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Introducción. El descenso de las coberturas de vacunación fue muy significativo en la última década. Los pediatras son una pieza fundamental para recuperar coberturas y aumentar la confianza en la vacunación. Objetivos. Describir la percepción de los pediatras acerca del conocimiento y prácticas sobre vacunas, e identificar barreras en el acceso. Métodos. Estudio analítico observacional, mediante encuesta en línea. Se incluyeron variables del perfil del profesional, capacitación y barreras en inmunizaciones. Resultados. Participaron 1696 pediatras (tasa de respuesta: 10,7 %), media de 50,4 años. El 78,7 % fueron mujeres. El 78,2 % contaba con ≥10 años de ejercicio profesional. El 78,4 % realizaba atención ambulatoria y el 56,0 % en el subsector privado. El 72,5 % realizó una capacitación en los últimos 2 años. Se manifestaron "capacitados" para transmitir a sus pacientes los beneficios de las vacunas: 97,2 %; objetivos de campañas: 87,7 %; contraindicaciones: 82,4 %; efectos adversos: 78,9 %; recupero de esquemas: 71,2 %; notificación de ESAVI: 59,5 %. La proporción fue estadísticamente superior, en todos los aspectos, en pediatras con ≥10 años de ejercicio y en aquellos con capacitación reciente (p ≤ 0,01). Barreras identificadas en el acceso a la vacunación: falsas contraindicaciones (62,3 %); falta temporaria de vacunas (46,4 %); motivos culturales (41,4 %); horario restringido del vacunatorio (40,6 %). Conclusiones. La percepción del grado de capacitación fue variable según el aspecto de la vacunación. Aquellos con mayor tiempo de ejercicio profesional y con actualización reciente se manifestaron con mayor grado de capacidad. Se identificaron múltiples barreras frecuentes asociadas al acceso en la vacunación.
Introduction. The decline in vaccination coverage has been very significant in the past decade. Pediatriciansplay a key role in catching-up coverage and increasing confidence in vaccination. Objectives. To describe pediatricians' perceptions of vaccine knowledge and practices and to identify barriers to access. Methods. Observational, analytical study using an online survey. Variables related to professional profile, training and barriers to vaccination were included. Results. A total of 1696 pediatricians participated (response rate: 10.7%). Their mean age was 50.4 years; 78.7% were women; 78.2% had ≥ 10 years of experience; 78.4% provided outpatient care and 56.0%, in the private subsector; and 72.5% received training in the past 2 years. Respondents described themselves as "trained" in convey the following aspects to their patients: benefits of vaccines: 97.2%; campaign objectives: 87.7%; contraindications: 82.4%; adverse effects: 78.9%; catchup vaccination: 71.2%; reporting of events supposedly attributable to vaccination or immunization: 59.5%. The proportion was statistically higher in all aspects, among pediatricians with ≥ 10 years of experience and those who received training recently (p ≤ 0.01). The barriers identified in access to vaccination were false contraindications (62.3%), temporary vaccine shortage (46.4%), cultural reasons (41.4%), and restricted vaccination center hours (40.6%). Conclusions. The perception of the level of training varied depending on the vaccination-related aspect. Pediatricians with more years of professional experience and those who received recent updates perceivedthemselves as more trained. Multiple barriers associated with access to vaccination were identified.
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Humanos , Pessoa de Meia-Idade , Vacinas , Vacinação , Percepção , Argentina , Inquéritos e Questionários , PediatrasRESUMO
At present, the contradiction between the lack of pediatricians and the increasing demand for pediatric medical services has become more and more prominent. Taking pediatricians as the research object, this paper explored the needs and motivation of professional development of pediatricians in China by referring to a series of excellent foreign research results, so as to improve the professional development of pediatricians, reconstruct the ecology of pediatricians and patients, then improve medical experience, and alleviate the "shortage of pediatricians" and "difficulty in seeing a doctor" in pediatrics. Enhancing the work enthusiasm and professional motivation of pediatricians can not only improve the satisfaction of patients, but also enhance the quality of medical services, so as to promote the growth of the hospital’s own economic and social benefits.
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RESUMEN Luego de que se autorizara en EEUU el uso de la vacuna contra el covid-19 en bebés de seis meses a niños y niñas de cuatro años, algunas personas (padres, madres, pediatras y comunicadores) plantearon la vacunación contra el covid-19 como una cuestión de acceso; sin embargo, muchas otras se mostraron reacias y otras se resistieron a las recomendaciones de los Centers for Disease Control and Prevention de EEUU. En este contexto, este estudio se propuso explorar: 1) reacciones divergentes ante la autorización de uso de la vacuna contra el covid-19 en niños y niñas de seis meses a cuatro años; y 2) lógicas contrapuestas que subyacen a las actitudes provacunación, antivacunación y vacilación ante las vacunas contra el covid-19. Para ello, se realizó una etnografía digital, con monitoreo de 5.700 reacciones a una serie de ocho infografías publicadas en las redes sociales por la John Hopkins Bloomberg School of Public Health, y observación participante en un grupo focal en línea a lo largo de un año, desde diciembre de 2021 hasta diciembre de 2022, conformado por 18 madres. Los resultados indican que el personal médico debe considerar diferentes nociones de "riesgo" al interactuar con los pacientes, especialmente aquellos que dudan en vacunarse.
ABSTRACT Following the authorization the use of COVID-19 vaccines in babies age six months through children four years old in the United States, some individuals (parents, pediatricians, and communicators) framed COVID-19 vaccination as an issue of access, while many others expressed hesitancy and some resisted recommendations from the US Centers for Disease Control and Prevention. In this context, this study aimed to explore: 1) divergent reactions to the authorization of COVID-19 vaccine use in children aged six months to four years; and 2) opposing logics underlying attitudes towards pro-vaccination, anti-vaccination, and vaccine hesitancy regarding COVID-19 vaccines. To achieve this, a digital ethnography was conducted, involving monitoring of 5,700 reactions to a series of eight infographics published on social media by the John Hopkins Bloomberg School of Public Health, and participant observation in an online focus group over a one-year period, from December 2021 to December 2022, consisting of 18 mothers. The findings suggest that healthcare professionals should consider different notions of "risk" when interacting with patients, especially those who are hesitant to vaccinate.
