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1.
Curr Eye Res ; 46(3): 309-317, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-32730721

RESUMO

PURPOSE: Investigating the modulation of neutrophil production of MIG and IP-10 during the inflammatory response to HSV-1 infection. MATERIALS AND METHODS: An ex vivo model of human corneal infection by HSV-1 was used for this study. This model permits the study of cytokine production by human corneal buttons in the presence, or absence, of gradient purified human neutrophils, under conditions of HSV-1 infection. All experimental samples were stimulated with a baseline concentration of recombinant human IFN-γ at 1 ng/mL. The relative levels of production for 12 pro-inflammatory mediators were screened using a multi-analyte ELISA assay. Neutrophil production of chemokines MIG and IP-10, under conditions of IFN-γ and/or HSV-1 stimulation were measured by quantitative ELISA. Lastly, antibody neutralization (goat IgG anti-human IL-1α, 2 µg/mL) of de novo production of IL-1α by corneal tissue was performed to investigated the effect on MIG and IP-10 production in the ex vivo model for HSV-1 infection. RESULTS: Four of the 12 pro-inflammatory mediators screened (IL-8, IL-6, IL-1α and IL-1ß) demonstrated elevated levels of production during corneal cell infection with HSV-1 and communication with neutrophils. Neutrophils were demonstrated to produce significant levels of both MIG and IP-10 under conditions of IFN-γ stimulation, and production of MIG was further upregulated by co-stimulation with IFN-γ and HSV-1. Neutralization of de novo IL-1α production in the model resulted in increased production of the chemokine production MIG but had no observable effect on IP-10 production. CONCLUSIONS: Our data provide evidence demonstrating the potential for expression patterns of MIG and IP-10 to be modulated by IL-1α, during the inflammatory response to HSV-1 corneal infection. Both corneal cells and neutrophils contribute to the production of T cell recruiting chemokines. However, IL-1α has the potential to upregulate MIG production by corneal cells while down-regulating MIG production by neutrophils.


Assuntos
Quimiocina CXCL9/metabolismo , Infecções Oculares Virais/metabolismo , Herpesvirus Humano 1/genética , Interferon gama/farmacologia , Interleucina-1alfa/metabolismo , Ceratite Herpética/metabolismo , Córnea/metabolismo , Ensaio de Imunoadsorção Enzimática , Infecções Oculares Virais/virologia , Herpes Simples/genética , Humanos , Ceratite Herpética/virologia , Neutrófilos/efeitos dos fármacos , RNA Viral/genética
2.
BJOG ; 127(13): 1665-1675, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32437088

RESUMO

OBJECTIVE: To review quality of care in births planned in midwifery-led settings, resulting in an intrapartum-related perinatal death. DESIGN: Confidential enquiry. SETTING: England, Scotland and Wales. SAMPLE: Intrapartum stillbirths and intrapartum-related neonatal deaths in births planned in alongside midwifery units, freestanding midwifery units or at home, sampled from national perinatal surveillance data for 2015/16 (alongside midwifery units) and 2013-16 (freestanding midwifery units and home births). METHODS: Multidisciplinary panels reviewed medical notes for each death, assessing and grading quality of care by consensus, with reference to national standards and guidance. Data were analysed using thematic analysis and descriptive statistics. RESULTS: Sixty-four deaths were reviewed, 30 stillbirths and 34 neonatal deaths. At the start of labour care, 23 women were planning birth in an alongside midwifery unit, 26 in a freestanding midwifery unit and 15 at home. In 75% of deaths, improvements in care were identified that may have made a difference to the outcome for the baby. Improvements in care were identified that may have made a difference to the mother's physical and psychological health and wellbeing in 75% of deaths. Issues with care were identified around risk assessment and decisions about planning place of birth, intermittent auscultation, transfer during labour, resuscitation and neonatal transfer, follow up and local review. CONCLUSIONS: These confidential enquiry findings do not address the overall safety of midwifery-led settings for healthy women with straightforward pregnancies, but suggest areas where the safety of care can be improved. Maternity services should review their care with respect to our recommendations. TWEETABLE ABSTRACT: Confidential enquiry of intrapartum-related baby deaths highlights areas where care in midwifery-led settings can be made even safer.


