RESUMO
The impact of Coronavirus Disease 2019 (COVID-19) mRNA vaccination on pregnancy and fertility has become a major topic of public interest. We investigated 2 of the most widely propagated claims to determine (1) whether COVID-19 mRNA vaccination of mice during early pregnancy is associated with an increased incidence of birth defects or growth abnormalities; and (2) whether COVID-19 mRNA-vaccinated human volunteers exhibit elevated levels of antibodies to the human placental protein syncytin-1. Using a mouse model, we found that intramuscular COVID-19 mRNA vaccination during early pregnancy at gestational age E7.5 did not lead to differences in fetal size by crown-rump length or weight at term, nor did we observe any gross birth defects. In contrast, injection of the TLR3 agonist and double-stranded RNA mimic polyinosinic-polycytidylic acid, or poly(I:C), impacted growth in utero leading to reduced fetal size. No overt maternal illness following either vaccination or poly(I:C) exposure was observed. We also found that term fetuses from these murine pregnancies vaccinated prior to the formation of the definitive placenta exhibit high circulating levels of anti-spike and anti-receptor-binding domain (anti-RBD) antibodies to Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) consistent with maternal antibody status, indicating transplacental transfer in the later stages of pregnancy after early immunization. Finally, we did not detect increased levels of circulating anti-syncytin-1 antibodies in a cohort of COVID-19 vaccinated adults compared to unvaccinated adults by ELISA. Our findings contradict popular claims associating COVID-19 mRNA vaccination with infertility and adverse neonatal outcomes.
Assuntos
COVID-19 , Animais , Anticorpos Antivirais , COVID-19/prevenção & controle , Feminino , Feto , Produtos do Gene env , Humanos , Camundongos , Placenta/metabolismo , Gravidez , Proteínas da Gravidez , RNA Mensageiro/genética , RNA Mensageiro/metabolismo , SARS-CoV-2 , VacinaçãoRESUMO
Objetivos: realizar un análisis económico para evaluar los costos de una intervención educativa, utilizando los principios de un modelo de seguridad humana en Bateyes del suroeste de la República Dominicana. Métodos: se consideraron cuatro recursos de intervención, incluyendo la capacitación del personal, los incentivos mensuales, la supervisión de las actividades de campo y el costo total asociado al tratamiento anual de la diarrea aguda. El gasto se comparó entre el programa estándar de atención (Batey Control) y la intervención con el modelo de seguridad humana (Batey Caso). Resultados: el ahorro del costo total anual para el Ministerio de Salud de República Dominicana asociado con la reducción de la incidencia de episodios de diarrea aguda fue de US$252,399. Si se extrapolan a los 300 Bateyes de República Dominicana, se podría ahorrar aproximadamente US$75 millones en prevención de enfermedades infecciosas. Conclusiones: el modelo de seguridad humana luce ser un método eficaz para mejorar el conocimiento sobre la prevención de enfermedades y aumentar el empoderamiento de la comunidad para la movilización de recursos. Aplicada a otros entornos, la intervención podría tener una incidencia beneficiosa en las poblaciones de refugiados e indocumentados bajo el impacto de la violencia estructural.
Objectives: To conduct an economic analysis to evaluate the costs of an educational intervention, using the human security model, and potential sources of economic benefits, in Southwestern Bateyes in the Dominican Republic. Methods: Four intervention resources were considered, including staff training, monthly incentives, supervision of field activities, and total cost associated with annual treatment for acute diarrhea. The expenditure was compared between the standard program of care and the intervention using the human security model. Results: The total annual cost saving to the Dominican Republic Ministry of Health, associated with reducing the incidence of acute diarrhea episodes, was US$252,399. If this is extrapolated to the 300 Bateyes of the Dominican Republic, the Ministry of Health could save approximately US$75 million in infectious disease prevention by implementing this intervention model in these isolated rural communities. Conclusions: The educational intervention, which incorporated a human security approach, appeared to be an effective method to enhance knowledge about disease prevention and to increase empathy among community members for resource mobilization and local empowerment. Applied to other settings, the intervention could have a beneficial impact on refugee and undocumented populations under the
Assuntos
Controle de Doenças Transmissíveis , Saúde Pública , Estudos Transversais , Diarreia , República Dominicana , Fatores EconômicosRESUMO
OBJECTIVES: Characterize occupational cancer risk perceptions and attitudes toward cancer prevention practices among firefighters in the Dominican Republic. METHODS: Focus group discussions and key informant interviews were conducted in June 2019 among firefighters from three fire departments. Themes were inductively created using a qualitative descriptive approach. RESULTS: Thirty-seven firefighters were interviewed with a group mean age of 36.2â±â10.3âyears, of which 97.3% were male, and 37.1% worked at least 10âyears. Six themes emerged: 1) availability of personal protective equipment (PPE); 2) toxic exposure during fire suppression; 3) work-related stress; 4) lack of workplace health promotion activities; 5) Dominican culture impacts medical checkups; and 6) expensive medical copays limits healthcare access. CONCLUSION: Dominican firefighters are willing to adopt cancer prevention practices, however organizational barriers (ie, PPE availability, cultural barriers, and health promotion practices) limit engagement.
