ABSTRACT
Abstract In pediatrics, drug therapy is commonly performed through adaptations of the dosage forms to adult use, increasing the risk of adverse drug reactions. In this context, studies assessing the severity and avoidability of the adverse reactions in children, especially those caused by antimicrobials, are still scarce. This work aimed to investigate suspected antimicrobial adverse reactions (ATM-ADRs) in pediatric patients admitted to a public hospital in northeastern Brazil, focusing on causality and avoidability analysis. A cohort study was carried out over a period of six months in a 64-bed pediatric unit. The incidence of suspected adverse reactions caused by antimicrobials was 14.65%. Most reactions were rated as probable (89.13%), with moderate severity (84.78%) and possibly avoidable (45.65%). The analysis indicated that the use of a larger number of medications (p<0.0001) and longer hospital stay (p=0.004) were related to the occurrence of ATM-ADR. Our findings demonstrated that almost half of the suspected reactions could be prevented and that the antimicrobial's clinical management is relevant in this context. Besides, increasingly accurate adverse reaction classification instruments are essential. These results can support the development of therapeutic guidelines addressed to a safe and effective pharmacotherapy in the pediatric area
Subject(s)
Humans , Male , Female , Child, Preschool , Patients/classification , Pediatrics/classification , Drug-Related Side Effects and Adverse Reactions/complications , Anti-Infective Agents/adverse effectsABSTRACT
Este estudo avaliou o perfil da mortalidade infantil e a evitabilidade dos óbitos de crianças menores de um ano dos municípios da 15ª Regional de Saúde. Foram investigados 74 óbitos de crianças no ano de 2008, em 15 municípios da 15a Regional de Saúde do Estado do Paraná. Foram coletados dados dos registros do comitê de prevenção do óbito infantil e fetal, estes contabilizados por meio de frequência e porcentagens simples e apresentados na forma de tabela. Dos 74 óbitos investigados, 51 (69%) foram neonatais e 23 (31%) pós-neonatais, com destaque para os municípios com menos de 20 mil habitantes, onde a mortalidade neonatal ocorreu em maior percentual com 82%. Quanto à evitabilidade dos óbitos, 82%, poderiam ser evitados, com percentual maior nos municípios acima de 50 mil habitantes. As causas de morte encontradas foram relacionadas ao período perinatal e as malformações congênitas. Segundo as medidas de evitabilidade, em 30 (40,5%) dos óbitos assim classificados, as mais encontradas foram às relacionadas com atenção à mulher na gestação. As medidas mais indicadas pelo comitê foram as de promoção de saúde e prevenção primária, 84(34%) das recomendações, com destaque para ações de educação em saúde, avaliação do risco gestacional e planejamento familiar.
The objective of this study was to evaluate the profile of infant mortality and avoidable deaths of children under one year old in the municipalities of the 15th Regional Health. There were investigated 74 deaths of children in 2008, in 15 cities of the 15th Heath Regional of the Paraná State. The data were collected from the records of the infant and fetal death prevention committee; these accounted for by means of frequency and simple percentages and presented in the form of table. Of the 74 investigated deaths, 51(69%) were neonatal and 23 (31%) were post-neonatal, highlighting the cities with less than 20 thousand inhabitants, where the neonatal mortality occurred in higher percentage, with 82%. Regarding the death avoidance, 82% could have been avoided, with higher percentage in cities with more than 50 thousand inhabitants. The causes of death found were related to the perinatal period and congenital malformations. According to the avoidance measures, in 30 (40,5%) of the classified deaths, the causes most found were those related to the attention provided to the pregnant woman. The main measures indicated by the committee were the promotion of health and primary prevention, 84 (34%) of the recommendations, highlighting actions towards health education, evaluation of gestational risk and family planning.
El objetivo de este estudio fue evaluar el perfil de la mortalidad infantil y la evitabilidad de los óbitos de niños menores de un año en los municipios de la 15ª Regional de Salud. Fueron investigados 74 óbitos de niños en el año de 2008, en 15 ciudades de la 15a Regional de Salud del Estado de Paraná. Fueron recolectados datos de los registros del comité de prevención del óbito infantil y fetal; éstos contabilizados por medio de frecuencia y porcentajes simples y presentados en la forma de tabla. De los 74 óbitos investigados, 51 (69%) fueron neonatales y 23 (31%) post neonatales, resaltando las ciudades con menos de 20 mil habitantes, donde la mortalidad neonatal ocurrió en mayor porcentaje, con 82%. En cuanto a la evitabilidad de los óbitos, 82% podrían ser evitados, con porcentaje mayor en las ciudades con más de 50 mil habitantes. Las causas de muerte encontradas fueron relacionadas al periodo perinatal y a las malformaciones congénitas. De acuerdo con las medidas de evitabilidad, en 30 (40,5%) de los óbitos así clasificados, las más encontradas fueron las relacionadas con la atención a la mujer embarazada. Las medidas más indicadas por el comité fueron las de promoción a la salud y prevención primaria, 84 (34%) de las recomendaciones, con destaque para las acciones de educación en salud, evaluación del riesgo gestacional y planificación familiar.
Subject(s)
Humans , Infant , Primary Health Care , Health Evaluation , Infant MortalityABSTRACT
Sobre la equidad se dice que tiene sus fundamentos en los derechos humanos fundamentales, la equidad no es igualdad; la desigualdad para ser equitativa requiere justificación ética y moral. En Cuba, la equidad es premisa para las decisiones como de forma implícita se anuncia en La Historia me absolverá. El sistema de salud cubano tiene como finalidad fundamental producir salud de la mejor manera posible y tiene, además, dos indicadores principales: la eficacia social y la satisfacción social. La equidad es condición estratégica, necesaria, para el acceso a los servicios de salud según necesidades y posibilidades. Se muestra que en Cuba la reforma del sector de la salud es un proceso continuo y sostenible y que decisiones políticas, disposiciones legales, y los valores de la sociedad, aseguran el acceso a los servicios de salud de todos los cubanos. La accesibilidad se entiende como la facilidad de acceder y recibir la atención de salud que se necesite, de forma integral y oportuna pero es necesario avanzar más en ella; la lista de espera, el orden de llegada son medidas administrativas para adecuar de alguna forma la demanda con la capacidad real existente en los servicios. La evitabilidad, concepto clave para la equidad se considera fuente de acción para eliminar, reducir, neutralizar las causas, subjetivas más y objetivas menos, que demoran la atención aún dentro del sistema de salud único, estatal, integral y gratuito.
This article offered the following elements on the term equity. Equity is rooted in the fundamental human rights; equity does not mean equality. For inequality to be equitable it requires ethical and moral justification and in Cuba equity is a premise for decisions as it was implicitly announced in "History will abssolve me". The cuban healthcare system is aimed at producing health in the best possible way based on two main indicators, that is, social efficacy and social satisfaction. Equity is a necessary strategic condition for access to health services according to needs and possibilities. The article demonstrated that the health sector reform in Cuba is a steady and sustainable process and that political decision-making, legal provisions and the society´s values assure the access of every Cuban to healthcare services. Accesibility is understood as easy way to gain access to and receive health care services whenever needed in a comprehensive and timely way, but it is imperative to advance further in this regard. The waiting list, the order of arrival are administrative measures to somehow adjust the demand to the real health service capacities; however, avoidability is considered the key concept for equity as a source of action to eliminate, reduce, neutralize the causes, more subjective than objective, that delay care to patient even in a comprehensive free state-run and unique healthcare system like ours.