[Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers]. / Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores.

BACKGROUND: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to intervene in time if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. OBJECTIVES: To understand of the day to day life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. PATIENTS AND METHODOLOGY: Descriptive and transversal study on IDDM patients between the ages of 3 and 18, treated within the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the 1st survey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient's daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professionals with pupils with IDDM. RESULTS: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were 10 to 14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4; 47% of teachers feel insecure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognise its signs and symptoms and know how to act when they occur. CONCLUSIONS: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certain skills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease.

Necesidades del niño escolarizado con diabetes mellitus. Visión de padres y profesores / Special needs of schoolchildren with diabetes mellitus. Point of view of parents and teachers

Fundamentos: el cuidado diario del niño y el adolescente con diabetes mellitus insulinodependiente (DMID), fundamental para la evolución a corto y largo plazo de la enfermedad, debe incluir las muchas horas de permanencia en la escuela. La presencia, en el entorno escolar, de personas entrenadas para evitar los riesgos de una intervención tardía ante una complicación aguda, como es la hipoglucemia, y facilitar el buen control de la enfermedad puede ser considerada una necesidad. La presencia de personal sanitario en nuestros centros educativos públicos es escasa al no estar establecida como obligatoria. Objetivos: conocer aspectos de la vida cotidiana de los niños con DMID centrados en su jornada escolar y conocer actitudes de profesores de colegios e institutos frente a alumnos con DMID. Pacientes y método: estudio descriptivo, transversal sobre pacientes con DMID de 3 a 18 años atendidos en el área sanitaria 3 de la Comunidad de Madrid y sus respectivos profesores mediante dos tipos de encuesta: primera encuesta, distribuida por la Fundación para la Diabetes, con 80 preguntas dirigidas a pacientes de 3 a 18 años y sus padres en relación con su vida diaria y el entorno escolar. Segunda encuesta, de elaboración propia, dirigida a profesores de enseñanza primaria y secundaria, que valora cómo viven la presencia de estos alumnos con DMID en el aula. Resultados: del cuestionario dirigido a pacientes y padres, fueron válidas 50 en el área correspondiente a nuestro centro, y destacamos que: la mayor participación fue de los niños de 10 a 14 años; el 86% de los niños saben medirse la glucemia y el 66% sabe administrarse insulina; el 74% no ha tenido problemas de inserción escolar; sin embargo, por edades, hasta le 50% de las menores de 6 años lo han padecido; hasta en el 50% de las ocasiones en que un paciente ha precisado la administración de insulina durante el horario escolar lo ha hecho un familiar; el 66% de las hipoglucemias son resueltas por el paciente; sólo disponen de personal sanitario en el centro educativo el 8% de los pacientes y, por último, el 98% cree oportuno que todos los profesores de niños con diabetes tengan información por escrito de los síntomas y pasos a seguir en caso de hipoglucemia cuando el alumno se incorpora al colegio. Del cuestionario dirigido a profesores, respondido por un 54% (76 de un total de 140), destacamos que: el 71% reconoce tener o haber tenido a un alumno diabético; el grado de conocimiento de los profesores sobre diabetes, valorado con una escala del 1 al 7, muestra una mediana de 3 y una moda de 4; la inseguridad generada por un alumno diabético la atribuyen (un 47%) a la falta de instrucciones explícitas sobre la actuación ante complicaciones concretas; el 97,4% de los profesores dicen saber lo que es una hipoglucemia; sin embargo, sólo el 67,1% conoce los signos y síntomas que genera y un 57% dice saber que debe hacer ante esta situación. Conclusiones: la integración y la aceptación escolar de los alumnos con DMID es buena, percepción compartida por padres y profesores. Estos niños desde muy pequeños se responsabilizan de su enfermedad y adquieren habilidades de autocuidado a edades tempranas, pero necesitan ayuda, y ésta es prestada diariamente desde el entorno familiar incluso durante el horario escolar. En general, los profesores muestran una buena disposición para adquirir habilidades que los capaciten para la eventual ayuda a estos niños; sin embargo, su carencia de conocimientos y la ausencia de personal sanitario en los centros educativos hacen necesaria una más amplia información para mejorar la comprensión y la asunción del problema (AU)

