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2.
Rev Lat Am Enfermagem ; 28: e3266, 2020.
Artículo en Portugués, Español, Inglés | MEDLINE | ID: mdl-32401903

RESUMEN

OBJECTIVE: To verify factors associated with early newborn access to biological neonatal screening. METHOD: A cross-sectional quantitative study was carried out with all newborns who underwent tests in healthcare units, hospitals, and laboratories of a city in the state of São Paulo, Brazil, with programs linking healthcare information. The following variables were investigated: child's age at collection (dependent); place of collection; date of collection; and type of user (independent). Descriptive and inferential statistics were applied. RESULTS: Records of 15,652 screenings were found in the two years analyzed. In the first year analyzed, 7,955 births and 7,640 (96.0%) tests were recorded, of which 5,586 (73.1%) were undertaken with newborns between three and five days old. In the next year analyzed, 8,316 births and 8,012 (96.3%) screenings were recorded, of which 7,025 (87.6%) were undertaken with newborns in the same age group. A statistically significant association was found between the variables "child's age" and "type of user" in one year, and between the variables "child's age" and "place of collection" in both years. CONCLUSION: Early access to these tests enables the screening of diseases and referral for treatment. The present study contributes to the management of child care programs by presenting strategies linking data and actions to improve access to biological neonatal screening.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Tamizaje Neonatal , Brasil , Servicios de Salud del Niño/estadística & datos numéricos , Estudios Transversales , Diagnóstico Precoz , Humanos , Recién Nacido , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/estadística & datos numéricos , Tamizaje Neonatal/enfermería , Tamizaje Neonatal/organización & administración , Factores de Tiempo
4.
Brasília, D.F.; OPAS; 2020-05-15. (OPAS-W/BRA/COVID-19/20-062).
en Portugués | PAHO-IRIS | ID: phr2-52176

RESUMEN

Introdução: Até 15 de maio de 2020, mais de 4 milhões de casos confirmados da doença causada pelo novo coronavírus (COVID-19), incluindo mais de 285.000 mortes, foram relatados à OMS. O risco de doença grave e morte tem sido maior em idosos e pessoas com doenças crônicas não transmissíveis (DCNT), como hipertensão, cardiopatia, doença pulmonar crônica e câncer. Dados limitados descrevem manifestações clínicas da COVID-19 geralmente mais leves em crianças do que em adultos, mas também mostram que algumas crianças requerem hospitalização e cuidados intensivos. Foram relatados relativamente poucos casos de bebês com COVID-19 confirmado; aqueles infectados tiveram doença leve. Ainda faltam evidências robustas associando doenças preexistentes e gravidade da infecção em crianças. Em 345 crianças com confirmação laboratorial de COVID-19 e informações completas sobre doenças preexistentes, 23% apresentavam doença de base, e as relatadas com maior frequência foram doença pulmonar crônica (incluindo asma), doença cardiovascular e munossupressão. Porém, relatos recentes da Europa e da América do Norte descreveram grupos (clusters) de crianças e adolescentes que necessitaram de internação em unidades de terapia intensiva com uma condição inflamatória multissistêmica, com algumas características semelhantes às da doença de Kawasaki e da síndrome do choque tóxico. Relatos de casos e pequenas séries descreveram uma apresentação de doença aguda, acompanhada de uma síndrome hiperinflamatória, levando à falência múltipla de órgãos e choque. As hipóteses iniciais são de que essa síndrome possa estar relacionada à COVID-19, com base nos testes laboratoriais iniciais. As crianças foram tratadas com anti-inflamatórios, incluindo imunoglobulina parenteral e corticoides. É fundamental caracterizar essa síndrome e seus fatores de risco para entender a causalidade e descrever as intervenções terapêuticas. Ainda não está claro o espectro total da doença, e se a distribuição geográfica na Europa e na América do Norte reflete um padrão verdadeiro, ou se a doença simplesmente não foi reconhecida em outros lugares.


