ABSTRACT
In 2006, the human papillomavirus (HPV) vaccine was approved for use as an effective intervention for reducing the risk of developing cervical cancer; however, its successful implementation is dependent on acceptability. This study aims to provide a comprehensive understanding of the reasons that favor or do not favor the acceptability of HPV vaccines. METHODS: We conducted a systematic review and meta-summary of qualitative research on 16 databases. A total of 32 articles that considered the perspectives of vaccine users, their parents, and the professionals who care for them were reviewed. Synthesis was conducted as described by Sandelowski and Barroso. RESULTS: We used inductive and deductive methods to obtain a total of 22 dimensions, out of which three issues stood out that should be considered to improve acceptability and are formed by three groups of study, namely, information about the vaccine, fears and side effects, and sexuality associated with the vaccine. CONCLUSIONS: Acceptability, as well as adherence to HPV vaccination, is a complex concept. This review highlights the perspectives of the three sets of actors involved in the process (i.e., users, parents, and professionals) and views these factors in relation to acceptability as a guide for new interventions.
ABSTRACT
Kidney abscess is an unusual entity in childhood with few studies about its clinical characteris tics. OBJECTIVE: To report the clinical presentation, diagnosis, and therapy used in a cohort of 20 children with kidney abscess. PATIENTS AND METHOD: retrospective study of cases of kidney abscess during a 10-year period at the Hospital Roberto del Río. The analysis of clinical, laboratory, and imaging characteristics were evaluated as well as the treatment usedfor this condition. RESULTS: 20 cases were reported among which 65% were women with a median age of 3.6 years. The most com mon clinical presentation was fever, vomit, and dysuria. Eighty percent of patients presented an increase of inflammatory parameters, 88% presented positive urine culture, and the most common organism identified was Escherichia Coli (77.8%). The diagnosis was mostly made through kidney ultrasound (75%) followed by an abdominal CT scan (35%). 93% of abscesses were unilateral. About 95% of the patients only required antibiotic treatment. Vesicoureteral reflux was diagno sed in 28% of the patients with no sphincter control, and only one of them presented high-grade reflux. In patients with sphincter control, bladder and bowel dysfunction (BBD) was diagnosed in 90% of the cases. Forty four percent of the patients with late DMSA renal scintigraphy presented renal scarring. CONCLUSIONS: In this series, pediatric kidney abscess appears with persistent fever despite the treatment, requiring prolonged antibiotic therapy and rarely surgical drains. We su ggest a study aimed at detecting modifiable factors, such as vesicoureteral reflux in patients with no sphincter control and BBD in patients with sphincter control, as well as identifying renal paren chymal sequels in all patients.
Subject(s)
Abdominal Abscess , Kidney Diseases , Urinary Tract Infections , Vesico-Ureteral Reflux , Abdominal Abscess/complications , Abdominal Abscess/drug therapy , Abscess/complications , Abscess/diagnosis , Abscess/drug therapy , Anti-Bacterial Agents/therapeutic use , Child , Child, Preschool , Female , Humans , Kidney Diseases/complications , Kidney Diseases/diagnosis , Male , Retrospective Studies , Urinary Tract Infections/complications , Urinary Tract Infections/diagnosis , Urinary Tract Infections/drug therapy , Vesico-Ureteral Reflux/complications , Vesico-Ureteral Reflux/drug therapyABSTRACT
BACKGROUND: Steroid use in renal transplant is related to multiple adverse effects. Long-term effects of early withdrawal steroids in pediatric renal transplant were assessed. METHODS: Renal transplant children with low immunological risk treated on basiliximab, tacrolimus, and mycophenolate with steroid withdrawal or steroid control were evaluated between 2003 and 2019. Clinical variables, treatment adherence, acute rejection, graft loss, and death were analyzed through hazard ratios, and Kaplan-Meier and multivariate analyses. RESULTS: The study included 152 patients, 71.1% steroid withdrawal, mean follow-up 8.5 years, 64.5% structural abnormalities, and 81.6% deceased donor. At 12 years of transplant, event-free survival analysis for graft loss or death showed no significant difference between steroid withdrawal and control steroid treatment (85.9% vs. 80.4%, p = .36) nor in acute rejection at 10 years (18.5% vs. 20.5%, p = .78) or in donor-specific antibody appearance (19.6% vs. 21.4%, p = .98). Delta height Z-score was increased in the steroid withdrawal group (p < .01). The main predictor of graft loss or death was non-adherence to treatment (p = .001; OR: 17.5 [3.3-90.9]). CONCLUSIONS: Steroid withdrawal therapy was effective and safe for low-risk pediatric renal transplant in long-term evaluation. Non-adherence was the main predictor of graft loss or death.
