Periconceptional care and offspring health at birth and long term, from the perspective of Avicenna.

Periconceptional care such as lifestyle plays an important impact role in offspring health. The aim of the present study was to clarify the perspective of Avicenna on periconceptional care. Avicenna (980-1037 A.D.) was one of the outstanding Persian physicians, who made great contributions to the field of medical sciences, in particular, obstetrics. In advance, Avicenna's book, Canon of Medicine, was considered to find his perspectives on periconceptional care. Then, his ideas and theories were compared to the current findings by searching the keywords in main indexing systems including PubMed/MEDLINE, Scopus and Institute for Scientific Information Web of Science as well as the search engine of Google Scholar. Current investigations show that gamete quality, pregnancy outcome, and offspring health at birth and long term depend on both parents' lifestyle in pre- and periconceptional period, as well as the intrauterine environment. Avicenna believed that seminal fluid, sperm, ovum, and developing conditions in utero were influenced by the stages of food digestion and the function of some organs. On the other hand, food digestion and function of the organs also depend on each parent's lifestyle and environmental factors. He mentioned 6 principles of healthy lifestyle: exercise, nutrition, sleep and awareness, excretion of body wastes and retention of necessary materials, psychic features, as well as air and climate. Thus, a multicomponent healthy lifestyle should be considered by parents of child-bearing age in an appropriate period before and in early pregnancy as well as elimination of any disorders in parents, to give birth to more healthy offspring.

The More Things Change, the More They Stay the Same: Thirty Years of Fetal Monitoring in Perspective.

Thirty years ago, the inaugural issue of The Journal of Perinatal & Neonatal Nursing was published and the entire perinatal portion of the journal was devoted to electronic fetal monitoring (EFM). This article provides a historical perspective on EFM in perinatal care since the 1980s by exploring the similarities and differences of the state of the science presented in that first issue. Both EFM and intermittent auscultation are discussed.

The controversy over the restructuring of perinatal emergency services in Portugal and the importance of citizen participation in health care decision-making processes.

This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies.

The controversy over the restructuring of perinatal emergency services in Portugal and the importance of citizen participation in health care decision-making processes / A controvérsia sobre a restruturação dos serviços de urgência perinatal em Portugal e a importância da participação cidadã em processos de decisão sobre saúde

This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies.

O artigo examina o processo de restruturação dos serviços de emergência perinatal implementado pelo Ministério da Saúde em Portugal em 2006 e tem como objetivo analisar essa decisão controversa. Especial ênfase é dada aos protestos desencadeados no país contra essa medida, os atores envolvidos e os argumentos contra e a favor, de forma a compreender os conhecimentos e as experiências trazidos para discussão dos problemas suscitados pela decisão tomada e como diferentes formas de conhecimento podem ser conciliadas no âmbito de procedimentos democráticos. Além disso, explora a relevância da participação cidadã na formulação de políticas de saúde, incluindo aquela que emerge de relações conflitantes.

Highly improved perinatal states in Japan.

To report on improved perinatal states in Japan, governmental and United Nations Children's Fund reports were analyzed. Initial maternal mortality, which was 409.8 in 1899, decreased to 4.1 in 2010, with a reduction rate of 409.8/4.1 (102.4) in 111 years: 2.5 in the initial 50 years in home delivery and 39.3 in the later 60 years in hospital births. The difference between 2.5 versus 39.3 was attributed to the medicine and medical care provided in hospital births. The total reduction of neonatal mortality was 77.9/1.1 (70.8), and the rate in the initial 50 versus later 60 years was 2.8/25. Also, there was a big difference after introduction of extensive neonatal care. Virtual perinatal mortality after 22 weeks was estimated to be 428 in 1000 births in 1900 (i.e. those infants born at 22-28 weeks were unlikely to survive at that time), while the perinatal mortality was reported to be 22 weeks or more in 1979 (i.e. premature babies born at ≥22 weeks survived in 1979 because of the improved neonatal care). Actually, 60% of premature infants of 400-500 g survived in the neonatal intensive care unit. In a recent report, 36% of infants born at 22 weeks survived to 3 years. Although there were neurodevelopmental impairments, outcomes were improved. In conclusion, perinatal states have remarkably improved in Japan.

Cuidados com o cordão umbilical do recém-nascido, no século XIX / Care for the newborn’s navel-string in the nineteenth-century / Cuidado del cordón umbilical del recién nacido, en el siglo XIX

Estudo de abordagem na microanálise sobre cuidados para a prevenção do tétano do recém-nascido, no século XIX. Os documentos utilizados para análise foram as teses da Faculdade de Medicina do Rio de Janeiro que tratassem da temática sobre o cordão umbilical do recém-nascido, no século XIX. O resultado analítico dos documentos evidenciou o discurso médico embasado em referências nacionais e internacionais, no sentido de introjetar na prática do cuidado mudança na cultura da higiene, na maioria das vezes praticadas por parteiras leigas, direcionada para as mães como uma das maneiras de se prevenir o tétano do recém-nascido.