Assuntos
Parto Domiciliar/normas , Tocologia/normas , Morte Perinatal , Qualidade da Assistência à Saúde , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Recém-Nascido , Gravidez , Reino Unido
3.
Midwifery ; 77: 16-23, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31233990

RESUMO

OBJECTIVE: To explore and synthesise evidence of asylum-seeking women's experiences of maternity care in the UK. DESIGN: A systematic review and thematic synthesis of peer-reviewed qualitative evidence. Relevant databases were searched from 2000 until 2018. Study quality was appraised using the Critical Appraisal Skills Programme (CASP) qualitative research appraisal tool. SETTING AND PARTICIPANTS: UK-based studies which describe asylum-seeking women's views and experiences of maternity care. FINDINGS: Six studies were included for thematic synthesis. Seven common themes emerged; 'Communication challenges', 'Isolation', Mental health challenges', 'Professional attitudes', Access to healthcare', 'Effects of dispersal' and 'Housing challenges'. The review indicated that pregnant asylum seekers face significant barriers to accessing maternity care due to practical issues related to the challenges of their status and lack of knowledge of maternity services, together with professional attitudes. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Mandatory provision of interpreter services, together with training for health care professionals could address urgent issues faced by pregnant asylum seekers. Further research and population-specific guidelines are needed to improve care for these women.


Assuntos
Serviços de Saúde Materna/normas , Refugiados/psicologia , Humanos , Serviços de Saúde Materna/estatística & dados numéricos , Pesquisa Qualitativa , Qualidade da Assistência à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Reino Unido
4.
J Stem Cells Regen Med ; 13(1): 3-13, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28684892

RESUMO

Cell and tissue specific somatic stem cells develop as dynamic populations of precursor cells to discrete tissue and organ differentiation during embryonic and fetal stages and their potential evolves with development. Some of their progeny are sequestered into separate cell niches of tissues as adult somatic stem cells at various times during organ development and differentiation These are diverse cell populations of stem and progenitor cells that respond to homeostatic needs for cell and tissue maintenance and the cycling of differentiated cells for physiological/ endocrinological changes. Nominally, multipotent stem cells in one or more niches follow specific lineages of differentiation that can be followed by diverse markers of differentiation. The activation of precursors appears to be stochastic and results in a population of heterogeneous progenitor cells. When variations in the functional need of the tissue or organ occurs, the progenitor cells exhibit flexibility in their differentiation capacity. Regulation of the progenitors is the result of signals from the stem cell niche that can cause adaptive changes in the behavior or function of the stem -progenitor cell lineage. A possible mechanism may be alteration in the differentiation capacity of the resident or introduced cells. Certain quiescent stem cells also serve as a potential cell reservoir for trauma induced cell regeneration through adaptive changes in differentiation of stem cells, progenitor cells and differentiated cells. If the stem-progenitor cell population is normally depleted or destroyed by trauma, differentiated cells from the niche microenvironment can restore the specific stem potency which suggests the process of dedifferentiation.

5.
BMC Obes ; 2: 35, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26401345

RESUMO

BACKGROUND: Regular weighing in pregnant women is not currently recommended in many countries but has been suggested to prevent excessive gestational weight gain. This study aimed to establish the feasibility and acceptability of incorporating regular weighing, setting maximum weight gain targets and feedback by community midwives. METHODS: Low risk pregnant women cared for by eight community midwives were randomised to usual care or usual care plus the intervention at 10-14 weeks of pregnancy. The intervention involved community midwives weighing and plotting weight on a weight gain chart, setting weight gain limit targets, giving brief feedback at each antenatal appointment and encouraging women to weigh themselves weekly between antenatal appointments. Women and midwives were interviewed about their views of the intervention. The focus of the study was on process evaluation. RESULTS: Community midwives referred 123 women and 115 were scheduled for their dating scan within the study period. Of these, 84/115 were approached at their dating scan and 76/84 (90.5 %) randomised. Data showed a modest difference favouring the intervention group in the percentage of women gaining excessive gestational weight (23.5 % versus 29.4 %). The intervention group consistently reported smaller increases in depression and anxiety scores throughout pregnancy compared with usual care. Most women commented the intervention was useful in encouraging them to think about their weight and believed it should be part of routine antenatal care. Community midwives felt the intervention could be implemented within routine care without adding substantially to consultation length, thus not perceived as adding substantially to their workload. CONCLUSIONS: The intervention was feasible and acceptable to pregnant women and community midwives and was readily implemented in routine care. TRIAL REGISTRATION: ISRCTN81605162.

