Revista de la Facultad de Ciencias Médicas de la Universidad de Cuenca

El uso inadecuado de antibióticos involucra al prescriptor: sobre el influye diversos factores acádemicos, sociales, ambientales, económicos, culturales y políticos; ocurre principalmente en el nivel de atención en el área pediátricoThe inappropriate use of antibiotics involves the prescriber : influences on various academic , social, environmental , economic, cultural and political factors ; It occurs mainly in the level of care in the pediatric areaCuencavolumen 32 número

Differences in antibiotic use and knowledge between adolescent and adult mothers in Ecuador

Objectives: To investigate the differences in antibiotic use and knowledge between adolescent and adult mothers of children under the age of 5 years in Ecuador. Methods: A cross sectional study was performed in four health centers and hospitals. Mothers of children under five years, seeking medical attention their child's upper respiratory tract infection (URI), were included. The data was collected through interviews, using a structured questionnaire. The questionnaire covered the topics knowledge of antibiotic treatment, risk and resistance. Results: 777 mothers were included in the study, of which 15.8% were adolescent and 84.1% adult mothers. There were significant differences in the social and economic characteristics of the mothers (p ? 0.05), with adolescent mothers being more likely to have an incomplete high school education and lack of basic services in their home. Significant differences between these groups were found in adherence to treatment, knowledge about risks associated with antibiotic use, and having heard of antibiotic resistance. Among the adult mothers, 83.5% reported correct adherence, 28.5% were knowledgeable about risks associated with antibiotic use, and 29.3% had heard of antibiotic resistance. Among the adolescent mothers, these numbers were 75.4%, 15.0%, and 19.8%, respectively. Conclusions: To develop successful interventions, it is crucial to understand the factors causing differences in antibiotic use and knowledge between mothers. © 2013 Quizhpe P A et al

High Proportion of Intestinal Colonization with Successful Epidemic Clones of ESBL-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Ecuador

Background and Aims:Neonatal infections caused by Extended-spectrum beta-lactamase (ESBL)-producing bacteria are associated with increased morbidity and mortality. No data are available on neonatal colonization with ESBL-producing bacteria in Ecuador. The aim of this study was to determine the proportion of intestinal colonization with ESBL-producing Enterobacteriaceae, their resistance pattern and risk factors of colonization in a neonatal intensive care unit in Ecuador.Methods:During a three month period, stool specimens were collected every two weeks from hospitalized neonates. Species identification and susceptibility testing were performed with Vitek2, epidemiologic typing with automated repetitive PCR. Associations between groups were analyzed using the Pearson X2 test and Fisher exact test. A forward step logistic regression model identified significant predictors for colonization.Results:Fifty-six percent of the neonates were colonized with ESBL-producing Enterobacteriaceae. Length of stay longer than 20 days and enteral feeding with a combination of breastfeeding and formula feeding were significantly associated with ESBL-colonization. The strains found were E. coli (EC, 89%) and K. pneumoniae (KP, 11%) and epidemiological typing divided these isolates in two major clusters. All EC and KP had blaCTX-M group 1 except for a unique EC isolate that had blaCTX-M group 9. Multi-locus sequence typing performed on the K. pneumoniae strains showed that the strains belonged to ST855 and ST897. The two detected STs belong to two different epidemic clonal complexes (CC), CC11 and CC14, which previously have been associated with dissemination of carbapenemases. None of the E. coli strains belonged to the epidemic ST 131 clone.Conclusions:More than half of the neonates were colonized with ESBL-producing Enterobacteriaceae where the main risk factor for colonization was length of hospital stay. Two of the isolated clones were epidemic and known to disseminate carbapenemases. The results underline the necessity for improved surveillance and infection control in this context. © 2013 Nordberg et al

Percepciones sobre infecciones respitatorias agudas, gravedad y tratamiento en responsables del cuidado de niños menores de cinco años

