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AIM: Hormone replacement therapy with testosterone for pubertal induction in boys with congenital hypogonadotropic hypogonadism (CHH) achieves virilization but not spermatogenesis. By contrast, human chorionic gonadotropin (hCG) and recombinant follicle stimulating hormone (rFSH) provides both virilization and spermatogenesis. Fertility outcomes of boys treated with recombinant therapy during adolescence have been infrequently described. We report fertility induction and pregnancy outcomes in CHH patients treated with recombinant gonadotropins during puberty. METHODS: Data of six subjects with CHH (n = 3 Kallmann syndrome & n = 3 Isolated hypogonadotropic hypogonadism) treated with hCG and FSH for pubertal induction were reviewed. Of these, five underwent subsequent fertility induction while one desired fertility at the end of pubertal induction. RESULTS: Partners of all subjects achieved pregnancies using hCG and rFSH, all with full term live births. All infants were clinically normal. CONCLUSION: This study provides early evidence of proof of concept of use of gonadotropin induction of puberty being beneficial in subsequent fertility outcome.
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Gonadotropina Coriônica , Hipogonadismo , Adulto , Gravidez , Lactente , Feminino , Adolescente , Humanos , Masculino , Gonadotropina Coriônica/uso terapêutico , Hipogonadismo/tratamento farmacológico , Hormônio Foliculoestimulante , Testosterona/uso terapêutico , Fertilidade , Proteínas Recombinantes/uso terapêutico , Puberdade , VirilismoRESUMO
BACKGROUND: Fibrous Dysplasia/McCune-Albright Syndrome (FD/MAS) is characterized by a spectrum of manifestations that may include fibrous dysplasia of bone and multiple endocrinopathies. AIM: To describe the clinical spectrum, the study and follow-up of patients with FD/MAS cared at our institution. MATERIAL AND METHODS: Review of medical records of 12 pediatric and adult patients (11 women) who met the clinical and genetic diagnostic criteria for FD/ MAS. RESULTS: The patients' mean age at diagnosis was 4.9 ± 5.5 years. The most common initial clinical manifestation was peripheral precocious puberty (PPP) in 67% of patients and 75% had café-au-lait spots. Fibrous dysplasia was present in 75% of patients and the mean age at diagnosis was 7.9 ± 4.7 years. Ten patients had a bone scintigraphy, with an age at the first examination that varied between 2 and 38 years of age. The most frequent location of dysplasia was craniofacial and appendicular. No patient had a recorded history of cholestasis, hepatitis, or pancreatitis. In four patients, a genetic study was performed that was positive for the pathogenic variant of guanine nucleotide binding protein, alpha stimulating (GNAS). CONCLUSIONS: These patients demonstrate the variable nature of the clinical presentation and study of FD/MAS. It is essential to increase the index of diagnostic suspicion and adherence to international recommendations.
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Displasia Fibrosa Óssea , Displasia Fibrosa Poliostótica , Puberdade Precoce , Adulto , Humanos , Criança , Feminino , Pré-Escolar , Adolescente , Adulto Jovem , Displasia Fibrosa Poliostótica/diagnóstico por imagem , Displasia Fibrosa Poliostótica/genética , Chile/epidemiologia , Displasia Fibrosa Óssea/diagnóstico por imagem , Puberdade Precoce/etiologia , Puberdade Precoce/genética , Manchas Café com Leite/genéticaAssuntos
Imunização , Triagem Neonatal , Recém-Nascido , Criança , Humanos , Lactente , Esquemas de ImunizaçãoAssuntos
Aneuploidia , Humanos , Feminino , Aberrações dos Cromossomos Sexuais , Masculino , Gravidez , Diagnóstico Pré-Natal/métodos , Criança , Recém-Nascido , Pré-Escolar , LactenteRESUMO
INTRODUCTION: The most frequent cause of congenital hyperthyroidism is maternal Graves' disease (GD), in which thyroid stimulating hormone (TSH) receptor antibodies (TRAb) cross the placenta and stimulate the fetal and/or neonatal TSH receptor to produce thyroid hormones. Thyroid dys function in these patients is confirmed by increased thyroxine (T4) and triiodothyronine (T3) levels accompanied by suppressed TSH levels. OBJECTIVE: To characterize the clinical and biochemical evo lution of newborns of mothers with GD and to suggest recommendations regarding treatment and follow-up. MATERIAL AND METHOD: A literature review using the MEDLINE database was made, iden tifying scientific articles that included more than 30 neonates of mothers with GD and described their evolution. In addition, a review of the topic with an emphasis on the evaluation and management of these patients was included. RESULTS: Nine cohort studies were included, with a total of 790 pregnant women. There was high heterogeneity among the studies. A variable percentage of newborns deve loped neonatal thyrotoxicosis, which was more frequent in those patients whose mothers had high levels of TRAb. The treatment of newborns was initiated according to different criteria. The literature recommends treating cases of clinical hyperthyroidism and considers it in cases of biochemical hy perthyroidism. CONCLUSION: Children of mothers with GD and high TRAb should be evaluated due to the likelihood of developing neonatal thyrotoxicosis. It is suggested to monitor thyroid function periodically during the first month of life and treat patients with clinical and biochemical hyper thyroidism.
