First symposium of ichthyosis experts.

On June 22, 2012 the First Symposium of Ichthyosis Experts in Spain was held at the Hospital Niño de Jesús in Madrid. It was a one-day symposium for dermatologists, pediatricians, and physicians-in-training interested in this disease, as well as for other health care professionals involved in the care of patients with ichthyosis. The aim of the meeting was to try to structure the care of ichthyosis patients in Spain. As happens in other rare diseases, because of the low prevalence of ichthyosis and the absence of designated referral centers, the number of patients treated in each center is very low and few dermatologists have any real clinical experience with this condition or know how to order diagnostic genetic tests. This article summarizes the presentations given at the symposium and is intended as a reference for anyone interested in the subject.

[Hospital admissions in adolescents with psychosomatic illnesses]. / Ingresos hospitalarios en adolescentes con enfermedades psicosomáticas.

OBJECTIVES: To determine the prevalence of hospital admissions due to psychosomatic diseases in the adolescents. To define the most frequent symptomatology that accompanies these disorders, the triggering factors, the complementary tests made and the possible existence of psychiatric illness in the parents. PATIENTS AND METHOD: A retrospective study was carried out with patients of 10 to 18 years who were admitted to the Niño Jesús Children's Hospital during the period from January 2002 to August 2006, whose discharge diagnosis included symptomatology of psychosomatic origin. RESULTS: The number of medical histories was 33. In this period the frequency of admissions due to psychosomatic diseases was 2.6 %. We found a predominance of female patients, with an average age of 11.5 years; the most frequent symptom was abdominal pain, isolated or accompanied by other pathology. The duration of the symptom before going to the hospital was 11 days. In 13/33 (39.4 %) of the cases previous symptoms of psychosomatic aetiology existed. The complementary study to discard organic disease was negative in all cases. The average stay was 5 days. The existence of triggering factors was found in 21/33 (63.6 %), school problems being the most common. In 7/33 (21 %) there was a family history of psychiatric disease. CONCLUSIONS: The most frequent somatic symptom was abdominal pain, being the triggering factor in most of the patients. The complementary study did not find significant abmormalities. In one out of five cases there was a family history of psychiatric disease. It is recommended to give these patients multidisciplinary care from the beginning of the stay, using consultation and link technique.

[Children against children: bullying as an emerging disorder]. / Niños contra niños: el bullying como trastorno emergente.

An increasing number of children are consulting for various problems or disorders that are based on mistreatment at school. Bullying is defined as persistent physical or emotional violence by a school-aged child or group of children against another school-aged child who is unable to defend himself in this situation, which takes place in the school area. This type of behavior involves the aggressor, the victim, the group of classmates, the institution (teachers, the psychopedagogic team, the management team) and the families (those of the aggressor and victim, and the parents association). Bullying is a type of disorder that can be included in some of the typologies described by Terr in Postraumatic Stress Disorder in childhood, specifically in type II or chronic disorder and in type III or mixed disorder (chronic with phases of acute reactivation). Longitudinal studies have reported an association between having been bullied at school and the possibility of suffering from mobbing, mostly in the form of work harassment. Surprisingly, there can be a "pact of silence" between classmates. Schools are perceived as being more tolerant with the aggressors than with the victims of bullying.

[Warning signs in pediatric psychoses: their recognition by the primary care pediatrician]. / Signos de alarma de las psicosis infantiles: reconocimiento por parte del pediatra de atención primaria.

The author present, for pediatristist of primary care of health, a alarm factors, in the psychic evolution of children will can develop a child psychoses. The author in two groups has classified them: major signs and minors signs, he was giving a characteristics and patterns for to be valuated.

[Psychological approach to headaches in children and adolescents]. / Dolor de cabeza de origen psicógeno en la infancia y la adolescencia.

The headache's concept in children and adolescents is updated. The author exposes an prevalence rate research and the clinical assessment approach in the Paediatric setting. An psychological perspective is exposed from a developmental and psychodynamic approach. The case management from Paediatric's setting includes: clinical assessment, psychological and developmental contents, family counselling and an methodological approach to refer they to Child and Adolescent Psychiatric Services.

[Primary care in maternal-child health]. / Atención primaria en salud materno-infantil.

