Transcultural adaptation and validation of IMPACT-III and IMPACT-III-P in Spanish families: a multicenter study from SEGHNP.

IMPACT-III and IMPACT-III-P are health-related quality of life (HRQoL) questionnaires for patients with pediatric inflammatory bowel disease (p-IBD) and their parents/caregivers. We aimed to perform a transcultural adaptation and validation for the Spanish context. Translation, back-translation, and evaluation of the questionnaires were performed by an expert committee and 12 p-IBD families. We recruited p-IBD patients aged 10-17 and their parents/caregivers. Utility, content, and face validity were considered. Validation was performed with Cronbach's alpha coefficient and varimax rotation. We confirmed the adequacy of the factor analysis using Kaiser-Meyer-Olkin (KMO) and Bartlett's sphericity tests. A confirmatory factor analysis was performed using the following goodness indexes: chi-square, Normed Fit Index (NFI), Root Mean Square Error of Approximation index (RMSEA), Standardized Root Mean Square Residual (SRMR), and Comparative Fit Index (CFI). The correlation coefficient between IMPACT-III and IMPACT-III-P was analyzed. We included 370 patients and 356 parents/caregivers (37 hospitals). Both questionnaires had good content and face validity and were considered user-friendly. The KMO measure (0.8998 and 0.9228, respectively) and Bartlett's sphericity test (p-value < 0.001 for both) confirmed the adequacy of the factor analysis. The 4-factor model, complying with Kaiser's criterion, explained 89.19% and 88.87% of the variance. Cronbach's alpha (0.9123 and 0.9383) indicated excellent internal consistency. The CFA showed an adequate fit (NFI 0.941 and 0.918, RMSEA 0.048 and 0.053, SRMR 0.037 and 0.044, and CFI 0.879 and 0.913). The correlation coefficient was excellent (0.92). CONCLUSION: The SEGHNP versions of IMPACT-III and IMPACT-III-P are valid and reliable instruments for Spanish p-IBD families. WHAT IS KNOWN: • IMPACT-III and parent-proxy IMPACT-III (IMPACT-III-P) are useful questionnaires for assessing health-related quality of life (HRQoL) in pediatric inflammatory bowel disease (p-IBD) patients and their parents/caregivers and have been translated and validated in several countries. • To date, no transcultural adaptation and validation of these questionnaires have been published for Spanish patients with p-IBD and their families. WHAT IS NEW: • This is the first transcultural adaptation and validation of IMPACT-III and IMPACT-III-P for Spanish p-IBD families. • These are valid and reliable instruments for assessing HRQoL in Spanish families of patients with p-IBD.

Increased incidence of eosinophilic esophagitis among the child population of Zaragoza. An emergent disease.

Eosinophilic esophagitis is a chronic inflammatory disease characterized by esophageal dysfunction and progression to fibrosis. Its incidence is increasing in our setting with deep regional variations. To corroborate this hypothesis, a longitudinal, retrospective, multicenter observational study was carried out of patients who received a diagnosis of eosinophilic esophagitis from 2008 to 2022 at public hospitals in the province of Zaragoza. The annual incidence rates and mean incidence rate were calculated using the data for the reference population. A total of 104 patients were included. The mean incidence rate was 5.1 cases per 100,000 inhabitants < 15 years old/year (0.75-11.2). In the first five-year period (2008-2012) the rate was 1.2 cases per 100,000 inhabitants/year, compared with a rate of 6 cases per 100,000 inhabitants/year in the second 5-year period (2013-2017), [OR 5,68 (IC 95% 2,55 - 12,67, p < 0,05]; and 8.1 cases per 100,000 inhabitants/year in the third five-year period (2018-2022), [OR 7,74 (IC 95% 3,52 - 16,99, p < 0,05] It is concluded that eosinophilic esophagitis incidence has increased among the child population of Zaragoza over the past 15 years, with a 7-fold higher risk of having the condition in the third five-year period compared with the first one.

Safety and effectiveness of vedolizumab in paediatric patients with inflammatory bowel disease: an observational multicentre Spanish study.

