To examine the development of resistance to erythromycin, chloramphenicol, trimethoprim-sulfamethoxazole (TMP-SMZ), and vancomycin of the invasive isolates of Streptococcus pneumoniae obtained from ...children in 10 Latin American/Caribbean countries during six years of surveillance.
Analysis of 8 993 isolates of S. pneumoniae recovered in 2000-2005 from children with invasive infections, who were less than 6 years of age, and from Argentina, Brazil, Chile, Colombia, Cuba, Dominican Republic, Mexico, Paraguay, Uruguay, or Venezuela. Antibiotic susceptibility was determined through the methods established and standardized by the SIREVA project. Multidrug resistance was defined as: resistance to three or more antibiotics of the same class; to the non-beta-lactams analyzed by this study; or, to the beta-lactams evaluated by a previous study, in which 37.8% of these isolates showed decreased susceptibility to penicillin.
Some degree of resistance was found to TMP-SMZ and erythromycin (56.4% and 15.4% of the isolates studied, respectively), with 4.6% highly resistant to chloramphenicol. All isolates were susceptible to vancomycin. The highest prevalence of TMP-SMZ resistance was observed in the pneumonia isolates; and that of erythromycin, in cases of sepsis (61.6% and 25.5%, respectively; P < 0.01). The highest prevalence of TMP-SMZ resistance was found in Brazil (71.9%), and that of erythromycin, in Mexico (38.2%) and Venezuela (32.9%). The 14, 6B, 19F, and 23F serotypes were most often associated with resistance to the antibiotics in the study.
High and increasing rates of isolates resistant to TMP-SMZ and erythromycin were observed, as well as a decreasing percentage of isolates resistant to chloramphenicol. These trends highlight differences among the countries studied.
Stress echocardiography (SE) has an established role in evidence-based guidelines, but recently its breadth and variety of applications have extended well beyond coronary artery disease (CAD). We ...lack a prospective research study of SE applications, in and beyond CAD, also considering a variety of signs in addition to regional wall motion abnormalities.
In a prospective, multicenter, international, observational study design, > 100 certified high-volume SE labs (initially from Italy, Brazil, Hungary, and Serbia) will be networked with an organized system of clinical, laboratory and imaging data collection at the time of physical or pharmacological SE, with structured follow-up information. The study is endorsed by the Italian Society of Cardiovascular Echography and organized in 10 subprojects focusing on: contractile reserve for prediction of cardiac resynchronization or medical therapy response; stress B-lines in heart failure; hypertrophic cardiomyopathy; heart failure with preserved ejection fraction; mitral regurgitation after either transcatheter or surgical aortic valve replacement; outdoor SE in extreme physiology; right ventricular contractile reserve in repaired Tetralogy of Fallot; suspected or initial pulmonary arterial hypertension; coronary flow velocity, left ventricular elastance reserve and B-lines in known or suspected CAD; identification of subclinical familial disease in genotype-positive, phenotype- negative healthy relatives of inherited disease (such as hypertrophic cardiomyopathy).
We expect to recruit about 10,000 patients over a 5-year period (2016-2020), with sample sizes ranging from 5,000 for coronary flow velocity/ left ventricular elastance/ B-lines in CAD to around 250 for hypertrophic cardiomyopathy or repaired Tetralogy of Fallot. This data-base will allow to investigate technical questions such as feasibility and reproducibility of various SE parameters and to assess their prognostic value in different clinical scenarios.
The study will create the cultural, informatic and scientific infrastructure connecting high-volume, accredited SE labs, sharing common criteria of indication, execution, reporting and image storage of SE to obtain original safety, feasibility, and outcome data in evidence-poor diagnostic fields, also outside the established core application of SE in CAD based on regional wall motion abnormalities. The study will standardize procedures, validate emerging signs, and integrate the new information with established knowledge, helping to build a next-generation SE lab without inner walls.
Use of litigation to ensure and guarantee access to medical inputs constitutes one of the most effective strategies to ensure observance (or remedy the violation) of the right to health, often in ...relation to other fundamental human rights such as the right to life or to bodily integrity.
