Lactancia materna y salud bucal de niños y niñas menores de dos años: revisión de la literatura

Introduction Children depend on their caregivers for their development and growth, they influence the creation of habits related to their oral health. The aim was to carry out a descriptive review of the scientific literature on breastfeeding and the oral health of children under 2 years of age. Methodology Original articles published between 2011 and 2020 (until August) were included. Seven databases were selected, the keywords were validated in thesauri, 45 articles were selected. Results Main findings by category: 1) growth and development: alterations of physiological spaces and deforming oral habits were reported; 2) oral hygiene habits: lack of knowledge was evidenced in mothers regarding the oral hygiene of their babies, among other issues; 3) oral conditions: the presence of a cariogenic diet, the use of a bottle and night-time breastfeeding without hygiene are determinants of caries, it was detected that children can suffer pathologies when exclusive breastfeeding is interrupted; 4) breastfeeding: lack of training causes mothers to be unaware of techniques and benefits of breastfeeding, so they abandon it prematurely; 5) health education: interventions reported they improved knowledge and practices, mainly on breastfeeding. Conclusion Most research focuses on mothers and ignores the role of the father and other caregivers. It is necessary to educate in breastfeeding, dentomaxillofacial growth and development, oral pathologies at an early age, and the relationship between oral health and systemic diseases.Introducción Los infantes dependen de sus cuidadores para su desarrollo y crecimiento, estos influyen en la creación de hábitos relacionados con su salud bucal. El objetivo fue efectuar una revisión descriptiva de la literatura científica sobre la lactancia materna y la salud bucal de niños y niñas menores de 2 años. Metodología Se incluyeron artículos originales publicados entre los años 2011 y 2020 (hasta agosto). Se seleccionaron siete bases de datos, los términos de búsqueda fueron validados en tesauros, se seleccionaron 45 artículos. Resultados Principales hallazgos por categoría: 1) crecimiento y desarrollo: se reportaron alteraciones de los espacios fisiológicos y hábitos bucales deformantes; 2) hábitos de higiene bucal: se evidenció desconocimiento en las madres respecto a la higiene bucal de sus bebés, entre otros temas; 3) afecciones bucales: la presencia de dieta cariogénica, uso de biberón y lactancia nocturna sin higiene son determinantes de la caries, se detectó que los niños/as pueden padecer patologías ante la interrupción de la lactancia materna exclusiva; 4) lactancia materna: la falta de capacitación ocasiona que las madres presenten desconocimiento de técnicas y beneficios de la lactancia, por lo que la abandonan prematuramente; 5) educación para la salud: se reportan intervenciones que mejoraron conocimientos y prácticas, principalmente sobre lactancia materna. Conclusión La mayoría de investigaciones se centran en las madres y desconocen el rol del padre y otros cuidadores. Es necesario educar en lactancia materna, crecimiento y desarrollo dentomaxilofacial, patologías bucales a edades tempranas, y la relación de la salud bucal con enfermedades sistémicas

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

Crecer a cielo abierto: salud colectiva y psicosocial de infantes, escolares y adolescentes de familias recicladoras

La presente investigación realiza, desde un enfoque de salud colectiva y psicología comunitaria, un diagnóstico participativo del estado nutricional, psicomadurativo, psicoemocional y psicosocial de niños, niñas y adolescentes (NNA) que pertenecen al núcleo familiar de personas recicladoras de la Asociación 17 de Septiembre en Portoviejo. Se estructura en cuatro fases: un prediagnóstico participativo para definir el universo de estudio y las bases del protocolo de investigación, la construcción del marco epistemológico, teórico y metodológico, del modelo analítico y de las herramientas de diagnóstico así como su digitalización, la capacitación del equipo técnico conformado por investigadoras, promotoras de salud, dirigentes de la asociación y estudiantes- pasantes, el levantamiento del diagnóstico, la sistematización, la devolución sistemática (individual y colectiva) de los hallazgos y la difusión de la investigación. La investigación trabaja con 67 familias, en las que se incluyen 165 NNA. El modelo analítico se organiza en tres dimensiones: general, particular y singular. En la primera, se estudia el territorio y los procesos de segregación histórico-sociales. En la segunda, se construye la tipología de grupos sociales en función de la identificación de la fracción de clase y se estudian sus modos de vida. En la tercera dimensión, se analizan dos subcomponentes: la inserción social, estructura, dinámica y funcionalidad de la familia; y los antecedentes, consideraciones etiológicas, desarrollo nutricional, psicomadurativo, psicoemocional y psicosocial de los NNA. La triangulación de métodos cualitativos, cuantitativos y geoespaciales incluye una encuesta epidemiológica de territorio, modos de vida de los grupos sociales y familia, curvas de crecimiento por peso y talla de los NNA, test de Denver, test de Bender, test de Sacks para NNA y finalmente, el dibujo de la niña1, su familia y su barrio. La investigación pretende orientar la toma de decisiones para el acompañamiento y recuperación de casos críticos y, especialmente, para el diseño de estrategias de promoción de la salud psicosocial y psicopedagógica