Assuntos
Bombeiros , Neoplasias , Exposição Ocupacional , Adulto , República Dominicana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/etiologia , Neoplasias/prevenção & controle , Exposição Ocupacional/efeitos adversos , Exposição Ocupacional/prevenção & controle , Equipamento de Proteção Individual , Pesquisa QualitativaRESUMO
OBJECTIVE: Characterize objective measurements of carcinogenic exposure using passive sampling silicone-based wristbands among Dominican firefighters. METHODS: Firefighters from a metropolitan fire service in the Dominican Republic were asked to wear a silicone-based wristband during one typical 24-hour shift. A pre- and post-shift survey collected work shift characteristics. Wristbands were processed for the type and quantity of polycyclic aromatic hydrocarbons (PAHs), a family of known carcinogenic compounds. RESULTS: Fifteen firefighters wore a wristband, of which 73.3% responded to a fire with an average of 3.7 calls during the shift. Total PAH exposure was significantly higher among firefighters who responded to a fire versus firefighters with no fire during their shift (261 parts per billion [ppb] vs 117âppb, Pâ=â0.003). CONCLUSIONS: Silicone-based wristbands as objective passive samplers documented exposure to carcinogenic compounds during a typical 24-hour firefighter shift.
Assuntos
Poluentes Ocupacionais do Ar , Carcinógenos , Bombeiros , Exposição Ocupacional , Hidrocarbonetos Policíclicos Aromáticos , Poluentes Ocupacionais do Ar/análise , Carcinógenos/análise , República Dominicana , Monitoramento Ambiental , Humanos , Exposição Ocupacional/análise , Hidrocarbonetos Policíclicos Aromáticos/análise , SiliconesRESUMO
Se trata de una revisión sistemática de una selección de artículos publicados en diferentes fuentes de información, post aparición del primer caso de 2019-nCoV en China, que incluye la información disponible a febrero 2 del año 2020 sobre diferentes aspectos clínico-epidemiológicos de la epidemia. Se incluye también un análisis comparativo de la forma de transmisión, origen, mortalidad, período de incubación y el número reproductivo básico (R0) o la velocidad con que una enfermedad puede propagarse en una población, de este nuevo coronavirus (2019-nCoV), con la evidencia disponible de estos parámetros para el SARS-CoV y el MERS-CoV, al 2 de febrero del año 2020. Se concluye recomendando la creación de unidades de salud global, lo cual podría favorecer que el sistema de salud perpetúe su impacto en los indicadores de salud de entidades de mayor prevalencia y de comportamiento endémico, mientras que, dichas unidades, orienten los esfuerzos a la implementación efectiva de las medidas de contención y prevención de brotes epidémicos en puertos de entrada y puntos estratégicos de una nación en particular, así como también mejorar la interconexión con otras unidades de similar envergadura y objetivos, en un principio, a nivel regional, pero, como fin último, a nivel global.
