Assessment of chloride natural background levels by applying statistical approaches. Analyses of European coastal aquifers in different environments.

Estimated natural background levels (NBLs) are needed to assess groundwater chemical status according to the EU Groundwater Directive. They are commonly derived for different substances by applying statistical methodologies. Due to the complexity of the sea water intrusion process, some of those methods do not always provide appropriate assessment of chloride NBLs. This paper analyzes the applicability of different NBL estimation methods in five EU coastal aquifers with significant differences in available datasets and hydrogeological settings. A sensitivity analysis of results to different constraints was performed to remove samples with anthropogenic impacts. A novel statistical approach combining different methods to identify the range of chloride NBLs is proposed. In all pilots the estimated NBLs were below 85 mg/L and fitted well with previous studies and expert judgment, except Campina del Faro aquifer (the maximum being 167.5 mg/L). Although this approach is more time consuming, it provides a more robust solution.

Role of CO2 in low to medium enthalpy geothermal systems in the Central Betic Cordillera (Spain).

There is growing interest in geothermal energy, which is considered as an efficient energy solution to mitigate rising atmospheric CO2. Besides known high enthalpy geothermal systems, increasing attention is paid to low temperature geothermal systems, as they are suitable for local use. Although geothermal production seems to be an environmentally advantageous renewable energy, it might result in significant CO2 emissions. In this study, we investigate the relationship between temperature, fugacity of CO2 (fCO2), and mineral buffers in the reservoir conditions, taking the low- to medium- enthalpy thermal waters in the Central Betic Cordillera as case study. Using geochemical modeling, three main groups of waters have been identified depending on temperature, buffering mineral assemblage, and fCO2 in their reservoir. A group of waters with a reservoir temperature ranging from 70 to 90 °C and located in the intramountain sedimentary basins shows a fCO2 in depth ranging from ~6 × 10-2 and 6 × 10-1. The reservoir chemistry of this water group seems to be mainly controlled by carbonates and evaporites displaying a fCO2 variation between depth and surface (ΔfCO2) of 10-1. Another intermediate group of waters, located in an active extension zone, displays lower temperature (50-60 °C) and fCO2 in the reservoir (from 10-3 to 10-2). Finally, the third group of waters, located on the metamorphic complexes contacts, show the highest estimated temperatures (130-140 °C) and fCO2 in the reservoir (1 to 102). The two latter groups suggest increasing buffering effect of alumino-silicates, in addition to carbonates and quartz. Therefore, we evidenced a strong relationship between temperature and fCO2 in the reservoir as well as the potential mineral buffers. We discussed the potential of geothermal systems as clean energy source based on the estimation of the CO2 emissions generated by the investigated thermal systems for a practical case of household heating.

SAR interferometry monitoring of subsidence in a detritic basin related to water depletion in the underlying confined carbonate aquifer (Torremolinos, southern Spain).

This research underlines the need to improve water management policies for areas linked to confined karstic aquifers subjected to intensive exploitation, and to develop additional efforts towards monitoring their subsidence evolution. We analyze subsidence related to intensive use of groundwater in a confined karstic aquifer, through the use of the InSAR technique, by the southern coast of Spain (Costa del Sol). Carbonates are overlain by an unconfined detritic aquifer with interlayered high transmissivity rocks, in connection with the Mediterranean Sea, where the water level is rather stable. Despite this, an accumulated deformation in the line-of-sight (LOS) direction greater than -100 mm was observed by means of the ERS-1/2 (1992-2000) and Envisat (2003-2009) satellite SAR sensors. During this period, the Costa del Sol experienced a major population increase due to the expansion of the tourism industry, with the consequent increase in groundwater exploitation. The maximum LOS displacement rates recorded during both time spans are respectively -6 mm/yr and -11 mm/yr, respectively. During the entire period, there was an accumulated descent of the confined water level of 140 m, and several fluctuations of more than 80 m correlating with the subsidence trend observed for the whole area. Main sedimentary depocenters (up to 800 m), revealed by gravity prospecting, partly coincide with areas of subsidence maxima; yet ground deformation is also influenced by other factors, the main ones being the fine-grained facies distribution and rapid urbanization due to high touristic pressure.

