Heel lance in newborn during breastfeeding: an evaluation of analgesic effect of this procedure

<p>Abstract</p> <p>Objectives</p> <p>The reduction of pain due to routine invasive procedures (capillary heel stick blood sampling for neonatal metabolic screening) in the newborn is an important objective for the so-called "Hospital with no pain". Practices such as skin to skin contact, or breastfeeding, in healthy newborn, may represent an alternative to the use of analgesic drugs. The aim of our work is to evaluate the analgesic effect of breastfeeding during heel puncture in full term healthy newborn.</p> <p>Methods</p> <p>We studied 200 healthy full term newborns (100 cases and 100 controls), proposing the puncture to mothers during breastfeeding, and explaining to them all the advantages of this practice. Pain assessment was evaluated by DAN scale (Douleur Aigue Nouveau ne scale).</p> <p>Results</p> <p>The difference in score of pain according to the DAN scale was significant in the two groups of patients (p = 0.000); the medium score was 5.15 for controls and 2.65 for cases (newborns sampled during breastfeeding).</p> <p>Conclusion</p> <p>Our results confirmed the evidence of analgesic effect of breastfeeding during heel puncture. This procedure could easily be adopted routinely in maternity wards.</p

Antimicrobial resistance of Escherichia coli isolates from outpatient urinary tract infections in women in six European countries including Russia

Objectives In the Northern Dimension Antibiotic Resistance Study (NoDARS), Finland, Germany, Latvia, Poland, Russia and Sweden collected urine samples from outpatient women (aged 18–65 years) with symptoms of uncomplicated urinary tract infection (UTI) to investigate the levels of antimicrobial resistance (AMR) among Escherichia coli isolates. Methods A total of 775 E. coli isolates from 1280 clinical urine samples were collected from October 2015 to January 2017. Antimicrobial susceptibility testing was performed and the results were interpreted according to European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. Results Overall AMR rates to the commonly used antibiotics nitrofurantoin, fosfomycin and mecillinam (except for Germany that was missing a result for mecillinam) were 1.2%, 1.3% and 4.1%, respectively. The highest overall resistance rates were determined for ampicillin (39.6%), trimethoprim (23.8%), trimethoprim/sulfamethoxazole (22.4%), amoxicillin/clavulanic acid (16.7%) and ciprofloxacin (15.1%), varying significantly between countries. The rate of extended-spectrum β-lactamase (ESBL) production was 8.7%. None of the isolates showed resistance to meropenem. Conclusions In most cases, low AMR rates were detected against the first-line antibiotics recommended in national UTI treatment guidelines, giving support to their future use. These results also support the European Association of Urology guidelines stating that nitrofurantoin, fosfomycin and mecillinam are viable treatment options for uncomplicated UTI.Peer Reviewe

Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis

Background: Infections due to antibiotic-resistant bacteria are threatening modern health care. However, estimating their incidence, complications, and attributable mortality is challenging. We aimed to estimate the burden of infections caused by antibiotic-resistant bacteria of public health concern in countries of the EU and European Economic Area (EEA) in 2015, measured in number of cases, attributable deaths, and disability-adjusted life-years (DALYs). Methods: We estimated the incidence of infections with 16 antibiotic resistance–bacterium combinations from European Antimicrobial Resistance Surveillance Network (EARS-Net) 2015 data that was country-corrected for population coverage. We multiplied the number of bloodstream infections (BSIs) by a conversion factor derived from the European Centre for Disease Prevention and Control point prevalence survey of health-care-associated infections in European acute care hospitals in 2011–12 to estimate the number of non-BSIs. We developed disease outcome models for five types of infection on the basis of systematic reviews of the literature. Findings: From EARS-Net data collected between Jan 1, 2015, and Dec 31, 2015, we estimated 671 689 (95% uncertainty interval [UI] 583 148–763 966) infections with antibiotic-resistant bacteria, of which 63·5% (426 277 of 671 689) were associated with health care. These infections accounted for an estimated 33 110 (28 480–38 430) attributable deaths and 874 541 (768 837–989 068) DALYs. The burden for the EU and EEA was highest in infants (aged <1 year) and people aged 65 years or older, had increased since 2007, and was highest in Italy and Greece. Interpretation: Our results present the health burden of five types of infection with antibiotic-resistant bacteria expressed, for the first time, in DALYs. The estimated burden of infections with antibiotic-resistant bacteria in the EU and EEA is substantial compared with that of other infectious diseases, and has increased since 2007. Our burden estimates provide useful information for public health decision-makers prioritising interventions for infectious diseases