Subject(s)
Immunosuppressive Agents/therapeutic use , Kidney Transplantation , Steroids/administration & dosage , Child , Female , Graft Rejection , Humans , Kidney Transplantation/mortality , Male , Medication AdherenceABSTRACT
End-stage renal disease (ESRD) has an incidence of 5.5 to 9 pmp, and a prevalence of 23 to 65 pmp in children under 15 years of age. Chronic peritoneal dialysis (PD) represents the most widely used renal replacement therapy in children before kidney transplantation. There are two PD modalities, the manual one (CAPD) and the automated one (APD). The choice is based on the peritoneum characteristics, evaluated through the peritoneal equilibrium test (PET), which divides patients into high transporters (rapid exchange membrane), high average, low average, and low transporters (slow exchange membrane). This test basically evaluates the solutes transport rate, and the MiniPET has been added which evaluates peritoneal free water transport. The amount of dialysis (Kt/V), which represents the dose of dialysis administered also must be evaluated to assure a minimal value of 1.7 related to morbidity and mortality. These parameters should be evaluated periodically to ad just the PD and whenever suspected an inadequate clearance or ultrafiltration. The objective of this review is to provide basic concepts on peritoneal transport physiology, PD modalities, free water transport and peritoneal solute transport evaluation, and the dialysis dose to be applied according to the patient's needs, as well as reviewing the correction mechanisms and procedure adjustment whenever required.
Subject(s)
Kidney Failure, Chronic/therapy , Peritoneal Dialysis/methods , Child , Humans , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/physiopathology , Pediatrics , Treatment OutcomeABSTRACT
Resumen: La enfermedad renal crónica terminal (ERCT) tiene una incidencia de 5,5 a 9 ppm, y una prevalencia de 23 a 65 ppm en menores de 15 años. La diálisis peritoneal (DP) crónica representa en pediatría la terapia de reemplazo renal más usada, previo al trasplante renal. Existen 2 tipos de DP crónicas, manual (DPCA) y automatizada (DPA), cuya elección se basa en las características del peritoneo eva luado mediante el test de equilibrio peritoneal (PET), que divide a los pacientes en transportadores altos (intercambio rápido), promedio alto, promedio bajo, y bajos (intercambio lento). Este test eva lúa básicamente el transporte de solutos, al cual se ha sumado el MiniPET, que evalúa el transporte peritoneal de agua libre. Se debe igualmente determinar la cuantía de diálisis (Kt/V), que representa la dosis de diálisis aplicada, con un valor mínimo sugerido de 1,7, relacionado a la morbimortalidad. Estos parámetros deben ser evaluados periódicamente para ajustar la DP, y cada vez que se sospeche una depuración o ultrafiltración inadecuadas. El objetivo de esta revisión es entregar conceptos bási cos sobre fisiología del transporte peritoneal, modalidades de DP, evaluación del transporte de agua y solutos peritoneal, y el cálculo de la dosis de diálisis para una diálisis ajustada a las necesidades de cada paciente, como también revisar los mecanismos de corrección y ajuste del procedimiento cada vez que se requiera.
