Consenso de VIH-2: tratamiento antirretroviral en niños, adolescentes y embarazadas

Consenso para el tratamiento antirretroviral de las mujeres embarazadas, los adolescentes y los niños

Consensus of Antiretroviral treatment of pregnant women, adolescents and children

Significado de las prácticas de cuidado para un grupo de adolescentes con hipertensión inducida por la gestación / Meaning of care practices for a group of adolescents with hypertension induced by pregnancy

Objetivo: Describir el significado de las prácticas de cuidado genérico para un grupo de adolescentes entre 14 - 19 años de edad, con hipertensión inducida por la gestación. Sincelejo (Sucre). Diseño: Estudio cualitativo de tipo etnográfico, con el enfoque de etnoenfermería propuesto por Madeleine Leininger, utilizando entrevistas semiestructuradas a profundidad, se realizaron 19 entrevistas con la participación de 9 informantes clave (adolescentes con diagnóstico de hipertensión inducida por la gestación, con edades entre 14 y 19 años) y 4 informantes generales. Resultados: Del análisis de los datos surgen tres grandes temas: Cambios en la alimentación de la adolescente gestante (Subtemas: comida saludable ­ comida que causa hipertensión), actividad física y disminuir el cansancio en la gestación; y apoyo de la adolescente gestante. Conclusiones: El significado de las prácticas de cuidado genérico para las adolescentes con hipertensión inducida por la gestación en Sincelejo muestran patrones de conocimiento cultural que contribuyen a guiar el cuidado de enfermería en la gestación. Se espera que los resultados de esta investigación faciliten una nueva manera de abordar el cuidado de enfermería a la gestante adolescente desde una perspectiva transcultural que contribuya a disminuir la morbimortalidad materno perinatal, en el Departamento de Sucre.

Objective: to describe the meaning of generic care practices for a group of adolescents between 14 - 19 years old, with pregnancy-induced hypertension. Sincelejo (Sucre). Design: ethnographic qualitative study, with the ethno-nursing approach proposed by Madeleine Leininger, using in-depth semi-structured interviews, 19 interviews were conducted with the participation of 9 key informants (adolescents diagnosed with gestational-induced hypertension, ages 14, and 19 years old), and, 4 general informants. Results: from the analysis of the data, three major themes emerged: Changes in the feeding of the pregnant adolescent (Subthemes: healthy food - food that causes hypertension), physical activity and decrease fatigue in pregnancy; and support of the pregnant adolescent. Conclusions: the meaning of generic care practices for adolescents with gestationalinduced hypertension in Sincelejo show patterns of cultural knowledge that contribute to guiding nursing care during pregnancy. It is expected that the results of this research will facilitate a new way of approaching the nursing care of the pregnant adolescent from a transcultural perspective that contributes to diminish maternal and perinatal morbidity and mortality, in the Department of Sucre.

Complicaciones maternas en adolescentes y adultas afiliadas al régimen subsidiado, 2012 / Maternal complications in adolescents and adults affiliated to the subsidized regime, 2012 / Complicações maternas em adolescentes e adultas inscritas no regime subsidiado de saúde, 2012

La intervención de las complicaciones maternas y la minimización de sus efectos en la salud materno-infantil es prioridad para el cuidado en salud de esta población. La identificación de factores asociados a la complicación materna es de vital importancia para definir políticas y estrategias de intervención de esta problemática. OBJETIVO: Determinar los factores asociados a complicaciones durante el tercer trimestre del embarazo, parto y puerperio de las maternas pertenecientes al régimen subsidiado atendidas en una institución de segundo nivel de complejidad de Medellín. METODOLOGIA: investigación de cohorte ambiespectivo, que tiene como factor de exposición la edad (expuesto: adolescentes entre 14 y 19 años, no expuesto: entre 20 y 34 años de edad) y la complicación materna. Se calcularon frecuencias absolutas y relativas para las variables cualitativas y media, mediana y rango intercuartílico para las variables cuantitativas, se calculó proporción de incidencia de las complicaciones y el riesgo relativo crudo y ajustado por variables de confusión. RESULTADOS : el principal factor de riesgo asociado a complicación materna fue la atención prenatal inadecuada (criterio de Kessner). Se encontró como factor protector la asistencia al curso psicoprofiláctico CONCLUSION: no se encontraron grandes diferencias entre la población adolescente y adulta, pero sí se identificaron aspectos sociales (relaciones familiares), educacionales y de atención en salud que pueden afectar la salud materna de la población del régimen subsidiado atendida por una institución de segundo nivel de complejidad.

