Applying the Consolidated Framework for Implementation Research to Identify Implementation Determinants for the Integrated District Evidence-to-Action Program, Mozambique.

INTRODUCTION: The Integrated District Evidence-to-Action program is an audit and feedback intervention introduced in 2017 in Manica and Sofala provinces, Mozambique, to reduce mortality in children younger than 5 years. We describe barriers and facilitators to early-stage effectiveness of that intervention. METHOD: We embedded the Consolidated Framework for Implementation Research (CFIR) into an extended case study design to inform sampling, data collection, analysis, and interpretation. We collected data in 4 districts in Manica and Sofala Provinces in November 2018. Data collection included document review, 22 in-depth individual interviews, and 2 focus group discussions (FGDs) with 19 provincial, district, and facility managers and nurses. Most participants (70.2%) were nurses and facility managers and the majority were women (87.8%). We audio-recorded all but 2 interviews and FGDs and conducted a consensus-based iterative analysis. RESULTS: Facilitators of effective intervention implementation included: implementation of the core intervention components of audit and feedback meetings, supportive supervision and mentorship, and small grants as originally planned; positive pressure from district managers and study nurses on health facility staff to strive for excellence; and easy access to knowledge and information about the intervention. Implementation barriers were the intervention's lack of compatibility in not addressing the scarcity of human and financial resources and inadequate infrastructures for maternal and child health services at district and facility levels and; the intervention's lack of adaptability in having little flexibility in the design and decision making about the use of intervention funds and data collection tools. DISCUSSION: Our comprehensive and systematic use of the CFIR within an extended case study design generated granular evidence on CFIR's contribution to implementation science efforts to describe determinants of early-stage intervention implementation. It also provided baseline findings to assess subsequent implementation phases, considering similarities and differences in barriers and facilitators across study districts and facilities. Sharing preliminary findings with stakeholders promoted timely decision making about intervention implementation.

Usability and Feasibility of an Innovative mLearning Approach for Nurses Providing Option B+ Services in Manica and Sofala Provinces, Mozambique.

The scaling of Option B+ services, whereby all pregnant women who test HIV positive are started on lifelong antiretroviral therapy upon diagnosis regardless of CD4 T-cell count, is ongoing in many high HIV burden, low-resource countries. We developed and evaluated a tablet-based mobile learning (mLearning) training approach to build Option B+ competencies in frontline nurses in central Mozambique. Its acceptability and impact on clinical skills were assessed in maternal child health nurses and managers at 20 intervention and 10 control clinics. Results show that skill and knowledge of nurses at intervention clinics improved threefold compared with control clinics (p = .04), nurse managers at intervention clinics demonstrated a 9- to 10-fold improvement, and nurses reported strong acceptance of this approach. "mLearning" is one viable modality to enhance nurses' clinical competencies in areas with limited health workforce and training budgets. This study's findings may guide future scaling and investments in commercially viable mLearning solutions.

Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique.

INTRODUCTION: Tuberculosis (TB) continues to be a leading cause of death in Sub-Saharan Africa, including Mozambique. While diagnostic methods and total notifications are improving, significant gaps remain between total numbers of TB cases annually, and the number that are notified. The purpose of this study was to elicit Mozambican patients with drug sensitive TB (DS-TB), TB/HIV and Multi drug resistant tuberculosis (MDR-TB) understanding and assessment of the quality of care for DS-TB, HIV/TB and MDR-TB services in Mozambique, along with challenges to effectively preventing, diagnosing and treating TB. MATERIALS AND METHODS: Qualitative data was collected via separate focus group discussions consisting of patients with DS-TB, TB/HIV and MDR-TB at four health centers in Sofala and Manica Province, Mozambique, to describe knowledge on TB, HIV and MDR-TB, and identify barriers to access and adherence to services and their recommendations for improvement. A total of 51 patients participated in 11 discussions. Content analysis was done and main themes were identified. RESULTS: Focus groups shared a number of prominent themes. Respondents identified numerous challenges including delays in diagnosis, stigma related with diagnosis and treatment, long waits at health facilities, the absence of nutritional support for patients with TB, the absence of a comprehensive psychosocial support program, and the lack of overall knowledge about TB or multi drug resistant TB in the community. DISCUSSION: TB patients in central Mozambique identified many challenges to effectively preventing, diagnosing and treating tuberculosis. Awareness strengthening in the community, continuous quality monitoring and in-service training is needed to increase screening, diagnosis and treatment for TB, HIV/TB and MDR-TB.

