Prevalencia de sobrepeso y obesidad en Aragón y variaciones según condicionantes de salud / Prevalence of overweight and obesity in Aragón and variations according to health determinants

Introducción: La obesidad infantil constituye un grave problema de salud global en continuo aumento en todo el mundo. Muchos estudios señalan que determinados factores socioeconómicos están relacionados con el desarrollo de obesidad. El objetivo de este estudio fue analizar la prevalencia de sobrepeso y obesidad en Aragón, calculadas según los estándares de la Organización Mundial de la Salud (OMS) y estudiar su relación con factores socioeconómicos. Material y métodos: Se recopiló información sobre la totalidad de la población infantil de Aragón entre dos y 14 años y cada individuo fue clasificado como normopeso, sobrepeso u obesidad según su índice de masa corporal (IMC). Se obtuvieron las prevalencias por provincias y zonas básicas de salud (ZBS). Utilizamos el índice de privación (IP) de Aragón como marcador de la situación socioeconómica. Resultados: La muestra final estuvo constituida por 161.335 niños (51%) y niñas (49%) de dos a 14 años. La prevalencia global de sobrecarga ponderal (SP) fue de 31,1% (17,7% sobrepeso y 13,3% obesidad), siendo significativamente mayor en niños. Detectamos un porcentaje elevado (65%) de infrarregistro en la historia clínica.Se encontró una relación directa entre el IP y la prevalencia de obesidad y SP en todo Aragón, con una fuerte correlación significativa en zonas urbanas, en las que los factores socioeconómicos llegan a explicar hasta 66,4% de la obesidad y 48,9% de la SP total. Conclusiones: En Aragón, la prevalencia de obesidad y SP es elevada y está relacionada con una situación socioeconómica familiar desfavorable. (AU)

Introduction: Childhood obesity is a serious global health problem that is continuously increasing worldwide. Many studies suggest that socioeconomic factors are related to the development of obesity. The objective of our study was to analyse the prevalence of overweight and obesity in Aragón, calculated applying the World Health Organization (WHO) growth standards, and to study its association with socioeconomic factors. Material and methods: We collected data for the entire paediatric population of Aragón aged 2–14 years. We classified each child as normal weight, overweight or obese based on the body mass index. We calculated prevalences by province and basic health care zone. To analyse differences in relation to social inequalities, we used the Aragón deprivation index as an indicator of socioeconomic status. Results: The final sample consisted of 161 335 children aged 2–14 years, 51% male and 49% female. The overall prevalence of excess weight was 31.1% (17.7% overweight and 13.3% obesity) and was significantly higher in boys. We found a high frequency of under-recording in health records (65%). There was a direct association between the deprivation index and the prevalence of obesity and overweight throughout Aragón, with a significant strong correlation in urban areas, where socioeconomic factors explained up to 66.4% of obesity and 48.9% of body weight excess. Conclusions: In Aragón, the prevalence of obesity and excess weight is high and associated with low family socioeconomic status. (AU)

Prevalence of overweight and obesity in Aragón and variations according to health determinants.

INTRODUCTION: Childhood obesity is a serious global health problem that is continuously increasing worldwide. Many studies suggest that socioeconomic factors are related to the development of obesity. The objective of our study was to analyse the prevalence of overweight and obesity in Aragón, calculated applying the World Health Organization (WHO) growth standards, and to study its association with socioeconomic factors. MATERIAL AND METHODS: We collected data for the entire paediatric population of Aragón aged 2-14 years. We classified each child as normal weight, overweight or obese based on the body mass index. We calculated prevalences by province and basic health care zone. To analyse differences in relation to social inequalities, we used the Aragón deprivation index as an indicator of socioeconomic status. RESULTS: The final sample consisted of 161 335 children aged 2-14 years, 51% male and 49% female. The overall prevalence of excess weight was 31.1% (17.7% overweight and 13.3% obesity) and was significantly higher in boys. We found a high frequency of under-recording in health records (65%). There was a direct association between the deprivation index and the prevalence of obesity and overweight throughout Aragón, with a significant strong correlation in urban areas, where socioeconomic factors explained up to 66.4% of obesity and 48.9% of body weight excess. CONCLUSIONS: In Aragón, the prevalence of obesity and excess weight is high and associated with low family socioeconomic status.

