Association between fractional exhaled nitric oxide and therapeutic adherence to controller management in pediatric asthma patients.

OBJECTIVES: Guidelines for asthma management recommend, before establishing additional therapeutic behaviors, to confirm correct use and adequate therapeutic adherence to treatment. Evidence exists on the use of fractional exhaled nitric oxide (FeNO) values for monitoring therapeutic adherence in adults. It is important to establish whether there is a correlation between FeNO and therapeutic adherence in children. This study aims to provide new knowledge about the relationship between FeNO and therapeutic adherence in asthmatic children. MATERIALS AND METHODS: Analytical cross-sectional study including asthma patients 5-18 years of age, attending follow-up at Hospital Militar Central (HMC) between May and November 2022 in Colombia. A sociodemographic survey was carried out, followed by the Pediatric Inhaler Adherence Questionnaire (PIAQ), and asthma control test (ACT) or childhood asthma control test (cACT). We defined adequate therapeutic adherence as not missing a single application of inhaled steroids in the last 15 days according to PIAQ. A poisson regression model was carried out including relevant predictors for therapeutic adherence such as FeNO values, age, tobacco exposure at home, atopy, and time since initiation of use of inhaled controller. RESULTS: Eighty-two children with a median age of 10 years (interquartile range: 7-12 years) were included. Adequate therapeutic adherence was reported by 68.3%. After adjusting for age, sex, exposure to cigarette smoke, duration of controller therapy, and atopy, FeNO < 20 ppb was independently associated with adequate therapeutic adherence (RR = 1.5, p = .04, 95% confidence interval: 1.03-2.19). CONCLUSIONS: FeNO values seem to be useful to identify pediatric patients with asthma who have adequate adherence to inhaled steroids in a MIC.

Cuidado nutricional en el tratamiento de la diabetes gestacional: una revisión sistemática de la literatura / Nutritional care in the treatment of gestational diabetes: a sytematic review of the literature

Fundamentos: La diabetes mellitus gestacional (DMG) es una de las morbilidades más frecuentes de la gestación, un adecuado cuidado nutricional evita las diferentes complicaciones que se puedan dar. El objetivo principal es presentar una revisión sistemática que defina las estrategias nutricionales o dietéticas relacionadas con el cuidado nutricional para el tratamiento de la DMG. Métodos: Se realizó una búsqueda en bases de datos y literatura gris; limitando la búsqueda a publicaciones en inglés y español realizadas en el periodo 2007-2017, resultados observados en mujeres gestantes adultas y en los que se mostrara la relación entre la patología y el cuidado nutricional. Resultados: Los estudios demuestran que las dietas de bajo índice glicémico o la dieta DASH (Dietary Approaches to StopHypertension) son estrategias que muestran beneficios en el tratamiento de la DMG, pues se observan mejores resultados de glicemia, perfil lipídico, entre otros aspectos. Conclusiones: Un adecuado cuidado nutricional es imprescindible en el tratamiento de la DMG, pues se demostró que existen estrategias nutricionales y dietéticas que mejoran los parámetros metabólicos maternos y los resultados neonatales. Además, es una herramienta que previene el desarrollo de otras complicaciones como la preeclampsia. (AU)

Background: The gestational diabetes mellitus is one ofthe most frequent morbidity in pregnant and it is indispensable to have an adequate nutritional care in order to prevent several complications. The principal object is present asystematic review in which nutritional or dietary strategiesare related to nutritional care to pregnant diabetes mellitustreatment.Methods: For this, a literature review was performed inthe following database and grey literature to complete. Theresearch was limited to English and Spanish publications, ina period between 2007 and 2017, with results observed onpregnant women and in which it had been observed a relationship between pathology and nutritional care.Results: Studies show that low-glycemic diets or theDASH diet (Dietary Approaches to Stop Hypertension) arestrategies that show benefits in the treatment of GDM, sincebetter results of glycemia, lipid profile, among other aspectsare observed.Conclusions: An adequate nutritional care is essential inthe treatment of GDM, as it was demonstrated that there arenutritional and dietary strategies that improve maternalmetabolic parameters and neonatal outcomes. In addition, itis a tool that prevents the development of other complications such as preeclampsia. (AU)

Assessment of nutrition and learning skills in children aged 5-11 years old from two elementary schools in Chocó, Colombia.

