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Вмешательства, направленные на обеспечение выживания новорожденных и детей через непрерывность ухода
Full text linkIMSP Institutul Mamei şi CopiluluiThe purpose of the study was to analyze the coverage and equity of clinical interventions provided to mothers and
children across the continuum of care based on national survey data of the Republic of Moldova.
Material and methods. The data for calculating the Composite Coverage Index (CCA) [1] to measure coverage with interventions across the continuum of maternal and neonatal care from household-based national surveys
[10,11,12,13] have been extracted. The СCA is a weighted average of eight interventions: satisfactory family planning,
at least one antenatal care visit, skilled attendant at delivery, three immunization indicators for a child aged 1 year, oral
rehydration therapy for diarrhea and care-seeking for pneumonia.
Results. We obtained the Composite Coverage Index of 84,59% in 2005 and 84,43% in 2012. The analysis shows a decrease of the total potential contraceptive need from 91,1% to 86,3%, a decrease in unsatisfied demand for family planning:
23% for all women and 29% for women in unions (1997), 7% (2005) and 9,5% (2012). The rate of the use of oral rehydration
therapy with salts has negative dynamics: 61% in 2005 compared to 41,5% in 2012. Other interventions are increasing over
time or are with a minor decrease. Calculating CCI for poorest and richest quintiles of mothers and children, we determined
the increase of the coverage with interventions for the lower quintile from 75,22 (2005) to 79,73 (2012).
Conclusions. The uneven collection of indicators in different national surveys allowed calculating CCI only for the
period between 2005 and 2012. The analysis highlighted the lack of any dynamics of interventions coverage, as well as
the decrease of the unequal coverage with reproductive, maternal, newborn and child health interventions.Цель исследования состояла в анализе охвата и справедливости охвата клиническими вмешательствами,
предоставляемыми матерям и детям через непрерывность процесса непрерывного ухода на основе данных национальных исследований, проведенных в Республике Молдова.
Материал и методы. Из национальных опросов домашних хозяйств [10,11,12,13] были извлечены данные
для расчета Композитного Индекса Охвата (КИО) [1] для измерения охвата вмешательствами в процессе непрерывного ухода матери и ухода за детьми. КИО представляет собой средневзвешенное из восьми вмешательств: удовлетворенный спрос на планирование семьи, по крайней мере, один визит по дородовой помощи, наличие квалифицированного персонала при родах, три показателя вакцинации детей в возрасте до 1 года,
оральная регидратация при диарее у детей и уход при пневмонии.
Результаты. КИО в 2005 году составил 84.59%, а в 2012 году - 84.43%. Анализ показал снижение общей потенциальной нужды в контрацепции от 91,1% до 86,3%, снижение неудовлетворенного спроса на планирование семьи: 23% для всех женщин и 29% для замужних женщин (1997), 7% (2005) и 9,5% (2012). Коэффициент
использования лечения диареи солями пероральной регидратации имеет отрицательную динамику: 61% в 2005
году, по сравнению с 41,5% в 2012 году. Другие вмешательства имеют динамику роста или уменьшились незначительно. Подсчет КИО для самых бедных и богатых квинтилей населения установил рост охвата вмешательствами для бедных квинтилей от 75.22 (2005) до 79,73 (2012).
Выводы. Неравномерный сбор показателей в различных национальных исследованиях позволило рассчитать КИО только в 2005 г. и в 2012 г. Анализ показал отсутствие какого-либо прогресса по охвату вмешательствами, но обнаружил уменьшение неравенства охвата репродуктивными, материнскими, неонатальными и др. вмешательствами
Неврологическое развитие в периоде младенчества новорожденных, которые перенесли в родах острую асфиксию
Full text linkIMSP Institutul Mamei şi CopiluluiGlobally asphyxia at birth is considered a major cause of morbidity and mortality.
Aim of the work: assessment of neurological development by domains of development as well as the analysis of cranial perimeter growth at 2 years of life in newborns who suffered from neonatal encephalopathy.
Material and methods. It was conducted a case-control study that included 104 term newborns who suffered from HIE. The children were examined according to the Bayley Scales of Infant and Toddler Development test – the 3rd edition (2004), cranial perimeter growth was as well examined at 3, 6, 9, 12, 18, and 24 months of life. Of 104 newborns investigated, 29 (group I) suffered from HIE at birth, and 75 were conditionally healthy (group II, of control).
