Caesarean sections can be a lifesaving procedure for mother and baby, but rates beyond 10% of live births are not associated with reductions in maternal and newborn mortality. Caesarean section rates ...at national level vary between around 2% in Chad, Burkina Faso, Ethiopia or Madagascar and above 50% in Brazil, Dominican Republic or Egypt. The trend towards overuse of caesarean sections is a major concern globally, given the risks to the mother and her child associated with unnecessary caesarean birth. These risks include avoidable maternal complications such as infections, haemorrhage, complications related to use of anaesthesia or blood transfusion, and infant morbidity, for example, respiratory problems, asthma and obesity in children. Caesarean sections can also lead to added complications for the mother in subsequent pregnancies, including uterine rupture, placental implantation problems and need for hysterectomy. High rates of caesarean sections are also associated with substantial health-care costs, which can pose a considerable burden on health systems. Multiple factors are driving increases in caesarean section rates. Clinical reasons for growing rates include increases in the incidence of maternal obesity, multiple pregnancies and a higher maternal age at birth. These factors alone are unlikely to explain the extent of the rise in caesarean section rates or the substantial variations among health-care providers, hospitals and regions. Studies have shown associations between caesarean section rates and non-clinical factors such as differences in health provider practices, fear of malpractice litigation and organizational, economic, social and cultural factors. A growing proportion of caesarean sections globally are not medically indicated and could have been avoided. To address the rising rates worldwide and prevent the harm to women and newborns resulting from overuse of this procedure, in 2018 the World Health Organization (WHO) published new recommendations on non-clinical interventions to reduce unnecessary caesarean sections. In this guideline, non-clinical interventions are defined as those interventions that are applied outside of the routine clinical interactions between a provider and pregnant woman. The interventions may target women (for instance, birth preparation classes), health-care providers (clinical practice guidelines) or health organizations (different payment systems for caesarean sections). The recommendations, are grouped according to the target of interventions and address major determinants of caesarean section rates. The recommendations are intended to inform the development of national and subnational policies and protocols to reduce unnecessary caesarean births in high-, middle- and low-income countries. The new recommendations should be integrated and implemented with other related WHO guidelines, such as WHO recommendations on antenatal and intrapartum care for a positive childbirth experience.
To evaluate the risk of recurrence of adverse perinatal outcomes in second pregnancies in developing countries.
Data from the 2004-2008 Global Survey on Maternal and Perinatal Health were used to ...determine the outcomes of singleton second pregnancies for 61 780 women in 23 developing countries. The mother-infant pairs had been followed up until discharge or for 7 days postpartum.
At the end of their second pregnancies, women whose first pregnancy had ended in stillbirth (n = 1261) or been followed by neonatal death (n = 1052) were more likely than women who had not experienced either outcome to have given birth to a child with a birth weight of < 1500 g (odds ratio, OR: 2.52 and 2.78, respectively) or 1500-2499 g (OR: 1.22 and 1.60, respectively), or to an infant requiring admission to an intensive care unit (OR: 1.64 and 1.68, respectively). At the end of their second pregnancies, those whose first pregnancy had ended in a stillbirth were at increased risk of another stillbirth (OR: 2.35) and those whose first infant had died as a neonate were at increased risk of having the second infant die within the first 7 days of life (OR: 2.82). These trends were found to be largely unaffected by the continent in which the women lived.
In the developing world, a woman whose first pregnancy ends in stillbirth or is followed by the death of the neonate is at increased risk of experiencing the same outcomes in her second pregnancy.
Herbal drugs have been used since ancient times to treat a wide range of diseases. Morinda citrifolia Linn (popularly known as "Noni") has been used in folk medicine by Polynesians for over 2,000 ...years. It is reported to have a broad range of therapeutic effects, including effects against headache, fever, arthritis, gingivitis, respiratory disorders, infections, tuberculosis, and diabetes. The aim of this study was to investigate the antioxidant, anti-inflammatory, antinociceptive, and antibacterial properties of the aqueous extract from M. citrifolia leaves (AEMC). Antioxidant activity was observed against lipid peroxidation, nitric oxide, and hydroxyl radicals. The antinociceptive effect of AEMC was observed in the acetic acid-induced writhing test at the higher dose. Moreover, AEMC significantly reduced the leukocyte migration in doses of 200 and 400 mg/kg and showed mild antibacterial activity. Together, the results suggest that properties of M. citrifolia leaf extract should be explored further in order to achieve newer tools for managing painful and inflammation conditions, including those related to oxidant states.