Feature selection approaches for predictive modelling of groundwater nitrate pollution: An evaluation of filters, embedded and wrapper methods.

Recognising the various sources of nitrate pollution and understanding system dynamics are fundamental to tackle groundwater quality problems. A comprehensive GIS database of twenty parameters regarding hydrogeological and hydrological features and driving forces were used as inputs for predictive models of nitrate pollution. Additionally, key variables extracted from remotely sensed Normalised Difference Vegetation Index time-series (NDVI) were included in database to provide indications of agroecosystem dynamics. Many approaches can be used to evaluate feature importance related to groundwater pollution caused by nitrates. Filters, wrappers and embedded methods are used to rank feature importance according to the probability of occurrence of nitrates above a threshold value in groundwater. Machine learning algorithms (MLA) such as Classification and Regression Trees (CART), Random Forest (RF) and Support Vector Machines (SVM) are used as wrappers considering four different sequential search approaches: the sequential backward selection (SBS), the sequential forward selection (SFS), the sequential forward floating selection (SFFS) and sequential backward floating selection (SBFS). Feature importance obtained from RF and CART was used as an embedded approach. RF with SFFS had the best performance (mmce=0.12 and AUC=0.92) and good interpretability, where three features related to groundwater polluted areas were selected: i) industries and facilities rating according to their production capacity and total nitrogen emissions to water within a 3km buffer, ii) livestock farms rating by manure production within a 5km buffer and, iii) cumulated NDVI for the post-maximum month, being used as a proxy of vegetation productivity and crop yield.

Pyloric gland adenoma: case report.

Pyloric gland adenoma (PGA), also called adenoma with gastric differentiation, is a rare neoplasm of the gastric mucosa that can appear as gastric heterotopia in several organs. A 49-year-old woman presented with gastric reflux and chronic elevation of liver enzymes. She had a history of type 2 diabetes mellitus, hypothyroidism and an unspecified allergy treated with deflazacor, and a family history of autoimmune diseases. A liver biopsy showed macro- and microvesicular steatohepatitis. Hepatitis B and virus serum tests were negative. Autoimmune hepatitis was suspected and investigated. As an evaluation for dyspeptic symptoms an upper gastrointestinal endoscopy was performed, showing diffuse gastroduodenitis. A few polyps were found and resected from the gastric fundus; histopathology revealed a pyloric gland adenoma. There is very few clinical data on this tumor type because it is frequently underdiagnosed and reported as dysplasia. Further research is needed on the pathophysiology of this disease.

Diferencias entre los estándares de referencia para el peso en niños de hasta 18 meses de edad / Differences between reference charts of weight in children up to the age of 18 months

Introducción: El crecimiento es un fenómeno complejo que en pediatría tiene especial relevancia por constituir un indicador fundamental del estado nutricional. Objetivo: Evaluar las diferencias en la interpretación del peso en una muestra de niños de nuestro medio, desde el nacimiento hasta los 18 meses, según los estándares nacionales e internacionales existentes. Métodos: Estudio longitudinal del peso y longitud en una cohorte de 383 niños de 0 a 18 meses representativa de la población aragonesa. Tras un análisis descriptivo se calculó la ‘puntuación típica’ a partir de cinco tablas de crecimiento poblacional. Finalmente se calculó el porcentaje de niños que quedaban por encima o debajo de 2DE para el peso según el estándar utilizado. Resultados: Del total, 50,1% eran varones y 49,9% mujeres. El peso y longitud de los niños fueron mayores que en las niñas en todas las edades (p<0,01). La mayor diferencia entre las puntuaciones típicas medias para el peso según el referente utilizado se encontró a partir de los 6 meses. El porcentaje de niños con un peso 2 DE osciló entre un0,5 y un 3,3 % a los 18 meses en dependencia del estándar. Conclusión: Existen diferencias globales al evaluar el peso de una misma muestra de niños menores de 18 meses según los diferentes estándares poblacionales, así como en el número de niños que quedan fuera de los límites de la normalidad con cada uno de ellos (AU)

