Lessons Learned From 10 Years of Preschool Intervention for Health Promotion: JACC State-of-the-Art Review.

Implementing a health promotion program for children is a complex endeavor. In this review, we outline the key lessons learned over 10 years of experience in implementing the SI! Program (Salud Integral-Comprehensive Health) for cardiovascular health promotion in preschool settings in 3 countries: Colombia (Bogotá), Spain (Madrid), and the United States (Harlem, New York). By matching rigorous efficacy studies with implementation science, we can help bridge the divide between science and educational practice. Achieving sustained lifestyle changes in preschool children through health promotion programs is likely to require the integration of several factors: 1) multidisciplinary teams; 2) multidimensional educational programs; 3) multilevel interventions; 4) local program coordination and community engagement; and 5) scientific evaluation through randomized controlled trials. Implementation of effective health promotion interventions early in life may induce long-lasting healthy behaviors that could help to curb the cardiovascular disease epidemic.

Development of an international standard set of patient-centred outcome measures for overall paediatric health: a consensus process.

OBJECTIVE: To develop an Overall Pediatric Health Standard Set (OPH-SS) of outcome measures that captures what matters to young people and their families and recognising the biopsychosocial aspects of health for all children and adolescents regardless of health condition. DESIGN: A modified Delphi process. SETTING: The International Consortium for Health Outcomes Measurement convened an international Working Group (WG) comprised of 23 international experts from 12 countries in the field of paediatrics, family medicine, psychometrics as well as patient advisors. The WG participated in 11 video-conferences, through a modified Delphi process and 9 surveys between March 2018 and January 2020 consensus was reached on a final recommended health outcome standard set. By a literature review conducted in March 2018, 1136 articles were screened for clinician and patient-reported or proxy-reported outcomes. Further, 4315 clinical trials and 12 paediatric health surveys were scanned. Between November 2019 and January 2020, the final standard set was endorsed by a patient validation (n=270) and a health professional (n=51) survey. RESULTS: From a total of 63 identified outcomes, consensus was formed on a standard set of outcome measures that comprises 10 patient-reported outcomes, 5 clinician-reported measures, and 6 case-mix variables. The four developmental age-specific packages (ie, 0-5, 6-12, 13-17, 18-24 years) include either five or six measures with an average time for completion of 20 min. CONCLUSIONS: The OPH-SS is a starting point to drive value-based paediatric healthcare delivery from a global perspective for enhancing child and adolescent physical health and psychosocial well-being.

Sustainability of and Adherence to Preschool Health Promotion Among Children 9 to 13 Years Old.

BACKGROUND: Long-term evaluations of child health promotion programs are required to assess their sustainability and the need for reintervention. OBJECTIVES: This study sought to explore the long-term impact of a preschool health promotion intervention delivered in an urban low-income area of Colombia (phase 1) and to assess the effect of a new community-based intervention (phase 2). METHODS: In phase 1, a cross-sectional analysis of knowledge, attitudes, and habits (KAH) toward a healthy lifestyle and ideal cardiovascular health (ICH) scores of 1,216 children 9 to 13 years old was performed. Of the total, 596 had previously received a preschool health promotion intervention at 3 to 5 years old, whereas the remaining 620 were not previously intervened (intervention-naive group). In phase 2, all children were cluster randomized 1:1 to receive either a 4-month educational intervention (the SI! Program) to instill healthy behaviors in community centers (24 clusters, 616 children) or to control (24 clusters, 600 children). Previously intervened and intervention-naive children were not mixed in the same cluster. The primary outcomes were the change from baseline in KAH and ICH scores. Intervention effects were tested for with linear mixed-effects models. RESULTS: In phase 1, ∼85% of children had nonideal cardiovascular health, and those who previously received a preschool intervention showed a negligible residual effect compared with intervention-naive children. In phase 2, the between-group (control vs. intervention) differences in the change of the overall KAH and ICH scores were 0.92 points (95% confidence interval [CI]: -0.28 to 2.13; p = 0.133) and -0.20 points (95% CI: -0.43 to 0.03; p = 0.089), respectively. No booster effect was detected. However, a dose-response effect was observed, with maximal benefit in children attending >75% of the scheduled intervention; the difference in the change of KAH between the high- and low-adherence groups was 3.72 points (95% CI: 1.71 to 5.73; p < 0.001). CONCLUSIONS: Although overall significant differences between the intervention and control groups were not observed, high adherence rates to health promotion interventions may improve effectiveness and outcomes in children. Reintervention strategies may be required at multiple stages to induce sustained health promotion effects (Salud Integral Colombia [SI! Colombia II]; NCT03119792).

