Estudio multicéntrico nacional sobre la organización de las consultas de Pediatría de Atención Primaria en España durante la primera ola de la pandemia de COVID-19 / Nationwide multicentre study on the organization of primary care paediatrics services in the first wave of the COVID-19

Introducción: la pandemia de COVID-19 ha originado cambios organizativos en los centros de Atención Primaria (AP). El objetivo de este estudio es conocer los cambios producidos en las consultas de Pediatría de AP durante la primera ola de la pandemia por COVID-19. Material y métodos: estudio observacional, descriptivo, retrospectivo, multicéntrico y de ámbito nacional, a través de una encuesta dirigida a los pediatras de Atención Primaria (PAP) distribuida en junio de 2020. Se recogieron datos desde el 16 de marzo al 10 de mayo de 2020, dividido en cuatro periodos de dos semanas cada uno. Se preguntó sobre la forma de trabajar en los centros durante ese periodo: existencia de sistema de triaje, modalidad de atención, presencial o telefónica, y volumen de consultas atendidas. Resultados: se consideraron válidas 105 encuestas de las 110 contestadas por PAP. Participaron pediatras de 17 comunidades autónomas (el 72,4% de medio urbano). Cubrían una población de 107 715 pacientes. Realizaron consulta telemática el 90,5% (38,1% antes de la pandemia). En todos los centros se realizó triaje. La media de pacientes atendidos por profesional en cada uno de los periodos considerados fue de 144, 114, 123, 136 (277, 214, 207 y 233 en los mismos periodos del año 2019). En el 88,6% de cupos se realizaron visitas presenciales del programa de salud infantil (PSI). De toda la población atendida, los PAP notificaron ingresos por cualquier motivo de 79 pacientes y en la unidad de cuidados intensivos (UCI) de siete. No se les notificó ningún fallecimiento. Conclusiones: durante el periodo inicial de pandemia COVID-19 se registró en las consultas de Pediatría de AP un aumento muy importante de la consulta telemática y, paralelamente, una disminución significativa de la consulta presencial. Se instauraron sistemas de triaje. Se mantuvo una actividad muy alta en el PSI. Hubo un número muy bajo de ingresos y casos graves (AU)

Introduction: the COVID-19 pandemic has driven changes in the organization of care delivery in primary care (PC) centres. The objective of our study was to describe the changes in PC paediatric care that took place in the first wave of the COVID-19 pandemic. Material and methods: we conducted a nationwide, multicentre, retrospective, observational and descriptive study through a survey of PC paediatricians with distribution of the questionnaire in June 2020. We collected data from March 16 to May 10, 2020, divided in four 2-week periods. We asked about care delivery in these centres during this period: use of triage systems, modalities of care delivery (in person or by telephone) and volume of visits. Results: we received 105 responses by PC paediatricians, of which 110 were considered valid. We obtained responses from paediatricians in 17 autonomous communities (72.4% in urban settings). Respondents served a cumulative population of 107 715 patients. A total of 90.5% provided remote care (38.1% did before the pandemic). Triage was conducted in all centres. The mean number of patients managed per paediatrician in each of the time intervals under study was 144, 114, 123 and 136 (compared to 277, 214, 207 and 233 in the same periods in 2019). In 88.6% of the caseloads, in-person appointments were conducted as part of the child health programme (CHP). The total number of hospital admissions for any reason in the cumulative catchment population was of 79 patients, and the number of admissions to the intensive care unit was 7. The respondents did not report any deaths. Conclusions: in the first wave of the COVID-19 pandemic, there was a substantial increase in remote primary care paediatric visits parallel to a significant decrease in in-person visits. Triage systems were implemented. There was still substantial activity in the CHP. The number of hospital admissions and cases of serious disease was very low (AU)

Acceso a pruebas complementarias para el diagnóstico de enfermedades infecciosas en las consultas de pediatría de atención primaria / Access to complementary tests for the diagnosis of infectious diseases in primary care paediatric clinics

