Construction and validation of an instrument to measure knowledge of mothers and caregivers on complementary feeding of infants. / Construcción y validación de un instrumento para medir conocimientos de madres y cuidadores sobre alimentación complementaria de infantes.

INTRODUCTION: Adequate nutrition during the first two years of life is crucial for the full development of human potential. Inadequate, early, or late introduction of complementary feeding has consequences in the short- and long-term. Complementary feeding depends largely on the knowledge of the caregiver who, in Latin American countries, is usually the mother. OBJECTIVE: To create and validate an ins trument to measure knowledge about complementary feeding. SUBJECTS AND METHOD: Observational study in which 80 community mothers and 12 expert pediatricians participated. It was carried out in two stages, the creation of the instrument (following the 7 phases proposed by Sampieri) and the va lidation through the evaluation of the apparent validity, construct and content validity, internal con sistency, and intra-observer reliability. RESULTS: A self-administered instrument was created that ini tially included 14 questions about maternal and caregiver's knowledge. During the validation of the construct, 3 domains were identified and four questions were eliminated. In the content validation, 10 questions of the final instrument scored higher than 9 (on a scale of 0-10) in the characteristics of quality, vocabulary, relevance, and topicality. The global internal consistency of the instrument was moderate (Cronbach's alpha: 0.64) and the intra-observer reliability was acceptable (k: 0.21-0.40) for 80% of its items. CONCLUSIONS: the first self-administered instrument validated in the region to measure the knowledge of mothers and caregivers about complementary feeding is presented. It will allow to design and develop strategies in relation to maternal and caregiver's knowledge of comple mentary feeding.

Corticosteroids for septic arthritis in children.

BACKGROUND: Septic arthritis is an acute infection of the joints characterised by erosive disruption of the articular space. It is the most common non-degenerative articular disease in developing countries. The most vulnerable population for septic arthritis includes infants and preschoolers, especially boys. Septic arthritis disproportionately affects populations of low socioeconomic status. Systemic corticosteroids and antibiotic therapy may be beneficial for treatment of septic arthritis. Even if the joint infection is eradicated by antibiotic treatment, the inflammatory process may produce residual joint damage and sequelae. OBJECTIVES: To determine the benefits and harms of corticosteroids as adjunctive therapy in children with a diagnosis of septic arthritis. SEARCH METHODS: We searched MEDLINE, Embase, the Cochrane Central Register of Controlled Trials (CENTRAL), in the Cochrane Library, Latin American Caribbean Health Sciences Literature (LILACS), the World Health Organization (WHO) trials portal (www.who.int/ictrp/en/), ClinicalTrials.gov (www.ClinicalTrials.gov), and Google Scholar. We searched all databases from their inception to 17 April 2018, with no restrictions on language of publication. SELECTION CRITERIA: We included randomised controlled trials (RCTs) with patients from two months to 18 years of age with a diagnosis of septic arthritis who were receiving corticosteroids in addition to antibiotic therapy or as an adjuvant to other therapies such as surgical drainage, intra-articular puncture, arthroscopic irrigation, or debridement. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility, data extraction, and evaluation of risk of bias. We considered as major outcomes the presence of pain, activities of daily living, normal physical joint function, days of antibiotic treatment, length of hospital stay, and numbers of total and serious adverse events. We used standard methodological procedures expected by Cochrane. We assessed the evidence using GRADE (Grading of Recommendations Assessment, Development and Evaluation) and created a 'Summary of findings' table. MAIN RESULTS: We included two RCTs involving a total of 149 children between three months and 18 years of age who were receiving antibiotics for septic arthritis. The most commonly affected joints were hips and knees. These studies were performed in Costa Rica and Israel. In both studies, dexamethasone administered intravenously (ranging from 0.15 to 0.2 mg/kg/dose every six to eight hours) during four days was the corticosteroid, and the comparator was placebo. Trials excluded patients with any degree of immunodeficiency or immunosuppression. The longest follow-up was one year. Trials did not report activities of daily living nor length of hospital stay. Both studies used adequate processes for randomisation, allocation concealment, and blinding, and review authors judged them to have low risk of selection and performance bias. Losses to follow-up were substantive in both studies, and we judged them to have high risk of attrition bias and of selective outcome reporting. We graded all outcomes as low quality due to concerns about study limitations and imprecision.The risk ratio (RR) for absence of pain at 12 months of follow-up was 1.33, favouring corticosteroids (95% confidence interval (CI) 1.03 to 1.72; P = 0.03; number needed to treat for an additional beneficial outcome (NNTB) = 13, 95% CI 6 to 139; absolute risk difference 24%, 95% CI 5% to 43%).The RR for normal function of the affected joint at 12 months of follow-up was 1.32, favouring corticosteroids (95% CI 1.12 to 1.57; P = 0.001; NNTB = 13, 95% CI 7 to 33; absolute risk difference 24%, 95% CI 11% to 37%).We found a reduction in the number of days of intravenous antibiotic treatment favouring corticosteroids (mean difference (MD) -2.77, 95% CI -4.16 to -1.39) based on two trials with 149 participants.Researchers did not report length of hospital stay. One trial (49 participants) reported that treatment with dexamethasone was associated with a shorter duration of IV antibiotic treatment, leading to a shorter hospital stay, and although duration of hospitalisation was a primary outcome of the study, study authors did not provide data on the duration of hospitalisation. We downgraded the quality by one level for concerns about study limitations (high risk of attrition bias and selective reporting), and by another level for imprecision.In one trial of 49 participants, researchers followed 29 children for 12 months, and parents reported that no children demonstrated adverse effects of the intervention. AUTHORS' CONCLUSIONS: Evidence for corticosteroids as adjunctive therapy in children with a diagnosis of septic arthritis is of low quality and is derived from the findings of two trials (N = 149). Corticosteroids may increase the proportion of patients without pain and the proportion of patients with normal function of the affected joint at 12 months, and may also reduce the number of days of antibiotic treatment. However, we cannot draw strong conclusions based upon these trial results. Additional randomised clinical trials in children with relevant outcomes are needed.

Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development.

BACKGROUND: Long chain polyunsaturated fatty acids (LCPUFA), especially docosahexaenoic acid (DHA), are the most abundant fatty acids in the brain and are necessary for growth and maturation of an infant's brain and retina. LCPUFAs are named "essential" because they cannot be synthesised efficiently by the human body and come from maternal diet. It remains controversial whether LCPUFA supplementation to breastfeeding mothers is beneficial for the development of their infants. OBJECTIVES: To assess the effectiveness and safety of supplementation with LCPUFA in breastfeeding mothers in the cognitive and physical development of their infants as well as safety for the mother and infant. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (6 August 2014), CENTRAL (Cochrane Library 2014, Issue 8), PubMed (1966 to August 2014), EMBASE (1974 to August 2014), LILACS (1982 to August 2014), Google Scholar (August 2014) and reference lists of published narrative and systematic reviews. SELECTION CRITERIA: Randomised controlled trials or cluster-randomised controlled trials evaluating the effects of LCPUFA supplementation on breastfeeding mothers (including the pregnancy period) and their infants. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility and trial quality, performed data extraction and evaluated data accuracy. MAIN RESULTS: We included eight randomised controlled trials involving 1567 women. All the studies were performed in high-income countries. The longest follow-up was seven years.We report the results from the longest follow-up time point from included studies. Overall, there was moderate quality evidence as assessed using the GRADE approach from these studies for the following outcomes measured beyond 24 months age of children: language development and child weight. There was low-quality evidence for the outcomes: Intelligence or solving problems ability, psychomotor development, child attention, and child visual acuity.We found no significant difference in children's neurodevelopment at long-term follow-up beyond 24 months: language development (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.56 to 0.02; two trials, 187 participants); intelligence or problem-solving ability (three trials, 238 participants; SMD 0.00, 95% CI -0.36 to 0.36); psychomotor development (SMD -0.11, 95% CI -0.48 to 0.26; one trial, 113 participants); motor development (SMD -0.23, 95% CI -0.60 to 0.14; one trial, 115 participants), or in general movements (risk ratio, RR, 1.12, 95% CI 0.58 to 2.14; one trial, 77 participants; at 12 weeks of life). However, child attention scores were better at five years of age in the group of children whose mothers had received supplementation with fatty acids (mean difference (MD) 4.70, 95% CI 1.30 to 8.10; one study, 110 participants)). In working memory and inhibitory control, we found no significant difference (MD -0.02 95% CI -0.07 to 0.03 one trial, 63 participants); the neurological optimality score did not present any difference (P value: 0.55).For child visual acuity, there was no significant difference (SMD 0.33, 95% CI -0.04 to 0.71; one trial, 111 participants).For growth, there were no significant differences in length (MD -0.39 cm, 95% CI -1.37 to 0.60; four trials, 441 participants), weight (MD 0.13 kg, 95% CI -0.49 to 0.74; four trials, 441 participants), and head circumference (MD 0.15 cm, 95% CI -0.27 to 0.58; three trials, 298 participants). Child fat mass and fat mass distribution did not differ between the intervention and control group (MD 2.10, 95% CI -0.48 to 4.68; one trial, 115 participants, MD -0.50, 95% CI -1.69 to 0.69; one trial, 165 participants, respectively).One study (117 infants) reported a significant difference in infant allergy at short-term follow-up (risk ratio (RR) 0.13, 95% CI 0.02 to 0.95), but not at medium-term follow-up (RR 0.52, 95% CI 0.17 to 1.59).We found no significant difference in two trials evaluating postpartum depression. Data were not possible to be pooled due to differences in the describing of the outcome. One study (89 women) did not find any significant difference between the LCPUFA supplementation and the control group at four weeks postpartum (MD 1.00, 95%CI -1.72 to 3.72).No adverse effects were reported. AUTHORS' CONCLUSIONS: Based on the available evidence, LCPUFA supplementation did not appear to improve children's neurodevelopment, visual acuity or growth. In child attention at five years of age, weak evidence was found (one study) favouring the supplementation. Currently, there is inconclusive evidence to support or refute the practice of giving LCPUFA supplementation to breastfeeding mothers in order to improve neurodevelopment or visual acuity.

Anaesthesia for evacuation of incomplete miscarriage.

