Perinatal factors associated with early deaths of preterm infants born in Brazilian Network on Neonatal Research centers

Objective: To evaluate perinatal factors associated with early neonatal death in preterm infants with birth weights (BW) of 400-1,500 g.Methods: A multicenter prospective cohort study of all infants with BW of 400-1,500 g and 23-33 weeks of gestational age (GA), without malformations, who were born alive at eight public university tertiary hospitals in Brazil between June of 2004 and May of 2005. Infants who died within their first 6 days of life were compared with those who did not regarding maternal and neonatal characteristics and morbidity during the first 72 hours of life. Variables associated with the early deaths were identified by stepwise logistic regression.Results: A total of 579 live births met the inclusion criteria. Early deaths occurred in 92 (16%) cases, varying between centers from 5 to 31%, and these differences persisted after controlling for newborn illness severity and mortality risk score (SNAPPE-II). According to the multivariate analysis, the following factors were associated with early intrahospital neonatal deaths: gestational age of 23-27 weeks (odds ratio - OR = 5.0; 95%CI 2.7-9.4), absence of maternal hypertension (OR = 1.9; 95%CI 1.0-3.7), 5th minute Apgar 0-6 (OR = 2.8; 95%CI 1.4-5.4), presence of respiratory distress syndrome (OR = 3.1; 95%CI 1.4-6.6), and network center of birth.Conclusion: Important perinatal factors that are associated with early neonatal deaths in very low birth weight preterm infants can be modified by interventions such as improving fetal vitality at birth and reducing the incidence and severity of respiratory distress syndrome. The heterogeneity of early neonatal rates across the different centers studied indicates that best clinical practices should be identified and disseminated throughout the country.

Brazilian network for the surveillance of maternal potentially life threatening morbidity and maternal near-miss and a multidimensional evaluation of their long term consequences

Background. It has been suggested that the study of women who survive life-threatening complications related to pregnancy (maternal near-miss cases) may represent a practical alternative to surveillance of maternal morbidity/mortality since the number of cases is higher and the woman herself is able to provide information on the difficulties she faced and the long-term repercussions of the event. These repercussions, which may include sexual dysfunction, postpartum depression and posttraumatic stress disorder, may persist for prolonged periods of time, affecting women's quality of life and resulting in adverse effects to them and their babies. Objective. The aims of the present study are to create a nationwide network of scientific cooperation to carry out surveillance and estimate the frequency of maternal near-miss cases, to perform a multicenter investigation into the quality of care for women with severe complications of pregnancy, and to carry out a multidimensional evaluation of these women up to six months. Methods/Design. This project has two components: a multicenter, cross-sectional study to be implemented in 27 referral obstetric units in different geographical regions of Brazil, and a concurrent cohort study of multidimensional analysis. Over 12 months, investigators will perform prospective surveillance to identify all maternal complications. The population of the cross-sectional component will consist of all women surviving potentially life-threatening conditions (severe maternal complications) or life-threatening conditions (the maternal near miss criteria) and maternal deaths according to the new WHO definition and criteria. Data analysis will be performed in case subgroups according to the moment of occurrence and determining cause. Frequencies of near-miss and other severe maternal morbidity and the association between organ dysfunction and maternal death will be estimated. A proportion of cases identified in the cross-sectional study will comprise the cohort of women for the multidimensional analysis. Various aspects of the lives of women surviving severe maternal complications will be evaluated 3 and 6 months after the event and compared to a group of women who suffered no severe complications in pregnancy. Previously validated questionnaires will be used in the interviews to assess reproductive function, posttraumatic stress, functional capacity, quality of life, sexual function, postpartum depression and infant development. © 2009 Cecatti et al.

