María Cafferata - Academia.edu (original) (raw)

Papers by María Cafferata

The American journal of tropical medicine and hygiene, 2008

We conducted a cross-sectional study of Chagas disease in five endemic areas in Argentina, Bolivi... more We conducted a cross-sectional study of Chagas disease in five endemic areas in Argentina, Bolivia, Honduras, and México to estimate the prevalence of Trypanosoma cruzi-specific antibodies in pregnant women, and to assess the use of a rapid test (Chagas Stat-Pak) to screen for T. cruzi infection at the time of delivery. The prevalence of antibodies to T. cruzi measured by enzyme-linked immunosorbent assay (ELISA) in maternal blood was 5.5% (a range of 0.8-28.8% among the countries) in 2,495 women enrolled. Compared with ELISA in maternal blood samples, the Chagas Stat-Pak rapid test sensitivity and specificity in umbilical cord blood were 94.6% and 99.0%, respectively. These results show the ability for a rapid determination of the presence of T. cruzi-specific antibodies in umbilical cord blood as a pragmatic strategy to screen for infection in pregnant women.

BMC pediatrics, Jan 7, 2004

Retinopathy of Prematurity (ROP) is a common retinal neovascular disorder of premature infants. I... more Retinopathy of Prematurity (ROP) is a common retinal neovascular disorder of premature infants. It is of variable severity, usually heals with mild or no sequelae, but may progress to blindness from retinal detachments or severe retinal scar formation. This is a preliminary report of the effectiveness and safety of a new and original use of topical ketorolac in preterm newborn to prevent the progression of ROP to the more severe forms of this disease. From January 2001 to December 2002, all fifty nine preterm newborns with birthweight less than 1250 grams or gestational age less than 30 weeks of gestational age admitted to neonatal intensive care were eligible for treatment with topical ketorolac (0.25 milligrams every 8 hours in each eye). The historical comparison group included all 53 preterm newborns, with the same inclusion criteria, admitted between January 1999 and December 2000. Groups were comparable in terms of weight distribution, Apgar score at 5 minutes, incidence of se...

The Lancet, 2007

Health inequality in Latin America. By - José M Belizán, María L Cafferata, María Belizán, Fernan... more Health inequality in Latin America. By - José M Belizán, María L Cafferata, María Belizán, Fernando Althabe.

Value in Health, 2011

Illness (COI), basada en la prevalencia, así como la creación de un panel de expertos multidiscip... more Illness (COI), basada en la prevalencia, así como la creación de un panel de expertos multidisciplinario que clasificó la atención médica, tomando en cuenta la gravedad de la enfermedad (CP I -CP IV): Ambulatoria, Hospitalización, Quirófano, Unidad de Cuidados Intensivos, Quimioterapia, Radioterapia y Cuidados Paliativos. Finalmente empleamos la fracción atribuible por tabaco para estimar los costos por tabaquismo. Los costos están expresados en pesos mexicanos ($) y en dólares americanos (USD) del 2009. RESULTADOS: El costo promedio anual por paciente asociado al consumo de tabaco fue de 1,105,250.9(84,590.5USD),independientementedelagravedaddelaenfermedad.LosnivelesdeseveridadIIIyIVdelCPfueronlosmaˊscostososparaelINCAN,conuncostopromedioanualporpacientede1,105,250.9 (84,590.5 USD), independientemente de la gravedad de la enfermedad. Los niveles de severidad III y IV del CP fueron los más costosos para el INCAN, con un costo promedio anual por paciente de 1,105,250.9(84,590.5USD),independientementedelagravedaddelaenfermedad.LosnivelesdeseveridadIIIyIVdelCPfueronlosmaˊscostososparaelINCAN,conuncostopromedioanualporpacientede862,398.9 (66,003.8 USD) y 1,174,011.5(89,853.1USD).ElcostototalanualdelCPportabaquismoenelINCANfuede1,174,011.5 (89,853.1 USD). El costo total anual del CP por tabaquismo en el INCAN fue de 1,174,011.5(89,853.1USD).ElcostototalanualdelCPportabaquismoenelINCANfuede245,735,016.9 (18,807,354.8 USD), donde el CP IV explicó el 96 % de este costo anual. CONCLUSIONES: Los resultados obtenidos confirman los altos costos del CP atribuido al tabaquismo y presentan evidencia científica para apoyar las políticas de salud orientadas al control del consumo de tabaco. El CP al ser una enfermedad evitable, los recursos económicos destinados al tratamiento de la enfermedad podrían asignarse en otras áreas de interés dentro del Instituto.

