Efecto del metilfenidato sobre el sueño. Resultados de un estudio multicéntrico en una población infantil afecta de trastorno por déficit de atención e hiperactividad / Methylphenidate and sleep: Results of a multicentre study on a population of children with attention deficit hyperactivity disorder

Introducción: El trastorno por déficit de atención e hiperactividad es el trastorno neuroconductual más frecuente entre la población infantil. El metilfenidato (MTF) es el fármaco utilizado más habitualmente en el tratamiento de dicho trastorno. Es importante conocer los efectos que sobre el sueño puede presentar el MTF debido a la repercusión que tiene un sueño insuficiente sobre la conducta y la función cognitiva en el niño. Objetivo: El objetivo de este trabajo es conocer las repercusiones que sobre el sueño puede tener el MTF, utilizando como instrumento evaluador una encuesta. Metodología: Se trata de un estudio multicéntrico en el que han intervenido seis hospitales de la Comunidad de Valencia. Durante un período de seis meses a todos aquellos pacientes a los que se diagnosticó de trastorno por déficit de atención e hiperactividad se les pasó una encuesta antes de iniciar el tratamiento y tres meses después de iniciar dicho tratamiento. La encuesta utilizada fue una versión abreviada del Pediatric Sleep Questionnaire. Se analizaron las diferencias encontradas. Resultados: Se estudió a un total de 114 niños. Se encontraron diferencias significativas en las preguntas que se asocian con enuresis, sonambulismo y somniloquias, disminuyendo estas parasomnias tras el inicio del tratamiento. El resto de variables no experimentó ningún cambio. Conclusiones: A la luz de nuestros resultados podemos decir que el MTF no solo no empeora el sueño, sino que mejora la calidad del sueño en lo que a parasomnias se refiere (AU)

Introduction: The attention-deficit/hyperactivity disorder (ADHD) is the most common neuro-behavioural disorder in children and adolescents. Methylphenidate (MPH) is the drug most often used in the treatment of this disorder. It is important to know the effects methylphenidate can have on sleep due to the repercussions that insufficient sleep can have on the behaviour and cognitive function of children and adolescents. Objectives: The purpose of this study was to find out the repercussions that methylphenidate can have on sleep, using a questionnaire. Methodology: This is a multicentre study in which six hospitals in the Valencian Community took part. All those patients who were diagnosed with ADHD over a period of 6 months were given a questionnaire, before starting treatment, and after three months of this treatment. The questionnaire was a version of the Paediatric Sleep Questionnaire. The differences found were analysed. Results: A total of 114 children were studied. Significant differences were found in the questions associated with enuresis, somnambulism and night-wakings, these sleep disorders decreasing after starting the treatment. The rest of variables did not show any changes.Conclusions: According to our results we can say that the MPH not only does not make worse the sleep, but that it improves the quality of the sleep in those patients with sleep disorders (AU)

[Methylphenidate and sleep: Results of a multicentre study on a population of children with attention deficit hyperactivity disorder]. / Efecto del metilfenidato sobre el sueño. Resultados de un estudio multicéntrico en una población infantil afecta de trastorno por déficit de atención e hiperactividad.

INTRODUCTION: The attention-deficit/hyperactivity disorder (ADHD) is the most common neuro-behavioural disorder in children and adolescents. Methylphenidate (MPH) is the drug most often used in the treatment of this disorder. It is important to know the effects methylphenidate can have on sleep due to the repercussions that insufficient sleep can have on the behaviour and cognitive function of children and adolescents. OBJECTIVES: The purpose of this study was to find out the repercussions that methylphenidate can have on sleep, using a questionnaire. METHODOLOGY: This is a multicentre study in which six hospitals in the Valencian Community took part. All those patients who were diagnosed with ADHD over a period of 6 months were given a questionnaire, before starting treatment, and after three months of this treatment. The questionnaire was a version of the Paediatric Sleep Questionnaire. The differences found were analysed. RESULTS: A total of 114 children were studied. Significant differences were found in the questions associated with enuresis, somnambulism and night-wakings, these sleep disorders decreasing after starting the treatment. The rest of variables did not show any changes. CONCLUSIONS: According to our results we can say that the MPH not only does not make worse the sleep, but that it improves the quality of the sleep in those patients with sleep disorders.

