We advance in health thanks to the PAPI children's health application.

INTRODUCTION: The family structure and parenting are changing in society, sedentary lifestyle, the use of screens and social networks is increasing. Families and health professionals must learn to educate, adapting their health advice to the new social and digital environment. MATERIALS AND METHODS: A survey was sent to the representatives of more than 5000 paediatricians to renew the Well Child Visits Programme of the Spanish Association of Primary Care Paediatrics (AEPap). Contributions from preventive programmes from Andalusia, the Balearic Islands and Asturias were incorporated. The different interventions and advice were distributed in nine age groups. RESULTS: Part of the recommendations are based on the work of the PrevInfad group. It uses the methodology of evidence-based medicine and performs the evaluation and synthesis of the evidence in the proposed preventive activities. The AEPap considers that the Well Child Programme should be carried out by the paediatric team: the paediatrician and the nurse, thus enhancing specific skills. The WHO considers it essential to empower individuals, families, and communities to optimize their health by making them caretakers of themselves and others, equipping them with tools that protect their well-being. CONCLUSION: Hence, it was decided to capture the Well Child Programme in the format of a free APP for mobile devices, as an innovative and affordable method of disseminating child and adolescent health. Information is given on parenting advice for family members, for children and adolescents and describes health check-ups for health workers.

COVID-19: Critical appraisal of the evidence.

We present the summary of a critical appraisal document of the available evidence on COVID-19, developed with a clinical practice guide format following GRADE methodology. The document tries to provide answers to a series of structured clinical questions, with an explicit definition of the population, intervention / exposure, comparison and outcome, and a rating of the clinical relevance of the outcome measures. We conducted a systematic review of the literature to answer the questions, grouped into six chapters: epidemiology, clinical practice, diagnosis, treatment, prevention, and vaccination. We assessed the risk of bias of the selected studies with standard instruments (RoB-2, ROBINS-I, QUADAS and Newcastle-Ottawa). We constructed evidence tables and, when necessary and possible, meta-analysis of the of the most relevant outcome measures. We followed the GRADE system to synthesise the evidence, assessing its quality, and, when appropriate, giving recommendations, rated according to the quality of the evidence, the values and preferences, the balance between benefits, risks and costs, equity and feasibility.

[COVID-19: Critical appraisal of the evidence]. / COVID-19 en pediatría: valoración crítica de la evidencia.

We present the summary of a critical appraisal document of the available evidence on COVID-19, developed with a clinical practice guide format following GRADE methodology. The document tries to provide answers to a series of structured clinical questions, with an explicit definition of the population, intervention/exposure, comparison and outcome, and a rating of the clinical relevance of the outcome measures. We conducted a systematic review of the literature to answer the questions, grouped into six chapters: epidemiology, clinical practice, diagnosis, treatment, prevention, and vaccination. We assessed the risk of bias of the selected studies with standard instruments (RoB-2, ROBINS-I, QUADAS and Newcastle-Ottawa). We constructed evidence tables and, when necessary and possible, meta-analysis of the of the most relevant outcome measures. We followed the GRADE system to synthesize the evidence, assessing its quality, and, when appropriate, giving recommendations, rated according to the quality of the evidence, the values and preferences, the balance between benefits, risks and costs, equity and feasibility.

Paediatricians provide higher quality care to children and adolescents in primary care: A systematic review.

AIM: The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. METHODS: MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. RESULTS: Fifty-four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. CONCLUSION: According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.

[Prevalence of breastfeeding and factors associated with the start and duration of exclusive breastfeeding in the Community of Madrid among participants in the ELOIN]. / Prevalencia de la lactancia materna y factores asociados con el inicio y la duración de la lactancia materna exclusiva en la Comunidad de Madrid entre los participantes en el estudio ELOIN.

INTRODUCTION: Breastfeeding has important benefits for population health. The aims of this study are: (i)to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (ii)analyse the reasons for not starting or abandoning of breastfeeding, and (iii)describe the factors associated with the initiation and duration of exclusive breastfeeding. MATERIAL AND METHODS: Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2,627 children born in 2008-2009 from the Community of Madrid was studied. Logistic regression models were used. RESULTS: Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6months 25.4%, and prevalence of breastfeeding at 2years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. CONCLUSIONS: Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008-2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring.

[Acute bacterial gastroenteritis: 729 cases recruited by a Primary Care national network]. / Gastroenteritis aguda bacteriana: 729 casos reclutados por una red nacional de atención primaria.

OBJECTIVE: To determine the main clinical and epidemiological features of bacterial gastroenteritis in our environment. PATIENTS AND METHODS: An observational study of a Spanish population in 17 Autonomous Communities. Questionnaires of children with a stool positive culture to bacteria were collected over a one year period. A bivariate analysis was performed on the variables involved, as well as two multivariate models (for antibiotic treatment variables, and comparison Campylobacter/Salmonella). RESULTS: A total of 729 bacterial gastroenteritis episodes were recorded in the 17 Spanish autonomous regions, of which 41.2% were girls and 58.8% boys. The median age was 3.41 years old (interquartile range 1.55 to 6.72). The bacteria isolated were 59.9% Campylobacter, 31.8% non-Typhi Salmonella, 2.7% Aeromonas, 2.4% Yersinia, and 1.5% had more than one strain. Most infections (70%) were direct contacts, and food poisoning was less probable (25.9%). Salmonella is significantly less frequent than Campylobacter in children under the age of 3 years (adjusted OR 0.61; 95%CI: 0.43 to 0.86; P=.005), and Campylobacter is more frequent in rural areas (adjusted OR 1.48; 95%CI: 1.07 to 2.07; P=.012). Antibiotic was prescribed in 33.2% of cases. There was a greater significant difference if stools contained blood or mucus (adjusted OR 1.53; 95%CI: 1.04 to 2.27; P=.031), if the symptoms lasted more than 7days (adjusted OR 2.81; 95%CI: 2.01 to 3.93; P<.000), or if the child was admitted to hospital (adjusted OR 1.95; 95%CI: 1.08 to 3.52; P=.027). CONCLUSIONS: The aetiology of bacterial diarrhoea in paediatrics is typical of that of a developed country. The transmission mechanism is mainly direct, and more cases than appropriate are treated with antibiotics.