Introducción: La mayoría de los niños tienen entre cuatro y seis infecciones agudas del tracto respiratorio cada año y representan una proporción considerable de consultas a los médicos de atención primaria. A pesar de que la causa predominantemente es la viral, los antibióticos se prescriben con frecuencia lo cual puede contribuir a la aparición de bacterias resistentes Objetivos: Establecer las percepciones de los responsables del cuidado de niños menores de cinco años sobre infecciones respiratorias agudas, su gravedad y su tratamiento. Diseño metodológico: Se realizó un estudio descriptivo en el centro de salud Nro 1, fueron incluidos 250 responsables del cuidado de niños menores de cinco años que acudieron al centro de salud en el mes de marzo de 2010 y firmaron el consentimiento informado. Se emplearon frecuencias, porcentajes, promedio y desvío estándar; y chi cuadrado y test de Fisher para asociación de variables. Resultados: la mayoría de participantes fueron mujeres (94.8%). Los cuidadores quienes estudiaron más de13 años indicaron que la causa de IRA fue por contagio (15.2% vs 7.23% en promedio), y los que no acabaron la primaria (<7 años de escolaridad) desconocían las causas (22.2% vs 6.2% en promedio) (p<0.05). El 42% indicaron que el tratamiento necesario eran los antibióticos y si el nivel de educación del cuidador era alto, afirmaron no necesitaban antibióticos (59.2% cuando tiene entre 11 y 13 años de escolaridad y 63% cuando tiene más de 13 años frente a 50.2% en promedio) (p<0.01). Un 72.69% completan el tratamiento antibiótico cuando el médico lo prescribía y si el nivel de educación era alto (más de 13 años) completaban el tratamiento en 88.4% (p<0.05). Conclusiones: hay escaso conocimiento de los responsables del cuidado de niños sobre las IRAs, su tratamiento y su gravedad, siendo la variable más consistente en la asociación al uso de antibióticos el nivel de educación de la madre.Background: Most children have between four and six respiratory tract infections acute each year and represent a significant proportion of visits to primary care physicians. Although the cause is predominantly viral, antibiotics are frequently prescribed which may contribute to the appearance of resistant bacteria. Objectives: To determine the perceptions of caregivers of children under five years old on acute respiratory infections, its severity and its treatment. Methodology: A descriptive study in Health Center # 1; there were included 250 caregivers of children under five years old attending the Health Center in March 2010 and signed informed consent. Frequencies, percentages, mean, standard deviation, chi square and Fisher's test for variable association. Results: Most participants were female (94.8%). Caregivers who had literacy over 13years studies indicated that the ARI was caused by infection (15.2% vs. 7.23% on average), and those who did not finish primary school (<7 years of schooling) unknown causes (22.2% vs 6.2% average) (p <0.05). 42% indicated that the necessary treatment were the antibiotics and if the caregiver's education level was high, they said they did not need antibiotics (59.2% when they have 11 through 13 years of schooling and 63% when they have over 13 years schooling versus 50.2 % on average) (p <0.01). A 72.69% completed the antibiotic treatment when the physician prescribed and whether the level of education was high (over 13 years) completed the treatment in 88.4% (p <0.05). Conclusions: There is little knowledge of the caregivers of children on ARI, its treatment and its severity, being the most consistent variable in association with antibiotic use the education level of the mother.Cuenc