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Introducción. El estado epiléptico constituye la emergencia neurológica más frecuente. Si bien la mortalidad en niños es baja, su morbilidad puede superar el 20 %. Objetivo. Conocer las pautas de manejo del estado epiléptico referidas por médicos pediatras que atienden esta patología en forma habitual. Población y métodos. Estudio descriptivo, transversal, basado en una encuesta a médicos de tres hospitales pediátricos monovalentes de gestión pública de la Ciudad Autónoma de Buenos Aires. Resultados. Se administraron 292 encuestas (la tasa de respuesta completa alcanzó el 86 %); el 77 % se administró a pediatras y el 16 %, a especialistas en cuidados intensivos. Un 47 % de los participantes refiere indicar la primera benzodiacepina en el tiempo correcto; el 56 % utilizar diazepam intrarrectal en ausencia de un acceso intravenoso; el 95 % elige lorazepam como benzodiacepina inicial en caso de contar con acceso intravenoso; el 58 % refiere iniciar la etapa de fármacos de segunda línea en tiempo adecuado; el 84 % opta por fenitoína como fármaco inicial de segunda línea, un 33 % no cronometra el tiempo durante el tratamiento. La adherencia global a las recomendaciones internacionales fue del 17 %. Conclusiones. Nuestro estudio advierte una baja adherencia referida de los pediatras a las guías internacionales, en particular en las decisiones tiempo-dependientes. También se observó mayor heterogeneidad en las conductas terapéuticas a medida que se avanza en el algoritmo de tratamiento.
Introduction. Status epilepticus is the most common neurological emergency. Although mortality in children is low, morbidity may exceed 20%. Objective. To evaluate the management of status epilepticus by pediatricians who usually treat this condition. Population and methods. Descriptive, cross-sectional study based on a survey administered to physicians from 3 pediatric hospitals in the City of Buenos Aires. Results. A total of 292 surveys were administered (complete response rate as high as 86%); 77% were administered to pediatricians and 16% to intensive care specialists. Forty-seven percent of the participants reported that they administer the first dose of a benzodiazepine within the correct timeframe; 56% use intrarectal diazepam when intravenous access is not available; 95% choose lorazepam as the initial benzodiazepine if an intravenous access is available; 58% initiate the administration of a second-line drug within the correct timeframe; 84% administer phenytoin as the first-choice, second-line drug; and 33% do not measure treatment time. Overall adherence to international recommendations was 17%. Conclusions. Our study highlights poor adherence of pediatricians to international guidelines, particularly in time-dependent decisions. Greater heterogeneity was observed in treatment approaches as the treatment algorithm progressed.
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Humanos , Criança , Estado Epiléptico/diagnóstico , Estado Epiléptico/tratamento farmacológico , Argentina , Estudos Transversais , Diazepam/uso terapêutico , Hospitais Pediátricos , Anticonvulsivantes/uso terapêuticoRESUMO
Abstract Objective: Emergency contraception (EC) is an effective and safe method for preventing unplanned pregnancy after unprotected sexual intercourse among adolescents but is infrequently prescribed by pediatricians. Because of the scarcity of data on the discomfort with EC prescription among physicians in Brazil, this study aimed to identify associated factors with discomfort with EC prescription among pediatricians in the state of Amazonas. Methods: A web-based, cross-sectional study including sociodemographic data, knowledge, attitudes, and discomfort with EC prescription was used. Multivariate logistic regression and artificial intelligence methods such as decision tree and random forest analysis were used to identify factors associated with discomfort with EC prescriptions. Results: Among 151 physicians who responded to the survey, 53.0% were uncomfortable with prescribing EC, whereas only 33.1% had already prescribed it. Inexperience was significantly associated with discomfort with EC prescription (odds ratio 4.47, 95% confidence interval 1.71-11.66). Previous EC prescription was protective against discomfort with EC prescription in the three models. Conclusions: EC is still infrequently prescribed by pediatricians because of inexperience and misconceptions. Training these professionals needs to be implemented as part of public health policies to reduce unplanned adolescent pregnancy.
RESUMO Objetivo: A contracepção de emergência (CE) é um método eficaz e seguro para prevenir gravidez não planejada após relação sexual desprotegida entre adolescentes, mas raramente prescrito por pediatras. Diante da escassez de dados sobre o desconforto com a prescrição de CE entre médicos no Brasil, o objetivo deste estudo foi identificar fatores associados a esse desconforto entre pediatras do estado do Amazonas. Métodos: Uma pesquisa do tipo e-survey coletou dados sociodemográficos, conhecimento, atitudes e desconforto com relação à prescrição de CE. Métodos de regressão logística multivariada e inteligência artificial, como árvore de decisão e random forest, foram usados para identificar fatores associados ao desconforto para a prescrição de CE. Resultados: Entre os 151 médicos que responderam à pesquisa, 53,0% sentiam-se desconfortáveis para prescrever CE e apenas 33,1% já a haviam prescrito. A inexperiência foi associada a esse desconforto (odds ratio — OR 4,47, intervalo de confiança — IC95% 1,71-11,66). A prescrição prévia de CE foi fator de proteção com relação ao desconforto nos três modelos. Conclusões: A CE ainda é pouco prescrita por pediatras. Apesar de sua segurança e eficácia, a inexperiência e conceitos equivocados foram associados ao desconforto para sua prescrição. Investigações sobre o assunto são importantes para subsidiar políticas públicas de saúde para a redução da gravidez não intencional na adolescência.
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Introducción: en los últimos años el incremento de vegetarianos es considerable. Se debe tener cautela al incorporar este tipo de dietas en la población pediátrica. No son contempladas en las actuales guías de nutrición nacionales, generando incertidumbre al realizar recomendaciones. Objetivo: describir los conocimientos sobre dietas vegetarianas en niños por parte de médicos pediatras, posgrados y residentes socios de la Sociedad Uruguaya de Pediatría en el período de junio-setiembre 2020. Determinar la necesidad de incorporar dietas vegetarianas a las guías uruguayas de nutrición pediátrica por parte de los encuestados. Material y método: estudio observacional descriptivo, tipo encuesta transversal, en el período entre junio y setiembre de 2020. Los criterios de inclusión fueron médicos residentes/posgrados en pediatría y pediatras de la Sociedad Uruguaya de Pediatría, de Montevideo y el interior del país. La fuente de datos fue una encuesta online anónima. El análisis de datos fueron frecuencias relativas y absolutas para variables cualitativas. Resultados: se enviaron 1.080 encuestas online, de las que se incluyeron 119. Sobre la autopercepción en el conocimiento de los encuestados, el 58,0% se calificó dentro del rango medio. Acerca del concepto de dieta ovolactovegetariana, 63,9% seleccionó la opción correcta. Más de 50,0% respondió correctamente acerca de conocimientos sobre nutrientes en la mayoría de los ítems. Iniciar estas dietas en la alimentación complementaria fue desaconsejado por el 58% de los socios. Un 79,8% pretende adquirir más conocimientos del tema. Conclusiones: más de la mitad de los profesionales tiene los conocimientos correctos acerca de la correcta planificación y suplementación de dietas vegetarianas en niños. Se destaca la necesidad de incluir dietas vegetarianas en las guías de alimentación pediátrica en territorio uruguayo.
