RESUMEN
El Comité de Infecciones en Inmunocomprometidos de la Sociedad Chilena de Infectología presenta aquí una actualización en el Manejo de episodios de neutropenia febril en adultos y niños con cáncer, derivado de los grandes cambios ocurridos en los últimos años en el enfrentamiento de estos pacientes. Para estos efectos, un grupo multidisciplinario desarrolló recomendaciones en relación a: su enfrentamiento inicial, exámenes de laboratorio requeridos, el tratamiento antimicrobiano inicial empírico y frente a focos infecciosos conocidos, las infecciones fúngicas invasoras y profilaxis antimicrobiana.
The Committee of Infections in Immunocompromised Patients of the Chilean Society of Infectious Diseases presents an update in the Management of febrile neutropenia in adults and children with cancer. It comes from the significant changes that occurred in recent years in the confrontation of these patients. For which a multidisciplinary task force group developed recommendations in relation to their initial handling, laboratory exams required, the initial empirical antimicrobial treatment and in front of known infectious focus, invasive fungal infections and antimicrobial prophylaxis.
Asunto(s)
Humanos , Niño , Adulto , Consenso , Neutropenia Febril/diagnóstico , Neutropenia Febril/tratamiento farmacológico , Neoplasias/complicaciones , Neutropenia Febril/etiología , Antiinfecciosos/uso terapéuticoRESUMEN
Los pacientes inmunosuprimidos presentan un riesgo mayor de infecciones, debido a sus disfunciones inmunes, producto de la actividad de su enfermedad y la terapia inmunosupresora. El uso de vacunas disminuye este riesgo, otorgando protección directa e indirecta, a través de la vacunación del paciente y sus contactos. Las vacunas inactivadas han demostrado un perfil de seguridad adecuado en estos pacientes, por lo que no están contraindicadas, aunque su respuesta inmune puede ser inadecuada. Las vacunas vivas atenuadas, formalmente contraindicadas, poseen una información creciente que permite evaluar su riesgo/beneficio de manera individual. Por este motivo es necesario procurar mantener el calendario de vacunas actualizado y complementado, evitando el retraso en esquemas de vacunación y poniéndolo al día lo antes posible, con estrategias basadas en el individuo. Para llevar a cabo esto, se debe conocer y considerar los intervalos entre las vacunas, los esquemas acelerados, la solicitud de vacunas especiales, las aprobaciones vigentes y, finalmente, sus contraindicaciones.
Immunecompromised patients are at higher risk of infections due to their immune dysfunction caused by ongoing disease processes and immunosuppressive therapy. Patient vaccination or vaccination of the people in contact with patients diminishes their risk of infection. Although the immune response of immunocompromised patients might be impaired, the use of inactivated vaccines is safe and it is not contraindicated in these patients. Formerly, live attenuated vaccines were contraindicated in immunecompromised patients, but recently more data supports their use when evaluating case by case the risks and benefits of their application. Thus, it is important to keep and up-to-date, taylor-based and enhanced vaccination schedule in these cases. For this, specialists need to be informed about the availability of regular and special vaccines, their current approvals, vaccine administration protocols under specific situations and vaccine contraindications.
