Aproximación a la cohesión social y su relación con la mortalidad evitable en la niñez de Chiapas, México, 2015 / Approximation to the social cohesion and its relation with the avoidable mortality in Chiapas's childhood, Mexico, 2015

RESUMEN. Objetivo: Relacionar los datos de la tasa de mortalidad en la niñez por diarrea y gastroenteritis de presunto origen infeccioso o TMN A(090-099) con el Grado de Cohesión Social (GCS). Métodos: Es un estudio transversal y ecológico para el año 2015. La TMN A(090-099) municipal se calculó con los registros de defunciones del Sistema Nacional en Información en Salud (SINAIS). La aproximación hacia la cohesión social se hizo con base en el Consejo Nacional de Evaluación de la Política de Desarrollo Social (CONEVAL) a través del grado de cohesión social (GCS) municipal. Se calculó una correlación bivariada con la prueba de significancia de Spearman. Se obtuvo la correlación entre la TMN A(090-099) y el GCS. También se hizo un modelo: TMN A(090-099) variable dependiente confrontada con el GCS, el índice de Gini, el índice de rezago social y la no derecho habiencia. Resultados: Existe relación negativa entre el GCS y la TMN A(090-099), con significancia pero débilmente correlacionadas (- 0.320**); la hipótesis se acepta con reservas. El modelo presenta correlación moderada y positiva (R=0.554), la R cuadrada sugiere que el modelo explica casi el 27 % de los casos y el valor Durbin-Watson sugiere que el modelo cubre casi 90 % de los casos estudiados. Discusión: La cohesión social en Chiapas es muy tenue al hacer la aproximación que trató este trabajo. Los datos dan cuenta de que existen municipios con muy alta TMN A(090-099) y baja cohesión social, además de alto grado de rezago social; este escenario predomina, pero es necesario replantear la utilidad del abordaje cualitativo como recomendación encontrada en la literatura.

ABSTRAC. Objective: To relate the information of the childhood rate of mortality due to diarrhea and gastroenteritis of supposed infectious origin or TMN A(090-099) with the social cohesion degree (GCS). Methods: It is a transverse and ecological study for the year 2015. The municipal TMN A(090-099) was calculated with the National System in Health Information (SINAIS) deaths records. The approximation towards the social cohesion was done with the National Council for the Evaluation of the Social Development Policy (CONEVAL) through the municipal Social Cohesion Degree (GCS). A bivariate correlation was calculated with Spearman test. The correlation between the TMN A(090-099) and the GCS was obtained. Also a model was calculated: TMN A(090-099) as the dependent variable confronted with the GCS, Gini's index, social blacklog index and the lack of medical services. Results: A negative relation between the GCS and the TMN TO (090-099) was found, with significant but weakly correlation (-0.320 **); the hypothesis is accepted with reservations. The model presents moderate and positive correlation (R=0.554), the square R suggests that the model explains almost 27 % of the cases, and the Durbin-Watson value suggests that the model covers almost 90 % of the studied cases. Discussion: The social cohesion in Chiapas is very subdued. There are municipalities with very high TMN A(090-099) and lower social cohesion degree besides high social backlog degree; this scene prevails, but is necessary to restate the usefulness of the qualitative boarding as recommendation found in social cohesion literature.

Relación entre sobrecarga hídrica y mortalidad en niños conshock séptico / Relation between fluid overload and mortality in children with septic shock

El shock séptico es una de las principales causas que puede llevar a la muerte. La reanimación hídrica constituye un destacado tratamiento para poder disminuir la mortalidad. Objetivo: determinar la relación entre el porcentaje de sobrecarga hídrica (%SH) y la mortalidad en niños con shock séptico. Métodos. Estudio de cohorte en pacientes con shock séptico de entre 1 y 17 años, posterior a la reanimación hídrica con presión venosa central ≥ 5 mmHg con monitoreo invasivo y registro completo de %SH hasta las 96 h. El seguimiento y la variable de desenlace se completaron hasta el día 28. Se registraron las siguientes variables del shock séptico, shock refractario, causa de la insuficiencia renal aguda, anemia, desnutrición, el tiempo de inicio de antimicrobiano, presión oncótica y puntaje de gravedad. Análisis estadístico: Se calculó el hazard ratio (HR) y se construyeron tres modelos pronósticos por riesgos proporcionales de Cox. Resultados. La población fue de 263 pacientes; con un promedio de edad de 8 ± 3 años y con mortalidad del 33 %. El %SH ≥ 10,1 acumulado a las 96 h fue el único asociado; el HR (IC 95 %) ajustado fue perfil hemodinámico HR = 2,6 (1,95,6); por shock refractario, HR = 2,5 (1,6-5,6) y por desnutrición, HR = 8,3 (3,5-14). Conclusiones. El %SH > 10,1 % se relacionó con una mayor mortalidad a 28 días de ajustado al perfil hemodinámico, la refractariedad del shock y el estado nutricional.