The Brazilian Network for HIV-1 Genotyping External Quality Control Assurance Programme

The Brazilian network for genotyping is composed of 21 laboratories that perform and analyze genotyping tests for all HIV-infected patients within the public system, performing approximately 25,000 tests per year. We assessed the interlaboratory and intralaboratory reproducibility of genotyping systems by creating and implementing a local external quality control evaluation. Plasma samples from HIV-1-infected individuals (with low and intermediate viral loads) or RNA viral constructs with specific mutations were used. This evaluation included analyses of sensitivity and specificity of the tests based on qualitative and quantitative criteria, which scored laboratory performance on a 100-point system. Five evaluations were performed from 2003 to 2008, with 64% of laboratories scoring over 80 points in 2003, 81% doing so in 2005, 56% in 2006, 91% in 2007, and 90% in 2008 (Kruskal-Wallis, p = 0.003). Increased performance was aided by retraining laboratories that had specific deficiencies. The results emphasize the importance of investing in laboratory training and interpretation of DNA sequencing results, especially in developing countries where public (or scarce) resources are used to manage the AIDS epidemic.

Modernizing the Brazilian active control network

The Brazilian Network for Continuous Monitoring of GPS - RBMC, since its foundation in December of 1996, has been playing an essential role for the maintenance and user access of the fundamental geodetic frame in the country,. It provides users with a direct link to the Brazilian Geodetic System - SGB. Its role has become more relevant with the increasing use of space navigation technology in the country. Recently, Brazil adopted a new geodetic system, SIRGAS2000, in February 2005, fully compatible with GNSS technology. The paper provides an overview of the recent modernization phases the RBMC network has undergone highlighting its future steps. From its current post-mission mode, the RBMC will evolve into a real-time network, providing real-time data and real-time correction to users. The network enhanced with modern GPS receivers and the addition of atomic clocks will be used to compute WADGPS-type corrections to be transmitted, in real time, to users in Brazil and surrounding areas. It is estimated that users will be able to achieve a horizontal accuracy around 0.5 m (1σ) in static and kinematic positioning and better for dual frequency users. The availability of the WADGPS service will allow users to tie to the new SIRGAS2000 system in a more rapid and transparent way for positioning and navigation applications. It should be emphasized that support to post-mission static positioning will continue to be provided to users interested in higher accuracy levels. In addition to this, a post-mission Precise Point Positioning (PPP) service will be provided based on the one currently provided by the Geodetic Survey Division of NRCan (CSRS-PPP). The modernization of the RBMC is under development based on a cooperation signed at the end of 2004 with the University of New Brunswick, supported by the Canadian International Development Agency and the Brazilian Cooperation Agency. The Geodetic Survey Division of NRCan is also participating in this modernization effort under the same project.

Latest Enhancements in the Brazilian Active Control Network

The Brazilian Network for Continuous Monitoring of GPS - RBMC, since its foundation in December of 1996, has been playing an essential role for the maintenance and user access of the fundamental geodetic frame in the country. It provides to users a direct link to the Brazilian Geodetic System. Its role has become more relevant with the increasing use of space navigation technology in the country. Recently, Brazil adopted a new geodetic frame, SIRGAS2000, in February 2005, fully compatible with GNSS technology. The paper provides an overview of the recent modernization phases the RBMC network has undergone highlighting its future steps. From its current post-mission mode, the RBMC will evolve into a real-time network, providing real-time data and real-time correction to users. The network enhanced with modern GPS receivers and the addition of atomic clocks will be used to compute WADGPS-type corrections to be transmitted, in real time, to users in Brazil and surrounding areas. It is estimated that users will be able to achieve a horizontal accuracy around 0.5 m (1 σ) in static and kinematic positioning and better for dual frequency users. The availability of the WADGPS service will allow users to tie to the new SIRGAS2000 frame in a more rapid and transparent way for positioning and navigation applications. It should be emphasized that support to post-mission static positioning, will continue to be provided to users interested in higher accuracy levels. In addition to this, a post-mission Precise Point Positioning (PPP) service will be provided based on the one currently provided by the Geodetic Survey Division of NRCan (CSRS-PPP). The modernization of the RBMC is under development based on a cooperation signed at the end of 2004 with the University of New Brunswick, supported by the Canadian International Development Agency and the Brazilian Cooperation Agency. The Geodetic Survey Division of NRCan is also participating in this modernization effort under the same project. © Springer-Verlag Berlin Heidelberg 2009.

