RESUMO
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic may have exacerbated existing socioeconomic inequalities in health. In Argentina, public hospitals serve the poorest uninsured segment of the population, while private hospitals serve patients with health insurance. This study aimed to assess whether socioeconomic inequalities in low birth weight (LBW) risk changed during the first wave of the COVID-19 pandemic. METHODS: This multicenter cross-sectional study included 15929 infants. A difference-in-difference (DID) analysis of socioeconomic inequalities between public and private hospitals in LBW risk in a pandemic cohort (March 20 to July 19, 2020) was compared with a prepandemic cohort (March 20 to July 19, 2019) by using medical records obtained from ten hospitals. Infants were categorized by weight as LBW < 2500 g, very low birth weight (VLBW) < 1500 g and extremely low birth weight (ELBW) < 1000 g. Log binomial regression was performed to estimate risk differences with an interaction term representing the DID estimator. Covariate-adjusted models included potential perinatal confounders. FINDINGS: Of the 8437 infants in the prepandemic cohort, 4887 (57â¢9%) were born in public hospitals. The pandemic cohort comprised 7492 infants, 4402 (58â¢7%) of whom were born in public hospitals. The DID estimators indicated no differences between public versus private hospitals for LBW risk (-1â¢8% [95% CI -3â¢6, 0â¢0]) and for ELBW risk (-0â¢1% [95% CI -0â¢6, 0â¢3]). Significant differences were found between public versus private hospitals in the DID estimators (-1â¢2% [95% CI, -2â¢1, -0â¢3]) for VLBW risk. The results were comparable in covariate-adjusted models. INTERPRETATION: In this study, we found evidence of decreased disparities between public and private hospitals in VLBW risk. Our findings suggest that measures that prioritize social spending to protect the most vulnerable pregnant women during the pandemic contributed to better birth outcomes. FUNDING: No funding was secured for this study.
RESUMO
La endoftalmitis endógena neonatal es una patología poco frecuente que puede causar daño ocular grave. Puede manifestarse en pacientes con comorbilidades, como nacimiento pretérmino, bajo peso al nacer, complicaciones posquirúrgicas perinatales o sepsis.El presente reporte de caso documenta a una paciente pretérmino que fue sometida a múltiples cirugías abdominales. Durante su internación, desarrolló sepsis, meningitis y endoftalmitis endógena neonatal. La frecuencia extremadamente baja de la endoftalmitis endógena a esta edad, la importancia de preservar la salud visual del paciente y el abordaje interdisciplinario son puntos importantes de aprendizaje en este caso.
Neonatal endogenous endophthalmitis is a rare condition that can cause serious eye injuries. It can manifest in patients with comorbidities, such as preterm birth, low birth weight, post-surgical perinatal complications, or sepsis.This case report documents a preterm patient who underwent multiple abdominal surgeries. During her hospitalization, she developed sepsis, meningitis and neonatal endogenous endophthalmitis. The extremely low frequency of endogenous endophthalmitis at this age, the importance of preserving the patient's visual health, and the interdisciplinary approach are important learning points in this case.
Assuntos
Humanos , Feminino , Recém-Nascido , Endoftalmite/diagnóstico por imagem , Complicações Pós-Operatórias , Endoftalmite/terapia , Enterobacter cloacae , SepseRESUMO
Neonatal endogenous endophthalmitis is a rare condition that can cause serious eye injuries. It can manifest in patients with comorbidities, such as preterm birth, low birth weight, postsurgical perinatal complications, or sepsis. This case report documents a preterm patient who underwent multiple abdominal surgeries. During her hospitalization, she developed sepsis, meningitis and neonatal endogenous endophthalmitis. The extremely low frequency of endogenous endophthalmitis at this age, the importance of preserving the patient's visual health, and the interdisciplinary approach are important learning points in this case.
