Objective: To assess the safety of botulinum toxin type A for children with cerebral palsy using data from randomized clinical trials.Data sources: A search was conducted of MEDLINE database for the period January 1990 to February 2008. A complementary search was carried out of references from previous reviews. From 122 articles, 20 randomized clinical trials were selected for the review.Review methods: Two authors independently assessed eligibility of the studies and methodological quality of those according to CONSORT guidelines. For each adverse effect, relative risk was calculated, and when more than one study reported adverse effects, a meta-analysis was carried out. Sensitivity analyses with different continuity corrections factors were performed when zero cases were reported in a study arm.Results: There were 882 participants in the 20 studies included in the meta-analysis. Six studies reported zero adverse effects. Thirty-five different adverse events were reported. Botulinum toxin type A use was related to respiratory tract infection, bronchitis, pharyngytis, asthma, muscle weakness, urinary incontinence, falls, seizures, fever and unspecified pain. Two deaths were reported in the study with higher person-time follow-up (relative risk (RR) 4.69, 95% confidence interval (CI) 0.23—95).Conclusions: Botulinum toxin type A has a good safety profile during the first months of use. However the occurrence of adverse events is more frequent among children with cerebral palsy than individuals with other conditions. Severe adverse events are potentially related with the use of botulinum toxin type A, but data are sparse and additional study is required to clarify the causal relation.

A peer-reviewed open access journal published by the National Institute of Environmental Health Sciences

To assess the association of social determinants on the performance of health systems around the world. A transnational ecological study was conducted with an observation level focused on the country. In order to research on the strength of the association between the annual maternal and child mortality in 154 countries and social determinants: corruption, democratization, income inequality and cultural fragmentation, we used a mixed linear regression model for repeated measures with random intercepts and a conglomerate-based geographical analysis, between 2000 and 2010. Health determinants with a significant association on child mortality(<1year): higher access to water (βa Quartile 4(Q4) vs Quartile 1(Q1) = -6,14; 95%CI: -11,63 to -0,73), sanitation systems, (Q4 vs Q1 = -25,58; 95%CI: -31,91 to -19,25), % measles vaccination coverage (Q4 vs Q1 = -7.35; 95%CI: -10,18 to -4,52), % of births attended by a healthcare professional (Q4 vs Q1 = -7,91; 95%CI: -11,36 to -4,52) and a % of the total health expenditure (Q3 vs Q1 = -2,85; 95%CI: -4,93 to -0,7). Ethnic fragmentation (Q4 vs Q1 = 9,93; 95%CI: -0.03 to 19.89) had a marginal effect. For child mortality<5 years, an association was found for these variables and democratization (not free vs free = 11,23; 95%CI: -0,82 to 23,29), out-of-pocket expenditure (Q1 vs Q4 = 17,71; 95%CI: 5,86 to 29,56). For MMR (Maternal mortality ratio), % of access to water for all the quartiles, % of access to sanitation systems, (Q3 vs Q1 = -171,15; 95%CI: -281,29 to -61), birth attention by a healthcare professional (Q4 vs Q1 = -231,23; 95%CI: -349,32 to -113,15), and having corrupt government (Q3 vs Q1 = 83,05; 95%CI: 33,10 to 133). Improving access to water and sanitation systems, decreasing corruption in the health sector must become priorities in health systems. The ethno-linguistic cultural fragmentation and the detriment of democracy turn out to be two factors related to health results.

El creciente número de publicaciones que abordan el tema del síndrome de burnout sugieren que se trata de la afección psicológica laboral más investigada en las últimas décadas. Resulta importante valorar el estado del arte de este fenómeno y ubicar en su justa medida la dimensión problemática que ha alcanzado. Por ello, el objetivo general de este trabajo fue realizar una revisión sistemática de la literatura científica para caracterizar la investigación sobre el síndrome de burnout en México. Método. Se realizó una búsqueda en 12 bases de datos considerando las que incluyen revistas latinoamericanas. Se examinaron todos los artículos existentes hasta el mes de julio de 2012 y se definieron cinco criterios que aseguraran la comparabilidad entre los estudios. Se realizaron metaanálisis en los promedios de las dimensiones de burnout y los alfas de Cronbach reportados. Resultados. Sesenta y cuatro estudios fueron seleccionados (n=13 801 empleados), los que en su mayoría se concentran en profesionales de la salud y poco más de la mitad en el Estado de Jalisco y el Distrito Federal. La revisión metodológica evidencio que más de 90% de dichos estudios son de diseño observacional-transversal y la mayoría con niveles de análisis que pueden ser vulnerables al efecto de variables confusoras. Destaca el hallazgo de la gran heterogeneidad existente en criterios para determinar la prevalencia. Los metaanálisis en 14 estudios seleccionados arrojaron valores promedio de “una vez al mes o menos” en la escala de frecuencia de síntomas de burnout. Discusión. El balance general de la presente revisión muestra que la investigación del burnout en nuestro país tiene aun áreas de oportunidad. Es necesario ampliar el abanico de ocupaciones y regiones, así como mejorar los diseños de investigación, de análisis de información y asegurarse de las propiedades psicométricas de escalas utilizadas en su evaluación. Se sugieren recomendaciones para investigación futura.