INTRODUCCIÓN: En los procesos infecciosos la realización de pruebas complementarias puede aumentar la precisión diagnóstica, la adecuación de los tratamientos, así como dar a conocer la epidemiología y patrón de resistencias bacterianas de la comunidad. El Grupo de Patología Infecciosa de la Asociación Española de Pediatría de Atención Primaria (GPI-AEPap) diseñó este estudio para conocer la accesibilidad a pruebas complementarias (PC) y sus resultados que tienen los pediatras que trabajan en atención primaria en el ámbito de la salud pública. MATERIAL Y MÉTODOS: Estudio observacional transversal descriptivo de ámbito nacional, a través de una encuesta de cumplimentación voluntaria, distribuida on line a todos los socios de AEPap y a los suscriptores de la lista de distribución PEDIAP entre los meses de abril y mayo de 2017. RESULTADOS: Se obtienen 517 respuestas. Se analizan datos del entorno profesional, así como los referidos a la solicitud de pruebas complementarias básicas (hemograma, bioquímica, sistemático de orina), utilización de Test Rápido Detección de Antígeno para Streptococo grupo A (TRDA), sobre cultivos bacterianos, serologías, pruebas diagnósticas de tosferina y tuberculosis (Mantoux) y pruebas de imagen. CONCLUSIONES: Hay variabilidad entre CCAA y áreas asistenciales. Se detectan claras áreas de mejora en la accesibilidad a diferentes PC, tiempo de recogida y envío de muestras, demora en la recepción, en los resultados y en tiempos de espera para pruebas de imagen no urgentes. Esto interfiere en la capacidad de intervención y resolución del pediatra de atención primaria

INTRODUCTION: The performing of complementary tests in infectious processes can increase the diagnostic precision, the adequacy of treatments, as well as determining the epidemiology and pattern of bacterial resistance of the community. The Infectious Pathology Group of the Spanish Association of Primary Care Paediatrics (GPI-AEPap) has designed this study in order to determine the availability of complementary tests (CT) for paediatricians working in Primary Care of the public health system as well as their results. MATERIAL AND METHODS: Observational cross-sectional descriptive national study was carried out using a voluntary self-report questionnaire distributed online to all AEPap members and to the subscribers of the PEDIAP distribution list between the months of April and May 2017. RESULTS: A total of 517 responses were obtained. An analysis was made of the data from the professional environment, as well as those related to the request for basic supplementary tests (blood count, biochemistry, and routine urine analysis), the use of Rapid Antigen Detection Test for group A Streptococcus, bacterial cultures, serology, diagnostic tests for pertussis and tuberculosis (Mantoux), as well as imaging tests. CONCLUSIONS: There is variability between Autonomous Communities and healthcare areas. Areas for improvement were found in the accessibility to different CT, collection time and sending of samples, delay in receiving results, as well as waiting times for non-urgent imaging tests. These affect the intervention and resolution capacity of the primary care paediatrician

[Access to complementary tests for the diagnosis of infectious diseases in primary care paediatric clinics]. / Acceso a pruebas complementarias para el diagnóstico de enfermedades infecciosas en las consultas de pediatría de atención primaria.

INTRODUCTION: The performing of complementary tests in infectious processes can increase the diagnostic precision, the adequacy of treatments, as well as determining the epidemiology and pattern of bacterial resistance of the community. The Infectious Pathology Group of the Spanish Association of Primary Care Paediatrics (GPI-AEPap) has designed this study in order to determine the availability of complementary tests (CT) for paediatricians working in Primary Care of the public health system as well as their results. MATERIAL AND METHODS: Observational cross-sectional descriptive national study was carried out using a voluntary self-report questionnaire distributed online to all AEPap members and to the subscribers of the PEDIAP distribution list between the months of April and May 2017. RESULTS: A total of 517 responses were obtained. An analysis was made of the data from the professional environment, as well as those related to the request for basic supplementary tests (blood count, biochemistry, and routine urine analysis), the use of Rapid Antigen Detection Test for group A Streptococcus, bacterial cultures, serology, diagnostic tests for pertussis and tuberculosis (Mantoux), as well as imaging tests. CONCLUSIONS: There is variability between Autonomous Communities and healthcare areas. Areas for improvement were found in the accessibility to different CT, collection time and sending of samples, delay in receiving results, as well as waiting times for non-urgent imaging tests. These affect the intervention and resolution capacity of the primary care paediatrician.

