RESUMO
OBJECTIVES: To explore obstetricians', midwives' and trainees' perceptions of caesarean section (CS) determinants in the context of public obstetric care services provision in Argentina. Our hypothesis is that known determinants of CS use may differ in settings with limited access to essential obstetric services. SETTING: We conducted a formative research study in 19 public maternity hospitals in Argentina. An institutional survey assessed the availability of essential obstetric services. Subsequently, we conducted online surveys and semistructured interviews to assess the opinions of providers on known CS determinants. RESULTS: Obstetric services showed an adequate provision of emergency obstetric care but limited services to support women during birth. Midwives, with some exceptions, are not involved during labour. We received 680 surveys from obstetricians, residents and midwives (response rate of 63%) and interviewed 26 key informants. Six out of 10 providers (411, 61%) indicated that the use of CS is associated with the complexities of our caseload. Limited pain management access was deemed a potential contributing factor for CS in adolescents and first-time mothers. Providers have conflicting views on the adequacy of training to deal with complex or prolonged labour. Obstetricians with more than 10 years of clinical experience indicated that fear of litigation was also associated with CS. Overall, there is consensus on the need to implement interventions to reduce unnecessary CS. CONCLUSIONS: Public maternity hospitals in Argentina have made significant improvements in the provision of emergency services. The environment of service provision does not seem to facilitate the physiological process of vaginal birth. Providers acknowledged some of these challenges.
Assuntos
Trabalho de Parto , Tocologia , Adolescente , Argentina , Atitude do Pessoal de Saúde , Cesárea , Feminino , Humanos , Parto , GravidezRESUMO
BACKGROUND: Perineal pain is a common but poorly studied adverse outcome following childbirth. Pain may result from perineal trauma due to bruising, spontaneous tears, surgical incisions (episiotomies), or in association with operative vaginal births (ventouse or forceps-assisted births). This is an update of a review last published in 2013. OBJECTIVES: To determine the efficacy of a single administration of paracetamol (acetaminophen) used in the relief of acute postpartum perineal pain. SEARCH METHODS: For this update, we searched the Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (9 December 2019), and reference lists of retrieved studies. SELECTION CRITERIA: Randomised controlled trials (RCTs), including cluster-RCTs, comparing paracetamol to placebo. We excluded quasi-RCTs and cross-over trials. Data from abstracts would be included only if authors had confirmed in writing that the data to be included in the review had come from the final analysis and would not change. DATA COLLECTION AND ANALYSIS: Two review authors assessed each study for inclusion and extracted data. One review author reviewed the decisions and confirmed calculations for pain relief scores. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: This update identified no new trials so the results remain unchanged. However, by applying the GRADE assessment of the evidence, the interpretation of main results differed from previous version of this review. We identified 10 studies involving 2044 women, but all these studies involved either three or four groups, looking at differing drugs or doses. We have only included the 1301 women who were in the paracetamol versus placebo arms of the studies. Of these, five studies (482 women) assessed 500 mg to 650 mg and six studies (797 women) assessed 1000 mg of paracetamol. One study assessed 650 mg and 1000 mg compared with placebo and contributed to both comparisons. We used a random-effects meta-analysis because of the clinical variability among studies. Studies were from the 1970s to the early 1990s, and there was insufficient information to assess the risk of bias adequately, hence the findings need to be interpreted within this context. The certainty of the evidence for the two primary outcomes on which data were available was assessed as low, downgraded for overall unclear risk of bias and for heterogeneity (I² statistic 60% or greater). More women may experience pain relief with paracetamol compared with placebo (average risk ratio (RR) 2.14, 95% confidence interval (CI) 1.59 to 2.89; 10 trials, 1279 women), and fewer women may need additional pain relief with paracetamol compared with placebo (average RR 0.34, 95% CI 0.21 to 0.55; 8 trials, 1132 women). However, the certainty of the evidence was low, downgraded for unclear overall risk of bias and substantial heterogeneity. One study used the higher dose of paracetamol (1000 mg) and reported maternal drug adverse effects. There may be little or no difference in the incidence of nausea (average RR 0.18, 95% CI 0.01 to 3.66; 1 trial, 232 women; low-certainty evidence), or sleepiness (average RR 0.89, 95% CI 0.18 to 4.30; 1 trial, 232 women; low-certainty evidence). No other maternal adverse events were reported. None of the studies assessed neonatal drug adverse effects. AUTHORS' CONCLUSIONS: A single dose of paracetamol may improve perineal pain relief following vaginal birth, and may reduce the need for additional pain relief. Potential adverse effects for both women and neonates were not appropriately assessed. Any further trials should also address the gaps in evidence concerning maternal outcomes such as satisfaction with postnatal care, maternal functioning/well-being (emotional attachment, self-efficacy, competence, autonomy, confidence, self-care, coping skills) and neonatal drug adverse effects.
Assuntos
Acetaminofen , Dor Aguda , Episiotomia , Feminino , Humanos , Recém-Nascido , Períneo , Período Pós-Parto , GravidezRESUMO
Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños.Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población.Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017).Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP.Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shockséptico, ingreso a Terapia Intensiva y asistencia respiratoria.
Introduction. Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CA-MRSA necrotizing pneumonia and empyema are now more common in children.Objectives. To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population.Material and methods. Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017).Results. Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CA-MRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32-16.38) and admission to the ICU (RR: 4.29; 2.70-6.83). No patient died due to SP pneumonia.Conclusions. The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Infecções Estafilocócicas/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Argentina/epidemiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Testes de Sensibilidade Microbiana , Epidemiologia Descritiva , Incidência , Prevalência , Estudos Transversais , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Hospitais PediátricosRESUMO
BACKGROUND: While cesarean section is an essential life-saving strategy for women and newborns, its current overuse constitutes a global problem. The aim of this formative research is to collect information from hospitals, health professionals and women regarding the use of cesarean section in Argentina. This article describes the methodology of the study, the characteristics of the hospitals and the profile of the participants. METHODS: This formative research is a mixed-method study that will be conducted in seven provinces of Argentina. The eligibility criteria for the hospitals are (a) use of the Perinatal Information System, (b) cesarean section rate higher than 27% in 2016, (c) ≥ 1000 deliveries per year. Quantitative and qualitative research techniques will be used for data collection and analysis. The main inquiry points are the determining factors for the use of cesarean section, the potential interventions to optimize the use of cesarean section and, in the case of women, their preferred type of delivery. DISCUSSION: It is expected that the findings will provide a situation diagnosis to help a context-sensitive implementation of the interventions recommended by the World Health Organization to optimize cesarean section use. Trial registration IS002316 Cesarean section is an essential medical tool for mothers and their children, but nowadays its overuse is a problem worldwide. Our purpose is to get information from hospitals, health professionals and women about how cesarean section is used in Argentina. In this protocol we describe how we will carry out the study and the characteristics of the hospitals and participants. We will implement this study in seven provinces of Argentina, in hospitals that have more than 1,000 births each year, had a cesarean section rate higher than 27% in 2016 and use the Perinatal Information System. We will gather information using forms, surveys and interviews. We want to identify the factors that decide the use of a cesarean section, the potential interventions that can improve the use of cesarean section and, in the case of women, the type of delivery they prefer. We expect that this study will give us a diagnosis of how cesarean section is used in Argentina, and that this will help to apply the interventions that the World Health Organization recommends to optimize the use of cesarean section in our specific context.
RESUMEN: INTRODUCCIóN: Aun cuando la cesárea es una intervención que puede ser esencial para salvar la vida de una mujer y su hijo, el crecimiento excesivo de su uso es un problema global. El propósito de esta investigación formativa es recolectar información sobre las instituciones, profesionales de la salud y mujeres acerca del uso de la cesárea en la Argentina. Este artículo describe la metodología del estudio, las características de los hospitales y el perfil de los participantes. METODOLOGíA: Esta investigación formativa usa un diseño mixto aplicado en siete provincias del país. Los criterios de elegibilidad para los hospitales son: (a) uso del Sistema Informático Perinatal, (b) tasa de cesáreas mayor al 27% en 2016, y (c) ≥ 1000 partos por año. Se usarán técnicas cualitativas y cuantitativas para la recolección de datos y el análisis. Los principales temas a indagar son los determinantes del uso de la cesárea, las intervenciones para optimizar su uso y, en el caso de las mujeres, sus preferencias sobre el modo de parto. DISCUSIóN: Se espera que los resultados den lugar a un diagnóstico de situación que permita una implementación de las intervenciones propuesas por la OMS para optimizar el uso de la cesárea más ajustada al contexto. Registro del estudio IS002316.
Assuntos
Cesárea , Parto Obstétrico , Adolescente , Argentina , Criança , Feminino , Hospitais Públicos , Humanos , Recém-Nascido , GravidezRESUMO
INTRODUCTION: Community-acquired methicillinresistant Staphylococcus aureus (CA-MRSA) infections have increased in recent years. CAMRSA necrotizing pneumonia and empyema are now more common in children. OBJECTIVES: To determine the prevalence of CA-MRSA pneumonia and its clinical and epidemiological characteristics compared to Streptococcus pneumoniae (SP) pneumonia in the same population. MATERIAL AND METHODS: Descriptive, observational, cross-sectional study of patients hospitalized due to CA-MRSA pneumonia at Hospital de Niños Víctor J. Vilela (period: January 2008-December 2017). RESULTS: Out of 54 Staphylococcus aureus pneumonia cases, 46 (85 %) corresponded to CA-MRSA. The rate of CA-MRSA pneumonia ranged from 4.9/10 000 (2008) to 10/10 000 hospital discharges (2017). Sepsis/septic shock was observed in 41 %; empyema, in 96 %; pneumothorax, in 35 %; 90 % of cases required pleural drainage and 55 %, surgical debridement. Also, 65 % of patients were admitted to the intensive care unit (ICU); half of them required assisted mechanical ventilation. Two patients died. Strain resistance: 17 %, gentamicin; 13 %, erythromycin; and 11 %, clindamycin. Compared to SP pneumonia, CAMRSA pneumonia showed a higher risk for sepsis (95 % confidence interval; relative risk: 7.38; 3.32- 16.38) and admission to the ICU (RR: 4.29; 2.70- 6.83). No patient died due to SP pneumonia. CONCLUSIONS: The prevalence of CA-MRSA pneumonia doubled in the past decade. Compared to SP pneumonia, CA-MRSA pneumonia was more commonly accompanied by sepsis and septic shock, admission to the ICU, and ventilatory support requirement.