Características clínicas y dificultades diagnósticas a partir de un estudio prospectivo sobre neumonía pediátrica adquirida en la comunidad / Clinical characteristics and diagnostic difficulties from a prospective study of community-acquired paediatric pneumonia

Introducción: la neumonía continúa siendo una de las principales causas de morbimortalidad infantil. En Atención Primaria pediátrica su abordaje sigue en revisión. Material y métodos: estudio prospectivo en nueve cupos pediátricos, sobre niños desde un mes a 14 años con neumonía. Diagnóstico etiológico mediante serología y aspirado a virus respiratorios. Se analiza la relación de diferentes variables con la etiología (vírica, bacteriana atípica y bacteriana típica). Resultados: se incluyeron 92 episodios. La edad media (47,5 meses) fue significativamente mayor en atípicas (74,2 ± 42,2), que víricas (36,1 ± 44,5; p <0,0001) y de sospecha neumocócicas (32,6 ± 21,1; p <0,0001). El 33,7% (intervalo de confianza del 95% [IC 95]: 24,9 a 43,8%) fueron de sospecha neumocócica, 30,4% (IC 95: 22,0 a 40,5) atípicas y 21,7% (IC 95: 14,5 a 31,2) víricas. Las atípicas no fueron raras en menores de 5 años (17,1%). Fiebre (89,1%) y tos (68,4%) fueron los síntomas principales. El patrón radiológico alveolar fue el más constatado (53,8%), sin diferencias entre grupos. La proteína C reactiva (PCR) fue significativamente mayor en víricas (7,6 ± 9,5 mg/dl) que en las de sospecha neumocócica (4,9 ± 10,1) (diferencias de medias [DM]: -2,7; p = 0,0490), y atípicas (1,7 ± 1,7) (DM: -5,8; p = 0,0111). Amoxicilina fue el fármaco más utilizado (66,3%), con buena evolución en todos los casos. Ingresaron más las víricas (50%) que las atípicas (7,4%; p = 0,0023) o de sospecha neumocócica (12,9%; p = 0,0100). Conclusión: las tendencias epidemiológicas de la neumonía adquirida en la comunidad en Pediatría parecen cambiantes, especialmente en gérmenes atípicos y virus. Su diagnóstico preciso y el consiguiente abordaje terapéutico continúan siendo un reto por resolver (AU)

Introduction: pneumonia is one of the main causes of morbidity and mortality in children. Its management at the paediatric primary care level is not yet solidly established.Material and methods: we conducted a prospective study in children aged 1 month to 14 years included in the paediatric caseloads of 9 paediatric primary care centres. The aetiological diagnosis was made by means of serology tests and viral testing in nasopharyngeal aspirate samples. We analysed the association of different variables with the aetiology of pneumonia (viral, atypical bacterial and typical bacterial).Results: the study included 92 patients. The mean age (47.58 months) was significantly higher in cases of atypical pneumonia (74.2 ± 42.2) compared to viral pneumonia (36.1 ± 44.5; p <0.0001) and probable typical pneumonia (32.6 ± 21.1; p <0.0001). The distribution by aetiology was 33.7% (95 CI: 24.9 to 43.8) probable pneumococcal, 30.4% (95 CI: 22.0 to 40.5) atypical and 21.7% (95 CI: 14.5 to 31.2) viral. Atypical pneumonia was relatively frequent in children under 5 years (17.1%). Fever (89.1%) and cough (68.4%) were the most frequent symptoms. The most common radiographic feature was alveolar infiltration (53.8%), with no differences between groups. C-reactive protein levels were significantly higher in viral cases (7.6 ± 9.5) compared to probable pneumococcal cases (4.9 ± 10.1) (DM: -2.7; p = 0.0490) and atypical cases (1.7 ± 1.7) (DM: -5.83; p = 0.0111). Amoxicillin was the most frequently used antibiotic (66.3%), which achieved favourable outcomes in all types of pneumonia. The frequency of hospital admission was higher in patients with viral pneumonia (50%) compared to atypical (7.4%; p = 0.0023) or probable pneumococcal pneumonia (12.90 %; p = 0.0100).Conclusion: the epidemiology of community-acquired pneumonia in the paediatric population is changing, especially when it comes to atypical bacterial and viral causative agents... (AU)

Estudio de seguimiento del prematuro tardío en un centro de atención primaria. ¿Cuál es la realidad de esta población? / Follow-up study of late premature infants in a primary care centre; what is the reality of this population?

