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Mass violence events, especially in healthcare settings, have devastating consequences and long-lasting effects on the victims and the community. The rate of violent events in Mexico, especially in hospital settings, has increased since 2006, but has become more evident in 2018. Guanajuato State, located in central Mexico, is among the states most affected by the wave of violence, especially active shooter events. The year 2019 had the highest number of incidents. Therefore, the Silver Code and the components of Safe Hospitals, in accordance with the Hartford consensus and PAHO guidelines, were implemented in the hospitals of the Institute of Public Health of the State of Guanajuato, with a focus on the actions of healthcare personnel to prevent collateral damage. Although subsequently there were still fatalities and injuries in the events involving active shooters in the hospitals, there were no casualties among healthcare personnel, according to data from the Institute of Public Health, Guanajuato State. This paper presents information from the data from General Directorate of Epidemiology to describe the hospital mass violence situation in the State of Guanajuato, Mexico and recounts the step taken to effectively manage and prevent these situations moving forward. Specific recommendations based on international consensus and our experience provided include increasing the level of security checks for people entering the hospital premises, training healthcare personnel on violence-related preparedness and improving management of active shooter events consistent with published evidence, to reduce the possibility of casualties.
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Serviço Hospitalar de Emergência , Humanos , México/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Serviço Hospitalar de Emergência/organização & administração , Armas de Fogo/estatística & dados numéricos , Ferimentos por Arma de Fogo/epidemiologia , Ferimentos por Arma de Fogo/mortalidade , Incidentes com Feridos em Massa/estatística & dados numéricos , Violência/estatística & dados numéricos , Violência/prevenção & controleRESUMO
Aspergillosis is an infrequent infection in the Central Nervous System with a mortality rate higher than 95 %. Early diagnosis is challenging and crucial. In this report, we present the case of a six-year-old female with an intense headache accompanied by left hemiparesis, gaze deviation, horizontal nystagmus, and vomiting of mucous content on five occasions. After several approaches, a cerebrospinal fluid PCR resulted positive for Aspergillus spp., and then management started with amphotericin B at 2.6 mg/kg/day and was managed to have voriconazole. She survived, and two years after her first hospital admission, she suffered from cerebral aspergillosis sequelae. An area of improvement is the coordination between the request and delivery of studies outside the institution. In this case, the patient´s mother did not report the analysis results on time, delaying the diagnosis.
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El sistema de atención de salud en Nicaragua se basa en el Programa de Enfermedades Crónicas No Transmisibles, demuestra beneficio clínico en personas de alto riesgo, pero en el caso de los pacientes con insuficiencia cardiaca severa (ICC) no se llegan a reducir los ingresos, reingresos hospitalarios y mortalidad. Objetivo. Proponer un modelo de gestión de atención integral dirigido a pacientes con ICC de un hospital general en Nicaragua. Materiales y métodos. Fue un estudio observacional prospectivo, la muestra fue de 289 pacientes con ICC, seleccionados de manera probabilística aleatoria simple; aceptaron participar bajo su consentimiento. La propuesta de gestión consistió evaluar durante un año descriptores demográficos y clínicos, indicadores de calidad, predictores primordiales de calidad de vida, eficiencia educativa. Para la recolección de datos se aplicaron las encuestas Escala Europea de Autocuidado (EEAC) y el Kansas City Cardiomyopathy Questionnaire (KCCQ). Resultados. La suma total de EEAC basal fue de 49.1 y el control 19.1 puntos, representando un bajo autocuidado en los pacientes. El sumario general del KCCQ basal fue de 86.84 y el control 30.84 puntos, representando resultados estadísticamente significativos, al 5% de la prueba de Wilcoxon, para todas las dimensiones del cuestionario asociado a la calidad de vida. Conclusiones. La gestión sanitaria en pacientes con ICC, basado en una atención integral, hospital y atención primaria, con seguimiento a través de visitas en los hogares, educación-autocuidado reducen los ingresos, reingresos y visitas a área de urgencias durante el primer el año de diagnósticos con el seguimiento por consulta externa a las comorbilidades.