Introducción. Las infecciones por Staphylococcus aureus resistente a meticilina adquirido de la comunidad (SARM-AC) se han incrementado en los últimos años. Neumonías necrotizantes y empiemas por SARM-AC son cada vez más frecuentes en niños. Objetivos. Determinar la prevalencia de neumonías por SARM-AC y sus características clínico-epidemiológicas, en comparación con las neumonías por Streptococcus pneumoniae (SP) en la misma población. Material y métodos. Estudio descriptivo, observacional, transversal, de pacientes internados con neumonía por SARM-AC en el Hospital de Niños Víctor J. Vilela (período: 1/2008-12/2017). Resultados. De 54 neumonías por Staphylococcus aureus, 46 (el 85 %) fueron SARM-AC. El índice de neumonías por SARM-AC varió de 4,9/10 000 (2008) a 10/10 000 egresos (2017). Presentaron sepsis/shock séptico el 41 %; empiema, el 96 %; neumotórax, el 35 %; requirieron drenaje pleural el 90 % y toilette quirúrgica el 55 %. Ingresaron a Terapia Intensiva el 65 %; la mitad necesitó asistencia respiratoria mecánica. Hubo dos muertes. Resistencia de las cepas: el 17 % a gentamicina, el 13 % a eritromicina, el 11 % a clindamicina. En las neumonías por SARM-AC vs. las neumonías por SP, se observó mayor riesgo de sepsis (IC 95 %; RR 7,38; 3,32-16,38) e ingreso a Terapia Intensiva (RR 4,29; 2,70-6,83). No hubo muertes por SP. Conclusiones. La prevalencia de neumonías por SARM-AC se duplicó durante la última década. Comparadas con las neumonías por SP, las neumonías por SARM-AC se acompañaron, más frecuentemente, de cuadros de sepsis y shock séptico, ingreso a Terapia Intensiva y asistencia respiratoria.
Assuntos
Infecções Comunitárias Adquiridas , Staphylococcus aureus Resistente à Meticilina , Pneumonia Estafilocócica , Infecções Estafilocócicas , Antibacterianos/uso terapêutico , Criança , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/epidemiologia , Estudos Transversais , Hospitais Pediátricos , Humanos , Pneumonia Estafilocócica/epidemiologia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/epidemiologiaRESUMO
En paralelo a la pandemia por el nuevo coronavirus (SARS-CoV-2) que causa la enfermedad por coronavirus (COVID-19), emerge otra epidemia denominada infodemia. Esto provoca una saturación y sobreexposición a información de calidad variable y dificulta el acceso a la información confiable por el personal de salud y otros tomadores de decisión. A su vez, existen diversas formas de síntesis de información; entre las más conocidas se encuentran las revisiones sistemáticas, que pueden asistir a los tomadores de decisiones en la formulación de políticas y cuidados basados en la evidencia. En este artículo, se resumen algunas de las limitaciones en las revisiones sistemáticas actuales y los retos que acarrean las nuevas metodologías para la síntesis de la evidencia. Cochrane y otras organizaciones han liderado la innovación metodológica para favorecer el acceso y uso de la síntesis de información en COVID-19. Aparecen en escena las revisiones sistemáticas rápidas para dar respuesta a preguntas de prioridad alta en los diferentes países, se crea un repositorio de ensayos clínicos sobre COVID-19 y se pone en marcha un protocolo a nivel internacional para conducir un metaanálisis en red vivo sobre la efectividad de las intervenciones terapéuticas y de prevención en pacientes infectados por SARS-CoV-2. A nivel regional, se destacan la base de datos COVID-19 de la Organización Panamericana de la Salud y el registro de estudios primarios y revisiones sistemáticas de libre acceso (plataforma Living OVerview of the Evidence, L·OVE).
Assuntos
Infecções por Coronavirus , Pandemias , Revisão SistemáticaRESUMO
AIM: It is of critical importance to have internationally constructed tools to address early childhood development. The aim of this second phase of a two-phase study was to examine the sensitivity and specificity of the Guide for Monitoring Child Development (GMCD) in identifying developmental delay in four diverse countries. METHODS: The first phase of this 2011-2015 back-to-back study included 4949 children up to 42 months of age from primary healthcare centres in Argentina, India, South Africa and Turkey. Distribution curves were generated to show the ages when the children attained GMCD milestones and those that could be used across sexes and countries were placed in age ranges corresponding to the 85th and 97th percentile point estimates. Phase two examined a separately recruited sample of children in those countries to determine sensitivity and specificity of the GMCD. RESULTS: The validation phase of the 85 milestones in the GMCD identified delayed development in 30% of the 1731 children in the four countries. The sensitivity and specificity ranged from 0.71-0.94 and 0.69-0.82, respectively, for the total sample and the different age groups. CONCLUSION: The GMCD standardised in four diverse countries has appropriate accuracy for identification of children with developmental delay.
Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/diagnóstico , Guias de Prática Clínica como Assunto , Argentina , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia , Lactente , Masculino , Sensibilidade e Especificidade , África do Sul , TurquiaRESUMO
Introducción: Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-ac) son motivo de consulta frecuente en pediatría. La mayoría se presentan como infecciones de piel y partes blandas; sin embargo, en la última década, se ha constatado un aumento de las infecciones invasivas. Objetivos: El objetivo principal es describir las características clínico-epidemiológicas de las infecciones producidas por SAMR-ac. El objetivo secundario es comparar la prevalencia, presentación clínica y susceptibilidad antibiótica con un período previo de estudio (1/2004-12/2007). Material y métodos: Estudio descriptivo, prospectivo, de tipo transversal. Criterios de inclusión: niños con diagnóstico de infección por SAMR-ac admitidos en el Hospital de Niños de Rosario, período de enero de 2008 a diciembre de 2014. Criterios de exclusión: internación reciente, antibiótico o cirugía previa, comorbilidades o inmunocompromiso. Resultados: De 728 niños con infecciones por Staphylococcus aureus, 529 (73%) fueron por SAMR-ac. La tasa de incidencia de infecciones por SAMR-ac varió de 12,2/10 000 egresos hospitalarios de 2004 a 145/10 000 del 2014: 75% (391) fueron infecciones de piel y partes blandas; 8% (43), os teo articular es; 6% (30), pleuropulmonares; 5% (24), sepsis. Se observó un aumento en el número de infecciones invasivas en el 2º período sin significancia estadística (OR= 0,895; IC: 0,52-1,53). La resistencia a gentamicina, clindamicina y eritromicina se mantuvo estable en ambos períodos. Conclusión: Las infecciones por SAMR-ac fueron cada vez más frecuentes, principalmente, las de piel y partes blandas. Se observó un aumento en el número de infecciones invasivas sin significancia estadística. La resistencia antibiótica se mantuvo estable.
