Skinfold thickness measurements are better predictors of body fat percentage than body mass index in male Spanish children and adolescents.

OBJECTIVE: To develop equations, from some simple anthropometric measurements, for the prediction of body density from underwater weighing in male spanish children and adolescents. SUBJECTS: One hundred and seventy-five males, aged 7.0-16.9 y, participated in this study, they were recruited from primary and secondary schools. MEASUREMENTS: Body weight and height and skinfold thicknesses by anthropometry, body density by underwater weighing. RESULTS: Correlations between body density and body mass index (BMI) were high until 14.0-16.9y. Correlations between body density and log sigma 4 skinfolds were higher than those with BMI at all ages. Log sigma 4 skinfolds explained between 61% (14.0-16.9 y) and 68% (11.0-13.9 y) of the body density variance. Regression equations for body density from BMI and triceps skinfold thickness explained between 51% (14.0-16.9y) and 68% (7.0-10.9 y) of the body density variance. CONCLUSIONS: The best estimators of body density in the children and adolescents studied were log sigma 4 skinfolds and a combination of BMI and triceps skinfold.

[Epidemiology and burden of acute otitis media in Valencia (Spain)]. / Epidemiología e impacto de la otitis media aguda en la Comunidad Valenciana.

OBJECTIVE: To assess the burden (incidence, treatment and complications) of acute otitis media (AOM) and otitis media with effusion (OME) in children younger than 5 years of age from Valencia, Spain. SUBJECT AND METHODS: We performed a retrospective cohort study of 1,399 children followed-up for the first 5 years of life. Seventeen pediatricians reviewed the medical records of their patients born in 1995 and 1996 and followed-up from birth until the age of 5 years. For each child, the number of otitis episodes, treatment, complications, and surgical interventions was obtained. RESULTS: There were 2,961 episodes of AOM in the first 5 years of life (2.23 cases/child). Four hundred seventy-six cases (16.1 %) occurred before 1 year of age and 1,346 between the first and second year of life (45.5 %). By the third year of life, 59.8 % had had at least one episode. In most children (80.9 %), diagnosis was made in primary care and required a median of 1.81 visits/episode for follow-up. A total of 94.5 % were treated with antibiotics (amoxicillin-clavulanate 38.8 %, cefuroxime 14.3 %, clarithromycin 8.2 % and amoxicillin 5.9 %) and 8.5 % required a change of antibiotic therapy. Two hundred seventeen children (15.2 %) had at least one episode of OME. Twenty-six patients (1.8 %, 95 % CI: 1.2-2.7 %) required insertion of ventilation tubes. Twenty-four patients (1.7 %) had secondary hypoacusis. There was one case of meningitis and two cases of chronic otorrhea. No cases of mastoiditis were recorded. CONCLUSIONS: The incidence of AOM in Valencia is 40,014 episodes/100,000 children younger than 5 years/year (95 % CI: 39,700-40,300). It represents a significant burden due to the large number of visits, antibiotic use, associated surgical procedures and need for auditory rehabilitation.

Body mass index, triceps skinfold and waist circumference in screening for adiposity in male children and adolescents.

UNLABELLED: Simple anthropometric measurements and indices are the most commonly used tools for assessing body composition. Only a few papers have examined the sensitivity and specificity of the body mass index (BMI) against total body fat percentage (TBF%) from underwater weighing in children and adolescents. The objective of the study was to evaluate the screening performance of BMI, triceps skinfold thickness and waist circumference for excess TBF%. A total of 175 healthy volunteer males, aged 7.0-16.9 y, participated in the study. TBF% was measured using underwater weighing as the reference method. Receiver operating characteristic (ROC) curves were constructed to assess the value of the three anthropometric measurements as a screening measure for total adiposity. Sensitivity and specificity were calculated at several percentile cut-offs for BMI, triceps skinfold and waist circumference. The areas under the ROC curves were also calculated, and were 0.86 for BMI, 0.90 for triceps skinfold and 0.88 for waist circumference. The point on the ROC curve closest to 1 corresponded to the 70th percentile for BMI, to the 75th percentile for triceps skinfold, and to the 70th percentile for waist circumference. CONCLUSION: BMI, triceps skinfold and waist circumference predicted total fat content well in male children and adolescents.

[Sexual and biological maturation]. / Maduración sexual y biológica.