BACKGROUND: Malnutrition has been identified as a factor in growth and learning. The current study aimed to determine the nutritional status and basic learning skills of children from Chocó, Colombia. METHODS: We conducted a cross-sectional study of 631 children aged 5-11 years from two schools, collecting anthropometric measurements, nutritional quality surveys and sociodemographic data. Neuropsychological batteries were applied. RESULTS: A total of 523 children were evaluated, with an average age of 8.49 ± 2.1 years. The results revealed that 2.9% of children were underweight, 0.4% were severely underweight, and 4.8% were diagnosed as having stunted growth. In addition, 71.8% of children were unable to draw a human figure. Beery-Buktenica Visual-Motor Integration test (VMI) performance was below the scores expected for these age groups in 73.9% of children. Battery of Differential and General Abilities (BADYG) performance revealed limited verbal skills. In a subsample of 117 children, anemia was detected in 12.8% of cases, and iron deficiency was present in 44.4% of cases. Global malnutrition was associated with impairments in BADYG performance (OR: 1.98; 95% CI: 1.07-3.86). CONCLUSIONS: The current results revealed that learning performance was below the expected level for children in these age groups across all of the applied tests. Although malnutrition could partially explain the poor performance of children in tests of learning abilities, additional factors are likely to be involved.

Factores asociados al inicio de vida sexual y al embarazo adolescente en Colombia. Estudio de corte transversal / Factors associated with the beginning of sexual life and adolescent pregnancy in Colombia. Cross-sectional study

RESUMEN Introducción: En Colombia, entre el año 2008 y 2014 el 23.4% de los nacimientos fueron producto de embarazos adolescentes, los cuales tienen graves consecuencias a nivel social, emocional y biológico tanto para la madre joven como para el bebé. Material y métodos: Estudio de corte transversal con componente analítico dónde se tomó una muestra representativa de 13.313 mujeres entre 13 y 19 años quienes respondieron la Encuesta Nacional de Demografía y Salud (ENDS) 2010. Se realizaron análisis bivariados y análisis de regresión logística multinomial con el fin de identificar factores individuales, del hogar y del comportamiento sexual asociados con el inicio de la vida sexual y con el embarazo en adolescentes colombianas. Resultados: A través del análisis multivariado se encontró que tener mayor edad, convivir en pareja, haber sufrido violencia parental y haber sufrido violencia sexual fueron factores de riesgo tanto para inicio de vida sexual como para embarazo adolescente. Se identificó que el hecho de estar asistiendo al colegio es un factor protector para ambos eventos. La pobreza, el hacinamiento y la falta de educación estuvieron asociados con el embarazo adolescente pero no con el inicio de la vida sexual. Conclusiones: Existen múltiples factores asociados con el inicio temprano de vida sexual y con el embarazo adolescente susceptibles de intervención. Este estudio presenta factores clave para generar programas de prevención para esta problemática.

ABSTRACT Introduction: In Colombia, between 2008 and 2014, 23.4% of births were product of adolescent pregnancies, which have serious social, emotional and biological consequences for both the young mother and the baby. Materials and methods: Cross-sectional study with analytical component, with a sample of 13,313 women between 13 and 19 years of age who answered the National Survey of Demography and Health (ENDS) 2010. Bivariate analyzes and multinomial logistic regression analysis were carried out in order to identify individual, home-related, and sexual behavior factors associated with sexual debut and adolescent pregnancy among Colombian adolescents in 2010. Results: Multivariate analysis shown that being older, living together as a couple, having suffered parental violence, and having suffered sexual violence, were risk factors for initiation of sexual life and teenage pregnancy. School attendance was found to be a protective factor for both events. Poverty, overcrowding and lack of education were associated with teen pregnancy but not with sexual debut. Conclusions: There are multiple factors associated with early sexual debut and adolescent pregnancy which are susceptible to intervention. This study presents key factors to generate prevention programs for these situations.

