Migrant children's health problems, care needs, and inequalities: European primary care paediatricians' perspective.

BACKGROUND: Primary care paediatricians' perception of migrant children's health in Europe has not been explored before. Our aim was to examine European paediatricians' knowledge on migrant children's health problems, needs, inequalities, and barriers to access health care. METHODS: European primary care paediatricians were invited by the European Academy of Paediatrics Research in Ambulatory Setting Network country coordinators to complete a web-based survey concerning health care of migrant children. A descriptive analysis of all variables was performed. RESULTS: The survey was completed by 492 paediatricians. Sixty-three per cent of the respondents reported that the general health of migrant children is worse than that of nonmigrants, chronic diseases cited by 66% of the respondents as the most frequent health problem. Sixty-six per cent of the paediatricians reported that migrant children have different health needs compared to nonmigrant children, proper oral health care mentioned by 86% of the respondents. Cultural/linguistic factors have been reported as the most frequent barrier (90%).to access health care. However, only 37% of providers have access to professional interpreters and cultural mediators. Fifty-two per cent and 32% do not know whether one or more of the family members are undocumented and whether they are refugees/asylum seekers, respectively. Updated guidelines for care of migrant children are available for only 35% of respondents, and 80% of them have not received specific training on migrant children's care. CONCLUSIONS: European primary care paediatricians recognize migrant children as a population at risk with more frequent and specific health problems and needs, but they are often unaware of their legal state. Lack of interpreters augments the existing language barriers to access proper care and should be solved. Widespread lack of guidelines and specific providers' training should be addressed to optimize health care delivery to migrant children.

Un nuevo test para la valoración de la memoria episódica. Test episódico y test episódico del cuidador / A new assessment for episodic memory. Episodic memory test and caregiver’s episodic memory test

Introducción y objetivos: Valorar la memoria episódica, adaptándola a la definición del concepto, haciéndola asequible a las familias, y aplicándola con una alta sensibilidad y especificidad, es el concepto del test episódico y el test episódico del cuidador. Métodos y resultados: Se aplicó un test formado por 10 preguntas relacionadas con hechos episódicos a 332 sujetos, de los cuales 65 tenían enfermedad de Alzheimer (EA), 115 deterioro cognitivo leve amnésico (DCLa) y 152 no mostraron alteración cognitiva, según la escala de deterioro global (GDS) de Reisberg. Se calculó la sensibilidad y especificidad del test episódico para detectar EA frente a DCLa y normalidad. El área bajo la curva ROC para el diagnóstico de DCLa fue de 0,94 y el mejor punto de corte fue 20, valor con el que se obtuvo una sensibilidad del 89% y una especificidad del 82%. Con respecto al diagnóstico de EA, el área bajo la curva ROC fue de 0,99 y el mejor punto de corte fue 17, con el que se obtuvo una sensibilidad del 98% y una especificidad del 91%. Un estudio posterior con similar metodología demostró resultados similares cuando el test era pasado directamente por el cuidador. Conclusiones: El test episódico y el test episódico del cuidador son herramientas útiles como test breves de cribado para la captación de enfermos con EA en estadios iniciales, adecuadas para la utilización en atención primaria y en él domicilio, al poder ser pasado directamente por el cuidador. Las limitaciones del test vienen dadas por la necesidad de un cuidador fiable y por la medición exclusiva de la memoria episódica (AU)

Introduction and objectives: The purpose of the episodic memory test and the caregiver’s episodic memory test is to evaluate episodic memory according to its definition in a way that is feasible for families and achieves high degrees of sensitivity and specificity. Methods and results: We administered a test consisting of 10 questions about episodic events to 332 subjects, of whom 65 had Alzheimer’s disease (AD), 115 had amnestic MCI (aMCI) and 152 showed no cognitive impairment according to Reisberg’s global deterioration scale (GDS). We calculated the test’s sensitivity and specificity to distinguish AD from episodic aMCI and from normal ageing. The area under the ROC curve for the diagnosis of aMCI was 0.94 and the best cut-off value was 20; for that value, sensitivity was 89% and specificity was 82%. For a diagnosis of AD, the area under the ROC curve was 0.99 and the best cut-off point was 17, with a sensitivity of 98% and a specificity of 91%. A subsequent study using similar methodology yielded similar results when the test was administered directly by the caregiver. Conclusions: The episodic memory test and the caregiver’s episodic memory test are useful as brief screening tools for identifying patients with early-stage AD. It is suitable for use by primary care medical staff and in the home, since it can be administered by a caregiver. The test’s limitations are that it must be administered by a reliable caregiver and the fact that it measures episodic memory only (AU)

[A new assessment for episodic memory. Episodic memory test and caregiver's episodic memory test]. / Un nuevo test para la valoración de la memoria episódica. Test episódico y test episódico del cuidador.

