[Salt intake profile and blood pressure in cystic fibrosis]. / Perfil ingestivo salino y presión arterial en la fibrosis quística.

BACKGROUND: High blood pressure (BP) is not considered a problem in patients with cystic fibrosis (CF). The loss of sodium in these patients may affect their sensitivity to the taste of salt. OBJECTIVES: To study the BP in a group of patients with CF and to analyse their salt intake profile and the relationship with their BP levels. PATIENTS AND METHODS: Cross-sectional analytical study with control group. Index group: 20 subjects, 4-30 years old with diagnosis of CF. CONTROL GROUP: 73 healthy subjects. Physical examination, BP measurement and specific tests to determine the salt ingestion profile. RESULTS: Systolic BP (SBP) and diastolic BP (DBP) values were lower in the CF group. SBP: 99.63+/-9.11mmHg vs. 111.94+/-10.71mmHg, P: 0.001. DBP: 57.84+/-7.40mmHg vs. 70.05+/-8.11mmHg, P: 0.001. When these values were adjusted for age, sex, weight and height of the participants, differences did not remain statistically significant. Values of the salt intake profile did not differ significantly between the two groups. While the control group showed a significant negative correlation between SBP and salt taste sensitivity (r: -0.341, P=0.003), this correlation was not confirmed in CF patients (r: -0.115 P=0.6). CONCLUSIONS: BP values and the salt intake profile values in CF patients are equivalent to the normal population values when their differences are adjusted to the potential confounding factors. There is no correlation between BP levels and salt taste sensitivity in patients with CF.

[Temporal and bacteriological comparison of neonatal urinary infections]. / Comparación temporal y bacteriológica de la infección urinaria neonatal.

OBJECTIVE: To find out the epidemiological and management changes of urinary tract infection over the last years. PATIENTS AND METHODS: Descriptive retrospective review of patients with urinary tract infections (UTIs) admitted to our neonatal unit over an 11 year period. A temporal, microorganism group and voiding cystourethrography (VCUG) group comparison. RESULTS: We studied 106 cases (5 cases/1,000 alive newborns). The most commonly isolated microorganisms were Escherichia coli (81.1%), Enterococcus faecalis (6.6%) and Enterobacter cloacae (4.7%). Gentamicin had an overall sensitivity of 93.2%, followed by cefotaxime 91.3% and amoxicillin-clavulanic acid 89.5%. We did not found temporal differences in microorganisms or sensitivities. We found differences in C reactive protein, nitrate and leucocyte values in E. coli versus non-E. coli UTIs, as well as patterns of antibiotic sensitivity with more resistances by non-E. coli microorganisms. No differences were found in patients with normal and pathological VCUG. We found ultrasound and VCGU disturbances in 35.2% and 21.4%, respectively. CONCLUSIONS: UTI is a common problem in our area. The most frequently isolated microorganism is E. coli. Non-E. coli UTIs have more resistances to usual therapies, although these did not show any increase in disease in the imaging tests. We found no increase in resistances throughout the study.

[Recommendations of the consensus conference "diagnostic and therapeutic management of urinary tract infection in childhood"]. / Recomendaciones de la Conferencia de Consenso ''Manejo Diagnóstico y Terapéutico de las Infecciones del Tracto Urinario en la Infancia''.

The recommendations of the Consensus Conference "Diagnostic and Therapeutic Management of Urinary Tract Infection in Childhood" are presented. Selection of the most appropriate urine collection technique depends on the child's ability to control urination and the urgency of the diagnosis. Directives for the interpretation of the various parameters of urinalysis are offered with the recommendation that diagnosis of urinary tract infection be based on urine culture. The indication of hospitalization does not depend on the location of the urinary tract infection but on the severity of repercussions and the risk of complications. Guidelines for first choice and alternative antibiotic therapy for parenteral or oral administration are established, as well as recommendations for the choice of route, type of regimen and the duration of the treatment, based on the patient's level of risk. Routine antibiotic prophylaxis is not recommended in children with a normal urinary tract after a first episode of urinary tract infection or in those with low-grade vesicoureteral reflux; the indication of prophylaxis in patients with recurrent infections or with high-grade reflux must be individualized. The current strategy of routine use of diagnostic imaging tests should be substituted by another strategy in which the use of these tests is individualized, taking into account each patient's level of risk.

