Perception of pain and distress in intubated and mechanically ventilated newborn infants by parents and health professionals

Background: An understanding of perceptions of parents and health caregivers who assist critically ill neonates is necessary to comprehend their actions and demands. Therefore this study aim to analyze the agreement among parents, nurse technicians and pediatricians regarding the presence and intensity of pain and distress in mechanically ventilated and intubated newborn infants.Methods: Cross-sectional study comprising 52 infants and 52 trios of adults composed of one parent, one nurse technician, and one pediatrician who all observed the same infant. All infants were intubated and under mechanical ventilation and were not handled during the observations. Each newborn was simultaneously observed by the trio of adults for 1 minute to evaluate the presence of pain and distress. the intensity of pain and distress that the adults believed was felt by the infants was marked in a visual analogical scale. Adults' agreement about the simultaneous presence of pain and distress in each infant was analyzed by marginal homogeneity and Cochran tests. the agreement about the intensity of pain and distress in each infant was studied by Bland-Altman plot and intraclass correlation coefficient (ICC).Results: the assessments of pain and distress were heterogeneous in all three investigated groups of adults as determined by the results of a Bland-Altman plot. the presence of distress was more frequently reported compared with pain (marginal heterogeneity, p < 0.01). the pain and distress scores in each adult group were not correlated as shown by ICC [parents, 0.36 (95% CI: 0.01-0.63); nurses 0.47 (0.23-0.66); pediatricians, 0.46 (0.22-0.65)].Conclusions: Adults systematically underscore pain in comparison to distress in mechanically ventilated newborns, without recognizing the association between them.Universidade Federal de São Paulo, Catanduva, SP, BrazilFac Integradas Padre Albino, Fac Med Catanduva, Catanduva, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Div Neonatal Med, BR-01410020 São Paulo, BrazilUniversidade Federal de São Paulo, Catanduva, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Div Neonatal Med, BR-01410020 São Paulo, BrazilWeb of Scienc

A modernização da política de contratos públicos da União Europeia

Dissertação de Mestrado, Relações Internacionais, 28 de setembro de 2018, Universidade dos Açores.A fim de promover e efetivar o mercado livre e concorrencial no espaço europeu, fruto dos princípios e objetivos que presidiram à fundação da União Europeia, surgiu a necessidade de uniformizar as regras praticadas pelos Estados-Membros relativas à contratação pública. As aquisições, fornecimentos e contratos de empreitada, concessões ou parcerias público-privadas representam cerca de 20% do PIB da União Europeia, justificando-se, desse modo, a particular atenção das instituições europeias para estas matérias. Neste contexto, moveu-nos a intenção de analisar a evolução, até 2014, da contratação pública no espaço europeu, sem esquecer as normas internacionais fora dessa área, e as consequências do seu efeito de cascata no ordenamento jurídico português, concluindo essa visitação com um olhar mais atento e crítico acerca da inovação jurídica que constituiu a transposição parcial da Diretiva n.º 2014/24/UE, do Parlamento Europeu e do Conselho, de 26 de fevereiro, relativa aos contratos públicos, através da aprovação do Regime Jurídico dos Contratos públicos na Região Autónoma dos Açores, procurando responder, neste último ponto, à questão sobre como a Região aproveitou esta oportunidade para tirar benefício do direito derivado europeu para a melhoria das regras que disciplinam a formação de contratos públicos e a utilização destes para fins económicos e sociais.ABSTRACT: With the purpose of promoting and make effective the free and concorrential market within the European Union, outcome of the goals of the foundation of the EU, it came the urge of setting the standards of the regulation practiced by the member states referring the public contracts. Public service contracts, public supply contracts and public works contracts, concessions or public-private partnerships account for around 20% of the European Union's GDP, thus justifying the particular attention of the European institutions to these matters. In this context, we have moved our intention to analyze the evolution of public procurement in Europe until 2014, without forgetting the international norms outside this area, and the consequences of its cascade effect in the Portuguese legal system, concluding this visitation with a closer and critical look at the legal innovation that constituted the partial transposition of Directive 2014/24/UE, of the European Parliament and of the Council of 26 february on public procurement, through the approval of the Legal Regime of Public Contracts in the Autonomous Region of the Azores, with a view to answering, in this last point, the question of how the Region took this opportunity to take benefit of European secondary legislation for the improvement of the rules governing the formation of public contracts and their use for economic and social purposes