This is a systematic review of selected articles published in different sources of information up until February 2, 2020, including the different clinical-epidemiological aspects of the epidemic reported after the first confirmed 2019-nCoV case in China. The article also compares the new coronavirus (2019-nCoV) data as of February 2, 2020, with the available evidence and parameters documented for SARS-CoV and MERS-CoV, including its form of transmission, origin, mortality, incubation period and the basic reproductive number (R0), or the speed at which a disease is capable of spreading in a population. The report concludes by recommending the creation of global health units, which could favor the impact of our health system on the health indicators of entities with higher prevalence and endemic behavior, while reinforcing the effective preparedness efforts and containment measures for epidemic outbreaks, at entry ports and strategic points in a particular nation. The improvement of interconnections with other units of similar constitution and objectives is also recommended, initially, at regional level, but, as the ultimate goal, also globally
Assuntos
Infecções por Coronavirus , Pandemias , COVID-19 , Monitoramento Epidemiológico , Sistemas de Informação em SaúdeRESUMO
ABSTRACT Objective To describe health care workers' practical recommendations for strengthening adherence to Mycobacterium tuberculosis infection control practices in their health institutions and elsewhere across the Dominican Republic. Methods In this qualitative study, 10 focus groups, with a total of 40 clinicians (24 physicians, 16 nurses), were conducted in 2016 at two tertiary-level institutions in the Dominican Republic. Grounded theory guided the analysis to expand on health care workers' recommendations for empowering clinicians to adhere to M. tuberculosis infection control practices. To ensure reliability and validity, the authors analyzed data and incorporated both peer debriefing with qualitative experts and participant feedback or validation on the final themes. Results Six emerging themes were described: 1) education and training; 2) administrative policy; 3) infrastructure policy; 4) economic allocations; 5) research; and 6) public health policy. Conclusions Future efforts may combine the health care workers' recommendations with evidence-based strategies in M. tuberculosis infection control in low-resource settings. This could pave the way for interventions that empower health care workers in their application of M. tuberculosis infection control measures in clinical practice.
RESUMEN Objetivo Definir las recomendaciones prácticas de los trabajadores de salud para consolidar la adhesión a las prácticas de control de la infección por Mycobacterium tuberculosis en instituciones de salud y otros lugares de la República Dominicana. Métodos En este estudio cualitativo, se organizaron 10 grupos de debate, con un total de 40 trabajadores clínicos (24 médicos, 16 enfermeras), en dos instituciones de nivel terciario de la República Dominicana en el 2016. El análisis para ampliar las recomendaciones de los trabajadores de salud a fin de estimular a los trabajadores clínicos a adherirse a las prácticas de control de la infección por M. tuberculosis se basó en teoría fundamentada. Para garantizar la fiabilidad y validez de los resultados, los autores analizaron los datos e incorporaron el asesoramiento sobre el diseño y el análisis del estudio a cargo de expertos cualitativos y la verificación de la información con los participantes sobre los temas finales. Resultados Se encontraron seis temas emergentes: 1) educación y capacitación; 2) política administrativa; 3) política de infraestructura; 4) asignaciones económicas; 5) investigación; y 6) política de salud pública. Conclusiones En iniciativas futuras para el control de la infección por M. tuberculosis en entornos de escasos recursos, se pueden combinar las recomendaciones de los trabajadores de salud con estrategias basadas en evidencia. De esta forma se podría allanar el camino para llevar a cabo intervenciones que ayuden a los trabajadores de salud a aplicar las medidas de control de la infección por M. tuberculosis en la práctica clínica.
RESUMO Objetivo Descrever as recomendações dos profissionais da saúde para reforçar a adesão às práticas de controle de infecção por Mycobacterium tuberculosis nas instituições de saúde e outros locais na República Dominicana. Métodos Estudo qualitativo realizado com 10 grupos de discussão, ao todo 40 profissionais da área clínica (24 médicos, 16 enfermeiros), em duas instituições de nível terciário na República Dominicana em 2016. A análise foi baseada em teoria fundamentada para expandir as recomendações dos profissionais da saúde a fim de habilitar o pessoal da área clínica a aderir às práticas de controle da infecção por M. tuberculosis. Para assegurar a confiabilidade e a validade dos dados, os autores analisaram as informações e incluíram um processo de revisão com especialistas em pesquisa qualitativa (peer debriefing) e observações ou validação dos participantes sobre os temas finais. Resultados Seis temas emergentes foram descritos: 1) educação e capacitação, 2) política administrativa, 3) política de infraestrutura, 4) alocações financeiras, 5) pesquisa e 6) política de saúde pública. Conclusões Iniciativas futuras podem combinar as recomendações dos profissionais da saúde com estratégias baseadas em evidências para o controle de infecção por M. tuberculosis em locais com poucos recursos. Isso poderia abrir o caminho para intervenções que habilitam os profissionais da saúde a empregar medidas de controle de infecção por M. tuberculosis na prática clínica.
