The objective of this study was to explore a possible association between infant mortality rate (IMR) and Medicaid dental benefit payouts per state, as well as propose an expansion of the dental benefits provided through Medicaid. Data was obtained from the Vital Statistics report 2012 and the Center for Medicare & Medicaid Services (CMS) Medicaid coverage database for fiscal year 2011. Population and demographic data was also collected for further comparison. The states observed were Alabama, Georgia, Kentucky, Louisiana, North Carolina, South Carolina, and Tennessee. The IMR data was ranked in ascending order and then the dental payments were compared between the seven southern states. There did not appear to be an association between the two variables. It was hypothesized that the state with the highest IMR would have the least amount of Medicaid dental payments; possibly indicating limited benefits and a need for expansion. The data did not support the hypothesis. Although Mississippi had the highest IMR at 9.9 per 1,000 live births, the amount dental benefits paid through Medicaid was not the lowest. Kentucky had the lowest IMR at 6.9 per 1,000 live births, and North Carolina had the highest amount of dental payments with $352,602 being paid by the state. However, the comparing variable in each state did not reflect an association. Limitations of the study were addressed and suggested improvements were made for future studies that would possibly yield significant findings. In conclusion, the data collected and observed did not provide evidence that the expansion of Medicaid dental benefits would combat infant mortality rates across the country.

Orientador: Roberto Calderon Gonçalves / Coorientador: Fernando José Benesi / Banca: Simone Biagio Chiacchio / Banca: Ivan Roque de Barros Filho / Resumo: Considerando a representatividade da bovinocultura de leite em nosso país, a preocupação com índices de mortalidade dos animais torna-se cada vez maior. No que se refere à mortalidade em bezerros, a Síndrome de Angústia Respiratória (SAR) tem importante relevância no período perinatal, sendo causada pela inadequada produção do surfactante no pulmão imaturo. Animais advindos de técnicas como fertilização in vitro e clonagem são acometidos pela SAR com maior frequência, assim como neonatos prematuros. O líquido amniótico encontra-se em contato íntimo com o feto, podendo fornecer indícios de sua maturidade. O objetivo deste estudo foi padronizar as características do líquido amniótico - coloração, aspecto, viscosidade, avaliação dos corpos lamelares e do surfactante presente pelo teste de Clements e citologia - de bezerros nascidos a termo, maduros, hígidos e com vitalidade comprovadas por escore Apgar, exame físico geral e medidas de coluna, amplitude respiratória (expansão torácica) e pH sanguíneo. Para tal finalidade, foram utilizados 50 bezerros da raça Holandesa Preta e Branca, cujas mães tiveram o parto acompanhado para colheita do líquido amniótico por punção no momento da exposição da bolsa fetal no canal vaginal. O líquido amniótico apresentou coloração clara e com turvação decorrente de variados graus de viscosidade e presença ou ausência de grumos. O teste de Clements foi adaptado à espécie bovina por meio de modificação caracterizada pela adição de 3mL de líquido amniótico em 1mL de etanol 95%. A metodologia de contagem de corpos lamelares no contador de partículas automático (hematológico) não foi aplicável à espécie bovina devido ao pequeno tamanho do corpo lamelar, que apresentou diâmetro aproximado de 130nm. O teste do Azul de Nilo não foi satisfatório para predizer a maturidade fetal na espécie bovina, diferentemente da citologia usando a coloração de... / Abstract: Considering the representativeness of dairy cattle in our country, the concern about the mortality rates of the animals increases each time. Regarding to calf mortality, the Respiratory Distress Syndrome (RDS) has an important relevance during the neonatal period, and it is present in immature lungs. The amniotic fluid is in direct contact with the fetus, and it is able to offer evidence about his maturity. The aim of this study was to standardize the characteristics of the amniotic fluid - color, aspect, viscosity, lamellar body and presence of surfactant evaluation by the Clements test and cytology - of term-born, mature, healthy calves and with proved vitality by the Apgar score, general physical exam and measurement of the spinal column and respiratory amplitude (thoracic expansion). There were used 50 Black and White Holstein calves, which mothers were observed at calving in order to collect the amniotic fluid by puncture in the moment of exposure of the fetal membrane through the vaginal canal. The amniotic fluid had a clear color and it was hazy because of the different degrees of viscosity and the presence or absence of clots. The Clements test could be adapted to the bovine species by the modification consisting in the addition of 3mL of amniotic fluid and 1mL of 95% ethanol. The methodology of the lamellar body count by the automated particle counter is not applicable for the bovine because of the small size of their lamellar body. The Nile Blue staining is unsatisfactory on predicting fetal maturity on the bovine species, different from cytology using Hematoxylin-Shorr stain. The cell stained orange counting, cells which are found in great amounts at the end of pregnancy. Measurements of the spine and thoracic amplitude are useful for the clinician who wants to evaluate fetal maturity, within a set of tools used with this purpose. The present study stablished new parameters for evaluation of fetal and pulmonary maturity in ... / Mestre

