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Background: For a medication dispensing service to function with quality, continuous evaluation is required, which is why it is necessary to have reliable measurement tools that make it possible. Quality indicators can serve as tools for managing quality, as they are variables that directly or indirectly measure changes in a situation and help evaluate the progress made in addressing it. This article aims to determine the feasibility and reliability of a quality indicator system for a drug dispensing service for paediatric outpatients in two Mexican hospitals. Methods: A study of the development type of health systems and services at a microlevel was conducted from October 2020 to October 2021 in the pharmaceutical service of two Mexican hospitals. To determine the feasibility of the quality indicators, a retrospective evaluation was performed, which considered the indicators that could be calculated with the available information to be feasible. To determine reliability, an inter-observer agreement study (Kappa (κ)) was performed. Results: The feasibility analysis revealed that all five reference indicators related to the structure were feasible in both hospitals. In the Infantil of the Californias hospital, all six process indicators evaluated were feasible, whilst only one was found feasible in H+ Querétaro. As for outcome indicators, only one was feasible in the Infantil of the Californias hospital. The causes of non-feasibility in both hospitals were the non-documentation of the primary data related to the stages of the process and the lack of instruments to measure patient satisfaction. The reliability of the indicators showed little variability. Conclusion: Although not all indicators were feasible, solutions were proposed so that the 15 reference indicators could be used if an organization decided to do so. The reliability of the indicators was demonstrated, evidencing the importance of the data sheet as a tool to generate valid reliable measures.This article is part of the Hospital pharmacy, rational use of medicines and patient safety in Latin America Special Issue: https://www.drugsincontext.com/special_issues/hospital-pharmacy-rational-use-of-medicines-and-patient-safety-in-latin-america/.
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Introducción. El efecto que tiene la lactancia materna y la alimentación complementaria sobre la prevalencia de las enfermedades alérgicas ha mostrado resultados inconsistentes. Objetivo. Evaluar el efecto de la lactancia materna y el momento de inicio de la alimentación complementaria en la prevalencia de las enfermedades alérgicas. Población y métodos. Estudio transversal analítico con base poblacional realizado en niños de 6 a 12 años de edad inscriptos en escuelas primarias, seleccionados mediante muestreo polietápico. Se aplicó a sus padres o tutores un cuestionario estructurado para identificar enfermedades alérgicas (asma, rinitis alérgica o dermatitis atópica), antecedente de lactancia materna prolongada y edad de inicio de la alimentación complementaria. La búsqueda de asociaciones entre variables se realizó mediante regresión logística. Resultados. Se incluyeron 740 niños. La frecuencia de lactancia e" 6 meses fue 73,4% y de alimentación complementaria con d" 4 meses fue 31,9%. La lactancia materna prolongada no tuvo efecto sobre la prevalencia de las enfermedades alérgicas. Se observó un efecto protector en la frecuencia de la dermatitis atópica cuando el inicio de la alimentación complementaria era tardío, OR ajustado= 0,36; IC95%: 0,1-0,8 (p 0,019). Conclusiones. El efecto protector de la lactancia materna sobre la prevalencia de las enfermedades alérgicas no pudo ser comprobado. La prevalencia de dermatitis atópica es menor con un comienzo tardío de la alimentación complementaria.(AU)
Introduction. The effect that breastfeeding and complementary feeding practices have on the prevalence of allergic diseases has shown inconsistent results. Objective. To assess the effect of breastfeeding and the initiation of complementary feeding on the prevalence of allergic disease. Population and Methods. Analytical, crosssectional population-based study conducted in 6-12 year old children attending primary school and selected through a multistage sampling technique. A structured questionnaire was administered to parents or tutors to identify allergic diseases (asthma, allergic rhinitis, or atopic dermatitis), a history of prolonged breastfeeding and age at initiation of complementary feeding. A logistic regression analysis was used to establish associations among variables. Results. A total of 740 children were included. The frequency of breastfeeding for >6 months was 73.4%, and of complementary feeding at <4 months old was 31.9%. Prolonged breastfeeding showed no effect on the prevalence of allergic diseases. A protective effect was observed on the frequency of atopic dermatitis when complementary feeding was initiated late, adjusted OR= 0.36, 95% confidence interval (CI): 0.1-0.8 (p 0.019). Conclusions. The protective effect ofbreastfeeding against the prevalence of allergic diseases has not been demonstrated. There is a reduction in the prevalence of atopic dermatitis when complementary feeding is started late.(AU)
