Prevalence of Severe Obesity among Primary School Children in 21 European Countries.

BACKGROUND: The World Health Organization (WHO) European Childhood Obesity Surveillance Initiative (COSI) was established more than 10 years ago to estimate prevalence and monitor changes in overweight and obesity in children aged 6-9 years. Since then, there have been five rounds of data collection in more than 40 countries involving more than half a million children. To date, no comparative studies with data on severe childhood obesity from European countries have been published. OBJECTIVES: The aim of this work was to present the prevalence of severe obesity in school-aged children from 21 countries participating in COSI. METHOD: The data are from cross-sectional studies in 21 European WHO member states that took part in the first three COSI rounds of data collection (2007/2008, 2009/2010, 2012/2013). School-aged children were measured using standardized instruments and methodology. Children were classified as severely obese using the definitions provided by WHO and the International Obesity Task Force (IOTF). Analyses overtime, by child's age and mother's educational level, were performed in a select group of countries. RESULTS: A total of 636,933 children were included in the analysis (323,648 boys and 313,285 girls). The prevalence of severe obesity varied greatly among countries, with higher values in Southern Europe. According to the WHO definition, severe obesity ranged from 1.0% in Swedish and Moldovan children (95% CI 0.7-1.3 and 0.7-1.5, respectively) to 5.5% (95% CI 4.9-6.1) in Maltese children. The prevalence was generally higher among boys compared to girls. The IOTF cut-offs lead to lower estimates, but confirm the differences among countries, and were more similar for both boys and girls. In many countries 1 in 4 obese children were severely obese. Applying the estimates of prevalence based on the WHO definition to the whole population of children aged 6-9 years in each country, around 398,000 children would be expected to be severely obese in the 21 European countries. The trend between 2007 and 2013 and the analysis by child's age did not show a clear pattern. Severe obesity was more common among children whose mother's educational level was lower. CONCLUSIONS: Severe obesity is a serious public health issue which affects a large number of children in Europe. Because of the impact on educational, health, social care, and economic systems, obesity needs to be addressed via a range of approaches from early prevention of overweight and obesity to treatment of those who need it.

[Safety of statins].

The discovery of statins, was a landmark in primary and secondary prevention of cardiovascular disease, where cholesterol plays a central pathophysiologic role. Currently there are 7 statins, which according to recent meta-analytic studies did not reveal significant differences in effectiveness measured by results of cardiovascular morbidity and mortality. This means that the selection of a particular statin, could be very important aspects of safety and cost. The two adverse reactions greater interest currently on statins are rhabdomyolysis and risk of type 2 diabetes mellitus; the first is an adverse reaction appeared almost from the birth of these drugs and caused the withdrawal of cerivastatin, while the second has been recently reported. Significant differences have been reported between different statins, in relation to the two mentioned adverse reactions.

Maternidad postergada / Postponed motherhood

En Cusco, el año 2000 durante el III Curso Internacional y III Congreso Peruano de Psicoprofilaxis Obstétrica, organizado por la Sociedad Peruana de Psicoprofilaxis Obstétrica (ASPPO), en el que participaron cientos de profesionales de la Obstetricia del Perú y Latinoamérica; a propuesta del autor, se acordó tomar en cuenta el término: Maternidad Postergada. Definición que nos permite identificar a la mujer que llega a los 40 años sin descendencia, con la característica de no haber procreado por voluntad propia. Es decir; que sin tener ningún antecedente patológico ni problema de fertilidad, postergó su embarazo. Situación que cada vez es más frecuente de encontrar debido al cambio que venimos observando en el rol que le toca cumplir a la mujer. De allí, el interás por conocer más acerca de esta nueva situación, especialmente ahora que cada vez más mujeres prefieren retrasar su primer embarazo, por motivos personales o laborales.

In Cusco, in the year 2000 during the III International Course and III Obstetrical Psychoprofilaxis Peruvian Congress, organized by the Peruvian Society of Obstetric Psychoprofilaxis (ASPPO), involving hundreds of Obstetrics professionals of Peru and Latin America, after a proposition of the author, it was agreed to consider the term: Postponed Motherhood. This definition allows us to identify the woman who reaches the age of 40 without offspring, with the characteristic of having not fathered by choice. Without any background of disease or fertility problems, she delayed pregnancy. This situation is increasingly common to find due to the change that we have observed in the role that women play. Hence, the interest in knowing more about this new situation; especially now that more and more women prefer to delay their first pregnancy because of personal or work reasons.

