RESUMO
Los trastornos de la conducta alimentaria (TCA) han adquirido relevancia en la pediatría chilena. Su tratamiento debe ser realizado, de preferencia, por equipos multidisciplinarios especializados o con alto grado de capacitación en la problemática. Sin embargo, los pediatras generales tienen un rol fundamental tanto en la prevención como en la pesquisa temprana de estas patologías. El objetivo de esta publicación es proporcionarles recomendaciones prácticas sobre las intervenciones que pueden llevar a cabo durante la atención de adolescentes, para la prevención de los TCA, la pesquisa precoz y evaluación de quienes ya los presentan, y su derivación oportuna a tratamiento especializado.
Eating disorders (ED) have become relevant in Chilean pediatrics. Their treatment must be prefe rably carried out by multidisciplinary teams with specialty or a high degree of training in the pro blem. However, general pediatricians have a fundamental role both in the prevention and in the early detection of these pathologies. The purpose of this publication is to provide them with practical recommendations on interventions that can be carried out during adolescent care for the prevention of ED, the early detection and evaluation of those who already have them, and their timely referral to specialized treatment.
Assuntos
Humanos , Adolescente , Pediatria/métodos , Pediatria/normas , Papel do Médico/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Pediatras/normas , Pediatras/psicologia , Equipe de Assistência ao Paciente , Exame Físico/métodos , Exame Físico/normas , Relações Médico-Paciente , Prevenção Primária/métodos , Prevenção Primária/normas , Encaminhamento e Consulta , Chile , Fatores de Risco , Diagnóstico Precoce , Diagnóstico Diferencial , Anamnese/métodos , Anamnese/normasRESUMO
Eating disorders (ED) have become relevant in Chilean pediatrics. Their treatment must be prefe rably carried out by multidisciplinary teams with specialty or a high degree of training in the pro blem. However, general pediatricians have a fundamental role both in the prevention and in the early detection of these pathologies. The purpose of this publication is to provide them with practical recommendations on interventions that can be carried out during adolescent care for the prevention of ED, the early detection and evaluation of those who already have them, and their timely referral to specialized treatment.
Assuntos
Transtornos da Alimentação e da Ingestão de Alimentos , Pediatras , Pediatria , Papel do Médico , Adolescente , Chile , Diagnóstico Diferencial , Diagnóstico Precoce , Transtornos da Alimentação e da Ingestão de Alimentos/diagnóstico , Transtornos da Alimentação e da Ingestão de Alimentos/etiologia , Transtornos da Alimentação e da Ingestão de Alimentos/psicologia , Transtornos da Alimentação e da Ingestão de Alimentos/terapia , Humanos , Anamnese/métodos , Anamnese/normas , Equipe de Assistência ao Paciente , Pediatras/psicologia , Pediatras/normas , Pediatria/métodos , Pediatria/normas , Exame Físico/métodos , Exame Físico/normas , Papel do Médico/psicologia , Relações Médico-Paciente , Prevenção Primária/métodos , Prevenção Primária/normas , Encaminhamento e Consulta , Fatores de RiscoAssuntos
Humanos , Prevenção Primária/normas , Doenças Cardiovasculares/prevenção & controle , Assistência Centrada no Paciente/normas , Tomada de Decisões , Fatores Socioeconômicos , Índice de Massa Corporal , Aspirina/normas , Medição de Risco/normas , Abandono do Uso de Tabaco , Diabetes Mellitus Tipo 2/prevenção & controle , Comportamento Sedentário , Alimentos, Dieta e Nutrição , Hipercolesterolemia/complicações , Hipertensão/complicações , Atividade Motora , Obesidade/prevenção & controleRESUMO
In Mexico, osteoporosis is a public health problem. In this document, the Mexican Association for Bone and Mineral Metabolism defines its position on calcium, vitamin D supplement use, and physical activity as an effective, safe, and cost-effective initiatives to prevent low bone mass. INTRODUCTION: In Mexico, osteoporosis is a public health problem that is expected to increase in the decades ahead. Generally, modifiable risk factors for bone health are related with lifestyles, especially nutrition and physical activity. METHODS: In this position paper, the Mexican Association for Bone and Mineral Metabolism (AMMOM, by its acronym in Spanish), which is a multidisciplinary group of researchers, dietitians, epidemiologists, nurses, and physicians who study bone and related tissues and communicate the best strategies for diagnosis, treatment, and prevention of bone problems, aims to analyze the association between nutrition and bone health, risk behaviors for low bone mass, and the economic impact that prevention of low bone mass represents for the health care system. RESULTS: Addressing therapeutic management with pharmacological and non-pharmacological approaches, we emphasize the important role the patient plays in the doctor-patient relationship, both in the consulting room and in daily life. Furthermore, the AMMOM defines its position on calcium and vitamin D supplement use as an effective, safe, and cost-effective initiative to prevent low bone mass. CONCLUSIONS: In summary, most research and clinical practice related to osteoporosis have focused on diagnosis and treatment, but general measures for primary prevention based on addressing modifiable risk factors as a public health priority to delay the onset of loss of bone mass have not been considered by Mexican authorities. Consequently, the AMMOM task force also seeks to provide information on concrete actions to prevent low bone mass.