Barriers to access and adherence to tuberculosis services, as perceived by patients: A qualitative study in Mozambique

Tuberculosis (TB) continues to be a leading cause of death in Sub-Saharan Africa, including Mozambique. While diagnostic methods and total notifications are improving, significant gaps remain between total numbers of TB cases annually, and the number that are notified. The purpose of this study was to elicit Mozambican patients with drug sensitive TB (DS-TB), TB/HIV and Multi drug resistant tuberculosis (MDR-TB) understanding and assessment of the quality of care for DS-TB, HIV/TB and MDR-TB services in Mozambique, along with challenges to effectively preventing, diagnosing and treating TB. Materials and methods: Qualitative data was collected via separate focus group discussions consisting of patients with DS-TB, TB/HIV and MDR-TB at four health centers in Sofala and Manica Province, Mozambique, to describe knowledge on TB, HIV and MDR-TB, and identify barriers to access and adherence to services and their recommendations for improvement. A total of 51 patients participated in 11 discussions. Content analysis was done and main themes were identified. Results: Focus groups shared a number of prominent themes. Respondents identified numerous challenges including delays in diagnosis, stigma related with diagnosis and treatment, long waits at health facilities, the absence of nutritional support for patients with TB, the absence of a comprehensive psychosocial support program, and the lack of overall knowledge about TB or multi drug resistant TB in the community. Discussion: TB patients in central Mozambique identified many challenges to effectively preventing, diagnosing and treating tuberculosis. Awareness strengthening in the community, continuous quality monitoring and in-service training is needed to increase screening, diagnosis and treatment for TB, HIV/TB and MDR-TB

Vitamin D, not iron, is the main nutrient deficiency in pre-school and school-aged children in Mexico City: a cross-sectional study.

INTRODUCTION: In 2012, the Mexican National Health Survey showed a moderate prevalence rate of vitamin D deficiency, around 16%, in a national representative sample of children. A decreasing prevalence of anemia during the last 15 years has been observed in Mexico. The aim of this study was to determine the levels of vitamin D in children 3-8 years old in four different locations within the metropolitan area of Mexico City and to compare them to levels of iron and zinc as references of nutritional status. METHODS: One hundred and seventeen healthy children aged 3-8 years attending four hospitals in Mexico City were invited to participate. All children received medical and nutritional evaluation, and blood samples were obtained. RESULTS: Children were selected in the four hospitals between April and August 2008. More than half (51.3%) were boys; their average age was 5.5 ± 1.6 years. The mean height and weight of the children were 112.1 ± 11.2 cm and 20.2 ± 4.9 kg respectively, with a body mass index [BMI] of 15.8 ± 1.7 kg/m². The mean Z-score (BMI) was 0.007 ± 0.999. The prevalence of subjects with deficient levels of 25-OH-vitamin D (<50 nmol/l) was 24.77%. None of the children had haemoglobin levels below the anaemia threshold, and zinc determination revealed 8.26% of individuals with deficient levels (<65 µg/dL). These data confirm the findings reported in the latest National Nutrition Survey (ENSANUT 2012) about the sustained reduction of anaemia prevalence among preschool and schoolchildren since 1999 and the rising rates of vitamin D deficiency in the same population. Similar to other studies, we found a link between socioeconomic status and the deficiency of micronutrients, these being markers of better nutrition, and vitamin D is remarkably related to the quality of the diet. This finding has not been considered in our population before. CONCLUSIONS: There is evidence of a sustained decrease of anaemia in Mexican children due to general enrichment of foods and focus on vulnerable populations, while vitamin D deficiency seems to have increased. More studies are needed to obtain more information on vitamin D levels at different ages and definition of susceptible groups in order to investigate the possibility of general population measures such as enrichment, which have proven to be effective.

