RESUMEN
BACKGROUND: While the number of reports of randomized controlled trials in physical therapy has increased substantially in the last decades, the quality and reporting of randomized trials have never been systematically investigated in the subdiscipline of cardiothoracic physical therapy. The primary aim was to determine the methodological quality and completeness of reporting of cardiothoracic physical therapy trials. Secondary aims were to investigate the range of clinical conditions investigated in these trials and the degree of association between trial characteristics and quality. METHODS: All reports of randomized trials indexed on the Physiotherapy Evidence Database (PEDro) and coded as being relevant to cardiothoracic physical therapy were surveyed. PEDro scale individual items and total score were downloaded, and some characteristics included in the Consolidated Standards of Reporting Trials (CONSORT) statement were extracted for each trial report. RESULTS: The mean ± SD total PEDro score for the 2,970 included reports of cardiothoracic trials was 4.7 ± 1.4, with 27% being of moderate to high quality. The clinical conditions studied included chronic lung diseases (32% of the trials), cardiac diseases (20%), cardiovascular surgical conditions (5%), sleep disorders (5%), peripheral vascular disease (4%), acute lung disease (4%), critical illness (3%), and other surgical conditions (3%). The multivariate linear regression analysis revealed that endorsement of the CONSORT statement by the publishing journal, time since publication, evidence of trial registration, sources of funding, description of the sample size calculation, and identification of the primary outcome(s) had associations with the total PEDro score. CONCLUSIONS: There is great potential to improve the quality of the conduct and reporting of trials evaluating the effects of cardiothoracic physical therapy.
Asunto(s)
Cardiopatías/rehabilitación , Modalidades de Fisioterapia/normas , Control de Calidad , Ensayos Clínicos Controlados Aleatorios como Asunto/normas , Enfermedades Respiratorias/rehabilitación , Humanos , Publicaciones Periódicas como AsuntoRESUMEN
PIP: In 1995, Nicaragua reported 195 suspected measles cases. 190 were discarded and five were clinically confirmed, indicating a failure of the surveillance system. In 1996, 194 suspected cases of measles had been reported, 193 of which were discarded. The distribution of suspected cases is as follows: 38% aged under 1 year, 28% aged 1-4 years, 21% aged 5-14 years, and 12% over age 15 years. Of the 194 suspected cases, 20% had received one dose of measles vaccine, 30% two or more doses, 43% were not vaccinated, and in 7% of cases the history was not known. 87% of the unvaccinated children were too young for vaccination. The national immunization program has a computerized database for suspected measles cases which evaluates the percentage of reporting units with weekly negative notification, the percentage of cases reported within 7 days of rash onset, the percentage of cases investigated within 48 hours of notification, the percentage of cases with complete investigation and adequate sample taken, and the percentage of cases with laboratory results within 7 days. Recommendations are made on surveillance and management. Nicaragua has an active epidemiological surveillance system at the national level capable of detecting suspected measles cases or outbreaks on a timely basis. The lack of confirmed cases indicates the effectiveness of the vaccination strategies used by the country to eradicate measles and the optimal levels of coverage attained. There is no evidence of measles virus circulating in the country. Finally, in order to maintain the successes attained, other public and private sector institutions, schools, and community organizations must become involved.^ieng
Asunto(s)
Epidemiología , Sarampión , Proyectos de Investigación , Américas , América Central , Recolección de Datos , Países en Desarrollo , Enfermedad , Estudios de Evaluación como Asunto , Salud , América Latina , Nicaragua , América del Norte , Salud Pública , Investigación , VirosisRESUMEN
Infant feeding is a multidimensional activity that can be described and analysed in many different ways. The World Health Organization (WHO) has recently issued recommended indicators for assessing infant feeding practices. This paper presents these indicators and demonstrates their applications using the 1989 Demographic and Health Survey (DHS) data for Bolivia. The results indicate that, although most Bolivian infants are breastfed and two-thirds are breastfed for > 1 year, supplementary feeding practices deviate considerably from international recommendations. Only 58% of infants < 4 months old are receiving breastmilk alone (the 'exclusive breastfeeding rate') and a similarly low percentage (54.7%) of 6-9 month olds are receiving the recommended combination of breast milk plus solid or semi-solid foods (the 'timely complementary feeding rate'). Furthermore, almost half of breastfed infants < 12 months old are also receiving bottle feeds. The infant feeding practices of city residents are least likely to conform to the infant feeding recommendations, while practices of mothers who have always lived in the country are most likely to be similar to the WHO guidelines. Mothers who have moved to the city since the age of 12 are most likely to be giving their infants other milks in addition to breast milk and to be bottle feeding their infants. The WHO infant feeding indicators provide a useful framework for quantifying infant feeding practices, and most of the indicators can readily be applied to DHS data. Nonetheless, improvements can be made in both the indicators themselves and the DHS questionnaire to improve reporting of internationally comparable infant feeding information.