Percepción sobre alimentación saludable en cuatro instituciones escolares / Perception of a healthy diet in four schools

Resumen Introducción: La obesidad infantil ha venido en aumento en los últimos años y Colombia no es ajena a esta problemática. Uno de los lugares para conocer la percepción sobre comida saludable son las instituciones educativas, en las cuales los escolares son quienes escogen sus alimentos. Objetivo: Caracterizar los hábitos alimentarios de una población pediátrica de cuatro instituciones educativas colombianas, con el fin de conocer las prioridades infantiles en cuanto a la escogencia de los alimentos, y por ende generar recomendaciones. Metodología: Estudio descriptivo multicéntrico que presenta los resultados de encuestas dirigidas a escolares entre 8 y 18 años, usuarios de tiendas escolares. Se realizó un análisis descriptivo de acuerdo con las preferencias de alimentación por institución, género, edad, entre otros. Resultados: Se incluyeron en total 512 escolares. La distribución por género y edad fue similar en las cuatro instituciones educativas. Entre los alimentos de preferencia predominaron los empaquetados, la pizza, los helados y, en menor proporción, las frutas. En cuanto a las bebidas sobresalieron la gaseosa y el té en botella. En las razones para escoger los alimentos predominó "el sabor" seguido de la "facilidad y rapidez", en tanto que entre las razones para no escoger se encontró el precio como el motivo principal. Conclusión: Es necesario hacer intervención desde temprana edad para generar hábitos de alimentación saludable y equilibrada. Así mismo, es prioritario diseñar un programa para la detección de hábitos alimentarios inadecuados en las instituciones escolares con el fin de combatirlos.

Abstract Introduction: Childhood obesity has been increasing in the last few years and Colombia is not excluded from this problem. One of the places to determine the perception of healthy food is in schools, where the schoolchildren are the ones who select their food. Objective: To provide a profile of the dietary habits of a childhood population in four Colombian schools, with the aim of determining their priorities as regards the choice of foods, and in order to provide recommendations. Methodology: A descriptive multicentre study that presents the results of questionnaires completed by schoolchildren between 8 and 18 years, users of school shops. A descriptive analysis was performed in accordance with the dietary preferences that included the school, gender, and age. Results: A total of 512 schoolchildren were included. The distribution by gender and age was similar in the four schools. Among the foods of preference there was a predominance of pre-packed food, pizza and ice-cream with a lower percentage of fruit. As regards drinks, there was an excess of fizzy ones and bottled tea. Among the reasons that predominated for choosing the foods was "the taste" followed by "ease and speed", whilst among the reasons for not choosing, the price was the main reason. Conclusion: Interventions are needed from an early age in order to develop healthy and balanced eating habits. Likewise, it should be a priority to design a program for the detection of inadequate eating habits in schools with the aim of combatting them.

