Do enhancements to the urban built environment improve physical activity levels among socially disadvantaged populations?

Background: There is growing recognition that the urban built environment influences physical activity at the population level, although the effects on disadvantaged groups are less well understood. Using the examples of open/green space and street connectivity, this paper explores whether enhancements to the built environment have potential for addressing physical activity-related health inequalities among Mori, Pacific and low income communities in New Zealand.

Method: A high-level review of the international literature relating open space and street connectivity to physical activity and/or related health outcomes at a population level was completed. Consideration was given to whether these features of the built environment have a disproportionate effect on disadvantaged populations.

Results: Findings from international studies suggest that open space and street connectivity have a beneficial effect on physical activity. Enhancing the built environment may be particularly advantageous for improving physical activity levels among disadvantaged populations.

Conclusion: It is likely that open space and street connectivity have a positive effect on physical activity behaviour; however due to the cross-sectional nature of existing research and the paucity of research among disadvantaged populations definitive conclusions about the effect in these populations cannot be made. Further research is required (e.g. natural experiments or quasi experimental research designs) to determine the effect of changing the environment on physical activity and obesity.

Animals in international development: ethics, dilemmas and possibilities

This paper explores the role and perceptions of animals in international development efforts and the possible contradictions between differing priorities of agencies involved in international charitable efforts. Although there is a wide range of purposes for a charitable organization, as shown in the (England and Wales) Charities Act 2011 (c.25) and having one purpose does not preclude a second, organizations concerned with animal welfare are quite distinct from those working for poverty alleviation in the developing world (and indeed the developed world). A fun and novel gift of a donkey may equally be perceived as a cruel, environmentally unsustainable and misguided development effort, a valuable asset, or a burden to a household struggling to feed existing mouths. Exacerbating this situation is the fact that much of the debate around animals in a developing context is heavily polarized between livestock welfare, and animal rights, with a very limited middle ground. This chapter analyzes the underlying tensions between human development, animal welfare, and poverty alleviation, exploring cultural tensions, philosophical tensions and where areas of common ground may be found, with specific reference to development programming. The chapter is framed by contemporary debate on ethics and international development. International development interventions are driven by human welfare concerns, within the broader context of an increasingly globalized world economy. There is a danger in not engaging with ethical considerations with regard to animals and development , as there are potentially complex, interrelated and unintended outcomes. Such outcomes include rising inequality for those who depend on livestock for livelihoods in a business-as-usual scenario of increasing production and intensification; a focus on animal welfare in isolation, with potential accusations of forcing limitations on animal production on low income communities and countries;, and, finally, a moral debate surrounding the issue of whether it is reasonable to require animal welfare standards of people who live in poverty, as a pathway out of poverty. Discourse and practice needs to engage with how to link debate on international development with ethics of livestock production, beyond animal welfare, with global sustainability as core.

Social and physical environmental factors influencing adolescents' physical activity in urban public open spaces: a qualitative study using walk-along interviews

Most previous studies examining physical activity in Public Open Spaces (POS) focused solely on the physical environment. However, according to socio-ecological models the social environment is important as well. The aim of this study was to determine which social and physical environmental factors affect adolescents' visitation and physical activity in POS in low-income neighbourhoods. Since current knowledge on this topic is limited, especially in Europe, qualitative walk-along interviews were used to obtain detailed and context-specific information. Participants (n = 30, aged 12-16 years, 64% boys) were recruited in POS in low-income neighbourhoods in Brussels, Ghent and Antwerp (Belgium). Participants were interviewed while walking in the POS with the interviewer. Using this method, the interviewer could observe and ask questions while the participant was actually experiencing the environment. All audio-recorded interviews were transcribed and analysed using Nvivo 10 software and thematic analysis was used to derive categories and subcategories using a grounded theory approach. The most important subcategories that were supportive of visiting POS and performing physical activity in POS were; accessibility by foot/bicycle/public transport, located close to home/school, presence of (active) friends and family, cleanliness of the POS and features, availability of sport and play facilities, large open spaces and beautiful sceneries. The most important subcategories that were unsupportive of visiting POS and physical activity in POS were; presence of undesirable users (drug users, gangs and homeless people), the behaviour of other users and the cleanliness of the POS and features. Social factors appeared often more influential than physical factors, however, it was the combination of social and physical factors that affected adolescents' behaviour in POS. Easily accessible POS with high quality features in the proximity of adolescents' home or school may stimulate physical activity, if adolescents also experience a safe and familiar social environment.

