Impact of maternal Tdap vaccination on pertussis infection in young infants

Undiagnosed infected mothers often are the source of pertussis illness in young infants. The Centers for Disease Control and Prevention (CDC) recommends Tdap vaccine for post-partum women before hospital discharge. This intervention has been implemented at Ben Taub General Hospital (BTGH) in Houston, TX since January 2008. Our objective was to compare the proportion of infants born at BTGH and developing pertussis to the total number of pertussis cases before and after the intervention. Methods. We conducted a cross-sectional comparative study between the pre-intervention (7/2000 to 12/2007) and post-intervention (1/2008 to 5/2009) periods. Information on pertussis diagnosis was determined using ICD-9 codes, infection control records, and molecular microbiology reports from Texas Children's Hospital (TCH) and BTGH. Only patients ≤ 6 months of age with laboratory-confirmed B. pertussis infection were included in the study. Results. 481 infants had pertussis illness; 353 (73.3%) during pre-intervention and 128 (26.6%) during post-intervention years. The groups were comparable in all measures including age (median 73 vs. 62.5 days; p=0.08), gender (males 54.2%; p=0.47), length of hospitalization (median 9.8 vs. 4 9.5 days; p=0.5), outcomes (2 deaths in each period; p=0.28) and pertussis illness at TCH (95.2% vs. 95.3%; p=0.9). The proportion of pertussis patients born at BTGH, and thus amenable to protection by the intervention, was not statically different between the two periods after adjusting for age, gender and ethnicity (7.3% vs. 9.3%; an OR=1.05, 95% CI 0.5-2.1, p=0.88). Conclusions. Vaccinating only mothers with Tdap in the post-partum period does not reduce the proportion of pertussis in infants age ≤ 6 months. Efforts should be directed at Tdap immunization of not only mothers, but also all household and key contacts of newborns to protect them against pertussis illness before the primary DTaP series is completed.^

William Osler: Original Papers 1907-1919

Part 1: 1907-1908 The Royal Medical Society of Edinburg, 1907 On the Library of a Medical School, 1907 On Telangiectasis Circumscripta Universalis, 1907 A Clinical Lecture on Abdominal Tumours Associated with Disease of the Testicle, 1907 A Clinical Lecture on Erythraemia, 1908 Vienna after Thirty-Four Years, 1908 Endocardites Infectieuses Chroniques, 1908 Part 2: 1909 Chronic Infectious Endocarditis, 1909 What the Public Can Do in the Fight Against Tuberculosis, 1909 Annual Oration on the Occasion of the Opening of the New Building of the Medical and Chirurgical Faculty of the State of Maryland, May 13, 1909 The Medical Library in Post-Graduate Work, 1909 The Treatment of Disease, 1909 Part 3: 1910-1911 The Pupil Symptoms in Thoracic Aneurysm, 1910 The Lumleian Lectures on Angina Pectoris, 1910 Certain Vasomotor, Sensory, and Muscular Phenomena Associated with Cervical Rib, 1910 An Address on the Hospital Unit in University Work, 1911 Sulle Telangiectasie Emorragiche Ereditarie, 1911 Transient Attacks of Aphasia and Paralyses in States of High Blood Pressure and Arterio-Sclerosis, 1911 The Pathological Institute of a General Hospital, 1911 Part 4: 1912-1914 An Address on High Blood Pressure: its Associations, Advantages, and Disadvantages, 1912 Specialism in the General Hospital, 1913 Syphilis of the Liver with the Picture of Banti’s Disease, 1913 An Introductory Address on Examinations, Examiners, and Examinees, 1913 The Medical Clinic: a retrospect and a Forecast, 1914 Part 5: 1915-1919 Remarks on the Diagnosis of Polycystic Kidney, 1915 The War and Typhoid Fever, 1914/15 The Cerebro-Spinal Fever in Camps and Barracks, 1915 Remarks on Arterio-Venous Aneurysm, 1915 Nerve & “Nerves”, 1915 Intensive Work in Science at the Public Schools in Relation to the Curriculum, 1916 Creators, Transmuters, and Transmitters, 1916 Annual Oration on the Campaign Against Syphilis, 1917 The First Printed Documents relating to Modern Surgical Anaesthesia, 1918 Observations on the Severe Anaemias of Pregnancy and the Post-Partum State, 1919 Typhoid Spine, 1919

The effects of adequacy and content of prenatal care on birth outcomes in a high -risk Missouri population

The purpose of this observational study was investigation of the relationship between quantitative adequacy of prenatal care, specific prenatal care content and pregnancy outcome in a high risk Missouri population. A sample of 1484 women from three Missouri regions known to have high rates of low birth weight, infant mortality, and inadequate prenatal care rates participated in structured post-partum interviews. Approximately one-half of the sample had received adequate prenatal care and the other half inadequate prenatal care as determined by an index utilized by the Missouri Department of Health.^ Prenatal care content was assessed by reports of prenatal education in six different areas: Diet, smoking, alcohol, drug, preterm labor counseling, and advice on when to call the health provider if preterm labor was suspected by the woman. Low birth weight, in both term and preterm infants, were the two birth outcomes examined. A variety of maternal socio-demographic variables were also considered.^ The results of this study suggest that specific educational content, delivered during prenatal care, may have lessen the risk of giving birth to a preterm-low birth weight infant. Prenatal education for recognition of preterm labor, and advice on when to call the health provider if preterm labor was suspected were found to be associated with a decreased risk of preterm delivery. Specific educational content was not, however, associated with risk of term-low weight birth nor was quantitative adequacy of care associated with the risk of either term- or preterm-low birth weight.^ These findings reinforce a body of literature which stresses the importance of appropriate prenatal care in preventing preterm low birth weight. Additionally, the findings suggest interventions that may be specifically effective for prematurity prevention. ^

