Atención en un centro de parto según las recomendaciones de la Organización Mundial de la Salud

Centros de parto constituem modelo que\ud adota tecnologia apropriada na assistência\ud à parturiente. O objetivo foi caracterizar\ud a assistência intraparto em um centro de\ud parto extra-hospitalar quanto às práticas\ud recomendadas pela Organização Mundial\ud da Saúde (OMS). Estudo descritivo sobre\ud 1.079 partos assistidos de 2006 a 2009 na\ud Casa do Parto de Sapopemba, São Paulo,\ud Brasil. Os resultados mostraram ausculta\ud intermitente (média=7 controles); posição\ud materna no expulsivo semissentada\ud (82,3%), lateral (16,0%), outras (1,7%);\ud aceitação da dieta (95,6%); acompanhante\ud (93,3%); até três exames vaginais (85,4%);\ud banho de aspersão (84,0%), deambulação\ud (68,0%), massagem (60,1%), exercícios\ud com bola suíça (51,7%); amniotomia\ud (53,4%); ocitocina na dilatação (31,0%),\ud banho de imersão (29,3%), ocitocina no\ud expulsivo (25,8%) e episiotomia (14,1%).\ud Concluiu-se que os profissionais do centro\ud de parto utilizam práticas recomendadas\ud pela OMS, contudo existem práticas cujo\ud uso pode ser reduzido, tais como amniotomia,\ud administração de ocitocina, episiotomia\ud e posição semissentada no expulsivoBirth centers are maternal care models\ud that use appropriate technology when\ud providing care to birthing women. This\ud descriptive study aimed to characterize intrapartum\ud care in a freestanding birth center,\ud in light of the practices recommended\ud by the World Health Organization (WHO),\ud with 1,079 assisted births from 2006 to\ud 2009 in the Sapopemba Birth Center, São\ud Paulo, Brazil. Results included the use of\ud intermittent auscultation (mean=7 controls);\ud maternal positions during delivery:\ud semi-sitting (82.3%), side-lying (16.0%),\ud other positions (1.7%), oral intake (95.6%);\ud companionship (93.3%); exposure to up\ud to three vaginal examinations (85.4%),\ud shower bathing (84.0%), walking (68.0%),\ud massage (60.1%), exercising with a Swiss\ud ball (51.7%); amniotomy (53.4%), oxytocin\ud use during the first (31.0%) and second\ud stages of labor (25.8%), bath immersion\ud (29.3%) and episiotomy (14.1%). In this\ud birth center, care providers used practices\ud recommended by the WHO, although\ud some practices might have been applied\ud less frequentlyCentros de parto constituyen un modelo\ud que adopta la tecnología apropiada en la\ud atención a la parturienta. El objetivo fue caracterizar\ud la atención intraparto en un centro\ud de parto extra-hospitalario en relación a las\ud prácticas recomendadas por la Organización\ud Mundial de la Salud (OMS). Estudio descriptivo\ud sobre 1.079 partos atendidos del 2006 al\ud 2009 en la Casa de Parto de Sapopemba, São\ud Paulo, Brasil. Los resultados mostraron: auscultación\ud intermitente (media=7 controles);\ud posición materna en el expulsivo - semisentada\ud (82,3%), lateral (16,0%), otras (1,7%);\ud aceptación de dieta (95,6%); acompañante\ud (93,3%); hasta tres exámenes vaginales\ud (85,4%); baño en ducha (84,0%), deambulación\ud (68,0%), masaje (60,1%), ejercicios con\ud pelota suiza (51,7%); amniotomía (53,4%);\ud oxitocina durante la dilatación (31,0%), baño\ud de inmersión (29,3%), oxitocina durante el\ud expulsivo (25,8%) y episiotomía (14,1%). Se\ud concluyó que los profesionales del centro de\ud parto utilizan prácticas recomendadas por\ud la OMS, pero existen algunas prácticas cuyo\ud uso puede reducirse, tales como la amniotomía,\ud administración de oxitocina, episiotomía\ud y posición semisentada en el período\ud expulsivoCNPqPIBIC 115521/2008-

Peri-operative red blood cell transfusion in neonates and infants: NEonate and Children audiT of Anaesthesia pRactice IN Europe: A prospective European multicentre observational study

