Abstract The aim to evaluate the raw material (agroforestry residues) for particleboard manufacture from the: pseudostem of Musa paradisiaca; the stem and pods of Theobroma cacao; and the sawdust of Ceiba pentandra. The particleboards produced from these cellulosic residues are mixed with cassava starch’s natural adhesive and urea formaldehyde’s synthetic adhesive. The results indicate that lignin, α-cellulose, hemicellulose, and extractives ranged from 6.2–19.0%, 41.4–50.2%, 24.4–31.5%, and 6.8–18.8% respectively and they were significantly different from each other. Additionally, tannins, alkaloids, saponins, flavonoids, phenols, glycosides, and sterols were the phytochemicals present in biomass materials in different quantities. Also, carbon, oxygen, nitrogen, and boron were the elementals significantly present in the manufactured particleboards in the range of 35.3–52.8, 30.2–43.0, 4.2–24.0, and 3.2–9.9 percentage concentration respectively. As for the mechanical properties, it was verified that the cellulose content influenced 96.5% of the variability of the modulus of rupture (MOR) values. Understanding the distribution, functional properties, and impact of biomass organic, phytochemicals and elemental constitutions is an impetus to the improvement of processes with higher retention of these constitutions in the utilization of agroforest residues in the particleboard industry. These chemical compositions of the residues under study contributed largely to the characteristics of the manufactured particleboards.

BACKGROUND: Every Preemie-SCALE developed and piloted the Family-Led Care model, an innovative, locally developed model of care for preterm and low birth weight babies receiving kangaroo mother care. AIM: The aim of this study was to describe healthcare workers' experience using Family-Led Care. SETTING: This study was conducted in five health facilities and their catchment areas in Balaka district, Malawi. METHODS: The mixed-methods design, with two data collection periods, included record reviews, observations and questionnaires for facility staff and qualitative interviews with health workers of these facilities and their catchment areas. The total convenience sample comprised 123 health professionals, support staff and non-professional community health workers. RESULTS: Facility-based staff generally had positive perceptions of Family-Led Care (83%). Knowledge and application-of-knowledge scores were 69% and 52%, respectively. A major change between the first and the second data periods was improvement in client record-keeping. Documentation of newborn vital signs increased from 62% to 92%. Themes emerging from the qualitative interview analysis were the following: benefits of Family-Led Care; activities supporting the implementation of Family-Led Care; own care practices; and families' reaction to and experience of Family-Led Care. CONCLUSION: This article reports improved quality of care through better documentation and better follow-up of preterm and low birth weight babies receiving kangaroo mother care according to the Family-Led Care model. Overall, health workers were positive about their involvement, and they reported positive reactions from families. Lessons learned have been incorporated into a universal Family-Led Care package that is available for adaptation by other countries.

ABSTRACT Background and aims: to assess the usefulness, efficacy and safety of single-operator cholangiopancreatoscopy (SOCP) with the SpyGlass(tm) system for the management of biliopancreatic diseases. Methods: a retrospective analysis of patients undergoing SOCP with the SpyGlass(tm) between September 2008 and April 2016 was performed. Data was obtained from a prospectively-maintained database at a tertiary referral center. The primary study outcomes were technical and complete endoscopic success of the procedure. Two different SpyGlass(tm) systems were employed; the former is called legacy and the latter, digital system (DS). Results: a total of 107 SOCP procedures in 93 patients performed by a single operator were analyzed. Technical success of the SpyGlass(tm) examination was achieved in 90/93 (97%) of patients and complete success by resolving the biliopancreatic condition in 82/93 (88%) cases. In indeterminate biliary strictures, a complete success was achieved in 45/52 (85%) of cases. With regard to stone treatment, technical success was achieved in 34/34 (100%) patients and complete success, in 31/34 (91%) cases. Electrohydraulic lithotripsy was applied in 16/34 (47%) of cases. There were a total of 7/93 adverse effects (7.5%). Conclusions: SOCP is a useful and safe technique for the treatment of biliopancreatic diseases with a low rate of adverse effects. The procedure seems technically demanding and dedication is required.

