Prematurity and functional gastrointestinal disorders in infancy: a cross-sectional study

ABSTRACT BACKGROUND: Functional gastrointestinal disorders (FGIDs) are defined as a variable combination of chronic or recurrent gastrointestinal symptoms that are not explained by structural or biochemical abnormalities. Their relationship with prematurity has been increasingly studied. OBJECTIVE: To compare the frequency of FGIDs in preterm and term infants and to evaluate whether invasive procedures during the neonatal period in preterm infants are associated with greater likelihood of FGIDs in the first two years of life. DESIGN AND SETTING: Controlled nested cross-sectional study conducted in a Brazilian university hospital. METHODS: This was a controlled nested cross-sectional study on a retrospective cohort of infants born preterm who were compared with infants born at term regarding the presence of FGIDs. Medical consultations were conducted by a single pediatric gastroenterologist to obtain information on the gestational and neonatal periods and on clinical manifestations of the digestive tract. The Rome IV criteria for the diagnosis of FGIDs were used. RESULTS: A total of 197 infants (< 24 months), including 99 preterm and 98 term infants, were studied. Infant regurgitation was more prevalent in term infants (35.1% and 15.6%; P < 0.001). The frequencies of other FGIDs (infant colic, functional constipation, functional diarrhea and infant dyschezia) in preterm infants did not differ from those of term infants (P > 0.05). No relationship was found between invasive procedures during the neonatal period and development of FGIDs in preterm infants. CONCLUSION: Infants born preterm did not have higher frequency of FGIDs in the first two years of life.

Determinantes sociais de saúde e autoeficácia de mães/cuidadores para prevenção da diarreia / Determinantes sociales de salud y autoeficacia de madres/cuidadores para prevención de diarrea / Social determinants of health and self-efficacy of mothers/caregivers for preventing diarrhea

Resumo Objetivo Verificar associação entre os determinantes sociais de saúde e os níveis de autoeficácia de mães ou cuidadores para prevenção da diarreia infantil. Métodos Estudo transversal realizado com 363 mães ou cuidadores de crianças menores de cinco anos, acompanhadas em unidade de Atenção Primária à Saúde. Para coleta de dados, utilizaram-se o formulário de caracterização sociodemográfica e a Escala de Autoeficácia Materna para Prevenção da Diarreia Infantil. Realizou-se o teste Qui-Quadrado e como medida de associação a razão de chances. Resultados Verificou-se que mães ou cuidadores com idades de 15 a 29 anos tiveram 1,6 vezes mais chances de apresentarem autoeficácia moderada, com significância estatística para o determinante individual "faixa etária" (p=0,017). Os participantes com determinantes intermediários "destino do lixo" e "origem da água do domicílio" inadequados tiveram, respectivamente, 3,5 e 2,8 vezes mais chances de apresentarem autoeficácia moderada. Conclusão O Determinante Social de Saúde "faixa etária" aumenta a chance de mães ou cuidadores apresentarem autoeficácia moderada para prevenção da diarreia infantil. Portanto, cabe aos enfermeiros uma maior ênfase em orientar as mães ou cuidadores, principalmente os mais jovens sobre a prevenção da diarreia e realizar ações educativas que visem aumentar a autoeficácia destes.

Resumen Objetivo Verificar la relación entre los determinantes sociales de salud y los niveles de autoeficacia de madres o cuidadores para la prevención de diarrea infantil. Métodos Estudio transversal realizado con 363 madres o cuidadores de niños menores de cinco años, atendidas en una unidad de Atención Primaria de Salud. Para la recopilación de datos se utilizó el formulario de caracterización sociodemográfica y la Escala de Autoeficacia Materna para la Prevención de la Diarrea Infantil. Se realizó la prueba χ2 de Pearson y, como medida de asociación, la razón de momios. Resultados Se verificó que las madres o cuidadores con edad de 15 a 29 años tuvieron 1,6 veces más chances de presentar autoeficacia moderada, con significación estadística del determinante individual "grupo de edad" (p=0,017). Los participantes con determinantes intermedios "destino de la basura" y "origen del agua del domicilio" inadecuados tuvieron más probabilidades de presentar autoeficacia moderada, 3,5 y 2,8 respectivamente. Conclusión El determinante social de salud "grupo de edad" aumenta la probabilidad de que madres o cuidadores presenten autoeficacia moderada para la prevención de la diarrea infantil. Por lo tanto, corresponde a los enfermeros hacer hincapié en orientar a las madres o cuidadores, principalmente los más jóvenes, sobre la prevención de la diarrea y realizar acciones educativas con el objetivo de aumentar su autoeficacia.

Abstract Objective To verify the association between the social determinants of health and the levels of self-efficacy of mothers or caregivers to prevent childhood diarrhea. Methods This is a cross-sectional study carried out with 363 mothers or caregivers of children under five years old, followed up in a Primary Health Care unit. For data collection, the sociodemographic characterization form and the Maternal Self-Efficacy Questionnaire for Prevention of Infantile diarrhea. The Chi-Square test was performed, and as a measure of association, odds ratio. Results It was found that mothers or caregivers aged 15 to 29 years were 1.6 times more likely to have moderate self-efficacy, with statistical significance for the individual determinant "age group" (p=0.017). Participants with inadequate intermediate determinants "waste destination" and "home water source" were 3.5 and 2.8 times more likely to have moderate self-efficacy, respectively. Conclusion The social determinant of health "age group" increases the chance of mothers or caregivers showing moderate self-efficacy to prevent childhood diarrhea. Therefore, nurses should place a greater emphasis on guiding mothers or caregivers, especially younger ones, on the prevention of diarrhea and carrying out educational actions aimed at increasing their self-efficacy.

Estudio de prevalencia de automedicación en niños que consultan por infección respiratoria aguda y enfermedad diarreica aguda a una clínica universitaria / Self Medication Prevalence in Child's who Consult for Respiratory Tract Diseases and Acute Diarrheal Disease to Clínica Universidad de la Sabana

RESUMEN Objetivo: La automedicación en niños tiene una prevalência mundial del 50 %. La enfermedad diarreica aguda y la infección del tracto respiratorio son enfermedades prevalentes de la infancia, y se ven afectadas por esta práctica. El objetivo fue establecer la prevalencia de automedicación en niños que consultan a un servicio de pediatría y explorar posibles factores asociados. Materiales y métodos: Se realizó un estudio de corte transversal. Se incluyeron niños que consultaron por infección respiratoria aguda y/o enfermedad diarreica aguda. Se desarrolló un instrumento (encuesta) para la recolección de la información. Con el objetivo de explorar los posibles factores asociados con la automedicación se realizaron análisis bivariados y se construyó un modelo de regresión logística. Se estimó como medida de efecto el OR con su intervalo de confianza. Se estableció el valor de significancia estadística con un valor de p< 0,05. Resultados: Se incluyeron 300 menores. La prevalencia de automedicación fue del 46 %. Los medicamentos más usados fueron el acetaminofén (78 %) y el ibuprofeno (15 %). Se encontró posible asociación de la automedicación con el antecedente de previo de automedicación y la edad del niño. Conclusiones: La prevalencia de automedicación es alta y similar a la encontrada en la literatura. Los posibles factores asociados a la automedicación en niños son la experiencia previa de automedicación y la edad del niño. Desde la atención primaria se deben realizar campañas educativas a la población de los riesgos de la automedicación.

ABSTRACT Objective: Self-medication in children has a worldwide prevalence of 50%. Acute diarrheal disease and respiratory tract infection are prevalent childhood diseases and are affected by this practice. The objective was established the prevalence of self-medication in children who consult a pediatric service and explore possible associated factors. Materials and methods: A cross-sectional study was conducted, children who consulted for acute respiratory disease or acute diarrheal disease were included. An instrument for information collection was developed and applied. In order to explore the possible risk factors associated with self-medication, bivariate analyzes were performed and a logistic regression model was constructed. The OR with its confidence interval was estimated as an effect measure. The statistical significance value was established with a value of p <0.05. Results: 300 children were included. The prevalence of self-medication was 46 %. The most used medications were acetaminophen (78 %) and ibuprofen (15 %). Association of self-medication was found with the history of prior self-medication and the child's age. Conclusions: The prevalence of self-medication is high and like that found in the literature. Possible associated factors are previous self-medication experience and the child's age. From primary care it is appropriate to carry out educational campaigns to the population of the risks of self-medication.