Modernization and new services of the Brazilian active control network

The Brazilian Network for Continuous Monitoring of GNSS - RBMC is a national network of continuously operating reference GNSS stations. Since its establishment in December of 1996, it has been playing an essential role for the maintenance and user access of the fundamental geodetic frame in the country. In order to provide better services for RBMC, the Brazilian Institute of Geography and Statistics - IBGE and the National Institute of Colonization and Land Reform - INCRA are both partners involved in the National Geospatial Framework Project - PIGN. This paper provides an overview of the recent modernization phases the RBMC network has undergone highlighting its future steps. These steps involve the installation of new equipment, provide real time data from a group of core stations and compute real-time DGPS corrections, based on CDGPS (The real-time Canada-Wide DGPS Service) (The Real-Time Canada-Wide DGPS Service. http://www.cdgps.com/ 2009a). In addition to this, a post-mission Precise Point Positioning (PPP) service has been established based on the current Geodetic Survey Division of NRCan (CSRS-PPP) service. This service is operational since April 2009 and is in large use in the country. All activities mentioned before are based on a cooperation signed at the end of 2004 with the University of New Brunswick, supported by the Canadian International Development Agency and the Brazilian Cooperation Agency. The Geodetic Survey Division of NRCan is also participating in this modernization effort under the same project. This infrastructure of 66 GNSS stations, the real time, post processing services and the potentiality of providing Wide Area DGPS corrections in the future show that the RBMC system is comparable to those available in USA and Europe. © Springer-Verlag Berlin Heidelberg 2012.

Late-Onset Sepsis in very Low Birth Weight Infants: A Brazilian Neonatal Research Network Study

Background: Late-onset sepsis (LOS) is an important cause of morbidity and mortality in very low birth weight (VLBW) infants.Aim: To determine the incidence, risk factors and etiology of LOS.Methods: LOS was investigated in a multicenter prospective cohort of infants at eight public university neonatal intensive care units (NICUs). Inclusion criteria included inborn, 23-33 weeks of gestational age, 400-1499 g birth weight, who survived >3 days.Results: Of 1507 infants, 357 (24%) had proven LOS and 345 (23%) had clinical LOS. Infants with LOS were more likely to die. The majority of infections (76%) were caused by Gram-positive organisms. Independent risk factors for proven LOS were use of central venous catheter and mechanical ventilation, age at the first feeding and number of days on parenteral nutrition and on mechanical ventilation.Conclusion: LOS incidence and mortality are high in Brazilian VLBW infants. Most risk factors are associated with routine practices at NICU.

Integration of a regional GPS network within ITRF using precise point positioning

GPS precise point positioning (PPP) can provide high precision 3-D coordinates. Combined pseudorange and carrier phase observables, precise ephemeris and satellite clock corrections, together with data from dual frequency receivers, are the key factors for providing such levels of precision (few centimeters). In general, results obtained from PPP are referenced to an arbitrary reference frame, realized from a previous free network adjustment, in which satellite state vectors, station coordinates and other biases are estimated together. In order to obtain consistent results, the coordinates have to be transformed to the relevant reference frame and the appropriate daily transformation parameters must be available. Furthermore, the coordinates have to be mapped to a chosen reference epoch. If a velocity field is not available, an appropriated model, such as NNR-NUVEL-IA, has to be used. The quality of the results provided by this approach was evaluated using data from the Brazilian Network for Continuous Monitoring of the Global Positioning System (RBMC), which was processed using GIPSY-OASIS 11 software. The results obtained were compared to SIRGAS 1995.4 and ITRF2000, and reached precision better than 2cm. A description of the fundamentals of the PPP approach and its application in the integration of regional GPS networks with ITRF is the main purpose of this paper.

Improving the passive doppler geolocation system through extension of the data reception network

O objetivo deste trabalho e apresentar uma investigação preliminar da precisão nos resultados do sistema de localização geográfica de transmissores desenvolvido utilizando o software da rede brasileira de coleta de dados. Um conjunto de medidas de desvio Doppler de uma única passagem do satélite, considerando uma Plataforma de Coleta de Dados (PCD) e uma rede de estações de recepção terrestrês, e denominado uma rede de recepção de dados. Assim, a rede brasileira de coleta de dados com o uso de múltiplas estações de recepção permitira o incremento na quantidade de dados coletados com consequente melhora na precisão e na confiabilidade das localizações fornecidas. Consequentemente uma maior quantidade de localizações válidas e mais precisas. Os resultados e análises foram obtidos sob duas condições: na primeira foi considerada uma condição prática com dados reais e dados ideais simulados, para comparar os resultados considerando a mesma passagem do satélite, transmissor e duas estações de recepção conhecidas; na segunda foram consideradas as condições ideais simuladas a partir de medidas de um transmissor fixo, três estações de recepção e dois satélites. Os resultados utilizando a rede de recepção de dados foram bastante satisfatórios. O estudo realizado mostrou a importãncia da instalação de novas estações de recepção terrenas distribuídas no territorio nacional, para um aumento na quantidade de medidas e consequentemente uma maior quantidade de localizações válidas e mais precisas.

