ABSTRACT
Pneumococcal conjugate vaccine (PCV13) has been recently added to the vaccine recommendations for immunosuppressed adults (ISP). We conducted a multicenter observational prospective study aimed to assess the evolving epidemiology of invasive pneumococcal disease (IPD) in adults, with especial focus on ISP. All IPD cases admitted from 1999 to 2014 were included. ISP was defined as patients on current cancer chemotherapy, immunosuppressive therapy for autoimmune disease, biological therapy, chronic systemic steroid use, hemodialysis, neutropenia or HIV infection. A total of 799 IPD episodes were analyzed, 198 were considered ISP. IPD incidence decreased from 20 to 8/100,000-population year (p < 0.004) over the study period. No changes in mortality were observed. Penicillin resistance experienced a significant decline. In 694 episodes the serotype was known. Global vaccine coverage considering the whole study period, was for PCV7 21.6% vs. 28.8% in general and in immunosuppressed population (p = 0.04) and for PCV13 64.5% and 56.6% respectively (p = 0.05). The proportion of IPD isolates included in PCV7 and PCV13 significantly decreased over time. A reduction in the incidence of IPD in adults was seen late after the vaccine licensure, both in general population and in ISP. Coverage of PCV13 vaccine might be suboptimal for ISP in the coming years.
Subject(s)
Immunocompromised Host , Pneumococcal Infections/epidemiology , Pneumococcal Vaccines , Adult , Aged , Aged, 80 and over , Female , Humans , Incidence , Male , Middle Aged , Penicillin Resistance , Pneumococcal Infections/mortality , Pneumococcal Vaccines/administration & dosage , Prospective Studies , Serogroup , Spain/epidemiology , Streptococcus pneumoniae/classification , Streptococcus pneumoniae/drug effects , Time Factors , Vaccination/statistics & numerical dataABSTRACT
La investigación en métodos alternativos para el alivio del dolor durante el trabajo de parto está experimentando muchos avances. Entre ellos, la hidroterapia. Su seguridad durante el trabajo de parto y su uso durante el periodo expulsivo es un tema muy debatido actualmente. Esta revisión bibliográfica tiene el objetivo de conocer la evidencia científica disponible sobre los beneficios y posibles complicaciones de la hidroterapia, tanto en los factores obstétricos como neonatales. La búsqueda bibliográfica se ha llevado a cabo en las bases de datos PubMed, Cinahl, Biblioteca Cochrane y Scopus, entre los años 2004 y 2014. Se seleccionaron 30 referencias bibliográficas. En el uso de hidroterapia durante el parto no se han detectado efectos perjudiciales sobre los parámetros obstétricos maternos estudiados, sino que disminuye la percepción del dolor y el uso de analgesia, se realizan menos episiotomías y aumenta la satisfacción del parto. Las repercusiones neonatales en cuanto a morbilidad por realizar un parto en agua es el aspecto más controvertido, en especial las complicaciones por aspiración de agua o rotura de cordón
Research into alternative methods of pain relief during labor is a field in which many advances are been made. Including hydrotherapy during labor is a controversial topic among professional associations. It seems proven its safety during labor, but its use during delivery is a hot topic today. There has been a literature review in order to know the available scientific evidence on the benefits and possible complications in both obstetric and neonatal factors. The literature search was conducted in PubMed, Cinahl, Cochrane Library, Scopus data between the years 2004-2014; 30 literature alerts were selected. In the use of hydrotherapy during labor were not detected harmful effects on maternal obstetric parameters studied, instead decreases pain perception and use of analgesia, fewer episiotomies are performed and increases satisfaction birth. The neonatal repercussions, in terms of morbidity for making a water birth, is the most controversial aspect, especially complications aspiration of water or cord breakage