Factors associated with diarrheal disease in the rural Caribbean region of Colombia / Factores asociados con enfermedad diarreica en área rural del Caribe colombiano

ABSTRACT OBJECTIVE: To analyze factors associated with diarrheal disease in the rural Caribbean region of Colombia. METHOD: A cross-sectional study conducted in the rural area of the Cesar Department, Colombia, between November 2017 and June 2018. Self-reported cases of diarrheal disease were surveyed, and water samples from 42 households were collected and analyzed. Descriptive statistics were employed in the analysis of socioeconomic status, environmental and sanitary conditions, and we evaluated their association with the diarrheal disease using the Poisson regression models. Each model was adjusted with variables suggested by specific directed acyclic graphs. RESULTS: Poor water supply conditions, hygiene and basic sanitation were reported in the study area. All water samples were classified either as high risk for health problems or unfit for human consumption. The diarrheal disease had a prevalence of 7.5% across all ages and of 23.5% in children under five years old. The variables rainy season (PR = 0.24; 95%CI 0.07-0.85), children under five years old (PR = 4.05; 95%CI 1.70-9.68), water from deep wells (PR = 16.90; 95%CI 2.45-116.67), water from artificial ponds (PR = 11.47; 95%CI 1.27-103.29), toilets availability (PRA = 0.23; 95%CI 0.06-0.96), and swine presence (PR = 0.20; 95%CI 0.05-0.74) were significantly associated with the occurrence of diarrheal disease. CONCLUSION: Water supply, hygiene and basic sanitation conditions have been associated with the diarrheal disease, affecting almost a quarter of the population under five years old. There is an urge for the design of effective policies that improve environmental and sanitation conditions in rural areas.

RESUMEN OBJETIVO: Analizar factores asociados con enfermedad diarreica en área rural del Caribe colombiano. MÉTODO: Estudio transversal en área rural dispersa del departamento del Cesar, Colombia, entre noviembre de 2017 y junio de 2018. Se indagó sobre morbilidad auto-reportada de enfermedad diarreica y se recolectaron y analizaron muestras de agua en 42 domicilios. Fue realizado un análisis descriptivo de condiciones socioeconómicas, ambientales y sanitarias y evaluamos su asociación con enfermedad diarreica mediante modelo robusto de regresión de Poisson. Cada modelo fue ajustado con variables sugeridas por diagramas causales específicos. RESULTADOS: Se evidenciaron condiciones precarias de abastecimiento de agua, higiene y saneamiento básico en la zona de estudio. Todas las muestras de agua se clasificaron entre los niveles de riesgo alto e inviable sanitariamente. La prevalencia de enfermedad diarreica fue 7,5% en todas las edades y 23,5% en niños menores de cinco años. Las variables estación lluviosa (RP = 0,24; IC95% 0,07-0,85), niños menores de cinco años (RP = 4,05; IC95% 1,70-9,68), abastecimiento de agua desde pozo profundo (RP = 16,90; IC95% 2,45-116,67), abastecimiento de agua desde estanco (RP = 11,47; IC95% 1,27-103,29), tenencia de baño (RPA = 0,23; IC95% 0,06-0,96) y presencia de cerdos (RP = 0,20; IC95% 0,05-0,74) mostraron asociaciones estadísticamente significativas con la ocurrencia de enfermedad diarreica. CONCLUSIÓN: Condiciones de abastecimiento de agua, higiene y saneamiento básico estuvieron asociadas con la ocurrencia de enfermedad diarreica, afectando alrededor de un cuarto de la población menor de cinco años. Urge un diseño efectivo de políticas que contribuyan al mejoramiento de condiciones ambientales y saneamiento en áreas rurales.

Relação entre diarreia infantil e hospitalização por desidratação / Relation between childhood diarrhea and hospitalization due to dehydration

OBJETIVO: Traçar o perfil epidemiológico e a relação entre diarreia infantil e hospitalização por desidratação. MÉTODOS: Trata-se de estudo retrospectivo, descritivo, de abordagem quantitativa. A população estudada correspondeu a crianças que geraram notificação por diarreia e/ou hospitalização por desidratação no Estado do Tocantins, entre 2010 e 2015. A informação foi extraída do banco de dados do Departamento de Informática do Sistema Único de Saúde (DATASUS) e do Sistema de Informação de Agravos e Notificação (SINAN) disponibilizados pelo Ministério da Saúde. RESULTADOS: Entre os anos de 2010 a 2015, foram registrados 82.973 casos de crianças com diarreia no Tocantins. Já o número de internações infantis por desidratação neste período totalizou 1.851. A prevalência média no período analisado foi de 1.382 casos de diarreia infantil por mês, com 31 registros de internações por desidratação infantil mensais. Em todos os anos estudados, a incidência foi aumentada entre junho e setembro, com acréscimo de até 50% em casos de diarreia e 185% em internações. Em geral, os parâmetros relacionados ao número de casos de diarreia em crianças e ao número de hospitalização por desidratação seguiram comportamentos associados, o que reforçou uma relação causal entre eles. CONCLUSÃO: O Tocantins apresentou destaque, em nível nacional, em relação a casos de desidratação e mortalidade infantil no período de 2010 e 2015. Por ser tão relevante na morbimortalidade infantil, a revisão de políticas públicas é urgente, com foco na prevenção e na terapêutica efetivas da diarreia e da desidratação infantis. (AU)

OBJECTIVE: To outline the epidemiological profile and relation between childhood diarrhea and hospitalization for dehydration. METHODS: This is a retrospective, descriptive, quantitative study. The studied population consisted of children who generated notification of diarrhea and/or hospitalization due to dehydration in the state of Tocantins from 2010 to 2015. The information was extracted from the database of the Informatics Department of the Brazilian Unified Health System (DATASUS), and from the National Disease Notification System (SINAN) provided by the Brazilian Ministry of Health. RESULTS: Between the years 2010 and 2015, 82,973 cases of children with diarrhea were recorded in Tocantins. The number of children hospitalizations due to dehydration in this period was 1,851. The mean prevalence in the analyzed period was 1382 cases of child's diarrhea per month, with 31 records of monthly hospitalizations from child's diarrhea. In all the years studied, the incidence was increased between June and September with an increase of up to 50% in cases of diarrhea, and 185% in hospitalizations. In general, the parameters related to the number of cases of child's diarrhea and the number of admissions due to dehydration followed associated behaviors, which reinforced a causal relation between them. CONCLUSION: Tocantins stands out nationally regarding the cases of dehydration and children mortality from 2010 to 2015. Due to its relevance to children's morbidity and mortality, the review of public policies focusing effective prevention and treatment of diarrhea and infant dehydration is urgent. (AU)

Elaboração e validação de cartilha para prevenção da diarreia infantil / Elaboración y validación de libreta para la prevención de la diarrea infantil / Elaboration and validation of a reader on childhood diarrhea prevention

Resumo Objetivo Elaborar, validar e avaliar uma cartilha educativa para a promoção da autoeficácia materna na prevenção da diarreia infantil. Método Estudo metodológico, desenvolvido a partir da elaboração, validação e avaliação do material educativo por 30 juízes de conteúdo e três técnicos. Para validação, avaliou-se clareza da linguagem, pertinência prática e relevância teórica, calculando-se o Índice de Validade de Conteúdo para cada item; e aplicou-se o instrumento Suitability Assesment of Materials (SAM) para avaliação da cartilha. Resultados A cartilha teve como título "Você é capaz de prevenir a diarreia no seu filho!" e foi elaborada tendo como referencial a Teoria da Autoeficácia. Os juízes de conteúdo atribuíram Índice de Validade de Conteúdo (IVC) global de 0,88 para clareza da linguagem, 0,91 para pertinência prática e 0,92 para relevância teórica; e os juízes técnicos atribuíram IVC de 0,96, 1,00 e 1,00 para os mesmos itens avaliados, respectivamente. A avaliação dos juízes de conteúdo e técnicos a partir do SAM classificou o material como "superior", com média de 88,7% e 90,1%, respectivamente. Conclusão A cartilha apresenta conteúdo e aparência adequados para a promoção da autoeficácia materna na prevenção da diarreia infantil.

