Impact of Intercurrent Respiratory Infections on Lung Health in Infants Born <29 Weeks with BPD

Abstract: Objective: To assess the impact of intercurrent respiratory infections on infants born <29 weeks gestation with bronchopulmonary dysplasia (BPD). Study Design: A retrospective cohort study was conducted on 111 infants born <29 weeks gestation with BPD in one academic center from 2008-2010. Results: Backward stepwise logistic regression showed viral infections significantly increased oxygen use with an OR of 15.5 [CI 3.4, 71.3]. Stratified bivariate Cochran-Mantel-Hansel chi-square analysis showed both viral and bacterial infections affected oxygen use (9% vs. 47%, p<0.0002 and 8% vs. 24%, p =0.02) with viral infections maintaining significance in the no/mild and severe BPD groups (2% vs. 40% p=0.02 and 26% vs. 83% p=0.02). Both viral and bacterial infections were associated with increased steroid use (11% to 29%, P=0.01 and 9% to 22%, p=0.03) but only viral infections were associated with an increased diuretic use in the combined BPD groups and no/mild BPD group (32% to 57%, P=0.02 and 10% to 50%, p=0.03). The Cochran-Armitage trend test showed that an increasing number of viral infections is associated with increased oxygen use (OR [95% CI] = 6.4 [2.3-17.4]), diuretic use (OR [95% CI] = 2.4 [1.1 - 5.2], p=0.02) and inhaled steroid use (OR [95% CI] = 2.2[1.003 - 5.2], p=0.049). Conclusions: Viral infections caused more long term pulmonary morbidity/mortality than bacterial infections on premature lung health over the first year of life

Are pregnancy outcomes associated with risk factor reporting in routinely collected perinatal data?

Relatório de estágio do mestrado em Ensino da Educação Física dos Ensinos Básico e Secundário, apresentado à Faculdade de Ciências do Desporto e Educação Física da Universidade de CoimbraApresentado como um documento reflexivo e figurativo das experiências e vivências tidas durante o ano de Estágio Pedagógico em Ensino da Educação Física nos Ensinos Básico e Secundário, este relatório final foi desenvolvido com base no contexto da Turma do 11º PS da Escola Secundária de Avelar Brotero, contendo, assim, todas as expetativas, conceções, aprendizagens, dificuldades, estratégias, soluções e etapas superadas. Estruturado em cinco capítulos – Enquadramento pessoal onde consta as expetativas iniciais relativas ao Estágio Pedagógico; contextualização da prática desenvolvida, onde caracterizamos o contexto; realização da prática profissional, da qual consta uma reflexão sobre todo o processo de planeamento, realização e avaliação; reflexões acerca do processo pedagógico, onde expomos opiniões edificantes dos desafios e dilemas na condução do processo de ensino-aprendizagem; e o aprofundamento do tema problema – foi evidenciado o caminho que fomos (re)construindo com identidade, partilha e reflexão, e a forma como encaramos o compromisso com as aprendizagens dos alunos. Fundamentado no paradigma construtivista, o desenvolvimento curricular foi neste relatório assumido como um processo que deverá centrar-se no aluno, aludindo ao conjunto de estratégias, métodos e procedimentos que permitem a concretização de um projeto de formação pessoal e social que a prática desportiva pode potenciar. Tendo em atenção os contextos e cenários de aprendizagem, os papéis e responsabilidades de quem ensina e de quem aprende, fomos delegando ao aluno autonomia, iniciativa, criatividade, capacidade de cooperação e entreajuda, capacidade de decidir, vontade de aprender e de praticar. O Modelo de Educação Desportiva, enquanto modelo de ensino, foi um marco neste processo, pelo que foi objeto de um estudo mais aprofundado. This document was presented as a reflective essay on the experiences lived during the year of Practicum in Teaching of Physical Education on learning stages of Elementary School and High School. This final report was based on the class of 11º PS of Avelar Brotero’s High School, and represents all the expectations, conceptions, learning skills, difficulties found in the process, strategies adopted, solutions found and overcome barriers. It was structured in five chapters: initial expectations relating to the Practicum; characterization of the context; professional practice, in which lies was a reflexion about all the process of planning, making and evaluation; problems and challenges occurred during the process of teaching and learning; and finally deep reflection about he main theme - was then noted the way in which we had been (re)building our study with identity, sharing and reflexion and the way we faced the commitment with the students own learning skills and paths. Under the influence of the constructivist paradigm, curriculum development was seen as a process that will focus on the student, alluding to the set of strategies, methods and procedures that allow the making of a project of personal and social development that the sports practice may enhance, delegating the student autonomy, responsibility, initiative, creativity, ability to cooperate and assist others, and ability to learn and share. The Sport Education Model while teaching model it was a milestone in this process, whereat it was object of further study

Investigating linkage rates among probabilistically linked birth and hospitalization records