BACKGROUND: An incomplete miscarriage occurs when all the products of conception are not expelled through the cervix. Curettage or vacuum aspiration have been used to remove retained tissues. The anaesthetic techniques used to facilitate this procedure have not been systematically evaluated in order to determine which provide better outcomes to the patients. OBJECTIVES: To assess the effects of general anaesthesia, sedation or analgesia, regional or paracervical block anaesthetic techniques, or differing regimens of these, for surgical evacuation of incomplete miscarriage. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (23 January 2012), CENTRAL (The Cochrane Library 2012, Issue 1), PubMed (1966 to 23 January 2012), EMBASE (1974 to 23 January 2012), CINAHL (1982 to 23 January 2012), LILACS (1982 to 23 January 2012) and reference lists of retrieved studies. SELECTION CRITERIA: All published and unpublished randomised controlled trials (RCTs) or cluster-RCTs comparing the use of any anaesthetic technique (defined by authors as general anaesthesia, sedation/analgesia, regional or paracervical local block (PCB) procedures) to perform surgical evacuation of an incomplete miscarriage. We excluded quasi-randomised trials and studies that were only available as abstracts. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed studies for inclusion and assessed risk of bias. Data were independently extracted and checked for accuracy. MAIN RESULTS: We included seven trials involving 800 women. The comparisons revealed a very high clinical heterogeneity. As a result of the heterogeneity in the randomisation unit, we did not combine trials but reported the individual trial results in the 'Data and analysis' section and in the text. Half of trials have unclear or high risk of bias in several domains.We did not find any trial reporting data about maternal mortality. In terms of postoperative pain, PCB does not improve the control of postoperative pain when it is compared against sedation/analgesia or versus no anaesthesia/no analgesia. In the comparison of PCB with lidocaine versus PCB with saline solution, significant differences favouring the group with lidocaine were found in one trial (moderate or severe postoperative pain) (risk ratio (RR) 0.32; 95% confidence interval (CI) 0.18 to 0.59).When opioids were used, postoperative nausea and vomiting was more frequent in two trials comparing those versus PCB. In terms of requirement of blood transfusion, two trials showed conflicting results. AUTHORS' CONCLUSIONS: Particular considerations that influence the choice of anaesthesia for this procedure such as availability, effectiveness, safety, side effects, practitioner's choice, costs and woman's preferences of each technique should continue to be used until more evidence supporting the use of one technique or another.

Quality of clinical practice guidelines for gestational and congenital toxoplasmosis: A systematic review of the literature.

OBJECTIVE: To evaluate the methodological quality and transparency of the clinical practice guidelines (CPGs) for the prevention, diagnosis, and treatment of gestational and congenital toxoplasmosis (CT). METHODS: Systematic review of the literature on gestational and CT CPGs conducted in the MEDLINE, Embase, TripDatabase, Biblioteca Virtual en Salud databases and extensive manual searches in 19 CPG repositories. The characteristics of each of the guidelines were extracted using My AGREE PLUS on-line. Three reviewers assessed overall quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. RESULTS: The combined systematic review found 8651 citations. Of them 46 full texts were reviewed, and eight documents were finally included: four toxoplasmosis CPGs, three prenatal care CPGs that included recommendations on toxoplasmosis, and one pregnancy infection guideline that also included recommendations on toxoplasmosis. The AGREE II domains found to have the highest scores were 'clarity of presentation' (85%; [37%-100%]), followed by 'scope and purpose' (73%; [33%-98%]), and 'editorial independence' (51%; [3%-94%]); the domains with the lowest scores were 'rigour of development' (36%; [11%-79%]), 'stakeholder involvement' (34%; [24%-85%]), and 'applicability' (17%; [6%-83%]). The Colombian and Spanish-Agencia de Evaluación de Tecnologías Sanitarias de Andalucía (AETSA) CPGs had the highest global AGREE II scores. Absolute interrater agreement was good to excellent. CONCLUSION: Substantial quality variation was found among CPGs, which provided recommendations in accordance with the context of the disease in the corresponding country or region. Only two of the CPGs appraised obtained a good score and are classified as 'recommended'.

Primary school interventions to promote fruit and vegetable consumption: a systematic review and meta-analysis.

OBJECTIVE: The consumption of fruits and vegetables (FV) may contribute to the prevention of many diseases. However, children at school age do not eat an enough amount of those foods. We have systematically reviewed the literature to assess the effectiveness of school interventions for promoting the consumption of FV. METHODS: We performed a search in MEDLINE, EMBASE, CINAHL and CENTRAL. We pooled results and stratified the analysis according to type of intervention and study design. RESULTS: Nineteen cluster studies were included. Most studies did not describe randomization method and did not take the cluster's effect into account. Pooled results of two randomized controlled trials (RCTs) of computer-based interventions showed effectiveness in improving consumption of FV [Standardized Mean Difference (SMD) 0.33 (95% CI 0.16, 0.50)]. No significant differences were found in pooled analysis of seven RCTs of multicomponent interventions or pooling results of two RCTs evaluating free/subsidized FV interventions. CONCLUSIONS: Meta-analysis shows that computer-based interventions were effective in increasing FV consumption. Multicomponent interventions and free/subsidized FV interventions were not effective. Improvements in methodology are needed in future cluster studies. Although these results are preliminary, computer-based interventions could be considered in schools, given that they are effective and cheaper than other alternatives.

Soft drinks consumption, diet quality and BMI in a Mediterranean population.