Prevalencia de factores de riesgo cardiovascular en escolares de un área rural y de una urbana en Colombia / Prevalence of cardiovascular risk factors in schoolchildren from a rural and urban area in Colombia

Introducción. Los factores de riesgo cardiovascular tienen su origen en la infancia. En diversos estudios, se han registrado diferencias en la prevalencia de tales factores entre las áreas rurales y las urbanas, probablemente asociadas con los estilos de vida. Objetivos. El presente estudio describe los factores de riesgo cardiovascular detectados en niños de una población rural y otra urbana en Colombia. Materiales y métodos. Se hizo un estudio de corte transversal, entre marzo y junio del 2013, en escolares de un área urbana y de otra rural en Colombia. Se midieron el peso, la talla, la presión arterial, los triglicéridos, la glucemia y el colesterol total en ayunas y se hizo una encuesta sobre la dieta, la actividad física y el tabaquismo pasivo. Asimismo, se evaluaron las prevalencias de los factores de riesgo cardiovascular con un intervalo de confianza (IC) del 95 %. Resultados. Se estudiaron 1.055 escolares, 833 en el área urbana y 222 en el área rural, cuyo promedio de edad fue de 6,71 años. Los factores de riesgo cardiovascular más prevalentes en la población rural y en la urbana fueron el sedentarismo (68,69 % y 90,16 %, respectivamente), una dieta no saludable (97,18 % y 95,44 %), el tabaquismo pasivo (11,16 % y 14,52 %), la obesidad (0 % y 5,64 %), la hipertensión arterial (6,31 % y 11,28 %), la diabetes (0 % y 0 %), y la hipercolesterolemia (18,28 % y 16,31 %). El 99,15 % de la población de estudio presentó, por lo menos, un factor de riesgo con un promedio de 3,14 (desviación estándar, DE=1,12) en el área urbana, y de 2,76 (DE=1,1) en la rural. Los niños con exceso de peso presentaron mayor prevalencia de hipertensión arterial (15,21 %) y de sedentarismo (90,69 %), comparados con aquellos sin exceso de peso, 8,98 % y 84,32 %, respectivamente. Conclusiones. Los resultados evidenciaron una alta prevalencia de factores de riesgo cardiovascular en niños, mayor en el área urbana. Se requieren estrategias de salud pública adaptadas a la población rural y a la urbana.

Introduction: Cardiovascular risk factors (CVRF) have their origin in childhood. Several studies have shown differences in the prevalence of CVRFs between rural and urban areas, probably related to lifestyle behaviors. Objective: To describe the CVRFs identified in children from a rural and urban population in Colombia. Materials and methods: A cross-sectional study was conducted between March and June 2013 in schoolchildren from an urban and a rural area in Colombia. Weight, height, blood pressure, triglycerides, fasting glucose, and total cholesterol were measured, and a survey covering nutrition, physical activity, and passive smoking was applied. The prevalence of CVRFs was calculated with a 95% CI. Results: A total of 1,055 schoolchildren (833 urban, 222 rural) participated; their mean age was 6.71 years. The prevalence of CVRFs in the rural and the urban study population, respectively, was 68.69%/90.16% for sedentary lifestyle, 97.18%/95.44% for unhealthy diet, 11.16%/14.52% for passive smoking, 0%/5.64% for obesity, 6.31%/11.28% for hypertension, 0%/0% for diabetes, and 18.28%/16.31% for total cholesterol. A total of 99.15% of the study population had at least one CVRF, with an average of 3.14 for the urban area (SD:1.12), and of 2.76 for the rural one (SD: 1.1). Overweight children had a higher prevalence of hypertension (15.21%; 95% CI:11.04%-20.59%) and sedentary lifestyle (90.69%), compared to those without this risk factor (8.98% and 84.32%, respectively). Conclusions: Our results showed a high prevalence of CVRFs in children, especially in the urban area. Public health strategies adapted to the rural and urban populations should be implemented.

Prevalence of cardiovascular risk factors in schoolchildren from a rural and urban area in Colombia / Prevalencia de factores de riesgo cardiovascular en escolares de un área rural y de una urbana en Colombia

