The subjectivity of pain causes enormous difficulties in evaluating neonatal pain with a single, practical and easy-to-apply tool. Pain evaluation in the neonatal period should be performed by valid, ...safe, useful and feasible methods.
To evaluate the validity of the Neonatal Facial Coding System (NFCS), Neonatal Infant Pain Scale (NIPS), heart rate (HR) and O2 saturation (O2 sat) for neonatal pain assessment.
Prospective, double-blind randomized trial.
A secondary level maternity hospital.
70 healthy neonates requiring bilirubin dosage were randomly assigned to receive a venous puncture (P: n = 33, BW 3.2 kg, SD 0.6; GA 39 wk, SD 1; 59 h of life, SD 25) or an alcohol swab friction (F: n = 37; BW 3.1 kg, SD 0.5; GA 39 wk, SD 1; 52 h of life, SD 17).
All measurements were taken prior to (PRE), during (TO), and 1 (T1), 3(T3), 5(T5) and 10(T10) minutes after the procedure.
A neonatologist evaluated NFCS, NIPS, HR and O2 sat by pulse oxymetry.
Median NFCS and NIPS results at T0, T1 and T3 were higher in P group, compared to F. More P neonates presented NFCS > 2 and/or NIPS > 3 at T0, T1 and T3. HR was lower in P group at T1. Average O2 sat was above 90% during the whole study period in both groups.
NFCS and NIPS are suitable instruments for neonatal pain evaluation. Heart rate and O2 saturation can be used only as auxiliary methods.
Both oxidative/nitrosative stress and alterations in DNA methylation are observed during carcinogenesis of different tumor types, but no clear correlation between these events has been demonstrated ...until now. Melanoma cell lines were previously established after submitting the nontumorigenicmelanocyte lineage, melan-a, to cycles of anchorage blockade. In this work, increased intracellular oxidative species and nitric oxide levels, as well as alterations in the DNA methylation, were observed after melan-a detachment, which were also associated with a decrease in intracellular homocysteine (Hcy), an element in the methionine (universal methyl donor) cycle. This alteration was accompanied by increase in glutathione (GSH) levels and methylated DNA content. Furthermore, a significant increase in dnmt1 and 3b expression was identified along melan-a anchorage blockade.
l
G
-Nitro-
l
-arginine methyl esther (
l
-NAME), known as a nitric oxide synthase (NOS) inhibitor, and
N
-acetyl-
l
-cysteine (NAC) prevented the increase in global DNA methylation, as well as the increase in dnmt1 and 3b expression, observed during melan-a detachment. Interestingly, both
l
-NAME and NAC did not inhibit nitric oxide (NO) production in these cells, but abrogated superoxide anion production during anchorage blockade. In conclusion, oxidative stress observed during melanocyte anchorage blockade seems to modulate DNA methylation levels and may directly contribute to the acquisition of an anoikis-resistant phenotype through an epigenetic mechanism.
If weight and height data given by the patients were accurate, direct measurements would be made redundant and unnecessary, bringing about substantial savings in terms of cost and time, during ...epidemiological studies. Data from direct measurements were compared to those given by the individuals, during a house visit. In order to assemble a representative population of 119,570 people, domiciles that met certain criteria were chosen at random. Individuals who were 15 years old or older from the selected domicile were interviewed and their social and demographic data were taken down, as informed. Both weight and height figures were verified through the use of electronic scales and laser estadiometer. Among the 3084 interviews, which were conducted, 739 individuals didn't know their weight and 1340 could not remember their height. The authors analyzed 2345 answers which mentioned weight and 1744 with figures for height. Among patients who were able to remember their weight, 49.7% were males. Most of those who remembered their height were also males (56.6%). According to the investigators' criteria, errors caused by rounding up figures were not taken into consideration. If the difference was less than 2.5%, the error was considered acceptable, while all other values were considered discrepant errors. The proportion test was used to verify whether the discrepant error was significantly bigger than zero. (See Table) Informed value Weight Height N % N % Correct 583 24.86 690 39.56 Acceptable error 1225 52.24 565 32.40 Discrepant error 537* 22.90 489* 28.04 *p< 0.0001 for discrepant errors bigger than zero Discrepant errors continued to be significantly bigger than zero, even when data was analyzed in terms of different genders and age brackets. It was possible to verify that informed weight and height values were not very accurate and figures obtained through direct measurement were different, both for the group as a whole or for subgroups, such as gender- and age-matched cohorts. On the basis of this investigation, the authors don't recommend the use of informed weight and height figures for population studies.