Made available in DSpace on 2015-12-10T14:23:13Z (GMT). No. of bitstreams: 0 Previous issue date: 2015-02-15. Added 1 bitstream(s) on 2015-12-10T14:29:28Z : No. of bitstreams: 1 000848951_20160223.pdf: 247290 bytes, checksum: 202e3f1a013e6f611d07b4083f75f663 (MD5) Bitstreams deleted on 2016-02-24T11:27:51Z: 000848951_20160223.pdf,. Added 1 bitstream(s) on 2016-02-24T11:28:34Z : No. of bitstreams: 1 000848951.pdf: 2152307 bytes, checksum: e1d435f239f6712ac15676b6aa0db7b8 (MD5) / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Considerando a representatividade da bovinocultura de leite em nosso país, a preocupação com índices de mortalidade dos animais torna-se cada vez maior. No que se refere à mortalidade em bezerros, a Síndrome de Angústia Respiratória (SAR) tem importante relevância no período perinatal, sendo causada pela inadequada produção do surfactante no pulmão imaturo. Animais advindos de técnicas como fertilização in vitro e clonagem são acometidos pela SAR com maior frequência, assim como neonatos prematuros. O líquido amniótico encontra-se em contato íntimo com o feto, podendo fornecer indícios de sua maturidade. O objetivo deste estudo foi padronizar as características do líquido amniótico - coloração, aspecto, viscosidade, avaliação dos corpos lamelares e do surfactante presente pelo teste de Clements e citologia - de bezerros nascidos a termo, maduros, hígidos e com vitalidade comprovadas por escore Apgar, exame físico geral e medidas de coluna, amplitude respiratória (expansão torácica) e pH sanguíneo. Para tal finalidade, foram utilizados 50 bezerros da raça Holandesa Preta e Branca, cujas mães tiveram o parto acompanhado para colheita do líquido amniótico por punção no momento da exposição da bolsa fetal no canal vaginal. O líquido amniótico apresentou coloração clara e com turvação decorrente de variados graus de viscosidade e presença ou ausência de grumos. O teste de Clements foi adaptado à espécie bovina por meio de modificação caracterizada pela adição de 3mL de líquido amniótico em 1mL de etanol 95%. A metodologia de contagem de corpos lamelares no contador de partículas automático (hematológico) não foi aplicável à espécie bovina devido ao pequeno tamanho do corpo lamelar, que apresentou diâmetro aproximado de 130nm. O teste do Azul de Nilo não foi satisfatório para predizer a maturidade fetal na espécie bovina, diferentemente da citologia usando a coloração de... / Considering the representativeness of dairy cattle in our country, the concern about the mortality rates of the animals increases each time. Regarding to calf mortality, the Respiratory Distress Syndrome (RDS) has an important relevance during the neonatal period, and it is present in immature lungs. The amniotic fluid is in direct contact with the fetus, and it is able to offer evidence about his maturity. The aim of this study was to standardize the characteristics of the amniotic fluid - color, aspect, viscosity, lamellar body and presence of surfactant evaluation by the Clements test and cytology - of term-born, mature, healthy calves and with proved vitality by the Apgar score, general physical exam and measurement of the spinal column and respiratory amplitude (thoracic expansion). There were used 50 Black and White Holstein calves, which mothers were observed at calving in order to collect the amniotic fluid by puncture in the moment of exposure of the fetal membrane through the vaginal canal. The amniotic fluid had a clear color and it was hazy because of the different degrees of viscosity and the presence or absence of clots. The Clements test could be adapted to the bovine species by the modification consisting in the addition of 3mL of amniotic fluid and 1mL of 95% ethanol. The methodology of the lamellar body count by the automated particle counter is not applicable for the bovine because of the small size of their lamellar body. The Nile Blue staining is unsatisfactory on predicting fetal maturity on the bovine species, different from cytology using Hematoxylin-Shorr stain. The cell stained orange counting, cells which are found in great amounts at the end of pregnancy. Measurements of the spine and thoracic amplitude are useful for the clinician who wants to evaluate fetal maturity, within a set of tools used with this purpose. The present study stablished new parameters for evaluation of fetal and pulmonary maturity in ...