Asunto(s)
Infecciones por Coronavirus , Coronavirus , Servicios de Salud del Niño , Servicios de Salud del Adolescente
5.
Can Fam Physician ; 66(5): 332-334, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32404451

RESUMEN

Question Coronavirus disease 2019 (COVID-19) is affecting millions of people worldwide. It seems that it affects mostly adults older than 40 years of age, and the death rate is highest for older individuals in the population. What should I tell parents worried about their children contracting the coronavirus (SARS-CoV-2) causing COVID-19, and what symptoms should I look for to determine if there is a need to test for the virus?Answer The COVID-19 global pandemic affects all ages. Severe respiratory manifestations have been the mainstay of illness in adults, with what seems to be rapid deterioration necessitating mechanical ventilation. Only 5% of those tested and found to have COVID-19 have been younger than 19 years, possibly owing to limited testing, as the symptoms in children are usually mild. Symptoms in children include fever, dry cough, rhinorrhea, sore throat, and fatigue, and in 10% diarrhea or vomiting. Rarely dyspnea or hypoxemia were also described. Blood tests and imaging have been shown to be of little value in children and should only be ordered for those in whom you would normally order these investigations for viral-like illness. No specific therapy is available and supportive care with rest, fluids, and antipyretics for children is the recommended approach. Ibuprofen or acetaminophen for fever and pain can be given. Antiviral and immunomodulatory treatment is not recommended at this time for otherwise healthy children, and corticosteroids should also not be used. Children with immunocompromised states should be isolated and avoid contact with others.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Salud Global , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Niño , Servicios de Salud del Niño , Técnicas de Laboratorio Clínico , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/fisiopatología , Humanos , Padres/psicología , Neumonía Viral/diagnóstico , Neumonía Viral/fisiopatología , Evaluación de Síntomas
6.
J Glob Health ; 10(1): 010505, 2020 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-32257159

RESUMEN

Background: Postnatal care (PNC) for mothers and newborns is essential to monitor risks of morbidity and adverse conditions following delivery. Current estimates of the coverage of PNC show substantial discordance between mothers and newborns. We investigate the sources of this discordance in Demographic and Health Surveys (DHS). Methods: We used DHS data from 48 countries collected since 2011, spanning phases 6 and 7 of the survey program with 32 and 16 surveys, respectively, analyzed. We assessed the distribution of the reported timing of PNC and conducted a sensitivity analysis that excludes/includes PNC reported within 0-1 hour or PNC in the day 2. Agreement in PNC reporting considered four groups: (1) Concordance, neither mother nor newborn received PNC; (2) Concordance, mother and newborn pair received PNC; (3) Discordance, mother received PNC and newborn did not; of (4) Discordance, mother did not receive PNC but the newborn did. We carried out logistic regressions to understand correlates of PNC discordance. All analyses distinguished phase 6 surveys from phase 7. Results: We found substantial differences in the PNC coverage estimated between phase 6 and phase 7 surveys. The phase 7 PNC questions for newborns were improved to increase the understanding of the questions by respondent which probably led to reducing the large PNC gap between mothers and newborns observed in phase 6 surveys. With phase 6 surveys, PNC coverage for mother was estimated on average at 62% compared to only 31% for newborns. No such gap was observed for phase 7 surveys, where for both mothers and newborns, the PNC coverage estimate was similar, at 56%. For both phases, over half of the reported PNC for mothers and newborns occurred during 0-1 hour following delivery, leading to substantial overestimation of PNC coverage, due to confusion between intrapartum care and PNC. There were 37% discordant cases between mother and newborn, largely in favor of the mother in phase 6 surveys, compared to 16% in phase 7 surveys. In phase 6 surveys, discordant PNC cases were observed largely among facility deliveries vs non-facility deliveries (44% compared to 19%). Conclusions: Current estimates of coverage of PNC from DHS phase 6 surveys appears to include substantial level of measurement noises that could explain substantial part of the mother-newborn discordance in PNC. The PNC estimates appear to capture a substantial number of intrapartum care. Current measurement approaches warrant further validation to ensure accurate monitoring of the PNC programs.