Prevalencia de enfermedad renal en niños aparentemente sanos con antecedente familiar de terapia de reemplazo renal / Prevalence of kidney disease in asymptomatic children with family history of renal replacement therapy

ResumenIntroducción:Se ha mencionado que tener un familiar directo con enfermedad renal es un factor de riesgo para el padecimiento. El objetivo del estudio fue conocer la prevalencia de enfermedad renal temprana en niños familiares de pacientes con enfermedad renal crónica terminal (ERCT).Métodos:Se realizó un estudio de tamiz en niños aparentemente sanos, familiares en primer o segundo grado de pacientes con ERCT en programa reemplazo renal (hemodiálisis o trasplante renal). Previa firma de consentimiento informado se realizó el examen físico completo. Se tomó una muestra de sangre para la determinación de creatinina y electrolitos séricos, así como examen general de orina.Resultado:Se incluyeron 45 sujetos, mediana de edad 9.6 años, 24 (53%) fueron varones. Se encontraron alteraciones urinarias/enfermedad renal en 11 niños (24.4%). La alteración urinaria más frecuente fue hematuria, encontrada en seis sujetos, seguida de microalbuminuria, encontrada en cuatro. Siete estaban en estadio 2 de enfermedad renal y cuatro en estadio 1.Conclusiones: El estudio de los familiares de pacientes en terapia sustitutiva renal permite identificar individuos con etapas tempranas de enfermedad renal.

AbstractBackground:Having a first- or second-degree relative with chronic kidney disease (CKD) has been reported as a risk factor for CKD development. The aim of the study was to determine the prevalence of CKD in children with a first- or second-degree relative undergoing renal replacement therapy (hemodialysis or renal transplant).Methods:A screening study was performed in asymptomatic children with a family history of CKD in a first- or second-degree relative undergoing renal replacement therapy. Informed consent was obtained in all cases. A clinical examination was performed. Blood and urine samples were obtained for serum creatinine, serum electrolytes, urinalysis, and microalbumin/creatinine ratio.Results:There were 45 subjects included with a median age of 9.6 years; 24 (53%) were male. Urinary abnormality/CKD was observed in 11 subjects (24.4%). The most common urinary abnormalities were hematuria (6/11) and microalbuminuria (4/11). Stage 2 CKD was found in seven subjects and four subjects with stage 1 CKD.Conclusions:The study of families of patients undergoing renal replacement therapy is useful to identify children in early stages of kidney disease.

Rapid response to Ebola outbreaks in remote areas - Liberia, July-November 2014.

West Africa is experiencing its first epidemic of Ebola virus disease (Ebola). As of February 9, Liberia has reported 8,864 Ebola cases, of which 3,147 were laboratory-confirmed. Beginning in August 2014, the Liberia Ministry of Health and Social Welfare (MOHSW), supported by CDC, the World Health Organization (WHO), and others, began systematically investigating and responding to Ebola outbreaks in remote areas. Because many of these areas lacked mobile telephone service, easy road access, and basic infrastructure, flexible and targeted interventions often were required. Development of a national strategy for the Rapid Isolation and Treatment of Ebola (RITE) began in early October. The strategy focuses on enhancing capacity of county health teams (CHT) to investigate outbreaks in remote areas and lead tailored responses through effective and efficient coordination of technical and operational assistance from the MOHSW central level and international partners. To measure improvements in response indicators and outcomes over time, data from investigations of 12 of 15 outbreaks in remote areas with illness onset dates of index cases during July 16-November 20, 2014, were analyzed. The times to initial outbreak alerts and durations of the outbreaks declined over that period while the proportions of patients who were isolated and treated increased. At the same time, the case-fatality rate in each outbreak declined. Implementation of strategies, such as RITE, to rapidly respond to rural outbreaks of Ebola through coordinated and tailored responses can successfully reduce transmission and improve outcomes.

