Governing cooperative quality schemes: some lessons from olive oil initiatives in the Region of Valencia (Spain)

This paper describes the development, functioning and governance of quality assurance schemes for olive oil in three cooperative organizations. Two questions are addressed: first, how the construction of new quality schemes by cooperatives can lead to the fragmentation of the membership base, and hence the need for new institutional arrangements; and second, how the development of such schemes alters the interdependencies between parties (cooperative organization and its members), and how this is governed. The comparative analysis shows the relevance of the social and cultural contexts in shaping the mechanisms of governance, as well contributing to the policy debate in the European Union regarding new food quality schemes.Moragues Faus, AM.; Ortiz Miranda, D. (2012). Governing cooperative quality schemes: some lessons from olive oil initiatives in the Region of Valencia (Spain). Outlook On Agriculture. 41(1):27-33. doi:10.5367/oa.2012.0072S273341

Outpatient anesthesiology - a condition of a question

Outpatient general anesthesia - the independent direction of modern anesthesiology. The level of the out-patient surgical help in Russia isn't great, not like in foreign countries, where this level is about 70% .There are no uniform protocols of carrying out anesthesia in out-patient surgery in our country. The question of a choice of an optimum method of anesthesia having crucial importance for out-patient surgery remains open, as well as the questions concerning selection, the volume of preoperative inspection of patients, education and accreditation of the personnel.Амбулаторное общее обезболивание - самостоятельное направление современной анестезиологии. По сравнению с рядом зарубежных стран, в которых число оперативных вмешательств, выполняемых в амбулаторных условиях достигает 70% , уровень амбулаторной хирургической помощи в России не велик. В нашей стране нет единых протоколов проведения анестезии в амбулаторной хирургии. Вопрос выбора оптимального метода обезболивания, имеющий решающее значение для амбулаторной хирургии, остается открытым, как и вопросы, касающиеся отбора, объема предоперационного обследования пациентов, образования и аккредитации персонала

Criteria of safety of anaesthesia by Sevofluran at patients of a surgical hospital of short-term stay

Maintenance adequate anaesthetic protection of an organism of the patient against operational stress? One of problems of out-patient anesthesiology. The purpose of our work - to prove efficiency and safety of anaesthesia by Sevofluran at patients of a surgical hospital of short-term stay. The group of the patients operated in a planned order concerning hernias of a forward belly wall and варикозной of illness of the bottom finitenesses under anaesthesia by Sevofluran in which cortisol level test, indicators of haemodynamics, gas structure of blood, and also restoration of the basic functions of an organism in the nearest postoperative period on the modified scale of Aldrete is conducted is surveyed. The analysis of the received data testifies that initial cortisol level and level kortysol by the operation end authentically did not differ and were in norm limits. Anaesthesia application from Sevofluran provides adequate and safe level of anaesthesia. Absence of change of cortisol level, short terms of restoration of consciousness and activity do this kind of anaesthesia preferable to a surgical hospital of short-term stay.Обеспечение адекватной анестезиологической защиты организма пациента от операционного стресса - одна из задач амбулаторной анестезиологии. Цель нашей работы - обосновать эффективность и безопасность анестезии севофлюраном у пациентов хирургического стационара краткосрочного пребывания. Обследована группа пациентов, прооперированных в плановом порядке по поводу грыж передней брюшной стенки и варикозной болезни нижних конечностей под анестезией севофлюраном, в которой проведено исследование уровня кортизола, показателей гемодинамики, газового состава крови, а также восстановление основных функций организма в ближайшем послеоперационном периоде по модифицированной шкале Алдрете. Анализ полученных данных свидетельствует, что исходный уровень кортизола и уровень кортизола к концу операции достоверно не отличались и находились в пределах нормы. Применение анестезии севофлюраном обеспечивает адекватный и безопасный уровень анестезии. Отсутствие изменения уровня кортизола, короткие сроки восстановления сознания и активности делают этот вид анестезии предпочтительным для хирургического стационара краткосрочного пребывания