International Journal of Gynecology & Obstetrics, 2014

Active management of third stage of labor (AMTSL) Multifaceted intervention Nicaragua Oxytocin Po... more Active management of third stage of labor (AMTSL) Multifaceted intervention Nicaragua Oxytocin Postpartum hemorrhage Professional behavior change Selective episiotomy Uniject Objective: To assess the effect of a multifaceted intervention among skilled birth attendants on the use of oxytocin during the third stage of labor, the active management of the third stage of labor (AMTSL), and the rate of routine episiotomy during vaginal births in two health districts in Nicaragua. Methods: An uncontrolled before-and-after study design was used. The rates of oxytocin use in the third stage of labor, AMTSL, and episiotomy were measured for vaginal births occurring in eight hospitals and health centers during 2011-2012, before and after implementation of a multifaceted facility-based intervention. The intervention involved the use of opinion leaders, interactive workshops to develop and implement evidence-based guidelines, academic detailing, the use of reminders, and feedback on the rates of oxytocin use and episiotomy. Results: Oxytocin use during the third stage of labor increased significantly from 95.3% to 97.4% (P = 0.003). The episiotomy rate dropped significantly from 31.2% to 21.2% overall, and from 59.6% to 40.5% in primiparous women (P b 0.001 for both comparisons). Conclusion: The multifaceted intervention improved the targeted care practices during childbirth. However, a further decrease in the routine use of episiotomy would be desirable.

BMC Health Services Research, 2014

Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly ... more Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher. WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of the package of evidence-based services included in the WHO ANC model in Mozambique. The primary hypothesis is that the intervention will increase the use of evidence-based practices during ANC visits in comparison to the standard dissemination channels currently used in the country.

Paediatric and Perinatal Epidemiology, 2008

Strategies for improving the quality of health care in maternal and child health in low-and middl... more Strategies for improving the quality of health care in maternal and child health in low-and middle-income countries: an overview of systematic reviews.

Gastroenterología y Hepatología, 2010

Reproductive Health, 2013

Background: Trypanosoma cruzi has been divided into Discrete Typing Units I and non-I (II-VI). T.... more Background: Trypanosoma cruzi has been divided into Discrete Typing Units I and non-I (II-VI). T. cruzi I is predominant in Mexico and Central America, while non-I is predominant in most of South America, including Argentina. Little is known about congenital transmission of T. cruzi I. The specific aim of this study is to determine the rate of congenital transmission of T. cruzi I compared to non-I. Methods/design: We are conducting a prospective study to enroll at delivery, 10,000 women in Argentina, 7,500 women in Honduras, and 13,000 women in Mexico. We are measuring transmitted maternal T. cruzi antibodies by performing two rapid tests in cord blood (Stat-Pak, Chembio, Medford, New York, and Trypanosoma Detect, InBios, Seattle, Washington). If at least one of the results is positive, we are identifying infants who are congenitally infected by performing parasitological examinations on cord blood and at 4-8 weeks, and serological follow-up at 10 months. Serological confirmation by ELISA (Wiener, Rosario, Argentina) is performed in cord and maternal blood, and at 10 months. We also are performing T. cruzi standard PCR, real-time quantitative PCR and genotyping on maternal venous blood and on cord blood, and serological examinations on siblings. Data are managed by a Data Center in Montevideo, Uruguay. Data are entered online at the sites in an OpenClinica data management system, and digital pictures of data forms are sent to the Data Center for quality control. Weekly reports allow for rapid feedback to the sites. Trial registration: Observational study with ClinicalTrials.gov Identifier NCT01787968