Introduction: Cardiovascular risk factors (CVRF) have their origin in childhood. Several studies have shown differences in the prevalence of CVRFs between rural and urban areas, probably related to lifestyle behaviors. Objective: To describe the CVRFs identified in children from a rural and urban population in Colombia. Materials and methods: A cross-sectional study was conducted between March and June 2013 in schoolchildren from an urban and a rural area in Colombia. Weight, height, blood pressure, triglycerides, fasting glucose, and total cholesterol were measured, and a survey covering nutrition, physical activity, and passive smoking was applied. The prevalence of CVRFs was calculated with a 95% CI. Results: A total of 1,055 schoolchildren (833 urban, 222 rural) participated; their mean age was 6.71 years. The prevalence of CVRFs in the rural and the urban study population, respectively, was 68.69%/90.16% for sedentary lifestyle, 97.18%/95.44% for unhealthy diet, 11.16%/14.52% for passive smoking, 0%/5.64% for obesity, 6.31%/11.28% for hypertension, 0%/0% for diabetes, and 18.28%/16.31% for total cholesterol. A total of 99.15% of the study population had at least one CVRF, with an average of 3.14 for the urban area (SD:1.12), and of 2.76 for the rural one (SD: 1.1). Overweight children had a higher prevalence of hypertension (15.21%; 95% CI:11.04%-20.59%) and sedentary lifestyle (90.69%), compared to those without this risk factor (8.98% and 84.32%, respectively). Conclusions: Our results showed a high prevalence of CVRFs in children, especially in the urban area. Public health strategies adapted to the rural and urban populations should be implemented.

Introducción. Los factores de riesgo cardiovascular tienen su origen en la infancia. En diversos estudios, se han registrado diferencias en la prevalencia de tales factores entre las áreas rurales y las urbanas, probablemente asociadas con los estilos de vida.Objetivos. El presente estudio describe los factores de riesgo cardiovascular detectados en niños de una población rural y otra urbana en Colombia.Materiales y métodos. Se hizo un estudio de corte transversal, entre marzo y junio del 2013, en escolares de un área urbana y de otra rural en Colombia. Se midieron el peso, la talla, la presión arterial, los triglicéridos, la glucemia y el colesterol total en ayunas y se hizo una encuesta sobre la dieta, la actividad física y el tabaquismo pasivo. Asimismo, se evaluaron las prevalencias de los factores de riesgo cardiovascular con un intervalo de confianza (IC) del 95 %.Resultados. Se estudiaron 1.055 escolares, 833 en el área urbana y 222 en el área rural, cuyo promedio de edad fue de 6,71 años. Los factores de riesgo cardiovascular más prevalentes en la población rural y en la urbana fueron el sedentarismo (68,69 % y 90,16 %, respectivamente), una dieta no saludable (97,18 % y 95,44 %), el tabaquismo pasivo (11,16 % y 14,52 %), la obesidad (0 % y 5,64 %), la hipertensión arterial (6,31 % y 11,28 %), la diabetes (0 % y 0 %), y la hipercolesterolemia (18,28 % y 16,31 %). El 99,15 % de la población de estudio presentó, por lo menos, un factor de riesgo con un promedio de 3,14 (desviación estándar, DE=1,12) en el área urbana, y de 2,76 (DE=1,1) en la rural. Los niños con exceso de peso presentaron mayor prevalencia de hipertensión arterial (15,21 %) y de sedentarismo (90,69 %), comparados con aquellos sin exceso de peso, 8,98 % y 84,32 %, respectivamente.Conclusiones. Los resultados evidenciaron una alta prevalencia de factores de riesgo cardiovascular en niños, mayor en el área urbana. Se requieren estrategias de salud pública adaptadas a la población rural y a la urbana.

Colombian reference growth curves for height, weight, body mass index and head circumference.

AIM: Published Growth studies from Latin America are limited to growth references from Argentina and Venezuela. The aim of this study was to construct reference growth curves for height, weight, body mass index (BMI) and head circumference of Colombian children in a format that is useful for following the growth of the individual child and as a tool for public health. METHODS: Prospective measurements from 27 209 Colombian children from middle and upper socio-economic level families were processed using the generalised additive models for location, scale and shape (GAMLSS). RESULTS: Descriptive statistics for length and height, weight, BMI and head circumference for age are given as raw and smoothed values. Final height was 172.3 cm for boys and 159.4 cm for girls. Weight at 18 years of age was 64.0 kg for boys and 54 kg for girls. Growth curves are presented in a ± 3 SD format using logarithmic axes. CONCLUSION: The constructed reference growth curves are a start for following secular trends in Colombia and are also in the presented layout an optimal clinical tool for health care.