The intervention of maternal complications and the minimization of its impact on mother and child health is a priority for this population's health care. Identifying factors associated with maternal complications is critical to devising policies and intervention strategies against this problem. OBJECTIVE: to determine the factors associated with complications during the third trimester of pregnancy, delivery and puerperium of the mothers belonging to the subsidized health regime who receive care in a second level health care providing institution in Medellin. METHODOLOGY: an ambispective study whose exposure factors are age (exposed: adolescents aged 14 to 19, non-exposed:individuals aged 20 to 34) and maternal complications. Absolute and relative frequencies were calculated for the qualitative variables. Likewise, the mean, median and interquartile range were calculated for the quantitative variables. Moreover, the ratio of incidence was calculated for the complications along with the crude relative risk and the risk adjusted for confounding variables. RESULTS: the main risk factor associated with maternal complications was inadequate prenatal care (Kessner criterion). In addition, attendance to the psychoprophilactic course was found to be a protecting factor. CONCLUSION:No significant differences were found between adolescents and adults. However, social (family relations), educational and health care aspects were found which may affect the health of the mothers belonging to the subsidized regime who receive health care in a second level institution in Medellin.

A intervenção das complicações maternas e a minimização de seus efeitos na saúde materno-infantil é prioridade para o cuidado em saúde desta população.A identificação de fatores associados à complicação materna é de importância fundamental para definir políticas e estratégias de intervenção desta problemática. OBJETIVO: Determinar os fatores associados com complicações durante o terceiro trimestre da gravidez, parto e puerpério das mães pertencentes ao regime subsidiado de saúde atendidas em uma instituição de segundo nível de complexidade de Medellín. METODOLOGÍA: Progresso na consecução dos Objetivos de Desenvolvimento do Milênio:adolescentes entre 14 e 19 anos, não exposto: entre 20 e 34 anos de idade) e a complicação materna. Foram calculadas frequências absolutas e relativas para as variáveis qualitativas e média, mediana e rango interquartílico para as variáveis quantitativas, foi calculada proporção de incidência das complicações e o risco relativo cru e ajustado por variáveis de confusão. RESULTADOS: O principal fator de risco associado à complicação materna foi a atenção pré-natal inapropriada (critério de Kessner). E encontrou-se como fator protetor a assistência ao curso psico-profilático. CONCLUSÃO: Não foram encontradas diferenças grandes entre a população adolescente e adulta, mas sim foram identificados aspectos sociais (relacionamentos familiares), educacionais e de atendimento em saúde que podem afetar a saúde materna da população com regime subsidiado de saúde atendido por uma instituição de segundo nível de complexidade.

Iron Status and Red Cell Parameters in Pregnant and Non-pregnant Adolescents in Côte d’Ivoire (West Africa).