BACKGROUND: Little is known about current clinical practice concerning peri-operative red blood cell transfusion in neonates and small infants. Guidelines suggest transfusions based on haemoglobin thresholds ranging from 8.5 to 12 g dl-1, distinguishing between children from birth to day 7 (week 1), from day 8 to day 14 (week 2) or from day 15 (≥week 3) onwards. OBJECTIVE: To observe peri-operative red blood cell transfusion practice according to guidelines in relation to patient outcome. DESIGN: A multicentre observational study. SETTING: The NEonate-Children sTudy of Anaesthesia pRactice IN Europe (NECTARINE) trial recruited patients up to 60 weeks' postmenstrual age undergoing anaesthesia for surgical or diagnostic procedures from 165 centres in 31 European countries between March 2016 and January 2017. PATIENTS: The data included 5609 patients undergoing 6542 procedures. Inclusion criteria was a peri-operative red blood cell transfusion. MAIN OUTCOME MEASURES: The primary endpoint was the haemoglobin level triggering a transfusion for neonates in week 1, week 2 and week 3. Secondary endpoints were transfusion volumes, 'delta haemoglobin' (preprocedure - transfusion-triggering) and 30-day and 90-day morbidity and mortality. RESULTS: Peri-operative red blood cell transfusions were recorded during 447 procedures (6.9%). The median haemoglobin levels triggering a transfusion were 9.6 [IQR 8.7 to 10.9] g dl-1 for neonates in week 1, 9.6 [7.7 to 10.4] g dl-1 in week 2 and 8.0 [7.3 to 9.0] g dl-1 in week 3. The median transfusion volume was 17.1 [11.1 to 26.4] ml kg-1 with a median delta haemoglobin of 1.8 [0.0 to 3.6] g dl-1. Thirty-day morbidity was 47.8% with an overall mortality of 11.3%. CONCLUSIONS: Results indicate lower transfusion-triggering haemoglobin thresholds in clinical practice than suggested by current guidelines. The high morbidity and mortality of this NECTARINE sub-cohort calls for investigative action and evidence-based guidelines addressing peri-operative red blood cell transfusions strategies. TRIAL REGISTRATION: ClinicalTrials.gov, identifier: NCT02350348

The Effect of Sociodemographic Factors on the Patient Satisfaction with Health Care System

The goal of this paper is to determine the level of patient satisfaction with health care among adults in the Republic of Serbia and to analyze the correlation between the satisfaction and socio-demographic characteristics of the interviewees. The paper is based on the data provided by the National health survey of the Republic of Serbia. For the purposes of this paper, we used data on age and household of the people aged 19 and more. By eliminating the interviewees who were neither satisfied nor dissatisfied with the health care services, we obtained the sample containing 18.206 interviewees. Demographic characteristics and well-being index represented independent variables in the research. Dependent variable of the patient satisfaction was transformed into a binary variable by categorizing satisfied and very satisfied interviewees into one group and by placing dissatisfied and very dissatisfied interviewees into group of dissatisfied patients. The connection between satisfaction and predictors was examined using Chi-Square test and logistic regression. The percentage of the satisfied patients with health care was 72.9%. The satisfaction level was directly connected to age, gender, marital status, employment, region the interviewee comes from and well-being index. Patients who were more satisfied included older people, women, as well as married people, the unemployed and those living in the cities. The analysis of the financial situation shows that the poorest interviewees were the most satisfied with health care

ESTABLISHMENT OF THE SERBIAN FADN INSTITUTIONAL FRAMEWORK

While the Republic of Serbia is increasingly moving towards EU integration, and while one of the many EU requirements is the yearly transmission of the accountancy data that are important for the annual determination of the incomes of agricultural holdings and analysis of their business operation, the need to establish and develop Serbian Farm Accountancy Data Network (FADN) system becomes a crucial strategic option. This research paper describes how this requirement has been fulfilled for the Republic of Serbia, with special focus on FADN institutional framework. In this paper it is used unique replicable European Union (EU) methodology that has been applied and adjusted in accordance with national conditions. Furthermore, a comparative research method was used in a particular area of this study, which aimed to make comparisons across different FADN institutional framework of certain EU member states and Republic of Serbia. The results of this research paper showed that the FADN institutional frameworks in EU member states as well as institutional framework of the Republic of Serbia as candidate country have been established on the same bases, such as accountancy data collection–processing–transmission chain. However, the FADN institutional frameworks in EU member states are different and complex. Furthermore, taking into consideration comparison of the current state of FADN institutional framework in certain EU member states and Republic of Serbia, this paper demonstrated that although currently there is no specific sub-legal act, that prescribes the functioning of the FADN system in Serbia, there is a dynamic phase at an early stage of the Serbian FADN institutional framework development. Evidently, it is in development and needs to be further improved and strengthened while the sub-legal act, that prescribes the functioning of the FADN system, needs to be adopted. Consequently, for completed Serbian FADN system establishment and its sustainable development and functioning, there are still many challenges to overcome