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Doença de Graves , Hipertireoidismo/congênito , Complicações na Gravidez , Feminino , Humanos , Hipertireoidismo/diagnóstico , Hipertireoidismo/terapia , Recém-Nascido , GravidezAssuntos
Recém-Nascido Prematuro , Glândula Tireoide , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Tireotropina , TiroxinaRESUMO
The thyroid nodule is a frequent cause of primary care consultation. The prevalence of a palpable thyroid nodule is approximately 4-7%, increasing up to 67% by the incidental detection of nodules on ultrasound. The vast majority are benign and asymptomatic, staying stable over time. The clinical importance of studying a thyroid nodule is to exclude thyroid cancer, which occurs in 5 to 10% of the nodules. The Board of SOCHED (Chilean Society of Endocrinology and Diabetes) asked the Thyroid Study Group to develop a consensus regarding the diagnostic management of the thyroid nodule in Chile, aimed at non-specialist physicians and adapted to the national reality. To this end, a multidisciplinary group of 31 experts was established among university academics, active researchers with publications on the subject and prominent members of scientific societies of endocrinology, head and neck surgery, pathology and radiology. A total of 14 questions were developed with key aspects for the diagnosis and subsequent referral of patients with thyroid nodules, which were addressed by the participants. In those areas where the evidence was insufficient or the national reality had to be considered, the consensus opinion of the experts was used through the Delphi methodology. The consensus was approved by the SOCHED board for publication.
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Consenso , Glândula Tireoide/diagnóstico por imagem , Glândula Tireoide/patologia , Nódulo da Glândula Tireoide/diagnóstico , Biópsia por Agulha Fina , Chile , Humanos , Medição de Risco , Fatores de RiscoRESUMO
BACKGROUND: Despite the low frequency of thyroid nodules (TN) in children, one of every four is malignant. Fine-needle aspiration cytology (FNAC) has a high accuracy detecting thyroid cancer. AIM: To evaluate the performance of FNAC in TN in Chilean children to detect thyroid cancer. PATIENTS AND METHODS: The pathological reports of 77 thyroidectomies and 103 FNAC carried out in patients aged less than 18 years, between 2002 and 2013 were reviewed. In 36 patients aged 15 ± 2 years (77% women), both the reports of the thyroidectomy and FNAC were available. The cytological specimens were reclassified based on Bethesda 2010. The histology was classified as benign (nodular hyperplasia and follicular adenoma, n = 18), or malignant (papillary, follicular and medullar carcinoma, n = 18). The concordance of the cytology with the final biopsy report was calculated. RESULTS: FNAC classified 13 specimens as definitively benign and 13 as definitively malignant. Among these, these concordances with the pathological study of the biopsy was 100%. Of six cytology tests considered "suspicious for follicular neoplasm" by FNAC, four were benign (67%), and two malignant (33%). Of four cytology tests considered "suggestive of carcinoma" by FNAC, one was benign (25%), and three malignant (75%). CONCLUSIONS: Among the studied children, there was a good concordance between FNAC and surgical biopsies. Therefore a FNAC should be carried out when malignancy is suspected in pediatric patients with a TN.
