Rio de Janeiro, Brazil
Rio de Janeiro, Brazil

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Homer C.S.E.,University of Technology, Sydney | Dias M.A.B.,Instituto Fernandes Figueira FIOCRUZ | Ten Hoope-Bender P.,Institute Cooperacion Social Integrare | Sandall J.,King's College London | Speciale A.M.,Autonomous University of Barcelona
The Lancet | Year: 2014

We used the Lives Saved Tool (LiST) to estimate deaths averted if midwifery was scaled up in 78 countries classified into three tertiles using the Human Development Index (HDI). We selected interventions in LiST to encompass the scope of midwifery practice, including prepregnancy, antenatal, labour, birth, and post-partum care, and family planning. Modest (10%), substantial (25%), or universal (95%) scale-up scenarios from present baseline levels were all found to reduce maternal deaths, stillbirths, and neonatal deaths by 2025 in all countries tested. With universal coverage of midwifery interventions for maternal and newborn health, excluding family planning, for the countries with the lowest HDI, 61% of all maternal, fetal, and neonatal deaths could be prevented. Family planning alone could prevent 57% of all deaths because of reduced fertility and fewer pregnancies. Midwifery with both family planning and interventions for maternal and newborn health could avert a total of 83% of all maternal deaths, stillbirths, and neonatal deaths. The inclusion of specialist care in the scenarios resulted in an increased number of deaths being prevented, meaning that midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care. © 2014 Elsevier Ltd.

Lima P.A.T.,Clinica Perinatal Laranjeiras | Lima P.A.T.,Instituto Fernandes Figueira FIOCRUZ | Lima P.A.T.,Federal University of Fluminense | De Carvalho M.,Clinica Perinatal Laranjeiras | And 6 more authors.
Jornal de Pediatria | Year: 2014

Objectives to determine the rate of extrauterine growth restriction in very low birth weight infants and to evaluate the influence of perinatal variables, clinical practices, and neonatal morbidities on this outcome. Methods a longitudinal study was performed in four neonatal units in the city of Rio de Janeiro. 570 very low birth weight infants were analyzed. The study included perinatal variables, variables related to clinical practices, and incident morbidities in these preterm infants. Extrauterine growth restriction was defined using z-scores for weight or head circumference ≤ -2 for corrected age. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) and R software. Results this study comprised 570 infants, of which 49% were males, and 33% were small for gestational age (SGA). The mean weight and head circumference at birth were 1,113 ± 267 g and 27 ± 2 cm, respectively. The mean z-scores of birth weight and weight at discharge were -0.96 ± 0.78 and -1.54 ± 0.75, respectively; for head circumference, the mean z-scores at birth and at discharge were -0.63 ± 1.18 and -0.45 ± 0.94, respectively. The rate of extrauterine growth restriction considering the weight was 26% (149/570) and considering the head circumference, 5% (29/570). SGA was the variable with the greatest impact on both growth restriction for weight (PR = 4.33) and for head circumference (PR = 2.11) in adjusted analyses. Conclusion extrauterine growth restriction was high in the population, especially for SGA newborns and those with neonatal morbidities. © 2013 Sociedade Brasileira de Pediatria.

De Carvalho M.,Instituto Fernandes Figueira Fiocruz | Mochdece C.C.,Instituto Fernandes Figueira Fiocruz | Sa C.A.M.,Instituto Fernandes Figueira Fiocruz | Lopes Moreira M.E.,Instituto Fernandes Figueira Fiocruz
Acta Paediatrica, International Journal of Paediatrics | Year: 2011

