Actions of primary health care professionals to reduce maternal mortality in the Brazilian Northeast

Background

Maternal mortality is a global public health problem. Statistics show that in 2013, 289,000 women died from complications during pregnancy, childbirth or the postpartum period worldwide. Between 2010 and 2015, there were 10,075 maternal deaths in Brazil, 3,522of which occurred in the Northeast region. The aim of this study was to investigate the actions taken by primary health care (PHC) professionals to reduce maternal mortality.

Method

This was a cross-sectional, descriptive field study with a qualitative approach. The sample comprised 81 graduate-level professionals working in PHC in the state of Ceará, Brazil. Data were collected from January to March 2016 using structured interviews, which were digitally audio recorded and transcribed. The results were organized using collective subject discourse and analyzed according with the relevant literature.

Results

The PHC professionals took both individual and joint measures to reduce maternal mortality. These activities included home visits, health education, active searches, prenatal care consultations, referrals to specialized care and outreach. The challenges that must be overcome to prevent maternal mortality include poor care and ineffective public policies that are associated with a lack of managerial support.

Conclusion

Interaction among professionals in the health care network is critical to the development of cross-sectoral projects that improve the quality of women’s health care. Prenatal care is a key factor in reducing maternal death and enables the identification and classification of the risks to which pregnant women may be exposed and the implementation of early actions that can ensure a safe and uncomplicated delivery. However, all of these actions require effective public policies and managerial support.

Formation of BixSey Phases Upon Annealing of the Topological Insulator Bi2Se3: Stabilization of In-Depth Bismuth Bilayers

The goal of this work is to study transformations that occur upon heating Bi₂Se₃ to temperatures up to 623 K. X-ray diffraction (XRD) and scanning tunneling microscopy (STM) and spectroscopy (STS) techniques were used in our investigation. XRD was measured following the 00L and 01L truncation rods. These measurements revealed that upon heating there is a coexistence of a major Bi₂Se₃ phase and other ones that present structures of quintuple-layers intercalated with Bismuth bilayers. STM measurements of the surface of this material showed the presence of large hexagonal Bi_xSe_y domains embedded in a Bi₂Se₃ matrix. STS experiments were employed to map the local electronic density of states and characterize the modifications imposed by the presence of the additional phases. Finally, density functional theory (DFT) calculations were performed to support these findings.

Role of antiferromagnetic ordering in the (1×2) surface reconstruction of Ca(Fe(1-x)Co(x))2As2

Low energy electron diffraction, scanning tunneling microscopy and spectroscopy, and first-principles spin-dependent density functional theory are utilized to investigate the geometric, electronic, and magnetic structures of the stripe-ordered (1×2) surface of Ca(Fe1-xCox)2As2 (x=0, 0.075). The surface is terminated with a 50% Ca layer. Compared to the bulk, the surface Ca layer has a large inward relaxation (∼0.5  Å), and the underneath As-Fe2-As layer displays a significant buckling. First-principles calculations show that the (1×2) phase is stabilized by the bulk antiferromagnetic spin ordering through the spin-charge-lattice coupling. Strikingly, a superconducting gap (∼7  meV at 7.4 K) is observed to spatially coexist with the (1×2) phase (x=0.075 compound). This implies the coexistence of both superconductivity and AFM ordering at the surface.

Electroconvulsive therapy use in adolescents: a systematic review

BACKGROUND

Considered as a moment of psychological vulnerability, adolescence is remarkably a risky period for the development of psychopathologies, when the choice of the correct therapeutic approach is crucial for achieving remission. One of the researched therapies in this case is electroconvulsive therapy (ECT). The present study reviews the recent and classical aspects regarding ECT use in adolescents.

METHODS

Systematic review, performed in November 2012, conformed to the PRISMA statement.

RESULTS

From the 212 retrieved articles, only 39 were included in the final sample. The reviewed studies bring indications of ECT use in adolescents, evaluate the efficiency of this therapy regarding remission, and explore the potential risks and complications of the procedure.

CONCLUSIONS

ECT use in adolescents is considered a highly efficient option for treating several psychiatric disorders, achieving high remission rates, and presenting few and relatively benign adverse effects. Risks can be mitigated by the correct use of the technique and are considered minimal when compared to the efficiency of ECT in treating psychopathologies.

