Analysis on vaccination willingness and related factors of influenza, pneumonia, and herpes zoster vaccine among people over 50 years old in Minhang district of Shanghai / 中华预防医学杂志

Objective: To determine the knowledge of influenza, pneumonia, herpes zoster and related vaccines, willingness to vaccinate under multiple payment scenarios, and corresponding risk factors among people over 50 years old in Minhang District of Shanghai. Methods: A total of 1 672 respondents aged 50-69 from 13 communities/towns in Minhang district of Shanghai were included in this study using a stratified random sampling strategy on December 2020. The knowledge of influenza, pneumonia, herpes zoster and vaccines was investigated using a questionnaire, and the differences in the willingness under multiple payment scenarios were determined using chi-square test. The consistency in the willingness under multiple payment scenarios was compared using Cohen's Kappa and the risk factors of the willingness was determined using ordinal logistic regression. Results: The average age of 1 672 respondents was (60.48±5.96) years old, including 777 (46.47%) males and 895 (53.53%) females. A total of 1 350 subjects (80.74%) had local household registration in Shanghai. The proportion of the willingness to vaccinate for themselves, spouses, and parents under any payment scenario was determined to be 80.6% (influenza vaccine), 81.5% (pneumonia vaccine), and 74.0% (herpes zoster vaccine). The willingness to vaccinate against influenza and pneumonia under multiple payment scenarios remained stable (Kappa value ≥0.6), while that against herpes zoster infection was inconsistent (Kappa value ≤0.35). Logistic regression analysis showed that respondents who had higher knowledge of influenza and influenza vaccine [OR (95%CI): 1.111 (1.054-1.170), 1.182 (1.126-1.240), respectively], aged 50-59 [1.305 (1.085-1.531)] and local household registration in Shanghai [1.372 (1.079-1.721)] had higher willingness to vaccinate against influenza, while males had lower willingness [0.733 (0.551-0.910)]. Respondents who had higher knowledge of pneumonia and pneumonia vaccine [OR (95%CI): 1.837 (1.152-2.517), 2.217 (1.541-2.893), respectively] had higher willingness to receive pneumonia vaccine. Respondents aged 50-59 [1.327 (1.059-1.537)] and with local household registration in Shanghai [2.497 (1.417-4.400)] were more likely to be vaccinated against herpes zoster, while those with middle school degree or below [0.664 (0.396-0.992)] and high school degree [0.559 (0.324-0.964)] were less likely to be vaccinated. Conclusion: Among people aged over 50 years old in Minhang district of Shanghai, the willingness to vaccinate for themselves, spouses, and parents against influenza, pneumonia and herpes zoster infection is quite different under multiple payment scenarios, especially for herpes zoster vaccine.

Emergency training need and effect evaluation analysis of novel coronavirus pneumonia in centers of disease control and prevention / 中华预防医学杂志

A questionnaire was used to investigate the emergency training needs of novel coronavirus pneumonia of disease prevention and control institutions in provinces, deputy provincial level regions and cities specifically designated in the state plan, and the effect evaluation of emergency training activities conducted by Chinese Center for Disease Control and Prevention (China CDC). The results showed that 67.4% of 47 disease prevention and control institutions (31/46) believed that the emergency training at the initial stage of the epidemic should be conducted as soon as possible, and the form of network training should be given priority. The training should focus on the urgently needed technologies such as epidemiological investigation, formulation and response of prevention and control strategies, laboratory testing, etc. The teaching materials should highlight pertinence and practicability and be presented in the form of electronic video. The average satisfaction score of the video training conducted by China CDC was (8.81±1.125) and the score of audio-video courseware was (8.97±0.893). The needs analysis and evaluation of novel coronavirus pneumonia prevention and control in disease prevention and control institutions could provide reference for the follow-up training and improve the emergency training management.

Causes of death in feedlot beef cattle and their control: a brief review / Causas de morte em bovinos de corte confinados e seu controle: uma breve revisão

This review reports the leading causes of death in feedlot beef cattle. It describes economic losses resulting from these deaths and suggests control alternatives. Diseases associated with the respiratory and digestive systems were the most frequently observed. In different geographical areas, the importance of each one might vary. Outbreaks of diseases such as botulism occur occasionally and can cause important economic losses. Cattle tick fever can cause significant losses in zones of enzootic tick instability. Technical assistance and sanitary and food management are critical for the best productivity in feedlot cattle.(AU)

Esta revisão discute as principais causas de morte em bovinos de corte em confinamento. Descreve as perdas econômicas resultantes dessas mortes e sugere alternativas de controle. As doenças associadas aos sistemas respiratório e digestivo foram as mais frequentemente observadas. Em diferentes áreas geográficas, a importância de cada uma pode variar. Surtos de doenças como o botulismo ocorrem ocasionalmente e podem causar importantes perdas econômicas. A tristeza parasitária bovina pode causar perdas significativas em zonas de instabilidade enzoótica do carrapato. A assistência técnica e um bom gerenciamento sanitário e alimentar são essenciais para a melhor produtividade em bovinos de corte confinados.(AU)

Duración del ayuno preoperatorio en pacientes con cirugía programada / Duration of preoperative fasting in patients with scheduled surgery

