10 research outputs found
Adesão de pediatras às diretrizes para doenças gastrointestinais
Introduction: Guidelines are publications of recommendations based on scientific
evidence. They aim to improve and standardize health professional practice.
Adherence to these protocols has been studied in different areas of Medicine and is
usually poor even in favorable socioeconomic contexts. Although gastrointestinal
diseases in children are prevalent and have a high burden on morbidity, mortality and
costs, pediatricians' adherence to guidelines for digestive tract diseases is still poorly
studied. Objective: To evaluate Brazilian pediatricians’ adherence to guidelines for
gastrointestinal diseases. Methods: Two observational, cross-sectional studies were
conducted by two surveys among Brazilian pediatricians, randomly selected during
two Brazilian Congress of Pediatrics (BCP). The first one was conducted during the
37th BCP in Rio de Janeiro-RJ, October-2015, and evaluated the adherence of
pediatricians to the guideline with joint recommendations of the European and North
American Societies of Pediatric Gastroenterology on management of
Gastroesophageal Reflux (GER) in children. A standardized questionnaire previously
used in an European multicenter study, translated to Portuguese, was applied. The
second study was performed during the 38th BCP in Fortaleza-CE, October-2017,
and evaluated Brazilian pediatricians' adherence to the Brazilian Food Allergy
Consensus and international guidelines, we also evaluated awareness of adherence
and reasons for intentional non-adherence with the guidelines. A questionnaire was
developed and the Delphi technique was used for content validation with 6 experts in
the field, in five rounds. In both studies, the interviewees’ characteristics and
adherence rate were evaluated. Predictors of adherence were identified in logistic
regression analysis. Results: In the first study, a total of 390 Brazilian pediatricians
from the five regions of the country answered the questionnaire. None showed
complete adherence to guideline recommendations. The adherence rate for GER
diagnosis and treatment was 23.7% and 42%, respectively. Working in public health
services (p = 0.026) was the only variable retained as a significant predictor of poor
adherence for GER diagnosis after multivariate logistic regression analysis. No
significant statistical differences were found between Brazilian regions on total score
(p = 0.774). In the second study, a total of 415 pediatricians from the five regions of
the country were interviewed. None showed complete adherence to Brazilian
consensus and international guidelines and 69 (16,7%) had a satisfactory adherence
rate (≥80%). Adequate adherence to the guidelines was associated with the variables
‘evaluating more than 10 children with suspected cow's milk allergy (CMA) per
month' and 'having read the Brazilian consensus', or 'being aware of any international
food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence,
a minority of respondents (20.3-43.5% variation) did not know if their approach was
following the guidelines. Conclusions: Brazilian pediatricians’ adherence to the
recommendations in consensus and guidelines for GERD and Food Allergy is poor.
When adherence to Food Allergy recommendations is present, it is mostly
unconscious. Be aware of the recommendations and attend a larger number of
children with suspected food allergy favors the adherence to recommendations.Introdução: Diretrizes de prática clínica são publicações com recomendações
baseadas em evidência científica que têm o objetivo de aprimorar e padronizar a
prática profissional em saúde. A adesão a essas diretrizes tem sido objeto de estudo
em diferentes áreas da medicina e costuma ser baixa mesmo em contextos
socioeconômicos mais favoráveis. Embora as doenças gastrointestinais em crianças
sejam prevalentes e tenham alto impacto em morbidade, mortalidade e custos, a
adesão de pediatras às diretrizes para manejo de patologias do trato digestório é
ainda pouco estudada. Objetivo: Avaliar a adesão de pediatras brasileiros às
diretrizes para doenças gastrointestinais. Métodos: Foram realizados dois estudos
observacionais, transversais, com aplicação de questionários a pediatras convidados
aleatoriamente em áreas de convivência do Congresso Brasileiro de Pediatria
(CBP), o maior e mais representativo evento dentro da especialidade no país. O
primeiro estudo foi executado durante o 37º CBP, na cidade do Rio de Janeiro-RJ,
no período de 13 a 16 de outubro de 2015, e avaliou a adesão dos pediatras à
diretriz publicada em conjunto pela Sociedade Europeia e Norte-americana de
Gastroenterologia Pediátrica (2009), com recomendações sobre manejo de refluxo
gastroesofágico (RGE) em crianças. Foi aplicado um questionário padronizado,
previamente utilizado em estudo multicêntrico europeu, e traduzido para o
português. O segundo estudo foi executado durante o 38º CBP, em Fortaleza/CE, no