Objectives: Infants delivered at ≥37 weeks’ gestation are considered full term, but research has demonstrated those born at 37 to 38 weeks (early term) have a higher risk for poor birth outcomes than deliveries at 39 to 41 weeks (full term). Despite this, many deliveries occur electively (scheduled, no medical indication) before 39 weeks. This study examined the risks of elective early-term delivery in a disadvantaged, rural sample and compared these results with national findings. Methods: Data were available for 638 rural women, recruited prenatally from three counties in rural southern Appalachia, who delivered electively at ≥37 weeks. Results: Compared with electively delivered full-term infants, those delivered electively at early term were 7.7 times more likely to be low birth weight, 4.4 times more likely to have a neonatal intensive care unit admission, and 2.5 times more likely to develop jaundice. Those living furthest from the hospital were most likely to deliver electively at <39 weeks. Although rates of elective deliveries <39 weeks were no higher than national rates, adjusted odds ratios (aOR) of associated admission to a neonatal intensive care unit doubled (aOR 4.4 vs aOR 2.2). Conclusions: Results demonstrate that initiatives targeting early-term elective deliveries are needed in rural, disadvantaged regions.

The serum fraction of blood is an ideal material in which to search for novel biomarkers for disease. It is easily obtained through relatively non-invasive means, routinely collected, and a rich treasure-trove of information about the health of an individual. Cells react to signal molecules, take up nutrients, and release waste products, fragments that are the result of proteolysis, and other molecules out into the bloodstream. If these components are unique to the cells in question, that part of the complex mixture that is the blood stream can potentially characterize the health of the tissue or organ those cells are a part of. Serum is dense with proteins that span over ten orders of magnitude in size and abundance. The top 22 most abundant proteins in serum account for 99% of the total protein. These abundant proteins are well-characterized and not useful in a search for novel biomarkers for disease. Removal of these large proteins is accomplished using an organic-solvent precipitation step. Analyzing the resultant mixture of low-molecular-weight serum peptides using cLC-MS produces large, data-rich, and very complex data files. We have developed a manual analysis method we have developed that is capable of performing all of the processing steps necessary to identify novel biomarkers for disease as well as a method for the sequencing of low-abundance, highly charged peptide species without additional sample preparation. These methods are applied to two serum sample sets collected to investigate two pregnancy-related diseases: preterm birth, and preeclampsia. Three novel biomarkers of preterm birth have been identified and a combination of these with 5 previously studied markers can predict women who will have preterm birth with a sensitivity of 89.9% and a specificity of 81.0%. Nineteen different molecular species have been identified that predict women at risk for preeclampsia with a p-value of <0.05. Weighted combinations of various groups of the 19 biomarkers can increase the sensitivity up to 96% and the specificity up to 100%. The use of cLC-MS in the search for novel serum biomarkers of pregnancy-related disease allows for seamless integration from potential biomarker selection to polypeptide sequence identification.

