A systematic review on the impact of financial insecurity on the physical and psychological well-being for people living with terminal illness.

BACKGROUND: People living with terminal illness are at higher risk of experiencing financial insecurity. The variance in definitions of financial insecurity, in addition to its impact on the well-being of this population has not yet been systematically analysed. AIM: To understand the definition, prevalence and impact of financial insecurity on the physical and psychological well-being of people living with terminal illness. DESIGN: A systematic review with a narrative synthesis (prospectively registered; CRD42023404516). DATA SOURCES: Medline, Embase, CINAHL, AMED, PsycINFO, ProQuest Central and Cochrane Central Register of Controlled Trials, from inception to May 2023. Included studies had to measure or describe the impact of financial insecurity on an aspect of participants' physical or mental well-being. Study quality was assessed using the Hawker tool. RESULTS: A total of 26 studies were included in the review. Financial insecurity was defined using many different definitions and terminology. Out of 4824 participants, 1126 (23%) reported experiencing high levels of financial insecurity. Nine studies reported 21 unique analyses across three domains of physical well-being. Out of those 21 analyses, 10 (48%) reported a negative result (an increase in financial insecurity was reported with a decrease in physical well-being). Twenty-one studies reported 51 unique analyses across nine domains of psychological well-being. Out of these analyses, 35 (69%) reported a negative result (an increase in financial insecurity was reported with a decrease in psychological well-being). CONCLUSIONS: People living with terminal illness require support with their financial situation to ensure their well-being is not negatively impacted by financial insecurity.

Actual cost of electricity: An economic index to overcome levelized cost of electricity limits.

The selection of renewable energy technologies is widely based on the economic index levelized cost of electricity (LCOE). However, the LCOE ignores the potential temporal mismatch between electricity generation and actual grid demand: this aspect is accounted for in the new index named actual cost of electricity (ACOE), here proposed. This index provides a more accurate economic assessment of renewable energy, minimizing the number of assumptions to be made and outlining the benefits of including a storage. The proposed index is tested across ten cases encompassing three renewable technologies: wind, photovoltaic, and concentrated solar power. The outcomes show that the actual renewable electricity generation of a plant can be reduced by 40%-50% when accounting for the actual electricity demand, resulting in an ACOE exceeding the LCOE by up to 100/150 $/MWh. In addition, the ACOE enables the identification of breakthrough conditions that make storage adoption economically feasible.

Adaptation of the technology readiness levels for impact assessment in implementation sciences: The TRL-IS checklist.

Background: Intervention development is a critical process in implementation research. There are key stages involved in the process to design, pilot, demonstrate and release a technology or an intervention. The Technology Readiness Level (TRL) is a globally accepted instrument for assessing the maturity of research development. However, the original levels do not fit all, and some adjustments are required for its applicability in implementation sciences. Aims: This study aimed to gather the prior knowledge base on TRL in public and population health research; to develop a standard definition of readiness, and to adapt and validate the TRL to an implementation science context (TRL-IS). Materials and methods: A Mixed methods approach has been followed in this study. A scoping review using the PRISMA extension (PRISMA-ScR) informed a nominal expert panel for developing a standard definition of readiness and to modify the TRL following an ontoterminology approach. Then the maturity of six practical case study examples were rated by ten researchers using the modified TRL to estimate inter-rater reliability, and a group of experts provided final content and face validity and feasibility.This mixed methods study included 1) a scoping review to examine the current literature and develop a knowledge base, identify knowledge gaps and to clarify concepts; 2) the development of a standard definition of 'Readiness' and related terms; and 3) adaptation of the TRL to implementation science and development of a checklist to rate the maturity of applications.A standard definition of readiness and related terms was produced by the core team, and an international nominal group (n = 30) was conducted to discuss and validate the definition and terms, and the location of 'Readiness' in the initiation and early development phases of implementation.Following feedback from the nominal group, the development of the TRL-IS was finalised and a TRL-IS rating checklist was developed to rate the maturity of applications. The TRL-IS checklist was tested using six cases based on real world studies on implementation research.The inter-rater reliability of the TRL-IS was evaluated by ten raters and finally six raters evaluated the content and face validity, and feasibility, of the TRL-IS checklist using the System Usability Scale (SUS). Results: Few papers (n = 11) utilised the TRL to evaluate the readiness of readiness of health and social science implementation research. The main changes in the adaption of the TRL-IS included the removal of laboratory testing, limiting the use of "operational" environment and a clearer distinction between level 6 (pilot in a relevant environment) and 7 (demonstration in the real world prior to release). The adapted version was considered relevant by the expert panel. The TRL-IS checklist showed evidence of good inter-rater reliability (ICC = 0.90 with 95 % confident interval = 0.74-0.98, p < .001) and provides a consistent metric. Conclusions: In spite of recommendations made by national and international research funding agencies, few health and social science implementation studies include the TRL as part of their evaluation protocol. The TRL-IS offers a high degree of conceptual clarity between scientific maturity phases or readiness levels, and good reliability among raters of varying experience. This study highlights that adoption of the TRL-IS framework in implementation sciences will bolster the scientific robustness and comparability of research maturity in this domain.