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Glândula Tireoide/patologia , Neoplasias da Glândula Tireoide/patologia , Adolescente , Biópsia por Agulha Fina , Criança , Feminino , Humanos , Masculino , Valor Preditivo dos Testes , Estudos Retrospectivos , Sensibilidade e Especificidade , Neoplasias da Glândula Tireoide/cirurgia , TireoidectomiaRESUMO
BACKGROUND: Waist-to-height ratio (WHtR) is a cardiometabolic risk indicator in children. A value greater than or equal to 0.55 is an effective screening tool for identifying obese children with metabolic syndrome. However, it is unclear whether this cutoff can be applied equally to any age or gender. AIM: To analyze the variability of WHtR by age, gender and pubertal stage in elementary school children. PATIENTS AND METHODS: Cross-sectional study in 2,980 school children (6-14 years old, 51% male) of Santiago, Chile. We measured weight, height and waist circumference and calculated body mass index and WHtR. Pubertal stage was assessed and classified as peripubertal (Tanner I and II) and pubertal (Tanner III, IV and V). RESULTS: The mean age was 9.9 ± 2.3 years, with no gender difference (p = 0.5). Eighty one percent of boys and 59.4% of girls were peripubertal (p < 0.001). The association between age-adjusted WHtR by gender and pubertal stage was not significant (p = 0.409). Therefore mean, standard deviation and percentiles of WHtR were calculated without sex and pubertal stage segmentations. CONCLUSIONS: Since WHtR does not vary with age, gender and pubertal status in elementary school children, it is possible to use a single cutoff value, previously defined in this population, to identify children with cardiometabolic risk.
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Obesidade/fisiopatologia , Razão Cintura-Estatura , Adolescente , Fatores Etários , Criança , Chile , Estudos Transversais , Feminino , Humanos , Masculino , Obesidade/diagnóstico , Puberdade/fisiologia , Valores de Referência , Fatores Sexuais , Fatores SocioeconômicosRESUMO
INTRODUCTION: Neonatal hyperthyroidism, often caused by maternal Graves' disease (GD), carries potential neurodevelopmental risks for children. Excessive thyroid hormones during fetal development are linked to neurological issues like ADHD and epilepsy. However, the impact of transient neonatal hyperthyroidism is not well understood. METHODS: In a retrospective study at the Royal Children's Hospital in Melbourne, 21 neonates with hyperthyroidism from mothers with GD were examined. Of these, the parents of 10 children consented to participate; thus, questionnaires assessing executive functions, behavior, and social communication were completed. The outcomes were compared to those of control subjects recruited from the community using standardized tools (BRIEF, SDQ, SCQ). The results were analyzed against socio-demographic factors, maternal, and neonatal health. RESULTS: No significant demographic or clinical differences were found between study participants (n = 10) and non-participants (n = 11). Participants, compared to controls, showed similar family demographics but a higher proportion of control parents had university-level education (p = 0.003). Patients displayed more social (SCQ scores: 12.1 ± 2.5 vs. 6 ± 1.07, p = 0.008) and behavioral difficulties (SDQ scores: 10.2 ± 2.17 vs. 6.14 ± 1.03, p = 0.03), with increased executive function challenges (BRIEF scores indicating problem-solving and self-regulation difficulties). Significant effects of family living situation and partner education level on neurodevelopmental measures were noted, underscoring the influence of socio-demographic factors. CONCLUSIONS: These findings suggest neonatal hyperthyroidism might lead to subtle neurodevelopmental variations, with socio-economic elements and family dynamics possibly intensifying these effects. While most children did not show severe impairments, early detection and intervention are recommended. The research emphasizes the necessity for inclusive care approaches that consider socio-economic factors for children affected by neonatal hyperthyroidism.
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INTRODUCTION: Pediatric thyroid nodules exhibit higher malignancy rates compared to adults and are associated with increased incidences of metastases and recurrences. The American Thyroid Association recommends surgery for indeterminate thyroid biopsies in children based on these higher malignancy risks, though this approach may lead to overtreatment. However, there remains a lack of comprehensive pediatric data to inform clinical decisions. This study examines the risk of malignancy (ROM) in pediatric thyroid nodules using the Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) and assesses the diagnostic accuracy of fine-needle aspiration biopsy (FNA) compared to histological outcomes. METHODS: A retrospective cross-sectional analysis was performed on patients under 19 years with thyroid nodules who underwent FNA and thyroidectomy at a tertiary care center. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and ROM of cytological biopsies were evaluated using TBSRTC criteria, with histology serving as the gold standard. Two analyses were conducted to assess diagnostic accuracy: (a) TBSRTC II as negative and TBSRTC VI as positive, and (b) TBSRTC II as negative with TBSRTC V and VI as positive. For neoplasia detection, TBSRTC II was deemed negative, while TBSRTC IV, V, and VI were considered positive. TBSRTC categories III and I were excluded from the performance analysis and evaluated separately. Follicular neoplasm or lesions suspicious for follicular neoplasm (FN/SFN) were treated as positive outcomes, correlated with the presence of adenoma or carcinoma in the surgical specimen. RESULTS: Of 75 nodules from 73 patients, 28 (37.3%) were benign and 47 (62.6%) malignant. No significant differences in gender or age were noted between groups. The ROM in each TBSRTC were Bethesda I 0/2, 0%; II 0/13, 0%; III 2/7, 29%: IV 6/14, 43%; V 10/10, 100%, and VI 29/29, 100%, respectively. A sensitivity of 78.38% and specificity of 100% for FNA in detecting malignancy was found, with an even higher sensitivity (100%) for detecting neoplasia in TBSRTC IV. CONCLUSIONS: This study reveals that indeterminate thyroid nodules in pediatric patients exhibit a higher rate of malignancy compared to adults, yet align with rates previously reported in the pediatric population. These findings highlight the critical need for guidelines tailored specifically to the management of thyroid nodules and thyroid cancer in children.
