Violence as a Health Problem.

Violence is a public health problem, and when it affects childhood, it can cause illness throughout the individual's life. Apart from being able to cause damage in the physical, mental and social spheres, it represents a violation of the rights of the affected children, and a high consumption of resources, both economic and social. A multitude of investigations have improved attention to this violence. However, these advances are not consistent with the practical management of victims, both in Primary and Hospital Care. There is a significant area of improvement for paediatric care. Through this article, different professionals from all established paediatric health care facilities develop general lines of knowledge and action regarding violence against children. An overview is taken of the legislation related to childhood, the different types of abuse that exist, their effects, management and prevention. It concludes with an epilogue, through which we aim to move sensibilities. In summary, this work aims to promote the training and awareness of all professionals specialized in children's health, so that they pursue the goal of achieving their patients' greatest potential in life, and in this way, to help create a healthier society, with less disease, and more justice.

La violencia como problema de salud / Violence as a health problem

La violencia es un problema de salud pública. Esta, cuando afecta a la infancia, puede generar enfermedad a lo largo de toda la vida del individuo. Aparte de poder producir daños en la esfera física, psíquica y social, supone una vulneración de los derechos de los niños afectados y un elevado consumo de recursos tanto económicos como sociales.Multitud de investigaciones han mejorado la atención a esta violencia. Sin embargo, estos avances no son parejos con el manejo práctico que se realiza a las víctimas tanto en la atención primaria como en la hospitalaria. Existe una significativa área de mejora para la atención pediátrica.A través de este artículo, distintos profesionales de todas las áreas sanitarias pediátricas establecidas desarrollan líneas generales de conocimiento y actuación con respecto a la violencia contra la infancia. Se hace un recorrido a través de la legislación relacionada con la infancia, las distintas tipologías de maltrato que existen, sus efectos, manejo y prevención. Concluye con un epílogo, a través del cual pretendemos mover sensibilidades.En resumen, este es un trabajo que pretende fomentar la formación y sensibilización de todos los profesionales especializados en la salud infantil, para que persigan como objetivo el que sus pacientes alcancen su mayor potencial en la vida y, de esa manera, ayudar a crear una sociedad más sana, con menos enfermedad y más justa.(AU)

Violence is a public health problem, and when it affects childhood, it can cause illness throughout the individual's life. Apart from being able to cause damage in the physical, mental and social spheres, it represents a violation of the rights of the affected children, and a high consumption of resources, both economic and social.A multitude of investigations have improved attention to this violence. However, these advances are not consistent with the practical management of victims, both in Primary and Hospital Care. There is a significant area of improvement for paediatric care.Through this article, different professionals from all established paediatric health care facilities develop general lines of knowledge and action regarding violence against children. An overview is taken of the legislation related to childhood, the different types of abuse that exist, their effects, management and prevention. It concludes with an epilogue, through which we aim to move sensibilities.In summary, this work aims to promote the training and awareness of all professionals specialized in children's health, so that they pursue the goal of achieving their patients’ greatest potential in life, and in this way, to help create a healthier society, with less disease, and more justice.(AU)

Seventy eight children born small for gestational age without catch-up growth treated with growth hormone from the prepubertal stage until adult height age. An evaluation of puberty and changes in the metabolic profile.

A wide variation in height gain rate is observed in children small for gestational age (SGA) treated with growth hormone (GH). The aim of this study was to evaluate prepubertal and pubertal growth, height gain attained at adult age and to assess potential predictive factors in catch-up growth. Changes in metabolic profile were also analyzed. PATIENTS AND METHODS: Seventy-eight children born SGA were treated with a GH median dose of 33.0±2.8mcg/kg/day at a mean age of 7.3±2.0 (boys) and 6.0±1.8 (girls). RESULTS: Mean height (SDS) at GH onset was -3.31±0.7 for boys and -3.48±0.7 for girls. According to age at pubertal growth spurt onset patients were classified in their pubertal maturity group. Adult height attained expressed in SDS was -1.75±0.7 for boys and -1.69±1.0 for girls, both below the range of their mid-parental height. The greatest height gain occurred during the prepubertal period. Patients with greater height gain were lighter (p<0.001), shorter (p=0.005), and younger (p=0.02) at the start of GH, and also showed a greater increase in growth velocity during the first year on GH (p<0.001). SGA children started puberty at the same age and with the same distribution into pubertal maturity group as the reference population. No relevant GH-related adverse events were reported, including in the insulin resistance parameters evaluated. Differences were found in fasting plasma glucose values, but were without clinical relevance. IGF-I plasma values remained within the safety range. CONCLUSIONS: GH therapy is safe and beneficial for SGA children. The response to GH therapy is widely heterogeneous, suggesting that GH should be started at a young age and the GH dose prescribed should be individualized. SGA children started puberty at the same age as the reference population. The only factor that predicts greater adult height is growth velocity during the first year of therapy.