Factors Associated With Red Blood Cell Transfusions In Very-low-birth-weight Preterm Infants In Brazilian Neonatal Units

Background: Preterm infants in neonatal intensive care units frequently receive red blood cells (RBC) transfusions due to the anemia of prematurity. A number of variables related to gestational age, severity of illness and transfusion practices adopted in the neonatal unit where the neonate was born may contribute to the prescription of RBC transfusions. This study aimed to analyse the frequency and factors associated with RBC transfusions in very-low-birth-weight preterm infants. Methods: A prospective cohort of 4283 preterm infants (gestational age: 29.9 +/- 2.9 weeks; birth weight: 1084 +/- 275 g) carried out at 16 university hospitals in Brazil between January 2009 and December 2011 was analysed. Factors associated with RBC transfusions were evaluated using univariate and multiple logistic regression analysis. Results: A total of 2208 (51.6 %) infants received RBC transfusions (variation per neonatal unit: 34.1 % to 66.4 %). RBC transfusions were significantly associated with gestational age (OR: -1.098; 95% CI: -1.12 to -1.04), SNAPPE II score (1.01; 1.00-1.02), apnea (1.69; 1.34-2.14), pulmonary hemorrhage (2.65; 1.74-4.031), need for oxygen at 28 days of life (1.56; 1.17-2.08), clinical sepsis (3.22; 2.55-4.05), necrotising enterocolitis (3.80; 2.26-6.41), grades III/IV intraventricular hemorrhage (1.64; 1.05-2.58), mechanical ventilation (2.27; 1.74-2.97), use of umbilical catheter (1.86; 1.35-2.57), parenteral nutrition (2.06; 1.27-3.33), > 60 days of hospitalization (5.29; 4.02-6.95) and the neonatal unit where the neonate was born. Conclusions: The frequency of RBC transfusions varied among neonatal intensive care units. Even after adjusting for adverse health conditions and therapeutic interventions, the neonatal unit continued to influence transfusion practices in very-low birth-weight infants.1

Transmission of signals using white LEDs for VLC applications

In this paper an integrated wavelength optical filter and photodetector for Visible Light Communication (VLC) is used. The proposed application uses indoor warm light lamps lighting using ultra-bright white LEDs pulsed at frequencies higher than the ones perceived by the human eye. The system was analyzed using two different types the white LEDs, namely, phosphor and trichromatic based LEDs. The signals were transmitted into free space and the generated photocurrent was measured by the pin-pin photodetector based on a-SiC:H/a-Si:H. This device operates in the visible spectrum, allowing thus the detection of the pulsed white light emitted by the LEDs. However, as it also works as a visible optical filter with controlled wavelength sensitivity through the use of adequate optical biasing light, it is able to detect different wavelengths. This feature allows the detection of the individual components of the tri-chromatic white LED, which enlarges the amount of information transmitted by this type of white LED, when compared to the phosphor based LED. A capacitive optoelectronic model supports the experimental results and the physical operation of the device. A numerical simulation is presented.info:eu-repo/semantics/publishedVersio

Effectiveness of a conservative protocol to reduce the need of red blood cells transfusions in very low birthweight infants