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BACKGROUND: Parathyroid hormone (PTH)-independent hypercalcemia in patients with chronic kidney failure is a rare and poor understood entity. CASE REPORT: We report the case of an infant with stage III chronic kidney failure secondary to multicystic dysplastic kidney disease, who presented at 3 months of life with severe hypercalcemia, suppressed PTH, and elevated PTH-related peptide. Malignancy was discarded, and the patient was treated twice with bisphosphonates with an initial partial response. During follow-up, the calcium levels descended. To date, he has maintained normal serum calcium level for 1 year after discharge. CONCLUSIONS: The presence of PTH-related peptide may play a role in hypercalcemia associated to multicystic dysplastic kidney disease possibly by the overproduction of this peptide in the kidney.
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Hipercalcemia/etiologia , Falência Renal Crônica/complicações , Rim Displásico Multicístico/complicações , Proteína Relacionada ao Hormônio Paratireóideo/sangue , Hormônio Paratireóideo/sangue , Humanos , Hipercalcemia/metabolismo , Lactente , Falência Renal Crônica/metabolismo , Masculino , Rim Displásico Multicístico/metabolismoRESUMO
OBJECTIVE: Chile is one of the few high-income countries in Latin America, being a pioneer in implementing a national newborn screening (NBS) program in 1992. Currently, it covers 98% of the population, but no long-term outcomes have been described so far. The aim of this study was to report the neurocognitive outcomes of children with congenital hypothyroidism (CH) diagnosed by the NBS program in Chile between 2005 and 2012 and to identify variables associated with the outcomes. METHODS: We performed a case-control study in children with CH born in the two largest regions of the country. The Leiter-R and TEVI-R tests were administered at home to 69 children with CH and 68 matched control subjects. Other variables affecting cognition were obtained. Multivariate logistic regression analyses were performed for Leiter-R and TEVI-R tests, using a model for cases alone and another model for cases and controls. RESULTS: No differences in Leiter-R and TEVI-R results were observed between children with CH and the control group. Children who performed better, regardless of whether they had CH, had a higher family income and more assets. CONCLUSIONS: These results suggest that the Chilean NBS program strategy results in children with normal language, attention, and memory development. Socioeconomic disadvantage represents a significant detriment in cognitive function.
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Hipotireoidismo Congênito , Estudos de Casos e Controles , Criança , Cognição , Hipotireoidismo Congênito/diagnóstico , Hipotireoidismo Congênito/epidemiologia , Humanos , Recém-Nascido , Triagem Neonatal/métodos , Classe SocialRESUMO
BACKGROUND AND OBJECTIVE: Gastrointestinal (GI) polyps with unknown malignant potential and a platelet storage pool deficiency that increases the risk of severe intraoperative and other types of bleeding have been identified in McCune-Albright syndrome (MAS). The natural course of these disorders has not been well characterized. The aim of this study was to report the follow-up of GI polyps and platelet dysfunction (PD) in a cohort of 28 patients with MAS. METHODS: Twenty-eight patients with MAS (15 females) were included. Endoscopic screening for GI polyps was undertaken in 14 subjects and 19 were tested for PD. RESULTS: Six subjects (5 males) were diagnosed with GI polyps at a median age of 23 (range 15-43) years, and were monitored for a median period of 8 (range 4.5-11.5) years. At endoscopic follow-up, the 4 patients with hamartomatous polyps at first endoscopy had either normal findings (n = 2), or duodenal gastric metaplasia (n = 2). Two patients with caecal polyps were identified. Of 8 subjects with a platelet storage pool deficiency, 5 required transfusions during surgery, and subsequent platelet cover in 2 markedly reduced intraoperative blood loss. CONCLUSIONS: New polyps with uncertain malignant potential are diagnosed after long term follow-up in MAS. Platelet cover reduces the need for red blood cell transfusion during orthopaedic surgery and may be useful to reduce non-operative bleeding events. We recommend regular upper and lower endoscopy and screening for PD in all MAS patients.