The health care system in Nicaragua is based on the Chronic Non-Communicable Diseases Program, which shows clinical benefit in high-risk individuals, but in the case of patients with severe heart failure (CHF), hospital admissions, hospital readmissions and mortality are not reduced. Objective. To propose a comprehensive care management model for CHF patients in a general hospital in Nicaragua. Materials and methods. This was a prospective observational study, the sample consisted of 289 patients with CHF, selected in a simple randomized probabilistic manner; they agreed to participate with their consent. The management proposal consisted of evaluating during one year demographic and clinical descriptors, quality indicators, primary predictors of quality of life, and educational efficiency. The European Self-Care Scale (ESCS) and the Kansas City Cardiomyopathy Questionnaire (KCCQ) were used for data collection. Results. The total sum of baseline EEAC was 49.1 and control 19.1 points, representing low self-care in patients. The overall sum of the baseline KCCQ was 86.84 and the control 30.84 points, representing statistically significant results, at 5% Wilcoxon test, for all dimensions of the questionnaire associated with quality of life. Conclusions. Health management in patients with CHF, based on integrated care, hospital and primary care, with follow-up through home visits, education-self-care, reduces admissions, readmissions and visits to the emergency department during the first year of diagnosis with outpatient follow-up for comorbidities.
O sistema de saúde da Nicarágua baseia-se no Programa de Doenças Crônicas Não Transmissíveis, que demonstra benefícios clínicos em indivíduos de alto risco, mas, no caso de pacientes com insuficiência cardíaca grave (ICC), não consegue reduzir as internações, readmissões hospitalares e mortalidade. Objetivo. Propor um modelo abrangente de gestão de cuidados para pacientes com ICC em um hospital geral na Nicarágua. Materiais e métodos. Este foi um estudo observacional prospectivo, a amostra consistiu em 289 pacientes com ICC, selecionados de forma probabilística aleatória simples; eles concordaram em participar com seu consentimento. A proposta de gerenciamento consistiu na avaliação de descritores demográficos e clínicos, indicadores de qualidade, preditores primários de qualidade de vida e eficiência educacional durante um ano. A Escala Europeia de Autocuidado (ESCS) e o Questionário de Cardiomiopatia de Kansas City (KCCQ) foram usados para a coleta de dados. Resultados. A soma total da EEAC da linha de base foi de 49,1 e a do controle, 19,1 pontos, representando baixo autocuidado nos pacientes. A soma total do KCCQ basal foi de 86,84 e o controle de 30,84 pontos, representando resultados estatisticamente significativos, a 5% no teste de Wilcoxon, para todas as dimensões do questionário associadas à qualidade de vida. Conclusões. O gerenciamento da saúde em pacientes com ICC, baseado em cuidados integrados, hospitalares e primários, com acompanhamento por meio de visitas domiciliares, educação e autocuidado, reduz as internações, readmissões e visitas ao departamento de emergência durante o primeiro ano de diagnóstico com acompanhamento ambulatorial das comorbidades.
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HumanosRESUMO
The prenatal approach from a preventive perspective is necessary to reduce perinatal complications. A perinatal care model with a holistic and horizontal approach is required. Mexico is currently considered an emerging market economy with inequality and an economic gap that impacts the accessibility and distribution of healthcare services. Guanajuato is one of the 32 states of Mexico and represents 1.6% of the country's surface. Strategies during the prenatal approach allow prediction, diagnosis, and anticipation of the principal causes of morbidity and mortality. Combining data from maternal characteristics and history with findings of biophysical and biochemical tests at 11 to 13 weeks of gestation can define the patient-specific risk for a large spectrum of complications that include miscarriage and fetal death, preterm delivery, preeclampsia, congenital disorders, and fetal growth abnormalities. We aim to describe the care model designed and implemented in the State Center for Timely Prenatal Screening of the Maternal and Child Hospital of Leon, Guanajuato, Mexico. Previous research showed there is a lack of information for low and middle-income countries regarding how to integrate prenatal screening strategies in the absence of resources to perform cell-free fetal DNA or biochemical serum markers in countries with emergent economies. This care model is carried out through horizontal processes where the screening is provided by trained and certified general practitioners who identify the population at risk in a timely manner for specialized care, and could help guide other Mexican states, and other countries with emergent economies with limited financial, professional, and infrastructural resources to improve prenatal care with a sense of equity, equality, and social inclusion as well as the timely evaluation of specialized perinatal care of high-risk patients.