Assuntos
Exposição Ocupacional , Pessoal de Saúde , Grupos Focais , Transmissão de Doença Infecciosa , Teoria Fundamentada , Mycobacterium tuberculosis , República DominicanaRESUMO
OBJECTIVE Diffusion tensor imaging (DTI) parameters are able to differentiate between meningioma subtypes. The hypothesis that there is a correlation between DTI parameters and the change in tumor size after Gamma Knife radiosurgery (GKRS) was analyzed. METHODS DTI parameters were measured using MRI before GKRS in 26 patients with meningiomas. The findings were correlated with the change in tumor size after treatment as measured at the last follow-up (range 12.5-45 months). RESULTS Only those meningiomas that showed the highest fractional anisotropy (FA), the lowest spherical index of the tensor ellipsoid (Cs), and the lowest radial diffusivity (RD) either increased or remained stable in terms of volume, whereas all other meningiomas decreased in volume. The correlation between the DTI parameters (correlation values of -0.81 for FA, 0.75 for Cs, 0.66 for RD, and 0.66 for mean diffusivity) and the rate of volume change per month was significant (p ≤ 0.001). Other factors, including original tumor size, prescription dose, and patient age, did not correlate significantly. CONCLUSIONS Meningiomas that show high FA values-as well as low Cs, low RD, and low mean diffusivity values-do not respond as well to GKRS in comparison with meningiomas with low FA values. This finding might be due to their higher content level of fibrous tissue. In particular, the meningioma with the highest FA value (0.444) considerably increased in volume (by 32.3% after 37 months), whereas the meningioma with the lowest FA value (0.151) showed the highest rate of reduction (3.3% per month) in this study.
Assuntos
Imagem de Tensor de Difusão , Neoplasias Meníngeas/radioterapia , Meningioma/radioterapia , Radiocirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Neoplasias Meníngeas/patologia , Meningioma/patologia , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Radiocirurgia/métodos , Carga TumoralRESUMO
In tropical spastic paraparesis, spinal cord atrophy is a well-known finding in magnetic resonance imaging. But in contrast to histological reports, focal lesions of the spinal cord have only been described in imaging reports in exceptional acute cases. Here, we looked for such focal lesions and for alterations of diffusion tensor imaging parameters of the long fibre tracts in the usual case of a long-standing and slowly progressive disease. We examined 10 symptomatic patients, 11 seropositive, but asymptomatic human T-lymphotrophic virus type 1 carriers and 18 seronegative volunteers as controls. Sagittal and transversal T2-weighted images were visually assessed for atrophy and focal cord lesions. The spinal cord cross-sectional areas and the segmental cord volumes were measured at all levels. High-resolution diffusion tensor imaging was performed in sagittal planes from the bregma down to the cervical spine. For tractography and calculation of fractional anisotropy and mean diffusivity, we used manufacturer-provided software. Two-thirds of patients showed focal lesions affecting the antero-lateral columns and in two cases also the dorsal columns. Compared to carriers and volunteers, patients presented a significant spinal cord atrophy and a reduction of fractional anisotropy (p < 0.05), correlating more to duration of symptoms than to clinical impairment. Because our carriers did not show a significant atrophy, focal lesions or a change of diffusion tensor imaging parameters, we need further long-term studies to see if these parameters at some stage may be used as early indicators of spinal cord affection in virus carriers.
Assuntos
Doenças Assintomáticas , Atrofia/patologia , Paraparesia Espástica Tropical/patologia , Medula Espinal/patologia , Adulto , Atrofia/diagnóstico , Portador Sadio , Estudos de Casos e Controles , Imagem de Tensor de Difusão , Feminino , Vírus Linfotrópico T Tipo 1 Humano/fisiologia , Humanos , Masculino , Pessoa de Meia-Idade , Paraparesia Espástica Tropical/diagnóstico , Índice de Gravidade de DoençaRESUMO
OBJECTIVE: Couple-oriented posttest HIV counselling (COC) provides pregnant women with tools and strategies to invite her partner to HIV counselling and testing. We conducted a randomized trial of the efficacy of COC on partner HIV testing in low/medium HIV prevalence settings (Cameroon, Dominican Republic, Georgia, India). METHODS: Pregnant women were randomized to receive standard posttest HIV counselling or COC and followed until 6 months postpartum. Partner HIV testing events were notified by site laboratories, self-reported by women or both combined. Impact of COC on partner HIV testing was measured in intention-to-treat analysis. Socio-behavioural factors associated with partner HIV testing were evaluated using multivariable logistic regression. RESULTS: Among 1943 pregnant women enrolled, partner HIV testing rates (combined indicator) were 24.7% among women from COC group versus 14.3% in standard posttest HIV counselling group in Cameroon [odds ratio (OR) = 2.0 95% CI (1.2-3.1)], 23.1 versus 20.3% in Dominican Republic [OR = 1.2 (0.8-1.8)], 26.8 versus 1.2% in Georgia [OR = 29.6 (9.1-95.6)] and 35.4 versus 26.6% in India [OR = 1.5 (1.0-2.2)]. Women having received COC did not report more conjugal violence or union break-ups than in the standard posttest HIV counselling group. The main factors associated with partner HIV testing were a history of HIV testing among men in Cameroon, Dominican Republic and Georgia and the existence of couple communication around HIV testing in Georgia and India. CONCLUSION: A simple prenatal intervention taking into account the couple relationship increases the uptake of HIV testing among men in different socio-cultural settings. COC could contribute to the efforts towards eliminating mother-to-child transmission of HIV.
