Academic detailing and adherence to guidelines for Group B streptococci prenatal screening: a randomized controlled trial

BACKGROUND: Clinical practice guidelines (CPGs) recommend universal prenatal screening for Group B Streptococcus (GBS) to identify candidates for intrapartum antibiotic prophylaxis to prevent early onset neonatal GBS infection. Interventions to promote physician adherence to these guidelines are imperative. This study examined the effectiveness of academic detailing (AD) of obstetricians, compared with CPG mailshot and no intervention, on the screening of pregnant women for GBS. METHODS: A randomized controlled clinical trial was conducted in the medical cooperative of Porto Alegre, Brazil. All obstetricians who assisted in a delivery covered by private health insurance managed by the cooperative in the 3 months preceding the study (n = 241) were invited to participate. The obstetricians were randomized to three groups: direct mail (DM, n = 76), AD (n = 76) and control (C, n = 89, no intervention). Those in the DM group were sent guidelines on GBS. The AD group received the guidelines and an educational visit detailing the guidelines, which was conducted by a trained physician. Data on obstetrician age, gender, time since graduation, whether patients received GBS screening during pregnancy, and obstetricians who requested screening were collected for all participant obstetricians for 3 months before and after the intervention, using database from the private health insurance information system. RESULTS: Three months post-intervention, the data showed that the proportion of pregnant women screened for GBS was higher in the AD group (25.4%) than in the DM (15.9%) and C (17.7%) groups (P = 0.023). Similar results emerged when the three groups were taken as a cluster (pregnant women and their obstetricians), but the difference was not statistically significant (Poisson regression, P = 0.108). Additionally, when vaginal deliveries were analyzed separately, the proportion screened was higher in the AD group (75%) than in the DM group (41.9%) and the C group (30.4%) (chi-square, P < 0.001). CONCLUSIONS: The results suggest that AD increased the prevalence of GBS screening in pregnant women in this population

Intracranial tumors of the central nervous system and air pollution - A nationwide case-control study from Denmark

Background: Inconclusive evidence has suggested a possible link between air pollution and central nervous system (CNS) tumors. We investigated a range of air pollutants in relation to types of CNS tumors. Methods: We identified all (n = 21,057) intracranial tumors in brain, meninges and cranial nerves diagnosed in Denmark between 1989 and 2014 and matched controls on age, sex and year of birth. We established personal 10- year mean residential outdoor exposure to particulate matter < 2.5 μm (PM2.5), nitrous oxides (NOX), primary emitted black carbon (BC) and ozone. We used conditional logistic regression to calculate odds ratios (OR) linearly (per interquartile range (IQR)) and categorically. We accounted for personal income, employment, marital status, use of medication as well as socio-demographic conditions at area level. Results: Malignant tumors of the intracranial CNS was associated with BC (OR: 1.034, 95%CI: 1.005–1.065 per IQR. For NOx the OR per IQR was 1.026 (95%CI: 0.998–1.056). For malignant non-glioma tumors of the brain we found associations with PM2.5 (OR: 1.267, 95%CI: 1.053–1.524 per IQR), BC (OR: 1.049, 95%CI: 0.996–1.106) and NOx (OR: 1.051, 95% CI: 0.996–1.110). Conclusion: Our results suggest that air pollution is associated with malignant intracranial CNS tumors and malignant non-glioma of the brain. However, additional studies are needed

Anthropometric cranial measurements of normal newborn in Sergipe - Northeast of Brazil

O estudo antropométrico do crânio é fundamental para a avaliação do recém-nascido. As medidas antropométricas usadas na atualidade são baseadas em resultados obtidos há mais de cinco décadas, os quais não são capazes de determinar um padrão nacional em decorrência de possíveis influências de algumas etnias. Realizamos estudo descritivo analítico em uma Maternidade em Aracaju-SE, com medidas de perímetro cefálico, distancia biauricular e anteroposterior, índice cefálico e medida da fontanela; foram examinadas 450 recém-nascidos com idade gestacional entre 37 e 42 semanas; 49,3% era do gênero masculino e 50,6% do feminino. O perímetro cefálico variou entre 30,0 cm e 39,8 cm com média de 34,14±2,48 com P50 34 cm. O índice cefálico variou entre 0,69 e 1,13 com média de 0,98±0,06 com P50 1. Foi feito uma comparação entre os estudos estrangeiros e brasileiros; o recém-nascido sergipano aproxima-se mais dos resultados obtidos nos estudos da região sudeste do que dos resultados da região nordeste, geograficamente semelhante. A possibilidade de influencias étnicas foi levantada, como também a necessidade de realizar um estudo multicêntrico para criar um perfil antropométrico do recém-nascido brasileiro. _________________________________________________________________________________________ ABSTRACT: The anthropometric mesureaments of the skull is essential for the evaluation of the newborn. The anthropometrics measureaments utilized at the present time are based in the results obtained for more than five decades, which are not able to determine a national pattern mostly likely due to some ethnic influences. We carried out an analytical descriptive study in a maternity hospital in Aracaju-Sergipe, Northeast of Brazil. Measurements of cephalic perimeter, biauricular and anteroposterior distances, cephalic index and fontanels were obtained from 450 newborns with gestacional age from 37 and 42 weeks; 49.3% were male and 50.6% female. The cephalic perimeter ranged from 30.0 cm to 39.8 cm with mean value of 34.14±2.48 P50 34 cm, and cephalic index ranged from 0.69 and 1.13 with mean value of 0.98±0.06 P50 1. A comparison was made between brazilian and foreign studies; the results of the newborn from Sergipe were closer to results obtained in the southeast region than the ones obtained in the northeast region itself. The possibility of ethnical influences was raised as well as the need to design a multicentric study in order to define an anthropometric profile of the brazilian newborn

Mapping human dispersals into the Horn of Africa from Arabian Ice Age refugia using mitogenomes

Rare mitochondrial lineages with relict distributions can sometimes be disproportionately informative about deep events in human prehistory. We have studied one such lineage, haplogroup R0a, which uniquely is most frequent in Arabia and the Horn of Africa, but is distributed much more widely, from Europe to India. We conclude that: (1) the lineage ancestral to R0a is more ancient than previously thought, with a relict distribution across the Mediterranean/Southwest Asia; (2) R0a has a much deeper presence in Arabia than previously thought, highlighting the role of at least one Pleistocene glacial refugium, perhaps on the Red Sea plains; (3) the main episode of dispersal into Eastern Africa, at least concerning maternal lineages, was at the end of the Late Glacial, due to major expansions from one or more refugia in Arabia; (4) there was likely a minor Late Glacial/early postglacial dispersal from Arabia through the Levant and into Europe, possibly alongside other lineages from a Levantine refugium; and (5) the presence of R0a in Southwest Arabia in the Holocene at the nexus of a trading network that developed after ~3 ka between Africa and the Indian Ocean led to some gene flow even further afield, into Iran, Pakistan and India