Abstract: End-stage renal disease (ESRD) has an incidence of 5.5 to 9 pmp, and a prevalence of 23 to 65 pmp in children under 15 years of age. Chronic peritoneal dialysis (PD) represents the most widely used renal replacement therapy in children before kidney transplantation. There are two PD modalities, the manual one (CAPD) and the automated one (APD). The choice is based on the peritoneum characteristics, evaluated through the peritoneal equilibrium test (PET), which divides patients into high transporters (rapid exchange membrane), high average, low average, and low transporters (slow exchange membrane). This test basically evaluates the solutes transport rate, and the MiniPET has been added which evaluates peritoneal free water transport. The amount of dialysis (Kt/V), which represents the dose of dialysis administered also must be evaluated to assure a minimal value of 1.7 related to morbidity and mortality. These parameters should be evaluated periodically to ad just the PD and whenever suspected an inadequate clearance or ultrafiltration. The objective of this review is to provide basic concepts on peritoneal transport physiology, PD modalities, free water transport and peritoneal solute transport evaluation, and the dialysis dose to be applied according to the patient's needs, as well as reviewing the correction mechanisms and procedure adjustment whenever required.
Subject(s)
Humans , Child , Peritoneal Dialysis/methods , Kidney Failure, Chronic/therapy , Pediatrics , Treatment Outcome , Kidney Failure, Chronic/diagnosis , Kidney Failure, Chronic/physiopathologyABSTRACT
RESUMEN Objetivo: Describir la percepción de un grupo de mujeres chilenas acerca de la calidad de la atención y las características del Papanicolaou (PAP) como factores que influyen en la decisión de realizarse o no el examen. Método: Investigación cualitativa descriptiva con análisis de contenido. Cincuenta y siete mujeres chilenas de 4 consultorios distintos del Servicio de Salud Metropolitano Sur Oriente participaron de este estudio. Los datos fueron recogidos mediante la metodología de grupo focal. Resultados: Las características del procedimiento, la asociación a síntomas y a cáncer, la periodicidad, la experiencia con cercanos con cáncer y la susceptibilidad son temas asociados al examen. En lo que respecta a la atención, el tipo de sistema de salud, la falta de dinero, el género del profesional, las experiencias negativas previas, la falta de información y el sistema de agendamiento de horas fueron los temas analizados. Conclusión: La adherencia al tamizaje de cáncer cérvicouterino es un fenómeno multifactorial y debe ser abordado como tal. Los profesionales de la salud juegan un papel importante en la promoción del tamizaje y deben abordar de manera proactiva las percepciones y el conocimiento de las mujeres sobre el mismo, sin olvidar que la calidad de la atención también influye de forma importante en la decisión de realizarse o no el PAP.
ABSTRACT Objective: To describe the perception of a group of Chilean women about the quality of care and the characteristics of the PAP test as factors that influence the decision to take or not the test. Method: Qualitative descriptive research with content analysis. Fifty-seven Chilean women from four public primary healthcare centers from the South East Metropolitan Health Service participated in this study. Data was obtained using the focus group methodology. Results: The characteristics of the procedure, the association with symptoms and cancer, the periodicity, the experience with close persons with cancer and the susceptibility are subjects associated with the exam. Regarding quality of care, the type of health system, the lack of money, the gender of the professional, the previous negative experiences, the lack of information and the appointment scheduling system were the topics analyzed. Conclusion: Adherence to cervical cancer screening is a multifactorial phenomenon and should be addressed as such. Healthcare professionals play an important role in the promotion of screening, and must proactively address women's perceptions and knowledge about it, without forgetting that the quality of care has also an important influence on the decision of taking or not the Pap test.