[Prevalence of kidney disease in asymptomatic children with family history of renal replacement therapy]. / Prevalencia de enfermedad renal en niños aparentemente sanos con antecedente familiar de terapia de reemplazo renal.

BACKGROUND: Having a first- or second-degree relative with chronic kidney disease (CKD) has been reported as a risk factor for CKD development. The aim of the study was to determine the prevalence of CKD in children with a first- or second-degree relative undergoing renal replacement therapy (hemodialysis or renal transplant). METHODS: A screening study was performed in asymptomatic children with a family history of CKD in a first- or second-degree relative undergoing renal replacement therapy. Informed consent was obtained in all cases. A clinical examination was performed. Blood and urine samples were obtained for serum creatinine, serum electrolytes, urinalysis, and microalbumin/creatinine ratio. RESULTS: There were 45 subjects included with a median age of 9.6 years; 24 (53%) were male. Urinary abnormality/CKD was observed in 11 subjects (24.4%). The most common urinary abnormalities were hematuria (6/11) and microalbuminuria (4/11). Stage 2 CKD was found in seven subjects and four subjects with stage 1 CKD. CONCLUSIONS: The study of families of patients undergoing renal replacement therapy is useful to identify children in early stages of kidney disease.

Strengthening breast and cervical cancer control through partnerships: American Indian and Alaska Native Women and the National Breast and Cervical Cancer Early Detection Program.

The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has played a critical role in providing cancer screening services to American Indian and Alaska Native (AI/ANs) women and strengthening tribal screening capacity. Since 1991, the NBCCEDP has funded states, tribal nations, and tribal organizations to develop and implement organized screening programs. The ultimate goal is to deliver breast and cervical cancer screening to women who do not have health insurance and cannot afford to pay for these services. The delivery of clinical services is supported through complementary program efforts such as professional development, public education and outreach, and patient navigation. This article seeks to describe the growth of NBCCEDP's tribal commitment and the unique history and aspects of serving the AI/AN population. The article describes: 1) how this program has demonstrated success in improving screening of AI/AN women; 2) innovative partnerships with the Indian Health Service, state programs, and other organizations that have improved tribal public health infrastructure; and 3) the evolution of Centers for Disease Control and Prevention work with tribal communities.

Key informant interviews with coordinators of special events conducted to increase cancer screening in the United States.

Special events such as health fairs, cultural festivals and charity runs are commonly employed in the community to increase cancer screening; however, little is known about their effectiveness. The purpose of this study is to assess the activities, screening outcomes, barriers and recommendations of special events to increase breast, cervical and colorectal cancer screening. In-depth interviews were conducted nationally with 51 coordinators of events in June to September 2012. Health fairs and screening days were the most common events conducted, primarily for breast cancer education. Goals were to increase awareness of cancer screening and reach special populations. Evidence-based Community Guide strategies to increase cancer screening employed were: small media, reducing structural barriers, one-on-one education or group education. For each event that provided screening on-site or through referral, a mean of 35 breast, 28 cervical and 19 colorectal cancer screenings were reported. Coordinators made recommendations for further evaluation of special events, and most plan to conduct another special event. These data are novel and provide baseline documentation of activities and recommendations for a commonly used community-based cancer screening intervention that lacks evidence of effectiveness. Additional research to better understand the use of special events for increasing cancer screening is warranted.

Outpatient colonoscopy complications in the CDC's Colorectal Cancer Screening Demonstration Program: a prospective analysis.