Age-Dependence of Flow Homeostasis in the Left Ventricle.

Background: Intracardiac flow homeostasis requires avoiding blood stasis and platelet activation during its transit through the cardiac chambers. However, the foundations of intraventricular blood washout and its exposure to shear stresses have been poorly addressed. We aimed to characterize and quantify these features in a wide population of healthy subjects and assess the relationships of these indices with age. Methods: We used color-Doppler echocardiography and custom post-processing methods to study 149 healthy volunteers from 26 days to 80 years old. From the intraventricular flow-velocity fields we obtained personalized maps of (1) the residence time of blood in the LV, and (2) the shear index, a metric accounting for the strongest occurrence of shear stresses inside the chamber. From these maps we derived quantitative indices of the overall intraventricular blood washout and shear exposure. We addressed the age-dependence of these indices and analyzed their relationship with age-related changes in filling-flow. Results: The entire intraventricular blood pool was replaced before 8 cycles. Average residence time of blood inside the LV was <3 cycles in all subjects and followed an inverse U-shape relationship with age, increasing from median (IQR) of 1.0 (0.7 to 1.2) cycles in the 1st year of life to 1.8 (1.4-2.2) cycles in young adults (17-30 years old), becoming shorter again thereafter. Shear index showed no relation with age and was bounded around 20 dyn·s/cm2. Regions with the longest residence time and highest shear index were identified near the apex. Differences in the degree of apical penetration of the filling waves and the duration of the late-filling phase explained the age-dependence of residence time ( R adj 2 = 0.48, p < 0.001). Conclusions: In average, blood spends 1 to 3 beats inside the LV with very low shear stress rates. The apical region is the most prone to blood stasis, particularly in mid-aged adults. The washout of blood in the normal LV is age-dependent due to physiological changes in the degree of apical penetration of the filling waves.

Recomendaciones de seguimiento del prematuro tardío / Follow-up recommendations for the late preterm infant

La población de prematuros tardíos (PT), aquellos nacidos entre las 340 y 366 semanas de gestación, representa el 70-74% de todos los prematuros, y no está incluida de forma específica en la mayoría de los protocolos de seguimiento para niños prematuros. Durante muchos años los PT han sido manejados como si de recién nacidos a término se tratasen, lo que ha llevado al desconocimiento de su evolución a medio y largo plazo. A la morbilidad neonatal se añade una mayor incidencia de afección posnatal, con una tasa de reingresos hospitalarios por malnutrición, hiperbilirrubinemia y problemas respiratorios superior a los nacidos a término. La inmadurez cerebral puede ser el principal responsable de los déficits observados en el neurodesarrollo a largo plazo en esta población y aumentar su vulnerabilidad. Se describen retrasos o discapacidades en la etapa preescolar, parálisis cerebral, retraso mental, discapacidad intelectual, esquizofrenia, trastornos del desarrollo psicológico, la conducta y la emoción. El grupo SEN34-36 de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, han desarrollado estas recomendaciones de seguimiento con el objetivo principal de disminuir el impacto de la prematuridad en el desarrollo de los PT. Los objetivos secundarios del documento son sensibilizar a neonatólogos y pediatras de los posibles riesgos de secuelas de los PT, determinar y unificar las evaluaciones y/o intervenciones que deberían realizarse, ofrecer herramientas de seguimiento clínico para detectar de manera precoz los déficits en el desarrollo y coordinar la atención de todos los profesionales implicados