[Continuum, the continuing education platform based on a competency matrix]. / Continuum, la plataforma de Formación Basada en Competencias.

Competency-Based Education is a learning method that has changed the traditional teaching-based focus to a learning-based one. Students are the centre of the process, in which they must learn to learn, solve problems, and adapt to changes in their environment. The goal is to provide learning based on knowledge, skills (know-how), attitude and behaviour. These sets of knowledge are called competencies. It is essential to have a reference of the required competencies in order to identify the need for them. Their acquisition is approached through teaching modules, in which one or more skills can be acquired. This teaching strategy has been adopted by Continuum, the distance learning platform of the Spanish Paediatric Association, which has developed a competency matrix based on the Global Paediatric Education Consortium training program. In this article, a review will be presented on the basics of Competency-Based Education and how it is applied in Continuum.

[Clustering of cardiovascular risk factors in obese offspring of parents with essential hypertension]. / Agrupamiento de factores de riesgo cardiovascular en hijos obesos de padres con hipertensión esencial.

INTRODUCTION: The prevalence of obesity in industrialized countries is increasing and is closely related to essential hypertension (EHT) in adolescents. OBJECTIVE: To analyze the prevalence of obesity and its association with other known cardiovascular risk factors in a sample of children and young adults with at least one parent with EHT. METHODS: The EHT group consisted 51 children and young adults (28 males [aged 5.4-25.6 years]) with at least one parent with EHT. The control group comprised 73 healthy normotensive children and young adults (43 males [aged 7.2-25.2 years]) who completed the follow-up visits of the RICARDIN study. Blood pressure (BP) was measured with a standardized technique using a mercury sphygmomanometer. A 12-hour fasting blood sample was taken for lipid profile and high sensitivity C-reactive protein (CRP) determinations. Financial support: FIS 03/0350, ESV Foundation Grant, 2003. RESULTS: The prevalence of obesity was five times higher in the EHT group than in controls (19.6% vs. 4.1%, p = 0.007). In this group, obese subjects showed higher systolic BP (122.0 vs. 110.4 mmHg p = 0.004) and lower high-density lipoprotein cholesterol (HDL-C) levels (47.6 vs. 58.0 mg/dl, p < 0.05). After adjustment for age and systolic BP, obese subjects in the EHT group showed significantly higher CRP values than non-obese subjects in this group (p = 0.024). CONCLUSIONS: The prevalence of obesity is higher in the offspring of parents with EHT than in non HT-prone subjects. Clustering of other additional risk factors indicates the need for high-risk preventive interventions in this group of children and young adults.

[Pattern of the distribution of total cholesterol and cHDL cholesterol Spanish children and adolescents: RICARDIN Study]. / Patrón de la distribución de colesterol total y cHDL en niños y adolescentes españoles: estudio RICARDIN.

BACKGROUND: The RICARDIN Study multicenter study of cardiovascular risk factors in children and adolescents has described the standards of normality of blood cholesterol levels in the Spanish school population. The objective of the present study was to compare mean values of cholesterol between different regions of Spain, and to compare the global mean with a pool international study. Also, the pattern of total cholesterol and cHDL by age and sex using mathematical model is described, and comparison with two international studies carried out in USA and Japan is performed. SUBJECTS AND METHODS: 10,683 children aged 6 to 18 were selected from 7 different Spanish provinces (Madrid, Vizcaya, Lugo, Badajoz, Murcia, Asturias and Barcelona). Blood samples were obtained by capilar puncture (Reflotron). RESULTS: Mean values of total cholesterol was different among provinces, and globally, were lower than the international pooled population, although the pattern observed in each population was very similar. Total cholesterol curve for Spanish boys showed a curvilinear trend that can be estimated through a cubic function that explains 89% of observed data, while for girls the best estimate was obtained through an inverse function (R2 = 0.40). cHDL for boys showed a cubic function as the best estimate (R2 = 0.90), while for girls the best estimate was obtained through a quadratic function (R2 = 0.59). CONCLUSIONS: There are important physiological variations of total cholesterol level by age and sex in children and adolescents. The pattern of cholesterol does not follow a linear model but a curvilinear one, that need to be considered in clinically assessing individual determinations of cholesterol, since highest percentiles can vary by age and sex.