Influenza vaccination coverages among children, adults, health care workers and immigrants in Spain: related factors and trends, 2003-2006.

OBJECTIVES: This study sought to: describe influenza vaccination coverage among Spanish children, adults, health care workers (HCWs), and immigrants according to the 2006 Spanish National Health Survey (NHS); and analyze the time trend for the period 2003-2006. METHODS: We analyzed 38,329 questionnaires drawn from the 2006 NHS, covering subjects aged 6 months and over. As the dependent variable, we took the answer to the question, "Did you (or your child) have a 'flu shot in the last campaign?". Independent variables were age group, gender, nationality, occupation (HCWs), and coexistence of chronic conditions. RESULTS: In 2006, vaccination coverage for the Spanish population was: 22.2% overall; 6.8% for all children; and 19.1% for children with a chronic medical condition. Coverages were: 66.8% among subjects aged >/=65 years; 26.6% among high-risk subjects aged <65 years; and 24.2% among HCWs. A significantly lower proportion of immigrants reported vaccination than did indigenous subjects. After controlling for possible confounders, the likelihood of having been vaccinated in 2006 was lower than in 2003 for the entire population (adjusted OR 92, 95%CI 0.86-0.97). In specific target groups, however, coverage underwent a significant reduction from 2003 to 2006 among high-risk subjects aged 16-64 years, and immigrants. Significant improvements were found among subjects aged over 64 years, and children. CONCLUSIONS: Available data show unacceptably low levels of influenza vaccination coverage among high-risk subjects aged under 65 years, children with chronic medical conditions, and HCWs. A special effort is thus called for to implement strategies that have demonstrated their effectiveness in enhancing vaccination coverages.

Diagnóstico de disfunción sexual femenina en el climaterio durante la consulta externa / Diagnosis of female sexual dysfunction in climacteric during the consultation

OBJETIVO: Conocer la frecuencia con la que se presenta en la consulta externa la Disfunción Sexual en la Mujer durante su Climaterio. MATERIAL Y MÉTODOS: Estudio prospectivo ramdomizado tipo encuesta a grupo de mujeres mayores de 40 años que acuden a la consulta externa del Institut Santé de la Femme y que aceptaron voluntariamente ser encuestadas con el Cuestionario Específico de Calidad de Vida en la Menopausia-Universidad de Toronto. Adaptado por Prosam (Chile). RESULTADOS: 400 mujeres mayores de 40 años fueron encuestadas. (+/- 53.5 años) todas tenían instrucción secundaria completa y tenían pareja estable, ninguna recibía TRH ni medicación estimulante del SNC.45% de mujeres menores de 50 años manifestó cambio en el deseo sexual, siendo 60% en las mayores de 50 años. En relación al acto sexual, 48% de las menores de 50 años evitaban el acto sexual y 58% de las mayores de 50 años. Evidenciándose que 60% independientemente de la edad disfrutaban de su sexualidad al tener parejas de menor edad. Asimismo, se observó que a mayor edad hubo mayor dispareunia y esto se asocio con mayor limitación para expresar su sexualidad con la pareja. CONCLUSIONES: La disfunción sexual femenina durante el climaterio es una realidad, es por tanto necesario considerar como parte de la anamnesis el interrogatorio sobre la sexualidad. Siendo mayor su frecuencia a mayor edad. Asimismo, un aspecto importante a tener en cuenta es la edad de la pareja.

OBJETIVE: To know the frequency of Sexual Dysfunction in Women during their climacteric. MATERIALS AND METHODS: Randomize prospective study, survey type, to a group of women older than 40 years who go to the external consultation of the Institut Santé de la Femme and who voluntarily accepted to answer the Specific Questionnaire of Quality of Life in the Menopause-University of Toronto. Adapted by Prosam (Chile). RESULTS: 400 women older than 40 years answered the survey. (+/- 53, 5 years) All of them had complete secondary instruction and had a stable partner. None of them received HRT nor stimulating medication of SNC. 45% of women younger than 50 years showed change in sexual desire, and 60% of women older than 50 years showed some change. In relation to the sexual act, 48% of the younger than 50 years avoided the sexual act, while 58% of the older than 50 years did the same. Independently from the age, 60% enjoyed their sexuality when they had younger partners. It was also observed that there was more dyspareunia in the older age and this was associated with greater limitation to express their sexuality with their partner. CONCLUSIONS: The female sexual dysfunctions during the climacteric are a reality. Therefore, it is necessary to consider the questionnaire on sexuality as part of the anamnesis. The presence of female sexual dysfunctions is more frequent in elder age. Also, the partnerÆs age is an important aspect to consider.

