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141.
Marcos Augusto Bastos Dias Rosa Maria Soares Madeira Domingues Arthur Orlando Corrêa Schilithz Marcos Nakamura-Pereira Maria do Carmo Leal 《Reproductive health》2016,13(3):114
Background
The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. 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).Methods
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.Results
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?<?4 cm 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.Conclusions
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.142.
Sonia Duarte de Azevedo Bittencourt Rosa Maria Soares Madeira Domingues Lenice Gnocchi da Costa Reis Márcia Melo Ramos Maria do Carmo Leal 《Reproductive health》2016,13(3):120
Background
In Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies.Methods
Nationwide cross-sectional hospital-based study “Birth in Brazil: national survey into labor and birth” conducted in 2011–2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the X 2 test to detect differences in categorical variables with the level of statistical significance set at p <0.05.Results
Global rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p?<?0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 %?×?24.4 % public hospitals; 40.3 %?×?10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU.Conclusions
The majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment.143.
Maria do Carmo Leal Ana Paula Esteves-Pereira Marcos Nakamura-Pereira Jacqueline Alves Torres Mariza Theme-Filha Rosa Maria Soares Madeira Domingues Marcos Augusto Bastos Dias Maria Elizabeth Moreira Silvana Granado Gama 《Reproductive health》2016,13(3):127
Background
The rate of preterm birth has been increasing worldwide, including in Brazil. This constitutes a significant public health challenge because of the higher levels of morbidity and mortality and long-term health effects associated with preterm birth. This study describes and quantifies factors affecting spontaneous and provider-initiated preterm birth in Brazil.Methods
Data are from the 2011–2012 “Birth in Brazil” study, which used a national population-based sample of 23,940 women. We analyzed the variables following a three-level hierarchical methodology. For each level, we performed non-conditional multiple logistic regression for both spontaneous and provider-initiated preterm birth.Results
The rate of preterm birth was 11.5 %?, (95 % confidence 10.3 % to 12.9 %) 60.7 % spontaneous - with spontaneous onset of labor or premature preterm rupture of membranes - and 39.3 % provider-initiated, with more than 90 % of the last group being pre-labor cesarean deliveries. Socio-demographic factors associated with spontaneous preterm birth were adolescent pregnancy, low total years of schooling, and inadequate prenatal care. Other risk factors were previous preterm birth (OR 3.74; 95 % CI 2.92–4.79), multiple pregnancy (OR 16.42; 95 % CI 10.56–25.53), abruptio placentae (OR 2.38; 95 % CI 1.27–4.47) and infections (OR 4.89; 95 % CI 1.72–13.88). In contrast, provider-initiated preterm birth was associated with private childbirth healthcare (OR 1.47; 95 % CI 1.09–1.97), advanced-age pregnancy (OR 1.27; 95 % CI 1.01–1.59), two or more prior cesarean deliveries (OR 1.64; 95 % CI 1.19–2.26), multiple pregnancy (OR 20.29; 95 % CI 12.58–32.72) and any maternal or fetal pathology (OR 6.84; 95 % CI 5.56–8.42).Conclusion
The high proportion of provider-initiated preterm birth and its association with prior cesarean deliveries and all of the studied maternal/fetal pathologies suggest that a reduction of this type of prematurity may be possible. The association of spontaneous preterm birth with socially-disadvantaged groups reaffirms that the reduction of social and health inequalities should continue to be a national priority.144.
