Patient-Reported Outcome Measures in Real-World Atopic Dermatitis Studies in Spain: A Systematic Review. / Medidas de los resultados percibidos por el paciente en estudios de vida real en dermatitis atópica en España: revisión sistemática de la literatura.

Atopic dermatitis (AD) is a chronic inflammatory skin disease with symptoms such as pruritus that can be a major burden for patients. Patient-reported outcomes (PRO) complement clinician-reported outcomes in AD. This systematic review aims to identify and describe patient-reported outcome measures (PROM) used in observational studies of AD over the last decade in Spain. Eighteen PROM were identified to measure 13 different PRO that assess multiple aspects of the disease, including symptoms and disease severity, impact on daily activities and on work productivity/functioning, psychosocial impact, patient empowerment, and health-related quality of life (HRQoL). HRQoL, symptoms (particularly pruritus), and anxiety/depression were the most frequently assessed PRO, and the Dermatology Quality of Life Index, the Visual Analogue Pruritus Scale, and the Hospital Anxiety and Depression Scale were the most frequently used PROM, respectively. The growing number of observational studies on AD including PROM in Spain suggests that PRO are becoming increasingly important in the management of AD.

Core Content for Undergraduate Medical Education in Spain: Recommendations of the Instructors' Group of the Spanish Academy of Dermatology and Venereology (AEDV).

BACKGROUND: Skin problems are among the most frequent reasons for seeking medical attention in primary care. In recent years, as a result of the process of adapting medical curricula to the requirements of the European Higher Education Area, the amount of time students spend learning the concepts of dermatology has been reduced in many universities. MATERIAL AND METHODS: In order to reach a consensus on core content for undergraduate education in dermatology, we sent a survey to the 57 members of the instructors' group of the Spanish Academy of Dermatology and Venereology (AEDV), asking their opinions on what objectives should be set for a dermatology course in Spain. A total of 131 previously selected objectives were listed. We then applied the Delphi method to achieve consensus on which ones the respondents considered important or very important (score≥4 on a Likert scale). RESULTS: Nineteen responses (33%) were received. On the second round of the Delphi process, 68 objectives achieved average scores of at least 4. The respondents emphasized that graduates should understand the structure and functions of the skin and know about bacterial, viral, and fungal skin infections, the most common sexually transmitted diseases (STDs), and the 4 main inflammatory dermatoses. Students should also learn about common complaints, such as itching and bald patches; the management of dermatologic emergencies; purpura and erythema nodosum as signs of internal disease; and the prevention of STDs and skin cancer. During clinical clerkships students should acquire the communication skills they will need to interview patients, write up a patient's medical history, and refer the patient to a specialist. CONCLUSIONS: The AEDV's group of instructors have defined their recommendations on the core content that medical faculties should adopt for the undergraduate subject of dermatology in Spain.

Blindness from bad bones.

Progressive visual loss is the most common neurologic finding in osteopetrosis. Several mechanisms may explain this phenomenon, including compression of the optic nerves caused by bony overgrowth of the optic canals and retinal degeneration. We report a child with osteopetrosis and progressive visual loss, even though patent optic canals were demonstrated by computed tomography and digital holography. This patient's visual loss was caused by increased intracranial pressure secondary, to obstruction of cerebral venous outflow at the jugular foramen. This case points to the importance of a full evaluation of the skull base foramina in the diagnostic workup of visual loss in patients with osteopetrosis.

[Physical activity programmes to reduce overweight and obesity in children and adolescents; a systematic review]. / Programas de actividad física para reducir sobrepeso y obesidad en niños y adolescentes; revisión sistemática.

INTRODUCTION: Obesity treatment has been the subject of much controversy; various authors have recommended the application of a comprehensive treatment programme, and in the light of this previous research, we consider the question of what is the most effective programme of physical activity to reduce overweight and obesity in children and adolescents. AIMS: To analyse major studies on the effectiveness of physical activity in reducing overweight and obesity in children and adolescents. METHOD: Systematic review of the results of physical activity programmes, published in scientific articles, to reduce overweight and obesity. Using an automated database search in PubMed and Google Scholar, conducted from October 2013 to March 2014, we identified 85 valid items. In selecting the items, the criteria applied included the usefulness and relevance of the subject matter and the credibility or experience of the research study authors. The internal and external validity of each of the articles reviewed was taken into account. CONCLUSIONS: This review confirmed the effectiveness of physical activity in reducing overweight and obesity in children and adolescents. The most effective programmes were those combining aerobic and anaerobic exercises. It is generally accepted that at least 180 minutes per week should be dedicated to exercise, in the form of three 60-minute sessions of moderate intensity. Such programmes could be sufficient for persons with overweight or obesity. Researchers in this field agree that when a diet based on an appropriate distribution of meals is combined with regular physical activity, they reinforce each other, and thus optimum results are obtained. Weight reduction programmes that take account of family involvement are more effective than nutrition education itself or other routine interventions that fail to consider family involvement. The role of pa rents and of the persons around the child or adolescent is essential to reinforce positive behaviour toward lifestyle change.