Variability on red blood cell transfusion practices among Brazilian neonatal intensive care units

BACKGROUND:Guidelines for red blood cell (RBC) transfusions exist; however, transfusion practices vary among centers. This study aimed to analyze transfusion practices and the impact of patients and institutional characteristics on the indications of RBC transfusions in preterm infants.STUDY DESIGN and METHODS:RBC transfusion practices were investigated in a multicenter prospective cohort of preterm infants with a birth weight of less than 1500 g born at eight public university neonatal intensive care units of the Brazilian Network on Neonatal Research. Variables associated with any RBC transfusions were analyzed by logistic regression analysis.RESULTS:Of 952 very-low-birth-weight infants, 532 (55.9%) received at least one RBC transfusion. The percentages of transfused neonates were 48.9, 54.5, 56.0, 61.2, 56.3, 47.8, 75.4, and 44.7%, respectively, for Centers 1 through 8. The number of transfusions during the first 28 days of life was higher in Center 4 and 7 than in other centers. After 28 days, the number of transfusions decreased, except for Center 7. Multivariate logistic regression analysis showed higher likelihood of transfusion in infants with late onset sepsis (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.4), intraventricular hemorrhage (OR, 9.4; 95% CI, 3.3-26.8), intubation at birth (OR, 1.7; 95% CI, 1.0-2.8), need for umbilical catheter (OR, 2.4; 95% CI, 1.3-4.4), days on mechanical ventilation (OR, 1.1; 95% CI, 1.0-1.2), oxygen therapy (OR, 1.1; 95% CI, 1.0-1.1), parenteral nutrition (OR, 1.1; 95% CI, 1.0-1.1), and birth center (p < 0.001).CONCLUSIONS:The need of RBC transfusions in very-low-birth-weight preterm infants was associated with clinical conditions and birth center. The distribution of the number of transfusions during hospital stay may be used as a measure of neonatal care quality.

Lightning activity in Brazilian thunderstorms during TROCCINOX: implications for NOx production

During the TROCCINOX field experiment in January and February 2005, the contribution of lightning-induced nitrogen oxides (LNOx) from tropical and subtropical thunderstorms in Southern Brazil was investigated. Airborne trace gas measurements (NO, NOy, CO and O-3) were performed up to 12.5 km with the German research aircraft Falcon. During anvil penetrations in selected tropical and subtropical thunderstorms of 4 and 18 February, NOx mixing ratios were on average enhanced by 0.7-1.2 and 0.2-0.8 nmol mol(-1) totally, respectively. The relative contributions of boundary layer NOx (BL-NOx) and LNOx to anvil-NOx were derived from the NOx-CO correlations. on average similar to 80-90% of the anvil-NOx was attributed to LNOx. A Lightning Location Network (LINET) was set up to monitor the local distribution of cloud-to-ground (CG) and intra-cloud (IC) radiation sources (here called 'strokes') and compared with lightning data from the operational Brazilian network RINDAT (Rede Integrada Nacional de Deteccao de Descargas Atmosfericas). The horizontal LNOx mass flux out of the anvil was determined from the mean LNOx mixing ratio, the horizontal outflow velocity and the size of the vertical cross-section of the anvil, and related to the number of strokes contributing to LNOx. The values of these parameters were derived from the airborne measurements, from lightning and radar observations, and from a trajectory analysis. The amount of LNOx produced per LINET stroke depending on measured peak current was determined. The results were scaled up with the Lightning Imaging Sensor (LIS) flash rate (44 flashes s(-1)) to obtain an estimate of the global LNOx production rate. The final results gave similar to 1 and similar to 2-3 kg(N) per LIS flash based on measurements in three tropical and one subtropical Brazilian thunderstorms, respectively, suggesting that tropical flashes may be less productive than subtropical ones. The equivalent mean annual global LNOx nitrogen mass production rate was estimated to be 1.6 and 3.1 Tg a(-1), respectively. By use of LINET observations in Germany in July 2005, a comparison with the lightning activity in mid-latitude thunderstorms was also performed. In general, the same frequency distribution of stroke peak currents as for tropical thunderstorms over Brazil was found. The different LNOx production rates per stroke in tropical thunderstorms compared with subtropical and mid-latitude thunderstorms seem to be related to the different stroke lengths (inferred from comparison with laboratory data and observed lengths). In comparison, the impact of other lightning parameters as stroke peak current and stroke release height was assessed to be minor. The results from TROCCINOX suggest that the different vertical wind shear may be responsible for the different stroke lengths.

