RESUMO Introdução: As vantagens e desvantagens do uso de alinhadores ortodônticos têm sido reportadas com base mais na experiência clínica e opinião de experts do que em evidências científicas. Outro aspecto importante é que os alinhadores estão em processo de evolução constante. Assim, torna-se importante obter evidências recentes, que abranjam as novas atualizações na tecnologia de confecção, no desenvolvimento de novos protocolos de planejamento para as movimentações, a incorporação e desenho dos attachments e o auxílio da ancoragem esquelética. Métodos: As evidências encontradas em seis bases de dados eletrônicas (CINAHL, MEDLINE, EMBASE, Psych Info, Biblioteca Cochrane e Biblioteca Joanna Briggs) serão apresentadas por meio de perguntas e respostas. Conclusões: Há evidências de que os alinhadores apresentam diferentes níveis de dificuldade para realizar cada tipo de movimento, sendo os movimentos rotacionais e verticais os mais difíceis de serem executados. Quanto à percepção da dor causada pela movimentação dentária, parece haver menos impacto no início do tratamento, mas os alinhadores produzem mais alterações fonoarticulatórias e parecem exigir mais tempo de tratamento em casos mais complexos. Não há evidência de diferença na estabilidade pós-tratamento, e os alinhadores não impedem a ocorrência de reabsorção radicular, apesar da incidência e a gravidade da reabsorção poderem ser menores, facilitam a higiene bucal, reduzindo o risco de manchas brancas, cáries e doenças periodontais. Dada a evidência conflitante, a liberação de bisfenol-A pelo alinhador não pode ser negada. É preciso encontrar soluções que reduzam o impacto ambiental do descarte dos alinhadores. Há uma necessidade urgente de ensaios clínicos randomizados bem desenhados. Introdução científicas constante Assim tornase torna se recentes confecção movimentações esquelética Métodos CINAHL, CINAHL (CINAHL MEDLINE EMBASE Info Briggs respostas Conclusões movimento executados dentária complexos póstratamento, póstratamento pós pós-tratamento radicular menores bucal brancas periodontais conflitante bisfenolA bisfenol A negada desenhados

ABSTRACT Introduction: The benefits and safety of using orthodontic aligners have been reported more by clinical experience and expert opinion than by scientific evidence. Another important aspect is that aligners are constantly evolving. It is important to obtain evidence that allows for new updates in manufacturing technology, in the development of new movement planning protocols, in the incorporation and design of attachments, and in the aid of skeletal anchorage. Methods: Evidence retrieved from six electronic databases (CINAHL, MEDLINE, EMBASE, Psych Info, the Cochrane Library and the Joanna Briggs Library) is presented by means of questions and answers. Conclusions: There is evidence that the aligners presented different levels of difficulty in performing each type of movement, with rotational and vertical movements being the most difficult to perform. Regarding perception of pain due to tooth movement, it seems to have less impact at the beginning of treatment; but dealing with more phonoarticulatory changes seems to require more treatment time in more complex cases. Aligners do not prevent the occurrence of root resorption, although the incidence and severity of resorption may be reduced, making oral hygiene easier and accepting the risk of white spots, caries and periodontal disease. Given the conflicting evidence, the release of bisphenol-A from the aligner cannot be denied. Solutions must be found to reduce the environmental impact of aligners disposal. There is an urgent need for well-designed randomized controlled trials. Introduction evolving technology protocols attachments anchorage Methods CINAHL, CINAHL (CINAHL MEDLINE EMBASE Info answers Conclusions perform cases reduced spots disease bisphenolA bisphenol A denied disposal welldesigned well designed trials

Resumo Introdução: Atualmente, um elevado número de intervenções coronárias percutâneas são realizadas via artéria radial ocasionando um aumento da variabilidade de métodos, dispositivos e protocolos de hemóstase. Objetivo: Mapear a evidencia disponível permitir-nos-á melhorar a prática diária. De momento não há evidencia de revisões publicadas sobre este tema. Métodos: Esta revisão segue a metodologia do Joanna Briggs Institute para scoping reviews. Dois revisores independentes selecionarão os estudos elegíveis. Os dados extrair-se-ão usando uma ferramenta criada ad hoc para reportar os objetivos e as questões de revisão. A análise será apresentada em formato tabular e sumario narrativo. Se reportarão os resultados segundo as guias Preferred Reporting Items for Systematic Reviews and Meta-Analysis com a extensão para scoping reviews. Realizar-se-á uma pesquisa numa seleção de bases de dados eletrónicas relevantes e de literatura cinzenta. Serão considerados estudos com participantes de ambos sexos, submetidos a angiografia coronária via artéria radial. Todos os estudos desde 1989 serão incluídos, ano em que se descreveu por primeira vez o acesso radial para uma intervenção coronária percutânea. Resultados: Mapear a evidencia contribuirá para identificar o foco do estudo, a hemóstase da artéria radial depois de angiografia coronária. Conclusão: Espera-se que esta revisão sirva de apoio a futuros estudos que permitam melhorar a prática clínica diária.

