Motor and Postural Patterns Concomitant with General Movements Are Associated with Cerebral Palsy at Term and Fidgety Age in Preterm Infants

General movements (GMs) in combination with neurological examination and magnetic resonance imaging at term age can accurately determine the risk of cerebral palsy. The present study aimed to assess whether 11 motor and postural patterns concomitant with GMs were associated with cerebral palsy. Video recordings performed after birth in 79 preterm infants were reviewed retrospectively. Thirty-seven infants developed cerebral palsy at 2 years corrected age and the remaining 42 showed typical development. GMs were assessed from preterm to fidgety age and GM trajectories were defined. The 11 motor and postural patterns were evaluated at each age and longitudinally, alone and in combination with GM trajectories. A logistic regression model was used to assess the association between GMs, concomitant motor and postural patterns, and cerebral palsy. We confirmed that high-risk GM trajectories were associated with cerebral palsy (odds ratio = 44.40, 95% confidence interval = 11.74-167.85). An association between concomitant motor and postural patterns and cerebral palsy was found for some of the patterns at term age and for all of them at fidgety age. Therefore, at term age, concomitant motor and postural patterns can support GMs for the early diagnosis of cerebral palsy

Serratia marcescens in a neonatal intensive care unit: two long-term multiclone outbreaks in a 10-year observational study

We investigated two consecutive Serratia marcescens (S. marcescens) outbreaks which occurred in a neonatal intensive care unit (NICU) of a tertiary level hospital in North Italy in a period of 10 years (January 2003-December 2012). Risk factors associated with S. marcescens acquisition were evaluated by a retrospective case-control study. A total of 21,011 clinical samples was examined: S. marcescens occurred in 127 neonates: 43 developed infection and 3 died. Seven clusters were recorded due to 12 unrelated clones which persisted for years in the ward, although no environmental source was found. The main epidemic clone A sustaining the first cluster in 2003 reappeared in 2010 as an extended spectrum ?-lactamase (ESBL)-producing strain and supporting the second epidemic. Birth weight, gestational age, use of invasive devices and length of stay in the ward were significantly related to S. marcescens acquisition. The opening of a new ward for non-intensive care-requiring neonates, strict adherence to alcoholic hand disinfection, the timely identification and isolation of infected and colonized neonates assisted in containing the epidemics. Genotyping was effective in tracing the evolution and dynamics of the clones demonstrating their long-term persistence in the ward

Neurodevelopmental Outcome and Neuroimaging of Very Low Birth Weight Infants from an Italian NICU Adopting the Family-Centered Care Model

Background: Improvements in perinatal care have substantially decreased mortality rates among preterm infants, yet their neurodevelopmental outcomes and quality of life persist as a pertinent public health concern. Family-centered care has emerged as a holistic philosophy that promotes effective alliances among patients, families, and healthcare providers to improve the quality of care. Aims: This longitudinal prospective study aims to evaluate the neurodevelopmental outcomes and brain MRI findings in a cohort of preterm newborns admitted to a neonatal intensive care unit (NICU) adopting a family-centered care model. Methods: Very low birth weight (VLBW) infants admitted to the NICU of Modena between 2015 and 2020 were enrolled. Infants who underwent conventional brain magnetic resonance imaging (MRI) at term-equivalent age were included. Neurodevelopmental follow-up was performed until the age of 24 months by a multidisciplinary team using the Amiel-Tison neurological assessment and the Griffiths Mental Developmental Scales (GMDS-R). Neurodevelopmental outcomes were classified as major sequelae (cerebral palsy, DQ ≤ 70, severe sensory impairment), minor sequelae (minor neurological signs such as clumsiness or DQ between 71 and 85), and normal outcomes (no neurological signs and DQ > 85). Risk factors for severe outcomes were assessed. Results: In total, 49 of the 356 infants (13.8%) died before hospital discharge, and 2 were excluded because of congenital disorders. Of the remaining 305 infants, 222 (72.8%) completed the 24 month follow-up and were included in the study. Neurodevelopmental outcomes were classified as normal (n = 173, 77.9%), minor (n = 34, 15.3%), and major sequelae (n = 15, 6.8%). Among 221 infants undergoing brain MRI, 76 (34.4%) had major lesions (intraventricular hemorrhage, hemorrhagic parenchymal infarction, periventricular leukomalacia, and large cerebellar hemorrhage). In the multivariate regression model, the retinopathy of prematurity (OR 1.8; p value 0.016) and periventricular–intraventricular hemorrhage (OR 5.6; p value < 0.004) were associated with major sequelae. Conclusions: We reported low rates of severe neurodevelopmental outcomes in VLBW infants born in an Italian NICU with FCC. Identifying the risk factors for severe outcomes can assist in tailoring and optimizing early interventions on an individual basis, both within the NICU and after discharge

