The perspective of primary health care pediatricians regarding childhood anemia and iron supplementation

Introducción. La anemia ferropénica es másfrecuente en los países de bajos y medianosingresos. La evidencia sugiere que el impacto delsuplemento con sulfato ferroso en la poblacióninfantil es bajo. Nuestro objetivo fue analizar lavisión de los pediatras en torno a la problemáticade la anemia y al suplemento con hierro.Población y métodos. Estudio cualitativo,exploratorio. Se realizaron entrevistassemiestructuradas a los pediatras del primernivel de atención de Rosario. Se incluyeron tresejes de indagación: ?relevancia del problema?,?práctica clínica? y ?representaciones sobre elsuplemento con hierro?. El análisis consistió ensistematizar la información obtenida mediantela transcripción de entrevistas grabadas yanotaciones.Resultados. Se realizaron 32 entrevistas. Todoslos entrevistados pensaban que la anemia era unproblema relevante. Actualmente, se la asociacon una alimentación de mala calidad. Loshallazgos llevan a considerar que la prácticapediátrica sigue las normativas nacionales. Hayacuerdo en que la baja adherencia es un obstáculopara el manejo clínico de la anemia ferropénica.Los pediatras expresaron ideas potencialmentebeneficiosas para el contexto local, que incluíanla organización de talleres sobre anemia y ladistribución gratuita de preparados con hierrode mejor sabor.Conclusiones. La anemia por déficit de hierrose consideró un problema grave. En atenciónprimaria, las intervenciones destacadas fueron laorganización de talleres y el acceso a preparadoscon hierro de sabor más agradable.Palabras clave: anemia ferropénica, entrevista,atención primaria de salud, pediatría, análisiscualitativo.Fil: Sguassero, Yanina. Centro Rosarino de Estudios Perinatales; ArgentinaFil: Guerrero, Marcia. Universidad Nacional de Rosario. Facultad de Ciencias Médicas; ArgentinaFil: Romero, Mariana. Centro de Estudios de Estado y Sociedad; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Commentaries on ‘Hand washing for preventing diarrhoea’, with a response from the review authors

944-950These are commentaries on a Cochrane review, published in this issue of EBCH, first published as: Ejemot RI, Ehiri JE, Meremikwu MM, Critchley JA. Hand washing for preventing diarrhoea. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004265. DOI: 10.1002/14651858.CD004265.pub2

