Covid-19 in Children and the Influence on the Employment Activity of Their Female Caregivers: A Cross Sectional Gender Perspective Study

INTRODUCTION: During the COVID-19 pandemic, women disproportionately assume more unpaid activities, affecting their employment. OBJECTIVE: Describe the influence of COVID-19 on the employment of caregivers of children and adolescents from a gender perspective. METHODS: Cross-sectional study in three high-complexity hospitals in Bogotá, Colombia from April 2020 to June 2021. A subsample of the FARA cohort was taken, including those patients with a positive test for SARS-COV2. We took as our analysis category children older than 8 years and younger than 18 years who had a positive SARS-COV2 test, as well as, caregivers of all children with a positive SARS-COV2 test. This subsample was drawn from the FARA cohort. A survey was applied to them. We carried out a descriptive and stratified analysis by age group, educational, and socioeconomic level. RESULTS: We included 60 surveys of caregivers and 10 surveys of children. The main caregiver in 94.8% of the cases was a female. At the beginning of the pandemic, 63.3% of the caregivers were employed, and 78.9% of those lost their employment. The vast majority of these caregiver were women (96.6%, CONCLUSION: Caregivers of children with COVID-19 with low educational levels and lower socioeconomic conditions, as well as those with children under 5 years showed greater likelihood of employment loss between the interviewed subsample

Use of High-Flow Cannula in Pediatric Patients With Respiratory Failure: A Prospective Cohort Study in Three High-Altitude Hospitals

BACKGROUND AND AIMS: Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high-flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high-flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals. METHODS: It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow-up was carried out at 1, 6, and 48 h after starting the management. RESULTS: Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. CONCLUSION: The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies

Tipología de experiencias en la Transferencia-Intercambio-Diálogo (TID) de conocimientos en salud materna y perinatal: un enfoque intercultural

Introducción: En el año 2000, los líderes de 189 países se unieron en las Naciones Unidas para formular los Objetivos del Desarrollo del Milenio (ODM) con el fin de combatir la pobreza en sus múltiples dimensiones.Sin embargo, para el 2017 los avances de dichas metas no fueron los esperados, registrándose una Razón de Mortalidad Materna (RMM) en Colombia de 51 muertes maternas por 100.000 nacidos vivos, siendo esta mayor en mujeres vulnerables y aquellas que viven en áreas dispersas. Objetivo: caracterizar las distintas tipologías de experiencias existentes que describen las formas de relación (el continuo transferencia-intercambio-diálogo) entre saberes tradicionales y saberes institucionales para la atención de la salud materno-perinatal en Chocó, Guajira y Cesar con el fin de marcar un primer momento y ser un insumo primordial para la puesta en marcha de la propuesta piloto de dicho objetivo. Metodología: Análisis descriptivo, de revisión primaria y secundaria de datos con enfoque participativo e interpretativo para la construcción de un marco y propuesta para el intercambio y transferencia de conocimientos y experiencias entre saberes comunitarios y profesionales sobre atención materno-perinatal. Discusión: La medicina occidental/biomedicina al igual que la medicina tradicional tienen como objetivo que sus prácticas y cuidados estén dirigidos a la búsqueda del bienestar de las comunidades. La búsqueda de una disminución en la brecha de ambos mundos, no busca que los médicos occidentales se vuelvan expertos en partería y viceversa; sino que se busca que trabajen en conjunto y se reconozca la importancia de la medicina tradicional y la partería en las zonas rurales de nuestro país. Este proyecto, demostró que existen una variedad de barreras y limitaciones para la posibilidad de que se de una adecuada transferencia-intercambio-diálogo de conocimientos entre ambos mundos, pero también demostró que existen oportunidades para ir abriendo puertas y posibilidadesIntroduction: In 2000, the leaders of 189 countries joined the United Nations to formulate the Millennium Development Goals (MDGs) in order to combat poverty in its multiple dimensions. These goals were not as expected, registering a Maternal Mortality Ratio (MMR) in Colombia of 51 maternal deaths per 100,000 live births, this being higher in vulnerable women and those who live in dispersed areas. Objective: to characterize the different typologies of existing experiences that describe the forms of relationship (the continuous transfer-exchange-dialogue) between traditional knowledge and institutional knowledge for maternal-perinatal health care in Chocó, Guajira and Cesar in order to mark a first moment and be a primary input for the implementation of the pilot proposal of said objective. Methodology: Descriptive analysis, primary and secondary review of data with a participatory and interpretive approach for the construction of a framework and proposal for the exchange and transfer of knowledge and experiences between community knowledge and professionals on maternal-perinatal care. Discusion:Western medicine / biomedicine as well as traditional medicine have the objective that their practices and care are directed to the search for the well-being of the communities. The search for a decrease in the gap of both worlds, does not look for western doctors to become experts in midwifery and vice versa; rather, it is intended that they work together and the importance of traditional medicine and midwifery in rural areas of our country is recognized. This project demonstrated that there are a variety of barriers and limitations for the possibility of an adequate transfer-exchange-dialogue of knowledge between both worlds, but it also demonstrated that there are opportunities to open doors and possibilities.Magíster en EpidemiologíaMaestrí

Benefits and harms of replacement therapy with Alpha 1 Antitrypsin in patients with documented enzyme deficiency and Chronic Obstructive Pulmonary Disease: A systematic review and network meta-analysis