An Investigation into Mechanical Properties and Printability of Potential Substrates for Inkjet Printing of Orodispersible Films

Inkjet printing is novel approach in drug manufacturing that enables dispensing precise volumes of ink onto substrates. Optimal substrate properties including suitable mechanical characteristic are recognized as crucial to achieve desired dosage form performance upon administration. Identification of relevant quality attributes and their quantification is subject of intensive scientific research. The aim of this work was to explore applicability of different materials as printing substrates and explore contribution of the investigated substrate properties to its printability. Substrates were characterized with regards to uniformity, porosity, disintegration time, mechanical properties and drug dissolution. Experimentally obtained values were mathematically transformed and the obtained results were presented as relevant radar charts. It was shown that structurally different substrates may be employed for orodispersible films inkjet printing. Main disadvantage of single-polymer films was low drug load, and their printability was dependent on film flexibility and mechanical strength. Structured orodispersible film templates exhibited favorable mechanical properties and drug load capacity. Wafer edible sheets were characterized with high mechanical resistance and brittleness which somewhat diminished printability, but did not hinder high drug load. Obtained results provide insight into application of different materials as printing substrates and contribute to understanding of substrate properties which can affect printability

Brain-Drain the Positive and Negative Aspects of the Phenomenon

A large number of available analyses and research on the brain-drain phenomenon support the fact that this issue is very relevant and important from different social aspects, and therefore we have chosen it as the topic of our paper. While analyzing the available theories, we were confronted with a number of different viewpoints regarding the brain-drain phenomenon: from a neutral impact over the negative to full positive impact of the brain-drain on countries of origin. All researchers, however, agree that there is a range of push and pull factors influencing the brain-drain phenomenon of the general social, economic, family, but also geographical and natural conditions. An important economic factor is the money arriving from developing countries precisely from the people who left their home countries. It is impossible to analyze the brain-drain phenomenon and ignore the globalization process. It directly affects the transformation of the brain-drain phenomenon into brain-circulation as a recent phenomenon

Determination of nitrate by the IE-HPLC-UV method in the brain tissues ofWistar rats poisoned with paraquat

This work was a part of an initial study regarding the involvement of reactive nitrogen species (RNS) in paraquat (PQ) neurotoxicity. The nitrate concentration in the vulnerable regions of the brain (cortex, striatum and hippocampus) of Wistar rats was used as a measure of nitric oxide (NO) production or catabolism of the formed RNS. The tissue homogenates were deproteinized with acetonitrile and then centrifuged. Nitrate was measured in filtrated supernatants by simple and rapid isocratic ion-exchange high performance liquid chromatography with UV detection (IE-HPLC-UV) at 214 nm. The mobile phase (pH 8.5) consisted of borate buffer/gluconate concentrate, methanol, acetonitrile and deionized water (2:12:12:74, v/v/v/v), and the flow rate was 1.3 mL/min. Physiological nitrate levels (18.8 ± 6.1 nmol/mg of proteins), as well as a diverse range of nitrate concentrations could be determined with good precision (CV = 2.2 %) and accuracy (recovery of spiked samples was 99 ± 4%) in the brain tissue homogenates. Linearity was achieved in the range of nitrate from 0‑80 mM. The retention time of nitrate anion was 5.3 ± 0.3 min

Investigation of the microbial diversity of an extremely acidic, metal-rich water body (Lake Robule, Bor, Serbia)

An investigation of the microbial diversity in the extremely acidic, metal-rich Lake Robule was performed using culture-dependant and culture-independent (T-RFLP) methods. In addition, the ability of the indigenous bacteria from the lake water to leach copper from a mineral concentrate was tested. T-RFLP analysis revealed that the dominant bacteria in the lake water samples were the obligate heterotroph Acidiphilium cryptum (approximate to 50 % of the total bacteria) and the iron-oxidizing autotroph Leptospirillum ferrooxidans (approximate to 40 %) The iron/sulfur-oxidizing autotroph Acidithiobacillus ferrooxidans was reported to be the most abundant bacteria in the Lake in an earlier study, but it was not detected in the present study using T-RFLP, although it was isolated on solid media and detected in enrichment (bioleaching) cultures. The presence of the two bacterial species detected by T-RFLP (L. ferrooxidans and A. cryptum) was also confirmed by cultivation on solid media. The presence and relative abundance of the bacteria inhabiting Lake Robule was explained by the physiological characteristics of the bacteria and the physico-chemical characteristics of the lake water