Asunto(s)
Humanos , Vacunas/administración & dosificación , Control de Enfermedades Transmisibles/métodos , Terapia de Inmunosupresión , Huésped Inmunocomprometido , Vacunas Atenuadas/administración & dosificación , Vacunas de Productos Inactivados/administración & dosificación , Esquemas de Inmunización , Vacunas Vivas no Atenuadas/administración & dosificaciónRESUMEN
BACKGROUND: Coinfections of HIV patients with hepatitis B virus (HBV) and hepatitis C virus (HCV) are mayor public health problems, contributing to the emerging burden of HIV-associated hepatic mortality. Coinfection rates vary geographically, depending on various factors such as predominant transmission modes, HBV vaccination rates, and prevalence of HBV and HCV in the general population. In South America, the epidemiology of coinfections is uncertain, since systematic studies are scarce. Our study aimed to analyze rates of HBV and HCV infection in people living with HIV attending centers of the public and private health system in Chile. METHODS: We performed a cross-sectional study including a public university hospital and a private health center in Santiago, Metropolitan Region in Chile. Serum samples were used to determine serological markers of hepatitis B (HBsAg, anti-HBs, anti-HBc total, HBeAg, anti-HBe) and anti-HCV. Demographic, clinical and laboratory data were obtained from medical records. RESULTS: 399 patients were included (353 from public, 46 from private health center). Most (92.8%) were male, with a median age of 38.3 years; 99.4% acquired HIV through sexual contact (75.0% MSM); 25.7% had AIDS and 90.4% were on ART. In 78.9%, viral loads were <40 cps/mL; the median CD4 cell count was 468 cells/mm3. According to their serological status, 37.6% of patients were HBV naïve (susceptible), 6.5% were vaccinated, 43.6% had resolved HBV infection, and 5.8% were chronically infected. The rate of vaccination was 4.5% in the public and 21.7% in the private system. HCV coinfection was found in 1.0% of all patients. CONCLUSION: HBV coinfection rate was within the range of other South American countries, but lower than in non-industrialized regions in Asia and Africa. A low percentage of patients were HBV vaccinated, especially within the public system. HCV coinfection rate was very low, most probably due to the rareness of injecting drug use.
Asunto(s)
Infecciones por VIH/complicaciones , Hepatitis B/complicaciones , Hepatitis C/complicaciones , Adulto , Chile/epidemiología , Coinfección/sangre , Coinfección/complicaciones , Coinfección/epidemiología , Estudios Transversales , Femenino , VIH/aislamiento & purificación , Infecciones por VIH/sangre , Infecciones por VIH/epidemiología , Hepacivirus/aislamiento & purificación , Hepatitis B/sangre , Hepatitis B/epidemiología , Virus de la Hepatitis B/aislamiento & purificación , Hepatitis C/sangre , Hepatitis C/epidemiología , Hospitales Privados , Hospitales Públicos , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Adulto JovenRESUMEN
The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of 2 manuscripts. This second part is a guideline that details these recommendations through screening strategies, prophylactic therapies and vaccines indications for bacterial, mycobacterial, viral, fungal and parasitic infections, both for adults and children.
Asunto(s)
Terapia Biológica/efectos adversos , Enfermedades Transmisibles/inducido químicamente , Consenso , Emigrantes e Inmigrantes , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Complicaciones Infecciosas del Embarazo/inducido químicamente , Chile , Femenino , Hepatitis B/inducido químicamente , Hepatitis B/prevención & control , Humanos , Tamizaje Masivo , Guías de Práctica Clínica como Asunto , Embarazo , Complicaciones Infecciosas del Embarazo/prevención & control , Medición de Riesgo , Factores de RiesgoRESUMEN
Resumen La incorporación de terapias biológicas ha significado un gran avance en el manejo de diversas patologías de origen autoinmune, neoplásico u otros. Si bien su uso ha implicado mejoras significativas en el pronóstico de estas enfermedades, no está exento de complicaciones, entre éstas, las infecciosas. El objetivo de este consenso fue evaluar el perfil de seguridad, desde la mirada infectológica, de las terapias biológicas de uso más frecuente y dar recomendaciones para la prevención de infecciones en pacientes tratados con ellas, basándose en la evidencia de mayor calidad disponible para los biológicos seleccionados. El consenso cuenta de dos manuscritos. Esta segunda parte corresponde a la guía clínica que detalla estas recomendaciones mediante estrategias de cribado, terapias profilácticas e indicación de vacunas, según corresponde, para infecciones bacterianas, y por micobacterias en particular, virus, hongos y parásitos, tanto para adultos como para niños.
The use of biological therapies has meant a great improvement in the management of several conditions like autoimmune, neoplastic or others diseases. Although its use has implied significant improvements in the prognosis of these diseases, it is not exempt from complications: infectious diseases as one of them. The objective of this consensus was to evaluate, from an infectious viewpoint, the safeness of the most frequently used biological therapies and give recommendations for the prevention of infections in patients treated with these drugs. These recommendations were based on the highest quality evidence available for the selected biologics. The consensus counts of 2 manuscripts. This second part is a guideline that details these recommendations through screening strategies, prophylactic therapies and vaccines indications for bacterial, mycobacterial, viral, fungal and parasitic infections, both for adults and children.
