Influence of Telemedicine on the Number of Visits and HbA1c Determinations in Latin American Children with Type 1 Diabetes.

Objective: To measure the changes in the number of medical visits and the number of hemoglobin A1c (HbA1c) determinations according to telemedicine access in children with type 1 diabetes (T1DM) during the pandemic 2020 compared with 2019 and 2018. Methods: This is a multinational study of children with T1DM from four Latin American countries. The number of medical visits, the number of HbA1c determinations, and access to telemedicine during 2020 were extracted from their records. Results: Two hundred twenty-seven children (59% females) aged 12.7 ± 3.2 years with a duration of 5.4 ± 2.7 years of T1DM in 2018 were evaluated. There was a higher prevalence of children with telemedicine access in the pandemic 2020 versus those without [145 (63.9%) vs. 82 (36.1%); P < 0.01]. There was a higher number of medical visits during 2020 in children with telemedicine access versus those without (6.9 vs. 2.6; P < 0.01). Children with telemedicine access had a higher number of visits in 2020 versus 2018 (6.87 vs. 5.04, P < 0.01), but similar to 2019. Children without access had a lower number of visits in 2020 versus 2019 (2.6 vs. 5.5; P < 0.01) and versus 2018 (2.6 vs. 5.1; P < 0.01). In 2020, the number of HbA1c determinations in children with telemedicine access was higher versus those without (1.8 vs. 0.9; P < 0.01). Children with telemedicine access had a lower number of HbA1c determinations in 2020 versus 2019 (1.8 vs. 2.4; P < 0.01), but similar to 2018. Furthermore, children without access had a lower number of HbA1c determinations in 2020 versus 2019 (0.9 vs. 1.9; P < 0.01) and versus 2018 (0.9 vs. 2.0; P < 0.01). Conclusions: We found that children with T1DM with telemedicine access had a significantly higher number of medical visits and HbA1c determinations during lockdown than those without access in different Latin American centers.

Cardio-metabolic risk factors in Argentine children. A comparative study.

UNLABELLED: Obesity and its complications are emerging in an epidemic manner in Latin American countries. AIMS: To estimate the prevalence of Cardio-Metabolic Risk Factors (CMRFs) and Metabolic Syndrome (MS) in overweight/obese (OW/OB) and normal weight (NW) adolescents and to examine the associated variables. MATERIAL AND METHODS: A cross-sectional comparative study was conducted in two groups of children, between 10 and 19 years of age, in seven Argentine provinces. A survey on dietary habits, physical activity, anthropometric and biochemical data was collected to identify CMRF and MS. The WHO definition adapted to children was used. RESULTS: 1009 children were assessed; 398 were male (39.4%), 601 (59.6%) were NW and 408 (40.4%) were OW/OB. The OW/OB had a significantly higher proportion of values defined as CMRF: 3.7% impaired fasting glucose >110mg/dl; 27.9% insulin >15 or 20µU/l as they were pubertal/prepubertal; 53.2% Homeostatic Model Assessment (HOMA)>2.5; 45.6% High Density Lipoprotein (HDL)<40mg/dl; 37.7% TG>110mg/dl and 13.5% hypertension (SBP and/or diastolic Blood Pressure percentile >90). Prevalence of the MS in OW/OB patients was 40.3%. The MS was not observed in NW children. Significant differences were found for: family history of OW/OB, birth weight (BW), age at menarche, presence of acanthosis nigricans, waist circumference (WC) >90th percentile. The WC was positively correlated with BP, TG, insulin, HOMA and Body mass index Z score and negatively with HDL in the study population. CONCLUSIONS: We confirm obesity as a major determinant of CMRF and MS (40%), especially fat centralization. We stress the need to address obesity prevention plans in children and adolescents.

[Three-year follow up of metabolic control in adolescents with type 1 diabetes with and without eating disorders]. / Seguimiento a 3 años del control metabólico en pacientes con diabetes tipo 1 con trastornos de la conducta alimentaria y sin ellos.

UNLABELLED: Eating disorders associated to type 1 diabetes (T1D) raise the risk of impairments in metabolic control increasing short and long term complications. OBJECTIVE: To compare the glycosylated hemoglobin (HbA1c) levels variation in a group of T1D adolescents with and without disordered eating behaviour (DEB) during 3-year follow-up and to relate the metabolic control, with pubertal stage, T1D duration, Body Mass Index and gender at the end of the study. MATERIAL AND METHODS: Analytyc an observational comparative study of two cohorts: patients were selected from a previous multicentric study done by the Paediatric Committee of the Argentinean Diabetes Association. One DEB sample group and another group without DEB were conformed. HbA1c levels were estimated al baseline and after 3 years. Pubertal stage, BMI, gender and duration of T1D were assessed at the end of the study. Comparison of statistical tests of HbA1c levels and association tests were made. RESULTS: Eighty seven patients, 22 with DEB and 65 without DEB were studied. Patient's mean ages (13.6 vs.14.3 years) and T1D evolution time (4.0 vs. 4.7 years) were similar in both groups. Three years later, there was an increase in the mean HbA1c levels in both groups, with statistical differences only in the DEB group (8.40 vs. 9.93) (p: 0.001), but not in the group without DEB [8.57 vs. 9.01 (p: 0.06)]. An association between metabolic control and the presence of DEB was observed but not with the other studied variables. CONCLUSION: Presence and persistence DEB in T1D patients implies a worsening prognosis of the metabolic control in the future.