Introduction: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are a common reason for consultation in pediatrics. Most of them present as skin and soft tissue infections; however, invasive infections have increased during the last decade. Objectives: The main objective was to describe the clinical-epidemiological characteristics of CA-MRSA infections. The secondary objective was to compare prevalence, clinical presentation and antibiotic susceptibility with a pre-study period (1/2004-12/2007). Material and methods: This is a descriptive, prospective, cross-sectional study. Inclusion criteria: children who have been diagnosed with CA-MRSA infection and admitted to Hospital de Niños de Rosario between January 2008 and December 2014. Exclusion criteria: recent hospitalization, previous antibiotic treatment or surgery, comorbidities or immune compromise. Results: Out of 728 cases of children with Staphylococcus aureus infections, 529 (73%) were due to CA-MRSA. The incidence rate of CA-MRSA infections varied from 12.2/10 000 hospital discharges in 2004 to 145/10 000 in 2014: 75% (391) were skin and soft tissue infections; 8% (43) were osteoarticular infections; 6% (30), pleuropulmonary infections; 5% (24), sepsis. There was an increase in the number of invasive infections in the second period, with no statistical significance (OR= 0.895; CI: 0.52-1.53). Gentamicin, clindamycin and erythromycin resistance remained stable throughout both periods. Conclusion: CA-MRSA infections were increasingly more frequent, mainly skin and soft tissue infections. An increase was observed in the number of invasive infections, with no statistical significance. Antibiotic resistance remained stable.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Adolescente , Infecções Estafilocócicas/epidemiologia , Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Argentina/epidemiologia , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/tratamento farmacológico , Testes de Sensibilidade Microbiana , Incidência , Prevalência , Estudos Transversais , Estudos Prospectivos , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/microbiologia , Infecções Comunitárias Adquiridas/tratamento farmacológico , Hospitais Pediátricos , Antibacterianos/uso terapêuticoRESUMO
INTRODUCTION: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are a common reason for consultation in pediatrics. Most of them present as skin and soft tissue infections; however, invasive infections have increased during the last decade. OBJECTIVES: The main objective was to describe the clinical-epidemiological characteristics of CA-MRSA infections. The secondary objective was to compare prevalence, clinical presentation and antibiotic susceptibility with a pre-study period (1/2004-12/2007). MATERIAL AND METHODS: This is a descriptive, prospective, cross-sectional study. Inclusion criteria: children who have been diagnosed with CA-MRSA infection and admitted to Hospital de Niños de Rosario between January 2008 and December 2014. Exclusion criteria: recent hospitalization, previous antibiotic treatment or surgery, comorbidities or immune compromise. RESULTS: Out of 728 cases of children with Staphylococcus aureus infections, 529 (73%) were due to CA-MRSA. The incidence rate of CA-MRSA infections varied from 12.2/10 000 hospital discharges in 2004 to 145/10 000 in 2014: 75% (391) were skin and soft tissue infections; 8% (43) were osteoarticular infections; 6% (30), pleuropulmonary infections; 5% (24), sepsis. There was an increase in the number of invasive infections in the second period, with no statistical significance (OR= 0.895; CI: 0.52-1.53). Gentamicin, clindamycin and erythromycin resistance remained stable throughout both periods. CONCLUSION: CA-MRSA infections were increasingly more frequent, mainly skin and soft tissue infections. An increase was observed in the number of invasive infections, with no statistical significance. Antibiotic resistance remained stable.
INTRODUCCIÓN: Las infecciones por Staphylococcus aureus meticilino resistente adquirido en la comunidad (SAMR-ac) son motivo de consulta frecuente en pediatría. La mayoría se presentan como infecciones de piel y partes blandas; sin embargo, en la última década, se ha constatado un aumento de las infecciones invasivas. OBJETIVOS: El objetivo principal es describir las características clínico-epidemiológicas de las infecciones producidas por SAMR-ac. El objetivo secundario es comparar la prevalencia, presentación clínica y susceptibilidad antibiótica con un período previo de estudio (1/2004-12/2007). MATERIAL Y MÉTODOS: Estudio descriptivo, prospectivo, de tipo transversal. Criterios de inclusión: niños con diagnóstico de infección por SAMR-ac admitidos en el Hospital de Niños de Rosario, período de enero de 2008 a diciembre de 2014. Criterios de exclusión: internación reciente, antibiótico o cirugía previa, comorbilidades o inmunocompromiso. RESULTADOS: De 728 niños con infecciones por Staphylococcus aureus, 529 (73%) fueron por SAMR-ac. La tasa de incidencia de infecciones por SAMR-ac varió de 12,2/10 000 egresos hospitalarios de 2004 a 145/10 000 del 2014: 75% (391) fueron infecciones de piel y partes blandas; 8% (43), os teo articular es; 6% (30), pleuropulmonares; 5% (24), sepsis. Se observó un aumento en el número de infecciones invasivas en el 2o período sin significancia estadística (OR= 0,895; IC: 0,52-1,53). La resistencia a gentamicina, clindamicina y eritromicina se mantuvo estable en ambos períodos. CONCLUSIÓN: Las infecciones por SAMR-ac fueron cada vez más frecuentes, principalmente, las de piel y partes blandas. Se observó un aumento en el número de infecciones invasivas sin significancia estadística. La resistencia antibiótica se mantuvo estable.
