RESUMENObjetivo. Estimar la proporción de niños menores de cinco años con acceso a agua de calidad y su comportamiento en función de la localización geográfica, abastecimiento de agua y situación de pobreza. Materiales y métodos. Encuesta continua (transversal repetida), por muestreo aleatorio multietápico, del universo de niños menores de cinco años residentes en el Perú. Se evaluó la presencia de cloro libre en muestras de agua para consumo en los hogares de 3570 niños (Lima metropolitana 666, resto de costa 755, sierra urbana 703, sierra rural 667 y selva 779). Se evaluó la presencia de coliformes totales y E. coli en muestras de agua de 2310 hogares (Lima metropolitana 445, resto de costa 510, sierra urbana 479, sierra rural 393 y selva 483). Resultados. La proporción nacional de niños menores de cinco años que residen en hogares con cloro libre adecuado en el agua para consumo, alcanza a 19,5% del total, mientras que la correspondiente a agua libre de coliformes y E. coli asciende a 38,3%. Existe una marcada diferencia de los resultados por área de residencia (los ámbitos más afectados fueron sierra rural y selva), red pública domiciliaria dentro de la vivienda y quintiles de ingreso. Conclusión. Existe una gran desventaja en los niños menores de cinco años provenientes de hogares pertenecientes al área rural y en extrema pobreza, para acceder al consumo de agua de calidad. Esta situación representa un serio problema para el control de las enfermedades diarreicas y la desnutrición infantil. Palabras clave: Microbiología del agua; Calidad del agua; Abastecimiento de agua; Encuestas nutricionales; Pobreza; Perú (fuente: DeCS BIREME). STATE OF THE QUALITY OF DRINKING WATER IN HOUSEHOLDS IN CHILDREN UNDER FIVE YEARS IN PERU, 2007-2010 ABSTRACTObjective. To evaluate the proportion of children under five with access to quality water and its behavior according to geographical location, water supply and poverty status. Material and methods. Continuous survey (repeated cross), with multistage random sampling, being the universe children under five years living in Peru. We evaluated the presence of free chlorine in drinking water samples in the dwellings of 3570 children (Metropolitan Lima 666, Rest of Coast 755, Urban Sierra 703, Rural Sierra 667, and Jungle 779). We evaluated the presence of total coliforms and E. coli in water samples of 2310 households (445 Metropolitan Lima, Rest of Coast 510, Urban Sierra 479, Rural Sierra Selva 393 and 483). Results. The national proportion of children under five years living in households with adequate free chlorine in drinking water reaches 19.5% of the total, while water free of coliforms and E. coli is 38.3%. There is a marked difference in results by area of residence (the most affected areas were rural Sierra and Jungle), public network at home inside the dwelling and income quintiles. Conclusion. Children under five years living in households belonging to the rural areas and extreme poverty, have a great disadvantage to access quality water consumption. This situation r...
El sobrepeso y la obesidad en niños y adolescentes representa un serio problema de salud pública en el Perú, con elevados costos para la sociedad, esto hace necesaria la implementación de un conjunto de políticas públicas dirigidas hacia el control de dicho inconveniente. Así, se han propuesto intervenciones como la regulación de la publicidad de alimentos no saludables, su autorregulación, la implementación de quioscos saludables y el etiquetado nutricional. Desde el análisis de la problemática del sobrepeso y obesidad en niños y adolescentes en el Perú, el presente artículo hace una revisión narrativa de dichas intervenciones.