Abstract Introduction: Nowadays, a great number of interventional cardiology procedures are made via radial artery, which has increased the variability of hemostasis methods, devices, and protocols. Objective: The focus of this scoping review is to map the literature on hemostasis of the radial artery after coronary angiography. To date, no previous reviews addressing this purpose have been found. Methods: This review follows the Joanna Briggs Institute methodology for scoping reviews. Two reviewers will independently perform the study selection regarding their eligibility. Data extraction will be accomplished using a researcher's developed tool to address the objectives and reviews questions. Any disagreements arisen between the reviewers will be resolved by discussion or consulting a third reviewer. Data synthesis will be presented in tabular form and a narrative summary that align with the review's objective. Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension to scoping reviews guidelines will be used to report the results. A set of relevant electronic databases and grey literature will be searched. Results: Mapping the evidence will contribute to identifying the focus of the study, the hemostasis of the radial artery after coronary angiography. Conclusion: It is expected that this review serves as a support to the development of future studies that will improve daily practice.

Resumen Introducción: Hoy día, un gran número de intervenciones coronarias percutáneas son realizadas vía artería radial razón para el incremento de la variabilidad de métodos, dispositivos y protocolos de hemostasia. Objetivo: Mapear la evidencia disponible nos permitirá mejorar la práctica diaria. Al presente, no hay constancia de revisiones publicadas sobre este tema. Métodos: Esta revisión sigue la metodología del Joanna Briggs Institute para scoping reviews. Dos revisores independientemente realizarán la selección de estudios elegibles. Los datos se extraerán usando una herramienta ad hoc de manera a reportar los objetivos y las cuestiones de revisión. El análisis será presentado en formato tabular y sumario narrativo. Se reportarán los resultados usando las guías Preferred Reporting Items for Systematic Reviews and Meta-Analysis con la extensión para scoping reviews. Se hará una búsqueda en una selección de bases de datos electrónicas relevantes y de literatura gris. Serán considerados estudios en los que hayan participado pacientes de ambos sexos, sometidos a una angiografía coronaria vía arteria radial. Todos los estudios desde 1989 serán incluidos, el año en que el acceso transradial se describió por primera vez para una intervención coronaria percutánea. Resultados: El mapeo de la evidencia contribuirá a la identificación del foco principal de estudio, la hemostasia de la arteria radial post angiografía coronaria. Conclusión: De esta revisión se espera que sirva de apoyo al desarrollo de futuros estudios que mejoren la práctica clínica diaria.

ABSTRACT Introduction: For nursing, comfort is a care-related objective in the multiple settings of professional performance; it leads to the formulation of theories with a holistic perspective and manages to be applied from a physical, psychospiritual, environmental and social point of view. Objective: To identify the attributes of the concept of comfort understood by nursing in different care settings. Methods: Integrative review carried out in the Scopus, Google Scholar, VHL, EBSCO, Cochrane, Ovid and Medline databases, using the following search strategy: "Comfort" AND "Nursing". The eligibility criteria considered primary studies, full texts, published between 2009 and 2019, in Spanish, English or Portuguese. The PRISMA diagram was used for the critical analysis of experimental, review and qualitative studies, using the templates of the Critical Appraisal Skills Program (Caspe). For the other designs, the checklists of the Joanna Briggs Institute were applied and sixteen articles were included. Conclusion: Comfort is related to issues that enclose the physical, social, psychic and environmental reality of a person, determined by the following attributes: physical relief of pain through pharmacological interventions and external elements in contact with the body; social support with the closeness of family members, which facilitates adaptation to the hospital environment and reduces anxiety; relationships with the accompanying health personnel and access to information on the patient's condition; an adapted environment to favor recovery and relief; rest including sleep and generating relief; and mental health with relief of anxiety, stress and adequate mental recovery.

RESUMEN Introducción: Para enfermería, el confort es un objetivo de cuidado en los múltiples escenarios del actuar disciplinario, lleva a la formulación de teorías con perspectiva holística y logra aplicar el confort desde una mirada física, psicoespiritual, ambiental y social. Objetivo: Identificar los atributos del concepto confort entendido por enfermería en los diferentes escenarios de cuidado. Métodos: Revisión integrativa, con estrategia de búsqueda: “Confort” AND “Nursing”, en las bases de datos Scopus, Google Académico, BVS, EBSCO, Cochrane, Ovid y Medline. Los criterios de elegibilidad fueron: estudios primarios, a texto completo, publicados entre 2009-2019, en español, inglés y portugués. Se utilizó el diagrama prisma para el análisis crítico de diseños experimentales, revisiones y cualitativos, se emplearon las plantillas del Critical Appraisal Skills Programme (Caspe). Para los demás diseños se aplicaron las listas de chequeo del Joanna Briggs Institute, quedaron incluidos 16 artículos. Conclusión: El confort está ligado a temas que enmarcan la realidad física, social, psíquica y ambiental de la persona, determinado por los atributos: 1. Alivio físico del dolor mediante intervenciones farmacológicas y de elementos externos en contacto con el cuerpo. 2. Soporte social con cercanía de los familiares, lo que facilita la adaptación al ambiente hospitalario y reduce la ansiedad. 3. Relaciones con el personal sanitario de acompañamiento y acceso a información sobre la condición del paciente. 4. Ambiente adaptado para favorecer la recuperación y alivio. 5. Descanso que incluye reposo y sueño, generando alivio; y 6. Salud mental con alivio de ansiedad, estrés y adecuada recuperación mental.