PIP: 1989 Demographic and Health Survey data for Bolivia is used to examine trends in World Health Organization (WHO) designated breast feeding measures. WHO measures are evaluated. WHO measures are the exclusive breast feeding rate (under 4 months), predominant breast feeding with supplementation of nonmilk liquids (under 4 months), timely complementary feeding rate, continuous breast feeding rate for children aged 12-15 months, bottle feeding rate, ever breast fed rate, and median duration of breast feeding. The timely complementary feeding rate or those 6-9 months receiving solid or semisolid foods is 55%. The continuous feeding rate is 66% for the 12-15 month old infants, and just under 50% for infants aged 20-23 months. Almost 50% of breast feeding infants also receive bottle feeding. 97% are ever breast fed. The median duration of breast feeding is 17 months. At under 4 months 57.6% receive both breast milk and other milk and not solids, and 8% are not breast fed. At 6-9 months 54.7% are receiving breast milk and solids, and almost 33% receive breast milk and other milk. About 15% are not being breast fed. At 10-11 months about 15% are still being exclusively breast fed, and almost 25% are not being breast fed at all. At 12 months about 4% receive breast milk and no solids. Exclusive breast feeding occurs among just under 50% of mothers who have always lived in the city and among those who migrated to the city. The highest rates are among women who lived in the country. The greatest differences in breast feeding are among mothers who always either lived in a city or the country. The lowest complementary feeding rate occurs in the city-always group (39.3%). The highest complementary feeding rate occurs among the town group (73.1%). Continued breast feeding is lowest in the city-always group. The highest proportion of infants receiving bottles is among infants with mothers who migrated to the city (72.0%) followed by city-always mothers (60.1%). The WHO indicators are found to be useful standards for guiding research and developing policy and practice norms.
Asunto(s)
Alimentación con Biberón/estadística & datos numéricos , Lactancia Materna/estadística & datos numéricos , Factores de Edad , Bolivia , Emigración e Inmigración , Humanos , Lactante , Alimentos Infantiles , Recién Nacido , Población Rural , Población Urbana , Organización Mundial de la SaludRESUMEN
PIP: The Women's Collective in Matagalpa, Nicaragua, Sanitaria VI region estimated maternal mortality rates for 1989 and 1990 to be 309 and 239/100,000 live births, respectively. The majority of births took place at home, assisted by untrained midwives, and in 68% of cases the place and attendant(s) were not listed. National figures for maternal mortality are 49.4 and 159/per 100,000 in 1989. Thus the proportion of unreported maternal mortality is probably high in Nicaragua. The Collective believers that health workers give substandard prenatal care and fail to refer high risk cases to higher levels of care. They recommend that women mount a permanent campaign, insist on training programs for health workers that focus on women's situation, that more data be collected, and that women themselves take action.^ieng
Asunto(s)
Directrices para la Planificación en Salud , Mortalidad Materna , Morbilidad , Madres , Desarrollo de Programa , Proyectos de Investigación , Américas , América Central , Recolección de Datos , Demografía , Países en Desarrollo , Enfermedad , Composición Familiar , Relaciones Familiares , América Latina , Mortalidad , Nicaragua , América del Norte , Padres , Población , Dinámica Poblacional , InvestigaciónRESUMEN
PIP: In 1991, the Ministry of Health and technical consultants from PAHO evaluated the measles surveillance system in Jamaica. This system consisted of the notification system, the sentinel sites system, active hospital surveillance, laboratory reporting, and special surveys. The team concentrated their efforts on the system's ability to detect and investigate suspected cases of measles. The team visited sentinel sites including health centers, hospitals, or a physician in all 13 parishes. 44 sites operated at the time. It spoke with medical Officers and Senior Public Health Nurses and evaluated written records. The notification system had recently classified measles as a Class I disease to encourage a rapid public health response and to secure investigation records. The major weakness of the notification system was case investigation. In 1991, health workers investigated only 6 (3%) of 208 suspected cases within 48 hours and eventually investigated only 76 (36.5%). 