Intersocietal consensus on the treatment of obesity in adolescents in Argentina

En un contexto socioeconómico mundial de profundas desigualdades, mientras que poblaciones enteras están siendo arrasadas por la desnutrición, es notorio el aumento de la obesidad en niños, adolescentes y adultos. La prevalencia de obesidad ha aumentado a un ritmo alarmante y está afectando progresivamente a muchos países de bajos y medianos ingresos, sobre todo en el medio urbano. Preocupa, especialmente de bido a las severas complicaciones clínicas que ocasiona1,2. De manera coincidente con las tendencias internacionales, en la Argentina la 2º Encuesta Nacional de Nutrición y Salud ( ENNYS) del año 2019 revela cifras del 20,7% y 20,4% de sobrepeso y obesidad en niños de 5 a 17 años, y en la tercera Encuesta Mundial de Salud Escolar del 2018 ( EMSE) , las cifras de la población de 13 a 17 años fueron de 30,7 % de sobrepeso y 7,4 % de obesidad3,4. La obesidad es una enfermedad crónica. Recientemente, la Asociación Europea para el Estudio de la Obesidad (EASO), la resume como una enfermedad por exceso de tejido adiposo. Las severas consecuencias en la salud que provoca dependen de la cantidad, la distribución y la localización del tejido adiposo. La enfermedad se produce, tanto a partir de la alteración en la función endócrina e inmulogógica del organismo, como causando alteraciones anatómicas en el organismo a partir del espacio físico que ocupa...Fil: Kovalskys, Irina. Pontificia Universidad Católica Argentina "Santa María de los Buenos Aires"; ArgentinaFil: Mayer, Marcos Alejandro. Consejo Nacional de Investigaciones Cientificas y Tecnicas. Centro Cientifico Tecnologico Conicet - Patagonia Confluencia. Instituto de Ciencias de la Tierra y Ambientales de la Pampa. Grupo Vinculado Fundacion Centro de Salud E Investigaciones Medicas | Universidad Nacional de la Pampa. Facultad de Ciencias Exactas y Naturales. Instituto de Ciencias de la Tierra y Ambientales de la Pampa. Grupo Vinculado Fundacion Centro de Salud E Investigaciones Medicas.; ArgentinaFil: Armeno, Marisa. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Matto, Liliana. Asociación Psiquiátrica de América Latina; Argentina. Asociación de Psiquiatras Argentinos; ArgentinaFil: Roussos, Adriana. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Schuldberg, Jacqueline. Asociación Argentina de Dietistas- Nutricionistas Dietistas; ArgentinaFil: Tozzi, Karina. Sociedad Argentina de Endocrinología Ginecológica y Reproductiva; ArgentinaFil: Valenti, Claudia. Gobierno de la Ciudad Autonoma de Buenos Aires. Ministerio de Salud. Subsecretaria de Atencion Primaria Ambulatoria y Comunitaria.; ArgentinaFil: Anger, Vanesa E.. Universidad Maimónides; ArgentinaFil: Araujo, María Beatriz. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Bakalarz, Beatriz. Asociación Psiquiatras Argentinos; ArgentinaFil: Bazan, Nelio Eduardo. Universidad Nacional de Rosario; ArgentinaFil: Ganduglia Cazaban, Mercedes. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños Pedro Elizalde (ex Casa Cuna); Argentina. Asociación Argentina de Nutricionistas y Nutricionistas Dietistas; ArgentinaFil: Ozuna, Blanca Acela. Gobierno de la Ciudad de Buenos Aires. Hospital de Pediatría "Juan P. Garrahan"; ArgentinaFil: Rampi, Gabriela. Universidad Austral. Hospital Universitario Austral; ArgentinaFil: Ruiz, Laura. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Sarubbi, Susana. Sociedad Argentina de Nutrición; ArgentinaFil: Tonietti, Miriam. Gobierno de la Ciudad de Buenos Aires. Hospital General de Niños "Ricardo Gutiérrez"; ArgentinaFil: Zonis, Luciana. Sociedad Argentina de Nutrición; ArgentinaFil: Salinas, Victoria. Sociedad Argentina de Nutrición; ArgentinaFil: Aguirre Ackermann, Marianela. Sociedad Argentina de Nutrición; Argentina. Universidad Nacional del Nordeste; Argentina. Universidad Favaloro; ArgentinaFil: Sguassero, Yanina. Sociedad Argentina de Nutrición; ArgentinaFil: Katz, Mónica. Sociedad Argentina de Nutrición; Argentina. Universidad Favaloro; Argentin