Abstract Introduction Children with hearing loss have been reported to perform lower in executive function and language tasks than their normal-hearing peers. Objective To describe EF performance profile in children and adolescents with hearing loss. Method Using different databases including PubMed, Scopus, and ScienceDirect, we conducted a systematic review of case-control, cross-sectional studies, and case series that evaluated executive function performance in children and adolescents with hearing loss with or without hearing aids, cochlear implants, and/or native sign language, since 2000 until April 2020. Fifteen studies were selected after quality assessment using Critical Appraisal Tools provided by Joanna Briggs Institute. Results The studies differed in the assessment tools, and the results obtained by different authors were inconsistent. However, these studies revealed that children and adolescents with hearing impairment have lower performance in working memory, inhibition, cognitive flexibility, and attention than their normal-hearing peers. Discussion and conclusion Executive function assessment tools are used indistinctively for both children with and without hearing loss. Consequently, as tools were designed for normal hearing population, results can significantly vary in the population with hearing impairment. Hence, it is important to establish a standardized protocol specifically adapted for this population.

Resumen Introducción Se ha reportado que los niños con pérdida auditiva tienen un desempeño más bajo en pruebas de función ejecutiva y lenguaje en comparación con sus pares oyentes. Objetivo Describir el perfil de desempeño en funciones ejecutivas en niños y adolescentes con pérdida auditiva. Método Utilizando diferentes bases de datos incluidas PubMed, Scopus y ScienceDirect, se llevó a cabo una revisión sistemática de estudios de corte transversal, casos y controles y series de casos que evaluaron el desempeño en funciones ejecutivas de niños y adolescentes con pérdida auditiva con y sin audífonos, implante coclear y/o uso de lenguaje de señas desde 2000 hasta abril de 2020. Se seleccionaron 15 estudios usando el instrumento de evaluación de calidad del Instituto Joanna Briggs. Resultados Los estudios utilizaron distintas herramientas de evaluación con resultados inconsistentes entre los diferentes autores. Sin embargo, los estudios reportaron que los niños y adolescentes con pérdida auditiva tienen un desempeño más bajo en memoria de trabajo, inhibición, flexibilidad cognitiva y atención que sus pares oyentes. Discusión y conclusión Las herramientas de evaluación de función ejecutiva fueron empleadas indistintamente para niños con y sin pérdida auditiva. Teniendo en cuenta que las pruebas están diseñadas para la población oyente, los resultados pueden variar significativamente en la población con pérdida auditiva. De ahí la importancia de establecer un protocolo estandarizado adaptado para esta población.

Abstract: The paradigm of collaborative health care delivery drove the development of interprofessional competency frameworks (ICFs). The Train4Health project, funded by the Erasmus+ program, aims to improve healthcare students’ competencies in behaviour change support to optimize self-care in chronic diseases. As part of this project, we surveyed the landscape of ICFs in health. Our aim was to characterize ICFs in health and its translation into learning outcomes embedded in academic curricula. An integrative review was conducted between March and September 2020 based on a predefined protocol. The search was performed in EBSCO, B-On, Scopus, Web of Science and Joanna Briggs Institute databases. Four articles were eligible, describing ICFs in different domains in health, such as digital healthcare environment, simulation and genetic healthcare. Generally, ICFs were planned and developed by a committee. Students were involved in all four ICFs. These frameworks supported the development of learning outcomes-based curricula, organized in a tiered or straightforward structure, with different learning outcomes depending on their complexity and specialization level. Despite the overlap in some areas across health professions, we found only four ICFs that can guide collaborative education and are linked to learning outcomes. Pursuing this integrated approach, ideally resorting to structured scientific methods, may facilitate competencies attainment and merits further attention.

RESUMO: Descreve-se um caso de parvovirose em uma lontra (Lontra longicaudis) enviada ao Núcleo de Reabilitação da Fauna Silvestre e Centro de Triagem de Animais Silvestres da Universidade Federal de Pelotas, Rio Grande do Sul, Brasil. O animal estava debilitado, apático, apresentava diarreia escura e fétida e lesões crostosas nos coxins palmares dos membros torácicos e pélvicos, morrendo após tratamento de suporte com antibiótico, anti-inflamatório e fluidoterapia. Na necropsia os intestinos estavam edematosos e avermelhados e o rim direito estava recoberto de material brancacento e esponjoso, com comprometimento de cerca de um terço do órgão. Foi observado, também, um exemplar de Dioctophyma renale, fêmea, livre na cavidade abdominal. Histologicamente havia fusionamento das vilosidades, dilatação das criptas intestinais com enterite linfocítica moderada multifocal e depleção linfoide nos linfonodos mesentéricos. Na técnica de imuno-histoquímica (IHQ) com anticorpo monoclonal anti-Parvovírus canino (Anti-CPV) houve marcação positiva nos enterócitos da base das vilosidades intestinais e na medula óssea, confirmando o diagnóstico de parvovirose. O peritônio sobre o rim direito estava espessado e revestido por células cuboides, formando múltiplas projeções papilares, nas quais observava-se acentuado infiltrado de células gigantes, macrófagos, linfócitos, eosinófilos e plasmócitos. Entre as projeções papilares havia ovos de Dioctophyma renale, áreas de necrose, calcificação e células gigantes. Conclui-se que a lontra, em função da fragmentação e degradação de seu habitat natural, aproximou-se do centro urbano e contaminou-se com o vírus, o qual é mantido e disseminado por animais domésticos. Por sua vez, a infecção por D. renale pode estar relacionada com a presença de animais domésticos parasitados, os quais eliminam ovos do helminto através da urina contaminando o ambiente, onde coabitam hospedeiros intermediários e paratênicos do parasito. As doenças desses animais podem ser um fator de declínio das populações de animais silvestres e alerta para o risco de spill-over na região.