Presentation, management, and outcomes of older compared to younger adults with hospital-acquired bloodstream infections in the intensive care unit: a multicenter cohort study

Purpose: Older adults admitted to the intensive care unit (ICU) usually have fair baseline functional capacity, yet their age and frailty may compromise their management. We compared the characteristics and management of older (≥ 75 years) versus younger adults hospitalized in ICU with hospital-acquired bloodstream infection (HA-BSI). Methods: Nested cohort study within the EUROBACT-2 database, a multinational prospective cohort study including adults (≥ 18 years) hospitalized in the ICU during 2019-2021. We compared older versus younger adults in terms of infection characteristics (clinical signs and symptoms, source, and microbiological data), management (imaging, source control, antimicrobial therapy), and outcomes (28-day mortality and hospital discharge). Results: Among 2111 individuals hospitalized in 219 ICUs with HA-BSI, 563 (27%) were ≥ 75 years old. Compared to younger patients, these individuals had higher comorbidity score and lower functional capacity; presented more often with a pulmonary, urinary, or unknown HA-BSI source; and had lower heart rate, blood pressure and temperature at presentation. Pathogens and resistance rates were similar in both groups. Differences in management included mainly lower rates of effective source control achievement among aged individuals. Older adults also had significantly higher day-28 mortality (50% versus 34%, p < 0.001), and lower rates of discharge from hospital (12% versus 20%, p < 0.001) by this time. Conclusions: Older adults with HA-BSI hospitalized in ICU have different baseline characteristics and source of infection compared to younger patients. Management of older adults differs mainly by lower probability to achieve source control. This should be targeted to improve outcomes among older ICU patients

The role of centre and country factors on process and outcome indicators in critically ill patients with hospital-acquired bloodstream infections

Purpose: The primary objective of this study was to evaluate the associations between centre/country-based factors and two important process and outcome indicators in patients with hospital-acquired bloodstream infections (HABSI). Methods: We used data on HABSI from the prospective EUROBACT-2 study to evaluate the associations between centre/country factors on a process or an outcome indicator: adequacy of antimicrobial therapy within the first 24 h or 28-day mortality, respectively. Mixed logistical models with clustering by centre identified factors associated with both indicators. Results: Two thousand two hundred nine patients from two hundred one intensive care units (ICUs) were included in forty-seven countries. Overall, 51% (n = 1128) of patients received an adequate antimicrobial therapy and the 28-day mortality was 38% (n = 839). The availability of therapeutic drug monitoring (TDM) for aminoglycosides everyday [odds ratio (OR) 1.48, 95% confidence interval (CI) 1.03-2.14] or within a few hours (OR 1.79, 95% CI 1.34-2.38), surveillance cultures for multidrug-resistant organism carriage performed weekly (OR 1.45, 95% CI 1.09-1.93), and increasing Human Development Index (HDI) values were associated with adequate antimicrobial therapy. The presence of intermediate care beds (OR 0.63, 95% CI 0.47-0.84), TDM for aminoglycoside available everyday (OR 0.66, 95% CI 0.44-1.00) or within a few hours (OR 0.51, 95% CI 0.37-0.70), 24/7 consultation of clinical pharmacists (OR 0.67, 95% CI 0.47-0.95), percentage of vancomycin-resistant enterococci (VRE) between 10% and 25% in the ICU (OR 1.67, 95% CI 1.00-2.80), and decreasing HDI values were associated with 28-day mortality. Conclusion: Centre/country factors should be targeted for future interventions to improve management strategies and outcome of HABSI in ICU patients

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes