Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis.

BACKGROUND: What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable. OBJECTIVES: To develop a conceptualisation of RMC. SEARCH STRATEGY: Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies. SELECTION CRITERIA: Primary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date. DATA COLLECTION AND ANALYSIS: A combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings. MAIN RESULTS: Sixty-seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent. CONCLUSIONS: This review presents an evidence-based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes. TWEETABLE ABSTRACT: Understanding respectful maternity care - synthesis of evidence from 67 qualitative studies.

Development of a novel hybrid Ti6Al4V-ZrO2 surface with high wear resistance by laser and hot pressing techniques for dental implants.

The development of implant metal-free surfaces has gained attention since non-benefic results have been reported related to the metallic ions released from metal implants to the human body. Ceramic coatings have been proposed as a possible solution however, the detachment of these coatings, during implantation or even in function, can compromise its function. In order to overcome this problem, this work proposes a novel hybrid Ti6Al4V-ZrO2 surface, starting with laser texturing of the Ti6Al4V substrate by Laser Nd:YV04, followed by the allocation of the zirconia (ZrO2) powder and its subsequent sintering by hot pressing process. Results revealed that zirconia strongly adheres to titanium textured surfaces since no detachment was found under tribological and adhesion scratch tests. Moreover, the tribological results showed that the incorporation of zirconia into textured titanium surface reduces significantly the wear rate of titanium (≈93%), which is a good indicator of low metallic particles/ions released to the body. These results suggest that this novel surface with good aesthetic properties and improved wear resistance (given by zirconia) and mechanical resistance (from titanium) can be a promising solution for dental implants, especially for implant/abutment or abutment/ceramic contact zones, and thus have a huge impact on the long-term performance of implants.

Novel laser textured surface designs for improved zirconia implants performance.

The development of new surface designs to enhance the integration process between surgically placed implants and biological tissues remains a challenge for the scientific community. In this way and trying to overcome this issue, in this work, laser technology was explored to produce novel textures on the surface of green zirconia compacts produced by cold pressing technique. Two strategies regarding line design (8 and 16 lines design) and different laser parameters (laser power and number of laser passages) were explored to assess their influence on geometry and depth of created textures. The produced textures were evaluated with Scanning Electron Microscopy (SEM) and it was observed that well-defined textured surfaces with regular geometric features (cavities or pillars) were obtained by laser combining different strategies lines design and parameters. The potential of proposed textures was also evaluated regarding surface wettability, friction performance (static and dynamic coefficient of friction evolution) against bone, aging resistance and flexural strength. Results demonstrated that all the produced textures display a super hydrophilic or hydrophilic behavior. Regarding the friction behavior, it was experimentally observed a high initial static coefficient of friction (COF) for all produced textures. Concerning the aging resistance, all the textured surfaces revealed a low monoclinic content, less than 25% after 5 h of hydrothermal aging. The flexural strength results showed that the mechanical resistance of zirconia was not significantly compromised with the laser action. Based on the obtained results, it is possible to prove that the processing route used for manufacturing the new and different surface designs (cold pressing technique followed by laser texturing) showed to be particularly effective for the production of zirconia implants with customized surface designs according to the properties required in a specific application. These new surface designs besides to enhance the surface wettability and also to improve the fixation at the initial moment of the implantation, do not significantly compromise the resistance to aging and the mechanical performance of zirconia. Hence, a positive impact on the long-term performance of the zirconia implants may be expected with the proposed novel laser textured surface designs.

Damping and mechanical behavior of metal-ceramic composites applied to novel dental restorative systems.

Conversely to natural teeth, where periodontal ligament (PDL) and pulp works as a damper reducing the effect of the stress on surrounding structures, when natural teeth is lost and replaced or restored the biting forces are directly transmitted to the bone or affect the integrity of the adjacent bottom layers. In this study, damping capacity and dynamic Young's modulus of CoCrMo-porcelain composites for dental restorations were evaluated. Dynamic Young's modulus and damping capacity of materials were assessed by dynamic mechanical analyzes (DMA) at 1 and 10 Hz frequencies, over a temperature ranging (18-60 °C). Results show that by reinforcing dental porcelain with metallic particles, producing ceramic matrix composites (CMCs) with 20 vol% and 40 vol% of metallic particles, the damping capacity and dynamic Young's modulus are improved. A decrease on both properties of the metal matrix composites (MMCs) with increasing ceramic particles content (from 20 vol% to 40 vol% of ceramic phase) was observed for all the studied frequencies and temperatures. While damping capacity is strongly dependent on frequency, no significant difference in dynamic Young's modulus was found. Results show that besides the yet reported advantages of the bio-inspired functionally graded restorations over traditional bilaminate ones, traduced by improved veneer to substrate adhesion and by the enhanced thermal and mechanical stress distribution, these restorations can also display improved behavior as regard to a damping capacity, which may have a positive impact in the long-term performance of implant - supported prosthesis.

Y-TZP/porcelain graded dental restorations design for improved damping behavior - A study on damping capacity and dynamic Young's modulus.

The development of dental restorative materials that mimic tooth-like properties provided by graded structures, aesthetics and properties such as strength, damping capacity and the ability for a continuous remodeling according to the biomechanical solicitation is a great challenge. In this work, damping capacity and dynamic Young's modulus of Y-TZP/porcelain composites for all-ceramic dental restorations were studied. These mechanical properties were assessed by dynamic mechanical analyses (DMA) at frequencies of 1, 5 and 10 Hz, over a temperature ranging from 0 to 60 °C, simulating extreme conditions when a cold or hot drink is experienced. The results showed that porcelain and porcelain-matrix composites exhibited higher damping capacity while Y-TZP and Y-TZP-matrix composites presented higher dynamic Young's modulus. Furthermore, while damping capacity is strongly influenced by the temperature, no significant difference in dynamic Young's modulus was found. For both damping and modulus properties, no significant influence of frequency was found for the tested materials. Based on the obtained results and also on the known advantages of the graded Y-TZP/porcelain structures over traditional bi-layer solutions (e.g., improved bending strength, enhanced mechanical and thermal stress distribution), a novel design of all-ceramic restoration with damping capacity has been proposed at the end of this study. A positive impact on the long-term performance of these all-ceramic restorations may be expected.

Endothelium-dependent vasodilator effect of Euterpe oleracea Mart. (Açaí) extracts in mesenteric vascular bed of the rat.

Açai (Euterpe oleracea Mart.) a fruit from the Amazon region, largely consumed in Brazil is rich in polyphenols. Experiments were undertaken to determine whether hydro-alcoholic extract obtained from stone of açaí induces a vasodilator effect in the rat mesenteric vascular bed precontracted with norepinephrine (NE) and, if so, to elucidate the underlying mechanism. Açai stone extract (ASE, 0.3-100 microg) induced a long-lasting endothelium-dependent vasodilation that was significantly reduced by N(G)-nitro-l-arginine methyl ester (l-NAME) and (1)H-[1,2,3] oxadiazolo [4,4-a] quinoxalin-l-one (ODQ) and abolished by KCl (45 mM) plus l-NAME. In vessels precontrated with NE and KCl (45 mM) or treated with K(Ca)(+2) channel blockers (charybdotoxin plus apamin), the effect of ASE was significantly reduced. However this effect is not affect by indomethacin, glybenclamide and 4-aminopiridine. Atropine, pyrilamine, yohimbine and HOE 140 significantly reduced the vasodilator effect of acetylcholine, histamine, clonidine and bradykinin, respectively, but did not change the vasodilator effect of ASE. In cultured endothelial cells ASE (100 microg/mL) induced the formation of NO that was reduced by N(G)-nitro-l-arginine (l-NA, 100 microM). The present study demonstrates that the vasodilator effect of ASE is dependent on activation of NO-cGMP pathway and may also involve endothelium-derived hyperpolarizing factor (EDHF) release. The vasodilator effect suggest a possibility to use ASE as a medicinal plant, in the treatment of cardiovascular diseases.

Factors that Influence Mycobacterium bovis Infection in Red Deer and Wild Boar in an Epidemiological Risk Area for Tuberculosis of Game Species in Portugal.

Bovine tuberculosis (bTB) is a worldwide zoonotic disease of domestic and wild animals. Eradication has proved elusive in those countries with intensive national programmes but with ongoing transmission between wildlife and cattle. In Portugal, a high-risk area for bTB was defined and specific measures implemented to assess and minimize the risk from wildlife. Data from the 2011 to 2014 hunting seasons for red deer (Cervus elaphus) and wild boar (Sus scrofa) were analysed with bovine demographic and bTB information to assess factors that determined the occurrence and distribution of bTB in both species. The likelihood of bTB-like lesions in wild boar was positively associated with density of red deer, wild boar and cattle, while for red deer, only their density and age were significant factors. The likelihood of Mycobacterium bovis isolation in wild boar was associated with density of cattle and red deer and also with the anatomical location of lesions, while for red deer, none of the variables tested were statistically significant. Our results suggest that, in the study area, the role of red deer and wild boar may be different from the one previously suggested by other authors for the Iberian Peninsula, as red deer may be the driving force behind M. bovis transmission to wild boar. These findings may assist the official services and game managing bodies for the management of hunting zones, what could also impact the success of the bTB eradication programme.

Delphinidin and cyanidin inhibit PDGF(AB)-induced VEGF release in vascular smooth muscle cells by preventing activation of p38 MAPK and JNK.

BACKGROUND AND PURPOSE: Red wine polyphenols (RWPs) inhibit the expression of vascular endothelial growth factor (VEGF), a major pro-angiogenic and pro-atherosclerotic factor, in vascular smooth muscle cells (VSMCs). The aim of this study was to identify which red wine polyphenols were inhibitory and to determine the mechanism underlying the inhibitory effects. EXPERIMENTAL APPROACH: Release of VEGF stimulated by platelet derived growth factor(AB) (PDGF(AB)), from human aortic VSMCs was measured by immunoassay and phosphorylation of kinases by Western blot analysis. The direct antioxidant properties of polyphenols were determined by electron paramagnetic resonance and the cellular formation of reactive oxygen species (ROS) by dichlorofluorescein. KEY RESULTS: The inhibitory effect of RWPs on PDGF(AB)-induced release of VEGF was mimicked by delphinidin but not by quercetin, catechins, resveratrol, gallic acid or caffeic acid. In the anthocyanin class, not only delphinidin but also cyanidin prevented VEGF release whereas malvidin and peonidin were without effect. RWPs, delphinidin and cyanidin directly scavenged ROS and prevented the PDGF(AB)-induced formation of ROS in VSMCs. Malvidin and peonidin did not scavenge ROS but prevented the cellular formation of ROS. Although the p38 MAPK, ERK1/2 and JNK pathways have been involved in the PDGF(AB)-induced expression of VEGF, in our experiments, only phosphorylation of p38 MAPK and JNK was inhibited by RWPs, delphinidin and cyanidin. CONCLUSIONS AND IMPLICATIONS: Anthocyanins presenting a hydroxyl residue at position 3' are able to inhibit PDGF(AB)-induced VEGF expression by preventing activation of p38 MAPK and JNK in VSMCs.

Critical analysis of the application of Bayes' theorem to sequential testing in the noninvasive diagnosis of coronary artery disease.

The utility of Bayes' theorem in the noninvasive diagnosis of coronary artery disease (CAD) was analyzed in 147 patients who underwent electrocardiographic stress testing, thallium-201 perfusion imaging and coronary angiography. Eighty-nine patients had typical anginal chest discomfort and 58 had atypical chest pain. Sensitivity and specificity of the tests and prevalence of CAD at each level of testing were tabulated and compared with the results generated from Bayes' theorem. The sensitivity of electrocardiographic stress was higher in patients with multivessel CAD than in patients with 1-vessel CAD. Sensitivity, but not specificity, of each test was dependent, in part, on the result of the other test. However, the probabilities calculated from Bayes' theorem when used for sequential testing are remarkably close to the tabulated data. Thus, Bayes' theorem is useful clinically despite some evidence of test dependence. Sequential test analysis by Bayes' theorem is most useful in establishing or ruling out a diagnosis when the pretest prevalence is approximately 50% and when the 2 tests are concordant.

Inoculation of BALB/c mice with Lacazia loboi.

In a previous study, the authors inoculated Swiss mice with Lacazia loboi (L. loboi) and succeeded in maintaining a granulomatous infiltrate and viable fungal cells up to one year and six months after inoculation. Considering the experimental work on paracoccidioidomycosis, 0.03 ml of a fungal suspension obtained from a biopsy of a Jorge Lobo's Disease patient were inoculated into both hind foot pads of 32 six week-old BALB/c mice of both sexes. The animals were sacrificed 1, 4, 7 and 10 months post inoculation. The suspension contained 1.3 x 10(6) fungi/ml and presented 38% viability. Seven months after inoculation, most of the animals presented profuse infiltrates consisting of isolated histiocytes, foreign body and Langhans' giant cells and a large number of fungi, most of them viable. Emergence of macroscopic lesions was observed during the 8th month. Based on fungal count, viability index before and after inoculation, presence of macroscopic lesions and histopathological findings similar to the findings in humans, the authors believe that BALB/c mice may be a good experimental model to study Jorge Lobo's Disease, mainly regarding therapeutic evaluation.

Jorge Lobo's disease: experimental inoculation in Swiss mice.

Sixty-four isogenic Swiss mice were intradermically inoculated in both hind foot pads. The inocula, consisting of fungal suspensions from biopsies obtained from Jorge Lobo's Disease patients, had the total number of fungi and the viability index determined using a Neubauer chamber and the fluorescein diacetate-ethidium bromide technique (FD-EB), respectively. The animals were sacrificed at times ranging from ten days to eighteen months after inoculation. The cellular infiltrate, mainly consisting of macrophages containing fungi, increased progressively up to end of the study; however, no macroscopic alterations were observed in the inoculated feet. After nine months, small numbers of Langhans' giant cells started to appear in the infiltrate. A considerable number of fungi was observed at the end of the experimental period, but only a few were viable when stained by the FD-EB technique. This fact suggests that there is a multiplication of fungal cells, which are destroyed by the macrophages but remain in the tissue for a long time due perhaps to the difficulties in their elimination. These findings led us to conclude that in spite of the maintenance of the infection in these animals, Swiss mice cannot be considered an ideal model to study Jorge Lobo's Disease. However, the authors call attention to the possibility of other mouse strains being more susceptible to Paracoccidioides loboi.

[Epidemiologic aspects of the dialysis treatment in Grande São Paulo. Comissão Regional de Nefrologia da Secretaria da Saúde de São Paulo and Centro de Informática da Escola Paulista de Medicina]. / Aspectos epidemiológicos do tratamento dialítico na Grande São Paulo. Comissão Regional de Nefrologia da Secretaria da Saúde de São Paulo e Centro de Informática da Escola Paulista de Medicina.

OBJECTIVE: Epidemiological data about the treatment of patients with end-stage renal disease in the Great Sao Paulo, Brazil, are presented. MATERIAL AND METHODS: Patients on dialysis in the city of Sao Paulo and surroundings, distributed in 15 Regional Offices of Health (ERSAs), during 1991, were studied. Data were collected by the Secretary of Health of the State of Sao Paulo. RESULTS: There was an increase of 18.6% in the number of alive patients on dialysis from January 1 to December 31 (n = 2,425 to 2,875). Patients were treated in 40 dialysis centers, of which 24 were located in the ERSAs 1, 2 and 3. Depending on the ERSA, a percentage of patients varying from 37% to 88% did not live in the same region where they received treatment. At the end of the year, 79% of the patients were on hemodialysis, 15% on continuous ambulatory peritoneal dialysis and 6% on intermittent peritoneal dialysis. The diagnoses more frequently reported of primary disease were non-determined, glomerulonephritis, hypertension and diabetes (36%, 27%, 17% and 8%, respectively). New cases (1,483) initiated dialysis during the year, corresponding to an incidence rate of 83 patients per million population (pmp). The prevalence of patients on dialysis was 148 pmp. The annual fatality rate was 17.2% (range in the ERSAs: 12.0-3.5). The actuarial one year survival for the patients who started treatment in 1991 was 80.2%. 246 patients received transplantation, corresponding to 14 patients pmp. CONCLUSIONS: Dialysis treatment provided in the Great Sao Paulo is satisfactory.(ABSTRACT TRUNCATED AT 250 WORDS)