Results. Of the 9 criteria proposed by ACOG (2002) to define asphyxia at birth, we found: HIE in all cases, of which 13,79% cases with severe evolution and 86,21% of cases with average severe evolution; metabolic acidosis in 6,9% of cases; cerebral palsy (CP) in 34,48% of cases; fetal heart rhythm disorders recorded at CTG in 65,52% of cases; Apgar score 0-3 points at 5 minutes of life in 13,79% cases and characteristic imaging signs in 31,3% of cases, evidence of poly-organic dysfunction in 44,83% of cases. Neurodevelopmental retardation in them was found in 62,07% of cases for the expressive domain, in 48,27% of cases for the cognitive domain, and only in 34,48% of cases for a motor domain.
To note that severe retardation in all the domains mentioned constituted around 30% of cases, with minor differences.
At the age of 1 year, we observe a decrease of the cranial perimeter in children from group I compared to the conditionally healthy children (p<0,05).
Conclusions: The prevalence of severe disability in children who suffered from hypoxic events at birth constituted 34,48% of cases, mainly manifested by cerebral palsy or combined with other neurological comorbidities. Neurological development in these children is compromised, mainly on account of expressive and cognitive domains and less of the motor domain. Monitoring of cranial perimeter growth in the case of neonatal encephalopathy helps to early detect the
a downturn of its growth, which is associated with the severity of the neurological pathology.В мире асфиксия в родах является основной причиной смертности и заболеваемости. Цель работы состояла в оценке неврологического развития по функциям развития, а также роста окружности головы в 2 года жизни новорожденных, которые перенесли неонатальную энцефалопатию.
Материалы и методы. Проведено исследование случай-контроль 104 доношенных новорожденных, из них 29 перенесли ГИЭ (1-ая группа) и 75 условно здоровых новорожденных (2-ая группа). Оценка проводилась с помощью теста Bayley Scales of Infant and Toddler Development – третье издание, 2004, а также с измерением
окружности головы в 3, 6, 9, 12, 18 и 24 месяца жизни.
Результаты: из 9 критериев, предложенных АКАГ (2002) для определения асфиксии в родах, было выявлено, что: все новорожденные перенесли ГИЭ, из них тяжелую форму в 13,79% случаях и среднетяжелую - в 86,21% случаях; метаболический ацидоз в 6,9% случаях; ДЦП в 34,48% случаях; нарушения сердечного ритма плода, зарегистрированных на КТГ в 65,52% случаях; оценку Apgar 0-3 балла на 5 минуте жизни в 13,79% случаях, характерные признаки на УЗИ головного мозга в 31,3% случаях, признаки полиорганной недостаточности в 44,83% случаях. В 1 год жизни у детей из 1-ой группы наблюдалось уменьшение окружности головы по сравнению с условно здоровыми новорожденными (p<0,05).
Выводы: распространенность тяжелой инвалидности после асфиксии в родах отмечалась в 34,48% случаях, в основном в виде ДЦП в сочетании с другой неврологической патологией. Неврологическое развитие было нарушено за счет выразительной, познавательной и моторной функций. Мониторинг роста окружности головы позволяет выявить задержку ее роста и тяжесть сопутствующей неврологической патологии
Needs of families with children from neurological risk groups
No full textIntroducere. Familia este cea mai importantă sursă de sprijin pentru
copiii cu nevoi speciale. Fiecare familie are nevoi specifice care necesită a fi
evaluate pentru a cunoaște preferințele lor privind serviciile familiale, dar și
pentru reducerea impactului negativ asupra familiei și sporirea nivelului de
sprijin. Studiul nevoilor familiilor cu copii din grupurile de risc neurologic a
avut ca obiectiv de a identifica nevoile părinților copiilor cu vârsta de până la
doi ani incluși în Programul de supraveghere neonatală.
Materiale și metode. Studiul a fost realizat la IMSP ImșiC. Am
utilizat versiunea revizuită a chestionarului standardizat elaborat de autorii
(Bailey și Blasco, 1990; Bailey și colab., 1992, 1999), care include 35 de itemi
și șapte domenii, adaptat la particularitățile sistemului de sănătate din republică.
Părinții au participat la studiu prin completarea chestionarului autoadministrat
în timpul vizitelor. Au răspuns prin completarea chestionarului 102 părinți din
care 100 (98%) mame, 2 (1,96%) persoane de însoțire și un tată. Chestionarul a
fost propus pentru completare părinților cu copii de diferite vârste (de la 3 la 24
luni) pentru a capta nevoile părinților copiilor în creștere. În total s-au obținut
3366 răspunsuri la întrebările chestionarului, din care 1938 (57,58%)
răspunsuri pozitive, 1076 (31,97%) răspunsuri negative și 352 (10,46%)
răspunsuri „Nu sunt sigur”. Pentru a analiza nevoile părinților în funcție de
existența și severitatea diagnosticului neurologic la copil, am făcut conexiune
dintre nevoile exprimate de părinți cu datele din fișa copilului.