Local cellular immune response in chronic periodontitis

Microflora of the oral cavity forms a biofilm that induces response of immune system at the mucous membranes. Transition to periodontal lesion is provided by certain classes of resident mucosal immune cells and inflammatory/immune cells migrating to the periodont. In periodontal diseases, Th1, Th2, Th17, Treg are detected. T regulatory cells (Tregs) are proven to comprise the main anti-inflammatory cell population. Th17 cells and Treg cells play an important role in osteoclast differentiation. IL-17 secreted by Th17 cells affects osteoclastogenesis and may induce macrophages to enhance the local inflammatory response. In this regard, the aim of our work was to identify the local immune cells in oral cavity which are associated with severity of chronic generalized periodontitis. The oral cavity cells from 58 persons aged 38-65 years of both sexes in their mature age with a diagnosis of «chronic periodontitis» were examined by means of flow cytofluorometry. When determining levels of CD64+CD16+CD14- neutrophils in the patients with periodontitis of different severity, a statistically significant increase of this cell population was revealed upon development of this disease. In mild cases of periodontitis, a significant increase of relative CD64+CD16+CD14-  neutrophil contents was revealed (Me = 36.16%, p < 0.05) compared to the control group (Me = 7.7%, Q0.25 = 2.4%, Q0.75 = 12%). When assessing relative numbers of CD14+ monocytes in periodontitis of various severity, we revealed a significant increase in the number of these cells in severe cases. When studying levels of regulatory T lymphocytes (CD4+CD25+CD127low) in periodontitis of different severity, we revealed significantly decreased amounts of this cell population during development of the disease. In mild cases of periodontitis, a decreased level of CD4+CD25+CD127low cells (p < 0.05, Me = 1356 cells/ml) was revealed, as compared with control group (Me = 10666 cells/ml). Although the concentration of CD4+CD25+CD127low (Me = 4709 cells/ml) in the patients with moderate periodontitis was higher than the values in milder cases, the range of the main values was comparable and lower, than in control group. In severe periodontitis, a significantly decreased concentration of regulatory T lymphocytes was revealed (Me = 2637 cells/ml). These results confirm the anti-inflammatory regulatory function of Tregs. Understanding the osteo-immune mechanisms of bone remodeling control will help to understand the pathophysiology of accelerated bone loss observed in severe chronic periodontitis

Restorative treatment decisions for carious lesions: Do Russian dentists and dental students apply minimal intervention dentistry?

Background - The concept of minimal intervention dentistry (MID) includes both delayed restorative treatment and conservative caries removal, and is now recognised as an evidence-based approach for dental caries management. In order to determine if dental professionals in Russia are incorporating this concept into their clinical practice, we investigated the restorative treatment decisions of Russian dentists and dental students, and the factors associated with these decisions. Methods - We included 171 general dental practitioners and dental therapists (collectively referred to here as “dentists”) from North-West Russia, and 76 dental undergraduate students from the Northern State Medical University in Arkhangelsk (response rate of 11.5% and 67.9%, respectively). Participants completed a questionnaire, which collected background information (sex, region of work, place of dental school graduation, practice type, years of working experience, working in an urban or rural area, and specialisation in restorative dentistry) and information on restorative treatment decisions for proximal and occlusal carious lesions of permanent teeth. Treatment options in accordance with MID were defined as intervention at dentin level and minimally invasive cavity preparation. Multinomial logistic regression was used for statistical analysis. Results - For the proximal carious lesion, 9.4% of participants said they would employ both MID treatment options; 60.7% said they would choose only one; and 29.9% said they would use neither option. For the occlusal carious lesion, the corresponding figures were 37.2%, 52.1%, and 10.7%. No differences in restorative treatment options were observed among general dental practitioners, dental therapists, and dental students. For the proximal carious lesion, dentists from regions outside Arkhangelsk had 4.15 (95% confidence interval [CI] 1.13–15.27) times higher odds of following one versus both MID treatment options. For the occlusal carious lesion, working experience above 15 years was associated with higher odds of using only one versus both MID treatment options (adjusted odds ratio = 3.04, 95% CI 1.33–6.91). Almost all respondents preferred tooth-coloured materials for restorations; more than 75% chose resin-based composite. Conclusions - The majority of Russian dentists and dental students do not apply the MID concept when treating dental caries in permanent teeth. Clinical protocols on dental caries treatment and dental school curriculums should be updated to place an enhanced focus on evidence-based practice and preventive strategies. Further studies with larger samples of Russian dentists and dental students and alternative methods of recruitment are needed to validate our results

Central haemodynamics parameters for cesarean section of pregnant patients with hypertension

The comparative analysis of the influence of various methods of anaesthesiological assistance on some parameters of mother’s haemodynamics for patients with hypertension has been performed.The parameters of central haemodynamics by noninvasive bioimpedance technology have been assessed in 40 patients. They were divide into two groups: 20 - group with sevofluran anaesthesia, 20 - group with spinal anaesthesia. Our results indicate that spinal anaesthesia gives more favourable changes of haemodynamics parameters versus sevoflurane anaesthesia. There were significant difference in Apgar scores at 1 min and no differences at 5 min in general and spinal groups.В статье проведен сравнительный анализ параметров центральной гемодинамики пациенток с хронической артериальной гипертензией при абдоминальном родоразрешении в условиях общей и спинальной анестезии. Было обследовано 40 пациенток (20 - родоразрешенных под общей анестезией севофлураном, 20 - в условиях спинальной анестезии) с помощью неинвазивной биоимпедансной технологии. Результаты исследований свидетельствуют о более благоприятных изменениях гемодинамики матери на фоне спинальной анестезии. Основные параметры центральной гемодинамики при обезболивании СА были стабильны на всех этапах операции и в послеоперационном периоде. При ОА севофлураном основные гемодинамические сдвиги наблюдались на пренатальном этапе, однако они были скомпенсированными, не влияющими существенно на системную гемодинамику рожениц. Применение общей анестезии севофлураном сопровождалось более низкой оценкой по шкале Апгар на 1 минуте, на 5 минуте различий в оценке по Апгар не выявлено

