Reduction of neonatal mortality: a current challenge in global and national health agenda

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

An Investigation of the Components of Platonic and Romantic Heterosexual Relationships

During the past twenty years, heterosexual relationships have been studied extensively by researchers in the field of interpersonal attraction without the attainment of consistent results (Wright, 1968). Wright (1968) stated that there were two methodological problems with this past research which are the treatment of variables used to explain attraction as both the independent and dependent variables in the same study and the use of dyadic indices. Also, Wright (1969) noted that past research has generally not examined heterosexual relationships separately for each sex. Finally, Guinsburg (1970a) found that most research dealing with heterosexual relationships has only examined the romantic relationship. However, over 1400 undergraduates at one university had platonic heterosexual relationships (Guinsburg, 1970a, b, c). The present study was concerned with the specification and operationalization of variables connected with the platonic and romantic heterosexual relationship for each sex. This would allow for the determination of variables important to the different forms of platonic and romantic relationships (close to distant relationships). An attempt was made to avoid the mistakes made in previous research. The following methodology was used: (1) Each subject was asked to describe a particular type of heterosexual relationship ranging from close platonic and close romantic to distant platonic and distant romantic relationships. Eight different types of heterosexual relationships were used and it was arranged so that there would be an equal number of subjects for each sex describing each type of heterosexual relationship. (2) A Validation Index Questionnaire was created and used to gain outside validation criteria about each of the relationships being described. . (3) Wright\u27s (1971) Acquaintance Description Form was used to allow subjects to describe further their heterosexual relationship in terms of items found to be relevant characteristics of same sex friends. (4) Subjects filled out the Opposite Sex Friendship Questionnaire Form Mor F so as to allow for the scaling of items dealing with platonic heterosexual relationships by a population describing eight types of heterosexual relationships. The results indicated that there was a continuous distribution of responses to all except one of the items from the three questionnaires. Then, for each sex, subjects were divided into two groups. The first group consisted of subjects who were describing a platonic or semi-platonic relationship and the second group consisted of subjects describing romantic and semi-romantic relationships~\u27 A-factor analysis was run separately for each sex on each of the two groups of subject descriptions dealing with either romantic or platonic relationships. The factors were interpreted for both the platonic and the romantic groups, and comparisons were made between the factors of the romantic and platonic group for males ·and females. Also, comparisons were made between males and females concerning the platonic and the romantic groups. From this study the following conclusions may be.drawn about heterosexual relationships. 1. Males and females describe the platonic relationship as differing from the romantic relationship because the platonic relationship lacks the emotional closeness and comfort of the romantic relationship. 2. Females saw.the platonic relationship as important for communication about personal problems, while males saw it as important for casual dating activities. 3. Only females saw the romantic relationship as more important to them than the platonic relationship. 4. The male.focuses on the various qualities and characteristics of .the romantic girl friend while the female stresses her emotional involvement in the relationship and its .importance to her. 5. Females generally express more emotional and intellectual involvement in the romantic relationship than males

Information Design and Sensitivity to Market Fundamentals

I study the problem of firms that disclose verifiable information to each other publicly, in the form of Blackwell Experiments, before engaging in strategic decisions. The signals designed can be either interpreted as statistical reports or as slices of physical quantities, i.e. market segments. Before the state of the world is realized, firms choose a signal policy, an estimation technique, about a private individual payoff state and then are forced to publicize the results of the investigations to all other firms before engaging in price or quantity competition. Because signals are made public, when a firm tries to assess the firm's individual payoff, it also ends up revealing the same information to her opponents. Full Disclosure enables companies to adapt to local market fundamentals at the expense of releasing crucial information to the competitors. On the other hand, Partial Revelation makes companies loose optimality of the decisions with regards to the true state of the world but enable them to commit to an aggressive policy of preclusion that increases the frequency of a favorable distribution of players actions. Whereas Partial Revelation acts as a commitment device and preclude entry in otherwise competitive markets, inducing insensitivity of the decisions with respect to local fundamentals, decentralized decision making is a dominant strategy when the profile of competitors is constant across markets or when a company cannot influence the extensive margin entry decision of the competitor with more or less disclosure of information. Since decentralization acts as a way to correlate decisions with local market fundamentals, and running one single policy in multiple states of the world acts as a commitment device to avoid competitors, I describe a trade off between commitment over a distribution of actions versus correlation with states of the world

Advances in the management of the extreme preterm infant

Universidade Federal do Rio Grande do SulHospital de Clínicas de Porto Alegre Serviço de NeonatologiaJornal de PediatriaUniversidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

Why is it important to assess indications for red blood cell transfusion in premature infants?

Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL

Differences between uni-and multidimensional scales for assessing pain in term newborn infants at the bedside

OBJECTIVES: This study sought to determine the level of agreement between behavioral and multidimensional pain assessment scales in term newborn infants submitted to an acute nociceptive stimulus. METHODS: This cross-sectional study was performed on 400 healthy term newborns who received an intramuscular injection of vitamin K during the first 6 hours of life. Two behavioral pain scales (the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain) and one multidimensional tool (the Premature Infant Pain Profile) were applied by a single observer before the procedure, during cleansing, during injection and two minutes after injection. The Cochran Q, McNemar and kappa tests were used to compare the presence and degree of agreement between the three scales. The Hotelling T2 test was used to compare the groups of newborns for which the scales showed agreement or disagreement. A generalized linear regression was used to compare the results of the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain across the four study time points. RESULTS: The neonates studied had a gestational age of 39±1 weeks, a birth weight of 3169±316 g and and postnatal age of 67±45 minutes. During the stimulus procedure, 80% of the newborns exhibited pain behaviors according to the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain, and 70% experienced pain according to the Premature Infant Pain Profile (

Differences between uni-and multidimensional scales for assessing pain in term newborn infants at the bedside

OBJECTIVES: This study sought to determine the level of agreement between behavioral and multidimensional pain assessment scales in term newborn infants submitted to an acute nociceptive stimulus. METHODS: This cross-sectional study was performed on 400 healthy term newborns who received an intramuscular injection of vitamin K during the first 6 hours of life. Two behavioral pain scales (the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain) and one multidimensional tool (the Premature Infant Pain Profile) were applied by a single observer before the procedure, during cleansing, during injection and two minutes after injection. The Cochran Q, McNemar and kappa tests were used to compare the presence and degree of agreement between the three scales. The Hotelling T2 test was used to compare the groups of newborns for which the scales showed agreement or disagreement. A generalized linear regression was used to compare the results of the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain across the four study time points. RESULTS: The neonates studied had a gestational age of 39±1 weeks, a birth weight of 3169±316 g and and postnatal age of 67±45 minutes. During the stimulus procedure, 80% of the newborns exhibited pain behaviors according to the Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain, and 70% experienced pain according to the Premature Infant Pain Profile (p<0.001). The frequencies of the detection of pain using the Behavioral Indicators of Infant Pain and the Neonatal Facial Coding System were similar. The characteristics of the neonates were not associated with the level of agreement between the scales. CONCLUSION: The Neonatal Facial Coding System and the Behavioral Indicators of Infant Pain behavioral scales are more sensitive for the identification of pain in healthy term newborn infants than the multidimensional Premature Infant Pain Profile scale.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade Federal de São Paulo (UNIFESP), Escola Paulista de Medicina (EPM) Division of Neonatal MedicineUNIFESP, EPM, Division of Neonatal Medicine2009-06145-5 e 2012/50511-9SciEL

Early nasal injury resulting from the use of nasal prongs in preterm infants with very low birth weight: a pilot study

OBJECTIVE:To analyze the incidence of early-onset nasal injury in infants with very low birth weight and indication for noninvasive ventilation via nasal prongs.METHODS:A prospective case series of infants with gestational age <37 weeks, weight <1.500 g and postnatal age <29 days. The patients were evaluated three times daily from the installation of nasal prongs to the 3rd day of use. The patients' clinical conditions and the device's characteristics and its application were analyzed. The initial analysis was descriptive, indicating the prevalence of nasal injury and factors associated with it. Categorical data were analyzed using the chi-squared test or Fisher's exact test, and numerical data were analyzed using the t-test or the Mann-Whitney test.RESULTS:Eighteen infants were included; 12 (with a gestational age of 29.8±3.1 weeks, birth weight of 1.070±194 g and a Score for Neonatal Acute Physiology - Perinatal Extension (SNAPPE) of 15.4±17.5) developed nasal injuries (injury group), and 6 (with a gestational age of 28.0±1.9 weeks, weight of 1.003±317 g and SNAPPE of 26.2±7.5) showed no nasal injury (uninjured group). The injury group subjects were more often male (75% versus 17%), and their injuries appeared after an average of 18 hours, predominantly during the night (75%).CONCLUSION:The incidence of nasal injury in preterm infants who experienced noninvasive ventilation via nasal prongs was high, and a study of associated factors may be planned based on this pilot.OBJETIVO:Analisar, em recém-nascidos de muito baixo peso e com indicação de ventilação não invasiva via pronga nasal, a incidência do aparecimento precoce de lesão nasal.MÉTODOS:Série de casos prospectiva de nascidos com idade gestacional <37 semanas, peso <1.500g e idade pós-natal <29 dias. Os pacientes foram avaliados desde a instalação da pronga nasal até o 3o dia de uso, três vezes ao dia. Foram analisadas as condições clínicas dos pacientes, características do dispositivo e de sua aplicação. A análise inicial foi descritiva, verificando-se a prevalência de lesão nasal bem como os fatores a ela associados. Os dados categóricos foram analisados por qui-quadrado ou exato de Fisher e os dados numéricos, por teste t ou Mann-Whitney.RESULTADOS:Dezoito recém-nascidos foram incluídos, dos quais 12 (idade gestacional de 29,8±3,1 semanas, peso ao nascer de 1.070±194g e Score for Neonatal Acute Phisiology - Perinatal Extension (SNAPPE) de 15,4±17,5) evoluíram com lesão nasal (Grupo Lesão) e 6 (idade gestacional de 28,0±1,9 semanas, peso de 1.003±317g e SNAPPE de 26,2±7,5) não apresentaram lesão nasal (Grupo Sem Lesão). No Grupo Lesão, houve maior frequência do gênero masculino (75% versus 17%), a lesão apareceu em média após 18 horas e predominantemente no período notur no (75%).CONCLUSÃO:A incidência de lesão nasal em prematuros submetidos à ventilação não invasiva via pronga nasal foi elevada, sendo possível planejar estudo dos fatores associados, com base neste piloto.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de Medicina Departamento de PediatriaUNIFESP, EPM, Depto. de PediatriaSciEL