Revista Cubana de Salud Pública

Introducción: la estrategia de Atención Integral de Enfermedades Prevalentes de la Infancia desarrollada por la Organización Mundial de la Salud y la UNICEF, puede reducir la mortalidad infantil y estimular el uso racional de antibióticos. Objetivo: valorar el cumplimiento de la mencionada estrategia en términos de diagnóstico y tratamiento, en especial el tratamiento con antibióticos, en niños con infección respiratoria aguda en el Ecuador. Métodos: se revisaron las historias clínicas de pacientes que tenían entre dos meses y cinco años de edad, que habían sido atendidos en dos centros de atención primaria de salud en zonas urbanas y rurales, donde los niños reciben atención médica gratuita, entre julio de 2010 y Junio de 2011. Se recolectaron retrospectivamente los datos sobre las características del paciente, diagnóstico y tratamiento. Resultados: en ambos centros de salud y en la mayoría de las historias clínicas se constató la falta de información sobre el tratamiento y la administración de los antibióticos. Se recopilaron los datos de 1 063 pacientes, que revelaron que la prescripción excesiva de antibióticos se produjo con mayor frecuencia (6,50 %) en los centros de atención rural. Conclusiones: hay incumplimiento parcial en la aplicación de la estrategia y es importante en investigaciones futuras profundizar en sus causas. La inaccesibilidad a los servicios de salud podría ser una causa asociada, especialmente en las zonas rurales. La contextualización de la estrategia puede ser necesaria para mejorar la salud infantil, promover el uso racional de los antibióticos y reducir la diseminación de resistencias antimicrobianas.Introduction: the strategy of Integrated Management of Childhood Illnesses (IMCI) developed by the World health Organization and the UNICEF is aimed at reducing infant mortality and at promoting the rational use of antibiotics. Objective: to evaluate the performance of the above-mentioned strategy for children with acute respiratory infections in Ecuador, in terms of diagnosis and treatment, particularly antibiotic therapy. Methods: the medical histories of patients aged two months to five-years old, who had been diagnosed with ARI and treated at 2 primary health care centers in urban or rural areas in the period of July 2010 through June 2011, were checked. Data about the characteristics of the patients, the diagnosis and the treatment followed were retrospectively collected. Results: in both primary health centers and in most of the medical records, information about the lines of treatment and administration of antibiotics was missing. Data collected on 1 063 patients revealed that over-prescription of antibiotics occurred more frequently in health centers located in rural areas (6.5 %). Conclusion: future research should focus on identifying the causes of failure in the IMCI implementation. The inaccessibility to health centers may be an example of associated causes, especially in rural areas. The contextualization of the IMCI strategy may be needed to improve child health, to promote the rational use of antibiotics and to reduce the spread of antimicrobial resistance.Cuencavolumen 39; número

Health Promotion International

"vacuna social" El término está diseñado para fomentar el sector de la salud biomédica orientada a reconocer la legitimidad de la acción sobre los determinantes sociales y económicos distales de la salud. Se propone como un término para ayudar al movimiento de promoción de la salud en argumentar a favor de una visión social de la salud que es tan a menudo en contra de las concepciones médicas y populares de la salud. La idea de una vacuna social se basa en una larga tradición en la medicina social, así como en una tradición biomédica de prevención de enfermedades a través de las vacunas que protegen contra las enfermedades. Vacunas Sociales se promueven como un medio para fomentar la movilización popular y la defensa para cambiar las condiciones sociales y económicas estructurales que hacen que las personas y las comunidades vulnerables a las enfermedades. Se facilitarían los procesos sociales y políticos que se desarrollan la voluntad popular y político para proteger y promover la salud a través de acciones (especialmente los gobiernos preparados para intervenir y regular para proteger la salud de la comunidad) sobre los determinantes sociales y económicos. Ejemplos proporcionados por los efectos de las vacunas sociales son: la restauración de la propiedad de tierras a los pueblos indígenas, la regulación de la publicidad de los productos nocivos y los impuestos progresivos para la protección social universal. Vacunas Sociales requieren más investigaciones para mejorar la comprensión de los procesos sociales y políticos que son susceptibles de mejorar la equidad en salud en todo el mundo. La metáfora de la vacuna debe ser útil para argumentar a favor de una mayor acción sobre los determinantes sociales de la salud. Vacunas Sociales para resistir y cambiar las estructuras sociales y económicas no saludables: una metáfora útil para la promoción de la salud.The term ‘social vaccine’ is designed to encourage the biomedically orientated health sector to recognize the legitimacy of action on the distal social and economic determinants of health. It is proposed as a term to assist the health promotion movement in arguing for a social view of health which is so often counter to medical and popular conceptions of health. The idea of a social vaccine builds on a long tradition in social medicine as well as on a biomedical tradition of preventing illness through vaccines that protect against disease. Social vaccines would be promoted as a means to encourage popular mobilization and advocacy to change the social and economic structural conditions that render people and communities vulnerable to disease. They would facilitate social and political processes that develop popular and political will to protect and promote health through action (especially governments prepared to intervene and regulate to protect community health) on the social and economic determinants. Examples provided for the effects of social vaccines are: restoring land ownership to Indigenous peoples, regulating the advertising of harmful products and progressive taxation for universal social protection. Social vaccines require more research to improve understanding of social and political processes that are likely to improve health equity worldwide. The vaccine metaphor should be helpful in arguing for increased action on the social determinants of health.Cuencavolumen 24; número

