Factors associated with the quality of prenatal care: an approach to premature birth

OBJECTIVETo assess the quality of prenatal care in mothers with premature and term births and identify maternal and gestational factors associated with inadequate prenatal care.METHODCross-sectional study collecting data with the pregnant card, hospital records and interviews with mothers living in Maringa-PR. Data were collected from 576 mothers and their born alive infants who were attended in the public service from October 2013 to February 2014, using three different evaluation criteria. The association of prenatal care quality with prematurity was performed by univariate analysis and occurred only at Kessner criteria (CI=1.79;8.02).RESULTSThe indicators that contributed most to the inadequacy of prenatal care were tests of hemoglobin, urine, and fetal presentation. After logistic regression analysis, maternal and gestational variables associated to inadequate prenatal care were combined prenatal (CI=2.93;11.09), non-white skin color (CI=1.11;2.51); unplanned pregnancy (CI=1.34;3.17) and multiparity (CI=1.17;4.03).CONCLUSIONPrenatal care must follow the minimum recommended protocols, more attention is required to black and brown women, multiparous and with unplanned pregnancies to prevent preterm birth and maternal and child morbimortality.

Phthalates in the NICU: Is it safe?

AIMS: As growing concerns exist regarding phthalate exposure, which could be teratogenic, carcinogenic or induce reproductive toxicity, we aimed to review the evidence of the risks due to the use of medical devices containing di(2-ethylhexyl)phthalate in hospitalized neonates. METHODS: We reviewed the literature, searching through medical literature databases (Pubmed, MEDLINE, EBM reviews, Cochrane database, Embase and Google Scholar) using the following keywords: phthalate, di(2-ethylhexyl)phthalate, newborn and neonate. RESULTS: We identified several associations with short and long term health dangers, mainly subfertility, broncho-pulmonary dysplasia, necrotising enterocolitis, parenteral nutrition associated cholestasis and neuro-developmental disorders. These data are based mainly on animal or observational human studies. CONCLUSION: Clinicians must be aware of the potential risks due to phthalate exposure in the NICU. Di(2-ethylhexyl)phthalate containing materials should be identified and alternative devices should be considered. There is a need to improve knowledge in this area.

Mirror therapy in children with hemiplegia: a pilot study.

Mirror therapy, which provides the visual illusion of a functional paretic limb by using the mirror reflection of the non-paretic arm, is used in the rehabilitation of hemiparesis after stroke in adults. We tested the effectiveness and feasibility of mirror therapy in children with hemiplegia by performing a pilot crossover study in ten participants (aged 6-14 y; five males, five females; Manual Ability Classification System levels: one at level I, two at level II, four at level III, three at level IV) randomly assigned to 15 minutes of daily bimanual training with and without a mirror for 3 weeks. Assessments of maximal grasp and pinch strengths, and upper limb function measured by the Shriner's Hospital Upper Extremity Evaluation were performed at weeks 0 (baseline), 3, 6 (intervention), and 9 (wash-out). Testing of grasp strength behind the mirror improved performance by 15% (p=0.004). Training with the mirror significantly improved grasp strength (with mirror +20.4%, p=0.033; without +5.9%, p>0.1) and upper limb dynamic position (with mirror +4.6%, p=0.044; without +1.2%, p>0.1), while training without a mirror significantly improved pinch strength (with mirror +6.9%, p>0.1; without +21.9%, p=0.026). This preliminary study demonstrates the feasibility of mirror therapy in children with hemiplegia and that it may improve strength and dynamic function of the paretic arm.

International Union of Pharmacology. XXXV. The glucagon receptor family.

