RESUMO
Rationale: Pneumonia is the leading cause of death in children worldwide. Identifying and appropriately managing severe pneumonia in a timely manner improves outcomes. Little is known about the readiness of healthcare facilities to manage severe pediatric pneumonia in low-resource settings. Objectives: As part of the HAPIN (Household Air Pollution Intervention Network) trial, we sought to identify healthcare facilities that were adequately resourced to manage severe pediatric pneumonia in Jalapa, Guatemala (J-GUA); Puno, Peru (P-PER); Kayonza, Rwanda (K-RWA); and Tamil Nadu, India (T-IND). We conducted a facility-based survey of available infrastructure, staff, equipment, and medical consumables. Facilities were georeferenced, and a road network analysis was performed. Measurements and Main Results: Of the 350 healthcare facilities surveyed, 13% had adequate resources to manage severe pneumonia, 37% had pulse oximeters, and 44% had supplemental oxygen. Mean (±SD) travel time to an adequately resourced facility was 41 ± 19 minutes in J-GUA, 99 ± 64 minutes in P-PER, 40 ± 19 minutes in K-RWA, and 31 ± 19 minutes in T-IND. Expanding pulse oximetry coverage to all facilities reduced travel time by 44% in J-GUA, 29% in P-PER, 29% in K-RWA, and 11% in T-IND (all P < 0.001). Conclusions: Most healthcare facilities in low-resource settings of the HAPIN study area were inadequately resourced to care for severe pediatric pneumonia. Early identification of cases and timely referral is paramount. The provision of pulse oximeters to all health facilities may be an effective approach to identify cases earlier and refer them for care and in a timely manner.
Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pneumonia/diagnóstico , Pneumonia/terapia , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Geografia , Guatemala , Humanos , Índia , Lactente , Recém-Nascido , Masculino , Oximetria , Peru , Pobreza/estatística & dados numéricos , População Rural/estatística & dados numéricos , RuandaRESUMO
OBJECTIVE: To report the results of a dissertation developed with nurses who perform childcare consultations in Family Health Units in a Health District of João Pessoa, Paraíba, Brazil. METHODS: Experience report of the presentation and interpretation of the research results, in 2018, with 42 nurses, using the conversation strategy with two focus groups. RESULTS: The nurses showed disappointment with the negative results evidenced in the study's feedback, but they highlighted the importance of this moment for discussion and reflection of their practices, thus arousing the interest in qualifying the child's health care. FINAL CONSIDERATIONS: This study achieved the objective of promoting the dissemination of the findings of a research, coupled with the social and ethical commitment to return to the nurses and participating services with the feedback of the research results to improve the reality in which they work.
Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Cuidados de Enfermagem , Atenção Primária à Saúde , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Brasil , Criança , Retroalimentação , Humanos , PediatriaRESUMO
Población por tipo de cobertura médica; gráfico de hospitales con internación por tipo y especialidad, y de centros de salud; y promedio diario de niños y adolescentes beneficiados por distintas dependencias de la Dirección General de Niños/as y Adolescentes.
Assuntos
Humanos , Masculino , Feminino , Criança , Adolescente , Hospitais Urbanos/provisão & distribuição , Hospitais Urbanos/estatística & dados numéricos , Centros de Saúde , Defesa da Criança e do Adolescente/estatística & dados numéricos , Serviços de Saúde da Criança/provisão & distribuição , Serviços de Saúde da Criança/estatística & dados numéricos , Estatísticas de Saúde , Estatísticas de Serviços de Saúde , Serviços de Saúde do Adolescente/provisão & distribuiçãoRESUMO
Introducción: la lactancia materna ha demostrado grandes beneficios para el recién nacido. En vista de que hay factores que afectan la correcta lactancia, en 2007 se crearon los bancos de leche materna y Colombia hace parte de esta iniciativa en pro de la niñez. Objetivo: identificar la utilización del banco de leche humana (BLH) de la ESE Hospital San Rafael de Fusagasugá, Colombia entre julio 2012 y junio 2016. Metodología: estudio descriptivo de corte transversal, con muestra de 1282 nacidos en el período que utilizaron el BLH. Resultados y discusión: entre los factores que llevaron al uso del BLH en estos menores están la baja producción de leche en la madre en 53,7%, cirugía materna 3,5%, mamá con bajo nivel cognitivo 0,2%, succión leve o pobre en 9,6%, madre ausente 0,4%, recién nacido que requirió hospitalización 4,6%, pezón invertido o plano 2,5% y labio leporino 0,5%. Conclusión: se pudo determinar que 22,7% de los niños que nacieron en el municipio necesitaron el servicio del banco de leche materna, logrando visualizar las bondades del mismo, brindando la oportunidad para que lo pudieran utilizar en la misma zona de nacimiento sin necesidad de desplazarse, evitando las subsiguientes consecuencias que ello desencadena en la familia y el recién nacido.