Antecedentes y objetivo: el ayuno preoperatorio disminuye el riesgo de aspiración del contenido gástrico y sus complicaciones. Sin embargo, si es excesivo, favorece la regurgitación y el riesgo de broncoaspiración tras la inducción anestésica, así como alteraciones metabólicas e hidroelectrolíticas. Analizamos su duración, en pacientes con cirugías programadas en un hospital público de agudos. Material y métodos: se encuestó a todos los pacientes mayores de 18 años con cirugías programadas. Se recolectaron datos sobre la prescripción médica de ayuno, la hora de inducción anestésica y personales. El ayuno prescripto se comparó con las recomendaciones de las guías de la AAARBA (Asociación de Anestesia, Analgesia y Reanimación de Buenos Aires). Resultados: se reclutaron 139 pacientes, con una mediana de edad de 48 años (30; 64), 53% femeninos. La mediana del ayuno prescripto fue de 12,5 horas tanto para sólidos como para líquidos. El ayuno para sólidos que realizaron los pacientes tuvo una mediana de 14 horas, la cual resultó significativamente mayor que la prescripción (p < 0,001). En cambio, el ayuno para líquidos tuvo una mediana de 12 horas, no hallándose una diferencia significativa (p = 0,452) con lo prescripto. En comparación con la guía de la AAARBA, el ayuno prescripto excedió la recomendación para sólidos (4,5 h) y para líquidos (10,5 h). El ayuno realizado por el paciente excedió lo prescripto para sólidos (1,5 h), mientras que para líquidos fue inferior (0,5 h). Conclusión: el ayuno preoperatorio prescripto no se adecuó a las recomendaciones actuales. Las horas de ayuno realizadas por el paciente resultaron excesivas. (AU)

Background and objective: preoperative fasting reduces the risk of aspiration of gastric contents and its complications. However, if fasting is excessive, it favours regurgitation and the risk of pulmonary aspiration in patients undergoing general anaesthetic, such as metabolic and electrolyte disorders. We analysed its duration in patients with elective surgeries in public acute care hospital. Material and methodologies: patients over 18 years old with elective surgeries were surveyed. Data about medical fasting indication, time of induction of anaesthesia and personal information was collected. The prescribed fast was compared with the recommendations of the AAARBA (Association of Anaesthesia, Analgesia and Reanimation of Buenos Aires) guidelines. Results: 139 patients were gathered with a median of 48 years old (30; 64), 53% of them were female. Fasting indication median was of 12.5 h for solids and liquids. The fasting made by the patient for solids had a median of 14 h which resulted to be significantly higher to the indication (p < 0.001). By contrast, the fasting for liquids had a median of 12 h which it did not show a significant difference (p = 0.452) with the indication. In comparison with the AAARBA guideline, the fasting indication exceeded the recommendation for solids (4.5 h) and for liquids (10.5 h). The fasting made by the patient exceeded to what was indicated for solids (1.5 h) while for liquids, it was inferior (0.5 h). Conclusion: the indicated preoperative fasting was not adequate to the current recommendations. The hours of fasting made by patient were excessive. (AU)

La anamnesis como pronóstico de mortalidad en la neumonía adquirida en la comunidad / Anamnesis as mortality prognosis in the community acquired pneumonia

RESUMEN Introducción: La neumonía adquirida en la comunidad constituye un importante problema de salud a nivel global, en Cuba es la cuarta causa de muerte. Los índices pronósticos ayudan a detectar tempranamente los pacientes de alto riesgo, pero esto tiene baja sensibilidad y especificidad. Objetivo: determinar durante la anamnesis factores pronósticos de mortalidad en la neumonía adquirida en la comunidad. Materiales y métodos: estudio analítico longitudinal retrospectivo con un grupo donde se aplicaron pruebas no paramétricas y cálculo de riesgo relativo. Resultados: edad de 78 ± 10 años con 53 % femeninas. La mortalidad global de 57 % antecedentes de diabetes mellitus, 53 % enfermedad cerebro vascular anterior 34 %, el 42 % estaba encamados. El 38 % tenían más de cinco días enfermos y el 69 % estaba consumiendo antimicrobianos antes del ingreso. El 23 % padecían de insuficiencia cardiaca congestiva y el 73 % de enfermedad pulmonar obstructiva crónica. El síndrome confusional fue un buen predictor de mortalidad (x2=0,05) (RR=2,8). El encamamiento prolongado no predijo mortalidad a los cinco días (x2=0,43). El uso de antimicrobianos previos incremento el riesgo en (RR=0,8) con (x2=0,05). La insuficiencia cardiaca fue el mejor predictor (x2=0,006) (RR=1,2). La enfermedad pulmonar obstructiva crónica predijo con(x2=0,019) y (RR=1,47). Conclusiones: se considera como factores fuertemente predictivos el antecedente de insuficiencia cardiaca, de enfermedad pulmonar obstructiva crónica y el paciente que acude con síndrome confusional.