Subject(s)
Humans , Female , Adult , Middle Aged , Quality of Health Care , Uterine Cervical Neoplasms/diagnosis , Early Detection of Cancer/methods , Papanicolaou Test , Uterine Cervical Neoplasms/epidemiology , Chile/epidemiology , Health Knowledge, Attitudes, Practice , Mass Screening , Epidemiology, Descriptive , Papanicolaou Test/statistics & numerical data , Treatment Adherence and ComplianceABSTRACT
Despite a clear association between human papillomavirus and cervical cancer, knowledge in adolescent populations regarding the disease and methods for its detection and prevention is deficient. The aim of this study was to develop and test a new questionnaire concerning knowledge on cervical cancer. An instrument was developed and validated to measure knowledge in 226 Chilean adolescents between April and June 2011. Content validity, construct validity, and reliability analysis of the instrument were performed. The new, validated instrument, called CEC-61 (Conocimientos en Cancer Cérvicouterino-61 items/Knowledge in Cervical Cancer-61 items), contains nine factors and 61 items. The new questionnaire explained 81% of the variance with a reliability of 0.96. The assessment of knowledge with a valid and reliable instrument is the first step in creating interventions for a population and to encourage appropriate preventive behavior. CEC-61 is highly reliable and has a clear factorial structure to evaluate knowledge in nine domains related to cervical cancer disease, cervical cancer risk, papilloma virus infection, the Papanicolaou test, and the papilloma virus vaccine.
Subject(s)
Health Knowledge, Attitudes, Practice , Papillomavirus Infections , Psychometrics/instrumentation , Surveys and Questionnaires/standards , Uterine Cervical Neoplasms , Adolescent , Chile , Female , Humans , Papillomavirus Infections/prevention & control , Reproducibility of Results , Uterine Cervical Neoplasms/prevention & controlABSTRACT
INTRODUCCIÓN Y OBJETIVO: Actualmente, las tasas de mortalidad por cáncer cérvicouterino (CC) en Latinoamérica y el Caribe son mayores comparadas con otros países, a pesar de ser altamente prevenible. El objetivo de este trabajo es identificar la relación entre la adherencia al tamizaje de cáncer cérvicouterino y las creencias sobre el CC y el Papanicolaou (PAP) en mujeres chilenas. MÉTODOS: Estudio realizado en una muestra probabilística de 969 mujeres entre 25 y 64 años de edad, beneficiarias del sistema de salud público y pertenecientes a la comuna de Puente Alto en Santiago, Chile. El reclutamiento y recolección de datos fue entre Marzo 2014 y Octubre 2015. Se midieron variables sociodemográficas, adherencia al PAP y creencias en relación al PAP y CC. RESULTADOS: La mayor adherencia al tamizaje de CC tiene relación significativa con el sentimiento de bienestar al estar cuidando la salud, la percepción de menor cantidad de barreras para tomarse el PAP particularmente en mujeres que adhieren en el sistema privado, el conocimiento de la radio o quimioterapia como tratamiento para el CC, la percepción del riesgo personal de desarrollar la enfermedad, saber que los síntomas no son un requisito para el PAP, y la motivación dada por profesionales de salud o la madre. CONCLUSIONES: La adherencia al PAP es multifactorial y las creencias de las mujeres deben ser consideradas para el éxito de un programa de tamizaje eficaz.
INTRODUCTION AND OBJECTIVES: Currently, cervical cancer's mortality rates in Latin America and the Caribbean are higher compared to other countries, despite being highly preventable. The aim of this study is to identify the relationship between beliefs on CC and PAP test and adherence to screening in Chilean women. MATERIAL AND METHOD: This study was carried out in a probabilistic sample of 969 women aged between 25 and 64 years old, belonging to public health care system and enrolled in any of the four selected primary healthcare centers in Puente Alto, Santiago, Chile. Data collection was carried out between March 2014 and October 2015. Socio-demographic variables, adherence to screening and beliefs regarding CC and PAP test were measured. RESULTS: Greater adherence to CC screening has a significant relationship with the feeling of well-being while taking care of one's health, the perception of fewer barriers to the test particularly in women who adhere in the private health care system, knowledge of radio or chemotherapy as a treatment for CC, the perception of the personal risk of developing the disease, knowing that symptoms are not a requirement for the test, and the motivation given by health care professionals or the mother. CONCLUSION: Adherence to screening is multifactorial and women's' beliefs should be considered for the success of an effective screening program.