This work presents the development of 3D printed microfluidic devices and their application to microchip analysis. Initial work was focused on the development of the printer resin as well as the development of the general rules for resolution that can be achieved with stereolithographic 3D printing. The next stage of this work involved the characterization of the printer with a variety of interior and exterior resolution features. I found that the minimum positive and negative feature sizes were about 20 μm in either case. Additionally, micropillar arrays were printed with pillar diameters as small as 16 μm. To demonstrate one possible application of these small resolution features I created microfluidic bead traps capable of capturing 25 μm polystyrene particles as a step toward capturing cells. A second application which I pioneered was the creation of devices for microchip electrophoresis. I separated 3 preterm birth biomarkers with good resolution (2.1) and efficiency (3600 plates), comparable to what has been achieved in conventionally fabricated devices. Lastly, I have applied some of the unique capabilities of our 3D printer to a variety of other device applications through collaborative projects. I have created microchips with a natural masking monolith polymerization window, spiral electrodes for capacitively coupled contactless conductivity detection, and a removable electrode insert chip. This work demonstrates the ability to 3D print microfluidic structures and their application to a variety of analyses.

Yes / Objectives In this study we aimed to test the associations between area-level ethnic density and health for Pakistani and White British residents of Bradford, England. Design The sample consisted of 8610 mothers and infant taking part in the Born in Bradford cohort. Ethnic density was measured as the percentage of Pakistani, White British or South Asian residents living in a Lower Super Output Area. Health outcomes included birth weight, preterm birth and smoking during pregnancy. Associations between ethnic density and health were tested in multilevel regression models, adjusted for individual covariates and area deprivation. Results In the Pakistani sample, higher ethnic density was associated with lower birth weight (b -0.82, 95% CI -1.63; -0.02), and higher South Asian density was associated with a lower probability of smoking during pregnancy (OR 0.99, 95% CI 0.98; 1.00). Pakistani women in areas with 50-70% South Asian residents were less likely to smoke than those living in areas with less than 10% South Asian residents (OR 0.39, 95% CI 0.16;0.97). In the White British sample, neither birth weight nor preterm birth was associated with ethnic density. The probability of smoking during pregnancy was lower in areas with 10-29.99% compared to < 10% South Asian density (OR 0.79, 95% CI 0.64; 0.98). Conclusion In this sample, ethnic density was associated with lower odds of smoking during pregnancy but not with higher birth weight or lower odds of preterm birth. Possibly, high levels of social disadvantage inhibit positive effects of ethnic density on health. / Hall Dorman studentship , also Wellcome and NIHR

Diss. (sammanfattning) Linköping : Linköpings universitet, 2007. / Härtill 4 uppsatser.

La prématurité, définie par une naissance avant 37 semaines d’aménorrhées (SA), est une cause majeur de mortalité et de morbidité infantile. Comparés aux enfants nés à terme, les prématurés font face à des risques importants de troubles moteurs et cognitifs durant l'enfance, ainsi que de maladies chroniques et décès prématurés à l’âge adulte. La prématurité constitue un enjeu important de santé publique et en Europe, les taux varient entre 5 et 10%. Notre objectif pour cette thèse était de mieux comprendre les sources d’hétérogénéité des taux à l’échelle des pays. Dans un premier temps, nous avons effectué une revue exhaustive de la littérature qui montre que les caractéristiques maternelles, les pratiques médicales, et les méthodes d'estimation de l'âge gestationnel ont un impact sur les taux de prématurité. Cependant, ces facteurs n'expliquent pas l’ampleur des différences observées entre les pays. Puis, en utilisant des données sur les femmes enceintes, les nouveau-nés et les mort-nés dans 34 pays à revenus élevés de 1996 à 2010, nous avons établi que: 1) les différences d'enregistrement des naissances dans les pays à revenus élevés ont un impact limité sur les taux, sauf pour les naissances à 22-23 SA, 2) les tendances de PTB dans les pays sont