6.
BMC Obes ; 3: 7, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-26885375

RESUMO

BACKGROUND: Many pregnant women gain excess weight during pregnancy which increases the health risks to the mother and her baby. Interventions to prevent excess weight gain need to be given to the whole population to prevent excess weight gain. The aim of this study was to assess the effectiveness of a simple and brief intervention embedded withinroutine antenatal care to prevent excessive gestation weight gain. METHODS: Six hundred and ten pregnant women (between 10-14 weeks gestation), aged ≥18 years with a body mass index (BMI) ≥18.5 kg/m2, planned to receive community midwife led care or shared care at the time of recruitment are eligible to take part in the study. Women will be recruited from four maternity centres in England. Community midwives complete a short training module before delivering the intervention. In the intervention, midwives weigh women, set maximum weight limits for weight gain at each antenatal appointment and ask women to monitor their weight at home. Themaximum weight limit is adjusted by the midwife at each antenatal appointment if women have exceeded their maximum weight gain limit set at their previous appointment. The intervention will be compared with usual antenatal care. The primary outcome is the proportion of women per group who exceed the Institute of Medicine guidelines for gestational weight gain at 38 weeks of pregnancy according to their early pregnancy BMI category. DISCUSSION: The proposed trial will test a brief intervention comprising regular weighing, target setting and monitoring ofweight during pregnancy that can be delivered at scale as part of routine antenatal care. Using the professional expertise of community midwives, but without specialist training in weight management, the intervention will incur minimal additionalhealthcare costs, and if effective at reducing excess weight gain, is likely to be very cost effective. TRIAL REGISTRATION: Current controlled trials ISRCTN67427351. Date assigned 29/10/2014.

7.
J Chem Phys ; 141(23): 234201, 2014 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-25527928

RESUMO

The connectivity between gelation and increasing water confinement and structuring within nanopores of a thermally induced gel is demonstrated for the first time through low frequency Raman spectroscopy and optical microrheology measurements. Specifically, the work confirms that increased ordering of individual water molecules can be observed during the gelation of agarose upon cooling. More importantly, it illustrates the ability of the two techniques to provide new insights and a more direct link between intermolecular interactions/microstructure and evolving rheological response in gelling systems.


Assuntos
Biopolímeros/química , Fenômenos Ópticos , Reologia , Análise Espectral Raman , Elasticidade , Géis , Luz , Nanoporos , Espalhamento de Radiação , Sefarose/química , Temperatura , Viscosidade
8.
BJOG ; 121 Suppl 4: 41-6, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25236632

RESUMO

Established in 1952, the programme of surveillance and Confidential Enquiries into Maternal Deaths in the UK is the longest running such programme worldwide. Although more recently instituted, surveillance and confidential enquiries into perinatal deaths are also now well established nationally. Recent changes to funding and commissioning of the Enquiries have enabled both a reinvigoration of the processes and improvements to the methodology with an increased frequency of future reporting. Close engagement with stakeholders and a regulator requirement for doctors to participate have both supported the impetus for involvement of all professionals leading to greater potential for improved quality of care for women and babies.


