Tuberculosis causes more deaths than any other infectious disease globally. Bacillus Calmette-Guérin (BCG) is the only available vaccine, but protection is incomplete and variable. The modified ...Vaccinia Ankara virus expressing antigen 85A (MVA85A) is a viral vector vaccine produced to prevent tuberculosis.
To assess and summarize the effects of the MVA85A vaccine boosting BCG in humans.
We searched the Cochrane Infectious Diseases Group Specialized Register; Central Register of Controlled Trials (CENTRAL); MEDLINE (PubMed); Embase (Ovid); and four other databases. We searched the WHO ICTRP and ClinicalTrials.gov. All searches were run up to 10 May 2018.
We evaluated randomized controlled trials of MVA85A vaccine given with BCG in people regardless of age or HIV status.
Two review authors independently assessed the eligibility and risk of bias of trials, and extracted and analyzed data. The primary outcome was active tuberculosis disease. We summarized dichotomous outcomes using risk ratios (RR) and risk differences (RD), with 95% confidence intervals (CI). Where appropriate, we combined data in meta-analyses. Where meta-analysis was inappropriate, we summarized results narratively.
The search identified six studies relating to four Phase 2 randomized controlled trials enrolling 3838 participants. Funding was by government bodies, charities, and philanthropic donors. Five studies included infants, one of them infants born to HIV-positive mothers. One study included adults living with HIV. All trials included authors from Oxford University who led the laboratory development of the vaccine. Participants received intradermal MVA85A after BCG in some studies, and before selective deferred BCG in HIV-exposed infants.The largest trial in 2797 African children was well conducted with low risk of bias for most parameters. Risk of bias was uncertain for selective reporting because there were no precise case definition endpoints for active tuberculosis published prior to the trial analysis.MVA85A added to BCG compared to BCG alone probably has no effect on the risk of developing microbiologically confirmed tuberculosis (RR 0.97, 95% CI 0.58 to 1.62; 3439 participants, 2 trials; moderate-certainty evidence), or the risk of starting on tuberculosis treatment (RR 1.10, 95% CI 0.92 to 1.33; 3687 participants, 3 trials; moderate-certainty evidence). MVA85A probably has no effect on the risk of developing latent tuberculosis (RR 1.01, 95% CI 0.85 to 1.21; 3831 participants, 4 trials; moderate-certainty evidence). Vaccinating people with MVA85A in addition to BCG did not cause life-threatening serious adverse effects (RD 0.00, 95% CI -0.00 to 0.00; 3692 participants, 3 trials; high-certainty evidence). Vaccination with MVA85A is probably associated with an increased risk of local skin adverse effects (3187 participants, 3 trials; moderate-certainty evidence), but not systemic adverse effect related to vaccination (144 participants, 1 trial; low-certainty evidence). This safety profile is consistent with Phase 1 studies which outlined a transient, superficial reaction local to the injection site and mild short-lived symptoms such as malaise and fever.
MVA85A delivered by intradermal injection in addition to BCG is safe but not effective in reducing the risk of developing tuberculosis.
Children and pregnant women require multiple contacts with the healthcare system. While most conditions can be managed by primary healthcare (PHC) providers, hospitalisations are common. This health ...system evaluation in Tajikistan quantifies unnecessary and unnecessarily prolonged hospitalisations and assesses antibiotic and polypharmacy practices.
Data were retrospectively collected from randomly selected medical records from 15 hospitals. Inclusion criteria were children 2-59 months of age with a primary diagnosis of acute respiratory infection or diarrhoea, or pregnant women with threatened preterm labour, threatened miscarriages, premature rupture of membranes or mild pre-eclampsia, hospitalised between January and September 2021.
Among 440 children and 422 pregnant women, unnecessary hospitalisations accounted for 40.5% and 69.2% of hospitalisations, respectively, ranging from 0% to 92.7% across the hospitals. Among necessary hospitalisations, 63.0% and 39.2% were unnecessarily prolonged in children and women, respectively.Prior to admission, 36.8% of children had received antibiotics, in which more than half intramuscularly. During hospitalisation, 92.5% of children and 28.9% of women received antibiotics. Children and women received an average of 5 and 6.5 drugs, respectively; most were not indicated or with no evidence of benefits.
The methodology is applicable across all health systems and can provide important insights on health service use and resource waste. Findings of this assessment in Tajikistan have led to evidence-based decisions and actions from stakeholders and policy makers with the goal of strengthening PHC and improving the management of common diseases in children and pregnant women.
Globally, approximately 21.6 million children need pediatric palliative care (PPC). The greatest burden lies in low- and middle-income countries, where the demand for PPC exceeds available resources.
...The objective of this study was to assess the impact of a PPC workshop on healthcare providers’ self-efficacy, comfort and confidence related to the provision of PPC in a Bhutanese referral-level hospital.
This mixed-methods study included a one-and-a-half day PPC workshop with surveys administered to participants at three time points (before, immediately after, and six months after the workshop) to evaluate changes in self-efficacy, comfort and confidence. The study was conducted in January 2017 with healthcare providers at the Jigme Dorji Wangchuck National Referral Hospital in Thimphu, Bhutan.
Forty-one providers participated in the workshop; 38 completed the post-workshop survey and 27 completed the six months post-workshop survey. Results showed statistically significant increases in comfort levels from pre- to post-workshop surveys across nearly all areas. Qualitative results supported these findings.