Antibody tests for identification of current and past infection with SARS-CoV-2

Background The diagnostic challenges associated with the COVID‐19 pandemic resulted in rapid development of diagnostic test methods for detecting SARS‐CoV‐2 infection. Serology tests to detect the presence of antibodies to SARS‐CoV‐2 enable detection of past infection and may detect cases of SARS‐CoV‐2 infection that were missed by earlier diagnostic tests. Understanding the diagnostic accuracy of serology tests for SARS‐CoV‐2 infection may enable development of effective diagnostic and management pathways, inform public health management decisions and understanding of SARS‐CoV‐2 epidemiology. Objectives To assess the accuracy of antibody tests, firstly, to determine if a person presenting in the community, or in primary or secondary care has current SARS‐CoV‐2 infection according to time after onset of infection and, secondly, to determine if a person has previously been infected with SARS‐CoV‐2. Sources of heterogeneity investigated included: timing of test, test method, SARS‐CoV‐2 antigen used, test brand, and reference standard for non‐SARS‐CoV‐2 cases. Search methods The COVID‐19 Open Access Project living evidence database from the University of Bern (which includes daily updates from PubMed and Embase and preprints from medRxiv and bioRxiv) was searched on 30 September 2020. We included additional publications from the Evidence for Policy and Practice Information and Co‐ordinating Centre (EPPI‐Centre) ‘COVID‐19: Living map of the evidence’ and the Norwegian Institute of Public Health ’NIPH systematic and living map on COVID‐19 evidence’. We did not apply language restrictions. Selection criteria We included test accuracy studies of any design that evaluated commercially produced serology tests, targeting IgG, IgM, IgA alone, or in combination. Studies must have provided data for sensitivity, that could be allocated to a predefined time period after onset of symptoms, or after a positive RT‐PCR test. Small studies with fewer than 25 SARS‐CoV‐2 infection cases were excluded. We included any reference standard to define the presence or absence of SARS‐CoV‐2 (including reverse transcription polymerase chain reaction tests (RT‐PCR), clinical diagnostic criteria, and pre‐pandemic samples). Data collection and analysis We use standard screening procedures with three reviewers. Quality assessment (using the QUADAS‐2 tool) and numeric study results were extracted independently by two people. Other study characteristics were extracted by one reviewer and checked by a second. We present sensitivity and specificity with 95% confidence intervals (CIs) for each test and, for meta‐analysis, we fitted univariate random‐effects logistic regression models for sensitivity by eligible time period and for specificity by reference standard group. Heterogeneity was investigated by including indicator variables in the random‐effects logistic regression models. We tabulated results by test manufacturer and summarised results for tests that were evaluated in 200 or more samples and that met a modification of UK Medicines and Healthcare products Regulatory Agency (MHRA) target performance criteria. Main results We included 178 separate studies (described in 177 study reports, with 45 as pre‐prints) providing 527 test evaluations. The studies included 64,688 samples including 25,724 from people with confirmed SARS‐CoV‐2; most compared the accuracy of two or more assays (102/178, 57%). Participants with confirmed SARS‐CoV‐2 infection were most commonly hospital inpatients (78/178, 44%), and pre‐pandemic samples were used by 45% (81/178) to estimate specificity. Over two‐thirds of studies recruited participants based on known SARS‐CoV‐2 infection status (123/178, 69%). All studies were conducted prior to the introduction of SARS‐CoV‐2 vaccines and present data for naturally acquired antibody responses. Seventy‐nine percent (141/178) of studies reported sensitivity by week after symptom onset and 66% (117/178) for convalescent phase infection. Studies evaluated enzyme‐linked immunosorbent assays (ELISA) (165/527; 31%), chemiluminescent assays (CLIA) (167/527; 32%) or lateral flow assays (LFA) (188/527; 36%). Risk of bias was high because of participant selection (172, 97%); application and interpretation of the index test (35, 20%); weaknesses in the reference standard (38, 21%); and issues related to participant flow and timing (148, 82%). We judged that there were high concerns about the applicability of the evidence related to participants in 170 (96%) studies, and about the applicability of the reference standard in 162 (91%) studies. Average sensitivities for current SARS‐CoV‐2 infection increased by week after onset for all target antibodies. Average sensitivity for the combination of either IgG or IgM was 41.1% in week one (95% CI 38.1 to 44.2; 103 evaluations; 3881 samples, 1593 cases), 74.9% in week two (95% CI 72.4 to 77.3; 96 evaluations, 3948 samples, 2904 cases) and 88.0% by week three after onset of symptoms (95% CI 86.3 to 89.5; 103 evaluations, 2929 samples, 2571 cases). Average sensitivity during the convalescent phase of infection (up to a maximum of 100 days since onset of symptoms, where reported) was 89.8% for IgG (95% CI 88.5 to 90.9; 253 evaluations, 16,846 samples, 14,183 cases), 92.9% for IgG or IgM combined (95% CI 91.0 to 94.4; 108 evaluations, 3571 samples, 3206 cases) and 94.3% for total antibodies (95% CI 92.8 to 95.5; 58 evaluations, 7063 samples, 6652 cases). Average sensitivities for IgM alone followed a similar pattern but were of a lower test accuracy in every time slot. Average specificities were consistently high and precise, particularly for pre‐pandemic samples which provide the least biased estimates of specificity (ranging from 98.6% for IgM to 99.8% for total antibodies). Subgroup analyses suggested small differences in sensitivity and specificity by test technology however heterogeneity in study results, timing of sample collection, and smaller sample numbers in some groups made comparisons difficult. For IgG, CLIAs were the most sensitive (convalescent‐phase infection) and specific (pre‐pandemic samples) compared to both ELISAs and LFAs (P < 0.001 for differences across test methods). The antigen(s) used (whether from the Spike‐protein or nucleocapsid) appeared to have some effect on average sensitivity in the first weeks after onset but there was no clear evidence of an effect during convalescent‐phase infection. Investigations of test performance by brand showed considerable variation in sensitivity between tests, and in results between studies evaluating the same test. For tests that were evaluated in 200 or more samples, the lower bound of the 95% CI for sensitivity was 90% or more for only a small number of tests (IgG, n = 5; IgG or IgM, n = 1; total antibodies, n = 4). More test brands met the MHRA minimum criteria for specificity of 98% or above (IgG, n = 16; IgG or IgM, n = 5; total antibodies, n = 7). Seven assays met the specified criteria for both sensitivity and specificity. In a low‐prevalence (2%) setting, where antibody testing is used to diagnose COVID‐19 in people with symptoms but who have had a negative PCR test, we would anticipate that 1 (1 to 2) case would be missed and 8 (5 to 15) would be falsely positive in 1000 people undergoing IgG or IgM testing in week three after onset of SARS‐CoV‐2 infection. In a seroprevalence survey, where prevalence of prior infection is 50%, we would anticipate that 51 (46 to 58) cases would be missed and 6 (5 to 7) would be falsely positive in 1000 people having IgG tests during the convalescent phase (21 to 100 days post‐symptom onset or post‐positive PCR) of SARS‐CoV‐2 infection. Authors' conclusions Some antibody tests could be a useful diagnostic tool for those in whom molecular‐ or antigen‐based tests have failed to detect the SARS‐CoV‐2 virus, including in those with ongoing symptoms of acute infection (from week three onwards) or those presenting with post‐acute sequelae of COVID‐19. However, antibody tests have an increasing likelihood of detecting an immune response to infection as time since onset of infection progresses and have demonstrated adequate performance for detection of prior infection for sero‐epidemiological purposes. The applicability of results for detection of vaccination‐induced antibodies is uncertain