Mental health among adolescents exposed to social inequality in Latin America and the Caribbean: a scoping review.

Background and objective: Adolescents from Latin America and the Caribbean grow up in a context of social inequality, which diminishes their well-being and leads to impaired emotional-cognitive development. To understand the problem, it is important to synthesize the available research about it. This study aims to explore the knowledge about adolescents' mental health in Latin America and the Caribbean exposed to social inequality. Methods: A systematic scoping review was conducted encompassing a search in five databases (Medline, CINAHL, PsycINFO, Scopus, and LILACS) in June 2022. Articles of various typologies were included without time limit. After two rounds of screening, relevant data were manually extracted and synthesized into self-constructed themes using thematic analysis. Results: Out of 8,825 retrieved records, 42 papers were included in the final review, with a predominance of quantitative approaches. The synthesis revealed two main analytical themes: (a) defining social inequality, wherein intersecting inequalities produce discrimination and determine conditions for social vulnerability; (b) social inequality and mental health, which highlights the association between socio-structural difficulties and emotional problems, amplifying vulnerability to mental ill health and poor mental health care. Conclusion: The scientific evidence reveals that social inequality is related to impaired well-being and mental ill health on the one hand and a lack of access to mental health care on the other hand.

Modifying effect of urban parks on socioeconomic inequalities in diabetes prevalence: a cross-sectional population study of Madrid City, Spain.

BACKGROUND: Evidence has shown contradicting results on how the density of urban green spaces may reduce socioeconomic inequalities in type 2 diabetes (equigenic hypothesis). The aim of this study is to test whether socioeconomic inequalities in diabetes prevalence are modified by park density. METHODS: We designed a population-wide cross-sectional study of all adults registered in the primary healthcare centres in the city of Madrid, Spain (n=1 305 050). We obtained georeferenced individual-level data from the Primary Care Electronic Health Records, and census-tract level data on socioeconomic status (SES) and park density. We modelled diabetes prevalence using robust Poisson regression models adjusted by age, country of origin, population density and including an interaction term with park density, stratified by gender. We used this model to estimate the Relative Index of Inequality (RII) at different park density levels. FINDINGS: We found an overall RII of 2.90 (95% CI 2.78 to 3.02) and 4.50 (95% CI 4.28 to 4.74) in men and women, respectively, meaning that the prevalence of diabetes was three to four and a half times higher in low SES compared with high SES areas. These inequalities were wider in areas with higher park density for both men and women, with a significant interaction only for women (p=0.008). INTERPRETATION: We found an inverse association between SES and diabetes prevalence in both men and women, with wider inequalities in areas with more parks. Future works should study the mechanisms of these findings, to facilitate the understanding of contextual factors that may mitigate diabetes inequalities.

Assessment of census-tract level socioeconomic position as a modifier of the relationship between short-term PM2.5 exposure and cardiovascular emergency department visits in Missouri.

