Motor development related to duration of exclusive breastfeeding, B vitamin status and B12 supplementation in infants with a birth weight between 2000-3000 g, results from a randomized intervention trial

Background: Exclusive breastfeeding for 6 months is assumed to ensure adequate micronutrients for term infants. Our objective was to investigate the effects of prolonged breastfeeding on B vitamin status and neurodevelopment in 80 infants with subnormal birth weights (2000-3000 g) and examine if cobalamin supplementation may benefit motor function in infants who developed biochemical signs of impaired cobalamin function (total homocysteine (tHcy) > 6.5 μmol/L) at 6 months. Methods: Levels of cobalamin, folate, riboflavin and pyridoxal 5´-phosphate, and the metabolic markers tHcy and methylmalonic acid (MMA), were determined at 6 weeks, 4 and 6 months (n = 80/68/66). Neurodevelopment was assessed with the Alberta Infants Motor Scale (AIMS) and the parental questionnaire Ages and Stages (ASQ) at 6 months. At 6 months, 32 of 36 infants with tHcy > 6.5 μmol/L were enrolled in a double blind randomized controlled trial to receive 400 μg hydroxycobalamin intramuscularly (n = 16) or sham injection (n = 16). Biochemical status and neurodevelopment were evaluated after one month. Results: Except for folate, infants who were exclusively breastfed for >1 month had lower B vitamin levels at all assessments and higher tHcy and MMA levels at 4 and 6 months. At 6 months, these infants had lower AIMS scores (p = 0.03) and ASQ gross motor scores (p = 0.01). Compared to the placebo group, cobalamin treatment resulted in a decrease in plasma tHcy (p < 0.001) and MMA (p = 0.001) levels and a larger increase in AIMS (p = 0.02) and ASQ gross motor scores (p = 0.03). Conclusions: The findings suggest that prolonged exclusive breastfeeding may not provide sufficient B vitamins for small infants, and that this may have a negative effect on early gross motor development. In infants with mild cobalamin deficiency at 6 months, cobalamin treatment significantly improvement cobalamin status and motor function, suggesting that the observed impairment in motor function associated with long-term exclusive breastfeeding, may be due to cobalamin deficiency.publishedVersio

A propriedade sem registro : o contrato e aquisição da propriedade imóvel na perspectiva civil-contitucional

Orientador : Prof. Dr. Eroulths Cortiano JuniorTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Jurídicas, Programa de Pós-Graduação em Direito. Defesa: Curitiba, 12/08/2014Inclui referênciasResumo: Esta tese objetiva uma releitura da obrigatoriedade do registro nas aquisições da propriedade imóvel, a partir do reconhecimento do contrato como dotado de função social, que realiza, igualmente, a função social como liberdade de acesso aos bens. A propriedade imobiliária no Direito Civil brasileiro está qualificada como direito real, conforme o art. 1225, I, do Código Civil, e sua transferência negocial se orienta pelo sistema da separação parcial dos planos dos direitos obrigacionais e reais, o qual prevê a necessidade do contrato de transmissão (compra e venda, doação ou permuta) com posterior registro no Cartório Imobiliário, nos termos do art. 1245 e seguintes. A Constituição Federal de 1988 garante o direito de propriedade, que deve atender à sua função social, considerando-a como direito fundamental (art. 5.o, XXII e XXIII) e como princípio geral da ordem econômica (art. 170, II e III). A necessária interação entre o Direito Civil e a Constituição, sob a supremacia hierárquica desta, conduz a entender que o direito de propriedade atual, para além da literalidade do Código Civil, deve nortear-se pela sintonia entre ambos os diplomas legais, mas a partir da observação dos princípios e dos valores constitucionais. O Direito Civil-Constitucional surge, então, como uma opção de desenvolvimento do pensamento jurídico, que visa oferecer espaço de reflexão que supere a dogmática unicamente codificada, pois, com fundamento nos princípios e na axiologia constitucional, auxilia na ressignificação de institutos clássicos, como a propriedade e o contrato. O acesso à propriedade, então, pode ser considerado para além da letra da lei, o que permite relevar o registro, com a funcionalização do contrato que, a partir de sua teleologia, da solidariedade, da alteridade e da boa-fé, pode ser o elemento constitutivo da propriedade, com base no caso concreto. A aplicação direta e imediata da Constituição nas relações interprivadas favorece a ressignificação do contrato, que alçará significado de título suficiente para garantir o direito à propriedade (acesso). A complexidade e a pluralidade das relações sociais conduzem a uma transição do modelo abstrato e individualista da propriedade para o da propriedade concreta, que se constrói na funcionalização como liberdade(s) com vistas à realização das necessidade da pessoa concretamente considerada.Abstract: The aim of this thesis is to re-read the mandatory registration on acquisition of immovable property, from the social function of contract's recognition, which also performs its social function as freedom of access to assets. The immovable property in the Brazilian Civil Law is qualified as a real right, according to art. 1225, I, Civil Code, and its negotiating transferring is guided by the partial separation between obligations and real rights, which predicts the registration of transmission's contract (sale, donation or exchange) with the state registration authority, according to art. 1245 and on Civil Code. The 1988 Federal Constitution guarantees the right to property, which must meet its social function, considering it as a fundamental right (art. 5, XXII and XXIII) and as a general principle of economic order (art. 170, II and III). The necessary interaction between the civil law and the Constitution, under the hierarchical supremacy of this leads to understand that the current property law, beyond its literal meaning of the Civil Code, shall be guided by the line between the two enactments, but from the observation of constitutional principles and values.The Civil-constitutional Law arises, then, as an option for legal thinking development, which aims to provide a reflection space that overcomes the consolidated dogmatic, therefore, on the basis of principles and the constitutional axiology, assists in reframing classical institutes, as property and contract. The access to the property can then be considered beyond the letter of the law, which allows to release the register, with the functionalization's contract which, from its teleology, solidarity, alterity and good faith, may be the constituent element of the property, based on the case. The direct and immediate constitutional applying in privates relations cooperate to the contract redefinition, which obtain the sufficient title to guarantee the right to property (access). The complexity and plurality of social relations lead to a transition from abstract and individualistic model of property to concrete one which is constructed on functionalization as freedom (s) to intending to accomplish persons needs concretely considered

