[Attitudes and needs of pediatric intensivists in relation to the death of their patients]. / Actitudes y necesidades de los intensivistas pediátricos ante la muerte de sus pacientes.

INTRODUCTION: Most deaths in infants and children occur in hospitals and especially in pediatric and neonatal intensive care units. OBJECTIVES: To determine 1) how often pediatric intensivists have to manage dying patients, 2) their approach to these patients, and 3) their knowledge of this field and their needs. MATERIAL AND METHOD: A 28-item questionnaire was sent by surface mail to each physician, as well as another questionnaire with general questions on the work of the pediatric intensive care unit (PICU) in 2000. RESULTS: Responses were obtained from 20 PICUs (54 %) from different parts of Spain. There where 373 deaths. More of the half of the deaths (62 %) were due to acute events or occurred during the neonatal period. Ninety-four physicians completed the questionnaire. Each physician attended four deaths (SD = 3.1; range 0-20). Sixty-eight percent of the physicians believed that families were helped by knowing the possibility that the child might die. Intensivists believed that pediatric patients should not be informed that they were dying. In 64 % of deaths, the physicians were with their patients at the moment of death. More than half of the patients died without physical contact with their parents. Forty-six percent of the physicians interpreted death among their patients as a personal or professional failure and most (92 %) wanted training. Only three PICUs allowed parents to stay all day with their children. CONCLUSIONS: Almost half the physicians experienced death as a personal or professional failure and most wanted training to help them deal with death in their professional work. Most PICUs restrict the time parents are allowed to stay with their children.

Actitudes y necesidades de los intensivistas pediátricos ante la muerte de sus pacientes / Attitudes and needs of pediatric intensivists in relation to the death of their patients

Introducción: Los niños mueren mayoritariamente en los hospitales y, sobre todo, en las unidades de cuidados intensivos pediátricos (UCIP) y neonatales. Objetivos: Conocer la frecuencia con la que los intensivistas pediátricos se enfrentan a la muerte; saber cómo actúan frente a los pacientes que se mueren en sus unidades, y saber cuál es su formación al respecto y qué necesidades tienen. Material y métodos: Se elaboró un cuestionario personal para cada médico con 28 preguntas y otro general sobre la UCIP y su actividad asistencial, con datos referidos al año 2000, que se enviaron por vía postal. Resultados: Respondieron 20 UCIP (54 %) de toda España. Hubo 373 fallecidos. Más de la mitad (62 %) fallecieron por una enfermedad aguda o del período neonatal. Un total de 94 médicos respondieron al cuestionario. Cada médico atendió 4 muertes (desviación típica = 3,1; rango = 0-20). El 68 % de los profesionales opina que el hecho de que la familia conozca la posibilidad del fallecimiento del niño ayuda a la familia. Los intensivistas piensan que no se debe informar al niño de que va a morir. Los médicos estuvieron junto a su paciente en el fallecimiento en el 64 % de las ocasiones. Más de la mitad de los niños murieron sin contacto físico con sus padres. Un 46 % de los profesionales manifiestan haber interpretado el fallecimiento como un fracaso personal o profesional al menos en una ocasión y la mayoría (92 %) desea formación. Sólo en 3 UCIP los padres pueden estar todo el día con sus hijos. Conclusiones: Casi la mitad experimentan la muerte de sus pacientes como un fracaso personal o profesional. La casi totalidad de los médicos desean formación que les ayude a afrontar la muerte en su ejercicio profesional. En la mayor parte de las UCIP hay restricciones para que los niños estén acompañados