ABSTRACT: This study describes a case of parvovirus infection in a river otter (Lontra longicaudis) assisted at the Wildlife Rehabilitation Center and Wildlife Screening Center, Federal University of Pelotas (UFPel), Rio Grande do Sul state, Brazil. Clinical signs included apathy, dark and fetid diarrhea, and crusted lesions on the palmar pads of the fore and hind limbs. The animal died after undergoing support treatment with antibiotics, anti-inflammatory, and fluid therapy. At necropsy, the intestines were reddened and edematous and the right kidney was diminished by one third of its normal size and covered with whitish, spongy material. A female Dioctophyma renale was found free in the abdominal cavity. Histologically, dilatation of the intestinal crypts and fusion and blunting of the intestinal villi were observed. In addition, moderate, multifocal lymphocytic enteritis with lymphoid depletion in Peyer’s patches and mesenteric lymph nodes were present. Immunohistochemistry with anti-canine parvovirus monoclonal antibody (anti-CPV) was strongly positive in the bone marrow cells and enterocytes of the intestinal crypts, confirming the diagnosis of parvovirus infection. The peritoneum on the right kidney was expanded with a cuboidal cell border, forming multiple papillary projections associated with eggs of D. renale and severe inflammatory infiltrate (giant cells, macrophages, lymphocytes, eosinophils, and plasma cells). Areas of necrosis and mineralization were also observed. Due to fragmentation and degradation of its natural habitat, the otter approached the urban area and was contaminated with the virus, which is hosted and disseminated by domestic animals. Infection with D. renale can be associated with the large population of parasitized domestic animals, which eliminate the helminth eggs through urine, contaminating the environment where the parasite intermediate and paratenic hosts co-inhabit. The diseases of these animals can be a decline factor of wild populations that inhabit the region and are an alert to spillover risk.

Abstract: Children's mental health services are said to be the biggest failure in Britain's National Health Service, specially, with regard to the treatment of depression and suicidal behaviour in children and adolescents. The use of antidepressants in children and adolescents shows the largest gap existing in health services between clinical practice and scientific evidence, among open label studies that claim its benefits and a big number of randomized controlled trials (RCTs) that indicate the opposite, and among RCTs as they are published and advertised and what their data actually prove. However, antidepressants are commonly used and they probably are the most prescribed drugs in adolescents. The context of antidepressant use during childhood, the evidence analysis, the harms and risks, the increase of suicidal events, and other issues related to clinical practice are addressed. The place of SSRIs in clinical practice might be related to their potential serenic effect, different from the anxiolytic effect of benzodiazepines and antipsychotics. If “this therapeutic principle” were considered as primary outcome, it would allow a better understanding of RCT data and a clinical practice based on a more balanced risk-benefit ratio. Its application would require a collaborative work with patients and a significant degree of autonomy with regards to what is included in the clinical guidelines. The paper examines general troubles of healthcare services, their sustainability, health promotion, and drug use, comparing the diagnosis and treatment of child and youth depression with those of osteoporosis and other diseases, like asthma and high blood pressure. Finally, a free access campaign to clinical trial data is advocated.

Resumen: Se dice que los servicios de salud mental infantil son el mayor fracaso de la sanidad británica; en particular, en lo que respecta al tratamiento de la depresión y las conductas suicidas en niños y adolescentes. El uso de los antidepresivos en niños y adolescentes ilustra la mayor brecha existente en los servicios sanitarios entre práctica médica y evidencias científicas, entre estudios de diseño abierto que reivindican beneficios y un gran número de ensayos clínicos aleatorizados (ECA) que señalan lo contrario, y entre los estudios ECA tal como se publican y publicitan y lo que en realidad demuestran sus datos. Sin embargo, los antidepresivos se usan de forma habitual y, probablemente, son los fármacos más prescritos en la adolescencia. Se examina el contexto del uso de antidepresivos en la infancia, el análisis de las pruebas, los daños y riesgos, el aumento de conductas suicidas y otras cuestiones de práctica clínica asociadas. El lugar para la clínica de los ISRS puede estar asociado a su posible efecto “serénico”, distinto al efecto ansiolítico de las benzodiacepinas y antipsicóticos. Considerar este “principio terapéutico” como resultado primario permitiría una mejor comprensión de los datos de los ensayos clínicos y una práctica clínica más equilibrada en su balance riesgo/beneficio. Su aplicación obligaría a un trabajo colaborativo con los pacientes y a un importante grado de autonomía respecto a lo que recogen las guías clínicas. Se analizan los problemas generales de los servicios sanitarios, su sostenibilidad, la promoción de la salud y el uso de medicamentos, ilustrado por el diagnóstico y tratamiento de la depresión infanto-juvenil y otras afecciones, como la osteoporosis, el asma o la hipertensión arterial. Finalmente, se aboga por una campaña de acceso libre a los datos de los ensayos clínicos.