ABSTRACT Introduction: community acquired pneumonia is an important health problem around the world, and in Cuba it is the fourth cause of death. Prognostic indexes help to detect early the patients at high risk, but they have low sensibility and specificity. Objective: to determine the mortality prognostic factors in the community acquired pneumonia during the anamnesis. Material and methods: analytic, retrospective, longitudinal study in a group applying non-parametric tests and relative risk calculation. Results: age: 78 ± 10 years; 53 % of women. Global mortality of 57 %; 53 % had antecedents of diabetes mellitus; 34 % had previous cerebro-vascular disease, and 42 % were bedridden patients. 38 % was sick more than five days and 69 % took antimicrobials before being admitted. 23 % suffered congestive heart failure and 73 % chronic obstructive pulmonary disease. Confusional syndrome was a good predictor of mortality (x2=0.05) (RR=2.8). Long confinement to bed did not predict mortality at the fifth day (x2=0.43). The previous use of antimicrobials increased the risk (RR=0.8) con (x2=0.05). Heart failure was the best predictor (x2=0.006) (RR=1.2). Chronic obstructive pulmonary disease predicted with (x2=0.019) y (RR=1.47). Conclusions: antecedents of heart failure and chronic obstructive pulmonary disease, and the patient arriving with confusional syndrome are considered strongly predictive factors.

Carga de neumonía en adultos hospitalizados / Pneumonia loading in hospitalized adults / Pneumonia carregando em adultos hospitalizados

La neumonía adquirida en la comunidad en adultos, es un importante problema de salud pública. En América Latina son muy escasas las publicaciones que documenten su incidencia. Esta comunicación breve proporciona datos preliminares sobre la incidencia (105 persona/año) de neumonías en adultos hospitalizados. La base de datos de una institución médica privada de Uruguay, posibilitó la estimación de la incidencia de esa patología, antes de la implementación de la vacuna conjugada neumocóccica (VCN) en la infancia y luego de su aplicación. En 1.688 pacientes con neumonía los mayores de 64 años predominaron y su incidencia fue de 1.938 en el período prevacunación, descendiendo significativamente a 1.365 luego de la VCN. A pesar de la posible protección indirecta de la vacunación, la información presentada alerta sobre la persistencia de morbimortalidad por neumonía en adultos mayores.

Pneumonia in adults poses severe health risks, but data on its burden still lacks in Latin American countries including Uruguay. To fill this gap preliminary information on hospitalized pneumonia incidence in adults was analyzed. A data base from a private medical institution enabled to estimate, pre and post pneumococcal conjugate vaccine incidences (105 person/year), by age groups. Out of 1 688 adults hospitalized due to pneumonia, the group aged >64 yers predominated. For the same age group, a significant difference (1.938 vs. 1.365) was observed on incidences before and after conjugate vaccine application in children. Although more robust information on adult pneumonia hospitalizations are required to confirm indirect vaccine effect, these data alert on pneumonia persistence which requires preventive measures.

A pneumonia adquirida na comunidade em adultos é um grande problema de saúde pública. Na América Latina existem muito poucas publicações que documentam sua incidência. Esta breve comunicação fornece dados preliminares sobre a incidência (105 pessoas / ano) de pneumonias em adultos hospitalizados. O banco de dados de uma instituição médica privada no Uruguai possibilitou estimar a incidência dessa patologia, antes da implementação da vacina conjugada pneumocócica (VCN) na infância e após sua aplicação. Em 1.688 pacientes com pneumonia, aqueles com mais de 64 anos de idade predominaram e sua incidência foi de 1.938 no período de pré-vacinação, descendo significativamente para 1.365 após a VCN. Apesar da possível proteção indireta da vacinação, as informações apresentadas alertam sobre a persistência da morbimortalidade por pneumonia em idosos.

Protocolo del Sistema Nacional de Vigilancia Epidemiológica: Infecciones respiratorias agudas y meningitis bacterianas. No. 02 / Protocol of the National Epidemiological Surveillance System: Acute Respiratory Infections and Bacterial Meningitis. No. 02

Estos protocolos están dirigido a personal médico, paramédico y otros profesionales que realizan acciones gerenciales y operativas de vigilancia epidemiológica en los servicios de salud del país, y están divididos en varios tomos para dar a conocer y actualizar la identificación y medidas de control para diversos padecimientos a fin de continuar con el mejoramiento de las capacidades técnicas de los trabajadores de salud, que permita planificar la prestación de servicios con decisiones partiendo de un enfoque epidemiológico comprobado, para responder a los cambios de tendencias epidemiológicas y con ello contribuir al fortalecimiento de prácticas asertivas de la salud pública de nuestro país. Las infecciones respiratorias agudas (IRAS), son la principal causa de morbilidad en países en desarrollo, las cuales en su mayoría suelen ser desatendidas siendo una amenaza para la supervivencia de niños menores de 5 años. Se considera que la verdadera mortalidad es subestimada por la ocurrencia de muertes en el hogar, sin tener un diagnóstico médico. Se estimó que para el año 2010, hubo a nivel global 1,071 millones de defunciones por neumonía en menores de 5 años. Del total de muertes, un 90 % se considera que ocurrió en los países en desarrollo y de estos el 50% en África.