Percepciones y prácticas de los escolares sobre las causas, gravedad y tratamiento de las infecciones respiratorias agudas. Azuay, Ecuador, 2012

Objetivo: Identificar las percepciones y prácticas que sobre las causas, gravedad y tratamiento en la infección respiratoria aguda tienen los escolares pertenecientes a distintos estratos sociales de Cuenca en el año 2011. Metodología: Se realizó un estudio descriptivo en una muestra por conveniencia de 498 escolares del sexto y séptimo año de educación básica, de la zona urbana y rural de Azuay. Se explicó a los responsables del cuidado de los escolares el objetivo de la encuesta y se obtuvo el consentimiento informado. Para el control de calidad se realizó un estudio piloto en otra institución diferente a la del estudio. Los datos fueron analizados en el programa SPSS versión 15, se emplearon frecuencias, porcentajes y medidas de tendencia central como promedio y desvío estándar, además se usó el chi cuadrado para buscar significancia estadística. Resultado: La edad promedio fue de 10.8 años para la población urbana y rural, y de conglomerados sociales bajo y medio. Los servicios básicos completos estuvieron presentes en la población de zona urbana en el 83.9% y de conglomerado social medio en 73.8%. El conglomerado social bajo y los escolares de género femenino utilizaban con más frecuencia fármacos en el hogar antes de recibir atención médica (42.3% y 43%). Los escolares del género femenino (41.9%) en mayor porcentaje conocían sobre los antibióticos, mientras que los de género masculino tuvieron mejor conocimiento sobre resistencia bacteriana (26.3%). Los centros de salud y escuelas fueron la principal fuente de información sobre los antibióticos y la resistencia bacteriana, aunque el acceso de los niños a la información en general fue bajo. El nivel de conocimiento de las causas y la gravedad de la infección respiratoria aguda fue inadecuado en un alto porcentaje de los niños y las niñas. La mayoría de los escolares, independientemente de su estado, identificaron que "el cuidado en clima frío" es una medida adecuada de prevención y protección contra IRA, pero muy bajo porcentaje de ellos consideraron reposo, no fumar, alimentación saludable, protección y limpieza nasal como prácticas de autocuidado para prevenir infecciones respiratorias agudas.Objective: To identify the perceptions and practices of schoolchildren belonging to different social strata about the causes, severity, and treatment of acute respiratory infection in Azuay province, Ecuador in 2012. Methodology: A descriptive study was conducted in a convenience sample of 498 schoolchildren in the sixth and seventh year of primary school, from both urban and rural areas of Azuay. We talk with the responsible people for the schoolchildren care about the aim of the study, and the informed consent was obtained. For quality control we performed a pilot study in a different institution than this study. Data were analyzed using SPSS version 15, we used frequencies, percentages and measures of central tendency such as middle and standard deviation, and chi-square was used to find statistical significance. Result: The average age of participants was 10.8 years. Children came from both urban and rural regions, and belonged to low or middle social strata. Those of low social strata and of feminine gender more commonly used drugs in the home before receiving medical care (42.3% and 45.0%). A higher percentage of female children (41.9 %) were aware of antibiotics, while the males had better knowledge of bacterial resistance (26.3%). The health-care centers and school were the main source of information on antibiotics and bacterial resistance, although children’s access to information overall was low. The level of knowledge of the causes and the severity of acute respiratory infection was inadequate in a high proportion of both boys and girls. The majority of participating schoolchildren, independent of their status identified that "taking care in cold weather" is an appropriate measure of prevention and protection against ARI, but very low percentages of them considered rest, no smoking, healthy food, protection and nasal cleaning as self-care practices to prevent ARI. Conclusions: Only a limited percentage of boys and girls had appropriate knowledge and perceptions about the severity of acute respiratory infection, the use of antibiotics and antibiotic resistance. Programs to contain antibiotic resistance require multilateral and comprehensive approaches that involve the community with an emphasis on the school, children, parents and their families.Cuenc