INTRODUCTION: Ambient particulate matter ≤ 2.5 µm in aerodynamic diameter (PM2.5) exposure elevates the risk for cardiovascular disease morbidity (CVDM). The aim of this study is to characterise which area-level measures of socioeconomic position (SEP) modify the relationship between PM2.5 exposure and CVDM in Missouri at the census-tract (CT) level. METHODS: We use individual level Missouri emergency department (ED) admissions data (n=3 284 956), modelled PM2.5 data, and yearly CT data from 2012 to 2016 to conduct a two-stage analysis. Stage one uses a case-crossover approach with conditional logistic regression to establish the baseline risk of ED visits associated with IQR changes in PM2.5. In the second stage, we use multivariate metaregression to examine how CT-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM. RESULTS: We find that overall, ambient PM2.5 exposure is associated with increased risk for CVDM. We test effect modification in statewide and urban CTs, and in the warm season only. Effect modification results suggest that among SEP measures, poverty is most consistently associated with increased risk for CVDM. For example, across Missouri, the highest poverty CTs are at an elevated risk for CVDM (OR=1.010 (95% CI 1.007 to 1.014)) compared with the lowest poverty CTs (OR=1.004 (95% CI 1.000 to 1.008)). Other SEP modifiers generally display an inconsistent or null effect. CONCLUSION: Overall, we find some evidence that area-level SEP modifies the relationship between ambient PM2.5 exposure and CVDM, and suggest that the relationship between air-pollution, area-level SEP and CVDM may be sensitive to spatial scale.

Evaluating the social benefits and network costs of heat pumps as an energy crisis intervention.

Fuel poverty, a pressing issue affecting social prosperity, has been exacerbated during the energy crisis triggered by the Russia-Ukraine conflict. This problem can be more severe for off-gas regions. Our study investigates heat pumps (HPs) as a cost-effective alternative to off-gas heating to alleviate fuel poverty in England and Scotland. We analyze regional fuel poverty rates and the associated greenhouse gas emission reduction by replacing all off-gas heating with HPs, observing positive effects under pre-crisis and crisis conditions, with existing government support for HP upfront costs. HP rollout can burden distribution networks especially for certain regions, but our correlation analysis shows that high benefits do not always come with network costs at the regional level, and we identify "priority" regions with low costs and high benefits. These findings provide valuable insights for policymakers to address fuel poverty and reach decarbonization. The methodology is adaptable to other countries with appropriate datasets.

Ambient air pollution is associated with graft failure/death in pediatric liver transplant recipients.

Children exposed to disproportionately higher levels of air pollution experience worse health outcomes. In this population-based, observational registry study, we examine the association between air pollution and graft failure/death in children following liver transplantation (LT) in the US. We modeled the associations between air pollution (PM2.5) levels localized to the patient's ZIP code at the time of transplant and graft failure or death using Cox proportional-hazards models in pediatric LT recipients aged <19 years in the US from 2005-2015. In univariable analysis, high neighborhood PM2.5 was associated with a 56% increased hazard of graft failure/death (HR: 1.56; 95% CI: 1.32, 1.83; P < .001). In multivariable analysis, high neighborhood PM2.5 was associated with a 54% increased risk of graft failure/death (HR: 1.54; 95% CI: 1.29, 1.83; P < .001) after adjusting for race as a proxy for racism, insurance status, rurality, and neighborhood socioeconomic deprivation. Children living in high air pollution neighborhoods have an increased risk of graft failure and death posttransplant, even after controlling for sociodemographic variables. Our findings add further evidence that air pollution contributes to adverse health outcomes for children posttransplant and lay the groundwork for future studies to evaluate underlying mechanisms linking PM2.5 to adverse LT outcomes.

The impact of open access mandates on scientific research and technological development in the U.S.

Getting to a net-zero emissions economy requires faster development and diffusion of novel clean energy technologies. We exploit a rare natural experiment to study the impact of an open-access mandate on the diffusion of scientific research into patented technologies. From 2014 onwards, the U.S. Department of Energy (DOE) required its 17 National Laboratories (NLs) to publish all peer-reviewed scientific articles without a paywall. Using data from more than 300,000 scientific publications between 2012 and 2018, we show that scientific articles subject to the mandate were used on average 42% more in patents, despite embargo periods of up to 12 months. We also show that articles subject to the mandate were not cited more frequently by other academic articles. Our findings suggest that the mandate primarily contributed to technological development but has not led to additional academic research. Lastly, we show that small firms were the primary beneficiaries of the increased diffusion of scientific knowledge.

Scope and financial impact of unpublished data and unused samples among U.S. academic and government researchers.

Unpublished data and unused samples are common byproducts of research activity, but little is known about the scope and economic impact of their disuse. To fill this knowledge gap, we collected self-reported anonymous survey responses from 301 academic and government scientists from randomly selected institutions. Respondents estimated that they published ∼60% of their data and 95% had unpublished data. Of those collecting specimens, 60% stored unused samples. Systemic and logistical issues were identified as major contributory factors. The median cumulative self-reported estimated value of unused resources per researcher was $28,857, with life science ($36k) and government ($109k) researchers reporting the costliest assets. Using NSF headcounts, we estimated that the current cumulative value of unused resources at universities is approximately $6.2 billion, about 7% of the current annual R&D budget. These findings provide actionable information that can be used by decision makers to reduce obstacles that undermine scientific progress and productivity.

