa constitute important case studies to understand species and new biodiversity formation. However, it is important to assess the divergence among them at different organismal levels and from an integrative perspective. For this purpose, this study used the brown seaweeds genus Fucus as a model to study speciation, as they constitute a good opportunity to study divergence at different stages. We investigated the divergence patterns in Fucus species from two marginal areas (northern Baltic Sea and the Tjongspollen area), based on phenetic, phylogenetic and biological taxonomical criteria that are respectively characterised by algal morphology, allele frequencies of five microsatellite loci and levels of secondary polyphenolic compounds called phlorotannins. The results from this study showed divergence at morphological and genetic levels to certain extent but complete lack of divergence at biochemical level (i.e. constitutive phlorotannin production) in the Baltic Sea or Norway. Morphological divergence was clearly evident in Tjongspollen (Norway) among putative taxa as they were identified in the field and this divergence corresponds with their neutral genetic divergence. In the Baltic, there are some distinguishable patterns in the morphology of the swedish and finnish individuals according to locality to certain extent but not among putative taxa within localities. Likewise, these morphological patterns have genetic correspondence among localities but not within each locality. At the biochemical level, measured by the phlorotannin contents there were neither evidence of divergence in Norway or the Baltic Sea nor any discernable aggregation pattern among or within localities. Our study have contributed with further understanding of the Baltic Sea Fucus system and its intriguingly rapid and recent divergence as well as of the Tjongspollen area systems where formally undescribed individuals have been observed for the first time; in fact they appear largely differentiated and they may well warrant a new species status. In current times, climate change threatens, peripheral ecosystems, biodiversity, and increased knowledge of processes generating and maintaining biodiversity in those ecosystems seem particularly important and needed.

Accessibility as a determinant of environmental dynamics in socio-economic disparities in mainland Southeast Asia

Access and accessibility are important determinants of people’s ability to utilise natural resources, and have a strong impact on household welfare. Physical accessibility of natural resources, on the other hand, has generally been regarded as one of the most important drivers of land-use and land-cover changes. Based on two case studies, this article discusses evidence of the impact of access to services and access to natural resources on household poverty and on the environment. We show that socio-cultural distances are a key limiting factor for gaining access to services, and thereby for improved household welfare. We also discuss the impact of socio-cultural distances on access to natural resources, and show that large-scale commercial exploitation of natural resources tends to occur beyond the spatial reach of socio-culturally and economically marginalised population segments. We conclude that it is essential to pay more attention to improving the structural environment that presently leaves social minority groups marginalised. Innovative approaches that use natural resource management to induce poverty reduction – for example, through compensation of local farmers for environmental services – appear to be promising avenues that can lead to integration of the objectives of poverty reduction and sustainable environmental stewardship.

Mainstreaming a Decade's Experiences in Watershed Management to Meet the Challenges of Environmental Change in the Hindu Kush-Himalayas

Like other mountain areas in the world, the Hindu Kush-Himalayan (HKH) region is particularly vulnerable to climate change. Ongoing climate change processes are projected to have a high impact on the HKH region, and accelerated warming has been reported in the Himalayas. These climate change impacts will be superimposed on a variety of other environmental and social stresses, adding to the complexity of the issues. The sustainable use of natural resources is crucial to the long-term stability of the fragile mountain ecosystems in the HKH and to sustain the socio-ecological resilience that forms the basis of sustainable livelihoods in the region. In order to be prepared for these challenges, it is important to take stock of previous research. The ‘People and Resource Dynamics Project’ (PARDYP), implemented by International Centre for Integrated Mountain Development (ICIMOD), provides a variety of participatory options for sustainable land management in the HKH region. The PARDYD project was a research for development project that operated in five middle mountain watersheds across the HKH – two in Nepal and one each in China, India, and Pakistan. The project ran from 1996 to 2006 and focused on addressing the marginalisation of mountain farmers, the use and availability of water, issues relating to land and forest degradation and declining soil fertility, the speed of regeneration of degraded land, and the ability of the natural environment to support the growing needs of the region’s increasing population. A key learning from the project was that the opinion of land users is crucial to the acceptance (and, therefore, successful application) of new technologies and approaches. A major challenge at the end of every project is to promote knowledge sharing and encourage the cross-fertilization of ideas (e.g., in the case of PARDYP, with other middle mountain inhabitants and practitioners in the region) and to share lessons learned with a wider audience. This paper will highlight how the PARDYP findings, including ways of addressing soil fertility and water scarcity, have been mainstreamed in the HKH region through capacity building (international, regional, and national training courses), networking, and the provision of backstopping services. In addition, in view of the challenges in watershed management in the HKH connected to environmental change, the lessons learned from the PARDYP are now being used by ICMOD to define and package climate change proof technology options to address climate change adaptation.