OBJECTIVES: Evidence of the effects of soft drinks consumption on BMI and lifestyle in adult populations is mixed and quite limited. The aim of the present study was to determine the association of soft drinks consumption with BMI and lifestyle in a representative Mediterranean population. DESIGN: Two independent, population-based, cross-sectional (2000 and 2005) studies. Dietary intake was assessed using a validated FFQ. Weight and height were measured. SETTING: Girona, Spain. SUBJECTS: Random sample of the 35- to 74-year-old population (3910 men and 4285 women). RESULTS: Less than half (41·7%) of the population consumed soft drinks; the mean consumption was 36·2 ml/d. The prevalence of sedentary lifestyle increased with the frequency of soft drinks consumption (P = 0·025). Daily soft drinks consumption significantly increased the risk of low adherence to the Mediterranean diet (OR = 0·57, 95% CI 0·44, 0·74 v. top tertile of Mediterranean diet score). Multiple linear regression analyses, controlled for potential confounders, revealed that an increment in soft drinks consumption of 100 ml was associated with a 0·21 kg/m² increase in BMI (P = 0·001). Only implausibly low reports of energy consumption showed a null association between soft drinks consumption and BMI. CONCLUSIONS: Soft drinks consumption was not embedded in a healthy diet context and was positively associated with BMI and sedentary lifestyle in this Mediterranean population.

Supplementation with long chain polyunsaturated fatty acids (LCPUFA) to breastfeeding mothers for improving child growth and development.

BACKGROUND: Long chain polyunsaturated fatty acids (LCPUFA), especially docosahexaenoic acid (DHA), are the most abundant fatty acids in the brain and are necessary for growth and maturation of the brain and retina. LCPUFA are named "essential" because they cannot be synthesised efficiently by the human body and come from maternal diet. It remains controversial whether LCPUFA supplementation to breastfeeding mothers is beneficial for the development of their infants. OBJECTIVES: To assess the effectiveness and safety of supplementation with LCPUFA in breastfeeding mothers in the cognitive and physical development of their infants as well as safety for the mother and infant. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (November 2009), CENTRAL (2009, Issue 2), PubMed (1966 to July 2009), EMBASE (1974 to June 2009), CINAHL (1984 to June 2009), LILACS (1982 to June 2009), Google Scholar (June 2009) and reference lists of published narrative and systematic reviews. SELECTION CRITERIA: Randomised controlled trials or cluster-randomised controlled trials evaluating the effects of LCPUFA supplementation on breastfeeding mothers and their infants. DATA COLLECTION AND ANALYSIS: Two review authors independently assessed eligibility and trial quality and performed data extraction. MAIN RESULTS: We included six randomised controlled trials involving 1280 women. We found no significant difference in children's neurodevelopment: language development (standardised mean difference (SMD) -0.14, 95% confidence interval (CI) -0.49 to 0.20; two trials, 349 participants); intelligence or problem-solving ability (two trials, 817 participants; SMD -0.22, 95% CI -0.23 to 0.66); psychomotor development (SMD 0.34, 95% CI -0.11 to 0.78; two trials, 279 participants); motor development (SMD 0.08, 95% CI -0.13 to 0.29; two trials, 349 participants); in child attention there was a significant difference (SMD 0.50, 95% CI 0.24 to 0.77; one study). For child visual acuity there was no significant difference (SMD -0.06, 95% CI -0.26 to 0.14; three trials, 401 participants). For growth, there were significant differences in length (MD -0.75 cm, 95% CI -1.38 to -0.12; two trials, 834 participants) and head circumference (MD 0.69 cm, 95% CI 0.35 to 1.02; one trial, 244 participants). One study reported a significant difference in infant allergy (risk ratio (RR) 0.12, 95% CI 0.02 to 0.95). We found no significant difference in one trial evaluating postpartum depression (SMD 0.15, 95% CI -0.11 to 0.41).   AUTHORS' CONCLUSIONS: Based on the limited evidence that we found, LCPUFA supplementation did not appear to improve children's neurodevelopment or visual acuity. In two studies, LCPUFA supplementation was associated with increased head circumference. Currently, there is insufficient evidence to support or refute the practice of giving LCPUFA supplementation to breastfeeding mothers in order to improve infant growth and development.

Quality assessment of clinical practice guidelines for the prevention and treatment of childhood overweight and obesity.

BACKGROUND: The prevalence of childhood overweight and obesity is increasing at dramatic rates in children and adolescents worldwide. Clinical practice guidelines (CPGs) are "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances." Their objective is to provide explicit recommendations for clinical practice based on current evidence for best practice in the management of diseases. MATERIALS AND METHODS: The aim of this study was to identify and assess the quality of CPGs for the prevention and treatment of obesity and overweight in childhood. We developed a search to identify CPGs published between January 1998 and August 2007. We considered for inclusion documents that provided recommendations for clinical practice referring to children and adolescents. Three independent appraisers assessed the quality of the1 CPGs using the AGREE (Appraisal of Guidelines Research and Evaluation) instrument. We identified 376 references and selected 22 for further assessment. RESULTS: The overall agreement among reviewers using the intraclass correlation coefficient was 0.856 (95% confidence interval [CI] 0.731-0.932). Six of the 22 initial guidelines were recommended and a further eight were recommended with conditions or provisos. We concluded that the number of documents with recommendations on the prevention and treatment of childhood obesity published during the 10-year study period was considerable, but only a few of them could be considered as high quality. CPGs were deficient in areas such as applicability, editorial independence and rigor in development. CONCLUSION: Due to the increasing burden of obesity among children and the potential for long-term comorbidities, clinicians need to be critical in assessing the rigor of how these are developed and their appropriateness for use in the clinician's own practice. There is a need to improve the methodology and the quality of CPGs on childhood obesity to help clinicians and other decision-makers to tackle this disease.

[Caregivers and health workers' perceptions of neonatal disease alarm signals in Guapi, Colombia]. / Percepciones de Signos de Alarma en Enfermedad Neonatal de los Cuidadores y Trabajadores de la Salud en Guapi, Colombia.