Temporal variation of chemical composition and relaxant action of the essential oil of Ocimum gratissimum L. (Labiatae) on guinea-pig ileum.

The medicinal plant Ocimum gratissimum L. (Labiatae) is widely encountered in the Northeast of Brasil where it is used to treat digestive problems. Its leaves have an essential oil (EOOG) content whose chemical composition varies according to the time of plant collection. We have compared the effects of the EOOG, collected at 08:00 a.m. (EOOG8) and at 12:00 a.m. (EOOG12), on the relaxation of guinea-pig isolated ileum. Both EOOG8 and EOOG12 (30-300 microg/ml) reversibly relaxed the spontaneous tonus of the guinea-pig ileum in a concentration-dependent manner, with similar IC50 values (49.3 and 23.8 microg/ml, respectively). The magnitude of the decrease in resting tonus was similar to that of the recognised smooth muscle relaxant papaverine. EOOG8 and EOOG12 relaxed 60 mM KCl-precontracted preparations similarly (38.33 +/- 9.91 microg/ml and 35.53 +/- 6.70), whereas a significantly more potent relaxant effect of EOOG12 compared to EOOG8 was observed when tissues were contracted using 10 microM acetylcholine (IC50 values of 69.55 +/- 4.93 and 128.16 +/- 15.70 microg/ml, respectively; p < 0.05). The principal constituents of the essential oil, eugenol and cineole, also relaxed KCl-precontracted preparations, although they were less potent than EOOG, suggesting that they alone were not responsible for EOOG-induced relaxations. Our results show that the essential oil extracted from the leaves of O. gratissimum L., collected at different time periods, exerts significant relaxant effects on isolated guinea-pig ileum which may underlie the therapeutic action of the plant.

The assessment of pitch discrimination ability in young children.

This study tested the hypothesis that some tasks used in assessing pitch discrimination ability may instead by assessing children's ability to deal with relational language. Five tasks were given to 36 normal children who were equally divided into three age groups, six to six and one-half years, seven to seven and one-half years, and eight to eight and one-half years of age. Task 1 involved a training procedure to assess the children's ability to hear the differences in the pitch of two tones, which were an octave apart. A simple motor response was required. Task 2 assessed the children's ability to label these tones as high or low. Task 3 assessed their ability to compare two tones and label the second as higher or lower than the first. Task 4 examined their ability to label as high or low the position of a man on a ladder. Task 5 examined their ability to compare the positions of two men on two ladders and say whether the second man was higher or lower than the first. Results indicated that children who make pitch discriminations as demonstrated by nearly perfect scores on Task 1 often fail to demonstrate those discriminations on tasks requiring relational language. A comparison of Tasks 2 and 3 to Tasks 4 and 5 suggests that children in the age range studied are less proficient in applying high-low and higher-lower to pitch than to spatial relations.

Experimental reproduction of the Jorge Lobo's disease in BAlb/c mice inoculated with Lacazia loboi obtained from a previously infected mouse.