[High prevalence of cardiovascular disease risk factors in a pediatric population]. / Prevalencia elevada de factores de riesgo cardiovascular en una población pediátrica.

INTRODUCTION: Cardiovascular disease risk factors begin in childhood. Their presence may predict cardiovascular disease in adulthood. OBJECTIVE: To determine the prevalence of cardiovascular disease risk factors in a group of nurses´ children at a health facility in Bogotá, Colombia. MATERIALS AND METHODS: A cross-sectional, population-based observational study among 3-17 year-old individuals evaluated between June, 2011, and July, 2012. RESULTS: A total number of 118 children were included. The mean age was 7.4 years, with a standard deviation of 3.86; 72.0% of the children had a normal weight. Prevalence of cardiovascular risk factors was distributed as follows: inadequate food habits, 89.0%; sedentary lifestyle, 78.8%; family history of cardiovascular disease, 16.1%; overweight, 15.3%, and obesity, 12.7%. There were no significant differences in risk factors between boys and girls. Among overweight and obese children, sedentary lifestyle was present in 90.9%, and among normal-weight children, in 36.5% (p<0.001). Inadequate food habits were present in 84.8% of the overweight and obese children, and in 42.4% of those with normal weight (p<0.001). Among the study population, 97.5% had at least one risk factor and 42.4% presented 3 or more. The presence of 3 or more cardiovascular disease risk factors was higher in obese children, when compared to overweight (p<0.001) and normal-weight children (p<0.001). CONCLUSIONS: The results of this study indicate that there was a substantial burden of cardiovascular disease risk factors in the 3-17 year-old children included, particularly in those who were obese or overweight.

Prevalencia elevada de factores de riesgo cardiovascular en una población pediátrica / High prevalence of cardiovascular disease risk factors in a pediatric population

Introducción. Los factores de riesgo cardiovascular pueden presentarse desde la infancia y predecir la enfermedad cardiovascular del adulto. Objetivo. Determinar la prevalencia de los factores de riesgo cardiovascular de un grupo de niños, hijos de enfermeras de una institución de salud de Bogotá, Colombia. Materiales y métodos. Se hizo un estudio de corte transversal en niños entre 3 y 17 años de edad, evaluados entre junio de 2011 y julio de 2012. Resultados. Participaron 118 niños, con una edad promedio de 7,4 años (desviación estándar=3,86), la mayoría de ellos eutróficos (72,0 %). Los niños presentaban los siguientes factores de riesgo para enfermedad cardiovascular: malos hábitos alimenticios (89,0 %), sedentarismo (78,8 %), exposición al tabaco (19,5 %), historia familiar de riesgo cardiovascular (16,1 %), sobrepeso (15,3 %) y obesidad (12,7 %). No se encontraron diferencias estadísticamente significativas entre los factores de riesgo según sexo. El sedentarismo en niños con sobrepeso u obesidad fue de 90,9 % y en niños eutróficos, de 36,5 %, (p<0,001). En 84,8 % de los niños con sobrepeso u obesidad y en 42,4 % de los eutróficos, se presentaron malos hábitos alimentarios (p<0,001). El 97,5 % de los niños presentó, al menos, un factor de riesgo, y el 42,4 %, tres o más. La presencia de tres o más factores fue más frecuente en los obesos que en aquellos con sobrepeso (p<0,001) y en los eutróficos (p<0,001). Conclusiones. Los resultados indican que los niños de 3 a 17 años incluidos en el estudio, presentaban varios factores de riesgo de enfermedad cardiovascular, en especial, aquellos con sobrepeso y obesidad.