Resumen Objetivo Elaborar, validar y evaluar una libreta educativa para la promoción de la Autoeficacia materna en la prevención de la diarrea infantil. Método Estudio metodológico desarrollado partiendo de la elaboración, validación y evaluación del material educativo por 30 expertos en contenido y tres técnicos. Para la validación se evaluó claridad del lenguaje, adecuación práctica y relevancia teórica, calculándose el Índice de Validez de Contenido para cada ítem; y se aplicó el instrumento Suitability Assessment of Materials (SAM) para evaluación de la libreta. Resultados La libreta se tituló "¡Tú eres capaz de prevenir la diarrea de tu hijo!", y fue elaborada sobre el referencial de la Teoría de la Autoeficacia. Los expertos en contenido le otorgaron Índice de Validez de Contenido (IVC) global de 0,88 a la claridad del lenguaje, 0,91 a adecuación práctica y 0,92 a relevancia teórica; y los técnicos puntuaron con IVC de 0,96, 1,00 y 1,00 a los mismos ítems evaluados, respectivamente. La evaluación de los expertos en contenido y técnicos a partir del SAM clasificaron al material como "superior", con promedio de 88,7% y 90,1%, respectivamente. Conclusión La libreta ofrece contenido y apariencia adecuados para promoción de Autoeficacia materna en la prevención de la diarrea infantil.

Abstract Objective Elaborate, validate and evaluate an educational reader to promote maternal self-efficacy in the prevention of childhood diarrhea. Method Methodological study, developed based on the elaboration, validation and evaluation of educational material by 30 content judges and three technicians. For the validation, the clarity of the language, practical pertinence and theoretical relevance were considered, calculating the Content Validity Index for each item; and the tool Suitability Assessment of Materials (SAM) was applied to evaluate the reader. Results The reader was titled "You can prevent diarrhea in you child" was elaborated in the framework of Self-Efficacy Theory. The content judges attributed a global Content Validity Index (CVI) of 0.88 for language clarity, 0.91 for practical pertinence and 0.92 for theoretical relevance; and the technical judges attributed CVI of 0.96, 1.00 and 1.00 for the same items assessed, respectively. The assessment of the content and technical judges based on the SAM tool classified the material as "superior", with average coefficients of 88.7% and 90.1%, respectively. Conclusion The reader was considered appropriate in terms of face and content validation to promote maternal self-efficacy in the prevention of childhood diarrhea.

Crenças e condutas maternas na autoeficácia para prevenir diarreia infantil: estudo transversal / Maternal beliefs and behaviors in self-efficacy to prevent childhood diarrhea: a cross-sectional study / Creencias y conductas maternas en la autoeficacia para prevenir diarrea infantil: estudio transversal

OBJETIVO: Investigar a associação entre crenças, conhecimento e condutas maternas e sua autoeficácia para prevenir diarreia infantil. MÉTODO: Estudo transversal, quantitativo realizado no interior do Ceará, com 385 mães de crianças menores de cinco anos. A coleta de dados foi realizada por meio da aplicação de um formulário sociodemográfico e Escala de Autoeficácia Materna para Prevenir Diarreia Infantil (EAPDI). Os dados foram analisados por meio do teste do qui-quadrado. RESULTADOS: Verificou-se relação significante entre os níveis de autoeficácia e conduta materna quanto alimentação durante diarreia (p=<0,001); comida mal cozida (p=0,004); água contaminada (p=0,036); comida gordurosa (p=0,007); calor (p=0,048); mãos/objetos sujos na boca (p=<0,001); medicamentos (p=<0,001); verminose (p=0,012); alimentos contaminados (p=0,001). CONCLUSÃO: Constatou-se que fatores como crenças, conhecimento, fonte de informação e condutas maternas adotadas na prevenção e manejo da diarreia infantil influenciaram estatisticamente a autoconfiança das mulheres em prevenir essa patologia.

AIM: To investigate the association between maternal beliefs, knowledge and behaviors and their self-efficacy to prevent childhood diarrhea. METHOD: This is a cross-sectional, quantitative study conducted in the interior of Ceará, with 385 mothers of children under five years of age. Data collection was performed through the application of a sociodemographic form and the Maternal Self-Efficacy Scale to Prevent Childhood Diarrhea (EAPDI). Data were analyzed using the chi-square test. RESULTS: There was a significant relationship between levels of self-efficacy and maternal behavior regarding diet during diarrhea (p=0.001); poorly cooked food (p=0.004); contaminated water (p=0.036); greasy food (p=0.007); heat (p=0.048); dirty hands/objects in the mouth (p=<0.001); drugs (p=<0.001); verminosis (p=0.012); contaminated food (p=0.001). CONCLUSION: Factors such as beliefs, knowledge, source of information and maternal behaviors adopted in the prevention and management of childhood diarrhea were statistically influenced by women's self-confidence in preventing this pathology.

OBJETIVO: Investigar la relación entre creencias, conocimiento y conductas maternas y su autoeficacia para prevenir diarrea infantil. MÉTODO: Estudio transversal, cuantitativo, realizado en el interior de Ceará, con 385 madres de niños menores de cinco años. La recolección de los datos se realizó a través de la aplicación de un formulario sociodemográfico y la Escala de Autoeficacia Materna para Prevenir Diarrea Infantil (EAPDI). Los datos se analizaron por medio del test Chi-cuadrado. RESULTADOS: Se verificó relación significante entre los niveles de autoeficacia y conducta materna cuanto a a alimentación durante la diarrea (p=<0,001); comida mal cocinada (p=0,004); agua contaminada (p=0,036); comida grasosa (p=0,007); calor (p=0,048); manos/objetos sucios en la boca (p=<0,001); medicamentos (p=<0,001); parásitos intestinales (p=0,012); alimentos contaminados (p=0,001). CONCLUSIÓN: Se constató que factores como creencias, conocimiento, fuente de información y conductas maternas adoptadas para prevenir y lidiar con la diarrea infantil influenciaron estadísticamente la autoconfianza de las mujeres al prevenir esta patología.

Factors associated with diarrhea in children under five years old in the state of Pernambuco, according to surveys conducted in 1997 and 2006 / Fatores associados à diarreia em menores de cinco anos, no estado de Pernambuco, segundo inquéritos realizados em 1997 e 2006

ABSTRACT OBJECTIVE Describe and compare variations of the factors associated with the prevalence of diarrhea in children under five years old in the state of Pernambuco. METHODS We used the databases of two population-based surveys from the years 1997 and 2006, with 2,078 and 1,650 children, respectively, evaluated in 18 municipalities of Pernambuco (Metropolitan Region of Recife, urban and rural interior). The variables, allocated at hierarchical levels, were analyzed using prevalence and Poisson regression ratios. RESULTS Only four variables were independently associated and were included in the final hierarchical model: geographical area, number of people per room, maternal age and the age of the child. In 1997: urban interior = 1.33 (95%CI 1.06-1.66), rural interior = 1.22 (95%CI 0.97-1.53) and in 2006: urban interior = 1.87 (95%CI 1.31-2.66), rural interior = 2.07 (95%CI 1.50-2.85); number of persons per room (1997): 1 to less than 2 = 1.29 (95%CI 0.98-1.68), two or more = 1.47 (95%CI 1.11-1.95) and in 2006: 1 to less than 2 = 0.86 (95%CI 0.68-1.09), two or more = 1.29 (95%CI 0.94-1.75); maternal age (1997): 10 to 19 years = 1.48 (95%CI 1.05-2.08), 20 to 24 years = 1.23 (95%CI 0.94-1.60), 25 to 34 years = 1.01 (95%CI 0.78-1.30) and in 2006: 10 to 19 years old = 1.70 (95%CI 1.08-2.66), 20 to 24 years old = 1.64 (95%CI 1.16-2.32), 25 to 34 years = 1.20 (95%CI 0.89-1.62); and age of the child (1997): 0-11 months = 1.57 (95%CI 1.27-1.94), 12-23 months = 1.73 (95%CI 1.41-2.12) and in 2006: 0-11 months = 1.04 (95%CI 0.76-1.41), 12-23 months = 1.77 (95%CI 1.41-2.23). CONCLUSIONS There was a great variability of the conditioners of diarrhea in children between the two periods analyzed. At the public policy level, despite changes in terms of people, time sequences, and geographic spaces, diarrhea remains on an important scale in the ranking of government power.