Introduction: Growth is a complex phenomenon that has in pediatric age special relevancy because it constitutes a fundamental indicator of nutritional status. Objective: To evaluate differences about weight analysis of infants aged 0-18 months depending on the population reference used. Methods: This is a longitudinal weight and length study in a representative sample of 383 infants from Aragon since birth until 18 months of age. A descriptive analysis was realized and ‘’z-scores’’ were calculated from five growth curves. Finally there was calculated the percentage of children who were staying above or under 2DS for weight depending on the standard used. Results: 50,1 % were males and 49,9 % women. Weight and length of the children were higher in girls than in boys in all the ages (p <0,01). Major differences between weight z-score averages from standards were at 6 months and later. The percentage of children on a weight 2 DS ranged between 0,5 and one 3,3 % at18 months of age depending on the standard. Conclusion: Global differences exist when weight is evaluated in the same sample of infants up to 18 months of age depending on different population standards, as well as in the number of children who stay out of the limits of the normality with each of them (AU)

[Differences between reference charts of weight in children up to the age of 18 months]. / Diferencias entre los estándares de referencia para el peso en niños de hasta 18 meses de edad.

INTRODUCTION: Growth is a complex phenomenon that has in pediatric age special relevancy because it constitutes a fundamental indicator of nutritional status. OBJECTIVE: To evaluate differences about weight analysis of infants aged 0-18 months depending on the population reference used. METHODS: This is a longitudinal weight and length study in a representative sample of 383 infants from Aragon since birth until 18 months of age. A descriptive analysis was realized and "z-scores" were calculated from five growth curves. Finally there was calculated the percentage of children who were staying above or under 2DS for weight depending on the standard used. RESULTS: 50.1% were males and 49.9% women. Weight and length of the children were higher in girls than in boys in all the ages (p<0.01). Major differences between weight z-score averages from standards were at 6 months and later. The percentage of children on a weight<2 DS ranged between 0.5 and one 3.3% at 18 months of age depending on the standard. CONCLUSION: Global differences exist when weight is evaluated in the same sample of infants up to 18 months of age depending on different population standards, as well as in the number of children who stay out of the limits of the normality with each of them.

Influencia de la etnia y el sexo en la ingesta de alimentos como factores de riesgo de malnutrición en escolares / Influence of ethnicity and gender in school children food intake as malnutrition risk factors

La dieta de los niños en nuestro país suele ser deficitaria en frutas y verduras y rica en alimentos hipercalóricos. El objetivo del presente estudio es valorar la frecuencia de la ingesta de los grupos de alimentos en escolares de nuestro medio y la influencia sobre ella del sexo y la etnicidad. Se valoraron en una población de 383 niños de 2.º, 3.º y 4.º de Educación Primaria las características socioeconómicas y demográficas, los estilos de vida y la frecuencia de ingesta de grupos de alimentos. Los niños ingirieron más raciones diarias de alimentos ricos en hidratos de carbono (4,38 ± 1,6 frente a 3,97 ± 1,4; p=0,03) y más lácteos (3,23 ± 1,1 frente a 2,83 ± 1,0; p= 0,002) que las niñas; por otro lado, la niñas consumieron más golosinas que los niños (2,81 ± 3,9 frente a 2,01 ± 2,3 raciones por semana; p= 0,03). Un alto porcentaje de niños no cumplía con las recomendaciones habituales de ingesta por defecto de frutas y verduras (78,1%), lácteos (43,4%) e hidratos de carbono (42,8%), y por exceso de proteicos (8,1%), bollería (21,2%),golosinas (18,9%) y refrescos-snacks (8,7%). Los niños pertenecientes al grupo con etnicidad ingirieron significativamente menos lácteos, alimentos proteicos y fruta-verdura y, sin embargo, más bollería, golosinas y refrescos-snacks que los niños sin etnicidad. En el análisis de la relación entre los distintos grupos de alimentos se han encontrado dos asociaciones significativas (p <0,01): 1) la ingesta de frutas y verduras se asoció a un mayor consumo de hidratos de carbono y de pescado, y aun menor consumo de refrescos-snacks y tiempo frente al televisor; 2) la ingesta de bollería se asoció a un mayor consumo de refrescos/snacks y de golosinas. El estudio concluye que el sexo y la etnicidad son factores que influyen en la dieta de los niños en edad escolar y deben considerarse como factores de riesgo de malnutrición (AU)