Assuntos
Infecções Comunitárias Adquiridas/epidemiologia , Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas/epidemiologia , Adolescente , Antibacterianos/uso terapêutico , Argentina/epidemiologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/diagnóstico , Infecções Comunitárias Adquiridas/tratamento farmacológico , Infecções Comunitárias Adquiridas/microbiologia , Estudos Transversais , Feminino , Hospitais Pediátricos , Humanos , Incidência , Lactente , Recém-Nascido , Masculino , Testes de Sensibilidade Microbiana , Prevalência , Estudos Prospectivos , Infecções Estafilocócicas/diagnóstico , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/microbiologiaRESUMO
BACKGROUND: Knowledge about typical development is of fundamental importance for understanding and promoting child health and development. We aimed to ascertain when healthy children in four culturally and linguistically different countries attain developmental milestones and to identify similarities and differences across sexes and countries. METHODS: In this cross-sectional, observational study, we recruited children aged 0-42 months and their caregivers between March 3, 2011, and May 18, 2015, at 22 health clinics in Argentina, India, South Africa, and Turkey. We obtained a healthy subsample, which excluded children with a low birthweight, perinatal complications, chronic illness, undernutrition, or anaemia, and children with missing health data. Using the Guide for Monitoring Child Development, caregivers described their child's development in seven domains: expressive and receptive language, gross and fine motor, play, relating, and self-help. Clinicians examining the children also completed a checklist about the child's health status. We used logit and probit regression models based on the lowest deviance information criterion to generate Bayesian point estimates and 95% credible intervals for the 50th percentile ages of attainment of 106 milestones. We assessed the significance of differences between sexes and countries using predefined criteria and regions of practical equivalence. FINDINGS: Of 10â246 children recruited, 4949 children (48·3%) were included in the healthy subsample. For the 106 milestones assessed, the median age of attainment was equivalent for 102 (96%) milestones across sexes and 81 (76%) milestones across the four countries. Across countries, median ages of attainment were equivalent for all play milestones, 20 (77%) of 26 expressive language milestones, ten (67%) of 15 receptive language milestones, nine (82%) of 11 fine motor milestones, 14 (88%) of 16 gross motor milestones, and eight (73%) of 11 relating milestones. However, across the four countries the median age of attainment was equivalent for only two (22%) of nine milestones in the self-help domain. INTERPRETATION: The ages of attainment of developmental milestones in healthy children, and the similarities and differences across sexes and country samples might aid the development of international tools to guide policy, service delivery, and intervention research, particularly in low-income and middle-income countries. FUNDING: Eunice Kennedy Shriver National Institute of Child Health and Human Development.
Assuntos
Desenvolvimento Infantil/fisiologia , Comparação Transcultural , Argentina , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Fatores Sexuais , África do Sul , TurquiaRESUMO
Introducción. La anemia ferropénica es más frecuente en los países de bajos y medianos ingresos. La evidencia sugiere que el impacto del suplemento con sulfato ferroso en la población infantil es bajo. Nuestro objetivo fue analizar la visión de los pediatras en torno a la problemática de la anemia y al suplemento con hierro. Población y métodos. Estudio cualitativo, exploratorio. Se realizaron entrevistas semiestructuradas a los pediatras del primer nivel de atención de Rosario. Se incluyeron tres ejes de indagación: "relevancia del problema", "práctica clínica" y "representaciones sobre el suplemento con hierro". El análisis consistió en sistematizar la información obtenida mediante la transcripción de entrevistas grabadas y anotaciones. Resultados. Se realizaron 32 entrevistas. Todos los entrevistados pensaban que la anemia era un problema relevante. Actualmente, se la asocia con una alimentación de mala calidad. Los hallazgos llevan a considerar que la práctica pediátrica sigue las normativas nacionales. Hay acuerdo en que la baja adherencia es un obstáculo para el manejo clínico de la anemia ferropénica. Los pediatras expresaron ideas potencialmente beneficiosas para el contexto local, que incluían la organización de talleres sobre anemia y la distribución gratuita de preparados con hierro de mejor sabor. Conclusiones. La anemia por déficit de hierro se consideró un problema grave. En atención primaria, las intervenciones destacadas fueron la organización de talleres y el acceso a preparados con hierro de sabor más agradable.
Introduction. Iron deficiency anemia is common in low- and middle-income countries. According to the evidence, the impact of ferrous sulfate supplementation in the pediatric population is low. Our objective was to analyze the perspective of pediatricians regarding anemia and iron supplementation. Population and methods. Qualitative, exploratory study. Semi-structured interviews were conducted with primary health care pediatricians from Rosario. Three core inquiry concepts were included: importance of this problem, clinical practice, and representations about iron supplementation. The analysis consisted in the systematization of the information collected by transcribing the recorded interviews and notes. Results. A total of 32 interviews were conducted. All interviewees considered anemia was a relevant problem. At present, anemia is associated with a poor-quality diet. Based on the findings, pediatric practice follows national standards. There is consensus that low adherence is a barrier for the clinical management of iron deficiency anemia. Pediatricians described concepts that are potentially beneficial for the local setting, including workshops on anemia and free provision of more flavorful iron supplements. Conclusions. Iron deficiency anemia was considered a severe problem. In the primary health care setting, outstanding interventions included workshops and access to more flavorful iron supplements.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Criança , Pediatria , Atenção Primária à Saúde , Compostos Ferrosos/uso terapêutico , Atitude do Pessoal de Saúde , Anemia Ferropriva/tratamento farmacológico , Pesquisas sobre Atenção à SaúdeRESUMO
INTRODUCTION: Iron deficiency anemia is common in low- and middle-income countries. According to the evidence, the impact of ferrous sulfate supplementation in the pediatric population is low. Our objective was to analyze the perspective of pediatricians regarding anemia and iron supplementation. POPULATION AND METHODS: Qualitative, exploratory study. Semi-structured interviews were conducted with primary health care pediatricians from Rosario. Three core inquiry concepts were included: importance of this problem, clinical practice, and representations about iron supplementation. The analysis consisted in the systematization of the information collected by transcribing the recorded interviews and notes. RESULTS: A total of 32 interviews were conducted. All interviewees considered anemia was a relevant problem. At present, anemia is associated with a poor-quality diet. Based on the findings, pediatric practice follows national standards. There is consensus that low adherence is a barrier for the clinical management of iron deficiency anemia. Pediatricians described concepts that are potentially beneficial for the local setting, including workshops on anemia and free provision of more flavorful iron supplements. CONCLUSIONS: Iron deficiency anemia was considered a severe problem. In the primary health care setting, outstanding interventions included workshops and access to more flavorful iron supplements.