RESUMO OBJETIVO Descrever e comparar variações dos fatores associados à prevalência de diarreia em menores de cinco anos no estado de Pernambuco. MÉTODOS Foram utilizados os bancos de dados de dois inquéritos de base populacional nos anos de 1997 e 2006, com 2.078 e 1.650 crianças, respectivamente, avaliadas em 18 municípios de Pernambuco (Região Metropolitana do Recife, interior urbano e rural). As variáveis, alocadas em níveis hierárquicos, foram analisadas por meio de razões de prevalência e regressão de Poisson. RESULTADOS Apenas quatro variáveis se mostraram independentemente associadas e constaram no modelo final hierarquizado: área geográfica, número de pessoas por cômodo, idade materna e idade da criança. Em 1997: interior urbano = 1,33 (IC95% 1,06-1,66), interior rural = 1,22 (IC95% 0,97-1,53) e em 2006: interior urbano = 1,87 (IC95% 1,31-2,66), interior rural = 2.07 (IC95% 1.50-2.85); número de pessoas por cômodo (1997): 1 a menos de 2 = 1,29 (IC95% 0,98-1,68), dois ou mais = 1,47 (IC95% 1,11-1,95) e em 2006: 1 a menos de 2 = 0.86 (IC95% 0,68-1,09), dois ou mais = 1,29 (IC95% 0,94-1,75); idade materna (1997): 10 a 19 anos = 1,48 (IC95% 1,05-2,08), 20 a 24 anos = 1,23 (IC95% 0,94-1,60), 25 a 34 anos = 1,01 (IC95% 0,78-1,30) e em 2006: 10 a 19 anos = 1,70 (IC95% 1,08-2,66), 20 a 24 anos = 1,64 (IC95% 1,16-2,32), 25 a 34 anos = 1,20 (IC95% 0,89-1,62); e idade da criança (1997): 0-11 meses = 1,57 (IC95% 1,27-1,94), 12-23 meses = 1,73 (IC95% 1,41-2,12) e em 2006: 0-11 meses = 1,04 (IC95% 0,76-1,41), 12-23 meses = 1,77 (IC95% 1,41-2,23). CONCLUSÕES Houve uma grande variabilidade dos condicionantes das diarreias em crianças entre os dois períodos analisados. Em nível de políticas públicas, apesar de mudanças em termos de pessoas, sequências temporais e espaços geográficos, as diarreias continuam em uma escala importante no elenco de prioridades do poder governamental.

[A multicenter randomized controlled study of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea in infants and young children].

Objective: To evaluate the efficacy and safety of Saccharomyces boulardii in the prevention of antibiotic-associated diarrhea (AAD) in infants and young children. Method: From November 2012 to September 2013, ten research units of large teaching hospitals or children's hospitals participated in this multicenter randomized controlled clinical trial. Hospitalized young children aged between 1 month and 3 years (nongastrointestinal infection and antibiotic therapy required)were involved in our study. The children were randomly divided into control group and prevention group by means of block random allocation method. The control group received antibiotic therapy and other conventional treatment. The prevention group was given additional Saccharomyces boulardii (250 mg/d) orally. Diarrhea rates of two groups were compared both during the usage of antibiotics and within 14 days after the antibiotics withdrawal. The adverse reactions of Saccharomyces boulardii were observed all through this study. The results were analyzed by χ(2) test or Kruskal-Wallis test or t test. Result: Totally 408 cases (213 cases in prevention group and 195 cases in control group) were enrolled. The age ranged from 1 month to 3 years, with an average age of 1.14 years. The basic diseases were parenteral infections: 368 cases with different kinds of respiratory tract infections or pneumonia, 10 cases of bacterial meningitis, 9 cases with septicemia or sepsis, 6 cases with pertussis or pertussis like syndrome, 5 cases with urinary infection, 5 cases with skin or subcutaneous tissue infections, 3 cases of Kawasaki disease, one with scarlet fever and one with congenital syphilis. During the administration of antibiotics, the incidence of AAD in prevention group was 10.3% (22 cases), which was significantly lower than that of control group (57 cases, 29.2%, χ(2)=23.296, P<0.05). Within 14 days after the discontinuation of antibiotics, the percent of new diarrhea cases in prevention group (2.4%, 5/213) was also significantly lower than that in control group (16.4%, 32/195, χ(2)=23.4, P<0.05). Further analysis revealed that the rate of AAD in children less than or equal to 1 year old (25.1%, 52/207) was significantly higher than that of over 1 year old (13.4%, 27/201, χ(2)=8.922, P<0.05). The incidence of AAD in children treated with antibiotics for more than 5 days was 22.2%(60/270), which was significantly higher than that of less than or equal to 5 days (13.8%, 19/138, χ(2)=4.180, P<0.05). Although no significant difference was observed, the AAD rate of patients with combined use of two antibiotics was higher than that of using one. During the antibiotic therapy, compared with the control group, the risk of AAD in children under 1 year old was reduced by 52% (χ(2)=9.217, P<0.05), and 91% (χ(2)=20.35, P<0.05) in the children over 1 year old in prevention group. The risk of AAD of prevention group decreased by 66% (χ(2)=13.67, P<0.05) in patients treated with one antibiotics, and 65% in children with combined use of antibiotics (χ(2)=10.57, P<0.05). In patients treated with antibiotics for less than or equal to 5 days, the risk of AAD decreased by 74% in prevention group (χ(2)=7.38, P<0.05); and 63% if the course lasted for over 5 days (χ(2)=16.87, P<0.05). Within 14 days after the withdrawal of antibiotics, compared with the control group, the risk of diarrhea in the prevention group decreased by 82% (χ(2)=13.35, P<0.05) in infants (≤1 year old) and 93% (χ(2)=12.00, P<0.05) in children (>1 year old); the risk of diarrhea was reduced by 86% (χ(2)=9.57, P<0.05) and 87% (χ(2)=17.71, P<0.05) respectively in prevention group with single and combined use of antibiotics. In patients treated with antibiotics for more than 5 days, the risk of diarrhea in prevention group was reduced by 63% (χ(2)=22.79, P<0.05), while there was no significant difference if the antibiotics course was less than or equal to 5 days (χ(2)=2.97, P>0.05). No adverse effects related with Saccharomyces boulardii were observed in our study. Conclusion:Saccharomyces boulardii is effective and safe to prevent AAD of infants and young children both during the usage of antibiotics and up to 14 days after drug discontinuance. It can be one of the drugs of for choice prevention of AAD in infants and young children. Trial registration Chinese Clinical Trial Tegister, ChiECRCT-2012-25.