COVID-19 pandemic and infodemic: challenges and opportunities for reliable and updated synthesis of knowledge

Fil: Franco, Juan Víctor Ariel. Instituto Universitario Hospital Italiano de Buenos Aires. Centro Cochrane Asociado; Argentina.Fil: Sguassero, Yanina. Centro Rosarino de Estudios Perinatales. Centro Cochrane Asociado; Argentina.En paralelo a la pandemia por el nuevo coronavirus (SARS-CoV-2) que causa la enfermedad por coronavirus (COVID-19), emerge otra epidemia denominada infodemia. Esto provoca una saturación y sobreexposición a información de calidad variable y dificulta el acceso a la información confiable por el personal de salud y otros tomadores de decisión. A su vez, existen diversas formas de síntesis de información; entre las más conocidas se encuentran las revisiones sistemáticas, que pueden asistir a los tomadores de decisiones en la formulación de políticas y cuidados basados en la evidencia. En este artículo, se resumen algunas de las limitaciones en las revisiones sistemáticas actuales y los retos que acarrean las nuevas metodologías para la síntesis de la evidencia. Cochrane y otras organizaciones han liderado la innovación metodológica para favorecer el acceso y uso de la síntesis de información en COVID-19. Aparecen en escena las revisiones sistemáticas rápidas para dar respuesta a preguntas de prioridad alta en los diferentes países, se crea un repositorio de ensayos clínicos sobre COVID-19 y se pone en marcha un protocolo a nivel internacional para conducir un metaanálisis en red vivo sobre la efectividad de las intervenciones terapéuticas y de prevención en pacientes infectados por SARS-CoV-2. A nivel regional, se destacan la base de datos COVID-19 de la Organización Panamericana de la Salud y el registro de estudios primarios y revisiones sistemáticas de libre acceso (plataforma Living OVerview of the Evidence, L·OVE

COVID-19 pandemic and infodemic: challenges and opportunities for reliable and updated synthesis of knowledge