Introduction: breastfeeding has shown great benefits for the newborn. In view of the fact that there are factors affecting proper breastfeeding, nursing mothers Ì milk banks were created in 2007 and Colombia is part of this initiative on behalf of children. Objective: to identify the use of the human milk bank (HMB) at ESE Hospital San Rafael in Fusagasugá, Colombia between July 2012 and June 2017. Methodology: descriptive cross-sectional study, with a sample of 1282 newborns delivered in said period using HMB. Results: among the factors that led to the use of HMB in these children are the mother Ìs low milk production in 53.7%, maternal surgery 3.5%, mother with low cognitive level 0.2%, mild or poor suction 9.6%, absent mother 0.4%, newborn requiring hospitalization 4.6%, inverted or flat nipple 2.5% and cleft lip 0.5%. Conclusion: it could be determined that 22.7% of the children born in the municipality needed the service of the mother Ìs milk bank, managing to visualize the benefits of it, providing the opportunity for them to use it in the same area of birth without having to move, avoiding the subsequent consequences that this triggers in the family and newborn.
Assuntos
Humanos , Masculino , Recém-Nascido , Adolescente , Adulto , Adulto Jovem , Aleitamento Materno , Estratégias de Saúde Locais , Serviços de Saúde da Criança/estatística & dados numéricos , Bancos de Leite Humano/estatística & dados numéricos , Recém-Nascido de Baixo PesoRESUMO
Objetivo: avaliar, sob a ótica do cuidador, o atributo da integralidade na atenção primária à saúde da criança no município de Porto Velho, Brasil. Método: estudo avaliativo, transversal realizado com 420 cuidadores de crianças atendidas em um hospital infantil em 2017. Utilizou-se o Primary Care Assessment Tool Brasil - versão criança e os dados foram analisados pelo software Statistic 13.0. A pesquisa foi aprovada pelo Comitê de Ética e Pesquisa. Resultados: na avaliação das dimensões do atributo integralidade, o escore médio dos serviços disponíveis (4,67) e dos serviços prestados (5,26) à criança mostrou baixa orientação para a atenção primária à saúde, principalmente no que tange às orientações recebidas pelos profissionais, sobre crescimento, segurança, benefícios sociais, problemas visuais e de comportamento da criança. Conclusão: o atributo integralidade na saúde da criança está presente, porém de forma fragmentada, necessitando que os serviços revejam as prioridades nos cuidados à criança junto ao familiar/cuidador.
Objective: to assess, from the caregiver's perspective, the comprehensiveness of children's primary health care in Porto Velho, Brazil. Method: in this evaluative, cross-sectional study of 420 caregivers at a children's hospital in 2017, the Primary Care Assessment Tool Brazil children's version was used and data were analyzed using Statistic 13.0 software. The research was approved by a research ethics committee. Results: in evaluation of dimensions of comprehensiveness, children's services available scored an average of 4.67 and services provided, 5.26, showing poor orientation towards primary health care, particularly as regards the guidance received by health personnel on children's growth, safety, social benefits, eyesight and behavioral problems. Conclusion: comprehensive child health care is present, although fragmented, requiring that services review child care priorities with family members/caregivers.
Objetivo: evaluar, desde la perspectiva del cuidador, la integralidad de la atención primaria de salud infantil en Porto Velho, Brasil. Método: en este estudio evaluativo, transversal de 420 cuidadores en un hospital infantil en 2017, se utilizó la Herramienta de Evaluación de Atención Primaria Brasil - versión infantil y los datos se analizaron mediante el software Estadística 13.0. La investigación fue aprobada por un comité de ética en investigación. Resultados: en la evaluación de las dimensiones de integralidad, los servicios disponibles para la infancia obtuvieron un promedio de 4,67 y los servicios prestados, 5,26, mostrando una mala orientación hacia la atención primaria de salud, particularmente en lo que respecta a la orientación que recibe el personal de salud sobre el crecimiento, la seguridad, los beneficios sociales, la vista del niño y problemas de comportamiento. Conclusión: la atención integral de la salud infantil está presente, aunque fragmentada, lo que requiere que los servicios revisen las prioridades del cuidado infantil con los miembros de la familia / cuidadores.
Assuntos
Humanos , Masculino , Feminino , Recém-Nascido , Lactente , Pré-Escolar , Atenção Primária à Saúde , Serviços de Saúde da Criança/estatística & dados numéricos , Cuidadores , Assistência Integral à Saúde/estatística & dados numéricos , Integralidade em Saúde , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Brasil , Saúde da Criança , Estudos Transversais , Hospitais PúblicosRESUMO
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic caused dramatic changes in daily routines and health care utilization and delivery patterns in the United States. Understanding the influence of these changes and associated public health interventions on asthma care is important to determine effects on patient outcomes and identify measures that will ensure optimal future health care delivery. OBJECTIVE: We sought to identify changes in pediatric asthma-related health care utilization, respiratory viral testing, and air pollution during the COVID-19 pandemic. METHODS: For the time period January 17 to May 17, 2015 to 2020, asthma-related encounters and weekly summaries of respiratory viral testing data were extracted from Children's Hospital of Philadelphia electronic health records, and pollution data for 4 criteria air pollutants were extracted from AirNow. Changes in encounter characteristics, viral testing patterns, and air pollution before and after Mar 17, 2020, the date public health interventions to limit viral transmission were enacted in Philadelphia, were assessed and compared with data from 2015 to 2019 as a historical reference. RESULTS: After March 17, 2020, in-person asthma encounters decreased by 87% (outpatient) and 84% (emergency + inpatient). Video telemedicine, which was not previously available, became the most highly used asthma encounter modality (61% of all visits), and telephone encounters increased by 19%. Concurrently, asthma-related systemic steroid prescriptions and frequency of rhinovirus test positivity decreased, although air pollution levels did not substantially change, compared with historical trends. CONCLUSIONS: The COVID-19 pandemic in Philadelphia was accompanied by changes in pediatric asthma health care delivery patterns, including reduced admissions and systemic steroid prescriptions. Reduced rhinovirus infections may have contributed to these patterns.
