Necesidades formativas docentes. El caso del municipio de Tatumbla, Francisco Morazán de Honduras

261 p.La diversidad de formación que poseen los docentes o profesores que ejercen en el Nivel de Educación Básica sin duda, enriquece los aportes de todas y todos los docentes. No obstante, el cambio de régimen legal, demanda una serie de funciones para el cargo que necesariamente responden a una propuesta de formación permanente para profesores en servicio. En este sentido, el objetivo del Trabajo de Graduación consiste en determinar necesidades formativas de los docentes permanentes de I y II Ciclo de Educación Básica del Municipio de Tatumbla, Francisco Morazán conforme a la Ley Fundamental de Educación1. El estudio pone acento en el enfoque cuantitativo, de diseño no experimental y tipo transeccional o transversal descriptivo. Para la recolección de información, se aplicó un instrumento adaptado de Ku Mota, 2013 y ONU Mujeres 2016 a 30 docentes con nombramiento permanente en los 11 centros educativos que brindan el Nivel de Educación Básica en el municipio. Los resultados responden a necesidades formativas principalmente ligadas al ejercicio de su docencia y se muestran interesados en que sus estudiantes aprendan y sean bien evaluados, a trabajar colaborativamente con sus pares y que el aprendizaje se refleje en las evaluaciones oficiales

Streptococcus pneumoniae serotype 19A in Latin America and the Caribbean: a systematic review and meta-analysis, 1990-2010

Q3Q11-13BACKGROUND: Pneumococcal conjugate vaccines (PCVs) are in the process of implementation in Latin America. Experience in developed countries has shown that they reduce the incidence of invasive and non-invasive disease. However, there is evidence that the introduction of PCVs in universal mass vaccination programs, combined with inappropriate and extensive use of antibiotics, could be associated to changes in non-PCV serotypes, including serotype 19A. We conducted a systematic review to determine the distribution of serotype 19A, burden of pneumococcal disease and antibiotic resistance in the region. METHODS: We performed a systematic review of serotype 19A data from observational and randomized clinical studies in the region, conducted between 1990 and 2010, for children under 6 years. Pooled prevalence estimates from surveillance activities with confidence intervals were calculated. RESULTS: We included 100 studies in 22 countries and extracted data from 63. These data reported 19733 serotyped invasive pneumococcal isolates, 3.8% of which were serotype 19A. Serotype 19A isolates were responsible for 2.4% acute otitis media episodes, and accounted for 4.1% and 4.4% of 4,380 nasopharyngeal isolates from healthy children and in hospital-based/sick children, respectively. This serotype was stable over the twenty years of surveillance in the region. A total of 53.7% Spn19A isolates from meningitis cases and only 14% from non meningitis were resistant to penicillin. CONCLUSIONS: Before widespread PCV implementation in this region, serotype 19A was responsible for a relatively small number of pneumococcal disease cases. With increased use of PCVs and a greater number of serotypes included, monitoring S. pneumoniae serotype distribution will be essential for understanding the epidemiology of pneumococcal disease

Non-capsulated and capsulated Haemophilus influenzae in children with acute otitis media in Venezuela: a prospective epidemiological study