Uso de antibióticos y lactancia materna / Breastfeeding and antiinfectious agents

Con frecuencia, la presencia de una infección o la administraciónde un tratamiento antibiótico en la madre que amamantason motivo de contraindicación o retirada de la lactanciamaterna. Son contados los tratamientos antiinfecciososincompatibles con la lactancia materna y, sin embargo, contraindicaro retirar una lactancia incrementa de forma significativael riesgo de morbi-mortalidad para el lactante amamantado.Por ello, es imprescindible que el profesional disponga delas herramientas adecuadas que permitan elegir el mejor tratamientocompatible con la lactancia materna. El presente trabajorevisa los conceptos básicos de farmacodinamia durante lalactancia y ofrece un listado alfabético de los principales fármacosantiinfecciosos disponibles en el mercado actual juntocon un código numérico que ordena el nivel de riesgo de cadafármaco para el lactante o la lactancia. Finalmente, se ofrecenlas fuentes bibliográficas y páginas Web a donde dirigirse paraampliar esta información. Con todo ello pretendemos ofreceral lector interesado una herramienta útil que permita evitarcasos de abandono innecesario de la lactancia materna inducidospor profesionales incorrectamente informados(AU)

Not infrequently an infection or an antibiotic treatmentneeded by a lactating mother leads to medical advice againstbreastfeeding. However, advising against breastfeeding increasesmorbi-mortality risk in the infant. Besides there are fewanti-infectious agents not compatible with breastfeeding, andin these cases, there is usually an alternative to treat the mother’sillness. Thus it is important for health professionals to beinformed of best sources where to look for the best treatmentfor the mother compatible with breastfeeding. This article offersthe reader a review of basic pharmacodynamics which influencedrug use in human lactation, an alphabetically orderedlist of available anti-infectious agents coded by numbers indicatingrisk level, and some web recommendations for the interestedreader. We hope to offer the interested reader a usefultool which may prevent some cases of physician led abandonmentof lactation(AU)

Coste social y asistencial de la gastroenteritis pediátrica por rotavirus en España / Cost of paediatric rotavirus gastroenteritis management

Introducción: La gastroenteritis pediátrica por rotavirus (GPR) afecta a prácticamente todos los niños de hasta 5 años de edad, lo que conlleva un elevado porcentaje de hospitalizaciones y una gran morbilidad infantil. Pacientes y métodos: Se llevó a cabo un estudio de los costes de la enfermedad a partir de datos epidemiológicos y del uso de recursos en 252 niños con GPR atendidos en el ambulatorio, el servicio de urgencias o el hospital. Para ello se utilizó un cuestionario y diversas bases de datos de costes unitarios. Se estimó el coste por episodio de GPR y para una cohorte de 1.000 pacientes en cada nivel asistencial, considerando los costes directos sanitarios, los costes directos no sanitarios y los costes indirectos desde las perspectivas del Sistema Nacional de Salud (SNS) y de la sociedad. Resultados: Desde la perspectiva de la sociedad, el coste de tratar un episodio de GPR es de 1.551,7 € en el nivel hospitalario, de 408,9 € en urgencias y de 165,9 € en atención primaria. Los costes médicos directos suponen el 81,4% del coste total en el nivel hospitalario y el 53,8% en urgencias, mientras que en atención primaria la pérdida de productividad provoca el 75,3%del gasto total. Conclusiones: La GPR genera un uso considerable de recursos y costes sustanciales desde las perspectivas del SNS y de la sociedad. La prevención efectiva de la GPR a través de un sistema de inmunización infantil podría comportar ahorros importantes para el SNS y la sociedad en general (AU)

Title: Cost of paediatric rotavirus gastroenteritis management in Spain Introduction: Pediatric rotavirus gastroenteritis (RVGE) affects nearly all infants by five years of age, and accounts for a high number of hospitalizations. Patients and methods: A study was conducted in order to assess the costs of the disease in Spain, based on epidemiological data and the use of resources needed for the treatment of 252 children with RVGE attended at primary care, emergency room or hospital settings. A questionnaire was used as well as information on unitary costs. The costs of the disease where calculated per person and for a cohort of 1,000 patients in each level, taking into account direct medical costs, non medical direct costs and indirect costs from the National Health System(NHS) and societal perspectives. Results: From the societal perspective, RVGE has a cost per case of 1,551.7€, 408.9 € and 165.9 € when attended at the hospital, emergency room or primary care settings, respectively. Direct medical costs represent the largest part of the total costs at the Hospital (81.4%) and at the emergency room (53.8%), while at primary care, indirect costs due to loss of productivity are 75.3% of the expenditure. Conclusions: RVGE results in considerable resource utilization in all healthcare settings and substantial costs from NHS and society perspectives. Effective prevention of RVGE, through universal immunisation of infants, could result in substantial savings for both the NHS and the society (AU)

[The relationship between headache and sleep disorders: findings from an epidemiological study in a population of Spanish school-age children]. / Relación entre cefalea y trastornos del sueño: resultados de un estudio epidemiológico en población escolar.

INTRODUCTION: Headache and sleep disorders have a high impact in children, both from the point of view of prevalence and from the perspective of the quality of life of the subjects who suffer their consequences. AIM. To determine the prevalence of sleep disorders among the child population that suffers from headaches. SUBJECTS AND METHODS: The Spanish version of the Paediatric Sleep Questionnaire was administered to a representative sample of the child and teenage population that attend the different schools in the town of Gandia. This questionnaire includes two questions about the existence of headache. RESULTS: In all, 887 subjects answered the survey (68% of respondents). The sleep disorders that are clearly associated with headache are: rhythmic movement disorders, sleep-talking, nightmares, waking up more than twice during the night, unwillingness to go to bed, early waking, delayed onset of sleep, insomnia, irregular hours of going to bed and getting up, excessive daytime sleepiness, snoring and positive screening for apnea-hypopnea syndrome. CONCLUSIONS: It is shown that the population with headaches has a greater number of sleep disorders, mainly insomnia, excessive daytime sleepiness and parasomnias. It is important to gather information about sleep habits in any child who is attended because of headache.

Relación entre cefalea y trastornos del sueño: resultados de un estudio epidemiológico en población escolar / The relationship between headache and sleep disorders: findings from an epidemiological study in a population of school age children

Introducción. La cefalea y los trastornos del sueño tienen un alto impacto en la población infantil, tanto desde el punto de vista de la prevalencia como desde el punto de vista de la calidad de vida de los sujetos que los presentan. Objetivo. Conocer la prevalencia de los trastornos del sueño entre la población infantil afectada de cefalea. Sujetos y métodos. Se utilizó la versión española del Pediatric Sleep Questionnaire, que se distribuyó entre una muestra representativa de la población de niños y adolescentes que acuden a los diferentes centros escolares de la ciudad de Gandía. Dicho cuestionario incluye dos preguntas acerca de la existencia de cefalea. Resultados. Respondieron a la encuesta un total de 887 sujetos (el 68% de respondedores). Las alteraciones de sueño que se asocian de forma clara con la cefalea son: trastorno del movimiento rítmico, somniloquias, pesadillas, presentar más de dos despertares nocturnos, resistencia a acostarse, despertares tempranos, retraso en el inicio del sueño, insomnio, irregularidad en el horario de levantarse y acostarse, excesiva somnolencia diurna, ronquidos y un cribado positivo para síndrome de apnea-hipopnea. Conclusiones. Se demuestra que la población afectada de cefaleas tiene un mayor número de trastornos del sueño, fundamentalmente insomnio, excesiva somnolencia diurna y parasomnias. Es importante recabar información acerca del sueño en todo niño que sea atendido a causa de cefalea (AU)

Introduction. Headache and sleep disorders have a high impact in children, both from the point of view of prevalence and from the perspective of the quality of life of the subjects who suffer their consequences. Aim. To determine the prevalence of sleep disorders among the child population that suffers from headaches. Subjects and methods. The Spanish version of the Paediatric Sleep Questionnaire was administered to a representative sample of the child and teenage population that attend the different schools in the town of Gandia. This questionnaire includes two questions about the existence of headache. Results. In all, 887 subjects answered the survey (68% of respondents). The sleep disorders that are clearly associated with headache are: rhythmic movement disorders, sleep-talking, nightmares, waking up more than twice during the night, unwillingness to go to bed, early waking, delayed onset of sleep, insomnia, irregular hours of going to bed and getting up, excessive daytime sleepiness, snoring and positive screening for apnea-hypopnea syndrome. Conclusions. It is shown that the population with headaches has a greater number of sleep disorders, mainly insomnia, excessive daytime sleepiness and parasomnias. It is important to gather information about sleep habits in any child who is attended because of headache (AU)

[Breastfeeding and antiinfectious agents]. / Uso de antibióticos y lactancia materna.

