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Leishmaniases are a group of vector-borne diseases caused by parasites of the genus Leishmania, which are renowned for increasing global spread due to factors like climate change, globalisation, urbanisation and migration. Leishmaniasis is classified as a neglected tropical disease but is endemic in several areas of the Mediterranean Basin, including Italy, where Leishmania infantum is most involved as the parasite, phlebotomine sand fly as the vector and dog as the principal reservoir. Effective surveillance of communicable infectious diseases is a goal worldwide for organisations such as the WHO and for local and national governments but is an unfulfilled objective. Even in Italy and particularly in the region of Tuscany, despite mandatory reporting, significant gaps each year are identified between reported cases and hospital admissions. By estimating the underreporting of confirmed human leishmaniasis cases, this protocol aims to suggest actions to strengthen the current epidemiological surveillance system to enable timely and effective public health intervention in human and veterinary populations.
This retrospective multicentre study, conducted in the Central Tuscany Health District, the most populous area of the Tuscany region with approximately 1.6 million inhabitants, is based on the analysis of data collected from 2014 to 2024 using diagnostic laboratory, hospital and regional information system sources. The primary objective is to estimate the degree of underreporting of leishmaniasis in this area through the application of capture-recapture models. The secondary objective is to analyse the clinical and demographic characteristics of individuals diagnosed as confirmed leishmaniasis cases between January 2014 and December 2024, as well as to perform a geolocation analysis of the cases. The study includes the entire population, both adult and paediatric, of the Central Tuscany Health District who underwent laboratory testing for leishmaniasis (serological tests identifying the presence of antibodies; parasitological examination with evidence of amastigotes in aspirates, smears or biopsy sections; culture examination of aspirates, biopsies and/or peripheral blood positive for the presence of promastigotes; identification of Leishmania nucleic acid in aspirates, biopsies and/or peripheral blood samples via molecular diagnosis).
The study is being conducted in accordance with the protocol approved by the Ethics Committee of the Tuscany Region – Pediatrics Section, in November 2024. Ethics Committee opinion register number: 219/2024. Because the study uses only pseudonymised, routinely collected administrative and laboratory data with no direct patient contact or intervention, individual informed consent was not required, as confirmed by the Ethics Committee. Findings will be submitted to a peer-reviewed journal, presented at international conferences and presented at stakeholder workshops.
To analyse the incidence of physical restraint use during painful and stressful procedures in hospitalised children, as well as the factors associated with its use.
Observational, longitudinal and prospective study.
Children aged between 28 days and 10 years in a public hospital in Brazil were each observed undergoing clinical procedures over a 6-h period. Data were collected on demographics, observed pain using validated measures, stress behaviours, and the use of physical restraint. Descriptive and inferential analyses were performed. National ethical guidelines were strictly followed.
1210 procedures were observed on 75 children, including 351 painful and 859 stressful procedures. Physical restraint was used in 270 (22.3%) procedures; of these, 131 (48.5%) were painful procedures and 139 (51.5%) were stressful procedures. In stressful procedures, at least one stress-related behaviour was observed before the initiation of physical restraint. Factors associated with increased use of physical restraint during painful procedures were younger children, with higher levels of care dependency, higher pain scores during procedures, and those who underwent intravenous medication administration, airway suctioning, tube insertion, and fixation changes. In stressful procedures, the factors associated with higher use of physical restraint were younger children, hospitalisation due to respiratory conditions, those who underwent physical examinations, inhaled medication, and nasal lavage; and the child's expression of stress behaviour before the procedure starts. Predictors of physical restraint included morning period, younger age group, male or female sex, and transfer from the Intensive Care Unit.
A high incidence of physical restraints was observed across multiple painful and stressful procedures performed within a 6-h period, associated with variables related to both the child's characteristics and the procedures.
This study aims to encourage reconsideration of the frequent use of physical restraint in paediatric procedures, calling for a reframing of its application as an unquestioned practice toward an approach that prioritises protecting and respecting a child as a subject with needs, rights, and desires.
Strengthening the Reporting of Observational studies in Epidemiology (STROBE).
El paciente con Covid-19 en UCI presenta una alta carga de trabajo de enfermería, sumado al aumento de personal no formado, surge la necesidad de estandarizar un PAE. El objetivo es la presentación de un PAE de un paciente con Covid-19 en la UCI para aportar el conocimiento necesario para ofrecer una atención óptima y holística. En estos pacientes hay que valorar el requerimiento de sedoanalgesia y relajación, la tolerancia a la nutrición enteral, las hiperglucemias por estrés y corticoterapia, así como la vigilancia de la monitorización y ventilación mecánica. Debido a la posición prona, estos pacientes tienen riesgo de úlceras por presión. Los principales diagnósticos de enfermería están relacionados con el sistema respiratorio: limpieza ineficaz de las vías aéreas y deterioro del intercambio de gases. Por la sedoanalgesia existe un alto riesgo de síndrome de desuso, de lesión corneal, de úlceras por presión...en lo que se debe prestar aten-ción.
Objetivos: determinar los indicadores de morbilidad de la tuberculosis en una ciudad del nordeste brasileño prioritaria para el control de la enfermedad y describir características sociodemográficas y clínicas-epidemiológicas de los casos notificados. Método: se trata de un estudio epidemiológico descriptivo con enfoque cuantitativo, considerando todos los casos notificados mediante el Sistema Nacional de Información y Agravios de Notificación en 2015 y expresando los coeficientes de incidencia y prevalencia. Las variables relacionadas con la caracterización sociodemográfica tales como género, edad, raza/color, nivel de educación y zona de residencia, así como las de investigación clínica-epidemiológica, tipo de ingreso, forma clínica, realización de baciloscopía, cultivo, realización de tratamiento supervisado y desenlace de tratamiento fueron analizadas por medio de la estadística descriptiva. Resultados: las tasas de prevalencia e incidencia fueron respectivamente 26,0 y 24,5 casos/100.000 habitantes, donde la mayoría de los casos notificados pertenecían a la zona urbana (98,48%), haciendo hincapié en hombres (68,18%), con edades ≤ 40 años (60%), raza/color pardo (78,79%) y con el predominio de la enseñanza primaria completa (34,85%). En lo que atañe a las características clínicas y epidemiológicas, la mayoría presentaba la forma clínica pulmonar (89,39%), resaltando la baciloscopía de esputo positivo (40,91%), cultivo de esputo no realizada (92,42%), rayos-x torácicos sospechosos para tuberculosis (54,55%), enfermedades y agravios – SIDA (10,61%), y la situación de desenlace predominante fue la cura (86,36%). Conclusiones: a pesar del panorama epidemiológico evidenciado con indicadores de morbilidad por debajo del promedio nacional, la identificación del perfil clínico-epidemiológico de la población afectada señaló aspectos importantes que deben ser observados relacionados con la organización de los sistemas y servicios sanitarios para el control y vigilancia de esta enfermedad.
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