The World Bank and higher education reform in Ethiopia: knowledge aid and its undesirable effects

This chapter critically examines World Bank (WB) support for Ethiopia, specifically for its higher education (HE) system. It is now almost commonplace for support for developing nations from International Organizations (IOs) such as the WB to be the subject of analysis and critique. Reasons for this are not difficult to discern, particularly in relation to the WB 's activities. This is because the WB is the largest external financial source for educational expenditure in developing countries in general and in Sub-Saharan Africa (SSA) in particular (Jones 2007). In fact, the Bank provides about a quarter of all external funds for education in low-income countries (LICs) (Domenech and Mora-Ninci 2009). In twenty years (1990-2010), the WB committed a total of nearly US$42 billion for education (Molla 2013b). Poor countries with low annual per capita income are eligible for the WB 's financial aid, which includes concessional outright grants and interest-free long-term loans (World Bank 2007a).

A Longitudinal Exploration of the Relationship Between Oral Reading Fluency and Reading Comprehension Achievement Among a Sample of Diverse Young Learners

Exploring the relationship between early oral reading fluency ability and reading comprehension achievement among an ethnically and racially diverse sample of young learners from low-income families, attending elementary school within a large public school district in southeast Florida is the purpose of this longitudinal study. Although many studies have been conducted to address the relationship between oral reading fluency ability and reading comprehension achievement, most of the existing research failed either to disaggregate the data by demographic subgroups or secure a large enough sample of students to adequately represent the diverse subgroups. The research questions that guided this study were: (a) To what extent does early oral reading fluency ability measured in first, second, or third grade correlate with reading comprehension achievement in third grade? (b) To what extent does the relationship of early oral reading fluency ability and reading comprehension achievement vary by demographic subgroup membership (i.e., gender, race/ethnicity, socioeconomic status) among a diverse sample of students? A predictive research design using archived secondary data was employed in this nonexperimental quantitative methods study of 1,663 third grade students who attended a cohort of 25 Reading First funded schools. The data analyzed derived from the Dynamic Indicators of Basic Early Literacy Skills Oral Reading Fluency (DIBELS ORF) measure administered in first, second, and third grades and the Florida Comprehensive Assessment Test of the Sunshine State Standards (FCAT-SSS) Reading administered in third grade. Linear regression analyses between each of the oral reading fluency and reading comprehension measures produced significant positive correlations. Hierarchical regression analyses supported the predictive potential of all three oral reading fluency ability measures toward reading comprehension achievement, with the first grade oral reading fluency ability measure explaining the most significant variance in third grade reading comprehension achievement. Male students produced significant overall differences in variance when compared to female students as did the Other student subgroup (i.e., Asian, Multiracial, and Native American) when compared to Black, White, and Hispanic students. No significant differences in variance were produced between students from low and moderate socioeconomic families. These findings are vital toward adding to the literature of diverse young learners.

Worldwide trends in blood pressure from 1975 to 2015: a pooled analysis of 1479 population-based measurement studies with 19·1 million participants