Introduction: Most deaths in infants and children occur in hospitals and especially in pediatric and neonatal intensive care units. Objectives: To determine 1) how often pediatric intensivists have to manage dying patients, 2) their approach to these patients, and 3) their knowledge of this field and their needs. Material and method: A 28-item questionnaire was sent by surface mail to each physician, as well as another questionnaire with general questions on the work of the pediatric intensive care unit (PICU) in 2000. Results: Responses were obtained from 20 PICUs (54 %) from different parts of Spain. There where 373 deaths. More of the half of the deaths (62 %) were due to acute events or occurred during the neonatal period. Ninety-four physicians completed the questionnaire. Each physician attended four deaths (SD = 3.1; range 0-20). Sixty-eight percent of the physicians believed that families were helped by knowing the possibility that the child might die. Intensivists believed that pediatric patients should not be informed that they were dying. In 64 % of deaths, the physicians were with their patients at the moment of death. More than half of the patients died without physical contact with their parents. Forty-six percent of the physicians interpreted death among their patients as a personal or professional failure and most (92 %) wanted training. Only three PICUs allowed parents to stay all day with their children. Conclusions: Almost half the physicians experienced death as a personal or professional failure and most wanted training to help them deal with death in their professional work. Most PICUs restrict the time parents are allowed to stay with their children

Hormonal and anthropometric predictors of bone mass in healthy elderly men: major effect of sex hormone binding globulin, parathyroid hormone and body weight.

Osteoporosis in men is a significant health problem, and factors associated with bone mass are being investigated. Although osteoporosis is a typical feature of hypogonadism, the influence of testosterone levels and other hormonal factors on bone mass of eugonadal males is unknown. Our aim was to identify several anthropometric and hormonal predictors that could be responsible for the variability in bone mineral density (BMD) in healthy men. One hundred elderly men (age 68 +/- 7 years) were investigated in this cross-sectional study. BMD was measured by dual-energy X-ray absorptiometry (DXA) at the lumbar spine and femoral sites (femoral neck, Ward's triangle, trochanter, intertrochanter and total femur). Anthropometric measures were obtained including: weight, height, body mass index (BMI), waist-hip ratio and testicular volume. Hormonal data measures were total, free and bioavailable testosterone, dihidrotestosterone, estradiol, sex hormone binding globulin (SHBG), insulin-like growth factor I (IGF-I), intact parathyroid hormone (iPTH) and 1,25-dihydroxyvitamin D3 (1,25(OH)2D3). One subject was excluded because primary hypogonadism was found. SHBG levels were increased in 53.5% of men, and 8% showed a mild increase in iPTH levels. Twenty-eight subjects had densitometric criteria of osteoporosis (T-score < or = -2.5). All BMD sites were positively correlated with body weight (r = 0.29-0.48, p < 0.001) and BMI (r = 0.24-0.47, p < 0.001). A negative correlation between SHBG levels and intertrochanter (IT) and total femur (TL) BMD was found (r = -0.24 and r = -0.22, p < 0.05). After adjusting for age and BMI, SHBG and IGF-I levels were negatively correlated (r = -0.33, p < 0.001). In multiple linear regression analysis independent predictors of bone mass were body weight, SHBG and iPTH levels. The best predictive model accounted for 24-40% of the observed variability of BMD. However, most of the BMD variability was explained by body weight. In conclusion, in our study body weight, SHBG and iPTH levels were predictors of BMD in healthy elderly men.

[Abused children. Role of the pediatrician]. / Niños maltratados. El papel del pediatra.

Child maltreatment, in it's different forms (physical, negligence, Münchausen syndrome by proxy, sexual abuses.), represents an important morbidity cause, especially in the first years of the life. Nowadays, the battered child syndrome includes forms of abuse and different degrees of negligence (moderate, serious and light) in which the physical abuse could be absent. Determination of the forms of abuse, their diagnosis, intervention and prevention, corresponds to multidisciplinary teams, in which the pediatrician has a crucial role.

Niños maltratados. El papel del pediatra / Abused children. Role of the pediatrician

Los malos tratos a los niños, en sus distintas formas, físico, negligencia, síndrome de Münchhausen, abusos sexuales... representan una importante causa de morbilidad, especialmente en los primeros años de la vida. El síndrome del niño apaleado incluye en la actulidad formas de abuso y negligencias moderadas, graves y leves en las que el maltrato físico puede estar ausente. La determinación de las formas de maltrato, su diagnóstico, la intervención y prevención corresponden a equipos multidisciplinarios en los que el pediatra tiene un papel fundamental (AU)