ABSTRACT
Background: Neonatal infection is a serious public health problem. The aim of this study was to assess the influence of the antenatal care on the risk of early-onset neonatal healthcare associated infection in two Brazilian maternities. Methods: Cohort study - Newborns admitted at two public neonatal intensive care units from 2008 to 2009 were included in the study. Data on antenatal and perinatal variables were collected from maternal prenatal cards and medical charts. Newborns were actively surveyed for early-onset neonatal healthcare associated infection, defined as a neonatal infection diagnosed within 48 h after birth. Multiple logistic regression was used to assess variables independently associated with early-onset neonatal healthcare associated infection. Results: 561 neonate-mother pairs were included in the study. Early-onset neonatal health-care associated infection was diagnosed in 283 neonates (51%), an incidence rate of 43.5/1000 live births. Neonates whose mothers had less then six antenatal visits were under risk significantly higher for early-onset neonatal healthcare associated infection (OR = 1.69, 95% CI = 1.11-2.57), after adjusting for birth weight, membranes ruptured for >18 h, maternal complications during delivery, maternal infection at admission, and hospital where patients received care. Conclusions: The risk of neonatal early-onset neonatal healthcare associated infection was significantly associated with insufficient number of antenatal care visits. Further studies assessing the quality of antenatal care and targeting its improvement are warranted. .
Subject(s)
Female , Humans , Infant, Newborn , Male , Pregnancy , Infant, Newborn, Diseases/diagnosis , Infectious Disease Transmission, Vertical/prevention & control , Pregnancy Complications, Infectious/diagnosis , Prenatal Care/standards , Brazil , Cohort Studies , Communicable Diseases , Intensive Care Units, Neonatal , Infant, Newborn, Diseases/prevention & control , Risk FactorsABSTRACT
In spite of the fact that musical hallucination have a significant impact on patients' lives, they have received very little attention of experts. Some researchers agree on a combination of peripheral and central dysfunctions as the mechanism that causes hallucination. The most accepted physiopathology of musical hallucination associated to hearing loss (caused by cochlear lesion, cochlear nerve lesion or by interruption of mesencephalon or pontine auditory information) is the disinhibition of auditory memory circuits due to sensory deprivation. Concerning the cortical area involved in musical hallucination, there is evidence that the excitatory mechanism of the superior temporal gyrus, as in epilepsies, is responsible for musical hallucination. In musical release hallucination there is also activation of the auditory association cortex. Finally, considering the laterality, functional studies with musical perception and imagery in normal individuals showed that songs with words cause bilateral temporal activation and melodies activate only the right lobe. The effect of hearing aids on the improvement of musical hallucination as a result of the hearing loss improvement is well documented. It happens because auditory hallucination may be influenced by the external acoustical environment. Neuroleptics, antidepressants and anticonvulsants have been used in the treatment of musical hallucination. Cases of improvement with the administration of carbamazepine, meclobemide and donepezil were reported, but the results obtained were not consistent.
Apesar das alucinações musicais causarem grandes repercussões na vida dos pacientes, sempre foram pouco valorizadas e estudadas pelos profissionais. Alguns investigadores sugerem uma combinação de disfunções periféricas e centrais como o mecanismo causador das alucinações. A fisiopatologia mais aceita entre os pesquisadores de alucinação musical associada à hipoacusia ou anacusia (causada por lesão coclear, de nervo coclear ou interrupção de informação na ponte ou mesencéfalo) é a desibinição de circuitos de memória auditiva devido à deprivação sensorial. Em relação às áreas corticais envolvidas na alucinação musical, há evidência de que um mecanismo excitatório no córtex temporal superior, como nas epilepsias, seja responsável pela alucinação musical. Finalmente, considerando a lateralidade, estudos funcionais de percepção e imagética em indivíduos normais mostraram que canções com letras levam a ativação temporal bilateral e melodias ativam apenas o lobo temporal direito. É bem documentado o efeito de aparelhos auditivos na alucinação musical através de uma melhora da perda auditiva. Neurolépticos, antidepressivos e anticonvulsivantes têm sido usados no tratamento de alucinação musical na experiência clínica, mas não há eficácia comprovada na maioria dos casos. Há casos descritos na literatura com melhora das alucinações musicais com uso de carbamazepina, meclobemide e donepezil, entretanto sem resultados consistentes.