Peptide hormones within the secretin-glucagon family are expressed in endocrine cells of the pancreas and gastrointestinal epithelium and in specialized neurons in the brain, and subserve multiple biological functions, including regulation of growth, nutrient intake, and transit within the gut, and digestion, energy absorption, and energy assimilation. Glucagon, glucagon-like peptide-1, glucagon-like peptide-2, glucose-dependent insulinotropic peptide, growth hormone-releasing hormone and secretin are structurally related peptides that exert their actions through unique members of a structurally related G protein-coupled receptor class 2 family. This review discusses advances in our understanding of how these peptides exert their biological activities, with a focus on the biological actions and structural features of the cognate receptors. The receptors have been named after their parent and only physiologically relevant ligand, in line with the recommendations of the International Union of Pharmacology Committee on Receptor Nomenclature and Drug Classification (NC-IUPHAR).

Statewide Assessment Instrument, June 15, 2010

The Iowa Department of Human Services (IDHS) has responsibility for Iowa’s child welfare system. Iowa’s child welfare system focuses on children that have been or are at risk of being abused or neglected, as well as children that are determined by the Juvenile Court to be a child in need of assistance (CINA). The child welfare system is focused on three major results that are safety, permanency, and child and family well-being.

House File 811 Legislative Report, December 14, 2009

The department of Human Services provides child protective and child welfare services to eligible families in the state of Iowa. Children ages 0-17 may receive services that include child protective assessments, child in need of assistance, safety plan services, family safety, risk and permanency services, foster care and case management. A confirmed child abuse assessment may lead to involvement with juvenile court via an adjudication hearing. The court provides oversight and support to the family to increase safety for the children. Al child abuse assessments, regardless of disposition, are sent to juvenile court for review and information.

Hierarchy of interactive functions in father-mother-baby three-way games

In developmental research, the family has mainly been studied through dyadic interaction. Three-way interactions have received less attention, partly because of their complexity. This difficulty may be overcome by distinguishing between four hierarchically embedded functions in three-way interactions: (1) participation (inclusion of all participants), (2) organization (partners keeping to their roles), (3) focalization (sharing a common focus) and (4) affective contact (being in tune). We document this hierarchical model on a sample of 80 families observed in the Lausanne Trilogue Play situation across four different sites. Hierarchy between functions was demonstrated by means of Guttman scalability coefficient. Given the importance of the child's development in a threesome, the pertinence of this model for family assessment is discussed.

Mechanical ventilation in the newborn; a simplified approach. Part 1: Intermittent positive pressure ventilation.

Positive pressure ventilation (PPV) is a frequent intervention in the neonatal intensive care unit. This article is directed towards paediatricians in training and attempts to cover the basics of PPV without being too technical. To do so we have employed an extensive use of graphics to illustrate the underlying principles.

AMCHP Issue Brief, February 2012

Children and youth with autism spectrum disorder and other developmental disabilities (ASD/DD) require a comprehensive array of medical, behavioral and developmental health services that are often inadequately covered under the current system of health coverage. This leaves children at risk for missed or delayed care and their families with significant financial burdens. The Patient Protection and Affordable Care Act (ACA) is designed to increase health coverage, improve benefits, and provide important new insurance protections for all Americans. Many of the law’s provisions will impact children, including those with ASD/DD, and will be implemented over time. This report, developed by The Catalyst Center at the Boston University School of Public Health, offers a brief description of selected provisions in the ACA that have implications for children with ASD/DD. It also describes how state Title V maternal and child health (MCH) programs can maximize opportunities under the ACA to develop and strengthen systems of care for children and youth with ASD/DD.

Direct Effect of Birth Weight on Childhood Blood Pressure: a Causal Mediation Analysis