23 cases were confirmed as measles. Serology tests revealed that most suspected cases were actually rubella. This indicated a need to include serological testing for confirmation. The team found that the notification system underreported cases. Each sentinel site was required to collect each week a count of the number of cases of measles and other conditions to monitor trends. 87% reported the counts weekly. The sites consistently reported measles bas ed on clinical suspicion. Public health staff visited hospitals weekly to review cases of target disease including measles. They visited at least 1 hospital regularly in each parish. Hospital records did not contain consistent measles data. For example, only 10 of 13 visit reports included patient's name, age, sex, and address and only 7 included outcome. Detailed information was only available on 13 of the 208 suspected cases so the team was only able to evaluate them.^ieng
Asunto(s)
Métodos Epidemiológicos , Entrevistas como Asunto , Sarampión , Métodos , Programas Nacionales de Salud , Organización Panamericana de la Salud , Evaluación de Programas y Proyectos de Salud , Proyectos de Investigación , Virosis , Américas , Región del Caribe , Recolección de Datos , Atención a la Salud , Países en Desarrollo , Enfermedad , Salud , Servicios de Salud , Agencias Internacionales , Jamaica , América del Norte , Organización y Administración , Organizaciones , Investigación , Naciones Unidas , Organización Mundial de la SaludRESUMEN
"This article investigates whether misreporting of ages contributes to the apparently low mortality at older ages in Latin America. It compares the size of cohorts enumerated at two censuses, after allowance for intercensal deaths, in 10 intercensal periods in four countries. It finds evidence of very pervasive overstatement of age at advanced ages. Using an empirical age-reporting matrix for Costa Rica, it estimates the bias that such misstatement produces in measured adult mortality levels in that country."
Asunto(s)
Adulto , Factores de Edad , Sesgo , Mortalidad , Proyectos de Investigación , Estadística como Asunto , Américas , América Central , Costa Rica , Recolección de Datos , Demografía , Países en Desarrollo , América Latina , América del Norte , Población , Características de la Población , Dinámica Poblacional , InvestigaciónRESUMEN
PIP: Although maternal mortality rates worldwide have declined dramatically over the past several decades, maternal mortality rates in developing countries are considered a public health problem. The true rates of maternal mortality are unknown and frequently underestimated. Data from the UN annual demographic report show that only 4 Central American countries met the requirements for publication of their maternal mortality rates. 1984 rates ranged from the high of 75.6/100,000 live births in Guatemala to the low of 22.4/100,000 in Costa Rica. The principal or only source of maternal mortality data in Central American countries is vital statistics reported by official organizations. Difficulties in reporting and collecting this information and the fact that vital statistics were not developed for study of maternal mortality make them a poor source of data. Death certificates do not include the final cause of death. Review of death certificates of fertile-aged women and combining other sources of data such as clinical histories or autopsy reports with the vital statistics are techniques for improving the registration of maternal deaths. A national system of epidemiologic surveillance of maternal mortality has the advantage of obtaining information from multiple sources, including the press, private physicians, midwives, hospital obstetrics and gynecology departments, health centers and posts, family planning clinics, private hospitals, maternal mortality committees, families, and the local and national vital statistics. A national level surveillance program should be recognized as the coordinator of activities in this area, and the systems of data collection, analysis, and use of the results should be easily adaptable, inexpensive, simple, and able to motivate. An outline of steps to be followed in organizing and developing a system of surveillance is included in this work, beginning with establishing the objectives and determining what data are needed and ending with identifying requisites for future development. The data should include the pregnancy outcome, type of delivery, gestational age, type of anesthesia used, medications given before death, and other factors that could have contributed to the death. Since there are no universally accepted scientific definitions or usages for causes or rates of maternal death, each national surveillance program must review and attempt to standardize its definitions. Definitions proposed by the maternal division of the US Centers for Disease Control are discussed in this article, including deaths associated with or related to pregnancy, maternal mortality rates and ratios, and specific mortality rates during pregnancy. Such a national surveillance program can help detect misclassified maternal deaths and clarify risk factors so that national level priorities and strategies can be developed to combat maternal deaths.^ieng