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Transtornos Plaquetários/complicações , Displasia Fibrosa Poliostótica/complicações , Pólipos Intestinais/complicações , Adolescente , Adulto , Transtornos Plaquetários/sangue , Transtornos Plaquetários/patologia , Feminino , Displasia Fibrosa Poliostótica/sangue , Displasia Fibrosa Poliostótica/patologia , Seguimentos , Humanos , Pólipos Intestinais/sangue , Pólipos Intestinais/patologia , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
INTRODUCTION: McCune-Albright syndrome (MAS) is a rare condition, in which GNAS mutations affect multiple organs. Fibrous dysplasia (FD), affecting only one or multiple skeletal territories, may severely affect craniofacial structures. Concomitant occurrence of acromegaly aggravates skull deformity, leading to eye, ear, and posterior cranial fossa compromise. CASE PRESENTATION: A 30-year-old man diagnosed with MAS at the age of 3 developed almost all known complications of the syndrome. The craniofacial component of his polyostotic FD increased over time, aggravated by difficult to control acromegaly. Acute onset of severe headache and neurologic compromise, caused by subarachnoid haemorrhage, caused his demise. Post-mortem examination revealed a meningeal artery aneurysm caused by disruption of the intracranial vasculature by severe bone disease. Adrenal histology revealed nodular hyperplasia without clinical evidence of hypercortisolism. DISCUSSION: The post-mortem findings described aid understanding of the multiorgan involvement of MAS, providing new insights into possible pathogenetic mechanisms underlying the systemic effects of GNAS mutations, and highlight a need for systematic surveillance for cerebrovascular changes in craniofacial FD that may be amenable to intervention to avoid catastrophic outcome.
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Displasia Fibrosa Poliostótica/patologia , Acromegalia/etiologia , Acromegalia/patologia , Acromegalia/terapia , Adulto , Autopsia , Evolução Fatal , Displasia Fibrosa Poliostótica/complicações , Displasia Fibrosa Poliostótica/terapia , Humanos , Masculino , Monitorização Fisiológica , Índice de Gravidade de Doença , Hemorragia Subaracnóidea/etiologia , Hemorragia Subaracnóidea/patologiaRESUMO
Background To determine the incidence of congenital hypothyroidism (CH) with a delayed increase in thyroid-stimulating hormone (TSH) levels in preterm infants and to describe the associated factors. Methods A prospective newborn screening (NBS) was conducted in 122 very low birth weight (VLBW) premature neonates born between June 2016 and September 2017. A dried blood spot thyroid stimulating hormone (TSH) level ≥15 mIU/L at 7 and 15 days of life, ≥10 in serum at the second screen or ≥5 at the third screen was defined as positive for CH. A concomitant increase in the TSH level and normal free thyroxine (T4) level was classified as hyperthyrotropinemia (HT). Results Before the first month of life, no cases of CH were identified. However, the second and third NBS identified 10 and six subjects with HT, respectively, but no cases of CH. The overall cumulative incidence of HT was 1:8. Small for gestational age (SGA) was a variable that was significantly associated with HT, even after the exclusion of patients with Down syndrome. Conclusions A high incidence of HT, but not CH, was found after the first month of life in preterm infants. Being SGA was strongly associated with having higher TSH. The need for repeating TSH screening after the first month of life in this population remains to be established.
