Resumen Objetivo: Estimar la razón de costo-efectividad de la reanimación cardiopulmonar con el uso del desfibrilador externo automático (DEA), comparado con la reanimación cardiopulmonar básica, para la reanimación de personas con pérdida de conciencia en espacios de afluencia masiva de público en Colombia. Métodos: Para estimar los costos y desenlaces de las dos alternativas de comparación, se diseñó un árbol de decisiones en el cual se reflejan los principales desenlaces posterior a la pérdida de conciencia y la reanimación con cualquiera de las dos alternativas. Se asumió la perspectiva del sistema de salud colombiano en un horizonte temporal comprendido entre el momento de la pérdida de conciencia de la persona hasta el ingreso al hospital. Las probabilidades de los eventos se obtuvieron de un meta-análisis de ensayos clínicos y la información de costos de fuentes oficiales y consulta directa a proveedores de DEA en Colombia. Los costos fueron expresados en pesos colombianos de 2016 y la efectividad en muertes evitadas. Se realizaron análisis de sensibilidad determinísticos y probabilísticos para estimar el impacto de la incertidumbre sobre las conclusiones. Resultados: La razón de costo-efectividad de la reanimación cardiopulmonar con DEA fue de $3.267.777 por muerte evitada. La probabilidad de que esta intervención sea costo-efectiva es superior al 90% para un umbral de costo-efectividad superior a 10 millones de pesos. Conclusión: Un programa de reanimación cardiopulmonar con desfibrilación temprana mediante el uso de DEA, en espacios de afluencia masiva de público, es una alternativa costo-efectiva para el sistema de salud colombiano.

Abstract Objective: To estimate the cost-effectiveness of cardiopulmonary resuscitation using an automated external defibrillator (AED) compared with basic cardiopulmonary resuscitation, for the resuscitation of unconscious patients in crowded public spaces in Colombia. Methods: A decision tree was designed in order to estimate the costs and outcomes of the two alternatives. This included the main outcomes after the loss of consciousness and resuscitation by any of the two alternatives. The perspective of the Colombian Health System was adopted in a time scale consisting of the time of loss of consciousness until hospital admission. The probabilities of the events were obtained from a meta-analysis of clinical trials, and the information on costs from official sources and direct consultations with AED providers in Colombia. The costs were expressed in Colombian pesos of 2016, and the effectiveness in deaths prevented. Deterministic and probabilistic sensitivity analyses were performed to estimate the impact of uncertainty on the conclusions. Results: The cost-effectiveness of cardiopulmonary resuscitation with AED was COP $3,267,777 per death avoided. The probability that this intervention would be cost-effective is greater than 90% for cost-effectiveness threshold greater than 10 million Colombian pesos. Conclusion: A cardiopulmonary resuscitation program with early defibrillation using an AED in crowded public spaces is a cost-effective alternative for the Colombian Health System.

Abstract The scarce knowledge about the growth and development of the species of arid and semiarid zones in Mexico, has generated an over-use. Among the most important economically in Coahuila is the candelilla, of which the technical information available for decision-making in management is limited. Therefore, the objectives were: a) to group six municipalities based on the individual production of biomass evaluated in 10 natural populations of Euphorbia antisyphilitica Zucc. and, b) adjust allometric models to estimate the biomass of E. antisyphilitica in different growing conditions in the center and south of Coahuila. With an analysis of variance and the minimum significant difference, the municipalities were grouped; for each group, models were adjusted, using the ordinary least squares method. Three biomass production groups were obtained per individual (GI, GII and GIII). The models to estimate the total green biomass (kilogram per individual) for each group, resulted with an R2 Ajus higher than 0.86, in the first two groups, and for GIII it was 0.64, the RMSE (root mean square error) was lower than 0.425 and the parameters of the models were significant (p < 0.05), in the four cases. In addition, the four selected models presented normality, homogeneity of variances and the nonexistence of collinearity between variables. The selected models are statistically reliable to estimate the biomass by individuals of each group considered in this study, so they can be a useful tool in the development of management plans for the use of candelilla.