INTRODUCCIÓN: La anemia ferropénica es más frecuente en los países de bajos y medianos ingresos. La evidencia sugiere que el impacto del suplemento con sulfato ferroso en la población infantil es bajo. Nuestro objetivo fue analizar la visión de los pediatras en torno a la problemática de la anemia y al suplemento con hierro. POBLACIÓN Y MÉTODOS: Estudio cualitativo, exploratorio. Se realizaron entrevistas semiestructuradas a los pediatras del primer nivel de atención de Rosario. Se incluyeron tres ejes de indagación: "relevancia del problema", "práctica clínica" y "representaciones sobre el suplemento con hierro". El análisis consistió en sistematizar la información obtenida mediante la transcripción de entrevistas grabadas y anotaciones. RESULTADOS: Se realizaron 32 entrevistas. Todos los entrevistados pensaban que la anemia era un problema relevante. Actualmente, se la asocia con una alimentación de mala calidad. Los hallazgos llevan a considerar que la práctica pediátrica sigue las normativas nacionales. Hay acuerdo en que la baja adherencia es un obstáculo para el manejo clínico de la anemia ferropénica. Los pediatras expresaron ideas potencialmente beneficiosas para el contexto local, que incluían la organización de talleres sobre anemia y la distribución gratuita de preparados con hierro de mejor sabor. CONCLUSIONES: La anemia por déficit de hierro se consideró un problema grave. En atención primaria, las intervenciones destacadas fueron la organización de talleres y el acceso a preparados con hierro de sabor más agradable.
Assuntos
Anemia Ferropriva/tratamento farmacológico , Atitude do Pessoal de Saúde , Compostos Ferrosos/uso terapêutico , Pediatria , Atenção Primária à Saúde , Criança , Pré-Escolar , Feminino , Pesquisas sobre Atenção à Saúde , Humanos , Lactente , MasculinoRESUMO
INTRODUCCIÓN El control del crecimiento físico constituye un método válido para determinar el grado en que se satisfacen las necesidades básicas del niño. OBJETIVO Analizar el estado actual de implementación de los estándares de la OMS en el primer nivel de atención de Rosario. MÉTODOS Estudio descriptivo, transversal. Se realizaron encuestas en línea a médicos pediatras y generalistas de centros de atención primaria y se entrevistaron a informantes clave de la Municipalidad de Rosario. La obtención del consentimiento informado fue un requisito para participar del estudio. Los ejes de indagación fueron; valoración de las curvas OMS, actividades de capacitación y acciones para promover su uso e interpretación. Se utilizaron métodos de análisis cuantitativos y cualitativos. RESULTADOS Durante agosto-octubre 2019, se enviaron 180 encuestas en línea a médicos de la red de atención primaria (119 generalistas y 61 pediatras). Se completaron 95 encuestas y se realizaron 8 entrevistas. Los participantes consideraron que la adopción de las curvas OMS ha sido un cambio favorable, aunque menos de la mitad conocía sobre la metodología utilizada para su construcción. Además, alrededor de un tercio de los médicos encuestados refirió utilizar otras curvas. El índice de masa corporal se valoró como un indicador útil particularmente para control del sobrepeso y obesidad. Las intervenciones consideradas de mayor utilidad fueron; promoción de consejería nutricional, impresión de gráficas de crecimiento para uso individual y mantenimiento de los equipos para mediciones antropométricas. Para los entrevistados, la falta de mantenimiento de los equipos no fue visualizada como un problema. Los médicos encuestados opinaron que las intervenciones para capacitación son útiles aunque poco factibles. DISCUSIÓN Sería posible lograr un mayor aprovechamiento del uso de las curvas de crecimiento OMS a través de estrategias tendientes a favorecer la implementación de intervenciones consideradas como útiles por los médicos de la red de atención primaria
Assuntos
AntropometriaRESUMO
INTRODUCCIÓN La anemia es un problema de salud pública en los países de bajos y medianos ingresos. Al no existir consenso sobre cómo evaluar el nivel de hierro en las poblaciones, la prevalencia de la deficiencia de hierro suele inferirse a partir de la concentración de hemoglobina. El HemoCue es un método recomendado por la OMS para realizar la cuantificación de la hemoglobina a nivel poblacional. OBJETIVO Describir la experiencia inédita de haber utilizado el HemoCue en la red de atención pública de la ciudad de Rosario. MÉTODOS Se realizó un estudio retrospectivo, de corte transversal, en niños de 6 a 42 meses de edad. Las variables de interés fueron el registro del HemoCue en la historia clínica del niño y la toma de conducta (diagnóstica, preventiva o terapéutica) durante la consulta pediátrica. Además se recolectó información (edad, sexo, antecedentes de desnutrición y/o anemia, peso, talla, etc.) con el fin de describir la muestra del estudio. Los datos se analizaron de forma global y según diagnóstico de anemia. Se utilizó el programa R. RESULTADOS Se incluyó un total de 500 niños provenientes de cinco centros de salud. La mediana de la edad fue de 17 meses. A nivel global se registró el HemoCue en un 42% y en alrededor de la mitad de estos casos se tomó algún tipo conducta clínica. En el grupo de niños con anemia (n=242), la toma de conducta basada en el resultado del HemoCue fue mayor (75%, 1C 95%: 660/0-820/0) en comparación con los niños sin anemia (n=258) que contaban con registro del HemoCue (33 0 0). La solicitud de un hemograma de rutina fue la intervención diagnóstica más frecuente y la ìnvestigación para suplementación con hierro por vía oral fue la intervención más utilizada para prevención y/o tratamiento de la anemia. DISCUSIÓN Nuestros hallazgos sugieren que el HemoCue es un método potencialmente útil para el control de la anemia infantil en el sistema público. La evidencia generada a partir de este estudio debería ser considerada en futuras investigaciones