RESUMENLa obesidad infantil representa uno de los mayores problemas de salud pública a nivel mundial. En el presente artículo se exponen las intervenciones para prevenir el sobrepeso y obesidad en niños menores de cinco años. Las intervenciones dirigidas a prevenir la obesidad en infantes fueron: promoción de la lactancia materna, vigilancia del crecimiento del niño y promoción de una adecuada alimentación complementaria, a través de la consejería nutricional con enfoque de alimentación responsiva, brindadas en distintos escenarios como el centro de salud o basados en el hogar a través de visitas domiciliarias. Las intervenciones dirigidas a prevenir obesidad en los preescolares incluyen las intervenciones con componentes de actividad física y nutrición que involucren activamente a los padres. La calidad de la evidencia de la mayoría de estudios es alta debido a que proviene de ensayos clínicos controlados, revisiones sistemáticas y metaanálisis. Todas estas intervenciones se realizan o podrían ser replicadas en nuestro país, mediante una adecuada contextualización. Palabras clave: Obesidad pediátrica, Sobrepeso, Nutrición infantil, Programas y políticas de nutrición y alimentación. (fuente DeCS BIREME) INTERVENTIONS TO PREVENT THE DEVELOPMENT OF OVERWEIGHT AND OBESITY IN CHILDREN YOUNGER THAN FIVE YEARS ABSTRACTChildhood obesity is one of the most severe public health problems worldwide. The present study describes the interventions used to prevent overweight and obesity in children younger than 5 years. The objective of the interventions was to stimulate breastfeeding, monitor the child's growth, and promote adequate complementary feeding by means of nutritional counseling using a responsive feeding approach in different settings, including health centers and residences. The interventions included physical activity and nutritional counseling, with the active participation of the parents. The quality of evidence from most studies was high because the evidence was derived from controlled clinical trials, systematic reviews, and meta-analyses. All interventions were conducted or could be replicated in Peru by adequate contextualization. Keywords
Background and aims In a study carried out in adults with diabetes mellitus has been shown that monitoring thyroid function is cost effective in patients with positive anti-thyroid antibodies from the start of the illness; but the incidence of hypothyroidism is low in those patients who did not have antibodies from the begging.Although autoimmune thyroiditis is rare in prepuberal age, the aim of our study was to determinate if the data obtained in adults correlates with the paediatric population diagnosed of diabetes mellitus and also to find out how many patients have thyroid antibodies during their follow up and when that positivization occurs. Methods Retrospective descriptive study of 76 paediatric patients diagnosed of diabetes (between 1988 and 2013) at our hospital with available data of anti-thyroid antibodies (anti-thyroglobulin and anti-thyroperoxidase). Characteristics of age at the begging, Tunner stage, thyroglobulin antibodies, anti-thyroperoxidase, thyroid function, glycosylated haemoglobin and other antibodies were analysed. Results 76 patients were included, 51% were men and 48% women. The mean age of the study population at diagnosis was 8.15 years (1-16), Tunner stage 1 in 61% of cases, with mean baseline TSH of 2.9 mUI/L. In an isolated case positive anti-thyroid antibodies were detected at the begging before puberty. Among all the patients with no anti-thyroid antibodies at the diagnosed of the illness, 3 patients had thyroid antibodies at prebuberal age and 6 after puberty, with a mean age 12.1 years at the time of the positivization (8-16 years). Conclusions Most of the patients have negative anti-thyroid antibody titles at diagnosis, positivization often occurs after puberty or in adulthood, that suggests monitoring thyroid function is not cost effective in paediatric patients. 10.1136/archdischild-2014-307384.734 Background and aims Given the heritability of a diabetic predisposition and the need for a timely initiation of screening and preventive measures it seems prudent to identify infants from (a) a mother with preexisting diabetes mellitus (DM) or (b) with gestational diabetes (GDM), in contrast to infants with simple macrosomia (M). Methods Identification of pregnant women with DM, GDM or fetal macrosomia in a level III obstetric department over a period of 5 months, using fetal ultrasound, medical history, oral glucose tolerance test and further variables. Collection of anthropometric and metabolic data from mother and infant. PO-0061 ARE CLINICAL OR METABOLIC VARIABLES USEFUL TO DISTINGUISH BETWEEN AN INFANT OF