Use of litigation to ensure and guarantee access to medical inputs constitutes one of the most effective strategies to ensure observance (or remedy the violation) of the right to health, often in ...relation to other fundamental human rights such as the right to life or to bodily integrity. More frequently, and in multiple national contexts, judges and courts support lawsuits filed by individuals who need immediate access to health technologies. On many occasions, the rulings that force the State and its institutions to guarantee the supply of a given product do not take into account the reasons the State gives for not providing it, which can range from cost-effectiveness calculations and evaluation, to public policy planning and implementation. Use and abuse of legal proceedings by interested third parties threaten the legitimacy of an instrument that has contributed, without a doubt, to strengthening public engagement in the defense of people's rights, including the right to health. This document is an attempt to provide a context for the evolution of this phenomenon with regard to the instruments, mechanisms, and procedures commonly used by health authorities to efficiently organize access to health technologies. In addition, steps to follow are suggested for both national and regional settings. Keywords Pharmaceutical preparations; health services accessibility; judiciary; legislation; jurisprudence La utilizacion de la via judicial para asegurar y garantizar el acceso a insumos medicos constituye una de las estrategias mas efectivas para asegurar el cumplimiento (o remediar la violacion) del derecho a la salud, a menudo en relacion con otros derechos humanos fundamentales como el derecho a la vida o a la integridad fisica. De manera mas frecuente y en multiples contextos nacionales, jueces y cortes respaldan las demandas interpuestas por particulares que necesitan acceso inmediato a tecnologias sanitarias. En muchas ocasiones, las sentencias que obligan al Estado y a sus instituciones a garantizar el suministro de un producto determinado no toman en consideracion las razones aducidas por el Estado para no suministrarlo que pueden variar desde calculos de costeefectividad a procesos de evaluacion, planificacion y ejecucion de politicas publicas. La utilizacion y abuso de procedimientos judiciales por terceras partes interesadas amenaza la legitimidad de un instrumento que ha contribuido, sin lugar a dudas, a fortalecer la participacion de la ciudadania en la defensa de sus derechos, incluido el derecho a la salud. El presente documento pretende contextualizar la evolucion del fenomeno en relacion con aquellos instrumentos, mecanismos y procedimientos que suelen utilizar las autoridades sanitarias para racionalizar el acceso a tecnologias sanitarias. Ademas, se sugieren pasos a seguir tanto en el ambito nacional como regional. Palabras clave Medicamentos; acceso a la atencion de salud; poder judicial; legislacion; jurisprudencia A utilizacao da via judicial para assegurar e garantir o acesso a insumos medicos e uma das estrategias mais efetivas para o cumprimento (ou remediar o descumprimento) do direito a saude, frequentemente relacionado a outros direitos humanos fundamentais como o direito a vida ou direito a integridade fisica. Com frequencia e em diversos contextos nacionais, juizes e tribunais dao respaldo aos recursos apresentados por individuos particulares que precisam ter acesso imediato a tecnologias em saude. Em varias ocasioes, as sentencas que obrigam o Estado e suas instituicoes a garantir a provisao de determinado produto nao levam em consideracao as razoes alegadas para a nao provisao, de calculos de custo-efetividade a processos de avaliacao, planejamento e execucao de politicas publicas. O uso e o abuso de recursos judiciais por terceiros interessados ameacam a legitimidade de um instrumento que vem indubitavelmente contribuindo para fortalecer a participacao dos cidadaos na defesa dos proprios direitos, inclusive o direito a saude. O presente documento tem o intuito de contextualizar a evolucao do fenomeno da judicializacao quanto aos instrumentos, mecanismos e procedimentos normalmente usados pelas autoridades sanitarias para racionalizar o acesso a tecnologias em saude. E feita recomendacao sobre os passos a serem seguidos ao nivel nacional e regional. Palavras-chave Preparacoes farmaceuticas; acesso aos servicos de saude; poder judiciario; legislacao; jurisprudencia.
This study examined the spatial distribution of childhood community-acquired pneumonia detected through prospective surveillance in Goiânia, Brazil. Three spatial analysis techniques were applied to ...detect intra-urban geographic aggregation of pneumonia cases: Kernel method, nearest neighbor hierarchical technique, and spatial scan statistic. A total of 724 pneumonia cases confirmed by chest radiography were identified from May 2000 to August 2001. All cases were geocoded on a digital map. The annual pneumonia risk rate was estimated at 566 cases/100,000 children. Analysis using traditional descriptive epidemiology showed a mosaic distribution of pneumonia rates, while GIS methodologies showed a non-random pattern with hot spots of pneumonia. Cluster analysis by spatial scan statistic identified two high-risk areas for pneumonia occurrence, including one most likely cluster (RR = 2.1; p < 0.01) and one secondary cluster (RR = 1.3; p = 0.01). The data used for the study are in line with recent WHO-led efforts to improve and standardize pediatric pneumonia surveillance in developing countries and show how GIS and spatial analysis can be applied to discriminate target areas of pneumonia for public heath intervention.
Background The conjugate Haemophilus influenzae type b (Hib) vaccine has been highly efficacious in reducing type b H. influenzae meningitis. However, information is limited about its impact on ...childhood pneumonia after vaccine introduction into the routine programme. This study evaluated the effectiveness of Hib conjugate vaccine in the reduction of community-acquired pneumonia among infants in Central Brazil. Methods A matched case-control study was built into an ongoing prospective population-based surveillance of pneumonia, enrolling 1293 participants between May 2000 and August 2001. Cases (n = 431) were children ≤2 years old hospitalized with radiologically definite pneumonia according to the World Health Organization standard criteria for the interpretation of radiographs for the diagnosis of pneumonia. Two controls (n = 862) without previous hospitalization for pneumonia were identified among children from the same neighbourhood and matched to cases by age stratum (±4 months). The Hib vaccination effectiveness was estimated as 1 minus odds ratio (OR). Results The greatest risk factor for pneumonia among children <2 years of age was day-care centre attendance (P < 0.001). Of the study participants, 83.3% (1072/1287) were classified as vaccinated according to immunization card and 16.7% (215/1287) were considered unvaccinated. By using conditional logistic regression the vaccine effectiveness was estimated as 31.0% (95% CI: −9.0%, 57.0%) after adjusting for sex, previous flu-like illnesses, day-care attendance, smokers at home, house ownership, mother's education, and age as continuous variable. Conclusion Under programme conditions the effectiveness of Hib conjugate vaccine in infants with radiologically confirmed pneumonia was 31% (95% CI: −9%, 57%) showing the potential benefit of Hib immunization in the prevention of likely non-bacteraemic pneumonia.