We have studied the physical characteristics of strength and the electrocardiographs of 291 boys, between 9 and 15 years of age, and 284 girls from 8 to 14 years old, divided into groups according to their sexual maturation stage (SMS). During this age period, children pass from SMS 1 to SMS 5. We have used the Ruffier-Dickson test as a test of strength and have also obtained an electrocardiographic index. Analysis of variance (ANOVA) showed that in girls, the number of hours of sport activity/week, systolic blood pressure (SBP) and diastolic blood pressure (DBP) both during rest and post-effort (SBPe and DBPe), Ruffier-Dickson index (RDI), pressure frequency product (PFP), increase of diastolic blood pressure (Inc DB) and the indices of Lewis and Sokolow right show a statistically significant dependence on the SMS. In boys, the number of hours of sport activity/week, SBP, DBP, heart frequency post-exercise, SBPe, RDI, PFP, increase in systolic blood pressure and the index of Sokolow right and left are dependent on the SMS. The objective of this paper is to draw the pediatrician's attention to the need to use the SMS for evaluating biological functions, not the chronological age.

[Relationship between sexual maturation and subcutaneous fat]. / Relación entre el desarrollo sexual y la grasa subcutánea.

Due to the great variability at the beginnings and the period of the puberty, authors have studied the modifications of the subcutaneous-fat and their relation with the sexual maturating. They have measured the skinfold thickness of biceps, triceps, subscapular and suprailiac in 358 boys from 10 to 15 years old and 424 girls from 8 to 14 years old inrelation to sexual maturating through the stages described by Tanner. It has been found more subcutaneous fat in girls than in boys (p less than 0.05). The boys increase their subcutaneous fat until the stage 3 (except the skinfold triceps) and decrease later (except the skinfold subscapular). In boys, the analysis of varianza, show that the variations are related with the sexual maturating and not with chronologic age.

[Blood lipids in children up to 12 years of age in a rural population from Extremadura]. / Lípidos en niños hasta 12 años, de una población rural extremeña.

We have studied the levels of total cholesterol and triglycerides in 398 children of both sexes, ranging in age from birth until 12 years, in a rural population from Extremadura (Spain). The measurements have been made when analyses were indicated for other reasons. We obtained the following mean values: Total cholesterol = 170.8 +/- 37.0 mg/dl in boys and 172.6 +/- 31.7 mg/dl in girls. Of these children, 43.5% had levels over the limit of 175 mg/dl. Triglycerides = 75.1 +/- 33.5 mg/dl in boys and 71.1 +/- 36.2 mg/dl in girls. In 14.2% of the children this value was over 100 mg/dl. The lipoprotein levels did not present any significant differences with respect to sex until 12 years of age. We compare our results to those of other authors.

[Effect of different kinds of feeding on morbidity during the first year of life]. / Influencia de los diferentes tipos de lactancia en la morbilidad durante el primer año de vida.

It is studied the influence of the different kinds of feeding on the morbidity in the first year. Four groups are made depending on whether they have had maternal feeding for 3 months or over 3 months (n = 46), artificial feeding at the beginning (n = 63), mixed feeding for 3 months or over 3 months (n = 84) and those who had introduced cow milk before the 6 months (n = 48). The children with maternal feeding and mixed feeding had less respiratory infections than those who had been fed with artificial feeding (p greater than 0.05 and p less than 0.02 respectively). The results are compared with those given by other authors and it is suggested that in civilized societies there is a smaller evidence of the protection of the human milk against infections.

[Lactation and growth in the first trimester of life]. / Lactancia y crecimiento en el primer trimestre de vida.

It has been studied the antropometrical parameters (weight, length, corporal mass index, biceps skinfold, triceps, subscapula and suprailiaca) in 170 children breast-fed and in 149 artificial-fed at birth, one month and the three months time life. At the first month of life it is observed a beneficial effect of the breast-fed above the artificial one in weight (p less than 0.001), length (p less than 0.05), corporal mass index (p less than 0.01), subscapula fold (p less than 0.01), suprailiaca fold (p less than 0.05) and sum of four folds (p less than 0.05), which disapprove at the first quarter of life. It could be suggested that breast-feeding has an effect on the children rising and growth because of its nutritional value and the decrease of infections, although in developed countries these facts are less demonstrable.

[The demand for primary pediatric care]. / Estudio de la demanda en Atención Primaria pediátrica.