Objetivo: el objetivo de este estudio fue explorar la percepción de las enfermeras y los médicos sobre el uso de un paquete de atención como una guía para el manejo del dolor en cuidados críticos. A pesar del desarrollo de guías y protocolos para el manejo del dolor en cuidados críticos, basados en la evidencia, el dolor sigue siendo un problema importante. La introducción de un paquete de atención para cuidados críticos ha mejorado el manejo de los pacientes ventilados. Un paquete de atención en el manejo del dolor tiene como objetivo reducir las variaciones en la práctica. Método: el estudio tiene un diseño prospectivo cualitativo desarrollado mediante una entrevista en profundidad y semi-estructurada de 23 enfermeros y médicos en una unidad de cuidado crítico. Resultado: cuatro temas principales surgieron: 1) la adecuación al escenario de cuidado crítico, 2) la aplicabilidad al escenario de cuidado crítico, 3) la propiedad del Paquete de Atención al Dolor, y 4) la necesidad en la práctica actual. Los resultados mostraron una pobre aceptación del paquete por parte de los profesionales de la salud en el manejo de dolor agudo en los enfermos críticos. Conclusión: el estudio encontró que las enfermeras y los médicos no percibieron el paquete de atención al dolor como una herramienta útil para mejorar el manejo del dolor, con pruebas que apuntan a una brecha entre la práctica del manejo del dolor, tal como se describe por el paquete de atención, y la práctica real.

Objective: The aim of this study was to explore nurses' and doctors' perception on using a care bundle as a guideline for the management of pain in critical care. Despite the development of evidence-based guidelines and protocols on the management of pain in critical care, pain is still a major problem. The introduction of care bundles in critical care has improved the management of ventilated patients. A care bundle in pain management aims to reduce variations in practice. Method: This study employed a qualitative prospective design using a semi-structured, in-depth interview of 23 nurses and doctors in a critical care unit. Result: Four main themes emerged: 1) suitability to the critical care setting; 2) applicability to the critical care setting; 3) ownership of the Pain Care Bundle; and 4) necessity for current practice. The results showed a poor uptake by the healthcare professionals in managing acute pain among critically ill patients. Conclusion: The study found that nurses and doctors did not perceive the pain care bundle as a useful tool for improving pain managment, with evidence pointing to a gap between pain management practice, as described by the care bundle, and actual practice.

Objetivo: o objetivo deste estudo foi explorar a percepção das enfermeiras e dos médicos sobre o uso de um pacote de atendimento como guia para lidar com a dor em cuidados críticos. Apesar do desenvolvimento de guias e protocolos para lidar com a dor em cuidados críticos, baseados na evidência, a dor continua sendo um problema importante. A introdução de um pacote de atendimento para cuidados críticos vem melhorando o tratamento dado a pacientes ventilados. Um pacote de atendimento no tratamento da dor tem como objetivo reduzir as variações na prática. Método: o estudo tem um desenho prospectivo qualitativo desenvolvido mediante uma entrevista em profundidade e semiestruturada de 23 enfermeiros e médicos em uma unidade de cuidado crítico. Resultado: quatro temas principais surgiram: 1) a adequação ao cenário de cuidado crítico; 2) a aplicabilidade ao cenário de cuidado crítico; 3) a propriedade do Pacote de Atendimento à Dor, e 4) a necessidade na prática atual. Os resultados mostraram uma baixa aceitação do pacote por parte dos profissionais em saúde no tratamento da dor aguda nos doentes críticos. Conclusão: o estudo constatou que as enfermeiras e os médicos não perceberam o pacote de atendimento à dor como uma ferramenta útil para melhorar o tratamento da dor, com provas que apontam a uma brecha entre a prática do tratamento da dor, tal como se descreve pelo pacote de atendimento, e a prática real.

Resumimos uma pesquisa sobre os mecanismos pelos quais agentes ambientais podem afetar a patogenia do lúpus. Discutimos três exposições, foco de pesquisa na área, e propomos recomendações para novas iniciativas de pesquisa. Examinamos estudos relativos a eventos mecanicistas e exposições relativas. A apoptose que resulta no aumento da produção ou diminuição da menor depuração de auto-antígenos imunogênicos intracelulares e de apoptoses defeituosas de células imunes auto-reativas sofre implicações com a perda da auto-tolerância. Foi necessário um adjuvante ou efeito do observador para gerar uma resposta autoimune sustentável. A ativação de receptores toll-like é um dos mecanismos através do qual esses efeitos podem ocorrer. A metilação anormal do DNA também pode contribuir à patogenia de lúpus. Cada exposição mostrou, em humanos e camundongos, que age conforme um ou mais desses passos patogênicos. Recomendações específicas ao contínuo progresso do conhecimento sobre as influências ambientais no lúpus e outras doenças autoimunes compreendem o desenvolvimento e utilização de modelos de camundongos com graus variados de penetrância e manifestações da doença, identificação de alvos moleculares ou fisiológicos de exposições específicas, desenvolvimento e uso de melhores metodologias de avaliação de exposição e colaborações multisite para examinar exposições ambientais sobre os humanos menos estudados.