Correlates of prenatal care initiation among low -income Hispanic women

Because Hispanic women are even less likely than women of other ethnic groups to receive early prenatal care, the purpose of this study was to identify factors that may influence these women to initiate care. After giving consent, 300 Hispanic women (100 who initiated first trimester care, 100 who initiated second trimester care, and 100 who initiated third trimester care or received no care) were interviewed in the post partum unit of a local public hospital. The interview included recollection of events leading to the first prenatal appointment, including first physical indicators of pregnancy, confirmation of pregnancy, feelings about the pregnancy, appointment making behavior, and system barriers encountered. The Health Belief Model was used as the theoretical framework for determining psychosocial variables. Using this model, perceived susceptibility to problems during pregnancy, perceived seriousness of possible problems, perceived benefits of prenatal care, perceived barriers to care, and cues to action were assessed. Time of entry into prenatal care was assessed by interview.^ In this sample of low-income Hispanic women, a higher perception of barriers to care was associated with later initiation of care and non-use of care, higher perceived benefits of care for the baby were associated with earlier care, especially in women without a card to access hospital district services, and having a card to access hospital district services was associated with earlier care. Several barriers to care were mentioned by women on open-ended questioning including long waiting times, embarrassment, and lack of transportation.^ Recommendations for practice included decreasing the number of visits for low-risk women while increasing the time spent with the provider, decreasing the number of vaginal exams for low-risk women, increasing the use of midwives, training lay workers to do risk assessment, giving specific messages about benefits of care to baby, and increasing general health motivation through community intervention methods. More research on the psychosocial and cultural factors associated with initiation of care is needed. In the meantime, the recommendations for practice can be implemented now to increase the use of prenatal care by low-income Hispanic women. ^

(Table 1) Stable carbon and nitrogen isotopic ratios of potential prey species of bearded seals (Erignathus barbatus), Svalbard

Changing patterns of sea-ice distribution and extent have measurable effects on polar marine systems. Beyond the obvious impacts of key-habitat loss, it is unclear how such changes will influence ice-associated marine mammals in part because of the logistical difficulties of studying foraging behaviour or other aspects of the ecology of large, mobile animals at sea during the polar winter. This study investigated the diet of pregnant bearded seals (Erignathus barbatus) during three spring breeding periods (2005, 2006 and 2007) with markedly contrasting ice conditions in Svalbard using stable isotopes (d13C and d15N) measured in whiskers collected from their newborn pups. The d15N values in the whiskers of individual seals ranged from 11.95 to 17.45 per mil, spanning almost 2 full trophic levels. Some seals were clearly dietary specialists, despite the species being characterised overall as a generalist predator. This may buffer bearded seal populations from the changes in prey distributions lower in the marine food web which seems to accompany continued changes in temperature and ice cover. Comparisons with isotopic signatures of known prey, suggested that benthic gastropods and decapods were the most common prey. Bayesian isotopic mixing models indicated that diet varied considerably among years. In the year with most fast-ice (2005), the seals had the greatest proportion of pelagic fish and lowest benthic invertebrate content, and during the year with the least ice (2006), the seals ate more benthic invertebrates and less pelagic fish. This suggests that the seals fed further offshore in years with greater ice cover, but moved in to the fjords when ice-cover was minimal, giving them access to different types of prey. Long-term trends of sea ice decline, earlier ice melt, and increased water temperatures in the Arctic are likely to have ecosystem-wide effects, including impacts on the forage bases of pagophilic seals.

Biostimulation methods associated with early weaning and reproductive rhythms in primiparous rabbit does