<p>Abstract</p> <p>Background</p> <p>Non-typeable <it>Haemophilus influenzae </it>(NTHi) and <it>Streptococcus pneumoniae </it>are major causes of bacterial acute otitis media (AOM). Data regarding AOM are limited in Latin America. This is the first active surveillance in a private setting in Venezuela to characterize the bacterial etiology of AOM in children < 5 years of age.</p> <p>Methods</p> <p>Between December 2008 and December 2009, 91 AOM episodes (including sporadic, recurrent and treatment failures) were studied in 87 children enrolled into a medical center in Caracas, Venezuela. Middle ear fluid samples were collected either by tympanocentesis or spontaneous otorrhea swab sampling method. Standard laboratory and microbiological techniques were used to identify bacteria and test for antimicrobial resistance. The results were interpreted according to Clinical Laboratory Standards Institute (CLSI) 2009 for non-meningitis isolates. All statistical analyses were performed using SAS 9.1 and Microsoft Excel (for graphical purposes).</p> <p>Results</p> <p>Overall, bacteria were cultured from 69.2% (63 of the 91 episodes); at least one pathogen (<it>S. pneumoniae, H. influenzae, S. pyogenes </it>or <it>M. catarrhalis</it>) was cultured from 65.9% (60/91) of episodes. <it>H. influenzae </it>(55.5%; 35/63 episodes) and <it>S. pneumoniae </it>(34.9%; 22/63 episodes) were the most frequently reported bacteria. Among <it>H. influenzae </it>isolates, 62.9% (22/35 episodes) were non-capsulated (NTHi) and 31.4% (11/35 episodes) were capsulated including types d, a, c and f, across all age groups. Low antibiotic resistance for <it>H. influenzae </it>was observed to amoxicillin/ampicillin (5.7%; 2/35 samples). NTHi was isolated in four of the six <it>H. influenzae </it>positive samples (66.7%) from recurrent episodes.</p> <p>Conclusions</p> <p>We found <it>H. influenzae </it>and <it>S. pneumoniae </it>to be the main pathogens causing AOM in Venezuela. Pneumococcal conjugate vaccines with efficacy against these bacterial pathogens may have the potential to maximize protection against AOM.</p

Determinación de clorhidrato de ranitidina por cromatografía líquida de alta resolución en una solución inyectable

En la Farmacopea de los Estados Unidos (usp) se orienta como valorar el clorhidrato de ranitidina en una solución inyectable, pero cuando se intentó reproducir esta monografía, la ranitidina no se adsorbió a una columna similar a la recomendada. Este trabajo tiene como objetivo validar un método alternativo para la cuantificación de clorhidrato de ranitidina en una solución inyectable. Se empleó como método alternativo el descrito en la Farmacopea de los Estados Unidos para la cuantificación del clorhidrato de ranitidina (la sustancia activa), con modificaciones. La validación del método se realizó siguiendo las indicaciones de la Guía Q2(R1) de la Conferencia Internacional sobre la Armonización. Además, se determinó la incertidumbre del método. Los coeficientes de variación obtenidos para la precisión intermedia fueron inferiores a 1,0%; en la exactitud el recobrado fue de 100,30% y en la linealidad se demostró la ausencia de curvatura en el intervalo 80% a 120%. La incertidumbre expandida calculada fue inferior al 2% de la concentración presente en las muestras. Todos los parámetros de validación evaluados se encontraron dentro de los límites de aceptación establecidos, por lo que se concluye que el método es adecuado para los fines propuestos

Burden of influenza in Latin America and the Caribbean: a systematic review and meta-analysis

Fil: Savy, Vilma. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas; Argentina.Fil: Ciapponi, Agustín. Instituto de Efectividad Clínica y Política de salud; Argentina.Fil: Bardach, Ariel. Instituto de Efectividad Clínica y Política de salud; Argentina.Fil: Glujovsky, Demián. Instituto de Efectividad Clínica y Política de salud; Argentina.Fil: Aruj, Patricia. Instituto de Efectividad Clínica y Política de salud; Argentina.Fil: Mazzoni, Agustina. Instituto de Efectividad Clínica y Política de salud; Argentina.Fil: Gibbons, Luz. Instituto de Efectividad Clínica y Política de salud; Argentina.Fil: Ortega-Barria, Eduardo. GlaxoSmithKline Biologicals; Brasil.Fil: Colindres, Romulo. GlaxoSmithKline Biologicals; Brasil.Objective: Influenza causes severe morbidity and mortality. This systematic review aimed to assess the incidence, etiology, and resource usage for influenza in Latin America and the Caribbean. Design: Meta-analytic systematic review. Arcsine transformations and DerSimonian Laird random effects model were used for meta-analyses. Setting: A literature search from 1980 to 2008 in MEDLINE, Cochrane Library, EMBASE, LILACS, Ministries of Health, PAHO, proceedings, reference lists, and consulting experts. Sample: We identified 1092 references, of which 31 were finally included, in addition to influenza surveillance reports. We also used information from the 10 reports from the collaborative group for epidemiological surveillance of influenza and other respiratory virus (GROG), and information retrieved from the WHO global flu database FLUNET. Main outcome measures: Incidence, percentage of influenza specimens out of the total received by influenza centers and resource-use outcomes. Results: A total of 483 130 specimens of patients with influenza were analyzed. Meta-analysis showed an annual rate of 36 080 (95%CI 28 550 43 610) influenza-like illness per 100 000 persons-years. The percentage of influenza out of total specimens received by influenza centers ranged between 4.66% and 15.42%, with type A the most prevalent, and A subtype H3 predominating. The mean length of stay at hospital due to influenza ranged between 5.8 12.9 days, total workdays lost due to influenza-like illnesses were 17 150 days, and the mean direct cost of hospitalization was US$575 per laboratory-confirmed influenza case. Conclusions: Our data show that seasonal influenza imposes a high morbidity and economic burden to the region. However, the vaccine-uptake rate has been low in this region. Population-based cohort studies are required to improve the knowledge about incidence and resource utilization, which would inform healthcare authorities for decision making