Not infrequently an infection or an antibiotic treatment needed by a lactating mother leads to medical advice against breastfeeding. However, advising against breastfeeding increases morbi-mortality risk in the infant. Besides there are few anti-infectious agents not compatible with breastfeeding, and in these cases, there is usually an alternative to treat the mother's illness. Thus it is important for health professionals to be informed of best sources where to look for the best treatment for the mother compatible with breastfeeding. This article offers the reader a review of basic pharmacodynamics which influence drug use in human lactation, an alphabetically ordered list of available anti-infectious agents coded by numbers indicating risk level, and some web recommendations for the interested reader. We hope to offer the interested reader a useful tool which may prevent some cases of physician led abandonment of lactation.

[Sleep disturbances among children and adolescents with learning disabilities. Comparative study between students from a mainstream school and a special school in the Valencia Community (Spain)]. / Trastornos del sueño en niños y adolescentes con incapacidad psíquica. Análisis comparativo entre alumnos escolarizados en centros ordinarios y centros de educación especial de la Comunidad Valenciana.

INTRODUCTION: Sleep disturbances affect daytime behaviour and cognitive functions in children. These disorders make the situation worse in children who already have learning difficulties. The objective of the present study was to study the prevalence of sleep disturbances among children from special schools and carry out a comparative study with children from mainstream schools. PATIENTS AND METHODS: We use the Spanish version of the Paediatric Sleep Questionnaire, which was given out in three special schools of the Valencia Community. Results were compared with a previous study in children from mainstream schools. RESULTS: A significantly higher proportion of children in special schools had insomnia, 32.3 % against 10.5 % in main-stream school, and sleep breathing disorders, 26.8 % against 5.7 % in mainstream schools, and a lower proportion of parasomnias. Among the whole population with learning difficulties, children with cerebral palsy are the most affected. CONCLUSIONS: Our results clearly show that children with learning difficulties have a higher risk of sleep disturbances and these disturbances have repercussions on daily functioning. It is important to rule out sleep disturbances when we see children with learning difficulties.

Migraña y mujer / Migraine and female

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Trastornos del sueño en niños y adolescentes con incapacidad psíquica. Análisis comparativo entre alumnos escolarizados en centros ordinarios y centros de educación especial de la Comunidad Valenciana / Sleep disturbances among children and adolescents with learning disabilities. Comparative study between students from a mainstream school and a special school in the Valencia Community (Spain)

Introducción: Las alteraciones del sueño repercuten de forma negativa sobre la conducta y la función cognitiva de la población infantil. En los niños con discapacidad estos trastornos empeoran una situación de por sí deficitaria. Es importante conocer qué alteraciones son más frecuentes en esta población. El objetivo de este trabajo es conocer la prevalencia de las alteraciones del sueño entre la población que acude a centros de educación especial, realizando un análisis comparativo con aquellos casos que acuden a centros ordinarios. Pacientes y métodos: Se utilizó la versión española del Pediatric Sleep Questionnaire, que se distribuyó entre tres centros de educación especial de la Comunidad Valenciana. Los resultados se compararon con los de un estudio previo entre estudiantes de centros ordinarios de la ciudad de Gandía. Resultados: La población que acude a centros educativos especiales presenta una mayor frecuencia de insomnio, un 32,3 frente a un 10,5 % en la población que acude a centros ordinarios, así como de trastornos respiratorios relacionados con el sueño, un 26,8 frente a un 5,7 % en la que acude a colegios ordinarios, y una menor frecuencia de parasomnias. Dentro del conjunto de personas con discapacidad, los que presentan parálisis cerebral son los más afectados. Conclusiones: Nuestros resultados demuestran de forma clara que las personas con discapacidad psíquica tienen un mayor riesgo de presentar trastornos del sueño. Se debe valorar siempre la existencia de dichos trastornos en esta población (AU)

Introduction: Sleep disturbances affect daytime behaviour and cognitive functions in children. These disorders make the situation worse in children who already have learning difficulties. The objective of the present study was to study the prevalence of sleep disturbances among children from special schools and carry out a comparative study with children from mainstream schools. Patients and methods: We use the Spanish version of the Paediatric Sleep Questionnaire, which was given out in three special schools of the Valencia Community. Results: were compared with a previous study in children from mainstream schools. Results A significantly higher proportion of children in special schools had insomnia, 32.3 % against 10.5 % in main-stream school, and sleep breathing disorders, 26.8 % against 5.7 % in mainstream schools, and a lower proportion of parasomnias. Among the whole population with learning difficulties, children with cerebral palsy are the most affected. Conclusions: Our results clearly show that children with learning difficulties have a higher risk of sleep disturbances and these disturbances have repercussions on daily functioning. It is important to rule out sleep disturbances when we see children with learning difficulties (AU)

[Attention-deficit/hyperactivity disorder and sleep disturbances. Results of an epidemiological study in schoolchildren in Gandia, Spain]. / Relación entre el trastorno por déficit de atención e hiperactividad y los trastornos del sueño. Resultados de un estudio epidemiológico en la población escolar de la ciudad de Gandía.

INTRODUCTION: The evaluation of comorbidity is an important factor in the treatment of children with attention-deficit/hyperactivity disorder. Sleep disturbances are one of the most common features of this disorder. OBJECTIVE: To find out the frequency of sleep disturbances among children with attention-deficit/hyperactivity disorder. MATERIAL AND METHODS: We used the Spanish version of the Paediatric Sleep Questionnaire, which was given out to a representative sample in Gandia (Spain). RESULTS: The questionnaire was answered by 887 (68 % of the sample). The sleep disturbances that showed a clear relationship with the three ADHD variables studied are: snoring, enuresis, rhythmic movement disturbances, night awakenings, and bedtime resistance. Sleep-disorder breathing, bruxism, somniloquy, day sleepiness, early awakenings and difficulty falling sleep are associated with only one of the three variables studied. CONCLUSIONS: Our study demonstrates that the population with attention-deficit/hyperactivity disorder has more sleep disturbances. The association with the enuresis is of particular interest due to the possible clinical implications.

Relación entre el trastorno por déficit de atención e hiperactividad y los trastornos del sueño. Resultados de un estudio epidemiológico en la población escolar de la ciudad de Gandía / Attention-deficit/hyperactivity disorder and sleep disturbances. Results of an epidemiological study in schoolchildren in Gandia, Spain

Introducción. Uno de los aspectos clave del tratamiento de los niños con trastorno por déficit de atención e hiperactividad (TDAH) es la valoración de la comorbilidad que dicho trastorno presenta. Uno de los trastornos comórbidos que asocia son las alteraciones del sueño. Objetivo. El objetivo de este trabajo es conocer la frecuencia con la que se presentan los trastornos del sueño en la población afectada de TDAH. Material y métodos. Se utilizó la versión española del Paediatric Sleep Questionaire, que se distribuyó entre una muestra representativa de la población de estudiantes de la ciudad de Gandía. El estudio fue aprobado por el Comité de Investigación del hospital. Resultados. Contestaron la encuesta un total de 887 sujetos (68 % de respondedores). Las alteraciones del sueño que se asocian de forma clara con las tres variables del TDAH estudiadas son: ronquido (roncar más de las mitad de la noche), enuresis, trastorno del movimiento rítmico, presentar más de dos despertares nocturnos y resistencia a acostarse. Se relacionan solamente con alguna de las tres variables estudiadas el trastorno respiratorio relacionado con el sueño, bruxismo, somniloquia, excesiva somnolencia diurna, despertares precoces y responder afirmativamente a la pregunta "¿Le cuesta dormirse por la noche?". Conclusiones. Nuestro trabajo demuestra que la población afectada de TDAH tiene un mayor número de trastornos del sueño. De particular interés pensamos que es la relación con la enuresis por las implicaciones clínicas que puede tener