Asunto(s)
Causas de Muerte , Recolección de Datos , Países en Desarrollo , Métodos Epidemiológicos , Planificación en Salud , Mortalidad Materna , Desarrollo de Programa , Proyectos de Investigación , Estadística como Asunto , Estadísticas Vitales , Américas , América Central , Demografía , Mortalidad , América del Norte , Organización y Administración , Población , Características de la Población , Dinámica Poblacional , InvestigaciónRESUMEN
PIP: Neonatal mortality rates are often used as indicators of the quality of neonatal care without consideration of their many limitations, 1 of which is the lack of unanimity in basic definitions. Chile's infant mortality rate has declined from 200.9/1000 live births in 1939 to 19.5/1000 in 1986. With increasing control of infection and lowering of infant mortality rates, the proportion of deaths occurring in the neonatal period has increased to 50% or more. Use of internationally established and accepted definitions for perinatal mortality will allow national and international comparisons and permit avoidance of errors in interpretation of infant mortality trends. Gestational age is defined as the complete number of weeks elapsed between the 1st day of the last menstrual period and the date of delivery. Fetal death is death occurring before the complete expulsion or extraction of the product of conception, regardless of the duration of pregnancy. Early fetal death or abortion is expulsion or extraction of a fetus or embryo with a gestational age under 22 weeks or a weight under 500 g. Late fetal death or stillbirth is the death before expulsion or delivery of a fetus with a gestational age over 22 complete weeks or a weight of 500 g or over. The fetal death rate is the number of late fetal deaths/1000 live births excluding abortions. A live birth corresponds to complete expulsion and extraction of a product of conception, regardless of the duration of pregnancy, which breathes or shows evidence of life after expulsion or extraction. Neonatal mortality refers to death in the 1st 28 days of life. Early neonatal mortality refers to death before 7 days and late neonatal mortality to death on days 7-28. The specific neonatal mortality rate by birth weight refers to the number of neonatal deaths of a determined weight per 1000 live births of the same birth weight. Perinatal mortality is the sum of early neonatal and late fetal mortality. Prematurity refers to a gestational age of less than 37 weeks or 258 completed days. Added to the problems of definition is the lack of unanimity in diagnosis of the cause of death. The immediate cause, basic cause, and concomitant morbid states are not always distinguished. Registration of neonatal deaths is not complete in Chile, especially among infants weighing less than 1000 g. Chile has almost no official statistics giving specific rates by birth weight and gestational age, which are indispensable for study of the highest risk groups of infants, those weighing under 1500 g at birth.^ieng
Asunto(s)
Mortalidad Infantil , Peso al Nacer , Causas de Muerte , Chile , Femenino , Muerte Fetal , Humanos , Recién Nacido , EmbarazoRESUMEN
PIP: World Fertility Survey (WFS) data is used to study household composition in 6 countries in Latin America: Mexico, Costa Rica, the Dominican Republic, Panama, Colombia and Peru. WFS's household schedule is a census-like document that lists household members as present, absent and visitors. This issue is significant because between 10-26% of all households in Colombia, the Dominican Republic, Panama and Peru were affected; between 5-19% of the homes had an absentee member while 5-10% of the homes had a visitor. Visitors had fewer children and more young adults (15-24) than the present population. Absent members tended to be adult, males and either household heads or children of household heads. A recommendation is made to use a dejure definition that excludes visitors but includes absent members. Another critical issue in the WFS is the definition of head of household. The variation in defining this term in the 6 countries was between 66-76% because WFS classified households according to the number of couples they contained. However the Hammel-Laslett classification scheme, solitaire, no family, simple family, extended family and multiple family is recommended with WFS data. The issue of marital status is important and confusing because many of those in stable unions have never been legally or religiously sanctioned. These are counted as married. With regard to the quality of the data, Kabir's check on the internal consistency of data from 17 countries found errors in 2% (or less) of the households. A check for consistency between household and age revealed that consistency in information increased considerably when the age of groups were used in 5 year categories and not individually; 61% of those interviewed in Colombia had the same age, but when using 5 year age groups it rose to 88%.^ieng