Reproductive Health, 2013

Background: Antenatal corticosteroids administered to women at risk of preterm birth is an interv... more Background: Antenatal corticosteroids administered to women at risk of preterm birth is an intervention which has been proved to reduce the risk of respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality. There is a significant gap in the literature regarding the prevalence of the use of antenatal corticosteroids in Latin American countries and the attitudes and opinions of providers regarding this practice. The aim of this study was to assess the knowledge, attitudes and practices of health care providers regarding the use of antenatal corticosteroids in women at risk of preterm birth in Latin America. Methods: This was a multicenter, prospective, descriptive study conducted in maternity hospitals in Ecuador, El Salvador, Mexico and Uruguay. Physicians and midwives who provide prenatal care or intrapartum care for women delivering in the selected hospitals were approached using a self-administered questionnaire. Descriptive statistics was used.

Maternal and Child Health Journal, 2014

To explore attitudes of physicians attending births in the public and private sectors and at the ... more To explore attitudes of physicians attending births in the public and private sectors and at the managerial level toward cesarean birth in Nicaragua. A qualitative study was conducted consisting of four focus groups with 17 physicians and nine in-depth interviews with decision-makers. Although study participants listed many advantages of vaginal birth and disadvantages of cesarean birth, they perceived that the increase in the cesarean birth rate in Nicaragua has resulted in a reduction in perinatal morbidity and mortality. They ascribed high cesarean birth rates to a web of interrelated provider, patient, and health system factors. They identified five actions that would facilitate a reduction in the number of unnecessary cesarean operations: establishing standards and protocols; preparing women and their families for labor and childbirth; incorporating cesarean birth rate monitoring and audit systems into quality assurance activities at the facility level; strengthening the movement to humanize birth; and promoting community-based interventions to educate women and families about the benefits of vaginal birth. Study participants believe that by performing cesarean operations they are providing the best quality of care feasible within their context. They do not perceive problems with their current practice. The identified causes of unnecessary cesarean operations in Nicaragua are multifactorial, so it appears that a multi-layered strategy is needed to safely reduce cesarean birth rates. The recent Nicaraguan Ministry of Health guidance to promote parto humanizado (''humanization of childbirth'') could serve as the basis for a collaborative effort among health care professionals, government, and consumer advocates to reduce the number of unnecessary cesarean births in Nicaragua.

International Journal of Gynecology & Obstetrics, 2011

a b s t r a c t a r t i c l e i n f o Keywords: Maternal mortality Oxytocin Postpartum hemorrhage... more a b s t r a c t a r t i c l e i n f o Keywords: Maternal mortality Oxytocin Postpartum hemorrhage Third stage of labor Uniject

International Journal of Gynecology & Obstetrics, 2009

European Journal of Gastroenterology & Hepatology, 2006

The main objectives of the consensus meeting were to provide evidence-based guidance with respect... more The main objectives of the consensus meeting were to provide evidence-based guidance with respect to the diagnosis and treatment of GORD, relevant to all countries in the region. The methodology, results and recommendations of the consensus are described in detail.

Epidemiology, 2007

Caesarean section (C-section) rates are rising in many middle-and high-income countries, with the... more Caesarean section (C-section) rates are rising in many middle-and high-income countries, with the justification that higher rates of C-section are associated with better outcomes. A review of 79 studies comparing outcomes of elective caesarean sections with vaginal deliveries, including both observational studies and randomized trials, suggests that caesarean sections may have substantially greater risks than vaginal deliveries. In this issue of EPIDEMIOLOGY, Leung and colleagues present data from Hong Kong on morbidity in offspring related to C-section. Such studies are needed to widen the scope of possible health outcomes related to elective C-sections, including such endpoints as maternal satisfaction and women's relationship with their child. Testing of interventions to reduce unnecessary C-sections is also needed, with strategies to enhance the role of women in the process of their obstetric care.