Introduction: Cardiovascular disease risk factors begin in childhood. Their presence may predict cardiovascular disease in adulthood. Objective: To determine the prevalence of cardiovascular disease risk factors in a group of nurses´ children at a health facility in Bogotá, Colombia. Materials and methods: A cross-sectional, population-based observational study among 3-17 year-old individuals evaluated between June, 2011, and July, 2012. Results: A total number of 118 children were included. The mean age was 7.4 years, with a standard deviation of 3.86; 72.0% of the children had a normal weight. Prevalence of cardiovascular risk factors was distributed as follows: inadequate food habits, 89.0%; sedentary lifestyle, 78.8%; family history of cardiovascular disease, 16.1%; overweight, 15.3%, and obesity, 12.7%. There were no significant differences in risk factors between boys and girls. Among overweight and obese children, sedentary lifestyle was present in 90.9%, and among normal-weight children, in 36.5% (p<0.001). Inadequate food habits were present in 84.8% of the overweight and obese children, and in 42.4% of those with normal weight (p<0.001). Among the study population, 97.5% had at least one risk factor and 42.4% presented 3 or more. The presence of 3 or more cardiovascular disease risk factors was higher in obese children, when compared to overweight (p<0.001) and normal-weight children (p<0.001). Conclusions: The results of this study indicate that there was a substantial burden of cardiovascular disease risk factors in the 3-17 year-old children included, particularly in those who were obese or overweight.

Promotion of cardiovascular health in preschool children: 36-month cohort follow-up.

BACKGROUND: Educational interventions in preschool children could improve dietary behavior and physical activity, and prevent unhealthy body weights in low- and middle-income countries. Previously, we have reported the beneficial impact of an educational intervention in preschoolers in a 6-month trial. We now report extended results after 36 months. METHODS: Evaluating the cohort of previously intervened children, baseline measurements were made in May 2009 in 14 preschool facilities in Usaquén (Bogotá, Colombia). Follow-up measurements were performed at 18 and 36 months. The primary outcome was the mean change in children's knowledge and attitudes scores regarding healthy eating and living an active lifestyle, including habits scores related to physical activity. Secondary outcomes were the change over time of children's nutritional status and the mean change in parent's knowledge, attitudes, and habits. RESULTS: We included 1216 children, 3-5 years of age, and 928 parents. After adjusting by sex and age of children, socioeconomic status, age of parents, and age and education level of teachers, we found a significant increase in mean knowledge, attitudes, and habits scores at 36 months, compared with baseline: 87.94 vs 76.15 (P <.001); 86.39 vs 57.03 (P <.001); and 66.29 vs 48.72 (P <.001), respectively. We observed a similar increase in knowledge and attitude scores in parents: 73.45 vs 70.01 (P <.001); and 78.08 vs 74.65 (P <.001). The proportion of eutrophic children increased from 62.1% at baseline to 75.0% at 36 months (P <.0001). CONCLUSIONS: After 36 months, the educational intervention maintained a beneficial trend toward a healthy lifestyle in children and their parents.

Targeting preschool children to promote cardiovascular health: cluster randomized trial.

BACKGROUND: School programs can be effective in modifying knowledge, attitudes, and habits relevant to long-term risk of chronic diseases associated with sedentary lifestyles. As part of a long-term research strategy, we conducted an educational intervention in preschool facilities to assess changes in preschoolers' knowledge, attitudes, and habits toward healthy eating and living an active lifestyle. METHODS: Using a cluster design, we randomly assigned 14 preschool facilities in Bogotá, Colombia to a 5-month educational and playful intervention (7 preschool facilities ) or to usual curriculum (7 preschool facilities ). A total of 1216 children aged 3-5 years, 928 parents, and 120 teachers participated. A structured survey was used at baseline, at the end of the study, and 12 months later to evaluate changes in knowledge, attitudes, and habits. RESULTS: Children in the intervention group showed a 10.9% increase in weighted score, compared with 5.3% in controls. The absolute adjusted difference was 3.90 units (95% confidence interval [CI], 1.64-6.16; P <.001). Among parents, the equivalent statistics were 8.9% and 3.1%, respectively (absolute difference 4.08 units; 95% CI, 2.03 to 6.12; P <.001), and among teachers, 9.4% and 2.5%, respectively (absolute difference 5.36 units; 95% CI, -0.29-11.01; P = .06). In the intervened cohort 1 year after the intervention, children still showed a significant increase in weighted score (absolute difference of 6.38 units; P <.001). CONCLUSIONS: A preschool-based intervention aimed at improving knowledge, attitudes, and habits related to healthy diet and active lifestyle is feasible, efficacious, and sustainable in very young children.