El objetivo general de esta Tesis Doctoral ha sido tratar de mejorar los parámetros reproductivos de las conejas primíparas lactantes, empleando dos métodos de manejo (destete temprano y extensificación del ritmo reproductivo), que están directamente relacionados con su balance energético. Para ello, se diseñaron 2 experimentos en este tipo de hembras. En el primero, se estudió el efecto del destete a 25 días post-parto (dpp) sobre la actividad ovárica y el metabolismo energético de las conejas una semana más tarde (32 dpp). Un total de 34 primíparas lactantes con 8 gazapos fueron distribuidas en tres grupos: 10 conejas se sacrificaron a los 25 dpp (grupo L25), 13 fueron destetadas a los 25 dpp y sacrificadas a los 32 dpp (grupo NL32), y 11 conejas no se destetaron y fueron sacrificadas a los 32 dpp (grupo L32). No se observaron diferencias significativas entre grupos en el peso corporal, el peso del ovario, ni en las concentraciones séricas de ácidos grasos no esterificados y de proteínas totales. A pesar de que el grupo NL32 presentó un bajo consumo de alimento (122 ± 23,5 g / día, p <0,001), su contenido corporal estimado de lípidos (16,9 ± 1,09%, P <0,008), proteínas (19,7 ± 0,07%, P <0,0001), y energía (1147 ± 42,7 MJ / kg, p <0,006) fueron más elevados y las concentraciones séricas de glucosa (158 ± 24,5 mg/dl, p <0,04) más bajas que en los grupos L25 (11,9 ± 1,3%, 18,5 ± 0,08%, 942 ± 51,3 MJ/kg y 212 ± 27,9 mg/dl) y L32 (13,4 ± 1,03%, 18,5 ± 0,1%, 993 ± 40,4 MJ/kg y 259 ± 29,5 mg/dl), respectivamente. En el grupo L25 se observó un menor número medio de folículos ≥ 1 mm en la superficie ovárica en comparación con los grupos NL32 y L32 (12,7 ± 1,5 vs. 18,0 ± 1,45 y 17,6 ± 1,67, p <0,05). La población folicular ovárica en las secciones histológicas y la inmunolocalización de los receptores de prolactina fueron similares en todos los grupos. En el grupo L25, tanto la maduración nuclear de oocitos, medida en términos de tasas alcanzadas de Metafase II (67,0 vs. 79,7 y 78,3%, P <0.05) y la maduración citoplasmática, medida por el porcentaje de gránulos corticales (GC) total o parcialmente migrados en los oocitos, fueron significativamente menores que en los grupos NL32 y L32 (16,0 vs 38,3 y 60,0%, P <0.05). En conclusión, a pesar de que el destete precoz a 25 dpp pareció mejorar las reservas de energía de las conejas primíparas, este hecho no se reflejó claramente a nivel ovárico a los 32 dpp y fue similar independientemente del destete, por lo que éste último podría llevarse a cabo más tarde. En el segundo experimento, se compararon dos ritmos reproductivos. Se utilizaron un total de 48 conejas primíparas lactantes con 8 gazapos que se asignaron al azar en dos grupos experimentales: a) lactantes sacrificadas a comienzos del post-parto (11 dpp) de acuerdo a un ritmo semi-intensivo (n = 24), y b) lactantes sacrificadas al final del período post-parto (25 dpp) de acuerdo con un ritmo más extensivo (n = 24). En ellas, se estudió el peso vivo, la composición corporal estimada, parámetros metabólicos y endocrinos (estradiol y progesterona) y características ováricas como la población folicular y la tasa de atresia, así como la maduración nuclear y citoplásmica de los oocitos. En este estudio, el peso vivo, el contenido de energía corporal, los depósitos grasos y los ácidos grasos no esterificados disminuyeron a lo largo del post-parto con respecto al momento del parto (P <0,05). Las concentraciones séricas de proteínas y glucosa aumentaron en el mismo periodo post-parto (P <0,05). Se observaron similares niveles de estradiol y progesterona en ambos ritmos, así como una población folicular, tasas de maduración nuclear (tasa de oocitos en metafase II) y citoplasmática (porcentaje de oocitos con gránulos corticales migrados), similares en ambos momentos del post-parto. Sin embargo, el número de folículos preovulatorios en la superficie ovárica fue menor (P <0,05) y la tasa de atresia tendió a ser mayor con un porcentaje también menor de folículos sanos (P <0,1) en los ovarios de las hembras sometidas al ritmo extensivo. En conclusión, al final del post-parto (25 días), las conejas primíparas sin destetar muestran un deterioro de sus reservas corporales, de sus parámetros metabólicos séricos y de la calidad de sus oocitos; incluso se ha observado una ligera influencia negativa en el desarrollo de sus folículos ováricos. Por esta razón, se considera que en las conejas primíparas lactantes el manejo reproductivo extensivo (25 dpp) no presenta ninguna ventaja en comparación con el semi-intensivo (11 dpp). A la vista de los resultados de estos dos experimentos, podemos decir que ni el destete temprano, ni la extensificación del ritmo reproductivo han conseguido una mejora en los parámetros reproductivos de una hembra primípara. Por ello, son necesarios más estudios sobre el estado metabólico de la coneja primípara lactante para conseguir métodos o estrategias que lo mejoren y tengan consecuencias directas sobre la actividad reproductiva y sobre su éxito productivo. The general aim of this Thesis was to study two management methods (early weaning and extensive reproductive rhythm) linked to the energy balance of the primiparous rabbit does to improve their reproductive performance. In this sense, 2 experiments were conducted using this kind of females. In the first experiment, the effect of weaning at 25 days post-partum (dpp) on ovarian activity and energetic metabolism one week later (32 dpp) was studied. A total of 34 primiparous lactating rabbit does were used and distributed among three groups: 10 does euthanized at 25 dpp (group L25), 13 does weaned at 25 dpp and euthanized at 32 dpp (group NL32), and 11 non weaned does euthanized at 32 dpp (group L32). No significant differences were observed in live body weight, ovary weight, serum non esterified fatty acids (NEFA) and total protein concentration among groups. Although NL32 does had a low feed intake (122±23.5 g/Day; P < 0.001), their estimated lipids (16.9±1.09%, P < 0.008), protein (19.7±0.07%, P < 0.0001), and energy (1147±42.7 MJ/kg, P < 0.006) body contents were higher and their serum glucose concentrations (158±24.5 mg/dl, P < 0.04) were lower compared to L25 does (11.9±1.3%, 18.5±0.08%, 942±51.3 MJ/kg and 212±27.9 mg/dl) and L32 does (13.4±1.03%, 18.5±0.1%, 993±40.4 MJ/kg and 259±29.5 mg/dl, respectively). A lower number of follicles ≥1mm was observed compared to NL32 and L32 groups (12.7±1.5 vs. 18.0±1.45 and 17.6 ±1.67; P < 0.05) in the ovarian surface of L25 does. Follicular population in the histological ovarian sections and immunolocalization of prolactin receptor were similar in all groups. In group L25, both nuclear maturation of oocytes in terms of Metaphase II rate (67.0 vs. 79.7 and 78.3%; P < 0.05) and cytoplasmic maturation measured by percentage of cortical granules (CG), totally or partially migrated in oocytes were significantly lower than in groups NL32 and L32 (16.0 vs. 38.3 and 60.0%; P < 0.05). Consequently, a higher rate of oocytes with non-migrated CGs was found in group L25 than in groups NL32 and L32 (76.0 vs. 46.8 and 33.3%; P < 0.05). In conclusion, even though early weaning at 25 dpp seemed to improve body energy stored in primiparous does, this fact was not well reflected on the ovarian status at 32 dpp, which was similar regardless of weaning time. In the second experiment, two reproductive rhythms were compared. A total of 48 primiparous Californian x New Zealand White rabbit does suckling 8 kits were randomly allocated in two experimental groups: a) lactating does euthanized at early post-partum period (11 dpp) according to a semi-intensive rhythm (n = 24), and b) lactating does euthanized on later post-partum period (25 dpp) according to a more extensive rhythm (n = 24). Live weight, estimated body composition, serum metabolic and endocrine parameters (oestradiol and progesterone concentrations) and ovarian features like follicle population and atresia rate, and oocyte maturation were studied. Live weight, body energy content, lipid depots and serum non esterified fatty acids (NEFA) concentrations diminished from parturition time to post-partum period (P < 0.05). In addition, serum protein and glucose concentrations increased along postpartum time (P < 0.05). Similar oestradiol and progesterone levels were shown in rhythms as well as similar follicle population and nuclear and cytoplasmic maturation rates measured as metaphase II and cortical granule migration, respectively in both postpartum times. However, number of preovulatory follicles on the ovarian surface was lower (P < 0.05) and atresia rate tended to be higher with also lower percentage of healthy follicles (P < 0.1) in ovaries of females of extensive group. In conclusion, primiparous non-weaned rabbits does at late post-partum time (25 days), Did no show any improvement regarding body reserves, serum metabolic parameters and oocyte quality; even a slight negative influence has been observed in the development of their ovarian follicles. Thus this reproductive management does not present any advantage compared to earlier post-partum (11 days) reproductive rhythm. In summary, according to the obtained results from these two experiments, we can say that the application of early weaning and the extensive rhythms did not achieve an improvement in the reproductive performance of primiparous does. Thus, it is necessary to conduct more studies about the metabolic status of the primiparous lactating doe to achieve strategies in order to improve it and consequently, to improve the reproductive activity and their productive success.