[Ambulatory blood pressure monitoring in multicystic dysplastic kidney disease]. / Monitorización ambulatoria de la presión arterial en pacientes con displasia renal multiquística.

OBJECTIVE: To evaluate blood pressure in a group of patients with multicystic dysplastic kidney (MDK) disease through ambulatory blood pressure (ABP) monitoring. PATIENTS AND METHODS: ABP monitoring was performed in 16 patients with MDK disease using a Spacelabs 90207 monitor and an appropriately sized armband. The patients performed their normal daily activities except physical exercise. The activity period was 8:00 am to 8:00 pm and the resting period was midnight to 6:00 am. Patients with a percentage of correct readings of less than 70 % were excluded. The mean systolic and diastolic blood pressures for each period were calculated. Circadian variability was determined by the ratio between mean systolic and diastolic values in the active and resting periods, respectively. The results were compared with ABP values in healthy children. RESULTS: Fourteen patients (mean age 16 3.1 years, range: 6-27.6) were included. No patients with hypertension were found through casual measurement. One patient had daytime systolic hypertension. Five patients presented an abnormal drop in blood pressure during sleep. CONCLUSION: Blood pressure should be monitored in patients with MDK disease. ABP monitoring may detect alterations that can go unnoticed in casual determinations. Further studies with large samples are needed to establish the real prevalence of hypertension in these patients.

[Drug abuse in pregnancy and neonatal morbidity: epidemiologic changes in the last ten years]. / Consumo de drogas durante el embarazo y morbilidad neonatal: cambios epidemiológicos en los últimos 10 años.

BACKGROUND: In the last few years, patterns of drug abuse have varied. This may have changed the problems presented by the infants of drug-abusing mothers. OBJECTIVES: To determine the incidence of prenatal drug-exposure in neonates in our health area in the last decade, to analyze possible changes in the drugs consumed, routes of administration and the infectious diseases affecting drug-abusing mothers, and to study possible changes in the clinical features presented by their offspring. PATIENTS AND METHODS: An observational, descriptive, retrospective study of all the infants born to drug-abusing mothers from January 1, 1992 to December 31, 2001 was performed. The series was analyzed and the periods 1992-1996 and 1997-2001 were compared. RESULTS: The mean incidence was 7.5 cases per 1000 live-born infants (8.7 in 1992-1996 and 6.3 in 1997-2001). Mothers in the second half of the study were less likely to use heroin and the intravenous route and were more likely to use methadone and cocaine than mothers in the 1997-2001 period. Hepatitis C virus infection and instrumental delivery were more frequent in the 1997-2001 period. No differences were found in neonates born in either period. Birthweight was less than 2500 g in 40 % and was low for gestational age in 20 %. Preterm deliveries were performed in 24 %. Congenital malformations were found in 6 %, neonatal withdrawal syndrome in 79 %, human immunodeficiency virus infection in 2 %, and hepatitic C virus infection in 3 %. Four percent were given in adoption. CONCLUSIONS: Maternal drug abuse patterns changed in the ten years under study, but outcome in their offspring showed no differences. Drug abuse by pregnant women is linked to a high rate of low birthweight, prematurity, neonatal withdrawal syndrome, vertical infection by human immunodeficiency virus and hepatitis C virus, as well as to social and family problems.

[Estimation of creatinine clearance by the height/plasma creatinine formula in critically-ill children]. / Estimación del aclaramiento de creatinina por la talla en pacientes críticamente enfermos.