Asunto(s)
Servicios de Salud del Niño/normas , Servicios de Salud Materna/normas , Atención Posnatal/normas , Adulto , Artefactos , Demografía , Femenino , Encuestas de Atención de la Salud , Humanos , Recién Nacido , Madres/estadística & datos numéricos , Embarazo , Atención Prenatal
7.
Hu Li Za Zhi ; 67(2): 91-98, 2020 Apr.
Artículo en Chino | MEDLINE | ID: mdl-32281087

RESUMEN

Child life services is a professional service that supports children and adolescents seeking medical treatment. These services provide age-appropriate medical understandings and psychological preparation, coping skills, and psychosocial support for children with the goal of reducing fear, anxiety, and psychological trauma during healthcare provision. In addition to supporting young patients, child life services also support family members and caregivers, facilitating their effective response to related disease and medical situations. Child life specialists are experts in providing child life services. This article reviews the historical development of child life services, including its development and theory, related professional training and education, and the application and intervention goals of child life services in medical care. Finally, the establishment and developmental model of promoting child life services in Taiwan are reviewed with the goal of providing information for the promotion and utilization of child life services by healthcare professionals in practice settings.


Asunto(s)
Servicios de Salud del Niño/organización & administración , Modelos Organizacionales , Niño , Humanos , Taiwán
8.
BMC Res Notes ; 13(1): 197, 2020 Apr 01.
Artículo en Inglés | MEDLINE | ID: mdl-32238186

RESUMEN

OBJECTIVE: In Ethiopia simulation-based anesthesia education is a new way of teaching method which started in Mekelle University as of January, 2019. Hence, the purpose of this study is to evaluate whether simulation-based training improves non-physician anesthetists' knowledge and attitude on maternal and neonatal anesthesia cares or not. RESULTS: Out of 50 study subjects, 66% had a working experience of less than 5 years. Knowledge score improved significantly from 49.78 to 66.22% in pretest and posttest results respectively. The posttest result was significantly improved (P < 0.001) for all knowledge questions. The respondents were asked about a negative statement and a positive statement about the need to have effective closed lope communication, maternal resuscitation and neonatal resuscitation. The attitude score improved from 72.45 to 79.11% in pretest and posttest respectively. From the 9 questions the attitudinal mean score for pretest was 6.52 and posttest 7.12. The null hypothesis of equal knowledge and attitude was rejected, t (49) = - 5.54, P < 0.001 and t (49) = - 2.25, P < 0.03 respectively.


Asunto(s)
Anestesiología/educación , Entrenamiento Simulado , Servicios de Salud del Niño , Etiopía , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Recién Nacido , Masculino , Maniquíes , Servicios de Salud Materna
9.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(3): 337-342, 2020 Mar 10.
Artículo en Chino | MEDLINE | ID: mdl-32294831

RESUMEN

Objective: To assess the health status and health service utilization of children born to syphilis infected mothers during pregnancy, in order to prevent mother-to-child transmission of syphilis to the newborns. Methods: Women with maternal syphilis were studied by trained researchers via phone calls, in Shanghai during 2014-2015. Data related to demographics, status of infection and health care, utilization by both mothers and their children were collected through specifically designed questionnaires. Non-parametric tests including chi-square were used to assess the health status and health service utilization of children born to mothers with different demographic and socioeconomic characteristics. Results: A total of 495 children born to mothers with maternal syphilis were recruited from 1 000 syphilis infected parturient women. A total of 61 out of the 495 children were diagnosed as having congenital syphilis (57 children were diagnosed at birth and another 4 were diagnosed during the follow-up period). Children born to women who received syphilis treatment during pregnancy were at lower risk on congenital syphilis (χ(2)=7.214, P=0.027). 37.8% of the children were reported to have had different illnesses in the past three months, mainly involving upper respiratory infections (32.3%) or diarrhea (3.6%). Children diagnosed with congenital syphilis showed a higher prevalence of different kinds of diseases, compared to those without congenital syphilis (47.5% vs. 36.6%). 81.6% of the children had received regular child health care services. Subjects with the following factors as: being immigrant, with lower education, unemployed, unmarried and multipara, were related to the less use of regular child healthcare services. Only 39.7% of the parents would inform the care-takers about the risk of congenital syphilis infection of their own children at the child health care centers. Mothers with residency of Shanghai, having higher education level and employed, were less willing to inform doctors about the risk of congenital syphilis infection of their children. Conclusions: Loss to follow-up among children born to syphilis infected pregnant women remained a serious problem. Few parents would be willing to inform the healthcare takers that their children are at risk of syphilis, when receiving child health care services at the centers. It was necessary to integrate the congenital syphilis follow-up programs into the routine child care services so as to timely diagnose and treat the patients with congenital syphilis.


