ABSTRACT
OBJECTIVES: Developing a new Inequity-in-Health Index (IHI) assuming inequity as "inequality of health outcomes," based on Millennium Development Goals (MDG). STUDY DESIGN AND SETTING: Ecological study. Countries from around the world were included from United Nations, the World Bank, and a nonprofit organization's databases. The reliability and validity of this bidimensional IHI was tested. Main factor analysis (promax rotation) and main component analysis were used. RESULTS: Six variables were used for constructing the IHI was constructed with six variables: underweight children, child mortality, death from malaria in children aged 0-4, death from malaria at all ages, births attended by skilled health personnel, and immunization against measles. The IHI had high internal consistency (Cronbach's alpha=0.8504), was reliable (Spearman>0.9, P=0.0000), and had 0.3033pi around the world (range: 0pi-0.5984pi). IHI had high correlation with the human development and poverty indexes, health gap indicator, life expectancy at birth, probability of dying before 40 years of age, and Gini coefficients (Spearman>0.7, P=0.0000). IHI discriminated countries by income, region, indebtedness, and corruption level (Kruskal Wallis, P<0.01). IHI had sensitivity to change (P=0.0000). CONCLUSION: IHI is a bidimensional, valid and reliable index to monitor MDG. A new reliable methodology for developing bidimensional indicators is shown, which could be used for constructing other ones with their corresponding scores and graphs.
Subject(s)
Global Health , Goals , Health Status Indicators , Child Welfare/statistics & numerical data , Child, Preschool , Developing Countries , Humans , Infant , Infant, Newborn , Malaria/epidemiology , Mortality , Reproducibility of Results , Socioeconomic Factors , Tuberculosis/epidemiologyABSTRACT
BACKGROUND: The use of enemas during labour usually reflects the preference of the attending healthcare provider. However, enemas may cause discomfort for women and increase the costs of delivery. OBJECTIVES: To assess the effects of enemas applied during the first stage of labour on infection rates in mothers and newborns, duration of labour, perineal wound dehiscence in the mother, perineal pain and faecal soiling. SEARCH STRATEGY: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (March 2007), PubMed (1966 to December 2006), the Cochrane Central Register of Controlled Trials and Database of Abstracts of Reviews of Effectiveness (The Cochrane Library 2006, Issue 4), clinical trials registers (December 2006) and reference lists of articles. SELECTION CRITERIA: Randomized controlled trials (RCTs) in which an enema was administered during the first stage of labour and which included assessment of possible neonatal or puerperal morbidity or mortality. DATA COLLECTION AND ANALYSIS: Two review authors assessed studies for inclusion independently. MAIN RESULTS: Three RCTs (1765 women) met the inclusion criteria. Meta-analysis revealed no significant differences for infection rates in puerperal women (2 RCTs; 594 women; relative risk (RR) 0.66, 95% CI 0.42 to 1.04) or newborn children (1 RCT; 370 newborns; RR 1.12, 95% CI 0.76 to 1.67) after one month of follow up. No significant differences were found in the incidence of lower or upper respiratory tract infections. One trial described labour to be significantly shorter with enema versus no enema (1 RCT, 1027 women; 409.4 minutes versus 459.8 minutes; weighted mean difference (WMD) -50,40 CI 95% -75.68 to -25.12; P < 0.001), but another, adjusted for parity, did not confirm this (median 515 minutes with enemas versus 585 minutes without enemas, P = 0.24). Two trials found no significant differences in neonatal umbilical infection (2 RCTs; 592 newborns; RR 3.16 95% CI 0.50 to 19.82). The one trial that researched women's views found no significant differences in satisfaction between groups. AUTHORS' CONCLUSIONS: The evidence provided by the three included RCTs shows that enemas do not have a significant effect on infection rates such as perineal wound infection or other neonatal infections and women's satisfaction. This evidence does not support the routine use of enemas during labour; therefore, such practice should be discouraged.