To determine whether adults can recognize neonatal facial expression of pain.
A cross-sectional study.
Neonatal intensive care unit, nursery, and outpatient clinic of one university hospital and one ...private hospital in São Paulo, Brazil.
Four hundred five adults divided into 2 groups: health and nonhealth professionals.
The faces of 3 healthy full-term newborns who needed glucose screening were photographed at rest and during light exposure, heel rubbing, and heel puncture. A series of adults answered a questionnaire on personal and professional data and then they analyzed for 1 minute each of the 3 sets of pictures to answer the following question: "In which picture of this set do you think that the baby is feeling pain?"
Number of correct answers for the 3 sets of photographs shown to the adults.
Seventy-four percent of the health professionals and 86% of the nonhealth professionals indicated correctly the picture with facial expressions of pain in at least 2 of the 3 sets. Regarding which picture was picked out by the interviewee, 94% of the health professionals and 92% of the nonhealth professionals indicated the picture taken during the heel puncture in set 1. The same observation was made by 53% and 54% of the health professional and by 68% and 66% of the nonhealth professional interviewees for sets 2 and 3, respectively.
Facial expression of pain represents an effective neonatal communication tool. However, the health professional group achieved a lower level of recognition of neonatal facial expressions of pain. Factors related to the personal and professional characteristics of the adults interviewed probably contributed to this result.
A collaborative effort to assess factors affecting newborn survival at neonatal intensive care units (NICUs) was made by studying 1948 newborns admitted to nine NICUs in the city of São Paulo between ...1 June and 30 November 1991. Data on the study subjects were obtained using a standardized form. This was the first activity undertaken by a network of neonatologists (the Paulista Collaborative Group on Neonatal Care) dedicated to jointly evaluating and improving neonatal care in that city. The study results showed an overall mortality of 59 deaths per 1000 neonates, with survival improving as gestational age and birthweight rose. Other variables significantly affecting survival were a poor maternal obstetric history (a previous stillbirth or neonatal death, or two or more spontaneous abortions); birth asphyxia (Apgar at 5 minutes <7); respiratory distress syndrome; severe infections; and major malformations. However, multiple logistic regression analysis showed that the rates of neonatal survival in the nine NICUs differed even when these factors were considered. Potential sources of this variability included undetermined population differences in neonatal disease severity and medical care. These results suggest a need for greater efforts to identify and reduce risk factors associated with neonatal mortality, and to adequately evaluate the medical care provided in NICUs. Within this context, the collaborative network of neonatologists established in São Paulo provides a sound organizational structure for evaluating and improving the effectiveness of neonatal care.
Trace concentrations of Cd, Cu, Pb and Zn in four different sediment fractions extracted in sequence were determined by isotope dilution inductively coupled mass spectrometry (IDICPMS). The metals ...from each fraction were extracted following the sequential extraction procedure recommended by the Bureau Commun de Référence (BCR) of the Commission of the European Communities. As an alternative to external calibration, the elements were quantified by spiking the extracted solutions with 112Cd, 63Cu, 208Pb and 66Zn and application of isotope dilution. The proposed approach was applied to a sample collected from a lake and two standard reference materials, NIST2704 river sediment from the National Institute of Standards & Technology and the BCR-277 estuarine sediment. Detection limits, for each extracted solution, varied from 0.31 to 0.53 mug L¹ for Cd, 0.92 to 2.9 mug L¹ for Cu, 0.22 to 1.1 mug L¹ for Pb and 1.3 to 7.6 mug L¹ for Zn. The sum of the metals concentration in the different fractions was compatible with 95% confidence level found amounts obtained with complete digestion of the samples and with the certified values of the standard reference materials.
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