Costos de la rehidratación oral y nasogástrica comparadas con la rehidratación endovenosa en niños con diarrea en Colombia / Costs of oral and nasogastric rehydration compared to intravenous rehydration in children under 5 years of age with diarrhea in Colombia

RESUMEN Objetivo Evaluar los costos de las terapias de rehidratación oral (TRO) y de rehidratación nasogástrica (TRN) comparadas con la terapia de rehidratación endovenosa (TRE) para corregir la deshidratación por diarrea en niños. Metodología Análisis de minimización de costos desde la perspectiva del Sistema de Salud colombiano comparando TRO (seguida de TRN ante falla de la TRO), con la TRE. El horizonte temporal fue la duración de la rehidratación. La medida de efectividad se extrajo de una revisión sistemática de literatura. Para determinar costos, se construyó un caso típico y un árbol de decisiones, a partir de revisión de guías e historias clínicas, validado con expertos. Los costos unitarios se obtuvieron de bases de datos colombianas. Costos fueron calculados en pesos colombianos (COP) y dólares americanos (USD). Se realizaron análisis de sensibilidad de una y dos vías. Resultados La TRO y la TRE son similares en efectividad para prevenir hospitalización y lograr rehidratación. En el caso base, el costo de la TRO fue $91,221COP (40.5 USD) y para TRE $112,944COP (50.14USD), es decir, un ahorro de $21,723 COP (9.64 USD). En los análisis de sensibilidad por regímenes de aseguramiento y complejidad del hospital, la TRO suele ser la estrategia menos costosa. Discusión Ambas intervenciones son similares en efectividad, pero la TRO, seguida de TRN ante falla de la primera resulta menos costosa que la TRE. La TRO es recomendable como primera opción para corregir la deshidratación. Deberían continuarse esfuerzos por implementar TRO y TRN en los servicios de salud en Colombia.(AU)

ABSTRACT Objective To evaluate the costs of oral rehydration therapy (ORT) and nasogastric rehydration therapy (NRT) compared with intravenous rehydration therapy (IRT) to treat dehydration in children under 5 years of age with diarrhea. Methodology Cost-minimization analysis from the perspective of the Colombian Health System, comparing ORT, (followed by NRT when ORT fails), with IRT. The time horizon was the duration of rehydration. The effectiveness measure was obtained from a systematic review of the literature. To determine costs, a typical case was created based on current guidelines and medical records; this case was validated by experts. Unit costs were obtained from Colombian databases and were provided in Colombian pesos (COP) and US dollars (USD) for 2010. One- and two-way sensitivity analyzes were performed. Results ORT and ERT are similarly effective to prevent hospitalization and to achieve rehydration. In the base case, the expected cost of ORT was $91,221 COP (40.5 USD) and for IRT was $112,944 COP ($50.14 USD), saving $21,723 COP ($9.64 USD) per case. In the sensitivity analyzes by health insurance and hospital level, ORT is often the least costly strategy. Discussion Both interventions are similarly effective, but ORT, followed by NRT when ORT fails, is less costly than IRT. ORT is recommended as the first option to treat dehydration since it is effective and less expensive. Efforts should be continued to implement TRO and NRT in the health services of Colombia.(AU)

Disparities in Breastfeeding: Impact on Maternal and Child Health Outcomes and Costs.

OBJECTIVE: To estimate the disease burden and associated costs attributable to suboptimal breastfeeding rates among non-Hispanic blacks (NHBs), Hispanics, and non-Hispanic whites (NHWs). STUDY DESIGN: Using current literature on associations between breastfeeding and health outcomes for 8 pediatric and 5 maternal diseases, we used Monte Carlo simulations to evaluate 2 hypothetical cohorts of US women followed from age 15 to 70 years and their infants followed from birth to age 20 years. Accounting for differences in parity, maternal age, and birth weights by race/ethnicity, we examined disease outcomes and costs using 2012 breastfeeding rates by race/ethnicity and outcomes that would be expected if 90% of infants were breastfed according to recommendations for exclusive and continued breastfeeding duration. RESULTS: Suboptimal breastfeeding is associated with a greater burden of disease among NHB and Hispanic populations. Compared with a NHW population, a NHB population had 1.7 times the number of excess cases of acute otitis media attributable to suboptimal breastfeeding (95% CI 1.7-1.7), 3.3 times the number of excess cases of necrotizing enterocolitis (95% CI 2.9-3.7), and 2.2 times the number of excess child deaths (95% CI 1.6-2.8). Compared with a NHW population, a Hispanic population had 1.4 times the number of excess cases of gastrointestinal infection (95% CI 1.4-1.4) and 1.5 times the number of excess child deaths (95% CI 1.2-1.9). CONCLUSIONS: Racial/ethnic disparities in breastfeeding have important social, economic, and health implications, assuming a causal relationship between breastfeeding and health outcomes.

Principales enfermedades asociadas al estado nutricional en el niño menor de un año / Main diseases associated with nutritional status in children under one year of age

Introducción: la nutrición tiene una importancia trascendental durante el período prenatal y los primeros años de la vida, incluida su influencia sobre el crecimiento, el desarrollo físico y mental. La desnutrición proteico-energética favorece las infecciones, disminuye la resistencia a casi todas las enfermedades, actúa como causa coadyuvante de morbilidad y mortalidad infantiles y repercute sobre el desarrollo psíquico. Objetivo: conocer las principales enfermedades asociadas al estado nutricional en los ni ños menores de un año ingresados en el Hospital Pediátrico «José Luis Miranda¼ de la provincia de Villa Clara, desde enero de 1997 hasta diciembre de 2010. Métodos: Se seleccionaron 361 niños con el diagnóstico de desnutrición proteico-energética y 361 con el estado nutricional normal. Se evaluaron diversas variables: edad, causas por las que enfermaron e ingresaron, así como los ingresos en las salas de cuidados especiales. Resultados: en ambos grupos predominaron los ni ños menores de seis meses (66 %), las enfermedades diarreicas (74 %) y los ingresos por esta causa (78 %); el ingreso de forma directa a las unidades de terapia fue mayor en los niños desnutridos. Se produjeron ocho fallecimientos. Conclusiones: existió relación entre el estado nutricional, la función inmunitaria, la morbilidad y la mortalidad por enfermedades infecciosas, sobre todo por diarreas. Estos resultados permitirían diseñar estrategias de intervención con vistas a mejorar este indicador.

Introduction: nutrition is of great and important significance during prenatal period and the first years of life, because of its influence over children's growth, as well as, their physical and mental development. Protein-energy malnutrition in infants brings about some infections; reduces the resistance to almost all of the diseases, works as a cause of adjuvant morbidity and infant mortality, and affects their psychological development. Objective: to know about the main diseases associated with nutritional status in children under one year of age, who were admitted at "José Luis Miranda" Pediatric Hospital in Villa Clara province, from January, 1997 to December, 2010. Methods: a number of 361 children diagnosed with protein-energy malnutrition were selected, as well as, 361children with a normal nutritional state. Diverse variables were evaluated, such as, age, the causes of getting sick and being admitted to the hospital, and admissions to special care units. Results: in both groups predominated children under six months (66 %), bacterial diarrheal diseases (74 %) and admissions due to this cause (78 %); the admission to special care units was higher in malnourished children. Eight children died. Conclusions: there was a relationship among nutritional status, immunological function, morbidity and mortality due to infectious diseases, mainly because of diarrheas. These results will allow us to design intervention strategies in order to improve this indicator.