Asunto(s)
Humanos , Femenino , Embarazo , Complicaciones Infecciosas del Embarazo/inducido químicamente , Terapia Biológica/efectos adversos , Enfermedades Transmisibles/inducido químicamente , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Consenso , Emigrantes e Inmigrantes , Complicaciones Infecciosas del Embarazo/prevención & control , Chile , Tamizaje Masivo , Factores de Riesgo , Guías de Práctica Clínica como Asunto , Medición de Riesgo , Hepatitis B/inducido químicamente , Hepatitis B/prevención & controlRESUMEN
INTRODUCTION: Antenatal magnesium sulphate (MgSO4) administration has shown to be effective in minimising cerebral palsy and severe motor dysfunction at the age of 2 years. The aim of this study is to analyse the initial clinical outcome of preterm neonates less than 29 weeks who have received prenatal MgSO4, as well as to determine the relationship between the magnesium dose delivered to the mother and the magnesium concentration in the neonates. MATERIAL AND METHODS: A prospective cohort study was conducted on neonates of less than 29 weeks gestation admitted to the Neonatal Intensive Care Unit (NICU) of Hospital Universitario de Vigo from December 2012 to July 2015. Comparative analysis was performed on the perinatal outcomes, neonatal morbidity, mortality, and magnesium levels between the groups of neonates exposed to magnesium sulphate and the control group. RESULTS: A total of 42 neonates were included in the study. The mothers of 28 of them had received MgSO4 as a neuroprotective agent. Statistical significance was obtained in the mortality variable. There were no significant differences in the rest of studied variables. There was a significant correlation between the full dose of MgSO4 received by the mother and the levels of magnesium in the neonate in the first 24hours of life (r2 0.436; P<.001). CONCLUSIONS: A lower mortality was observed in the group that had been exposed to MgS04. No significant side effects were found as a result of administering of MgS04. The MgS04 dose received by mother has a linear relationship with the magnesium levels obtained in neonates.
Asunto(s)
Sulfato de Magnesio/uso terapéutico , Magnesio/sangre , Fármacos Neuroprotectores/uso terapéutico , Atención Prenatal , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Embarazo , Estudios Prospectivos , Resultado del TratamientoRESUMEN
Mutations in the dihydropteroate synthase (DHPS) gene of Pneumocystis jirovecii are associated with the failure of sulfa prophylaxis. They can develop by selection in patients receiving sulfa drugs or be acquired via person-to-person transmission. DHPS mutations raise concern about the decreasing efficacy of sulfa drugs, the main available therapeutic tool for Pneumocystis pneumonia (PCP). The prevalence of Pneumocystis DHPS mutations was examined in Pneumocystis isolates from 56 sulfa-prophylaxis-naive adults with a first episode of PCP from 2002 to 2010 in Santiago, Chile. Their clinical history was reviewed to analyze the effect of these mutations on response to trimethoprim-sulfamethoxazole (TMP-SMX) therapy and outcome. Mutant genotypes occurred in 22 (48%) of 46 HIV-infected patients and in 5 (50%) of 10 HIV-uninfected patients. Compared to patients with a wild-type genotype, those with mutant genotypes were more likely to experience sulfa treatment-limiting adverse reactions and to have a twice-longer duration of mechanical ventilation if mechanically ventilated. Specific genotypes did not associate with death, which occurred in none of the HIV-infected patients and in 50% of the non-HIV-infected patients. Chile has a high prevalence of DHPS mutations, which were presumably acquired through interhuman transmission because patients were not on sulfa prophylaxis. These results contrast with the low prevalence observed in other Latin American countries with similar usage of sulfa drugs, suggesting that additional sources of resistant genotypes may be possible. The twice-longer duration of mechanical ventilation in patients with mutant DHPS genotypes suggests a decreased efficacy of TMP-SMX and warrants collaborative studies to assess the relevance of DHPS mutations and further research to increase therapeutic options for PCP.