Prior to 2007, efforts to monitor and conserve hawksbill turtles (Eretmochelys imbricata) in the eastern Pacific Ocean were opportunistic and records were virtually non-existent. The first abundance estimates were published in 2010, but contained limited data on the species. Ongoing research since that time has led to the identification of several rookeries, including sites containing large proportions of the overall hawksbill nesting currently known to occur in the region. Monitoring projects were established at several sites and have since provided substantial nesting data on the species. Here we summarize data collected between 1983 and March 2016 from all sites (n = 9) confirmed to host >10 nests in any given season to provide an update on hawksbill nesting in the eastern Pacific. We documented a total of 3,508 hawksbill nests, 265,024 hatchlings and 528 individual nesting females in the region. The vast majority of these records (99.4%, 99.9% and 99.6%, respectively) were generated subsequent to 2007, coinciding with the discovery of eight of the nine rookeries included in this study and the organization of monitoring efforts at those sites, which led to the increased documentation conferred here. Our findings should not be misconstrued as increases in actual nesting or signs of recovery, which could diminish the ongoing need for conservation actions, but rather as optimism, that there is still an opportunity to restore the species in the eastern Pacific. The top three sites in terms of average annual number of nests were Estero Padre Ramos (Nicaragua; 213.2 ± 47.6 nests), Bahia de Jiquilisco (El Salvador; 168.5 ± 46.7 nests) and Aserradores (Nicaragua; 100.0 ± 24.0 nests), and all three sites are located in mangrove estuaries in Central America, highlighting the importance of these rookeries/habitats for the survival and recovery of hawksbills in the region. The remaining six sites received between 6.9 ± 7.3 nests (Costa Careyes, Mexico) and 59.3 ± 17.7 nests (Los Cobanos, El Salvador) annually. By integrating data collected on nesting hawksbills with local conservation realities at the most important known hawksbill rookeries in the eastern Pacific, we provide a more holistic view of the conservation status and management needs of the species in this ocean region.

OBJECTIVE: To develop a decision-support tool to help policy-makers in sub-Saharan Africa assess whether intermittent preventive treatment in infants (IPTi) would be effective for local malaria control. METHODS: An algorithm for predicting the effect of IPTi was developed using two approaches. First, study data on the age patterns of clinical cases of Plasmodium falciparum malaria, hospital admissions for infection with malaria parasites and malaria-associated death for different levels of malaria transmission intensity and seasonality were used to estimate the percentage of cases of these outcomes that would occur in children aged < 10 years targeted by IPTi. Second, a previously developed stochastic mathematical model of IPTi was used to predict the number of cases likely to be averted by implementing IPTi under different epidemiological conditions. The decision-support tool uses the data from these two approaches that are most relevant to the context specified by the user. FINDINGS: Findings from the two approaches indicated that the percentage of cases targeted by IPTi increases with the severity of the malaria outcome and with transmission intensity. The decision-support tool, available on the Internet, provides estimates of the percentage of malaria-associated deaths, hospitalizations and clinical cases that will be targeted by IPTi in a specified context and of the number of these outcomes that could be averted. CONCLUSION: The effectiveness of IPTi varies with malaria transmission intensity and seasonality. Deciding where to implement IPTi must take into account the local epidemiology of malaria. The Internet-based decision-support tool described here predicts the likely effectiveness of IPTi under a wide range of epidemiological conditions.

OBJETIVO: Desarrollar una herramienta de apoyo a las decisiones para ayudar a los encargados de la formulación de políticas en el África subsahariana a evaluar si el tratamiento preventivo intermitente en lactantes (TPIL) sería eficaz en el control local de la malaria. MÉTODOS: Se creó un algoritmo para pronosticar el efecto del TPIL utilizando dos métodos. En primer lugar, se utilizaron datos del estudio relativos a patrones de edad de los casos clínicos de malaria por Plasmodium falciparum, ingresos hospitalarios por infección con parásitos causantes de la malaria y fallecimientos asociados a malaria para distintos grados de intensidad y estacionalidad de la transmisión de la malaria, con el fin de calcular el porcentaje de casos con estos desenlaces que se producirían en niños <10 años que serían objeto del TPIL. En segundo, lugar, se utilizó un modelo matemático estocástico desarrollado previamente para pronosticar el número de casos que sería probable que se evitaran mediante la implementación del TPIL en distintas condiciones epidemiológicas. Esta herramienta de apoyo a las decisiones utiliza los datos obtenidos con estos dos métodos que sean más pertinentes para el contexto especificado por el usuario. RESULTADOS: Los resultados obtenidos con estos dos métodos indicaron que el porcentaje de casos objeto del TPIL aumenta al hacerlo la gravedad del desenlace de la malaria y la intensidad de la transmisión. La herramienta de apoyo a las decisiones, disponible en Internet, proporciona estimaciones del porcentaje de fallecimientos, hospitalizaciones y casos clínicos asociados a la malaria que serán objeto del TPIL en un contexto determinado, así como de la cantidad de estos desenlaces que se podría haber evitado. CONCLUSIÓN: La eficacia del TPIL varía en función de la intensidad y la estacionalidad de la transmisión de la malaria. A la hora de decidir dónde implementar el TPIL habrá que tener en cuenta la epidemiología local de la malaria. La herramienta de apoyo a las decisiones disponible en Internet y descrita en este trabajo pronostica la eficacia probable del TPIL en una gran variedad de condiciones epidemiológicas.