ABSTRACT
Introducción. El efecto que tiene la lactancia materna y la alimentación complementaria sobre la prevalencia de las enfermedades alérgicas ha mostrado resultados inconsistentes. Objetivo. Evaluar el efecto de la lactancia materna y el momento de inicio de la alimentación complementaria en la prevalencia de las enfermedades alérgicas. Población y métodos. Estudio transversal analítico con base poblacional realizado en niños de 6 a 12 años de edad inscriptos en escuelas primarias, seleccionados mediante muestreo polietápico. Se aplicó a sus padres o tutores un cuestionario estructurado para identificar enfermedades alérgicas (asma, rinitis alérgica o dermatitis atópica), antecedente de lactancia materna prolongada y edad de inicio de la alimentación complementaria. La búsqueda de asociaciones entre variables se realizó mediante regresión logística. Resultados. Se incluyeron 740 niños. La frecuencia de lactancia e" 6 meses fue 73,4% y de alimentación complementaria con d" 4 meses fue 31,9%. La lactancia materna prolongada no tuvo efecto sobre la prevalencia de las enfermedades alérgicas. Se observó un efecto protector en la frecuencia de la dermatitis atópica cuando el inicio de la alimentación complementaria era tardío, OR ajustado= 0,36; IC95%: 0,1-0,8 (p 0,019). Conclusiones. El efecto protector de la lactancia materna sobre la prevalencia de las enfermedades alérgicas no pudo ser comprobado. La prevalencia de dermatitis atópica es menor con un comienzo tardío de la alimentación complementaria.
Introduction. The effect that breastfeeding and complementary feeding practices have on the prevalence of allergic diseases has shown inconsistent results. Objective. To assess the effect of breastfeeding and the initiation of complementary feeding on the prevalence of allergic disease. Population and Methods. Analytical, crosssectional population-based study conducted in 6-12 year old children attending primary school and selected through a multistage sampling technique. A structured questionnaire was administered to parents or tutors to identify allergic diseases (asthma, allergic rhinitis, or atopic dermatitis), a history of prolonged breastfeeding and age at initiation of complementary feeding. A logistic regression analysis was used to establish associations among variables. Results. A total of 740 children were included. The frequency of breastfeeding for >6 months was 73.4%, and of complementary feeding at <4 months old was 31.9%. Prolonged breastfeeding showed no effect on the prevalence of allergic diseases. A protective effect was observed on the frequency of atopic dermatitis when complementary feeding was initiated late, adjusted OR= 0.36, 95% confidence interval (CI): 0.1-0.8 (p 0.019). Conclusions. The protective effect ofbreastfeeding against the prevalence of allergic diseases has not been demonstrated. There is a reduction in the prevalence of atopic dermatitis when complementary feeding is started late.
Subject(s)
Humans , Infant , Asthma/epidemiology , Breast Feeding , Prevalence , Cross-Sectional Studies , Dermatitis, Atopic/epidemiology , Rhinitis, Allergic/epidemiology , Infant Nutritional Physiological Phenomena , Mexico/epidemiologyABSTRACT
INTRODUCTION: The effect that breastfeeding and complementary feeding practices have on the prevalence of allergic diseases has shown inconsistent results. OBJECTIVE: To assess the effect of breastfeeding and the initiation of complementary feeding on the prevalence of allergic disease. POPULATION AND METHODS: Analytical, crosssectional population-based study conducted in 6-12 year old children attending primary school and selected through a multistage sampling technique. A structured questionnaire was administered to parents or tutors to identify allergic diseases (asthma, allergic rhinitis, or atopic dermatitis), a history of prolonged breastfeeding and age at initiation of complementary feeding. A logistic regression analysis was used to establish associations among variables. RESULTS: A total of 740 children were included. The frequency of breastfeeding for >6 months was 73.4%, and of complementary feeding at <4 months old was 31.9%. Prolonged breastfeeding showed no effect on the prevalence of allergic diseases. A protective effect was observed on the frequency of atopic dermatitis when complementary feeding was initiated late, adjusted OR= 0.36, 95% confidence interval (CI): 0.1-0.8 (p 0.019). CONCLUSIONS: The protective effect of breastfeeding against the prevalence of allergic diseases has not been demonstrated. There is a reduction in the prevalence of atopic dermatitis when complementary feeding is started late.