Assuntos
Mortalidade Materna , Auditoria Médica/organização & administração , Mortalidade Perinatal , Vigilância da População , Humanos , Bem-Estar Materno , Qualidade da Assistência à Saúde , Natimorto , Reino Unido
9.
Pregnancy Hypertens ; 4(3): 233-4, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-26104618

RESUMO

Pregnancy is a critical period for the development of later obesity. Regular weighing of pregnant women is not currently recommended in the UK. This study aimed to demonstrate the feasibility of regular weighing by community midwives (CMWs) as a potential intervention to prevent excessive gestational weight gain. Low risk healthy/overweight pregnant women cared for by eight CMWs were randomised to usual care or usual care plus the intervention at 10-14 weeks of pregnancy. The intervention involved CMWs weighing and charting weight gain on an IOM weight gain chart, setting a weight target and giving brief feedback at antenatal appointments. The focus of the study was on process evaluation outcomes. Data on other outcomes were also collected including gestational weight gain. We interviewed women and CMWs about their views of the intervention. CMWs referred 123 women, 95 agreed to participate and 76 were randomised. Over 90% of women were weighed at 38 weeks of pregnancy demonstrating high follow up. There was no evidence the intervention caused anxiety. Most women commented they had found the intervention useful in encouraging them to think about their weight and believed it should be part of routine antenatal care. CMW's felt the intervention could be implemented within antenatal care without adding substantially to consultation length. To conclude, pregnant women were keen to participate in the study and the intervention was acceptable to pregnant women and CMWs. An effectiveness trial is now planned.

10.
BJOG ; 120(11): 1403-12, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23786339

RESUMO

OBJECTIVE: Evidence suggests that a high dose of oxytocin for nulliparous women at 37-42 weeks of gestation with confirmed delay in labour increases spontaneous vaginal birth. We undertook a pilot study to test the feasibility of this treatment. DESIGN: Pilot double-blind randomised controlled trial. SETTING: Three teaching hospitals in the UK. POPULATION: A total of 94 consenting nulliparous women at term with confirmed delay in labour were recruited, and 18 were interviewed. METHODS: Women were assigned to either a standard (2 mU/min, increasing every 30 minutes to 32 mU/minute) or a high-dose regimen (4 mU/minute, increasing every 30 minutes to 64 mU/minutes) oxytocin by computer-generated randomisation. Simple descriptive statistics were used, as the sample size was insufficient to evaluate clinical outcomes. The constant comparative method was used to analyse the interviews. MAIN OUTCOMES MEASURES: The main outcome measures: number of women eligible; maternal and neonatal birth; safety; maternal psychological outcomes and experiences; health-related quality of life outcomes using validated tools and data on health service resource use; incidence of suspected delay of labour (cervical dilatation of <2 cm after 4 hours, once labour is established); and incidence of confirmed delay of labour (progress of <1 cm on repeat vaginal examination after a period of 2 hours). RESULTS: We successfully developed systems to recruit eligible women in labour and to collect data. Rates of spontaneous vaginal birth (10/47 versus 12/47, RR 1.2, 95% CI 0.6-2.5) and caesarean section (15/47 versus 17/47, RR 1.1, 95% CI 0.6-2.0) were increased, and rates of instrumental birth were reduced (21/47 versus 17/47, RR 0.8, 95% CI 0.5-1.3). No evidence of increased harm for either mother or baby was found. The incidences of suspected delay (14%) and confirmed delay (11%) in labour were less than anticipated. Of those who did not go on to have delayed labour confirmed, all except one woman gave birth vaginally. CONCLUSIONS: A pilot trial assessing the efficacy of high-dose oxytocin was feasible, but uncertainty remains, highlighting the need for a large definitive trial. The implementation of national guidance of suspected and confirmed delay in labour is likely to reduce intervention.


