Estimación de prevalencia de niños con enfermedades limitantes de la vida en un hospital pediátrico de alta complejidad / Prevalence of patients with life-limiting conditions in a high complexity pediatric hospital

En Chile fallecen aproximadamente 800 niños menores de 15 años por diversas causas, entre ellas, por enfermedades sin tratamiento curativo. La Sociedad Chilena de Pediatría creó el Comité de Niños y Adolescentes con Necesidades Especiales en Atención de Salud (NANEAS), que entregó las pautas para una atención integral de estos pacientes, incluyendo los cuidados paliativos (CP). Resulta indispensable conocer el número y características de los pacientes que padecen enfermedades limitantes de la vida (ELV) para elaborar programas de atención que prioricen por un cuidado ambulatorio bajo la supervisión de equipos multidisciplinarios. Objetivo: Estimar la prevalencia de pacientes con ELV en un hospital pediátrico de alta complejidad. Pacientes y método: Se revisaron los egresos de las Unidades de Pediatría General y Unidad de Paciente Crítico del Hospital Roberto del Río, durante el 2009 y 2010. Se seleccionaron los casos con diagnósticos de ELV según CIE-10, registrando datos demográficos y clasificándolos según los grupos de la ACT para ELV. Se excluyeron pacientes con cáncer avanzado. Resultados: De 6585 pacientes egresados, 190 tenían diagnóstico ELV (2.89 por ciento). Los lactantes fueron el grupo más numeroso (33 por ciento). El 51,6 por ciento de los pacientes pertenecían al grupo 4 (parálisis cerebral severa, genopatías complejas, TEC con secuelas graves) y todos fueron atendidos por 3 o más especialistas. Conclusión: Los niños con ELV constituyen un grupo emergente entre los pacientes pediátricos hospitalizados, demandando una atención de alta complejidad. Es un desafío implementar políticas públicas que optimicen su manejo y permitan planificar unidades especializadas para su atención, incluyendo los CP.

In Chile, approximately 800 children under the age of 15 years die from a variety of causes, including life-limiting conditions (LLC). The Chilean Society of Pediatrics established a Committee on Children and Adolescents with Special Health Care Needs (NANEAS), which established guidelines for comprehensive care of these patients, including palliative care (PC). It is essential to know the number and characteristics of patients with LLC, in order to develop programs for outpatient care under the supervision of multidisciplinary teams. Objective: To estimate the prevalence of patients with LLC in a high complexity pediatric hospital. Patients and methods: We reviewed the discharges from General Pediatric Units and the Critical Patient Unit at the Roberto del Rio Hospital during 2009 and 2010. We selected patients with LLC according to ICD-10. Their demographic characteristics were registered and classified into the four ACT groups. Patients with advanced cancer were excluded. Results: Of 6585 patients discharged, 190 were diagnosed as LLC (2.89 percent). Infants were the largest group (33 percent). 51.6 percent of patients belonged to group 4 (severe cerebral palsy, genopathies, serious sequelae of traumatic brain injury) and all were attended by at least three specialists. Conclusion: Children with LLC are an emerging group among hospitalized pediatric patients and they are demanding attention of high complexity. It is a challenge to design and implement public policies that can optimize health care for these patients, and facilitate the establishement of specialized units for this purpose, including PC.

The Latin American Consortium of Studies in Obesity (LASO).

Current, high-quality data are needed to evaluate the health impact of the epidemic of obesity in Latin America. The Latin American Consortium of Studies of Obesity (LASO) has been established, with the objectives of (i) Accurately estimating the prevalence of obesity and its distribution by sociodemographic characteristics; (ii) Identifying ethnic, socioeconomic and behavioural determinants of obesity; (iii) Estimating the association between various anthropometric indicators or obesity and major cardiovascular risk factors and (iv) Quantifying the validity of standard definitions of the various indexes of obesity in Latin American population. To achieve these objectives, LASO makes use of individual data from existing studies. To date, the LASO consortium includes data from 11 studies from eight countries (Argentina, Chile, Colombia, Costa Rica, Dominican Republic, Peru, Puerto Rico and Venezuela), including a total of 32,462 subjects. This article describes the overall organization of LASO, the individual studies involved and the overall strategy for data analysis. LASO will foster the development of collaborative obesity research among Latin American investigators. More important, results from LASO will be instrumental to inform health policies aiming to curtail the epidemic of obesity in the region.

Interethnic differences in the accuracy of anthropometric indicators of obesity in screening for high risk of coronary heart disease.

BACKGROUND: Cut points for defining obesity have been derived from mortality data among Whites from Europe and the United States and their accuracy to screen for high risk of coronary heart disease (CHD) in other ethnic groups has been questioned. OBJECTIVE: To compare the accuracy and to define ethnic and gender-specific optimal cut points for body mass index (BMI), waist circumference (WC) and waist-to-hip ratio (WHR) when they are used in screening for high risk of CHD in the Latin-American and the US populations. METHODS: We estimated the accuracy and optimal cut points for BMI, WC and WHR to screen for CHD risk in Latin Americans (n=18 976), non-Hispanic Whites (Whites; n=8956), non-Hispanic Blacks (Blacks; n=5205) and Hispanics (n=5803). High risk of CHD was defined as a 10-year risk > or =20% (Framingham equation). The area under the receiver operator characteristic curve (AUC) and the misclassification-cost term were used to assess accuracy and to identify optimal cut points. RESULTS: WHR had the highest AUC in all ethnic groups (from 0.75 to 0.82) and BMI had the lowest (from 0.50 to 0.59). Optimal cut point for BMI was similar across ethnic/gender groups (27 kg/m(2)). In women, cut points for WC (94 cm) and WHR (0.91) were consistent by ethnicity. In men, cut points for WC and WHR varied significantly with ethnicity: from 91 cm in Latin Americans to 102 cm in Whites, and from 0.94 in Latin Americans to 0.99 in Hispanics, respectively. CONCLUSION: WHR is the most accurate anthropometric indicator to screen for high risk of CHD, whereas BMI is almost uninformative. The same BMI cut point should be used in all men and women. Unique cut points for WC and WHR should be used in all women, but ethnic-specific cut points seem warranted among men.

[Determinants of fertility in Costa Rica]. / Determinantes de la fecundidad en Costa Rica.

PIP: An attempt to systematize variables or factors traditionally associated with fertility, this study is not intended as a theoretical framework. 2 periods in Costa Rican fertility are recognized: one before 1960 and one after 1960. Within these periods 4 stages, each with different "key" determinants, are recognized. Until 1960, high fertility rates prevailed, with more than 6 children as total. Fluctuations were due to voluntary factors such as nuptiality and breastfeeding, and involuntary factors such as demand for less children during economic recession. Between 1960 and 1975 fertility declined. It is believed that the "key" factors in this fertility decline were on the contraceptive "offert" side rather than on the children demand side. The participation of peasants and low socioeconomic groups in the fertility decline and governmental health and family planning services are also recognized as important factors. Since the mid 70's a new stage of relative stability has been reached with an apparent convergence towards a total fertility of 3 children. How close this level is reached in the near future will depend on the control of unwanted fertility. The possibility of a 2nd fertility decline in Costa Rica depends mainly on factors which determine why couples have a 3rd child. Consequently, investigation of these factors is suggested to anticipate the future course of Costa Rican fertility. Basic fertility data are given in tables and an appendix.^ieng