Aplicación de redes neuronales en la predicción de mortalidad por neumonía / Neuronal networks as predictors of death in pneumonia

RESUMEN Introducción: la neumonía adquirida en la comunidad constituye un importante problema de salud a nivel global. En nuestro país es la cuarta causa de muerte. Los índices pronósticos ayudan a detectar tempranamente los pacientes de alto riesgo, pero estos tienen baja sensibilidad y especificidad. Objetivo: proponer un modelo matemático predictivo de mortalidad de la neumonía adquirida en la comunidad. Materiales y métodos: estudio analítico longitudinal en un universo de 73 pacientes, muestra no probabilística de 48. El test de Mann Withney se utilizó para obtener variables con significación en la mortalidad. Se calculó correlación de Pearson a las variables con significación y luego se elaboró el modelo matemático, el cual se probó en una red neuronal creada y entrenada al efecto. Posteriormente se llevó a la curva ROC para encontrar el área bajo la curva así como las coordenadas del punto de corte. Resultados: se obtuvo para la edad de 79 ± 11 años con 50 % femeninas. La mortalidad global estuvo en el orden del 27 %. Las variables con diferencias de comportamiento fueron la presión arterial sistólica (x2=0,001), así como la presión arterial diastólica (x2=0,001). El valor de la creatinina se comportó con (x2=0,03). La frecuencia respiratoria de (x2=0,01). La presión de oxigeno de (x2=0,036) al igual que las cifras de hemoglobina, el nivel de sodio (Na) (x2=0,004) con marcada diferencia entre los grupos y la edad (x2=0,003) IC=0,32. Conclusiones: este modelo matemático es una herramienta útil a pie de cama del paciente teniendo en cuenta que ayuda al juicio clínico en hacer un pronóstico más acertado (AU).

ABSTRACT Background: the community-acquired pneumonia represents an important problem around the world. It is the fourth cause of death in our country. Prognoses indexes are helpful to early detect the high risk patients, but they have low sensibility and specificity. Objective: to propose a predictive mathematical model of mortality by community-acquired pneumonia. Materials and methods: longitudinal, analytic study in a universe of 73 patients and a non-probabilistic sample of 48. The Mann Whitney's test was used to find variables with signification for mortality. Pearson correlation was applied to the significant variables and after that a mathematical model was elaborated and tested in a neuronal net created and trained for that. Later, data were introduced in a ROC curve to find the area under the curve as well as the coordinates of the cut-off point. Results: the average age was 79 ±11 years and 50 % of the patients were women. Global mortality was around 27 %. The variables with behavioral differences were systolic arterial hypertension (x2=0.001), as well as the diastolic arterial pressure (x2=0.001). The creatinine value was (x2=0.03) and the respiratory frequency (x2=0.01). The oxygen pressure (x2=0.036), and also hemoglobin values and sodium (Na) level (x2=0.004) show a significant difference between groups and ages (x2=0.003) IC=0, 32. Conclusions: this mathematical model is a useful tool at the patients´ bedside taking into account its help to clinical judgment when arriving to a more accurate prognosis (AU).

Community acquired pneumonia incidence among children less than 5 years of age in Concordia, Argentina: vaccination impact / Incidencia de la neumonía extrahospitalaria en menores de 5 años en Concordia (Argentina): repercusión de la vacunación / Incidência de pneumonia adquirida na comunidade em crianças menores de 5 anos em Concordia, Argentina: impacto da vacinação

ABSTRACT Objective To measure the effectiveness of pneumococcal conjugated vaccine (PCV13) against Community Acquired Pneumonia (CAP) and invasive pneumococcal disease, 2 years after the vaccine (2+1) was included into the National Immunization Program of Argentina, and to describe variables associated with bacterial pneumonia and hospitalization. Methods This was a prospective, population-based surveillance study of CAP incidence (ambulatory and hospitalized) among children less than 5 years of age in the Department of Concordia (Entre Rios, Argentina) from April 2014 - March 2016. The diagnosis of probable bacterial pneumonia (PBP) was determined following the standardized WHO protocol. Incidence during the post-vaccine introduction period was compared with the results from a previous study that used similar methodology for the pre-PCV13 introduction period from 2002 - 2005. Results During the study period, 330 patients had a clinical diagnosis of CAP, of which 92 were PBP (6 with pleural effusion). S. pneumoniae was not isolated from any sample. No factors associated with PBP were found in multivariable analysis. The decrease in PBP and pleural effusion was significant in relation to the previous study: 63% (P < 0.0001) and 80.9% (P < 0.003), respectively. PCV13 uptake was 97.3% for the 1st dose and 84.8% for the booster dose. Conclusions PCV13 was effective to reduce incidence of consolidated pneumonia and pleural effusion, among children less than 5 years of age in Concordia, Argentina. Vaccination is a very effective public health strategy for reducing vaccine preventable diseases, with impact on burden of disease and hospitalization.