Assuntos
Primeira Fase do Trabalho de Parto , Complicações do Trabalho de Parto/tratamento farmacológico , Ocitócicos/administração & dosagem , Ocitocina/administração & dosagem , Parto Obstétrico , Relação Dose-Resposta a Droga , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Consentimento Livre e Esclarecido , Entrevistas como Assunto , Paridade , Projetos Piloto , Gravidez
11.
Int J Inflam ; 2012: 810359, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22518343

RESUMO

In this study we show that murine and human neutrophils are capable of secreting IP-10 in response to communication from the HSV-1 infected cornea and that they do so in a time frame associated with the recruitment of CD8(+) T cells and CXCR3-expressing cells. Cellular markers were used to establish that neutrophil influx corresponded in time to peak IP-10 production, and cellular depletion confirmed neutrophils to be a significant source of IP-10 during HSV-1 corneal infection in mice. A novel ex vivo model for human corneal tissue infection with HSV-1 was used to confirm that cells resident in the cornea are also capable of stimulating neutrophils to secrete IP-10. Our results support the hypothesis that neutrophils play a key role in T-cell recruitment and control of viral replication during HSV-1 corneal infection through the production of the T-cell recruiting chemokine IP-10.

13.
BJOG ; 117(11): 1344-9, 2010 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-20633002

RESUMO

OBJECTIVE: To investigate whether publication of the results of the ORACLE Children's Study, a 7-year follow-up of the ORACLE trial, changed practice with regard to the routine prescription of antibiotics to women with preterm rupture of membranes or spontaneous preterm labour (intact membranes). DESIGN: A comparative questionnaire survey of clinical practice in November 2007 (before publication) and March 2009 (after publication). POPULATION: Lead obstetricians for labour wards of all maternity units in the UK. METHODS: Self-administered questionnaires requested information about the routine prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour (intact membranes). MAIN OUTCOME MEASURES: Change in practice for prescription of antibiotics. RESULTS: The response rate was 166/214 (78%) in 2007 and 158/209 (76%) in 2009. In total, 120 maternity units responded on both occasions. For women with preterm rupture of membranes, 162/214 (98%) in 2007 and 151/158 (96%) in 2009 maternity units reported that they prescribed antibiotics, with the majority using erythromycin (98%). For women with spontaneous preterm labour (intact membranes), 35/166 (21%) in 2007 and 25/158 (16%) in 2009 maternity units reported that they routinely prescribed antibiotics. The findings from units who responded on both occasions are similar. CONCLUSIONS: There has been little change in the reported prescription of antibiotics to women with either preterm rupture of membranes or spontaneous preterm labour following publication of the ORACLE Children's Study. This suggests that current practice may require updated guidance.


Assuntos
Antibacterianos/uso terapêutico , Eritromicina/uso terapêutico , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Trabalho de Parto Prematuro/prevenção & controle , Obstetrícia/normas , Prática Profissional , Feminino , Seguimentos , Maternidades , Humanos , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Inquéritos e Questionários , Reino Unido
14.
ScientificWorldJournal ; 10: 954-71, 2010 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-20526526

RESUMO

The developmental potential of the limb regeneration blastema, a mass of mesenchymal cells of mixed origins, was once considered as being pluripotent, capable of forming all cell types. Now evidence asserts that the blastema is a heterogeneous mixture of progenitor cells derived from tissues of the amputation site, with limited developmental potential, plus various stem cells with multipotent abilities. Many specialized cells, bone, cartilage, muscle, and Schwann cells, at the injury site undergo dedifferentiation to a progenitor state and maintain their cell lineage as they redifferentiate in the regenerate. Muscle satellite reserve stem cells that are active in repair of injured muscle may also dedifferentiate and contribute new muscle cells to the limb blastema. Other cells from the dermis act as multipotent stem cells that replenish dermal fibroblasts and differentiate into cartilage. The blastema primordium is a self-organized, equipotential system, but at the cellular level can compensate for specific cell loss. It is able to induce dedifferentiation of introduced exogenous cells and such cells may be transformed into new cell types. Indigenous cells of the blastema associated with amputated tissues may also transform or possibly transdifferentiate into new cell types. The blastema is a microenvironment that enables dedifferentiation, redifferentiation, transdifferentiation, and stem cell activation, leading to progenitor cells of the limb regenerate.


