Promotion of WHO feeding recommendations: a model evaluating the effects on HIV-free survival in African children.

In Africa, HIV and feeding practices deeply affect child mortality. To prevent mother-to-child transmission, the World Health Organization recommends exclusive breastfeeding for 6 months and replacement feeding when acceptable, feasible, affordable, and sustainable. Determining the proportion and number of children saved with exclusive breastfeeding and replacement feeding is essential to design and implement crucial nationwide policies. Using data on 31 sub-Saharan countries and a decision tree for risk assessment, the authors estimated the number of children's lives potentially saved according to 6 scenarios that combine exclusive breastfeeding for 6 months or replacement feeding with 3 promotion strategies. Among all HIV-negative children born to HIV-positive mothers who die in sub-Saharan Africa per year, 52,315 (9.6%) would be saved yearly with exclusive breastfeeding versus 21,638 (4.0%) with replacement feeding. Promotion support would double these numbers (110,625 vs 45,330; ie, 20.3% vs 8.3%), and with additional prenatal group education, 132,633 versus 54,192 lives would be saved (24.3% vs 9.9%). Wherever replacement feeding is not possible, exclusive breastfeeding with promotion support and prenatal group education would save 1 of 4 exposed children.

[Qualitative evaluation of the enforcement of the perinatal decree--strengthening mechanisms for over-medicalisation]. / Evaluation qualitative de l'application du décret périnatalité. Un renforcement des mécanismes de la surmédicalisation.

In France, the policy on decentralisation and the organisation of prenatal care is governed and mandated by a decree issued in 1998 whose objective is to improve prevention of pre-maturity and prenatal risks. Within this context, 49 maternal and child health professionals were interviewed by using a qualitative questionnaire to evaluate the implementation and enforcement of the decree specifically in the region of Lyon. This report presents an analysis of the mechanisms and psychosocial issues of the over-medicalisation of birth. This over-medicalisation stems from the inseparable interactions between the ranking of skills within a firm hierarchy - linked in and of itself to the hierarchical status of health facilities - and the progression of attributing the birthing process as one with is more disease-based, surgically-based and judicially-based.

Calciuria and preeclampsia: a case-control study.

OBJECTIVE: The aim of this study was to compare calciuria of preeclamptic cases to normotensive controls among pregnant women hospitalized in the French West Indies obstetrics department. STUDY DESIGN: This case-control study included 47 preeclamptic women and 50 controls. The main outcome was 24h urinary calcium excretion rate. Serum levels of creatinine, calcium and uric acid were also analyzed. A logistic regression analysis has been performed to investigate the relationship between hypocalciuria and preeclampsia after having taken into account prognostic preeclampsia factors and pertinent clinical criteria. RESULTS: Women with preeclampsia had significantly lower calciuria than normotensive patients (1.5 mmol/24h+/-1.0 versus 6.0 mmol/24h+/-4.2, p=0.0001). After taking into account gestational age at hospitalization, body mass index and nulliparity, hypocalciuria was significantly associated with preeclampsia (ORa=21.74; 95% CI, 6.9-66.7). The diagnosis value of a calciuria less than 2.1 mmol/24h is interesting because of its negative predictive value (97%), but its positive predictive value is weak (42%). CONCLUSION: In our population, preeclamptic women had a calciuria significantly lower than controls.

Risk of influenza-like illness in an acute health care setting during community influenza epidemics in 2004-2005, 2005-2006, and 2006-2007: a prospective study.