Children’s diet in our country seems to be deficient in fruits and vegetables and rich in hyper caloric food. The purpose of this study is to access intake frequency of food groups in school children of our environment and the influence gender and ethnicity pose over it as well. We have evaluated the socioeconomic and demographic characteristics, lifestyles and the intake frequency of food groups in a population of 383 2nd, 3rd and 4th grade children from elementary school. Boys consume more daily servings of food rich in carbohydrates (4.38 ± 1.6 vs. 3.97 ± 1.4; p=0.03) and more dairy products (3.23 ± 1.1 vs. 2.83 ± 1.0; p= 0.002) than girls, and, on the other hand, girls eat more candy than boys (2.81 ± 3.9 vs. 2.01 ± 2.3 servings per week; p= 0.03). A high percentage of children did not meet regular recommended food percentages, both by deficiency: fruits and vegetables (78.1%), dairy products (43.4%) and carbohydrates (42.8%); and by excess: protein food (8.1%), pastries (21.2%), candy (18.9%), and sodas/snacks (8.7%). Children belonging to a certain ethnic group consume significantly less dairy products, protein products and fruits/vegetables; and, at the same time, more pastries, candy and sodas/snacks than children that do not belong to a specific ethnic group. Two significant associations (p <0.01) have been found in the analysis of the relationship between different food groups: 1) fruits and vegetables intake was associated with a higher consumption of carbohydrates and fish, and with alower consumption of sodas/snacks and time watching TV; and2) pastry intake was associated with a higher consumption of sodas/snacks and sweets. The study concludes that gender and ethnicity are factors that influence the school children´s diet and they shall be considered as risk factors for malnutrition (AU)

Programas de intervención para promocionar la lactancia materna. Proyecto PALMA / Intervention programs to promote breastfeeding: the PALMA project

La lactancia materna (LM) es la mejor forma de alimentar al recién nacido y al lactante, ya que confiere una serie de beneficios tanto a corto como a largo plazo. Según recomienda la Organización Mundial de la Salud, la LM debe mantenerse durante los primeros 6 meses como alimento exclusivo, y a partir de este momento junto con la alimentación complementaria, mientras la madre y el niño deseen. Según los datos disponibles, el tiempo medio de mantenimiento de la LM en nuestro entorno no supera los 3-5 meses, el abandono precoz durante el primer mes de vida ocurre en un 30% de los casos y sólo en un 10-20% se mantiene a los 6 meses. Se revisan los factores de riesgo para la instauración y el mantenimiento de la LM, los momentos clave para la promoción de la LM desde las instituciones sanitarias y el tipo de medidas que son más efectivas. Asimismo, se presenta el Proyecto PALMA, que pretende evaluarla efectividad de un programa de intervención de apoyo multidisciplinario a la LM desde atención primaria en un grupo de lactantes frente a un grupo control (AU)

Breastfeeding is the best way to feed infants as the properties of breast milk confer many short and longer-term benefits. As recommended by the World Health Organization, exclusive breastfeeding should continue throughout the first 6 months of life and, after this time, be accompanied by complementary feeding for as long as the mother and infant want. Data from our general population show that the mean duration of breastfeeding does not exceed 3-5 months, early cessation during the first month occurs in 30% of cases and only 10%-20% of the mother infantdyads maintain it up to 6 months. We review the risk factors for the initiation and continuation of breastfeeding, the best moments to promote breastfeeding on the part of health institutions and the most effective actions. At the same time, we present the PALMA project, the purpose of which is to evaluate the effectiveness of a multidisciplinary intervention program to promote breastfeeding at the primary care level, comparing a group of infants with a control group (AU)

Sediment phosphate composition in relation to emergent macrophytes in the Doñana Marshes (SW Spain).