Annals of Oncology, 2010

Malignant peritoneal mesothelioma (MPM) is a rare disease characterized by a difficult diagnosis,... more Malignant peritoneal mesothelioma (MPM) is a rare disease characterized by a difficult diagnosis, different types of presentation, variable course and poor prognosis. Eighty-one patients with MPM observed in 14 Italian oncology institutions from 1982 to 2007 have been examined with the aim of delineating the history of MPM. Presentation symptoms were ascites, abdominal pain, asthenia, weight loss, anorexia, abdominal mass, fever, diarrhea and vomiting in various associations. Computed tomography scan and echotomography signs were ascites, abdominal mass and peritoneal thickening. Peritoneal fluid cytology (61 cases) was positive for mesothelioma in 31 and for malignancy, not mesothelioma, in 13. Laparoscopy was carried out in 40 cases and laparotomy in 36. Thrombocytosis was present in 59 cases. Associated tumors diagnosed during the lifetime were colorectal cancer in two cases and cheek carcinoma, thyroid carcinoma, tongue carcinoma, bladder carcinoma and testicular seminoma. Thirty patients were treated with surgery and 45 with chemotherapy. The median survival time from diagnosis is 13 months. Ascites, fever and vomiting were significative variables at presentation; only vomiting holds significance in a multivariate analysis. MPM is a disease with various types of presentation, frequently associated with thrombocytosis, sometimes with other tumors. Survival and diagnosis time can differ in various types of MPM. Prognosis is poor.

International Journal of Gynecology & Obstetrics, 2010

Use of health institutions by mothers and their children in lowincome countries has not shown maj... more Use of health institutions by mothers and their children in lowincome countries has not shown major improvement in recent years . Many organizations have begun to investigate patient and familycentered models of care, considering consumer involvement as a key issue in improving population health. Evidence supporting the implementation of "community interventions"-interventions that do not take place in health facilities-to reduce maternal and perinatal mortality is increasing .

The American journal of tropical medicine and hygiene, 2008

We conducted a cross-sectional study of Chagas disease in five endemic areas in Argentina, Bolivi... more We conducted a cross-sectional study of Chagas disease in five endemic areas in Argentina, Bolivia, Honduras, and México to estimate the prevalence of Trypanosoma cruzi-specific antibodies in pregnant women, and to assess the use of a rapid test (Chagas Stat-Pak) to screen for T. cruzi infection at the time of delivery. The prevalence of antibodies to T. cruzi measured by enzyme-linked immunosorbent assay (ELISA) in maternal blood was 5.5% (a range of 0.8-28.8% among the countries) in 2,495 women enrolled. Compared with ELISA in maternal blood samples, the Chagas Stat-Pak rapid test sensitivity and specificity in umbilical cord blood were 94.6% and 99.0%, respectively. These results show the ability for a rapid determination of the presence of T. cruzi-specific antibodies in umbilical cord blood as a pragmatic strategy to screen for infection in pregnant women.

BMC pediatrics, Jan 7, 2004

Retinopathy of Prematurity (ROP) is a common retinal neovascular disorder of premature infants. I... more Retinopathy of Prematurity (ROP) is a common retinal neovascular disorder of premature infants. It is of variable severity, usually heals with mild or no sequelae, but may progress to blindness from retinal detachments or severe retinal scar formation. This is a preliminary report of the effectiveness and safety of a new and original use of topical ketorolac in preterm newborn to prevent the progression of ROP to the more severe forms of this disease. From January 2001 to December 2002, all fifty nine preterm newborns with birthweight less than 1250 grams or gestational age less than 30 weeks of gestational age admitted to neonatal intensive care were eligible for treatment with topical ketorolac (0.25 milligrams every 8 hours in each eye). The historical comparison group included all 53 preterm newborns, with the same inclusion criteria, admitted between January 1999 and December 2000. Groups were comparable in terms of weight distribution, Apgar score at 5 minutes, incidence of se...

The Lancet, 2007

Health inequality in Latin America. By - José M Belizán, María L Cafferata, María Belizán, Fernan... more Health inequality in Latin America. By - José M Belizán, María L Cafferata, María Belizán, Fernando Althabe.