Introduction: the number of vegetarian people has increased considerably in recent years. Caution is suggested when incorporating this type of diet to the pediatric population. This diet has not been contemplated in the current national nutritional guidelines, generating uncertainty among pediatricians when making recommendations. Objective: describe the knowledge Pediatric Physicians and graduate / resident members of the Uruguayan Society of Pediatrics have regarding vegetarian diets in children during the period June-September 2020. Determine the need of the participants of the survey to incorporate vegetarian diet information into the Uruguayan Pediatric Nutritional Guidelines. Materials and methods: descriptive observational study, cross-sectional survey carried out from June to September 2020. The inclusion criteria included resident doctors / postgraduate pediatricians and pediatricians from the Uruguayan Society of Pediatrics of Montevideo and the interior of the country. The data source was an anonymous online survey. The data analyses were relative and absolute frequencies of qualitative variables. Results: 1.080 online surveys were sent and 119 were included. Regarding the respondents' self-perception of knowledge, 58.0% were rated within the medium range. Regarding the concept of lacto-ovo-vegetarian diet, 63.9% selected the correct option. Regarding knowledge about nutrients, we obtained more than 50.0% of correct answers in most of the items. Starting these diets as supplementary food was discouraged by 58% of the participants. 79.8% expressed the intention to acquire more knowledge regarding the subject. Conclusions: more than half of the professionals have the correct knowledge about the correct planning and supplementation of vegetarian diets in children. They stressed the need to include vegetarian diets in pediatric food guidelines in Uruguay.
Introdução: nos últimos anos, o aumento das pessoas vegetarianas tem sido considerável. Deve-se ter cuidado ao incorporar esse tipo de dieta na população pediátrica. Ela não está incluída nas atuais diretrizes nacionais de nutrição, gerando incerteza nos pediatras no momento de fazer recomendações. Objetivo: descrever o conhecimento sobre dietas vegetarianas em crianças dos Pediatras e pós-graduados/residentes da Sociedade Uruguaia de Pediatria no período de junho a setembro de 2020 para poder determinar a necessidade de incorporar dietas vegetarianas às diretrizes nutricionais pediátricas uruguaias. Material e métodos: estudo observacional descritivo, tipo de pesquisa transversal realizada no período de junho a setembro de 2020. Os critérios de inclusão foram médicos residentes/pós-graduados em pediatria e pediatras da Sociedade Uruguaia de Pediatria, Montevidéu e interior do país. A fonte de dados foi uma pesquisa on-line anônima sobre a necessidade de incorporar dietas vegetarianas às diretrizes uruguaias para nutrição pediátrica. As análises dos dados foram frequências relativas e absolutas de variáveis qualitativas. Resultados: 1.080 pesquisas online foram enviadas e 119 foram incluídas. Quanto à autopercepção de conhecimento dos entrevistados, 58,0% foram avaliados dentro da faixa média. Quanto ao conceito de dieta lacto-ovo-vegetariana, 63,9% selecionaram a opção correta. Quanto ao conhecimento sobre nutrientes, obtivemos mais de 50,0% das respostas corretas na maioria dos itens. O início dessas dietas como alimentos suplementares foi desencorajado por 58% dos participantes. 79,8% expressaram a intenção de adquirir mais conhecimento sobre o assunto. Conclusões: mais da metade dos profissionais têm o conhecimento correto sobre o planejamento correto e suplementação de dietas vegetarianas em crianças. Eles enfatizaram a necessidade de incluir dietas vegetarianas nas diretrizes de alimentos pediátricos no Uruguai.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Dieta Vegetariana/métodos , Competência Clínica/estatística & dados numéricos , Pediatras/educação , Vitamina B 12 , Inquéritos sobre Dietas/estatística & dados numéricos , Ferro da Dieta , Suplementos Nutricionais , Ingestão de Alimentos , Nutrição da CriançaRESUMO
Introducción. El tratamiento de la diarrea aguda se basa en prevenir la deshidratación, reducir la duración y gravedad de la enfermedad. El objetivo fue conocer los patrones de tratamiento ambulatorio de la diarrea aguda en <5 años. Métodos. Estudio observacional, analítico, mediante encuestas autoadministradas a pediatras de un hospital de niños de la Ciudad Autónoma de Buenos Aires. Se indagó: edad, sexo, lugar de trabajo, fuentes bibliográficas, indicación de tratamientos farmacológicos, no farmacológicos y medidas de prevención e higiene. Se evaluó la asociación entre prescripciones farmacológicas y características de los encuestados. Resultados. Respondieron 182/216 pediatras; la edad media fue 42,4 ± 10,24 años (el 78,6 %, mujeres); el 59,2 %, del sector público; el 22,4 %, de servicios de guardia. El 91,2 % consultaba guías/consensos. El 92,9 % prescribió fórmulas de rehidratación oral; el 46,2 %, antieméticos; el 43,4 %, antiácidos y/o protectores gástricos; el 35,7 %, probióticos, y el 30,7 %, cinc. El 91,7 % indicó realimentación precoz; el 96,7 %, lactancia materna y el 96-100 %, medidas de prevención e higiene. En el análisis multivariado, tener >40 años se asoció con prescribir antiácidos/protectores gástricos (odds ratio [OR] 2,6; 1,22-5,61), probióticos (OR 3,03; 1,34-6,83) y cinc (OR 0,39; 0,17-0,87); trabajar en el sector privado con prescribir probióticos (OR 3,05; 1,56-5,94) y en servicios de guardia, con prescribir antiácidos/ protectores gástricos (OR 2,60; 1,22-5,54). Conclusiones. El tratamiento se basó principalmente en hidratación, alimentación precoz y lactancia. La edad y el lugar de desempeño de los pediatras modifican el patrón de prescripción.