BACKGROUND: The person-to-person transmission of influenza-like illness (ILI) and influenza has been described mostly in long-term care units. Studies in acute hospital settings are rare and mostly retrospective. METHODS: We prospectively estimated the relative risk (RR) of hospital-acquired (HA) ILI during hospitalization according to in-hospital exposures to contagious individuals. Surveillance of ILI and laboratory-confirmed influenza was undertaken at Edouard Herriot Hospital (1100 beds) during 3 influenza seasons. A total of 21 519 patients and 2153 health care workers (HCWs) from 2004 to 2007 were included. The RR of HA-ILI in patients was calculated according to exposure to other contagious patients and HCWs. RESULTS: For patients exposed to at least 1 contagious HCW compared with those with no documented exposure in the hospital, the RR of HA-ILI was 5.48 (95% confidence interval [CI], 2.09-14.37); for patients exposed to at least 1 contagious patient, the RR was 17.96 (95% CI, 10.07-32.03); and for patients exposed to at least 1 contagious patient and 1 contagious HCW, the RR was 34.75 (95% CI, 17.70-68.25). CONCLUSIONS: Hospitalized patients exposed to potentially infectious patients and HCWs with ILI inside the hospital are at greater risk for HA-ILI. Such results identify priorities regarding preventive measures for seasonal or pandemic influenza.

[Value of morbidity and mortality review conferences for physician education and improvement of care quality and safety: a literature review]. / Intérêt des revues de mortalité et de morbidité pour la formation des médecins et l'amélioration de la qualité et de la sécurité des soins : revue de la littérature.

BACKGROUND: In France, national incentives promote the development of morbidity and mortality conferences (M&MC) in hospitals. OBJECTIVE: A systematic literature review was performed to investigate the effectiveness of M&MC as well as how they were conducted and how participants experienced them. DATABASES: The review was carried out by searching the MEDLINE and PASCAL databases and included articles in English and French. The following keywords were used: mortality, morbidity, conference, rounds, review, meetings, committee. STUDY SELECTION: Two independent reviewers selected all original studies describing or evaluating M&MC and published from 1st January 2002 through 31st December 2008. RESULTS: We analyzed 17 articles, of which 11 reported structured interviews, 3 analyzed M&MC minutes, 2 monitored indicators, and 1 described observations of M&MC. They showed good physician participation and a wide variety of types of meeting organization. Attendance by paramedical staff, the number of cases covered per meeting, and case selection criteria affected their content. Studies of the efficacy of M&MC were rare and concerned specific topics (digestive endoscopy and childbirth). STUDY LIMITATIONS: Both the methods and the objectives of studies analyzing M&MC are heterogeneous. CONCLUSION: The published studies viewed M&MC as a valuable tool for physician education and quality assurance, but the factors associated with their effectiveness require further study.

Ajuste oclusal pós-tratamento ortodôntico em pacientes que não apresentam disfunção temporomandibular / Occlusal adjustment post orthodontic treatment in patients which had not showed disorders of temporomandibular joint

O objetivo deste trabalho foi realizar uma revisão da literatura a respeito da necessidade do ajuste oclusal por desgaste seletivo pós-tratamento ortodôntico em pacientes que não apresentavam disfunção temporomandibular, visto que é um procedimento clínico que tem como finalidade obter uma estabilidade mandibular, livre de prematuridades e interferências oclusais. Após revisar a literatura, desde 1899 até 2003, chegou-se à conclusão que o ajuste oclusal pode ser indicado após o tratamento ortodôntico a fim de se obter uma estabilidade mandibular adequada, livre de interferências oclusais, que sabemos causam recidivas e problemas articulares. Porém, o ajuste oclusal por desgaste seletivo, deve ser feito com muito critério, pois qualquer falha em seu planejamento ou execução leva a danos irreversíveis para o paciente.

The aim of this project was to review of literature about the necessity of occlusal adjustment post orthodontic treatment in patients which hadn't showed disorders of temporomandibular joint(TMJ). The occlusal adjustment is one clinic procedure that get mandibular stability, without occlusal interferences. After the review of literature, from 1899 until 2003, we concluded that the occlusal adjustmentcould be indicate after the orthodontic treatment with the purpose of to obtain the mandibular stability, without occlusal interferences, which are the motive of releapse and articular problems of TMJ. It is very important to remember that the occlusal adjustment must be do with very criterion and attention, because some defect in their planning or performance, take to irreparable damages of our patients.