Background: Raised blood pressure is an important risk factor for cardiovascular diseases and chronic kidney disease. We estimated worldwide trends in mean systolic and mean diastolic blood pressure, and the prevalence of, and number of people with, raised blood pressure, defined as systolic blood pressure of 140 mm Hg or higher or diastolic blood pressure of 90 mm Hg or higher. Methods: For this analysis, we pooled national, subnational, or community population-based studies that had measured blood pressure in adults aged 18 years and older. We used a Bayesian hierarchical model to estimate trends from 1975 to 2015 in mean systolic and mean diastolic blood pressure, and the prevalence of raised blood pressure for 200 countries. We calculated the contributions of changes in prevalence versus population growth and ageing to the increase in the number of adults with raised blood pressure. Findings: We pooled 1479 studies that had measured the blood pressures of 19·1 million adults. Global age-standardised mean systolic blood pressure in 2015 was 127·0 mm Hg (95% credible interval 125·7–128·3) in men and 122·3 mm Hg (121·0–123·6) in women; age-standardised mean diastolic blood pressure was 78·7 mm Hg (77·9–79·5) for men and 76·7 mm Hg (75·9–77·6) for women. Global age-standardised prevalence of raised blood pressure was 24·1% (21·4–27·1) in men and 20·1% (17·8–22·5) in women in 2015. Mean systolic and mean diastolic blood pressure decreased substantially from 1975 to 2015 in high-income western and Asia Pacific countries, moving these countries from having some of the highest worldwide blood pressure in 1975 to the lowest in 2015. Mean blood pressure also decreased in women in central and eastern Europe, Latin America and the Caribbean, and, more recently, central Asia, Middle East, and north Africa, but the estimated trends in these super-regions had larger uncertainty than in high-income super-regions. By contrast, mean blood pressure might have increased in east and southeast Asia, south Asia, Oceania, and sub-Saharan Africa. In 2015, central and eastern Europe, sub-Saharan Africa, and south Asia had the highest blood pressure levels. Prevalence of raised blood pressure decreased in high-income and some middle-income countries; it remained unchanged elsewhere. The number of adults with raised blood pressure increased from 594 million in 1975 to 1·13 billion in 2015, with the increase largely in low-income and middle-income countries. The global increase in the number of adults with raised blood pressure is a net effect of increase due to population growth and ageing, and decrease due to declining age-specific prevalence. Interpretation: During the past four decades, the highest worldwide blood pressure levels have shifted from high-income countries to low-income countries in south Asia and sub-Saharan Africa due to opposite trends, while blood pressure has been persistently high in central and eastern Europe.

Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4·4 million participants

Background: One of the global targets for non-communicable diseases is to halt, by 2025, the rise in the age-standardised adult prevalence of diabetes at its 2010 levels. We aimed to estimate worldwide trends in diabetes, how likely it is for countries to achieve the global target, and how changes in prevalence, together with population growth and ageing, are affecting the number of adults with diabetes. Methods: We pooled data from population-based studies that had collected data on diabetes through measurement of its biomarkers. We used a Bayesian hierarchical model to estimate trends in diabetes prevalence - defined as fasting plasma glucose of 7·0 mmol/L or higher, or history of diagnosis with diabetes, or use of insulin or oral hypoglycaemic drugs - in 200 countries and territories in 21 regions, by sex and from 1980 to 2014. We also calculated the posterior probability of meeting the global diabetes target if post-2000 trends continue. Findings: We used data from 751 studies including 4 372 000 adults from 146 of the 200 countries we make estimates for Global age-standardised diabetes prevalence increased from 4·3% (95% credible interval 2·4-7·0) in 1980 to 9·0% (7·2-11·1) in 2014 in men, and from 5·0% (2·9-7·9) to 7·9% (6·4-9·7) in women. The number of adults with diabetes in the world increased from 108 million in 1980 to 422 million in 2014 (28·5% due to the rise in prevalence, 39·7% due to population growth and ageing, and 31·8% due to interaction of these two factors). Age-standardised adult diabetes prevalence in 2014 was lowest in northwestern Europe, and highest in Polynesia and Micronesia, at nearly 25%, followed by Melanesia and the Middle East and north Africa. Between 1980 and 2014 there was little change in age-standardised diabetes prevalence in adult women in continental western Europe, although crude prevalence rose because of ageing of the population. By contrast, age-standardised adult prevalence rose by 15 percentage points in men and women in Polynesia and Micronesia. In 2014, American Samoa had the highest national prevalence of diabetes (>30% in both sexes), with age-standardised adult prevalence also higher than 25% in some other islands in Polynesia and Micronesia. If post-2000 trends continue, the probability of meeting the global target of halting the rise in the prevalence of diabetes by 2025 at the 2010 level worldwide is lower than 1% for men and is 1% for women. Only nine countries for men and 29 countries for women, mostly in western Europe, have a 50% or higher probability of meeting the global target. Interpretation Since 1980, age-standardised diabetes prevalence in adults has increased, or at best remained unchanged, in every country. Together with population growth and ageing, this rise has led to a near quadrupling of the number of adults with diabetes worldwide. The burden of diabetes, both in terms of prevalence and number of adults aff ected, has increased faster in low-income and middle-income countries than in high-income countries.