PIP: The theoretical and methodological elements of primary health care (PHC) include a philosophy of work and an epistemological focus toward the processes of health and illness, as well as a practical medical anthropological knowledge of the culture-specific aspects of disease. The work methodology of PHC requires care of the individual as a bio-psycho-socio-affective being integrated into a particular environment; none of the aspects of being should be neglected or given priority. Care should also be integrated in the sense of providing preventive health care as well as curative and rehabilitative services, in all phases from training of health personnel to record keeping. The primary health care team is multidisciplinary in constitution and interdisciplinary in function. PHC assumes that health care will be accessible to users and that continuity of care will be provided. The need for community participation in all phases of health care has been reiterated in several international health declarations. A well-functioning PHC system will require new types of pre- and postgraduate health education in a changing social and professional system and continuing education under adequate supervision for health workers. Research capability for identifying community health problems, a rigorous evaluation system, and epidemiologic surveillance are also needed. All of these elements are applicable to the field of maternal and child health as well as to PHC. The most appropriate place to intervene in order to correct existing imbalances in access to health care for mothers and children is in the PHC system. Examples of areas that should be stressed include vaccinations, nutrition, psychomotor development, early diagnosis and treatment for handicapped children, prevention of childhood accidents, school health and absenteeism, all aspects of health education, adoption and alternatives to abandonment of children, alcoholism and addiction, adolescent pregnancy and family planning, dental health, and mental problems. Trained primary care pediatricians working within the community as part of the PHC system will be required to confront and solve complex health problems. The training needed does not signify a new speciality or subspeciality, but rather a training methodology and a new type of professional practice.^ieng

[The continuous improvement process in mental health services management]. / Abandonar el actual impasse: el proceso de mejora continua de la calidad (PMCC) aplicado a la gestión de los servicios de salud mental.

The basic tenet of continuous quality improvement is that there is always room for additional improvement in the clinical care provided to patients. The opportunities for this improvement come from the analysis of information collected during the ongoing monitoring of important elements of care. The provision of clinical psychiatric care is seen as a complex process that is dependent on the effective functioning of all of the health and mental health care organization. The concept of continuous quality improvement is the most recent stage in a long process of defining and redefining the basic goals and tenants of medical and psychiatric quality assurance. The determination of the actual improvement of psychiatric and mental health care due to quality assurance is a substantial and important technical problem. The determination of the value of this improvement in mental health care is an even greater ethical and social problem.

[Ambulatory paediatric care: epidemiology and effectiveness (author's transl)]. / Asistencia pediátrica en ambulatorios: epidemiología y evaluación.

Some aspects of the routine work of the team in a paediatric ambulatory clinic (Social Security) is presented. Patients are classified on a sociological basis. Relationship between duration of consultations and number of prescriptions is compared with a team working in identical conditions. Monday is the day with a maximum of consultations and a minimum of prescriptions in comparison with saturday with the opposite situation. Finally, principal conditions consulted are classified from a syndromic point of view. This classification is thought to be useful for the training of paediatricians as well as for new aspects of epidemiology.

[Classification of psychiatric disorders in children: a comparison of the most frequent systems]. / La clasificación de los trastornos en psiquiatría infantil: comparación de los sistemas más frecuentes.

Six different systems of classification are compared in Child Psychiatry (ICD-9, ICD-10, DSM-III, DSM-III-R, RUTTER, Alfred Binet Centre). Some critical aspects they have exposed about the contents in each systems with practical examples. The classification systems is very different a psychopathological aspects. You emphasize the role of classificatory exercises for the training and the research, and the psychiatric case registers.

[Prevalence of mental disorders in childhood in pediatric primary care]. / Prevalencia de trastornos mentales de la infancia en atención primaria pediátrica.

This research is conducted in two stages with an epidemiological methodology. The population of the study is composed of boys and girls aged between 6 and 11 years old, who seek a consultation in a Primary Care Paediatric Centre for a period of three months (point prevalence, one day prevalence). In the first stage, the Achenbach CBCL is used as screening instrument, and in the second stage, the ESPI clinical interview with DSM-III-R criteria. The CBCL acts as an adequate screening instrument for a cross-section corresponding to p 70 in this sample. The emotional disturbances in this paediatric population are a 30.2% rate of prevalence, of which only less than half are forwarded to a Child Mental Health Service.

[Screening methods in mental disorders of children and adolescents in primary health care]. / Métodos de screening de trastornos mentales infanto-juveniles en Atención Primaria de Salud.

A revision of the principal studies of prevalence of mental disorders in childhood is made. We present a bibliographic research about screening instruments for mental disorders in children and adolescents comparing the child behaviour scales checklists most usually employed in epidemiological surveys.

[Compulsive masturbation in the child]. / Masturbación compulsiva en el niño.

Onanism is approached on a theoretical base. Evolutive and pathological significance is also studied. Characteristics of children, family and children attitudes, personality structure, onanism pattern on children and parents fantasies are observed. The importance of affection demand and a permissive therapy is emphasized.