Value in Health, 2011

Illness (COI), basada en la prevalencia, así como la creación de un panel de expertos multidiscip... more Illness (COI), basada en la prevalencia, así como la creación de un panel de expertos multidisciplinario que clasificó la atención médica, tomando en cuenta la gravedad de la enfermedad (CP I -CP IV): Ambulatoria, Hospitalización, Quirófano, Unidad de Cuidados Intensivos, Quimioterapia, Radioterapia y Cuidados Paliativos. Finalmente empleamos la fracción atribuible por tabaco para estimar los costos por tabaquismo. Los costos están expresados en pesos mexicanos ($) y en dólares americanos (USD) del 2009. RESULTADOS: El costo promedio anual por paciente asociado al consumo de tabaco fue de 1,105,250.9(84,590.5USD),independientementedelagravedaddelaenfermedad.LosnivelesdeseveridadIIIyIVdelCPfueronlosmaˊscostososparaelINCAN,conuncostopromedioanualporpacientede1,105,250.9 (84,590.5 USD), independientemente de la gravedad de la enfermedad. Los niveles de severidad III y IV del CP fueron los más costosos para el INCAN, con un costo promedio anual por paciente de 1,105,250.9(84,590.5USD),independientementedelagravedaddelaenfermedad.LosnivelesdeseveridadIIIyIVdelCPfueronlosmaˊscostososparaelINCAN,conuncostopromedioanualporpacientede862,398.9 (66,003.8 USD) y 1,174,011.5(89,853.1USD).ElcostototalanualdelCPportabaquismoenelINCANfuede1,174,011.5 (89,853.1 USD). El costo total anual del CP por tabaquismo en el INCAN fue de 1,174,011.5(89,853.1USD).ElcostototalanualdelCPportabaquismoenelINCANfuede245,735,016.9 (18,807,354.8 USD), donde el CP IV explicó el 96 % de este costo anual. CONCLUSIONES: Los resultados obtenidos confirman los altos costos del CP atribuido al tabaquismo y presentan evidencia científica para apoyar las políticas de salud orientadas al control del consumo de tabaco. El CP al ser una enfermedad evitable, los recursos económicos destinados al tratamiento de la enfermedad podrían asignarse en otras áreas de interés dentro del Instituto.

International Journal of Gynecology & Obstetrics, 2014

Active management of third stage of labor (AMTSL) Multifaceted intervention Nicaragua Oxytocin Po... more Active management of third stage of labor (AMTSL) Multifaceted intervention Nicaragua Oxytocin Postpartum hemorrhage Professional behavior change Selective episiotomy Uniject Objective: To assess the effect of a multifaceted intervention among skilled birth attendants on the use of oxytocin during the third stage of labor, the active management of the third stage of labor (AMTSL), and the rate of routine episiotomy during vaginal births in two health districts in Nicaragua. Methods: An uncontrolled before-and-after study design was used. The rates of oxytocin use in the third stage of labor, AMTSL, and episiotomy were measured for vaginal births occurring in eight hospitals and health centers during 2011-2012, before and after implementation of a multifaceted facility-based intervention. The intervention involved the use of opinion leaders, interactive workshops to develop and implement evidence-based guidelines, academic detailing, the use of reminders, and feedback on the rates of oxytocin use and episiotomy. Results: Oxytocin use during the third stage of labor increased significantly from 95.3% to 97.4% (P = 0.003). The episiotomy rate dropped significantly from 31.2% to 21.2% overall, and from 59.6% to 40.5% in primiparous women (P b 0.001 for both comparisons). Conclusion: The multifaceted intervention improved the targeted care practices during childbirth. However, a further decrease in the routine use of episiotomy would be desirable.

BMC Health Services Research, 2014

Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly ... more Background: Antenatal care (ANC) reduces maternal and perinatal morbidity and mortality directly through the detection and treatment of pregnancy-related illnesses, and indirectly through the detection of women at increased risk of delivery complications. The potential benefits of quality antenatal care services are most significant in low-resource countries where morbidity and mortality levels among women of reproductive age and neonates are higher. WHO developed an ANC model that recommended the delivery of services scientifically proven to improve maternal, perinatal and neonatal outcomes. The aim of this study is to determine the effect of an intervention designed to increase the use of the package of evidence-based services included in the WHO ANC model in Mozambique. The primary hypothesis is that the intervention will increase the use of evidence-based practices during ANC visits in comparison to the standard dissemination channels currently used in the country.