Subject(s)
Asthma/epidemiology , Breast Feeding , Dermatitis, Atopic/epidemiology , Infant Nutritional Physiological Phenomena , Rhinitis, Allergic/epidemiology , Age Factors , Child , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Male , Mexico/epidemiology , Prevalence , Retrospective Studies , Urban HealthABSTRACT
Case report of 18-year old female patient with clinical signs of pulmonary tuberculosis during pregnancy at beginning of fourth month into term, with airway impairment, as evidenced by dry cough, fever and night sweats, as well as a 6 kg. weightloss. Twenty-two days after giving birth, the patient was hospitalized with high fever and deteriorated health conditions, requiring treatment in the intensive care unit due to complications such as severe malnutrition, septic shock, pulmonary abscess, pachypleuritis, empyema and bronchopleural fistula. The tuberculosis diagnosis was established through ABF identification with Ziehl-Neelsen stain of the pleural fluid. The patient was hospitalized for 42 days, including eleven days on a mechanical ventilator, before being discharged. Her newborn daughter was admitted to the Pediatric Intensive Care Unit on the 19th day of life due to coughing, fever, difficulty in breathing, liquid stool and rejecting food. The newborn was hospitalized in the newborn intensive care unit for twenty-two days, developing major sepsis and multiple organ failure, which complications led to her death. An autopsy was conducted, revealing granulomatous lesions consistent with tuberculosis in lungs, liver, small intestine, large intestine and peritoneum; additionally the PCR of bronchial aspirate was positive to Mycobacterium tuberculosis DNA.
Subject(s)
Infectious Disease Transmission, Vertical , Pregnancy Complications, Infectious/physiopathology , Tuberculosis, Pulmonary/complications , Adolescent , Fatal Outcome , Female , Humans , Infant, Newborn , Intensive Care Units, Pediatric , Multiple Organ Failure/microbiology , Multiple Organ Failure/physiopathology , Pregnancy , Pregnancy Complications, Infectious/microbiology , Sepsis/microbiology , Sepsis/physiopathology , Tuberculosis, Pulmonary/physiopathologyABSTRACT
Introducción: En México existe incertidumbre acerca de los recursos humanos y tecnológicos disponibles para el diagnóstico de la neurodiscapacidad, es por eso que el objetivo de este estudio fue conocer la disponibilidad de dichos recursos, así como identificar la existencia de programas para establecer el diagnóstico en el periodo neonatal, en los diferentes centros de trabajo del país. Material y métodos: Durante el XVI Congreso Nacional de Neonatología que celebró la Federación Nacional de Neonatología de México, en febrero de 2011 en Cancún, México, se realizó una encuesta entre los pediatras, neonatólogos, enfermeras y personal de salud del país. Resultados: El 65% respondió que en su lugar de trabajo cuentan con programas de tamizaje para retinopatía del prematuro, sordera, parálisis cerebral, epilepsia y retraso mental; también los encuestados mencionaron tener los siguientes especialistas en sus instituciones: neurólogos, oftalmólogos y personal para la detección de problemas de sordera. Conclusiones: El panorama es sombrío, ya que en todas las áreas de cobertura se reporta menos del 70% de estos recursos. Se hace notar que para la detección de la ceguera y la sordera se cuenta con más recursos disponibles. El resto de los problemas investigados presenta graves indicadores negativos, por lo tanto, es urgente legislar en el campo de acción de la neonatología, cuestionando la eficacia y seguridad de algunos de los tratamientos y su contribución al daño neurológico.