Introduction. The evaluation of comorbidity is an important factor in the treatment of children with attention-deficit/hyperactivity disorder. Sleep disturbances are one of the most common features of this disorder. Objective. To find out the frequency of sleep disturbances among children with attention-deficit/hyperactivity disorder. Material and methods. We used the Spanish version of the Paediatric Sleep Questionnaire, which was given out to a representative sample in Gandia (Spain). Results. The questionnaire was answered by 887 (68 % of the sample). The sleep disturbances that showed a clear relationship with the three ADHD variables studied are: snoring, enuresis, rhythmic movement disturbances, night awakenings, and bedtime resistance. Sleep-disorder breathing, bruxism, somniloquy, day sleepiness, early awakenings and difficulty falling sleep are associated with only one of the three variables studied. Conclusions. Our study demonstrates that the population with attention-deficit/hyperactivity disorder has more sleep disturbances. The association with the enuresis is of particular interest due to the possible clinical implications

[Sleep patterns and sleep disturbances among schoolchildren in the town of Gandia]. / Patrones normales y trastornos del sueño entre la población escolar de la ciudad de Gandía.

INTRODUCTION: Knowledge of sleep patterns and sleep disturbances among healthy children is interesting, particularly, amongst other things, for carrying out comparative studies with children with certain diseases. The objective of the present study was to study sleep patterns and the prevalence of sleep disturbances among schoolchildren. METHODS: We used the Spanish version of the Pediatric Sleep Questionnaire, which was given out to a representative sample of Gandia Town. RESULTS: The prevalence of sleep disturbances were as follows: insomnia 10.5 %, daytime sleepiness 13 %, a positive score for sleep-disorder breathing 5.7 %, snoring 5.7 %, enuresis 5.3 %, sleepwalking 12.5 %, night terrors 18.4 %, nightmares 12.8 %. As regards sleep patterns, the average time for getting up was 7:45 am, the average time for going to bed was 22:13 pm, and the average sleep duration was 9 hours and 30 minutes. CONCLUSIONS: Comparison among different populations studies is difficult due to the use of different instruments to measure the same variables. Our results are similar to other studies, with the exception of sleep-disorder breathing and snoring, where the prevalences are lower in our study. The sleep patterns also did not show any differences between other published studies.

Patrones normales y trastornos del sueño entre la población escolar de la ciudad de Gandía / Sleep patterns ans sleep disturbances among schoolchildren in the town of Gandia

Introducción: El conocimiento de los patrones de sueño normales y las alteraciones de éste en una población infantil sana tiene interés, entre otras cosas, para poder realizar posteriores análisis comparativos con grupos afectados de determinadas patologías. El objetivo del presente trabajo es, por tanto, conocer los patrones normales de sueño y la prevalencia de los diferentes trastornos de éste en una población escolar. Material y métodos: Se utilizó la versión española del Pediatric Sleep Questionaire, que se distribuyó entre una muestra representativa de la población de estudiantes de la ciudad de Gandía. Resultados: Se encontró una prevalencia de insomnio del 10,5 %, somnolencia diurna del 13,9 %, un cribado positivo para el trastorno respiratorio relacionado con el sueño en el 5,7 %, ronquido en el 4,3 %, enuresis en el 5,3 %, sonambulismo en el 12,5 %, terrores nocturnos en el 18,4 % y pesadillas en el 12,8 %. Respecto a los patrones de sueño, la hora media de levantarse fue las 7:45 h; la de acostarse, las 22:13 h, y la duración media de sueño nocturno de 9 h y 30 min. Conclusiones: La comparación entre estudios poblacionales diferentes es difícil, debido a la utilización de diferentes instrumentos para medir el mismo fenómeno. Nuestros resultados son similares a los de otras series a excepción del trastorno respiratorio relacionado con el sueño y el ronquido, en el que hemos detectado una menor prevalencia de la encontrada en otras series. Los hábitos de sueño tampoco difieren mucho de otras series publicadas (AU)