Results Optimal cut-off values for automatically detected inspiratory and expiratory wheezing were 2% and 3%, respectively. The resulting sensitivity of inspiratory and expiratory wheezing were 83.3% and 84.6%, and the specificity 78% and 82.5%, respectively ( Figure). The inter-rater agreement was moderate with a Fleiss' Kappa of 0.59 for inspiratory wheezing and 0.54 for expiratory wheezing. Conclusion Computerised lung sound analysis is feasible already during the first months of life and provides quantitative and noninvasive information about the extent of wheezing, whereas the assessment by trained clinicians was subjective and only moderate in inter-rater agreement. Introduction Fraction of exhaled nitric oxide (FeNO) is a biomarker of eosinophilic airway inflammation, determining airway responsiveness to inhaled corticosteroid treatment and atopy. It is a non-invasive, reproducible, simple and safe method of measuring airway inflammation that provides a complementary tool to other ways of assessing airways disease, including asthma. Methods Retrospective descriptive study. The data of 99 paediatric patients attending outpatients in paediatric pneumology (from July 2012 to June 2013) with 2 consecutive measurements of FeNO was included. Characteristics of sex, age, exerciseinduced asthma, prick test, FeNO, forced expiratory volume (FEV1), asthma control test (ACT) and baseline asthma treatment were analysed. PS-180 MEASUREMENT OF FRACTIONAL NITRIC OXIDE CONCENTRATION IN EXHALED BREATH IN MONITORING THE PAEDIATRIC PATIENTThe variations in FeNO, ACT, exercise-induced asthma and FEV 1 after intensifying or initiating treatment were collected. Results 99 patients, 46 men and 53 women were included. The mean age of the study population was 12.5 years (5-17) with an initial average ACT of 20.13 (10-25), FEV1 of 78% (42-132%) and an initial FeNO of 51.02 (7 -170). 95.8% had a positive prick test. 45 exercise tests were performed, in 18 (40%) of them a decrease in FEV1 >10% was found. 15.2% of the patients were not taking any treatment at the first visit, 23.3% received Smart therapy (long-acting beta2-agonists and inhaled corticosteroids), 20.2% beta2-adrenergic agonist, 15% therapy Smart + montelukast, inhaled corticosteroids 13.1% and 13% other combined therapies.A statistically significant decrease in FeNO to 31.9 t = 6.594 (p = 0.000) was found after starting treatment, intensifying or modifying basic treatment. A statistically significant correlation was found between FeNO decrease and ACT improvement r = -0398 (p = 0.000) and FEV1 r = -0.260 (p = 0.01) between the first and the second visit. Conclusions The decrease in airway inflammation correlates with an increased subjective control of the disease and also with a higher forced expiratory volume. In our series of patients these results were achieved increasing Smart treatment therapy, as well as adding inhaled corticosteroid in patients not previously taking, including other treatment options. The value of FeNO also served to identify non-compliant patien...
Objetivos: Evaluar la capacidad predictiva de las recomendaciones de ganancia de peso gestacional respecto del bajo peso al nacer (BPN) y la macrosomía neonatal, propuestas por el Institute of Medicine (IOM) y el Centro Latinoamericano de Perinatología (CLAP). Materiales y métodos: La búsqueda bibliográfica se realizó en PubMed, Embase (vía Ovid), Cochrane Library, EBSCOhost, Scopus, LILACS y SciELO. La calidad metodológica se evaluó utilizando QUADAS 2. Resultados: Se obtuvieron 1192 artículos, cinco cumplieron los criterios de inclusión, ningún estudio evaluó las recomendaciones CLAP. La sensibilidad y especificidad para predecir el BPN y la macrosomía variaron largamente según el país de realización del estudio. En las cohortes de América Latina, la sensibilidad para predecir el BPN varió entre 62,8% y 74%, y la especificidad, entre 61,7% y 68%, mientras que la sensibilidad para predecir macrosomía fue 28,8%, y la especificidad, 43,8%. En la mayoría de estudios el valor predictivo positivo fue inferior al 25%, y el valor predictivo negativo, superior al 90%. La mayoría de los estudios tuvo alto riesgo de sesgo y problemas de aplicabilidad en la selección de pacientes. Conclusiones: La limitada calidad metodológica y representatividad de las cohortes estudiadas, probables factores de confusión no ajustados y modestos valores de sensibilidad y especificidad sugieren la necesidad de desarrollar estudios para establecer recomendaciones que se ajusten a las características epidemiológicas de la población peruana.
Objetivo. Estimar la proporción de niños menores de cinco años con acceso a agua de calidad y su comportamiento en función de la localización geográfica, abastecimiento de agua y situación de pobreza. Materiales y métodos. Encuesta continua (transversal repetida), por muestreo aleatorio multietápico, del universo de niños menores de cinco años residentes en el Perú. Se evaluó la presencia de cloro libre en muestras de agua para consumo en los hogares de 3570 niños (Lima metropolitana 666, resto de costa 755, sierra urbana 703, sierra rural 667 y selva 779). Se evaluó la presencia de coliformes totales y E. coli en muestras de agua de 2310 hogares (Lima metropolitana 445, resto de costa 510, sierra urbana 479, sierra rural 393 y selva 483). Resultados. La proporción nacional de niños menores de cinco años que residen en hogares con cloro libre adecuado en el agua para consumo, alcanza a 19,5% del total, mientras que la correspondiente a agua libre de coliformes y E. coli asciende a 38,3%. Existe una marcada diferencia de los resultados por área de residencia (los ámbitos más afectados fueron sierra rural y selva), red pública domiciliaria dentro de la vivienda y quintiles de ingreso. Conclusión. Existe una gran desventaja en los niños menores de cinco años provenientes de hogares pertenecientes al área rural y en extrema pobreza, para acceder al consumo de agua de calidad. Esta situación representa un serio problema para el control de las enfermedades diarreicas y la desnutrición infantil.
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