We have studied the effect of the presence of emergent macrophytes on the sediment phosphate composition of a eutrophic shallow marsh on the NE margin of Doñana (SW Spain). Top sediment and water samples were collected from both the open-water and the vegetated sites at three areas covered by different plant species: Scirpus maritimus, Juncus subulatus and Phragmites australis. The concentration of organic matter was significantly higher in the top sediment of sites covered by vegetation than in their adjacent open-water sites at the three vegetation areas. The P-fractional composition showed that the sediment was dominated by the inorganic P-fractions in all cases, reaching the highest concentration in the Ca-bound P-fraction (281-372 microg g(-1) d.w.). The sum of all P-fractions was significantly higher in the top sediment of the sites covered by J. subulatus and S. maritimus than in their adjacent open-water sites, and so were the org-P fraction extracted by hot NaOH and the concentration of phytate within this fraction. Deposition of plant material on the top sediment of areas vegetated by J. subulatus and S. maritimus explains these differences. The P-fractional composition of the seeds from J. subulatus showed that they contained a large proportion of organic P-fractions, particularly of the fraction extracted by hot NaOH (1868 microg g(-1) d.w., 85% of which was phytate). The presence of emergent macrophytes, therefore, influenced the distribution of P-fractions in the sediment depending on plant species. The P-bioavailability of shallow aquatic systems must be fully understood if wetlands are to be protected from further eutrophication.

Accumulation of As, Cd and selected trace elements in tubers of Scirpus maritimus L. from Doñana marshes (South Spain).

The collapse of a pyrite-mining, tailing dam on 1998 contaminated an area of 4286 ha along the Agrio and Guadiamar river valleys in southern Spain. Over 2700 ha of the Doñana marshes, an important wintering area for wetland European birds, were contaminated. This study reports analyses of the tubers of Scirpus maritimus (an important food for greylag geese, Anser anser) collected in 2000 in the "Entremuros" (spill-affected area) and in nearby unaffected Doñana marshes (control areas). In the spill-affected area mean tuber tissue concentrations of Cd (0.25 mg kg-1) and Zn (61 mg kg-1) were greater than in those tubers from the control area (0.02 mg kg-1 for Cd, and 22 mg kg-1 for Zn); values of Cd and Zn in "Entremuros" (samples collected two years after the mine spill) were much smaller than those reported only a few months after the accident. Trace elements (As, Fe, Mn and Tl, and to a lesser extent Cd and Pb) showed a preferential accumulation in the outer skin of tubers. Surprisingly, concentrations of As and Fe were greater in tubers from some marsh sites not affected by the mine-spill than in tubers from the "Entremuros". We suggest that relic river channels within the Doñana marshes may be contaminated by trace elements from historic mining activities. An exhaustive study of macrophytes and other plant species in this area is recommended to identify potential risks to wildlife.

[Determination of nicotine dependence in school-aged smokers through a modified Fagerström Test]. / Determinación de la dependencia nicotínica en escolares fumadores a través de un test de Fagerström modificado.

BACKGROUND: Approximately 65 % of young smokers have failed to give up smoking because of their addiction to nicotine. The Fagerström Test for Nicotine Dependence is used to quantify nicotine dependence in adults but studies in teenagers are scarce. OBJECTIVES: To determine whether young smokers are nicotine-dependent, and if so, to what extent, as well as the factors linked to nicotine dependence. METHODS: A total of 2647 schoolchildren, aged 10 to 17 years old, from 41 different schools were interviewed. A sample size was calculated for each age, in years, by using the equation of finite population, but adding an extra 10 % so that if the numbers decreased, the final absolute error would not be increased. For each age the sample was stratified by sex and type of school, with proportional affixation to the number of individuals within each stratum. Schools and students were chosen by using the random numbers table. In addition to eliciting personal data, the questionnaire also included a version of the FTND adapted for use in teenagers. RESULTS: The mean age was 13.77 years and 51.5 % were male. A total of 23.1 % reported they were smokers (54.5 % of them were girls and 45.5 % were boys). Most (86.6 %) of these teenager smokers showed low-moderate nicotine dependence and 3.3 % showed high dependence. No differences were found according to sex or age. CONCLUSIONS: Most teenagers who smoke show low nicotine dependence. Campaigns to prevent smoking should be aimed at children aged less than 10 years old to delay smoking the first cigarette and the subsequent next step of becoming a daily smoker for as long as possible since both factors have proved decisive in nicotine dependence.