Introduction. The management of acute diarrhea is based on preventing dehydration and reducing disease duration and severity. The study objective was to establish the patterns for the outpatient management of acute diarrhea in children younger than 5 years. Methods. Observational, analytical study using a self-administered survey among pediatricians from a children's hospital in the Autonomous City of Buenos Aires. Age, sex, place of work, bibliographic sources, indication of drug and non-drug therapies, and preventive and hygiene measures were recorded. The association between drug prescription and the characteristics of surveyed pediatricians was assessed. Results. In total, 182/216 pediatricians completed the survey. Their mean age was 42.4 ± 10.24 years; 78.6% were females; 59.2% worked in the public sector; 22.4% worked in the emergency department; and 91.2% consulted guidelines and/or consensuses. Also, 92.9% prescribed oral rehydration solutions; 46.2%, antiemetics; 43.4%, antacids and/or gastric protectors; 35.7%, probiotics; and 30.7%, zinc. Early food reintroduction was indicated by 91.7%; breastfeeding, by 96.7%; and preventive and hygiene measures, by 96-100%. The multivariate analysis showed an association between age > 40 years and prescribing antacids/ gastric protectors (odds ratio [OR]: 2.6; 1.22-5.61), probiotics (OR: 3.03; 1.34-6.83), and zinc (OR: 0.39; 0.17-0.87); between working in the private sector and prescribing probiotics (OR: 3.05; 1.565.94); and between working in the emergency department and prescribing antacids/gastric protectors (OR: 2.60; 1.22-5.54). Conclusions. Treatment was mainly based on hydration, early food reintroduction, and breastfeeding. Age and work sector affected the prescription pattern.
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Humanos , Lactente , Pré-Escolar , Adulto , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Padrões de Prática Médica , Pediatras/psicologia , Diarreia/prevenção & controle , Diarreia/terapia , Hospitais PediátricosRESUMO
At present, the contradiction between the lack of pediatricians and the increasing demand for pediatric medical services has become more and more prominent. Taking pediatricians as the research object, this paper explored the needs and motivation of professional development of pediatricians in China by referring to a series of excellent foreign research results, so as to improve the professional development of pediatricians, reconstruct the ecology of pediatricians and patients, then improve medical experience, and alleviate the "shortage of pediatricians" and "difficulty in seeing a doctor" in pediatrics. Enhancing the work enthusiasm and professional motivation of pediatricians can not only improve the satisfaction of patients, but also enhance the quality of medical services, so as to promote the growth of the hospital’s own economic and social benefits.
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Resumen: Introducción: la infección por el virus de papiloma humano (HPV) es la infección de transmisión sexual más frecuente en el mundo, vinculándose a lesiones premalignas y cáncer de cuello uterino (CCU). En Uruguay es el tercer tipo de cáncer en frecuencia y la cuarta causa de mortalidad por cáncer en mujeres. Existen vacunas contra HPV seguras y eficaces. En Uruguay en 2013 se comenzó a administrar de forma gratuita la vacuna tetravalente (serotipos16,18,11y 6) para todas las adolescentes de 11 años y desde 2019 también a los varones de la misma franja etaria. La cobertura de la vacuna aún es baja. Objetivo: conocer la actitud de algunos pediatras de Montevideo frente a la indicación de la vacuna contra HPV. Materiales y métodos: se realizó un estudio descriptivo, observacional, transversal mediante encuesta anónima y autogestionada a pediatras de diferentes prestadores de salud: Casmu, Hospital Militar, Hospital Británico y Casa de Galicia, en agosto-setiembre de 2018. Resultados: total: 67 pediatras encuestados: 66 recomiendan la vacuna, 58 consideran que tiene información necesaria sobre la vacuna, 64 conocen las indicaciones y contraindicaciones, a 63 les gustaría contar con información oficial por parte del Ministerio de Salud Pública, 63 consideran que los pacientes no tienen información adecuada, 21 necesitan entre 15 -30 min para dar información y 65 piensa que puede influir en la postura de los padres frente a la vacuna. Conclusiones: los pediatras encuestados recomiendan la vacuna contra el HPV en sus consultas. La confianza en el médico y la necesidad de información son dos variables fundamentales sobre las que tenemos que seguir trabajando. Se necesita profundizar en éstos y otros aspectos que influyen negativamente en la decisión de los adolescentes y sus tutores, determinando una baja cobertura de vacunación.
Summary: Introduction: the human papillomavirus (HPV) infection is the most frequent sexually transmitted disease globally, associated with pre malignant lesions and uterine cervical cancer. It is the third most frequent type of cancer in Uruguay and the fourth cause of death in women with cancer. There are safe and effective HPV vaccines. In 2013, Uruguay started administering the quadrivalent vaccine (serotypes 16, 18, 11 and 6), for free to all 11-year-old adolescent girls, and in 2019 to all adolescent boys of the same age. The HPV vaccine coverage is still low. Objective: to learn about the position of some pediatricians from Montevideo, Uruguay, regarding the HPV vaccine. Methodology: cross-sectional observational descriptive study, carried out through anonymous, self-administered surveys to some pediatricians from different health providers: Casmu, Armed Forces Hospital, British Hospital and Casa de Galicia, from August to September 2018. Results: total: 67 surveyed pediatricians, 66 recommend the vaccine, 58 believe that they have all the necessary information about the vaccine, 64 understand the indications and contraindications, 63 would like to have official information from the Ministry of Public Health, 63 think that patients do not have adequate information about the vaccine, 21 consider they need between 15 and 30 minutes to give information to patients about the vaccine and 65 think they can influence the parents' opinions regarding the use of the vaccine. Conclusions: the surveyed pediatricians recommend the HPV vaccine. We need to continue to research the issues of trust in doctors and the need for additional information, as well as other aspects, because they are a negative influence when adolescents and their tutors need to make decisions regarding the use of the vaccine, which results into low adherence.
Resumo: Introdução: a infecção pelo papilomavírus humano (HPV) é a infecção sexualmente transmissível mais comum no mundo, e está associada a lesões pré-malignas e câncer cervical (CCU). No Uruguai, é o terceiro tipo de câncer mais frequente e a quarta causa de mortalidade por câncer em mulheres. Existem vacinas contra o HPV seguras e eficazes. No Uruguai, em 2013, a vacina quadrivalente (sorotipos 16,18,11 e 6) começou a ser administrada gratuitamente a todas as adolescentes de 11 anos e, a partir de 2019, também a homens adolescentes da mesma faixa etária. A cobertura vacinal ainda é baixa. Objetivo: conhecer a opinião de alguns pediatras de Montevidéu quanto à indicação da vacina contra o HPV. Materiais e métodos: realizou-se um estudo descritivo, observacional e transversal por meio de um inquérito anônimo e autogerido com pediatras de diferentes prestadores de saúde: Casmu, Hospital Militar, Hospital Britânico e Casa de Galicia, de agosto a setembro de 2018. Resultados: total: 67 pediatras pesquisados: 66 recomendam a vacina, 58 consideram que possuem a informação necessária sobre a vacina, 64 conhecem as indicações e contraindicações, 63 gostariam de ter informação oficial do Ministério da Saúde Pública, 63 consideram que o os pacientes não possuem informação adequada, 21 acham que precisam de 15 a 30 minutos para fornecer informação aos pacientes e 65 acham que poderiam influenciar a posição dos pais em relação à vacina. Conclusões: os pediatras pesquisados recomendam a vacina contra o HPV em suas consultas. A confiança no médico e a necessidade de informação são duas variáveis fundamentais nas quais ainda devemos continuar trabalhando. É necessário aprofundar esses e outros aspectos que influenciam negativamente na decisão dos adolescentes e seus responsáveis, determinando uma baixa cobertura vacinal.
