[Implementation process evaluation of the Integrated Management Childhood Illness strategy in the Family Health Program, Pernambuco State, Brazil]. / Avaliação do processo de implantação da estratégia da Atenção Integrada às Doenças Prevalentes da Infância no Programa Saúde da Família, no Estado de Pernambuco, Brasil.

This evaluative study attempts to define the contextual determinants of the degree of implementation in the Integrated Management of Childhood Illnesses strategy in Pernambuco State, Brazil. A total of 33 Family Health Program teams were selected from 10 municipalities. In order to define the degree of implementation, the study used a specific score system and the process indicators provided by the strategy. Municipalities were classified as critical, unsatisfactory, and acceptable. All municipalities except for one presented an acceptable degree of implementation in relation to the structure. In relation to process evaluation, two municipalities received one follow-up visit and their scores were unsatisfactory. Four municipalities received two visits, and one was classified as unsatisfactory on the second follow-up visit, while another presented a critical score on the first follow-up visit. Among four municipalities that received three follow-up visits, one was classified as unsatisfactory in the three evaluations. Four municipalities achieved mean unsatisfactory scores, when considering the mean scores acquired in the three follow-up visits. There was no association between the organizational context and degrees of implementation.

Empyema and bacteremic pneumococcal pneumonia in children under five years of age.

We compared bacteremic pneumococcal pneumonia (BPP) and pneumococcal empyema (PE), in terms of clinical, radiological, and laboratory findings, in under-fives. A cross-sectional nested cohort study, involving under-fives (102 with PE and 128 with BPP), was conducted at 12 centers in Argentina, Brazil, and the Dominican Republic. Among those with PE, mean age was higher; disease duration was longer; and tachypnea, dyspnea, and high leukocyte counts were more common. Among those with BPP, fever and lethargy were more common. It seems that children with PE can be distinguished from those with BPP on the basis of clinical and laboratory findings. Because both conditions are associated with high rates of morbidity and mortality, prompt diagnosis is crucial.

Penicillin-resistant pneumococcus and risk of treatment failure in pneumonia.

OBJECTIVE: To determine whether the presence of in vitro penicillin-resistant Streptococcus pneumoniae increases the risk of clinical failure in children hospitalised with severe pneumonia and treated with penicillin/ampicillin. DESIGN: Multicentre, prospective, observational study. SETTING: 12 tertiary-care centres in three countries in Latin America. PATIENTS: 240 children aged 3-59 months, hospitalised with severe pneumonia and known in vitro susceptibility of S pneumoniae. INTERVENTION: Patients were treated with intravenous penicillin/ampicillin after collection of blood and, when possible, pleural fluid for culture. The minimal inhibitory concentration (MIC) test was used to determine penicillin susceptibility of the pneumococcal strains isolated. Children were continuously monitored until discharge. MAIN OUTCOME MEASURES: The primary outcome was treatment failure (using clinical criteria). RESULTS: Overall treatment failure was 21%. After allowing for different potential confounders, there was no evidence of association between treatment failure and in vitro resistance of S pneumoniae to penicillin according to the Clinical Laboratory Standards Institute (CLSI)/National Committee for Clinical Laboratory Standards (NCCLS) interpretative standards ((adj)RR = 1.03; 95%CI: 0.49-1.90 for resistant S pneumoniae). CONCLUSIONS: Intravenous penicillin/ampicillin remains the drug of choice for treating penicillin-resistant pneumococcal pneumonia in areas where the MIC does not exceed 2 microg/ml.

Frequência de Escherichia coli e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda / The frequency of Escherichia coli and its sensitivity to antimicrobials in children aged under five years admitted to hospital for treatment of acute diarrhea

Determinar a frequência de Escherichia coli diarreiogênica e sua sensibilidade aos antimicrobianos em menores de cinco anos hospitalizados por diarreia aguda. MÉTODOS: estudo prospectivo tipo corte transversal realizado no Instituto de Medicina Integral Prof. Fernando Figueira, entre janeiro de 2010 e fevereiro de 2011. Foram excluídas as crianças com diagnóstico de imunodeficiência ou usando antimicrobianos. Para cada paciente foi feito uma única coleta de swab retal nas primeiras 24 horas de internação. Os patógenos foram identificados na coprocultura e sorotipagem. Os antibiogramas foram obtidos por disco-difusão. RESULTADOS: 140 crianças foram arroladas, em sua maioria provinham de famílias de baixa renda da Região Metropolitana do Recife. Foram isolados 99 microorganismos: 9 (6,4 por cento) E. coli enteropatogênica (EPEC) e 4 (2,9 por cento) E. coli enteroinvasora (EIEC) e 80 (57,1 por cento) outras E.coli não EPEC, não EIEC, 3 (2,1 por cento) Shigella spp e 3 (2,1 por cento) Salmonella spp. O perfil de sensibilidade aos antimicrobianos demonstrou níveis elevados de resistência à ampicilina e sulfametoxazol-trimetoprima. CONCLUSÕES: a baixa frequência de EPEC observada pode estar associada às condições de saneamento básico favoráveis apresentadas pelos pacientes do estudo. A análise local do perfil da sensibilidade da E. coli aos antimicrobianos reforça a recomendação da Organização Mundial de Saúde para o uso racional dessas drogas visando prevenção da resistência bacteriana...