OBJECTIVES: Exploring caregivers (CG) and health workers' (HW) perceptions of danger signals in the newborn and establishing the type of medical attention they require in rural and urban areas of Guapi on Colombia's Pacific coast. METHODS: A descriptive design was used combining qualitative and quantitative methods. Three focus groups, three semi-structured interviews and two case-studies were employed. Some signals obtained from these data were used for constructing a structured interview. A survey was carried out with 200 CGs (mothers with newborn, grandmothers, community mothers, housewives) and 40 HWs (general practitioners, health promoters, nursing auxiliaries, traditional medicine healers, midwifes and FAMI-mothers). The data was analysed using MaxQDA 2.0 qualitative data software and ethnographic analysis. RESULTS: The first 5 signs of illness (in order of importance) perceived by CGs and HWs were: diarrhoea, dehydration, fever, vomiting and breathing problems. They coincided in their perceptions of the need for emergency consultation for convulsions, tetanus and dehydration. Significant differences were found between HW and CG perceptions regarding "type of consultation" for dehydration, fever, convulsions, breathing problems and tetanus (p<0.05). Cultural illnesses (i.e. the evil eye and ghosts) also emerged. CONCLUSIONS: CGs and HWs in Guapi were good at recognising danger signals for neonatal illness; however, there were differences regarding the search for attention. The finding of cultural illnesses must be taken into account in newborn attention strategies. This acceptable level of recognition was hindered by the lack of quality medical care services for the newborn encountering health problems.

Factors associated with length of hospital stay in minor and moderate burns at Popayan, Colombia. Analysis of a cohort study.

OBJECTIVE: To determine the independent contribution of prognostic factors to length of hospital stay of minor and moderate burn victims at the Hospital Universitario San José (HUSJ), Popayán, Colombia, 2000-2010. METHODS: This was a retrospective cohort study of minor and moderate burn victims admitted between 2000 and 2010, at the burn unit (HUSJ). This is a further analysis of a same cohort previously published in Burns. The following variables were recorded and analyzed: age, gender, origin, depth and extent of burn, causal agent, length of hospital stay and mortality. The main outcome under study was length of stay. Survival analysis was done to explore the association of covariates and length of hospital stay and Cox regression model to adjust the effect of covariates in the outcome. RESULTS: During the study period 2000-2010, 842 of 921 (91.5%) patients treated at the Burn Unit of HUSJ that had complete data were included. There were 520 (61.8%) males and 322 (38.2%) females with a male to female ratio of 1.6:1. Their median age was 9 years (IQR 3-28). The median of percent total body surface area burned (TBSA) was 12% (IQR 7-21) and the most common degree of burn was 2nd degree with 58% (488 patients). There were 12 deaths (censored data) and 830 patients were discharged alive. After multivariate adjustment, significant associations with length of hospital stay remained for age group, burn degree and extension of the burn. The strongest relationship found was for burn degree (2nd degree superficial vs. 3rd degree hazard ratio=2.66 CI 95% [2.13-3.33]). CONCLUSIONS: In patients admitted with mild and moderate burns at HUSJ, the main predictors of length of stay were age, burn degree and extension of the burn.

Construcción y validación de un instrumento para medir conocimientos de madres y cuidadores sobre alimentación complementaria de infantes / Construction and validation of an instrument to measure knowledge of mothers and caregivers on complementary feeding of infants

INTRODUCCIÓN: La nutrición adecuada durante los primeros dos años de vida es fundamental para el desarrollo pleno del potencial del ser humano. La introducción inadecuada, precoz o tardía de la alimentación complementaria trae consecuencias a corto y largo plazo. La alimentación complementaria depende en gran medida de los conocimientos del cuidador que en los países de Latinoamérica generalmente es la madre. OBJETIVO: construir y validar un instrumento para medir los conocimientos maternos y de cuidadores sobre alimentación complementaria. SUJETOS Y MÉTODO: Estudio de observación. Participaron 80 madres comunitarias y 12 pediatras expertos. Se desarrolló en dos etapas: la creación del instrumento a partir de las 7 fases propuestas por Sampieri, y la validación mediante la evaluación de validez aparente, de constructo, de contenido, consistencia interna y fiabilidad intra-observador. RESULTADOS: Se creó un instrumento autoadministrado que incluyó inicialmente 14 preguntas sobre conocimientos maternos y de cuidadores. Durante la validación de constructo se identificaron 3 dominios y se eliminaron cuatro preguntas. En la validación de contenido, 10 preguntas del instrumento definitivo obtuvieron calificaciones superiores a 9 (en una escala de 0-10) en las características: calidad, vocabulario, relevancia y actualidad. La consistencia interna global del instrumento fue moderada (Alfa de Cronbach: 0,64) y la fiabilidad intra-observador fue aceptable (k: 0,21-0,40) para el 80% de ítems del instrumento. CONCLUSIONES: Se presenta el primer instrumento autoadministrado validado en la región, que permite medir conocimientos de las madres y los cuidadores sobre alimentación complementaria. A futuro, permitirá diseñar y desarrollar estrategias de evaluación e intervención en relación con los conocimientos maternos y de los cuidadores sobre alimentación complementaria.