BACKGROUND: To the authors's knowledge, there are few published prospective cohort studies of colonoscopy complications in patients at average risk for colorectal cancer who received colorectal cancer screening from a community-based program. In this article, the authors report the rate of colonoscopy complications in the Centers for Disease Control and Prevention (CDC)'s Colorectal Cancer Screening Demonstration Program (CRCSDP), which provided colorectal cancer screening to a medically underserved population aged 50 years to 64 years for screening, diagnostic follow-up after positive stool blood tests, and surveillance purposes. METHODS: Clinical data were collected prospectively from 5 community-based colorectal cancer screening programs. Complications were identified by reviewing the standardized clinical data and medical complication reporting forms submitted by the programs to the CDC. Serious complications were defined as conditions or symptoms that resulted in hospital admission within 30 days after the procedure, including perforation, gastrointestinal bleeding requiring or not requiring blood transfusion, cardiopulmonary events, postpolypectomy syndrome, excessive abdominal pain, or death. RESULTS: A total of 3215 individuals underwent 3355 colonoscopies. Of these, 89% of the colonoscopies were conducted for screening, 9% were conducted for diagnostic follow-up, and 2% were conducted for surveillance purposes. The mean age of the individuals was 55.9 years. Eight individuals experienced serious complications, for an incidence of 2.38 per 1000 colonoscopies. Three patients experienced bowel perforations that required surgery, 1 patient was hospitalized for postpolypectomy bleeding, 3 patients experienced cardiopulmonary events, and 1 patient visited the emergency room for excessive abdominal pain and underwent surgery for an identified colorectal mass. No deaths were reported. CONCLUSIONS: In the CDC's CRCSDP, in which a total of 3215 individuals underwent 3355 colonoscopies, the overall incidence of serious complications from colonoscopy was found to be low.

Estado nutricional de niños en condiciones críticas de ingreso a las unidades de terapia intensiva pediátrica / Nutritional status of children in critical condition at admission to pediatric intensive care units

Introducción. En México, la epidemiología del estado nutricional en pediatría ha cambiado. Actualmente, este estado se aprecia mejor cuando los pacientes ingresan a las unidades de terapia intensiva pediátrica. Métodos. Se realizó un estudio retrospectivo, de noviembre de 2002 a diciembre de 2007, en la Unidad de Terapia Intensiva Pediátrica (UTIP) del Hospital Infantil de México Federico Gómez. Se registraron los datos de la antropometría de los niños a su ingreso a la UTIP. Se calculó el estado nutricional por puntaje Z de índice de masa corporal en <2 años de edad, de acuerdo con la Organización Mundial de la Salud, y de 2 a 18 años, de acuerdo con los Centros para el Control y Prevención de Enfermedades. Resultados. Las prevalencias para desnutrición, riesgo de desnutrición, sobrepeso y obesidad para los <2 años de edad fueron de 36.2%, 24.1%, 4.6% y 4.9%, respectivamente, y para los preescolares 24.2%, 22.1%, 9.2% y 7.6%, respectivamente. En escolares, los porcentajes resultaron de 16.1% para desnutrición, 16.8% riesgo de desnutrición, 16.1% sobrepeso y 5.8% obesidad. En adolescentes, 16.2%, 16.9%, 15.6% y 2.1%, respectivamente. Conclusiones. Las enfermedades de riesgo, como la desnutrición, continúan presentes en los niños que ingresan a las unidades de terapia intensiva pediátrica. Sin embargo, otras enfermedades emergentes, como el sobrepeso y la obesidad, presentan una frecuencia alta. Esto muestra que el panorama epidemiológico de niños con enfermedades graves no es muy distinto al de la población general.