Assuntos
Pediatria , Estudos Retrospectivos , Hemoglobinometria , AnemiaAssuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Tripanossomicidas/uso terapêutico , Doenças Cardiovasculares/tratamento farmacológico , Nitroimidazóis/uso terapêutico , Tripanossomicidas/efeitos adversos , Trypanosoma cruzi/isolamento & purificação , Trypanosoma cruzi/genética , Doenças Cardiovasculares/complicações , Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/mortalidade , Ensaios Clínicos Controlados Aleatórios como Assunto , Reação em Cadeia da Polimerase , Doença Crônica , Falha de Tratamento , Progressão da Doença , Carga Parasitária , Genótipo , Nitroimidazóis/efeitos adversosRESUMO
BACKGROUND: Chagas disease is caused by the flagellate protozoan Trypanosoma cruzi (T. cruzi). It is endemic in Latin American countries outside the Caribbean. The current criterion for cure in the chronic phase of the disease is the negativization of at least two serological tests such as enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence assay (IIF) and indirect hemagglutination assay (IHA). The serological evolution of treated subjects with chronic T. cruzi infection is variable. Treatment failure is indicated by a positive parasitological and/or molecular test (persistence of parasitemia). OBJECTIVES: To summarize the pattern of response to treatment of parasitological, molecular and serological tests performed during the follow-up of subjects with chronic T. cruzi infection. METHODS: Electronic searches in relevant databases and screening of citations of potentially eligible articles were accomplished. Organizations focusing on neglected infectious diseases were asked for help in identifying relevant studies. Included studies were randomized controlled trials (RCTs), quasi-RCTs, and cohort studies involving adults and children with chronic infection who received trypanocidal treatment (benznidazole or nifurtimox) and were followed over time. The assessment of risk of bias was performed separately for each study design. The Cochrane Collaboration's tool and the guidelines developed by Hayden et al. were used. Two reviewers extracted all data independently. A third review author was consulted in case of discordant opinion. Additional analyses were defined in ad-hoc basis. Scatter plots for percentage of positive parasitological and molecular tests and for negative serological tests were developed by using the lowess curve technique. Heterogeneity was measured by I2. The protocol was registered in PROSPERO, an international prospective register of systematic review protocols (Registration Number CRD42012002162). RESULTS: Out of 2,136 citations screened, 54 studies (six RCTs and 48 cohort studies) were included. The smoothed curves for positive xenodiagnosis and positive polymerase chain reaction (PCR) were characterized by a sharp decrease at twelve month posttreatment. Afterwards, they reached 10-20% and 40% for xenodiagnosis and PCR, respectively. The smoothed curves for negative conventional serological tests increased up to 10% after 48 months of treatment. In the long-term, the rate of negativization was between 20% and 45%. The main sources of bias identified across cohort studies were the lack of control for confounding and attrition bias. In general, RCTs were judged as low risk of bias in all domains. The level of heterogeneity across included studies was moderate to high. Additional analysis were incomplete because of the limited availability of data. In this regard, the country of origin of study participants might affect the results of parasitological and molecular tests, while the level of risk of bias might affect serological outcomes. Subgroup analysis suggested that seronegativization occurs earlier in children compared to adults. CONCLUSIONS: We acknowledge that there is a dynamic pattern of response based on parasitological, molecular and serological tests in subjects chronically infected with T. cruzi after treatment. Our findings suggest a trypanocidal effect in the long-term follow-up. Further research is needed to explore potential sources of heterogeneity and to conduct reliable subgroup analysis.
Assuntos
Anticorpos Antiprotozoários/sangue , Doença de Chagas/tratamento farmacológico , Nifurtimox/uso terapêutico , Nitroimidazóis/uso terapêutico , Parasitemia/tratamento farmacológico , Tripanossomicidas/uso terapêutico , Trypanosoma cruzi/imunologia , Adulto , Doença de Chagas/epidemiologia , Doença de Chagas/imunologia , Doença de Chagas/parasitologia , Criança , Doença Crônica , Estudos de Coortes , DNA de Protozoário/sangue , Progressão da Doença , Ensaio de Imunoadsorção Enzimática , Técnica Indireta de Fluorescência para Anticorpo , Seguimentos , Testes de Hemaglutinação , Humanos , Parasitemia/epidemiologia , Parasitemia/imunologia , Parasitemia/parasitologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Falha de Tratamento , XenodiagnósticoRESUMO
Las infecciones de piel y partes blandas son una causa frecuente de consulta en los centros de atención primaria de la salud. Los datos de la epidemiología local de estas infecciones son escasos; el Staphylococcus aureus y el Streptococcus pyogenes son los principales agentes etiológicos. La emergencia, en los últimos años, de cepas de S. aureus meticilino resistentes provenientes de la comunidad y S. pyogenes resistentes a eritromicina plantea controversia en la elección del tratamiento empírico inicial. Este consenso nacional está dirigido a médicos pediatras, de familia, dermatólogos, infectólogos y otros profesionales de la salud. Trata el manejo clínico, especialmente el diagnóstico y tratamiento, de las infecciones de piel y partes blandas de origen bacteriano provenientes de la comunidad en pacientes inmunocompetentes menores de 19 años de edad.