Asunto(s)
Servicios de Salud del Niño/estadística & datos numéricos , Salud del Niño/estadística & datos numéricos , Complicaciones Infecciosas del Embarazo/epidemiología , Sífilis/epidemiología , Niño , China/epidemiología , Femenino , Humanos , Recién Nacido , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Embarazo , Complicaciones Infecciosas del Embarazo/terapia , Sífilis/terapia , Sífilis/transmisión , Sífilis Congénita/diagnóstico
11.
Washington, D.C.; OPS; 2020-04-28.
en Español | PAHO-IRIS | ID: phr-52043

RESUMEN

El abuso sexual, que abarca la agresión sexual o la violación, de niños y adolescentes es un grave problema de salud pública en todo el mundo y una violación de los derechos humanos que tiene muchas consecuencias para la salud a corto y a largo plazo. Las consecuencias físicas, sexuales, para la salud reproductiva y la salud mental de ese abuso son de amplio alcance y deben abordarse. Los datos recabados en diferentes entornos indican que los niños y adolescentes están representados desproporcionadamente entre los casos de abuso sexual que se llevan a la atención de los prestadores de atención de salud. En esta directriz se formulan recomendaciones dirigidas en especial a los prestadores de atención de salud que se encuentran en la primera línea de acción (por ejemplo, médicos generales, enfermeras, pediatras, ginecólogos), que atienden a niños y adolescentes hasta la edad de 18 años, que han sufrido, o podrían haber sufrido algún tipo de abuso sexual, como la agresión sexual o la violación. También puede ser útil para otros cuadros de prestadores especializados de atención de salud que tienen probabilidad de atender a niños o adolescentes. En la directriz, aunque es de alcance mundial, se asigna particular importancia a su aplicación en entornos de atención de salud de los países de ingresos bajos y medianos, teniendo en cuenta que allí los recursos de atención de salud son más limitados. Por consiguiente, en la redacción se tuvo en cuenta la factibilidad de poner en práctica las recomendaciones en entornos de escasos recursos... La directriz se formuló según las normas y los requisitos especificados en el manual de la OMS para la elaboración de directrices, segunda edición. El proceso incluyó: a) la determinación de las preguntas de investigación fundamentales y sus resultados; b) la recuperación de la evidencia, lo que incluyó la ejecución de revisiones sistemáticas; c) la síntesis de la evidencia; d) la evaluación de la calidad, efectuada por un Grupo de Elaboración de las Directrices (GED); y e) la formulación de recomendaciones con el GED y aportes de un Grupo de Revisión Externa. No se detectaron conflictos de intereses importantes para el GED ni el Grupo de Revisión Externa. El documento también comprende principios generales que sustentan la práctica clínica y que se derivan de normas internacionales éticas y de derechos humanos. Incluye enunciados de prácticas adecuadas que se basan tanto en los principios orientadores como en los valores y las preferencias de las personas sobrevivientes, sus cuidadores y los prestadores de atención de salud. Las recomendaciones se fundamentan en las recomendaciones vigentes de la OMS, así como en el nuevo contenido elaborado como parte de este proceso de formulación de directrices. A continuación, se resumen los principios orientadores, las recomendaciones y los enunciados de las prácticas adecuadas.