Background: Numerous studies have shown a negative association between birth weight (BW) and blood pressure (BP) later in life. To estimate the direct effect of BW on BP, it is conventional to condition on current weight (CW). However, such conditioning can induce collider stratification bias in the estimate of the direct effect. Objective: To bound the potential bias due to U, an unmeasured common cause of CW and BP, on the estimate of the (controlled) direct effect of BW on BP. Methods: Data from a school based study in Switzerland were used (N = 4,005; 2,010 B/1,995 G; mean age: 12.3 yr [range: 10.1-14.9]). Measured common causes of BW-BP (SES, smoking, body weight, and hypertension status of the mother) and CW-BP (breastfeeding and child's physical activity and diet) were identified with DAGs. Linear regression models were fitted to estimate the association between BW and BP. Sensitivity analyses were conducted to assess the potential effect of U on the association between BW and BP. U was assumed 1) to be a binary variable that affected BP by the same magnitude in low BWand in normal BW children and 2) to have a different prevalence in low BW children and in normal BW children for a given CW. Results: A small negative association was observed between BW and BP [beta: -0.3 mmHg/kg (95% CI: -0.9 to 0.3)]. The association was strengthened upon conditioning for CW [beta: -1.5 mmHg/kg (95% CI: -2.1 to -0.9)]. Upon further conditioning on common causes of BW-BP and CW-BP, the association did not change substantially [beta: -1.4 mmHg/kg (95% CI: -2.0 to -0.8)]. The negative association could be explained by U only if U was strongly associated with BP and if there was a large difference in the prevalence of U between low BWand normal BW children. Conclusion: The observed negative association between BW and BP upon adjustment for CW was not easily explained by an unmeasured common cause of CWand BP.

Mechanical ventilation in the newborn; a simplified approach. Part 2: High-frequency ventilation.

High frequency oscillatory ventilation (HFOV) is becoming an increasingly popular intervention in the neonatal intensive care unit. This article will attempt to explain the principles of HFOV. It is inherently more difficult to become skilled in this technique than in other forms of mechanical ventilation, so caution is warranted.

Shorter time since inflammatory bowel disease diagnosis in children is associated with lower mental health in parents.

AIM: This study assessed the mental health of parents of children with inflammatory bowel disease (IBD), compared their mental health with age-matched and gender-matched references and examined parental and child predictors for mental health problems. METHODS: A total of 125 mothers and 106 fathers of 125 children with active and inactive IBD from the Swiss IBD multicentre cohort study were included. Parental mental health was assessed by the Symptom Checklist 27 and child behaviour problems by the Strengths and Difficulties Questionnaire. Child medical data were extracted from hospital records. RESULTS: While the mothers reported lower mental health, the fathers' mental health was similar, or even better, than in age-matched and gender-matched community controls. In both parents, shorter time since the child's diagnosis was associated with poorer mental health. In addition, the presence of their own IBD diagnosis and child behaviour problems predicted maternal mental health problems. CONCLUSIONS: Parents of children with IBD may need professional support when their child is diagnosed, to mitigate distress. This, in turn, may help the child to adjust better to IBD. Particular attention should be paid to mothers who have their own IBD diagnosis and whose children display behaviour problems.

Determinants of maternal sex steroids during the first half of pregnancy.

OBJECTIVE: To examine the associations of maternal and child characteristics with early pregnancy maternal concentrations of testosterone, androstenedione, progesterone, 17-hydroxyprogesterone, and estradiol (E2). METHODS: We analyzed these hormones among 1,343 women with singleton pregnancies who donated serum samples to the Finnish Maternity Cohort from 1986 to 2006 during the first half of pregnancy (median 11 weeks). The associations of maternal and child characteristics with hormone concentrations were investigated by correlation and multivariable regression. RESULTS: Women older than age 30 years had lower androgen and E2 but higher progesterone concentrations than women younger than that age. Multiparous women had 14% lower testosterone, 11% lower androstenedione and 17-hydroxyprogesterone, 9% lower progesterone, and 16% lower E2 concentrations compared with nulliparous women (all P<.05). Smoking mothers had 11%, 18%, and 8% higher testosterone, androstenedione, and 17-hydroxyprogesterone levels, respectively, but 10% lower progesterone compared with nonsmoking women (all P<.05). E2 concentrations were 9% higher (P<.05) among women with a female fetus compared with those with a male fetus. CONCLUSION: Parity, smoking, and, to a lesser extent, maternal age and child sex are associated with sex steroid levels during the first half of a singleton pregnancy. The effects of smoking on the maternal hormonal environment and the possible long-term deleterious consequences on the fetus deserve further evaluation. LEVEL OF EVIDENCE: II.