RESUMEN Objetivo Medir la efectividad de la vacuna antineumocócica conjugada (VNC13)contra la neumonía extrahospitalaria y las enfermedades neumocócicas invasoras, dos años después de que se incorporara la vacuna (2+1) en el Programa Nacional de Vacunación de Argentina, y describir las variables asociadas con la neumonía bacteriana y la hospitalización. Métodos Se llevó a cabo un estudio prospectivo de vigilancia poblacional de la incidencia de la neumonía extrahospitalaria (pacientes ambulatorios y hospitalizados) en menores de 5 años en el departamento Concordia (Entre Ríos, Argentina) desde abril del 2014 hasta marzo del 2016. Se determinó el diagnóstico de probable neumonía bacteriana según el protocolo estandarizado de la OMS. Se comparó la incidencia durante el período posterior a la incorporación de la vacuna con los resultados de un estudio anterior en el que se usó una metodología similar para el período previo a la incorporación de la VNC13 entre el 2002 y el 2005. Resultados Durante el estudio, 330 pacientes presentaron un diagnóstico clínico de neumonía extrahospitalaria, de los cuales 92 presentaron probable neumonía bacteriana (6 con derrame pleural). No se aisló ninguna muestra del S. pneumoniae. No se encontraron factores asociados con la neumonía bacteriana probable en el análisis multivariante. La disminución de la neumonía bacteriana probable y el derrame pleural fue significativa en relación con el estudio anterior: 63 % (P < 0,0001) y 80,9 % (P < 0,003), respectivamente. La absorción de la VNC13 fue de 97,3 % para la primera dosis y de 84,8 % para la dosis de refuerzo. Conclusiones La VNC13 fue efectiva para reducir la incidencia consolidada de derrame pleural y neumonía en menores de 5 años en Concordia (Argentina). La vacunación es una estrategia de salud pública muy efectiva para reducir las enfermedades prevenibles por vacunación, con repercusión en la carga de enfermedad y la hospitalización.

RESUMO Objetivo Avaliar a efetividade da vacina pneumocócica conjugada (PCV13) em prevenir pneumonia adquirida na comunidade (PAC) e doença pneumocócica invasiva (DPI) após 2 anos da incorporação da vacina (2 + 1) ao Programa Nacional de Vacinação da Argentina e descrever as variáveis associadas à ocorrência de pneumonia bacteriana e internação hospitalar. Métodos Estudo prospectivo de base populacional de vigilância da incidência de PAC (atendimento ambulatorial e em internação hospitalar) em crianças menores de 5 anos de idade realizado no Departamento de Concordia, Entre Rios, na Argentina, de abril de 2014 a março de 2016. O diagnóstico de provável pneumonia bacteriana foi determinado segundo o protocolo padronizado da OMS. A incidência no período pós-introdução da vacina foi comparada aos resultados de um estudo anterior realizado com metodologia semelhante no período pré-introdução da PCV13 de 2002 a 2005. Resultados No período de estudo, foi feito o diagnóstico clínico de PAC em 330 pacientes, dos quais 92 foram casos de provável pneumonia bacteriana (6 com derrame pleural). A bactéria Streptococcus pneumoniae não foi isolada em nenhuma amostra. Não foi observado nenhum fator associado à provável pneumonia bacteriana na análise multivariada. Houve uma redução significativa da ocorrência de provável pneumonia bacteriana e derrame pleural em relação ao estudo anterior: 63% (P < 0,0001) e 80,9% (P < 0,003), respectivamente. A cobertura vacinal de PCV13 foi de 97,3% para a primeira dose e 84,8% para a dose de reforço. Conclusões A PCV13 foi efetiva em reduzir a incidência de pneumonia com consolidação e derrame pleural em crianças menores de 5 anos em Concordia, na Argentina. A vacinação é uma estratégia de saúde pública muito efetiva para reduzir doenças que podem ser evitadas com vacina, com impacto na morbidade e nas internações hospitalares.

Compliance with the vaccination schedule in children hospitalized with pneumonia and associated factors / Cumprimento do esquema vacinal em crianças internadas por pneumonia e fatores associados

ABSTRACT OBJECTIVE: To verify the adequacy and factors associated with compliance with the immunization schedule (BCG, DTP-Hib, MMR, PCV-10) in children hospitalized with pneumonia at a pediatric referral hospital in Northeast Brazil. METHODS: This is a cross-sectional, descriptive study with an analytical component, with a sample of 452 children hospitalized with pneumonia at the Instituto de Medicina Integral Prof. Fernando Figueira, between 2010 and 2013. The inclusion criterion was children aged from one month to less than five years of age with proof in the immunization record. The exclusion criterion was the presence of hospital-acquired pneumonia or concomitant disease. We have evaluated the adequacy of the immunization schedule for the BCG, tetravalent, MMR, and 10-valent pneumococcal conjugate (PCV-10) vaccines. We used the chi-square test and Fisher's exact test followed by multivariate Poisson regression, estimating the crude and adjusted prevalence ratios and respective 95% confidence intervals. The variables with p < 0.20 in the univariate analysis were included in the multivariate analysis. RESULTS: There was good adequacy in the immunization schedule, except for PCV-10, which presented a percentage lower than 85%. We have observed an association between adequate compliance with the immunization schedule and education level of the mother (89.9% complete high school), sex of the child (87.2% female), age of the child (94.2% younger than six months), and breastfeeding (84.3% breastfed). CONCLUSIONS: Given the high rate of education level of the mother and the high percentage of breastfeeding, we can understand that there is a better understanding of the health of the child by the mothers studied in this study, showing the effectiveness of public policies for infant feeding. However, children did not have good adequacy of the immunization schedule of PCV-10, one of the main vaccines against pneumonia, which can be one of the main factors in the causes of hospitalization, with no influence on the classification of the severity of the disease. In this way, we emphasize that the causes of pneumonia morbidity are not associated with a single factor.