Vedolizumab is a humanised monoclonal antibody that binds to integrin α4ß7 expressed in T-cells, inhibiting its binding to the mucosal addressin cell adhesion molecule-1 (MAdCAM-1), which is specifically expressed in the small intestine and colon, playing a fundamental role in T-cell migration to the gastrointestinal tract. Vedolizumab has been shown to be effective in treating adults with inflammatory bowel disease; however, efficacy data for paediatric use are scarce. The objective of the present study was to assess the effectiveness and safety of vedolizumab for inducing and maintaining clinical remission in children with inflammatory bowel disease. We conducted a retrospective multicentre study of patients younger than 18 years with inflammatory bowel disease refractory to anti-tumour necrosis factor alpha (anti-TNF-α) drugs, who underwent treatment with vedolizumab. Clinical remission was defined as a score < 10 points in the activity indices. We included 42 patients, 22 of whom were male (52.3%), with a median age of 13.1 years (IQR 10.2-14.2) at the start of treatment. Of the 42 patients, 14 (33.3%) had Crohn's disease (CD) and 28 (66.7%) had ulcerative colitis (UC). At the start of treatment with vedolizumab, the Paediatric Crohn's Disease Activity Index was 36 (IQR 24-40) and the Paediatric Ulcerative Colitis Activity Index was 47 (IQR 25-65). All of them had received prior treatment with anti-TNF and 3 patients ustekinumab. At week 14, 69% of the patients responded to the treatment (57.1% of those with CD and 75% of those with UC; p=0.238), and 52.4% achieved remission (35.7% with CD and 60.7% with UC; p=0.126). At 30 weeks, the response rate was 66.7% (46.2% and 78.3% for CD and UC, respectively; p=0.049), and 52.8% achieved remission (30.8% and 65.2% for CD and UC, respectively; p=0.047). Among the patients with remission at week 14, 80% of the patients with CD and 84.5% of those with UC maintained the remission at 52 weeks. Adverse effects were uncommon and mild. Three patients (7.1%) presented headaches, 1 presented alopecia, 1 presented anaemia and 1 presented dermatitis.Conclusion: The results show that treatment with vedolizumab is a safe and effective option for achieving clinical remission in paediatric patients with inflammatory bowel disease with primary failure or loss of response to other treatments, especially in UC. What is Known: • Vedolizumab is effective in inducing and maintaining remission in adult patients with inflammatory bowel disease. • Most studies and clinical trials have been performed on adult populations, and there is currently no indication for paediatric populations. What is New: • Children with inflammatory bowel disease refractory to anti-TNF presented higher clinical remission rates than those published for adults. • There are few publications of this magnitude on paediatric populations treated with vedolizumab and with long-term follow-up (52 weeks).

Reproducibility and Inter-rater Reliability of 2 Paediatric Nutritional Screening Tools.

OBJECTIVES: The aim of the present study was to assess reproducibility and inter-rater reliability of 2 nutritional screening tools (NST): Screening Tool for Risk on Nutritional Status and Growth (STRONGkids) and Screening Tool for the Assessment of Malnutrition in Paediatrics (STAMP). METHODS: Prospective observational multicentre study. Patients ages 1 month or older admitted to paediatric or surgical wards were tested within 24 hours of admission by 2 independent observers: experts specialized in paediatric nutrition (physicians or dieticians) and clinical staff nonexpert in nutrition. Diagnosis on admission, underlying diseases, and length of stay were registered. STATISTICAL ANALYSIS: Kappa index (κ) to evaluate agreement between observers. RESULTS: A total of 223 patients were included (53.4% boys), with mean age of 5.59 (95% confidence interval 4.94-6.22) years. Experts classified 9.9% of patients at high risk with STRONGkids and 19.7% using STAMP, whereas nonexpert staff assigned 6.7% of patients to the high-risk category with STRONGkids and 21.9% with STAMP. Agreement between expert and nonexpert staff was good: 94.78% for STRONGkids (κ 0.72 [P < 0.001]); 92.55% for STAMP (κ 0.74 [P < 0.001]). The rate of malnutrition was significantly higher among high-risk patients with both NST, independent of examiner experience. After adjusting for age, both STRONGkids and STAMP high-risk scores predicted longer length of stay, whether assessed by experts or nonexperts, although differences were higher with STRONGkids. CONCLUSIONS: Agreement between experts and nonexpert staff in nutrition was good, producing a similar high-risk patient profile. Our results demonstrate that these NSTs are appropriate for nutritional screening in settings in which users have no previous experience in the field.

Dilatación de la vena cava inferior en pacientes con anorexia nerviosa / Dilatation of inferior vena cava in patients with anorexia nervosa

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Tendencia secular del crecimiento durante la primera infancia en el norte de España / Growth secular trend during early childhood in northern Spain

Objective: To check whether secular changes exist in growth pattern of caucasic children from the North of Spain up to 2 years of age compared with 25-30 years ago population growth curves. Material and methods: Longitudinal study of a representative cohort of caucasic infants born a term in Aragon (n=1.099). Standard deviation scores (z-scores) for weight, length and body mass index (BMI) have been calculated by two available 25-30 years ago population growth curves (Sobradillo et al. and Ferrández et al.). Results: At all ages, weight, length and BMI mean z-scores significantly vary depending on the growth standard curve used (p≤0.001). At birth, weight z-score is -0.36 (95%CI:-0.42;-0.30) according to Sobradillo et al. and -0.26 (95%CI:-0.29;0.33) according to Ferrández et al. These differences decreased progressively becoming minimum at 2 years (mean weight z-score -0.08 and -0.05; respectively). At this age, length mean z-score is +0.54 (95%CI:0.48;0.61) according to Sobradillo et al. and +0.19 (95%CI:0.12;0.25) according to Ferrández et al. Mean BMI z-scores of our sample showed lower values than selected standards. Conclusions: Current birth weight of caucasic infants from Northern Spain is lower than in the previous generation. At 2 years of age there is a trend of increasing length, with a similar weight, resulting in lower BMI values (AU)