INTRODUCTION AND OBJECTIVES: The purpose of the episodic memory test and the caregiver's episodic memory test is to evaluate episodic memory according to its definition in a way that is feasible for families and achieves high degrees of sensitivity and specificity. METHODS AND RESULTS: We administered a test consisting of 10 questions about episodic events to 332 subjects, of whom 65 had Alzheimer's disease (AD), 115 had amnestic MCI (aMCI) and 152 showed no cognitive impairment according to Reisberg's global deterioration scale (GDS). We calculated the test's sensitivity and specificity to distinguish AD from episodic aMCI and from normal ageing. The area under the ROC curve for the diagnosis of aMCI was 0.94 and the best cut-off value was 20; for that value, sensitivity was 89% and specificity was 82%. For a diagnosis of AD, the area under the ROC curve was 0.99 and the best cut-off point was 17, with a sensitivity of 98% and a specificity of 91%. A subsequent study using similar methodology yielded similar results when the test was administered directly by the caregiver. CONCLUSIONS: The episodic memory test and the caregiver's episodic memory test are useful as brief screening tools for identifying patients with early-stage AD. It is suitable for use by primary care medical staff and in the home, since it can be administered by a caregiver. The test's limitations are that it must be administered by a reliable caregiver and the fact that it measures episodic memory only.

Evaluación de calidad asistencial en la utilización de toxina botulínica para el tratamiento de la espasticidad postictus en adultos / Quality evaluation of clinical practice in treatment with botulinum neurotoxin in adults with spasticity post-stroke

Introducción. El ictus es la enfermedad neurológica más común y la espasticidad una de sus secuelas más discapacitantes. La toxina botulínica (TBo) es utilizada en el tratamiento de la espasticidad por su capacidad de bloquear la liberación de acetilcolina en la unión neuromuscular. La frecuente indicación de este tratamiento ha derivado en la creación de consultas específicas en las unidades de Neurorrehabilitación. Objetivo. Evaluar la calidad asistencial científico-técnica del tratamiento realizado en nuestra unidad en pacientes con espasticidad post-ictus, utilizando como indicador de calidad la evidencia clínica disponible. Pacientes y método. Búsqueda bibliográfica con las palabras clave botulinum neurotoxin y stroke; selección aleatoria de 50 historias de pacientes en seguimiento en la unidad de Neurorrehabilitación, de los cuales 23 cumplieron los criterios de inclusión. Se recogieron seis variables: diagnóstico clínico, afectación motora, escala Ashworth modificada, tratamiento con TBo, músculos infiltrados y técnica utilizada. Resultados. Hay suficiente evidencia para recomendar la utilización de la TBo en el tratamiento de la espasticidad para reducir el tono muscular y mejorar la función pasiva, pero no existe una técnica de infiltración determinada que haya demostrado mayor efectividad. En nuestra muestra en el 61% de los pacientes la indicación de tratamiento fue la más recomendable, aunque en el 13% no se pudo valorar por falta de datos. Discusión. Son necesarios más estudios para analizar la efectividad sobre la función activa y las repercusiones en calidad de vida, delimitando el grupo diana para el tratamiento con TBo y podamos realizar un análisis de calidad más exacto(AU)

Introduction. Stroke is the most common neurological disease causing disability, mainly by spasticity. Botulinum neurotoxin (BTx) is used to treat that problem by means of its pharmacological action, blocking acetylcholine release at neuromuscular junctions. It is so frequent that some specific outpatient departments (included in Neurorehabilitation) are created to be focused in that treatment. Objective. Make an evaluation related to science quality evidence in BTx treatment applying to clinical practice with spasticity post-stroke at our department. Patients and methods. A literature research with botulinum neurotoxin and stroke as key words; and a randomised selection of Neurorehabilitation patients’ 50 medical charts. Only 23 patients adjusted to inclusion criteria. We studied 5 variables: main injury, motor impairment, modified Ashworth scale, treatment with BTx, muscles injected and injection technique. Results. There are evidence based recommendations to treat with BTx stroke patients with spasticity in order to reduce muscle tone and improve passive function. However, there is no evidence based recommendation about what the best injection technique is. In our study 61% of patients got the most recommended treatment, but we couldn’t evaluate 13% of patients. Discussion. We would need more trials that test BTx's results in active function and its quality of life consequences. It would let us evaluate more accurately our clinical practice by getting a target group to be treated(AU)

Optical spectroscopy of conductive junctions in plasmonic cavities.

