Prenatal Care for Adolescents and attributes of Primary Health Care

Objective

evaluate prenatal care for adolescents in health units, in accordance with the attributes of Primary Health Care (PHC) guidelines.

Method

quantitative study conducted with health professionals, using the Primary Care Assessment Tool-Brazil to assess the presence and extent of PHC attributes.

Results

for all the participating units, the attribute Access scored ≤6.6; the attributes Longitudinality, Coordination (integration of care), Coordination (information systems) and Integrality scored ≥6.6, and the Essential Score ≤6.6. Comparing basic units with family health units, the attribute scores were equally distributed; Accessibility scored ≤6.6, the others attributes scored ≥6.6; however, in the basic units, the Essential Score was ≤6.6 and, in the family health units, ≥6.6.

Conclusion

expanding the coverage of family health units and the training of professionals can be considered strategies to qualify health care.     

The accuracy of transrectal ultrasound in predicting the pathological stage of low-lying rectal cancer after preoperative chemoradiation therapy

Purpose: There has been a growing interest in the use of preoperative radiation therapy in rectal cancer treatment in the last years. The need for accurate preoperative staging is important so as to avoid overtreatment in stage I patients, and to select patients who require downstaging prior to surgery as they are technically inoperable. While transrectal ultrasound (TRUS) has been reported to accurately stage preoperative patients, its efficacy postradiation has been questioned. The authors report a series studied by TRUS to contribute to the discussion on the role of this method.

Methods and Materials: Twenty-eight patients with rectal cancer were accrued. Twenty-six patients, clinically staged T2-T4 or/and N1-N3 between March 1990 to October 1993, underwent preoperative chemoradiation. Two patients (T2N0) were treated by local excision and postoperative radiotherapy. Following therapy and just before surgery, each patient was restaged by TRUS. These results were subsequently compared with a pathological stage of resected specimen for both the primary tumor (T) and regional lymph nodes (LN).

Results: The accuracy of TRUS for T stage after chemoradiation was 92.8% (positive predictive value [PPV] 94.4%, negative predictive value [NPV] 90.0%). The accuracy for LN staging after chemoradiation was 60.7% (PPV 100.0%, NPV 54.0%), because LN located outside the scanning range were missed.

Conclusion: Based on our results, we conclude that TRUS of the primary tumor is an accurate staging technique for patients with rectal cancer treated with preoperative chemoradiation.     

Intravenous recombinant interferon-beta versus interferon-alpha-2b and ribavirin in combination for short-term treatment of chronic hepatitis C patients not responding to interferon-alpha. Multicenter Interferon Beta Italian Group Investigators.

BACKGROUND: Little is known about the therapeutic role of intravenous interferon-beta in chronic hepatitis C patients unresponsive to a previous treatment with interferon-alpha. METHODS: Two hundred interferon-alpha non-responders were randomized to receive either intravenous recombinant interferon-beta or interferon-alpha-2b and ribavirin for 12 weeks. The responders in both groups were followed up for a further 48 weeks. RESULTS: At week 12 a biochemical and virologic response was documented in 42% of the patients treated with interferon-beta and in 22% of the patients treated with combination therapy. A sustained response was observed in 21% of the patients treated with interferon-beta and in 13% of those treated with combination therapy, with similar differences on intention-to-treat analysis. CONCLUSIONS: Short-term treatment with intravenous interferon-beta seems to offer a chance for sustained response in a subset of interferon-alpha non-responders. The role of long-term therapy in these patients still remains to be explored.     

Quantitative assessment of portal vein flow in subjects with active chronic hepatitis: comparison of magnetic resonance angiography with bolus tracking with color Doppler ultrasonography]

PURPOSE: To assess the accuracy of time-of-flight MR Angiography (MRA) with bolus tracking in evaluating mean blood velocity and flowrate in the portal vein in patients with chronic hepatitis versus healthy volunteers. MATERIAL AND METHODS: Fifteen patients with clinically-defined post-viral chronic hepatitis (viruses B and C) were examined with bolus tracking MRA and color Doppler US to evaluate portal blood flow. Both examinations were performed before and after a 1500 kcal meal. We evaluated mean blood flow velocity and flowrate in the portal vein. MRA results were compared with color Doppler findings; the results in chronic hepatitis patients were compared with those of healthy volunteers. RESULTS: The correlation between mean portal blood velocity, as measured with MRA and color Doppler US, was r = .82 before and r = .79 after the meal. There was no significant difference in mean velocity between the chronic hepatitis patients and the healthy volunteers. The correlation between portal flowrate, as measured with MRA and color Doppler US, was r = .87 before and r = .91 after the meal. There was no significant difference in mean flowrate between the chronic hepatitis patients and the healthy volunteers. In contrast, there were significant differences in mean velocity and portal flowrate, as measured with MRA before the meal, between the chronic hepatitis patients and the healthy volunteers. DISCUSSION AND CONCLUSIONS: Bolus tracking MRA is superior to color Doppler US in quantitating blood flow in the portal vein and evaluating changes after a meal. Decreased mean velocity and flowrate may indicate impaired function, as it happens in early chronic hepatitis.     