Asunto(s)
Factores de Edad , Composición Familiar , Fertilidad , Estado Civil , Reproducibilidad de los Resultados , Proyectos de Investigación , Estadística como Asunto , Américas , Tasa de Natalidad , Región del Caribe , América Central , Colombia , Recolección de Datos , Demografía , Países en Desarrollo , República Dominicana , América Latina , Matrimonio , América del Norte , Panamá , Perú , Población , Dinámica Poblacional , Investigación , América del SurRESUMEN
Information on the activities, practices and social context of pregnancy and delivery care provided by traditional birth attendants (TBA) is a critical requirement in planning, monitoring and evaluating maternal health programs in many countries. As a result of experimental studies in which such information was obtained by a variety of methods, and a review of alternative methodologies, a set of guidelines has been developed for the collection of such information. High-lighted are the need for good background knowledge on the local situation, involving TBAs themselves in design and collecting methods, a system of supervision to ensure adequate training and careful monitoring, and finally sharing the findings with the TBAs as well as with health officials.
PIP: Information on the activities, practices and social context of pregnancy and delivery care as provided by traditional birth attendants (TBA) is a critical requirement in planning, monitoring and evaluating maternal health programs in many countries. As a result of experimental studies in which information was obtained by a variety of methods, and a review of alternative methodologies, a set of guidelines has been developed for the collection of such information. The need for good background knowledge on the local situation, involving TBAs themselves in design and collecting methods, a system of supervision to ensure adequate training and careful monitoring, and finally sharing the findings with the TBAs as well as with, health officials are stressed. Early development efforts in Egypt and Brazil are described and the lessons learned are summarized. Some new data collection strategies currently in use are also discussed. It was found that TBAs, whether or not they are literate, can report information on several variables. Improvements made in the data collection instruments as a result of these projects assure better information on referrals and contraceptive intentions. Better study design helps to assure more complete reporting of cases. A number of guidelines evolved: good background information on the local situation should be obtained; TBAs should participate in development of a data collection system; an appropriate system of supervision should be set up adequate training and careful monitoring of data collection activities are essental; and study findings should be shared with health officials and TBAs.
Asunto(s)
Partería , Brasil , Educación , Egipto , Femenino , Humanos , Entrevistas como Asunto , Perinatología/métodos , Embarazo , RegistrosRESUMEN
PIP: Indirect estimation techniques for analyzing adult mortality data are presented and applied to data for Chile from 1952 to 1970. The need for corrections to inter-censal growth rates is emphasized. The impact of age misstatement on the consistency between population and death data is noted.^ieng
Asunto(s)
Adulto , Factores de Edad , Demografía , Mortalidad , Características de la Población , Crecimiento Demográfico , Reproducibilidad de los Resultados , Proyectos de Investigación , Estadística como Asunto , Américas , Chile , Recolección de Datos , Países Desarrollados , Países en Desarrollo , América Latina , Población , Dinámica Poblacional , Investigación , América del SurRESUMEN
PIP: The development of a program to insure maximum use of information obtained from the 1981 Cuban census of population and housing is discussed. Some past policies and laws directed toward the use of census data are first reviewed. The principal objectives and content of the program are then described. A list of the principal publications and analyses used in program development is included. (summary in ENG, RUS)^ieng