Sesame street: changing cardiovascular risks for a lifetime.

The prevalence of cardiovascular risk factors continues increasing, as its onset is drifting toward younger populations. The development of these factors is greatly influenced by lifestyle habits. It is known that early behaviors persist during childhood and are perpetuated in the adult. Research has proven that lifelong-acquired behavior is unlikely to change, and therefore acquisition of healthy behaviors should begin as early in life as possible. In this report we described the strategy and first stages of a school-based program aiming at promoting (cardiovascular) health through a multilevel intervention supported by Sesame Street materials and educational background.

Palidez palmo-plantar como método diagnóstico de anemia leve-moderada / Palm-plantar pallor as a diagnostic method of mild-moderate anemia

Objetivo: determinar las características operativas de la palidez palmo-plantar en una población rural infantil colombiana como método diagnóstico de anemia, estableciendo la correlación con los valores de microhematocrito. Metodología: a través de un estudio de corte transversal para análisis de método diagnóstico, se evaluaron ciento sesenta y nueve niños y niñas entre los dos meses y los doce años de edad del área rural de influencia del municipio San Vicente del Caguán que ingresaron a una brigada de salud y aceptaron participar en el estudio, previo consentimiento informado. Se excluyeron aquellos con patologías agudas o crónicas que pudieran influenciar los resultados. Se determinó la presencia de palidez palmo-plantar por observadores entrenados en la estrategia de atención integrada a las enfermedades prevalentes en la infancia (AIEPI) y se midió el hematocrito por técnica manual microcapilar. Previo al análisis general, se realizó un estudio de concordancia entre los observadores; posteriormente se determinaron la sensibilidad, la especificidad y los valores predictivos positivo y negativo usando el hematocrito como estándar. Resultados: de la muestra evaluada, noventa y tres fueron varones y setenta y siete niñas; 45% tenía palidez palmar. Al medir el microhematocrito, 34,1% presentaba anemia. El análisis de prueba diagnóstica mostró una sensibilidad de 67,2%, una especificidad de 66,6%, un valor predictivo positivo de 51,3% y un valor predictivo negativo de 79,5%. En la mayoría de muestras del frotis de sangre periférica de niños anémicos se encontró hipocromía y eosinofilia. Conclusiones: aunque esta herramienta presenta una baja sensibilidad y especificidad cuando se trata de anemia leve-moderada, puede ser útil para excluir anemia en los niños ante la ausencia de palidez palmar.

Objective: to determine the palm-plant paleness’ characteristics in Colombian infant rural population, as a diagnostic method of anemia, and to establish a correlation between the finding of palm-plant paleness and the Hematocrit values. Methodology: a cross sectional study was used to evaluate 169 boys and girls, between 2 months and 12 years old, of the rural area of San Vicente del Caguan, who entered into a Health Campaign. Following the signature of an informed consent, parents accept their children to participate in the study. Those with acute or chronic pathologies were excluded. The presence of palm-plant paleness was determined by observers trained in the Integrated Management of Childhood Illness (IMCI) Strategy. Hematocrit was measured to all children, as well as a peripheral blood smear. Interrater concordance evaluation (Kappa index) was determined through a pilot test and a validation (sensitivity, specificity) was performed, using Hematocrit as the standard. Results: 93 of the participants were male and 77 were female. 45% of them had palm paleness. The Hematocrit showed anemia in 34.1% of the children. The validation analysis demonstrated a 67.2% of sensibility, a 66.6% of specificity, a 51.3% of positive predictive values and a 79.5% of negative predictive values. Hypochromic and Eosinophilia were found in most of the peripheral blood smears’ children with anemia. Conclusions: although this tool presents a low sensibility and specificity for low/moderated anemia, it is useful for excluding it in infants without palm paleness.