Assuntos
Aconselhamento Diretivo/estatística & dados numéricos , Soropositividade para HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Complicações Infecciosas na Gravidez/prevenção & controle , Adulto , Camarões/epidemiologia , República Dominicana/epidemiologia , Feminino , República da Geórgia/epidemiologia , Soropositividade para HIV/diagnóstico , Soropositividade para HIV/psicologia , Humanos , Índia/epidemiologia , Masculino , Programas de Rastreamento , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/psicologia , Cuidado Pré-Natal , Atenção Primária à Saúde , Comportamento Sexual/psicologia , Parceiros Sexuais/psicologiaRESUMO
In 1999, prevention of mother-to-child transmission (pMTCT) using antiretrovirals was introduced in the Dominican Republic (DR). Highly active antiretroviral therapy (HAART) was introduced for immunosuppressed persons in 2004 and for pMTCT in 2008. To assess progress towards MTCT elimination, data from requisitions for HIV nucleic acid amplification tests for diagnosis of HIV infection in perinatally exposed infants born in the DR from 1999 to 2011 were analyzed. The MTCT rate was 142/1,274 (11.1%) in 1999-2008 and 12/302 (4.0%) in 2009-2011 (P < .001), with a rate of 154/1,576 (9.8%) for both periods combined. This decline was associated with significant increases in the proportions of women who received prenatal HAART (from 12.3% to 67.9%) and infants who received exclusive formula feeding (from 76.3% to 86.1%) and declines in proportions of women who received no prenatal antiretrovirals (from 31.9% to 12.2%) or received only single-dose nevirapine (from 39.5% to 19.5%). In 2007, over 95% of DR pregnant women received prenatal care, HIV testing, and professionally attended delivery. However, only 58% of women in underserved sugarcane plantation communities (2007) and 76% in HIV sentinel surveillance hospitals (2003-2005) received their HIV test results. HIV-MTCT elimination is feasible but persistent lack of access to critical pMTCT measures must be addressed.
Assuntos
Fármacos Anti-HIV/uso terapêutico , Terapia Antirretroviral de Alta Atividade/métodos , Infecções por HIV/transmissão , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Adolescente , Adulto , Aleitamento Materno/efeitos adversos , Pré-Escolar , República Dominicana , Feminino , HIV/isolamento & purificação , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Lactente , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gravidez , Cuidado Pré-Natal , Carga Viral , Adulto JovemRESUMO
Objetivos: Conocer la actitud de estudiantes de odontología de Cali respecto del manejo de personas con diagnóstico de VIH/SIDA. Método: Estudio observacional descriptivo mediante aplicación de una encuesta aplicada en 1.173 estudiantes de tres facultades de odontología de Cali, clasificados en tres grupos (preclínica, clínica inicial y clínica final). Resultados: participó un 63,4 por ciento; 50 por ciento tenía menos de 20 años, 68 por ciento mujeres. 92 por ciento solteros y 82 por ciento católicos. Se encontró actitud positiva entre 86 por ciento y 92 por ciento, la disposición de atender pacientes fue más favorable en preclínica (p=0.03). Aunque 88,7 por ciento mostró disposición de atender pacientes VIH+; entre los que pensaban que sería difícil hacerlo para su personal auxiliar, se encontró 33 por ciento de estudiantes con probabilidad de hacerlo, (p= 0.03). Cuando se interrogó sobre conocimientos acerca del VIH/SIDA, 66,7 por ciento (clínica final) y 82,2 por ciento (preclínica) percibían que no habían recibido entrenamiento previo (p<0,001). Conclusiones: Se evidenció que la intención de atender pacientes VIH+ era similar a lo reportado en otros países americanos e Irlanda. Los estudiantes necesitan recibir un mejor entrenamiento con el fin de disminuir sus temores y mejorar su actitud para atenderlos.