período de 10 a 14 de outubro de 2017, e avaliou a adesão de pediatras às
recomendações do Consenso Brasileiro de Alergia Alimentar (2007) e de diretrizes
internacionais, a consciência na adesão e as razões para desacordo intencional. Foi
construído um questionário e submetido à validação de conteúdo pela técnica Delphi
em 5 etapas com 6 juízes especialistas na área de alergia alimentar. Em ambos os
estudos, foram avaliadas as características dos entrevistados, taxa de adesão e
realizada análise por regressão logística em busca de variáveis preditoras de
adesão. Resultados: No primeiro estudo, foram entrevistados 390 pediatras das
cinco regiões do país e nenhum aderiu totalmente às recomendações. Observamos
uma taxa de adesão de 23,7% no diagnóstico de RGE e 42% no tratamento. A única
variável considerada como preditora de baixa adesão no diagnóstico, após análise
multivariada em modelo de regressão logística, foi trabalhar em serviço público (p =
0,026). Não houve diferenças estatisticamente significantes entre as diferentes
regiões do país no escore total (p = 0,774). No segundo estudo, foram entrevistados
415 pediatras das cinco regiões brasileiras; nenhum apresentou adesão total e 69
(16,7%) apresentaram taxa de adesão satisfatória (≥80%). As variáveis ‘atender
mais de 10 crianças com suspeita de alergia ao leite de vaca por mês’, ‘ter lido o
Consenso Brasileiro’ e ‘conhecer alguma diretriz internacional’ estiveram associadas
a adesão satisfatória. Em 8/10 questões que avaliaram consciência na adesão às
diretrizes, a minoria (20,3-43,5%) dos entrevistados sabia estar em acordo com elas.
Conclusões: A adesão dos pediatras brasileiros às recomendações presentes em
consensos e diretrizes para RGE e Alergia Alimentar é baixa. A adesão às
recomendações em Alergia Alimentar, quando presente, não é na maioria das vezes
consciente. Conhecer as recomendações e atender maior número de crianças com
suspeita de Alergia Alimentar favorece a adesão.Aracaj
Coronavirus disease‐19 deaths among children and adolescents in an area of Northeast, Brazil: why so many?
Objective: To describe COVID-19 deaths among children and adolescents in Sergipe, Brazil.
Methods: This was an ecological study of all COVID-19 reported cases and deaths occurring in children and adolescents < 19 years of age in Sergipe reported by the health surveillance and mortality information systems of Sergipe’s Health Secretary and hospital records.
Results: 37 deaths in children <19 years old were reported up to the 30th September, corresponding to 4.87 deaths for 100,000 population < 19 years old. Most deaths occurred among infants (n=15; 41%) and this age group had the highest case fatality rate (15.3 %). Most children had comorbidities such as chronic neurological diseases (n=7; 19%) and prematurity (n=4; 11%). Most children who died (n=18; 49%) were not admitted to the intensive care units (ICU).
Conclusion: COVID-19 mortality in children and adolescents in Sergipe was higher than in other Brazilian states and in high income countries. A high proportion of the deaths occurred among children with co-morbidities and a minority of children were admitted to ICU, reflecting the limited provision of these beds in the State. Newborns and infants are a high risk group that must have priority in health public policy
Alergia às proteínas do leite de vaca e a atenção primária à saúde: uma revisão narrativa das diretrizes atuais
OBJECTIVES: To perform a narrative review of the literature about current guidelines for food allergy and present the main recommendations for Cow’s Milk Protein Allergy (CMPA) management in children at primary health care by algorithms.
METHODS: We searched for relevant publications on the Cochrane Library, MEDLINE, PubMed, Guidelines International Network, National Guidelines Clearinghouse and National Institute for Health and Clinical Excellence (NICE) using the keywords on this topic. We made a comprehensive review of these publications as well as the recommendations of the Brazilian guide and consensus for food allergy.
FINAL REMARKS: Adequate diagnosis and treatment for CMPA in children is essential, considering its nutritional, emotional and socioeconomic burden. Clinical practice guidelines provide recommendations based on scientific evidence improving quality of care; however, their implementation is challenging due to the lack of practical algorithms applicable and accessible for the management of CMPA in primary care. In addition, the lack of algorithms that favor accessibility to information from the extensive scientific content available is a reality that makes relevant a more practical proposal for a management of CMPA, applicable and accessible in order to consolidate a clinical practice based on scientific evidence
Effects of the COVID-19 pandemic on routine pediatric vaccination in Brazil
BACKGROUND
COVID-19 pandemic has disrupted health services, including vaccination demand. We describe the impact of the COVID-19 pandemic on routine pediatric vaccination in Brazil.