To determine the frequency of diarrheic Escherichia coli and its sensitivity to antimicrobials in children aged under five years admitted to hospital for treatment of acute diarrhea. METHODS: a prospective cross-sectional study was carried out at the Instituto de Medicina Integral Prof. Fernando Figueira, between January 2010 and February 2011. Children were excluded if they had been diagnosed as immunodeficient or were using antimicrobials. A single rectal swab was taken from each patient during the first 24 hours of hospitalization. The pathogens were identified in the coproculture and serotyping. Antibiograms were obtained using disc-diffusion. RESULTS: 140 children were recruited. Most were from low-income families in the Metropolitan Region of Recife. Ninety-nine micro-organisms were isolated: 9 (6.4 percent) enteropathogenic E. coli (EPEC) and 4 (2.9 percent) enteroinvasive E. coli (EIEC) and 80 (57.1 percent) other E.coli that are neither EPEC nor EIEC, 3 (2.1 percent) Shigella spp and 3 (2.1 percent) Salmonella spp. The profile of sensitivity to antimicrobials showed high levels to resistance to ampicillin and sulfametho-xazol-trimetropime. CONCLUSIONS: the low frequency of EPEC found may be associated with basic sanitary conditions among the patients in the study. The local analysis of the profile of sensitivity of E. coli to antimicrobials corroborates the World Health Organization recommendation that these drugs be used prudently to ensure prevention of resistance in bacteria...

[Analysis of social and environmental risk for pleural involvement in severe pneumonia in children younger than 5 years of age]. / Análise de risco sócio-ambiental para comprometimento pleural na pneumonia grave em crianças menores de 5 anos.

OBJECTIVE: To determine social and environmental risk factors associated with pleural involvement among children from 3 to 59 months old who were hospitalized with severe pneumonia in northeastern Brazil. METHODS: This was an observational and descriptive cross-sectional study with an analytical component. We evaluated 154 patients hospitalized due to severe pneumonia, with or without pleural involvement. Pleural involvement was determined based on radiological findings. The following variables were analyzed: age, sex, place of residence, housing conditions, day care attendance, passive smoking, family income, presence of consumer goods in the home (e.g., television, radio, refrigerator, automobile), and schooling and occupation of the mother or other caregiver. The information was obtained by interviewing the mother or other caregiver or by consulting the inpatient medical chart. RESULTS: The frequency of pleural involvement among the 154 patients evaluated was 25.3%. The following factors were associated with pleural involvement: living in a rural area, being in a household with two or fewer rooms, family income below 170 U.S. dollars per month, and birthweight < 2 500 g. CONCLUSIONS: These findings indicate the need to improve the socioeconomic and living conditions of the less-privileged population, especially in rural areas. The health sector should emphasize primary care, focusing on a preventive approach beginning in the prenatal period.

Avaliaçäo do processo de implantaçäo da estratégia da Atençäo Integrada às Doenças Prevalentes da Infância no Programa Saúde da Família, no Estado de Pernambuco, Brasil / Implementation process evaluation of the Integrated Management Childhood Illness strategy in the Family Health Program, Pernambuco State, Brazil

Estudo avaliativo que procura definir os determinantes contextuais do grau de implantaçäo da estratégia Atençäo Integrada às Doenças Prevalentes da Infância, no estado de Pernambuco. Selecionou-se 33 unidades do Programa Saúde da Família, de dez municípios. Para definir o grau de implantaçäo, utilizou-se um sistema de escores específico e os indicadores de processo normatizados pela estratégia, classificando os municípios nos níveis Crítico, Insatisfatório e Aceitável. Os municípios, com uma exceçäo, apresentaram nível aceitável em relaçäo à estrutura. Quanto à avaliaçäo do processo, dois receberam uma visita de seguimento e os escores encontraram-se no nível insatisfatório. Quatro receberam duas visitas, com um deles classificado no nível insatisfatório no 2º seguimento e outro apresentando nível crítico no 1º seguimento. Em quatro municípios que receberam três visitas, um obteve escores no nível insatisfatório nas três avaliaçöes. Observa-se que quatro municípios atingiram escores médios, que os classificam no nível insatisfatório quando se consideram as médias dos escores obtidos nas 3 visitas de seguimento. Näo foi encontrada associaçäo entre contexto organizacional e os graus de implantaçäo