Clinical features and outcomes of elderly hospitalised patients with chronic obstructive pulmonary disease, heart failure or both

Background and objective: Chronic obstructive pulmonary disease (COPD) and heart failure (HF) mutually increase the risk of being present in the same patient, especially if older. Whether or not this coexistence may be associated with a worse prognosis is debated. Therefore, employing data derived from the REPOSI register, we evaluated the clinical features and outcomes in a population of elderly patients admitted to internal medicine wards and having COPD, HF or COPD + HF. Methods: We measured socio-demographic and anthropometric characteristics, severity and prevalence of comorbidities, clinical and laboratory features during hospitalization, mood disorders, functional independence, drug prescriptions and discharge destination. The primary study outcome was the risk of death. Results: We considered 2,343 elderly hospitalized patients (median age 81 years), of whom 1,154 (49%) had COPD, 813 (35%) HF, and 376 (16%) COPD + HF. Patients with COPD + HF had different characteristics than those with COPD or HF, such as a higher prevalence of previous hospitalizations, comorbidities (especially chronic kidney disease), higher respiratory rate at admission and number of prescribed drugs. Patients with COPD + HF (hazard ratio HR 1.74, 95% confidence intervals CI 1.16-2.61) and patients with dementia (HR 1.75, 95% CI 1.06-2.90) had a higher risk of death at one year. The Kaplan-Meier curves showed a higher mortality risk in the group of patients with COPD + HF for all causes (p = 0.010), respiratory causes (p = 0.006), cardiovascular causes (p = 0.046) and respiratory plus cardiovascular causes (p = 0.009). Conclusion: In this real-life cohort of hospitalized elderly patients, the coexistence of COPD and HF significantly worsened prognosis at one year. This finding may help to better define the care needs of this population

