RESUMO
Children and adolescents with rheumatologic diseases require specialized and comprehensive care, but pediatric rheumatologists and immunologists are concentrated in hospitals with specific, high-cost and modern technology. Considering that some patients with juvenile idiopathic arthritis (JIA) live in rural, remote and limited accessibility areas, the use of Telemedicine (TM) can optimize diag nosis, follow-up and prognosis. OBJECTIVE: Reporting 10 years of experience of a mixed care model: face-to-face and distance, using basic TM; the institutional impact, advantages, disadvantages and acceptance informed by parents and patients. PATIENTS AND METHOD: Exploratory, descriptive, and re trospective study with qualitative component. After the authorization of a scientific-ethics committee of the Reloncaví Health Service and the application of informed consent, a review of medical records was carried out and a qualitative survey was applied to parents and children over 14 years of age with JIA, seen between 2005-2015 in the pediatric ambulatory rheumatology polyclinic of Puerto Montt Hospital. RESULTS: The were 27/35 participating patients with JIA attended by a trained pediatrician and assisted by distance (1,000 km) by an immunologist. The 8/35 patients did not answer by choice or change of address. The 70% of parents and patients accepted the model of care and 4% would pre fer sporadic care only by specialists for diagnosis and follow-up. The number of patients transferred annually decreased from 10 to 1. The advantages of the care model outweighed the disadvantages perceived by parents and JIA patients. CONCLUSION: The use of TM tools in JIA decreased transfers, improved follow-up and were considered advantageous by patients and their parents.
Assuntos
Artrite Juvenil/terapia , Acessibilidade aos Serviços de Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Telemedicina , Adolescente , Criança , Pré-Escolar , Chile , Feminino , Pesquisas sobre Atenção à Saúde , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Hospitais , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Estudos Retrospectivos , Serviços de Saúde Rural/estatística & dados numéricos , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricosRESUMO
BACKGROUND: There is little information about the prevalence of asthma in Latin American children. AIM: To determine the prevalence of asthma among Chilean school age children. SUBJECTS AND METHODS: The prevalence of respiratory symptoms related to asthma in schoolchildren aged 7 and 13 years, coming from South Santiago, Central Santiago, Valdivia and Punta Arenas, was determined using the methodology of the International Study on Asthma and Allergies in Childhood (ISMC). A random sample of school children aged 6-7 and 13-14 years from each locality was selected. This resulted in 24)470 surveyed children (11,723 aged 6-7 years and 12,747 aged 13-14 years). RESULTS: The current prevalence of wheezing ("wheezing in the last 12 months") ranged from 16.5% to 20.0% in children aged 67 years, and from 6.8% to 11.7% in children aged 13-14 years. The cumulative prevalence of asthma ("asthma ever"), ranged from 9.7% and 16.5% in the 6-7 years group and from 7.3% to 12.4% in those aged 13-14 years. CONCLUSIONS: This study found much higher figures for prevalence of respiratory symptoms related to asthma in school children than those previously reported in this country, with a significant variability between centers (p < 0.05). The prevalence of asthma in Chilean schoolchildren is as high and variable as that reported in industrialized countries.
Assuntos
Asma/epidemiologia , Adolescente , Criança , Chile/epidemiologia , Feminino , Humanos , Masculino , Prevalência , Distribuição Aleatória , Transtornos Respiratórios/epidemiologia , Inquéritos e QuestionáriosAssuntos
Leucemia Linfoide/patologia , Neoplasias Meníngeas/patologia , Adolescente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Criança , Pré-Escolar , Terapia Combinada , Ciclofosfamida/administração & dosagem , Citarabina/administração & dosagem , Combinação de Medicamentos/administração & dosagem , Humanos , Lactente , Leucemia Linfoide/terapia , Neoplasias Meníngeas/terapia , Metotrexato/administração & dosagem , Prednisona/administração & dosagem , Prognóstico , Vincristina/administração & dosagemRESUMO
En un grupo de 56 ninos con leucemia aguda (39 LAL y 17 LAM), 13 (23%: 8 LAL y 5 LAM) presentaron compromiso meningeo. Ocho pacientes tenian dos o mas factores predictivos de desarrollar una LMe, destacando las blastemias elevadas y la trombocitopenia asociada. El grupo con LMe tuvo una elevada mortalidad (88,8% en LAL y 75% en LAM), atribuida al tipo citologico (solo un paciente preteneciente al tipo LAL1), a la mayor frecuencia de compromiso meningeo en el momento del diagnostico inicial de leucemia y a las edades bajo dos y sobre diez anos. Los dos pacientes vivos estan en RC con una sobrevida de 75 y 96 meses. El tratamiento de la leucemia meningea es muy controvertido. El Grupo Oncologico Pediatrico Chileno (GOPECH) ha recomendado un esquema terapeutico que reune criterios diferentes