Peculiarities of slow wave processes of haemodynamics in patients with hypertension

In the article the comparative analysis of parametres of central haemodynamics and features of autoregulation of haemodynamics in patients with uncomplicated pregnancy and pregnancy with hypertension is carried out. Complex investigation of central haemodynamics in 50 patients in the third trimester of pregnancy (20— with physiologically proceeding pregnancy, 15 — with chronic arterial hypertensia, 15 patients with the pregnancy complicated by preeclampsia) by means of noninvasive bioimpedance technology with calculation of oscillatory activity and the spectral analysis of nine parametres of haemodynamics was carried. Authentic differences of parameters of central haemodynamics and the data of the spectral analysis between healthy pregnant women and pregnant women with hypertensive the disorders were received, the most expressed deviations are noted in preeclampsia. Considering compromised haemodynamics regulation in patients with preeclampsia the differentiated approach to therapy and choice of anesthesiological protection is required at operative delivery in this group of pregnant women.В статье проведен сравнительный анализ параметров центральной гемодинамики и особенностей ауторегуляции гемодинамики у пациенток с неосложненной беременностью и при беременности на фоне гипертензивных расстройств. Проведено комплексное обследование центральной гемодинамики у 50 пациенток в третьем триместре беременности (20 — с физиологически протекающей беременностью, 15 — с хронической артериальной гипертензией, 15 пациенток с беременностью, осложнившейся гестозом) с помощью неинвазивной биоимпедансной технологии с расчетом колебательной активности и спектральным анализом девяти параметров гемодинамики. Получены достоверные отличия показателей центральной гемодинамики и данных спектрального анализа у здоровых беременных и у беременных с гипертензивными расстройствами, наиболее выраженные отклонения отмечены при гестозе. Учитывая дизрегуляцию гемодинамики у пациенток с гестозом, требуется дифференцированный подход к выбору терапии и метода анестезиологической защиты при оперативном родоразрешении этой группы беременных

Autoregulation of haemodynamic parameters during spinal anaesthesia for caesarean section

The parameters of mother’s haemodynamics were investigated in pregnant women during spinal anaesthesia. The parameters of autoregulation of the central haemodynamics by noninvasive bioimpedance technology have been assessed in 25 patients undergoing elective caesarean section. Our results indicate that spinal anaesthesia gives favourable changes of haemodynamics parameters. The main parameters of central haemodynamics during spinal anesthesia were stable at all stages of the operation and postoperative periods, that was provided by effective tension of autoregulation.В статье проведен анализ параметров центральной гемодинамики и ауторегуляции при оперативном родоразрешении пациенток с неосложненной беременностью в условиях спинальной анестезии. Было обследовано 25 пациенток с помощью неинвазивной биоимпедансной технологии. Результаты исследований свидетельствуют о благоприятных изменениях гемодинамики матери на фоне спинальной анестезии. Основные параметры центральной гемодинамики при обезболивании СА были стабильны на всех этапах операции и в послеоперационном периоде, что обеспечивалось эффективным напряжением механизмов ауторегуляции

Assessment of the predictive value of the NTISS scale for neonatal outcomes

The aim of the work is to determine the predictive value of the NTISS scale at the stage of pre-transport preparation in relation to the treatment outcomes of newbornsЦелью работы является определение предиктивной ценности шкалы NTISS на предтранспортном этапе в отношении исходов госпитального этапа лечения новорожденны

The effect of multimodal anesthesia on the cardiovascular system of patients who underwent uterine amputation

The article considers a study conducted to assess the effect of multimodal anesthesia on the cardiovascular system, which included 26 patients who underwent planned surgery in the amount of uterine amputation. The intensity of the pain syndrome was evaluated on a visually analog scale and the data of daily ECG monitoring, during epidural and long-term local anesthesia. It is shown that the performed anesthesia allows to achieve adequate postoperative analgesia in patients with gynecological profile and does not have negative effects on the cardiovascular system.В статье рассмотрено исследование, проведенное с целью оценки влияния мультимодальной анестезии на сердечно-сосудистую систему, включившее 26 пациенток, прооперированных в плановом порядке в объёме ампутация матки. Оценивалась интенсивность болевого синдрома по визуально аналоговой шкале и данные суточного мониторирования ЭКГ, при эпидуральной и длительной локальной анестезии. Представлено, что проводимая анестезия позволяют достичь адекватного послеоперационного обезболивания у пациенток гинекологического профиля и не оказывает негативных эффектов на сердечно сосудистую систему