Introduction: In Mexico there is uncertainty about the human and technological resources available for the diagnosis of neurodisability, so the objective of the present study was: to determine the availability of those resources and to identify the existence of programs to establish the diagnosis in the neonatal period, in different workplaces in the country. Material and methods: During the Sixteenth National Congress of Neonatology, held by the National Federation of Neonatology of Mexico, in February 2011 in Cancún, Mexico. It was conducted a survey among pediatricians, neonatologists, nurses, and health personnel working in the country. Results: 65% answered that in their workplace have screening programs for: retinopathy of prematurity, deafness, cerebral palsy, mental retardation epilepsy, also the respondents mentioned that count with the following specialists at their institutions: neurologists, ophthalmologist and personal for the detection of deafness. Conclusions: The picture is bleak; in all areas reported coverage less than 70%. It is noted that for detection of blindness and deafness there are more resources available. The rest of the problems investigated have severe negative indicators. So it is urgent to legislate currently in the field of neonatology, questioning the efficacy and safety of some treatments and their contribution to neurological damage.
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Introducción. La pentalogía de Cantrell es un padecimiento congénito raro; reportados 90 casos en la literatura y descrito por Cantrell-Heller-Ravitch, se caracteriza por: hernia diafragmática anterior, onfalocele, pericardio diafragmático, anomalías congénitas intracardiacas y tercio inferior del esternón. Caso clínico. Recién nacida (RN) femenina de término, eutrófica, producto de la cuarta gestación, madre de 36 años, originaria de Guadalajara y residente de Pto. Vallarta. Antecedentes de: tabaquismo y alcoholismo, asmática tratada con salbutamol durante la gestación, infección de vías urinarias y cervicovaginitis tratada, preeclampsia 4 meses previos al parto, sin manejo, diagnosticada por ecosonograma obstétrico a las 35.2 semanas de gestación con presencia de onfalocele y ectopia cordis; interrumpiendo la gestación vía abdominal, obteniéndose RN con los defectos mencionados, además de cardiopatía intracardiaca (atresia pulmonar, transposición de vasos, comunicación interventricular e interauricular). Falleció a los 5 días de vida. Conclusión. Los casos de supervivencia reportados en la literatura son excepcionales (variantes no graves), siendo las cardiopatías determinantes del pronóstico.
Introduction. The pentalogy of Cantrell is a infrequent congenital syndrome. There are 90 cases reported in the literature, described by Cantrell-Heller-Ravitch and characterized by hernia of the anterior diaphragm, omphalocele, diaphragmatic pericardium, congenital heart defect and in the lower sternum. Case report. Female newborn delivered at term, product of the 4th pregnancy from a 36 year-old mother with history of smoking and alcoholism, asthma treated with salbutamol during pregnancy, urogenital tract infection treated, preeclampsia in the 4th month of gestation non-treated. Diagnosis by ultrasound at 35.2 weeks of pregnancy of omphalocele and ectopia cordis; abdominal delivery of the newborn with the defects described above, associated with intracardiac lesions: pulmonary atresia, vascular transposition, ventricular septal defect and atrial septal defect. The infant died on the 5th day. Conclusion. The survival rate in cases reported in literature is rare and depends on the complexity of the cardiac defect.
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El 80 por ciento de los recién nacidos presentan grados variables de ictericia durante los primeros 7 días de vida, en la mayoría de ellos desaparecerá sin dejar ninguna consecuencia, sin embargo, aquellos neonatos que desarrollen hiperbilirrubinemia grave tienen el riesgo de presentar secuelas neurológicas. Este artículo analiza las manifestaciones clínicas de la encefalopatía bilirrubínica, su fisiopatología y las recomendaciones actuales de prevención y tratamiento además de la neuropatología del kernícterus.