Introduction: Knowledge of sleep patterns and sleep disturbances among healthy children is interesting, particularly, amongst other things, for carrying out comparatives studies with children with certain diseases. The objective of the present study was to study sleep patterns and the prevalence of sleep disturbances among schoolchildren. Methods: We used the Spanish version of the Pediatric Sleep Questionnaire, which was given out to a representative sample of Gandia Town. Results: The prevalence of sleep disturbances were as follows: insomnia 10.5 %, daytime sleepiness 13 %, a positive score for sleep-disorder breathing 5.7 %, snoring 5.7 %, enuresis 5.3 %, sleepwalking 12.5 %, night terrors 18.4 %, nightmares 12.8 %. As regards sleep patterns, the average time for getting up was 7:45 am, the average time for going to bed was 22:13 pm, and the average sleep duration was 9 hours and 30 minutes. Conclusions: Comparison among different populations studies is difficult due to the use of different instruments to measure the same variables. Our results are similar to other studies, with the exception of sleep-disorder breathing and snoring, where the prevalences are lower in our study. The sleep patterns also did not show any differences between other published studies (AU)

[Spanish version of the Pediatric Sleep Questionnaire (PSQ). A useful instrument in investigation of sleep disturbances in childhood. Reliability analysis]. / Versión española del Pediatric Sleep Questionnaire. Un instrumento útil en la investigación de los trastornos del sueño en la infancia. Análisis de su fiabilidad.

INTRODUCTION: Sleep questionnaires are useful tools both for screening patients who require medical tests and for epidemiologic research. The Pediatric Sleep Questionnaire (PSQ) has two versions: a shorter one, which has been validated for sleep-related breathing disorders, and an extended version, which deals with a wider range of sleep disturbances. MATERIAL AND METHODS: The PSQ was translated into Spanish and its reliability was determined by means of test-retest and internal consistency methods among a random sample of 99 patients. RESULTS: Ninety-one percent of the questions showed good concordance, following the criteria established in the test- retest method. Internal consistency was good in parts A (nighttime and sleep behavior) and C (items for inattention and hyperactivity) of the questionnaire but was weak in part B (daytime behavior and other possible problems). Therefore, the reliability of the questionnaire can be considered to be adequate except for the internal consistency of part B. CONCLUSIONS: The Spanish version of the PSQ is a suitable tool both for screening patients who require medical tests and for epidemiological research.

Versión española del Pediatric Sleep Questionnaire. Un instrumento útil en la investigación de los trastornos del sueño en la infancia. Análisis de su fiabilidad / Spanish version of the Pediatric Sleep Questionnaire (PSQ). A useful instrument in investigation of sleep disturbances in childhood. Reliability analysis

Introducción Los cuestionarios de sueño son instrumentos útiles, tanto para el cribado de pacientes a los que hay que realizar pruebas complementarias, como para la investigación epidemiológica. El Pediatric Sleep Questionnaire (PSQ) tiene dos versiones, una reducida, que ha sido validada para la detección de los trastornos respiratorios relacionados con el sueño (TRS) y una completa que contempla una gama más amplia de trastornos del sueño. Material y métodos Tras realizar la traducción del PSQ, se llevó a cabo un estudio de fiabilidad mediante los métodos de consistencia interna y el test-retest entre 99 pacientes escogidos al azar. Resultados El 91 % de las preguntas presentaron una buena concordancia siguiendo los criterios previamente establecidos en el método test-retest. Respecto a la consistencia interna fue buena en los apartados A (conducta durante la noche y mientras duerme) y C (preguntas dirigidas a identificar el trastorno por déficit de atención e hiperactividad (TDAH) de la encuesta y débil en el apartado B (conducta durante el día y otros problemas), por lo cual pensamos que la fiabilidad del cuestionario se puede considerar adecuada a excepción de la consistencia interna del apartado B. Conclusiones La versión española del PSQ es un instrumento adecuado, tanto para el cribado de pacientes a los que haya que realizar pruebas complementarias, como para la investigación epidemiológica

Sleep questionnaires are useful tools both for screening patients who require medical tests and for epidemiologic research. The Pediatric Sleep Questionnaire (PSQ) has two versions: a shorter one, which has been validated for sleep-related breathing disorders, and an extended version, which deals with a wider range of sleep disturbances. Material and methods The PSQ was translated into Spanish and its reliability was determined by means of test-retest and internal consistency methods among a random sample of 99 patients. Results Ninety-one percent of the questions showed good concordance, following the criteria established in the test- retest method. Internal consistency was good in parts A (nighttime and sleep behavior) and C (items for inattention and hyperactivity) of the questionnaire but was weak in part B (daytime behavior and other possible problems). Therefore, the reliability of the questionnaire can be considered to be adequate except for the internal consistency of part B. Conclusions The Spanish version of the PSQ is a suitable tool both for screening patients who require medical tests and for epidemiological research