Rezultate. Părinții copiilor incluși în studiu aveau vârsta medie de
28,13 ani, iar vârsta medie a copiilor a fost de 12,11 luni. Părinții au exprimat
cele mai multe răspunsuri pozitive privind nevoia de suport: informațional 580
(81,23%), familial şi social 520 (72,83%) și financiar 312 (43,70%). Fiecare al
patrulea părinte – 177 (24,79%) a menționat nevoia serviciilor de comunitate,
fiecare al cincilea părinte 148 (20,73%) – nevoia de a explica altor persoane
despre starea copilului.
În baza fișelor copiilor aflați la evidența Centrului de supraveghere/ IT
am stabilit diagnosticul clinic la 66 copii, făcând conexiune cu rezultatele interviului părinților. Acești copii au fost divizați în 3 loturi în funcție de
severitatea diagnosticului neurologic (sănătoși, cu patologie de severitate
medie, cu patologie severă) pentru a estima dacă nevoile părinților cresc odată
cu complexitatea cazului de boală la copil. Din totalul de 2178 răspunsuri
obținute de la părinți și atribuite celor 66 copii cu diagnosticul stabilit, cele mai
multe au fost obținute de la 957 (43,93%) părinți ai copiilor fără abateri ale
dezvoltării neurologice, urmate de 825 (37,87%) răspunsuri ale părinților cu
copii cu patologie neurologică de gravitate medie și în ultimul rând de
răspunsurile a 396 (18,18%) părinți cu copii cu patologii severe.
Din cele 209 (45,24%) răspunsuri afirmative invocate de părinți care
au menționat nevoia suportului financiar acestea au prevalat la părinții copiilor
cu maladii severe: 52 (61,90%) față de 84 (41,38%) părinți ai copiilor sănătoși
și 73 (41,71%) părinți ai copiilor cu maladii neurologice medii-grave,
2 13.62,
df 4, p=0.009. Similar, din cele 60 (45,45%) răspunsuri afirmative ale părinților
privind nevoia de suport pentru îngrijirea copilului 19 (79,17%) răspunsuri au
parvenit de la părinții copiilor cu patologie neurologică severă, față de 22
(37,93%) părinți cu copii sănătoși, și 19 (38,00%) părinți cu copii cu patologie
neurologică de gravitate medie,
2 15,09, p=0.005.
Concluzii. Studiul nevoilor părinților a oferit date valoroase despre
nevoile părinților cu copii din grupul de risc neurologic. Mamele au exprimat
cea mai mare nevoie de suport pe domeniile: informațional, familial și social și
financiar. Prezența maladiilor neurologice severe la copii sporește nevoia
părinților în suportul financiar și cel de îngrijire a acestor copii, comparativ cu
părinții copiilor cu maladii neurologice de severitate medie (p<0,05), fapt care
confirmă povara financiară asupra familiei a patologiei neurologice
invalidizante la copil.Introduction. The family is the most important source of support for
children with special needs. Each family has specific needs that need to be
assessed to know their preferences regarding family services, but also to reduce
the negative impact on the family and increase the level of support. The study
of the needs of families with children from neurological risk groups aimed to
identify the needs of parents of children up to two years of age included in the
Neonatal Follow-up Program.
Materials and methods. The study was conducted at the Mother and
Child Institute. We used the revised version of the standardized questionnaire
developed by the authors (Bailey and Blasco, 1990; Bailey et al., 1992, 1999),
which includes 35 items and seven domains, adapted to the particularities of the
health system in the republic. Parents participated in the study by completing
the self-administered questionnaire during the visits. 102 parents responded by
completing the questionnaire, of which 100 (98%) were mothers, 2 (1.96%)
were accompanying persons and one was a father. The questionnaire was
proposed for completion by parents with children of different ages (from 3 to
24 months) in order to capture the needs of parents of growing children. A total
of 3366 responses were obtained to the questionnaire questions, of which 1938
(57.58%) were positive responses, 1076 (31.97%) were negative responses and
352 (10.46%) were “Not sure” responses. In order to analyze the needs of
parents according to the existence and severity of the neurological diagnosis in
the child, we made a connection between the needs expressed by the parents
and the data from the child’s file.