RESUMO OBJETIVO: Verificar a adequação e os fatores associados ao cumprimento do esquema vacinal (BCG, DTP-Hib, SCR, VCP-10) em crianças internadas com pneumonia em um hospital de referência pediátrica no Nordeste do Brasil. MÉTODOS: Estudo transversal, descritivo com componente analítico, composto por 452 crianças hospitalizadas por pneumonia no Instituto de Medicina Integral Prof. Fernando Figueira, entre 2010 e 2013. Critérios de inclusão: idade de um mês a menores de cinco anos; com comprovação do cartão vacinal. Critérios de exclusão: pneumonia hospitalar ou doença de base concomitante. Avaliamos a adequação do esquema vacinal da BCG, tetravalente, tríplice viral e pneumocócica conjugada 10 valente (VPC-10). Foram utilizados os testes qui-quadrado e exato de Fisher seguidos de regressão multivariada de Poisson, estimando-se as razões de prevalência brutas, ajustadas e os respectivos intervalos de confiança de 95%. Participaram da análise multivariada as variáveis que na análise univariada apresentaram valor p < 0,20. RESULTADOS: Houve boa adequação no calendário vacinal, exceto a vacina VPC-10, que apresentou percentual inferior a 85%. Observou-se associação entre o adequado cumprimento do esquema vacinal e escolaridade materna (89,9% ensino médio completo), sexo da criança (87,2% feminino), idade da criança (94,2% menor que seis meses) e aleitamento materno (84,3% amamentaram). CONCLUSÕES: Pela elevada taxa na escolaridade materna e pelo elevado percentual de alimentação por leite materno, pode-se entender que há uma melhor compreensão no cuidado da saúde da criança pelas genitoras estudadas nesta pesquisa, apresentando a eficácia das políticas públicas de alimentação infantil. Porém, as crianças não tiveram uma boa adequação do esquema vacinal da VPC-10, uma das principais vacinas contra a pneumonia, podendo ser esse um dos principais fatores nas causas do internamento, não apresentando influência com a classificação da gravidade da doença. Enfatiza-se dessa maneira que as causas de morbidade por pneumonia não são associadas a um único fator.

Clinical study of the oxygen drive aerosol inhalation with budesonide and ambroxol in the prevention of adult post-thoracotomy pneumonia / 北京大学学报(医学版)

OBJECTIVE@#To study the clinical effect of the oxygen drive aerosol in halation with budesonide and ambroxol in the prevention of adult post-thoracotomy pneumonia.@*METHODS@#This was a randomized, open and parallel controlled trial. We chose 80 cases of patients in the department of thoracic surgery in the First Affiliated Hospital of Xi'an Jiaotong University which fitted our criteria as the research object. The selected patients were randomly divided into the active group and the control group, and the active group underwent oxygen drive aerosol inhalation (2 mg budesonide combined 60 mg ambroxol) for 3 days before operation, and the control group without preoperative aerosol inhalation, and their postoperative therapy was the same.@*RESULTS@#The baseline data showed that the differences in sex, age, disease and smoking were not statistically significant between the two groups, P>0.05. The results of blood gas analysis before 12 hours of operation suggested that, the PaO₂and PaCO₂values of the active group were (88.40±9.40) mmHg and (38.30±6.10) mmHg; The PaO₂and PaCO₂ values of the control group were (85.09±7.18) mmHg and (41.21±3.15) mmHg. And the two groups' P values were 0.029 and 0.011, with statistical differences. There were 3 patients who developed postoperative pneumonia out of 40 patients in the active group, the incidence was 7.50%, but the incidence of control group was 25.00%. The P value was 0.034, with statistical differences. We also analyzed the influence of different diseases and surgical methods on postoperative pneumonia, and the results showed that in the active group and the control group, the incidence of postoperative pneumonia in the patients with esophageal cancer was lower than that in lung cancer patients, and there was a statistically significant difference (P<0.05). In the active group, the numbers of pulmonary deed resection, lobectomy and pulmonary sleeve resection were 2, 21 and 1 cases respectively, and the corresponding numbers in the control group were 2, 21 and 2. Among the two groups, the incidence of postoperative pneumonia in the patients with different surgical methods of lung cancer was statistically significant (P<0.05).@*CONCLUSION@#If we implement respiratory preparation with budesonide plus ambroxol inhalation for 3 days before operation, we can greatly reduce the incidence of postoperative pneumonia?

Efecto del sulfato de cobre en el daño pulmonar inducido por la exposición crónica intermitente a ozono / Effect of copper sulphate on the lung damage induced by chronic intermittent exposure to ozone

Background: Ozone exposure could increase lung damage induced by airborne particulate matter. Particulate matter lung toxicity has been attributed to its metallic content. Aim: To evaluate the acute effect of intratracheal administration of copper sulfate (CuSO4) on rat lungs previously damaged by a chronic intermittent ozone exposure. Material and Methods: Two-months-old male Sprague-Dawley rats were exposed to 0.5 ppm ozone four h per day, five days a week, during two months. CuSO4 was intratracheally instilled 20 h after ozone exposure. Controls breathed filtered air or were instilled with 0.9% NaCl or with CuSO4 or were only exposed to ozone. We evaluated lung histopathology. F2 isoprostanes were determined in plasma. Cell count, total proteins, γ glutamyl-transpeptidase (GGT) and alkaline phosphatases (AP) were determined in bronchoalveolar lavage fluid (BALF). Results: Ozone increased total cell count, macrophages, proteins and AP in BALF (p < 0.05), and induced pulmonary neutrophil inflammation. CuSO4 plus air increased plasma F2 isoprostane levels and total cell count, neutrophils and proteins in BALF (p < 0.05). Histopathology showed foamy macrophages. Ozone plus CuSO4 exposed animals showed a neutrophil inflammatory lung response and an increase in total cell count, proteins, GGT and AP in BALF (p < 0.05). Foamy and pigmented alveolar macrophages were detected in all lungs of these animals (p < 0.001). Conclusions: Intratracheal instillation of a single dose of CuSO4 in rats previously subjected to a chronic and intermittent exposure to ozone induces a neutrophil pulmonary inflammatory response and cytoplasmic damage in macrophages.