Prospective Risk Assessment of Medicine Shortages in Europe and Israel: Findings and Implications

Introduction: While medicine shortages are complex, their mitigation is more of a challenge. Prospective risk assessment as a means to mitigate possible shortages, has yet to be applied equally across healthcare settings. The aims of this study have been to: 1) gain insight into risk-prevention against possible medicine shortages among healthcare experts; 2) review existing strategies for minimizing patient-health risks through applied risk assessment; and 3) learn from experiences related to application in practice. Methodology: A semi-structured questionnaire focusing on medicine shortages was distributed electronically to members of the European Cooperation in Science and Technology (COST) Action 15105 (28 member countries) and to hospital pharmacists of the European Association of Hospital Pharmacists (EAHP) (including associated healthcare professionals). Their answers were subjected to both qualitative and quantitative analysis (Microsoft Office Excel 2010 and IBM SPSS Statistics®) with descriptive statistics based on the distribution of responses. Their proportional difference was tested by the chi-square test and Fisher's exact test for independence. Differences in the observed ordinal variables were tested by the Mann-Whitney or Kruskal-Wallis test. The qualitative data were tabulated and recombined with the quantitative data to observe, uncover and interpret meanings and patterns. Results: The participants (61.7%) are aware of the use of risk assessment procedures as a coping strategy for medicine shortages, and named the particular risk assessment procedure they are familiar with failure mode and effect analysis (FMEA) (26.4%), root cause analysis (RCA) (23.5%), the healthcare FMEA (HFMEA) (14.7%), and the hazard analysis and critical control point (HACCP) (14.7%). Only 29.4% report risk assessment as integrated into mitigation strategy protocols. Risk assessment is typically conducted within multidisciplinary teams (35.3%). Whereas 14.7% participants were aware of legislation stipulating risk assessment implementation in shortages, 88.2% claimed not to have reported their findings to their respective official institutions. 85.3% consider risk assessment a useful mitigation strategy. Conclusion: The study indicates a lack of systematically organized tools used to prospectively analyze clinical as well as operationalized risk stemming from medicine shortages in healthcare. There is also a lack of legal instruments and sufficient data confirming the necessity and usefulness of risk assessment in mitigating medicine shortages in Europe. © Copyright © 2020 Miljković, Godman, Kovačević, Polidori, Tzimis, Hoppe-Tichy, Saar, Antofie, Horvath, De Rijdt, Vida, Kkolou, Preece, Tubić, Peppard, Martinez, Yubero, Haddad, Rajinac, Zelić, Jenzer, Tartar, Gitler, Jeske, Davidescu, Beraud, Kuruc-Poje, Haag, Fischer, Sviestina, Ljubojević, Markestad, Vujić-Aleksić, Nežić, Crkvenčić, Linnolahti, Ašanin, Duborija-Kovačević, Bochenek, Huys and Miljković

Is consumption of sugar-sweetened soft drinks during pregnancy associated with birth weight?

In Norway, there were parallel increases and subsequent decreases in birth weight (BW) and consumption of sugar-sweetened carbonated soft drinks (SSC) during the period 1990–2010, and by an ecological approach, we have suggested that the relationship was causal. The objective of this study was to examine if such a relationship was present in a prospectively followed cohort of pregnant women. The study population included 62,494 term singleton mother–infant dyads in the Norwegian Mother and Child Cohort Study (MoBa), a national prospective cohort study in Norway from 1999 to 2008. The association between SSC consumption and BW was assessed using multiple regression analyses with adjustment for potential confounders. Each 100 ml intake of SSC was associated with a 7.8 g (95% confidence interval [CI]: −10.3 to −5.3) decrease in BW, a decreased risk of BW > 4,500 g (odds ratio [OR]: 0.94, 95% CI: 0.90 to 0.97) and a near significantly increased risk of BW 4,500 g (OR: 1.18, 95% CI: 1.00 to 1.39) and a trend towards significant increase in mean BW (25.1 g, 95% CI: −2.0 to 52.2) per 100 ml SSC. Our findings suggest that increasing consumption of rapidly absorbed sugar from SSC had opposite associations with BW in normal pregnancies and pregnancies complicated by gestational diabetes mellitus

Renal function and blood pressure in 11 year old children born extremely preterm or small for gestational age.

BACKGROUND:Preterm birth and low birth weight are associated with reduced nephron numbers and increased risk of hypertension and kidney disease in later life. AIMS:We tested the hypothesis that extremely preterm birth and intrauterine growth restriction is associated with decreased renal function in mid childhood. METHODS:At 11 years of age the following measures were obtained in a regional cohort of children born extremely premature (EP, i.e. 0.2) and did not differ between the groups. CONCLUSIONS:Children born EP/ELBW, particularly those born SGA, had impaired renal function at age 11 years as judged from estimated GFRs and plasma levels of SDMA. Since reduced renal function is associated with an increased risk of later disease, these children should be followed in order to minimize additional risk factors

Early ultrasound in routine pregnancy care

publishedVersio