Assuntos
Extremidades/fisiologia , Regeneração , Urodelos/fisiologia , Animais , Diferenciação Celular , Extremidades/embriologia , Urodelos/embriologia
15.
BJOG ; 116(13): 1809-14, 2009 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-19781044

RESUMO

In a multicentre randomised, unblinded patient preference pilot trial to assess the feasibility of a definitive randomised trial comparing colposuspension with tension-free vaginal tape (TVT) plus anterior repair in women with incontinence and prolapse, we found that 31 of 56 eligible women agreed to participate (55%). Recruitment was more successful face to face (87%) than by letter (16%). Only four of our women agreed to be randomised, 21 (68%) chose anterior repair+TVT and six (19%) chose colposuspension. This study demonstrates the importance of pilot work for complex trials to identify issues likely to adversely affect recruitment.


Assuntos
Slings Suburetrais , Bexiga Urinária/cirurgia , Incontinência Urinária por Estresse/cirurgia , Prolapso Uterino/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Preferência do Paciente , Seleção de Pacientes , Projetos Piloto
16.
Curr Stem Cell Res Ther ; 3(3): 151-62, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18781999

RESUMO

Stem cells obtained from early mammalian embryos and the subsequent establishment of self replicating embryonic stem cell lines (ES) provided a legacy resource of pluripotent cells capable of differentiating into specific cell lineages of the adult organism. Still the most versatile source of pluripotent cells, their application to potential human therapeutic use has been encumbered by various technical and ethical objections. New sources of embryonic pluripotent stem cells have been sought, the isolation of ES cell lines from a single blastomere that avoids destruction of the human embryo, the use of arrested embryos no longer capable of completing development or using post-implantation embryos as stem cell providers. The successful cloning and reprogramming of adult animal cell nuclei by somatic cell nuclear transplantation (SCNT) or nuclear transfer (NT) provides stem cells tailored to the donor organism, though a step away for human use. Variations in this procedure are altered SCNT, that would block human use for reproduction and the use of parthenotes to induce pluripotent stem cell lines. All of these NT methods depend upon a very limited supply of healthy oocyte host cells. Enucleated fertilized eggs have been substituted for oocytes and the production of stem cell somatic cell hybrids by cell fusion have potential use for nuclear transfer ES cells not directly dependent on oocytes. Recovery of cells from human amniotic fluid has yielded stem cells that share some pluripotent characteristics but are multipotent stem cells. Adult somatic cells have been reprogrammed recently by retroviral transduction using four transcription factors to induce pluripotent stem cells (iPS) with great promise. Each of these procedures has limitations at present for extensive use in human regenerative medicine.


Assuntos
Células-Tronco Pluripotentes/citologia , Animais , Linhagem Celular , Células-Tronco Embrionárias/citologia , Humanos
17.
Lancet ; 372(9646): 1310-8, 2008 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-18804274

RESUMO

BACKGROUND: The ORACLE I trial compared the use of erythromycin and/or amoxicillin-clavulanate (co-amoxiclav) with that of placebo for women with preterm rupture of the membranes without overt signs of clinical infection, by use of a factorial randomised design. The aim of the present study--the ORACLE Children Study I--was to determine the long-term effects on children of these interventions. METHODS: We assessed children at age 7 years born to the 4148 women who had completed the ORACLE I trial and who were eligible for follow-up with a structured parental questionnaire to assess the child's health status. Functional impairment was defined as the presence of any level of functional impairment (severe, moderate, or mild) derived from the mark III Multi-Attribute Health Status classification system. Educational outcomes were assessed with national curriculum test results for children resident in England. FINDINGS: Outcome was determined for 3298 (75%) eligible children. There was no difference in the proportion of children with any functional impairment after prescription of erythromycin, with or without co-amoxiclav, compared with those born to mothers who received no erythromycin (594 [38.3%] of 1551 children vs 655 [40.4%] of 1620; odds ratio 0.91, 95% CI 0.79-1.05) or after prescription of co-amoxiclav, with or without erythromycin, compared with those born to mothers who received no co-amoxiclav (645 [40.6%] of 1587 vs 604 [38.1%] of 1584; 1.11, 0.96-1.28). Neither antibiotic had a significant effect on the overall level of behavioural difficulties experienced, on specific medical conditions, or on the proportions of children achieving each level in reading, writing, or mathematics at key stage one. INTERPRETATION: The prescription of antibiotics for women with preterm rupture of the membranes seems to have little effect on the health of children at 7 years of age. FUNDING: UK Medical Research Council.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Antibioticoprofilaxia , Proteção da Criança , Eritromicina/uso terapêutico , Ruptura Prematura de Membranas Fetais/tratamento farmacológico , Infecção Pélvica/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto , Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Criança , Mortalidade da Criança , Escolaridade , Inglaterra/epidemiologia , Eritromicina/efeitos adversos , Feminino , Seguimentos , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Gravidez , Resultado do Tratamento
18.
Lancet ; 372(9646): 1319-27, 2008 Oct 11.
Artigo em Inglês | MEDLINE | ID: mdl-18804276