Telma Pereira Francisco L. Ferreira Sandra Cardoso Dina Silva Alexandre de Mendonça Manuela Guerreiro Sara C. Madeira for the Alzheimer’s Disease Neuroimaging Initiative 《BMC medical informatics and decision making》2018,18(1):137
Background
Predicting progression from Mild Cognitive Impairment (MCI) to Alzheimer’s Disease (AD) is an utmost open issue in AD-related research. Neuropsychological assessment has proven to be useful in identifying MCI patients who are likely to convert to dementia. However, the large battery of neuropsychological tests (NPTs) performed in clinical practice and the limited number of training examples are challenge to machine learning when learning prognostic models. In this context, it is paramount to pursue approaches that effectively seek for reduced sets of relevant features. Subsets of NPTs from which prognostic models can be learnt should not only be good predictors, but also stable, promoting generalizable and explainable models.Methods
We propose a feature selection (FS) ensemble combining stability and predictability to choose the most relevant NPTs for prognostic prediction in AD. First, we combine the outcome of multiple (filter and embedded) FS methods. Then, we use a wrapper-based approach optimizing both stability and predictability to compute the number of selected features. We use two large prospective studies (ADNI and the Portuguese Cognitive Complaints Cohort, CCC) to evaluate the approach and assess the predictive value of a large number of NPTs.Results
The best subsets of features include approximately 30 and 20 (from the original 79 and 40) features, for ADNI and CCC data, respectively, yielding stability above 0.89 and 0.95, and AUC above 0.87 and 0.82. Most NPTs learnt using the proposed feature selection ensemble have been identified in the literature as strong predictors of conversion from MCI to AD.Conclusions
The FS ensemble approach was able to 1) identify subsets of stable and relevant predictors from a consensus of multiple FS methods using baseline NPTs and 2) learn reliable prognostic models of conversion from MCI to AD using these subsets of features. The machine learning models learnt from these features outperformed the models trained without FS and achieved competitive results when compared to commonly used FS algorithms. Furthermore, the selected features are derived from a consensus of methods thus being more robust, while releasing users from choosing the most appropriate FS method to be used in their classification task.145.
Who still remains at risk of arrhythmic death at time of implantable cardioverter‐defibrillator generator replacement?
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146.
147.
Barros JH Almeida AB Figueiredo FB Sousa VR Fagundes A Pinto AG Baptista C Madeira MF 《Transactions of the Royal Society of Tropical Medicine and Hygiene》2012,106(7):419-423
Trypanosoma caninum is a parasite of the Trypanosoma genus recently described in the natural infection of dogs in the municipality of Rio de Janeiro, Brazil. Suspecting the existence of a natural cycle and the circulation of this new species, the objective of this study was the taxonomic identification of samples of Trypanosoma spp. isolated from dogs in different Brazilian regions. Parasites were solely obtained from skin fragments culture and characterized by nested-PCR targeting the partial sequence of 18S rRNA gene and PCR products were sequenced. Thirty-three samples, obtained in S?o Paulo, Minas Gerais, Goiás, Mato Grosso and Rio de Janeiro states were analyzed. PCR and sequencing showed that the isolates were genetically identical or closely similar and confirmed T. caninum identity. This report broadens the geographical distribution of T. caninum in Brazil and discusses the impact of the presence of this parasite in areas of canine leishmaniasis occurrence. 相似文献
148.
Di Beneditto AP Bittar VT Camargo PB Rezende CE Kehrig HA 《Archives of environmental contamination and toxicology》2012,62(2):264-271
The present study raised the hypothesis that the trophic status in a tropical coastal food web from southeastern Brazil can
be measured by the relation between total mercury (THg) and nitrogen isotope (δ15N) in their components. The analysed species were grouped into six trophic positions: primary producer (phytoplankton), primary
consumer (zooplankton), consumer 1 (omnivore shrimp), consumer 2 (pelagic carnivores represented by squid and fish species),
consumer 3 (demersal carnivores represented by fish species) and consumer 4 (pelagic-demersal top carnivore represented by
the fish Trichiurus lepturus). The values of THg, δ15N, and trophic level (TLv) increased significantly from primary producer toward top carnivore. Our data regarding trophic
magnification (6.84) and biomagnification powers (0.25 for δ15N and 0.83 for TLv) indicated that Hg biomagnification throughout trophic positions is high in this tropical food web, which
could be primarily related to the quality of the local water. 相似文献
149.
Gonzaga Carla Castiglia Garcia Paula Pontes Wambier Letícia Maíra Prochnow Fernanda Harumi Oku Madeira Luciano Cesar Paulo Francisco 《Clinical oral investigations》2022,26(8):5129-5142
Clinical Oral Investigations - This systematic review was performed to determine the main cause of technical failure of tooth-supported zirconia crowns and fixed partial dentures (FPDs),... 相似文献
150.
Fábio José Fabrício de Barros Souza Anne Rosso Evangelista Juliana Veiga Silva Grégory Vinícius Périco Kristian Madeira 《Jornal brasileiro de pneumologia》2016,42(1):55-60