Deaf Educators in Brazil: history, training and performance spaces

Esta pesquisa intitulada Educadores Surdos no Brasil: história, formação e espaços de atuação, aborda o percurso de formação de professores e instrutores Surdos ao longo da história e no Brasil e as possibilidades de atuação na contemporaneidade. Assim sendo, o objetivo geral desta pesquisa é conhecer o processo de formação e atuação de profissionais surdos em vários espaços educacionais no Brasil. Desta forma, os objetivos específicos, são: 1) Analisar as funções dos primeiros educadores surdos mencionados na história; 2) Traçar a cronologia dos primeiros professores surdos no Brasil, a partir do século XIX e 3) Apresentar as possibilidades e campos de atuação de educadores surdos na atualidade. Em relação aos procedimentos metodológicos, a pesquisa em tela é de abordagem qualitativa e exploratória. Com o intuito de identificar produções que dialogassem com o tema proposto foi realizado um levantamento bibliográfico utilizando duas bases de dados: o Banco de Teses e Dissertações da Biblioteca Eletrônica Online (Scielo) e da Biblioteca Digital Brasileia de Teses e Dissertações (BDTD), de 2015 a 2019, totalizando cinco anos de produções cientificas publicadas. As buscas foram realizadas a partir de quatro palavras-chave: repetidor surdo, instrutor surdo, formação de professores surdos e professor surdo. Foi realizada a leitura de 586 títulos e resumos de trabalhos publicados nas duas bases de dados consultadas. Esta dissertação está organizada em três capítulos: o Capítulo 1, intitulado A atuação dos repetidores surdos nos Séculos XIX e XX, foi baseado em Rocha (2007, 2009, 2010, 2018) e Sofiato (2011, 2016, 2018), pois tais autoras abordam a atuação dos repetidores surdos, no reinado de D. Pedro II. Além disso, foram abordadas várias gestões do Instituto Nacional de Educação de Surdos em diferentes períodos, bem como, a atuação dos repetidores surdos e regimentos internos. O Capítulo 2, intitulado Formação de Professores de Surdos no Brasil apresenta o contexto da formação de professores no Brasil, envolvendo ações para o público ouvinte e surdo, de acordo com uma cronologia que tem início no século XIX. O Capítulo 3, intitulado A Formação de Professores Surdos no Brasil trata da formação de professores surdos e atuação do professor surdo em diferentes espaços educacionais no Brasil. Como resultado, foram tecidas algumas considerações no que nos convidam a refletir a respeito dos avanços e desafios presentes na formação de profissionais surdos para o campo da educação. Ademais, destaca as funções desempenhadas por tais profissionais atribuições de acordo com o espaço de atuação de/em Libras, como norteadores para o protagonismo de professores surdos, inclusive reforçando a importância da Libras na formação de professores.This research entitled Deaf Educators in Brazil: history, training and performance spaces, addresses the path of training of Deaf teachers and instructors throughout history and in Brazil and the possibilities of performance in contemporary times. Thus, the general objective of this research is to know the process of training and performance of deaf professionals in various educational spaces in Brazil. Thus, the specific objectives are: 1) Analyze the functions of the first deaf educators mentioned in history, 2) Trace the chronology of the first deaf teachers in Brazil, from the nineteenth century and 3) Present the possibilities and fields of action of deaf educators today. Regarding the methodological procedures, the research in question is qualitative and exploratory. In order to identify productions that dialogued with the proposed theme, a bibliographic survey was conducted using two databases: the Electronic Library Online Theses and Dissertations Database (Scielo) and the Brazilian Digital Library of Theses and Dissertations (BDTD), from 2015 to 2019, totaling five years of published scientific productions. The searches were performed from four keywords: deaf repeater, deaf instructor, deaf teacher training and deaf teacher. It was performed the reading of 586 titles and abstracts of published works in the two databases consulted. This dissertation is organized into three chapters: Chapter 1, entitled The performance of deaf repeaters in the 19th and 20th Centuries, was based on Rocha (2007, 2009, 2010, 2018) and Sofiato (2011, 2016, 2018), as these authors address the performance of deaf repeaters, in the reign of D. Pedro II. In addition, several managements of the National Institute for the Education of the Deaf in different periods were addressed, as well as, the performance of deaf repeaters and internal regiments. Chapter 2, entitled Training of Teachers of the Deaf in Brazil presents the context of teacher training in Brazil, involving actions for the hearing and deaf public, according to a chronology that begins in the nineteenth century. Chapter 3, entitled Deaf Teacher Training in Brazil deals with the training of deaf teachers and performance of the deaf teacher in different educational spaces in Brazil. As a result, some considerations were made in what invites us to reflect on the advances and challenges present in the training of deaf professionals for the field of education. Moreover, it highlights the functions performed by such professionals assignments according to the space of performance of / in Libras, as guidelines for the protagonism of deaf teachers, including reinforcing the importance of Libras in teacher training