Background. In Mexico the epidemiology of the nutritional status of pediatric patients has changed. Currently, nutritional diseases are better appreciated when patients are admitted to the pediatric intensive care units. Methods. A retrospective study was conducted from November 2002 to December 2007 in the Pediatric Intensive Care Unit (PICU) at the Hospital Infantil de México Federico Gómez. We recorded anthropometric data of children upon admission to the PICU. Nutritional status was calculated according to Z-score of body mass index in children <2 years of age according to the World Health Organization and in children 2-18 years of age according to the Centers for Disease Control and Prevention. Results. Prevalence of malnutrition, risk of malnutrition, overweight and obesity for children <2 years of age was 36.2%, 24.1%, 4.6% y 4.9%, respectively, and for preschool-age children was 24.2%, 22.1%, 9.2% and 7.6%, respectively. For school-age children, the percentages were 16.1% for malnutrition, 16.8% risk for malnutrition, 16.1% overweight, and 5.8% for obesity. In adolescents these values were 16.2%, 16.9%, 15.6% and 2.1%, respectively, for malnutrition, risk of malnutrition, overweight and obesity. Conclusions. Risk for diseases such as malnutrition continues to be present in children admitted to pediatric intensive care units. However, other emerging diseases such as overweight and obesity have a high frequency. This shows that the epidemiological situation of children with serious illnesses is not very different from the general population.

Historia del Hospital de Peñaflor / History of the Hospital de Peñaflor

En el pueblo antes conocido como "El Valle de las Siete Puertas", que hoy lleva el nombre de Peñaflor, el año 1929 se inauguró una "Casa de Socorros", cerca de la Plaza de Armas, en una casona de fundo que miraba hacia la mansión de Doña Javiera Carrera Verdugo, ubicada esta última a los pies del Cerro de la Virgen, desde el que aún hoy es posible observar toda la ciudad. El señor Don Enrique Laval, Director de la Beneficencia Pública y vecino de la Comuna fue quien toma la decisión de fundar este recinto, que en 1951 se convierte en el "Hospital de Peñaflor" y abre sus dos primeras salas comunes que fueron bautizadas con los nombres de los padres del fundador, Don Ramón Laval y Doña Ema Manrique.De los muchos nombres perdidos en el tiempo rescatamos su primer personal: Director del Hospital Dr. Leonardo Monardes; Pediatra Dr. Arturo Baeza Goñi; Dentista Dr. Jorge Román Guerrero; Matrona Sra. Ismenia Inda; Enfermera Sra. Julia Silva y de colaboradores locales como los hermanos Ramón y Alejandro Larenas; Don Vicente Caro; Doña Rosalba Rodríguez; Don Manuel Abarca; Don Alejandro Pavez y Doña Mimí Faray.En 1985, el terremoto que asoló la zona central del país, destruyó la vieja casa patronal que albergaba el Hospital, cerrando un capítulo nostálgico de la historia. La reconstrucción dotó al Hospital de un nuevo edificio, que trató de conservar en su arquitectura la chilenidad del estilo, con notables mejoras en los aspectos de infraestructura y equipamiento.

[Enteral nutrition in the preterm and term newborn with low birth weight]. / Alimentación enteral en el recién nacido pretérmino y de término con bajo peso: estado actual en México.

UNLABELLED: Nutritioinal practices vary dramatically among neonatal intensive care units (NICU) in other countries. In many hospitals, nutrition is introduced gradually over the first weeks of life because the risk of necrotizing enterocolitis or nutrient intolerance is considered inevitable. Enteral nutrition practices among premature and near term infants with low birth weight were investigated. We hypothetized these practices would be very different among facilities and among staff at these same facilities. METHODS: We carried out a survey in public and private neonatal care units in urban and peri-urban areas of Mexico City. An adapted version of the Vermont-Oxford Neonatal Network was administered. We included 290 questions on practices, initiation, progression, methods, type and cessation of feedings. We also included milk feeds supplementation and written protocols. RESULTS: 116 surveys were administered in seventeen second and tertiary care facilities to 86 neonatologists and 30 neonatology residents. CONCLUSION: We found great variability in progression, methods, type, suspension and supplementation among NICU and among staff There is an urgent need to standardize nutritional criteria among physicians and medical facilities.