Assuntos
Poluição do Ar/estatística & dados numéricos , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Serviços de Saúde da Criança/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Infecções por Adenovirus Humanos/diagnóstico , Infecções por Adenovirus Humanos/epidemiologia , Adolescente , Corticosteroides/uso terapêutico , Assistência Ambulatorial/estatística & dados numéricos , Asma/fisiopatologia , Betacoronavirus , COVID-19 , Teste para COVID-19 , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronaviridae/diagnóstico , Infecções por Coronaviridae/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/prevenção & controle , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Pediátricos , Humanos , Influenza Humana/diagnóstico , Influenza Humana/epidemiologia , Masculino , Dióxido de Nitrogênio , Ozônio , Pandemias/prevenção & controle , Infecções por Paramyxoviridae/diagnóstico , Infecções por Paramyxoviridae/epidemiologia , Material Particulado , Philadelphia/epidemiologia , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/epidemiologia , Pneumonia Viral/diagnóstico , Pneumonia Viral/prevenção & controle , Infecções por Vírus Respiratório Sincicial/diagnóstico , Infecções por Vírus Respiratório Sincicial/epidemiologia , SARS-CoV-2 , Telemedicina/estatística & dados numéricos , Telefone , Comunicação por VideoconferênciaRESUMO
OBJETIVO: Describir la oferta programática en primera infancia destinada a favorecer el desarrollo infantil integral en Chile. MÉTODO: Se realizó una revisión exploratoria siguiendo el marco método lógico del Joanna Briggs Institute. La búsqueda fue realizada por un investigador y los criterios de inclusión fueron: programas gubernamentales destinados al desarrollo integral en menores de 5 años en Chile. Los datos fueron organizados y sintetizados para describir características del programa y de la o las prestaciones que entrega. RESULTADOS: La búsqueda identificó 2060 documentos y 72 cumplieron los criterios de inclusión. Se describen 59 programas vigentes que abarcan la primera infancia, es tando principalmente a cargo de los Ministerio de Justicia, Educación, Salud y Desarrollo Social. Los programas están destinados en su mayoría a la promoción e intervención, se encuentran focalizados en población vulnerable, son intersectoriales y utilizan diversas estrategias para su implementación. CONCLUSIÓN: La oferta programática en Chile para la primera infancia presenta características sugeridas como efectivas para favorecer el desarrollo infantil.
OBJECTIVE: To describe the program offering designed to promote comprehensive early childhood de velopment in Chile. METHOD: A scoping review was carried out following the Joanna Briggs Institute's methodological framework. A researcher conducted the review considering as inclusion criteria go vernment programs aimed at the comprehensive development of children under 5 years of age in Chile. The data were organized and synthesized to describe the characteristics of the program and the service(s) it provides. RESULTS: The search identified 2.060 documents and 72 met the inclusion crite ria. 59 current programs are covering early childhood, which are mainly managed by the Ministries of Justice, Education, Health, and Social Development. Most of the programs are aimed at promotion and intervention, focusing on vulnerable populations, are cross-sectoral, and use different strategies for their implementation. CONCLUSION: The program offering in Chile for early childhood has charac teristics suggested as effective to promote child development.
Assuntos
Humanos , Lactente , Pré-Escolar , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Desenvolvimento Infantil , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Proteção da Criança , Saúde da Criança , Programas Governamentais/métodos , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Chile , Intervenção Educacional Precoce/métodos , Intervenção Educacional Precoce/organização & administração , Intervenção Educacional Precoce/estatística & dados numéricos , Populações VulneráveisRESUMO
BACKGROUND: Integrated Management of Childhood Illnesses (IMCI) is a strategy developed by the World Health Organization (WHO) and UNICEF in 1992. It was deployed as an integrated approach to improve children's health in the world. This strategy is divided into three components: organizational, clinical, and communitarian. If the Integrated Management of Childhood Illnesses implementation-related factors in low- and middle-income countries are known, the likelihood of decreasing infant morbidity and mortality rates could be increased. This work aimed to identify, from the clinical component of the strategy, the implementation-related factors to Integrated Management of Childhood Illnesses at 18 Colombian cities. METHODS: A quantitative cross-sectional study was performed with a secondary analysis of databases of a study conducted in Colombia by the Public Health group of Universidad de Los Andes in 2016. An Integrated Care Index was calculated as a dependent variable and descriptive bivariate and multivariate analyses to find the relationship between this index and the relevant variables from literature. RESULTS: Information was obtained from 165 medical appointments made by nurses, general practitioners, and pediatricians. Health access is given mainly in the urban area, in the first level care and outpatient context. Essential medicines availability, necessary supplies, second-level care, medical appointment periods longer than 30 min, and care to the child under 30 months are often related to higher rates of Integrated Care Index. CONCLUSION: Health care provided to children under five remains incomplete because it does not present the basic minimums for the adequate IMCI's implementation in the country. It is necessary to provide integrated care that provides medicine availability and essential supplies that reduce access barriers and improve the system's fragmentation.
Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/estatística & dados numéricos , Saúde Pública/estatística & dados numéricos , Criança , Serviços de Saúde da Criança/organização & administração , Pré-Escolar , Cidades , Colômbia , Estudos Transversais , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , Acessibilidade aos Serviços de Saúde/organização & administração , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Lactente , Masculino , Nações Unidas , Organização Mundial da SaúdeRESUMO
OBJECTIVE: To verify factors associated with early newborn access to biological neonatal screening. METHOD: A cross-sectional quantitative study was carried out with all newborns who underwent tests in healthcare units, hospitals, and laboratories of a city in the state of São Paulo, Brazil, with programs linking healthcare information. The following variables were investigated: child's age at collection (dependent); place of collection; date of collection; and type of user (independent). Descriptive and inferential statistics were applied. RESULTS: Records of 15,652 screenings were found in the two years analyzed. In the first year analyzed, 7,955 births and 7,640 (96.0%) tests were recorded, of which 5,586 (73.1%) were undertaken with newborns between three and five days old. In the next year analyzed, 8,316 births and 8,012 (96.3%) screenings were recorded, of which 7,025 (87.6%) were undertaken with newborns in the same age group. A statistically significant association was found between the variables "child's age" and "type of user" in one year, and between the variables "child's age" and "place of collection" in both years. CONCLUSION: Early access to these tests enables the screening of diseases and referral for treatment. The present study contributes to the management of child care programs by presenting strategies linking data and actions to improve access to biological neonatal screening.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Triagem Neonatal , Brasil , Serviços de Saúde da Criança/estatística & dados numéricos , Estudos Transversais , Diagnóstico Precoce , Humanos , Recém-Nascido , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Triagem Neonatal/enfermagem , Triagem Neonatal/organização & administração , Fatores de TempoRESUMO
OBJECTIVE: To describe the program offering designed to promote comprehensive early childhood de velopment in Chile. METHOD: A scoping review was carried out following the Joanna Briggs Institute's methodological framework. A researcher conducted the review considering as inclusion criteria go vernment programs aimed at the comprehensive development of children under 5 years of age in Chile. The data were organized and synthesized to describe the characteristics of the program and the service(s) it provides. RESULTS: The search identified 2.060 documents and 72 met the inclusion crite ria. 59 current programs are covering early childhood, which are mainly managed by the Ministries of Justice, Education, Health, and Social Development. Most of the programs are aimed at promotion and intervention, focusing on vulnerable populations, are cross-sectoral, and use different strategies for their implementation. CONCLUSION: The program offering in Chile for early childhood has charac teristics suggested as effective to promote child development.
Assuntos
Desenvolvimento Infantil , Serviços de Saúde da Criança , Saúde da Criança , Proteção da Criança , Programas Governamentais , Promoção da Saúde , Serviços Preventivos de Saúde , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Chile , Intervenção Educacional Precoce/métodos , Intervenção Educacional Precoce/organização & administração , Intervenção Educacional Precoce/estatística & dados numéricos , Programas Governamentais/métodos , Programas Governamentais/organização & administração , Programas Governamentais/estatística & dados numéricos , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Promoção da Saúde/estatística & dados numéricos , Humanos , Lactente , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Populações VulneráveisRESUMO
Introdução: apesar do aumento da sobrevida as neoplasias infanto-juvenil continuam ocupando a segunda posição em óbitos nos países em desenvolvimento. Objetivo: analisar a distribuição espacial de óbitos de neoplasia maligna em pacientes de 0 a 19 anos de idade entre as regionais de saúde do estado do Rio de Janeiro. Método: estudo ecológico, que analisou a distribuição espacial de óbitos no período de janeiro a dezembro de 2015 através do Sistema de Informações sobre Mortalidade. Os dados foram tabulados no Tabnet e analisados no programa estatístico R. Resultados: dos 101 óbitos observados, 24 (23,8%) foram por neoplasias malignas do Sistema Nervoso Central, e a maior taxa de óbito geral foi na Metropolitana I (63,3%), e por leucemia na Baixada Litorânea (27,9%). Conclusão: a identificação de óbitos mais frequentes por neoplasia maligna torna possível a construção de políticas públicas, visando medidas de prevenção, diagnosticas e tratamento condizente com a realidade local
Introduction: Despite the increase in survival, childhood and juvenile neoplasias continue to occupy the second position in deaths in developing countries. Objective: analyze the spatial distribution of malignant neoplasm deaths in patients aged 0 to 19 years of age in the health regions of the State of Rio de Janeiro. Method: An ecological study that analyzed the spatial distribution of deaths in the period from January to December 2015 through the Mortality Information System. The data were tabulated in Tabnet and analyzed in the statistical program R. Results: of the 101 deaths observed, 24 (23.8%) due to malignant neoplasms of the Central Nervous System, and the highest overall death rate was in the Metropolitan I (63.3%), and leukemia in the coastal plain (27.9%). Conclusion: the identification of more frequent deaths due to malignant neoplasia makes possible the construction of public policies, aiming at preventive measures, diagnoses and treatment consistent with the local reality