Asunto(s)
Delitos Sexuales , Violencia de Género , Exposición a la Violencia , Violaciones de los Derechos Humanos , Derechos Humanos , Salud Mental , Servicios de Salud del Adolescente , Servicios de Salud del Niño
12.
PLoS One ; 15(3): e0229755, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32182241

RESUMEN

BACKGROUND: Malnutrition is a major public health problem in India, especially among urban poor children. The objective of the study was to determine the effectiveness of a culturally appropriate nutrition educational intervention that can be delivered through health services and digitized child undernutrition tracking module for health workers to improve complementary feeding of infants of age six months to 12 months in Chandigarh, North India, to prevent malnutrition in infants. METHODS: A quasi-experimental study was conducted in a non-randomized intervention (Burail) and control area (Maloya) among a vulnerable population in Chandigarh, North India. The mother-infant dyads (MIDs) in the intervention group(n = 202) received culturally appropriate nutrition educational intervention, were supported individually by trained health workers in infant feeding and followed up for six months. Health workers were monitored through a digitized tracking module. The MIDs in the control group (n = 202) received routine care under the national health program. The mean (±S.D.) age of infants in the intervention and control group was 5.4 (±0.8) months and 5.5 (±0.7) months, respectively. The data was collected using a pre-tested semi-structured questionnaire and anthropometry of infants at baseline and end line. The primary outcome was a mean change in weight. The effectiveness of the intervention was measured by conducting the difference in difference (DID) analysis in mean change in weight between intervention and control group. RESULT: At baseline, the mean (±S.D.) weight of infants was 6.6(±0.64) kg and 6.6 (±0.52) kg in the intervention and control group. The mean (±S.D.) length of infants was 64.3 (±2.0) cm in the intervention group and 65.1 (±1.7) cm in the control group. Out of 404, 190 and 191 MIDs in the intervention and control group completed the study, respectively. A significantly higher number of infants in the intervention group were started on complementary feeding at six months of age (72.6% versus45.5%, p<0.01) and received foods having thick consistency (82.1% versus 41.9%, p<-0.01). There was significant weight gain in intervention group infants (DID means = 0.27 kg, p<0.01) and length gain (DID means = 0.9 cm, p<0.01) from the baseline. Also, there was significant decline in the proportion of undernourished (10% versus18.8%, OR = 0.47, p = 0.01) and wasted infants (7.3% versus15.7%, OR = 0.42, p = 0.01) in the intervention group. CONCLUSION: Community-based nutrition educational intervention delivered through the routine health services and digitized tracking of malnourished children can effectively improve the complementary feeding and growth of children six months to one year among vulnerable populations.


Asunto(s)
Servicios de Salud del Niño/normas , Educación en Salud/normas , Fenómenos Fisiológicos Nutricionales del Lactante , Desnutrición/prevención & control , Adulto , Tecnología Culturalmente Apropiada , Femenino , Educación en Salud/métodos , Humanos , India , Lactante , Masculino , Apoyo Nutricional
13.
Pediatr Clin North Am ; 67(2): 309-324, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32122562

RESUMEN

For migrant children, many obstacles stand in the way of them securing even the most basic of necessities, and many live with the constant threat of being returned to countries where their very lives are in danger. These children and families, many of whom have experienced multiple forms of trauma, both in their home countries and on the journey to the United States, have extensive needs (for medical, mental health, educational, and legal services) that are not being met. Although pediatric medical professionals cannot respond to all issues, they are well situated to assist these vulnerable children.