BACKGROUND: With the increasing use of probabilistically linked administrative data in health research, it is important to understand whether systematic differences occur between the populations with linked and unlinked records. While probabilistic linkage involves combining records for individuals, population perinatal health research requires a combination of information from both the mother and her infant(s). The aims of this study were to (i) describe probabilistic linkage for perinatal records in New South Wales (NSW) Australia, (ii) determine linkage proportions for these perinatal records, and (iii) assess records with linked mother and infant hospital-birth record, and unlinked records for systematic differences. METHODS: This is a population-based study of probabilistically linked statutory birth and hospital records from New South Wales, Australia, 2001-2008. Linkage groups were created where the birth record had complete linkage with hospital admission records for both the mother and infant(s), partial linkage (the mother only or the infant(s) only) or neither. Unlinked hospital records for mothers and infants were also examined. Rates of linkage as a percentage of birth records and descriptive statistics for maternal and infant characteristics by linkage groups were determined. RESULTS: Complete linkage (mother hospital record – birth record – infant hospital record) was available for 95.9% of birth records, partial linkage for 3.6%, and 0.5% with no linked hospital records (unlinked). Among live born singletons (complete linkage = 96.5%) the mothers without linked infant records (1.6%) had slightly higher proportions of young, non-Australian born, socially disadvantaged women with adverse pregnancy outcomes. The unlinked birth records (0.4%) had slightly higher proportions of nulliparous, older, Australian born women giving birth in private hospitals by caesarean section. Stillbirths had the highest rate of unlinked records (3-4%). CONCLUSIONS: This study shows that probabilistic linkage of perinatal records can achieve high, representative levels of complete linkage. Records for mother’s that did not link to infant records and unlinked records had slightly different characteristics to fully linked records. However, these groups were small and unlikely to bias results and conclusions in a substantive way. Stillbirths present additional challenges to the linkage process due to lower rates of linkage for lower gestational ages, where most stillbirths occur

Spinal cord stimulation for predominant low back pain in failed back surgery syndrome: study protocol for an international multicenter randomized controlled trial (PROMISE study)

Background: Although results of case series support the use of spinal cord stimulation in failed back surgery syndrome patients with predominant low back pain, no confirmatory randomized controlled trial has been undertaken in this patient group to date. PROMISE is a multicenter, prospective, randomized, open-label, parallel-group study designed to compare the clinical effectiveness of spinal cord stimulation plus optimal medical management with optimal medical management alone in patients with failed back surgery syndrome and predominant low back pain. Method/Design: Patients will be recruited in approximately 30 centers across Canada, Europe, and the United States. Eligible patients with low back pain exceeding leg pain and an average Numeric Pain Rating Scale score >= 5 for low back pain will be randomized 1:1 to spinal cord stimulation plus optimal medical management or to optimal medical management alone. The investigators will tailor individual optimal medical management treatment plans to their patients. Excluded from study treatments are intrathecal drug delivery, peripheral nerve stimulation, back surgery related to the original back pain complaint, and experimental therapies. Patients randomized to the spinal cord stimulation group will undergo trial stimulation, and if they achieve adequate low back pain relief a neurostimulation system using the Specify (R) 5-6-5 multi-column lead (Medtronic Inc., Minneapolis, MN, USA) will be implanted to capture low back pain preferentially in these patients. Outcome assessment will occur at baseline (pre-randomization) and at 1, 3, 6, 9, 12, 18, and 24 months post randomization. After the 6-month visit, patients can change treatment to that received by the other randomized group. The primary outcome is the proportion of patients with >= 50% reduction in low back pain at the 6-month visit. Additional outcomes include changes in low back and leg pain, functional disability, health-related quality of life, return to work, healthcare utilization including medication usage, and patient satisfaction. Data on adverse events will be collected. The primary analysis will follow the intention-to-treat principle. Healthcare use data will be used to assess costs and long-term cost-effectiveness. Discussion: Recruitment began in January 2013 and will continue until 2016

Women’s Experiences with Epilepsy Treatment in Southern India: A Focused Ethnography

Women with epilepsy in rural southern India often do not receive anti-epilepsy drugs (AEDs) or take these drugs regularly, but little is known about how they experience the epilepsy treatment they do receive. The purpose of this study was to provide an in-depth description of the treatment experiences of women in this region who had been diagnosed with epilepsy but who do not consistently take AEDs. Focused ethnography was conducted using participant observation and in-depth interviews with six women with epilepsy, eight of their family members, and two traditional healers. The women's treatment experiences are best described as living at the intersection of Western allopathic ("English") medicine and traditional healing practices-approaches that could be complementary or conflicting. The women revealed a variety of perceived barriers to the use of "English" medicine. Health care professionals should appreciate the dynamic interplay of the two treatment approaches and consider all cultural, social, and economic factors that influence the women's treatment experiences

Women’s Experiences with Epilepsy Treatment in Southern India: A Focused Ethnography

Women with epilepsy in rural southern India often do not receive anti-epilepsy drugs (AEDs) or take these drugs regularly, but little is known about how they experience the epilepsy treatment they do receive. The purpose of this study was to provide an in-depth description of the treatment experiences of women in this region who had been diagnosed with epilepsy but who do not consistently take AEDs. Focused ethnography was conducted using participant observation and in-depth interviews with six women with epilepsy, eight of their family members, and two traditional healers. The women’s treatment experiences are best described as living at the intersection of Western allopathic (“English”) medicine and traditional healing practices—approaches that could be complementary or conflicting. The women revealed a variety of perceived barriers to the use of “English” medicine. Health care professionals should appreciate the dynamic interplay of the two treatment approaches and consider all cultural, social, and economic factors that influence the women’s treatment experiences