Endometrial response toward bovine herpesvirus 4 infection

Metriti ed endometriti sono le patologie maggiormente responsabili delle perdite economiche negli allevamenti bovini da latte, specialmente nel periodo successivo al parto. Mentre le metriti coinvolgono e si sviluppano in tutto l’utero e sono caratterizzate dalla presenza di sintomi sistemici, le endometriti consistono in una infiammazione che riguarda il solo endometrio, con la presenza di perdite purulente, distruzione della superficie epiteliale, congestione vascolare, edema stromale ed accumulo di linfociti e plasmacellule. Queste patologie, inoltre, possono causare, disfunzione ovarica, con conseguente infertilità e riduzione sia dell’efficienza riproduttiva della vacca sia della produzione stessa di latte. Nonostante queste malattie siano, nella maggior parte dei casi, correlate all’instaurarsi di infezioni batteriche, che possono subentrare nell’utero direttamente durante il parto, il ruolo di alcuni virus nello sviluppo di queste patologie è stato recentemente approfondito e la correlazione tra l’ Herpesvirus Bovino 4 e l’insorgere di metriti ed endometriti è stata dimostrata. L’ Herpesvirus Bovino 4 (BoHV-4) è un gamma-herpesvirus ed il suo genoma è costituito da una molecola lineare di DNA a doppio filamento con una struttura genomica di tipo B, caratterizzata dalla presenza di un’unica lunga sequenza centrale (LUR) fiancheggiata da multiple sequenze poli-ripetute (prDNA). BoHV-4 è stato isolato sia da animali sani sia da animali con differenti patologie, tra cui malattie oculari e respiratorie, ma soprattutto da casi di metriti, endometriti, vaginiti o aborti. Generalmente, il ruolo svolto dal virus in questo tipo di patologie è associato alla compresenza di altri tipi di patogeni, che possono essere virus, come nel caso del Virus Della Diarrea Virale Bovina (BVDV), o più frequentemente batteri. Usualmente, l’iniziale difesa dell’endometrio bovino nei confronti dei microbi si fonda sul sistema immunitario innato e l’attivazione di specifici recettori cellulari determina la sintesi e la produzione di citochine e chemochine pro infiammatorie, che possono essere in grado di modulare la replicazione di BoHV-4. Il genoma di BoHV-4 possiede due principali trascritti per i geni Immediate Early (IE), trai quali ORF50/IE2 è il più importante ed il suo prodotto, Rta/ORF50, è fortemente conservato tra tutti gli Herpesvirus. Esso è responsabile della diretta trans-attivazione di numerosi geni virali e cellulari e può essere modulato da differenti stimoli extracellulari. Precedentemente è stato dimostrato come il TNF-, prodotto dalle cellule stromali e dai macrofagi all’interno dell’endometrio, in conseguenza ad infezione batterica, sia in grado di aumentare la replicazione di BoHV-4 attraverso l’attivazione del pathway di NFkB e direttamente agendo sul promotore di IE2. Per queste ragioni, è risultato di forte interesse investigare quali potessero essere, invece, i fattori limitanti la replicazione di BoHV-4. In questo lavoro è stata studiata la relazione tra cellule endometriali stromali bovine infettate con l’Herpesvirus Bovino 4 e l’interferon gamma (IFN-) ed è stata dimostrata la capacità di questa molecola di restringere la replicazione di BoHV-4 in maniera IDO1 indipendente ed IE2 dipendente. Inoltre, la presenza di alcuni elementi in grado di interagire con l’ IFN-γ, all’interno del promotore di IE2 di BoHV-4, ha confermato questa ipotesi. Basandoci su questi dati, abbiamo potuto supporre l’esistenza di uno stretto vincolo tra l’attivazione dell’asse dell’interferon gamma e la ridotta replicazione di BoHV-4, andando a porre le basi per una nuova efficiente cura e prevenzione per le patologie uterine. Poiché il meccanismo corretto attraverso il quale BoHV-4 infetta l’endometrio bovino non è ancora ben compreso, è stato interessante approfondire in maniera più accurata l’interazione presente tra il virus ed il substrato endometriale, analizzando le differenze esistenti tra cellule infettate e non, in termini di espressione genica. Basandoci su dati preliminari ottenuti attraverso analisi con RNA sequencing (RNAseq), abbiamo visto come numerosi geni risultino over-espressi in seguito ad infezione con BoHV-4 e come, tra questi, la Metalloproteasi 1 sia uno dei più interessanti, a causa delle sue possibili implicazioni nello sviluppo delle patologie dell’endometrio uterino bovino. Successive analisi, effettuate tramite westernblotting e real time PCR, sono state in grado di confermare tale dato, sottolineando l’efficacia di un nuovo approccio sperimentale, basato sul RNAseq, per lo studio dell’insorgenza delle patologie.