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Hipertireoidismo/sangue , Hipertireoidismo/epidemiologia , Tireotropina/sangue , Estudos de Coortes , Hipotireoidismo Congênito/sangue , Feminino , Idade Gestacional , Humanos , Incidência , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Recém-Nascido Pequeno para a Idade Gestacional , Recém-Nascido de muito Baixo Peso , Masculino , Triagem Neonatal , Estudos Prospectivos , Tiroxina/sangueAssuntos
Adenoma/complicações , Edema/etiologia , Cervicalgia/etiologia , Neoplasias da Glândula Tireoide/complicações , Adenoma/diagnóstico por imagem , Adolescente , Diagnóstico Diferencial , Edema/diagnóstico , Feminino , Humanos , Pescoço , Cervicalgia/diagnóstico , Cintilografia , Neoplasias da Glândula Tireoide/diagnóstico por imagem , UltrassonografiaRESUMO
BACKGROUND: Fibrous Dysplasia/McCune-Albright Syndrome (FD/MAS) is characterized by a spectrum of manifestations that may include fibrous dysplasia of bone and multiple endocrinopathies. AIM: To describe the clinical spectrum, the study and follow-up of patients with FD/MAS cared at our institution. MATERIAL AND METHODS: Review of medical records of 12 pediatric and adult patients (11 women) who met the clinical and genetic diagnostic criteria for FD/ MAS. RESULTS: The patients' mean age at diagnosis was 4.9 ± 5.5 years. The most common initial clinical manifestation was peripheral precocious puberty (PPP) in 67% of patients and 75% had café-au-lait spots. Fibrous dysplasia was present in 75% of patients and the mean age at diagnosis was 7.9 ± 4.7 years. Ten patients had a bone scintigraphy, with an age at the first examination that varied between 2 and 38 years of age. The most frequent location of dysplasia was craniofacial and appendicular. No patient had a recorded history of cholestasis, hepatitis, or pancreatitis. In four patients, a genetic study was performed that was positive for the pathogenic variant of guanine nucleotide binding protein, alpha stimulating (GNAS). CONCLUSIONS: These patients demonstrate the variable nature of the clinical presentation and study of FD/MAS. It is essential to increase the index of diagnostic suspicion and adherence to international recommendations.
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Humanos , Feminino , Pré-Escolar , Criança , Adolescente , Adulto , Adulto Jovem , Puberdade Precoce/etiologia , Puberdade Precoce/genética , Displasia Fibrosa Óssea/diagnóstico por imagem , Displasia Fibrosa Poliostótica/genética , Displasia Fibrosa Poliostótica/diagnóstico por imagem , Chile/epidemiologia , Manchas Café com Leite/genéticaRESUMO
RESUMEN Objetivo: Determinar asociación entre cultura de seguridad, complejidad de pacientes e incidencia de eventos adversos (EA) asociados al cuidado de enfermería en un hospital chileno de alta complejidad. Material y Método: Estudio transversal, cuantitativo, analítico y diseño ecológico, que en 869 reportes midió los EA ocurridos entre 2014 y 2017. Se midió la cultura de seguridad con el total de enfermeros/as (95) a través del Cuestionario sobre Seguridad de los Pacientes, versión española adaptada de Hospital Survey on Patient Safety Culture, encuesta original de la Agency for Healthcare Research and Quality (AHRQ), de los Estados Unidos; la complejidad del paciente se midió según datos del Grupo Relacionado de Diagnósticos (GRD). El análisis consideró estadística descriptiva y correlaciones de Spearman y regresiones logísticas entre incidencia de EA ajustada a complejidad y cultura de seguridad. Resultados: La media de la percepción de seguridad global fue de 7,69 puntos; las dimensiones 4 (aprendizaje organizacional/mejora continua) y 5 (trabajo en equipo en la unidad/servicio) son consideradas fortalezas; la dimensión 9 (dotación de personal) una oportunidad de mejora; los servicios de mayor complejidad presentan mayor incidencia de EA y mayor cultura de seguridad; existe asociación lineal entre incidencia de EA ajustada a complejidad y clima de seguridad global (coeficiente beta=-5,11; p valor 0,004; IC 1,65-8,5). Conclusiones: Se confirma la asociación entre eventos adversos con cultura de seguridad y complejidad del cuidado. La mayor incidencia de EA se debe al mayor número de reportes y no a su mayor ocurrencia. Las instituciones de salud deben promover estrategias que incrementen el nivel de cultura de seguridad para mejorar los cuidados de enfermería y la calidad en salud.