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Background: The emergence of the SARS-CoV-2 and the COVID-19 have become a global health crisis. The infection has been present in all the social sectors. Subjects under 18 years are one of them. The objective was to analyze the case fatality ratio of COVID-19 cases in the Mexican population under 18 years of age registered in the National Epidemiological Surveillance System from March 2020 to December 31, 2020. Material and Methods: The design is cross-sectional, quantitative, and analytical. All the suspected cases of respiratory viral disease, with a real-time polymerase chain reaction (RT-PCR) test result, aged from 0 to 17 years, were included. Descriptive statistics are presented for all the variables. Epidemiological curves were designed. The chi-squared test and its P-values were obtained to show the relationship between comorbidities and death. The case fatality ratio was computed for each comorbidity, sex, and age group. Multivariable logistic regression models were fitted to study the effect between comorbidities with the fatality of cases, adjusting for sex and age group as potential confounders. The alpha value was fixed to 0.05 to assess significance. Results: The number of records for this study was 167,856. Among them, 48,505 were from SARS-CoV-2-positive patients (28.90%), and 119,351 (71.10%) were negative. Of those who died, males (55.29%) (P < 0.05) and those under 2 years of age (50.35%) (P < 0.05) predominated. Unlike in older populations, from the comorbidities considered risk factors for death by COVID-19, only immunosuppression showed a statistically significant effect on the fatality of cases after adjustment by the other related variables. Sex and age group were not confounders for the models in those under 18 years old. Pneumonia, being younger than 5 years, and immunosuppression are related to death. Conclusion: The case fatality ratio in those under 18 years old is low. Special attention must be paid to those children under 5 years. The development of pneumonia is a warning indicator while treating them. On the other hand, having an open database of cases allows the researchers to analyze the impact of COVID-19 in different population sectors, which has clear benefits for public health.
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A consequence of the late awareness of Chagas disease in North America is that many early studies were never published in peer-reviewed journals and are not easily accessible for inclusion in systematic reviews. We reviewed data from the state of Guanajuato, Mexico, as an illustration. Three population-based surveys have been performed between 1991 and 2002 and were never fully published. Systematic reviews should recognize this publication bias.
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Cancer has increased in all the countries of the world and Mexico is no exception. The recognised risk factors for the main types of cancer are reviewed and searched through the Mexican government web pages and cancer prevention programmes to tackle the risk factors in the population. The Mexican government, a member of the World Health Organization, shows that the main approach is an early diagnosis rather than prevention, forgetting that an ounce of prevention is better than a pound of cure. Effective public programmes should be promoted to reduce preventable risk factors in the population (smoking, nutrition, obesity, diet, environmental toxicity, sedentary lifestyle) and control the non-preventable factors (genetics) if we really want to control the incidence of different types of cancer.
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Introduction: In December 2019, cases of pneumonia of unknown cause arose in Wuhan, China. The causative agent was subsequently identified as 2019-nCoV and later called SARS-CoV-2. In Mexico, since January 2020 when the first cases were reported, the spread of the infection has occurred throughout the country. The state of Guanajuato, which is located in the center of the country, has taken isolation measures and closed public places in March 2020. The objective of this study was to analyze the evolution, symptoms, co-morbidities and deaths due to confirmed cases of COVID-19. Methods: An ecological study was designed from the database of confirmed cases of COVID-19 in the state of Guanajuato. Odds ratios and 95% confidence intervals were calculated for symptoms and co-morbidities in deaths of confirmed cases. Logistic regression models were generated adjusting for age group and gender. Results: Among the 838 confirmed cases in the state, cases with dyspnea and cyanosis showed more significant effect on death. Age group and gender had little involvement as confounders. For practically all comorbidities (including diabetes, hypertension, cardiovascular disease, chronic kidney disease, and immunosuppression), there was a significant effect (odds ratio greater than 2) on mortality from COVID-19. Age group showed a confounding effect on comorbidities and death, but not gender. Conclusions: The confirmed cases had more than twice the possibility of having comorbidities, compared with those who did not die.
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INTRODUCTION: Occupational exposure to ionizing radiation can potentially lead to adverse health effects, including cancer and genetic defects. Genetic damage caused by radiation can be detected if micronuclei are observed. The objective of this pilot study was to detect the presence of micronuclei in cells of the oral mucosa in inidividuals occupationally exposed to ionizing radiation. METHODS: We implemented a pilot case-control study in which we compared oral mucosa micronuclei in 30 medical and nursing personnel in radiology centers in Celaya, Mexico, with 30 volunteers not exposed to ionizing radiation recruited from a public University. The oral mucosa was brushed and the amount of micronuclei was quantified. Chi-square test or t-test for two proportions were used to compared ionizing radiation and genetic damage between exposed and non-exposed groups. RESULTS: The exposed group had an average of 5.37 ± 3.49 micronuclei and the non-exposed had 0.37 ± 0.61 (P<0.01). In the exposed group, 90% of participants exhibited genetic damage compared to 6.67% in the unexposed group (P<0.05). CONCLUSION: In this pilot study, medical and nursing staff from radiology centers presented with higher genetic damage compared to control group. Further studies are needed to identify the prevalence of genetic damage due to occupational radiation exposure in Mexico.
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Introducción: La diabetes como enfermedad crónica es un evento catastrófico que origina comportamientos negativos hacia la adherencia terapéutica, lo que hace necesario usar teorías cognoscitivas y sociales para reorientar los cuidados de enfermería. Objetivo: Dar respuesta a las preguntas orientadoras de la investigación: ¿cuál es la representación social que la mujer tiene sobre la diabetes tipo 2? ¿Qué elementos integran el núcleo central y los sistemas periféricos de la representación social? Método: Revisión integrativa utilizando como guía el método prisma, de artículos cuyos descriptores primarios fueran "representaciones sociales", "diabetes tipo 2" y "mujeres" y secundarios "pacientes con diabetes tipo 2". La búsqueda se realizó en bases de datos informatizadas: Web of Science, Medline, PubMed, SciELO, LILACS, Bireme y CUIDEN. Resultados: Los hallazgos señalan que el fenómeno de la diabetes dio origen a una representación social irreversible. Este sistema de informaciones, actitudes y creencias se organizan y estructuran alrededor del padecimiento, alimentación, ejercicio y medicación, lo que dificulta la identidad social y, probablemente, la adherencia terapéutica a la enfermedad. Conclusión: El identificar la estructura de la representación social y elementos que integran el núcleo central les permite a los profesionales de la salud planear intervenciones que favorezcan la identidad social y la adherencia terapéutica de las mujeres en la diabetes tipo 2.
Introduction: As a chronic disease, diabetes is a disastrous event bringing about negative behaviors regarding the treatment adherence, which makes necessary the use of cognitive and social theories in order to redirect the nursing care. Objective: To answer the guiding research questions: What is the social representation that women have about Diabetes Type 2? What elements form the central core and the peripheral systems of the social representation? Method: This is a comprehensive review using the Prism Method as a guide. It includes articles whose primary descriptors are "social representations", "Diabetes Type 2" and "women"; and the secondary descriptor "type 2 diabetes patients". The search was carried out in systematized databases: Web of Science, Medline, PubMed, SciELO, LILACS, Bireme, and CUIDEN. Results: The findings indicate that diabetes phenomenon gave rise to an irreversible social representation. This system of data, attitudes and beliefs is organized and structured around the suffering, feeding, exercise and medication, which makes difficult to ascertain the social identity and, probably, the treatment adherence specific to this disease. Conclusion: To identify the structure of the social representation and elements forming the central core allows the health professionals to plan interventions intended to favor the social identity and treatment adherence among women with diabetes type 2.
Introdução: O diabete como urna doença crónica é um evento catastrófico que origina comportamentos negativos para a adesão terapêutica, o que faz preciso usar teorias cognoscitivas e sociais para reorientar os cuidados de enfermagem. Objetivo: Dar resposta às perguntas norteadoras da pesquisa: qual a representação social que a mulher possue sobre o diabete tipo 2? Quais elementos compõem o núcleo central e os sistemas periféricos da representação social? Método: Revisão integrativa utilizando como guia o método prisma, de artigos cujos descritores primarios foram "representações sociais", "diabete tipo 2" e "mulheres" e secundarios "pacientes com diabete tipo 2". A busca foi realizada em bases de dados informatizadas: Web of Science, Medline, PubMed, SciELO, LILACS, Birerne e CUIDEN. Resultados: Os achados apontam que o fenômeno da diabete deu origem a urna representação social irreversível. Esse sistema de informações, atitudes e crenças é organizado e estruturado em torno do padecimento, alimentação, exercício e medicação, o que dificulta a identidade social e, provavelmente, a adesão terapêutica à doença. Conclusão: Identificar a estrutura da representação social e elementos que integram o núcleo central permite os pro fissionais de a saúde planejarem intervenções favorecendo a identidade social e a adesão terapêutica das mulheres em diabetes tipo 2.
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Feminino , Doença Crônica , Diabetes Mellitus Tipo 2/diagnóstico , Cooperação e Adesão ao Tratamento/psicologiaRESUMO
BACKGROUND: Publishing negative seroprevalence studies not only helps to have more accurate seroprevalence estimates but also allows calculating the specificity of the diagnostic tests used. We performed a population-based Trypanosoma cruzi seroprevalence survey in a community in central Mexico. RESULTS: We surveyed 204 women and children and collected blood by finger prick. We performed rapid tests (Stat-Pak, Chembio, Inc., Medford, New York) and recombinant Chagas ELISA tests v3.0 (Wiener, Rosario, Argentina). All rapid tests and all ELISA tests were negative. CONCLUSION: The rapid test had 100 % of specificity compared to the ELISA.
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Testes Diagnósticos de Rotina/normas , Ensaio de Imunoadsorção Enzimática/normas , Trypanosoma cruzi/imunologia , Adolescente , Adulto , Anticorpos Antiprotozoários/sangue , Doença de Chagas/diagnóstico , Doença de Chagas/epidemiologia , Doença de Chagas/imunologia , Doença de Chagas/parasitologia , Criança , Pré-Escolar , Feminino , Humanos , México/epidemiologia , Pessoa de Meia-Idade , Gravidez , Sensibilidade e Especificidade , Estudos SoroepidemiológicosRESUMO
BACKGROUND: Type 2 diabetes is a chronic disease that presents a significant burden on health care systems in many countries. With the rise of obesity, the incidence of Type 2 diabetes has also been steadily increasing. A healthy lifestyle and understanding of diabetes management are important factors for delaying the onset of comorbidities associated with Type 2 diabetes. The objective of this study was to evaluate the self-perception of health in individuals with Type 2 diabetes as it relates to BMI status, which has important implications for the implementation of preventive programs. METHODS: A cross-sectional lifestyle survey was implemented in the region of Celaya, Guanajuato, Mexico, targeting 100 participants diagnosed with Type 2 diabetes. Anthropometric measurements and participant characteristics were also obtained. Fisher's exact test was used to determine if the proportions of lifestyles perceptions differed by BMI status. RESULTS: Participants had a mean age of 56.12 ± 10.26, a mean BMI of 29.13 ± 5.48 kg/m2, were mostly married (67.0%), and female (70.0%). None of the normal weight participants perceived themselves as unhealthy. 95% of overweight/obese participants perceived themselves to be healthy, despite a diagnosis of diabetes and being overweight/obese, while only 5% perceived themselves to be unhealthy. However, these differences in the perceptions of health classified by BMI status were not statistically significant (p = 0.42). CONCLUSION: Our findings indicate that overweight and obese persons with Type 2 diabetes in Celaya, Mexico may have misperceptions about their own health, even though these findings were not statistically significant. These preliminary data highlight the importance of implementing prevention and educational programs among those with diabetes, in order to combat health misperceptions and raise awareness about the dangers of diabetes and obesity. Furthermore, more research with larger sample sizes is needed in order to fully understand the effects of perception of health on actual health.
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OBJECTIVE: To compare body temperature measurements using tympanic, skin and digital axillary thermometers. METHOD: Hospitalized or outpatient children from the General Hospital Celaya, ISSSTE Hospital Clinic and General Hospital No. 4 IMSS, and the pediatric private service in Celaya, Guanajuato, from 1 day of life until 16 years old, were recruited over a one month period, after their parents signed the consent form. The order of each institution was selected by simple randomization. Body temperatures were measured in triplicate using tympanic, skin and digital axillary thermometers. RESULTS: The sample consisted of 554 children. The Pearson r between the tympanic and digital axillary thermometers was 0.57 to 0.65, with a positive linear relationship (P<.05); between the skin and the digital axillary thermometers, it was between 0.47 and 0.52 with a positive linearrelationship (P<.05). The intra-observer Kappa for the tympanic thermometer was 0.86, and for the inter-observer was 0.77; for the skin thermometer it was 0.82 and 0.67, respectively, and for the digital axillary thermometer it was 0.86 for intra-observer reliability and 0.78 for inter -observer reliability. CONCLUSION: Tympanic and axillary thermometers showed better precision in measuring the body temperature in children than skin thermometers.
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Temperatura Corporal , Termômetros , Adolescente , Axila , Criança , Pré-Escolar , Orelha Média , Desenho de Equipamento , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Prospectivos , Reprodutibilidade dos Testes , PeleRESUMO
Introducción: la diabetes tipo 2 es considerada como un problema de salud pública por su creciente prevalencia e incidencia. Objetivo: describir el efecto de los factores socioculturales en la capacidad de autocuidado del paciente hospitalizado con diabetes tipo 2 en el Hospital General de Tecomán, Colima, México. Método: estudio transversal, observacional. Se trabajó con 68 pacientes hospitalizados con diabetes tipo 2; se utilizó un instrumento que midió el efecto de los factores socioculturales en la capacidad de autocuidado. El análisis de datos se realizó con Razón de Momios, intervalos de confianza al 95% y fracción atribuible en expuestos. Resultados: los factores socioculturales tuvieron un leve efecto positivo en la capacidad de autocuidado (RM = 1,10; IC 95%: 0,26-4,74) en pacientes hospitalizados con diabetes tipo 2. Conclusiones: los factores socioculturales: experiencias vitales, experiencias laborales, religión, costumbres y tradiciones, prácticas curativas y ritos, señalados en la Teoría General del Déficit de Autocuidado, muestran un efecto positivo sobre la capacidad de autocuidado de las personas con diabetes tipo 2.
Introduction: Type 2 diabetes is considered a public health problem because of its increasing prevalence and incidence. Objective: The purpose of this research is to describe the effect of socio-cultural factors on the self-care capacity of patients with type 2 diabetes who are hospitalized at the Tecomán General Hospital in Colima, Mexico. Method: This is a cross-sectional, observational study of 68 hospitalized patients with type 2 diabetes. An instrument to measure the effect of socio-cultural factors on the capacity for self-care was used. Data analysis was conducted with the odds ratio method, confidence intervals at 95% and attributable fraction in exposures. Results: Socio-cultural factors had a slight positive effect on the capacity for self-care among hospitalized patients with type 2 diabetes (RM = 1.10, 95% CI, 0.26 to 4.74). Conclusions: The socio-cultural factors outlined in the General Self-care Deficit Theory; namely, life experiences, work experiences, religion, customs and traditions, healing practices and rituals, were shown to have a positive effect on the self-care capacity of people with type 2 diabetes.