associées à des variations plus importantes dans la distribution des âges gestationnels 3) et enfin, en utilisant les données d'un échantillon représentatif des naissances en France en 2010, qu’il existe des facteurs de risques maternels prénatals et socio-démographiques communs aux naissances avant terme (<37SA) et proche du terme à 37-38 SA. Viser à réduire les facteurs de risques de la naissance proche du terme et de la prématurité dans une approche conjointe pourrait apporter un nouvel élan à la prévention de la prématurité. Comparés aux enfants prématurés, les enfants nés proche du terme sont individuellement moins à risque, mais à l’échelle des pays ces enfants représentent environ une naissance sur quatre et ils contribuent de manière importante au fardeau de morbi-mortalité néonatale et infantile. Au niveau national, élargir les efforts de prévention de la prématurité à cette nouvelle population-cible pourrait avoir un plus grand impact sur la santé publique. / Preterm birth (PTB), defined as birth before 37 weeks, is a leading cause of infant mortality and morbidity. Compared to term infants, preterm infants face important risks of motor and cognitive impairments throughout childhood, as well as chronic diseases and premature death later in life. PTB represents a significant public health burden and in Europe, rates range between 5 and 10%. Such wide differences suggest that reductions may be possible, but there are few effective interventions, and these tend to target selected groups of high-risk pregnancies, based on clinical risk factors. Our aim for this thesis was to better appraise sources of population-level PTB rate variations and trends. First, we conducted an exhaustive review of the literature and found that maternal characteristics, reproductive policies, medical practices and methods of gestational age (GA) estimation affected PTB rates, but could not explain observed differences across countries. Next, using population-based data on pregnant women, newborns and stillbirths in 34 high-income countries from 1996 to 2010, we showed that: 1) reporting criteria for births and deaths affected PTB rates at early gestations and PTB rankings, but differences between countries with high and low rates are not just due to artefact 2) PTB trends were associated with broader shifts in countries’ gestational age GA distribution of births, and 3) using data from a representative sample of births in France in 2010, that there were shared maternal prenatal and socio-demographic risk factors for deliveries that did not reach full term, at 39 weeks GA. Our work confirms that recording differences in high-income countries have a limited impact on PTB rate variations. However, a broader focus on earlier delivery, including early term birth at 37-38 weeks, could shed light on the determinants of low PTB rates and provide a useful public health prevention paradigm.

A adequação do peso ao nascimento é um fator de risco para atrasos de desenvolvimento. Dentre outras causas de morbidade e mortalidade, encontra-se a prematuridade e a Restrição de Crescimento Intrauterino (RCIU). O termo \"Pequeno para a Idade Gestacional\" (PIG) é utilizado muitas vezes, como indicador de RCIU, cujo feto pode ter sido submetido a agravos em diferentes momentos da gestação. A literatura aponta o PIG como risco para atraso no desenvolvimento neuropsicomotor, incluindo a linguagem. Objetivo: Acompanhar a maturação da via auditiva em lactentes nascidos PIG, comparando-os aos lactentes nascidos Adequados para Idade Gestacional (AIG) a termo e pré-termo, por meio do estudo das respostas do PEATE por estímulo click e tone burst (TB) nos seis primeiros meses de vida. Método: Estudo longitudinal, observacional de caráter multicêntrico. Foram avaliados 172 lactentes nascidos PIG e AIG, a termo e pré-termo, nos períodos neonatal, aos três e aos seis meses, por meio do PEATE com estímulo tipo click e tone burst em 0,5 kHz e 1 kHz, a 80dBnNA. Resultados: no período neonatal, os RN T/PIG não se diferenciaram dos RN T/AIG quanto às respostas do PEATE, o mesmo ocorrendo entre PT/PIG e PT/AIG. Ao se comparar o grupo T e PT/PIG, observou-se diferença entre as latências das ondas III, V e intervalos interpicos (Itpc) I-III e I-V, com latências maiores nos PT/PIG; não foram evidenciadas diferenças com TB nas frequências avaliadas. Na comparação do grupo T e PT/AIG, observou-se diferença entre as latências das ondas III, V e nos Itpc III-V e I-V e latências maiores nos PT/AIG. Não houve diferenças no TB