Subject(s)
Humans , Female , Adult , Middle Aged , Uterine Cervical Neoplasms/prevention & control , Health Knowledge, Attitudes, Practice , Mass Screening/psychology , Patient Compliance , Papanicolaou Test/psychology , Uterine Cervical Neoplasms/diagnosis , Uterine Cervical Neoplasms/psychology , Uterine Cervical Neoplasms/epidemiology , Chile , CultureABSTRACT
Background: Pap smear coverage in Chile has gradually decreased in the last years, from 67% to 59%, making it necessary to determine the causes of this decline. Aim: To analyze the relationship between the characteristics of the cervical cancer screening target population in the public health care system and the percentage of PAP coverage. Material and Methods: This study was carried out in women aged between 25 and 64 years, belonging to a public health care system and registered in any of the eight primary healthcare centers of a Metropolitan Santiago low income community. The analysis considered information from the recruitment database (n = 6,058) and interviewed women database (n = 1,042). Results: In 52% of cases there were difficulties in recruiting women, mainly due to wrong addresses. Among contacted women, 4.1% had a hysterectomy or had cervical cancer and 1.4% were dead. When analyzing the variable adherence to cervical cancer screening in the interviewed women, 76.8% reported to comply with the ministerial guidelines. From that group, 20.5% reported to attend screening at the private health care system. Seventy seven percent of women who had timely screening visits, reported attending screening periodically every 3 years or less. Conclusions: Pap smear coverage must be analyzed considering the different factors that affect it. Among the latter, the exclusion of some women from the target population and performing the screening in private clinics stand out.
Subject(s)
Humans , Female , Adult , Middle Aged , Health Knowledge, Attitudes, Practice , Mass Screening/statistics & numerical data , Patient Compliance/statistics & numerical data , Papanicolaou Test/statistics & numerical data , Socioeconomic Factors , Urban Population , Chile , Surveys and QuestionnairesABSTRACT
Chronic respiratory diseases are one of the most prevalent health problems in the world. Treatment for these kind of afflictions often take place at home, where the continuous care of a medical specialist is frequently beyond the economical means of the patient, therefore having to rely on informal caregivers (family, friends, etc.). Unfortunately, these treatments require a deep involvement on their part, which results in a heavy burden on the caregivers' routine and usually end up deteriorating their quality of life. In recent years, mHealth and eHealth applications have gained a wide interest in academia due to new capabilities enabled by the latest advancements in mobile technologies and wireless communication infrastructure. These innovations have resulted in several applications that have successfully managed to improve automatic patient monitoring and treatment and to bridge the distance between patients, caregivers and medical specialists. We therefore seek to move this trend forward by now pushing these capabilities into the field of respiratory therapies in order to assist patients with chronic respiratory diseases with their treatment, and to improve both their own and their caregivers' quality of life. This paper presents a cloud-based mobile system to support and improve homecare for respiratory diseases. The platform described uses vital signs monitoring as a way of sharing data between hospitals, caregivers and patients. Using an iterative research approach and the user's direct feedback, we show how mobile technologies can improve a respiratory therapy and a family's quality of life.
