[Encouraging healthy habits by playing with the child in the family milieu: the snakes and ladders game]. / Promoción de hábitos saludables jugando con el niño en el ámbito familiar: la oca saludable.

In recent decades society has been undergoing many changes and these have had a strong incidence on infant morbidity and mortality. Diseases that have practically vanished due to the impact of vaccinations and the improvement of the standard of living have given way to others derived from the changes in eating habits and life style; accidents, on the other hand, have come to be the first cause of morbidity and mortality after the first year of life has been passed. Strategies must be directed towards avoiding the causes of this new way of falling ill. We present a Spanish version of a game similar to "snakes and ladders" called "the healthy goose", which encourages healthy living habits. In order that the child should internalize safe habits by means of the game, certain squares in the game have been replaced by positive drawings, in which the child carries out healthy activities, receiving prizes for these, and others in which risky activities are performed, which are penalized. The areas dealt with are: habits (nutrition, sleep, study, games, etc.), Accidents at home, road safety (pedestrian, cyclist and automobile traveler), and swimming pools. The game starts with a child of 3-4 years and the goal is reached as a healthy adolescent. Given that the variation in personalities is enormous, we believe the family milieu should be the complement to legislative and educational measures and general campaigns in the means of communication, since it is what the child knows best and where he learns his deepest attitudes. This game could be a help to parents in this difficult task.

[Hypoacusis during childhood. Diagnosis and treatment]. / Hipoacusias en la edad infantil. Diagnóstico y tratamiento.

The evaluation of hearing is an important activity in paediatric practice, making it possible to confirm by different techniques whether the child hears well or not, a fact that might be suggested from other sources (the family, school). It is thus fundamental that this should be suitably evaluated since it will have an important incidence on the development of the child. Thus hypoacusis can be the cause of lack of adaptation or school failure, depending on age, or of language alterations. Different types of hypoacusis are described as well as techniques for its diagnosis and corresponding treatment. A reflection is offered on the problem of otitis media serous in primary care and its referral to the child ENT unit.

A novel mutation Thr162Arg of the melanocortin 4 receptor gene in a Spanish children and adolescent population.

OBJECTIVE: The melanocortin 4 receptor gene (MC4R) is involved in body weight regulation. While many studies associated MC4R mutations with childhood obesity, information on MC4R mutations in Spanish children and adolescents is lacking. Our objective was to screen a population of children and adolescents from the north of Spain (Navarra) for MC4R mutations and to study the phenotypes of carriers and their families. In addition, functional assays were performed for a novel MC4R mutation. METHODS: The study was composed of 451 Spanish children and adolescents (49% boys), aged 5-18 year. According to the International Obesity Task Force (IOTF) criteria, the groups included 160 obese, 132 overweight and 159 normal-weight control subjects. RESULTS: One novel (Thr162Arg) and three known nonsynonymous mutations in the MC4R gene (Ser30Phe, Thr150Ile, Ala244Glu) were detected heterozygously. The MC4R mutations were found in three male (one obese and two overweight) and two female subjects (one obese and one overweight). The novel mutation did not appear to lead to an impaired receptor function. An unequivocal relationship of MC4R mutations with obesity in pedigrees together with an impaired function of the encoded receptor could not be established for any of the mutations. CONCLUSIONS: The presence of heterozygous MC4R mutations in obese and overweight subjects indicates that these mutations may be a susceptibility factor for obesity development, but lifestyle factors, such as exercise or sedentary activities, may modify their effect.

Gene-gene interaction between PPAR gamma 2 and ADR beta 3 increases obesity risk in children and adolescents.

AIMS: Multiple genes are likely to be involved in obesity and these genes may interact with environmental factors to influence obesity risk. Our aim was to explore the synergistic contribution of the two polymorphisms: Pro12Ala of the PPAR gamma 2 gene and Trp64Arg of the ADR beta 3 gene to obesity risk in a Spanish children and adolescent population. METHODS: We designed a sex- and age-matched case-control study. Participants were 185 obese and 185 control children (aged 5-18 y) from the Navarra region, recruited through Departments of Pediatrics (Hospital Virgen del Camino, Navarra University Clinic and several Primary Health Centers). The obesity criterion (case definition) was BMI above the 97th percentile according to Spanish BMI reference data for age and gender. Anthropometric parameters were measured by standard protocols. The genotype was assessed by PCR-RFLP after digestion with BstUI for PPAR gamma 2 mutation and BstNI for ADR beta 3 variants. Face-to-face interviews were conducted to assess the physical activity. Using a validated physical activity questionnaire, we computed an activity metabolic equivalent index (METs h/week), which represents the physical exercise during the week for each participant. Statistical analysis was performed by conditional logistic regression, taking into account the matching between cases and controls. RESULTS: Carriers of the polymorphism Pro12Ala of the PPAR gamma 2 gene had a significantly higher obesity risk than noncarriers (odds ratio (OR)=2.18, 95% CI=1.09-4.36) when we adjusted for sex, age and physical activity. Moreover, the risk of obesity was higher (OR=2.59, 95% CI=1.17-5.34) when family history of obesity was also taken into account in the model. The OR for obesity linked to both polymorphisms (PPAR gamma 2 and ADR beta 3) was 5.30 (95% CI=1.08-25.97) when we adjusted for sex, age and physical activity. After adjustment for family history of obesity, the OR for carriers of both polymorphisms was 19.5 (95% CI=2.43-146.8). CONCLUSIONS: A synergistic effect between polymorphism Pro12Ala of the PPAR gamma 2 gene and Trp64Arg of the ADR beta 3 gene for obesity risk was found in a case-control study including children and adolescents.