nas frequências avaliadas. Aos três meses, não houve diferenças entre os T/PIG e T/AIG; na comparação PT/PIG e PT/AIG, houve diferenças no Itpc III-V, com latência menor no grupo PT/PIG. Não houve diferenças entre T/PIG e PT/PIG; o grupo AIG mostrou diferença entre T e PT nas latências da onda V e Itpc I-V. Na terceira coleta, aos seis meses, os T/PIG e T/AIG evidenciaram diferenças significativas entre as latências da onda III e Itpc I-III, o mesmo não ocorrendo quando se comparou PT/PIG e PT/AIG, os quais se diferenciaram somente no Itpc III-V. Ao se comparar T/PIG e PT/PIG, verificou-se diferenças relevantes somente no TB 0,5 kHz. Conclusão: Os achados do presente estudo permitiram concluir que o processo maturacional da via auditiva em lactentes nascidos PIG ocorre em diferente velocidade quando comparado ao de lactentes AIG; os PIG têm maturação acelerada, principalmente nos três primeiros meses, caracterizando desta forma um período de recuperação do ponto de vista da audição; a prematuridade influencia mais a maturação do sistema nervoso auditivo central que o fator peso ao nascer no período neonatal; a maturação ocorreu no sentido caudo-rostral nos dois grupos. O PEATE com TB em 0,5 kHz e em 1 kHz evidenciou o processo maturacional, porém não de modo tão detalhado quanto o fez com o estímulo tipo click. As crianças PIG devem ser monitoradas até pelo menos os três anos de idade / The appropriateness of weight at birth is a risk factor for developmental delays. Prematurity and intrauterine growth restriction (IUGR) are among other causes of morbidity and mortality. The term \"small for gestational age\" (SGA) is often used as an indicator of IUGR, when the fetus may have been subjected to restrictions at different periods of pregnancy. The literature points SGA as a risk for neuropsychological developmental delay, including language. Objective: to monitor the maturation of the auditory pathway in SGA infants, comparing to term and preterm appropriate for gestational age (AGA) infants, through the analysis of the ABR responses to click and tone burst stimulus in the first six months of life. Method: A longitudinal, observational and multicenter study was conducted. A total of 172 SGA and AGA infants, term and preterm, were evaluated in the neonatal period and at three and six months of age through the ABR with click and tone burst stimulus with 0.5 kHz and 1 kHz at 80dBHL. Results: in the neonatal period, the term SGA infants did not differ from term AGA infants for ABR responses. The same was observed between preterm SGA and preterm AGA infants. When comparing the term and preterm SGA groups, there was a difference between the latencies of waves III, V and interpeak intervals (lTPI) I-III and I-V, with longer latencies in preterm SGA; there were no differences with the tone burst stimuli in the analyzed frequencies. When comparing the AGA term and preterm groups, differences were observed on latencies of waves III, V and ITPI III-V and I-V, with longer latencies for preterm infants. There were no differences in the frequencies evaluated with the tone burst stimuli. At three months of age, there were no differences between the term SGA and AGA; when comparing preterm SGA and AGA, differences were found for ITPI III-V, with shorter latencies in preterm SGA. SGA term and preterm infants did not differ; there were differences between term and preterm AGA in latencies of wave V and ITPI I-V. In the third data collection, at six months of age, term SGA and AGA infants significantly differed on latencies of wave III and ITPI I-III, which did not occur when comparing preterm SGA and AGA infants, who differed only regarding ITPI III-V. Significant differences were only observed when comparing term and preterm SGA infants regarding the tone burst stimuli at 0.5 kHz. Conclusion: The findings of this study showed that the maturational process of the auditory pathway in SGA infants occurs at different speed when compared to AGA infants; SGA infants have accelerated maturation, especially in the first three months of age, thus characterizing a recovery period from the hearing standpoint; in the neonatal period, the maturation of the central auditory nervous system is more influenced by prematurity than birth weight; maturation occurred in caudo-rostral direction in the two groups. The ABR with tone burst at 0.5 kHz and 1 kHz evidenced maturational process, but not in such detail as with the click stimuli. The SGA infants should be monitored until at least three years of age