Racial and ethnic differences in the availability of community medical services after leaving prison.

INTRODUCTION: Incarcerated individuals experience increased health problems, presenting additional challenges as they leave prison and re-enter the community. These challenges are disproportionally experienced by racial and ethnic minorities. Despite these trends, little is known regarding the availability of medical services within the communities to which incarcerated individuals return. METHODS: We examined all prison returns in the state of Florida between 2008 and 2017. We examined the odds of returning from prison to a community that is formally designated as medically underserved by the Health Resources and Services Administration. We also examined whether Florida communities with a greater proportion of racial and ethnic minority returns were more likely to be designated as medically underserved. RESULTS: Overall, each SD increase in community return rate resulted in a 20% increase in the odds of medical underservice designation. For each SD increase in the proportion of black and Latino returns, the odds of medical underservice designation increased by 50% and 14%, respectively, compared with the proportion of white returns. DISCUSSION: Within Florida, previously incarcerated individuals are more likely to return to communities with limited availability of medical services. These findings are even more pronounced for communities with more black returnees. Previously incarcerated individuals are more likely to return to communities that lack the medical infrastructure required to address their unique healthcare needs, potentially leading to worsened health, and increased racial and ethnic health disparities.

Long-term association between neighbourhood socioeconomic deprivation in early childhood and perceived stress in early adulthood: a multilevel cohort study.

BACKGROUND: Previous studies have shown that neighbourhood socioeconomic deprivation is related to mental health problems, with chronic stress responses as one possible biopsychological pathway; however, less is known about the possible long-term effects of neighbourhood deprivation throughout the life course. The aim of this study was to examine the association between neighbourhood socioeconomic deprivation in early childhood and perceived stress in early adulthood. METHODS: Data from the, Danish National Health Survey 2017 in which Cohen's 10-item Perceived Stress Scale was measured (range 0-40) were used to follow a cohort consisting of all survey respondents aged 20-24 years born between 1992 and 1996. The respondents were linked to Danish register data, including data on the parent(s) with whom the respondents lived, to measure family-level socioeconomic characteristics, parental mental health problems and neighbourhood socioeconomic deprivation at age 3 for each respondent. Furthermore, the respondents were linked to georeferenced neighbourhoods. Linear mixed models were used to estimate the association between neighbourhood socioeconomic deprivation at age 3 and perceived stress at age 20-24. RESULTS: A 1 SD increase in neighbourhood socioeconomic deprivation in early childhood was associated with a 0.59-point increase in perceived stress in early adulthood (95% CI 0.41 to 0.77). The association was attenuated but remained statistically significant after controlling for individual and family characteristics and neighbourhood socioeconomic deprivation in early adulthood (coef 0.26, 95% CI 0.06 to 0.46). CONCLUSION: The findings suggest that children growing up in more socioeconomically deprived neighbourhoods may be prone to higher levels of perceived stress later in life.

CLC Estimator: A Tool for Latent Construct Estimation via Congeneric Approaches in Survey Research.

This article proposes the Shiny app 'CLC Estimator' -Congeneric Latent Construct Estimator- to address the problem of estimating latent unidimensional constructs via congeneric approaches. While congeneric approaches provide more rigorous results than suboptimal parallel-based scoring methods, most statistical packages do not provide easy access to congeneric approaches. To address this issue, the CLC Estimator allows social scientists to use congeneric approaches to estimate latent unidimensional constructs smoothly. The present app provides a novel solution to the challenge of limited access to congeneric estimation methods in survey research.

Austerity, economic hardship and access to medications: a repeated cross-sectional population survey study, 2013-2020.