Asunto(s)
Dihidropteroato Sintasa/genética , Mutación , Pneumocystis carinii/genética , Neumonía por Pneumocystis/tratamiento farmacológico , Combinación Trimetoprim y Sulfametoxazol/farmacología , Infecciones Oportunistas Relacionadas con el SIDA/tratamiento farmacológico , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Caspofungina , Chile/epidemiología , Dapsona/uso terapéutico , Equinocandinas/uso terapéutico , Femenino , Humanos , Lipopéptidos/uso terapéutico , Masculino , Persona de Mediana Edad , Pneumocystis carinii/efectos de los fármacos , Neumonía por Pneumocystis/epidemiología , Neumonía por Pneumocystis/microbiología , Resultado del Tratamiento , Combinación Trimetoprim y Sulfametoxazol/uso terapéuticoRESUMEN
Fructosamine is an alternative method to hemoglobin A1c (HbA1c) for determining average glycemia. However, its use has not been extensively evaluated in persons living with HIV (PLWH). We examined the relationship between HbA1c and fructosamine values, specifically focusing on anemia (which can affect HbA1c) and albumin as a marker of liver disease. We included 345 PLWH from two sites. We examined Spearman rank correlations between fructosamine and HbA1c and performed linear test for trends to compare fructosamine and HbA1c correlations by hemoglobin and albumin quartiles. We examined discrepant individuals with values elevated only on one test. We found a correlation of 0.70 between fructosamine and HbA1c levels. Trend tests for correlations between fructosamine and HbA1c were significant for both albumin (p = 0.05) and hemoglobin (p = 0.01) with the lowest correlations in the lowest hemoglobin quartile. We identified participants with unremarkable HbA1c values but elevated fructosamine values. These discrepant individuals had lower mean hemoglobin levels than those elevated by both tests. We demonstrated a large correlation between HbA1c and fructosamine across a range of hemoglobin and albumin levels. There were discrepant cases particularly among those with lower hemoglobin levels. Future studies are needed to clarify the use of fructosamine for diabetes management in PWLH.
RESUMEN
N. meningitidis serogroup W has recently been introduced into Chile. This serogroup has been associated with hypervirulent strains capable of causing outbreaks. Furthermore, there is data suggesting that the spectrum of clinical manifestations varies among different serogroups. Here we describe three cases of community acquired respiratory infections caused by N. meningitidis W, which were diagnosed by blood culture during 2013 in our hospital.
Asunto(s)
Bacteriemia/microbiología , Infecciones Meningocócicas/microbiología , Neisseria meningitidis Serogrupo W-135/aislamiento & purificación , Infecciones del Sistema Respiratorio/microbiología , Adolescente , Anciano , Anciano de 80 o más Años , Chile , Humanos , MasculinoRESUMEN
AIM: To optimize diagnosis and treatment guidelines for this geographic region, a panel of gastroenterologists, epidemiologists, and basic scientists carried out a structured evaluation of available literature. METHODS: Relevant questions were distributed among the experts, who generated draft statements for consideration by the entire panel. A modified three-round Delphi technique method was used to reach consensus. Critical input was also obtained from representatives of the concerned medical community. The quality of the evidence and level of recommendation supporting each statement was graded according to United States Preventive Services Task Force criteria. RESULTS: A group of ten experts was established. The survey included 15 open-ended questions that were distributed among the experts, who assessed the articles associated with each question. The levels of agreement achieved by the panel were 50% in the first round, 73.3% in the second round and 100% in the third round. Main consensus recommendations included: (1) when available, urea breath and stool antigen test (HpSA) should be used for non-invasive diagnosis; (2) detect and eradicate Helicobacter pylori (H. pylori) in all gastroscopy patients to decrease risk of peptic ulcer disease, prevent o retard progression in patients with preneoplastic lesions, and to prevent recurrence in patients treated for gastric cancer; (3) further investigate implementation issues and health outcomes of H. pylori eradication for primary prevention of gastric cancer in high-risk populations; (4) prescribe standard 14-d triple therapy or sequential therapy for first-line treatment; (5) routinely assess eradication success post-treatment in clinical settings; and (6) select second- and third-line therapies according to antibiotic susceptibility testing. CONCLUSION: These achievable steps toward better region-specific management can be expected to improve clinical health outcomes.