5 de octubre: día de la medicina peruana / October 5: peruvian medicine day

En homenaje y recuerdo al heroísmo de Daniel Alcides Carrión, cada 5 de octubre celebramos el Día de la Medicina Peruana. Carrión, héroe de nuestra medicina peruana, fue un serrano auténtico, lo que se llama un ônuevo indioõ, vale decir un producto del mestizaje, esencialmente cultural antes que genético, de ese que ocurre como resultado de la eclosión entre dos civilizaciones en el escenario agreste de los Andes. Guadalupano y San Fernandino, que además de su heroísmo, nos dejó un buen ejemplo: Investigar y publicar. Daniel Alcides Carrión, a ciento veintisiete años de su muerte, es sin duda; el personaje más importante de la medicina peruana y con alcance universal.

In honor and remember the heroism of Daniel Alcides Carrión, celebrated each October 5: Peruvian Medicine Day. Carrión, Peruvian hero of our medicine, was a real mountain, which is called a ônew Indianõ, that is a product of miscegenation, essentially cultural rather than genetic, that happens as a result of the emergence of two civilizations in the rugged scenery of the Andes. Guadalupe and San Fernandino, in addition to their heroism, we left a good example: research and publish. Daniel Alcides Carrión, a hundred and twenty seven years of his death, is without doubt, the most important character in Peruvian medicine and universal.

Sangrado uterino postmenopáusico asociado a ingesta de Sacha Inchi y Linaza: a propósito de 2 casos / Postmenopausal uterine bleeding associated with sacha inchi and linaza intake. About 2 cases

Se presenta el primer reporte de sangrado uterino anormal en la postmenopausia asociado al consumo de fitoestrógenos. En 2 mujeres, con menopausia mayor a 6 años: la primera, con antecedente de consumo de aceite de Sacha inchi y la segunda con ingesta de Linaza. Se discute el efecto estrogénico de ambas sustancias, el seguimiento a corto plazo de estas pacientes y las recomendaciones para el consumo de fitoestrógenos.

This is the first report about the association between postmenopausal abnormal uterine bleeding and Phytoestrogens intake. There appear 2 women with more 6 years menopause: The first one with Sacha inchi intake and the second one with Linaza intake. The estrogenic effect of the skill, the short-term follow-up of these patients and the recommendations for phytoestrogens intake are discussed.

Bacilos de Doderlein y su rol en la prevención y tratamiento probiótico de la infección vaginal / Doderlein's bacilli and its role in the prevention and treatment probiotic of the vaginal infection

Los bacilos de Doderlein o Lactobacilos fueron identificados por primera vez en 1894 por el médico alemán A. Doderlein al estudiar una muestra de secreción vaginal. Se caracterizan por ser las bacterias más importantes y predominantes de la flora vaginal normal, encontrándose de 10 a 100 millones por gramo de fluido, sirviendo como freno al desarrollo de gérmenes y hongos gracias a la producción de H202 que dificulta la reproducción de especies que no poseen catalasa (anaerobios, Gardnerella vaginalis, Mobilincus, Streptococos, entre otros), liberación de ácido láctico, lactacidina, acidolina y lacticin B que actúan sinérgicamente para inhibir el crecimiento bacteriano, disminuyendo el riesgo a padecer cualquier proceso infeccioso vaginal. En la actualidad, los Bacilos de Doderlein son descritos como microorganismos probióticos utilizados para restablecer el equilibrio ecológico de la vagina, debido a su capacidad de adherirse a la mucosa inhibiendo el crecimiento de gérmenes patógenos, metabolizando la glucosa y obteniendo ácido láctico que mantiene un pH vaginal bajo (3.5-4.5) con lo que previenen y tratan la vaginitis por un mecanismo denominado Interferencia Bacteriana, evitando la reinfección y cronicidad de un proceso que de no ser controlado podría asociarse a la adquisición de infecciones de transmisión sexual.