The results of this study suggest that a short, interactive and interdisciplinary workshop, originally designed for the United States setting but adapted to a low resource context, is an effective way to improve providers’ self-efficacy, comfort and confidence in the provision of PPC in resource-limited settings.
Based on our recent health system evaluation conducted across 10 public hospitals in Romania in December 2021 and the ensuing review of 240 randomly selected medical records, 44.2% of women who gave ...birth were found to be discharged with a diagnosis of hypogalactia, defined as insufficient milk secretion to maintain exclusive breastfeeding 4. Researchers in the Romanian study could not differentiate whether the diagnosis of hypogalactia reported in the medical records was based on a diagnosis made by a health professional or based on self-reported information of insufficient milk from the mother 4. 1 World Health Organization Regional Office for Europe, Quality of care and patient safety office, Athens, Greece 2 World Health Organization Regional Office for Europe, Child and Adolescent Health, Copenhagen, Denmark 3 World Health Organization Romania country office, Bucharest, Romania 4 Witten Herdecke University, Witten, Germany
•Inflammatory and endothelial activation markers, whose plasma concentrations can be readily measured upon first encounter, can predict poor prognosis in children with pneumonia.•sTREM-1 performed ...significantly better than commonly used acute phase markers (e.g., CRP, PCT).•The addition of sTREM-1 significantly improved the predictive accuracy of lower chest wall indrawing as a clinical sign.
Pneumonia is the leading cause of post-neonatal death amongst children under five years of age; however, there is no simple triage tool to identify children at risk of progressing to severe and fatal disease. Such a tool could assist for early referral and prioritization of care to improve outcomes and enhance allocation of scarce resources. We compared the performance of inflammatory and endothelial activation markers in addition to clinical signs or scoring scales to risk-stratify children hospitalized with pneumonia at the national referral hospital of Bhutan with the goal of predicting clinical outcome. Of 118 children, 31 evolved to a poor prognosis, defined as either mortality, admission in the paediatric intensive care unit, requirement of chest drainage or requirement of more than five days of oxygen therapy. Soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) was the best performing biomarker and performed better than clinical parameters. sTREM-1 levels upon admission had good predictive accuracy to identify children with pneumonia at risk of poor prognosis. Our findings confirm that immune and endothelial activation markers could be proactively used at first encounter as risk-stratification and clinical decision-making tools in children with pneumonia; however, further external validation is needed.
Primary health care for children in Europe is often not optimal. Primary care providers might not have been trained adequately in dealing with common conditions affecting children and adolescents, ...and outdated practices often persist. To address these problems, WHO developed the Pocket Book of Primary Health Care for Children and Adolescents. It is for use by doctors, nurses and other health workers who are responsible for the care of children and adolescents at the primary health care level. It summarizes guidance on how to manage – and when to refer – children and adolescents presenting with common complaints and conditions. It includes information to enable primary health care providers to coordinate the continued care of children and adolescents with long-term conditions and diseases managed by specialists. Preventive and promotive measures from the newborn period to adolescence include advice on the timing and content of well-child visits, the promotion of early childhood development and health messages for adolescents.
The recommendations of the Pocket Book apply across the WHO European Region and may be adapted by countries to suit their specific circumstances. A mobile APP for Android and IOS phones is available to facilitate uptake and dissemination. The Pocket Book and APP aim to improve quality of care for children and adolescents at the primary health care level. Quality of care is at the core of the comprehensive European Child and Adolescent Health Strategy that is being developed by Member States supported by WHO and partners to refocus attention on child and adolescent health after the COVID-19 pandemic had scooped attention and resources away from this age group. Countries are encouraged to adapt Pocket Book and Strategy to improve the situation of child and adolescent health and well-being in their settings and monitor progress.
Hace falta ayunar antes de una sedación? Esparza Olcina, Mª Jesús; Jullien, Sophie
Pediatría Atención Primaria,
03/2019, Letnik:
21, Številka:
81
Journal Article
Recenzirano
Odprti dostop
Conclusiones de los autores del estudio: no hubo asociación entre la duración del ayuno y ningún tipo de evento adverso, lo que indica que retrasar la sedación para cumplir con las pautas de ayuno ...establecidas por guías clínicas no mejora los resultados de la sedación en niños en el servicio de urgencia. Comentario de los revisores: es prudente mantener rígidamente los protocolos en casos de riesgo como enfermedad grave, hiperémesis, obstrucción intestinal, endoscopia o broncoscopia, pero en otros casos esta práctica carece de evidencia de beneficio, por lo que sería adecuada una revisión de los protocolos de ayuno de preparación para la sedación.
Resumen: Conclusiones de los autores del estudio: la exposición anestésica a edades menores de cuatro años tiene un efecto pequeño sobre el rendimiento académico o inteligencia en la adolescencia. ...Aunque pueden existir grupos vulnerables con un riesgo mayor, la baja diferencia global en el rendimiento académico en niños expuestos a cirugía es tranquilizadora. Comentario de los revisores: aunque se trata de un efecto mínimo y dudoso, es una información que debemos considerar cuando nos planteemos someter niños en edad preescolar a actos quirúrgicos programados que podrían ser aplazados.
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