Fil: Franco, Juan Víctor Ariel. Instituto Universitario Hospital Italiano de Buenos Aires. Centro Cochrane Asociado; Argentina.Fil: Sguassero, Yanina. Centro Rosarino de Estudios Perinatales. Centro Cochrane Asociado; Argentina.En paralelo a la pandemia por el nuevo coronavirus (SARS-CoV-2) que causa la enfermedad por coronavirus (COVID-19), emerge otra epidemia denominada infodemia. Esto provoca una saturación y sobreexposición a información de calidad variable y dificulta el acceso a la información confiable por el personal de salud y otros tomadores de decisión. A su vez, existen diversas formas de síntesis de información; entre las más conocidas se encuentran las revisiones sistemáticas, que pueden asistir a los tomadores de decisiones en la formulación de políticas y cuidados basados en la evidencia. En este artículo, se resumen algunas de las limitaciones en las revisiones sistemáticas actuales y los retos que acarrean las nuevas metodologías para la síntesis de la evidencia. Cochrane y otras organizaciones han liderado la innovación metodológica para favorecer el acceso y uso de la síntesis de información en COVID-19. Aparecen en escena las revisiones sistemáticas rápidas para dar respuesta a preguntas de prioridad alta en los diferentes países, se crea un repositorio de ensayos clínicos sobre COVID-19 y se pone en marcha un protocolo a nivel internacional para conducir un metaanálisis en red vivo sobre la efectividad de las intervenciones terapéuticas y de prevención en pacientes infectados por SARS-CoV-2. A nivel regional, se destacan la base de datos COVID-19 de la Organización Panamericana de la Salud y el registro de estudios primarios y revisiones sistemáticas de libre acceso (plataforma Living OVerview of the Evidence, L·OVE

Update about the use of World Health Organization growth standards within the primary health care network of Rosario

Objetivo: a más de 10 años del cambio del patrón de referencia del crecimiento infantil en argentina, se realizó un estudio para conocer el estado de implementación de los estándares de crecimiento de 0 a 5 años de la organización mundial de la salud en atención primaria de la salud. Métodos: estudio transversal realizado en la ciudad de rosario, santa fe (mayo 2018—mayo 2019). Se enviaron encuestas en línea a médicos pediatras y generalistas, y se entrevistaron a informantes clave. Los ejes de indagación fueron: valoración de la herramienta, estrategias de capacitación, e intervenciones para promover el uso e interpretación. El análisis fue cuali—cuantitativo. Resultados: se completaron 95 encuestas y se realizaron ocho entrevistas. La adopción de los estándares oms fue considerado un cambio favorable para la argentina. Las intervenciones de valoradas como de mayor utilidad para optimizar el uso de los estándares de la organización mundial de la salud por los médicos encuestados fueron: mantenimiento de los equipos para mediciones antropométricas, promoción de consejería nutricional e impresión de gráficas de crecimiento para uso individual. Las diferencias de opinión entre los médicos de los centros de salud y quienes ocupan un cargo en gestión estuvieron dadas por la factibilidad de algunas intervenciones en atención primaria de la salud. Conclusión: existen estrategias tendientes a favorecer la implementación de intervenciones valoradas por los médicos de la red de atención primaria que permitirían un mayor aprovechamiento de los estándares de la organización mundial de la salud.At 10 years from the change of the child growth reference in Argentina, a study about the state of implementation of the growth standards of 0 to 5 years of the World Health Organization in primary health care was conducted. Methods: Cross—sectional study carried out in the city of Rosario, Santa Fe (May 2018—May 2019). Online surveys were sent to pediatric and general practitioners, and key informants were interviewed. The axes of inquiry were: appreciation of the tool, training strategies, and interventions to promote its use and interpretation. The analysis was quali—qualitative. Results: 95 surveys were completed and eight interviews were conducted. The adoption of the World Health Organization standards was considered a favorable change for Argentina. The interventions considered most useful by the surveyed physicians were: maintenance of equipment for anthropometric measurements, printing of growth charts for individual use, and promotion of nutritional counseling. Differences of opinion between physicians at health care centers and those in a management position were given by feasibility. Discussion: The physician’s opinions represent a great contribution to improve the quality of the control of child growth in primary health care