Vigor, variação na concentração de metabólitos sanguíneos e avaliação da transferência de imunidade passiva em bezerros leiteiros neonatos

O objetivo deste trabalho foi identificar o padrão de vigor e status metabólico através da determinação da frequência dos sinais objetivos e metabólitos sanguíneos após o nascimento, possivelmente associados à transferência de imunidade passiva, além de determinar o melhor horário para o uso do refratômetro de Brix na avaliação da transferência de imunidade passiva em bezerros neonatos após a ingestão de colostro. No primeiro experimento foram utilizados 46 bezerros neonatos de ambos os sexos, nascidos entre setembro de 2013 e julho de 2014. A avaliação do vigor dos animais foi realizada entre 15 e 30 minutos após o nascimento com o auxílio da escala APGAR modificada pela Universidade de Guelph. A colheita de sangue para análise de metabólitos seguiu os horários de 0h (antes da ingestão), 1h, 2h, 4h, 6h, 12h, 24h, 48h contadas a partir da ingestão do colostro. Os parâmetros sanguíneos foram determinados por kit enzimático específico para cada parâmetro em Sistema Automático para Bioquímica. Todos os animais utilizados neste estudo foram oriundos de partos eutócicos e apresentaram, de acordo com a escala APGAR, vigor satisfatório. As concentrações de metabólicos sanguíneos dos neonatos mostraram que o consumo de colostro aumentou a disponibilidade de energia e a concentração de frações proteicas, comumente utilizadas como indicativos da transferência de imunidade passiva. No segundo experimento foram utilizados 47 bezerros neonatos de ambos os sexos, nascidos entre março e julho de 2014. O colostro foi ordenhado após o parto e a qualidade determinada com auxílio do colostrômetro e do refratômetro digital. A colheita do sangue para a análise dos parâmetros sanguíneos seguiu os horários de 0h (antes da ingestão), 1h, 2h, 4h, 6h, 12h, 24h, 48h, 72h, 96 e 120h, contadas a partir da ingestão do colostro. A concentração de proteína total foi determinada por refratômetro de Brix e por kit enzimático em Sistema Automático para Bioquímica. Os demais parâmetros sanguíneos foram determinados por kit enzimático específico para cada parâmetro em Sistema Automático para Bioquímica. A contagem global e diferenciada das células sanguíneas foi realizada nos tempos 0, 12 e 24h após o fornecimento do colostro. O colostro se manteve na faixa de boa qualidade, segundo os critérios de classificação de medidas pelo colostrômetro e refratômetro digital de Brix. O consumo de colostro foi o principal fator de variação dos parâmetros estudados neste trabalho. A avaliação da transferência de imunidade passiva em bezerros recém-nascidos deve ser realizada por volta das 24 horas após a ingestão do colostro, pois neste momento a absorção de macromoléculas colostrais já está encerrada e a PT alcança estabilidade. A partir deste período, não é possível determinar se as frações proteicas avaliadas são de origem colostral ou endógena, o que não garante avaliação segura sobre a transferência de imunidade passiva.