Paediatric and Perinatal Epidemiology, 2008

Strategies for improving the quality of health care in maternal and child health in low-and middl... more Strategies for improving the quality of health care in maternal and child health in low-and middle-income countries: an overview of systematic reviews.

Gastroenterología y Hepatología, 2010

Reproductive Health, 2013

Background: Trypanosoma cruzi has been divided into Discrete Typing Units I and non-I (II-VI). T.... more Background: Trypanosoma cruzi has been divided into Discrete Typing Units I and non-I (II-VI). T. cruzi I is predominant in Mexico and Central America, while non-I is predominant in most of South America, including Argentina. Little is known about congenital transmission of T. cruzi I. The specific aim of this study is to determine the rate of congenital transmission of T. cruzi I compared to non-I. Methods/design: We are conducting a prospective study to enroll at delivery, 10,000 women in Argentina, 7,500 women in Honduras, and 13,000 women in Mexico. We are measuring transmitted maternal T. cruzi antibodies by performing two rapid tests in cord blood (Stat-Pak, Chembio, Medford, New York, and Trypanosoma Detect, InBios, Seattle, Washington). If at least one of the results is positive, we are identifying infants who are congenitally infected by performing parasitological examinations on cord blood and at 4-8 weeks, and serological follow-up at 10 months. Serological confirmation by ELISA (Wiener, Rosario, Argentina) is performed in cord and maternal blood, and at 10 months. We also are performing T. cruzi standard PCR, real-time quantitative PCR and genotyping on maternal venous blood and on cord blood, and serological examinations on siblings. Data are managed by a Data Center in Montevideo, Uruguay. Data are entered online at the sites in an OpenClinica data management system, and digital pictures of data forms are sent to the Data Center for quality control. Weekly reports allow for rapid feedback to the sites. Trial registration: Observational study with ClinicalTrials.gov Identifier NCT01787968

Reproductive Health, 2013

Background: Antenatal corticosteroids administered to women at risk of preterm birth is an interv... more Background: Antenatal corticosteroids administered to women at risk of preterm birth is an intervention which has been proved to reduce the risk of respiratory distress syndrome, intraventricular hemorrhage, and neonatal mortality. There is a significant gap in the literature regarding the prevalence of the use of antenatal corticosteroids in Latin American countries and the attitudes and opinions of providers regarding this practice. The aim of this study was to assess the knowledge, attitudes and practices of health care providers regarding the use of antenatal corticosteroids in women at risk of preterm birth in Latin America. Methods: This was a multicenter, prospective, descriptive study conducted in maternity hospitals in Ecuador, El Salvador, Mexico and Uruguay. Physicians and midwives who provide prenatal care or intrapartum care for women delivering in the selected hospitals were approached using a self-administered questionnaire. Descriptive statistics was used.

Maternal and Child Health Journal, 2014

To explore attitudes of physicians attending births in the public and private sectors and at the ... more To explore attitudes of physicians attending births in the public and private sectors and at the managerial level toward cesarean birth in Nicaragua. A qualitative study was conducted consisting of four focus groups with 17 physicians and nine in-depth interviews with decision-makers. Although study participants listed many advantages of vaginal birth and disadvantages of cesarean birth, they perceived that the increase in the cesarean birth rate in Nicaragua has resulted in a reduction in perinatal morbidity and mortality. They ascribed high cesarean birth rates to a web of interrelated provider, patient, and health system factors. They identified five actions that would facilitate a reduction in the number of unnecessary cesarean operations: establishing standards and protocols; preparing women and their families for labor and childbirth; incorporating cesarean birth rate monitoring and audit systems into quality assurance activities at the facility level; strengthening the movement to humanize birth; and promoting community-based interventions to educate women and families about the benefits of vaginal birth. Study participants believe that by performing cesarean operations they are providing the best quality of care feasible within their context. They do not perceive problems with their current practice. The identified causes of unnecessary cesarean operations in Nicaragua are multifactorial, so it appears that a multi-layered strategy is needed to safely reduce cesarean birth rates. The recent Nicaraguan Ministry of Health guidance to promote parto humanizado (''humanization of childbirth'') could serve as the basis for a collaborative effort among health care professionals, government, and consumer advocates to reduce the number of unnecessary cesarean births in Nicaragua.