Evaluación de vídeos educativos producidos en Brasil sobre diarrea infantil: estudio documental / Avaliação de vídeos educativos produzidos no Brasil sobre diarreia infantil: estudo documental / Evaluation of educational videos produced in Brazil about infant diarrhea: a documental study

Aim: to characterize and evaluate educational videos produced in Brazil that deal with the aspects related to the prevention and/or management of infant diarrhea. Method: this is a documental study which evaluated 25 educational videos in terms of their content and the technical information they contained. Results: it was observed that 60% of the videos were produced in the 1990s and none were adapted for the hearing-impaired. With regard to their pathological preventive steps, 52% mentioned the treatment of drinkable water, and 48% mentioned the washing of hands. Breastfeeding was mentioned in 80% of the videos as a protective measure against the aggravation of the health issue. Maternal self-efficiency to prevent infant diarrhea was present in 28% of the sample. The production of the videos analyzed occurred mainly during the 1990s, due to an intense movement to reduce significantly infant mortality in Brazil at that time. Conclusion: the need to produce new videos related to the topic, including self-efficiency within the context of the prevention of infant diarrhea was confirmed.(AU)

Objetivo: caracterizar y evaluar vídeos educativos nacionales que aborden aspectos relacionados a la prevención y/o manejo de la diarrea infantil. Método: estudio del tipo documental, que evaluó 25 vídeos educativos con relación al contenido y a las informaciones técnicas. Resultados: se constató que 60% de los vídeos fueron producidos en los años 90 y ninguno tenía acceso para deficientes auditivos. Con relación a las medidas preventivas de la patología, 52% mencionaron el tratamiento del agua para el consumo y 48% el lavado de las manos. La lactancia materna fue mencionada en 80% como factor protector para esa gravedad. La autoeficacia materna para la prevención de la diarrea infantil fue presente en 28%. La producción de los vídeos se concentró en la década de 1990, debido a la intensa mobilización para reducir la mortalidad infantil en el país. Conclusión: se comprobó la necesidad de la producción de nuevos vídeos acerca de la temática, con la inserción la autoeficacia en el contexto de la prevención de la diarrea infantil.(AU)

Objetivo: Caracterizar vídeos educativos produzidos no Brasil relacionados à prevenção ou ao manejo da diarreia infantil. Método: Estudo do tipo documental, que avaliou 25 vídeos educativos quanto ao conteúdo e às informações técnicas. Resultados: Constatou-se que 60% dos vídeos foram produzidos nos anos 90 e nenhum possuía acessibilidade para deficientes auditivos. Quanto às medidas preventivas da patologia, 52% dos vídeos mencionaram o tratamento da água para consumo e 48% a lavagem das mãos. O aleitamento materno foi mencionado em 80% dos vídeos como fator protetor para esse agravo. A autoeficácia materna para a prevenção da diarreia infantil fez-se presente em 28% dos vídeos. Discussão: A produção dos vídeos concentrou-se nos anos 90, devido à intensa mobilização para a redução da mortalidade infantil no Brasil.Conclusão: Constatou-se a necessidade de produção de novos vídeos acerca da temática, inserindo a autoeficácia no contexto da prevenção da diarreia infantil.(AU)

Evaluación del impacto de la vacuna contra rotavirus en Colombia usando métodos rápidos de evaluación / Impact assessment of the rotavirus vaccine in Colombia using rapid evaluation methods

OBJETIVO: Estimar la efectividad de la vacuna monovalente antirrotavírica para prevenir la hospitalización por enfermedad diarreica aguda en niños menores de 2 años en cinco ciudades de Colombia. MÉTODOS: Se realizó una encuesta poblacional sobre una muestra probabilística de niños mayores de 2 meses y menores de 24 meses de edad en cinco ciudades de Colombia (Barranquilla, Bogotá, Cali, Cartagena y Riohacha) en el período de agosto a octubre de 2010. La vacuna fue introducida en el Programa Ampliado de Inmunizaciones en enero de 2009. Se estimaron las coberturas de vacunación contra rotavirus por grupos de edad y la incidencia acumulada de hospitalización por diarrea severa, y se evaluó la magnitud de la asociación entre la vacunación con una o dos dosis de vacuna antirrotavírica y la hospitalización por diarrea, utilizando la razón de probabilidades (RP) ajustada por edad y otros factores de importancia epidemiológica. La efectividad de la vacunación se estimó usando la expresión 1 - RP. RESULTADOS: La cobertura de vacunación con una dosis de vacuna fue de 87,3%. En los 12 meses previos a la encuesta 43,2% (1 453 niños) de menores de 24 meses presentaron diarrea, y de ellos, 5,2% (174 niños) fueron hospitalizados por esta causa. La efectividad de dos dosis de vacuna antirrotavírica para prevenir la hospitalización por diarrea severa fue de 68% (intervalo de confianza de 95%: 55%-77%). CONCLUSIONES: La vacunación contra rotavirus en Colombia protege contra la hospitalización por diarrea por cualquier causa. El uso de encuestas transversales se mostró adecuado para evaluar rápidamente la efectividad de un programa de vacunación con una nueva vacuna.

OBJECTIVE: Estimate the effectiveness of the monovalent rotavirus vaccine in preventing the need to hospitalize children under 2 years old for acute diarrheal disease in five Colombian cities. METHODS:A population survey was conducted based on a probability sample of children over 2 months and under 24 months of age in five Colombian cities (Barranquilla, Bogotá, Cali, Cartagena, and Riohacha) over the period from August through October 2010. The vaccine had been introduced in the Expanded Program on Immunization in January 2009. Rotavirus vaccination coverage was estimated by age group; the cumulative incidence of hospitalization for severe diarrhea was determined; and the magnitude of correlation between vaccination with one or two doses of rotavirus vaccine and hospitalization for diarrhea was calculated using the age-adjusted probability ratio (PR) and other epidemiologically significant factors. Effectiveness of the vaccine was estimated using the expression 1-PR. RESULTS: Coverage with a single dose of the rotavirus vaccine was 87.3%. During the 12 months prior to the survey, 1 453 of the children under 24 months old in the study areas (43.2%) had presented with diarrhea, and of these, 174 (5.2%) had been hospitalized for this cause. The effectiveness of two doses of the vaccine in preventing hospitalization for severe diarrhea was 68% (CI 95% = 55%−77%). CONCLUSIONS: In Colombia, rotavirus vaccination protects against hospitalization for diarrhea due to any cause. The use of cross-sectional surveys appeared to be adequate for rapid evaluation of an immunization program's effectiveness with a new vaccine.

Self-effectiveness in preventing diarrhea and child care: a transversal study

Aim: To check the association between the levels of maternal self-effectiveness to prevent child diarrhea and the conditions of health and healthcare provided to the children. Method: This is a transversal study performed in the municipality of Fortaleza, Brazil, with 448 mothers of children under five years old. The interviews were taken using the Scale of Maternal Self-Effectiveness to Prevent Child Diarrhea. During the analysis, chi-square tests and Likelihood Ratio were used. Results: A significant association was found between levels of self-effectiveness and the variables: care provided to the child out of the home (p=0.03), only breastfeeding until six months old (p=0.001), previous diarrheic episode (p=0.001), the fact that the child has any pathology (p=0.020), hospitalization of the child during the first month of life (p=0.038) and vaccination against rotavirus (p=0.003). Conclusion: Self-effectiveness must be taken seriously during the development and implementation of interventions, with regards to improve maternal care provided to children.

Apparent and content validation of maternal self-efficiency scale for prevention of childhood diarrhea / Validação aparente e de conteúdo da escala de autoeficácia materna para prevenção da diarreia infantil / Validación aparente y de contenido de la escala de autoeficacia materna para prevención de diarrea infantil

AIM: The aim of this paper is to describe the apparent and content validation for the Maternal Self-Efficiency Scale for the Prevention of Childhood Diarrhoea. METHOD: Methodological study with the execution of apparent and content validation by seven judges; semantic analysis, by 30 mothers of children under 5 years old and also a pre-test involving 31 mothers who have been selected through convenience. It has been considered necessary to have the agreement of at least 70% of the judges for apparent validation and a minimum of 80% for pertinence and Index of Content Validation. RESULTS: This paper shows that most items have been considered clear, comprehensive and relevant by the judges. The final Content Validity Index of the scale was 0.96. The suggestions of the mothers were accepted. CONCLUSION: The scale ended up having 25 items and two domains (family hygiene and general/eating practices) which assess the maternal self-efficiency for the prevention of diarrhea in their children, thereby contributing to the planning of nursing interventions.