Seventy eight children born small for gestational age without catch-up growth treated with growth hormone from the prepubertal stage until adult height age. An evaluation of puberty and changes in the metabolic profile.

A wide variation in height gain rate is observed in children small for gestational age (SGA) treated with growth hormone (GH). The aim of this study was to evaluate prepubertal and pubertal growth, height gain attained at adult age and to assess potential predictive factors in catch-up growth. Changes in metabolic profile were also analyzed. PATIENTS AND METHODS: Seventy-eight children born SGA were treated with a GH median dose of 33.0±2.8mcg/kg/day at a mean age of 7.3±2.0 (boys) and 6.0±1.8 (girls). RESULTS: Mean height (SDS) at GH onset was -3.31±0.7 for boys and -3.48±0.7 for girls. According to age at pubertal growth spurt onset patients were classified in their pubertal maturity group. Adult height attained expressed in SDS was -1.75±0.7 for boys and -1.69±1.0 for girls, both below the range of their mid-parental height. The greatest height gain occurred during the prepubertal period. Patients with greater height gain were lighter (p<0.001), shorter (p=0.005), and younger (p=0.02) at the start of GH, and also showed a greater increase in growth velocity during the first year on GH (p<0.001). SGA children started puberty at the same age and with the same distribution into pubertal maturity group as the reference population. No relevant GH-related adverse events were reported, including in the insulin resistance parameters evaluated. Differences were found in fasting plasma glucose values, but were without clinical relevance. IGF-I plasma values remained within the safety range. CONCLUSIONS: GH therapy is safe and beneficial for SGA children. The response to GH therapy is widely heterogeneous, suggesting that GH should be started at a young age and the GH dose prescribed should be individualized. SGA children started puberty at the same age as the reference population. The only factor that predicts greater adult height is growth velocity during the first year of therapy.

Síndrome d'activació macrofàgica com a forma de debut d'una artritis idiopàtica juvenil sistèmica / Síndrome de activación macrofágica como debut de una artritis idiopática juvenil sistémica / Juvenile systemic rheumatoid arthritis presenting as macrophage activation syndrome

INTRODUCCIÓ: La síndrome d'activació macrofàgica (SAM) és una limfohistiocitosi hemofagocítica que apareix en el context d'una malaltia reumatològica I típicament s'associa a l'artritis idiopàtica juvenil sistèmica (AIJS). CAS CLÍNIC: Es presenta el cas d'una nena de 23 mesos amb febre de 6 dies, hiperèmia conjuntival, exantema I edema al dors de mans I peus. Inicialment es va descartar una malaltia infecciosa I posteriorment es va orientar com a malaltia de Kawasaki. Se li va fer una ecocardiografia, amb resultat normal, I es va iniciar gammaglobulina endovenosa I ibuprofèn; no es va objectivar resposta clínica. L'estudi d'autoanticossos va ser negatiu. La pacient va presentar de manera progressiva artràlgies, hepatosplenomegàlia I embassament pleural. En l'analítica destacava anèmia, trombocitopènia, leucocitosi I elevació dels reactants de fase aguda (RFA). Davant la sospita clínica I analítica de SAM es va fer un aspirat de medul·la òssia, I no es van objectivar signes d'hemofagocitosi ni malignitat. Es va iniciar tractament amb corticosteroides a dosis altes; l'estat general va millorar, però van persistir la febre, les artràlgies, la leucocitosi I els RFA augmentats. Es va orientar com a debut d'AIJS associat a SAM, motiu pel qual es va afegir al tractament l'anti-IL-1 (anakinra). Al cap de 48 hores la febre va desaparèixer I la pacient ja presentava millora clínica I dels paràmetres inflamatoris I d'activació macrofàgica. COMENTARIS: La SAM és una malaltia potencialment mortal I pot ser el debut d'una malaltia sistèmica, com l'AIJS. Conèixer els criteris clínics I analítics de totes dues entitats és fonamental per al diagnòstic precoç. El tractament amb corticosteroides I amb anti-IL-1 sol ser molt eficaç