Asunto(s)
Antibacterianos/uso terapéutico , Técnica Delphi , Infecciones por Helicobacter/tratamiento farmacológico , Helicobacter pylori/efectos de los fármacos , Inhibidores de la Bomba de Protones/uso terapéutico , Técnicas Bacteriológicas , Consenso , Progresión de la Enfermedad , Farmacorresistencia Bacteriana , Quimioterapia Combinada , Infecciones por Helicobacter/diagnóstico , Infecciones por Helicobacter/epidemiología , Infecciones por Helicobacter/microbiología , Helicobacter pylori/aislamiento & purificación , Humanos , América Latina/epidemiología , Úlcera Péptica/epidemiología , Úlcera Péptica/microbiología , Úlcera Péptica/prevención & control , Guías de Práctica Clínica como Asunto , Lesiones Precancerosas/tratamiento farmacológico , Lesiones Precancerosas/epidemiología , Lesiones Precancerosas/microbiología , Valor Predictivo de las Pruebas , Recurrencia , Neoplasias Gástricas/epidemiología , Neoplasias Gástricas/microbiología , Neoplasias Gástricas/prevención & control , Factores de Tiempo , Resultado del TratamientoRESUMEN
There is great interest in the potential of the human endocrine pancreas for regeneration by ß-cell replication or neogenesis. Our aim was to explore this potential in adult human pancreases and in both islet and exocrine tissue transplanted into mice. The design was to examine pancreases obtained from cadaver donors, autopsies, and fresh surgical specimens and compare these findings with those obtained from islet and duct tissue grafted into the kidney. Islets and exocrine tissue were transplanted into normoglycemic ICR-SCID mice and studied 4 and 14 weeks later. ß-Cell replication, as assessed by double staining for insulin and Ki67, was 0.22 ± 0.03% at 4 weeks and 0.13 ± 0.03% at 14 weeks. In contrast, no evidence of ß-cell replication could be found in 11 cadaver donor and 10 autopsy pancreases. However, Ki67 staining of ß-cells in frozen sections obtained at surgery was comparable to that found in transplanted islets. Evidence for neogenesis in transplanted pancreatic exocrine tissue was supported by finding ß-cells within the duct epithelium and the presence of cells double stained for insulin and cytokeratin 19 (CK19). However, ß-cells within the ducts never constituted more than 1% of the CK19-positive cells. With confocal microscopy, 7 of 12 examined cells expressed both markers, consistent with a neogeneic process. Mice with grafts containing islet or exocrine tissue were treated with various combinations of exendin-4, gastrin, and epidermal growth factor; none increased ß-cell replication or stimulated neogenesis. In summary, human ß-cells replicate at a low level in islets transplanted into mice and in surgical pancreatic frozen sections, but rarely in cadaver donor or autopsy pancreases. The absence of ß-cell replication in many adult cadaver or autopsy pancreases could, in part, be an artifact of the postmortem state. Thus, it appears that adult human ß-cells maintain a low level of turnover through replication and neogenesis.
Asunto(s)
Autopsia , Cadáver , Células Secretoras de Insulina/citología , Trasplante de Islotes Pancreáticos , Animales , Factor de Crecimiento Epidérmico/metabolismo , Exenatida , Gastrinas/metabolismo , Humanos , Células Secretoras de Insulina/metabolismo , Ratones , Péptidos/metabolismo , Ponzoñas/metabolismoRESUMEN
Clostridium tertium is rare in a human clinical specimen and its pathogenicity is often uncertain. However, the organism has been increasingly recognized as a cause of bacteremia and other infections in immunocompromised patients, especially those with hematologic malignancies. The diagnosis and treatment of C. tertium are difficult due to its growth pattern, micromorphology, and antibiotic resistance. The organism can easily be misidentified as Gram-positive aerobic rods such as Bacillus species, usually considered as a contaminant. Furthermore, it is not covered by empirical treatment with many broad-spectrum antibiotics. Here we report a case of breakthrough bacteremia due to C. tertium that occurred in a patient with acute leukemia and neutropenic fever, who was treated with an empirical regimen of ceftazidime and amikacin. The bacterium was rapidly identified by new mass spectrometry technology (MALDI-TOF MS) and the patient recovered under meropenem and vancomycin treatment, without complications.