Summary Background Active management of the third stage of labour reduces the risk of post-partum haemorrhage. We aimed to assess whether controlled cord traction can be omitted from active ...management of this stage without increasing the risk of severe haemorrhage. Methods We did a multicentre, non-inferiority, randomised controlled trial in 16 hospitals and two primary health-care centres in Argentina, Egypt, India, Kenya, the Philippines, South Africa, Thailand, and Uganda. Women expecting to deliver singleton babies vaginally (ie, not planned caesarean section) were randomly assigned (in a 1:1 ratio) with a centrally generated allocation sequence, stratified by country, to placental delivery with gravity and maternal effort (simplified package) or controlled cord traction applied immediately after uterine contraction and cord clamping (full package). After randomisation, allocation could not be concealed from investigators, participants, or assessors. Oxytocin 10 IU was administered immediately after birth with cord clamping after 1–3 min. Uterine massage was done after placental delivery according to local policy. The primary (non-inferiority) outcome was blood loss of 1000 mL or more (severe haemorrhage). The non-inferiority margin for the risk ratio was 1·3. Analysis was by modified intention-to-treat, excluding women who had emergency caesarean sections. This trial is registered with the Australian and New Zealand Clinical Trials Registry, ACTRN 12608000434392. Findings Between June 1, 2009, and Oct 30, 2010, 12 227 women were randomly assigned to the simplified package group and 12 163 to the full package group. After exclusion of women who had emergency caesarean sections, 11 861 were in the simplified package group and 11 820 were in the full package group. The primary outcome of blood loss of 1000 mL or more had a risk ratio of 1·09 (95% CI 0·91–1·31) and the upper 95% CI limit crossed the pre-stated non-inferiority margin. One case of uterine inversion occurred in the full package group. Other adverse events were haemorrhage-related. Interpretation Although the hypothesis of non-inferiority was not met, omission of controlled cord traction has very little effect on the risk of severe haemorrhage. Scaling up of haemorrhage prevention programmes for non-hospital settings can safely focus on use of oxytocin. Funding United States Agency for International Development and UN Development Programme/UN Population Fund/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research.
Abstract The role of fostering Openness to the World (OW) refers to disciplinarian parenting behaviors that encourage children to take risks and persevere when facing challenges. This study aimed to ...characterize, compare, and define typologies of OW for fathers and mothers in southern Brazil. The Openness to the World Questionnaire was answered by 171 heteroaffective couples with preschool children. Inferential statistical analyzes indicated that mothers reported providing significantly more Stimulus to Perseverance than fathers. Eight different types of typologies of OW were identified: Activating Father/Mother, Protective Father/Mother, Reckless Father/Mother, Authoritarian Father, and Overprotective Mother. The analysis of these results allows us to conclude that there is a society transition process in which more traditional families (mothers responsible for the children’s education) coexist with others in which fathers and mothers play the role of fostering OW. Because of the benefits that OW brings to child development, it is suggested that it should be included in public policies that promote positive parenting.
Resumo A função de Abertura ao Mundo (AM) refere-se a comportamentos parentais que estimulam a criança a assumir risco, perseverar diante de desafios e disciplinadores. Esse estudo teve como objetivo caracterizar, comparar e definir tipologias da AM de pais e mães da região sul do Brasil. O Questionário de AM foi respondido por 171 casais heteroafetivos com crianças pré-escolares. Análises estatísticas inferenciais indicaram que mães relataram exercer significativamente mais Estímulo à Perseverança que os pais. Identificaram-se oito diferentes tipologias de AM: Pai/Mãe Ativador(a), Pai/Mãe Protetor(a), Pai/Mãe Imprudente, Pai Autoritário e Mãe Superprotetora. A análise desses resultados permite concluir que ocorre um processo de transição da sociedade em que coexistem famílias mais tradicionais (mães responsáveis pela educação das crianças) e outras com compartilhamento do exercício da função de AM entre pais e mães. Pelos benefícios da AM para o desenvolvimento infantil, sugere- se incluí-la em Políticas Públicas que promovam parentalidade positiva.
Resumen La función de Apertura al Mundo (AM) se refiere a comportamientos parentales que alientan a los niños a asumir riesgos, perseverar ante los desafíos y la disciplina. El presente estudio tuvo como objetivo caracterizar, comparar y definir tipologías de AM de padres y madres en la región Sur de Brasil. Contestaron al cuestionario de AM 171 parejas heteroafectivas con niños preescolares. Los análisis estadísticos inferenciales indicaron que las madres informaron ejercitar significativamente más el Estímulo a la Perseverancia que los padres. Se identificaron ocho tipologías diferentes de AM: Padre/Madre Activador/a; Padre/Madre Protector/a; Padre/Madre Imprudente; Padre Autoritario y Madre Sobreprotectora. El análisis de estos resultados nos permite concluir que existe un proceso de transición de la sociedad en el que coexisten familias más tradicionales (madres responsables de la educación de los niños) y otras que comparten el ejercicio del papel de AM entre padres y madres. Debido a los beneficios de la AM para el desarrollo infantil, se sugiere incluirla en las Políticas Públicas que promueven la parentalidad positiva.