Brazilian multicenter study on prevalence of preterm birth and associated factors

Abstract Background The occurrence of preterm birth remains a complex public health condition. It is considered the main cause of neonatal morbidity and mortality, resulting in a high likelihood of sequelae in surviving children. With variable incidence in several countries, it has grown markedly in the last decades. In Brazil, however, there are still difficulties to estimate its real occurrence. Therefore, it is essential to establish the prevalence and causes of this condition in order to propose prevention actions. This study intend to collect information from hospitals nationwide on the prevalence of preterm births, their associated socioeconomic and environmental factors, diagnostic and treatment methods resulting from causes such as spontaneous preterm labor, prelabor rupture of membranes, and therapeutic preterm birth, as well as neonatal results. Methods/Design This proposal is a multicenter cross-sectional study plus a nested case-control study, to be implemented in 27 reference obstetric centers in several regions of Brazil (North: 1; Northeast: 10; Central-west: 1; Southeast: 13; South: 2). For the cross sectional component, the participating centers should perform, during a period of six months, a prospective surveillance of all patients hospitalized to give birth, in order to identify preterm birth cases and their main causes. In the first three months of the study, an analysis of the factors associated with preterm birth will also be carried out, comparing women who have preterm birth with those who deliver at term. For the prevalence study, 37,000 births will be evaluated (at term and preterm), corresponding to approximately half the deliveries of all participating centers in 12 months. For the case-control study component, the estimated sample size is 1,055 women in each group (cases and controls). The total number of preterm births estimated to be followed in both components of the study is around 3,600. Data will be collected through a questionnaire all patients will answer after delivery. The data will then be encoded in an electronic form and sent online by internet to a central database. The data analysis will be carried out by subgroups according to gestational age at preterm birth, its probable causes, therapeutic management, and neonatal outcomes. Then, the respective rates, ratios and relative risks will be estimated for the possible predictors. Discussion These findings will provide information on preterm births in Brazil and their main social and biological risk factors, supporting health policies and the implementation of clinical trials on preterm birth prevention and treatment strategies, a condition with many physical and emotional consequences to children and their families.

Sistema de informação: uma proposição para o Hospital Universitário da Universidade Federal de Juiz de Fora-MG