Determinación de la dependencia nicotínica en escolares fumadores a través de un test de Fagerström modificado / Determination of nicotine dependence in school-aged smokersthrough a modified Fagerströmtest

Antecedentes. Alrededor del 65 por ciento de los jóvenes fumadores ha intentado dejar de fumar sin conseguirlo debido a su dependencia nicotínica. El método para cuantificar dicha dependencia en adultos es el test de Fagerström, y son escasos los estudios realizados en adolescentes. Objetivos. Establecer la posible existencia de dependencia nicotínica en los jóvenes fumadores, el grado de ésta y los factores asociados a su aparición. Métodos. Se entrevistaron 2.647 escolares, de 10 a 17 años, de 41 centros escolares. Se calculó un tamaño muestral para cada edad, en años, mediante la ecuación de poblaciones finitas, añadiendo el 10 por ciento para en el caso de existir mermas no aumentasen el error absoluto final. Para cada edad el muestreo fue estratificado por sexo y tipo de centro, con afijación en cada estrato proporcional al número de individuos. La elección de los centros y alumnos se llevó a cabo mediante tabla de números aleatorios. La encuesta, además de recoger los principales datos personales, comprendía una versión adaptada a adolescentes del Test de Fagerström para la Dependencia de Nicotina. Resultados. Edad media de 13,77 años (varones, 51,5 por ciento). El 23,1 por ciento se declararon fumadores (54,5 por ciento mujeres y 45,5 por ciento varones). El 86,6 por ciento de los adolescentes fumadores tienen dependencia nicotínica baja-moderada y el 3,3 por ciento alta, sin que se observen diferencias en función del sexo ni edad. Conclusiones. La mayor parte de los adolescentes fumadores presentan dependencia nicotínica baja. Las campañas de prevención del consumo de tabaco se deben realizar antes de los 10 años, retrasando en lo posible, el consumo del primer cigarrillo y el paso a fumador diario, pues ambos factores se han mostrado determinantes en la presencia de dependencia nicotínica (AU)

[Cut-off point for a positive bronchodilation test]. / Cuándo se considera positivo el test de broncodilatación.

OBJECTIVE: To determine bronchodilation in healthy children aged 7-14 years in order to establish the value defining a positive bronchodilation test. PATIENTS AND METHODS: We performed a cross-sectional study in healthy, nonsmoking schoolchildren aged 7-14 years in the city of Huesca (Spain). The sample (n 145) was representative of the pediatric population aged 7-14 years (N 4,272). Health was determined through a validated questionnaire. Expired carbon monoxide was measured with a Micro III Smokerlyzer EC50(R). Forced basal and post-bronchodilation spirometry (0.2 mg of inhaled salbutamol with a Babyhaler(R) chamber) was performed with a Vitalograph spirometer mod. 2120(R). Forced vital capacity (FVC), forced expiratory volume in one second (FEV1), FEV1/FVC, forced expiratory flow at 24-25 % of forced vital capacity (FEF25-75 %) and peak expiratory flow (PEF) were measured. To establish whether increments in the variables followed normal distribution, the Kolmogorov-Smirnov test (Lilliefors modification) and histograms were used. The relationship between increases in FEV1 and the variables in the questionnaire was analyzed using Student's t-test (qualitative variables) and Pearson's correlation (quantitative variables). To evaluate the reliability of the test, Spearman's non-parametric correlation coefficient and dispersion graphs were used. RESULTS: The percentage increase in FEV1 compared with the theoretical value was: mean (SD), 3.97 (2.65); 95 % percentile, 8.87 %; and 97.5 percentile, 10.25 %. The percentage increase in FEV1 compared with the previous value was: mean: 3.99 (2.63), 95-percentile: 8.43 %; and 97.5 percentile: 10.14 %. CONCLUSIONS: In children aged 7-14 years, increases of greater than 9 % above the theoretical or previous FEV1 value define the bronchodilation test as positive.