The population of late preterm infants (PT), those born between 34 + 0 and 36 + 6 weeks of gestation, accounts for 70-74% of all premature infants, and is not specifically included in most of the follow-up protocols for preterm infants. For many years, PTs have been handled as if they were term newborns, which has led to a limited knowledge of their outcome in the medium and long term. Their neonatal morbidity is associated with a higher incidence of postnatal complications, with an increased rate of hospital re-admissions due to malnutrition, hyperbilirubinaemia, and respiratory problems, when compared to term infants. Cerebral immaturity may be the main cause of the deficits observed in the long-term neurodevelopment of this population, making them more vulnerable. Several issues have been described, such as delays or disabilities in the pre-school stage, cerebral palsy, mental retardation, intellectual disability, schizophrenia, and psychological development of behavioural and emotional disorders. The SEN34-36 Group of the Spanish Society of Neonatology, in collaboration with the Spanish Association of Primary Care Paediatrics, have developed these follow-up recommendations with the main objective of reducing the impact of prematurity on PT development. The secondary objectives of the document are to make neonatologists and paediatricians aware of the risks of sequelae of PTs, to determine and unify the evaluations and / or interventions that should be carried out, to offer clinical follow-up tools for the early detection of developmental delays, and to coordinate the care by all the professionals involved

[Follow-up recommendations for the late preterm infant]. / Recomendaciones de seguimiento del prematuro tardío.

The population of late preterm infants (PT), those born between 34+0 and 36+6 weeks of gestation, accounts for 70-74% of all premature infants, and is not specifically included in most of the follow-up protocols for preterm infants. For many years, PTs have been handled as if they were term newborns, which has led to a limited knowledge of their outcome in the medium and long term. Their neonatal morbidity is associated with a higher incidence of postnatal complications, with an increased rate of hospital re-admissions due to malnutrition, hyperbilirubinaemia, and respiratory problems, when compared to term infants. Cerebral immaturity may be the main cause of the deficits observed in the long-term neurodevelopment of this population, making them more vulnerable. Several issues have been described, such as delays or disabilities in the pre-school stage, cerebral palsy, mental retardation, intellectual disability, schizophrenia, and psychological development of behavioural and emotional disorders. The SEN34-36 Group of the Spanish Society of Neonatology, in collaboration with the Spanish Association of Primary Care Paediatrics, have developed these follow-up recommendations with the main objective of reducing the impact of prematurity on PT development. The secondary objectives of the document are to make neonatologists and paediatricians aware of the risks of sequelae of PTs, to determine and unify the evaluations and / or interventions that should be carried out, to offer clinical follow-up tools for the early detection of developmental delays, and to coordinate the care by all the professionals involved.

Recomendaciones de seguimiento del prematuro tardío / Recommendations for the follow-up of the late preterm infant

La prematuridad continúa siendo la primera causa de morbimortalidad neonatal e infantil y constituye uno de los problemas de salud más importantes, sobre todo en la sociedad industrializada. La población de prematuros tardíos, que incluye a los niños nacidos entre las 340 y 366 semanas de edad gestacional, representa el 70-74% de todos los prematuros. Los prematuros tardíos presentan mayor incidencia de patología comparados con los recién nacidos a término y no solo en el periodo neonatal sino también durante la infancia, con unas mayores tasas de rehospitalización y consulta a los servicios de urgencias, un mayor riesgo de infecciones, de fallo de medro, de problemas respiratorios y de trastornos del neurodesarrollo. Nuestro objetivo debe ser poder realizar diagnósticos e intervenciones precoces, principalmente a nivel del neurodesarrollo, que multiplicarán la probabilidad de buena evolución. En esta línea, desde el grupo de trabajo SEN34-36 de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, se ha desarrollado este documento de Recomendaciones de seguimiento del prematuro tardío, con el objetivo de sensibilizar a pediatras y neonatólogos de las patologías en las que los prematuros tardíos presentan mayor riesgo y sobre las que debemos focalizar nuestra atención, facilitando una guía de trabajo a los profesionales implicados en el seguimiento de este grupo de prematuros