Aim: To describe the clinical approach to term and near-term newborn infants with severe hyperbilirubinaemia and to analyse the effect of high-intensity phototherapy on total serum bilirubin (TSB) levels. Methods: We analysed a cohort of 116 newborn infants with severe nonhaemolytic hyperbilirubinaemia (TSB ≥ 20 mg? dL ? 342 lmol ? L). All patients were treated with high-intensity phototherapy. The main outcomes were reduction in TSB levels in the first 24 h of phototherapy, incidence of exchange transfusion, pathological brainstem auditory evoked responses and pathological findings on neurological examination at discharge. Results: The mean birth weight and gestational age were 3161 ± 466 g and 37.8 ± 1.6 weeks. Mean initial TSB concentration was 22.4 ± 2.4 mg? dL. Per cent decreases in TSB after 2, 4, 6, 12, 18 and 24 h of phototherapy were 9.4%, 16%, 23%, 40%, 44% and 50%, respectively. No infant was treated with exchange transfusion. Brainstem evoked response audiometry (BAER) was performed in 100% of the patients, and in three of them, this examination was altered. However, when repeated 3 months later, these BAER examinations were normal. Neurological examination was normal in all patients. Conclusions: High-intensity phototherapy significantly reduces TSB in nonhaemolytic severe hyperbilirubinaemia and decreases the need for exchange transfusion. ©2011 The Author(s)/Acta Pædiatrica ©2011 Foundation Acta Pædiatrica.

Ribeiro C.R.,Instituto Fernandes Figueira Fiocruz | Gomes R.,Instituto Fernandes Figueira Fiocruz | Moreira M.C.N.,Instituto Fernandes Figueira Fiocruz
Ciencia e Saude Coletiva | Year: 2015

In this theoretical essay we aim to discuss paternity as a health issue in the context of contemporary gender roles by considering two lines of argument: (a) paternity, parenting and rearrangements of gender roles; and (b) paternity and parenting as a mutual relationship based on care. In our discussion, we highlight the inclusion of men in the health system from the point of view of paternity. At present this appears to be operating in an instrumental manner, with the mother-infant dyad still a major concern and men not being viewed as individuals with rights to health. Thus, we seek to question the system itself, in relation to its perceptions of the current state of paternity, by taking into consideration recent discussions about gender and sexuality as well as and new family arrangements that may challenge beliefs about the roles of families, fathers and mothers, which have impacts on care. Among other aspects, we conclude that we need to reinvent ourselves because we were not raised under the aegis of diversity and we were also not trained as professionals with a basis in the current problematic divisions that exist between father/mother and sex/gender, among many other previous certainties, all of which does not always help us to promote actions in the area of health. © 2015 Associacao Brasileira de Pos - Graduacao em Saude Coletiva. All righrts reserved.

Horovitz D.D.G.,Instituto Fernandes Figueira FIOCRUZ | Magalhaes T.D.S.P.C.,Instituto Fernandes Figueira FIOCRUZ | Costa A.P.,Instituto Fernandes Figueira FIOCRUZ | Carelli L.E.,Instituto Nacional Of Traumato Ortopedia | And 3 more authors.
Molecular Genetics and Metabolism | Year: 2011

Spinal cord compression (SCC) is a known complication of mucopolysaccharidosis type VI (MPS VI) secondary to atlantoaxial subluxation, craniovertebral stenosis, posterior longitudinal ligament hypertrophy, or dural thickening. SCC is expected to occur in the natural history of the disease, regardless of enzyme replacement therapy (ERT), as intravenous enzyme does not cross the blood-brain barrier. We describe six MPS VI children with SCC, all diagnosed before 7. years of age. Within this group, four of the children were diagnosed with SCC after the introduction of ERT. We hypothesize that these patients may illustrate the previously undetected risk of increased joint mobility caused by ERT which may have contributed to increased cervical instability by loosening the neck joint, thus leading to or unmasking SCC. We reinforce the need for close follow-up of SCC, periodic neurological assessment, spine imaging, and neurophysiology in all MPS VI patients before and during ERT. Neurophysiological abnormalities may precede changes in MRI images (as shown in patients 4 and 5 from this sample) and should, therefore, be accessed in MPS VI patient evaluations, allowing for timely intervention and better prognosis. We recognize the limitations of these data due to the small sample size and recommend further investigation into this patient population. © 2011 Elsevier Inc.

