Conocimiento y actuación de los padres sobre la fiebre / Knowledge and management of fever by parents

Objetivos: evaluar los conocimientos y actitudes que tienen los padres sobre la fiebre, así como la influencia de los aspectos familiares. Material y métodos: cuestionario distribuido a padres de dos áreas asistenciales con hijos de 1-5 años. Para variables cualitativas se aplicaron pruebas de asociación mediante el test X2; para las variables cuantitativas se aplicó la diferencia de medias mediante la t de Student o análisis de la varianza (ANOVA). Se consideró como valor estadísticamente significativo p < 0,05. Resultados: se analizaron 288 cuestionarios. El 50% de los encuestados tiene dos hijos. Trabaja el 64,5%. En el área urbana son de mayor edad y nivel de estudios (p < 0,001). Un 50,3% considera la fiebre mala, menos los de edad media superior (p < 0,05). El 67,7% utiliza termómetro electrónico. Consideran fiebre una temperatura de 37,7 ºC en axila. Ante la fiebre, el 58,3% utiliza en primer lugar un antitérmico. El 98,2% usa medidas físicas y el 49,3% de ellos piensa que mejoran la fiebre; las usan menos los que trabajan (p < 0,05). Los de estudios superiores quitan ropa y dan líquidos más que los de estudios primarios (p = 0,035). Los antitérmicos más empleados fueron paracetamol e ibuprofeno. Un 64,6% de los encuestados percibe diferencias en cuanto a eficacia. El 85,4% utiliza la dosis indicada por su pediatra y el 21,5%, la que indica la ficha técnica, sobre todo los de estudios superiores frente a los de estudios primarios (p < 0,05). El 67,4% alterna antitérmicos, siempre aconsejados por el pediatra. Conclusiones: globalmente, en la población estudiada existe un buen conocimiento y una actitud adecuada ante la fiebre (AU)

Objective: To assess parental knowledge and attitudes about fever and the influence of social and family aspects. Methods: Questionnaires distributed to parents of children 1-5 years old in two health districts. For qualitative variables association tests with X2 test were applied, and mean differences by Student’s t-distribution or analysis of variance (ANOVA) were used for quantitative variables. It was considered statistically significant the value of p < 0.05. Results: There were 288 questionnaires analyzed. Fifty percent of respondents have 2 children, and 64.5% work. Older age and higher education levels were found in urban areas (p < 0.001). Fever was considered to be a bad thing by 50.3%, less so those with higher mean age (p < 0.05). Electronic thermometers was used in 67.7%, and 86.2% took armpit temperature considering 37.7 ºC as fever. When faced with fever, 58.3% of parents first use antipyretics. Physical measures are used in the first term by 98.2% and 49.3% think these measures lower the fever; they are used less by those parents who work (p < 0.05). Parents with higher education levels remove the clothing and give liquids more than those with primary education (p = 0.035). Most commonly used antipyretics are acetaminophen and ibuprofen; 64.6% perceived differences in efficiency; 65.4% think that ibuprofen is more effective than acetaminophen. Most parents use the dosage prescribed by the pediatrician (85.4%), and 21.5% use the dosage specified in the leaflet, especially those with higher education levels, compared to parents with primary education (p < 0.05). They sometimes alternate antipyretics (67.4%), always following the advice of their pediatrician. Conclusions: There is an overall good knowledge and attitudes about fever (AU)

Flemón periamigdalar / Peritonsillar phlegmon

Las infecciones de las vías altas en la infancia tienen una elevada incidencia y son fuente habitual de consultas, cuyo manejo a veces es controvertido por la excesiva utilización de medicación. El anillo de Waldeyer actúa como un paraguas protector, al impedir muchas veces el progreso de las infecciones al resto del organismo. En ocasiones, por circunstancias poco conocidas, esa protección puede perderse y causar una patología relevante para la salud del niño. Presentamos el caso de una niña con un proceso realmente poco frecuente en la infancia, que es preciso diagnosticar con prontitud para evitar su progreso. El flemón periamigdalar es el primer síntoma de un absceso y, a pesar de que la primera intención terapéutica es el ingreso de los pacientes, administrar tratamiento intravenoso y realizar exámenes complementarios complejos, en bastantes casos podría adoptarse una actitud más conservadora, que fue la que se siguió en esta paciente. Se revisa la bibliografía para conocer los últimos cambios en la actuación ante esta patología (AU)

The upper respiratory airways infections in childhood have a high incidence and they are a frequent source of consultation whose management sometimes is controversial because of the use of excessive treatment. The Waldeyer's tonsillar ring is the umbrella protector to prevent many times the infection’s progress to the whole organism. Sometimes due to less known circumstances this protection can be lost and therefore cause an important pathology in the health of the child. We show a girl with a very infrequent process during childhood and which is necessary to diagnose rapidly to avoid its progress. The peritonsilar phlegmon is the first step for an abscess and even though the first intention is to hospitalize hospital, intravenous treatment, complex complementary exams, in many cases a more conservative attitude could be adopted than the one we used in this case. We review the bibliography to learn the last changes in how to act in the presence of this disease (AU)

¿Qué opinan pediatras y residentes de Pediatría sobre la rotación por Atención Primaria? / What do Pediatricians and Pediatric Residents think of the rotation inTO Primary Health Care?