Objetivo: Comprobar si existen cambios seculares en el patrón de crecimiento de los niños caucásicos en el norte de España hasta los 2 años de edad, en comparación con los estándares poblacionales disponibles de hace 25-30 años. Material y métodos: Estudio longitudinal de una cohorte representativa de la población de niños aragoneses caucásicos nacidos a término (n=1.099). Se han calculado las puntuaciones típicas (Pt) para el peso, longitud e índice de masa corporal (IMC) según dos estándares disponibles de hace 25-30 años (Sobradillo et al. y Ferrández et al.). Resultados: Las Pt medias de peso, longitud e IMC de la muestra varían significativamente según el estándar empleado en todas las edades estudiadas (p≤0,001). Al nacimiento, la Pt media para el peso es -0,36 (IC95%:-0,42;-0,30) respecto a los estándares de Sobradillo et al. y -0,26 (IC95%:-0,29;0,33) respecto a los de Ferrández et al. Estas diferencias se atenúan paulatinamente haciéndose mínimas a los 2 años (Pt media para el peso -0,08 y -0,05; respectivamente). A los 2 años de edad, la Pt media para la longitud es +0,54 (IC95%:0,48;0,61) respecto a Sobradillo et al. y +0,19 (IC95%:0,12;0,25) respecto a Ferrández et al. El IMC de nuestra muestra presenta valores inferiores respecto a los estándares seleccionados. Conclusión: El peso al nacer de los niños caucásicos del norte de España en la actualidad es menor que en la generación anterior. A los 2 años de edad se comprueba una aceleración secular de la longitud pero con un peso similar, lo que conlleva valores inferiores de IMC (AU)

[Growth secular trend during early childhood in Northern Spain]. / Tendencia secular del crecimiento durante la primera infancia en el norte de España.

OBJECTIVE: To check whether secular changes exist in growth pattern of caucasic children from the North of Spain up to 2 years of age compared with 25-30 years ago population growth curves. MATERIAL AND METHODS: Longitudinal study of a representative cohort of caucasic infants born a term in Aragon (n=1.099). Standard deviation scores (z-scores) for weight, length and body mass index (BMI) have been calculated by two available 25-30 years ago population growth curves (Sobradillo et al. and Ferrández et al.). RESULTS: At all ages, weight, length and BMI mean z-scores significantly vary depending on the growth standard curve used (p≤0.001). At birth, weight z-score is -0.36 (95%CI:-0.42;-0.30) according to Sobradillo et al. and -0.26 (95%CI:-0.29;0.33) according to Ferrández et al. These differences decreased progressively becoming minimum at 2 years (mean weight z-score -0.08 and -0.05; respectively). At this age, length mean z-score is +0.54 (95%CI:0.48;0.61) according to Sobradillo et al. and +0.19 (95%CI:0.12;0.25) according to Ferrández et al. Mean BMI z-scores of our sample showed lower values than selected standards. CONCLUSIONS: Current birth weight of caucasic infants from Northern Spain is lower than in the previous generation. At 2 years of age there is a trend of increasing length, with a similar weight, resulting in lower BMI values.

Objetivo: Comprobar si existen cambios seculares en el patrón de crecimiento de los niños caucásicos en el norte de España hasta los 2 años de edad, en comparación con los estándares poblacionales disponibles de hace 25-30 años. Material y métodos: Estudio longitudinal de una cohorte representativa de la población de niños aragoneses caucásicos nacidos a término (n=1.099). Se han calculado las puntuaciones típicas (Pt) para el peso, longitud e índice de masa corporal (IMC) según dos estándares disponibles de hace 25-30 años (Sobradillo et al. y Ferrández et al.). Resultados: Las Pt medias de peso, longitud e IMC de la muestra varían significativamente según el estándar empleado en todas las edades estudiadas (p≤0,001). Al nacimiento, la Pt media para el peso es -0,36(IC95%:-0,42;-0,30) respecto a los estándares de Sobradillo et al. y -0,26 (IC95%:-0,29;0,33) respecto a los de Ferrández et al. Estas diferencias se atenúan paulatinamente haciéndose mínimas a los 2 años (Pt media para el peso -0,08 y -0,05; respectivamente). A los 2 años de edad, la Pt media para la longitud es +0,54(IC95%:0,48;0,61) respecto a Sobradillo et al. y +0,19(IC95%:0,12;0,25) respecto a Ferrández et al. El IMC de nuestra muestra presenta valores inferiores respecto a los estándares seleccionados. Conclusión: El peso al nacer de los niños caucásicos del norte de España en la actualidad es menor que en la generación anterior. A los 2 años de edad se comprueba una aceleración secular de la longitud pero con un peso similar, lo que conlleva valores inferiores de IMC.