ABSTRACT TITLE: Benefits and harms of replacement therapy with Alpha 1 Antitrypsin in patients with documented enzyme deficiency and Chronic Obstructive Pulmonary Disease: A systematic review and network meta-analysis. OBJECTIVE: To identify the available scientific evidence regarding the benefits and safety of replacement therapy with Alpha 1-Antitrypsin compared with endobronchial or surgical management for reduction of lung volume, lung transplantation, standard of care for chronic obstructive pulmonary disease, and placebo or control/no treatment in patients with documented enzyme deficiency, presenting with chronic obstructive pulmonary disease. METHODS: A systematic review and meta-analysis was conducted. MEDLINE-PubMed (via Ovid), EMBASE (via Elsevier), LILACS and the Cochrane Library of Controlled Register of Trials (CENTRAL) were assessed for randomized controlled trials (RCT); cluster, factorial, parallel-design and cross-over designs were included, from inception to May of 2021. Any restrictions regarding language, setting, report status or date of publication were included. Non-published articles in clinicaltrials.gov, and grey literature in ProQuest were also considered. Trials studying adult patients with documented Alpha-1 Antitrypsin Deficiency (A1AD) and diagnosed with Chronic Obstructive Pulmonary Disease (COPD), treated with A1A augmentation therapy or other standard care interventions (according to current guidelines for COPD treatment1) such as inhaled corticosteroids, phosphodiesterase 4 inhibitors, antibiotics, inhaled anticholinergic or beta 2 agents, anti-oxidant, lung volume reduction interventions or lung transplant were included. Patient important outcomes as well as surrogate outcomes were assessed. Risk of bias (ROB) for each included trial was independently assessed, using the Cochrane Risk of Bias tool (ROB2). DerSimonian-Laird random-effects models for all pairwise comparisons were used. Heterogeneity was calculated with Q statisticABSTRACT TITLE: Benefits and harms of replacement therapy with Alpha 1 Antitrypsin in patients with documented enzyme deficiency and Chronic Obstructive Pulmonary Disease: A systematic review and network meta-analysis. OBJECTIVE: To identify the available scientific evidence regarding the benefits and safety of replacement therapy with Alpha 1-Antitrypsin compared with endobronchial or surgical management for reduction of lung volume, lung transplantation, standard of care for chronic obstructive pulmonary disease, and placebo or control/no treatment in patients with documented enzyme deficiency, presenting with chronic obstructive pulmonary disease. METHODS: A systematic review and meta-analysis was conducted. MEDLINE-PubMed (via Ovid), EMBASE (via Elsevier), LILACS and the Cochrane Library of Controlled Register of Trials (CENTRAL) were assessed for randomized controlled trials (RCT); cluster, factorial, parallel-design and cross-over designs were included, from inception to May of 2021. Any restrictions regarding language, setting, report status or date of publication were included. Non-published articles in clinicaltrials.gov, and grey literature in ProQuest were also considered. Trials studying adult patients with documented Alpha-1 Antitrypsin Deficiency (A1AD) and diagnosed with Chronic Obstructive Pulmonary Disease (COPD), treated with A1A augmentation therapy or other standard care interventions (according to current guidelines for COPD treatment1) such as inhaled corticosteroids, phosphodiesterase 4 inhibitors, antibiotics, inhaled anticholinergic or beta 2 agents, anti-oxidant, lung volume reduction interventions or lung transplant were included. Patient important outcomes as well as surrogate outcomes were assessed. Risk of bias (ROB) for each included trial was independently assessed, using the Cochrane Risk of Bias tool (ROB2). DerSimonian-Laird random-effects models for all pairwise comparisons were used. Heterogeneity was calculated with Q statisticMagíster en EpidemiologíaMaestrí

Use of high‐flow cannula in pediatric patients with respiratory failure: A prospective cohort study in three high‐altitude hospitals

Abstract Background and Aims Acute respiratory failure (ARF) is a common cause of morbimortality, and a frequent reason for admission to the pediatric intensive care unit (PICU). It requires a high‐flow oxygen device as treatment. Our aim is to determine the frequency and main indications for the use of high‐flow nasal cannula (HFNC), and the prevalence of HFNC failure and its main causes, in three hospitals Methods It is a multicenter prospective cohort study, developed in three hospitals in Bogota. Eligible patients were children older than 1 month and younger than 18 years who presented ARF and required management with an HFNC. The study was carried out between April 2020 and December 2021. The follow‐up was carried out at 1, 6, and 48 h after starting the management. Results Of 685 patients included in the study, 296 developed ARF. The prevalence of patients with ARF who required management with HFNC was 48%. The frequency of the pathologies that cause the ARF was: Bronchiolitis was the most frequent pathology (34.5%), followed by asthmatic crisis (15.5%) and pneumonia (12.7%). The average time of use of HFNC was 81.6 h. Regarding treatment failure with HFNC, 15 patients presented torpid evolution and required invasive mechanical ventilation, with a prevalence of therapeutic failure of the HFNC of 10.6%. Conclusion The use of HFNC is more frequent in patients with bronchiolitis, in children under 2 years of age and in males, which is in line with what has been reported in the literature. In addition, the failure rate of HFNC is low (10.6%), and it may be useful in other pathologies besides bronchiolitis, such as asthma, pneumonia, among others. It opens the possibility to continue evaluating the role of HFNC in pediatric pathology in new studies