Wolbachia ‐carrying Aedes mosquitoes for preventing dengue infection

Background Dengue is a global health problem of high significance, with 3.9 billion people at risk of infection. The geographic expansion of dengue virus (DENV) infection has resulted in increased frequency and severity of the disease, and the number of deaths has increased in recent years. Wolbachia, an intracellular bacterial endosymbiont, has been under investigation for several years as a novel dengue‐control strategy. Some dengue vectors (Aedes mosquitoes) can be transinfected with specific strains of Wolbachia, which decreases their fitness (ability to survive and mate) and their ability to reproduce, inhibiting the replication of dengue. Both laboratory and field studies have demonstrated the potential effect of Wolbachia deployments on reducing dengue transmission, and modelling studies have suggested that this may be a self‐sustaining strategy for dengue prevention, although long‐term effects are yet to be elucidated. Objectives To assess the efficacy of Wolbachia‐carrying Aedes species deployments (specifically wMel‐, wMelPop‐, and wAlbB‐ strains of Wolbachia) for preventing dengue virus infection. Search methods We searched CENTRAL, MEDLINE, Embase, four other databases, and two trial registries up to 24 January 2024. Selection criteria Randomized controlled trials (RCTs), including cluster‐randomized controlled trials (cRCTs), conducted in dengue endemic or epidemic‐prone settings were eligible. We sought studies that investigated the impact of Wolbachia‐carrying Aedes deployments on epidemiological or entomological dengue‐related outcomes, utilizing either the population replacement or population suppression strategy. Data collection and analysis Two review authors independently selected eligible studies, extracted data, and assessed the risk of bias using the Cochrane RoB 2 tool. We used odds ratios (OR) with the corresponding 95% confidence intervals (CI) as the effect measure for dichotomous outcomes. For count/rate outcomes, we planned to use the rate ratio with 95% CI as the effect measure. We used adjusted measures of effect for cRCTs. We assessed the certainty of evidence using GRADE. Main results One completed cRCT met our inclusion criteria, and we identified two further ongoing cRCTs. The included trial was conducted in an urban setting in Yogyakarta, Indonesia. It utilized a nested test‐negative study design, whereby all participants aged three to 45 years who presented at healthcare centres with a fever were enrolled in the study provided they had resided in the study area for the previous 10 nights. The trial showed that wMel‐Wolbachia infected Ae aegypti deployments probably reduce the odds of contracting virologically confirmed dengue by 77% (OR 0.23, 95% CI 0.15 to 0.35; 1 trial, 6306 participants; moderate‐certainty evidence). The cluster‐level prevalence of wMel Wolbachia‐carrying mosquitoes remained high over two years in the intervention arm of the trial, reported as 95.8% (interquartile range 91.5 to 97.8) across 27 months in clusters receiving wMel‐Wolbachia Ae aegypti deployments, but there were no reliable comparative data for this outcome. Other primary outcomes were the incidence of virologically confirmed dengue, the prevalence of dengue ribonucleic acid in the mosquito population, and mosquito density, but there were no data for these outcomes. Additionally, there were no data on adverse events. Authors' conclusions The included trial demonstrates the potential significant impact of wMel‐Wolbachia‐carrying Ae aegypti mosquitoes on preventing dengue infection in an endemic setting, and supports evidence reported in non‐randomized and uncontrolled studies. Further trials across a greater diversity of settings are required to confirm whether these findings apply to other locations and country settings, and greater reporting of acceptability and cost are important

Optimizing the use of cesarean section in Argentina: design and methodology of a formative research for the development of interventions

Fil: Ramos, Silvina. CEDES. Centro de Estudio de Estado y Sociedad. Área de Salud, Economía y Sociedad; Argentina.Fil: Romero, Mariana. CEDES. Centro de Estudio de Estado y Sociedad. Área de Salud, Economía y Sociedad. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); Argentina.Fil: Perrotta, Carla. School of Public Health, University College Dublin, National University of Ireland, Dublin; Ireland.Fil: Sguassero, Yanina. CREP: Centro Rosarino de Estudios Perinatales, Rosario; Argentina.Fil: Straw, Cecilia. CEDES. Centro de Estudio de Estado y Sociedad. Área de Salud, Economía y Sociedad. Facultad de Ciencias Sociales, Universidad de Buenos Aires; Argentina.Fil: Gialdini, Celina. CREP: Centro Rosarino de Estudios Perinatales, Rosario; Argentina.Fil: Righetti, Natalia. CEDES. Centro de Estudio de Estado y Sociedad. Área de Salud, Economía y Sociedad; Argentina.Fil: Betran, Ana P. Department of Reproductive Health and Research, UNDP, UNFPA, UNICEF, WHO, World Bank Special Programme of Research, Development and Research Training in Human Reproduction, World Health Organization, Geneva; Switzerland.Background While cesarean section is an essential life-saving strategy for women and newborns, its current overuse constitutes a global problem. The aim of this formative research is to collect information from hospitals, health professionals and women regarding the use of cesarean section in Argentina. This article describes the methodology of the study, the characteristics of the hospitals and the profile of the participants. Methods This formative research is a mixed-method study that will be conducted in seven provinces of Argentina. The eligibility criteria for the hospitals are (a) use of the Perinatal Information System, (b) cesarean section rate higher than 27% in 2016, (c) ≥ 1000 deliveries per year. Quantitative and qualitative research techniques will be used for data collection and analysis. The main inquiry points are the determining factors for the use of cesarean section, the potential interventions to optimize the use of cesarean section and, in the case of women, their preferred type of delivery. Discussion It is expected that the findings will provide a situation diagnosis to help a context-sensitive implementation of the interventions recommended by the World Health Organization to optimize cesarean section use. Trial registration IS002316 Plain English Summary Cesarean section is an essential medical tool for mothers and their children, but nowadays its overuse is a problem worldwide. Our purpose is to get information from hospitals, health professionals and women about how cesarean section is used in Argentina. In this protocol we describe how we will carry out the study and the characteristics of the hospitals and participants. We will implement this study in seven provinces of Argentina, in hospitals that have more than 1,000 births each year, had a cesarean section rate higher than 27% in 2016 and use the Perinatal Information System. We will gather information using forms, surveys and interviews. We want to identify the factors that decide the use of a cesarean section, the potential interventions that can improve the use of cesarean section and, in the case of women, the type of delivery they prefer. We expect that this study will give us a diagnosis of how cesarean section is used in Argentina, and that this will help to apply the interventions that the World Health Organization recommends to optimize the use of cesarean section in our specific context