[Nutritional screening in hospitalized pediatric patients: systematic review]. / Tamizaje nutricional en paciente pediátrico hospitalizado: revisión sistemática.

INTRODUCTION: malnutrition in the pediatric population has been associated with a great number of physiological problems and complications, which lead to a longer period of hospitalization, a higher risk of infections, a rise in mortality rate, and hence, a rise in assistance expenses. OBJECTIVE: to collect available evidence on tools of nutritional screening frequently used in pediatrics that allow identifying, preventing and intervening hospital malnutrition, as well as providing guidelines regarding the appropriate application instant. MATERIALS AND METHODS: a systematic review of literature was carried out in accordance with the PRISMA Declaration (Preferred Reporting Items in Systematic Reviews and Meta-Analyses) and in the main databases, search in ClinicalTrials and gray literature in Open Gray and TRIP Database. Then, the articles were selected and classified depending on the type of study. The quality assessment was done in accordance with the Scottish Intercollegiate Guidelines Network (SIGN) checklists. RESULTS: one hundred and ten articles were identified, following the parameters of the PRISMA declaration. Twenty-one articles were analyzed and evaluated through the SIGN methodology; 19 met the high quality criteria and were included in the present review. Six nutritional screening tools in pediatrics were identified, STRONGkids being the tool referred by 63% of the studies for the detection of malnutrition risk. CONCLUSIONS: the present systematic review allowed us to conclude that STRONGkids is the best screening tool for hospitalized children since it is practical, quick, easy to use and it reliably predicts the risk of malnutrition. However, further studies are required to validate the use of this in the Colombian context.

INTRODUCCIÓN: la malnutrición en la población pediátrica está asociada a problemas fisiológicos y complicaciones, que conllevan mayor estanciahospitalaria y aumento de la morbimortalidad y de costos de atención. OBJETIVO: el propósito de esta revisión sistemática es recopilar la evidencia disponible sobre herramientas de tamizaje nutricional en pediatría que permitan prevenir e intervenir la malnutrición hospitalaria y entregar directrices en cuanto al momento oportuno de aplicación. MATERIAL Y MÉTODOS: se realizó una revisión sistemática de literatura de acuerdo con la Declaración Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) en las principales bases de datos, búsqueda en ClinicalTrials y literatura gris en Open grey y TRIP Database. Luego se seleccionaron y clasificaron los artículos dependiendo del tipo de estudio. La evaluación de calidad se hizo acorde con las listas de verificación Scottish Intercollegiate Guidelines Network (SIGN). RESULTADOS: se identificaron 110 artículos, siguiendo los parámetros de la declaración PRISMA. Veintiún artículos fueron analizados y evaluados mediante la metodología SIGN; 19 cumplieron con los criterios de alta calidad y fueron incluidos en la presente revisión. Se identificaron seis herramientas de tamizaje nutricional en pediatría, siendo STRONGkids la herramienta referida por el 63% de los estudios para la detección del riesgo de desnutrición. CONCLUSIONES: la presente revisión sistemática permitió concluir que la mejor herramienta de tamizaje en niños hospitalizados es STRONGkids puesto que es práctica, rápida, de fácil uso y predice con fiabilidad el riesgo de desnutrición. No obstante, se requieren mayores estudios para validar el uso de esta en el contexto colombiano.