Resumen El escaso conocimiento sobre el crecimiento y desarrollo de las especies de zonas áridas y semiáridas en México ha generado un sobreaprovechamiento. Entre las especies más importantes económicamente en Coahuila está la candelilla, cuya información técnica disponible para la toma de decisiones en el manejo es limitada. Por lo anterior, los objetivos del presente trabajo fueron a) agrupar seis municipios con base en la producción individual de biomasa evaluada en 10 poblaciones naturales de Euphorbia antisyphilitica Zucc. y b) ajustar modelos alométricos para estimar la biomasa de E. antisyphilitica en diferentes condiciones de crecimiento, en el centro y sur de Coahuila. Con un análisis de varianza y la diferencia mínima significativa, se agruparon los municipios; para cada grupo se ajustaron modelos, mediante el método de mínimos cuadrados ordinarios. Se obtuvieron tres grupos de producción de biomasa por individuo (GI, GII y GIII). Los modelos para estimar la biomasa total verde (kilogramo por individuo) para cada grupo, resultaron con R2 Ajus superiores a 0.86, en los primeros dos grupos, y de 0.64 para GIII. La RCME (raíz del cuadrado medio del error) fue inferior a 0.425 y los parámetros de los modelos fueron significativos (p < 0.05), en los cuatro casos. Además, los cuatro modelos seleccionados presentaron normalidad, homogeneidad de varianzas y la inexistencia de colinealidad entre variables. Los modelos seleccionados son estadísticamente confiables para estimar la biomasa por individuo de cada grupo considerado en este estudio, por lo que podrán ser una herramienta útil en la elaboración de planes de manejo para el aprovechamiento de candelilla.

Background. At the request of the program "Medical Insurance for a New Generation in Mexico" (SMNG), we evaluated the quality of care provided to infants with respiratory distress syndrome (RDS) in the neonatal intensive care unit (NICU) financed by SMNG. Methods. There were 22 NICUs that were evaluated, with 19 structural indexes, 23 medical staff personnel, and 37 processes and outcomes measured by the mortality of RDS. The indexes were validated and qualified with the Likert metric or dichotomous scale. The average score of the qualifications were categorized as: "good" between 85 and 100 points, "average" between 60 and 84 points and "poor" <59 points. RDS as a tracer condition was evaluated from the birth of the newborn in level I or II NICU, during transportation and during hospital stay at level III. Results. Below are some indexes in the "poor" categories in the following components: structure, 11 without gasometer in the NICU and eight in the supply of essential drugs. For medical staff, in 22 NICUs the staff had not read a medical article during the last month, and 17 staff members do not use evidence-based medicine. According to processes, 13 NICU (level I or II) did not administer surfactant to infants, in nine NICU they did not perform blood gas analysis, 12 physicians did not accompany the neonate during transport and several infants arrived at level III NICU with hypothermia. The latter were categorized as "poor" according to several aspects related to the administration of surfactant and in terms of mortality as the result component was higher at lower total score indexes. Conclusions. The quality of care was poor or average in many NICUs, from the time of birth, during transportation and during the newborn's stay in Level III NICU.

Introducción. Por solicitud del programa Seguro Médico para una Nueva Generación, se evaluó la calidad de atención brindada a neonatos con síndrome de dificultad respiratoria (SDR) en las unidades de cuidados intensivos neonatales (UCIN) financiadas por ellos. Métodos. Se evaluaron 22 UCIN con 19 índices de "estructura", 23 de "personal médico" y 37 de "procesos". El "resultado" se determinó con base en la mortalidad por SDR. Los índices fueron validados y, con la métrica tipo Likert o una dicotómica, se asignaron categorías ( buena , entre 85 y 100 puntos; regular , entre 60 y 84; y mala <59 puntos). El SDR, como padecimiento trazador, se evaluó desde el nacimiento del neonato en la UCIN de nivel I o II, durante su transportación y hasta su estancia en el nivel III. Resultados. En la categoría de mala para el índice de "estructura" destacaron 11 UCIN sin gasómetro y 8 sin la disponibilidad de medicamentos indispensables. Para el índice de "personal médico", de las 22 UCIN los médicos no leyeron algún artículo sobre neonatología en el último mes, y en 17 UCIN no utilizaron en su práctica diaria la Medicina Basada en Evidencias. En los "procesos", 13 UCIN nivel I o II no administraron a los neonatos el surfactante, en 9 no realizaron gasometría arterial, en 12 no acompañaron los médicos al neonato durante la trasportación, y en varias los neonatos llegaron a las unidades de nivel III con hipotermia. En estas últimas, hubo en la categoría de mala varios índices relacionados con la administración del surfactante, y en cuanto a la mortalidad, fue más elevada a menor puntaje total de los índices. Conclusiones. La calidad fue categoría mala o regular en numerosas UCIN, desde el sitio de nacimiento, durante la transportación y durante su estancia en las UCIN nivel III.