Cuándo se considera positivo el test de broncodilatación / Cut-off point for a positive bronchodilation test

Objetivo: Determinar la broncodilatación que se produce en la población normal de 7 a 14 años de edad, para establecer el valor que define una prueba de broncodilatación como positiva. Pacientes y métodos. Estudio transversal en niños sanos, no fumadores, realizado en ámbito escolar en la ciudad de Huesca en una muestra representativa (n 145) de la población infantil de 7 a 14 años (N 4.272). Se identificó salud mediante encuesta validada. Se monitorizó el monóxido de carbono (CO) espirado con un Micro III Smokerlyzer EC50. La espirometría forzada basal y posbroncodilatación (salbutamol inhalado, 0,2 mg con cámara Babyhaler) se realizaron con un espirómetro Vitalograph mod. 2120. Se midieron las variables capacidad vital forzada (FVC), volumen espiratorio máximo en el primer segundo (FEV1), FEV1/FVC, flujo espiratorio máximo entre el 25-75% de la FVC (FEF25-75) y pico espiratorio máximo (PEF). Para establecer si los incrementos de los parámetros seguían o no una distribución normal, se utilizó el contraste de Kolmogorov-Smirnov (modificación Lilliefors) y los histogramas. La relación entre el incremento de FEV1 y las variables del cuestionario se establecieron con el test de la t de Student (variables cualitativas) y la prueba de correlación de Pearson (variables cuantitativas). Para evaluar la fiabilidad del test se empleó el coeficiente de correlación no paramétrico de Spearman y los gráficos de dispersión. Resultados: Incremento porcentual de FEV1 respecto al valor teórico: media (desviación estándar [DE]), 3,97 (2,65); percentil (P) P95, 8,87% y P97,5, 10,25%. Incremento porcentual de FEV1 respecto al valor previo: media, 3,99 (2,63): P95, 8,43%, y P97,5, 10,14%. Conclusiones: En niños de 7 a 14 años de edad, los incrementos porcentuales sobre el valor teórico o sobre el previo del FEV1 superiores al 9 por ciento definen la prueba de broncodilatación como positiva (AU)

[Risk factors for asthma, allergy and bronchial hyperresponsiveness in children aged 6-8 years old]. / Factores de riesgo de asma, alergia e hiperreactividad bronquial en niños de 6 a 8 años.

OBJECTIVE: To determine risk factors for asthma, allergy and bronchial hyperresponsiveness in children aged 6-8 years old from Huesca (Spain). PATIENTS AND METHODS: Cross-sectional study of asthma, rhinitis and atopic dermatitis, using the prick test and bronchial hyperresponsiveness (free-running test, forced expiratory volume in 1 sec) in a random sample (n = 309) of children aged 6-8 years oldfrom an urban area (n = 1,051). To evaluate differences in the study variables between asthmatics and non-asthmatics, allergic and non-allergic children and BHR-positive and BHR-negative children, a bivariate analysis was performed using the Chi-squared test and Fisher's exact test. Multiple regression analysis was used to study the association between asthma, allergy and BHR and the study variables. Beta-coefficients and their corresponding standard deviations were calculated according to the maximum verisimilitude method using the SPSS program. RESULTS: The theoretical sample included 305 children and informed consent was requested from 357 parents or guardians. The participation rate was 86.55 % (n = 309). The results of the multivariate analysis were as follows: (1) risk factors for asthma were a history of asthma in the immediate family (OR: 5.17; 95 % CI: 21.82-1.23), cutaneous sensitization to aeroallergens (OR: 8.49; 95 % CI: 30.52-2.37) and recurrent bronchitis during the first 2 years of life (OR: 4.68; 95 % CI: 17.76-1.24); (2) risk factors for allergy were symptoms of atopic dermatitis (OR: 10.87; 95 % CI: 38.63-3.06), a history of asthma in the immediate family (OR: 6.11; 95 % CI: 27.68-1.38) and male sex (OR: 4.53; 95 % CI: 19.55-1.05); (3) risk factors for BHR were recurrent bronchitis during the first 2 years of life (OR: 4.56; 95 % CI: 20.24-1.02), symptoms of atopic dermatitis (OR: 4.15; 95 % CI: 16.28-1.06) and cutaneous sensitization to aeroallergens (OR: 3.43; 95 % CI: 10.91-1.08). CONCLUSIONS: The risk factors for asthma, allergy and BHR have been determined in children aged 6-8 years old from Huesca.

[Current prevalence of asthma, allergy and bronchial hyperresponsiveness in children aged 6 to 8 years old]. / Prevalencia actual de asma, alergia e hiperrespuesta bronquial en niños de 6-8 años.