Safety and tolerability of ertapenem versus ceftriaxone in a double-blind study performed in children with complicated urinary tract infection, community-acquired pneumonia or skin and soft-tissue infection.

The carbapenem antibiotic ertapenem has been shown to be safe, well tolerated and effective in treating adults with complicated urinary tract infection, skin and soft-tissue infection and community-acquired pneumonia. In this study, we evaluated ertapenem for treating these infections in children in a randomised, double-blind, active-controlled clinical trial. The primary outcome was the incidence of clinical and laboratory drug-related serious adverse events (AEs). Children were randomised in a 3:1 ratio (ertapenem:ceftriaxone) stratified by index infection and age to receive ertapenem or ceftriaxone; 303 children received ertapenem and 100 children received ceftriaxone. The median duration of parenteral therapy was 4 days for both treatments. The most commonly reported drug-related clinical AEs during parenteral therapy were diarrhoea (5.9% ertapenem, 10% ceftriaxone), infusion site erythema (3% ertapenem, 2% ceftriaxone) and infusion site pain (5% ertapenem, 1% ceftriaxone). One child in each group reported a serious drug-related clinical AE. No serious drug-related laboratory AEs were reported. In children aged 3 months to 17 years, ertapenem was well tolerated and had a comparable safety profile to that of ceftriaxone.

Lactose vs. lactose free regimen in children with acute diarrhoea: a ramdomized controlled trial / Dieta con o sin lactosa en niños con diarrea aguda: un experimento clínico aleatorio

To determine whether the routine use of a lactose free formula (AL-110, Nestle Labs) in hospitalized children aged one to 24 months reduces the duration of acute diarrhea (AD). After being stratified according to age and nutritional state, 28 and 24 patients were randomly allocated to receive AL-110 or lactose formula, respectively. The main autcome was the duration of diarrhea after refeeding, both hours and days. Secondary autcomes were evaluated by blind observers. Results were compared using t test, the Mann-Whitney test and Chi square. No differences were found between the diets without and with lactose regarding duration of diarrhoea in hours (mean, 41,9 h vs 54.4 h; p=0.247) or days (median, 0 d vs 0 d; p=0.717), the percentage of failures (3.6 per cent vs 8.3; p=0.2), and the mean weight increment (0.78 kg vs. 0.82 kg; p=0.788). The study power to fing a 50 per cent (27 h) reduction of AD duration was 71 per cent. Although the power of this trial was slightly bellow that previously fixed (80 per cent), the results suggest that routine use of lactose free formula does not reduce the duration of AD in hospitalized

efectos de la interdicción en los organismos nacionales y seguridad y en la institucionalidad del estado bolivia

Contiene: 1. La polícia nacional en labores de interdicción en la lucha antidroga. 2. La polícia nacional y la seguridad interna. 3. Justificación del por qué la polícia nacional participa en la lucha antidroga. 4. Periodización de la acción polícial en el campo de la interdicción. 5. Fuerza especial de lucha contra el narcotráfico. 6. Lay 1008 del régimen de la coca y sustancias peligrosas. 7. Los efectos de la interdicción en los organismos nacionales de seguridad y en la institucionalidad del Estado Nacional.

efectos de la interdicción en los organismos nacionales y seguridad y en la institucionalidad del estado bolivia

Contiene: 1. La polícia nacional en labores de interdicción en la lucha antidroga. 2. La polícia nacional y la seguridad interna. 3. Justificación del por qué la polícia nacional participa en la lucha antidroga. 4. Periodización de la acción polícial en el campo de la interdicción. 5. Fuerza especial de lucha contra el narcotráfico. 6. Lay 1008 del régimen de la coca y sustancias peligrosas. 7. Los efectos de la interdicción en los organismos nacionales de seguridad y en la institucionalidad del Estado Nacional.