OBJECTIVE: To determine the pediatric demands in a primary health care center in order to better plan the work, as well as to up-date the health care and continuing education programs. PATIENTS AND METHODS: The total number of pediatric consultations to a health care center during two years were studied. RESULTS: A total number of 3,848 children, with a maximum age of 13 years, consulted this office a total of 48,936 times. The annual frequency index increases in accordance with a decrease in age, with an average of 6.2 consultations per child per year. The assistencial pressure was 24.15 consultations/ pediatrician/day in 1993 and 27.33 consultations/pediatrician/day in 1994. Consultations by children older than 7 years of age comprised 24.4% of the total. As for the distribution of these consultations, 74.19% were with a previous appointment, 18.06% without appointment, 7.16% due to health programs and 0.58% due to consultations done at home. For every 100 visits, 1.34 complementary tests, 1.8 x-rays and 6.5 referrals were done. Using Wonca's classifications, 42.23% belonged to group VIII, the next greatest number to group XVIII, followed by I, with the last being XVI. The most frequent reasons for consultations were: SRI in 24.3% of the cases, followed by the breast-feeding program, normality, tonsillitis and otitis. In addition, acute respiratory tract infection and acute childhood diarrhoea had weekly distributions throughout these two years. CONCLUSIONS: We comment on the necessity of adapting the continued education programs and the prevention and health promotion plans so that they better address the pathologies that are most frequently found in primary care.

[Determination of body fat by means of densitometry and anthropometry in children 6 to 10 years of age]. / Determinación de la grasa corporal mediante densitometría y antropometría en niños de siete a diez años.

The authors have studied the body composition in a group of 36 boys from 7 to 10 years old, through densitometry and anthropometry. They have found significant correlations between the percentage of fat, got by densitometry and some anthropometric indices: Quetelet index (r = 0.79), sum of 4 skinfolds (r = 0.78) and logarithm of the sum of 4 skinfolds (r = 0.80). After a multiple regression analysis, they got equations which permit you to calculate the percentage of fat, using several anthropometric parameters with a 10% of error. They bring two nomograms which facilitate the estimation of body fat. They compare the results obtained with the ones described by others authors and suggest the need to extend this study to boys with other ages as well as to girls.

Otitis media aguda en Atención Primaria / Acute otitis media in primary care

Objetivos: Debido a la muy alta incidencia de otitis media aguda (OMA) referida en algunos trabajos y a la disponibilidad de una vacuna conjugada para su prevención, hemos estudiado la incidencia de OMA en nuestro medio en los últimos 9 años. Material y métodos: Se realiza el trabajo en el Centro de Salud de Manises, población de 26.000 habitantes (4.560 niños hasta 14 años), a 6 km de Valencia capital. Se obtienen los diagnósticos de otitis de 230.020 consultas entre 1993 y 2001. El criterio diagnóstico de OMA ha sido la presencia de otalgia más algún signo timpánico. Resultados: La OMA ha sido la causa del 4% de todas las consultas. Al cumplir 1 año de vida, el 35,4% de los niños ha tenido algún episodio de OMA, y al cumplir 4 años lo ha sufrido el 84,6%. Ha tenido tres o más cuadros de OMA el 5,7% de los niños al año de vida y el 31,8% al llegar a los 4. Se comprueba que cuanto antes tiene un niño la primera OMA, mayor número de episodios va a tener. La incidencia de mastoiditis es del 0,011%. Se comparan los resultados con los obtenidos por otros autores. Conclusiones: Encontramos una incidencia de OMA más baja que la referida por otros autores, probablemente porque es un trabajo retrospectivo donde sólo se han diagnosticado las OMA sintomáticas (AU)

Objective: In view of the very high incidence of acute otitis media (AOM) in children reported in some studies and the availability of a polysaccharide conjugate vaccine for its prevention, we studied the incidence of AOM in our population over the last nine years. Materials and methods: The research was carried out in the Health Center of Manises, a city 6 kilometers from Valencia, Spain, which has a population of 26,000 inhabitants (4,560 children of up to 14 years of age). The diagnosis was obtained from 230,020 consultations between 1993 and 2001. The diagnostic criteria were earache and any type of tympanic involvement. Results: AOM accounted for 4% of all consultations. Within the first year of life, 35.4% of children had had at least one AOM episode and 84.6% before the fourth year of life. 5.7% of children had had 3 or more AOM episodes within the first year and 31.8% before the fourth. There is a direct relationship between early age at the first episode and the number of episodes of AOM. The incidence of mastoiditis was 0.011%. These results were compared with those obtained by other authors. Conclusions: We found a lower incidence of AOM than that reported by other authors, probably because ours is a retrospective study involving only symptomatic AOM (AU)

Títulos de antiHBs tras un programa devacunación en niños y adolescentes: ¿revacunar? / Antihepatitis B virus surface antigen titers after a vaccination program in children and adolescents. Should a booster dose be given?