Pneumococcal conjugate vaccines and hospitalization of children for pneumonia: a time-series analysis, South Africa, 2006­2014

Objective To assess the impact of immunization with pneumococcal conjugate vaccines on all-cause pneumonia hospitalizations among children in Soweto, South Africa. Methods We used data collected at the Chris Hani Baragwanath Hospital in Soweto between 2006 and 2014 ­ i.e. before and after April 2009, when a pneumococcal conjugate vaccine was first included in South Africa's routine immunization programme. Using a Bayesian generalized seasonal autoregressive moving-average model and the data collected in 2006­2008, we estimated the numbers of children that would have been hospitalized for pneumonia between 2010 and 2014 if no pneumococcal conjugate vaccines had been used. These estimates were then compared with the corresponding numbers of hospitalizations observed. Findings Between 2006 and 2014, 26 778 children younger than five years ­ including 3388 known to be infected with human immunodeficiency virus (HIV) ­ were admitted to the study hospital for pneumonia. We estimated that, for the children known to be infected with HIV and for the other children, pneumococcal conjugate vaccines reduced the numbers of hospitalizations for pneumonia in 2014 by 33% (50% credible interval, CrI: 6 to 52) and 39% (50% CrI: 24 to 50), respectively. In the study hospital in 2012­2014, as a result of immunizations with these vaccines, there were an estimated 3100 fewer pneumonia hospitalizations of children younger than five years. Conclusion. In our study hospital, following the introduction of pneumococcal conjugate vaccines into the national immunization programme, there were significant reductions in pneumonia hospitalizations among children

Effects of CpG oligodeoxynucleotide 1826 on acute radiation-induced lung injury in mice

BACKGROUND: The radiation-induced lung injury is a common complication from radiotherapy in lung cancer. CpG ODN is TLR9 activator with potential immune modulatory effects and sensitization of radiotherapy in lung cancer. This study aimed to examine the effect of CpG ODN on acute radiation-induced lung injury in mice. METHODS AND RESULTS: The mouse model of radiation-induced lung injury was established by a single dose of 20 Gy X-rays exposure to the left lung. The results showed that the pneumonia score was lower in RT+CpG group than in RT group on 15th and 30th days. Compared with RT group, CpG ODN reduced the serum concentrations of MDA (P < 0.05) and increased the serum concentrations of SOD, GSH (P < 0.05). The serum concentration of TNF-α in RT+CpG group was lower on 15th and 30th days post-irradiation (P < 0.05). CONCLUSION: The study demonstrated that CpG ODN has preventive effects of acute radiation-induced lung injury in mice. Lung inflammatory reaction and oxidative stress are promoted in the initiation of radiation-induced pneumonia. CpG ODN may reduce the injury of reactive oxygen species and adjust the serum TNF-α concentration in the mice after irradiation, which reduces the generation of the inflammatory cytokines.

Prevenção de Infecções pelo Vírus Sincicial Respiratório (VSR): uso do palivizumabe / Respiratory Syncytial Vírus (RSV) infection prevention: palivizumab use

Introdução: o vírus sincicial respiratório (VSR) pode causar quadros graves de bronquiolites e pneumonias, principalmente em grupos de risco como prematuros, cardiopatas e portadores de pneumopatias. O palivizumabe (PVZ) trouxe grande avanço na prevenção dessa doença e, devido ao alto custo, a Secretaria de Estado da Saúde de Minas Gerais (SES-MG) disponibiliza o produto aos grupos de alto risco. Objetivo: orientar os pediatras quanto à prevenção da infecção pelo VSR com orientações práticas sobre a prescrição do PVZ em MG. Métodos: são apresentados os critérios de inclusão para o uso dessa medicação em MG segundo portaria do Ministério da Saúde de 2013, como também os procedimentos adequados para a prescrição e fornecimento segundo normas da SES-MG. Resultados e conclusões: o conhecimento sobre o uso do PVZ para a prevenção do VSR e dos fluxos adequados para a prescrição e aplicação dessa medicação é fundamental para a prevenção da bronquiolite, portanto, deve ser amplamente divulgado entre os pediatras. Dessa forma, poderá ocorrer a redução dos casos graves, diminuindo a prevalência de sequelas e óbitos por essa doença.(AU)