Results. The parents of the children included in the study had an
average age of 28.13 years, and the average age of the children was 12.11
months. Parents expressed the most positive responses regarding the need for
support: informational 580 (81.23%), family and social 520 (72.83%) and
financial 312 (43.70%). Every fourth parent – 177 (24.79%) mentioned the
need for community services, every fifth parent 148 (20.73%) – the need to
explain to other people about the child’s condition. Based on the records of children registered at the Follow-up Center, we
established the clinical diagnosis in 66 children, linking it with the results of the
interview with the parents. These children were divided into 3 groups according
to the severity of the neurological diagnosis (healthy, with moderate pathology,
with severe pathology) to estimate whether the needs of the parents increase
with the complexity of the child’s illness.
Of the total of 2178 responses obtained from parents and attributed to
the 66 children with the established diagnosis, most were obtained from 957
(43.93%) parents of children without neurological developmental
abnormalities, followed by 825 (37.87%) responses from parents of children
with moderate neurological pathology and lastly by the responses of 396
(18.18%) parents of children with severe pathologies.
Of the 209 (45.24%) affirmative responses invoked by parents who
mentioned the need for financial support, these prevailed among parents of
children with severe diseases: 52 (61.90%) compared to 84 (41.38%) parents of
healthy children and 73 (41.71%) parents of children with moderate-severe
neurological diseases,
2 13.62, df 4, p=0.009. Similarly, of the 60 (45.45%)
affirmative responses from parents regarding the need for support for child
care, 19 (79.17%) responses came from parents of children with severe
neurological pathology, compared to 22 (37.93%) parents with healthy
children, and 19 (38.00%) parents with children with moderate neurological
pathology,
2 15.09, p=0.005.
Conclusions. The study of parents’ needs provided valuable data on
the needs of parents with children in the neurological risk group. Mothers
expressed the greatest need for support in the areas of: informational, family
and social, and financial. The presence of severe neurological diseases in
children increases the parents’ need for financial support and care for these
children, compared to parents of children with neurological diseases of medium
severity (p<0.05), which confirms the financial burden on the family of the
disabling neurological pathology in the child
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
Влияние инфекции на смертность, заболеваемость и инвалидность недоношенных новорожденных
Full text linkIMSP Institutul Mamei şi CopiluluiThe purpose of the study was to analyze the rate of infections in newborn mortality and morbidity, as well as the effects of the infectious factor on disability in 2 years of life.
We studied the trend of newborns mortality and morbidity, as well as the proportion of infections that caused causes of neonatal mortality and morbidity in statistical yearbooks of the health system of the Republic of Moldova for 1990-2017 and other statistical forms (32a-san).
To study neurological development status, we extracted from the database of children enrolled in the Newborns at Risk Follow Up Program, carried out in the PMSI Mother and Child Institute, 128 children with a birth weight less than 1500 g depending on the realization (sub-group IA) or on the lack of infection during the neonatal period (sub-group
IB). It is noted that the proportion of this cause of mortality decreases by the child’s five years of age. The proportion of neonatal infection caused by infectious diseases (J12; J14-J16; J18; P35-P39) in morbidity, according to the International
Classification of Disease by the revision X, remains unchanged over the past 10 years (10/1000), while in mortality it remains stable since 2001 (1/1000).
The analysis of neurological pathology in children shows that cerebral palsy was most common in newborns with infection: 6 cases (6,81%) at 1 year, 6 (7,14%) at 1,5 years, and 10 (12, 82%) at 2 years. In newborns without CP infection, it was recorded in about 3% of cases at 1 and 1,5 years. The delay of language was severe in newborns who have
suffered from infections, which shows that, besides the age of gestation, the infection has an impact on the expressive function of neurodevelopment. Speech delay was severe in newborns who suffered from infections, which shows that, besides the age of gestation, the infection has an impact on the expressive function of neurodevelopment.Целью исследования явился анализ удельного веса инфекций в смертности и заболеваемости новорожденного, а также влияние инфекционного фактора на психомоторное развитие недоношенных новорожденных в первые 2 года жизни.
Мы изучили показатели смертности и заболеваемости новорожденных, а также удельный вес инфекций, как причины смертности и заболеваемости в статистических ежегодниках системы здравоохранения республики на 1990-2017 годы и других статистических формах (32a-здор.). Для изучения статуса психомоторного развития новорожденных мы извлекли из базы данных о детях, включенных в программу Follow up при Институте Матери и Ребенка, 128 детей с весом при рождении менее 1500 г в зависимости от реализации (подгруппа IA) или отсутствия инфекции в неонатальном периоде (подгруппа IB).