Itzkovitz B.,Montreal Childrens Hospital Research Institute | Jiralerspong S.,Montreal Childrens Hospital Research Institute | Nimmo G.,Montreal Childrens Hospital Research Institute | Loscalzo M.,University of South Florida | And 7 more authors.
Human Mutation | Year: 2012

Rhizomelic chondrodysplasia punctata (RCDP) is a disorder of peroxisome metabolism resulting from a deficiency of plasmalogens, a specialized class of membrane phospholipids. Classically, patients have a skeletal dysplasia and profound mental retardation, although milder phenotypes are increasingly being identified. It is commonly caused by defects in the peroxisome transporter, PEX7 (RCDP1), and less frequently due to defects in the peroxisomal enzymes required to initiate plasmalogen synthesis, GNPAT (RCDP2) and AGPS (RCDP3). PEX7 transports AGPS into the peroxisome, where AGPS and GNPAT partner on the luminal membrane surface. The presence of AGPS is thought to be required for GNPAT activity. We present six additional probands with RCDP2 and RCDP3, and the novel mutations identified in them. Using cell lines from these and previously reported patients, we compared the amounts of both AGPS and GNPAT proteins present for the first time. We used protein modeling to predict the structural consequences of AGPS mutations and transcript analysis to predict consequences of GNPAT mutations, and show that milder RCDP phenotypes are likely to be associated with residual protein function. In addition, we propose that full GNPAT activity depends not only on the presence of AGPS, but also on the integrity of substrate channeling from GNPAT to AGPS. © 2011 Wiley Periodicals, Inc.

Henriques C.,Federal University of Rio de Janeiro | Henriques C.,Instituto Nacional Of Ciencia E Tecnologia Em Biologia Estrutural E Biomagens Inbeb | Henriques-Pons A.,Laboratorio Of Inovacoes Em Terapias | Meuser-Batista M.,Laboratorio Of Inovacoes Em Terapias | And 5 more authors.
Parasites and Vectors | Year: 2014

Background: The development of techniques that allow the imaging of animals infected with parasites expressing luciferase opens up new possibilities for following the fate of parasites in infected mammals. Methods. D-luciferin potassium salt stock solution was prepared in phosphate-buffered saline (PBS) at 15 mg/ml. To produce bioluminescence, infected and control mice received an intraperitoneal injection of luciferin stock solution (150 mg/kg). All mice were immediately anesthetized with 2% isofluorane, and after 10 minutes were imaged. Ex vivo evaluation of infected tissues and organs was evaluated in a 24-well plate in 150 μg/ml D-luciferin diluted in PBS. Images were captured using the IVIS Lumina image system (Xenogen). Dissected organs were also evaluated by microscopy of hematoxylin-eosin stained sections. Results: Here we describe the results obtained using a genetically modified Dm28c strain of T. cruzi expressing the firefly luciferase to keep track of infection by bioluminescence imaging. Progression of infection was observed in vivo in BALB/c mice at various intervals after infection with transgenic Dm28c-luc. The bioluminescent signal was immediately observed at the site of T. cruzi inoculation, and one day post infection (dpi) it was disseminated in the peritoneal cavity. A similar pattern in the cavity was observed on 7 dpi, but the bioluminescence was more intense in the terminal region of the large intestine, rectum, and gonads. On 14 and 21 dpi, bioluminescent parasites were also observed in the heart, snout, paws, hind limbs, and forelimbs. From 28 dpi to 180 dpi in chronically infected mice, bioluminescence declined in regions of the body but was concentrated in the gonad region. Ex vivo evaluation of dissected organs and tissues by bioluminescent imaging confirmed the in vivo bioluminescent foci. Histopathological analysis of dissected organs demonstrated parasite nests at the rectum and snout, in muscle fibers of mice infected with Dm28c-WT and with Dm28c-luc, corroborating the bioluminescent imaging. Conclusion: Bioluminescence imaging is accurate for tracking parasites in vivo, and this methodology is important to gain a better understanding of the infection, tissue inflammation, and parasite biology regarding host cell interaction, proliferation, and parasite clearance to subpatent levels. © 2014 Henriques et al.; licensee BioMed Central Ltd.

