Perinatal and newborn care in a two years retrospective study in a first level peripheral hospital in Sicily (Italy)

BACKGROUND: Two hundred seventy-five thousand maternal deaths, 2.7 million neonatal deaths, and 2.6 million stillbirths have been estimated in 2015 worldwide, almost all in low-income countries (LICs). Moreover, more than 20 million severe disabilities result from the complications of pregnancy, childbirth or its management each year. A significant decrease of mortality/morbidity rates could be achieved by providing effective perinatal and newborn care also in high-income countries (HICs), especially in peripheral hospitals and/or rural areas, where the number of childbirths per year is often under the minimal threshold recognized by the reference legislation. We report on a 2 years retrospective cohort study, conducted in a first level peripheral hospital in Cefalù, a small city in Sicily (Italy), to evaluate care provided and mortality/morbidity rates. The proposed goal is to improve the quality of care, and the services that peripheral centers can offer. METHODS: We collected data from maternity and neonatal records, over a 2-year period from January 2017 to December 2018. The informations analyzed were related to demographic features (age, ethnicity/origin area, residence, educational level, marital status), diagnosis at admission (attendance of birth training courses, parity, type of pregnancy, gestational age, fetal presentation), mode of delivery, obstetric complications, the weight of the newborns, their feeding and eventual transfer to II level hospitals, also through the Neonatal Emergency Transport Service, if the established criteria were present. RESULTS: Eight hundred sixteen women were included (age 18-48 years). 179 (22%) attended birth training courses. 763 (93%) were Italian, 53 foreign (7%). 175 (21%) came from outside the province of Palermo. Eight hundred ten were single pregnancies, 6 bigeminal; 783 were at term (96%), 33 preterm (4%, GA 30-41 WG); 434 vaginal deliveries (53%), 382 caesarean sections (47%). One maternal death and 28 (3%) obstetric complications occurred during the study period. The total number of children born to these women was 822, 3 of which stillbirths (3.6‰). 787 (96%) were born at term (>37WG), 35 preterm (4%), 31 of which late preterm. Twenty-one newborns (2.5%) were transferred to II level hospitals. Among them, 3 for moderate/severe prematurity, 18 for mild prematurity/other pathology. The outcome was favorable for all women (except 1 hysterectomy) and the newborns transferred, and no neonatal deaths occurred in the biennium under investigation. Of the remaining 798 newborns, 440 were breastfed at discharge (55%), 337 had a mixed feeding (breastfed/formula fed, 42%) and 21 were formula fed (3%). CONCLUSIONS: Although the minimal standard of adequate perinatal care in Italy is >500 childbirths/year, the aims of the Italian legislation concern the rationalization of birth centers as well as the structural, technological and organizational improvement of health facilities. Therefore, specific contexts and critical areas need to be identified and managed. Adequate resources and intervention strategies should be addressed not only to perinatal emergencies, but also to the management of mild prematurity/pathology, especially in vulnerable populations for social or orographic reasons. The increasing availability and spread of health care offers, even in HICs, cannot be separated from the goal of quality of care, which is an ethic and public health imperative

Standard and Specialized Infant Formulas in Europe: Making, Marketing, and Health Outcomes

Infant formulas are the only suitable substitute for human milk. The most common infant formulas are standard formulas based on cow's milk. In addition, there are formulas for infants showing signs and symptoms of intolerance and for clinical conditions such as allergy, prematurity, and gastrointestinal diseases. A comprehensive review of the literature was made to review the composition of standard and specialized infant formulas and analyze indications for use, real or presumed nutrition differences and properties, and impact on infant growth. A brief consideration on costs is outlined for each formula. Over the past few years, industrial production and advertising of infant formulas have increased. Human milk still remains the most complete source of nutrition for infants and should be continued according to the current recommendations. Few differences exist between infant formulas, both for the nutrition action and the macronutrient/micronutrient composition. Specialized infant formulas have limited indications for use and high costs. The role of the pediatrician is crucial in the management of infant nutrition, promotion of breastfeeding, and prescribing of specialized formulas only in specific clinical conditions