In shoulder arthroscopy, on an outpatient basis, the patient needs a good control of the postoperative pain that can be achieved through regional blocks. Perineural dexamethasone may prolong the ...effect of these blocks. The aim of this study was to evaluate the effect of perineural dexamethasone on the prolongation of the sensory block in the postoperative period for arthroscopic shoulder surgery in outpatient setting.
After approval by the Research Ethics Committee and informed consent, patients undergoing arthroscopic shoulder surgery under general anesthesia and ultrasound-guided interscalene brachial plexus block were randomized into Group D – blockade performed with 30mL of 0.5% levobupivacaine with vasoconstrictor and 6mg (1.5mL) of dexamethasone and Group C – 30mL of 0.5% levobupivacaine with vasoconstrictor and 1.5mL of 0.9% saline. The duration of the sensory block was evaluated in 4 postoperative moments (0, 4, 12 and 24hours) as well as the need for rescue analgesia, nausea and vomiting incidence, and Visual Analog Pain Scale (VAS).
Seventy-four patients were recruited and 71 completed the study (Group C, n=37; Group D, n=34). Our findings showed a prolongation of the mean time of the sensitive blockade in Group D (1440±0min vs. 1267±164min, p<0.001). It was observed that Group C had a higher mean pain score according to VAS (2.08±1.72 vs. 0.02±0.17, p<0.001) and a greater number of patients (68.4% vs. 0%, p<0.001) required rescue analgesia in the first 24hours. The incidence of postoperative nausea and vomiting was not statistically significant.
Perineural dexamethasone significantly prolonged the sensory blockade promoted by levobupivacaine in interscalene brachial plexus block, reduced pain intensity and rescue analgesia needs in the postoperative period.
Na artroscopia de ombro em regime ambulatorial, o paciente necessita de um bom controle da dor pós-operatória, que pode ser conseguido por meio de bloqueios regionais. A dexametasona perineural pode prolongar o efeito desses bloqueios. O objetivo deste estudo foi avaliar o efeito da dexametasona perineural quanto ao prolongamento do bloqueio sensitivo no período pós-operatório para cirurgia artroscópica de ombro em regime ambulatorial.
Após aprovação do Comitê de Ética em Pesquisa e consentimento informado, foram incluídos no estudo pacientes submetidos a cirurgia artroscópica de ombro sob anestesia geral e bloqueio de plexo braquial interescalênico guiado por ultrassonografia. Eles foram randomizados nos Grupo D – bloqueio com 30mL de levobupivacaína 0,5% com vasoconstritor e 6mg (1,5mL) de dexametasona, e Grupo C – bloqueio com 30mL de levobupivacaína 0,5% com vasoconstritor e 1,5mL solução salina. A duração do bloqueio sensitivo foi avaliada em quatro momentos pós-operatórios (0, 4, 12 e 24horas), assim como a necessidade de analgesia de resgate, incidência de náuseas e vômitos e Escala Visual Analógica de Dor (EVA).
Setenta e quatro pacientes foram randomizados e 71 completaram o estudo (Grupo C, n=37; Grupo D, n=34). Observou-se um prolongamento do tempo médio de bloqueio sensitivo no Grupo D (1440±0min vs. 1267±164min; p<0,001). Pacientes do Grupo C apresentaram maior média de escore de dor de acordo com a EVA (2,08±1,72 vs. 0,02±0,17; p<0,001) e um maior número de pacientes solicitou analgesia de resgate nas primeiras 24 horas (68,4% vs. 0%; p<0,001). A incidência de náuseas e vômitos não foi estatisticamente significante.
A dexametasona perineural prolongou significativamente o bloqueio sensitivo da levobupivacaína no bloqueio de plexo braquial interescalênico, reduziu a intensidade de dor e a necessidade de analgesia de resgate pelo paciente no período pós-operatório.
High δ
C in human tissues in Brazil indicate high consumption of C
-based sources due to the consumption of highly processed food and animal protein. The significant positive correlation between the ...human developed index (HDI) developed by the United Nations Development Program, and fingernail δ
C at the county level proved to be useful as a new proxy in tracking human nutrition. Regions with higher HDI are those with higher consumption of highly processed food.