Impact of rotavirus vaccination on childhood deaths from diarrhea in Brazil

SummaryObjectivesRotavirus vaccination was introduced in Brazil in March 2006, targeting an annual birth cohort of approximately 3.5 million. We analyzed trends in all-cause gastroenteritis-related deaths in children <5 years of age during the pre- and post-vaccination periods.MethodsData from the National Immunization Program and the Mortality Information System were used to calculate vaccine coverage and mortality rates related to gastroenteritis in children <1 year and 1–4 years of age, using population estimates from the census as the denominator. Relative reductions in mortality rates were calculated for 2007 and 2008, using the 2004–2005 mean as baseline before vaccine introduction.ResultsCoverage of two doses of human rotavirus vaccine was 39% in 2006, increasing to 72% in 2007 and 77% in 2008. During 2004–2005, the gastroenteritis mortality rate in children <1 year of age was 56.9 per 100 000, decreasing by 30% (95% confidence interval (CI) 19–41) in 2007 and by 39% (95% CI 29–49) in 2008. In children 1–4 years of age, the mortality rate was 4.5 per 100 000 during 2004–2005, decreasing by 29% (95% CI 10–49) in 2007 and by 33% (95% CI 15–52) in 2008.ConclusionsThe decreased rates of childhood gastroenteritis-related deaths in Brazil following rotavirus vaccine introduction, particularly among children <1 year of age, suggest the potential benefit of vaccination

Trends in hospitalizations from all-cause gastroenteritis in children younger than 5 years of age in Brazil before and after human rotavirus vaccine introduction, 1998 - 2007

GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brasil.Secretaria de Estado de Saúde do Estado do Pará. Belém, PA, Brasil.GlaxoSmithKline Biologicals. Bangalore, India.Secretaria de Estado de Saúde do Estado do Pará. Belém, PA, Brasil.GlaxoSmithKline. Rio de Janeiro, RJ, Brasil.Ministério da Saúde. Fundação Serviços de Saúde Pública. Instituto Evandro Chagas. Belém, PA, Brasil.GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brasil.Rotavirus vaccination was introduced in Brazil in March 2006.We describe trends in hospitalizations from all-cause gastroenteritis in children younger than 5 years during pre- and postvaccination periods using hospital discharge data from Brazil Hospital Information System (SIH-SUS). A reduction in gastroenteritis hospitalizations of 26% and 48% in 2006 and in 2007, respectively, was observed among children younger than 1 year compared with prevaccination period (1998 2005). The largest reduction rates among children younger than 1 year were noted in the South and Southeast regions, approximately 56% in 2007, where vaccine coverage was the highest

Clinical development, registration, and introduction of human rotavirus vaccine: The Latin American experience

