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INTRODUCTION: The RACHS-1 method (Risk Adjustment for Congenital Heart Surgery) is widely used to predict mortality and risk adjustment in pediatric cardiovascular surgery and constitutes a valid tool to compare results among different health centers. OBJECTIVE: To analyze if the mortality observed in the neonatal group is related to age and/or the risk stratification according to RACHS-1. METHODS: From March 2001 to May 2008 we operated on 751 consecutive patients: 160 neonates (0-30 days), 309 infants (31 days-1 year) and 282 olders (1-18 years). Patients in each group were analyzed according to age, RACHS-1, and mortality. We used a logistic regression in which the mortality was the dependent variable and the age and RACHS-1 the independent variables. RESULTS: The total crude mortality was 4.3%, the neonatal 9.2%. We observed a significant statistical difference of RACHS-1 distribution according to age (chi(2)= 219, p< 0.0001). Logistic analysis showed no statistical difference of mortality (p> 0.05) in the age groups compared to RACHS-1. Furthermore, RACHS-1 is a most powerful mortality predictor (p< 0.001) while age is not (p= 0.8). Using our unit one of RACHS-1 as control group, the odds ratio of the different ages were 2.1 (CI 95%: 1.6-2.7) for each RACHS group. CONCLUSIONS: The age of surgery was not an independent risk factor as to mortality. The RACHS-1 method appeared as a powerful risk factor predictor of mortality; no differences were found in the age groups when classified by RACHS -1.

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Introducción. El método RACHS-1 (Risk Adjustment for Congenital Heart Surgery) se utiliza para predecir mortalidad y ajuste de riesgo en cirugía cardiovascular pediátrica y constituye una herramienta válida para la comparación de resultados. Objetivo. Establecer si la mortalidad neonatal se relaciona con la edad y con la estratificación según RACHS-1. Material y método. De marzo de 2001 a mayo de 2008 se operaron en forma consecutiva 751 pacientes: 160 neonatos (0-30 días), 309 lactantes(31-365 días) y 282 mayores (1-18 años); se analizó la distribución de los pacientes según edad, RACHS-1 y mortalidad. Se empleó un análisis de regresión logística con la mortalidad como variable dependiente y la edad y el RACHS-1 como variables independientes. Resultados. La mortalidad total bruta fue del 4,3 por ciento, la neonatal 9,2 por ciento. Se observó una diferencia estadísticamente significativa (c2= 219, p< 0,0001) de distribución por grupo etario y de RACHS-1. El análisis logístico indicó que no hay diferencias estadísticamente significativas (p> 0,05) de mortalidad entre los grupos etarios agrupados por RACHS-1 y que, mientras este último es un poderoso factor predictivo de mortalidad (p> 0,001), la edad no lo es (p= 0,8). Utilizando la unidad uno del RACHS-1 como grupo control, las razones de probabilidades (odds ratio) de las distintas edades fueron 2,1 (IC 95 por ciento: 1,6-2,7) por cada unidad de RACHS-1. Conclusiones. La edad de la operación no resultó un factor de riesgo independiente para las mortalidades. El RACHS-1 resultó un factor de riesgo de mortalidad de alto valor predictivo, no hubo diferencias de mortalidad entre los grupos etarios al ser agrupados por RACHS-1.

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Introducción. El método RACHS-1 (Risk Adjustment for Congenital Heart Surgery) se utiliza para predecir mortalidad y ajuste de riesgo en cirugía cardiovascular pediátrica y constituye una herramienta válida para la comparación de resultados. Objetivo. Establecer si la mortalidad neonatal se relaciona con la edad y con la estratificación según RACHS-1. Material y método. De marzo de 2001 a mayo de 2008 se operaron en forma consecutiva 751 pacientes: 160 neonatos (0-30 días), 309 lactantes(31-365 días) y 282 mayores (1-18 años); se analizó la distribución de los pacientes según edad, RACHS-1 y mortalidad. Se empleó un análisis de regresión logística con la mortalidad como variable dependiente y la edad y el RACHS-1 como variables independientes. Resultados. La mortalidad total bruta fue del 4,3 por ciento, la neonatal 9,2 por ciento. Se observó una diferencia estadísticamente significativa (c2= 219, p< 0,0001) de distribución por grupo etario y de RACHS-1. El análisis logístico indicó que no hay diferencias estadísticamente significativas (p> 0,05) de mortalidad entre los grupos etarios agrupados por RACHS-1 y que, mientras este último es un poderoso factor predictivo de mortalidad (p> 0,001), la edad no lo es (p= 0,8). Utilizando la unidad uno del RACHS-1 como grupo control, las razones de probabilidades (odds ratio) de las distintas edades fueron 2,1 (IC 95 por ciento: 1,6-2,7) por cada unidad de RACHS-1. Conclusiones. La edad de la operación no resultó un factor de riesgo independiente para las mortalidades. El RACHS-1 resultó un factor de riesgo de mortalidad de alto valor predictivo, no hubo diferencias de mortalidad entre los grupos etarios al ser agrupados por RACHS-1.(AU)

