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Objective: To review current scientific evidence on the physiological effects of kangaroo care, explore barriers and facilitators to its implementation, and identify areas requiring further research. Materials and methods: An integrative review was conducted using PubMed, Scopus, Web of Science, and Cochrane databases without language restrictions. Studies included quantitative and qualitative review studies. Critical appraisal of studies was performed using the Joanna Briggs Institute tool. Results: Sixteen studies were analyzed, providing heterogeneous support for the efficacy of kangaroo care in improving various neonatal physiological parameters including heart rate, body temperature, and oxygen saturation. Major barriers to implementation included restricted visiting hours, healthcare staff workload, negative cultural beliefs, lack of information and empowerment for mothers, and limited involvement of fathers. Conclusions: kangaroo care positively impacts premature or low birth weight neonatal development, though implementation is influenced by sociocultural factors. Further research is needed to better assess real effects on neonatal physiological parameters. Additional qualitative studies could aid in developing culturally adapted strategies to optimize kangaroo care implementation across contexts by better understanding family and medical team perspectives.
Objetivo. El objetivo es revisar la evidencia científica actual sobre los efectos fisiológicos del método canguro, explorar las barreras y facilitadores para su aplicación, además de identificar áreas de conocimiento aún no exploradas. Materiales y métodos. Revisión Integrativa, que incluyó estudios de revisión cuantitativos y cualitativos, en las bases de datos PubMed, Scopus, Web of Science y Cochrane, sin restricción de idioma. La valoración crítica de los estudios se realizó con la herramienta del Joanna Briggs Institute. Resultados. Se analizaron 16 estudios, entre los cuales se encontró evidencia que respalda la eficacia del método canguro en la mejora de diversos parámetros fisiológicos del neonato. Entre estos parámetros se encuentran la frecuencia cardíaca, la temperatura corporal y la saturación de oxígeno. Sin embargo, los resultados son heterogéneos. Las principales barreras para la implementación del método canguro incluyen: restricciones de las horas de visita, carga de trabajo del personal sanitario, creencias culturales negativas, falta de información y empoderamiento de las madres, además de la limitada participación de los padres. Conclusiones. El método canguro tiene un impacto positivo en el desarrollo los neonatos prematuros o de bajo peso. Sin embargo, su implementación se ve afectada por diversos factores socioculturales. Futuras investigaciones deben identificar los efectos reales sobre los parámetros fisiológicos del neonato. Se necesitan estudios cualitativos para comprender mejor las perspectivas de las familias, de los equipos médicos, y así desarrollar estrategias de adaptación cultural que optimicen la aplicación del este método en diferentes contextos.
Objetivo: O objetivo deste estudo é revisar as evidências científicas atuais sobre os efeitos fisiológicos do Método Canguru, explorar as barreiras e facilitadores para sua aplicação, além de identificar áreas do conhecimento ainda não exploradas.Materiais e Métodos: Foi realizada uma Revisão Integrativa, incluindo estudos de revisão quantitativa e qualitativa, nas bases de dados PubMed, Scopus, Web of Science e Cochrane, sem restrição de idioma. A avaliação crítica dos estudos foi conduzida com a ferramenta Joanna Briggs Institute.Resultados: Foram analisados 16 estudos, nos quais foram encontradas evidências que sustentam a eficácia do Método Canguru na melhoria de diversos parâmetros fisiológicos do recém-nascido, tais como frequência cardíaca, temperatura corporal e saturação de oxigênio. No entanto, os resultados apresentaram heterogeneidade. As principais barreiras à implementação do Método Canguru incluem restrições nos horários de visita, carga de trabalho do pessoal de saúde, crenças culturais negativas, falta de informação e empoderamento das mães, além da participação limitada dos pais.Conclusões: O Método Canguru demonstrou ter impacto positivo no desenvolvimento de neonatos prematuros ou de baixo peso. Contudo, sua implementação é afetada por diversos fatores socioculturais. Pesquisas futuras devem identificar os reais efeitos nos parâmetros fisiológicos do neonato. Estudos qualitativos são necessários para melhor compreender as perspectivas das famílias e das equipes médicas, visando desenvolver estratégias de adaptação cultural que otimizem a aplicação deste método em diferentes contextos.