Introduction: Respiratory Syncytial Vírus (RSV) can cause severe cases of bronchiolitis and pneumonia especially in risk groups such as premature neonates, cardiac patients and children with lung disease. Palivizumab (PVZ) has been successfully used in the prevention of this disease and due to the high cost, the Health's Secretary of Minas Gerais (SESMG) provides the product to high-risk groups. Objective: guide pediatricians regarding the prevention of RSV infection with practical guidelines for the prescription of PVZ in MG. Methods: Here are the inclusion criteria for the application of this medication in MG following the guidelines of the Ministry of Health in 2013, as well as the proper procedures for the prescription and supply according to standards of SES-MG. Results and Conclusions: Knowledge about the use of PVZ for the prevention of RSV and about the guidelines for prescription and application of this medication are key to the prevention of bronchiolitis, therefore should be widely disseminated to pediatricians. Thus may occur the reduction of severe cases decreasing the prevalence of sequelae and deaths from this disease.(AU)

One-Year Experience Managing a Cancer Survivorship Clinic Using a Shared-Care Model for Gastric Cancer Survivors in Korea

Given the rapid growth of the population of cancer survivors, increased attention has been paid to their health problems. Although gastric cancer is one of the most common cancers, empirical evidence of survivorship care is limited. The objectives of this study were to describe the health care status of gastric cancer survivors and to report the experience of using the shared-care model during a one-year experience at the cancer survivorship clinic in Seoul National University Hospital. This is a descriptive, single-center study of 250 long-term gastric cancer survivors who were referred to the survivorship clinic. The status of their health behaviors, comorbid conditions, secondary cancer screenings, and survivorship care status were investigated through questionnaires and examining the medical records. Among the survivors, 7.2% were current smokers, 8.8% were at-risk drinkers, and 32.4% were physically inactive. Among the patients who did not know their bone density status, the majority were in the osteopenic (37.1%) or osteoporotic range (24.1%). Screening among the eligible population within the recommended time intervals were 76.3% for colorectal cancer, but only 13.6% for lung cancer. All of the survivors were provided with counseling and medical management at the survivorship clinic, as appropriate. In conclusion, Long-term gastric cancer survivors have various unmet needs. Shared-care through survivorship clinics can be an effective solution for providing comprehensive care to cancer survivors.

Effect of remote ischemic postconditioning in inflammatory changes of the lung parenchyma of rats submitted to ischemia and reperfusion / Efeito do pós-condicionamento isquêmico remoto nas alterações inflamatórias do parênquima pulmonar de ratos submetidos à isquemia e reperfusão

AbstractObjective:To assess the effects of postconditioning remote in ischemia-reperfusion injury in rat lungs.Methods:Wistar rats (n=24) divided into 3 groups: GA (I/R) n=8, GB (R-Po) n=8, CG (control) n=8, underwent ischemia for 30 minutes artery occlusion abdominal aorta, followed by reperfusion for 60 minutes. Resected lungs and performed histological analysis and classification of morphological findings in accordance with the degree of tissue injury. Statistical analysis of the mean rating of the degree of tissue injury.Results:GA (3.6), GB (1.3) and CG (1.0). (GA GB X P<0.05).Conclusion:The remote postconditioning was able to minimize the inflammatory lesion of the lung parenchyma of rats undergoing ischemia and reperfusion process.

ResumoObjetivo:Avaliar os efeitos do pós-condicionamento remoto no fenômeno de isquemia e reperfusão nos pulmões de ratos.Métodos:Ratos Wistar (n=24) divididos em 3 grupos: GA (I/R) n=8, GB pós-condicionamento remoto n=8, GC (controle) n=8, submetidos à isquemia de 30 minutos por oclusão da artéria aorta abdominal, seguida de reperfusão de 60 minutos. Ressecados os pulmões e realizada a análise histológica e classificação dos achados morfológicos de acordo com o grau de lesão tecidual. Análise estatística das médias da classificação do grau de lesão tecidual.Resultados:GA (3,6); GB (1,3) e GC (1,0). (GA X GB P<0,05).Conclusão:O pós-condicionamento remoto foi capaz de minimizar a lesão inflamatória do parênquima pulmonar de ratos submetidos ao processo de isquemia e reperfusão.

Ideal Vaccination Strategy in Inflammatory Bowel Disease / 대한소화기학회지

Inflammatory bowel disease (IBD) is a long-standing disease that often requires long-term use of immunosuppressive agents including immunomodulators (such as azathioprine, 6-mercaptopurine and methotrexate) and tumor necrosis factor-alpha inhibitors (such as infliximab and adalimumab). Introduction of immunosuppressive therapies, however, involves the risk of host susceptibility to opportunistic infections in this patient population. Therefore, adequate immunization for vaccine-preventable infectious diseases is currently recommended for all patients with IBD and is emerging as an important target for quality improvements in IBD care. However, ongoing issues regarding underuse of immunization, safety and efficacy of vaccines in patients with IBD remain. For quality improvements in IBD care, all physicians should follow the recent immunization guidelines proposed by professional IBD societies. Additionally, there are ongoing needs for intensive educational programs regarding a role of immunization in long-term care of IBD and up-to-date immunization guidelines. Immunization status should be checked at the time of diagnosis of IBD and timely vaccination before initiation of immunosuppressive therapies can be a practical solution for maximizing the efficacy of vaccination at this point. Inactivated vaccines can be used safely irrespective of immunization status of patients, while attenuated vaccines are contraindicated in patients on immunosuppressive therapies. This article reviews an ideal strategy for vaccinating patients with IBD based on the currently recommended immunization guidelines.