ABSTRACT Objective: To determine the association between safety culture, the degree of complexity of the patients and the incidence of adverse events associated with nursing care in a Chilean hospital. Method: Cross-seccional study, with a quantitative approach, analytical and ecological design, which in 869 reports measured AE that occurred between 2014 - 2017. Safety culture was measured with the total number of nurses (95) through the Patient Safety Questionnaire, a Spanish version adapted from the Hospital Survey on Patient Safety Culture, an original survey from the Agency for Healthcare Research and Quality (AHRQ), from the United States; the complexity of the patient was measured according to data from the Related Group of Diagnoses (DRG). The analysis considered descriptive statistics and Spearman correlations and logistic regressions between AD incidence adjusted for complexity and safety culture. Results: The mean global security perception was 7.69 points; Dimensions 4 (organizational learning / continuous improvement) and 5 (teamwork in the unit / service) are considered strengths; dimension 9 (staffing) with opportunity for improvement; more complex services have a higher incidence of AE and a higher safety culture; There is a linear association between the incidence of AD adjusted to complexity and the global security climate (beta coefficient = -5.11; p value 0.004; CI 1.65 and 8.5). Conclusions: The association between quality culture, complexity of care and adverse events is confirmed. The higher incidence of AE is due to the greater number of reports and not to its greater occurrence. Health institutions must promote and implement strategies to increase the safety culture level in nursing personnel to improve the delivery of quality care in health.
RESUMO Objetivo: Determinar a associação entre cultura de segurança, complexidade do paciente e incidência de eventos adversos (EA) associados à assistência de enfermagem em um hospital chileno de alta complexidade. Material e Método: Estudo transversal, quantitativo, analítico e de desenho ecológico, que em 869 relatórios mediu EA ocorridos entre 2014-2017. A cultura de segurança foi medida com todos os enfermeiros (95) por meio do Questionnaire, versão em espanhol adaptada do Hospital Survey on Patient Safety Culture, pesquisa original da Agência dos Estados Unidos para Pesquisa e Qualidade em Saúde (AHRQ), a complexidade do paciente foi medida de acordo com dados do Related Group of Diagnoses (DRG). A análise considerou estatísticas descritivas e correlações de Spearman e regressões logísticas entre a incidência de DA ajustada para complexidade e cultura de segurança. Resultados: A percepção de segurança global média foi de 7,69 pontos; As dimensões 4 (aprendizagem organizacional / melhoria contínua) e 5 (trabalho em equipe na unidade / serviço) são consideradas pontos fortes; dimensão 9 (pessoal) com oportunidade de melhoria; serviços mais complexos apresentam maior incidência de EA e maior cultura de segurança; Existe uma associação linear entre a incidência de DA ajustada à complexidade e clima de segurança global (coeficiente beta = -5,11; valor de p 0,004; IC 1.65 e 8.5). Conclusões: Confirma-se a associação entre cultura de qualidade, complexidade do atendimento e eventos adversos. A maior incidência de EA se deve ao maior número de notificações e não à sua maior ocorrência. As instituições de saúde devem promover e implementar estratégias que aumentem o nível de cultura de segurança no pessoal de enfermagem para melhorar a prestação de cuidados e a qualidade em saúde.
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BACKGROUND: High sodium intake has been associated with various noncommunicable disease like hypertension, cardiovascular disease, or stroke. To estimate accurately sodium intake is challenging in clinical practice. We investigate the usefulness and limitations of assessing sodium intake simultaneously by dietary assessment and urinary samples in both children and adults. METHODS: We used a cross-sectional study design inviting 298 Chilean subjects (74 children and 222 adults) aged between 9 and 66 years of both genders. Sodium intake by dietary assessment was obtained from Chilean food composition data, based on FAO tables. Sodium and creatinine excretion were measured in 24-hour urine samples, in all participants. RESULTS: Adequate urinary collection was obtained in 81% of children (59/74) and 61% of adults (135/222). The mean sodium intake by dietary assessment was similar to the sodium excretion in 24 hours (3,121±1,153mg/d vs. 3,114±1,353mg/24h, P = nonsignificant) in children but was significantly lower (3,208±1,284mg/d vs. 4,160±1,651mg/24h, P < 0.001) in adults. In both children and adults, sodium intake correlated with urinary sodium excretion (r = 0.456, P < 0.003 and r = 0.390, P < 0.001, respectively). Secondary analyses also suggested that the dietary assessment was more inaccurate in overweight adult subjects. CONCLUSIONS: Our results showed that average sodium intake was higher than recommended in both children and adults (WHO ≤2,000mg/d). The sodium intake estimated by dietary assessment correlated with urinary excretion in all subjects, but in obese adults was more inaccurate than in children. Future studies to validate the appropriate test to assess sodium intake by age and nutritional status are warranted.