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Nutrition during pregnancy influences perinatal outcomes and predispositions to chronic diseases. A prospective cohort study was carried out with the objectives of describing the dietary patterns in the pregnant population in the city of Quito, Ecuador and analysing the sociodemographic and lifestyle factors that influence the adherence to each dietary pattern. The body mass index was calculated for each patient, and the patients were classified according to the Atalah criteria. The Global Physical Activity Questionnaire was also applied. The dietary patterns were assessed using a dietary survey with a 24 h recall on two occasions. A total of 535 pregnant women were included. A positive association was found between the pattern "dairy, salads and sweet snacks/dressings" and foreign nationality (ß = 0.82 (0.43;1.21)). The "refined carbohydrates" pattern was negatively associated with education equal to or less than 7 years and an income of up to one basic salary (ß = -0.59 (-1.05; -0.14)). The "traditional Ecuadorian" pattern showed a positive association with being born in the coastal region of Ecuador (ß = 0.62 (0.22; 1.01)). This study identified three dietary patterns in pregnant women and their possible associations with certain sociodemographic factors. More studies are needed to better understand these patterns as well as to analyse their nutritional and caloric properties.
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Padrões Dietéticos , Gestantes , Humanos , Gravidez , Feminino , Equador , Estudos Prospectivos , Dieta , Verduras , Comportamento AlimentarRESUMO
Abstract Introduction: Since the first COVID-19 cases were reported, the disease's clinical and epidemiological characteristics have continuously been studied, although they have not been yet defined. Objective: To estimate the epidemiological profile of pediatric patients with COVID-19, as well as their clinical, laboratory and radiological characteristics. Materials and methods: A living systemic review was conducted in the PubMed, Scopus and SciELO databases. Observational studies describing clinical, radiological, and laboratory characteristics of pediatric patients with COVID-19 and published between January 1, 2020, and July 20, 2020, were considered for the search; there were no language restrictions. Government, epidemiological, and pre-print papers were also considered. Meta-analyses of single proportion (frequentist approach) and two proportions (Bayesian method) were carried out. The study registration and protocol are available at https://osf.io/y43wm and https://osf.io/r8ktv, respectively. Results: 13 studies, with a total of 9 152 patients, were retrieved. The Bayesian meta-analysis reported that males are more affected by the disease: OR 1.24 (HDI95%: 1.09-1.4). The proportion results calculated by means of the frequentist meta-analysis are: 52% cough (95%CI: 50-55), 0% death (95%CI: 0-0.1), 16% high aspartate transaminase levels (95%CI: 13-19), and 60% lung changes observed in chest X-ray (95%CI: 57-64). Conclusions: Based on the current data, it is not possible to describe accurately the clinical and epidemiological characteristics of COVID-19 in the pediatric population. However, evidence suggests that males are more affected by the disease and that lung alterations in imaging studies are more frequent than clinical signs such as cough and fever. Laboratory test results are not conclusive and show that different organs and systems of the human body may be affected by SARS-CoV-2. The results reported here must be compared to prospective controlled studies conducted in larger samples and a more rigorous design.
Resumen Introducción. Desde que se reportaron los primeros casos de COVID-19, sus características clínicas y epidemiológicas han sido constantemente estudiadas, pero aún no han sido definidas. Objetivo. Estimar el perfil epidemiológico, así como las características clínicas, radiológicas y de laboratorio en pacientes pediátricos con COVID-19. Materiales y métodos. Se realizó una revisión sistemática viva en las bases de datos PubMed, Scopus y SciELO; para la búsqueda se consideraron estudios observacionales publicados entre enero 1 de 2020 y julio 20 de 2020, sin restricción de idioma, que describieran características clínicas, radiológicas y de laboratorio en población pediátrica con COVID-19; también se incluyeron reportes gubernamentales y epidemiológicos, y artículos publicados en formato pre-print. Se realizaron metaanálisis de proporción única (método frecuentista) y de dos proporciones (método bayesiano). El registro y el protocolo del estudio están disponibles en https://osf.io/y43wm y https://osf.io/r8ktv, respectivamente. Resultados. Se encontraron 13 estudios, con un total de 9 152 pacientes. El metaanálisis bayesiano reportó una mayor afectación del sexo masculino: OR: 1.2 (HDI95%: 1.09-1.4). Los resultados de la proporción calculada por el metaanálisis frecuentista fueron: tos 52% (IC95%: 50-55), muerte 0% (IC95%: 0-0.1), niveles elevados de aspartato aminotransferasa 16% (IC95%: 13-19) y alteraciones pulmonares evidenciadas mediante estudios de imagen 60% (IC95%: 57-64). Conclusiones. Con los datos actuales no es posible describir con exactitud las características clínicas y epidemiológicas de la COVID-19 en población pediátrica. Sin embargo, existen indicios de una mayor afectación al sexo masculino, y de que las anormalidades pulmonares detectadas en radiografías y tomografías del tórax son más frecuentes que signos clínicos como la tos y la fiebre. Los resultados de laboratorio no son concluyentes y reflejan que diferentes órganos y sistemas son afectados por el SARS-CoV-2. Los hallazgos del presente estudio deben ser contrastados con estudios prospectivos controlados, con un mayor número de pacientes y un diseño más riguroso.