RESUMO

BACKGROUND: The ORACLE II trial compared the use of erythromycin and/or amoxicillin-clavulanate (co-amoxiclav) with that of placebo for women in spontaneous preterm labour and intact membranes, without overt signs of clinical infection, by use of a factorial randomised design. The aim of the present study--the ORACLE Children Study II--was to determine the long-term effects on children after exposure to antibiotics in this clinical situation. METHODS: We assessed children at age 7 years born to the 4221 women who had completed the ORACLE II study and who were eligible for follow-up with a structured parental questionnaire to assess the child's health status. Functional impairment was defined as the presence of any level of functional impairment (severe, moderate, or mild) derived from the mark III Multi-Attribute Health Status classification system. Educational outcomes were assessed with national curriculum test results for children resident in England. FINDINGS: Outcome was determined for 3196 (71%) eligible children. Overall, a greater proportion of children whose mothers had been prescribed erythromycin, with or without co-amoxiclav, had any functional impairment than did those whose mothers had received no erythromycin (658 [42.3%] of 1554 children vs 574 [38.3%] of 1498; odds ratio 1.18, 95% CI 1.02-1.37). Co-amoxiclav (with or without erythromycin) had no effect on the proportion of children with any functional impairment, compared with receipt of no co-amoxiclav (624 [40.7%] of 1523 vs 608 [40.0%] of 1520; 1.03, 0.89-1.19). No effects were seen with either antibiotic on the number of deaths, other medical conditions, behavioural patterns, or educational attainment. However, more children whose mothers had received erythromycin or co-amoxiclav developed cerebral palsy than did those born to mothers who received no erythromycin or no co-amoxiclav, respectively (erythromycin: 53 [3.3%] of 1611 vs 27 [1.7%] of 1562, 1.93, 1.21-3.09; co-amoxiclav: 50 [3.2%] of 1587 vs 30 [1.9%] of 1586, 1.69, 1.07-2.67). The number needed to harm with erythromycin was 64 (95% CI 37-209) and with co-amoxiclav 79 (42-591). INTERPRETATION: The prescription of erythromycin for women in spontaneous preterm labour with intact membranes was associated with an increase in functional impairment among their children at 7 years of age. The risk of cerebral palsy was increased by either antibiotic, although the overall risk of this condition was low. FUNDING: UK Medical Research Council.


Assuntos
Combinação Amoxicilina e Clavulanato de Potássio/efeitos adversos , Antibioticoprofilaxia/efeitos adversos , Eritromicina/efeitos adversos , Trabalho de Parto Prematuro/tratamento farmacológico , Infecção Pélvica/prevenção & controle , Complicações Infecciosas na Gravidez/prevenção & controle , Efeitos Tardios da Exposição Pré-Natal , Atividades Cotidianas , Adulto , Combinação Amoxicilina e Clavulanato de Potássio/uso terapêutico , Paralisia Cerebral/epidemiologia , Paralisia Cerebral/etiologia , Criança , Mortalidade da Criança , Escolaridade , Inglaterra/epidemiologia , Eritromicina/uso terapêutico , Feminino , Seguimentos , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Gravidez , Resultado do Tratamento
19.
J Dairy Sci ; 91(9): 3439-53, 2008 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-18765602