International Journal of Gynecology & Obstetrics, 2011

a b s t r a c t a r t i c l e i n f o Keywords: Maternal mortality Oxytocin Postpartum hemorrhage... more a b s t r a c t a r t i c l e i n f o Keywords: Maternal mortality Oxytocin Postpartum hemorrhage Third stage of labor Uniject

International Journal of Gynecology & Obstetrics, 2009

European Journal of Gastroenterology & Hepatology, 2006

The main objectives of the consensus meeting were to provide evidence-based guidance with respect... more The main objectives of the consensus meeting were to provide evidence-based guidance with respect to the diagnosis and treatment of GORD, relevant to all countries in the region. The methodology, results and recommendations of the consensus are described in detail.

Epidemiology, 2007

Caesarean section (C-section) rates are rising in many middle-and high-income countries, with the... more Caesarean section (C-section) rates are rising in many middle-and high-income countries, with the justification that higher rates of C-section are associated with better outcomes. A review of 79 studies comparing outcomes of elective caesarean sections with vaginal deliveries, including both observational studies and randomized trials, suggests that caesarean sections may have substantially greater risks than vaginal deliveries. In this issue of EPIDEMIOLOGY, Leung and colleagues present data from Hong Kong on morbidity in offspring related to C-section. Such studies are needed to widen the scope of possible health outcomes related to elective C-sections, including such endpoints as maternal satisfaction and women's relationship with their child. Testing of interventions to reduce unnecessary C-sections is also needed, with strategies to enhance the role of women in the process of their obstetric care.

Annals of Oncology, 2010

Malignant peritoneal mesothelioma (MPM) is a rare disease characterized by a difficult diagnosis,... more Malignant peritoneal mesothelioma (MPM) is a rare disease characterized by a difficult diagnosis, different types of presentation, variable course and poor prognosis. Eighty-one patients with MPM observed in 14 Italian oncology institutions from 1982 to 2007 have been examined with the aim of delineating the history of MPM. Presentation symptoms were ascites, abdominal pain, asthenia, weight loss, anorexia, abdominal mass, fever, diarrhea and vomiting in various associations. Computed tomography scan and echotomography signs were ascites, abdominal mass and peritoneal thickening. Peritoneal fluid cytology (61 cases) was positive for mesothelioma in 31 and for malignancy, not mesothelioma, in 13. Laparoscopy was carried out in 40 cases and laparotomy in 36. Thrombocytosis was present in 59 cases. Associated tumors diagnosed during the lifetime were colorectal cancer in two cases and cheek carcinoma, thyroid carcinoma, tongue carcinoma, bladder carcinoma and testicular seminoma. Thirty patients were treated with surgery and 45 with chemotherapy. The median survival time from diagnosis is 13 months. Ascites, fever and vomiting were significative variables at presentation; only vomiting holds significance in a multivariate analysis. MPM is a disease with various types of presentation, frequently associated with thrombocytosis, sometimes with other tumors. Survival and diagnosis time can differ in various types of MPM. Prognosis is poor.

International Journal of Gynecology & Obstetrics, 2010

Use of health institutions by mothers and their children in lowincome countries has not shown maj... more Use of health institutions by mothers and their children in lowincome countries has not shown major improvement in recent years . Many organizations have begun to investigate patient and familycentered models of care, considering consumer involvement as a key issue in improving population health. Evidence supporting the implementation of "community interventions"-interventions that do not take place in health facilities-to reduce maternal and perinatal mortality is increasing .