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Objective: To summarize the best available evidence about the frequency of presentation of: signs, symptoms, main laboratory tests and, radiological alterations in patients younger than 19 years with a diagnosis of COVID-19. Method: By searching PubMed, Scopus and academic Google, data from studies where present clinical, laboratory and radiological characteristics were collected to perform single-proportion meta-analyzes. Results: 11 studies were found, including a total of 1180 patients. The meta-analysis showed a greater incidence of the male sex 0.56 (95% CI; 0.51: 0.61), asymptomatic patients 0.15 (95% CI; 0.09: 0.22), mild and very mild infections 0.44 (95% CI; 0.25: 0.63) , moderate infections 0.44 (95% CI; 0.38: 0.45), incidence of fever 0.56 (95% CI; 0.48: 0.65), cough 0.46 (95% CI; 0.39: 0.53), pharyngitis 0.18 (95% CI; 0.03: 0.39 ), laboratory tests showed a higher incidence of leukopenia 0.33 (95% CI; 0.25: 0.42), C-reactive Protein 0.19 (95% CI; 0.15: 0.24), patients with radiological alteration 0.68 (95% CI; 0.56: 0.79), severe patients n = 5 and deceased n = 1. Conclusions: The presence of radiological abnormalities is more frequent than the clinical signs of cough and fever, which are the most common symptoms. On the blood count: leukopenia is more frequent. There is a trend of greater incidence in the male sex. This meta-analysis will serve as a basis for future comparisons of the similarities or differences that may occur now that the pandemic is in America. It also has limitations so the results must be contrasted, with controlled prospective studies, with a greater number of patients and a stricter design.
Objetivo: Resumir la mejor evidencia disponible acerca de la frecuencia de presentación de: signos, síntomas, principales exámenes de laboratorio y, alteraciones radiológicas en pacientes menores de 19 años con diagnóstico de COVID-19. Método: Mediante búsquedas en PubMed, Scopus y Google académico, se recopilaron los datos de los estudios que presentaban las características clínicas, de laboratorio y radiología, para realizar metaanálisis de proporción única. Resultados: Se encontró 11 estudios, que incluían un total de 1180 pacientes. El meta-análisis presentó una mayor afectación del sexo masculino 0.56(IC 95%; 0.51:0.61), pacientes asintomáticos 0.15(IC 95%; 0.09:0.22), infecciones leves y muy leves 0.44(IC 95%; 0.25:0.63), infecciones moderadas 0.44(IC 95%; 0.38:0.45), incidencia de fiebre 0.56(IC 95%; 0.48:0.65), tos 0.46(IC 95%; 0.39:0.53), faringitis 0.18(IC 95%; 0.03:0.39), en los exámenes de laboratorio presentó mayor incidencia la leucopenia 0.33(IC 95%; 0.25:0.42), la Proteína C reactiva 0.19(IC 95%; 0.15:0.24), los pacientes con alteración radiológica 0.68(IC 95%; 0.56:0.79), pacientes graves n=5 y fallecidos n=1. Conclusiones: La presencia de anormalidades radiológicas es mas frecuente que los signos clínicos de tos y fiebre que son los síntomas más comunes. En el hemograma: la leucopenia es mas frecuente. Existe una tendencia de mayor afectación en el sexo masculino. Este metaanálisis servirá de base para futuras comparaciones acerca de las similitudes o diferencias que pueden presentarse ahora que la pandemia está en América. También presenta limitaciones por lo que los resultados deben ser contrastados, con estudios prospectivos controlados, con mayor número de pacientes y un diseño mas estricto.