Objetivos: Avaliar a efetividade da Introdução de um protocolo conservador de indicacoes de transfusoes de hemacias na reducao das mesmas, em prematuros de muito baixo peso (RNMBP) nascidos em sete Unidades Neonatais da Rede Publica do Municipio de São Paulo, e determinar os fatores de risco associados a necessidade, ao numero e ao volume de transfusoes de hemacias nessa populacao. Metodo: Estudo coorte prospectivo realizado em duas fases. Fase 1 (01/07/00 a 15112/00): periodo no qual as indicacoes para as transfusoes de eritrocitos nao eram uniformes. Fase 2 (16/01/01 a 15/10/01): periodo no qual foi introduzido um protocolo conservador de indicacoes de transfusoes nas unidades neonatais estudadas, modificado de Shannon et al (1995). Foram incluidos apenas RNMBP com idade gestacional < 37 semanas, sendo coletados dados demograficos, hematimetricos, de espoliacao sanguinea e de transfusoes de hemacias. Resultados: Os 149 pacientes da Fase 1 apresentaram caracteristicas demograficas, de morbidade e mortalidade similares aos 196 neonatos da Fase 2. A espoliacao sanguinea ate a alta foi 30 mukg nos dois periodos. Apos a implantacao do protocolo conservador houve reducao de 10 por cento na porcentagem de pacientes transfundidos (Fase 1: 76,5 por cento; Fase 2: 68,9 por cento), de uma transfusao no numero mediano de transfusoes por neonato (Fase 1: 2; Fase 2: 1), de 0,5 transfusao no numero medio de transfusoes por prematuro (Fase 1: 3,0 n 3,6; Fase 2: 2,5 n 3,4) e de 6,9 mL/kg no volume de hemacias transfundido por prematuro incluido no estudo (Fase 1: 38,0 n 46,8; Fase 2: 31,1 n 42,0). Os fatores de risco associados a maior necessidade de receber pelo menos uma transfusao de eritrocitos foram: espoliacao sanguinea, dias de ventilacao mecanica e fase do estudo. Nascei na Fase 1 foi fator de risco para transfusoes: OR 1,908 (IC95 por cento: 1,015 a 3,588). Os fatores associados ao maior numero e volume de transfusoes de hemacias entre os que sobreviveram ate a alta hospitalar foram: espoliacao sanguinea (p<0,001), tempo de ventilacao mecanica (p<0,001), tempo de internacao (p<0,001) e pertencer a Fase 1 da pesquisa (p=0,006). O maior peso ao nascer associou-se ao maior numero de transfusoes, mas nao ao volume de hemacias transfundido. Cada paciente que nascer. na Fase 2 e sobreviveu ate a alta recebeu 0,414 (IC95 por cento: 0,123 a 0,706) transfusoes a menos e 5,580 (IC95 por cento: 1,607 a 9,554) mL/kg de volume transfundido a menos que...(au)BV UNIFESP: Teses e dissertaçõe

Repercussions of preterm birth on symptoms of asthma, allergic diseases and pulmonary function, 6-14 years later

Background: Prevalence of allergic diseases and impaired pulmonary function may be high in children born prematurely. This study aimed to assess pulmonary function and prevalence of asthma, atopic diseases and allergic sensitisation in these patients. Methods: A cross-sectional study was conducted with children aged 6-14 years who were born prematurely with birth weight <2000 g from January 2008 to May 2011. Exclusion criteria were: major malformations, or acute respiratory disorders. The International Study of Asthma and Allergies in Childhood questionnaire was applied followed by allergic skin prick test and spirometry. Results: The study included 84 children aged 9.3 +/- 2.3 years born at mean gestational age of 31.8 +/- 2.4 weeks. The prevalence of current asthma was 25%, more severe asthma was 15.5%rhinitis was 38.1%flexural eczema was 8.3%and a positive skin-prick test was 69.6%. Frequencies of children with values <80% of predicted were: FVC (8.3%), FEV1 (22.6%), and FEV1/FVC ratio (16.7%). Prevalence of children with FEF25-75% <70% of the predicted value was 32.4%, positive bronchodilator response was observed in 20.5% of cases, and altered pulmonary function in 42.9%. Factors associated with altered pulmonary function were oxygen dependency at 28 days of life (OR: 4.213, p=0.021), the presence of wheezing in childhood (OR: 5.979, p=0.014) and infant's height (OR: 0.945, p=0.005). Conclusions: There was a high prevalence of severe asthma, allergic sensitisation, and altered pulmonary function among children and adolescents born prematurely. Bronchopulmonary dysplasia and a history of wheezing were risk factors for altered pulmonary function. (C) 2016 SEICAP. Published by Elsevier Espana, S.L.U. All rights reserved.Medical Research CouncilUniv Fed Sao Paulo, Dept Pediat, Neonatal Div Med, Sao Paulo, SP, BrazilUniv Fed Sao Paulo, Dept Pediat, Div Allergy Clin Immunol & Rheumatol, Sao Paulo, SP, BrazilDepartment of Pediatrics – Neonatal Division of Medicine, Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, BrazilDepartment of Pediatrics – Division of Allergy, Clinical Immunology and Rheumatology – Universidade Federal de São Paulo (UNIFESP), São Paulo, SP, BrazilMedical Research Council: G1000758Web of Scienc