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Objective:To analyze the changes in the number and workload of pediatricians, for evidences in further optimizing the allocation of pediatrician resources and formulating relevant policies in China.Methods:According to data from the National Bureau of Statistics and the " China Health and Health Statistics Yearbook", descriptive analysis was made to investigate the changes in the number and workload of pediatricians in China from 2010 to 2019.Results:During 2010 and 2019, the number of pediatric practitioners(assistants) increased from 115 800 to 158 500, and the growth rate was faster than that of the children aged 0-14 years, but slower than that of overall medical practitioners(assistants). The number of pediatric practitioners(assistants) per thousand children in China had grown steadily from 0.52 to 0.67, compared with the burden and the workload of medical practitioners nationwide, the workload of pediatricians was still relatively heavy.Conclusions:The number of pediatricians had increased gradually between 2010 and 2019, and the effects of various policies began to work, while the workload was still heavy. It is recommended to further develop a salary system and supporting policies in line with the characteristics of pediatrics sector, and focus on such problems as unbalanced and inadequate distribution of pediatricians.
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Resumen: En nuestro país, la enfermedad meningocóccica presenta una baja endemia y alta letalidad, con exis tencia de brotes epidémicos, algunos de ellos de carácter histórico, como el acaecido durante la pri mera mitad del siglo pasado. La acción de un grupo de médicos, pioneros en los aspectos clínicos, de investigación y docencia, junto al personal de salud que constituía su equipo, inmersos en una política pública sanitaria exitosa, permitieron consolidar el cuidado necesario del niño enfermo de esta grave patología, como también de muchas otras, posibilitando así el desarrollo de una propuesta estructurada y científica a la luz del conocimiento disponible en aquella época. Por ello, luego de 80 años, es importante revisar los diversos aspectos clínicos, fisiopatológicos y terapéuticos, además del contexto hospitalario y social de esta exitosa historia del sistema de salud público chileno.
Abstract: In our country, meningococcal disease has a low endemic and high lethality, with epidemic out breaks; some of them of historical character, like the one happened during the first half of the last century. The action of a group of doctors, pioneers in clinical, research and teaching aspects, together with the health personnel that constituted their team, immersed in a successful public health policy, allowed to consolidate the necessary care of the sick child of this serious pathology, as well as many others, thus enabling the development of a structured and scientific proposal, in the light of the knowledge available at that time. Therefore, after 80 years, it is important to review the various clini cal, pathophysiological and therapeutic aspects, in addition to the hospital and social context, of this successful history of the Chilean public health system.
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Humanos , Lactente , Pré-Escolar , Criança , Choque Séptico/história , Epidemias/história , Infecções Meningocócicas/história , Pediatria/história , Choque Séptico/diagnóstico , Choque Séptico/terapia , Choque Séptico/epidemiologia , Chile/epidemiologia , Hospitalização , Infecções Meningocócicas/diagnóstico , Infecções Meningocócicas/terapia , Infecções Meningocócicas/epidemiologiaRESUMO
Con este artículo se buscó ampliar los datos biográficos del eminente científico cubano Antonio María Béguez César y divulgar aspectos poco conocidos de su prolífica existencia. Para ello se consultaron los archivos personales de la familia Béguez López y el índice de autores y materias del Boletín de la Sociedad Cubana de Pediatría y de la Revista Cubana de Pediatría, donde se consigna su bibliografía activa; además, se analizaron documentos de la época y se consideraron los testimonios de familiares, colegas y amigos del ilustre pediatra santiaguero. El trabajo forma parte del proyecto investigativo "Estrategia para incrementar la visibilidad del hallazgo científico del pediatra Dr. Antonio María Béguez César", que revela al descubridor de la "neutropenia crónica maligna familiar con granulaciones atípicas de los leucocitos", entidad clínica inscrita entre los diez hitos de la inmunología cubana, que ha sido erróneamente divulgada en el mundo científico-médico como síndrome de Chédiak-Higashi.
This work aimed at widen the biographical data of the eminent Cuban scientist Antonio María Béguez César and to spread not very well-known aspects of his prolific existence. The personal files of Béguez López family and the index of authors and matters of the Pediatrics Cuban Society Bulletin and the Pediatrics Cuban Magazine were consulted, where his active bibliography is consigned; also, documents of that time were analyzed and testimonies of family, colleagues and friends of the distinguished pediatrician from Santiago were considered. The work is part of the investigative project "Strategy to increase the visibility of the pediatrician Dr. Antonio María Béguez César scientific finding" that reveals the discoverer of "the family malignant chronic neutropenia with atypical granulations of the leukocytic cells", clinical entity inscribed among the ten landmarks of the Cuban immunology that has been erroneously spread in the scientific-medical world as Chediak-Higashi syndrome.
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Síndrome de Chediak-Higashi , Cuba , Pessoas Famosas , Pediatras , História da MedicinaRESUMO
Resumen: Introducción: el electrocardiograma (ECG) es una prueba sencilla de realizar en atención primaria, de fácil acceso y bajo costo. Varios estudios que comparan la interpretación de la lectura del ECG de médicos de familia e internistas en relación con cardiológos muestran las dificultades en la interpretación de los mismos por parte de los primeros. No se encontraron estudios que realicen comparaciones con pediatras. Objetivo: valorar la competencia de dos posgrados de Pediatría para leer ECG, que reciben entrenamiento convencional previo. Material y método: previo al inicio del trabajo se realizó capacitación en lectura de ECG para los posgrados de Pediatría de forma de sistematizar la lectura de éste a cargo de un cardiólogo pediatra. Estudio transversal, prospectivo, doble ciego donde dos posgrados de Pediatría interpretaron los ECG y luego fueron evaluados por cardiólogo pediatra, sin ninguno conocer la interpretación de los demás, ni de quién era el trazado. Un investigador externo realizó la comparación de los estudios. Se solicitó autorización a la Dirección General y al Comité de Ética. La participación fue voluntaria, previo consentimiento informado. Población: se incluyeron todos los ECG de los niños entre 5-15 años que asistieron a la Jornada de evaluación predeportiva. Se realizó ECG de 12 derivaciones por técnico neumocardiólogo a todos los niños. Materiales: se utilizó una ficha precodificada para el registro de las variables. Se anotó: frecuencia cardíaca, ritmo, onda p, intervalo PR, eje eléctrico, QRS, QTc, onda T y segmento ST. Se consideró frecuencia cardíaca normal entre 60-110 lpm; intervalo PR 0,12-0,20 s, QTC valor normal entre 0,33-0,44seg. Resultados: se analizaron 209 ECG de niños y adolescentes. En la onda P, el ritmo y el eje eléctrico hubo una concordancia de 100%. El índice de concordancia superó el 73% en todas las variables, alcanzando una coincidencia del orden de 95%. Sin embargo, para frecuencia cardíaca y QRS, si bien el valor puntual de kappa puede considerarse aceptable, los límites inferiores de los intervalos de confianza están posicionados en valores inferiores a los aceptables.