2001 Iowa Termination of Pregnancy Report, March 3 2003

The total number of pregnancy terminations decreased from 7,602 in 2000 to 6,845 in 2001. This represents a 10% decrease. Induced termination decreased from 6,059 to 5,722 (a 6% decrease) and spontaneous termination decreased from 1,541 to 1,119 (a 27% decrease). Pregnancy terminations by maternal and child health regions (MCH) • The fertility rate for the state as a whole increased from 62.3 per 1,000 to 62.6 per 1,000, from 2000 to 2001. In 2000, 15 MCH regions had a higher rate than the statewide fertility rate, while in 2001, the number of MCH regions with a higher rate than the statewide fertility rate dropped to 12. Region 7 continued to have the highest fertility rate and region 12 continued to have the lowest rate. • The pregnancy rate decreased from 74.6 per 1,000 to 74.1 per 1,000. Region 16 continued to have the lowest pregnancy rate. However, region 23 had the highest pregnancy rate in 2001, compared to region 7 in 2000. • The induced termination rate decreased 0.6 per 1,000 and down to 9.4 per 1,000 in 2001. Compared to 2000 reports, two fewer regions had a higher rate than the statewide induced termination rate in 2001 (8 regions in 2000 vs. 6 regions in 2001). • The spontaneous termination rate for the state dropped to 1.8 per 1,000 from 2.5 per 1,000. The number of regions with a higher spontaneous termination rate decreased from 9 to 7. Region 14 had the highest rate, and region 20 had the lowest. • The statewide induced termination ratio increased from 145.7 per 1,000 to 149.6 per 1,000. Region 12 had the highest ratio for both years, and region 22 had the lowest ratio. • The statewide spontaneous termination ratio decreased from 39.7 per 1,000 to 29.3 per 1,000. One less region was higher, compared to 2000 data (9 regions in 2000 vs. 8 regions in 2001). In summary, the geographic distribution of the 2001 data showed a pattern similar to that seen in 2000. Generally, the frequency for both induced and spontaneous terminations decreased by month of occurrence, gestational age, marital status, and education level and mother’s age

Experiencias vividas por niños y niñas con cáncer a través de la musicoterapia: un proyecto de acción- participación

Justificación: este trabajo muestra una mirada más profunda acerca de cómo viven los niños y niñasla experiencia de vivir con el Cáncer, enfermedad que representa la primera causa de mortalidadentre los 5-14 años, en Cataluña.El profesional de Enfermería es clave en indagar y reflexionar acerca de la experiencia, y endesarrollar el papel que juega la intervención enfermera denominada Musicoterapia comoherramienta de expresión y comunicación, para descubrir que hay detrás de su realidad.Indagar en este contexto puede contribuir a mejorar la calidad de vida del colectivo infantil inmersoen la patología.Objetivo: conocer cómo viven la experiencia oncológica los niños y niñas, utilizando comoherramienta de trabajo la Musicoterapia en el escenario del Hospital Materno-Infantil Vall d´Hebrónde Barcelona.Diseño: proyecto de Investigación Acción-Participativa (IAP), enmarcado en el paradigma cualitativo.Metodología: se llevó a cabo una búsqueda en bases de datos: Pubmed, CINAHL, Cuiden, Cuidatge,entre otras y diferentes fuentes de información. Los sujetos de estudio fueron 14 niños y niñas entre8 y 12 años de edad ingresados en la planta de Oncología durante al menos 8 semanas. Para larecogida de datos se utilizaron las siguientes estrategias: entrevistas semiestructuradas, notas decampo y grupos de discusión.En cuanto al análisis mencionar que se siguió un riguroso trabajo para asignar unidades de significadoa la información obtenida.Consideraciones finales: Este proyecto ha permitido avanzar hacia el conocimiento enfermero yprofundizar en el cuidado holístico de los niños.