The optical properties of a nanoparticle dimer bridged by a conductive junction depend strongly on the junction conductivity. As the conductivity increases, the bonding dimer plasmon blueshifts and broadens. For large conductance, a low energy charge transfer plasmon also appears in the spectra with a line width that decreases with increasing conductance. A simple physical model for the understanding of the spectral feature is presented. Our finding of a strong influence of junction conductivity on the optical spectrum suggests that plasmonic cavities might serve as probes of molecular conductance at elevated frequencies not accessible through electrical measurements.

Influencia de la asistencia a las guarderías sobre la morbilidad y el consumo de recursos sanitarios en niños menores de 2 años / No disponible

Objetivo: evaluar la influencia de la asistencia a la guardería sobre la morbilidad y elconsumo de recursos sanitarios en los niños menores de 2 años.Material y métodos: diseño: estudio longitudinal prospectivo. Centros participantes: centrosde Atención Primaria, coordinados por el Grupo de Investigación de la Asociación Españolade Pediatría de Atención de Primaria (AEPap). Sujetos: niños menores de 2 años que acudena las consultas de pediatría de los centros de salud participantes. Muestra: niños nacidosentre el 1 de abril y el 30 de octubre de 2009 que cumplan los criterios de inclusión. Variables:la variable independiente será asistencia o no a la guardería. Como variables dependientes seanalizarán el número y el tipo de infecciones, los tratamientos recibidos y la asistencia a centrossanitarios. Se recogerán variables de caracterización familiares y personales que pudieranactuar como factores de confusión. Recogida de datos: entrevistas realizadas en la primera visitay a los 6, 12, 18 y 24 meses de edad. Análisis estadístico: para analizar las diferencias entreel número de infecciones dependiendo de la edad del niño al entrar en la guardería se realizaráun test de Anova. Para comparar el consumo de antibióticos y de broncodilatadores, asícomo la utilización de recursos sanitarios entre los niños que acuden a la guardería y aquellosque no lo hacen se aplicará el test de la T de Student o el test U de Mann-Whitney. Se realizaráun análisis multivariante de regresión lineal paso a paso para identificar factores personalesy familiares que pueden considerarse como variables predictoras del número de infecciones,controlando los posibles factores de confusión e interacciones(AU)

Objective: to evaluate the influence of child day-care centres on morbidity and consumptionof health resources in children younger than 2 years.Methods: design: prospective longitudinal study. Participating institutions: Primary HealthCare centers, coordinated by “Grupo de Investigación de la Asociación Española de Pediatríade Atención Primaria” (AEPap) (Research Group of the Spanish Primary Care PediatricsAssociation). Subjects: children aged 0 to 2 years attending pediatric appointments ofthe participating health centres. Sample: all children born between April 1st and October30th, 2009, that meet the inclusion criteria. Variables: independent variable will be Childday-care center or not. As dependent variables it will be analyzed the number and type ofinfection, treatments received and assistance to Health Care centers. Characterization personaland family variables that could act as confounding factors will be also collected. Datacollection: interviews conducted during the first visit and at 6, 12, 18 and 24 months of age.Statistical analysis: to analyze the differences between number of infections depending onage of child when entering child day-care center, an Anova test will be done. We will applyStudent’s T test or Mann-Whitney´s U test to compare antibiotic consumption, use of bronchodilators,health resource utilization among children attending child day-care center andthose who don’t. A multivariate lineal regression analysis will be done step by step to identifypersonal and family factors that may be considered as predictors of the number of infectionsafter controlling potential confounders and interaction factors(AU)

Distribución de la heterocromatina estructural de los cromosonas 1, 9, 16, y Y, en niños portadores de hemoglobina S / Distribution of the structural heterochromatin of chromosomes 1, 9, 16 and Y in children carrying S hemoglobine

Se comparan las características de la distribución de la heterocromatina de los pares cromosomicos 1, 9, 16 y y en niños sanos y portadores de hemoglobina S. los segmentos C de los cromosomas se evidenciaron en cultivos de sangre periferica y su análisis se realizó por el método policuantitativo de cinco puntos, desarrollado por el grupo de citogenética del Instituto de Genética Médica de la Academia de Ciencias de la URSS. El análisis comparativo del polimorfismo de los segmentos C de los cromosomas 1, 9, 16 y y, no reflejó diferencias significativas (p > 0.05) en la distribución de la heterocromatina entre el grupo control y el portador de hemoglobina S. Se discuten los resultados obtenidos y se enfatizan sobre la necesidad de localizar estudios poblacionales de este polimorfismo en nuestra población negroide sana