Alimentación enteral en el recién nacido pretérmino y de término con bajo peso: estado actual en México / Enteral nutrition in the preterm and term newborn with low birth weight

La práctica de inicio de la alimentación enteral es realizada lentamente y varía entre las unidades de cuidado intensivo neonatal (UCIN). El objetivo del estudio fue documentar las prácticas en la alimentación enteral del recién nacido de pretérmino y de término postulando que éstas variarían entre instituciones en México. Material y métodos: Se realizó una encuesta en forma abierta anónima a médicos de diferentes UCIN del área metropolitana y estados circunvecinos. La encuesta, adaptada de la Vermont Oxford Neonatal Network, contenía 290 preguntas: inicio, progresión, métodos, tipo y suplementación de la alimentación neonatal. Las respuestas fueron de acuerdo al grupo de peso, considerando a neonatos de peso extremadamente bajo (menores de 999 g), muy bajo (1000 a 1499 g) y bajo (1500 a 2499 g). Resultados: Se realizaron 116 encuestas a 86 médicos adscritos y a 30 residentes de Neonatología en 17 hospitales con UCIN Nivel II o Nivel III. Las formas, métodos y prácticas de introducir, aumentar, modificar o suspender la alimentación neonatal tuvieron mucha variación en el recién nacido pretérmino y de término con peso bajo. Sin embargo, existió una mayor uniformidad en los criterios al tratarse de neonatos de extremadamente peso bajo o en casos de neonatos con problemas graves como asfixia al nacer, requerir de apoyo ventilatorio, con apnea importante, hipotensión arterial o con datos clínicos abdominales anormales. Las formas, métodos y prácticas de introducir, aumentar, modificar o suspender la alimentación neonatal tuvieron mucha variación. Conclusiones: Se requiere unificar los criterios de alimentación en las instituciones sobre todo en los aspectos que en la actualidad se han definido como los mejores.

Nutritional practices vary dramatically among neonatal intensive care units (NICU) in other countries. In many hospitals, nutrition is introduced gradually over the first weeks of life because the risk of necrotizing enterocolitis or nutrient intolerance is considered inevitable. Enteral nutrition practices among premature and near term infants with low birth weight were investigated. We hypothetized these practices would be very different among facilities and among staff at these same facilities. Methods: We carried out a survey in public and private neonatal care units in urban and peri urban areas of Mexico City. An adapted version of the Vermont Oxford Neonatal Network was administered. We included 290 questions on practices, initiation, progression, methods, type and cessation of feedings. We also included milk feeds supplementation and written protocols. Results: 116 surveys were administered in seventeen second and tertiary care facilities to 86 neonatologists and 30 neonatology residents. Conclusion: We found great variability in progression, methods, type, suspension and supplementation among NICU and among staff. There is an urgent need to standardize nutritional criteria among physicians and medical facilities.

[Use of a preterm formula with long chain polyunsaturated fatty acids: acceptability and tolerance]. / Uso de una fórmula para prematuros adicionada con ácidos grasos poliinsaturados de cadena larga: aceptabilidad y tolerancia.

INTRODUCTION: The majority of preterm formulas have included long chain polyunsaturated fatty acids (LCPUFAS) for the relationship with visual and cognoscitive brain development. This work tried to probe the tolerance and acceptability of a preterm formula from the point of view of palatability for the LCPUFAs origin. METHODS: Infants under 37 weeks of gestational age at birth and birth weight below 2,500g with the possibility of being fed by suction and not receiving breast milk were included. Using a scale modified from "Pain Analog Scale," the nurse who was feeding the infant had to qualify the baby's facial expression at these moments. RESULTS: 50 infants with age 37.2 +/- days of life at least receiving the formula for 3 complete days were included. Ninety percent of them had weight gain each day and the third day was the most. There were no problems in number and frequency of stools. Thus, 782 evaluations by the nurses were made (15 for each patient); 66.8% of the time the infants accepted the formula with no problem; 21.1% were satisfactory; 3.7% were very satisfactory. Also, 91.8% of the nurses declared their satisfaction with the formula, and in 4 cases they declared dissatisfaction. They attributed it to the patient's pathology.