The prognostic value of postoperative seizures following epilepsy surgery

Among 55 patients undergoing temporal lobectomy for refractory epilepsy, patients with seizures in the week following surgery had a poor long-term, seizure-free outcome compared with patients without seizures. Outcome for patients with single seizures or seizures restricted to the first postoperative day seemed favorable compared with patients with multiple or later seizures. Seizure type and similarity to preoperative events did not predict outcome.     

Interaction Behaviors of Bilingual Parents With Their Young Children With Autism Spectrum Disorder

Given concerns that bilingual exposure might confuse children with disabilities—including autism spectrum disorder (ASD)—bilingual parents may restrict exposure to one language, often the community-dominant language. We investigated a potential consequence of this decision; the possibility that non-native language use might influence parental communicative behaviors during interaction with the child. We recruited 39 parent–child dyads, each with a young child with ASD (mostly boys) and parent/carer (mostly mothers). Parents were either monolingual speakers of community-dominant English (n = 20) or bilingual with English as the second language (n = 19). We confirmed our assumption that the latter group would have significantly poorer non-native English language via standardized assessment of expressive vocabulary, and ensured children were matched on age, ASD symptoms, and developmental level. We sampled parent–child interaction—including in each of bilinguals’ native and non-native languages—and coded parents’ amount and complexity of speech, communicative synchrony, and imitations and expansions of their child’s speech. Few differences presented across bilingual parents’ native versus non-native language samples, but this group showed reduced synchrony and use of expansions compared to monolinguals. Further, bilinguals’ English-language knowledge was associated with self-reported comfort using this language and with two coded interaction measures. These empirical data only partially support qualitative accounts that non-native language use may influence bilingual parents’ interaction behaviors with their young children. With growing rates of ASD diagnosis and increasing cultural/linguistic diversity around the world, further dedicated clinical and experimental attention to this issue is clearly warranted.     

Is there a best approach for extracorporeal life support cannulation: a review of the extracorporeal life support organization

Background

Neurologic complications are common, and amongst the most devastating complications in pediatric patients undergoing extracorporeal life support (ECLS). Carotid artery cannulation (CAN) has been associated with an increase in these complications, thereby shaping practices to avoid this approach in most pediatric patients in which other cannulation approaches are viable.

Mapping the organization of atrial fibrillation with basket catheters. Part II: Regional patterns in chronic patients

The aim of this study was to investigate the spatial patterns of organization of fibrillation in the right atrium using bipolar recordings from a basket catheter in a population of 17 patients with persistent AF. The number of occurrences (NO) (i.e., the number of points laying on the baseline) was used as an objective measure of organization. This parameter significantly matches Wells' criteria for the classification of bipolar recordings during AF. The anatomic correspondence of the splines with eight atrial regions (namely anterior free wall, lateral free wall, posterolateral free wall, posterior free wall, posterior atrial septum, atrial septum, tricuspid valve, and anterior tricuspid valve) was assessed by fluoroscopic projections and electrogram morphology. Each region was further divided into high, mid-high, mid-low, and low segments. It was observed that individual and well-defined patterns of organization characterize the electrical activity of the right atrium in patients with persistent AF. When observed over 10 minutes, these patterns are rather stable in time. In each patient, the NO measurements were significantly different in the various right atrium regions (P < 0.0001 for all patients, Friedman test). The NO averaged over the population was significantly different among the regions (P < 0.001, Kruskal-Wallis test), owing to a common disorganized pattern observed in the tricuspid valve and anterior tricuspid valve regions. When these regions were removed from the analysis, the differences among the remaining regions were not statistically significant (P = 0.77). In conclusion, the quantitative assessment of organization in the entire right atrium showed an individual rather than common distribution. This may have implications in the choice of regions candidate for ablation.     

Cardiac autonomic imbalance in patients with reversible ventricular dysfunction takotsubo cardiomyopathy

BACKGROUND: Although in reversible takotsubo cardiomyopathy (TC), wall motion generally recovers dramatically within a few weeks, there are few data on changes in autonomic function in this condition. AIM: To investigate cardiac autonomic function in the acute and chronic phases of TC. METHODS: Ten patients with TC (mean age 70.1 +/- 13.7 years) underwent cardiac catheterization on the first hospital day, when left ventricular (LV) ejection fraction (EF) was calculated. A Holter electrocardiographic study was performed within 3 days after the onset of symptoms (0 months) and 3 months after discharge (3 months). The standard deviation of the mean cycle length of normal-normal R-R (NN) intervals over 24 h (SDNN), and the 24-h standard deviation of the mean value of the difference between the NN intervals for each 5-min segment (SDANN), were calculated according to time-area analysis of heart rate variability over 24 h. Frequency domain analysis was also done. RESULTS: Coronary angiography in the acute and chronic phases revealed no significant stenosis in any TC patient. LV wall motion returned to normal in 17.6 +/- 6.4 days. LVEF was 45.7 +/- 8.8% in the acute phase and 69.8 +/- 6.8% after the improvement of wall motion (p < 0.001). Between 0 months and 3 months, SDNN and SDANN improved significantly, from 88.8 +/- 35.5 to 109.5 +/- 33.4 ms (p = 0.01) and from 79.9 +/- 34.7 to 99.3 +/- 40.3 ms (p = 0.03), respectively. No significant changes were observed in frequency domain parameters. DISCUSSION: These results support our previous hypothesis that TC might be caused by neurogenic stunning of the myocardium, due to acute autonomic dysfunction.