We summarize research on mechanisms through which environmental agents may affect the pathogenesis of lupus, discuss three exposures that have been the focus of research in this area, and propose recommendations for new research initiatives. We examined studies pertaining to key mechanistic events and specific exposures. Apoptosis leading to increased production or decreased clearance of immunogenic intracellular self-antigens and defective apoptosis of autoreactive immune cells both have been implicated in the loss of self-tolerance. The adjuvant or bystander effect is also needed to produce a sustained autoimmune response. Activation of toll-like receptors is one mechanism through which these effects may occur. Abnormal DNA methylation may contribute to the pathogenesis of lupus. Each of the specific exposures has been shown, in humans or in mice, to act upon one or more of these pathogenic steps. Specific recommendations for the continued advancement of our understanding of environmental influences on lupus and other autoimmune diseases include the development and use of mouse models with varying degrees of penetrance and manifestations of disease, identification of molecular or physiologic targets of specific exposures, development and use of improved exposure assessment methodologies, and multisite collaborations designed to examine understudied environmental exposures in humans.

Resumimos uma pesquisa sobre os mecanismos pelos quais agentes ambientais podem afetar a patogenia do lúpus. Discutimos três exposições, foco de pesquisa na área, e propomos recomendações para novas iniciativas de pesquisa. Examinamos estudos relativos a eventos mecanicistas e exposições relativas. A apoptose que resulta no aumento da produção ou diminuição da menor depuração de auto-antígenos imunogênicos intracelulares e de apoptoses defeituosas de células imunes auto-reativas sofre implicações com a perda da auto-tolerância. Foi necessário um adjuvante ou efeito do observador para gerar uma resposta autoimune sustentável. A ativação de receptores toll-like é um dos mecanismos através do qual esses efeitos podem ocorrer. A metilação anormal do DNA também pode contribuir à patogenia de lúpus. Cada exposição mostrou, em humanos e camundongos, que age conforme um ou mais desses passos patogênicos. Recomendações específicas ao contínuo progresso do conhecimento sobre as influências ambientais no lúpus e outras doenças autoimunes compreendem o desenvolvimento e utilização de modelos de camundongos com graus variados de penetrância e manifestações da doença, identificação de alvos moleculares ou fisiológicos de exposições específicas, desenvolvimento e uso de melhores metodologias de avaliação de exposição e colaborações multisite para examinar exposições ambientais sobre os humanos menos estudados.

We summarize research on mechanisms through which environmental agents may affect the pathogenesis of lupus, discuss three exposures that have been the focus of research in this area, and propose recommendations for new research initiatives. We examined studies pertaining to key mechanistic events and specific exposures. Apoptosis leading to increased production or decreased clearance of immunogenic intracellular self-antigens and defective apoptosis of autoreactive immune cells both have been implicated in the loss of self-tolerance. The adjuvant or bystander effect is also needed to produce a sustained autoimmune response. Activation of toll-like receptors is one mechanism through which these effects may occur. Abnormal DNA methylation may contribute to the pathogenesis of lupus. Each of the specific exposures has been shown, in humans or in mice, to act upon one or more of these pathogenic steps. Specific recommendations for the continued advancement of our understanding of environmental influences on lupus and other autoimmune diseases include the development and use of mouse models with varying degrees of penetrance and manifestations of disease, identification of molecular or physiologic targets of specific exposures, development and use of improved exposure assessment methodologies, and multisite collaborations designed to examine understudied environmental exposures in humans.

OBJECTIVE: To determine risk factors for poor birth outcome and their population attributable fractions. METHODS: 1688 women who attended for antenatal care were recruited into a prospective study of the effectiveness of syphilis screening and treatment. All women were screened and treated for syphilis and other reproductive tract infections (RTIs) during pregnancy and followed to delivery to measure the incidence of stillbirth, intrauterine growth retardation (IUGR), low birth weight (LBW) and preterm live birth. FINDINGS: At delivery, 2.7% of 1536 women experienced a stillbirth, 12% of live births were preterm and 8% were LBW. Stillbirth was independently associated with a past history of stillbirth, short maternal stature and anaemia. LBW was associated with short maternal stature, ethnicity, occupation, gravidity and maternal malaria whereas preterm birth was associated with occupation, age of sexual debut, untreated bacterial vaginosis and maternal malaria. IUGR was associated with gravidity, maternal malaria, short stature, and delivering a female infant. In the women who had been screened and treated for syphilis, in between 20 and 34% of women with each outcome was estimated to be attributable to malaria, and 63% of stillbirths were estimated as being attributable to maternal anaemia. Screening and treatment of RTIs was effective and no association was seen between treated RTIs and adverse pregnancy outcomes. CONCLUSION: Maternal malaria and anaemia continue to be significant causes of adverse pregnancy outcome in sub-Saharan Africa. Providing reproductive health services that include treatment of RTIs and prevention of malaria and maternal anaemia to reduce adverse birth outcomes remains a priority.