Tamizaje nutricional en paciente pediátrico hospitalizado: revisión sistemática / Nutritional screening in hospitalized pediatric patients: systematic review

Introducción: la malnutrición en la población pediátrica está asociada a problemas fisiológicos y complicaciones, que conllevan mayor estancia hospitalaria y aumento de la morbimortalidad y de costos de atención. Objetivo: el propósito de esta revisión sistemática es recopilar la evidencia disponible sobre herramientas de tamizaje nutricional en pediatría que permitan prevenir e intervenir la malnutrición hospitalaria y entregar directrices en cuanto al momento oportuno de aplicación. Material y métodos: se realizó una revisión sistemática de literatura de acuerdo con la Declaración Preferred Reporting Items in Systematic Reviews and Meta-Analyses (PRISMA) en las principales bases de datos, búsqueda en Clinical Trials y literatura gris en Open grey y TRIP Database. Luego se seleccionaron y clasificaron los artículos dependiendo del tipo de estudio. La evaluación de calidad se hizo acorde con las listas de verificación Scottish Intercollegiate Guidelines Network (SIGN). Resultados: se identificaron 110 artículos, siguiendo los parámetros de la declaración PRISMA. Veintiún artículos fueron analizados y evaluados mediante la metodología SIGN; 19 cumplieron con los criterios de alta calidad y fueron incluidos en la presente revisión. Se identificaron seis herramientas de tamizaje nutricional en pediatría, siendo STRONG kids la herramienta referida por el 63% de los estudios para la detección del riesgo de desnutrición. Conclusiones: la presente revisión sistemática permitió concluir que la mejor herramienta de tamizaje en niños hospitalizados es STRONG kids puesto que es práctica, rápida, de fácil uso y predice con fiabilidad el riesgo de desnutrición. No obstante, se requieren mayores estudios para validar el uso de esta en el contexto colombiano

Introduction: malnutrition in the pediatric population has been associated with a great number of physiological problems and complications, which lead to a longer period of hospitalization, a higher risk of infections, a rise in mortality rate, and hence, a rise in assistance expenses. Objective: to collect available evidence on tools of nutritional screening frequently used in pediatrics that allow identifying, preventing and intervening hospital malnutrition, as well as providing guidelines regarding the appropriate application instant. Materials and methods: a systematic review of literature was carried out in accordance with the PRISMA Declaration (Preferred Reporting Items in Systematic Reviews and Meta-Analyses) and in the main databases, search in Clinical Trials and gray literature in Open Gray and TRIP Database. Then, the articles were selected and classified depending on the type of study. The quality assessment was done in accordance with the Scottish Intercollegiate Guidelines Network (SIGN) checklists. Results: one hundred and ten articles were identified, following the parameters of the PRISMA declaration. Twenty-one articles were analyzed and evaluated through the SIGN methodology; 19 met the high quality criteria and were included in the present review. Six nutritional screening tools in pediatrics were identified, STRONG kids being the tool referred by 63% of the studies for the detection of malnutrition risk. Conclusions: the present systematic review allowed us to conclude that STRONG kids is the best screening tool for hospitalized children since it is practical, quick, easy to use and it reliably predicts the risk of malnutrition. However, further studies are required to validate the use of this in the Colombian context

Cuidado nutricional en la prevención de la preeclampsia: Una revisión sistemática / Nutritional care in theprevention of preeclampsia: A systematic review

Fundamentos: La preeclampsia (PE) es una de las principales causas de morbimortalidad materna en Colombia, por lo que se hace necesario indagar sobre el papel de la nutrición en la prevención de la PE a partir de los resultados y conclusiones de las publicaciones encontradas en la revisión. Métodos: Se realizó una revisión sistemática sobre la literatura existente en diferentes bases de datos como PubMed, Embase, Science Direct Freedom collection, Biblioteca Virtual de la Salud y Scielo, complementándose con una búsqueda de literatura gris. Se incluyeron datos de 28 estudios evaluados bajo las directrices Scottish Intercollegiate Guidelines Network (SIGN), en los que se abordaba aspectos nutricionales relacionados con la prevención de la PE. Resultados: Se encontró evidencia que respalda que la suplementación con vitamina D, calcio, ácido fólico, coenzima Q y L-Arginina cumplen un papel importante en la prevención de la PE, debido a su participación en diferentes procesos como el estrés oxidativo, la adecuada implantación de la placenta, entre otros. Conclusiones: El cuidado nutricional puede tener una posible relación en la prevención de la preeclampsia, sin embargo, se hace necesario realizar estudios complementarios que permitan confirmar la información existente desde el impacto de la nutrición

