Immunoglobulins in saliva of preterm and full-term infants. A longitudinal study from 0-18 months of age

The aim of this longitudinal study was to determine salivary levels of total IgA, IgG and IgM in 84 preterm and 214 full-term infants, from birth to 18 months of age. Unstimulated whole saliva was collected from each infant at birth, and subsequently at 3-monthly intervals. Immunoglobulin levels were estimated using an ELISA technique. At birth, IgA was detected in 147/214 (69%) full-term infants but only 47/84 (56%) preterm infants (P

Neonatal respiratory therapy in the new millennium: Does clinical practice reflect scientific evidence?

Respiratory therapy has historically been considered the primary role of the physiotherapist in neonatal intensive care in Australia. In 2001 a survey was undertaken of all level three neonatal intensive care units in Australia to determine the role of the physiotherapist and of respiratory therapy in clinical practice. It appears that respiratory therapy is provided infrequently, with the number of infants treated per month ranging from 0 to 10 in 15 of the 20 units who provide respiratory therapy, regardless of therapist availability. The median number of respiratory treatments per month during the week was three, and on weekends it was one. Respiratory therapy was carried out by physiotherapists and nurses in 54.6% of units, by physiotherapists only in 36.4% of units, and by nurses only in the remaining 9% of units surveyed. There was also a diminution of the role of respiratory therapy in the extubation of premature infants. A review of the literature shows that overall the use of respiratory therapy reflects current evidence. The question remains whether it is possible to maintain the competency of staff and justify the cost of training in the current healthcare economic climate. It seems probable that the future role of physiotherapists in neonatal intensive care unit may be in the facilitation of optimal neurological development of surviving very low birth weight infants.

Centile reference for total energy expenditure in infants from 1 to 12 months

Background: A knowledge of energy expenditure in infancy is required for the estimation of recommended daily amounts of food energy, for designing artificial infant feeds, and as a reference standard for studies of energy metabolism in disease states. Objectives: The objectives of this study were to construct centile reference charts for total energy expenditure (TEE) in infants across the first year of life. Methods: Repeated measures of TEE using the doubly labeled water technique were made in 162 infants at 1.5, 3, 6, 9 and 12 months. In total, 322 TEE measurements were obtained. The LMS method with maximum penalized likelihood was used to construct the centile reference charts. Centiles were constructed for TEE expressed as MJ/day and also expressed relative to body weight (BW) and fat-free mass (FFM). Results: TEE increased with age and was 1.40,1.86, 2.64, 3.07 and 3.65 MJ/day at 1.5, 3, 6, 9 and 12 months, respectively. The standard deviations were 0.43, 0.47, 0.52, 0.66 and 0.88, respectively. TEE in MJ/kg increased from 0.29 to 0.36 and in MJ/day/kg FFM from 0.36 to 0.48. Conclusions: We have presented centile reference charts for TEE expressed as MJ/day and expressed relative to BW and FFM in infants across the first year of life. There was a wide variation or biological scatter in TEE values seen at all ages. We suggest that these centile charts may be used to assess and possibly quantify abnormal energy metabolism in disease states in infants.

Aging per se does not influence glucose homeostasis - In vivo and in vitro evidence

OBJECTIVE - To assess the effect of age on glucose metabolism by examining 1) glucose metabolism in young and middle-aged subjects when total or regional adiposity is taken into account and 2) in vitro glucose transport in adipose tissue explants from young and middle-aged women paired for total and abdominal adiposity. RESEARCH DESIGN AND METHODS - Study 1: body composition, subcutaneous abdominal and visceral adipose tissue areas, and fasting and oral glucose-stimulated glucose and insulin were measured in 84 young and 81 middle-aged men and in 110 young and 91 middle-aged women. Study 2: glucose uptake in subcutaneous abdominal and visceral adipose tissue explants were measured in eight young and eight middle-aged women. RESULTS - Study 1: young and middle-aged men showed similar subcutaneous abdominal tissue area, whereas fat mass and visceral adipose tissue were greater in middle-aged than in young men (P < 0.01). Fat mass and subcutaneous and visceral adipose tissue areas were greater in middle-aged as compared with young women (P < 0.01). Fasting plasma glucose and the glucose response to an oral glucose tolerance test were significantly higher in middle-aged than in young men and women (P < 0.001). Statistical control for visceral adipose tissue area eliminated the difference seen in glucose response in men and women. Study 2: glucose transport in subcutaneous and omental adipose tissue did not differ between young and middle-aged women. CONCLUSIONS - 1) Visceral obesity, more than age per se, correlates with glucose intolerance in middle-aged subjects; 2) aging does not influence in vitro adipose tissue glucose uptake.

Systematic review of the role of pre-oxygenation for tracheal suctioning in ventilated newborn infants

Pre-oxygenation for endotracheal suctioning for mechanically ventilated infants is routine practice in many neonatal intensive care units. In the present systematic review the evidence to support its use is discussed and the authors conclude that no confident recommendations can be made from the results of this review.