INTRODUCTION: Adequate nutrition during the first two years of life is crucial for the full development of human potential. Inadequate, early, or late introduction of complementary feeding has consequences in the short- and long-term. Complementary feeding depends largely on the knowledge of the caregiver who, in Latin American countries, is usually the mother. OBJECTIVE: To create and validate an ins trument to measure knowledge about complementary feeding. SUBJECTS AND METHOD: Observational study in which 80 community mothers and 12 expert pediatricians participated. It was carried out in two stages, the creation of the instrument (following the 7 phases proposed by Sampieri) and the va lidation through the evaluation of the apparent validity, construct and content validity, internal con sistency, and intra-observer reliability. RESULTS: A self-administered instrument was created that ini tially included 14 questions about maternal and caregiver's knowledge. During the validation of the construct, 3 domains were identified and four questions were eliminated. In the content validation, 10 questions of the final instrument scored higher than 9 (on a scale of 0-10) in the characteristics of quality, vocabulary, relevance, and topicality. The global internal consistency of the instrument was moderate (Cronbach's alpha: 0.64) and the intra-observer reliability was acceptable (k: 0.21-0.40) for 80% of its items. CONCLUSIONS: the first self-administered instrument validated in the region to measure the knowledge of mothers and caregivers about complementary feeding is presented. It will allow to design and develop strategies in relation to maternal and caregiver's knowledge of comple mentary feeding.

Enhancing nutritional environments through access to fruit and vegetables in schools and homes among children and youth: a systematic review.

BACKGROUND: Low fruit and vegetable (FV) consumption is one of the top 10 global risk factors for mortality, and is related to increased risk for cancer, cardiovascular disease and diabetes. Many environmental, sociodemographic and personal factors affect FV consumption. The purpose of this review is to examine the effects of interventions delivered in the home, school and other nutritional environments designed to increase FV availability for five to 18-year olds. METHODS: The search included: 19 electronic bibliographic databases; grey literature databases; reference lists of key articles; targeted Internet searching of key organization websites; hand searching of key journals and conference proceedings; and consultation with experts for additional references. Articles were included if: in English, French and Spanish; from high-, middle-, and low-income countries; delivered to anyone who could bring about change in FV environment for 5 to 18 year olds; with randomized and non-randomized study designs that provided before-after comparisons, with or without a control group. Primary outcomes of interest were measures of FV availability. RESULTS: The search strategy retrieved nearly 23,000 citations and resulted in 23 unique studies. Interventions were primarily policy interventions at the regional or state level, a number of curriculum type interventions in schools and community groups and a garden intervention. The majority of studies were done in high-income countries.The diversity of interventions, populations, outcomes and outcome measurements precluded meta-analysis. The most promising strategies for improving the FV environment for children are through local school food service policies. Access to FV was successfully improved in four of the six studies that evaluated school-based policies, with the other two studies finding no effect. Broader state or federally mandated policies or educational programs for food service providers and decision makers had mixed or small impact. Similarly family interventions had no or small impact on home accessibility, with smaller impact on consumption. CONCLUSIONS: The studies have high risk of bias but more rigorous studies are difficult to impossible to conduct in naturalistic settings and in policy implementation and evaluation. However, there are promising strategies to improve the FV environment, particularly through school food service policies.

Scientific and academic production and visibility of the Faculty of Health Sciences of Universidad del Cauca / Producción y visibilidad científico-académica de la Facultad de Ciencias de la Salud de la Universidad del Cauca

Abstract Introduction: Bibliometric indexes are important indicators of the quality of the country's medical programs. There are few studies of this kind at the Universidad del Cauca. Objective: To evaluate the scientific-academic activity of the Faculty of Health Sciences (FHS) of the Universidad del Cauca based on bibliometric production indicators of the authors, visibility and impact during the period 2010-2016. Materials and methods: Descriptive, cross-sectional, bibliometric research. Different categories of the academic production of the FHS were identified (citation by authors, language of publication, areas of health sciences), and the main journals where the authors published. In addition, the metric indicators of the journals and citation indexes of the authors were determined, as well as their enrollment in research groups and the most cited publications according to SCOPUS. Results: 183 articles were found. The main language of publication was Spanish and mainly in the clinical-surgical area. 60% of the articles of the main authors have some international collaboration. The Revista de la Facultad de Ciencias de la Salud of Universidad del Cauca had the largest number of articles published by authors of the same faculty during the period under study. Conclusion: The scientific and academic production and visibility of the FHS of the Universidad del Cauca is low. The findings reveal the need for greater institutional support for research, and the creation and support of research groups and incubators. Therefore, this work seeks to encourage greater visibility of the FHS in the national and international scientific field.

Resumen Introducción. Los índices bibliométricos son indicadores importantes de la calidad de los programas de medicina del país. En la Universidad del Cauca se cuenta con pocos estudios de este tipo. Objetivo. Evaluar la actividad científico-académica de la Facultad Ciencias de la Salud (FCS) de la Universidad del Cauca a partir de indicadores bibliométricos de producción de los autores, visibilidad e impacto durante el período 2010-2016. Materiales y métodos. Investigación bibliométrica descriptiva de corte transversal. Se identificaron diferentes categorías de la producción académica de la FCS (citación por autores, idioma de publicación, áreas de las ciencias de la salud) y las principales revistas donde publicaron los autores. Se determinaron los indicadores métricos de las revistas, los índices citacionales, la vinculación a grupos de investigación y las publicaciones más citadas de acuerdo a Scopus. Resultados. Se encontraron 183 artículos. El principal idioma fue español y la mayoría de publicaciones eran del área clínico-quirúrgica. El 60% de los artículos de los principales autores tienen alguna colaboración internacional. La Revista de la Facultad de Ciencias de la Salud de la Universidad del Cauca presenta el mayor número de artículos publicados por autores de la misma facultad durante el periodo en estudio. Conclusión. La producción y visibilidad científico-académica de la FCS de la Universidad del Cauca es baja. Los hallazgos encontrados revelan la necesidad de un mayor apoyo institucional para la investigación, la creación y el apoyo a grupos y semilleros de investigación. Con esto se pretende tener un grado mayor de visibilidad en el campo científico, tanto nacional como internacional.