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•Sample of industrial waste, mill scale (MS), milled using high-energy ball mill.•Composite with magnetic properties characterized and applied as electrode sustainable ...modifier.•Selectivity through reuse, unique, and simple modification step.•Multianalyte detection with low LoD and wide linear response range.•Quantification of neurotransmitters dopamine (DA), serotonin (5-HT), and tryptophan (TRP).
This study aimed to reuse waste from the steel industry as a sustainable electrode modifier material in a simple and one-step modification approach for the electrochemical monitoring of the neurotransmitters dopamine (DA), serotonin (5-HT), and tryptophan (TRP), biomarkers related to depression diagnostics. Iron oxides constitute the mill scale (MS), composed of wüstite (FeO), magnetite (Fe3O4), and hematite (Fe2O3). This material was generated from the hot rolling process, and later it was ball milled using a high-energy shaker mill. X-ray powder diffraction (XRPD) was used to investigate the structural and microstructural evolution of the MS with milling time. Effects of mechanical force on solids include a reduction in the crystalline size by controlling the milling time, with consequently peculiar properties and chemical reactivity. The magnetic measurements show superparamagnetic characteristics in the samples, governed mainly by small crystallites of iron oxides. Two samples (milled for 2 and 30 min) were applied in the construction of new sensors. The MS carbon paste electrode (MS/CPE) with 30 min-sample allowed more defined oxidation peaks through a simple and one-step electrode modification step. Selectivity for the detection of the multianalytes was achieved after the modification of the carbonaceous substrate with the mixture of metal oxides with magnetic properties; overlapping peaks were observed for DA and 5-HT using the unmodified electrode. Under optimum conditions of square wave voltammetry, a linear relationship was observed between the peak current intensities and the concentrations of the analytes. Linear responses were obtained for DA, 5-HT, and TRP in the 0.49–21, 0.49–13.6, and 2.9–25 µmol L−1 concentration ranges, with detection limits of 0.21, 0.13, and 2.18 µmol L−1, respectively. The reuse of waste as a sustainable electrode modifier material for clinical and biomedical applications, with improved selectivity and sensibility, is hereby present.
OBJECTIVETo investigate gender inequity in the scientific production of the University of Sao Paulo. METHODSMembers of the University of Sao Paulo faculty are the study population. The Web of Science ...repository was the source of the publication metrics. We selected the measures: total publications and citations, average of citations per year and item, H-index, and history of citations between 1950 and 2019. We used the name of the faculty member as a proxy to the gender identity. We use descriptive statistics to characterize the metrics. We evaluated the scissors effect by selecting faculty members with a high H-index. The historical series of citations was projected until 2100. We carry out analyses for the general population and working time subgroups: less than 10 years, 10 to 20 years, and 20 years or more. RESULTSOf the 8,325 faculty members, we included 3,067 (36.8%). Among those included, 1,893 (61.7%) were male and 1,174 (38.28%) female. The male gender presented higher values in the publication metrics (average of articles: M = 67.0 versus F = 49.7; average of citations/year: M = 53.9 versus F = 35.9), and H-index (M = 14.5 versus F = 12.4). Among the 100 individuals with the highest H-index (≥ 37), 83% are male. The male curve grows faster in the historical series of citations, opening a difference between the groups whose separation is confirmed by the projection. DISCUSSIONScientific production at the Universidade de São Paulo is subject to a gender bias. Two-thirds of the faculty are male, and hiring over the past few decades perpetuates this pattern. The large majority of high impact faculty members are male. CONCLUSIONOur analysis suggests that the Universidade de São Paulo will not overcome gender inequality in scientific production without substantive affirmative action. Development does not happen by chance but through choices that are affirmative, decisive, and long-term oriented.
O objetivo deste artigo é problematizar implicações da intensificação da violência letal e desafios frente a isso no cotidiano de trabalhadores sociais que atuam em uma das regiões com maiores taxas ...de homicídios na cidade de Fortaleza. Trata-se de um desdobramento de uma pesquisa-intervenção, à luz do método da cartografia, que analisou práticas institucionais em torno da problemática dos homicídios de adolescentes e jovens. Os dados foram produzidos por observações, conversas no cotidiano, entrevistas e grupos de discussões. A seção de resultados e discussão destaca: 1) a violência como fortalecedora de barreiras no acesso de profissionais aos territórios e no acesso das juventudes mais estigmatizadas aos serviços existentes; 2) os desafios de profissionais de tomar a violência como objeto de ação-reflexão-ação e 3) a experiência de grupos de discussões intersetoriais na Barra do Ceará como estratégia de coletivização da problemática dos homicídios.
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