OBJETIVO: descrever a validação aparente e de conteúdo da escala de autoeficácia materna para a prevenção da diarreia infantil. MÉTODO: este é um estudo metodológico com realização da validação aparente e de conteúdo por sete juízes; da análise semântica, por 30 mães de crianças menores de 5 anos e do pré-teste, por 31 mães, selecionadas por conveniência. Considerou-se necessária uma concordância de pelo menos 70% entre os juízes para a validação aparente e o mínimo de 80% para a pertinência e índice de validade de conteúdo. RESULTADOS: verificou-se que a maioria dos itens foi considerada clara/compreensível e pertinente pelos juízes. O índice de validade de conteúdo final da escala foi de 0,96. As sugestões das mães foram acatadas. CONCLUSÃO: a escala ficou com 25 itens e dois domínios (higiene da família e práticas alimentares/gerais), que avaliam a autoeficácia materna para prevenir diarreia em seus filhos, contribuindo para o planejamento das intervenções de enfermagem.

OBJETIVO: describir la validación aparente y de contenido de la Escala de Autoeficacia Materna para la Prevención de la Diarrea Infantil. MÉTODO: estudio metodológico con comprobación de la validez aparente y de contenido por siete jueces, de análisis semántico por 30 madres de niños menores de 5 años y de prueba piloto con 31 madres, seleccionadas por conveniencia. Se consideró necesaria una concordancia de, por lo menos, 70% entre los jueces para la validez aparente y un mínimo de 80% para la pertinencia e Índice de Validez de Contenido. RESULTADOS: se verificó que la mayoría de los ítems fue considerada clara/comprensiva y pertinente por los jueces. El Índice de Validez de Contenido final de la escala fue 0,96. Las sugerencias de las madres fueron acatadas. CONCLUSIÓN: la escala quedó con 25 ítems y dos dominios (higiene de la familia y prácticas de alimentación/generales), que evalúan la autoeficacia materna para prevenir diarrea en sus hijos, contribuyendo para la planificación de las intervenciones de enfermería.

Habilidades maternas para prevenção e manejo da diarreia infantil / Habilidades maternas para prevención y manejo de la diarrea infantil / Maternal abilities in the prevention and handling of infantile diarrea

Objetivo: Identificar as habilidades maternas na prevenção e manejo da diarreia infantil. Materiale e método: Estudo transversal, quantitativo, realizado com 448 mães de crianças menores de 5 anos residentes em Fortaleza-CE. A coleta de dados ocorreu por meio de entrevista, utilizando-se um formulário abordando características sociodemográfIcas e aspectos relacionados ao cuidado materno para prevenção e manejo da diarreia em seus filhos. Resultados: As mães tinham em média 28,34 anos e 9,1 anos de estudo. A mediana da renda per capta foi R$150. A maioria possuía companheiro, trabalhava em casa e morava há mais de cinco anos na mesma residência. Verificou-se correlação estatisticamente significante entre a realização de receita caseira e idade materna (p=0,027); entre oferta de solução de reidratação oral para a criança e anos de estudo da mãe (p=0,013), bem como com renda familiar (p<0,001). A mãe ter recebido informação anterior sobre prevenção de diarreia infantil mostrou associação estatística com idade materna (p<0,001). Conclusão: As mães apresentaram como principais habilidades para prevenir e manejar a diarreia infantil o encaminhamento da criança a um servicio de saúde, o uso de receitas caseiras e a inmunizaçao contra rotavirus, evidenciando que estas são situaçõnes nas quais os enfermeiros são capazes de intervir.

Aim: To identify the maternal abilities in the prevention and handling of infantile diarrhea. Method: Transversal, quantitative study, carried out with 448 mothers of children under 5 years old, resident in Fortaleza-CE. Data were collected through interviews, using a form containing socio demographical characteristics and aspects related to maternal care for prevention and handling of infantile diarrhea. Results: The mothers had an average age of 28.34 years and 9.1 years of study. The medium income per capita was R$150. Most of the women had a couple and worked at home. Significant statistical correlation was observed between the realization of a homemade recipe and maternal age (p=0,027); and between the availability of oral rehydration solutions for the child and schooling of the mother (p=0,013). The previous act of receiving the information on prevention of infantile diarrhea showed statistical association with maternal age (p< 0.001). Conclusion: The mothers has as main hability to prevent and handle infantile diarrhea the referal of the child to a health service, the use of homemade recipes and inmunization against rotavirus, showing that these are situations in which nurses are able to intervene.

Objetivo: Identificar las habilidades maternas en la prevención y manejo de la diarrea infantil. Método: Estudio transversal, cuantitativo, realizado con 448 madres de niños menores de 5 años, en Fortaleza. Los datos fueron recolectados a través de entrevistas, utilizando un formulario que contenía datos sociodemográficos y aspectos relacionados a la atención materna para la prevención y manejo de la diarrea infantil. Resultados: Las madres tuvieron un promedio de 28,34 años y 9,1 años de estudio. La mediana de la renta per cápita fue de R$150. La mayoría tenía una pareja, trabajaba en casa y vivía hacía más de cinco años en la misma residencia. Hubo una correlación estadísticamente significativa entre la realización de medicinas caseras y la edad materna (p = 0,027); entre la oferta de solución de rehidratación oral para el niño y los años de estudio de la madre (p = 0,013), así como con el ingreso familiar (p<0,001). La madre que había recibido información previa sobre la prevención de la diarrea infantil mostró asociación estadística con la edad (p <0,001).La información previa recibida acerca de la prevención de la diarrea infantil mostró asociación estadística con la edad materna (p <0,001). Conclusión: Las madres tuvieron como principales habilidades para prevenir y manejar la diarrea infantil derivación del niño a un servicio de salud, el uso de recetas caseras y la inmunización contra el rotavirus, que demuestra que se trata de situaciones en las que las enfermeras pueden intervenir.

Acute diarrhea in hospitalized children of the municipality of juiz de fora, MG, Brazil: prevalence and risk factors associated with disease severity / Diarreia aguda em crianças hospitalizadas no município de Juiz de Fora, MG: prevalência e fatores de risco associados à gravidade da doença

CONTEXT: Acute diarrhea is a common cause of hospitalization among children under 5 years of age. Knowing the prevalence and risk factors associated with the severity of acute diarrhea is essential to control morbidity and mortality. OBJECTIVE: Describe the prevalence of demographic, epidemiologic and clinical features of children under 6 years of age hospitalized for acute diarrhea, and investigate the association between these determinants and the severity of the diarrheic episode. METHOD: Retrospective, cross-sectional study, during the period from January, 2005 through December, 2008, in the municipality of Juiz de Fora, MG, Brazil. Files from 6,201 children from 0 to 6 years of age, hospitalized in two public teaching institutions (which account for 84% of all the hospitalizations in the municipality), were assessed. Acute diarrhea was defined as the presence of at least three evacuations of liquid or loose stools, within 24 hours, for a maximum period of 14 days. The patients with acute diarrhea were divided in two groups, according to disease severity, severe diarrhea being considered whenever hospitalization lasted for at least 4 days. Epidemiologic and clinical data were assessed and compared through the application of the chi-squared test and the binomial logistic regression model. RESULTS: The prevalence rate for admission due to acute diarrhea was 8.4%. The factors significantly associated with the severity of the diarrheic episode were: age under 6 months (P = 0.01, OR = 2.762); disease onset during fall (P = 0.033, OR = 1.742), presence of fever (P = 0.017, OR = 1.715) and antibiotic use during hospitalization (P = 0.000, OR = 3.872). CONCLUSIONS: Diarrhea is the third most common cause of hospitalization among children under 6 years of age in Juiz de Fora. Young age (under or equal to 6 months), fever, antibiotic use during hospitalization and disease onset during fall are risk factors associated with longer hospital stay.