Giant congenital cervical teratoma: case report and review about therapeutic options

OBJECTIVE: To report a case of congenital cervical teratoma, highlighting the severity and the therapeutic difficulties associated. CASE DESCRIPTION: A 30-year old mother, with pregnancy by assisted fertilization. At 23 weeks, a cervical fetal malformation was diagnosed. A cesarean section was indicated with 31 weeks due to fetal distress. A male newborn infant with birth weight of 1800g and Apgar score of 4/9 presented a large right cervical tumor, with extensions to the mandible and to the upper chest. Patient presented congestive heart failure due to flow steal by the tumor 40 hours after birth, which caused progressive respiratory, hemodynamic and renal deterioration refractory to vasopressors, volume replacement and increased ventilatory support. Tumor resection was indicated, but the clinical instability of the patient did not allow his transport to the operating room and the infant died 70 hours after birth. COMMENTS: The case is representative of the difficulties related to postnatal treatment of bulky cervical teratomas. Despite prenatal diagnosis, the patient developed airway obstruction, complicated by refractory cardiogenic shock. The surgical approach during delivery is crucial for survival. Nowadays, management includes surgical removal of the tumor while maintaining the maternal-fetal circulation, allowing continuous fetal oxygenation. The clinical course described in the case is consistent with the literature that reports poor prognosis when the intra-partum surgical approach is not performed.OBJETIVO: Relatar um caso de teratoma cervical congênito, destacando a gravidade e as dificuldades terapêuticas associadas. DESCRIÇÃO DO CASO: Mãe de 30 anos, com gestação por fertilização assistida. Com 23 semanas, diagnosticada malformação cervical fetal à direita. Parto cesáreo por indicação fetal com 31 semanas. Recém-nascido masculino, peso ao nascer de 1800g, Apgar 4 e 9, com volumoso processo expansivo à direita, ocupando toda a região cervical, comprometendo a mandíbula e estendendo-se para o terço superior do tórax. Com 40 horas de vida, apresentou insuficiência cardíaca congestiva de alto débito por roubo de fluxo pelo tumor. A partir de 54 horas de vida, houve progressiva deterioração hemodinâmica e respiratória, com hipotensão, anúria e labilidade de oxigenação, refratárias às aminas vasoativas, reposição de volume e aumento do suporte ventilatório. Indicada abordagem cirúrgica para ressecção tumoral, todavia o paciente não apresentou estabilidade clínica que permitisse seu transporte ao centro cirúrgico e faleceu com 70 horas de vida. COMENTÁRIOS: O caso demonstra as dificuldades relacionadas à abordagem pós-natal dos teratomas cervicais volumosos. Apesar do diagnóstico pré-natal, o paciente evoluiu com obstrução de vias aéreas, complicada por um choque cardiogênico refratário, que culminou no óbito. A abordagem intraparto é fundamental nesses pacientes, consistindo em exérese tumoral, enquanto a manutenção da circulação materno-fetal permite a oxigenação fetal contínua. A evolução neonatal no caso descrito é condizente com a literatura que mostra prognóstico reservado quando não é realizada a abordagem cirúrgica intraparto.Universidade Federal de São Paulo (UNIFESP) Escola Paulista de MedicinaUNIFESP, EPMSciEL