Summary: Introduction: electrocardiograms (ECGs) are accessible, low cost tests, simple to perform at primary care level. Several studies have compared ECG readings made by family doctors and internists to those made by cardiologists and they have shown that the former have difficulties interpreting them. No studies were found that made such comparisons with pediatricians. Objective: assess the competence to read ECGs shown by pediatricians who had previously received conventional training. Material and methods: prior to the start of the study, a Pediatric Cardiologist trained Pediatricians to read and interpret ECGs in order to systematize the reading approach. Cross-sectional, prospective, double-blind study where two Pediatricians interpreted ECGs and were later assessed by a Pediatric Cardiologist. Pediatricians did not know the colleague's readings or whose ECGs they were interpreting. An external researcher compared them. Authorization was requested from the General Management Department and from the Ethics Committee. Participation was voluntary, and prior informed consent was obtained. The population included ECGs of children aged between 5-15 years of old who attended the Pre-Assessment Sports Day. A pneumologist-cardiologist performed ECGs on 12 children. Materials: A pre-coded file was used to record the variables: heart rate, rhythm, p wave, PR interval, electric axis, QRS, QTc, T wave and ST segment. 60-110 bpm was considered a normal heart rate; PR interval 0.12-0.20 sec, QTC normal value between 0.33-0.44 sec. Results: the study analyzed results of 209 children and adolescents' ECGs. There was 100% concordance between the rhythm and the electrical axis for the P wave. The concordance index exceeded 73% for all the variables and it reached a concordance of about 95%. However, for heart rate and QRS, although the Kappa point value can be considered acceptable, the confidence interval lower limits were lower than acceptable.
Resumo: Introdução: O eletrocardiograma (ECG) é um exame acessível, de baixo custo e simples de realizar no nível de atenção primária. Vários estudos compararam as leituras de eletrocardiograma realizadas por médicos de família e médicos de clínica geral com aquelas realizadas por cardiologistas e mostraram que os primeiros têm dificuldades em interpretá-las. Não encontramos estudos que fizessem tais comparações com pediatras. Objetivo: avaliar a competência para interpretar ECGs de dois pediatras que tinham recebido treinamento convencional. Material e métodos: Antes do início do estudo, um cardiologista pediátrico treinou pediatras para ler e interpretar ECGs, a fim de sistematizar a abordagem de interpretação. Estudo transversal, prospectivo, duplo-cego, em que dois pediatras interpretaram ECGs e posteriormente foram avaliados por um cardiologista pediátrico. Os pediatras não conheciam as leituras dos colegas ou a quem pertenciam os resultados dos ECGs. Um pesquisador externo os comparou. A Gerência Geral e o Comitê de Ética deram autorização para realizar o estudo. A participação foi voluntária, com consentimento prévio e informado. A população incluiu ECGs de crianças de entre 5 e 15 anos de idade que compareceram à Pré-Avaliação no Dia de Esportes. Um pneumologista-cardiologista realizou ECGs em 12 crianças. Materiais: Um arquivo pré-codificado foi utilizado para registrar as variáveis: frequência cardíaca, ritmo, onda P, intervalo PR, eixo elétrico, QRS, QTc, onda T e segmento ST. 60-110 bpm foi considerado uma frequência cardíaca normal; Intervalo PR 0,12-0,20 s, valor normal do QTC entre 0,33-0,44 s. Resultados: analisaram-se 209 eletrocardiogramas de crianças e adolescentes. Na onda P, o ritmo e o eixo elétrico atingiram 100% de concordância. O índice de concordância superou 73% em todas as variáveis atingindo uma concordância aproximada de 95%. No caso de frequência cardíaca e QRS, embora o valor de Kappa possa ser considerado aceitável, os limites inferiores dos intervalos de confiança estão posicionados em valores inferiores aos aceitáveis.
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Resumen: Introducción: la formación de especialistas en Pediatría en Centros Docentes Asociados (CEDAS) acreditados por la Escuela de Graduados, Facultad de Medicina, contribuye al proceso de descentralización de la enseñanza y a la mejora continua de la calidad asistencial. Objetivo: describir las características, avance curricular y nivel de satisfacción de los residentes en este CEDA, entre 2009 y 2019. Material y método: variables: edad, procedencia, estado civil, hijos, enfermedades crónicas, actividad laboral, aprobación de cursos y rotaciones, trabajos obligatorios, prueba final, presentaciones en congresos, publicaciones, extensión del régimen de residencia, subespecialidades. Las características y el avance curricular fueron obtenidos de los legajos. Para valorar nivel de satisfacción, se realizó una encuesta anónima, voluntaria, online. Resultados: durante este período se incorporaron 24 residentes, 17 finalizaron y 7 se encuentran cursando. En el grupo que finalizaron, la mediana de edad al inicio de la residencia fue 27 años, procedían del interior 5, estaban en concubinato estable 15 y tenian hijos 9. Obtuvieron el título de especialistas en pediatría 15 y 9 de ellos desempeñan cargos de alta dedicación. En el grupo que está cursando, la mediana de edad al inicio de la residencia es 26 años, todos proceden de Montevideo, están en concubinato estable 5, tiene hijos 1 y desarrollan actividad laboral extracurricular 6. Más del 70% de las respuestas en todas las dimensiones exploradas correspondieron a nivel de satisfacción alto. Conclusiones: la experiencia durante estos primeros diez años ha resultado positiva. Permitió la generación de recursos humanos genuinos, con altos índices de compromiso e identidad institucional, buen desempeño curricular y elevado nivel de satisfacción académico-laboral.