Introducción: El tratamiento contra la obesidad ha sido muy discutido y varios autores abogan por un tratamiento integral de la obesidad. Todos los referentes conducen a plantear ¿cuál es el programa de actividad física más efectivo para reducir el sobrepeso y la obesidad de niños y adolescentes? Objetivo: Analizar los principales estudios sobre la eficacia de la actividad física para reducir el sobrepeso y la obesidad de niños y adolescentes. Método: Revisión sistemática de los resultados de programas de actividad física para reducir el sobrepeso y la obesidad publicados en artículos científicos. Se identificaron 85 artículos a través de la búsqueda automatizada en las bases de datos PUBMED y Google Scholar; se llevó a cabo entre los meses de octubre de 2013 y marzo de 2014. Para seleccionar los artículos fue preciso considerar la utilidad y la relevancia del tema estudiado y la credibilidad o experiencia de los autores en la temática. Se tuvo en cuenta la validez interna y externa de cada uno de los artículos revisados. Conclusiones: Se identificó la efectividad de la actividad física para reducir el sobrepeso y la obesidad de niños y adolescentes. El programa de actividad física más efectivo es el que combina ejercicios aeróbicos y anaeróbicos. Existe consenso en acumular más de 180 minutos a la semana dedicados a estos fines, con 3 sesiones de 60 minutos cada una de ejercicio físico a la semana. De una intensidad moderada, podrían ser suficientes para ejecutar un programa de ejercicio físico para esas personas con sobrepeso y obesidad. Coinciden los autores en que, cuando se combina una dieta controlada por una adecuada distribución de las comidas y con la práctica de actividad física, se potencian mutuamente, con lo que se obtie nen los mejores resultados. Los programas de reducción de peso que tengan en cuenta la participación familiar son más eficaces que la propia educación alimentaria y otras intervenciones de rutina que no consideren esa participación familiar. El rol de los padres y de las personas que rodean al niño y al adolescente es fundamental para reforzar las conductas positivas hacia el cambio de estilo de vida.

Prevalence of usual-corrected distance visual acuity impairment in Hispanic and non-Hispanic children and adolescents.

Data from the Hispanic Health and Nutrition Examination Survey and the National Health and Nutrition Examination Survey I were analysed to determine the prevalence of visual acuity impairment among US Hispanics and non-Hispanics aged 6-19 years. The prevalence of 20/30 or worse distance visual acuity with usual or habitual correction ranged from 10.8% in non-Hispanic whites to 19.1% in Puerto Ricans. Puerto Rican boys aged 13-19 years had significantly greater rates of moderate or greater impairment (20/70 or worse) than 6-12-year-old Puerto Rican boys (5.7% vs. 0.7%). The prevalence of visual impairment was generally greater in girls than in boys. Assessment and comparison of refractive error and eye disease prevalence rates are necessary in future studies to determine factors influencing prevalence of visual acuity impairment in children.

Removal of retained lens fragments after phacoemulsification reverses secondary glaucoma and restores visual acuity.

PURPOSE: The purpose of the study is to evaluate the effect of vitrectomy on secondary glaucoma and visual acuity outcomes in patients with retained lens fragments after phacoemulsification. METHODS: A retrospective analysis of 126 patients who had vitrectomy for retained lens fragments after phacoemulsification during the 3-year period between January 1, 1993, and December 31, 1995. RESULTS: Glaucoma, defined as an intraocular pressure of greater than or equal to 30 mmHg, occurred in 42 (36.8%) of 114 patients before vitrectomy and in 4 patients (3.2%) of 126 after vitrectomy. There were no differences in the rates of persistent glaucoma regardless of the intervals between cataract surgery and the vitrectomy: less than or equal to 1 week, 2 patients (4.1%); greater than 1 week to less than or equal to 4 weeks, 1 patient (2.5%) and greater than 4 weeks, 1 patient (2.6%). The visual acuity was 20/40 or better in 13 patients (11.4%) before vitrectomy and in 75 patients (59.5%) after vitrectomy. The rates of visual acuity 20/40 or better also were similar for all intervals: less than or equal to 1 week, 29 patients (59.2%); greater than 1 week to less than or equal to 4 weeks, 22 patients (56.4%) and greater than 4 weeks, 24 patients (63.1%). CONCLUSIONS: Vitrectomy for removal of retained lens fragments reduces secondary glaucoma and yields favorable visual acuity outcomes. In eyes with elevated intraocular pressure, early vitrectomy generally is recommended, but delayed vitrectomy also has favorable outcomes.