Asunto(s)
Servicios de Salud del Niño/organización & administración , Emigrantes e Inmigrantes , Pediatras , Rol del Médico , Adolescente , Niño , Humanos , Estados Unidos
15.
Pediatrics ; 145(3)2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32024751

RESUMEN

OBJECTIVES: In this study, we sought to establish priorities for a national research agenda for children and youth with special health care needs (CYSHCN) through a structured, multistakeholder, mixed-methods approach. METHODS: Using surveys, we solicited responses from >800 members of expert-nominated stakeholder organizations, including CYSHCN families, health care providers, researchers, and policymakers, to identify what research with or about CYSHCN they would like to see in a national research agenda. From 2835 individual free-text responses, 96 research topics were synthesized and combined. Using an adapted RAND/UCLA Appropriateness Method (a modified Delphi approach), an expert panel rated research topics across 3 domains: need and urgency, research impact, and family centeredness. Domains were rated on 9-point Likert scales. Panelist ratings were used to sort research topics into 4 relative-priority ranks. Rank 1 (highest priority) research topics had a median of ≥7 in all domains. RESULTS: The RAND/UCLA Appropriateness Method was used to prioritize CYSHCN research topics and depict their varying levels of stakeholder-perceived need and urgency, research impact, and family centeredness. In the 15 topics that achieved rank 1, social determinants of health (disparities and rurality), caregiving (family resilience and care at home), clinical-model refinement (effective model elements, labor divisions, telemedicine, and system integration), value (stakeholder-centered value outcomes, return on investment, and alternative payment models), and youth-adult transitions (planning, insurance, and community supports) were emphasized. CONCLUSIONS: High-priority research topics identified by CYSHCN experts and family leaders underscore CYSHCN research trends and guide important directions. This study is the first step toward an efficient and cohesive research blueprint to achieve highly-effective CYSHCN health systems.


Asunto(s)
Servicios de Salud del Niño , Investigación sobre Servicios de Salud , Servicios de Salud para Personas con Discapacidad , Investigación , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos , Adulto Joven
16.
Cochrane Database Syst Rev ; 2: CD011779, 2020 02 10.
Artículo en Inglés | MEDLINE | ID: mdl-32036618

RESUMEN

BACKGROUND: Despite the existence of effective interventions and best-practice guideline recommendations for childcare services to implement evidence-based policies, practices and programmes to promote child healthy eating, physical activity and prevent unhealthy weight gain, many services fail to do so. OBJECTIVES: The primary aim of the review was to examine the effectiveness of strategies aimed at improving the implementation of policies, practices or programmes by childcare services that promote child healthy eating, physical activity and/or obesity prevention. The secondary aims of the review were to: 1. Examine the cost or cost-effectiveness of such strategies; 2. Examine any adverse effects of such strategies on childcare services, service staff or children; 3. Examine the effect of such strategies on child diet, physical activity or weight status. 4. Describe the acceptability, adoption, penetration, sustainability and appropriateness of such implementation strategies. SEARCH METHODS: We searched the following electronic databases on February 22 2019: Cochrane Central Register of Controlled trials (CENTRAL), MEDLINE, MEDLINE In Process, Embase, PsycINFO, ERIC, CINAHL and SCOPUS for relevant studies. We searched reference lists of included studies, handsearched two international implementation science journals, the World Health Organization International Clinical Trials Registry Platform (www.who.int/ictrp/) and ClinicalTrials.gov (www.clinicaltrials.gov). SELECTION CRITERIA: We included any study (randomised or nonrandomised) with a parallel control group that compared any strategy to improve the implementation of a healthy eating, physical activity or obesity prevention policy, practice or programme by staff of centre-based childcare services to no intervention, 'usual' practice or an alternative strategy. Centre-based childcare services included preschools, nurseries, long daycare services and kindergartens catering for children prior to compulsory schooling (typically up to the age of five to six years). DATA COLLECTION AND ANALYSIS: Two review authors independently screened study titles and abstracts, extracted study data and assessed risk of bias; we resolved discrepancies via consensus. We performed meta-analysis using a random-effects model where studies with suitable data and homogeneity were identified; otherwise, findings were described narratively. MAIN RESULTS: Twenty-one studies, including 16 randomised and five nonrandomised, were included in the review. The studies sought to improve the implementation of policies, practices or programmes targeting healthy eating (six studies), physical activity (three studies) or both healthy eating and physical activity (12 studies). Studies were conducted in the United States (n = 12), Australia (n = 8) and Ireland (n = 1). Collectively, the 21 studies included a total of 1945 childcare services examining a range of implementation strategies including educational materials, educational meetings, audit and feedback, opinion leaders, small incentives or grants, educational outreach visits or academic detailing, reminders and tailored interventions. Most studies (n = 19) examined implementation strategies versus usual practice or minimal support control, and two compared alternative implementation strategies. For implementation outcomes, six studies (one RCT) were judged to be at high risk of bias overall. The review findings suggest that implementation strategies probably improve the implementation of policies, practices or programmes that promote child healthy eating, physical activity and/or obesity prevention in childcare services. Of the 19 studies that compared a strategy to usual practice or minimal support control, 11 studies (nine RCTs) used score-based measures of implementation (e.g. childcare service nutrition environment score). Nine of these studies were included in pooled analysis, which found an improvement in implementation outcomes (SMD 0.49; 95% CI 0.19 to 0.79; participants = 495; moderate-certainty evidence). Ten studies (seven RCTs) used dichotomous measures of implementation (e.g. proportion of childcare services implementing a policy or specific practice), with seven of these included in pooled analysis (OR 1.83; 95% CI 0.81 to 4.11; participants = 391; low-certainty evidence). Findings suggest that such interventions probably lead to little or no difference in child physical activity (four RCTs; moderate-certainty evidence) or weight status (three RCTs; moderate-certainty evidence), and may lead to little or no difference in child diet (two RCTs; low-certainty evidence). None of the studies reported the cost or cost-effectiveness of the intervention. Three studies assessed the adverse effects of the intervention on childcare service staff, children and parents, with all studies suggesting they have little to no difference in adverse effects (e.g. child injury) between groups (three RCTs; low-certainty evidence). Inconsistent quality of the evidence was identified across review outcomes and study designs, ranging from very low to moderate. The primary limitation of the review was the lack of conventional terminology in implementation science, which may have resulted in potentially relevant studies failing to be identified based on the search terms used. AUTHORS' CONCLUSIONS: Current research suggests that implementation strategies probably improve the implementation of policies, practices or programmes by childcare services, and may have little or no effect on measures of adverse effects. However such strategies appear to have little to no impact on measures of child diet, physical activity or weight status.