GlaxoSmithKline (GSK) Biologicals was the funding source and was involved in all stages of the study conduct and analysis. GSK Biologicals also funded all costs associated with the development and the publishing of the present manuscript.Ministerio de Salud. Universidad Central de Venezuela. Instituto de Biomedicina. Retired Investigator. Carmelitas, Caracas, Venezuela.University of Chile. Faculty of Medicine. Institute of Biomedical Sciences. Santiago, Chile.Hospital del Niño. Ciudad de Panamá, Panama.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Belém, PA, Brasil.Instituto Mexicano del Seguro Social. CMN-SXXI. Pediatrics Hospital. Medical Research Unit on Infectious Diseases. México City, México.GlaxoSmithKline Biologicals. Rio de Janeiro, RJ, Brazil.GlaxoSmithKline Biologicals. Rixensart, Belgium.Rotavirus (RV) is the leading cause of severe gastroenteritis (GE) among infants and young children worldwide, accounting for 453,000 deaths in children aged <5 years. In Latin America rotavirus causes an estimated 15,000 deaths annually and accounts for 20–70% of acute gastroenteritis cases requiring hospitalization. This results in an estimated annual cost of approximately US$86 million. The most common G type has been G1 (∼50%), followed by G4, G3 and G9, although regional and temporal variations are significant. There are currently two effective rotavirus vaccines: a single-strain, human attenuated-based (RotarixTM, GlaxoSmithKline Biologicals), and a five-strain, bovine-human reassortant vaccine (RotaTeqTM, Merck and Company). The pioneering strategy behind the development and licensure of RotarixTM was part of a new paradigm for global vaccine research and development focusing on introduction first in countries with greatest medical needs. Rotarix™ demonstrated high efficacy and a good safety profile in Phase II and III clinical trials performed in Latin America. In the pivotal phase III study involving 11 Latin American countries a 2-year efficacy of 81% (95% CI: 71–87) was achieved against severe rotavirus acute gastroenteritis. A high protective efficacy was observed against severe rotavirus gastroenteritis caused by G1 and non-G1 strains. RotarixTM proved to be safe regarding intussusception (IS) in a two-dose vaccine schedule beginning at 6–12 weeks of age. First registered in Mexico in July 2004, Rotarix™ gained World Health Organization (WHO) prequalification in February 2007 and has been introduced for routine use into the universal mass vaccination programs of Brazil, Panama, Mexico, Venezuela, Ecuador, Guatemala, Honduras, Colombia, Paraguay, Bolivia, Peru, and El Salvador. The main factors influencing the decision-making process of introducing rotavirus vaccines in Latin American countries included: (a) demonstration of good efficacy/safety profiles; (b) political decision to decrease mortality; (c) decision from ministries of health; (d) availability of data on the disease burden; (e) cold chain available; and, importantly (f) the use of PAHO's Revolving Fund for the purchase of vaccines. Post-licensure studies have shown 76% (95% CI: 64–84%) effectiveness in El Salvadoran children and 76% (95% CI: 58–86%) to 85% (95% CI: 53–94%) in Brazil. Observational studies in Panama, Mexico, El Salvador and Brazil reported reduction in all-cause diarrhea-related hospitalizations at rates of 22–37%, 11–40%, 35–48%, and 17–48%, respectively. The decline in diarrhea-associated deaths reached 35% (95% CI: 29–39%) in Mexico and ranged from 22% (95% CI: 6–45%) to 33% (95% CI: 15–52%) among Brazilian children. A low, increased risk of intussusception was detected among Mexican infants within 7 days after first vaccine dose [odds ratio, 5.8 (95% CI: 2.6–13)]. Continuous and expanding post-licensure rotavirus surveillance studies are needed to better assess the effect of universal vaccination in Latin American countries and elsewhere

A cross-sectional study assessing the pharyngeal carriage of Neisseria meningitidis in subjects aged 1–24 years in the city of Embu das Artes, São Paulo, Brazil