OBJETIVO: Identificar los factores de riesgo de desenlace adverso del parto y sus fracciones poblacionales atribuibles. MÉTODOS: En un estudio prospectivo sobre la eficacia de la detección y tratamiento de la sífilis se incluyeron 1688 mujeres que esperaban recibir atención prenatal. Todas ellas fueron sometidas a pruebas de detección y tratamiento de la sífilis y de otras infecciones del aparato reproductor durante el embarazo, y fueron observadas hasta el parto para determinar la incidencia de muerte fetal, retraso del crecimiento intrauterino, bajo peso al nacer y parto antes del término. RESULTADOS: Entre las 1536 mujeres observadas hasta el parto hubo un 2,7% de muertes fetales, un 12% de nacidos vivos antes del término y un 8% de recién nacidos con bajo peso al nacer. La muerte fetal se asoció de forma independiente a los antecedentes de muerte fetal y a la anemia y la baja estatura de la madre. El bajo peso al nacer se asoció a la baja estatura de la madre, su etnia y ocupación, el número de embarazos anteriores y los antecedentes de paludismo, mientras que el parto antes del término se asoció con la ocupación, la edad de inicio de las relaciones sexuales, la vaginosis bacteriana no tratada y los antecedentes de paludismo. El retraso del crecimiento intrauterino se asoció con el número de embarazos anteriores, el paludismo, la baja estatura de la madre y el sexo femenino del recién nacido. En estas mujeres sometidas a pruebas de detección y tratamiento de la sífilis, entre un 20 y un 34% de cada uno de los desenlaces adversos fueron atribuibles al paludismo, mientras que el 63% de las muertes fetales fueron atribuibles a la anemia materna. La detección y tratamiento de las infecciones del aparato reproductor fue eficaz y no se observó ninguna asociación entre las infecciones tratadas y los desenlaces adversos del embarazo. CONCLUSIÓN: El paludismo y la anemia materna siguen siendo causas importantes de desenlace adverso del embarazo en el África subsahariana. La prestación de servicios de salud reproductiva que incluyan el tratamiento de las infecciones del aparato reproductor y la prevención de la malaria y la anemia materna siguen siendo prioritarias para reducir los desenlaces adversos del embarazo.

OBJECTIF: Déterminer les facteurs de risque pour diverses issues défavorables de l'accouchement et les fractions attribuables en population de ces issues. MÉTHODES: 1688 femmes bénéficiant de soins anténataux ont été incluses dans une étude prospective visant à évaluer l'efficacité du dépistage de la syphilis et de son traitement. Pendant leur grossesse, ces femmes ont toutes été soumises à un dépistage de la syphilis et ont éventuellement été traitées contre cette maladie ou d'autres infections de l'appareil reproducteur. Elles ont également fait l'objet d'un suivi jusqu'à l'accouchement, en vue de mesurer l'incidence des mortinaissances, des retards de développement intra-utérins, des faibles poids à la naissance et des naissances avant terme. RÉSULTATS: Parmi les 1536 accouchements, 2,7 % ont donné un enfant mort-né, 12 % un enfant prématuré vivant et 8 % un enfant de faible poids à la naissance. La mortinaissance était associée de manière indépendante aux facteurs suivants : antécédents d'accouchement d'un enfant mort-né, et faible stature ou anémie maternelles. Le faible poids à la naissance pouvait être associé à une petite stature de la mère, à son origine ethnique, à sa profession, au nombre de grossesses et à la présence du paludisme chez la mère, tandis que la naissance avant terme pouvait être mise en relation avec la profession, l'âge au début de l'activité sexuelle et la présence d'une vaginite bactérienne non traitée ou d'un paludisme chez la mère. Le retard de croissance intra-utérin pouvait être corrélé avec le nombre de grossesses, la présence d'un paludisme chez la mère, une faible stature maternelle et la mise au monde d'une fille. Parmi les femmes chez lesquelles on avait détecté et traité une syphilis, 20 à 24 % des issues défavorables de l'accouchement ont été considérées comme imputables au paludisme et 63 % des mortinaissances à une anémie maternelle. Le dépistage et le traitement des infections de l'appareil reproducteur se sont révélés efficaces et aucune association n'a été relevée entre ces infections et des issues défavorables de la grossesse. CONCLUSION: Le paludisme et l'anémie maternels restent des causes importantes d'issues défavorables de la grossesse en Afrique subsaharienne. L'apport de services de santé génésique comprenant le traitement des infections de l'appareil reproducteur et la prévention du paludisme et de l'anémie chez la mère demeure une priorité pour réduire les issues défavorables de l'accouchement.