Surface-stabilized nonferromagnetic ordering of a layered ferromagnetic manganite

An outstanding question regarding the probing or possible device applications of correlated electronic materials (CEMs) with layered structure is the extent to which their bulk and surface properties differ or not. The broken translational symmetry at the surface can lead to distinct functionality due to the charge, lattice, orbital, and spin coupling. Here we report on the case of bilayered manganites with hole doping levels corresponding to bulk ferromagnetic order. We find that, although the hole doping level is measured to be the same as in the bulk, the surface layer is not ferromagnetic. Further, our low-energy electron diffraction and x-ray measurements show that there is a c-axis collapse in the outermost layer. Bulk theoretical calculations reveal that, even at fixed doping level, the relaxation of the Jahn-Teller distortion at the surface is consistent with the stabilization of an A-type antiferromagnetic state.

Chronic obstructive pulmonary disease is associated with osteoporosis and low levels of vitamin D

We did a cross-sectional analysis of chronic pulmonary obstructive disease (COPD) patients without chronic use of systemic glucocorticoids (CUG). Osteoporosis was found in 51% and bone mineral density (BMD) was correlated with severity of disease. Low levels of vitamin D were found in 94%. All COPD patients may benefit from vitamin D supplementation and screening for low BMD.

INTRODUCTION

Patients with chronic pulmonary obstructive disease have low bone mineral density, caused by chronic use of systemic glucocorticoids and hypovitaminosis D. However, patients without CUG may also have low BMD.

METHODS

We performed a cross-sectional analysis in 49 patients (21 men, 28 postmenopausal women), with COPD without CUG, from Brazil (25 degrees 25' S). Several markers of bone metabolism were measured, plus BMD. Osteoporosis risk factors and history of fractures were investigated. Respiratory function was assessed by venous gasometry, spirometry, and oximetry. BMD results were compared to those of 40 healthy non-smokers controls.

RESULTS

COPD patients had lower BMD at all sites (p < 0.01). Osteoporosis was observed in 51%. BMD independently correlated with stage of disease (lumbar spine, R = 0.38, p = 0.01; total femur, R = 0.36, p = 0.01; femoral neck, R = 0.40, p < 0.01). Ninety-four percent had low levels of vitamin D (<30 ng/mL) and 67% had secondary hyperparathyroidism. Vitamin D was correlated with oxygen saturation (R = 0.36, p = 0.01), with lower levels in those with saturation <88% (p = 0.01).

CONCLUSION

Patients with COPD without CUG have increased risk for osteoporosis. Such patients have hypovitaminosis D, which is correlated with the severity of disease. Screening for low BMD and vitamin D supplementation may be warranted to all COPD patients.

Surface geometric and electronic structures of BaFe2As2(001)

BaFe2As2 exhibits properties that are characteristic of the parent compounds of the newly discovered iron (Fe)-based high-T(C) superconductors. By combining real-space imaging of scanning tunneling microscopy and spectroscopy (STM+STS) with momentum-space quantitative low-energy electron diffraction (LEED), we have identified the surface plane of cleaved BaFe2As2 crystals as the As terminated Fe-As layer-the plane where superconductivity occurs. LEED and STM+STS data on the BaFe2As2(001) surface indicate an ordered arsenic (As) terminated metallic surface without reconstruction or lattice distortion. It is surprising that STM images the different Fe-As orbitals associated with the orthorhombic structure, but not the As atoms in the surface plane.

Manifestations of broken symmetry: the surface phases of Ca(2-x)SrxRuO4

The surface structural phases of Ca(2-x)SrxRuO4 are investigated using quantitative low energy electron diffraction. The broken symmetry at the surface enhances the structural instability against the RuO6 rotational distortion while diminishing the instability against the RuO6 tilt distortion occurring within the bulk crystal. As a result, suppressed structural and electronic surface phase transition temperatures are observed, including the appearance of an inherent Mott metal-to-insulator transition for x=0.1 and possible modifications of the surface quantum critical point near x(c) approximately 0.5.

A surface-tailored, purely electronic, mott metal-to-insulator transition

Mott transitions, which are metal-insulator transitions (MITs) driven by electron-electron interactions, are usually accompanied in bulk by structural phase transitions. In the layered perovskite Ca(1.9)Sr(0.1)RuO4, such a first-order Mott MIT occurs in the bulk at a temperature of 154 kelvin on cooling. In contrast, at the surface, an unusual inherent Mott MIT is observed at 130 kelvin, also on cooling but without a simultaneous lattice distortion. The broken translational symmetry at the surface causes a compressional stress that results in a 150% increase in the buckling of the Ca/Sr-O surface plane as compared to the bulk. The Ca/Sr ions are pulled toward the bulk, which stabilizes a phase more amenable to a Mott insulator ground state than does the bulk structure and also energetically prohibits the structural transition that accompanies the bulk MIT.