Summary: Introduction: training of specialists in Pediatrics accredited by the Graduate Medical School at Associated Training Centers (ATC) contributes to the decentralized training and continuous improvement process of quality of care. Objective: describe characteristics, academic progress and level of satisfaction of the residents at this ATC between 2009 and 2019. Materials and methods: variables: age, origin, marital status, number of children, chronic diseases, professional activities, number of courses passed, mandatory papers, final tests passed, research papers submitted to congresses, publications, residency period, sub-specialties. The characteristics and academic progress were obtained from files. The level of satisfaction was obtained from an anonymous voluntary online survey. Results: 24 residents were included during this period. 17 had finished curricular studies, 15 had obtained their degree, median age at the beginning of residency: 27 years, 5 were from the interior of the country, 15 had a stable partner, 9 had children and 9 had full-time positions at the institution. Regarding the present 7 residents, the median age at the beginning of residency: 26 years, all are from Montevideo, 5 have a stable partner, 1 has children and 6 have extracurricular activities. More than 70% of all responses assessed showed a high level of satisfaction. Conclusions: the experience of the last 10 years has been positive. It enabled the organization to obtain develop genuine highly committed human resources with institutional identity, good academic development and a high level of academic and job satisfaction.
Resumo: Introdução: a formação de especialistas em pediatria nos Centros de Formação Associados (ATC) credenciados pela Faculdade de Medicina no Departamento do Pós-Graduação contribui para o processo de formação descentralizada e melhoria contínua da qualidade do atendimento da saúde. Objetivo: descrever características, evolução dos conteúdos programáticos e nível de satisfação dos residentes deste ATC entre 2009 e 2019. Materiais e métodos: variáveis: idade, procedência, estado civil, número de filhos, doenças crônicas, atividades profissionais, número de cursos aprovados, trabalhos obrigatórios, provas finais, trabalhos de pesquisa submetidos a congressos, publicações, período de residência, subespecialidades. As características e o progresso acadêmico foram obtidos dos arquivos. O nível de satisfação foi obtido a partir de uma pesquisa online voluntária anônima. Resultados: 24 residentes foram incluídos neste período. 17 haviam concluído os cursos curriculares, 15 haviam-se graduado, idade mediana de início da residência: 27 anos, 5 eram do interior do país, 15 tinham uniões estáveis, 9 tinham filhos e 9 ocupavam cargos de tempo integral na instituição. Em relação aos atuais 7 residentes, a mediana de idade no início da residência: 26 anos, todos de Montevidéu, 5 têm uniões estáveis, 1 tem filhos e 6 realizam atividades extracurriculares. Mais de 70% de todas as respostas avaliadas mostraram um alto nível de satisfação. Conclusões: a experiência dos últimos 10 anos foi positiva. Permitiu à organização gerar recursos humanos genuínos e altamente comprometidos com identidade institucional, bom desenvolvimento acadêmico e alto nível de satisfação acadêmica e profissional.
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Autism is a known developmental disorder that is prevalent across the world. Saudi Arabia has largely beendisadvantaged with respect to evidence-based research on autism. The presence of limited research and studieson autism in Saudi Arabia has an impact on how pediatricians undertake their treatment interventions on childrenwith autism. This study assesses the awareness levels of Saudi pediatricians with regards to knowledge andattitudes towards autism among children. The degree of knowledge and attitudes displayed by the respondentshave a direct correlation with the level of care and treatment for autism. This study is thus a baseline case whichcan be used to inform future treatment interventions for autism. The study showed that male children were morelikely to be in the risk of being affected by autism which according to the analysis obtained from the chi squaregender was not a significance of likeliness of a child being affected by autism. Correlation was used to determinethe strength of the relationship between lack of eye contact as a result of autism causing communication disorder,a correlation of -0.132 which implied a weak negative relationship between the two variables. From the chisquare, a p value of 0.808 was obtained which indicated that there was insufficient statistical significance to theclaim that there was a difference between gender and long-life condition of autism.
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Abstract Introduction: Focused critical care echocardiography (FCCE) has become a necessary competency for physicians working in pediatric intensive care units. Objective: To asses a theoretical and practical training program designed to explore skills acquisition for obtaining views and some echocardiographic measurements suggested for FCCE. Materials and methods: A 26-hour long theoretical and practical training for pediatricians and pediatric intensivists under the guidance of a pediatric cardiologist. The program included qualitative analysis of the variables pertaining to basic echocardiographic windows, and quantitative analysis of FCCE. Results: There were significant differences between having prior echocardiography knowledge, associated with a higher score in the 4-chamber apical window (mean: 9.0; standard deviation [SD]: 1.02; P = 0.021), and better correlation with the pediatric cardiologist regarding left ventricular function measurements (mean: 92.02; SD: 6.3; P = 0.036). Conclusion: The program was useful for basic level training in FCCE with an optimal level of acquisition of the main echocardiographic windows and some echocardiographic measurements.
Resumen Introducción: La ecocardiografía, enfocada al cuidado crítico, se ha convertido hoy en día en una competencia necesaria del médico que labora en las unidades de cuidado intensivo pediátrico. Objetivo: Evaluar un programa de entrenamiento te6rico y práctico, diseñado para explorar la adquisición de habilidades en la obtención de imágenes y algunas medidas ecocardiográficas sugeridas para la ecocardiografía enfocada al cuidado crítico. Materiales y métodos: Se realizó un entrenamiento teórico-práctico, de 26 horas de duración, por médicos pediatras y pediatras intensivistas, bajo la tutoría de un cardiólogo pediatra. El programa incluyó análisis cualitativos de las variables pertenecientes a las ventanas básicas y cuantitativos de la ecocardiografía enfocada al cuidado crítico. Resultados: Las diferencias significativas se presentaron entre tener conocimientos previos en ecocardiografía, que se asoció a un mejor puntaje en la ventana apical cuatro cámaras (media: 9,0 DE: 1,02 P = 0,021), y mejor correlación con el cardiólogo pediatra en la medición de la funcionalidad del ventrículo izquierdo (media:92,2 DE:6,3 P = 0,036). Conclusiones: Este programa de entrenamiento fue útil para el entrenamiento en nivel básico de la ecocardiografía enfocada al cuidado crítico, con un nivel óptimo en la adquisición de las principales ventanas ecocardiográficas, y para la toma de algunas medidas ecocardiográficas.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Ecocardiografia , Unidades de Terapia Intensiva Pediátrica , Médicos , Cuidados Críticos , Educação , Cardiologistas , Pediatras , Unidades de Terapia IntensivaRESUMO
PURPOSE: To evaluate intra- and inter-observer variability and guideline adherence amongst pediatricians in treating children aged between 4 and 18 years referred with recurrent abdominal pain (RAP) without red flags. METHODS: The first part of the study is a retrospective single-center cohort study. The diagnostic work-ups of eight pediatricians were compared to the national guidelines. Intra- and inter-observer variability were examined by Cramer's V test. Intra-observer variability was defined as the amount of variation within a pediatrician and inter-observer variability as the amount of variation between pediatricians in the application of diagnostic work-up in children with RAP. Prospectively, the same pediatricians were requested to provide a report on their management strategy with a fictitious case to prove similarities in retrospective diagnostic work-up. RESULTS: A total of 10 patients per pediatrician were analyzed. Retrospectively, a (very) weak association between pediatricians' diagnostic work-ups was found (0.22), which implies high inter-observer variability. The association between intra-observer diagnostic was moderate (range, 0.35–0.46). The Cramer's V of 0.60 in diagnostic work-up between pediatricians in the fictitious case implied the presence of a moderately strong association and lower inter-observer variability than in the retrospective study. Adherence to the guideline was 66.8%. CONCLUSION: We found a high intra- and inter-observer variability and moderate guideline adherence in daily clinical practice amongst pediatricians in treating children with RAP in a teaching hospital.