Background: The daily care of a diabetic (IDDM) child is essential for the short and long term evolution of the disease, and must include the hours the child spends in school. The presence of Trained personnel are needed who will be able to interveneintime if a serious complication, such as hypoglycemia, occurs. Their presence can help to ensure correct control of the disease and avoid long term complications. Objectives: To understand of the day today life of children with IDDM, focusing on their school hours. To understand the attitude of primary and secondary school teachers towards pupils with IDDM. Patients and methodology: Descriptive and transversal study on IDDM patients between the ages of 3 and18, treated with in the Healthcare Area number 3 in the Madrid Region, and their teachers. Two different kinds of surveys were distributed: the1 stsurvey by Fundación para la Diabetes (Foundation for Diabetes) contained 80 questions aimed at patients between the ages of 3 and 18 and their parents. Questions were related to patient’s daily life and school environment. The 2nd survey, which allowed free response, was aimed at primary and secondary school teachers about their own experiences working as professional swith pupils with IDDM. Results: Fifty questionnaires addressed to parents and patients were valid in our remit, and we emphasize the following: the ages of major participation were10 to14 years; 86% of children knew how to measure blood glucose and 66% how to administer insulin; 74% had no problems with school integration, however, up to 50% of children under 6 years had suffered a problem occasionally; on the 50% of the occasions when a patient needed insulin administration during school hours, it was done by a relative; 66% of hypoglycaemias were resolved by the patient. Health personnel is present only in 8% of the schools studied; 98% of those surveyed think teachers should have written instructions on the signs and symptoms and action to be taken if a hypoglycemia occurs. Questionnaires for teachers were answered by 54% of them (76 of a total of 140), we would like to point out the following: 71% of them recognise having a diabetic pupil; the degree of teacher knowledge on diabetes, rated on a scale from 1 to 7 shows a median of 3 and a mode of 4;47% of teachers feel in secure when having a diabetic pupil because they do not have instructions on actions to take in case a complication occurs; 97% of teachers affirm to know what a hypoglycaemia is, however only 67% and 57% of them recognize its signs and symptoms and know how to act when they occur. Conclusions: The school integration and acceptance of pupils with IDDM is good, according to both teachers and parents. Children with IDDM take responsibility for their disease at an early age and are able to develop certains kills. However they still need help, which they get from their family even during school hours. Generally, teachers are willing to learn new skills to be able to help these children, however, further training is required to improve the understanding and management of this disease (AU)

[Correlation between IGA from colostrum and serum and IGA is closer than between salivary IGA and total IGA]. / Mejor relación de los anticuerpos-IgA calostrales con la IgA total y con los anticuerpos séricos que con los salivares.

Colostrum, serum and saliva were simultaneously obtained from 50 normal mothers. 19-45 years old, 36-72 hours post-delivery. Total IgA level and class-IgA antibodies against 3 common food antigens (lactoglobulin, gliadin and ovalbumin) and 4 types of salmonella (typhi, paratyphi A, B and C) were determined in all samples. The 7 antibodies (Ab) were detected in colostrum, by ELISA, in a higher percentage of samples (88-62%), than in serum (82-34%) and saliva (77-27%). These percentages were higher for food-Ab than for anti-salmonella Ab. The total colostral IgA was close correlated with food-Ab in colostrum (p less than 0.001) and quite poorer with anti-salmonella Ab (p less than 0.05-p less than 0.01). A good correlation was generally also present between Ab from colostrum/serum, but was worse between both secretions (colostrum/saliva). The present results suggest that colostrum specific Ab levels can be predicted, depending on total IgA and the specific Ab from serum.

[Pregnancy in adolescent mothers (between the ages of 15 and 18). Neonatal results]. / Embarazo en madre adolescente (quince a dieciocho años). Resultado neonatal.

A total of 61 infants of adolescent mothers (aged 15 to 18 years) were compared at birth with two control groups of 78 infants born of nonadolescents (aged 19 to 30 years). Control group I were adults mothers, married, with adequate prenatal care, without gestational risk factors, and similar parity to adolescents mothers. Control group II were adult mothers with prenatal care, risk factors during pregnancy, marital status and parity in like proportions to adolescent mothers. Only statistically significant difference was that adolescent mothers delivered infants whose mean weight was 180 g less (p less than 0.01) than infants of group I, and 152 g less (p less than 0.05) than infants of group II. Prematurity, low-birth-weight, low Apgar score, and difficulties at birth, had not greater incidence in adolescent group.