Scope and effectiveness of mobile phone messaging for HIV/AIDS care: a systematic review.

The objective of this mixed method systematic review was to assess the scope, effectiveness, acceptability and feasibility of the use of mobile phone messaging for HIV infection prevention, treatment and care. We comprehensively searched the peer-reviewed and grey literature. Two authors independently screened citations, extracted data and assessed study quality of included studies (any research design) focusing on mobile phone messaging interventions for HIV care. We present a narrative overview of the results. Twenty-one studies met the inclusion criteria: three randomized controlled trials, 11 interventional studies using other study designs and seven qualitative or cross-sectional studies. We also found six on-going trials and 21 projects. Five of the on-going trials and all the above mentioned projects took place in low or middle-income countries. Mobile phone messaging was researched for HIV prevention, appointment reminders, HIV testing reminders, medication adherence and for communication between health workers. Of the three randomized controlled trials assessing the use of short message service (SMS) to improve medication adherence, two showed positive results. Other interventional studies did not provide significant results. In conclusion, despite an extensive search we found limited evidence on the effectiveness of mobile phone messaging for HIV care. There is a need to adequately document outcomes and constraints of programs using mobile phone messaging to support HIV care to assess the impact and to focus on best practice.

[Prenatal steroids, cesarean section, and cerebral hemorrhage in newborns with birth weight under 1500 g]. / Steroidi prenatali, parto cesareo ed emorragia cerebrale nel neonato con peso alla nascita inferiore a 1500 g.

OBJECTIVE: To identify perinatal risk and protective factors for peri-intraventricular hemorrhage (PIVH) in 214 very low birth weight (VLBW) infants. METHOD: Perinatal risk and protective factors for PIVH were examined by univariate analysis and by multivariate logistic regression analysis that adjusted simultaneously for the effects of year of birth and perinatal characteristics. Because mode of delivery and antenatal use of steroid represent the only factors, among those considered, that could in most cases be controlled by the clinician, we calculated for each of the four combinations the relative risk of PIVH. RESULTS: By univariate analysis, antenatal steroid administration, cesarean section delivery, increasing birth weight and increasing gestational age were protective perinatal factors. By using logistic regression, significant protective factors against PIVH included a complete course of antenatal steroid therapy and increasing gestational age. Intrauterine growth retardation was associated with an increased risk of PIVH. The relative risk of intraventricular hemorrhage for each of the four combination of mode of delivery and antenatal steroid exposure demonstrate that antenatal steroid exposure and cesarean section delivery are most protective with a relative risk of 14% compared with vaginal delivery and no antenatal steroid exposure. CONCLUSIONS: Association of antenatal steroid administration with cesarean section delivery has an important role in lowering the risk of PIVH in VLBW infants.

[Nasal CPAP in newborns with birth weight under 1500 g]. / Assistenza respiratoria con CPAP nasale nei neonati con peso alla nascita inferiore a 1500 g.

OBJECTIVE: To evaluate the efficacy and safety of early nasal continuous positive airway pressure (CPAP) in the pulmonary management of very low birth weight (VLBW) infants. METHOD: Since 1993 in our neonatal intensive care unit we decided to reduce the rate of tracheal intubation and mechanical ventilation (IPPV) using more extensively nasal CPAP. By Student's t test and c2 analysis, VLBW infants with gestational age < 32 weeks born in 1988-92 were compared with those born in 1993-97. RESULTS: The 144 enrolled infants were comparable for birth weight and gestational age. There was a difference in the rate of antenatal steroid administration and cesarean section delivery, significantly more used in the second period. In both groups, 93% of the infants required respiratory support. The use of IPPV decreased from 68% in the first period to 30% in the second, conversely the use of CPAP increased from 25 to 63%. With regard to the primary outcome, in the second period the mortality rate and the incidence of pneumothorax were significantly lower. CONCLUSIONS: As the long-term survival of VLBW neonates continues to improve, pulmonary management is increasingly directed at minimizing the invasivity. This study demonstrated that early nasal CPAP may be successfully used in most VLBW infants. Also in the smallest neonates the procedure is safe and effective and may be important in lowering pulmonary morbidity and subsequent mortality.

[Use and efficacy of treatment with porcine surfactant in newborns with birth weight < or = 1000 g: experience in 3 years]. / Utilizzazione ed efficacia della terapia con surfactant suino nel neonato con peso neonatale < or = 1000 g: esperienza di un triennio.

OBJECTIVE: Evaluate the clinical response to the first and subsequent doses of natural surfactant for the treatment of respiratory distress syndrome (RDS) in extremely low birth weight infants (ELBWI). METHODS: Retrospective chart review of all ELBWI admitted to Neonatal Intensive Care Unit of Padova from July 1995 to December 1998 who received porcine surfactant for the treatment of RDS. Data collection included: (a) standard clinical variables (birth weight, gestational age, maternal steroid treatment, etc) (b) surfactant dosing), and (c) response to surfactant treatment as assessed by changes in the fraction of inspiratory oxygen (F1O2) and by the Oxygenation Index (OI). Outcome data (d) which included: death, duration of mechanical ventilation, duration of oxygen therapy, days in hospital stay, OI at 3,7 and 21 days of age, oxygen dependency at 28 days and at 36 week post conception were also collected. Data were analyzed by group comparison tests when comparing the groups that received one (S1), two (S2) or three (S3) surfactant doses and by multiple regression for the "predictors" of the response to surfactant treatment and for the "predictors" of outcome. RESULTS: Ninety-four ELBWI were evaluated. F1O2 at 12 hours after surfactant was reduced by more than one/third in 62% of the infants after the first dose, in 54% of the second doses and 61% of the third doses (non significant). S1, S2 and S3 groups had similar demographics and birth characteristics but the OI differed at 3 and 7 days (1.73 +/- 1.39, 3.34 +/- 2.15 and 6.45 +/- 5.23 at day 3 and 1.42 +/- 1.27, 1.98 +/- 1.83 and 4.03 +/- 3.91 at day 6 for S1, S2 and S3 respectively, p = 0.003). The response of exogenous was not found to be a significant predictor in our multiple regression model for major outcome variables such as oxygen dependency at 28 d or 36 wk. CONCLUSIONS: In ELBWI in spite of the high percentages of good clinical response to the first, to the second and even to the third surfactant dose, response to surfactant treatment did not predict major general and respiratory outcomes.