Objective: To know attitude of students at three dental schools in Santiago de Cali, Colombia, toward HIV+ patients. Methods: This is a cross-sectional study with using a questionnaire to 1173 invited to attend students from three dental schools in Cali. Students were classified in three groups (Pre-clinic: semester I-IV; initial clinic: V to VII and last clinical: VIII to X). Results: Participation rate was 63.4 percent. 50 percent under 20 years old, 68 percent female, 92 percent single, and 82 percent Catholics. Between 86 percent and 92 percent had positive attitudes; when asked about their willingness to care patients being more favorable preclinical students (p=0.03). Although, 88.7 percent of all students showed a willingness to address HIV patients. Among those who believed that it would be difficult for assistant staff to accept treating such patients there was a 33 percent chance of doing so (p=0.003). When we asked about training to manage, between 67 percent (clinical) and 82 percent (preclinical) perceive not receiving any. Conclusions: The intention to dental care was similar to that reported in the other American countries, and Ireland. Dental students need better training, because they do not perceived adequate training, to reduce their fear and increase positive attitudes to care for HIV/AIDS patients.
Objetivos: Conhecer a atitude de estudantes de odontologia de Cali a respeito do manejo de pessoas com diagnóstico de HIV/AIDS. Método: Estudo observacional descritivo mediante aplicação de um questionário aplicado em 1.173 estudantes de três faculdades de odontologia de Cali, classificados em três grupos (pré-clínica, clínica inicial e clínica final). Resultados: participaram 63,4 por cento; 50 por cento tinham menos de 20 anos, 68 por cento mulheres. 92 por cento solteiros e 82 por cento católicos. Foi encontrada atitude positiva entre 86 por cento e 92 por cento; a disposição de atender pacientes foi mais favorável na pré-clínica (p=0.03). Ainda que 88,7 por cento mostraram disposição de atender pacientes HIV+; entre os que pensavam que sería difícil fazê-lo para o seu pessoal auxiliar, foram encontrados 33 por cento de estudantes com probabilidade de fazê-lo, (p= 0.03). Quando se interrogou a cerca de conhecimentos sobre HIV/AIDS, 66,7 por cento (clínica final) e 82,2 por cento (pré-clínica) perceberam que não haviam recebido treinamento prévio (p<0,001). Conclusões: Foi evidenciado que a intenção de atender pacientes HIV+ era similar ao reportado em outros países americanos e Irlanda. Os estudantes necessitam receber um melhor treinamento com a finalidade de diminuir seus temores e melhorar sua atitude para atendê-los.
Assuntos
Adulto Jovem , Atitude Frente a Saúde , Estudantes de Odontologia/psicologia , Infecções por HIV , Síndrome da Imunodeficiência Adquirida , Estudos Transversais , Conhecimentos, Atitudes e Prática em Saúde , Inquéritos e QuestionáriosRESUMO
OBJECTIVES: To critically assess the prevalence among schoolchildren 6 to 9 years of age throughout the Dominican Republic of a bacille Calmette-Guérin (BCG) vaccination scar, and to examine the relationship between nutritional and sociodemographic factors and the likelihood of having a BCG scar. METHODS: This correlational study used the database of the Second National Census on Height and Weight of Elementary School First Grade Students, which was conducted in the Dominican Republic August 2001-May 2002, to provide a critical assessment of BCG coverage nationwide. The Census information for the children included the presence of BCG scar, their nutritional status, and basic demographic data. We developed a new sociodemographic indicator, the "Rosa Index," to examine the potential influence of poverty and other environmental characteristics on scar presence. We used logistic regression models to predict the presence of a BCG scar. RESULTS: An overall BCG scar prevalence of 55.3 percent (85 644/154 887) was found. Malnourished children were less likely to have a BCG scar than were children with adequate nutritional status (odds ratio = 0.91; 95 percent confidence interval: 0.87, 0.95, P < 0.05). Children who were 7-9 years old were less likely to have a BCG scar than were children 6 years old. Children in the areas of the country more than two hours' driving distance from the capital city of Santo Domingo more often exhibited lower BCG scar prevalence levels than did children in Santo Domingo. A higher Rosa Index (better level of socioeconomic characteristics) was correlated with higher BCG scar prevalence values (r = 0.54, P < 0.05). CONCLUSIONS: Our study findings indicate that BCG coverage appears to be inadequate for schoolchildren in the Dominican Republic. Nevertheless, the presence of a scar in a higher proportion of younger children suggests that coverage has improved in recent years. More programmatic and economic emphasis needs...