Отмечается, что доля инфекции, как причины смерти, снижается от 0-6 дней до пятилетнего возраста ребенка. Доля неонатальных инфекций в заболеваемости, вызванных заболеваниями (J12, J14-J16, J18, P35-P39), согласно МКБ X, не изменилась за последние 10 лет, оставаясь стабильной и в смертности новорожденных с 2001 года. Анализ неврологической патологии, обнаруженной у младенцев в зависимости от перенесенной инфекции, указывает на то, что церебральный паралич наиболее распространен у новорожденных с инфекцией: 6 случаев (6,81%) в 1 год, 6 (7,14%) в 1,5 лет и 10 (12,82%) в 2 года. У новорожденных без инфекций он регистрировался примерно в 3% случаев в 1 год и 1,5 года.
Задержка речи была серьезной у новорожденных, перенесших инфекцию, что свидетельствует о том, что, помимо гестационного возраста на эту функцию психомоторного развития оказывает влияние и инфекция
Роль внутриутробной инфекции (ВУИ) в заболеваемости, смертности и инвалидности недоношенных детей
Full text linkIMSP Institutul Mamei şi CopiluluiThe purpose of the study was to determine the incidence, structure, risk factors for MFI developing in premature
newborns, bacteriological profile, the efficacy of diagnostic tests and treatment of this nosology, as well as to determine
neurologic sequelae at 2 years ago.
Material and methods. A prospective cohort study that included 200 premature babies born at MCI was conducted
in 2011-2014. Division of babies per group was performed according to their weight at birth: group I - 86 babies with
birth weight ≤1499g (VLBW) and group II - 114 children weighing intermediate (IW) ≥1500g. Besides anamnestic and
clinical parameters, laboratory indices were studied to confirm the MFI (blood formula and indices calculated on its
basis, C-reactive protein, acid-base balance, procalcitonin, and interleukin 6 (IL-6), instrumental investigations, and
blood culture). Neurological development was assessed in 109 (54,5%) babies.
Results. The overall MFI incidence was 68,0 ‰ and death rate – 170,0‰, with higher rates in VLBW babies –
89,5‰ and 209,3‰, respectively. Among the risk factors commonly associated with MFI are the following: maternal
infectious pathology (52,0%), PRM (67,5%), chorioamnionitis (10,0%), and hyperthermia in birth (6,5%). Gram-positive flora prevails in microbiological profiles (74,2%). The absolute number of neutrophils and the immature/total ratio
showed positive values in 1/3 cases, and the most sensitive pro-inflammatory marker was shown to be IL-6. The first-line antibacterial therapy has corresponded to the standards of good practices.
Conclusions. VLBW newborns have higher risks of developing MFI, whose correct management is based on anamnestic, clinical, and laboratory risk factors, determined in the study, as well as on severe neurological sequelae.Цель исследования заключалась в определении частоты, структуры, факторов риска развития ВУИ у
преждевременно рожденного новорожденного, бактериологического профиля, эффективности диагностических тестов и лечения подобной нозологии, а также в определении неврологических осложнений в возрасте
двух лет.
Материал и методы. Было проведено проспективное когортное исследование, которое включало 200 недоношенных детей, родившихся в ИМиР в 2011-2014 годах. Разделение детей по группам осуществлялось
в соответствии с их весом при рождении: I группа - 86 детей с очень низким весом при рождении ≤1499г
(ОНВР) и II группа - 114 детей с промежуточным весом (ПВ) ≥1500г. Помимо анамнестических и клинических параметров, были изучены лабораторные показатели для подтверждения ВУИ (формула крови и показатели рассчитанные на ее основе, С-реактивный белок, кислотно-щелочной баланс, прокальцитонин и интерлейкин 6 (IL-6), инструментальные исследования и посев крови). У 109 (54,5%) детей было оценено неврологическое развитие.
Результаты. В целом заболеваемость ИМП составила 68,0‰, а уровень смертности - 170,0‰, с более высокими показателями у детей с ОМВР - 89,5‰ и 209,3‰ соответственно. Среди факторов риска, обычно связанных с ВУИ, были определены: материнская инфекционная патология (52,0%), ПРОО
(67,5%), хориоамнионит (10,0%) и гипертермия в родах (6,5%). В микробиологическом профиле преобладает грамположительная флора (74,2%). Абсолютное число нейтрофилов и соотношение незрелых/лым лейкоцитов показали наличие положительных величин в 1/3 случаев, а наиболее чувствительным провоспалительным маркером стал IL-6. Антибактериальная терапия первой линии соответствует стандартам надлежащих практик.
Выводы. Новорожденные с ОНВР больше подвержены риску развития ВУИ, надлежащее ведение которой
основано на анамнестических, клинических и лабораторных факторах риска, определенных в ходе исследования, а также тяжелым неврологическим осложнениям
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