RESUMO

Body condition scoring, an indirect measure of the level of subcutaneous fat in dairy cattle, has been widely adopted for research and field assessment or for management purposes on farms. The feasibility of utilizing digital images to determine body condition score (BCS) was assessed for lactating dairy cows at the Scottish Agricultural College Crichton Royal Farm. Two measures of BCS were obtained by using the primary systems utilized in the United Kingdom (UK-BCS) and the United States (USBCS). Means were 2.12 (+/-0.35) and 2.89 (+/-0.40), modes were 2.25 and 2.75, and ranges were 1.0 to 3.5 and 1.5 to 4.5 for the UKBCS (n = 2,346) and USBCS (n = 2,571), respectively. Up to 23 anatomical points were manually identified on images captured automatically as cows passed through a weigh station. Points around the hooks were easier to identify on images than points around pins and the tailhead. All identifiable points were used to define and formulate measures describing the cow's contour. For both BCS systems, hook angle, posterior hook angle, and tailhead depression were significant predictors of BCS. When the full data set testing only the angles around the hooks was used, 100% of predicted BCS were within 0.50 points of actual USBCS and 92.79% were within 0.25 points; and 99.87% of predicted BCS were within 0.50 points of actual UKBCS and 89.95% were within 0.25 points. In a reduced data set considering only observations in which the tailhead depression angle was available, adding the tailhead depression to models did not improve model predictions. The relationships of the calculated angles with USBCS were stronger than those with UKBCS. This research demonstrates the potential for using digital images for assessing BCS. Future efforts should explore ways to automate this process by using a larger number of animals to predict scores accurately for cows across all levels of body condition.


Assuntos
Composição Corporal , Bovinos/classificação , Bovinos/fisiologia , Indústria de Laticínios/métodos , Processamento de Imagem Assistida por Computador , Fotografação/veterinária , Tecido Adiposo/fisiologia , Animais , Bovinos/anatomia & histologia , Indústria de Laticínios/normas , Feminino , Reprodutibilidade dos Testes
20.
J Evol Biol ; 20(2): 707-16, 2007 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-17305836

RESUMO

Reproductive manipulations of hosts by maternally inherited bacterial endosymbionts often result in an increase in the proportion of infected female hosts in the population. When this involves the conversion of incipient males to genetic or functional females, it presents unique difficulties for symbionts invading hosts with sex-specific reproductive behaviours, such as the autoparasitic Encarsia pergandiella. In sexual forms of this species, female eggs are laid in whitefly nymphs and male eggs are laid in conspecific or heterospecific parasitoids developing within the whitefly cuticle. Further, eggs laid in the 'wrong' host do not ordinarily complete development. This study explored the role of a bacterial symbiont, Cardinium, in manipulating oviposition behaviour in a thelytokous population of E. pergandiella. Oviposition choice was measured by the number and location of eggs deposited by both infected and uninfected adult waSPS in arenas containing equal numbers of hosts suitable for the development of male and female waSPS. Uninfected waSPS included antibiotic-treated female waSPS and (untreated) daughters of antibiotic-treated female waSPS. The choices of waSPS in the thelytokous population treatments were compared with those of a conspecific sexual population. We found that offspring of antibiotic-cured thelytokous waSPS reverted to the behaviour of unmated sexual waSPS, laying their few eggs almost exclusively in hosts appropriate for male eggs. Infected thelytokous waSPS distributed their eggs approximately evenly between host types, much like mated sexual female waSPS. The antibiotic-treated female waSPS exhibited choices intermediate to waSPS in the other two treatments. The change in the observed behaviour appears sufficient to allow invasion and persistence of Cardinium in sexual populations. Lastly, our results suggest a reduction in host discrimination as a possible mechanism by which Cardinium influences this change.


Assuntos
Bacteroidetes/fisiologia , Oviposição/fisiologia , Vespas/microbiologia , Animais , Antibacterianos/farmacologia , Bacteroidetes/efeitos dos fármacos , Comportamento Animal , Feminino , Hemípteros/parasitologia , Masculino , Oviposição/efeitos dos fármacos , Rifampina/farmacologia , Vespas/anatomia & histologia , Vespas/fisiologia
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