Avaliação comparativa da suplementação de ácidos graxos saturados e insaturados sobre o desempenho produtivo, qualidade oocitária e embrionária, e metabolismo de vacas leiteiras no período de transição e início de lactação

Objetivou-se avaliar a suplementação dietética de ácidos graxos saturados e insaturados sobre o metabolismo, e desempenhos produtivo e reprodutivo no período de transição e início de lactação de vacas leiteiras. Foram utilizadas 36 vacas da raça holandesa distribuídas aleatoriamente para receber uma das três dietas experimentais. No período pré-parto as dietas foram: Controle (CON), sem adição de gordura e 2,8% de extrato etéreo baseado na matéria seca; Gordura Saturada (SAT), com inclusão de 2,4% de MAGNAPAC® (Tectron Ltda.) com 4,7% de EE baseado na MS; Gordura Insaturada (INS), com inclusão de 11% de grão de Soja, com 4,7% de EE baseado na MS. No período pós-parto, Controle (CON), sem adição de gordura e com 2,8% de EE baseado na MS; Gordura Saturada (SAT), com inclusão de 2,6% de MAGNAPAC® (Tectron Ltda.) com 5,0% de EE baseado na MS; Gordura Insaturada (INS), com inclusão de 13% de Grão de Soja, com 5% de EE baseado na MS. As dietas foram fornecidas 35 dias da data prevista do parto até 90 dias de lactação. No período pré-parto foi utilizada silagem de milho como volumoso, em uma relação volumoso:concentrado de 70:30, enquanto que no período pós-parto foram utilizados 5% de feno de tifton e 45% de silagem de milho como fontes de volumoso, com uma relação entre volumoso:concentrado de 50:50. A produção de leite foi mensurada diariamente durante todo o período experimental. As amostras utilizadas para análise da composição e o perfil de ácidos graxos do leite foram coletadas semanalmente, sendo provenientes das duas ordenhas diárias. As amostras de sangue para análise dos metabólitos sanguíneos foram coletadas semanalmente. Do dia 14 ao dia 90 pós-parto foi realizado avaliação da dinâmica folicular por ultrassonografia. Nos dias 30, 60 e 90 foram realizadas aspirações foliculares, com posterior fertilização in vitro dos oócitos. Todas as variáveis mensuradas foram avaliadas pelo procedimento PROC MIXED do SAS (2004) utilizando-se os seguintes contrastes ortogonais: Controle vs Fontes de Lipídeo (C1); Fonte de ácidos graxos saturados x Fonte de ácidos graxos insaturados (C2). Foi utilizado nível de 5% de significância. No período pós-parto, a suplementação de lipídeos aumentou as concentrações de AGNE quando comparada a dieta CON. O tratamento INS reduziu as concentrações de proteínas totais e de BHB quando comparado ao SAT. Houve interação entre tempo e dieta paras as variáveis colesterol total, LDL e BHB. Houve redução da produção de leite corrigida para 3,5% de gordura, na produção total de gordura e de proteína, e no teor de gordura do leite quando comparado o tratamento INS com o SAT. A suplementação de lipídeo reduziu as concentrações do somatório dos ácidos graxos saturados (Σ A.G. Saturados), dos ácidos graxos com menos de 16 carbonos (>C16), e da relação entre ácidos graxos saturados com insaturados (Σ SFA/(MUFA+PUFA)); e aumentou as concentrações de ácidos graxos acima de 16 carbonos (>C16), de ácidos graxos insaturados com 18 carbonos, da somatória dos ácidos graxos insaturados e dos ácidos graxos poli-insaturados (Σ A.G. Poli-insaturados). O tratamento INS aumentou a concentração de ácidos graxos poli-insaturados totais (Σ A.G. poli-insaturados), e reduziu o total de ácidos graxos de 16 carbonos (C16) em relação ao tratamento SAT. Houve redução no número de folículos classe 1, e folículos totais (NC1 e NTFol) com suplementação de lipídeo. O tratamento SAT aumentou o número de folículos classe 5 (NC5), em relação ao INS. Não houve alteração na qualidade oocitária e embrionária com a suplementação de lipídeo e entre as duas fontes de lipídeo. A suplementação de lipídeos insaturados através da suplementação via grão de soja cru e integral, quando comparada à suplementação de lipídeos saturados, para vacas no período de transição e início de lactação, não interferiu na dinâmica folicular e qualidade oocitária e embrionária; e reduziu o desempenho produtivo, devido às reduções na produção de gordura do leite a na produção de leite corrigida para 3,5% dos animais suplementados

Paracetamol vs ibuprofeno para el dolor de la episiotomía en las 42 horas postparto

Objetivo: Evaluación de la eficacia analgésica para el dolor de la episiotomía entre el paracetamol y el Ibuprofeno, en las primeras 42 horas postparto. Método: Estudio cuasi-experimental (prospectivo y simple ciego) en mujeres que dieron a luz en el HOSPITAL UNIVERSITARIO CENTRAL DE ASTURIAS (OVIEDO), excluyendo alérgicas, patologías asociadas ó aquellas que el idioma impidiese un correcto entendimiento. Dos grupos: 1) Paracetamol 1 gr; 2) Ibuprofeno 600 mg. Tamaño de muestra: 110 por grupo para alcanzar mínimo de 80. Variable principal: grado de dolor según puntuación de escala (0 a 3). Otras variables: edad de paciente, semanas de gestación, peso neonatal, paridad, inicio del parto, anestesia epidural, tipo de parto, desgarro, inflamación y enrojecimiento, hematoma, hemorroides, necesidad de sondaje evacuador, aplicación de hielo y solicitud de analgesia. Tamaño final de la muestra: 88 grupo paracetamol y 97 grupo ibuprofeno. La escala de dolor se midió a las 2 horas postparto (previo al tratamiento) y, posteriormente, cada 8 hasta 42 horas. Se realizó análisis descriptivo y comparación entre grupos. Resultados: No encontramos diferencias significativas en la escala de dolor entre ambos fármacos, ni en los subgrupos analizados, salvo en el subgrupo de partos eutócicos, donde el ibuprofeno fue superior al paracetamol. En el global de la serie, el grupo de paracetamol solicitó hielo y otra medicación con mayor frecuencia que el grupo de ibuprofeno. Conclusiones: El ibuprofeno 600 mg y el paracetamol de 1 gr obtienen una respuesta similar en las primeras 42 horas postparto, si bien el ibuprofeno parece tener algunas ventajas adicionales.