OBJETIVO: Tras haber pasado 6 años desde el inicio de la campaña de vacunación masiva de la hepatitis B en recién nacidos y adolescentes (12 años), se pretende conocer la eficacia e inmunogeneicidad de la misma, la persistencia de la misma, la persistencia de los valores de antihbs y la necesidad de realizar dosis de recuerdo. MATERIAL Y MÉTODOS: Se utilizó la vacuna engerix desde 1993 hasta 1987 (10 mg) y desde entonces la vacuna recombivax (5 mg). El calendario vacunal fue el estándar de 3 dosis (0, 1 y 6 años). Para realizar el estudio se aprovechó cualquier análisis de sangre para cuantificar el título de antihbs, entre octubre de 1998 y mayo de 2000. RESULTADOS: se obtuvieron 382 casos. A los 5 años de la primera dosis, el 96,1% (73/76) tenian antihbs y el 75% (57/76) por encima de 10U/L. A los 6-7 años de la vacunación, en el 94,1% (32/34) de los niños se detectaba antihbs y en el 70,6% (24/34) de éstos por encima de 10/Ul sólo en 5 niños fue negativo el anticuerpo. CONCLUSIÓN: en este estudio se ha encontrado un alto porcentaje de niños con buenos valores de antihbs, tras 6-7 años de la vacunación. La bibliografía reciente demuestra que, dada la memoria inmunológica que produce la vacuna, no es necesaria la revacunación. También debe olvidarse el denominado nivel protectivo de antihbs 10U/l, sólo válido cuando se aplica inmunidad pasiva con inmunoglobulinas (AU)

Epidemiología e impacto de la otitis media aguda en la Comunidad Valenciana / Epidemiology and burden of acute otitis media in Valencia (Spain)

Objetivo: Estimar el impacto (incidencia, tratamiento y complicaciones) de la otitis media aguda (OMA) y la otitis media serosa (OMS) en los niños menores de 5 años de la Comunidad Valenciana (España). Sujetos y métodos: Cohorte retrospectiva de 1.399 niños seguidos durante los primeros 5 años de vida. Diecisiete pediatras revisaron las historias clínicas de sus pacientes nacidos en 1995 y 1996, controlados desde su nacimiento hasta los 5 años. Se obtuvo de cada niño el número de episodios de otitis, tratamiento, complicaciones e intervenciones quirúrgicas requeridas. Resultados: Hubo 2.961 episodios de OMA en los primeros 5 años de vida (2,23 casos/niño), 476 casos (16,1 por ciento) antes del año y 1.346 entre el primer y segundo año (45,5 por ciento). Al tercer año, el 59,8 por ciento habían presentado al menos un episodio. La mayoría de casos (80,9 por ciento) se diagnosticaron en atención primaria, con 1,81 visitas/episodio de media para su seguimiento. El 94,5 por ciento de los episodios fueron tratados con antibiótico (amoxicilina-ácido clavulánico 38,8 por ciento, cefuroxima-axetilo, 14,3 por ciento; claritromicina, 8,2 por ciento, y amoxicilina 5,9 por ciento). El 8,5 por ciento requirió cambio a un segundo antibiótico. Presentaron al menos un episodio de OMS 217 niños (15,2 por ciento). Necesitaron implantación de tubos de ventilación 26 pacientes (1,8 por ciento, intervalo de confianza del 95 por ciento (IC 95 por ciento), 1,2-2,7). Presentaron hipoacusia secundaria 24 niños (1,7 por ciento). Hubo un caso de meningitis y dos de otorrea crónica. No hubo mastoiditis. Conclusiones: La incidencia de OMA en la Comunidad Valenciana es de 40.014 episodios/100.000 niños menores de 5 años/año (IC 95 por ciento, 39.700-40.300). Supone un gran impacto sanitario por el elevado número de visitas, uso antibiótico, cirugía asociada y necesidad de rehabilitación auditiva (AU)