Asunto(s)
Servicios de Salud del Niño , Dieta Saludable , Ejercicio Físico/fisiología , Promoción de la Salud/métodos , Obesidad Pediátrica/prevención & control , Niño , Preescolar , Guías como Asunto , Política de Salud , Humanos , Desarrollo de Programa , Ensayos Clínicos Controlados Aleatorios como Asunto
17.
PLoS One ; 15(2): e0228558, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32053615

RESUMEN

BACKGROUND: Timely and appropriate health care seeking for diarrhea of under-five children is important to reduce severe and life-threatening complications. However, different findings indicate that mothers of under-five children often delay in seeking care which in turn contributes to the death of large number of children without ever reaching a health facility. Therefore, a proper pinpointing of determinants of delay in seeking care informs intervention strategies for health service planners. OBJECTIVES: Of this study was to identify the determinants of delay in care seeking for diarrheal disease among mothers/caregivers of under-five children in public health facilities of Arba Minch town, South Ethiopia, 2019. METHODS: Facility based case control study was conducted from March 4 to April 30, 2019. Total sample size was 400. Cases were selected by systematic random sampling technique while controls were mothers of under-five children with signs and symptoms of diarrhea who came to the same health facility within 24 hours following cases. Data was collected by using pretested structured questionnaire by three data collectors and entered into EpiData V4 and exported to SPSS V23 for further analysis. Bivariable logistic regression was done to identify variables candidate for Multivariable LR at p-value<0.25. Multivariable logistic regression was done and p-value <0.05 and 95%CI of AOR was used to declare statistical significance. RESULT: Female sex[AOR = 1.93, (95%CI: 1.11,3.36)], child age <24 months[AOR = 4.47,95%CI:2.51,7.97)], mothers'/caregivers without formal education[AOR = 6.90, (95%CI:3.10,15.37)], and attended primary school [AOR = 3.12,(95%CI:1.44,6.73)], poorest household wealth index category[AOR = 2.81, (95%CI:1.20,6.58) and poor household wealth index category [AOR = 2.61,(95%CI: 1.12, 6.09)], mothers/caregivers who did not visit health facility to first episode diarrhea [AOR = 4.55, (95%CI:2.41,8.59)], mothers/caregivers who were satisfied in the last six month visit [AOR = 0.29, (95%CI:0.15,0.55)], and poor perceived health care professionals respect[AOR = 4.91, (95%CI:2.64,9.15)] were important determinants of delay in seeking care. CONCLUSIONS: Sex and age of the child, educational status of the mother/caregiver, poor wealth index category, not visiting health facility at first response, satisfaction with the care and examination, and respect of health care professionals were important determinants of delay in seeking care among mothers/caregivers of under-five children with diarrhea illness. All concerned body should focus interventions on poor and less educated mothers/caregivers with emphasis on female children and <24 months. Health workers are needed to provide respectful service to promote satisfaction level of clients.