Epidemiological profile of minor and moderate burn victims at the University Hospital San José, Popayán, Colombia, 2000-2010.

OBJECTIVES: To describe the epidemiological profile of minor and moderate burn victims at the University Hospital San José, Popayán, Colombia, 2000-2010. METHODS: This study was retrospective description of minor and moderate burn victims admitted between 2000 and 2010 at the Burn Unit of University Hospital San José (UHSJ). The following variables were recorded and analyzed: age, gender, origin, social security, depth and extent of burn, days of hospitalization, causal agent and mortality. SPSS 19.0 was used. The level of significance was p<0.05. RESULTS: During 2000-2010, 845 patients were included. 61.7% were men. The average age was 17.9 years. Most of patients were from rural areas (80.4%). Most people belonged to the Subsidized Health Colombian System (85.3%). The most common causal agent was scalding liquids (49.7%). The most frequent depth was second degree burns (57.8%) and the average burned body surface was 20%. The average hospital stay was 20.4 days, and the median hospitalization time was 14 days. Mortality was 1.4%. CONCLUSIONS: The findings of this study are the first to define the characteristics of burns in Popayán. This study is the basis for identifying preventative measures in the local health care system.

Efectividad del conteo de hidratos de carbono para el control metabólico de niños con diabetes mellitus tipo 1: revisión sistemática / Effectiveness of carbohydrate counting for metabolic control of children with type 1 diabetes mellitus: Systematic review

El conteo de hidratos de carbono como intervención terapéutica en pacientes con diabetes mellitus tipo 1 (DM1) desempeña un importante papel para obtener el nivel óptimo de glucemia posprandial, que se demuestra con los correctos niveles de hemoglobina glucosilada (HbA1c). Sin embargo, las recomendaciones para niños con DM1 se basan en revisiones narrativas de la evidencia disponible. Nuestro objetivo fue evaluar mediante una revisión sistemática la eficacia del conteo de hidratos de carbono sobre el control metabólico de niños con DM1. Se realizó la búsqueda en Pubmed, Google Académico y el registro de ensayos controlados de la colaboración Cochrane, CENTRAL. Se desarrolló una búsqueda desde enero del 2000 hasta septiembre del 2015. Se identificaron 5 ensayos elegibles, de 261 estudios potencialmente relevantes; 2 ensayos clínicos fueron incluidos. La calidad de los estudios en general no fue adecuada. Los 2 estudios incluidos concuerdan en la reducción de los niveles de HbA1c con la técnica del recuento de hidratos de carbono, como medida de control metabólico. En general, los demás parámetros medidos mostraron resultados contradictorios sin diferencias significativas, a excepción de la lipoproteína de alta densidad en uno de los estudios, que fue más alta en el grupo intervención. Aunque el conteo de hidratos de carbono es una técnica prometedora en el control metabólico para niños con DM1, la evidencia encontrada en esta revisión no es suficiente para recomendarla.

Carbohydrate counting as a therapeutic intervention in patients with Diabetes Mellitus type 1 (DM1) plays an important role in obtaining an optimal postprandial glucose level, which is demonstrated with the correct levels of glycosylated haemoglobin (HbA1c). However, recommendations for children with DM1 are based on narrative reviews of the available evidence. Our objective was to evaluate the effectiveness of carbohydrate counting on metabolic control of children with DM1. This study was a systematic review. The search was conducted in PubMed, Google Scholar, and controlled trials of the Cochrane collaboration (CENTRAL), published from January 2000 to September 2015. Five eligible trials out of 261 potentially relevant studies were identified, which include two trials. The quality of the studies was generally poor. The two studies included agreed on the positive impact of carbohydrate counting in reducing HbA1c levels as a measure of metabolic control. In general, the other parameters measured showed conflicting results with no significant differences, except for the high density lipoprotein in one study, higher in the intervention group. Although carbohydrate counting is a promising technique for metabolic control in children with type 1 diabetes, the evidence found in this review is not enough to recommend it.

Quality assessment of clinical practice guidelines in perioperative care: a systematic appraisal.

BACKGROUND: Surgical care is an important burden in healthcare, and the complications and harm related to surgery are of special concern. Clinical practice guidelines in perioperative care should provide the opportunity to minimise these risks and improve surgical outcomes, but their quality has not yet been evaluated systematically. OBJECTIVE: To evaluate the quality of clinical practice guidelines (CPGs) for the prevention of perioperative adverse events. MATERIALS AND METHODS: A systematic search of scientific literature published between 1990 and 2008 was undertaken to identify and select CPGs related to the treatment of surgical patients, particularly those seeking to prevent surgical adverse events. The authors searched the main guideline databases and guideline developer websites, and completed the search in MEDLINE. Three independent reviewers assessed the eligible guidelines using the Appraisal of Guidelines for Research and Evaluation (AGREE) instrument. Their degree of agreement was evaluated with the intraclass correlation coefficient (ICC). RESULTS: Twenty-two CPGs were chosen for evaluation from a total of 6181 references. The overall agreement among reviewers was moderate (ICC: 0.68; 95% CI 0.46 to 0.84). The scores for each of the AGREE domains were: scope and purpose 80.9% (range: 40.7-100%); stakeholder involvement 51.3% (range: 8.3-88.8%); rigour of development 61.2% (range: 26.9-96.8%); clarity and presentation 69.7% (range: 33.3-94.4%); applicability 42.5% (range: 7.4-92.5%); and editorial independence 57% (range: 27.7-100%). Most of the appraised guidelines could be recommended (n = 10) or recommended with provisos (n = 10) for use in clinical practice. Guidelines developed by research agencies or guideline developers were of a higher quality than those developed by scientific societies. The authors did not detect any improvement over time in guideline quality. CONCLUSIONS: The quality of guidelines for perioperative care is moderate. Measures should be taken to guarantee that CPGs are based on the best available evidence and rigorously developed and reported. Greater efforts are needed to provide high-quality guidelines that serve as a useful and reliable tool for clinical decision-making in this field.

The quality of clinical practice guidelines over the last two decades: a systematic review of guideline appraisal studies.

BACKGROUND: Despite the increasing number of manuals on how to develop clinical practice guidelines (CPGs) there remain concerns about their quality. The aim of this study was to review the quality of CPGs across a wide range of healthcare topics published since 1980. METHODS: The authors conducted a literature search in MEDLINE to identify publications assessing the quality of CPGs with the Appraisal of Guidelines, Research and Evaluation (AGREE) instrument. For the included guidelines in each study, the authors gathered data about the year of publication, institution, country, healthcare topic, AGREE score per domain and overall assessment. RESULTS: In total, 42 reviews were selected, including a total of 626 guidelines, published between 1980 and 2007, with a median of 25 CPGs. The mean scores were acceptable for the domain 'Scope and purpose' (64%; 95% CI 61.9 to 66.4) and 'Clarity and presentation' (60%; 95% CI 57.9 to 61.9), moderate for domain 'Rigour of development' (43%; 95% CI 41.0 to 45.2), and low for the other domains ('Stakeholder involvement' 35%; 95% CI 33.9 to 37.5, 'Editorial independence' 30%; 95% CI 27.9 to 32.3, and 'Applicability' 22%; 95% CI 20.4 to 23.9). From those guidelines that included an overall assessment, 62% (168/270) were recommended or recommended with provisos. There was a significant improvement over time for all domains, except for 'Editorial independence.' CONCLUSIONS: This review shows that despite some increase in quality of CPGs over time, the quality scores as measured with the AGREE Instrument have remained moderate to low over the last two decades. This finding urges guideline developers to continue improving the quality of their products. International collaboration could help increasing the efficiency of the process.

Síntomas laringofaríngeos posoperatorios en cirugía electiva. Incidencia y factores asociados / Postoperative laringo-pharyngeal symptoms in elective surgery - Incidence and related factors

Introducción: Los síntomas laringofaríngeos (SLF) son comunes en anestesia. La incidencia de morbilidad laringofaríngea varía en la literatura. Objetivos: Determinar la incidencia de SLF al usar máscara laríngea y tubo endotraqueal en la primera y a las 24h posoperatorias y estimar la asociación de factores de riesgo. Métodos: Estudio de cohorte cerrada que incluyó 451 pacientes. Se indagó la presencia de odinofagia, disfonía y disfagia. Se utilizaron modelos marginales para estimar asociación con variables en estudio. Resultados: La incidencia de SLF durante la primera y 24h posoperatorias fue del 26 y del 13%, respectivamente. A las 24 h, la incidencia disminuyó significativamente. Conclusiones: La incidencia en un centro hospitalario colombiano de SLF en cirugía ambulatoria es importante. Existen diferencias en la reducción con el tubo endotraqueal y la máscara laríngea en el tiempo.

Introduction: To determine cumulative incidence of sore throat complaints (STCs) which occur with the insertion of the laryngeal mask (LM) and endotracheal tube (ETT) during the first hour and 24 hours after elective surgery. In addition, to establish risk factors associated with its occurrence. Methods: In a cohort study, a total of 451 patients scheduled for elective non-cardiac surgery were included consecutively for 6 months (ASA I-II-III, >18 years old) who underwent LM or ETT airway management for general anesthesia. Through a questionnaire with indirect and direct questions the presence of sore throat, hoarseness, dysphagia and the composite endpoint STCs were assessed one and 24 hours after surgery. Marginal models were used to identify risk factors. Results:We found an incidence of STCs of 26.8% and 13.5% at first and 24 postoperative hours respectively. At first hour, they were classified as sore throat (23.9%), hoarseness (6.7%) and dysphagia (6.4%). Each compound was not mutually exclusive. At 24 hours of follow up, incidence of STCs and its compounds decreases significantly but differently to ETT and LM. STCs were associated with female gender (OR=1.53 95%CI 1.00-2.37, p=0.05), ETT intubation (OR=4.20 95%CI 2.19-8.04, p<0.01) and bloodstain on airway device at extubation (OR=2.00 95%CI 1.18-3.36, p<0.01). Conclusions: The incidence of STCs remains important. There are differences in the pattern of reduction between ETT and LM over time and this study confirms risk factors for postoperative STCs like use of ETT, presence of blood during the airway device extraction and female gender.