de Oliveira M.I.C.,Federal University of Fluminense | Hartz Z.M.A.,New University of Lisbon | do Nascimento V.C.,Federal University of Fluminense | da Silva K.S.,Instituto Fernandes Figueira Fiocruz
Revista Brasileira de Saude Materno Infantil | Year: 2012

Objectives: To evaluate the implantation of the baby-friendly hospital initiative in Rio de Janeiro. Methods: An evaluative study was carried out in 2009 at seven baby-friendly hospitals (BFHs) and eight non-accredited hospitals (NAHs) forming part of the Brazilian National Health System. Evaluation of the structure (Steps 1 and 2) was carried out by way of observation and interviews with 215 staff members. Evaluation of the process (steps 3 to 10) involved interviews with a representative sample of 461 pregnant women, 687 mothers on the wards and 148 mothers with a newborn in a neonatal unit. The degree of implantation was assessed in terms of the fulfillment of each step and the parameters covered by it. The correlation between the degree of implantation and outcomes was analyzed using linear regression: Breastfeeding (BF) in the first hour of life, exclusive breastfeeding (EBF) and the satisfaction of the women with the care provided. Results: The degree of implantation varied from 9 to 5 steps (90.6% to 70.1% of parameters) completed at the BFHs and 5 to 1 steps (76.1% to 43.9% of parameters) at the NAHs. A significant linear correlation was found between the degree of implantation, expressed in terms of steps and parameters, respectively and BF in the first hour of life (r=0.78 and r=0.74), EBF (r=0.72 and r=0.69), and satisfaction (r=0.69 and r=0.73). Conclusions: Both forms of evaluation were shown to be consistent with the results. The BFHs performed better than the NAHs and there is therefore a need for investment in the sustainability of this initiative.

PubMed | Instituto Nacional Of Infectologia Evandro Chagas Fiocruz, Instituto Fernandes Figueira FIOCRUZ and Escola Nacional Saude Publica Sergio Arouca FIOCRUZ
Type: Journal Article | Journal: Reproductive health | Year: 2016

The rate of cesarean delivery (CD) in Brazil has increased over the past 40years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS).This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95% confidence intervals.The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with<4cm of dilatation, a decision late in pregnancy for CD, and the use of analgesia were associated with a greater risk for CD. Favorable advice for vaginal birth during antenatal care, induction of labor, and the use of any good practices during labor were protective factors for CD. The type of professional who attended birth was not significant in the final analyses, but bivariate analysis showed a higher use of good practices and a smaller proportion of epidural analgesia in women cared for by at least one nurse midwife.The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns. Information and support for vaginal birth during antenatal care, avoiding early admission, and promoting the use of good practices during labor assistance can reduce unnecessary CD. Considering the experience of other countries, incorporation of nurse midwives in childbirth care may increase the use of good practices during labor.

PubMed | Perinatal Maternity Hospital and Instituto Fernandes Figueira FIOCRUZ
Type: Journal Article | Journal: Journal of neonatal-perinatal medicine | Year: 2016

The objective of the present study was to evaluate adverse perinatal outcome in a group of high order pregnancies pared with singletons by BW and GA at birth.Data was reviewed for all admissions of triplets and quadruplets in a 7 year period. For each study neonate we selected two singleton infants to constitute a control group. Variables analyzed included: respiratory distress syndrome, patent ductus arteriosus, intraventricular hemorrhage, necrotizing enterocolitis (NEC), bronchopulmonary dysplasia, retinopathy of prematurity and periventricular leukomalacia.We studied a total of 128 multiple and 260 singleton infants. Mean gestational age and birth weight were similar in both groups (31.3 2,5 wks e 31.5 2,8 wks; 1470 461g vs 1495 540g). There was no significant difference between the groups in the majority of main morbidities. The incidence of NEC was higher in triplets (6.3 vs 0.8%, p value <0.01). Mortality was higher in singletons (9.6 vs 3.1%, p value <0.037).Results show that major neonatal outcomes are very similar between multiples and singletons births when paired by gestational age and birth weight. NEC remained a significant morbidity in infants born from multiple gestations after adjustment for maternal and neonatal risk factors.

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