The incidence of insect predators on orchids was evaluated in seven plots located at the Las Joyas Research Station (LJRS), Jalisco, Mexico. This research was conducted between September 2009 and February 2010. A total of 130 species from 16 orchid genera were identified. S. martiniana, C. pendula, O. tigrinum and R. splendens were the main host orchid species. All of them showed significant damages in their organs due to the incidence of phytophagous Hemiptera. M. lutem and A. spiraecola (Patch) were the phytophagous insect species that provoked major damage in orchids. Insects caused significant damages in species located in anthropised areas. This assessment would improve the current conservation strategy of Orchidaceae in Jalisco.

Se evaluó la incidencia de insectos depredadores sobre las orquídeas existentes en siete parcelas ubicadas en la Estación Científica Las Joyas (ECLJ), Sierra de Manantlán, Jalisco, México. La investigación se realizó entre los meses de septiembre de 2009 y febrero de 2010. Fueron identificadas 130 especies de 16 géneros de orquídeas. Las principales especies de orquídeas hospederas de insectos fitófagos en la ECLJ son S. martiniana, C. péndula, O. tigrinum y R. splendens. Todas mostraron daños considerables en sus órganos por la incidencia de hemípteros fitófagos. Las especies de insectos fitófagos que provocaron el daño mayor en las orquídeas fueron M. lutem y A. spiraecola (Patch). Los insectos causaron daños considerables en las especies localizadas en las áreas antropizadas. Esta evaluación permitirá mejorar la estrategia actual de conservación de Orchidaceae en Jalisco.

As infecções respiratórias agudas (IRA) são as principais causas da40 mortalidade mundial em crianças menores de cinco anos de idade e a maioria dessas mortes são próprias da bronquiolite e pneumonia. Recentes evidências de estudos usando sistemas de detecção no genoma tais como reação em cadeia da polimerase ou tecnologia de microarrays mostram que, na maioria dos casos, essas mortes são causadas ou precipitadas por vírus. Neste artigo, as definições das infecções dos tratos respiratórios superior e inferior são revisadas. Os principais sinais da gravidade da doença e a carga viral como causas da IRA estão descritas. O papel proeminente do vírus sincicial respiratório é enfatizado, com dados de estudos clínicos e epidemiológicos. Outros importantes patógenos virais, tais como o metapneumovírus humano, o coronavírus humano e influenza são examinados. O papel dos vírus recentemente descritos tais como o bocavírus, é também discutido. O impacto do HIV/AIDS na apresentação e ônus da IRA é avaliado e a sobrecarga das infecções de Pneumocystis jiroveci e Mycobacterium tuberculosis é reconhecidas. Conclui-se que há uma necessidade urgente de melhorar o diagnóstico, a terapêutica e as vacinas, bem como a ingestão de macro e micronutrientes das crianças do mundo, particularmente aquelas de países em desenvolvimento.

Acute respiratory infections (ARI) are the leading cause of mortality in children under five years of age worldwide and most of these deaths are due to bronchiolitis and pneumonia. Recent evidence from studies using genome detection systems such as polymerase chain reaction or micro-array technology show that, in most cases, these deaths are caused or precipitated by viruses. In this paper, the definitions of upper and lower respiratory tract infections are reviewed. The principal signs of disease severity and the burden of viruses as causes of ARI are described. The prominent role of Respiratory Syncytial Virus is stressed, with data from epidemiological and clinical studies. Other important viral pathogens, such as Human Metapneumovirus, Human coronaviruses and Influenza are examined. The role of newly described viruses, such as bocavirus, is also discussed. The impact of HIV/AIDS in ARI burden and presentation assessed and the weight of Pneumocystis jiroveci and Mycobacterium tuberculosis infections is recognized. It is concluded that there is an urgent need to improve diagnostics, therapeutics and vaccines, as well as macro and micronutrient intake of children of the world, particularly in developing countries.