A importância da adaptação da linguagem do visual merchandising para o varejo de baixa renda

A evolução do varejo no Brasil, também atribuída ao crescimento econômico das últimas décadas, foi marcada pelo surgimento de novos formatos e estratégias comerciais e por um surpreendente processo de transformação social. Observa-se que a referida transformação social foi seguida pelo aumento do poder aquisitivo das diferentes classes sociais que compõem o cenário econômico. O crescimento econômico, proporcionado pela instituição de políticas econômicas e de inclusão social, fez despontar um nicho de mercado, que até o momento apresentava-se com acesso restrito ao consumo, formado pela classe social de baixa renda. O surgimento de um novo cenário mercadológico constituído por indivíduos pertencentes à classe social de baixa renda e a concorrência saturada dos mercados consolidados despertaram o interesse de muitas empresas em incrementar suas atividades investindo no emergente mercado de consumo. Para consolidar suas atuações em um mercado pouco conhecido, algumas empresas perceberam a necessidade de compatibilizar sua estratégias comerciais e de marketing ao novo perfil e comportamento dos respectivos consumidores. Entretanto, ainda é possível observar que muitas das referidas estratégias são desenvolvidas a partir de mitos acerca das motivações e comportamentos de consumo da classe social de baixa renda e, desta forma, não correspondente ao estilo de vida e formação cultural do referido público alvo. O presente estudo pretende contribuir para o aperfeiçoamento do varejo de baixa renda e, desta forma, apresentar a importância de planejar ações comerciais e de convencimento de consumo coordenadas com estratégias de marketing, notadamente do visual merchandising, adaptadas ao referido público alvo. Para alcançar a proposta deste estudo fez-se necessária a compreensão do estilo de vida do respectivo público alvo através do desenvolvimento de métodos de pesquisa investigativos, para uma análise detalhada e assertiva das respectivas motivações de consumo.

Health extension workers' and mothers' attitudes to maternal health service utilization and acceptance in Adwa Woreda, Tigray Region, Ethiopia.

BACKGROUND: The maternal health system in Ethiopia links health posts in rural communities (kebeles) with district (woreda) health centres, and health centres with primary hospitals. At each health post two Health Extension Workers (HEWs) assist women with birth preparedness, complication readiness, and mobilize communities to facilitate timely referral to mid-level service providers. This study explored HEWs' and mother's attitudes to maternal health services in Adwa Woreda, Tigray Region. METHODS: In this qualitative study, we trained 16 HEWs to interview 45 women to gain a better understanding of the social context of maternal health related behaviours. Themes included barriers to health services; women's social status and mobility; and women's perceptions of skilled birth attendant's care. All data were analyzed thematically. FINDINGS: There have been substantial efforts to improve maternal health and reduce maternal mortality in Adwa Woreda. Women identified barriers to healthcare including distance and lack of transportation due to geographical factors; the absence of many husbands due to off-woreda farming; traditional factors such as zwar (some pregnant women are afraid of meeting other pregnant women), and discouragement from mothers and mothers-in-law who delivered their children at home. Some women experienced disrespectful care at the hospital. Facilitators to skilled birth attendance included: identification of pregnant women through Women's Development Groups (WDGs), and referral by ambulance to health facilities either before a woman's Expected Due Date (EDD) or if labour started at home. CONCLUSION: With the support of WDGs, HEWs have increased the rate of skilled birth attendance by calling ambulances to transfer women to health centres either before their EDD or when labour starts at home. These findings add to the growing body of evidence that health workers at the community level can work with women's groups to improve maternal health, thus reducing the need for emergency obstetric care in low-income countries.

Assessing the sustained impact of a school-based obesity prevention program for adolescent boys: the ATLAS cluster randomized controlled trial

BACKGROUND: Obesity prevention interventions targeting 'at-risk' adolescents are urgently needed. The aim of this study is to evaluate the sustained impact of the 'Active Teen Leaders Avoiding Screen-time' (ATLAS) obesity prevention program.

METHODS: Cluster RCT in 14 secondary schools in low-income communities of New South Wales, Australia. Participants were 361 adolescent boys (aged 12-14 years) 'at risk' of obesity. The intervention was based on Self-Determination Theory and Social Cognitive Theory and involved: professional development, fitness equipment for schools, teacher-delivered physical activity sessions, lunch-time activity sessions, researcher-led seminars, a smartphone application, and parental strategies. Assessments for the primary (body mass index [BMI], waist circumference) and secondary outcomes were conducted at baseline, 8- (post-intervention) and 18-months (follow-up). Analyses followed the intention-to-treat principle using linear mixed models.