OBJECTIF: Développer un outil d'aide à la prise de décision pour aider les responsables politiques en Afrique subsaharienne à évaluer si un traitement préventif intermittent des nourrissons (IPTi) serait efficace pour contrôler la malaria. MÉTHODES: Un algorithme pour prédire l'effet de l'IPTi a été développé au moyen de deux approches. D'abord, des données d'étude sur les profils d'âge de cas cliniques de malaria causée par le Plasmodium falciparum, les admissions en hôpital pour infection aux parasites de la malaria et les décès associés aux différents niveaux d'intensité de transmission de la malaria et son caractère saisonnier, ont été utilisées pour évaluer le pourcentage de cas de ces résultats qui se produisent chez des enfants de moins de 10 ans visés par l'IPTi. Ensuite, un modèle mathématique stochastique, développé avant l'IPTi, a été utilisé pour prévoir le nombre de cas pouvant être évités en appliquant l'IPTi sous différentes conditions épidémiologiques. L'outil d'aide à la prise de décision utilise les données les plus pertinentes des deux approches dans le contexte spécifié par l'utilisateur. RÉSULTATES: Les résultats des deux approches indiquent que le pourcentage de cas visés par l'IPTi augmente avec la sévérité des résultats de la malaria et avec l'intensité de la transmission. L'outil d'aide à la prise de décision, disponible sur Internet, fournit des évaluations du pourcentage de décès, d'hospitalisations et de cas cliniques associés à la malaria, qui seront visés par l'IPTi dans un contexte spécifié et du nombre de cas qui pourraient être évités. CONCLUSION: L'efficacité de l'IPTi varie avec l'intensité de la transmission de la malaria et son caractère saisonnier. Pour décider où appliquer l'IPTi, on doit prendre en considération l'épidémiologie locale de la malaria. L'outil d'aide à la prise de décision sur Internet ici décrit l'efficacité possible de l'IPTi avec une large gamme de conditions épidémiologiques.

En el presente estudio se evaluó la capacidad probiótica in vitro de una cepa nativa de Saccharomyces cerevisiae (A) y se comparó con una cepa comercial (B) utilizada como probiótico. Para esto se determinó la concentración de melaza de caña (10, 20 y 30% (p/v)) que permitiera obtener la mayor cantidad de biomasa de las cepas, así mismo se determinaron parámetros cinéticos. La concentración de melaza que arrojó mejores resultados fue 20% (p/v) y se encontró diferencia en la producción de biomasa para la cepa en estudio A (28g/L) y la cepa control B (3g/L) en medio melaza. Se realizaron pruebas in vitro como resistencia a sales biliares, tolerancia a rangos de pH y jugos gástricos, donde no se observaron diferencias entre la cepa A y B al medir el crecimiento. La reducción del colesterol en presencia de sales biliares después de 12 horas de incubación fue de 54% para la cepa A y 58% para la B. Por último se realizó una prueba de adherencia en células Caco-2, encontrando adherencia a estas por parte de ambas cepas. De acuerdo con los resultados anteriores se demostró que la cepa A tiene propiedades probióticas in vitro que pueden ser corroboradas con posteriores estudios in vivo que confirmen su utilización como probiótico en nutrición animal.

The in vitro probiotic capacity of a native strain of Saccharomyces cerevisiae (A) was evaluated and compared with a commercial strain (B) used as a probiotic. The effect of the concentration of sugarcane molasses (10, 20 and 30% (w/v)) on the biomass production was investigated and kinetic parameters were determined. The best molasses concentration was 20% (w/v) and differences in biomass production on molasses medium between strain A (28 g/L) and control strain B (3 g/L) were observed. In vitro tests such as tolerance to bile salts, pH and gastric juices were carried out, and no differences in growth between strain A and B were found. Cholesterol reduction on presence of bile salts after 12 hours of incubation was of 54% for strain A and 58% for strain B. Both strains showed adherence to Caco-2 cells. Results reveal that strain A possesses in vitro probiotic properties that can be verified with further in vivo studies to confirm its suitability as probiotic in animal nutrition.

Introduction: In France, general practice is playing an increasing role in the management of common mental disorders. This is due to a variety of factors, among which the way general practice and specialised mental health services have evolved over time. Methods: A description of the status quo in France, with a comparison between France, the UK and the Netherlands. A review of reasons for the present position. Results: The general practitioner (GP) is often the only medical carer to be contacted in cases of psychological distress and over 80% of psychotropic medications are prescribed in this setting. Although most common forms of mental disorder can be managed at the primary care level, GPs need to be able to refer patients rapidly to specialised mental health services. Yet there are delays for consultations with both private and public psychiatrists along with difficulties in finding beds for full-time hospitalisation. The situation is predicted to get worse with the reduction in the number of psychiatrists and GPs forecasted for the coming years. 'Psychiatric sectorisation' has led to a substantial development of community mental health care services, yet this has not compensated fully for the reduction in full-time hospital beds. Furthermore, community mental health care services remain relatively isolated from other community health services with very limited exchanges with general practice. Conclusion: GPs report an urgent need for training in mental health. Along with improving their ability to accurately detect and treat mental disorders, it is crucial also to improve communication between GPs and psychiatrists and increase shared case-management. Structural changes are also necessary to ensure a quicker and easier access to specialised mental health care services.

OBJECTIVE: The Integrated Management of Childhood Illness (IMCI) strategy is designed to address the five leading causes of childhood mortality, which together account for 70% of the 10 million deaths occurring among children worldwide annually. Although IMCI is associated with improved quality of care, which is a key determinant of better health outcomes, it has not yet been widely adopted, partly because it is assumed to be more expensive than routine care. Here we report the cost of IMCI compared with routine care in four districts in the United Republic of Tanzania. METHODS: Total district costs of child care were estimated from the societal perspective as the sum of child health-care costs incurred in a district at the household level, primary health-facility level and hospital level. We also included administrative and support costs incurred by national and district administrations. The incremental cost of IMCI is the difference in costs of child health-care between districts with and without IMCI, after standardization for population size. FINDINGS: The annual cost per child of caring for children less than five years old in districts with IMCI was US$ 11.19, 44% lower than the cost in the districts without IMCI (US$ 16.09). Much of the difference was due to higher rates of hospitalization of children less than 5 years old in the districts without IMCI. Not all of this difference can be attributed to IMCI but even when differences in hospitalization rates are excluded, the cost per child was still 6% lower in IMCI districts. CONCLUSION:IMCI was not associated with higher costs than routine child health-care in the four study districts in the United Republic of Tanzania. Given the evidence of improved quality of care in the IMCI districts, the results suggest that cost should not be a barrier to the adoption and scaling up of IMCI.

OBJETIVO: La estrategia de Atención Integrada a las Enfermedades Prevalentes de la Infancia (AIEPI) se ha concebido para abordar las cinco causas principales de mortalidad en la niñez, que juntas representan un 70% de los 10 millones de defunciones registradas anualmente entre los niños en todo el mundo. Aunque garantiza una atención de mayor calidad, y ello es un factor clave para conseguir mejores resultados de salud, la AIEPI todavía no ha sido adoptada de forma generalizada, en parte porque se supone que es más costosa que la atención ordinaria. Informamos aquí sobre el costo de la AIEPI en comparación con la atención habitual en cuatro distritos de la República Unida de Tanzanía. MÉTODOS: Los costos distritales totales de la atención infantil se estimaron desde la perspectiva de la sociedad sumando para cada distrito los costos de esa atención a nivel de los hogares, a nivel de los servicios de atención primaria y a nivel hospitalario. Incluimos también los gastos administrativos y de apoyo de las administraciones nacional y distritales. El costo marginal de la AIEPI es la diferencia entre el costo de la atención infantil en los distritos con AIEPI y los distritos sin AIEPI, después de normalizar en función del tamaño de la población. RESULTADOS: El costo anual por niño de la atención a los menores de cinco años en los distritos con AIEPI fue de US$ 11,19, un 44% inferior al costo en los distritos sin AIEPI (US$ 16,09). Gran parte de la diferencia se debió a las mayores tasas de hospitalización registradas entre los menores de 5 años en los distritos sin AIEPI. No toda esa diferencia puede atribuirse a la AIEPI, pero, aun excluyendo las diferencias en las tasas de hospitalización, el costo por niño fue un 6% inferior en los distritos con AIEPI. CONCLUSIÓN: La AIEPI no entrañó un mayor costo que la atención infantil ordinaria en los cuatro distritos estudiados en la República Unida de Tanzanía. Dada la evidencia que demuestra la mejor calidad de la atención en los distritos con AIEPI, los resultados indican que los costos no deben suponer un obstáculo para adoptar y extender masivamente la AIEPI.

OBJECTIF: La stratégie de prise en charge intégrée des maladies de l'enfance (PCIME) est conçue pour faire face aux cinq causes principales de mortalité infantile, responsables dans leur ensemble de 70 % des 10 millions de décès d'enfants survenant chaque année dans le monde. Bien que la PCIME s'accompagne d'une amélioration de la qualité des soins, qui est la clé d'une issue plus clémente de la maladie, elle n'a pas encore été largement adoptée, en partie parce qu'elle est présumée plus onéreuse que les soins systématiques. Cet article compare le coût de la PCIME à celui des soins systématiques dans quatre districts de la République-Unie de Tanzanie. MÉTHODES: On a estimé les coûts totaux pour la société des soins infantiles dispensés dans les districts comme la somme des coûts des soins de santé infantiles supportés dans le district au niveau du ménage, de l'installation de santé primaire et de l'hôpital. On a aussi pris en compte les coûts administratifs et les dépenses d'appui subis par les administrations relevant de l'Etat et du district. Le coût marginal de la PCIME correspond à la différence de coût des soins de santé infantiles entre les districts bénéficiant d'une prise en charge intégrée et ceux n'en bénéficiant pas, après standardisation pour la taille de la population. RÉSULTATS: Le coût annuel par enfant de la dispensation de soins à des enfants de moins de cinq ans dans un district bénéficiant de la PCIME était de US $ 11,19, c'est-à-dire inférieur de 44 % à celui supporté dans les districts ne bénéficiant pas de cette prise en charge (US $ 16,09). Une grande partie de la différence était imputable aux taux plus élevés d'hospitalisation des enfants de moins de cinq ans dans les districts ne disposant pas de la PCIME. La totalité de cette différence ne peut être attribuée à la PCIME. Cependant, même si l'on fait abstraction des différences de taux d'hospitalisation, le coût par enfant reste inférieur de 6 % dans les districts où une PCIME a été mise en place. CONCLUSION: Dans les quatre districts tanzaniens étudiés, la PCIME n'entraînait pas des coûts plus élevés que ceux des soins de santé infantiles systématiques. Compte tenu de l'amélioration de la qualité des soins dans les districts bénéficiant de cette prise en charge, les résultats laissent à penser que les coûts ne devraient pas faire obstacle à l'adoption et à l'élargissement de la PCIME.

A cross-sectional study was conducted in four rural communities of northeastern Trinidad to determine the microbial quality of water supply to households and that quality's relationship to source and storage device. Of the 167 household water samples tested, total coliforms were detected in 132 of the samples (79.0%), fecal coliforms in 102 (61.1%), and E. coli in 111 (66.5%). There were significant differences among the towns in the proportion of the samples contaminated with coliforms (P < 0.001) and E. coli (P < 0.001). Of 253 strains of E. coli studied, 4 (1.6%) were mucoid, 9 (3.6%) were hemolytic, and 37 (14.6%) were nonsorbitol fermenters. Of 69 isolates of E. coli tested, 10 (14.5%) were verocytotoxigenic. Twenty-eight (14.0%) of 200 E. coli isolates tested belonged to enteropathogenic serogroups. Standpipe, the most common water source, was utilized by 57 (34.1%) of the 167 households. Treated water (pipeborne in homes, standpipes, or truckborne) was supplied to 119 households (71.3%), while 48 households (28.7%) used water from untreated sources (rain, river/stream, or well) as their primary water supply. The type of household storage device was associated with coli-form contamination. Water stored in drums, barrels, or buckets was more likely to harbor fecal coliforms (74.2% of samples) than was water stored in tanks (53.3% of samples), even after controlling for water source (P = 0.04). Compared with water from other sources, water piped into homes was significantly less likely to be contaminated with total coliforms (56.9% versus 88.8%, P < 0.001) and fecal coliforms (41.2% versus 69.8%, P < 0.01), even when the type of storage device was taken into account. However, fecal contamination was not associated with whether the water came from a treated or untreated source. We concluded that the drinking water in rural communities in Trinidad was grossly unfit for human consumption, due both to contamination of various water sources and during household water storage.

Se realizó un estudio transversal en cuatro comunidades rurales del nordeste de la isla de Trinidad para determinar la calidad microbiológica de los suministros domésticos de agua y la relación entre dicha calidad y el origen del agua y los recipientes utilizados para su almacenamiento. Entre las 167 muestras de agua doméstica analizadas, se detectaron coliformes totales en 132 (79,0%), coliformes fecales en 102 (61,1%) y Escherichia coli en 111 (66,5%). Hubo diferencias significativas entre los pueblos con respecto a la proporción de muestras contaminadas con coliformes (P < 0,001) y E. coli (P < 0,001). De las 253 cepas de E. coli estudiadas, 4 (1,6%) eran mucoides, 9 (3,6%) hemolíticas y 37 (14,6%) no fermentadoras de sorbitol. De 69 aislados de E. coli en los que se analizó esta característica, 10 (14,5%) fueron citotóxicos para las células Vero. Veintiocho de 200 (14,0%) aislados de E. coli analizados pertenecían a serogrupos enteropatógenos. El origen más frecuente del agua fueron las fuentes (57 de los 167 domicilios; 34,1%). Ciento diecinueve domicilios (71,3%) recibían agua tratada (agua canalizada hasta el domicilio, de fuente o de camión cisterna), mientras que los otros 48 (28,7%) utilizaban agua no tratada (de lluvia, ríos/arroyos o pozos) como principal suministro de agua. El tipo de recipiente de almacenamiento en el domicilio se asoció con la contaminación por coliformes. El agua almacenada en bidones, barriles o cubos tenía mayores probabilidades de albergar coliformes fecales (74,2% de las muestras) que el agua almacenada en tanques (53,3% de las muestras), incluso después de controlar el efecto del origen del agua (P = 0,04). En comparación con el agua de otras fuentes, el agua canalizada hasta las casas tenía una probabilidad significativamente menor de estar contaminada por coliformes totales (56,9% frente a 88,8%; P < 0,001) y coliformes fecales (41,2% frente a 69,8%, P < 0,01), incluso después de tener en cuenta el tipo de recipiente de almacenamiento. Sin embargo, la contaminación fecal no se asoció con el origen tratado o no tratado del agua. Concluimos que el agua para beber de las comunidades rurales de Trinidad era en general no apta para el consumo humano debido a su contaminación tanto en el origen como durante el almacenamiento en el domicilio.