Changes of intestinal microbiota in early life

There is increasing evidence that the intestinal microbiota plays a pivotal role in the maturation of the immune system and in the prevention of diseases occurring during the neonatal period, childhood and adulthood. A number of nonphysiological conditions during the perinatal period (ie caesarean section, prolonged hospitalization, formula feeding, low gestational age) may negatively affect the normal development of the microbiota, leading to decreased amounts of lactobacilli and bifidobacteria and increased amounts of Clostridia . In addition, perinatal antibiotics can cause intestinal dysbiosis that has been associated with short- and long-term diseases. For example, prolonged early empiric antibiotics increase the risk of necrotizing enterocolitis and late-onset sepsis in preterm neonates, whereas the administration of intrapartum antibiotic prophylaxis has been associated with inflammatory bowel diseases, obesity and atopic conditions, such as eczema and wheezing. Promoting breastfeeding, reducing the length of hospital stay, and reducing unnecessary antibiotic therapies are useful strategies to counterbalance unintended effects of these conditions

Oxidative stress in renal patients

non disponibil

From environmental proxy to archaeological evidence: A multi-disciplinary approach to landscape and settlement history in the Leventina and the Ticino Alpine valleys

While we are used to rely on archaeological features and finds to evidence human settlement and activity, there is a series of environmental proxies from soils, vegetation history, and floral or faunal remains that provide indirect and mostly off-site clues to human presence and impact on the natural environment. Landscape history can thus be built from both archaeological and environmental data; however, the two are not always in good accordance. Taking the site of Airolo-Madrano, the Leventina and Ticino Alpine valleys and their wider setting as an example, a multi-disciplinary research program investigated the evidence for prehistoric settlement and the relationship between human activities and environmental transformations in the years 2004–12. Archaeological information was gathered from archival sources, extensive and intensive survey activities, as well as archaeological excavations; vegetation history relied on pollen, macrofossil and charcoal signals in sediment cores, as well as on archaeobotanical and anthracological analysis of soil samples and settlement strata for subsistence activities. A large series of radiocarbon dates provided a reliable chronological framework, ranging from early postglacial to post-medieval periods, with a priority on the younger prehistoric periods. We focus on the pause and pulse signals obtained from the various environmental proxies and the chronological distribution of the archaeological evidence. There is only partial overlap of the different data, and apparent contradictions between e.g., proxies for agricultural activity and a total lack of archaeological finds, such as in the Neolithic, or the obvious time shift between valley-bottom and subalpine sites in certain phases of the Bronze and Iron ages, leave ample room for the discussion of methodological and source-based problems. GIS-based models provide powerful visualization opportunities in these contexts

Effects of Early Vocal Contact in the Neonatal Intensive Care Unit: Study Protocol for a Multi-Centre, Randomised Clinical Trial

Preterm infants are at risk for developing altered trajectories of cognitive, social, and linguistic competences compared to a term population. This is mainly due to medical and environmental factors, as they are exposed to an atypical auditory environment and simultaneously, long periods of early separation from their parents. The short-term effects of early vocal contact (EVC) on an infant’s early stability have been investigated. However, there is limited evidence of its impact on the infant’s autonomic nervous system maturation, as indexed by heart rate variability, and its long-term impact on infant neurodevelopment. Our multi-centric study aims to investigate the effects of EVC on a preterm infant’s physiology, neurobehaviour, and development. Eighty stable preterm infants, born at 25–32 weeks and 6 days gestational age, without specific abnormalities, will be enrolled and randomised to either an intervention or control group. The intervention group will receive EVC, where mothers will talk and sing to their infants for 10 min three times per week for 2 weeks. Mothers in the control group will be encouraged to spend the same amount of time next to the incubator and observe the infant’s behaviour through a standard cluster of indicators. Infants will be assessed at baseline; the end of the intervention; term equivalent age; and 3, 6, 12, and 24 months corrected age, with a battery of physiological, neurobehavioral, and developmental measures. Early interventions in the neonatal intensive care unit have demonstrated effects on the neurodevelopment of preterm infants, thereby lowering the negative long-term effects of an atypical auditory and interactional environment. Our proposed study will provide new insight into mother–infant early contact as a protective intervention against the sequelae of prematurity during this sensitive period of development. Early intervention, such as EVC, is intuitive and easy to implement in the daily care of preterm infants. However, its long-term effects on infant neurodevelopment and maternal sensitivity and stress are still unclear. Trial Registration: NCT04759573, retrospectively registered, 17 February 2021