Evaluation of performance of health systems: a model for analysis

Submitted by Anderson Silva ([email protected]) on 2013-04-19T12:49:01Z No. of bitstreams: 1 Avaliação de Desempenho de Sistemas de Saúde.pdf: 189769 bytes, checksum: de79f01fca74517a54199c7d37e0d63a (MD5)Approved for entry into archive by Gentil Jeorgina([email protected]) on 2013-04-19T18:29:31Z (GMT) No. of bitstreams: 1 Avaliação de Desempenho de Sistemas de Saúde.pdf: 189769 bytes, checksum: de79f01fca74517a54199c7d37e0d63a (MD5)Made available in DSpace on 2013-04-22T13:30:01Z (GMT). No. of bitstreams: 1 Avaliação de Desempenho de Sistemas de Saúde.pdf: 189769 bytes, checksum: de79f01fca74517a54199c7d37e0d63a (MD5) Previous issue date: 2012Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, Brasil.Fundação Oswaldo Cruz. Escola Nacional de saúde Pública. Rio de Janeiro, Brasil.Fundação Oswaldo Cruz. Escola Nacional de saúde Pública. Rio de Janeiro, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, Brasil.Fundação Oswaldo Cruz. Instituto de Comunicação e Informação Científica e Tecnológica em Saúde. Rio de Janeiro, Brasil.Este artigo apresenta uma revisão da Matriz de Dimensões da Avaliação do Sistema de Saúde no Brasil desenvolvida em 2003, e uma atualização conceitual de parte das subdimensões de avaliação do desempenho dos serviços de saúde: efetividade, acesso, eficiência e adequação. Descreve o processo de seleção dos indicadores utilizados e uma síntese dos resultados para cada subdimensão do desempenho. O comportamento dos indicadores utilizados para avaliar o desempenho dos serviços de saúde no Brasil, no que se refere às quatro subdimensões selecionadas, não é uniforme e as melhorias mais acentuadas são observadas naquelas influenciadas pela atuação dos serviços no campo da atenção primária, as melhorias mais significativas foram observadas nas Efetividade e Acesso. Em relação à Eficiência dos serviços de saúde coexistem situações de alta eficiência com outras de baixo desempenho. A atuação dos serviços de saúde na subdimensão Adequação foi pior do que nas demais apresentadas.This paper presents a review of the Dimension Matrix for Evaluation of the Brazilian Health System that was initially developed in 2003, as well as a conceptual update of some of the sub-dimensions for the evaluation of health service performance, namely effectiveness, access, efficiency and appropriateness of health care. It also describes the indicator selection process as well as the results obtained in each performance dimension. The behavior of the indicators used to assess the performance of health services in Brazil, with respect to each sub-dimension, was not uniform. Areas of marked improvement were found in indicators that are influenced by activities in the field of primary care. The most significant improvements were seen in the sub-dimensions of Effectiveness and Access. With respect to the Efficiency of health services, situations of high efficiency coexist with others with substandard performance. The performance of health services in the sub-dimension of Appropriateness of Health Care was the lowest of all indicators

Analysis of Toll-Like Receptors in Human Milk: Detection of Membrane-Bound and Soluble Forms

The bioactive and anti-inflammatory role of human milk components has been recognized; active milk components include soluble forms of Toll-like receptors (TLRs). Preterm babies are more susceptible to infections and may succumb to necrotizing enterocolitis (NEC), a gastrointestinal disease which is exacerbated by an excessive inflammatory response after TLR activation. Here, we investigated the presence of Toll-like receptors TLR1/2/4/6 in colostrum and mature milk of women who delivered before (preterm) or after (term) 37 weeks of gestational age, integrating classical immune-related techniques with proteomic LC-MS/MS analysis. We have detected immunoreactivity for TLRs mostly in preterm samples, even for TLR1 and TLR6, until now not described in human milk. We demonstrated the presence of only TLR2 in the milk fat globule membrane, while the immunoreactivity of TLR1/4/6 was ascribed to crossreaction with some interesting milk proteins sharing leucine-rich repeat domains. These results will provide new insights into the definition of the role of TLRs in intestinal immune regulation of the newborns

Large variation in ESBL-producing Escherichia coli carriers in six European countries including Russia