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El artículo expone los resultados de una encuesta a pacientes de 10 instituciones médicas de la ciudad de Buenos Aires, sobre el grado de satisfacción a sus expectativas durante su internación. El estudio corrobora la trascendencia de las relaciones humanas que se establecen entre cliente y enfermero, y jerarquiza aspectos interesantes sobre el rol del enfermero y del servicio de enfermería desde la perspectiva del usuario

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El artículo expone los resultados de una encuesta a pacientes de 10 instituciones médicas de la ciudad de Buenos Aires, sobre el grado de satisfacción a sus expectativas durante su internación. El estudio corrobora la trascendencia de las relaciones humanas que se establecen entre cliente y enfermero, y jerarquiza aspectos interesantes sobre el rol del enfermero y del servicio de enfermería desde la perspectiva del usuario (AU)

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Hazard analyses of food preparation practices were conducted in three households in a new settlement in the rocky, dusty hillsides at the outskirts of Lima, Peru. These analyses consisted of watching all steps of preparation, recording temperatures throughout these steps, and collecting samples of the food and testing them for common foodborne pathogens and indicator organisms. The residents had migrated from different regions of the country; consequently, they prepared different foods. These included soya cereal, milk formula, rice and carrots for feeding a baby who had diarrhea, soups, mashed potatoes with spinach, carrot and beet salad, cow's foot soup, beans, rice and a mixture of beans and rice. The temperatures attained were high enough to kill vegetative forms of foodborne pathogens, but not their spores. During the interval between cooking in the morning and serving at either lunch or supper time, foods were held either on unheated ranges or in unheated ovens. This interval was long enough to permit some bacterial multiplication, but apparently not to massive quantities. Just before the evening meal, foods were reheated to temperatures that usually exceeded 70°C. Rice, however, was either served cold or if reheated, the center temperature rose a few degrees only. Critical control points for preparation of family meals are cooking, holding between cooking and serving, and reheating. Critical control points for milk formula for babies are using recently-boiled water for the formula, cleaning and boiling bottles and nipples, and, of particular importance, time of holding at room temperature.

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Hazard analyses of food preparation practices were conducted in two households in Indiana (a settlement along the Peruvian Amazon River), in a household in a cluster of about a half dozen houses up river, and in three households in Belen (a district near Iquitos), Peru. These analyses consisted of watching all steps of the operation, recording temperatures throughout all these steps, and collecting samples of food and testing them for common foodborne pathogens and indicator organisms. Foods prepared included rice, plantains, yuca, dry fish, fresh fish, beef, and chicken. During cooking, foods attained temperatures of at least 93.3°C; they usually boiled. Such time-temperature exposure would kill vegetative forms of foodborne pathogenic bacteria, but not heat-resistant spores. When cooked foods were leftover, they were kept either on tables or on the unheated stoves or grills on which they were cooked. During this interval, at the prevailing ambient temperature and high humidity of the jungle region, conditions were such that considerable microbial growth could occur. Time of exposure, however, limited counts to the 105-106 level. In the evening, foods were only mildly reheated, if reheated at all, so temperatures were not attained in the center regions of the food that would have killed microorganisms that had multiplied during the holding period. Hence, the primary critical control point is holding between cooking and serving, but cooking and reheating are critical control points also.

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Hazard analyses of food preparation practices were conducted in two households in an Andean Indian Pueblo near Puno, Peru and in a house on the outskirts of this city. These analyses consisted of watching all steps of preparation, recording temperatures throughout all these steps, and collecting samples of food and testing them for common foodborne pathogens and indicator organisms. Only cereal-potato soup (a very popular and inexpensive food in the region), kidney stew, and parched cereal were prepared during the survey. The soups boiled during cooking and most of them were eaten during the first serving. Vegetative forms of pathogenic bacteria would have been killed during cooking, but heat-resistant spores would have survived. Leftovers in the pueblo homes, when there were any, remained without heat on the clay stoves on which they had been cooked until eaten or reheated. In the other household, cooked foods were moved from the stove to an earthen floor and kept there until reheating. Under this condition, cooling was more rapid than when left on stoves. The interval of time that cooked foods were between 49°C (120°F) and 21°C (70°F) during holding was less than 4 h, thereby limiting spore germination and bacterial multiplication. In the only household in which foods were reheated, they boiled. Critical control points for food preparation in homes are cooking, holding between cooking and serving, and reheating.