Introdução: a diabete tipo 2 é considerada um problema de saúde pública por sua crescente prevalência e incidência. Objetivo: descrever o efeito dos fatores socioculturais na capacidade de autocuidado do paciente hospitalizado com diabete tipo 2 no Hospital General de Tecomán, Colima, México. Método: estudo transversal, observacional. Trabalhou-se com 68 pacientes hospitalizados com diabete tipo 2; utilizou-se um instrumento que mediu o efeito dos fatores socioculturais na capacidade de autocuidado. A análise de dados foi realizada com Razão de Chances, intervalos de confiança de 95% e fração atribuível em expostos. Resultados: os fatores socioculturais tiveram um leve efeito positivo na capacidade de autocuidado (RM = 1,10; IC 95%: 0,26-4,74) em pacientes hospitalizados com diabete tipo 2. Conclusões: os fatores socioculturais, como experiências vitais, experiências laborais, religião, costumes e tradições, práticas curativas e rituais, indicados na Teoria Geral do Déficit de Autocuidado, mostram um efeito positivo sobre a capacidade de autocuidado das pessoas com diabete tipo 2.
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Humanos , Saúde Pública , Diabetes Mellitus Tipo 2 , Autocuidado , Enfermagem , Assistência ao Paciente , MéxicoRESUMO
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. RESULTS: The percentage of use of ACT in threatened preterm labour (TPL) reported by providers varies from 70% in Mexico to 97% in Ecuador. However, 60% to 20% of the providers mentioned that they would not use this medication in women at risk and would limit its use when there was a threatened preterm labour. In only one country recommended regimens of antenatal corticosteroids are followed by around 90% of providers whereas in the other three countries recommended regimens are followed by only 21%, 61%, 69% of providers. Around 40% of providers mentioned that they would administer a new dose of corticosteroids again, regardless the patient already receiving an entire regimen. Between 11% and 35% of providers, according to the countries, mentioned that they do not have adequate information on the correct use of this medication. CONCLUSIONS: This study shows that the use of this intervention could be improved by increasing the knowledge of Latin American providers on its indications, benefits, and regimens.
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Competência Clínica , Glucocorticoides/administração & dosagem , Nascimento Prematuro/tratamento farmacológico , Cuidado Pré-Natal/métodos , Adulto , Atitude do Pessoal de Saúde , Esquema de Medicação , Uso de Medicamentos/estatística & dados numéricos , Feminino , Glucocorticoides/efeitos adversos , Glucocorticoides/provisão & distribuição , Glucocorticoides/uso terapêutico , Humanos , Recém-Nascido , Recém-Nascido Prematuro , América Latina , Masculino , Pessoa de Meia-Idade , Padrões de Prática Médica/estatística & dados numéricos , Gravidez , Complicações na Gravidez/tratamento farmacológico , Estudos Prospectivos , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controleRESUMO
This short communication piece provides an overview of the Latin American Supercourse, a collection of public health lectures in Spanish targeting educators in Mexico, US, and Spanish speaking countries.
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Doença Crônica/prevenção & controle , Pessoal de Saúde , Idioma , Grupos Minoritários , Materiais de Ensino , Promoção da Saúde , Humanos , Neoplasias , Saúde PúblicaRESUMO
We sought to determine the serological test that could be used for Trypanosoma cruzi seroprevalence studies in Mexico, where lineage I predominates. In a previous study among pregnant women and their newborns in the states of Yucatan and Guanajuato, we reported a 0.8-0.9% of prevalence for T. cruzi -specific antibodies by Stat-Pak and Wiener ELISA. We have expanded this study here by performing an additional non-commercial ELISA and confirming the seropositives with Western blot, using whole antigens of a local parasite strain. We found a seroprevalence of 0.6% (3/500) in Merida and 0.4% in Guanajuato (2/488). The 5 seropositive umbilical cord samples reacted to both non-commercial ELISA and Western blot tests, and only 1 of the maternal samples was not reactive to non-commercial ELISA. A follow-up of the newborns at 10 mo was performed in Yucatan to determine the presence of T. cruzi antibodies in children as evidence of congenital infection. None of the children was seropositive. One newborn from an infected mother died at 2 wk of age of cardiac arrest, but T. cruzi infection was not confirmed. The T. cruzi seroprevalence data obtained with both commercial tests (Stat-Pak and ELISA Wiener) are similar to those from non-commercial tests using a local Mexican strain of T. cruzi.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/diagnóstico , Complicações Parasitárias na Gravidez/diagnóstico , Trypanosoma cruzi/imunologia , Adulto , Antígenos de Protozoários/imunologia , Western Blotting , Doença de Chagas/epidemiologia , Doença de Chagas/parasitologia , Doença de Chagas/transmissão , Estudos Transversais , Ensaio de Imunoadsorção Enzimática/métodos , Ensaio de Imunoadsorção Enzimática/normas , Feminino , Sangue Fetal/imunologia , Humanos , Recém-Nascido , Transmissão Vertical de Doenças Infecciosas , México/epidemiologia , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Complicações Parasitárias na Gravidez/parasitologia , Sensibilidade e Especificidade , Estudos Soroepidemiológicos , Trypanosoma cruzi/classificação , Trypanosoma cruzi/isolamento & purificação , Adulto JovemRESUMO
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.