RESULTS: After 18-months, there were no intervention effects for BMI or waist circumference. Sustained effects were found for screen-time, resistance training skill competency, and motivational regulations for school sport.

CONCLUSIONS: There were no clinically meaningful intervention effects for the adiposity outcomes. However, the intervention resulted in sustained effects for secondary outcomes. Interventions that more intensively target the home environment, as well as other socio-ecological determinants of obesity may be needed to prevent unhealthy weight gain in adolescents from low-income communities.

Family and carer smoking control programmes for reducing children's exposure to environmental tobacco smoke

BackgroundChildren's exposure to other people's cigarette smoke (environmental tobacco smoke, or ETS) is associated with a range of adverse health outcomes for children. Parental smoking is a common source of children's exposure to ETS. Older children are also at risk of exposure to ETS in child care or educational settings. Preventing exposure to cigarette smoke in infancy and childhood has significant potential to improve children's health worldwide.ObjectivesTo determine the effectiveness of interventions aiming to reduce exposure of children to ETS.Search methodsWe searched the Cochrane Tobacco Addiction Group Specialized Register and conducted additional searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, PsycINFO, EMBASE, CINAHL, ERIC, and The Social Science Citation Index & Science Citation Index (Web of Knowledge). Date of the most recent search: September 2013.Selection criteriaControlled trials with or without random allocation. Interventions must have addressed participants (parents and other family members, child care workers and teachers) involved with the care and education of infants and young children (aged 0 to 12 years). All mechanisms for reduction of children's ETS exposure, and smoking prevention, cessation, and control programmes were included. These include health promotion, social-behavioural therapies, technology, education, and clinical interventions.Data collection and analysisTwo authors independently assessed studies and extracted data. Due to heterogeneity of methodologies and outcome measures, no summary measures were possible and results were synthesised narratively.Main resultsFifty-seven studies met the inclusion criteria. Seven studies were judged to be at low risk of bias, 27 studies were judged to have unclear overall risk of bias and 23 studies were judged to have high risk of bias. Seven interventions were targeted at populations or community settings, 23 studies were conducted in the 'well child' healthcare setting and 24 in the 'ill child' healthcare setting. Two further studies conducted in paediatric clinics did not make clear whether the visits were to well or ill children, and another included both well and ill child visits. Thirty-six studies were from North America, 14 were in other high income countries and seven studies were from low- or middle-income countries. In only 14 of the 57 studies was there a statistically significant intervention effect for child ETS exposure reduction. Of these 14 studies, six used objective measures of children's ETS exposure. Eight of the studies had a high risk of bias, four had unclear risk of bias and two had a low risk of bias. The studies showing a significant effect used a range of interventions: seven used intensive counselling or motivational interviewing; a further study used telephone counselling; one used a school-based strategy; one used picture books; two used educational home visits; one used brief intervention and one study did not describe the intervention. Of the 42 studies that did not show a significant reduction in child ETS exposure, 14 used more intensive counselling or motivational interviewing, nine used brief advice or counselling, six used feedback of a biological measure of children's ETS exposure, one used feedback of maternal cotinine, two used telephone smoking cessation advice or support, eight used educational home visits, one used group sessions, one used an information kit and letter, one used a booklet and no smoking sign, and one used a school-based policy and health promotion. In 32 of the 57 studies, there was reduction of ETS exposure for children in the study irrespective of assignment to intervention and comparison groups. One study did not aim to reduce children's tobacco smoke exposure, but rather aimed to reduce symptoms of asthma, and found a significant reduction in symptoms in the group exposed to motivational interviewing. We found little evidence of difference in effectiveness of interventions between the well infant, child respiratory illness, and other child illness settings as contexts for parental smoking cessation interventions.Authors' conclusionsWhile brief counselling interventions have been identified as successful for adults when delivered by physicians, this cannot be extrapolated to adults as parents in child health settings. Although several interventions, including parental education and counselling programmes, have been used to try to reduce children's tobacco smoke exposure, their effectiveness has not been clearly demonstrated. The review was unable to determine if any one intervention reduced parental smoking and child exposure more effectively than others, although seven studies were identified that reported motivational interviewing or intensive counselling provided in clinical settings was effective.