Subject(s)
Enema , Labor Stage, First , Female , Humans , Pregnancy , Randomized Controlled Trials as Topic , RiskABSTRACT
OBJECTIVES: To compare the accuracy of laparoscopy performed within 24 h of admission and the conventional method based on clinical observation in the etiological diagnosis of non-specific acute lower abdominal pain (NSLAP) in women of reproductive age. METHODS: A total of 110 patients who met the selection criteria and were seen from November 1997 to June 2000 at the Instituto Materno Infantil, a referral hospital for maternal and perinatal care in Bogotá, were randomly divided into two groups. The effectiveness of each method was evaluated according to number of diagnoses reached, length of in-patient stay before diagnosis, complications, and diagnostic accuracy when compared with a standard given by microbiological and histopathological findings as well as clinical course. RESULTS: The early laparoscopy group did not experience more accurate diagnoses (85% vs. 79%, P=0.61) or a greater number of complications (11% vs. 9%, P=0.48), although the patients' stay was shorter (1.3 vs. 2.3 days, P=0.008) than the stay of the conventional-diagnosis group. Sensitivity analysis showed more accurate judgements with laparoscopy in four of the five NSLAP causes, but only in two of the cases did this greater accuracy have clinical significance. CONCLUSIONS: Early laparoscopy did not show a clear benefit in women with NSLAP.
Subject(s)
Abdomen, Acute/etiology , Laparoscopy , Abdomen, Acute/surgery , Adult , Female , Genital Diseases, Female/diagnosis , Humans , Intestinal Diseases/diagnosis , Laparotomy , Sensitivity and SpecificityABSTRACT
BACKGROUND: Improving obstetric care in resource-limited countries is a major international health priority. OBJECTIVE: To reduce infection rates after cesarean section by optimizing systems of obstetric care for low-income women in Colombia by means of quality improvement methods. METHODS: Multidisciplinary teams in 2 hospitals used simple methods to improve their systems for prescribing and administering perioperative antibiotic prophylaxis. Process indicators were the percentage of women in whom prophylaxis was administered and the percentage of these women in whom it was administered in a timely fashion. The outcome indicator was the surgical site infection rate. RESULTS: Before improvement, prophylaxis was administered to 71% of women in hospital A; 24% received prophylaxis in a timely fashion. Corresponding figures in hospital B were 36% and 50%. Systems improvements included implementing protocols to administer prophylaxis to all women and increasing the availability of the antibiotic in the operating room. These improvements were associated with increases in overall and timely administration of prophylaxis (P<.001) in both hospitals by time series analysis, with adjustment for volume and case mix. After improvement, overall and timely administration of prophylaxis was 95% and 96% in hospital A and 89% and 96% in hospital B. In hospital A, the surgical site infection rate decreased immediately after the improvements (P<.001). In hospital B, the infection rate began a downward trend before the improvements that continued after their implementation (P =.04). CONCLUSION: Simple quality improvement methods can be used to optimize obstetric services and improve outcomes of care in resource-limited settings.
Subject(s)
Ampicillin/therapeutic use , Anti-Bacterial Agents/therapeutic use , Antibiotic Prophylaxis , Cephalosporins/therapeutic use , Cephalothin/therapeutic use , Cesarean Section/adverse effects , Gentamicins/therapeutic use , Penicillin G/therapeutic use , Penicillins/therapeutic use , Surgical Wound Infection/drug therapy , Surgical Wound Infection/prevention & control , Total Quality Management , Colombia , Endometritis/drug therapy , Endometritis/etiology , Endometritis/prevention & control , Female , Hospitals, Voluntary , Humans , Obstetrics and Gynecology Department, Hospital , Perioperative Care , Poverty , Pregnancy , Quality Indicators, Health Care , Surgical Wound Infection/etiologyABSTRACT