Septic shock is one of the main causes of mortality. Fluid replacement stands out as the treatment of choice to reduce mortality. Objective. To determine the relation between the percentage of fluid overload (%FO) and mortality in children with septic shock. Methods. Cohort study in patients aged 1-17 years with septic shock, after fluid replacement with central venous pressure ≥ 5 mmHg, invasive monitoring, and complete recording of %FO up to 96 h. Follow-up and outcome measures were recorded up to day 28. The following outcome measures of septic shock were recorded: refractory shock, cause of acute kidney injury, anemia, malnutrition, time to antibiotic initiation, oncotic pressure, and severity score. Statistical analysis. The hazard ratio (HR) was estimated and three Cox proportional hazard models were developed. Results. The population included 263 patients; their average age was 8 ± 3 years. Mortality was 33 %. A %FO ≥ 10.1 % accumulated at 96 h was the only associated outcome measure; the HR (95 % confidence interval) was adjusted for hemodynamic profile, HR = 2.6 (1.95.6); refractory shock, HR = 2.5 (1.6-5.6); and malnutrition, HR = 8.3 (3.5-14). Conclusions. A %FO > 10.1 % was related to a higher mortality at 28 days of adjustment for hemodynamic profile, refractory shock, and nutritional status.

Morbimortalidad por cáncer infantil en la República Argentina: 2006-2008 / Morbidity and mortality rates for childhood cancer in Argentina: 2006-2008

Introducción. El cáncer en los niños es un problema importante de salud pública en un país por el número elevado de años de vida perdidos prematuramente. Objetivo. Describir la morbimortalidad por cáncer en los argentinos menores de 15 años de edad en el trienio 2006-2008. Método. Se analizaron tasas de mortalidad específcas y tasas de incidencia expresadas por millón de habitantes menores de 15 años de edad, según el tipo de tumor y por sexo. Se utilizaron datos de estadísticas vitales a partir de bases de datos provistas por la Dirección de Estadísticas e Información de Salud del Ministerio de Salud y la población de niños de entre 0 y 14 años estimada por el Instituto Nacional de Estadísticas y Censos (INDEC). En relación con los datos de morbilidad, se utilizó la información publicada por el Registro Oncopediátrico Hospitalario Argentino (ROHA). Resultados. La tasa de mortalidad por neoplasias fue de 43,8 por millón (3,5% de las muertes totales en el grupo etario) y la tasa de incidencia, de 123,7 por millón. La leucemia presentó la mayor tasa de mortalidad específca (14,9 por millón), seguida de los tumores del sistema nervioso central (12,7 por millón). Estos tumores también registraron las mayores tasas de incidencia (45,2 y 15,5 por millón respectivamente). Conclusiones. La mortalidad por tumores representó el 3,5% de las muertes en menores de 15 años de la Argentina. La leucemia y los tumores del sistema nervioso central presentaron las mayores tasas de mortalidad específca y de incidencia.

Introduction. Childhood cancer is a serious public health problem in any country given the large number of years of life lost in an early manner. Objective. To describe morbidity and mortality rates for cancer in Argentinean children and adolescents younger than 15 years old in the 2006-2008 three year period. Method. Specifc mortality rates and incidence rates per million inhabitants were analyzed in children and adolescents younger than 15 years old by type of tumor and gender. Vital statistics data were used based on the databases provided by the Statistics and Health Information Department of the Ministry of Health of Argentina and the population of 0-14 year old children estimated by the National Statistics and Censuses Institute of Argentina (Instituto Nacional de Estadísticas y Censos, INDEC). In relation to morbidity data, the information published by the Argentine Hospital Oncopediatric Registry (Registro Oncopediátrico Hospitalario Argentino, ROHA) was used. Results. Mortality rate from malignancies was 43.8 per million (3.5% of total deaths in this age group) and the incidence rate was 123.7 per million. Leukemia had the highest specifc mortality rate (14.9 per million), followed by tumors in the central nervous system (12.7 per million). The highest incidence rates were also registered for these tumors (45.2 and 15.5 per million, respectively). Conclusions. Mortality from malignancies accounted for 3.5% of deaths in children and adolescents younger than 15 years old in Argentina. Leukemia and tumors in the central nervous system had the highest specifc mortality and incidence rates.