Análise de risco sócio-ambiental para comprometimento pleural na pneumonia grave em crianças menores de 5 anos / Analysis of social and environmental risk for pleural involvement in severe pneumonia in children younger than 5 years of age

OBJETIVO: Determinar fatores de risco sócio-ambientais associados ao desenvolvimento de comprometimento pleural em crianças de 3 a 59 meses internadas com pneumonia grave em um hospital do Nordeste brasileiro. MÉTODOS: Estudo observacional, transversal, descritivo, com componente analítico. Foram avaliados 154 pacientes hospitalizados com pneumonia grave, com ou sem comprometimento pleural. O comprometimento pleural foi definido segundo achados radiológicos. As seguintes variáveis sócio-ambientais foram analisadas: faixa etária, sexo, local de residência, condições do domicílio, freqüência à creche, fumo passivo, renda familiar, presença de bens de consumo, escolaridade e trabalho extra-domiciliar da mãe ou responsável pela criança. As informações foram obtidas através de entrevistas com o responsável pelo paciente ou consulta ao prontuário médico durante a hospitalização. RESULTADOS: A freqüência de comprometimento pleural foi de 25,3 por cento. Os seguintes fatores foram associados à ocorrência de comprometimento pleural: residência em zona rural, dois cômodos ou menos no domicílio, renda familiar mensal inferior a 170 dólares e peso de nascimento <2 500 g. CONCLUSÕES: Os achados sugerem a necessidade de priorizar a melhoria das condições socioeconômicas e de moradia da população mais carente, principalmente aquela oriunda do meio rural. O setor saúde deve enfatizar a atenção primária, com enfoque preventivo desde o período pré-natal.

Objective. To determine social and environmental risk factors associated with pleural involvement among children from 3 to 59 months old who were hospitalized with severe pneumonia in northeastern Brazil. Methods. This was an observational and descriptive cross-sectional study with an analytical component. We evaluated 154 patients hospitalized due to severe pneumonia, with or without pleural involvement. Pleural involvement was determined based on radiological findings. The following variables were analyzed: age, sex, place of residence, housing conditions, day care attendance, passive smoking, family income, presence of consumer goods in the home (e.g., television, radio, refrigerator, automobile), and schooling and occupation of the mother or other caregiver. The information was obtained by interviewing the mother or other caregiver or by consulting the inpatient medical chart. Results. The frequency of pleural involvement among the 154 patients evaluated was 25.3%. The following factors were associated with pleural involvement: living in a rural area, being in a household with two or fewer rooms, family income below 170 U.S. dollars per month, and birthweight < 2 500 g. Conclusions. These findings indicate the need to improve the socioeconomic and living conditions of the less-privileged population, especially in rural areas. The health sector should emphasize primary care, focusing on a preventive approach beginning in the prenatal period.

Etiologia bacteriana da infecçäo hospitalar em um Hospital Geral de Pediatria - 1989-1990 / Bacterial etiology of hospitalar infection in a General Pediatric Hospital

Os autores apresentam os achados bacteriológicos em uma série de pacientes com infecçäo hospitalar, provenientes de um hospital geral de pediatria. Destacam a Klebsiella pneumoniae, Pseudomonas aeuriginosa e Staphylococus aureus como agentes mais frequentemente isolados. Comentam a sensibilidade destes agentes aos antibióticos e o aparecimento de multiresistência. Analisam e discutem os resultados e fazem consideraçÖes sobre prevençäo e tratamento das infecçÖes hospitalares

Etiologia da meningite bacteriana em crianças no Estado de Pernambuco / Etiology of bacterial meningitis in children in the State of Pernambuco

Verificou-se os agentes etiológicos em crianças com meningoencefalite bacteriana, hospitalizadas no HGP/IMIP, no periódo de agosto à novembro de 1988 e julho à outubro de 1989. Hemophylus influenzae foi o agente causal mais frequentemente isolado, seguido pela N. meningitidis e o bacilo de Koch