INTRODUCTION: Critically-ill children frequently show impaired renal function, necessitating adjustment of drug dosages. Our objectives were to study estimated creatinine clearance through the correlation between the height/plasma creatinine formula (CrClest) and measured creatinine clearance (CrClms) and to examine whether CrClest over- or underestimates CrClms by analyzing the influence of diagnosis, severity, and the practical consequences. PATIENTS AND METHODS: Seventy-seven patients admitted to the pediatric intensive care unit were included. CrClms was calculated using serum creatinine and creatinine in urine collected over 24 hours. CrClest was estimated using serum creatinine, height, and a constant. The difference between CrClms and CrClest was expressed as a percentage: (CrClms CrClest) x 100/CrClms. Differences of greater than 15 % were considered poor estimates. ResultsThe mean percentage difference was 29.2 (standard error: 39.9). There were no differences among diagnoses in the distribution of significant bias, although the frequency of metabolic diagnoses was high. Incorrect evaluation of CrClest would result in a therapeutic error in 11.69 % of the cases, with overdosage in 10.39 %. The Pediatric Risk of Mortality (PRISM) score was higher (p < 0.05) in patients at risk for overdosage. CONCLUSIONS: CrClest estimation using the height/plasma creatinine formula was not an accurate method in critically ill children. In 10.39 % of patients with more severe illness, the dosage of renally excreted drugs would be too high. The highest risk was found in patients with metabolic and neurological diagnoses.

[Co-authorship and Spanish pediatric scientific collaboration networks (2006-2010)]. / Coautoría y redes de colaboración científica de la pediatría española (2006-2010).

INTRODUCTION: Scientific collaboration is very important, as it is the basis of the scientific development of every discipline. The aim of this paper is to identify the indicators of scientific collaboration and co-authorship networks of Spanish researchers and institutions publishing in national and international paediatric, multidisciplinary or other knowledge areas journals during the period 2006-2010. METHODS: The papers studied were obtained from the databases including, Science Citation Index Expanded, Scopus, Índice Médico Español and Índice Bibliográfico Español en Ciencias de la Salud, by means of applying different search profiles. All the papers signed by co-authors were quantified in order to identify the authorship and institutional collaboration networks. Furthermore the degree, betweenness index, and closeness index were obtained as a measurement of the structural analysis. Co-authorships were represented graphically by the network analysis and display software Pajek. RESULTS: A total of 7971 articles were published during the period 2006-2010, with 90.55% completed in collaboration. Using a threshold of 10 or more co-authorships, 77 research groups in Pediatrics were identified. Most papers were published in collaboration between institutions of the same Autonomous Community (42.28%), and 14.84% with international collaboration. The analysis of institutional participation enabled a large nucleus or institutional collaboration network to be identified, with 52 linked institutions. International collaboration was led by the USA and European countries, such as United Kingdom, Germany and Italy. DISCUSSION: Authors, institutions and the most active working groups in Spanish pediatrics were identified, which is very interesting information to establish contacts to increase the existing networks, to prevent redundancies, and to take advantage of the new emerging groups. It is necessary to promote the collaboration of Spanish researchers, especially with their international colleagues, since a positive relationship is found between international collaboration and quality and impact of publications measured by citation analysis.

[Analysis of the scientific productivity and impact of Spanish paediatrics (2006-2010)]. / Análisis de la productividad e impacto científico de la pediatría española (2006-2010).