OBJECTIVE: To determine the current prevalence of asthma, allergy and bronchial hyperresponsiveness in children aged 6to 8years old from Huesca (Spain). PATIENTS AND METHODS: We carried out a cross-sectional study to determine the prevalence of asthma, rhinitis and dermatitis by questionnaire (ISAAC), skin test and bronchial hyperresponsiveness (exercise challenge, forced expiratory volume1) in all children aged 6 to 8 years old living in an urban area (n=1051) and in a representative sample from the same area (n=309). RESULTS: The questionnaire response rate was 88.01% (n=925). Current prevalence rates were 7.4% for wheezing, 10.5% for rhinitis and 8.5% for dermatitis. Participation rate in the skin test and bronchial hyperresponsiveness study was 86.55% (n=309): bronchial hyperresponsiveness was found in 5.3% and skin test was positive in 21.8% while sensitization against grass pollen was found in 45.5%, against olives in 34.8% and against house dust mite in 10.6%. Rhinitis and/or dermatitis symptoms and positive skin test were found in 7.92%. Asthma related symptoms and bronchial hyperresponsiveness were found in 5.5%. CONCLUSIONS: This study reports the current prevalence of asthma (5.5%), allergy (7.92%) and bronchial hyperresponsiveness (7.92) in children aged 6 to 8 years old from Huesca.

Prevalencia actual de asma, alergia e hiperrespuesta bronquial en niños de 6 a 8 años / Current prevalence of asthma, allergy and bronchial hyperresponsiveness in children aged 6 to 8 years old

OBJETIVO: Determinar la prevalencia actual de asma, alergia y de hiperrespuesta bronquial en niños de 6 a 8años de Huesca. MATERIAL Y MÉTODOS: Estudio transversal de prevalencia asma, rinitis y dermatitis por encuesta International Study of Asthma and Allergies in Childhood (ISAAC) a toda la población de 68años de un área urbana (n=1.051) y pricktest e hiperrespuesta bronquial (test de carrera libre, volumen espiratorio máximo en el primer minuto [FEV1]) en una muestra representativa de la misma (n=309). RESULTADOS: La tasa de participación en encuestas fue de 88,01% (n=925): prevalencia actual de síntomas relacionados con asma, 7,4%; rinitis, 10,5% y dermatitis, 8,5%. La participación en el estudio depricktest e hiperrespuesta bronquial fue del 86,55% (n=309): hiperrespuesta bronquial 5,3%; pricktest positivo 21,8% con sensibilizaciones a pólenes de gramíneas 45,5%, olivo 34,8% y ácaros 10,6%. Síntomas de rinitis y/o de dermatitis junto con pricktest positivo, 7,92%. Síntomas relacionados con asma junto con hiperrespuesta bronquial, 5,5%. CONCLUSIÓN: Se ha establecido en niños de 6 a 8 años de edad de la población de Huesca la prevalencia actual de asma (5,5 %), de alergia (7,92 %) y de hiperrespuesta bronquial (5,3%) (AU)

[Alertness disorders and parasomnias of the wakefulness-sleep transition]. / Trastornos del alertamiento y parasomnias de la transición vigilia-sueño.

INTRODUCTION: Disorders of arousal and parasomnias of sleep-wake transition are revisited. Disorders of arousal are: Sleepwalking (SW), confusional arousals (CA) and sleep terrors (ST). SW, CA and ST are different clinical manifestations of the same disorder being ST the most severe and SW the mildest manifestation. Disorders of arousal are typical parasomnias of NREM sleep, mainly slow wave sleep. Pathophysiological mechanism of these disorders is the state's dissociation of wakefulness and sleep. The conjunction of the constitutional factors (genetic, age, sleep privation, drugs, psychological, etc.), and precipitant factors (light, sound, temperature, touch, apnea, gastroesophageal reflux, seizure, fever, psychological, etc.) permit three possible arousal behavioral response: A full awakening, a shift stage of sleep or a partial arousal. Clinical significance of arousal parasomnias depend on the age. In children are caused by developmental and genetic factors and usually are autolimited. In adults usually are caused by psychopathology. In the elderly are often caused by organic brain syndromes. Parasomnias of sleep-wake transition are: Rhythmic movements of sleep, sleeptalking, starts and the nocturnal cramp. Most of them are mild disorders, almost physiological phenomena that usually don't need any treatment.