Impact of bronchopulmonary dysplasia, brain injury, and severe retinopathy on the outcome of extremely low-birth-weight infants at 18 months

CONTEXT: Despite more than 2 decades of outcomes research after very preterm birth, clinicians remain uncertain about the extent to which neonatal morbidities predict poor long-term outcomes of extremely low-birth-weight (ELBW) infants. OBJECTIVE: To determine the individual and combined prognostic effects of bronchopulmonary dysplasia (BPD), ultrasonographic signs of brain injury, and severe retinopathy of prematurity (ROP) on 18-month outcomes of ELBW infants. DESIGN: Inception cohort assembled for the Trial of Indomethacin Prophylaxis in Preterms (TIPP). SETTING AND PARTICIPANTS: A total of 910 infants with birth weights of 500 to 999 g who were admitted to 1 of 32 neonatal intensive care units in Canada, the United States, Australia, New Zealand, and Hong Kong between 1996 and 1998 and who survived to a postmenstrual age of 36 weeks. MAIN OUTCOME MEASURES: Combined end point of death or survival to 18 months with 1 or more of cerebral palsy, cognitive delay, severe hearing loss, and bilateral blindness. RESULTS: Each of the neonatal morbidities was similarly and independently correlated with a poor 18-month outcome. Odds ratios were 2.4 (95% confidence interval [CI], 1.8-3.2) for BPD, 3.7 (95% CI, 2.6-5.3) for brain injury, and 3.1 (95% CI, 1.9-5.0) for severe ROP. In children who were free of BPD, brain injury, and severe ROP the rate of poor long-term outcomes was 18% (95% CI, 14%-22%). Corresponding rates with any 1, any 2, and all 3 neonatal morbidities were 42% (95% CI, 37%-47%), 62% (95% CI, 53%-70%), and 88% (64%-99%), respectively. CONCLUSION: In ELBW infants who survive to a postmenstrual age of 36 weeks, a simple count of 3 common neonatal morbidities strongly predicts the risk of later death or neurosensory impairment.

O processo decis??rio da reforma tribut??ria e da previd??ncia social: per??odo de 1994 a 1998

An??lise da reforma constitucional no governo Fernando Henrique Cardoso a partir dos estudos de caso da reforma tribut??ria e da previd??ncia social, compreendendo tamb??m uma reconstitui????o do processo decis??rio de pol??ticas nestas ??reas desde a era Collor.

Formar dirigentes, capacitar gestores, desenvolver gerentes: do que estamos falando? A experi??ncia da ENAP-Brasil no per??odo 2003-2007

Este texto busca em sua primeira parte analisar as contribui????es ofertadas pela Carta Iberoamericana da Fun????o P??blica na constru????o de uma linguagem comum entre nossos governos e organiza????es formadoras e depois se dedica a apresentar alguns elementos contextualizadores da atua????o da Escola Nacional de Administra????o P??blica (ENAP ??? Brasil) no que diz respeito ?? forma????o e capacita????o de dirigentes p??blicos

Relat??rio do comit?? gestor da Rede Nacional de Escolas de Governo: per??odo junho-2012/julho-2014

Este relat??rio cont??m tr??s partes. A primeira delas comp??e-se de um informe sobre a situa????o das a????es propostas pela plen??ria final do IX Encontro. A segunda apresenta breve avalia????o qualitativa das atividades desempenhadas pelo CG-Rede. Na terceira e ??ltima parte, o documento apresenta sugest??es para discuss??o e encaminhamento no X Encontro Nacional.

A qualidade do gasto p??blico e a avalia????o das pol??ticas sociais: o or??amento do Minist??rio do Trabalho no per??odo 2000-2006

Nos ??ltimos anos, o debate sobre a melhoria da qualidade do gasto p??blico tem ganhado espa??o crescente. As quest??es mais gerais do tema s??o relevantes, mas n??o substituem o exame espec??fico dos gastos sociais dos diversos minist??rios ??? raz??o pela qual a avalia????o das pol??ticas p??blicas ?? instrumento fundamental para melhoria do gasto. O trabalho corrente faz uma avalia????o da din??mica or??ament??ria das pol??ticas do Minist??rio do Trabalho e Emprego. Essa an??lise revela um crescente desequil??brio: enquanto o valor destinado ??s pol??ticas passivas de emprego aumentou brutalmente, os valores destinados ??s pol??ticas ativas de emprego ca??ram significativamente. Esse cen??rio ??? oposto ao que seria desej??vel ??? ?? ainda mais preocupante na medida em que as pol??ticas passivas de emprego n??o beneficiam os mais pobres. Neste contexto, o trabalho avalia a possibilidade de que parte dos recursos reservados para pol??ticas passivas seja dirigido ??s pol??ticas ativas de emprego.

Portaria n?? 61, de 4 de abril de 2014: torna p??blicos o Plano Diretor de Tecnologia da Informa????o - PDTI e o Plano Estrat??gico de Tecnologia da Informa????o - PETI, do per??odo 2014/2015

Tornar p??blicos o Plano Diretor de Tecnologia da Informa????o - PDTI e o Plano Estrat??gico de Tecnologia da Informa????o - PETI, do per??odo 2014/2015, validados e aprovados pelo Comit?? de Tecnologia da Informa????o - CTI em reuni??o extraordin??ria de 02 de abril de 2014.

Influência da idade e da posição radial na flexão estática da madeira de Eucalyptus grandis Hill ex. Maiden

Este trabalho objetivou testar a variação da flexão estática da madeira de Eucalyptus grandis, ao longo da seção radial e sob quatro diferentes idades (10, 14, 20 e 25 anos), provenientes de talhões comerciais. As amostras foram retiradas da prancha diametral, de cada uma das 16 árvores (quatro para cada idade), tomadas de quatro posições eqüidistantes (0, 33, 66 e 100%), no sentido medula-casca, com oito repetições por posição. Verificou-se que os módulos de elasticidade (MOE) e de ruptura (MOR) apresentaram valores médios de 129.230 kgf/cm2 e 854 kgf/cm2, respectivamente, e ambos se mostraram positivamente correlacionados com a idade e com a posição radial, no sentido medula-casca. Os maiores valores foram conseguidos nas madeiras de 20 anos de idade e localizadas na região mais próxima da casca.