South Carolina Housing Trust Fund Emergency Repair Manual

The emergency repair activity under the South Carolina Housing Trust Fund program is designed to assist very low‐income homeowners in making needed and necessary repairs to their owner‐occupied homes to eliminate life, health and safety issues to the occupant. This document explains emergency repair activity guidelines, eligibility requirements for properties, rehabilitation construction guidelines and payments.

FY 2015-16 Housing Trust Fund Annual Report

The South Carolina State Housing Finance and Development Authority publishes an annual report on the South Carolina Housing Trust Fund, a state-funded program designed to provide financial assistance in the development, rehabilitation and acquisition of affordable workforce housing for low-income households throughout the state.

Factores asociados a embarazo no deseado en mujeres en edad reproductiva en Colombia 2010

Objetivo: Identificar factores sociodemográficos y de fecundidad, asociados a ocurrencia de embarazo no deseado en mujeres colombianas en edad reproductiva en el año 2010. Métodos: Se realizó estudio retrospectivo de corte transversal, basado en los datos de la ENDS Colombia-2010, del total de mujeres en edad fértil (13-49 años) que al momento de la encuesta se encontraban en embarazo. La variable de interés fue embarazo no deseado, se describió la población a estudio y se evaluó la posible asociación con variables sociodemográficas y de fecundidad, a través de análisis bivariado y multivariado. Se realizaron los mismos análisis por grupo de edad (adolescentes vs adultas). Resultados: La prevalencia de embarazo no deseado en las mujeres colombianas en el 2010 fue de 61,4 %. De acuerdo al modelo de regresión logística, no estar en unión a una pareja (OR: 4,01 IC95%: 3,066-5,269), tener hijos (OR: 2,040 IC95%: 1,581 – 2,631), estar en el quintil de menor riqueza (OR: 2,137 IC95%: 1,328-3,440), y ser adolescente (OR: 1,599 IC95%: 1,183-2,162), son factores que aumentan la probabilidad de tener un embarazo no deseado. Se encontraron diferencias en los factores asociados al realizar segmentación por edad. Conclusiones: La prevalencia de embarazo no deseado permanece alta en Colombia respecto a años anteriores y a otros países. Los resultados pueden ser de utilidad para el desarrollo de políticas en salud sexual y reproductiva teniendo en cuenta los factores asociados identificados priorizando a la población adolescente y de menor estatus socioeconómico, para la prevención de embarazo no deseado en Colombia.

Infección por virus sincitial respiratorio y su relación con valores de IGG en niños críticos

Antecedente: La infección por el virus sincitial respiratorio (VSR) representa una elevada morbimortalidad, y en algunos casos necesidad de manejo en unidades de cuidado intensivo pediátrico (UCIP). La respuesta inmunológica influye de manera directa en la expresión de la severidad y pronóstico de los pacientes con infección respiratoria. Metodología: Estudio de una cohorte retrospectiva de pacientes con infección respiratoria grave secundaria a VSR, sin historia de inmunodeficiencia, atendidos en la UCIP del Hospital Universitario Clínica San Rafael. Se realizó análisis descriptivoglobaly de acuerdo a la categorización de las prueba de IgG. Resultados: De 188 pacientes que ingresaron a la UCIP, 13% presentaron infección por VSR (24), con una edad promedio de 7,3 (DE=3,6) meses. Pertenecían al sexo masculino79,83%. Se encontró que 12,5% tenían un valor de IgGbajo para su edad, 58,33% tenían valores en límite inferior y el 29,17% dentro de rangos normales para su edad. En los pacientes con IgG baja, fue mayor la presentación de choque séptico que no responde a líquidos (100 vs 92 vs 86%), la mediana de días de ventilación mecánica fue mayor (8 vs 6 vs 5 respectivamente), así como la mortalidad (67 vs 7,1 vs 0%). Conclusión: Nuestra serie encontró que aquellos pacientes con niveles bajos o valores en el límite inferior de IgG sérica tuvieron mayor compromiso sistémico, mayor duración de ventilación mecánica y mayor mortalidad. Se necesitan estudios prospectivos que relaciones niveles bajos de IgG con severidad y pronostico en estos pacientes con infección grave por VSR.