Uso de una fórmula para prematuros adicionada con ácidos grasos poliinsaturados de cadena larga: aceptabilidad y tolerancia / Use of a preterm formula with long chain polyunsaturated fatty acids: acceptability and tolerance

Introducción: la mayoría de las fórmulas para prematuros ha sido adicionada de ácidos grasos poliinsaturados de cadena larga (LCPUFAS) por su relación con el desarrollo visual y cognoscitivo del cerebro. El objetivo del trabajo fue probar la tolerancia y aceptabilidad de una fórmula de prematuros adicionada de LCPUFAS desde el punto de vista de la aceptabilidad, paleatibilidad, tolerancia y por el origen de los mismos. Material y métodos: pacientes que hubiesen tenido menos de 37 semanas de gestación y un peso al nacer menor a 2,500 g. con la posibilidad de ser alimentados por vía bucal a través de succión por al menos 3 días completos y que no recibieran seno materno por indicación médica. Se usó la escala modificada de la "Escala analógica del dolor " se solicitó a la enfermera que alimentaba al neonato que calificara la expresión facial al momento de darle la fórmula. Resultados: se incluyeron 50 pacientes con una edad de vida de 37.8 ± 18.6 días. Tuvo ganancia de peso ponderal por día 90% de ellos, siendo más importante al tercer día, no hubo problemas en cuanto a la frecuencia y número de evacuaciones. Se realizaron 782 evaluaciones (15 promedio por paciente) encontrando que en 66.8% de las veces los neonatos aceptaron la fórmula sin problema, 21.1% la aceptaron con satisfacción y un 3.7% con gran satisfacción. El 91.8% de los alimentadores se declararon satisfechos con la fórmula y en cuatro casos en los que declararon insatisfacción, ésta la relacionaron con la patología de base del paciente. Conclusiones: las fórmulas adicionadas con PUF AS presentan tolerancia, aceptabilidad y paleatibilidad adecuadas para el neonato.

Introduction: The majority of preterm formulas have included long chain polyunsaturated fatty acids (LCPUFAS) for the relationship with visual and cognoscitive brain development. This work tried to probe the tolerance and acceptability of a preterm formula from the point of view of palatability for the LCPUFAs origin. Methods: Infants under 37 weeks of gestational age at birth and birth weight below 2,500g with the possibility of being fed by suction and not receiving breast milk were included. Using a scale modified from "Pain Analog Scale, " the nurse who was feeding the infant had to qualify the baby's facial expression at these moments. Results: 50 infants with age 37.2 ± days of life at least receiving the formula for 3 complete days were included. Ninety percent of them had weight gain each day and the third day was the most. There were no problems in number and frequency of stools. Thus, 782 evaluations by the nurses were made (15 for each patient); 66.8% of the time the infants accepted the formula with no problem; 21.1% were satisfactory; 3.7% were very satisfactory. Also, 91.8% of the nurses declared their satisfaction with the formula, and in 4 cases they declared dissatisfaction. They attributed it to the patient's pathology.

Indicadores del establecimiento de la lactancia en mújeres primíparas / Indicators of the unitialization of lactancy in primiparous women

El objetivo del presente trabajo fue conocer el perfil de la mujer primípara en riesgo de no iniciar o abandonar tempranamente la lactancia, bajo la influencia de las prácticas hospitalarias, el control prenatal y la educación en salud. A partir de un banco de datos creado por tres estudios longitudinales-prospectivos en mujeres captadas desde el embarazo hasta los 6 meses postparto. El proceso utilizado fue análisis categórico multivariado. Los modelos categóricos para 907 primíparas mostraron que cuando las mujeres y sus compañeros presentan escolaridades < = a 9 años, la mujer trabaje fuera del hogar, desea alimentar con fórmula a su nuevo hijo, es soltera, además de atenderse en instituciones que no promueben la lactancia, así como no asistir a cursos de educación en salud durante el embarazo; lleva que la lactancia se establezca por abajo del 20%, porque las mujeres con este perfil, reuniendo dos o más de las características anteriores, inicia la introducción de sucedáneos antes de los 15 días de vida del niño.