Course of Chronic Trypanosoma cruzi Infection after Treatment Based on Parasitological and Serological Tests: A Systematic Review of Follow-Up Studies.

Chagas disease is caused by the flagellate protozoan Trypanosoma cruzi (T. cruzi). It is endemic in Latin American countries outside the Caribbean. The current criterion for cure in the chronic phase of the disease is the negativization of at least two serological tests such as enzyme-linked immunosorbent assay (ELISA), indirect immunofluorescence assay (IIF) and indirect hemagglutination assay (IHA). The serological evolution of treated subjects with chronic T. cruzi infection is variable. Treatment failure is indicated by a positive parasitological and/or molecular test (persistence of parasitemia).To summarize the pattern of response to treatment of parasitological, molecular and serological tests performed during the follow-up of subjects with chronic T. cruzi infection.Electronic searches in relevant databases and screening of citations of potentially eligible articles were accomplished. Organizations focusing on neglected infectious diseases were asked for help in identifying relevant studies. Included studies were randomized controlled trials (RCTs), quasi-RCTs, and cohort studies involving adults and children with chronic infection who received trypanocidal treatment (benznidazole or nifurtimox) and were followed over time. The assessment of risk of bias was performed separately for each study design. The Cochrane Collaboration's tool and the guidelines developed by Hayden et al. were used. Two reviewers extracted all data independently. A third review author was consulted in case of discordant opinion. Additional analyses were defined in ad-hoc basis. Scatter plots for percentage of positive parasitological and molecular tests and for negative serological tests were developed by using the lowess curve technique. Heterogeneity was measured by I2. The protocol was registered in PROSPERO, an international prospective register of systematic review protocols (Registration Number CRD42012002162).Out of 2,136 citations screened, 54 studies (six RCTs and 48 cohort studies) were included. The smoothed curves for positive xenodiagnosis and positive polymerase chain reaction (PCR) were characterized by a sharp decrease at twelve month posttreatment. Afterwards, they reached 10-20% and 40% for xenodiagnosis and PCR, respectively. The smoothed curves for negative conventional serological tests increased up to 10% after 48 months of treatment. In the long-term, the rate of negativization was between 20% and 45%. The main sources of bias identified across cohort studies were the lack of control for confounding and attrition bias. In general, RCTs were judged as low risk of bias in all domains. The level of heterogeneity across included studies was moderate to high. Additional analysis were incomplete because of the limited availability of data. In this regard, the country of origin of study participants might affect the results of parasitological and molecular tests, while the level of risk of bias might affect serological outcomes. Subgroup analysis suggested that seronegativization occurs earlier in children compared to adults.We acknowledge that there is a dynamic pattern of response based on parasitological, molecular and serological tests in subjects chronically infected with T. cruzi after treatment. Our findings suggest a trypanocidal effect in the long-term follow-up. Further research is needed to explore potential sources of heterogeneity and to conduct reliable subgroup analysis