Childhood mortality: still a global priority

Mortality of children under-5 continues to be a global priority. In 2012, 6.6 million children under-5 died worldwide; more than half of these deaths are due to diseases that are preventable and treatable through simple, affordable interventions. In response to the United Nations' Millennium Development Goal (MDGs) which called, through MDG4,to "reduceby two thirds the under-5 child mortality, between 1990 and 2015", global organizations and many countries set targets and developed specific strategies to reduce child mortality and monitor progress.As a result, the number of deaths in children under-5 worldwide declined from 12.4 million in 1990 to 6.6 in 2012. Under-5 child mortality dropped in all regions of the world. However, two major challenges face the international community: The wide disparity in the risk of child death among countries, and the emerging role of neonatal death as a major component of child mortality. In order to continue the progress in reducing under-5 child mortality worldwide, current efforts must continue and new strategies need to be implemented to focus on preventing neonatal deaths as they start to represent a larger proportion of under-5 child deaths. In particular, further reduction in neonatal mortality will depend heavily on improving maternal health (MDG5).The world leaders continue to support the MDGs. In 2010, in a major push to accelerate progress on women's and children's health, a number of Heads of State and Government from developed and developing countries, along with the private sector, foundations, international organizations, civil society and research organizations, pledged over $40 billion in resources over the next five years...

Mortalidade por doenças respiratórias em crianças menores de cinco anos no município de Caxias do Sul entre 1996 e 2001 / Mortality due respiratory diseases in children under five years of age at the city of Caxias do Sul from 1996 to 2001

Introdução: doenças do aparelho respiratório têm assumido importância crescente entre as causas de mortalidade no Brasil. Objetivo: apresentar os dados particularizados para causas de óbito secundárias a doenças respiratórias em crianças menores de cinco anos no Município de Caxias do Sul, Rio Grande do Sul, Brasil. Material e métodos: estudo retrospectivo baseado em dados do Sistema de Informações de Mortalidade da Secretaria da Saúde. Foram levantados e classificados, segundo a 10a Classificação Internacional das Doenças da Organização Mundial da Saúde, todos os óbitos de crianças com menos de cinco anos de idade ocorridos em Caxias do Sul entre os anos de 1996 e 2001. Resultados: no período estudado, o coeficiente de mortalidade por 1.000 indivíduos foi maior no ano de 1998 (0,68) e menor no ano de 2000 (0,14). Doenças respiratórias foram a terceira causa de óbito no grupo etário de 0 a 5 anos, representando 9,6% do total. Conclusões: o impacto das doenças respiratórias na mortalidade de crianças menores de cinco anos em Caxias do Sul tem sido importante. Recomenda-se que os programas voltados à saúde da criança sejam intensificados, sugerindo-se assistência especial à criança com infecção respiratória aguda, especialmente as pneumonias (AU)

Introduction: respiratory diseases have become an important Brazilian issue as cause of mortality. Objective: to show the epidemiological data about the mortality due respiratory diseases in children under five years of age at the city of Caxias do Sul, Rio Grande do Sul, Brazil. Material and methods: retrospective study based on the Mortality Information System database of the Health Secretary. All deaths of children under five years old occurred from 1996 to 2001 at the city of Caxias do Sul, were identified and classified according with the 10th International Classification of Diseases (World Heath Organization). Results: the mortality coefficient (death per 1,000 subjects) was more significant in 1998 (0.68) and reached the lowest point in 2000 (0.14). The respiratory diseases were the third cause of death, representing 9.6% of the total number in the studied period of time. Conclusions: the impact of the respiratory diseases on the coefficient of mortality of children under five years old at the city of Caxias do Sul has been important. Therefore, it is recommended that programs directed to the health of the children being intensified, suggesting special assistance to the patient with acute respiratory infection, especially pneumonia (AU)