Cuidar no parto : prática de episiotomia

Enquadramento – A episiotomia é uma incisão feita no períneo para aumentar o canal vaginal com o objetivo de evitar outros traumas perineais durante o parto. No entanto, esta prática, por si só, já se considera um trauma perineal pelo corte em estruturas que podem desencadear problemas futuros. A Organização Mundial de Saúde (1996) recomenda a utilização limitada da episiotomia uma vez que não existem evidências credíveis de que a utilização generalizada ou de rotina desta prática tenha um efeito benéfico. Objetivos: Demonstrar evidência científica dos determinantes da prática de episiotomia seletiva em mulheres com parto normal/eutócico; identificar a prevalência de episiotomia; analisar os fatores (variáveis sociodemográficas, variáveis relativas ao recém-nascido, variáveis contextuais da gravidez e contextuais do parto) que influenciam na ocorrência de episiotomia. Métodos: O estudo empírico I seguiu a metodologia de revisão sistemática da literatura. Efetuou-se uma pesquisa na EBSCO, PubMed, SciELO, RCAAP de estudos publicados entre janeiro de 2008 e 23 de dezembro de 2014. Os estudos encontrados foram avaliados tendo em consideração os critérios de inclusão previamente estabelecidos. Dois revisores avaliaram a qualidade dos estudos a incluir utilizando a grelha para avaliação crítica de um estudo descrevendo um ensaio clínico prospetivo, aleatorizado e controlado de Carneiro (2008). Após avaliação crítica da qualidade, foram incluídos no corpus do estudo 4 artigos nos quais se obteve um score entre 87,5% e 95%. O estudo empírico II enquadra-se num estudo quantitativo, transversal, descritivo e retrospetivo, desenvolvido no serviço de Obstetrícia do Centro Hospitalar Cova da Beira, segundo um processo de amostragem não probabilística por conveniência (n = 382). A recolha de dados efetuou-se através da consulta dos processos clínicos das mulheres com idade ≥ 18 anos que tiveram um parto vaginal com feto vivo após as 37 semanas de gestação. Resultados: Evidência de que a episiotomia não deve ser realizada de forma rotineira, cujo uso deve restringir-se a situações clínicas específicas. A episiotomia seletiva, comparada com a episiotomia de rotina, está relacionada com um menor risco de trauma do períneo posterior, a uma menor necessidade de sutura e a menos complicações na cicatrização. Amostra constituída por 382 mulheres, na faixa etária dos 18-46 anos. Apenas, não se procedeu à episiotomia em 41,7% da amostra, apontando para a presença da episiotomia seletiva. Número significativo de mulheres com parto eutócico (80,5%), com sutura (95,0%), laceração de grau I (64,9%), dor perineal (89,1%) sujeitas a episiotomia (58,3%). A maioria dos recém-nascidos nasceram com peso normal (92,3%), com um valor expressivo de mulheres sujeitas a episiotomia (91,4%). Ainda se constatou a existência de casos, apesar de reduzidos, em que o recém-nascido nasceu macrossómico (5,4%), tendo-se recorrido igualmente a esta prática. Não há uma associação direta entre a realização de episiotomia e os scores do APGAR. Conclusão: Face a estes resultados e com base na evidência científica disponível que recomenda, desde há vários anos, que se faça um uso seletivo da episiotomia, sugere-se que os profissionais de saúde estejam mais despertos para esta realidade, de modo a que se possam anular as resistências e as barreiras de mudanças por parte dos mesmos face ao uso seletivo da episiotomia. Para promover essa mudança de comportamentos é importante não só mostrar as evidências científicas, bem como transpô-las para a prática, capacitando os profissionais de saúde, sobretudo os enfermeiros, na sua atuação. Palavras-chave: Parto Normal/eutócico; Episiotomia; Episiotomia seletiva; Episiotomia de rotina.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Construção e validação do instrumento de investigação do conhecimento de gestantes sobre sua saúde bucal e a do seu bebê: perspectiva do cuidado em saúde