Assuntos
Osteoporose/prevenção & controle , Guias de Prática Clínica como Assunto , Prevenção Primária/normas , Comitês Consultivos , Densidade Óssea , Cálcio da Dieta/uso terapêutico , Suplementos Nutricionais/normas , Exercício Físico , Feminino , Humanos , Estilo de Vida , Masculino , México , Relações Médico-Paciente , Fatores de Risco , Vitamina D/uso terapêuticoRESUMO
The American Academy of Nursing has identified toxic stress in childhood as a health policy concern of high priority. Adult diseases (e.g., obesity, diabetes, hypertension and cardiovascular disease) should be viewed as developmental disorders that begin early in life that could be reduced with the alleviation of toxic stress in childhood. The provision of human milk/breastfeeding is an evidence-based intervention that may hold the greatest potential to mitigate the effects of toxic stress from the moment of birth. Assisting families to make an informed choice to initiate and continue breastfeeding from birth has the potential to address both the disparity in the quality of nutrition provided infants and the economic stress experienced by families who purchase formula. The Expert Panel on Breastfeeding endorses initiatives to improve the initiation, duration, and exclusivity of breastfeeding to mitigate the effects of toxic stress in this call to action for research to build the evidence to support these critical relationships.
Assuntos
Aleitamento Materno/psicologia , Leite Humano/química , Guias de Prática Clínica como Assunto , Prevenção Primária/normas , Estresse Fisiológico , Adulto , Feminino , Substâncias Perigosas , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estados UnidosRESUMO
The increasing global stroke burden strongly suggests that currently implemented primary stroke prevention strategies are not sufficiently effective, and new primary prevention strategies with larger effect sizes are needed. Here, we review the latest stroke epidemiology literature, with an emphasis on the recently published Global Burden of Disease 2013 Study estimates; highlight the problems with current primary stroke and cardiovascular disease (CVD) prevention strategies; and outline new developments in primary stroke and CVD prevention. We also suggest key priorities for the future, including comprehensive prevention strategies that target people at all levels of CVD risk; implementation of an integrated approach to promote healthy behaviours and reduce health disparities; capitalizing on information technology to advance prevention approaches and techniques; and incorporation of culturally appropriate education about healthy lifestyles into standard education curricula early in life. Given the already immense and fast-increasing burden of stroke and other major noncommunicable diseases (NCDs), which threatens worldwide sustainability, governments of all countries should develop and implement an emergency action plan addressing the primary prevention of NCDs, possibly including taxation strategies to tackle unhealthy behaviours that increase the risk of stroke and other NCDs.