Estima-se que a anemia afeta metade dos escolares e adolescentes nos países em desenvolvimento. As principais causas são enteroparasitoses, malária e/ou baixa ingesta de ferro. Este estudo objetivou descrever a prevalência de anemia e de enteroparasitoses, assim como o estado nutricional de escolares de primeiro grau de escolas públicas municipais de Aracaju, SE, Brasil. Dos 360 estudantes, 26,7% estavam anêmicos, sendo a prevalência maior nos menores de oito anos e nos maiores de 15. A prevalência geral de enteroparasitoses foi de 42%. Ascaris lumbricoides (28,7%), Trichuris trichiura (15,6%) e ancilostomídeos (1,7%) estavam entre os mais freqüentemente encontrados. Houve associação entre enteroparasitose e má condição de saneamento, mas não entre anemia e presença de enteroparasitos. Os escores de desvio padrão (Z-scores) de altura para idade foram inferiores aos padrões do NCHS, com prevalência de 5,4% de desnutrição pregressa (stunting). Apesar de as enteroparasitoses não terem sido associadas com anemia, as crianças que tinham parasitas ao exame apresentavam pior estado nutricional (peso/altura) que aquelas cujos exames resultaram negativos.

Anemia is estimated to affect half the school-age children and adolescents in developing countries. The main causes are parasitic infections, malaria, and low iron intake. This study aimed to describe the prevalence of anemia, parasitic infections, and nutritional status of children attending public primary schools in Aracaju, Northeast Brazil. Of 360 students, 26.7% were anemic, and prevalence was higher in children under 8 and over 15 years of age. Overall prevalence of intestinal parasites was 42%, with Ascaris lumbricoides (28.7%), Trichuris trichiura (15.6%), and hookworm (1.7%) most frequently found. There was an association between parasitic infections and poor sanitary conditions, but there was no association between anemia and presence of intestinal parasites. Height-for-age Z scores were lower than the NCHS standard, and prevalence of stunting was 5.4%. Although intestinal parasites were not associated with anemia, children with parasites had lower nutritional indices (weight- and height-for-age Z scores) than those without parasites.

Estima-se que a anemia afeta metade dos escolares e adolescentes nos países em desenvolvimento. As principais causas são enteroparasitoses, malária e/ou baixa ingesta de ferro. Este estudo objetivou descrever a prevalência de anemia e de enteroparasitoses, assim como o estado nutricional de escolares de primeiro grau de escolas públicas municipais de Aracaju, SE, Brasil. Dos 360 estudantes, 26,7% estavam anêmicos, sendo a prevalência maior nos menores de oito anos e nos maiores de 15. A prevalência geral de enteroparasitoses foi de 42%. Ascaris lumbricoides (28,7%), Trichuris trichiura (15,6%) e ancilostomídeos (1,7%) estavam entre os mais freqüentemente encontrados. Houve associação entre enteroparasitose e má condição de saneamento, mas não entre anemia e presença de enteroparasitos. Os escores de desvio padrão (Z-scores) de altura para idade foram inferiores aos padrões do NCHS, com prevalência de 5,4% de desnutrição pregressa (stunting). Apesar de as enteroparasitoses não terem sido associadas com anemia, as crianças que tinham parasitas ao exame apresentavam pior estado nutricional (peso/altura) que aquelas cujos exames resultaram negativos.

Anemia is estimated to affect half the school-age children and adolescents in developing countries. The main causes are parasitic infections, malaria, and low iron intake. This study aimed to describe the prevalence of anemia, parasitic infections, and nutritional status of children attending public primary schools in Aracaju, Northeast Brazil. Of 360 students, 26.7% were anemic, and prevalence was higher in children under 8 and over 15 years of age. Overall prevalence of intestinal parasites was 42%, with Ascaris lumbricoides (28.7%), Trichuris trichiura (15.6%), and hookworm (1.7%) most frequently found. There was an association between parasitic infections and poor sanitary conditions, but there was no association between anemia and presence of intestinal parasites. Height-for-age Z scores were lower than the NCHS standard, and prevalence of stunting was 5.4%. Although intestinal parasites were not associated with anemia, children with parasites had lower nutritional indices (weight- and height-for-age Z scores) than those without parasites.