Avaliação e mensuração da sutura palatina mediana por meio da radiografia oclusal total digitalizada em pacientes submetidos à expansão rápida maxilar / Evaluation and measurement of midpalatal suture through the digitalized occlusal radiography in patients submitted to rapid maxillary expansion

OBJETIVOS: avaliar e mensurar a sutura palatina mediana por meio de radiografias oclusais totais de maxila digitalizadas, antes e depois da sua disjunção. MÉTODOS: a amostra constou de 17 pacientes, com idades entre 7 e 22 anos. Radiografias oclusais totais da maxila foram executadas antes e depois da abertura da sutura palatina mediana, e digitalizadas em scanner HP Scanjet 6110 C com adaptador de transparências HPC 6261 6100 C, utilizando-se o programa Deskscan II. Para a avaliação e medição, foi utilizado o programa Radioimp® (Radiomemory, MG/Brasil). Na análise estatística, foram utilizados a média, o desvio-padrão, o coeficiente de variação e os testes "t" e ANOVA. CONCLUSÕES: após os resultados, foi possível concluir que (1) na região dos incisivos, houve uma abertura palatina mediana estatisticamente significativa; (2) houve abertura de diastema entre os incisivos centrais superiores em torno de 69,37 por cento dos casos; (3) houve uma maior abertura da sutura palatina mediana na região a 10mm a partir da crista para posterior, em comparação com a região a 3mm para posterior do parafuso expansor; (4) na região a 3mm para posterior do parafuso expansor houve uma abertura de 35,97 por cento, e na região a 10mm para posterior da crista uma abertura de 69,37 por cento.

AIM: to evaluate and to measure the midpalatal suture through digitalized occlusal radiographies before and after its disjunction. METHODS: The sample was comprised by 17 patients, with ages from 7 to 22 years. Occlusal radiographies of these patients were obtained before and after the suture's opening. The occlusal radiographies were digitalized in a HP Scanjet 6100 C scanner with the HPC 6261 6100 C transparencies adaptor and the Deskscan II software. The statistical analysis used average, standard deviation, variation coefficient, "t" test and ANOVA. CONCLUSIONS: After the results, it was possible to conclude that: (1) statistically, there was a significant midpalatal opening in the incisors area; (2) there was an opening in the diastema between upper central incisors in about 69.37 percent of the cases; (3) there was a bigger midpalatal suture opening in the 10mm area from the crest to posterior than in the 3mm area to posterior from the screw; (4) in the 3mm area to posterior from the screw there was an opening of 35.97 percent and in the 10mm area to posterior of the crest there was an opening of 69.37 percent.

Estudo das densidades base e velamento obtidas de filmes radiográficos em diferentes condições de processamento / Study of base-plus-fog densities assessed from radiographic films in different processing conditions

Os autores neste trabalho comparam as densidades base e velamento de quatro filmes radiográficos: Ultra-speed; D;E e Insight (Eastman Kodak Company, Rochester, E.U.A.) utilizando-se o processamento automático roller. Tabelacomparativa foi construída para os quatro filmes utilizando-se duas condições de processamento e a mesma solução processadora (Kodak Readymatic). Todos os filmes foram processados automaticamente utilizando-se o equipamento AT2000 com velocidades normal e endospeed. Análise comparativa foi realizada para avaliar a densidade base e velamento para cada filme e processamento. As maiores densidades base e velamento, foram alcançadas nos três filmes (D, E e Insight) utilizando-se o equipamento AT2000 com velocidade normal. As DBV foram as mesmas para o filme Ultra-speed em ambos os métodos de processamento. Todos os filmes devem ser processados utilizando-se o sistema roller (AT2000) com velocidade normal para alcançar densidade base e velamento ideal. A utilização do sub-processamento (Endospeed) causa redução da DBV para os filmes D, E e Insight. O filme Ultra-speed é o único que apresenta estabilidade da DBV neste método