Skin and soft tissue infections are a common reason for consultation in primary health care centers. Data from the local epidemiology of these infections are rare, but Staphylococcus aureus and Streptococcus pyogenes are known to be the major etiologic agents. The appearance in recent years of community-originated strains of methicillin-resistant S. aureus and erythromycin-resistant pyogenes raises controversy in the choice of initial empirical treatment. This national consensus is for pediatricians, dermatologists, infectologists and other health professionals. It is about clinical management, especially the diagnosis and treatment of community-originated skin and soft tissue infections in immunocompetent patients under the age of 19.
Assuntos
Humanos , Criança , Dermatopatias Infecciosas/diagnóstico , Dermatopatias Infecciosas/terapia , Infecções dos Tecidos Moles/diagnóstico , Infecções dos Tecidos Moles/terapiaRESUMO
INTRODUCTION: Medicinal iron supplementation is a free and widely used intervention to prevent and treat childhood anemia. OBJECTIVES: To determine the prevalence of anemia in a sample of children from Rosario, to describe the use of iron supplements in children included in the studied sample, and to illustrate variables potentially related to mothers' adherence to oral iron administration. POPULATION AND METHODS: A cross-sectional study involving mothers and infants younger than 42 months old assisted by the public health network of Rosario from December 2011 to April 2012 was conducted. Sociodemographic variables and data on children's health, growth, anemia, and iron administration were collected. A rapid test was used to determine hemoglobin level. RESULTS: A total of 325 mother-infant dyads were included. The overall prevalence of anemia was 40% (95% CI: 35-45%), and it increased up to 56% in the 6-23 month old group. Fifty-one percent of mothers reported that their children had at some time received iron. Mothers' adherence to oral iron administration was higher in the group of children without anemia in comparison to those with anemia (OR: 0.28; 95% CI: 0.1-0.69). The most common causes for lack of adherence included gastrointestinal intolerance (38%) and forgetfulness (36%). CONCLUSIONS: Prevalence of childhood anemia in the studied sample was high. A lower mothers' adherence to iron administration was observed in the group of children with anemia.
Assuntos
Anemia/tratamento farmacológico , Suplementos Nutricionais , Ferro/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Adulto , Anemia/epidemiologia , Argentina , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Mães , Prevalência , Saúde PúblicaRESUMO
Introducción. La suplementación con hierro medicinal es una intervención gratuita y ampliamente utilizada para prevenir y tratar la anemia infantil. Objetivos. Determinar la prevalencia de la anemia en una muestra de niños rosarinos, describir el uso de suplementos con hierro en los niños de la muestra estudiada y detallar las variables potencialmente relacionadas con la adherencia de las madres a la administración oral del hierro. Población y métodos. Se realizó un estudio transversal que incluyó a madres y niños menores de 42 meses atendidos en la red de salud pública de la ciudad de Rosario entre diciembre de 2011 y abril de 2012. Se recolectaron variables sociodemográficas y datos sobre salud, crecimiento, anemia y administración de hierro en el niño. Se usó una prueba rápida para determinar el nivel de hemoglobina. Resultados. Se incluyeron 325 pares de madres y niños. La prevalencia global de la anemia fue del 40% (IC 95% 35% a 45%) y aumentó hasta un 56% en el grupo de 6 a 23 meses. El 51% de las madres refrieron que su hijo había tomado hierro alguna vez. La adherencia de las madres a la administración del hierro fue mayor en los niños sin anemia en comparación con los niños con anemia (OR 0,28; IC 95% 0,1 a 0,69). Las causas más frecuentes de falta de adherencia fueron la intolerancia digestiva (38%) y el olvido (36%). Conclusiones. La prevalencia de la anemia infantil en la muestra estudiada fue alta. Se observó menor adherencia de las madres a la administración del hierro en el grupo de niños con anemia.
Introduction. Medicinal iron supplementation is a free and widely used intervention to prevent and treat childhood anemia. Objectives. To determine the prevalence of anemia in a sample of children from Rosario, to describe the use of iron supplements in children included in the studied sample, and to illustrate variables potentially related to mothers' adherence to oral iron administration. Population and methods. A cross-sectional study involving mothers and infants younger than 42 months old assisted by the public health network of Rosario from December 2011 to April 2012 was conducted. Sociodemographic variables and data on children's health, growth, anemia, and iron administration were collected. A rapid test was used to determine hemoglobin level. Results. A total of 325 mother-infant dyads were included. The overall prevalence of anemia was 40% (95% CI: 35-45%), and it increased up to 56% in the 6-23 month old group. Fifty-one percent of mothers reported that their children had at some time received iron. Mothers' adherence to oral iron administration was higher in the group of children without anemia in comparison to those with anemia (OR: 0.28; 95% CI: 0.1-0.69). The most common causes for lack of adherence included gastrointestinal intolerance (38%) and forgetfulness (36%). Conclusions. Prevalence of childhood anemia in the studied sample was high. A lower mothers' adherence to iron administration was observed in the group of children with anemia.