BACKGROUND: In Finland, austerity measures included an increase in medication and healthcare copayments and a decrease in many social security allowances. This study examines whether austerity coincided with an increase in socioeconomic inequality in access to medications (going short of medications because of lack of money) and whether medication access problems increased more than other forms of economic hardship (going short of food or physician visits). METHODS: Pooled cross-sectional population surveys collected in 2013-2015, 2018 and 2020 (n=139 324) and multinomial logistic regression, with interaction between study year and economic activity (EA) (full-time work vs part-time work/retirement; old age retirement; unemployment; disability/illness; family; student), were used to estimate the effect of EA on the probability of experiencing economic hardship (no hardship/hardship including medication problems/hardship excluding medication problems) and how it varies across years. RESULTS: Working-age adults outside full-time employment have a higher risk of economic hardship than full-time workers, and old age retirees have a lower risk. In 2018, when austerity was most pronounced, economic hardship including medication problems increased for the disabled/ill (women and men), unemployed (women) and part-time workers/retirees (men), significantly more than for full-time workers. Hardship excluding medication access problems either decreased or remained unchanged. CONCLUSION: Austerity coincided with increasing economic hardship among vulnerable groups, thus exacerbating socioeconomic inequalities. Strengthening the role for medication access problems suggests that medication copayment increases contributed to this accumulating disadvantage.

Bayes factor testing of equality and order constraints on measures of association in social research.

Measures of association play a central role in the social sciences to quantify the strength of a linear relationship between the variables of interest. In many applications researchers can translate scientific expectations to hypotheses with equality and/or order constraints on these measures of association. In this paper a Bayes factor test is proposed for testing multiple hypotheses with constraints on the measures of association between ordinal and/or continuous variables, possibly after correcting for certain covariates. This test can be used to obtain a direct answer to the research question how much evidence there is in the data for a social science theory relative to competing theories. The stand-alone software package 'BCT' allows users to apply the methodology in an easy manner. The methodology will also be available in the R package 'BFpack'. An empirical application from leisure studies about the associations between life, leisure and relationship satisfaction and an application about the differences about egalitarian justice beliefs across countries are used to illustrate the methodology.

Building climate resilience, social sustainability and equity in global fisheries.

Although the Paris Agreement establishes targets to limit global warming-including carbon market mechanisms-little research has been done on developing operational tools to achieve them. To cover this gap, we use CO2 permit markets towards a market-based solutions (MBS) scheme to implement blue carbon climate targets for global fisheries. The scheme creates a scarcity value for the right to not sequester blue carbon, generating an asset of carbon sequestration allowances based on historical landings, which are considered initial allowances. We use the scheme to identify fishing activities that could be reduced because they are biologically negative, economically inefficient, and socially unequitable. We compute the annual willingness to sequester carbon considering the CO2e trading price for 2022 and the social cost of carbon dioxide (SC-CO2), for years 2025, 2030 and 2050. The application of the MBS scheme will result in 0.122 Gt CO2e sequestered or US$66 billion of potential benefits per year when considering 2050 SC-CO2. The latter also implies that if CO2e trading prices reach the 2050 social cost of carbon, around 75% of the landings worldwide would be more valuable as carbon than as foodstuff in the market. Our findings provide the global economy and policymakers with an alternative for the fisheries sector, which grapples with the complexity to find alternatives to reallocate invested capital. They also provide a potential solution to make climate resilience, social sustainability and equity of global fisheries real, scientific and practical for a wide range of social-ecological and political contexts.

Does climate action bring peace? Assessing the geopolitics of renewables using global investment data.

The transition toward renewables is central to climate action. The paper empirically tests whether renewables also enhance international peace, a hypothesis discussed in the International Political Economy (IPE) of renewables literature. It develops and tests hypotheses about the pacifying effects of renewables, with a view to establishing the foundations for analyzing more detailed causal mechanisms. These mechanisms rest on the 'energy democracy' debate, suggesting that a low carbon world sees less interstate tension thanks to more states being democratic; the 'capitalist peace' theorem, establishing that the deployment of renewables brings about economic development, reducing conflict; and the human security literature, positing that renewables reduce local-level reduce vulnerabilities, thus enhancing social stability and reducing violence. Using a longitudinal dataset on global renewable energy investment, econometric tests suggest that distributed renewable energy systems do not seem to foster democratic rule, nor do they have a significant influence on human development. Countering the energy democracy literature, it is a higher concentration of renewable investment that tends to increase stability/ absence of violence and human development, instead of decentralized investment patterns. We find no evidence for the 'peace through prosperity' argument. Overall, there is no support for the assumption that renewables bring about peace and reduce conflict. The paper critically discusses the limitations of these findings and suggests further avenues for empirical research.