Medicamentos, plantas, tóxicos, enfermedades y lactancia: una ayuda en español en Internet / Drugs, plants, toxins, diseases and breastfeeding: ana aid in Spanish on the Internet

Los beneficios de la lactancia materna, para el niño y la madre, su familia, el sistema sanitario y la sociedad en general, están muy bien documentados en múltiples publicaciones. Suprimir una lactancia sin un motivo de peso es una grave irresponsabilidad desde el punto de vista sanitario. Más del 90% de las mujeres pueden tener que tomar medicamentos o productos de fitoterapia durante el periodo de lactancia, lo que constituye un motivo clásico de cese de la lactancia, pese a no estar demostrado su peligro real más que en un pequeñísimo porcentaje de productos: fenindiona, amiodarona, derivados del ergot, antineoplásicos, y oduros y psicodrogas de abuso. Del mismo modo, sólo 6 enfermedades de la madre contraindican o hacen prácticamente imposible la lactancia. Con sentido común, unos conocimientos básicos de farmacología y pediatría y buenas guías (libros, revistas y páginas web), podemos asesorar a las mujeres que lactan, deben tomar remedios para alguna dolencia o sufren una enfermedad. Las madres huirán de informaciones erróneas, basadas sólo en prejuicios o en el Vademécum. Una página web(www.e-lactancia.org), en español y de sencillo manejo, nos ayudará a tomar decisiones acertadas antemás de 1.400 opciones diferentes implicadas en la lactancia materna

The benefits of breast feedingf or the infant, the mother, the family, the health care system and society in general are well documented in numerous scientific publications. The medical advice for weaning a child without a justified reason is an act of irresponsibility from an ethical point of view. Moret han 90% of women might need to take some type of medication while breastfeeding their babies at any time, this being a commonly alleged reason for weaning. However, only a few drugs have been shown to represent a real hazard: phenindione, amiodarone, ergot derivatives, antineoplastic agents, iodides and drugs of abuse. Seemingly, only six maternal diseases are considered to contraindicate breast feeding or make it nearly impossible. By exercising common sense, applying basic knowledge of Pharmacology and Pediatrics and using up dated guidelines (e.g. books, journals and web resources), we should be able to adequately advise those lactating mothers who require medication. Therefore, healthcare givers are committed to offering them proper assistance since mothers will ultimately reject misin formation or recommendations based on prejudice so rreleased by the industry, like that contained in the Physician's Desk Reference. A website, www.e-lactancia.org, an easy-touse resource in both Spanish and English, will help us make appropriate decisions concerning more than 1.400 options that a lactating mother may have to confront

[Iatrogenic botulism: a complication to be taken into account in the treatment of child spasticity]. / Botulismo yatrógeno: una complicación a tener en cuenta en el tratamiento de la espasticidad en la infancia.

INTRODUCTION: During the last decades the use of botulinum toxin for management of muscular disorders and spasticity associated to cerebral palsy has become a widespread practice. CASE REPORT: A 6-years female suffering of cerebral palsy secondary to a partial agenesis of the corpus callosum who was receiving bolulinum toxin since October 2001. One week after the last dose (Dysport 46 U/kg/dose) she started high grade fever, malaise, food refusal, choking, constipation, eyelid ptosis, absence of deep tendon reflexes, and abundant mucous discharge. Such features were so progressively severe that ventilatory support became mandatory. After a previous dose five months before, she developed similar features but they were less severe and thought to be related to a respiratory infection. CONCLUSIONS: At the present, there are two forms of botulinum toxin commercially available: the British brand Dysport and the American brand Botox. Bio equivalences are 1 U Botox to 2 or 6 U Dysport. Dosing (U/kg per session) has been established as follows: 5 U for Botox, 35 U for Dysport. Safety limits are a wide range with a therapeutic toxic index rate of 1:10. Generalized side effects after diffusion to blood of locally injected botulinum toxin are rare.