RESUMO
RESUMEN. Objetivo: Relacionar los datos de la tasa de mortalidad en la niñez por diarrea y gastroenteritis de presunto origen infeccioso o TMN A(090-099) con el Grado de Cohesión Social (GCS). Métodos: Es un estudio transversal y ecológico para el año 2015. La TMN A(090-099) municipal se calculó con los registros de defunciones del Sistema Nacional en Información en Salud (SINAIS). La aproximación hacia la cohesión social se hizo con base en el Consejo Nacional de Evaluación de la Política de Desarrollo Social (CONEVAL) a través del grado de cohesión social (GCS) municipal. Se calculó una correlación bivariada con la prueba de significancia de Spearman. Se obtuvo la correlación entre la TMN A(090-099) y el GCS. También se hizo un modelo: TMN A(090-099) variable dependiente confrontada con el GCS, el índice de Gini, el índice de rezago social y la no derecho habiencia. Resultados: Existe relación negativa entre el GCS y la TMN A(090-099), con significancia pero débilmente correlacionadas (- 0.320**); la hipótesis se acepta con reservas. El modelo presenta correlación moderada y positiva (R=0.554), la R cuadrada sugiere que el modelo explica casi el 27 % de los casos y el valor Durbin-Watson sugiere que el modelo cubre casi 90 % de los casos estudiados. Discusión: La cohesión social en Chiapas es muy tenue al hacer la aproximación que trató este trabajo. Los datos dan cuenta de que existen municipios con muy alta TMN A(090-099) y baja cohesión social, además de alto grado de rezago social; este escenario predomina, pero es necesario replantear la utilidad del abordaje cualitativo como recomendación encontrada en la literatura.
ABSTRAC. Objective: To relate the information of the childhood rate of mortality due to diarrhea and gastroenteritis of supposed infectious origin or TMN A(090-099) with the social cohesion degree (GCS). Methods: It is a transverse and ecological study for the year 2015. The municipal TMN A(090-099) was calculated with the National System in Health Information (SINAIS) deaths records. The approximation towards the social cohesion was done with the National Council for the Evaluation of the Social Development Policy (CONEVAL) through the municipal Social Cohesion Degree (GCS). A bivariate correlation was calculated with Spearman test. The correlation between the TMN A(090-099) and the GCS was obtained. Also a model was calculated: TMN A(090-099) as the dependent variable confronted with the GCS, Gini's index, social blacklog index and the lack of medical services. Results: A negative relation between the GCS and the TMN TO (090-099) was found, with significant but weakly correlation (-0.320 **); the hypothesis is accepted with reservations. The model presents moderate and positive correlation (R=0.554), the square R suggests that the model explains almost 27 % of the cases, and the Durbin-Watson value suggests that the model covers almost 90 % of the studied cases. Discussion: The social cohesion in Chiapas is very subdued. There are municipalities with very high TMN A(090-099) and lower social cohesion degree besides high social backlog degree; this scene prevails, but is necessary to restate the usefulness of the qualitative boarding as recommendation found in social cohesion literature.
Assuntos
Humanos , Lactente , Pré-Escolar , Criança , Cuidado da Criança , Mortalidade Infantil , Causas de Morte , Coesão Social , MéxicoRESUMO
El shock séptico es una de las principales causas que puede llevar a la muerte. La reanimación hídrica constituye un destacado tratamiento para poder disminuir la mortalidad. Objetivo: determinar la relación entre el porcentaje de sobrecarga hídrica (%SH) y la mortalidad en niños con shock séptico. Métodos. Estudio de cohorte en pacientes con shock séptico de entre 1 y 17 años, posterior a la reanimación hídrica con presión venosa central ≥ 5 mmHg con monitoreo invasivo y registro completo de %SH hasta las 96 h. El seguimiento y la variable de desenlace se completaron hasta el día 28. Se registraron las siguientes variables del shock séptico, shock refractario, causa de la insuficiencia renal aguda, anemia, desnutrición, el tiempo de inicio de antimicrobiano, presión oncótica y puntaje de gravedad. Análisis estadístico: Se calculó el hazard ratio (HR) y se construyeron tres modelos pronósticos por riesgos proporcionales de Cox. Resultados. La población fue de 263 pacientes; con un promedio de edad de 8 ± 3 años y con mortalidad del 33 %. El %SH ≥ 10,1 acumulado a las 96 h fue el único asociado; el HR (IC 95 %) ajustado fue perfil hemodinámico HR = 2,6 (1,95,6); por shock refractario, HR = 2,5 (1,6-5,6) y por desnutrición, HR = 8,3 (3,5-14). Conclusiones. El %SH > 10,1 % se relacionó con una mayor mortalidad a 28 días de ajustado al perfil hemodinámico, la refractariedad del shock y el estado nutricional.
Septic shock is one of the main causes of mortality. Fluid replacement stands out as the treatment of choice to reduce mortality. Objective. To determine the relation between the percentage of fluid overload (%FO) and mortality in children with septic shock. Methods. Cohort study in patients aged 1-17 years with septic shock, after fluid replacement with central venous pressure ≥ 5 mmHg, invasive monitoring, and complete recording of %FO up to 96 h. Follow-up and outcome measures were recorded up to day 28. The following outcome measures of septic shock were recorded: refractory shock, cause of acute kidney injury, anemia, malnutrition, time to antibiotic initiation, oncotic pressure, and severity score. Statistical analysis. The hazard ratio (HR) was estimated and three Cox proportional hazard models were developed. Results. The population included 263 patients; their average age was 8 ± 3 years. Mortality was 33 %. A %FO ≥ 10.1 % accumulated at 96 h was the only associated outcome measure; the HR (95 % confidence interval) was adjusted for hemodynamic profile, HR = 2.6 (1.95.6); refractory shock, HR = 2.5 (1.6-5.6); and malnutrition, HR = 8.3 (3.5-14). Conclusions. A %FO > 10.1 % was related to a higher mortality at 28 days of adjustment for hemodynamic profile, refractory shock, and nutritional status.
Assuntos
Humanos , Criança , Choque Séptico , Equilíbrio Hidroeletrolítico , Criança , MortalidadeRESUMO
Mortality of children under-5 continues to be a global priority. In 2012, 6.6 million children under-5 died worldwide; more than half of these deaths are due to diseases that are preventable and treatable through simple, affordable interventions. In response to the United Nations' Millennium Development Goal (MDGs) which called, through MDG4,to "reduceby two thirds the under-5 child mortality, between 1990 and 2015", global organizations and many countries set targets and developed specific strategies to reduce child mortality and monitor progress.As a result, the number of deaths in children under-5 worldwide declined from 12.4 million in 1990 to 6.6 in 2012. Under-5 child mortality dropped in all regions of the world. However, two major challenges face the international community: The wide disparity in the risk of child death among countries, and the emerging role of neonatal death as a major component of child mortality. In order to continue the progress in reducing under-5 child mortality worldwide, current efforts must continue and new strategies need to be implemented to focus on preventing neonatal deaths as they start to represent a larger proportion of under-5 child deaths. In particular, further reduction in neonatal mortality will depend heavily on improving maternal health (MDG5).The world leaders continue to support the MDGs. In 2010, in a major push to accelerate progress on women's and children's health, a number of Heads of State and Government from developed and developing countries, along with the private sector, foundations, international organizations, civil society and research organizations, pledged over $40 billion in resources over the next five years...