Bioethics and sociology: the place of social studies of science and technology / Bioética e sociologia: o lugar dos estudos sociais da ciência e tecnologia / Bioética y sociología: el lugar de los estudios sociales de la ciencia y tecnología

The social sciences have integrated the analytical and normative practices of bioethics. However, with some exceptions, the proposals have been epistemically limited to the methodological scope and strictly directed to biomedical care practices. Taking some data on the strategies of production of new drugs by the pharmaceutical industry, this essay intends to demonstrate the possible contributions of the social studies of science and technology to a theoretical-methodological foundation of bioethical analyzes around global health issues, such as the production and distribution of technologies. We conclude that at least three types of analyzes would benefit from this proximity: analyzes of the epistemological integrity of the health sciences; ethical-political analyzes around the access and security of new and old health technologies; and ethical-philosophical analyzes of harmful attitudes of the scientific community and health professionals in relation to health care.(AU)

As ciências sociais têm integrado as práticas analíticas e normativas da bioética. No entanto, com algumas exceções, as propostas têm sido epistemicamente limitadas ao âmbito metodológico e estritamente direcionadas às práticas de cuidado biomédico. Tomando alguns dados sobre as estratégias de produção de novos medicamentos pela indústria farmacêutica, este ensaio pretende demonstrar as possíveis contribuições dos estudos sociais da ciência e tecnologia para uma fundamentação teórico-metodológica das análises bioéticas em torno de questões globais em saúde, tais como a produção e distribuição de tecnologias. Concluímos que pelo menos três tipos de análises se beneficiariam dessa proximidade: análises da integridade epistemológica das ciências da saúde; análises ético-políticas em torno do acesso e segurança de novas e antigas tecnologias em saúde; e análises ético-filosóficas de posturas nocivas da comunidade científica e dos profissionais de saúde em relação à assistência à saúde.(AU)

Las ciencias integran las prácticas analíticas y normativas de la bioética. Sin embargo, con algunas excepciones, las propuestas han sido epistémicamente limitadas al ámbito metodológico y rigurosamente dirigidas a las prácticas del cuidado biomédico. Tomando algunos datos sobre las estrategias de producción de nuevos medicamentos por la industria farmacéutica, este ensayo pretende demostrar las posibles contribuciones de los estudios sociales de la ciencia y la tecnología para una fundamentación teórico-metodológica de los análisis bioéticos sobre de cuestiones globales de salud, tales como la producción y distribución de tecnologías. Concluimos que al menos tres tipos de análisis se beneficiarían de esa proximidad: análisis de la integridad epistemológica de las ciencias de la salud, análisis ético-políticos sobre el acceso y la seguridad de nuevas y antiguas tecnologías de salud y análisis ético-filosóficos de posturas nocivas de la comunidad científica y de los profesionales de salud con relación a la asistencia de la salud.(AU)

Assessment of diagnosis and treatment practices of diarrhoea in children under five in Maputo-Mozambique.

Background: Although diagnosis and treatment of diarrhoea are considered easy, statistics show that 525,000 children worldwide die annually due to diarrhoea, 90% of the deaths are in Sub-Saharan Africa and South Asia, and Mozambique account for 6.9%. Assessment of practices of diagnosis and treatment of diarrhoea in children under five were con-ducted in Maputo, Mozambique. Design and method: The study was retrospective - source of information: record books from 2015 to 2019. All statements about age, gender, signs and symptoms, diagnoses, and treatment were collected to assess practices implemented by the health professionals to diagnose diarrhoea in children under five. Results: A total of 9,041 cases were found, where 4,052 (44, 8 %) were female, urban area accounts for 7,668 (74.8 %). Children younger than 6 months 1,013 (11,2%); from 6 to 11 months 1,370 (15,2%); from 12 to 23 months 2,535 (28 %); from 24 to 35 months 1,674 (18.5 %), from 36 to 47 months 1,239 (13.7 %) and from 48 to 59 months 1,210 (13.4 %). About 3,644 (40.3 %) had fever, 3,467 (38 %) vomit, 1,999 (22 %) blood in stool and other symptoms; only 5 (1 %) of the children's stools were submitted for laboratory analysis. The clinical diagnoses were diarrhoea 3,905 (43 %), diarrhoea and vomit 2,037(22 %) and others. The main treatment was oral rehydration salts 7,118 (79 %) and 21 % antibiotics. Conclusion: Even when the signs and symptoms (fever and blood in stool) suggested or required laboratory exams, this was not done. Nevertheless, the children were treated with antibiotic without the screening of etiological agent.