New gravitational solutions via a Riemann-Hilbert approach

We consider the Riemann-Hilbert factorization approach to solving the field equations of dimensionally reduced gravity theories. First we prove that functions belonging to a certain class possess a canonical factorization due to properties of the underlying spectral curve. Then we use this result, together with appropriate matricial decompositions, to study the canonical factorization of non-meromorphic monodromy matrices that describe deformations of seed monodromy matrices associated with known solutions. This results in new solutions, with unusual features, to the field equations.Comment: 29 pages, 2 figures; v2: reference added, matches published versio

Two exchange-correlation functionals compared for first-principles liquid water

The first-principles description of liquid water using ab initio molecular dynamics (AIMD) based on Density Functional theory (DFT) has recently been found to require long equilibration times, giving too low diffusivities and a clear over-structuring of the liquid. In the light of these findings we compare here the room-temperature description offered by two different exchange correlation functionals: BLYP, the most popular for liquid water so far, and RPBE, a revision of the widely used PBE. We find for RPBE a less structured liquid with radial distribution functions closer to the experimental ones than the ones of BLYP. The diffusivity obtained with RPBE for heavy water is still 20% lower than the corresponding experimental value, but it represents a substantial improvement on the BLYP value, one order of magnitude lower than experiment. These characteristics and the hydrogen-bond (HB) network imperfection point to an effective temperature ~3% lower than the actual simulation temperature for the RPBE liquid, as compared with BLYP's ~17% deviation. The too long O--O average nearest-neighbor distance observed points to an excessively weak HB, possibly compensating more fundamental errors in the DFT description.Comment: Jorunal reference adde

Depletion of chondrocyte primary cilia reduces the compressive modulus of articular cartilage

Primary cilia are slender, microtubule based structures found in the majority of cell types with one cilium per cell. In articular cartilage, primary cilia are required for chondrocyte mechanotransduction and the development of healthy tissue. Loss of primary cilia in Col2aCre;ift88(fl/fl) transgenic mice results in up-regulation of osteoarthritic (OA) markers and development of OA like cartilage with greater thickness and reduced mechanical stiffness. However no previous studies have examined whether loss of primary cilia influences the intrinsic mechanical properties of articular cartilage matrix in the form of the modulus or just the structural properties of the tissue. The present study describes a modified analytical model to derive the viscoelastic moduli based on previous experimental indentation data. Results show that the increased thickness of the articular cartilage in the Col2aCre;ift88(fl/fl) transgenic mice is associated with a reduction in both the instantaneous and equilibrium moduli at indentation strains of greater than 20%. This reveals that the loss of primary cilia causes a significant reduction in the mechanical properties of cartilage particularly in the deeper zones and possibly the underlying bone. This is consistent with histological analysis and confirms the importance of primary cilia in the development of a mechanically functional articular cartilage

Black brane solutions and their solitonic extremal limit in Einstein-scalar gravity

We investigate static, planar, solutions of Einstein-scalar gravity admitting an anti-de Sitter (AdS) vacuum. When the squared mass of the scalar field is positive and the scalar potential can be derived from a superpotential, minimum energy theorems indicate the existence of a scalar soliton. On the other hand, for these models, no-hair theorems forbid the existence of hairy black brane solutions with AdS asymptotics. By considering a specific example (an exact integrable model which has the form of a Toda molecule) and by deriving explicit exact solution, we show that these models allow for hairy black brane solutions with non-AdS domain wall asymptotics, whose extremal limit is a scalar soliton. The soliton smoothly interpolates between a non-AdS domain wall solution at $r=\infty$ and an AdS solution near $r=0$.Comment: 5 pages, no figure

Covariant density functional theory: The role of the pion

We investigate the role of the pion in Covariant Density Functional Theory. Starting from conventional Relativistic Mean Field (RMF) theory with a non-linear coupling of the $\sigma$-meson and without exchange terms we add pions with a pseudo-vector coupling to the nucleons in relativistic Hartree-Fock approximation. In order to take into account the change of the pion field in the nuclear medium the effective coupling constant of the pion is treated as a free parameter. It is found that the inclusion of the pion to this sort of density functionals does not destroy the overall description of the bulk properties by RMF. On the other hand, the non-central contribution of the pion (tensor coupling) does have effects on single particle energies and on binding energies of certain nuclei.Comment: 12 pages, 5 figure