Objective Delivery by a skilled birth attendant (SBA) serves as an indicator of progress towards reducing maternal mortality worldwide -the fifth Millennium Development Goal. Though WHO tracks the proportion of women delivered by SBAs, we know little about their competence to manage common life-threatening obstetric complications. We assessed SBA competence in five high maternal mortality settings as a basis for initiating quality improvement. Methods The WHO Integrated Management of Pregnancy and Childbirth (IMPAC) guidelines served as our competency standard. Evaluation included a written knowledge test, partograph (used to record all observations of a woman in labour) case studies and assessment of procedures demonstrated on anatomical models at five skills stations. We tested a purposive sample of 166 SBAs in Benin, Ecuador, Jamaica and Rwanda (Phase I). These initial results were used to refine the instruments, which were then used to evaluate 1358 SBAs throughout Nicaragua (Phase II). Findings On average, Phase I participants were correct for 56% of the knowledge questions and 48% of the skills steps. Phase II participants were correct for 62% of the knowledge questions. Their average skills scores by area were: active management of the third stage of labour -46%; manual removal of placenta -52%; bimanual uterine compression -46%; immediate newborn care -71%; and neonatal resuscitation -55%. Conclusion There is a wide gap between current evidence-based standards and provider competence to manage selected obstetric and neonatal complications. We discuss the significance of that gap, suggest approaches to close it and describe briefly current efforts to do so in Ecuador, Nicaragua and Niger. Une traduction en français de ce résumé figure à la fin de l'article. Al final del artículo se facilita una traducción al español.Are skilled birth attendants really skilled? A measurement method, some disturbing results and a potential way forward Introduction BackgroundEach year obstetric complications kill over 500 000 women worldwide. 1,2Skilled attendance during labour, delivery and in the early postpartum period could prevent many of these deaths, though establishing a causal link between skilled attendance and maternal survival remains problematic.2-6 Still, the proportion of deliveries assisted by a skilled birth attendant (SBA) has become an indicator for measuring maternal mortality reduction, including the 75% reduction called for by the fifth Millennium Development Goal (MDG-5). 7,8 WHO defines an SBA as someone "trained to proficiency in the skills needed to manage normal (uncomplicated) But are skilled birth attendants really skilled? Do the health personnel enumerated by household surveys fit WHO's definition? This question was the focus of our two-phase study. In Phase I, we developed and piloted evaluation instruments, then carried out small-scale competency assessments in four countries. In Phase II, shortcomings identified in Phase I were corrected and the revised instruments used to conduct a large...
Objectives To evaluate the impact of time to results (TTR) on the outcome of patients with carbapenemase-producing Enterobacterales bloodstream infections (CPE-BSI). Methods Times-series study conducted from January 2014 to December 2021, selecting patients with first CPE-BSI episodes. Periods of intervention were defined according to implementation of diagnostic bundle tests in the microbiology laboratory: pre-intervention (January 2014–December 2017) and post-intervention (January 2018–December 2021). TTR was defined as time elapsed from positivity time of the blood culture bottles to physicians’ notification of CPE-BSI episodes, and was evaluated in patients who received inappropriate empirical and switched to appropriate targeted treatment (switch group). Analysis of a composite unfavourable outcome (mortality at Day 30 and/or persistent and/or recurrent bacteraemia) was performed for the total episodes and in the switch group. Results One hundred and nine episodes were analysed: 66 pre-intervention and 43 post-intervention. Compared with pre-intervention, patients in the post-intervention period were younger (68 versus 63 years, P = 0.04), had INCREMENT score > 7 (31.8% versus 53.5%, P = 0.02) and unfavourable outcome (37.9% versus 20.9%, P = 0.04). Proportion of TTR > 30 h was more frequent pre-intervention than post-intervention (61.7% versus 35.5%, P = 0.02). In multivariate analysis of the 109 episodes, source other than urinary or biliary (OR 2.76, 95% CI 1.11–6.86) was associated with unfavourable outcome, while targeted appropriate treatment trended to being protective (OR 0.17, 95% CI 0.03–1.00). Considering the switch group (n = 78), source other than urinary or biliary (OR 14.9, 95% CI 3.25–69.05) and TTR > 30 h (OR 4.72, 95% CI 1.29–17.22) were associated with unfavourable outcome. Conclusions Decreased TTR in the post-intervention period was associated with the outcome in patients with CPE-BSI episodes.
El durazno (Prunus persica L. Batsch), es una de las especies frutales caducifolias más cultivadas en las zonas templadas del mundo, su fruto presenta buenas características nutritivas, lo que lo hace un alimento saludable con importante uso agroindustrial. Se observa que el durazno es el cultivo que genera mayor nivel de participación en el ingreso neto de los hogares del municipio de Chitaga Departamento Norte de Santander, con un 87,74% del neto de los ingresos obtenidos por la explotación. Dentro de los factores que limitan la producción agrícola y la calidad de las cosechas están las enfermedades y las plagas, las cuales pueden atacar los cultivos desde que las plantas inician su crecimiento, hasta la cosecha y su almacenamiento. Existe un abuso indiscriminado en la utilización de pesticidas por parte de los agricultores superando las dosis requeridas para el control de plagas y enfermedades. En el municipio de Chitaga para el control de plagas y enfermedades se utilizan frecuentemente fungicidas como baycor, score, difenoconasol, daconil, funlate, insecticidas como karate, acaricida como vertimek, sunfire, herbicida como finale y compuestos de azufre como microthiol. En este trabajo se determinó la genotoxicidad producida por extractos de durazno (Prunus pérsica (L.) Batsch) cultivado en Chitaga, Norte de Santander utilizando el ensayo cometa para la evaluación de la actividad genotoxica. Se encontró que extractos de durazno inducen daño genotóxico dependiente de la dosis en linfocitos Humanos, lo cual lo cual podría convertirse en un factor de riesgo para la población expuesta. Palabras clave: Durazno; genotoxicidad; ruptura DNA; Chitaga; Norte de Santander.
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