Aims: The objective of this study was to evaluate iron metabolism and compare iron stores between pregnant and non-pregnant adolescents in Côte d’Ivoire. Place and Duration of Study: The study was undertaken with 187 volunteers adolescents aged from 15 to 19 years. For this study, adolescents were divided into 2 groups with 75 non-pregnant adolescents and 112 pregnant adolescents. Study population was recruited January 2006 to January 2008 in 4 urban community health centers, of Abidjan. Assays of blood samples were performed in Laboratory of Physiology, Pharmacology and Phytotherapy (Nangui Abrogoua University) and in Laboratory of Medical Biochemistry of University Hospital Centre (Cocody, Félix Houphouët-Boigny University). Methodology: In each pregnant adolescent a blood sample was collected by venipuncture on a dry and EDTA tubes of 5 ml. With these blood samples, haematological and biochemical parameters were determined. Results: Haematological parameters were decreased in pregnant adolescents at the third trimester of pregnancy compared with control adolescents. Pregnant adolescents were more anaemic during pregnancy (77.7 %) compared with non-pregnant adolescents (42.7 %). Iron stores were greatly decreased in 72.3 %, 83.9 % and 95.6 % of adolescents respectively during the 3 trimesters of pregnancy compared with non-pregnant adolescents (34.7 %). In addition, high prevalence of iron deficiency anaemia was recorded throughout pregnancy in adolescents. Therefore, iron status was more altered in pregnant adolescents (11.6 %, 9.8 % and 0.0 % respectively) compared with non-pregnant adolescents (13.3 %). The results of this study show that the causes of pronounced degradation in iron status are insufficient in size of iron stores in pregnant adolescents and non-pregnant adolescents. Conclusion: Iron metabolism alteration is important in pregnant adolescents in Côte d’Ivoire, causing severe anaemia in this group of population.

Prevalencia de deficiencia de hierro y de anemia por deficiencia de hierro en adolescentes embarazadas del noroeste de México 2007-2008 / Prevalence of iron deficiency and iron deficiency anemia in pregnant adolescents from northwest Mexico 2007-2008

La anemia por deficiencia de hierro (Fe) es un problema de salud pública mundial, principalmente en niños y en mujeres en edad fértil. Las adolescentes requieren cubrir las demandas de Fe propias del crecimiento acelerado y del inicio de la menstruación y en adolescentes embarazadas se agrega el crecimiento de los tejidos fetales. El objetivo de este estudio fue determinar la prevalencia de deficiencia de Fe y de anemia por deficiencia de Fe en adolescentes embarazadas del noroeste de México. Participaron 186 mujeres menores de 19 años de edad, comprendidas en el primer o segundo trimestre del embarazo y atendidas en Centros de Salud Públicos de la ciudad de Hermosillo, Sonora. Se aplicaron cuestionarios sobre el nivel socioeconómico e información dietaria mediante la aplicación de recordatorio de 24 horas. Se cuantificó hemoglobina (Hb), hematocrito, ferritina y protoporfirina eritrocitaria. De acuerdo a los valores de Hb y ferritina, se agruparon como normales (37.4 por ciento de las voluntarias), como deficientes de Fe sin anemia (55.5 por ciento) y con anemia por deficiencia de Fe (7.1 por ciento). En este último grupo, seis participantes clasificaron con anemia moderada y siete con anemia ligera. Las variables que se asociaron con indicadores de Fe, en al menos dos grupos de mujeres fueron la ingesta de Fe y de fibra y las semanas de embarazo. El elevado porcentaje de mujeres con reserva deficiente de Fe demanda la identificación y atención de factores maternos y de hábitos de consumo de alimentos que afectan el estado de Fe en las adolescentes embarazadas.

Iron deficiency anemia (IDA) remains a word public health problem, particularly in children and child-bearing-age women. Iron demands need to be covered by adolescent women due to the increased physical growing, menstruation, pregnancy and fetal growing tissues at this life stage. This study was proposed to investigate the prevalence of iron deficiency and IDA in pregnant adolescent women from Northwestern Mexico. Participated 186 women under 19 years old during the first or second trimester of pregnancy who attended the local health institutions in Hermosillo Sonora. Questionnaires and 24 hr recalls were administered to collect socioeconomic and dietary information respectively. Hemoglobin (Hb), hematocrit, ferritin and eritrocytic protoporphyrin were measured. Hb and ferritin values were used to categorize the recruited women into normal (37.4 percent), iron deficient (55.5 percent) and IDA (7.1 percent) groups. Six and seven women showed moderated and light anemia status in the IDA group. Fe and fiber intake and weeks of pregnancy were associated with the biochemical indicators of iron at least in two women groups. The high percentage of iron deficient women in this study is demanding the identification and attention of maternal factors and food habits that are risk of iron deficiency in pregnant women.