Assuntos
Doença de Chagas/diagnóstico , Sangue Fetal/parasitologia , Complicações Parasitárias na Gravidez/diagnóstico , Kit de Reagentes para Diagnóstico , Adulto , Animais , Anticorpos Antiprotozoários/sangue , Argentina/epidemiologia , Bolívia/epidemiologia , Doença de Chagas/epidemiologia , Estudos Transversais , Doenças Endêmicas , Ensaio de Imunoadsorção Enzimática , Feminino , Honduras/epidemiologia , Humanos , México/epidemiologia , Gravidez , Complicações Parasitárias na Gravidez/epidemiologia , Sensibilidade e Especificidade , Trypanosoma cruzi/imunologiaRESUMO
Se aplicó el puntaje de Breese a 608 niños que asistían al consultorio privado de dos de los autores, por padecer de faringoamigdalitis. Tomando como punto de corte 28, se consideró que si el puntaje era igual o superior a esta cifra cabría sospechar que el estreptococo beta hemolítico fuera el causante de la infección. Con este criterio se identificaron 310 niños con faringoamigdalitis estreptocócica probable, y 298 con faringoamigdalitis no estreptocócica; 267 fueron verdaderos positivos, 289 verdaderos negativos, 43 falsos positivos y 9 falsos negativos. El ®estándar de oro¼ fu el resultado del cultivo del exudado faríngeo; con este estándar, el puntaje de Breese obtuvo una sensibilidad de 86.12 y una especificidad de 87.05 por ciento; el valor predictivo positivo fue de 86.12 por ciento y el valor predictivo negativo de 96.74 por ciento; la validez fue de 91.44 por ciento y la prevalencia de 45.39 por ciento. De acuerdo a estos resultados, se concluye que el puntaje de Breese es un criterio clínico aceptable para discriminar las faringoamigdalitis agudas estreptocócicas de las no estreptocócicas
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Adolescente , Streptococcus/isolamento & purificação , Faringite/diagnóstico , Faringite/etiologia , Tonsilite/diagnóstico , Tonsilite/etiologia , Meios de Cultura/análise , Meios de Cultura , Análise de VariânciaRESUMO
Se realizó un estudio clínico, abierto, prospectivo para evaluar las pruebas de transmisión comparada del sonido y de transmisión comparada con extensión/flexión para el diagnóstico de enfermedad luxante de la cadera en el neonato; estas pruebas fueron descritas por Stone y cols., en 1987, en Escocia. Se revisaron las caderas de 150 recién nacidos del Centro de Especialidades Médicas de Celaya, Guanajuato, a los que se les aplicaron dichas pruebas, y se buscó la asimetría de pliegues, las maniobras de Ortolani y Barlow y se les sometió a ultrasonido de caderas. Se obtuvo una prevalencia de alteración de la cadera en el 58.66 por ciento. Para la prueba de transmisión del sonido se obtuvo sensibilidad del 27.27 por ciento y especificidad del 94.35 por ciento. Para la prueba de transmisión comparada del sonido con extensión/flexión. Se obtuvo una sensibilidad del 86.36 por ciento y especificidad del 97.09 por ciento; esta prueba tiene la mejor sensibilidad, valor predictivo positivo, valor predictivo negativo y efectividad, que la prueba de transmisión comparada del sonido, asimetría de pliegues, Ortolani y Barlow. Se concluyó que las pruebas de transmisión del sonido son de utilidad en el periodo neonatal para el diagnóstico de la enfermedad luxante de la cadera.