Assuntos
Saúde Global/normas , Prevenção Primária/métodos , Prevenção Primária/normas , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/prevenção & controle , Humanos , Acidente Vascular Cerebral/mortalidadeRESUMO
OBJECTIVE: The Patient Protection and Affordable Care Act (ACA) increases Medicaid physician fees for preventive care up to Medicare rates for 2013 and 2014. The purpose of this paper was to model the relationship between Medicaid preventive care payment rates and the use of U.S. Preventive Services Task Force (USPSTF)-recommended preventive care use among Medicaid enrollees. DATA SOURCES/STUDY SESSION: We used data from the 2003 and 2008 Medical Expenditure Panel Survey (MEPS), a national probability sample of the U.S. civilian, noninstitutionalized population, linked to Kaiser state Medicaid benefits data, including the state Medicaid-to-Medicare physician fee ratio in 2003 and 2008. STUDY DESIGN: Probit models were used to estimate the probability that eligible individuals received one of five USPSF-recommended preventive services. A difference-in-difference model was used to separate out the effect of changes in the Medicaid payment rate and other factors. DATA COLLECTION/EXTRACTION METHODS: Data were linked using state identifiers. PRINCIPAL FINDINGS: Although Medicaid enrollees had a lower rate of use of the five preventive services in univariate analysis, neither Medicaid enrollment nor changes in Medicaid payment rates had statistically significant effects on meeting screening recommendations for the five screenings. The results were robust to a number of different sensitivity tests. Individual and state characteristics were significant. CONCLUSIONS: Our results suggest that although temporary changes in primary care provider payments for preventive services for Medicaid enrollees may have other desirable effects, they are unlikely to substantially increase the use of these selected USPSTF-recommended preventive care services among Medicaid enrollees.
Assuntos
Honorários e Preços/legislação & jurisprudência , Medicaid/economia , Médicos de Atenção Primária/economia , Prevenção Primária/economia , Adulto , Idoso , Feminino , Pesquisas sobre Atenção à Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Patient Protection and Affordable Care Act , Prevenção Primária/normas , Prevenção Primária/estatística & dados numéricos , Estados Unidos , Adulto JovemRESUMO
This study characterized the HIV epidemic among men who have sex with men (MSM) in Quito, Ecuador and contrasted risk patterns with other STI's. 416 MSM ages 15 years and older were recruited using respondent-driven sampling in 2010-2011. Biological testing and a self-interview survey assessed HIV and STI infections and risk behaviors. Analysis incorporated recruiter-level variables and clustering adjustments to control for recruitment patterns. We identify high levels of HIV (11 %), HSV-2 (14 %) and active syphilis (5.5 %) infections, low levels of lifetime HIV testing (57 %), limited knowledge of HIV and STI's (<48 %) and limited consistent condom use independent of partner type (<40 %). Sex work was associated with all infections while associations with residential location, how casual partners are met and other variables, varied. Scale-up of behavioral prevention and HIV testing is urgently needed. Interventions should target male sex workers and exploit differential patterns of HIV-STI risk to stay ahead of the epidemic.
Assuntos
Infecções por HIV/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Homossexualidade Masculina/estatística & dados numéricos , Prevenção Primária/organização & administração , Infecções Sexualmente Transmissíveis/epidemiologia , Adolescente , Adulto , Equador/epidemiologia , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Hepatite B/epidemiologia , Herpes Genital/epidemiologia , Herpes Simples/epidemiologia , Herpesvirus Humano 2 , Humanos , Masculino , Prevenção Primária/normas , Assunção de Riscos , Infecções Sexualmente Transmissíveis/diagnóstico , Infecções Sexualmente Transmissíveis/prevenção & controle , Infecções Sexualmente Transmissíveis/psicologia , Sífilis/epidemiologia , Adulto JovemRESUMO
BACKGROUND: In this longitudinal cohort study we evaluated the congenital transmission of Chagas disease (CD) in a nonendemic area. The aim of this work was to analyze the predictive value of a Trypanosoma cruzi-positive polymerase chain reaction (PCR) result in pregnant women for the diagnosis of vertical transmission and to evaluate the use of PCR as a tool for early detection of infection. METHODS: The offspring of 59 seropositive pregnant mothers were followed up. The parasitological status of mothers was studied by PCR in a total of 64 pregnancies; 10 of these women had received treatment before pregnancy. Sixty-five infants (including a pair of twins) were monitored at 0, 6, 9, and 12 months of age by PCR and serology. In cases of congenital transmission, hemoculture and parasite lineage typing were performed. RESULTS: Nine infants had acquired CD congenitally. This represents a transmission rate of 13.8% among seropositive mothers (9 infected newborns of 65 total live births). All infants were infected with T. cruzi discrete typing unit V strain. A statistically significant correlation was found between T. cruzi vertical transmission and a positive PCR result during pregnancy (31%; 9 infected newborns in 29 live births). No infected infants were detected among 10 mothers who were treated before they became pregnant, compared with 16.4% (9 of 55 live births) among untreated mothers. CONCLUSIONS: PCR is a useful tool for the detection of congenital CD, and the treatment of infected women of childbearing age seems to be useful for preventing vertical transmission.