Esse trabalho aborda a elaboração de requisitos dos usuários como parte da adequação do sistema de informação-SISTEMA DE INFORMAÇÃO DE GESTÃO ACADÊMICA-Administrativo- SIGA-Adm, proposto para o Hospital Universitário da Universidade Federal de Juiz de Fora. SIGA-Adm está em utilização, desde 2007, na Universidade Federal de Juiz de Fora. No entanto, para a efetiva aplicabilidade no âmbito do Hospital Universitário, torna-se necessário uma investigação acerca dos processos de trabalho, dentro do HU e uma ação de melhoria desses processos, a fim de evitar a incorporação de um sistema de informação que não corresponda a realidade apresentada. A elaboração dos requisitos dos usuários para a adequação visa a ser um instrumento de intermediação para discussão acerca da elaboração do SIGA-Adm para o HU/UFJF. Os requisitos apresentados originaram-se no processo de gerenciamento de materiais, como resultado da utilização da Metodologia de Análise e Melhoria de Processos-MAMP, aplicada na cadeia de suprimentos do Hospital Universitário, no período de 2004 a 2005. O acompanhamento do gerenciamento de materiais é uma estratégia utilizada pela Rede Sentinela para o desenvolvimento de ações de pós-comercialização de produtos para a saúde tais como: investigação de uso, registro de produtos, retirada de produto do mercado e etc... O Hospital Universitário da UFJF é integrante da Rede Brasileira de Hospitais Sentinela, implementada pela Agência Nacional de Vigilância Sanitária, desde 2001. As ações Pós-Comercialização de Produtos para a Saúde, em Tecnovigilância, são compartilhadas pela ANVISA e pelos integrantes da Rede Sentinela, através de informações relativas a queixas técnicas e/ou eventos adversos que possam causar algum dano à população. A pesquisa indica a possibilidade do SIGA-Adm armazenar informações sobre os produtos que permitam o rastreamento em condições normais e/ou anormais de uso pela instituição, contribuindo para o exercício em Tecnovigilância. Além disso, espera-se que construção do SIGA-Adm/HU-UFJF permita integrar os sistemas existentes no HU.

Contribuições da Educação a Distância para a Educação Ambiental: utilização da rede sociotécnica na análise das concepções de meio ambiente e saúde no Polo de Nova Friburgo.

Este trabalho descreve as contribuições da Educação a Distância para a elaboração e efetivação de projetos de educação ambiental, a partir da análise das concepções de meio ambiente e saúde de estudantes dos cursos semipresenciais de formação de professores do Consórcio CEDERJ, no Polo de Nova Friburgo, Rio de Janeiro. Foi realizada pesquisa qualitativa do tipo etnográfica utilizando-se observação participante, análise documental e entrevista semi-estruturada na coleta de dados. O conceito de rede sociotécnica, tal qual proposto por Bruno Latour, fertilizou a análise dos dados de campo e permitiu olhar a Educação Ambiental e a Educação a Distância sob um prisma que questiona a relação sujeito-objeto e o estatuto da ciência como saber hierarquicamente superior. A utilização do aporte teórico da antropologia das ciências e das técnicas evidenciou a indissociabilidade entre atividade cognitiva e fatores sociais e a reunião de elementos de todos os tempos na composição da rede de Educação a Distância brasileira, na qual atuantes humanos e não humanos estão entrelaçados nas ações de ensinar-aprender, constituindo-se num híbrido de naturezas-culturas.

Bancos comunitários de desenvolvimento como instrumento de políticas públicas: o caso do Banco Cidade de Deus

O objetivo dessa dissertação foi investigar os desafios da utilização dos Bancos Comunitários de Desenvolvimento (BCDs) como política pública. Segundo a Rede Brasileira de Bancos Comunitários estes podem ser definidos como serviços financeiros solidários, de natureza associativa e comunitária, voltados para a geração de trabalho e renda na perspectiva de reorganização das economias locais por meio da constituição de redes de economia solidária. Desde o surgimento da primeira experiência de banco comunitário, em 1998 em Fortelza/CE, até o presente momento os BCDs foram replicados em mais de 100 localidades. Pela singularidade em lidar com a concessão de microcrédito e por conseguir uma capilaridade junto as populações em situação de pobreza ou extrema pobreza, os BCDs despontaram como alternativas a algumas políticas públicas do microcrédito tradicional e tem recebido apoio do governo federal para replicação de novas experiências e consolidação das já existentes. Além disso, os governos estaduais e municipais também vem adotando políticas de replicação dos bancos comunitários e em alguns casos, como é o estudo de caso desta investigação, a iniciativa para a constituição dos BCDs tem partido das prefeituras. A pergunta de pesquisa que norteia este trabalho foi analisada por meio de uma abordagem qualitativa, com a utilização de entrevistas e observação participante junto ao Banco Comunitário Cidade de Deus, situado na cidade de Rio de Janeiro/RJ. A pesquisa de campo abrangeu os meses de maio a agosto do corrente e ano e os resultados apontam para existência de três dimensões de desafios aos processos de instrumentalização dos BCDs como políticas públicas, quais sejam: eficiência técnica, sustentabilidade financeira e conflitos políticos internos.