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The Baby-Friendly Initiative in Spain: A Challenging Pathway.

The Baby-Friendly Initiative (BFI-Spain) was founded in 1995 by members of key professional associations (pediatricians, midwives, obstetricians, and nurses) and some mother-to-mother support groups. The United Nations International Children's Fund was instrumental in supporting the establishment of BFI-Spain as a not-for-profit organization. In 2007, the need for change was identified. A detailed analysis of BFI-Spain identified its main strengths, weaknesses, opportunities, and threats. A new strategic plan was devised that included the adoption of a staged accreditation system, a new website, expanding the initiative into the community, consolidating working teams to distribute tasks and responsibilities, and trying to involve the national health authorities. This article describes the analysis that was undertaken, the strategies implemented, and some of the outcomes observed 4 years later. The aim of the article is to support BFI teams in other countries who might be facing similar challenges.

ESPGHAN's 2008 recommendation for early introduction of complementary foods: how good is the evidence?

Since 2002, the World Health Organization and many governments and professional associations have recommended exclusive breastfeeding for 6 months followed by complementary feeding (giving solid foods alongside breast milk) as optimal infant feeding practice. Several articles have been published challenging this recommendation. Arguably, the most influential has been the 2008 commentary of the European Society for Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition, which recommended that complementary foods should be introduced to all infants between 17 and 26 weeks. We challenge the validity of ESPGHAN's position, questioning the adequacy of the literature search, the interpretation and evidence used to reach their conclusions and the balance of an approach that focuses on disease prevention, with scant consideration of growth and neuromotor development. We contend that ESPGHAN's position should be understood as an expert opinion that may be influenced by conflicts of interest. In our view, the ESPGHAN position paper is not evidence based and does not justify a change of the current public health recommendation for 6 months of exclusive breastfeeding. At an individual level, health professionals should understand that developmental readiness for starting solid foods has an age range like other developmental milestones; that fewer infants will probably be ready to start complementary feeding before, rather than after, 6 months; and that their role is to equip parents with the confidence and skills to recognise the signs of developmental readiness. This empowerment process for infants and parents should be preferred over the prescriptive ESPGHAN approach.

A breastfeeding e-learning project based on a web forum.

OBJECTIVE: The Internet has introduced new ways of learning that may complement medical training during the residency period. We describe the experience with a new method of e-learning for training in human lactation and breastfeeding counselling. Pediatric residents participated in the Human Lactation Forum maintained by the Spanish Pediatric Association Breastfeeding Committee, a site on the Internet where parents may write in for pediatric advice on breastfeeding. METHODS: From April 2005 to May 2006, 42 pediatric residents from four hospitals in Spain received a month of intensive theoretical training on breastfeeding, and afterward, they took weekly turns answering parents' questions in the forum. Before and after the experience, they completed a pre-post knowledge test and an opinion postexperience questionnaire with open questions. A t-test was used to analyze the differences pre- and posttest; the opinion questionnaire was analyzed qualitatively. RESULTS: The mean age of participants was 28.3 years; 88% were women, and 80% were in their third or fourth year of residency. The percentage of correct answers was higher after participation in the program, and the difference had statistic significance. The residents estimated that nearly a half of their patients needed breastfeeding advice, and they thought that the program improved their knowledge of breastfeeding and their communication skills with mothers. On average, they spent 2.9 hours daily to answer the questions. CONCLUSIONS: The learning experience was positively evaluated by the participants and contributed to increase their knowledge and skills in breastfeeding issues. We think it is a good method for training future pediatricians on breastfeeding management. In addition, the instrument may contribute to improve lactation knowledge among pediatricians.