INTRODUCTION: The aim of this paper is to quantify, by means of bibliometric indicators, the scientific production of Spanish researchers and institutions publishing in national and international paediatric journals, as well as multidisciplinary and other knowledge areas publications during the period 2006-2010, and to determine their impact. METHODS: The articles were obtained by applying specific search strategies in databases including, Science Citation Index-Expanded, Scopus, Índice Médico Español, and Índice Bibliográfico Español en Ciencias de la Salud. RESULTS: A total of 7971 articles were published in 971 journals, in which 142 were from Spain and 829 were international. The most productive journals were Anales DE PEDIATRÍA (n=1257), Acta Pediátrica Española (n=456) and Evidencias en Pediatría (n=358). Articles were published mostly in English (41.04%) and in Spanish (38.18%), with the participation of 17 874 different authors from 3302 institutions. Approximately 60% of the papers were cited at least once, and 39.81% were never cited. The mean number of citations per document was 4.28 (SD=9.54). The most cited journals were Pediatrics (n=770), Pediatric Infectious Disease Journal, and Journal of Clinical Endocrinology and Metabolism (n=553). DISCUSSION: The number of articles progressively increased from 2006 to 2010, which confirms the consolidation and growth of Spanish pediatric research, where the results are published in a wide range of Spanish and international journals, among which stands out is the ANALES DE PEDIATRÍA, the only Spanish pediatric journal with an impact factor. The increasing internationalization of Spanish Pediatrics is also confirmed, since a sustained growth of articles published in international journals is observed, where a quarter was published in US or British journals, as well as the importance of the publication in English. There is a concern about the fact that almost 40% of the articles did not receive a citation, which should encourage authors to complete research of quality, and editors to start editorial policies addressed to increase manuscript and journal quality.

Hacia un calendario vacunal de máximos. Balance de una estrategia / Towards a maximum vaccination calendar: Assessment of a strategy

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[Classic and emergent cardiovascular risk factors in schoolchildren in Asturias]. / Factores de riesgo cardiovascular clásicos y emergentes en escolares asturianos.

INTRODUCTION: Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponectin are the most important inflammatory cardiovascular risk markers. PATIENTS AND METHODS: A descriptive, cross-sectional study, including children aged 6-12 years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin. RESULTS: A total of 459 schoolchildren were included of whom 31% were overweight and 10.9% were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children. CONCLUSIONS: Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children.

Continuum, la plataforma de Formación Basada en Competencias / Continuum, the continuing education platform based on a competency matrix

La Formación Basada en Competencias es una modalidad formativa que ha cambiado el enfoque tradicional centrado en la enseñanza por otro basado en el aprendizaje. Los alumnos son el centro del proceso, en el que deben aprender a aprender, a resolver problemas y a adaptarse a los cambios en su entorno. El objetivo es lograr un aprendizaje que integre el saber, el saber hacer, el saber ser y el saber estar. A este conjunto de saberes se les denomina competencias. Es fundamental disponer de una referencia de las competencias requeridas para identificar la necesidad de las mismas. Su adquisición se aborda a través de módulos docentes en los que se pueden adquirir una o más competencias. Esta estrategia docente ha sido adoptada por Continuum, la plataforma de formación a distancia de la Asociación Española de Pediatría, que ha desarrollado una matriz de competencias, basada en el programa de formación del Global Pediatric Education Consortium. En este artículo repasaremos los fundamentos de la Formación Basada en Competencias y cómo se aplica en Continuum

Competency-Based Education is a learning method that has changed the traditional teaching-based focus to a learning-based one. Students are the centre of the process, in which they must learn to learn, solve problems, and adapt to changes in their environment. The goal is to provide learning based on knowledge, skills (know-how), attitude and behaviour. These sets of knowledge are called competencies. It is essential to have a reference of the required competencies in order to identify the need for them. Their acquisition is approached through teaching modules, in which one or more skills can be acquired. This teaching strategy has been adopted by Continuum, the distance learning platform of the Spanish Paediatric Association, which has developed a competency matrix based on the Global Paediatric Education Consortium training program. In this article, a review will be presented on the basics of Competency-Based Education and how it is applied in Continuum

El profesor Sánchez Villares y las Especialidades Pediátricas. Lo que va de ayer a hoy / Professor Sánchez Villares and Pediatric Specialities. So far from yesterday to today

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Obesidad en Oviedo: prevalencia y tendencias temporales de 1992 a 2012 / Obesity in Oviedo: Prevalence and time trends from 1992 to 2012

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