INTRODUCCIÓN: El síndrome de activación macrofágica (SAM) es una linfohistiocitosis hemofagocítica que aparece en el contexto de una enfermedad reumatológica y típicamente se asocia a la artritis idiopática juvenil sistémica (AIJS). CASO CLÍNICO: Se presenta el caso de una niña de 23 meses con fiebre de 6 días de evolución, hiperemia conjuntival, exantema y edema en el dorso de manos y pies. Inicialmente se descartó una enfermedad infecciosa y posteriormente se orientó como enfermedad de Kawasaki. Se realizó ecocardiografía, que resultó normal, y se iniciaron gammaglobulinas endovenosas e ibuprofeno, sin objetivarse una respuesta clínica. El estudio de autoanticuerpos resultó negativo. Progresivamente presentó artralgias, hepatoesplenomegalia y derrame pleural. Analíticamente destacaba anemia, trombocitopenia, leucocitosis y elevación de los reactantes de fase aguda (RFA). Bajo la sospecha de SAM se realizó aspirado de médula ósea sin objetivarse signos de hemofagocitosis ni malignidad. Se inició tratamiento con corticosteroides a dosis altas con mejoría del estado general, pero persistiendo fiebre, artralgias, leucocitosis y RFA aumentados. Se orientó como debut de AIJS asociado a SAM, por lo que se añadió al tratamiento la anti-IL-1 (anakinra). A las 48 horas desapareció la fiebre y presentó mejoría clínica y de los parámetros inflamatorios y de activación macrofágica. COMENTARIOS: El SAM es una enfermedad potencialmente mortal y puede ser el debut de una enfermedad sistémica como la AIJS. Conocer los criterios clínicos y analíticos de las dos entidades es fundamental para su diagnóstico precoz. El tratamiento con corticosteroides y con anti-IL-1 suele ser muy eficaz

INTRODUCTION: The macrophage activation syndrome (MAS) is a hemophagocytic lymphohystiocytosis developing in the context of a rheumatologic disease and it is commonly associated to systemic juvenile idiopathic arthritis (sJIA). CASE REPORT: A 23-month-old child was admitted with a six-day history of fever, conjunctival hyperemia, rash, and hand and foot edema. An infectious disease process was first ruled out, and Kawasaki disease was then suspected. The echocardiogram did not show abnormalities, and intravenous gamma globulin and ibuprofen were administered, without clinical response. The autoantibody screening was negative. The patient progressively developed arthralgias, hepatosplenomegaly and pleural effusion. Blood tests showed anemia, thrombocytopenia, leukocytosis, and elevated inflammatory markers. MAS was suspected, and bone marrow aspirate was performed, which showed no signs of hemophagocytosis or malignancy. Treatment with high-dose corticosteroids was started, resulting in improvement of the general condition of the patient, but with persistence of fever, joint pain, leukocytosis, and elevated inflammatory markers. sJIA-associated MAS was suspected, and interleukin-1-receptor antagonist (anakinra) was started, with significant clinical improvement, decrease in inflammatory markers, and resolution of the fever in 48 hours. COMMENTS: MAS is a life-threatening illness that can present as the first sign of sJIA. It is important to know the diagnostic criteria of both entities for early diagnosis. Treatment with corticosteroids and anti-IL-1 is very effective

[Pertussis in fully vaccinated infants and children. Are new vaccination strategies required?]. / Tos ferina en lactantes y niños bien vacunados. ¿Son necesarias nuevas estrategias de vacunación?

OBJECTIVE: To analyse the vaccination status of children diagnosed with pertussis and to compare the clinical manifestations of fully vaccinated with unvaccinated, or incompletely-vaccinated, children. METHODS: The clinical histories and vaccination cards of patients under 16years of age seen in the Emergency Room of the University Hospital Vall d'Hebron, Barcelona (Spain), for pertussis confirmed by a microbiological study were reviewed. The study period lasted from January 1, 2009 to December 31, 2011. RESULTS: Two hundred and twelve cases were studied: 35 in 2009, 28 in 2010 and 149 in 2011. RT-PCR was positive in 210 patients, and 73 had a positive culture. Infants under 6months of age account for 36.8% of all cases. Forty-four patients (21.5%) were not vaccinated. Forty-four (21.5%) children were between 2 and 5months of age and had received 1-2vaccine doses. One hundred and seventeen (57%) children were fully vaccinated; 76.9% (90cases) had received the last dose less than 4years ago. When clinical manifestations of the fully vaccinated patients were compared with those of the non-vaccinated or incompletely-vaccinated children, only cyanosis was found with a higher frequency in the latter group (P<.001). The age-adjusted probability of hospitalisation was significantly associated with non-vaccination (P=.001). The case mortality rate among inpatients was 1.3%. CONCLUSIONS: The number of pertussis cases seen in our centre has risen significantly in the last year. More than half (57%) of the patients were fully vaccinated, and 76.9% had received the last dose in the previous 4years. Other vaccination strategies, such as vaccination of adolescents, adults, and pregnant women, as well as a cocoon strategy are required to protect infants under 6months of age. More effective vaccines need to be developed.