Meningococcal carriage is a prerequisite for invasive infection. This cross-sectional study assessed the pharyngeal carriage prevalence in healthy subjects aged 1–24 years in Embu das Artes city, São Paulo, Brazil. Pharyngeal swabs were examined for the presence of Neisseria meningitidis. The isolates were tested for different serogroups using agglutination and polymerase chain reaction. A logistic regression model assessed any independent association between Neisseria meningitidis carriage and various risk factors. A total of 87/967 subjects (9%, 95% Confidence Interval (CI): 7.3–11.0) tested positive for N. meningitidis: 6.2% (95% CI: 3.8–9.4) in 1–4 years, 8.5% (95% CI: 5.1–13.0) in 5–9 years, 12.5% (95% CI: 7.8–18.6) in 10–14 years, 12.6% (95% CI: 7.4–19.7) in 15–19 years and 9% (95% CI: 4.9–14.9) in 20–24 years age groups. Highest carriage prevalence was observed in adolescents 10–19 years old. Serogroup C was predominant (18.4%) followed by serogroup B (12.6%). The 15–19 years age group showed a significant association between number of household members and carriers of N. meningitidis. This cross-sectional study is the first in Brazil to evaluate meningococcal carriage prevalence and associated factors in a wide age range. Keywords: Carriage, Meningococcal disease, Neisseria meningitidis, Pharyngeal, Serogrou

Sustained decrease in gastroenteritis-related deaths and hospitalizations in children less than 5 years of age after the introduction of rotavirus vaccination: a time–trend analysis in Brazil (2001–2010)

Secretaria de Saúde do Estado do Pará. Department of Epidemiology. Belém, PA, Brazil.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.Secretaria de Saúde do Estado do Pará. Department of Epidemiology. Belém, PA, Brazil.GSK Vaccines. Rio de Janeiro, RJ, Brazil.GSK Vaccines. Regional Office. Epidemiology and Health Outcomes. Panamá.Ministério da Saúde. Secretaria de Vigilância em Saúde. Instituto Evandro Chagas. Ananindeua, PA, Brasil.GSK Pharmaceuticals. Research & Development. Bangalore, IndiaGSK Vaccines. Regional Office. VxR&D Medical. Panamá.GSK Vaccines. VxR&D Medical & Clinical Latin America. Rio de Janeiro, RJ, Brazil.Background: Rotavirus (RV) vaccine, Rotarix, was introduced into the Brazil national immunization program in 2006. To estimate populationlevel vaccine effect, we conducted a time–trend analysis on all-cause gastroenteritis (GE)-related death certificate–reported deaths (DCRDs), hospital deaths (HDs) and hospitalizations trends in <5-year-olds before and after RV vaccine introduction. Methods: National level all-cause GE-related death certificate [Mortality Information System] and admission (Hospital Information System) data were aggregated and analyzed. Negative-binomial regression models (adjusting for age, year and region) compared DCRDs, HDs and hospitalization trends in <5-year-olds between baseline (2001−2005) and postvaccine introduction periods (Mortality Information System: 2007−2009 and Hospital Information System: 2007−2010). Negative-binomial regression models were fitted to data for each outcome before 2006, and the predicted annual frequencies of each outcome were plotted against corresponding observed annual frequencies. Results: During the postvaccine introduction period, there was an overall age-independent GE-related DCRDs reduction (20.9%, P = 0.04) observed in children <5 years of age; a reduction was also seen in infants <1 year of age (20.8%, P = 0.003). Age-independent GE-related HDs and hospitalizations reductions (57.1%, P < 0.0001 and 26.6%, P < 0.0001, respectively) were observed in <5-year-olds; HDs reductions were also observed for each age group (<1-year-olds: 55.0%, P < 0.0001 and 1- to <5-year-olds: 59.5%, P < 0.0001). Observed annual frequencies of GE-related DCRDs, HDs and hospitalizations were lower than the predicted value in each age group in all years after 2006. Conclusions: GE-related DCRDs, HDs and hospitalizations were significantly reduced in <1 and in 1- to <5-year-old Brazilian children after Rotarix introduction, which provides additional evidence of the direct and indirect population-level effect of RV vaccination on GE-related mortality and morbidity in children