Revista de la Facultad de Ciencias Médicas

Objetivo: evaluar el impacto de la migración de los padres en el bienestar psicológico de los ado - lescentes en abandono (LBA) en el Ecuador. Ado - lescentes abandonados son quienes permanecen en su país de origen, mientras su (s) padre (s) mi - graron. Métodos: en un estudio Transversal, 659 adoles - centes de edad escolar (43% mujeres, con una edad media de 13.9 +- 1.2) llenaron los cuestio - narios de fortalezas y dificultades (SDQ), y deter - minantes socio-demográficos. Las estadísticas fue - ron utilizadas para comparar el impacto de los determinantes socio-demográficos en el grupo de adolescentes en abandono (LBA) y adolescentes en no abandono (NLBA). Resultados: El 46% de los (LBA) puntuaron sig - nificativamente más alto en el cuestionario (SDQ) que los (NLBA), especialmente las niñas. Los de - terminantes socio-demográficos fueron significa - tivamente asociados con menos problemas psico - lógicos, por ejemplo, hablando acerca de problemas personales y migración después de la edad de 5 años en LBA. Conclusiones: la migración de los padres tiene un impacto en el bienestar psicológico de los adolescentes en abandono en el Ecuador. Las ca - racterísticas socio-demográficas influencian dicho impacto. Este artículo enfatiza un importante y hasta ahora ignorado problema de salud publica en el Ecuador. Esto subraya la necesidad del des - arrollo de políticas de salud y una profunda in - vestigaciónPurpose: To assess the impact of parental migration on psychological wellbeing of Left-Behind Adolescents (LBA) in Ecuador. Left-behind are adolescents who stay in their host country, while their parent(s) migrated. Methods: In a cross-sectional study, 659 schoolchildren (43% girls, age 13.9}1.2) filled in the Strength and Difficulty Questionnaire (SDQ), advanced emotional questions and socio-demographic determinants. Statistics were used to compare the group of LBA and non-LBA (NLBA) and impacts of socio- demographic determinants within LBA’s. Results: LBA (46%) scored significant higher on the SDQ then NLBA, especially girls. Socio-demographic determinants were significantly associated with less psychological problems, for example talking about personal problems and migration after LBA aged 5. Conclusions: Parental migration has an impact on psychological wellbeing of LBA in Ecuador. Socio-de - mographic characteristics influence this impact. This article emphasizes an important and so far neglected public health problem in Ecuador. It underlines the need for policy development and profound research. Key words: adolescent psychology, Child abandoned, adolescent, migration/statistics & numerical data, socioeconomic factors, demographics, child welfare psychology, Adolescent Behavior/psychology, Ecuador.Cuenc

Implementation of the strategy of integrated management of childhood illnesses [Aplicación de la estrategia de Atención Integral de Enfermedades Prevalentes de la Infancia en Ecuador]

Introduction: the strategy of Integrated Management of Childhood Illnesses (IMCI) developed by the World health Organization and the UNICEF is aimed at reducing infant mortality and at promoting the rational use of antibiotics. Objective: to evaluate the performance of the above-mentioned strategy for children with acute respiratory infections in Ecuador, in terms of diagnosis and treatment, particularly antibiotic therapy. Methods: the medical histories of patients aged two months to five-years old, who had been diagnosed with ARI and treated at 2 primary health care centers in urban or rural areas in the period of July 2010 through June 2011, were checked. Data about the characteristics of the patients, the diagnosis and the treatment followed were retrospectively collected. Results: in both primary health centers and in most of the medical records, information about the lines of treatment and administration of antibiotics was missing. Data collected on 1 063 patients revealed that over-prescription of antibiotics occurred more frequently in health centers located in rural areas (6.5 %). Conclusion: future research should focus on identifying the causes of failure in the IMCI implementation. The inaccessibility to health centers may be an example of associated causes, especially in rural areas. The contextualization of the IMCI strategy may be needed to improve child health, to promote the rational use of antibiotics and to reduce the spread of antimicrobial resistance