Em estudo de intervenção educativa sobre diarréia e infecções respiratórias agudas (IRA) nos Municípios de Olinda e Recife, realizaram-se duas pesquisas domiciliares em uma amostra de famílias, com pelo menos uma criança abaixo de cinco anos, em abril-maio de 1992 e 1994. Foram estudadas 5.436 crianças. A incidência anual corrigida (IAC) de diarréia foi de 2,7 episódios por criança/ano, com uma incidência de 10,2% nas duas semanas prévias ao inquérito, estável para 1992 e 1994. Os fatores associados de forma constante a um maior risco de diarréia foram a idade da criança abaixo de dois anos, ausência de saneamento básico e de eletrodomésticos no domicílio. IAC de IRA foi de 9,5 episódios por criança/ano. A incidência de IRA foi de 41,0% em 1992 e de 32,6% em 1994, sendo a maioria de vias respiratórias altas (75,9%). Só o fator baixa idade mostrou associação com o maior risco de IRA. Os resultados indicam a importância que ambas patologias ainda têm na saúde das crianças menores de cinco anos, e, no caso da diarréia, a necessidade urgente de ampliar a cobertura dos serviços básicos visando ao impacto na redução da incidência.

Magnitude and distribution of Diarrhoea and Acute Respiratory Infections (ARI) in children were studied within a larger research that focused on health education. Two household surveys were conducted in a sample of families with at least one child under five years of Recife and Olinda in April-May 1992 and 1994. The total number of children studied was 5436. The estimated adjusted annual incidence rate (AAIR) of diarrhoea was 2.7 episodes per child. The two-week incidence rate of diarrhoea was 10.2% for both years. Risk factors associated with higher incidence of diarrhoea were age (under two years), lack of sanitation facilities and the absence of electric appliances in the household. The estimated AAIR of ARI was 9.5 episodes per child. The two-week incidence rate of ARI was 41.0% in 1992 and 32.6% in 1994. Majority of ARI affected the high respiratory track (75.9%). The only factor consistently associated with a higher risk of ARI was age (under three years). Study results indicate that both pathologies are still an important health problem for children under five in Pernambuco. In particular, in the case of diarrhoea the need for improving the access to basic services, such as water supply and sewerage system is urgently needed.

Em estudo de intervenção educativa sobre diarréia e infecções respiratórias agudas (IRA) nos Municípios de Olinda e Recife, realizaram-se duas pesquisas domiciliares em uma amostra de famílias, com pelo menos uma criança abaixo de cinco anos, em abril-maio de 1992 e 1994. Foram estudadas 5.436 crianças. A incidência anual corrigida (IAC) de diarréia foi de 2,7 episódios por criança/ano, com uma incidência de 10,2% nas duas semanas prévias ao inquérito, estável para 1992 e 1994. Os fatores associados de forma constante a um maior risco de diarréia foram a idade da criança abaixo de dois anos, ausência de saneamento básico e de eletrodomésticos no domicílio. IAC de IRA foi de 9,5 episódios por criança/ano. A incidência de IRA foi de 41,0% em 1992 e de 32,6% em 1994, sendo a maioria de vias respiratórias altas (75,9%). Só o fator baixa idade mostrou associação com o maior risco de IRA. Os resultados indicam a importância que ambas patologias ainda têm na saúde das crianças menores de cinco anos, e, no caso da diarréia, a necessidade urgente de ampliar a cobertura dos serviços básicos visando ao impacto na redução da incidência.

Magnitude and distribution of Diarrhoea and Acute Respiratory Infections (ARI) in children were studied within a larger research that focused on health education. Two household surveys were conducted in a sample of families with at least one child under five years of Recife and Olinda in April-May 1992 and 1994. The total number of children studied was 5436. The estimated adjusted annual incidence rate (AAIR) of diarrhoea was 2.7 episodes per child. The two-week incidence rate of diarrhoea was 10.2% for both years. Risk factors associated with higher incidence of diarrhoea were age (under two years), lack of sanitation facilities and the absence of electric appliances in the household. The estimated AAIR of ARI was 9.5 episodes per child. The two-week incidence rate of ARI was 41.0% in 1992 and 32.6% in 1994. Majority of ARI affected the high respiratory track (75.9%). The only factor consistently associated with a higher risk of ARI was age (under three years). Study results indicate that both pathologies are still an important health problem for children under five in Pernambuco. In particular, in the case of diarrhoea the need for improving the access to basic services, such as water supply and sewerage system is urgently needed.