Prematurity continues to be the leading cause of neonatal and infant morbidity and mortality and stands as one of the most important health problems, especially in industrialized countries. Late preterm infants are those born between 34 and 36 weeks of gestational age and represent 70-74% of all premature births. Late preterm infants show a higher incidence of pathology compared to term infant and not only in the neonatal period but also during childhood, with higher rates of hospital readmissions and visits to emergency services, an increased risk of infections, of failure to thrive, respiratory problems and neurodevelopmental disorders. Our objective will be to anticipate diagnoses and apply early interventions, mainly at the level of neurodevelopment, which will increase the likelihood of better outcomes. In this line, from the working group SEN34-36 of the Spanish Society of Neonatology and in collaboration with the Spanish Association of Pediatrics of Primary Care, this document of Recommendations for the follow-up of the late preterm infant has been edited in order to raise awareness among pediatricians and neonatologists about the most common pathologies in these babies, and on which we must focus our attention, thereby providing a working guide to the professionals involved in the follow-up of this group of premature infants

Protocolo de seguimiento para el recién nacido menor de 1.500 g o menor de 32 semanas de edad gestación / Follow-up protocol for newborns of birthweight less than 1500 g or less than 32 weeks gestation

La mortalidad de los niños nacidos con peso menor de 1.500 g o con una edad gestacional menor de 32 semanas (<1.500 < 32) ha disminuido significativamente en las últimas décadas. Dado el mayor riesgo de discapacidad de estos niños, el seguimiento tras el alta hospitalaria se considera muy necesario. En este documento, el Grupo de Seguimiento de la Sociedad Española de Neonatología, en colaboración con la Asociación Española de Pediatría de Atención Primaria, propone un protocolo de seguimiento específico para los < 1.500 < 32, cuyo objetivo es estandarizar las actividades y evaluaciones según los criterios de buena práctica

The mortality of children with a birthweight of less than 1500 g or with a gestational age of less than 32 weeks (<1500 < 32) has decreased significantly in the last 20 years or so. Given the higher risk of disability in these children, follow-up after hospital discharge is considered essential. In this document, the Follow-Up Group of the Spanish Society of Neonatology, in collaboration with the Spanish Society of Paediatric Primary Care, propose a follow-up protocol specific for the < 1500 < 32, which has as its aim to standardise the activities and evaluations according to good practice criteria

[Follow-up protocol for newborns of birthweight less than 1500 g or less than 32 weeks gestation]. / Protocolo de seguimiento para el recién nacido menor de 1.500 g o menor de 32 semanas de edad gestación.

The mortality of children with a birthweight of less than 1500g or with a gestational age of less than 32 weeks (<1500<32) has decreased significantly in the last 20 years or so. Given the higher risk of disability in these children, follow-up after hospital discharge is considered essential. In this document, the Follow-Up Group of the Spanish Society of Neonatology, in collaboration with the Spanish Society of Paediatric Primary Care, propose a follow-up protocol specific for the<1500<32, which has as its aim to standardise the activities and evaluations according to good practice criteria.

Examining Maternal Psychopathology, Family Functioning and Coping Skills in Childhood Obesity: A Case-Control Study.

The shared family environment is an important risk factor in the development of childhood obesity. This study aims to examine differences in maternal psychopathology, family functioning, expressed emotion and coping skills between families of a child with obesity and those with a normal-weight child. This case-control study consisted of 50 mothers with a child (age 8-12 years) with obesity (p ≥ 97) and a control group of 50 mothers of a child with normal weight (p < 85), matched for age, sex and socio-economic status. Compared with families with normal-weight children, those with children with obesity showed significant differences in levels of trait anxiety, criticism and over-protectiveness, and maladaptive coping skills. Structural equation modelling revealed that the mothers' psychopathology predicted children's body mass index (BMI) z-scores through expressed emotion and maladaptive coping scores. There were significant direct and indirect relations among maternal BMI, psychopathology, expressed emotion and coping, which all together explained 26.5% of variance of children's BMI z-scores. Considering this relation between maternal variables and child weight status, childhood obesity intervention programs may benefit from targeting maternal BMI, psychopathology, expressed emotion and coping skills. Copyright © 2017 John Wiley & Sons, Ltd and Eating Disorders Association.