Evaluar el valor del diagnóstico clínico de la Incontinencia Urinaria de Esfuerzo (IUE) frente al diagnóstico urodinámico de estabilidad vesical. Es un estudio de validez diagnóstica de corte transversal, donde se analizaron 100 historias clínicas de pacientes que consultaron a la Clínica de Incontinencia Urinaria del Instituto Materno Infantil de Bogotá en el período comprendido entre el 1o de enero de 1995 al 31 de diciembre de 1997. El 32 por ciento de las pacientes consultaron por sintomatología de incontinencia de esfuerzo pura, 5 por ciento de incontinencia de urgencia pura y 63 por ciento de incontinencia urinaria mixta. La urodinamia reportó 74 por ciento de pacientes con detrusor estable y 26 por ciento con detrusor inestable. Los síntomas de incontinencia urinaria de esfuerzo tienen una sensibilidad del 97 por ciento y una especificidad del 68 por ciento para el diagnóstico de IUE. Los síntomas de incontinencia urinaria de urgencia tienen una sensibilidad de 68 por ciento y una especificidad de 23 por ciento para el diagnóstico urodinámico de vejiga inestable.Los métodos clínicos (historia clínica y examen físico), no poseen la suficiente sensibilidad y especificidad como métodos diagnósticos únicos en in continencia urinaria de esfuerzo. Por lo tanto, se recomienda en el estudio de toda paciente que consulta por incontinencia urinaria, realizar una historia clínica adecuada, examen físico completo, examen neurológico, prueba de Bonney, Q-tip, parcial de orina, urocultivo, cistoscopia (cuando esté indicada) y urodinamia. Lo cual llevará a un diagnóstico más preciso y al manejo correcto de la patología que padece
Subject(s)
Urinary Incontinence, Stress , Homeopathic Anamnesis , Medical Records , Urodynamics/physiologyABSTRACT
This multicenter, prospective, double-blind study compared the safety and efficacy of clindamycin and ciprofloxacin versus ceftriaxone and doxycycline in the treatment of outpatients with mild to moderate pelvic inflammatory disease (PID) diagnosed by laparoscopy. Samples taken from the endocervix, endometrium, and abdominal cavity before treatment and from the endocervix after treatment were cultured for aerobes, anaerobes, Neisseria gonorrhoeae, and Chlamydia trachomatis. Of the 138 patients enrolled, 131 were evaluable for efficacy. The most prevalent bacteria were streptococci, staphylococci, and Escherichia coli (among aerobes) and Bacteroides species and peptostreptococci (among anaerobes). N. gonorrhoeae was present in 2% (3) of the 131 evaluable patients, and C. trachomatis was in 11% (15). The clinical cure rate was 97% (65 of 67) in the clindamycin and ciprofloxacin group and 95% (61 of 64) in the ceftriaxone and doxycycline group. Side effects were similar in both groups. In conclusion, the two regimens for the outpatient treatment of mild to moderate PID were similarly effective and safe.
Subject(s)
Ceftriaxone/administration & dosage , Ciprofloxacin/administration & dosage , Clindamycin/administration & dosage , Doxycycline/administration & dosage , Pelvic Inflammatory Disease/drug therapy , Administration, Oral , Adult , Ceftriaxone/adverse effects , Ciprofloxacin/adverse effects , Clindamycin/adverse effects , Double-Blind Method , Doxycycline/adverse effects , Drug Therapy, Combination , Female , Humans , Injections, Intramuscular , LaparoscopyABSTRACT
Con el fin de comparar la eficacia y seguridad de dos regímenes terapéuticos(clindamicina-gentamicina y pefloxacina-metronidazol) en el tratamiento de la endometritis post-cesárea, se incluyeron 71 pacientes que fueron sometidas a parto abdominal de urgencia en el Instituto Materno Infantil del 1§ de septiembre de 1993 al 31 de agosto de 1994 y que se presentaron endometritis post-cesárea diagnosticada por la presencia de tres de nueve criterios utilizados en el Servicio de Sépticas. Se asignaron de manera aleatoria de manera a uno de los dos grupos de tratamiento: gentaicina-clindamicina o metronidazol-pefloxacina. Se estudió la eficacia terapéutica mediante la comparación del tiempo de desaparición de la fiebre, la evolución clínica, los fracasos terapéuticos y las complicaciones. También se evaluó la seguridad de los dos regímenes. Se aplicó la prueba t de student y Chi cuadrado para significación estadística(a=0.05). Resultados: La seguridad se determinó en 68 pacientes que asistieron al control el día 5 de tratamiento y la eficacia en 63 pacientes que asistieron al control del día 7. Los cultivos de endometrio mostraron gérmenes anaerobios en el 48 por ciento de las pacientes y se aislaron en promedio 1.9 gérmenes por paciente. No hubo diferencias entre los dos grupos de tratamiento en cuanto a desaparición de la fiebre(p=0.82), tasa de mejoría (p=0.49), complicaciones (p=0.44). La sensibilidad antibiótica de los gérmenes aerobios fue alta para los antibióticos utilizados y no se encontró b lactamasa en los cuatro casos en los que se aislo N. gonorrohae. Conclusiones: La asociación clindamicina-gentamicina fue tan eficaz como la asociación pefloxacina-metronidazol en el tratamiento de la endometritis post-cesárea por lo que ésta última asociación se podría tener como una alternativa terapéutica