Introducción: a pesar del aumento de la supervivencia las neoplasias infanto-juvenil continúan ocupando la segunda posición en muertes en los países en desarrollo. Objetivo: analizar la distribución espacial de los óbitos de neoplasia maligna en pacientes de 0-19 años de edad entre las regiones de salud del Estado de Rio de Janeiro. Método: estudio ecológico, que analizó la distribución espacial de los óbitos del período de enero a diciembre de 2015 a través del Sistema de Información sobre la Mortalidad. Los dados fueron tabulados en el Tabnet e analizado en el programa estadístico R. Resultados: de los 101 fallecimientos observados, 24 (23,8%) por neoplasias malignas del Sistema Nervioso Central, y la mayor tasa de muerte general fue en la Metropolitana I (63,3%), y por leucemia en la Bajada Litoránea (27,9 %). Conclusión: la identificación de muertes más frecuentes por neoplasia maligna hace posible la construcción de políticas públicas, buscando medidas de prevención, diagnósticos y tratamiento acorde con la realidad local
Assuntos
Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Adolescente , Neoplasias , MortalidadeRESUMO
Abstract Objective: To verify factors associated with early newborn access to biological neonatal screening. Method: A cross-sectional quantitative study was carried out with all newborns who underwent tests in healthcare units, hospitals, and laboratories of a city in the state of São Paulo, Brazil, with programs linking healthcare information. The following variables were investigated: child's age at collection (dependent); place of collection; date of collection; and type of user (independent). Descriptive and inferential statistics were applied. Results: Records of 15,652 screenings were found in the two years analyzed. In the first year analyzed, 7,955 births and 7,640 (96.0%) tests were recorded, of which 5,586 (73.1%) were undertaken with newborns between three and five days old. In the next year analyzed, 8,316 births and 8,012 (96.3%) screenings were recorded, of which 7,025 (87.6%) were undertaken with newborns in the same age group. A statistically significant association was found between the variables "child's age" and "type of user" in one year, and between the variables "child's age" and "place of collection" in both years. Conclusion: Early access to these tests enables the screening of diseases and referral for treatment. The present study contributes to the management of child care programs by presenting strategies linking data and actions to improve access to biological neonatal screening.
Resumo Objetivo: verificar fatores associados ao acesso precoce de recém-nascidos à triagem neonatal biológica. Método: estudo transversal, quantitativo, com todos os bebês que realizaram exame em unidades de saúde, hospitais ou laboratórios de um município do estado de São Paulo, Brasil, com programas que vinculam informações de atenção à saúde. Foram investigadas as variáveis: idade da criança na coleta (dependente), local da coleta, data da coleta, tipo de usuário (independentes). Aplicou-se estatística descritiva e inferencial. Resultados: há registro de 15.652 triagens nos dois anos analisados. No primeiro ano analisado, ocorreram 7.955 nascimentos e 7.640 (96,0%) exames, 5.586 (73,1%) deles em recém-nascidos de três a cinco dias de vida. Para 8.316 bebês nascidos no ano seguinte, foram registradas 8.012 (96,3%) triagens, 7.025 (87,6%) delas na mesma faixa etária. Encontrou-se associação estatisticamente significativa entre as variáveis "idade da criança" e "tipo de usuário" em um ano, e entre "idade da criança" e "local da coleta" em ambos os anos. Conclusão: o acesso precoce ao exame oportuniza a triagem de doenças e o encaminhamento para tratamento. O estudo contribui com a gestão de programas de atenção à criança, ao apresentar estratégias que articulam informações e ações para melhoria do acesso à triagem neonatal biológica.
Resumo Objetivo: verificar factores asociados al acceso precoz del recién nacido al tamizaje neonatal biológico. Método: estudio transversal, cuantitativo, con todos los bebés examinados en unidades de salud, hospitales o laboratorios de un municipio del estado de São Paulo, Brasil; con programas integradores de información de atención de salud. Fueron investigadas las variables: edad del niño en la recolección (dependiente), lugar de recolección, fecha de recolección y tipo de usuario (dependientes). Se aplicó estadística descriptiva e inferencial. Resultados: existen registrados 15.652 triajes en los dos años estudiados. Durante el primero, ocurrieron 7.955 nacimientos y 7.640 (96,0%) análisis, 5.586 (73,1%) en recién nacidos de tres a cinco días de vida. Hubo 8.316 nacimientos en el año siguiente, se registraron 8.012 triajes, 7.025 (87,6%) para la misma faja etaria. Se encontró asociación estadísticamente significante entre las variables "edad del niño" y "tipo de usuario" en un año, y entre "edad del niño" y lugar de recolección" en ambos años. Conclusión: el acceso precoz al análisis permite el tamizaje de enfermedades y la derivación para tratamiento. El estudio contribuye a la gestión de programas de atención infantil, presentando estrategias que articulan información y acciones para mejorar el acceso al tamizaje neonatal biológico.
Assuntos
Humanos , Recém-Nascido , Fatores de Tempo , Brasil , Serviços de Saúde da Criança/estatística & dados numéricos , Triagem Neonatal , Diagnóstico Precoce , Acessibilidade aos Serviços de Saúde , Programas Nacionais de SaúdeRESUMO
OBJECTIVE: To evaluate early childhood development (ECD) and its determinants in 12 to 59 months old children residents of communities <100 000 inhabitants. MATERIALS AND METHODS: The Encuesta Nacional de Salud y Nutrición of communities <100 000 inhabitants (Ensanut 100k) evaluated language level, access to ECD care services and standardized indicators of the eight quality of the development environment. We report indicator prevalence and standardized language scores according to variables of interest. RESULTS: 20.7% of children attended eight wellchild care visits within the first year of life, 13.0% received an ECD assessment, 75.0% receive support for learning, 23.4% have books and 57.7% experiment violent discipline. Improved language levels are associate with socioeconomic capacities, maternal education, preschool attendance, support for learning and household books. Children exposed to more protective factors present a language level 1.5 standard deviations higher than their peers exposed to more risk factors. CONCLUSIONS: There is a need to increase the coverage of ECD care services and to improve early development opportunities within households.
OBJETIVO: Evaluar el desarrollo infantil temprano (DIT) y sus determinantes en niños/as de 12 a 59 meses residentes en localidades de menos de 100 000 habitantes. MATERIAL Y MÉTODOS: . La Encuesta Nacional de Salud y Nutrición en localidades con menos de 100 000 habitantes (Ensanut 100k) evaluó el nivel de lenguaje, acceso a servicios de atención al DIT e indicadores de calidad del contexto de desarrollo. Se estiman prevalencias de indicadores y puntajes estandarizados de lenguaje según variables de interés. RESULTADOS: 20.7% de los niños/as asistió a ocho consultas del niño sano en su primer año, 13.0% recibió evaluación de DIT, 75.0% recibe apoyo al aprendizaje, 23.4% cuenta con libros y 57.7% sufre disciplina violenta. Mejores niveles de lenguaje se asocian con las capacidades económicas, escolaridad materna, asistencia a preescolar, apoyo al aprendizaje y acceso a libros. Los niños/as expuestos a más factores protectores presentan nivel de lenguaje 1.5 DE mayor que en niños/as con más factores de riesgo. CONCLUSIONES: Se requiere aumentar la cobertura de atención al DIT y mejorar las oportunidades de desarrollo en hogares.
Assuntos
Desenvolvimento Infantil , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , MéxicoRESUMO
Resumen: Objetivo: Evaluar el desarrollo infantil temprano (DIT) y sus determinantes en niños/as de 12 a 59 meses residentes en localidades de menos de 100 000 habitantes. Material y métodos: La Encuesta Nacional de Salud y Nutrición en localidades con menos de 100 000 habitantes (Ensanut 100k) evaluó el nivel de lenguaje, acceso a servicios de atención al DIT e indicadores de calidad del contexto de desarrollo. Se estiman prevalencias de indicadores y puntajes estandarizados de lenguaje según variables de interés. Resultados: 20.7% de los niños/as asistió a ocho consultas del niño sano en su primer año, 13.0% recibió evaluación de DIT, 75.0% recibe apoyo al aprendizaje, 23.4% cuenta con libros y 57.7% sufre disciplina violenta. Mejores niveles de lenguaje se asocian con las capacidades económicas, escolaridad materna, asistencia a preescolar, apoyo al aprendizaje y acceso a libros. Los niños/as expuestos a más factores protectores presentan nivel de lenguaje 1.5 DE mayor que en niños/as con más factores de riesgo. Conclusión: Se requiere aumentar la cobertura de atención al DIT y mejorar las oportunidades de desarrollo en hogares.
Abstract: Objective: To evaluate early childhood development (ECD) and its determinants in 12 to 59 months old children residents of communities <100 000 inhabitants. Materials and methods: The Encuesta Nacional de Salud y Nutrición of communities <100 000 inhabitants (Ensanut 100k) evaluated language level, access to ECD care services and standardized indicators of the eight quality of the development environment. We report indicator prevalence and standardized language scores according to variables of interest. Results: 20.7% of children attended eight well-child care visits within the first year of life, 13.0% received an ECD assessment, 75.0% receive support for learning, 23.4% have books and 57.7% experiment violent discipline. Improved language levels are associate with socioeconomic capacities, maternal education, preschool attendance, support for learning and household books. Children exposed to more protective factors present a language level 1.5 standard deviations higher than their peers exposed to more risk factors. Conclusion: There is a need to increase the coverage of ECD care services and to improve early development opportunities within households.
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Desenvolvimento Infantil , Serviços de Saúde da Criança/estatística & dados numéricos , MéxicoRESUMO
OBJECTIVES: To analyze the health care network for at-risk infants in the western region of the city of São Paulo, with the primary health care as coordinator, and to compare the presence and extension of attributes of primary health care in the services provided, according to the service management model (Family Health Strategy and traditional basic health units). METHODS: A survey was conducted with all at-risk infants born in the western region of São Paulo between 2013 and 2014. The children were then actively searched for a later application of the PCATool - child version. The total of 233 children were located in the territory; 113 guardians agreed to participate, and 81 composed the final sample. RESULTS: Regarding the results of PCATool for overall and essential scores, the units with Family Health Strategy were better evaluated by users, when compared with traditional basic health units, showing a statistically significant difference. However, these scores were low for both management models. Regarding attributes, the Family Health Strategy presented better performance compared with traditional basic health units for most of them, except for coordination of information systems. Of ten assessed attributes, seven reached values ≥6.6 for Family Health Strategy and two for the traditional basic health unit. CONCLUSIONS: Regardless of the type of management model, low overall and essential scores were found, indicating that guardians of at-risk infants rated some attributes as unsatisfactory, with emphasis on accessibility, integrality and family guidance. Such a performance may have negative consequences for the quality and integrality of these infants' health care.
Assuntos
Serviços de Saúde da Criança/provisão & distribuição , Serviços de Saúde da Criança/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Brasil , Estudos Transversais , Saúde da Família , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/organização & administração , Garantia da Qualidade dos Cuidados de Saúde , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To analyze the distribution of patient-centered medical homes (PCMHs) among US adolescents, and to examine whether disparities exist among subgroups. STUDY DESIGN: Data on adolescents ages 12-17 years (n = 34â601) from the 2011-2012 National Survey of Children's Health were used in this cross-sectional study to determine what proportion had access to a PCMH. Multivariable logistic regression was used to calculate the odds of having a PCMH, adjusting for sociodemographic characteristics and special health care needs. Comparisons were made to distribution of PCMH in 2007. RESULTS: Although most US adolescents had a usual source of care (91%), only about one-half (51%) had access to a PCMH. Disparities in the prevalence of PCMHs were seen by race/ethnicity, poverty, and having special health care needs. There were lower adjusted odds in having a PCMH for Hispanic (aOR, 0.56; 95% CI, 0.45-0.68) and black adolescents (aOR, 0.55; 95% CI, 0.46-0.66) compared with white adolescents. Those living below 4 times the poverty level had lower adjusted odds of PCMH access. Adolescents with 3-5 special health care needs had lower adjusted odds (aOR, 0.43; 95% CI, 0.35-0.52) of having a PCMH compared with adolescents without any special health care needs. Other than receiving family centered care, every component of PCMH was slightly lower in 2011-2012 compared with 2007. CONCLUSIONS: PCMH access was lower among minorities, those living in poverty, and those with multiple special health care needs. These disparities in PCMH access among these typically underserved groups call for further study and interventions that would make PCMHs more accessible to all adolescents.
Assuntos
Medicina do Adolescente/organização & administração , Acessibilidade aos Serviços de Saúde , Assistência Centrada no Paciente/organização & administração , Adolescente , Negro ou Afro-Americano , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Estudos Transversais , Feminino , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Hispânico ou Latino , Humanos , Masculino , Análise Multivariada , Razão de Chances , Pobreza , Prevalência , Atenção Primária à Saúde/estatística & dados numéricos , Análise de Regressão , Classe Social , Estados UnidosRESUMO
BACKGROUND: Technological advances in health care currently provide better care conditions and have increased survival rates of premature infants, along with increasing the life expectancy of chronically ill children. In this context, the home care service has emerged as an effective tool for the treatment of this group of children. Thus, this preliminary study aimed at evaluating the effectiveness of the Home Care Service (HCS) with regard to pediatric care. METHODS: A cross-sectional study was performed through a medical record analysis of a tertiary hospital in Minas Gerais/Brazil. Two groups were compared: 36 patients from the HCS (home group) and 13 patients hospitalized with an indication for home care (hospital group). To analyze the effectiveness of HCS, we evaluated the number of readmissions, infection rate, number of procedures, and optimization of beds. RESULTS: The hospital group presented 6.04 times more infections and was submitted to 6.43 times more procedures. The home group presented lower readmission rates; with 41.66% of children studied not being readmitted and 76.19% of those who needed readmissions did so after more than 30 days from hospital discharge. HCS optimized hospital beds and allowed, over five (5) years, the hospitalization of around 102 patients in the hospital studied. CONCLUSION: In this preliminary study, HCS reduced the number of procedures and infections compared to hospitalized patients. Moreover, HCS presented lower readmission rates and optimized hospital beds, which could be considered an indication of effectiveness.
Assuntos
Serviços de Assistência Domiciliar/normas , Hospitalização/estatística & dados numéricos , Infecções/terapia , Brasil/epidemiologia , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Doença Crônica , Estudos Transversais , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Humanos , Lactente , Infecções/epidemiologia , Masculino , Alta do Paciente/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricosRESUMO
OBJECTIVE: To investigate the influence of maternal depression on child health-care services utilization. METHODOLOGY: Data from The Pelotas 2004 Birth Cohort collected at birth and at 12- and 24-month follow-ups were used. Four outcomes occurring in the second year of life were investigated: number of well-baby visits, number of medical appointments, number of visits to emergency rooms, and number of hospitalizations. The main exposure was maternal depression symptoms at 12-month post-partum as assessed by the Edinburgh Postpartum Depression Scale (EPDS). Adjusted prevalence ratios (PR) with 95% confidence intervals (95% CI) were calculated by Poisson regression. RESULTS: The prevalence of mothers with depressive symptoms was 27.6% (95% CI: 26.2-29.0%). These mothers showed a 10% lower probability of taking their children to well-baby visits (0.90; 0.85-0.95; pâ¯=â¯0.001); 16% higher probability to seek medical consultations (1.16; 1.09-1.25, pâ¯=â¯0.001); and they sought emergency services for their children more often (1.30; 1.17-1.45, p < 0.001) as compared to mothers who did not present depressive symptoms. Although the PR for hospitalizations was 26% higher for children from mothers with depressive symptoms, the association did not achieve statistical significance (1.26; 0.98-1.63; pâ¯=â¯0.072). CONCLUSION: Children from mothers with depressive symptoms attend fewer number of preventive consultations. In contrast, they are taken to medical and emergency care more often, suggesting that these children are given healthcare when they are at more advanced stages of their illnesses.
Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Depressão Pós-Parto , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Brasil/epidemiologia , Pré-Escolar , Fatores de Confusão Epidemiológicos , Depressão Pós-Parto/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Cuidado do Lactente/estatística & dados numéricos , Masculino , Prevalência , Escalas de Graduação Psiquiátrica , Adulto JovemRESUMO
The scope of this study was to establish the influence of the Family Healthcare Strategy (FHS) in the use of health services for Brazilian children under 5 years of age interviewed in the 2013 National Health Survey (NHS). The Propensity Score Matching (PSM) method was used to correct the lack of comparability between the groups of children under scrutiny. The PSM was estimated by logistic regression and reflects the conditional probability of receiving registration in the FHS given a set of covariates that depict the socioeconomic, demographic, sanitary and health aspects of children and families who comprise same. The prevalence of medical visits and hospitalizations were estimated and incorporate the effects of the complex sample of NHS on all phases of analysis. It was found that children living in households with FHS coverage have worse socioeconomic, sanitary and health conditions, although they had options of medical appointments and hospitalizations close to the children without this healthcare link. The data suggest that the FHS can correct individual and contextual inequalities that impact the health of Brazilians by promoting the use of health services for children even when they have worse living and health conditions.
Este estudo verificou a influência da Estratégia Saúde da Família (ESF) no uso de serviços de saúde por crianças brasileiras menores de 5 anos de idade entrevistadas na Pesquisa Nacional de Saúde (PNS) 2013. Utilizou-se o método de Escore de Propensão (EP) para corrigir a falta de comparabilidade entre os grupos de crianças em estudo. O EP foi estimado por meio de regressão logística e reflete a probabilidade condicional de receber o cadastro na ESF dado um conjunto de covariáveis que retratam aspectos socioeconômicos, demográficos, sanitários e de saúde das crianças e das famílias que estes compõem. Foram estimadas as prevalências de consultas médicas e de internações hospitalares e incorporaram-se os efeitos da amostragem complexa da PNS em todas as fases da análise. Verificou-se que as crianças residentes de domicílios com cobertura da ESF têm piores condições socioeconômicas, sanitárias e de saúde, porém elas tiveram estimativas de consultas médicas e de internações hospitalares próximas a de crianças sem esse vínculo assistencial. Os dados sugerem que ESF pode corrigir desigualdades individuais e contextuais que impactam a saúde dos brasileiros ao favorecer o uso de serviços de saúde por crianças mesmo quando possuem piores condições de vida e saúde.
Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Atenção à Saúde/estatística & dados numéricos , Saúde da Família , Programas Nacionais de Saúde/estatística & dados numéricos , Brasil , Serviços de Saúde da Criança/organização & administração , Pré-Escolar , Estudos Transversais , Atenção à Saúde/organização & administração , Feminino , Inquéritos Epidemiológicos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Programas Nacionais de Saúde/organização & administração , Pontuação de Propensão , Fatores SocioeconômicosRESUMO
OBJECTIVES: To determine rates of at least 1 high-risk infant follow-up (HRIF) visit by 12 months corrected age, and factors associated with successful first visit among very low birth weight (VLBW) infants in a statewide population-based setting. STUDY DESIGN: We used the linked California Perinatal Quality of Care Collaborative and California Perinatal Quality of Care Collaborative-California Children's Services HRIF databases. Multivariable logistic regression examined independent associations of maternal, sociodemographic, neonatal clinical, and HRIF program factors with a successful first HRIF visit among VLBW infants born in 2010-2011. RESULTS: Among 6512 VLBW children referred to HRIF, 4938 (76%) attended a first visit. Higher odds for first HRIF visit attendance was associated with older maternal age (OR, 1.48; 95% CI, 1.27-1.72; 30-39 vs 20-29 years), lower birth weight (OR, 2.11; 95% CI, 1.69-2.65; ≤750 g vs 1251-1499 g), private insurance (OR, 1.65; 95% CI, 1.19-2.31), a history of severe intracranial hemorrhage (OR, 1.61; 95% CI, 1.12-2.30), 2 parents as primary caregivers (OR, 1.18, 95% CI 1.03-1.36), and higher HRIF program volume (OR, 2.62; 95% CI, 1.88-3.66; second vs lowest quartile); and lower odds with maternal race African American or black (OR, 0.65; 95% CI, 0.54-0.78), and greater distance to HRIF program (OR, 0.69; 95% CI, 0.57-0.83). Rates varied substantially across HRIF programs, which remained after risk adjustment. CONCLUSIONS: In a population-based California VLBW cohort, maternal, sociodemographic, and home- and program-level disparities were associated with HRIF non-attendance. These findings underscore the need to identify challenges in access and resource risk factors during hospitalization in the neonatal intensive care unit, provide enhanced education about the benefits of HRIF, and create comprehensive neonatal intensive care unit-to-home transition approaches.