Nul ne conteste la nécessité aujourd’hui de se former tout au long de la vie pour faire face aux évolutions rapides de nos sociétés et à leur complexité toujours croissante. Les enseignants de ...sciences et de technologies n’y échappent pas, et leur formation conditionne pour partie l’intégration de leurs élèves à la société dans laquelle ils vont vivre. Dans ce contexte, les apports de la recherche notamment en didactique peuvent être décisifs, qu’ils nourrissent directement les actions de formation (quand ils concernent l’enseignement et l’apprentissage de concepts et de méthodes scientifiques ou technologiques, ou encore la nature des sciences ou des technologies) ou qu’ils analysent des actions de formation des enseignants du domaine et de leurs effets sur les pratiques. C’est à ce second volet de la recherche que le numéro est consacré : que nous apprend la recherche en didactique des sciences et des technologies sur la formation des enseignants de ces domaines ? Au-delà de la spécification des enjeux actuels des formations et de quelques points de repères généraux issus des recherches, on y trouve plus particulièrement la description, la caractérisation ou encore l’analyse des effets de formations initiales ou continues à la programmation et à l’investigation dans le primaire ou encore à l’autonomie et à l’enseignement des SVT dans le secondaire. No one disputes the need today for lifelong learning to cope with the quick changes in our societies and their ever-increasing complexity. Science and technology teachers are no exception to this, and their training partly conditions the integration of their pupils into the society in which they will live. In this context, the contributions of research, particularly in education, can be decisive, whether they feed directly into training activities (when they concern the teaching and learning of scientific or technological concepts and methods, or the nature of science or technology) or whether they analyse the training activities of teachers in the field and their effects on practices. This issue is devoted to this second aspect: what can we learn from research in science and technology education about teacher training in these fields? Beyond the specification of current training issues and some general benchmarks from research, it describes, characterizes or analyses the effects of initial or continuing training in programming and investigation in elementary school or in autonomy and the teaching of life sciences in secondary school.
For the last 14 years the Pan American Health Organization has been promoting surveillance of invasive pneumococcal disease in Latin American children for better understanding of the disease ...tendencies regarding capsular types circulation in each country and susceptibility to antimicrobials.
Laboratory-based surveillance data from 10 Latin American countries collected from 2000 to 2005 were analyzed, including serotype distribution and susceptibility to beta-lactam antibiotics.
Although 61 different capsular types were identified during the 6-year surveillance, 13 serotypes accounted for 86% of all isolates. These were consistently the most prevalent throughout the study period with serotype 14 predominating. Diminished susceptibility to penicillin was detected in 38% of all Streptococcus pneumoniae isolates, with the highest prevalence in Dominican Republic and Mexico. Decreased susceptibility to penicillin increased in Brazil and Colombia whereas decreased high resistance rates was recorded in Chile.
These data indicate that 10 countries of the Region continue to have high quality laboratory-based surveillance for pneumococcal disease thus generating valuable information so that healthcare decision makers may prioritize interventions. The heptavalent vaccine will potentially cover from 52.4% to 76.5% of strains causing invasive pneumococcal disease and the 13 valent from 76.7% to 88.3%.
OBJETIVO:El objetivo de este estudio es el análisis del marco legal de salud y propiedad intelectual en Cuba y su incidencia en las condiciones de acceso de la población a los recursos de salud y el ...papel de los diferentes actores sociales. METODOLOGÍA: Se utilizó la metodología desarrollada por la Organización Panamericana de la Salud para la ejecución del Proyecto Mapa Conceptual sobre Salud Pública y Propiedad Intelectual. RESULTADOS: La información recobrada en específico sobre el marco legal y su evolución en el tiempo en Cuba relacionado con el Sistema Nacional de Salud, el Sistema de Propiedad Intelectual y el fortalecimiento de la industria biofarmacéutica del país, fue procesada y analizada generando el Mapa Conceptual sobre Salud Pública y Propiedad Intelectual de Cuba. CONCLUSIONES: El análisis de la experiencia cubana en la adecuación de su marco legal y la evaluación de la interrelación de los actores sociales permite observar cómo la voluntad política existente a lo largo de varias décadas ha impactado de manera positiva en el acceso a la salud de la población.
PDF