OBJETIVOS: Evaluar críticamente la prevalencia de cicatrices por la vacunación con el bacilo de Calmette-Guérin (BCG) en niños de 6 a 9 años de la República Dominicana y examinar la relación entre los factores nutricionales y socioeconómicos y la probabilidad de tener cicatriz de BCG. MÉTODOS: Para este estudio correlacional se empleó la base de datos del II Censo Nacional de Talla y Peso en Escolares de Primer Grado de Básica, realizado en la República Dominicana entre agosto de 2001 y mayo de 2002, para evaluar críticamente el nivel de cobertura nacional de la vacunación con BCG. Entre la información censal de los niños estaban si tenían cicatriz de BCG, su estado nutricional y sus datos demográficos básicos. Se desarrolló un nuevo indicador sociodemográfico, el "índice de Rosa", para analizar la posible influencia de la pobreza y de otras características ambientales en la presencia de esa cicatriz. Se emplearon modelos de regresión logística para predecir la presencia de la cicatriz de BCG. RESULTADOS: La prevalencia general de cicatrices de BCG fue de 55,3 por ciento (85 644/ 154 887). Los niños desnutridos presentaron una menor probabilidad de tener cicatriz de BCG que los niños con un adecuado estado nutricional (razón de posibilidades = 0,91; intervalo de confianza de 95 por ciento: 0,87 a 0,95; P < 0,05). Los niños de 7-9 años tuvieron menor probabilidad de tener cicatriz de BCG que los niños de 6 años. Los niños de zonas del país que se encuentran a más de dos horas de viaje de Santo Domingo, la capital, presentaron menor prevalencia de cicatrices de BCG con mayor frecuencia que los niños de Santo Domingo. Se encontró correlación entre tener un mayor índice de Rosa (mejor nivel en las características socioeconómicas) y una mayor prevalencia de cicatrices de BCG (r = 0,54; P < 0,05). CONCLUSIONES: Los resultados del presente estudio indican que la cobertura de vacunación de escolares con la vacuna BCG parece no ser la adecuada...
Assuntos
Humanos , Criança , Vacina BCG/administração & dosagem , Cicatriz , Tuberculose/prevenção & controle , Fatores Etários , Intervalos de Confiança , República Dominicana , Modelos Logísticos , Estado Nutricional , Razão de Chances , Vigilância da População , Pobreza , Fatores SocioeconômicosRESUMO
Retrospecto EGB es una importante causa de sepsis en recién nacidos. Su prevalencia y transmisión vertical es desconocida en la República Dominicana. Métodos: En un período de dos meses, 207 embarazadas y sus hijos se incluyeron consecutivamente en el presente estudio. Después del informe de consentimiento, se realizó una entrevista estandarizada. Las muestras de las madres fueron tomadas de vagina y recto durante la labor de parto. A los recién nacidos, se les tomó de la región inguinal y conducto auditivo externo. Las muestras fueron colocadas en un medio selectivo (Caldo de Todd-Hewitt con gentamicina y ácido nalidíxico) y después de un período de incubación de 18-24 horas a 37°C, se subcultiva en agar sangre de carnero con gentamicina. Todos los estreptococos aislados fueron identificados por los métodos rutinarios y confirmados mediante pruebas serológicas. Las diferencias entre las proporciones y variables numéricas fueron determinadas usando el Chi-cuadrado y la t de Student. Resultados: A 90 (44%, 95% IC: 36.7, 50) de las embarazadas se les aisló el EGB de la vagina o el recto. De los recién nacidos, 71 (38%, 95% IC: 31.4, 45.4) resultaron colonizados con EGB antes de las 24 horas de nacimiento, y 27 (16%, 95% IC: 10.4, 51.4) tenían cultivo positivo a los 14-30 días de edad. Se observó que de las madres colonizadas (n = 90) y no colonizadas (n = 117), no hubo diferencias con relación a características demográficas, factores de riesgo y momento en que se tomó el cultivo. Los nacidos por la vía vaginal de madres colonizadas tenían seis veces más probabilidad de tener cultivo positivo para EEGB (OR = 6, 95% IC: 1.87, 19.85; P < 0.05). Conclusión: Una alta prevalencia de EGB fue observada en embarazadas. Medidas urgentes de prevención son necesarias para reducir la probabilidad de transmisión vertical del EGB y la infección en el recién nacido
Assuntos