INTRODUCTION: Humanized and quality prenatal and post-partum care is critical to maternal and newborn health, as well as oral health care. Currently, the National Oral Health Policy is aiming at expanding dental care for pregnant women. Thus, the promotion of oral health and attention to prenatal care policies should be integrated; however, there is still limited participation of pregnant women. Thus, it is necessary to verify the knowledge of pregnant women related to oral health, seeking to estimate the quality of dental care provided during prenatal care, being essential for the Family Health strategy to organize personnel, plan costs and to ensure the quality standard of care. OBJECTIVE: To develop and validate a research instrument on the knowledge of pregnant women about their oral health and of their baby. METHOD: This is a construction and validation study with 93 pregnant women in Family Health Units and specialized private clinics in Obstetrics, in the city of Natal / RN. It was authorized by the Onofre Lopes University Hospital Ethics Committee of the Universidade Federal do Rio Grande do Norte (UFRN) under the registration number 421.163/13. The construction of the instrument followed steps so that it was valid, reliable and sensitive: creation and reduction of the items (drafting of the instrument), content validity and testing of the instrument, and hypotheses validation. Once constructed, the instrument was evaluated by experts who suggested modifications. There was consultation with the target population about the new version of the created instrument, which had the instrument validation verified by internal consistency through intra and inter-calibration and test-retest. Next, the hypotheses were validated. A database was built in the Statistical Package for Social Sciences (SPSS), version 22.0. After creating the hypotheses, an association was found for validating the criteria between each of the specific issues for each established criteria, considering a 5% significance level. Data analysis was carried out by describing the absolute and relative frequencies of the variables pertaining to issues relating to their pregnancy knowledge about their oral health and their baby. The Kappa coefficient was used for the calibration process (Inter and Intra-examiner calibration) and Cronbach's alpha coefficient was used to analyze instrument reproducibility (test-retest). In addition, the chi-square test was used to cross the dependent variable with the (dichotomized) independent variables. RESULTS: The intra and inter agreement analysis presented a Kappa coefficient between 0.400 and 1.000. Internal consistency through the analysis showed that 90% of the instrument's questions showed great reliability in the answers (Cronbach α ˃ 0.7). In the investigation of the relationship between the dependent variable (knowledge about oral health) and the independent variables (trimester of pregnancy, education, income and multiparous), it was found that none of these independent variables were significantly associated. All hypotheses had their Ho confirmed. CONCLUSION: The constructed instrument was validated, considering that it showed to be sensitive with good reliability and good accuracy, and therefore can be used to assess pregnant women’s knowledge about their oral health and the oral health of their baby.

Essays on the Role of Government Incentives in the Private Provision of Social Goods

The economic rationale for public intervention into private markets through price mechanisms is twofold: to correct market failures and to redistribute resources. Financial incentives are one such price mechanism. In this dissertation, I specifically address the role of financial incentives in providing social goods in two separate contexts: a redistributive policy that enables low income working families to access affordable childcare in the US and an experimental pay-for-performance intervention to improve population health outcomes in rural India. In the first two papers, I investigate the effects of government incentives for providing grandchild care on grandmothers’ short- and long-term outcomes. In the third paper, coauthored with Manoj Mohanan, Grant Miller, Katherine Donato, and Marcos Vera-Hernandez, we use an experimental framework to consider the the effects of financial incentives in improving maternal and child health outcomes in the Indian state of Karnataka.

Grandmothers provide a significant amount of childcare in the US, but little is known about how this informal, and often uncompensated, time transfer impacts their economic and health outcomes. The first two chapters of this dissertation address the impact of federally funded, state-level means-tested programs that compensate grandparent-provided childcare on the retirement security of older women, an economically vulnerable group of considerable policy interest. I use the variation in the availability and generosity of childcare subsidies to model the effect of government payments for grandchild care on grandmothers’ time use, income, earnings, interfamily transfers, and health outcomes. After establishing that more generous government payments induce grandmothers to provide more hours of childcare, I find that grandmothers adjust their behavior by reducing their formal labor supply and earnings. Grandmothers make up for lost earnings by claiming Social Security earlier, increasing their reliance on Supplemental Security Income (SSI) and reducing financial transfers to their children. While the policy does not appear to negatively impact grandmothers’ immediate economic well-being, there are significant costs to the state, in terms of both up-front costs for care payments and long-term costs as a result of grandmothers’ increased reliance on social insurance.

The final paper, The Role of Non-Cognitive Traits in Response to Financial Incentives: Evidence from a Randomized Control Trial of Obstetrics Care Providers in India, is coauthored with Manoj Mohanan, Grant Miller, Katherine Donato and Marcos Vera-Hernandez. We report the results from “Improving Maternal and Child Health in India: Evaluating Demand and Supply Side Strategies” (IMACHINE), a randomized controlled experiment designed to test the effectiveness of supply-side incentives for private obstetrics care providers in rural Karnataka, India. In particular, the experimental design compares two different types of incentives: (1) those based on the quality of inputs providers offer their patients (inputs contracts) and (2) those based on the reduction of incidence of four adverse maternal and neonatal health outcomes (outcomes contracts). Along with studying the relative effectiveness of the different financial incentives, we also investigate the role of provider characteristics, preferences, expectations and non-cognitive traits in mitigating the effects of incentive contracts.

We find that both contract types input incentive contracts reduce rates of post-partum hemorrhage, the leading cause of maternal mortality in India by about 20%. We also find some evidence of multitasking as output incentive contract providers reduce the level of postnatal newborn care received by their patients. We find that patient health improvements in response to both contract types are concentrated among higher trained providers. We find improvements in patient care to be concentrated among the lower trained providers. Contrary to our expectations, we also find improvements in patient health to be concentrated among the most risk averse providers, while more patient providers respond relatively little to the incentives, and these difference are most evident in the outputs contract arm. The results are opposite for patient care outcomes; risk averse providers have significantly lower rates of patient care and more patient providers provide higher quality care in response to the outputs contract. We find evidence that overconfidence among providers about their expectations about possible improvements reduces the effectiveness of both types of incentive contracts for improving both patient outcomes and patient care. Finally, we find no heterogeneous response based on non-cognitive traits.

Characterizing bupropion metabolism, pharmacokinetics and drug-drug interaction liability

Thesis (Ph.D.)--University of Washington, 2016-06