La endoftalmitis endógena neonatal es una patología poco frecuente que puede causar daño ocular grave. Puede manifestarse en pacientes con comorbilidades, como nacimiento pretérmino, bajo peso al nacer, complicaciones posquirúrgicas perinatales o sepsis. El presente reporte de caso documenta a una paciente pretérmino que fue sometida a múltiples cirugías abdominales. Durante su internación, desarrolló sepsis, meningitis y endoftalmitis endógena neonatal. La frecuencia extremadamente baja de la endoftalmitis endógena a esta edad, la importancia de preservar la salud visual del paciente y el abordaje interdisciplinario son puntos importantes de aprendizaje en este caso.
Assuntos
Endoftalmite , Nascimento Prematuro , Sepse , Endoftalmite/etiologia , Feminino , Humanos , Recém-Nascido , GravidezRESUMO
BACKGROUND: Beyond the well-known deleterious effects of ethanol defining Fetal Alcohol Spectrum Disorders (FASD), the notion of fetal alcohol programming has gained scientific support. This phenomenon implies early neural plasticity relative to learning mechanisms comprising ethanol´s sensory cues and physiological effects of the drug; among others, its reinforcing properties and its depressant effects upon respiration. In this study, as a function of differential ethanol exposure during gestation, we analyzed neonatal physiological and behavioral responsiveness recruited by the odor of the drug. METHODS: A factorial design defined by maternal ethanol intake during pregnancy (Low, n = 38; Moderate, n = 18 or High, n = 19) and olfactory stimulation (ethanol odor and/or or a novel scent) served as the basis of the study. Neonatal respiratory and cardiac frequencies, oxygen saturation levels and appetitive or aversive facial expressions, served as dependent variables. RESULTS: Newborns of High drinkers exhibited significant physiological and behavioral signs indicative of alcohol odor recognition; specifically, respiratory depressions and exacerbated appetitive facial reactions coupled with diminished aversive expressions. Respiratory depressions were not accompanied by heart rate accelerations (cardiorespiratory dysautonomia). According to ROC curve analyses respiratory and behavioral reactivity were predictive of high maternal intake patterns. CONCLUSIONS: These results validate the notion of human fetal alcohol programming that is detected immediately after birth. The reported early functional signs indicative of relatively high alcohol gestational exposure should broaden our capability of diagnosing FASD and lead to appropriate primary or secondary clinical interventions (Registry of Health Research N.3201- RePIS, Córdoba, Argentina).
Assuntos
Inteligência Artificial , Cuidados Críticos , Aprendizado de Máquina , Assistência Perioperatória , Manuseio das Vias Aéreas , Algoritmos , Anestesia , Pesquisa Biomédica , Transfusão de Sangue , Parada Cardíaca/diagnóstico , Hemorragia/prevenção & controle , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva Pediátrica , Complicações Intraoperatórias/prevenção & controle , Monitorização Intraoperatória , Admissão do Paciente , Complicações Pós-Operatórias/prevenção & controle , Medição de Risco , UltrassonografiaRESUMO
The health care demand for transgenders has increased in Chile and worldwide. However, in Chile health care professionals are not trained to understand and face this problem. We herein review issues that should be considered in the training of non-specialist physicians to provide health care to transgenders, issues about terminology of body reassignment treatments and gender identity and the way Chilean professionals should deal with transgender persons.
Assuntos
Atenção à Saúde , Serviços de Saúde para Pessoas Transgênero , Padrões de Prática Médica , Pessoas Transgênero , Chile , Educação Médica , Feminino , Identidade de Gênero , Nível de Saúde , Humanos , Masculino , Comportamento SexualRESUMO
The health care demand for transgenders has increased in Chile and worldwide. However, in Chile health care professionals are not trained to understand and face this problem. We herein review issues that should be considered in the training of non-specialist physicians to provide health care to transgenders, issues about terminology of body reassignment treatments and gender identity and the way Chilean professionals should deal with transgender persons.