Long-term maintenance of Lacazia loboi in the laboratory has not been reported. We report here the use BALB/c mice to maintain the Lacazia loboi for extended period of time. Eight to ten week-old mice were inoculated intradermally in both hind footpads with a fungal suspension from a macerated footpad obtained from an original mouse previously infected with the fungi and sacrificed 8 months after inoculation. The inoculated animals were sacrificed at different time intervals, footpads were excised, the right one was submitted to histopathological examination and the left one was macerated in sterile saline for fungal count and viability index determination. The inoculated animals presented the histopathological picture identical to the mice previously inoculated with material from human lesion. Granulomatous infiltrates with predominance of macrophages and giant cells were observed. The granulomas evolved progressively as observed in the different times of sacrifice. After 7 months of inoculation, macroscopic lesions were observed, and the number of fungi obtained from macerated footpads was higher than the number of inoculated fungi. The pattern of lesion development was similar to what was observed in animals infected with a fungal suspension obtained from a human lesion. Considering the histopathological findings, the clinical manifestations, and the finding of a higher number of fungi obtained than the inoculated into footpads of each mice, we believe the BALB/c mice strain is as an excellent way to maintain L. loboi in laboratory. Moreover, even after serial passages of the fungi, the granulomatous lesions are reproduced consistently in laboratory conditions.

Evaluation of the vital staining method for Lacazia loboi through the experimental inoculation of BALB/c mice.

The viability of the currently unculturable fungal pathogen Lacazia loboi can be determined by means of fluorescein diacetate-ethidium bromide (FD-EB) staining. This technique can be used in experimental study of the mycosis, in attempts to cultivate the fungus and in attempts to gauge the success of therapies. In the present study, the potential applications of FD-EB vital staining were studied using a proposed murine experimental model of lobomycosis. BALB/c mice were inoculated in the footpads with an L. loboi suspension that appeared in FD-EB staining to have lost viability after being held for 15 days at room temperature, whereas a control group of mice was inoculated with apparently viable fungi. The animals were killed after 1, 2, 4, 6, 8, 11 and 13 months. Both inoculated footpads were excised, one for determination of viability and the other for histological examination. In the group injected with nonviable material, no active infection was noted; inoculation sites showed small quantities of macrophage-laden infiltrate and no viable fungal cells. In the control group, the infection progressed with exuberant infiltrates surrounding copious fungal growth, most of which consisted of cells staining as viable in FD-EB. These results suggest that the FD-EB vital staining is a sensitive and specific method that can reliably be used for viability determination in L. loboi.

Quantitative thallium-201 imaging: limitations in detecting pathophysiologically significant obstructive coronary artery disease.

Washout of thallium-201 after stress testing has been proposed as a method of detecting abnormal zonal myocardial perfusion without relating it to a reference "normal" area. Therefore, 18 patients with single-vessel coronary artery disease, undergoing percutaneous transluminal coronary angioplasty, underwent maximum stress testing and thallium imaging. A myocardial perfusion defect was seen in the immediate postexercise images in all 19 zones (one patient studied twice) supplied by the vessel with the obstructive lesion. Delayed images showed improvement in 15 of the 19 segments. Of the four zones which did not improve, three had evidence of a prior nontransmural myocardial infarction. Quantitative analysis of washout curves showed that counts decreased in 17 of 19 zones after background subtraction and in all 19 zones if background was not subtracted. In the corresponding normal zones directionally similar decreases in counts were seen. Thus washout characteristics were similar for both diseased and normal zones. These data indicate that washout curves are limited in their ability to detect the presence of a physiologically significant lesion.

A sequential approach to the diagnosis of coronary artery disease using multivariate analysis.

There has been considerable interest in recent years in enhancing the accuracy of noninvasive tests in diagnosing coronary artery disease. The recognition that no currently available test is a perfect predictor has led to the use of probability analysis as a means of assessing the presence or absence of coronary disease. In this article we present a multivariate approach to the diagnosis of coronary disease. One hundred forty-seven patients undergoing coronary angiography, thallium-201 imaging, and exercise ECG were studied. Patients were classified according to age, sex, and typical vs atypical chest pain. Sequential stepwise logistic regression analysis was performed to develop probability statements prior to testing, after exercise ECG, and after exercise ECG and thallium-201. The results indicate that this sequential approach can be used to develop strategies for the diagnosis of coronary disease in the same way as Bayes' theorem, while permitting integration of multiple characteristics into one model.