METHODS
We conducted a retrospective analysis of all vaccine doses provided to children aged 0-6 years from January 2019 to December 2020. We obtained data stratified by age group (0 to 2 years and >2 to 6 years) and Brazilian region. Difference-in-difference (DiD) analyses were performed to compare vaccine uptake in the pre-pandemic (January-February), stay-at-home (March-June), and reopening (July-December) periods.
RESULTS
The number of vaccine doses administered declined in the stay-at-home period. For children aged 0 to 2 years, the highest reductions were recorded in the North (-25.3%), Northeast (-16.8%) and Central-West (-10.2%) regions. For children aged >2 to 6 years, the highest decline was observed in the North (DiD = -27.2%) and South (DiD = -14.0%) regions. The number of vaccine doses administered in the reopening period has slightly increased in all regions.
CONCLUSIONS
Vaccination decreased during the COVID-19 pandemic. Although the number of doses recovered in part during the reopening phase, additional strategies, such as increased public awareness and vaccination booster campaigns are required
Acute diarrhoea in a community cohort of children who received an oral rotavirus vaccine in Northeast Brazil
Rotavirus is an important cause of childhood diarrhoea. A monovalent rotavirus vaccine (Rotarix®) was introduced into the Immunization Program of Brazil in 2006. In this study, we describe the incidence and burden of disease of rotavirus diarrhoea in two cohorts of children (vaccinated and unvaccinated). We followed two groups of 250 children under one year old, who were enrolled in December 2006 from a low-income residential area in Northeast Brazil. The children were monitored every two weeks for two years. Stool samples from children with diarrhoea were examined for the presence of rotavirus. Rotaviruses were genotyped using real time-polymerase chain reaction. The mean numbers of all-cause diarrhoea episodes/child (adjusted for age) in the first year were 0.87 and 0.84, in vaccinated and unvaccinated children, respectively. During the second year, the number of episodes/child decreased to 0.52 and 0.42. Only 16 (4.9%) of 330 stool samples were rotavirus-positive (10 vaccinated and 6 unvaccinated children) and only P[4]G2 rotaviruses were identified. All-cause diarrhoea episodes were more severe in unvaccinated children in the first year of age (p < 0.05), while vaccinated children had more severe episodes 18 months after vaccination. Rotavirus diarrhoea incidence was very low in both groups
SARS-CoV-2 has been circulating in northeastern Brazil since February 2020: evidence for antibody detection in asymptomatic patients
We screened stored samples collected before COVID-19 had been reported in Brazil. 989 samples were tested for SAR-CoV-2 antibodies using two different methods; 16 (1.6%) were positive (7 (43.8%) IgM, 3 (18.8%) IgG and 6 (37.5%) IgG/IgM positive), suggesting SARS-CoV-2 had circulated before the first reported COVID-19 case in Brazil
Brazilian pediatricians' adherence to food allergy guidelines-A cross-sectional study.
Food allergy is an emerging clinical condition in pediatrics, so recommendations on its management have been widely published. Studying pediatricians' adherence to these clinical practice guidelines (CPG) and understanding the reasons for their non-compliance can help to promote better management of this condition. A cross-sectional study was conducted by a survey among Brazilian pediatricians, randomly selected during the 38th Brazilian Congress of Pediatrics, which took place in October, 2017. A validated questionnaire with 16 questions addressing knowledge and practice on food allergy, as well as self-reported adherence to international guidelines was applied. Of the total of 415 pediatricians from all regions of the country who were surveyed, only 69 (16.7%) had a satisfactory adherence rate (≥80%). Adequate adherence to the guidelines was associated with the variables: 'evaluating more than 10 children with suspected cow's milk allergy (CMA) per month'; 'having read the Brazilian consensus'; or 'being aware of any international food allergy guideline'. In 8 of the 10 questions that assessed conscious adherence, a minority of those surveyed (20.3-42.3% variation) stated that they knew that their response was in line with the guidelines. This finding was statistically significant (p<0.05) in 7 of these 8 questions. The self-reported adherence of Brazilian pediatricians to international food allergy guidelines was low. Pediatricians who evaluated a higher number of children with suspected CMA or who were aware of the recommendations, had a higher rate of adherence. The results of the survey found that lack of resource was the major reported barrier to guideline adherence but lack of awareness must be a relevant non perceived barrier. This study shows the pediatricians´ self-reported adherence to food allergy guidelines in a widely overview for the first time in Brazil. More studies are necessary to investigate adherence to guidelines by pediatricians in other countries and to develop strategies to improve adherence