Asunto(s)
Bacteriemia/complicaciones , Infecciones por Clostridium/complicaciones , Clostridium tertium , Neutropenia Febril/etiología , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Bacteriemia/diagnóstico , Bacteriemia/tratamiento farmacológico , Infecciones por Clostridium/diagnóstico , Infecciones por Clostridium/tratamiento farmacológico , Neutropenia Febril/diagnóstico , Neutropenia Febril/tratamiento farmacológico , Femenino , Humanos , Persona de Mediana Edad , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicaciones , Leucemia-Linfoma Linfoblástico de Células Precursoras/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamiento farmacológico , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Resultado del TratamientoAsunto(s)
Masculino , Femenino , Adolescente , Adulto , Persona de Mediana Edad , Humanos , Líquido Cefalorraquídeo , Drenaje/métodos , Encefalopatías/cirugía , Fístula , Bombas de Infusión , Succión/métodos , Succión , Chile , Hidrocéfalo Normotenso/diagnóstico , Hidrocéfalo Normotenso/líquido cefalorraquídeoRESUMEN
Evaluar en el Servicio de Otorrinolaringología del Hospital Clínico de la Universidad de Chile HCUCH, si junto con el aumento en las cirugías durante los últimos años, disminuyeron las de mayor complejidad, afectando la calidad docente. Y determinar si existieron cambios epidemiológicos en el tipo de procedimientos, y si la cantidad de éstos, es suficiente para capacitar a los alumnos de postgrado. Se analizaron los años 1990, 1999 y 2003 para el total y el detalle de las intervenciones quirúrgicas, y las consultas. Se clasificaron las operaciones según complejidad 1999 y 2003. Para evaluar el número mínimo de procedimientos necesarios para cumplir los objetivos terminales del programa se compararon los datos del HCUCH, con datos nacionales e internacionales. Aumentaron 53 por ciento las consultas y 148 por ciento las cirugías 1990-2003. Esto no significó disminuir proporcionalmente la cantidad de cirugías de mediana y mayor complejidad. Han disminuido cirugías, han aumentado y aparecido nuevas técnicas quirúrgicas. El número de procedimientos realizados por los residentes está sobre los requerimientos mínimos encontrados.
Asunto(s)
Humanos , Competencia Clínica , Educación Basada en Competencias , Educación de Postgrado , Otolaringología/tendencias , Procedimientos Quirúrgicos Otorrinolaringológicos/tendencias , ChileRESUMEN
El presente documento es el resultado de la experiencia de Ipas-Bolivia, en la busqueda de promover una atencion integral a las victimas y sobrevivientes de violencia sexual, se identifico que la violencia sexual esta invisibilizada, constituyendose en uno de los flagelos mas denigrantes y perversos que puede suceder a una mujer cuyas secuelas fisicas y psicologicas pueden ser irreversibles si es que no parece en el interin.(au)
Asunto(s)
Humanos , Masculino , Femenino , Violencia , Acoso Sexual , Sobrevivientes , Víctimas de Crimen , Bolivia , Atención Integral de SaludRESUMEN
El objetivo del estudio es identificar, analizar y realizar una sistematización de experiencias de Educación Para la Sexualidad - EPS- que servirá como insumo para los actores que trabajan en la temática. Se planteó tres estrategias para el estudio: identificación de experiencias, sistematización y finalmente, la socialización de los resultados, en la perspectiva de delinear estrategias de intervención con base en los resultados de estudio.
RESUMEN
Este estudio tiene como objetivo identificar, analizar y realizar una sistematización de experiencias de Educación Para la Sexualidad - EPS- que servirá como insumo para los actores que trabajan en la temática así como estimular la coordinación interagencial e interinstitucional, entre organizaciones no gubernamentales - ONG's - y agencias e instituciones que trabajan en la materia...
Asunto(s)
Humanos , Educación Sexual , Educación de la Población , Salud del AdolescenteRESUMEN
El contenido del informe, intenta dar una visión de los referentes conceptuales en cuanto a políticas de salud que influyeron en el desarrollo del trabajo del equipo de la Consultoría y las actividades planteadas para la consecución de los objetivos. El programa integrado de servicios básicos y fortalecimiento institucional del sector P.S.F. es un Programa especial de la Secretaría Nacional de Salud. Conformado por cuatro componentes: Fortalecimiento de los programas de salud prioritarios de la secretaría nacional de salud. Fortalecimiento institucional. Fortalecimietno de la red de servicios. Componente de estudios