Asunto(s)
Diagnóstico Tardío , Diarrea/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Tiempo de Tratamiento , Adolescente , Adulto , Cuidadores , Estudios de Casos y Controles , Servicios de Salud del Niño , Preescolar , Estudios Transversales , Escolaridad , Etiopía , Femenino , Instituciones de Salud , Conocimientos, Actitudes y Práctica en Salud , Investigación sobre Servicios de Salud , Humanos , Lactante , Recién Nacido , Masculino , Madres , Satisfacción del Paciente , Salud Pública , Análisis de Regresión , Encuestas y Cuestionarios , Adulto Joven
18.
PLoS One ; 15(2): e0229357, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32084214

RESUMEN

INTRODUCTION: Data on the variation in the medical resource utilization rate of Human Respiratory Syncytial Virus (HRSV) infected children by gestational age have recently been made available. This review aimed to determine whether prematurity is independently associated with the use of medical resources in hospitalized children for HRSV infections. METHODS: We conducted this systematic review on cohort studies published on the medical resources use in preterm and full-term patients hospitalized for confirmed HRSV infections. We searched PubMed, Embase, and Global Index medicus for eligible studies. The standardized mean difference (SMD) and Risk Ratio (RR) with their 95% confidence intervals (95% CI) were estimated as summary statistics with random effects meta-analysis. The overall results were adjusted to the common confounders by stratified analyses. RESULTS: A total of 14 articles (20 studies) were included. Compared to full-term, preterm hospitalized with HRSV infections had more frequent intensive care unit admission (RR = 2.6, 95% CI = 1.9-3.5), increased length of stay in hospital (SMD = 0.6, 95% CI = 0.5-0.8) and intensive care unit (SMD = 0.6, 95% CI = 0.4-0.8) and increased case fatality rate (RR = 6.9, 95% CI = 2.0-23.8). Mechanical ventilation utilization was more frequent in preterm children ≤ 2 years (RR = 15.5, 95% CI = 8.9-26.4) and those who did not receive prophylaxis against HRSV (RR = 15.9, 95% CI = 9.1-27.9)] than in full-term children. No differences were identified in the frequency of emergency department visits, oxygen utilization, and the age at the first HRSV episode between preterm and full-term infants. CONCLUSIONS: Regardless of gestational age, preterm infants hospitalized for HRSV infections, especially those ≤ 2 years, have an increased frequency of use of health resources and poor outcomes compared to full-term infants. HRSV vaccine development programs for pregnant women should be accelerated. CLINICAL TRIALS REGISTRATION: Review registration PROSPERO, CRD42019124375.


Asunto(s)
Servicios de Salud del Niño/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Enfermedades del Prematuro/terapia , Aceptación de la Atención de Salud/estadística & datos numéricos , Infecciones por Virus Sincitial Respiratorio/terapia , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Edad Gestacional , Humanos , Lactante , Recien Nacido Prematuro , Enfermedades del Prematuro/virología , Infecciones por Virus Sincitial Respiratorio/virología , Estudios Retrospectivos
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