Microanalysis study on prevention care against neonatal tetanus in the nineteenth century. The theses of the Faculdade de Medicina do Rio de Janeiro (The University of Rio de Janeiro Medical School) addressing the newborn’s navel-string in nineteenth century provided the basis for the analysis. The analysis showed that medical discourses, relying on national and international references, signaled to the need of cultural changes in hygiene by lay midwives and mothers, as a way to prevent tetanus of the newborn.

Estudio de enfoque en el microanálisis sobre cuidados para la prevención del tétano del recién nacido, en el siglo XIX. Los documentos utilizados para análisis fueron las tesis de la Facultad de Medicina de Rio de Janeiro-Brasil teniendo como tema el cordón umbilical del recién nacido, en el siglo XIX. El resultado del análisis de los documentos mostró el discurso médico basado en referencias nacionales e internacionales, en el sentido de introjetar en la práctica del cuidado cambio en la cultura de la higiene, muchas veces ejercida por parteras laicas, dirigido para las madres como una de las maneras de prevenir el tétano del recién nacido.

People and ideas in medical informatics - a half century review.

OBJECTIVE. Reviewing the onset and the rapid changes to make realistic predictions on the future of medical informatics. METHODS. Pointing to the contributions of the early pioneers, who had their roots in other disciplines and by illustrating that from the onset an interdisciplinary approach was characteristic for our field. RESULTS. Some of the reasons for the changes in medical informatics are that nobody was able to predict the advent of the personal computer in the 1970s, the world-wide web in 1991, and the public start of the Internet in 1992, but foremost that nobody expected that it was not primarily the hardware or the software, but human factors that would be crucial for successful applications of computers in health care. In the past sometimes unrealistic expectations were held, such as on the impact of medical decision-support systems, or on the overly optimistic contributions of electronic health records. Although the technology is widely available, some applications appear to be far more complex than expected. Health care processes can seldom be fully standardized. Humans enter at least in two very different roles in the loop of information processing: as subjects conducting care - the clinicians - and as subjects that are the objects of care - the patients. CONCLUSIONS. Medical informatics lacks a specific methodology; methods are borrowed from adjacent disciplines such as physics, mathematics and, of course, computer science. Human factors play a major role in applying computers in health care. Everyone pursuing a career in biomedical informatics needs to be very aware of this. It is to be expected that the quality of health care will increasingly be assessed by computer systems to fulfill the requirements of medical evidence.

Early hospital discharge in maternal and newborn care.

This article highlights the historic precedence of early discharge practices and the debate regarding length of stay for new mothers and newborns in the United States. Although the documented effects of early discharge on maternal and newborn health are inconsistent, research findings universally support follow-up care for mothers and infants within 1 week of hospital discharge. Research is needed to identify the components and timing of follow-up care to optimize maternal and newborn outcomes.

Hakim Esmail Jorjani (1042-1137 AD: ): Persian physician and jurist.

The great 11th-12th century Persian physician Seyed Esmail Jorjani (known as Hakim Jorjani) is known for his 750,000 word encyclopedia of medicine, the Treasure of King Khwarazm, which has been ranked along with Avicenna's Canon and the works of Haly Abbas. Translations of this work provide modern readers with a detailed insight into medical practice in medieval Persia. Parts of the Treasure are devoted to guidance about midwifery and perinatal care. In this article we present translations of excerpts from this part of the work.

The emergence of high-tech birthing.

The journey from "normal" to high-tech childbirth has taken place gradually over the past century. This article gives a historic review of maternity care and defines normal birth according to care practices adapted from the World Health Organization. The issues facing today's consumers, care providers, and caregivers that have led to the high-tech approach to birth are discussed. Recommendations for nursing practice are proposed to balance a normal approach to childbirth with a high-tech clinical environment.

The history of preconception care: evolving guidelines and standards.

This article explores the history of the preconception movement in the United States and the current status of professional practice guidelines and standards. Professionals with varying backgrounds (nurses, nurse practitioners, family practice physicians, pediatricians, nurse midwives, obstetricians/gynecologists) are in a position to provide preconception health services; standards and guidelines for numerous professional organizations, therefore, are explored. The professional nursing organization with the most highly developed preconception health standards is the American Academy of Nurse Midwives (ACNM); for physicians, it is the American College of Obstetricians and Gynecologists (ACOG). These guidelines and standards are discussed in detail.

Adolphe Pinard (1844-1934) of Paris and intrauterine paediatric care.

Pinard was a pioneer of modern perinatal care. His provision of social care to deprived pregnant women progressed to a recognition of the value of medical care of mother and baby before as well as after birth. The creation of antenatal departments and wards in maternity hospitals followed. He also established abdominal obstetric palpation on sound principles.