Background: The preeclampsia is one of the principal causes of morbidity and mortality in Colombian pregnant women, because of that it is necessary to investigate about the role of nutrition in the prevention of this disease base on results and conclusions of papers found on the systematic review done. Methods: A systematic review was performed on several different databases such as PubMed, Embase, Science Direct Freedom collection, BibliotecaVirtual de la Salud and Scielo, complemented with a search in gray literature. Data from different studies in which nutritional aspects related to PE prevention was collected. The quality of the articles was evaluated under the Scottish Intercollegiate Guidelines Network (SIGN) guidelines and finally a total of 28 articles were analyzed. Results: The evidence founded support the supplementation with vitamin D, calcium, folic acid, coenzyme Q and L-Arginine play an important role in the prevention of PE, since these participate in different process like the oxidative stress, the adequate implantation of the placenta, in other aspects. Conclusions: Care nutrition can have a possible relation in the prevention of preeclampsia, however, it is necessary to carryout complementary studies to confirm the existing information from the impact of nutrition

Acute respiratory infection in children from developing nations: a multi-level study.

BACKGROUND: Worldwide, acute respiratory infections (ARI) are the leading cause of death of children under 5 years of age. AIM: To assess the accomplishment of the Millennium Development Goal on under-5 mortality particularly related to ARI in developing countries, and to explore the associations between country characteristics and ARI in children under 5 taking into account child, mother and household attributes. METHODS: The study included a representative sample of 354,633 children under 5 years from 40 developing nations. A multilevel analysis of data from the Demographic and Health Surveys and the World Bank was conducted. RESULTS: The prevalence of ARI was 13%. Country inequalities were associated with the disease - GINI index (95% CI 1.01-1.04). The country's per capita gross domestic product (GDP) (95% CI 1.00-1.01) and health expenditure (95% CI 1.01-1.01) affected the relationship between immunization and ARI, while inequalities influenced the relationship between household wealth (95% CI 0.99-0.99) and the disease. Other factors positively associated with ARI were male gender, low birthweight, working mothers and a high-risk indoor environment. Factors associated with ARI reduction were older children, immunization, breastfeeding for more than 6 months, older maternal age, maternal education and planned pregnancy. CONCLUSIONS: In developing countries, public health campaigns to target ARI should consider the country's macro characteristics. At country level, inequalities but not health expenditure or GDP were associated with the disease and were independent of child, family and household characteristics. The effect of immunization on reducing ARI is greater in countries with a higher GDP and health expenditure. The effect of household wealth on ARI is less in countries with fewer inequalities. Reduction of inequalities is an important measure to decrease ARI in developing countries.

Low birth weight and prenatal care in Colombia: a cross-sectional study.

BACKGROUND: Low birth weight (LBW) is one of the most important factors affecting child morbidity and mortality worldwide; approximately one third of neonatal deaths are attributable to it. Most research and public health policy on LBW arise from developed nations, despite that most cases (96.5%) take place in developing countries. The specific features of prenatal care that prevent LBW in developing countries are unclear. This study aims to identify the characteristics of prenatal care associated with LBW in a developing country as Colombia. METHODS: Observational cross-sectional study using data from the Colombian Demographic and Health Survey 2010. A total of 10,692 children were included. Descriptive statistics were calculated, followed by bivariate regressions of LBW with all other study variables. Finally, stepwise logistic binomial regression analyses were done. RESULTS: A LBW prevalence of 8.7% was found. Quality of prenatal care (95%CI: 0.33, 0.92; OR = 0.55), number of prenatal visits (95%CI: 0.92, 0.93; OR = 0.92), and first prenatal visits during pregnancy (95%CI: 1.02, 1.07; OR = 1.08) were associated with LBW even after controlling for all the studied variables. The health care provider conducting prenatal checkup, and insurance coverage, were not associated with LBW. CONCLUSION: This research provides information on the characteristics of prenatal care (quality, number of visits, and gestational age at first prenatal visit) which may strengthen LBW prevention in Colombia and possibly in countries with similar socioeconomic characteristics.