CONTEXTO: Diarreia aguda é uma causa frequente de internação em crianças menores de 5 anos. O conhecimento da prevalência e dos fatores de risco associados à gravidade da diarreia aguda é fundamental no controle da morbimortalidade. OBJETIVO: Descrever a prevalência das características demográficas, epidemiológicas e clínicas de pacientes menores de 6 anos hospitalizados por diarreia aguda e investigar a associação entre esses determinantes e a gravidade do episódio diarreico. MÉTODO: Estudo transversal, retrospectivo, realizado no período de janeiro de 2005 a dezembro de 2008, no município de Juiz de Fora, MG. Foram avaliados 6.201 prontuários das crianças de 0 a 6 anos de idade hospitalizadas em duas instituições públicas de ensino que respondem juntas por 84% das internações no município. Diarreia aguda foi definida como presença de pelo menos três evacuações líquidas ou de consistência amolecida em 24 horas por no máximo 14 dias. Os pacientes com diarreia aguda foram divididos em dois grupos, de acordo com a gravidade do quadro e foi considerado diarreia grave o período de hospitalização maior ou igual a 4 dias. Os dados epidemiológicos e clínicos dos pacientes foram avaliados e comparados através da aplicação do teste do qui ao quadrado e do modelo de regressão logística binomial. RESULTADOS: A prevalência de internações por diarreia aguda foi de 8,4%. Os fatores que mostraram associação significativa com gravidade do episódio diarreico foram: idade inferior a 6 meses (P = 0,01, OR = 2,762); início da doença no outono (P = 0,033, OR = 1,742), presença de febre (P = 0,017, OR = 1,715) e uso de antibioticoterapia durante a internação (P = 0,000, OR = 3,872). CONCLUSÕES: Diarreia é a terceira causa de internação em crianças abaixo dos 6 anos em Juiz de Fora. Baixa idade (inferior ou igual a 6 meses), febre, uso de antibiótico na internação e início do episódio diarreico no outono são fatores de risco associados ao maior tempo de hospitalização.

User satisfaction with the Family Health Program in Vespasiano, Minas Gerais, Brazil / Satisfacción de los usuarios con el Programa de Salud Familiar en Vespasiano, Minas Gerais, Brasil

OBJECTIVE: To assess factors influencing perspectives on Brazil's national Family Health Program (PSF) by exploring satisfaction with PSF units and home-visit community health agents and perceptions about PSF unit accessibility among frequent users (primary caretakers of children under age 5) in Vespasiano, Minas Gerais. METHODS: Data were collected though cross-sectional household surveys to determine pro grammatic and demographic factors affecting user satisfaction with the PSF. Multivariate logistic modeling was used to estimate users' satisfaction with PSF units and agents and perceived access to PSF unit services. Chi-square and analysis of variance (ANOVA) tests were used to estimate statistical differences. RESULTS: The majority of caretakers were satisfied with both their PSF unit and their PSF community health agent and had received at least one monthly home visit from the health agent. Satisfaction with both the health agent and the unit was positively associated with per ceived access to the unit and frequency of agent home visits. Caretakers who reported that their PSF agent made one or more home visits per month were more likely to perceive the PSF unit as being "accessible" (or "sometimes accessible"). CONCLUSIONS: The current data are important indicators of population health in Minas Gerais, Brazil, and suggest that users' satisfaction with the PSF and perceptions about its accessibility can be improved by ensuring that all households receive at least one health agent home visit per month. These results could be applied to other parts of Brazil or Latin America to improve understanding of user perceptions of health systems.

OBJETIVO: Evaluar los factores que influyen en las perspectivas sobre el Programa de Salud Familiar (PSF) del Brasil, mediante el análisis de la satisfacción de los usuarios frecuentes del PSF (cuidadores primarios de niños menores de 5 años) con las unidades y los agentes de salud comunitarios que efectúan las visitas a domicilio, y de la percepción de dichos usuarios respecto de la accesibilidad a la unidad del PSF en Vespasiano, Minas Gerais. MÉTODOS: Se recopilaron datos mediante encuestas transversales de hogares para determinar los factores programáticos y demográficos que afectaban la satisfacción de los usuarios con el PSF. Para estimar la satisfacción de los usuarios con las unidades y los agentes de salud del PSF y su percepción sobre el acceso a los servicios prestados por la unidad del PSF se usó un modelo logístico multifactorial. Para calcular las diferencias estadísticas se usaron las pruebas de ji al cuadrado y análisis de la varianza (ANOVA). RESULTADOS: La mayoría de los cuidadores estuvieron satisfechos tanto con su unidad del PSF como con su agente de salud comunitario del programa, de quien habían recibido al menos una visita a domicilio mensual. La satisfacción con este y con la unidad se asoció positivamente con la percepción de acceso a la unidad y con la frecuencia de las visitas a domicilio del agente. Los cuidadores que informaron que su agente del PSF hizo una o más visitas al domicilio por mes presentaron mayores probabilidades de considerar a la unidad del PSF como "accesible" (o "a veces accesible"). CONCLUSIONES: Los datos actuales son indicadores importantes del estado de salud de la población en Minas Gerais, Brasil, y sugieren que la satisfacción de los usuarios con el PSF y su percepción acerca de la accesibilidad a este pueden mejorarse si se garantiza que todos los hogares reciban al menos una visita a domicilio mensual del agente de salud. Estos resultados podrían aplicarse a otras zonas del Brasil o de América Latina para comprender mejor la percepción de los usuarios sobre los sistemas de salud.

Enfermedad diarreica por rotavirus en brotes epidémicos / Diarrheal disease caused by rotavirus in epidemic outbreaks

Objetivo. Determinar el perfil epidemiológico de los brotes de enfermedad diarreica aguda por rotavirus (RV) ocurridos en pacientes pediátricos, mediante una revisión crítica de la literatura publicada entre 2000 y 2010. Métodos. Se realizó una búsqueda de artículos publicados desde enero de 2000 hasta abril de 2010, recogidos por las bases de datos Artemisa, EBSCO, Embase, Imbiomed, Lilacs, Ovid, PubMed y Science Direct. En los estudios que cumplieron con los criterios de inclusión, se identificaron posibles factores de confusión y se atribuyeron riesgos de sesgo con base en el número de ítems considerados inadecuados en cada caso. Se describieron las características epidemiológicas y microbiológicas de los brotes. Resultados. Solo 14 (10,8%) de los 129 títulos identificados formaron parte de la muestra, los cuales sumaron 91 092 casos de diarrea aguda notificados. En 5 250 de estos casos se realizó la búsqueda de RV, la cual arrojó 1 711 (32,5%) aislamientos positivos. Se observó que el RV del grupo A fue el agente causal en 100% de los brotes, mientras que el genotipo G9 fue documentado en 50% de los artículos. Conclusiones. El RV, principalmente el serotipo G9, fue uno de los principales agentes responsables de los brotes de EDA en la última década. Un cuidadoso estudio de brote puede aportar información valiosa para el control y la prevención de la enfermedad por RV.

Objective. Determine the epidemiological profile of outbreaks of acute diarrheal disease caused by rotavirus (RV) occurring in pediatric patients, based on a critical review of the literature published between 2000 and 2010. Methods. A search was carried out for articles published from January 2000 to April 2010, collected by the Artemisa, EBSCO, Embase, Imbiomed, Lilacs, Ovid, PubMed, and Science Direct databases. In the studies that met the inclusion criteria, possible confounding factors were identified and risks of bias were attributed based on the number of items considered inadequate in each case. The epidemiological and microbiological characteristics of the outbreaks were described. Results. The sample was comprised of only 14 (10.8%) of the 129 titles identified, which accounted for 91 092 reported cases of acute diarrhea. In 5 250 of these cases, a search for rotavirus was conducted, yielding 1 711 (32.5%) positive isolations. It was observed that the RV from Group A was the causative agent in 100% of the outbreaks, while genotype G9 was documented in 50% of the articles. Conclusions. Rotavirus, mainly serotype G9, was one of the principal agents responsible for outbreaks of acute diarrheal disease over the past decade. A careful outbreak study can contribute valuable information for RV disease control and prevention.