Subject(s)
Cloud Computing , Quality of Life , Respiratory Therapy , Telemedicine , Caregivers , Home Care Services , HumansABSTRACT
BACKGROUND: Pap smear coverage in Chile has gradually decreased in the last years, from 67% to 59%, making it necessary to determine the causes of this decline. AIM: To analyze the relationship between the characteristics of the cervical cancer screening target population in the public health care system and the percentage of PAP coverage. MATERIAL AND METHODS: This study was carried out in women aged between 25 and 64 years, belonging to a public health care system and registered in any of the eight primary healthcare centers of a Metropolitan Santiago low income community. The analysis considered information from the recruitment database (n = 6,058) and interviewed women database (n = 1,042). RESULTS: In 52% of cases there were difficulties in recruiting women, mainly due to wrong addresses. Among contacted women, 4.1% had a hysterectomy or had cervical cancer and 1.4% were dead. When analyzing the variable "adherence to cervical cancer screening" in the interviewed women, 76.8% reported to comply with the ministerial guidelines. From that group, 20.5% reported to attend screening at the private health care system. Seventy seven percent of women who had timely screening visits, reported attending screening periodically every 3 years or less. CONCLUSIONS: Pap smear coverage must be analyzed considering the different factors that affect it. Among the latter, the exclusion of some women from the target population and performing the screening in private clinics stand out.
Subject(s)
Health Knowledge, Attitudes, Practice , Mass Screening/statistics & numerical data , Papanicolaou Test/statistics & numerical data , Patient Compliance/statistics & numerical data , Adult , Chile , Female , Humans , Middle Aged , Socioeconomic Factors , Surveys and Questionnaires , Urban PopulationABSTRACT
ANTECEDENTES: Los Determinantes Sociales (DS) consideran "características del contexto social que afectan la salud, así como también los mecanismos por los cuales las condiciones sociales se traducen en impactos en salud". Las intervenciones cuyo objetivo son reducir la enfermedad serán exitosas solamente cuando consideren adecuadamente los DS de salud. OBJETIVO: Analizar, en base a la literatura existente, el modelo de determinantes sociales de la OMS y su aplicación a la adherencia al tamizaje de cáncer cérvicouterino (CC). RESULTADOS: Son variados los estudios que establecen la relación entre los determinantes estructurales e intermediarios y la adherencia al tamizaje. Si bien hay estudios contradictorios, es relevante la asociación positiva entre determinantes estructurales y mayor adherencia: un mayor nivel educacional, la presencia de empleo y un mayor ingreso familiar determinan una mayor adherencia al tamizaje. Como determinantes estructurales, son varios los factores reportados, entre los que se encuentran las características del hogar, el tiempo de permanencia, las características del sistema de salud, su disponibilidad y contacto con profesionales de la salud, factores de riesgo para CC, conocimiento acerca de la enfermedad así como también las creencias, entre otras. CONCLUSIÓN: Es necesario considerar la prevención de CC desde una perspectiva mucho más amplia, con un enfoque que va mas allá de los fenómenos biomédicos que la falta de adherencia al tamizaje conlleva, sino como una problemática social que explica dicho comportamiento en salud. Se sugiere que las campañas de prevención de CC consideren el enfoque de DS.
BACKGROUND: Social Determinants consider "characteristics of the social context that affect health, as well as the mechanisms by which social conditions translate into health impacts". Interventions aimed at reducing diseases will be successful only when properly considered the social determinants of health. OBJECTIVE: Analyze, based on the existing literature, WHO's Social Determinants of health model and its application to cervical cancer (CC) screening adherence. RESULTS: There are many studies that establish the relationship between structural and intermediate determinants and adherence to screening. Even though there are contradictory studies, it is important the positive association between structural determinants and greater adherence: a higher education, employment and the presence of increased house holding come determine a greater adherence to screening. As structural determinants, several factors are reported, including house hold characteristics, residence time, characteristics of the health system, availability and contact with health professionals, risk factors for cervical cancer, knowledge and beliefs of the disease, among others. CONCLUSION: It is necessary to consider CC prevention from a much wider perspective, with an approach that goes beyond the biomedical phenomena that the lack of screening adherence entails, but as a social problem that explains this health behavior. It is suggested that CC prevention campaigns should consider the Social Determinants approach.