Feminino , Gravidez , Recém-Nascido , Adolescente , Adulto , Humanos , Transmissão Vertical de Doenças Infecciosas , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/transmissão , Streptococcus agalactiae/isolamento & purificação , Estudos Transversais , República Dominicana/epidemiologiaRESUMO
Desde los años 80 ha aumentado la tasa de los aislamientos de Klebsiella pneumoniae productoras de Beta-Lactamasas de Espectro Extendido-KpBLEE- a nivel mundial. La Kp BLEE ha sido aislada en recién nacidos de la UCIN del principal hospital pediátrico de Rep. Dominicana. Fueron incluidos en este estudio 212 niños menores de 28 días de edad, hospitalizados en la UCIN del Hospital Infantil Dr. Robert Reid Cabral en un período de cuatro meses. Se tomaron hemocultivos a cada niño a su ingreso y en cualquier momento, cuando se sospechara infección. Para la identificación de los aislamientos se utilizó el sistema API 20-E (BioMerieux). La detección de BLEE se realizó por el método de difusión del doble disco. Para la confirmación de BLEE se usaron los discos de cefotaxime: cefotaxime/ácido clavulánico y ceftazidime:ceftazidime/ácido clavulánico. Toda Kp con una diferencia mayor de 5 mm entre ambos pares de discos se consideró una KpBLEE. La diferencia entre las proporciones se determinó usando las pruebas de Chi cuadrado y Fisher exacto. Ocurrieron 26 casos de infección nosocomial entre los 212 neonatos (26/212 = 12.3). De estos, en 15 se aisló K. pneumoniae (15/26 = 57.7), de las cuales 10 (67) fueron cepas productoras de BLEE. La tasa de fatalidad fue de 80 (8/10). La condición de riesgo más importante fue la prematuridad y el bajo peso al nacer. Se observó una elevada prevalencia de KpBLEE durante el período de estudio. En República Dominicana se necesitan medidas preventivas urgentes para reducir la transmisión de estas infecciones
Assuntos
Recém-Nascido , Masculino , Feminino , Humanos , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Klebsiella pneumoniae/isolamento & purificação , beta-Lactamases/isolamento & purificação , Estudos RetrospectivosRESUMO
El autor presenta las nuevas estrategias de alimentación diseñadas por la Organización Mundial de la Salud para niños VIH positivos de países en vías de desarrollo. Se expone además, la problemática actual de la transmisión del VIH de madre a hijo, sus implicaciones en países en vías de desarrollo y la necesidad del apoyo de los gobiernos de dichos países para la implementación de estas nuevas estrategias
Assuntos
Humanos , Masculino , Feminino , Infecções por HIV , Soropositividade para HIV , Nutrição dos Grupos VulneráveisRESUMO
Se investiga la presencia de agentes enteropatógenos mediante coproanálisis y coprocultivo en 132 niños con diarrea aguda de 3 a 6 años encontrándose un 74//de casos con parásitos instentinales, 29//con bacterias enteropatógenas y 4.5//con virus. Diarrea aguda. Gérmenes Enteropatógenos. Niños
Assuntos
Humanos , Masculino , Feminino , Pré-Escolar , Diarreia/microbiologiaRESUMO
Con fines de conocer la situación epidemiológica del cáncer de pene en la República Dominicana, conducimos un estudio retrospectivo-descriptivo donde se estudiaron todos los expedientes de los pacientes con cáncer de pene en el Instituto Oncológico Dr. Heriberto Pieter de Santo Domingo durante el período comprendico entre enero de 1981 y diciembre de 1991, para determinar la prevalencia del mismo de acuerdo a todas las neoplasias en hombres diagnosticadas por dicha institución. Se aplicó un cuestionario standarizado a todos los expedientes, que recogía aspectos sociodemograficos y posibles factores de riesgo, asi como aspectos clínicos. La proporción de cáncer de pene durante el período de estudio fue alta, ya que resultó ser de 6 por ciento , siendo los años de mayor impacto el 1981, 1985 y 1983 con 9.9 por ciento , 8.6 por ciento y 7.6 por ciento respectivamente. El promedio de edad de los pacientes con cáncer de pene fue de 57 años y la mayoria de ellos devengaban un salario por debajo de los 1,200 pesos mensuales reflejando un estado socioeconomico bajo-Asimismo en unas del 50 por ciento de los casos no habia ningún tipo de escolaridad