We investigated the faecal carriage prevalence of extended-spectrum β-lactamase production in Escherichia coli (EP-EC) and/or Klebsiella pneumoniae (EP-KP) and risk factors associated with carriage among adult study subjects in Finland, Germany, Latvia, Poland, Russia and Sweden (partner countries). The aim was to get indicative data on the prevalence of ESBL-carriage in specific populations in the region. Faecal samples were collected from four study populations and screened on ChromID-ESBL and ChromID-OXA-48 plates. Positive isolates were further characterised phenotypically. Our results show a large variation in carrier prevalence ranging from 1.6% in Latvia to 23.2% in Russia for EP-EC. For the other partner countries, the prevalence of EP-EC were in increasing numbers, 2.3% for Germany, 4.7% for Finland, 6.6% for Sweden, 8.0% for Poland and 8.1% for all partner countries in total. Carriers of EP-KP were identified only in Finland, Russia and Sweden, and the prevalence was < 2% in each of these countries. No carriers of carbapenemase-producing isolates were identified. This is the first study reporting prevalence of carriers (excluding traveller studies) for Finland, Latvia, Poland and Russia. It contributes with important information regarding the prevalence of EP-EC and EP-KP carriage in regions where studies on carriers are limited.Peer Reviewe

Considerações Metodológicas sobre o Relatório 2000 da Organização Mundial de Saúde

Made available in DSpace on 2010-08-23T16:58:49Z (GMT). No. of bitstreams: 3 Travassos_Considerations on methodology_2001--.pdf: 69656 bytes, checksum: 2bb91e79023c1291e2b847fe9b4f4591 (MD5) license.txt: 1842 bytes, checksum: 1508aa3388b06f8ceb457793a9861279 (MD5) Travassos_Considerations on methodology_2001--.pdf.txt: 39482 bytes, checksum: d3e4949814d268574f5ab810e81a2021 (MD5) Previous issue date: 2001Made available in DSpace on 2010-11-04T14:19:48Z (GMT). No. of bitstreams: 3 Travassos_Considerations on methodology_2001--.pdf.txt: 39482 bytes, checksum: d3e4949814d268574f5ab810e81a2021 (MD5) license.txt: 1842 bytes, checksum: 1508aa3388b06f8ceb457793a9861279 (MD5) Travassos_Considerations on methodology_2001--.pdf: 69656 bytes, checksum: 2bb91e79023c1291e2b847fe9b4f4591 (MD5) Previous issue date: 2001Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Departamento de Informação para a Saúde, Centro de Informação Científica e Tecnológica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Departamento de Informação para a Saúde, Centro de Informação Científica e Tecnológica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Departamento de Informação para a Saúde, Centro de Informação Científica e Tecnológica, Fundação Oswaldo CruzFundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Ciências Sociais. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Ciências Sociais. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Presidência. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Escola Nacional de Saúde Pública Sergio Arouca. Departamento de Administração e Planejamento em Saúde. Rio de Janeiro, RJ, Brasil.O artigo discute o Relatório da Organização Mundial de Saúde para 2000, com ênfase na análise metodológica dos indicadores utilizados para comparar e classificar o desempenho dos sistemas de saúde dos 191 países membros. O Relatório contribui ao colocar na agenda o compromisso de monitorar o desempenho dos sistemas de saúde dos países membros porém, a forma inconsistente de sua elaboração e a utilização de metodologias de avaliação questionáveis cientificamente, impõem uma criteriosa revisão metodológica. Os principais problemas destacados são a escolha de indicadores individuais de desigualdade em saúde que desconsideram o perfil populacional; o controle inadequado do impacto das desigualdades sociais sobre o desempenho dos sistemas; a avaliação da responsabilidade dos sistemas, apenas parcialmente articulada aos direitos dos cidadãos; a ausência de dados para um grande número de países levando a diversas estimativas pouco consistentes; a falta de transparência nos procedimentos metodológicos para o cálculo de alguns dos indicadores. O artigo sugere uma ampla revisão de caráter metodológico do Relatório.The article analyzes the World Health Organization Report for 2000, with emphasis placed on the methodology used to analyze the indicators utilized to compare and classify the performance of the health systems of the 191 member countries. The Report’s contribution was the compromise of monitoring the performance of the health systems of member countries, but because of the inconsistent way it was elaborated, and the utilization of questionable scientific evaluation methodologies, the Report fails to give a clear picture. A criterion-based methodology revision is imposed. The main problems in evidence are the choice of individual indicators of disparity in health that discount the population profile, the inadequate control of the impact of social disparities over the performance of the systems, the evaluation of the responsibility of systems that are only partially articulated to the right of the citizens, the lack of data for a great number of countries, consequently having inconsistent estimations, and the lack of transparency in the methodological procedures in the calculation of some indicators. The article suggests a wide methodological revision of the Report