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For children younger than 5 years with pneumonia, high-flow nasal cannula oxygen has higher mortality than bubble continuous positive airway pressure. A future randomized controlled trial in this population is unlikely to find high-flow nasal cannula oxygen superior to bubble continuous positive airway pressure.

We present a systematic review on the effectiveness of noninvasive respiratory support techniques in bronchiolitis.DATA SOURCES: Systematic review with pairwise meta-analyses of all studies and network meta-analyses of the clinical trials. STUDY SELECTION:Patients below 24 months old with bronchiolitis who require noninvasive respiratory support were included in randomized controlled trials (RCTs), non-RCT, and cohort studies in which high-flow nasal cannula (HFNC) was compared with conventional low-flow oxygen therapy (LFOT) and/or noninvasive ventilation (NIV). DATA EXTRACTION: Emergency wards and hospitalized patients with bronchiolitis.DATA SYNTHESIS: A total of 3,367 patients were analyzed in 14 RCTs and 8,385 patients in 14 non-RCTs studies. Only in nonexperimental studies, HFNC is associated with a lower risk of invasive mechanical ventilation (MV) than NIV (odds ratio, 0.49; 95% CI, 0.42-0.58), with no differences in experimental studies. There were no differences between HFNC and NIV in other outcomes. HFNC is more effective than LFOT in reducing oxygen days and treatment failure. In the network meta-analyses of clinical trials, NIV was the most effective intervention to avoid invasive MV (surface under the cumulative ranking curve [SUCRA], 57.03%) and to reduce days under oxygen therapy (SUCRA, 79.42%), although crossover effect estimates between interventions showed no significant differences. The included studies show methodological heterogeneity, but it is only statistically significant for the reduction of days of oxygen therapy and length of hospital stay. CONCLUSIONS:Experimental evidence does not suggest that high-flow oxygen therapy has advantages over LFOT as initial treatment nor over NIV as a rescue treatment.

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¿Es el cooperativismo una vía para la formalización y el acceso al sistema de seguridad social en el trabajo sexual? Antecedentes internacionales y análisis de opinión para el caso uruguayo Pablo Guerra RESUMEN La relación entre el trabajo sexual, la prostitución y el cooperativismo no está exenta de polémicas, aún en países donde la prostitución está legalizada y se reconoce el estatus legal de trabajador/a sexual. En estos países la legislación cooperativa abre las puertas a la creación de cooperativas de trabajadores/as sexuales en la medida en que habilita en términos generales a cooperativizar cualquier actividad considerada legal. Aún así son muy pocos los casos en el mundo donde esta particular actividad ha dado lugar a emprendimientos cooperativos. En este artículo nos detendremos en describir los antecedentes internacionales para luego analizar el caso uruguayo a partir de una investigación que indaga la opinión de trabajadoras sexuales en relación a su seguridad social y la eventual posibilidad de constituir cooperativas como forma de formalizar su situación en el marco del trabajo autónomo y colectivo.