Estrés en niños con diabetes tipo 1 y sus padres: estilos de afrontamiento con y sin tratamiento psicológico / Stress in Type 1 Diabetic Children and their Parents: Coping Styles with and without Psychological Treatment

La diabetes tipo 1 (DT1) es la enfermedad crónica más frecuente en la infancia que no sólo afecta la salud sino que además, puede generar elevados niveles de estrés en el paciente y en su familia. OBJETIVO: Evaluar los estilos de afrontamiento ante el estrés en niños con DT1 y sus progenitores, comparando un grupo que recibió una intervención psicológica sistematizada con otro de similares características sin intervención psicológica alguna. MÉTODOS: Un total de 34 niños de 9 a 14 años de edad con DT1 y su respectivo progenitor (madre o padre) fueron divididos en dos grupos: 17 bajo tratamiento psicológico sistematizado durante nueve meses y 17 sin dicho tratamiento (grupo control). Se midieron las estrategias con el Cuestionario de Afrontamiento de Lazarus y Folkman adaptado para niños y adultos. RESULTADOS: El grupo de niños y padres bajo intervención psicológica presentó mayores puntajes en las estrategias centradas en el problema que el grupo control; a su vez, este último registró mayores niveles de estrategias no saludables, centradas en la emoción. CONCLUSIONES: El presente estudio evidencia la importancia de una intervención psicológica destinada a mejorar el afrontamiento saludable de la DT1 en los niños afectados y en sus progenitores...

Type 1 Diabetes (T1D) is the most common chronic disease in childhood. It not only affects health, but also creates great stress on both the patient and his/her family as well. OBJECTIVE: To assess the coping styles for stress in children with T1D and their parents, by comparing a group receiving systematic psychological treatmentto a similar one without such treatment. METHODS: There was a sample of 34 T 1D children aged 9 to 14 year sold and one of their parents. Two groups were made: 17 children and their father or mother who undergo a systematic psychological treatment during a nine months period and 17 without such treatment (control group). Lazarus and Folkman questionnaires were used to measure the coping strategies in children and adults. RESULTS: Both children and parents from the group receiving psychological treatment had higher scores on problem-focused strategies than those in the control group, which in turn showed greater levels of emotion-focused un healthy strategies. CONCLUSIONS: The present study highlights the importance of psychological assistance to improve healthy coping of T1D in children and their parents...

Seguimiento a 3 años del control metabólico en pacientes con diabetes tipo 1 con trastornos de la conducta alimentaria y sin ellos / Three-year follow up of metabolic control in adolescents with type 1 diabetes with and without eating disorders

Los trastornos de conducta alimentaria pueden repercutir notoriamente sobre el control metabólico y aumentar el riesgo de complicaciones a corto y largo plazos.Objetivo. Comparar la variación de la hemoglobina glucosilada A1c (HbA1c) en un grupo de adolescentes diabéticos tipo 1 con y sin trastornos de conducta alimentaria al inicio y a los 3 años,y determinar asociaciones del control metabólico con el estadio puberal, índice de masa corporal (IMC), género y duración de la diabetes.Material y métodos. Estudio analítico, observacional de comparación entre dos cohortes. Los pacientes se seleccionaron de un estudio multicéntricoprevio y se conformó una muestra de dosgrupos: con y sin trastornos de conducta alimentaria.Se determinaron las concentraciones de HbA1c iniciales y a los 3 años de seguimiento, y las variablesindependientes estadio puberal, IMC, género y tiempo de evolución de la diabetes, al final del estudio. Se realizaron pruebas estadísticas decomparaciones entre concentraciones medias de HbA1c y de asociación.Resultados. Se estudiaron 87 pacientes, 22 presentaron trastornos de conducta alimentaria y 65 no, edad media 13,6 contra 14,3 años y tiempo de evolución de diabetes 4,0 contra 4,7 años. Lasconcentraciones de HbA1c a 3 años, aumentaron significativamente, sólo en el grupo con trastornos de conducta alimentaria (8,40 contra 9,93; p=0,001). Hubo asociación del control metabólico con trastornos de conducta alimentaria.Conclusión. La presencia de trastornos de conducta alimentaria en pacientes con diabetes tipo 1 presupone peor pronóstico en el control metabólico futuro.

Vacunación contra hepatitis B en un hospital pediátrico / Vaccination against Hepatitis B in a pediatric hospital

Introduccion.En el mes de Septiembre de 1987,en el Hospital de Niños "Ricardo Gutierrez"de Santa Fe,se ofreció un programa gratuito de vacunación contra la hepatitis B a todo el personal hospitalario.Materialy Métodos.Se empleó Engeri x B,vacuna de ADN recombinado que contiene el antígeno de superficie purificadoOcho meses después de comenzado el plan,solo el 14 por ciento del personal hospitalario había recibido la vacunación completa.Se realizaron tareas de promoción y difusión mediante afiches y entrevistas personales que hacían hincapié en las formas de evolución de la enferemdad y las característica de la vacumaA los catorce meses de comenzado el plan,se logró que el porcentaje de vacunados ascendiera de un 14 por ciento a un 54 por ciento.Conclusiones.Los resultados de la campaña muestran que se deben realizar esfuerzos educacionales continuos y más específicos sobre los planes de vacunación anti hepatitis B,para lograr mayores y mejores resultados entre la población considerada de alto riesgo