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Criança , Humanos , Dor Abdominal , Estudos de Coortes , Fidelidade a Diretrizes , Hospitais de Ensino , Variações Dependentes do Observador , Estudos Prospectivos , Estudos RetrospectivosRESUMO
PURPOSE: No national survey has yet described the guidelines followed by Korean pediatricians to treat acute gastroenteritis (AGE). An online survey was performed to investigate the management of AGE followed by members of The Korean Society of Pediatric Gastroenterology, Hepatology, and Nutrition, and the results were compared between pediatric gastroenterologists (PG) and general pediatricians (GP). METHODS: Questionnaires were sent to pediatricians between June 2 and 4, 2018 regarding the type of hospital, indications for admission, antiemetic and antidiarrheal drugs and antibiotics prescribed, and dietary changes advised. RESULTS: Among the 400 pediatricians approached, 141 pediatricians (35.3%) responded to the survey. PG comprised 39% of the respondents and 72.7% worked at a tertiary hospital. Both PG and GP considered diarrhea or vomiting to be the primary symptom. The most common indication for hospitalization was severe dehydration (98.8%). Most pediatricians managed dehydration with intravenous fluid infusions (PG 98.2%, GP 92.9%). Antiemetics were prescribed by 87.3% of PG and 96.6% of GP. Probiotics to manage diarrhea were prescribed by 89.1% of PG and 100.0% of GP. Antibiotics were used in children with blood in diarrheal stool or high fever. Dietary changes were more commonly recommended by GP (59.3%) than by PG (27.3%) (p<0.05). Tests to identify etiological agents were performed primarily in hospitalized children. CONCLUSION: This survey assessing the management of pediatric AGE showed that the indications for admission and rehydration were similar between GP and PG. Drug prescriptions for diarrhea and dietary changes were slightly commonly recommended by GP than by PG.
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Criança , Humanos , Antibacterianos , Antidiarreicos , Antieméticos , Criança Hospitalizada , Desidratação , Diarreia , Gerenciamento Clínico , Prescrições de Medicamentos , Febre , Hidratação , Gastroenterite , Gastroenterologia , Hospitalização , Probióticos , Inquéritos e Questionários , Centros de Atenção Terciária , VômitoRESUMO
ABSTRACT Objective This study evaluated the knowledge and practices of pediatricians and nutritionists about cow's milk protein allergy in infants, with an emphasis on issues related to the exclusion diet and nutritional status. Methods A cross-sectional, descriptive study was performed with a convenience sample of 204 pediatricians and 202 nutritionists randomly invited in scientific events in the city of São Paulo, from November 2014 to March 2016. Results Between 1.5% and 21.0% of respondents indicated inadequate products for the treatment of cow's milk protein allergy, including goat's milk, beverages or juices based on soy extract, lactose-free milk formula and partially hydrolyzed formula. The daily calcium recommendation for children between zero and 36 months of age was correctly indicated by 27.0% of pediatricians and 46.0% of nutritionists (p=0.001). Additionally, 96.1% of pediatricians and 82.7% of dietitians (p<0.001) provided guidance on about labels of industrialized products. Conclusion Pediatricians and nutritionists present gaps in knowledge about cow's milk protein allergy treatment in infants and educational strategies that increase the knowledge of the professionals are important for the management of cow's milk protein allergy.
RESUMO Objetivo Este estudo avaliou o conhecimento e práticas de pediatras e nutricionistas sobre alergia às proteínas do leite de vaca em lactentes, com ênfase em questões relacionadas à dieta de exclusão e ao estado nutricional. Métodos Estudo transversal, descritivo, realizado com uma amostra de conveniência de 204 pediatras e 202 nutricionistas, convidados aleatoriamente em eventos científicos na cidade de São Paulo, de novembro de 2014 a março de 2016. Resultados Entre 1,5% e 21,0% dos entrevistados indicaram produtos inadequados para o tratamento da alergia às proteínas do leite de vaca, incluindo leite de cabra, bebidas ou sucos à base de extrato de soja, fórmula de leite sem lactose e fórmula parcialmente hidrolisada. A recomendação diária de cálcio para crianças entre zero e 36 meses de idade foi corretamente indicada por 27,0% de pediatras e 46,0% de nutricionistas (p=0,001). Além disso, 96,1% dos pediatras e 82,7% dos nutricionistas (p<0,001) forneceram orientação sobre os rótulos dos produtos industrializados. Conclusão Pediatras e nutricionistas apresentam lacunas no conhecimento sobre o tratamento da alergia às proteínas do leite de vaca em lactentes. Estratégias educacionais que aumentam o conhecimento dos profissionais são importantes para o gerenciamento da alergia às proteínas do leite de vaca.
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Humanos , Masculino , Feminino , Hipersensibilidade a Leite , Conhecimentos, Atitudes e Prática em Saúde , Estudos Transversais , Entrevista , Substitutos do Leite Humano , Nutricionistas , Pediatras , Lactente , Proteínas do LeiteRESUMO
In 2017, a 10-year-old girl, who was allegedly raped and impregnated, was denied an abortion on the basis of the Medical Termination ofPregnancy Act 1971. This perspective re-examines this issue while prioritizing the best interest of the child. We recommend that boardsshould be constituted at district-level hospitals, headed by senior pediatricians, and supported by obstetricians, psychologists,neonatologists, medical social workers, and others to decide the course of action – in particular, the outcome, irrespective of the weeksof pregnancy. If not compatible with the child’s life, earlier termination of pregnancy should be considered ensuring the availability ofstate-of-the-art care to the newborn and the young mother