Introducción: Desde 2007 y de forma obligatoria, los médicos especialistas en formación de Pediatría (MIR) deben rotar por centros de salud durante 3 meses. Al discrepar de la forma de rotación propuesta, el grupo de docencia MIR de la Asociación Española de Pediatría de Atención Primaria (AEPap) se planteó conocer las opiniones de pediatras hospitalarios (PH), pediatras de Atención Primaria (PAP) y MIR en cuanto a necesidad, duración, período de realización y expectativas de la rotación. Metodología: Estudio transversal con encuesta validada de 13 preguntas, cuya distribución a las distintas asociaciones de la AEPap y su cumplimentación se realizó a través de su página web. Los datos se procesaron con el paquete estadístico SPSS 12.0, utilizándose en su análisis el test de χ2. Resultados: Se analizaron 323 encuestas de 13 comunidades, contestadas por el 56% de PAP, el 38,7% de MIR y el 5,3% de PH, siendo mujeres el 67,5%; predominan 2 tramos de edad: menores de 30 años y entre 41 y 50 años. De los encuestados, el 99% cree necesaria la rotación, con una duración para el 73,3% de los PAP de 6 meses con respecto a una duración de uno o 2 meses para el 56,9% de los MIR (p<0,001), preferentemente para realizar en 2 períodos (65,1% de PAP). De los PAP, el 75,5% considera que los MIR que vayan a trabajar en Atención Primaria (AP) deberían rotar 6 meses más el ultimo año de residencia (p<0,001). De los MIR, el 63,9% espera mejorar su formación en la rotación por Atención Primaria. Conclusiones: La necesidad de rotar por AP es casi unánime, 3 meses son insuficientes para la mayoría de los encuestados y los PAP consideran más adecuada una rotación de 6 meses. En la forma de realizar la rotación hay 2 preferencias mayoritarias: durante un período en cualquier año de residencia o en 2 períodos. Los MIR que piensan trabajar en AP deben rotar 6 meses durante el cuarto año de residencia. La expectativa de los MIR en su rotación es mejorar su formación (AU)

Introduction: Since 2007, on a mandatory, pediatric residents (PR) have been obliged to rotate into primary health care centers for 3 months. On disagreeing with the type of rotation proposed, the teaching group of the Spanish Primary Care Pediatrics Association (AEPap) was raised to find out the views of Hospital Pediatricians (PH), Pediatrics Health Care (PHC) and PR in terms of need, length, year in which it should take place and rotation expectations. Methodology: Cross-sectional study using a 13 question validated questionnaire, which was distributed to the various AEPap associations, and completed via the website. The data was processed with SPSS 12.0 and analysed using the Chi2 test. Results: A total of 323 surveys from 13 Autonomous Regions were analysed, of which 56% were answered by PHC, 38.7% by PR and 5.3% by PH, 67.5% of which were women, with two age groups; one under 30 years old and the other between 41–50 years. Of the participants, 99% believed it was necessary to rotate, with a duration of 6 months proposed by the PHC (73.3%) while PR considered 1 or 2 months (56.9%), (P<0001), preferably performed in two periods (65.1% of PHC). Of the PHC, 75.5% believed that the PR who were going to work in Primary Care should work 6 months more in their last year of residency (P<0001). Of the PR, 63,9% hoped to improve their training in the rotation into Primary Health Care. Conclusions: The need to rotate into Primary Health Care was almost unanimous and three months are insufficient for the majority of respondents and PHC believe it should be 6 months. There appears to be two preferences for rotation: in a period in any year of residence or in two periods. Those PR who are thinking of working in a Primary Health Care should rotate 6 months during the fourth year of residency. The PR expect rotation to improve their training (AU)

[What do pediatricians and pediatric residents think of the rotation into Primary Health Care]. / ¿Qué opinan pediatras y residentes de Pediatría sobre la rotación por Atención Primaria?

INTRODUCTION: Since 2007, on a mandatory, pediatric residents (PR) have been obliged to rotate into primary health care centers for 3 months. On disagreeing with the type of rotation proposed, the teaching group of the Spanish Primary Care Pediatrics Association (AEPap) was raised to find out the views of Hospital Pediatricians (PH), Pediatrics Health Care (PHC) and PR in terms of need, length, year in which it should take place and rotation expectations. METHODOLOGY: Cross-sectional study using a 13 question validated questionnaire, which was distributed to the various AEPap associations, and completed via the website. The data was processed with SPSS 12.0 and analysed using the Chi(2) test. RESULTS: A total of 323 surveys from 13 Autonomous Regions were analysed, of which 56% were answered by PHC, 38.7% by PR and 5.3% by PH, 67.5% of which were women, with two age groups; one under 30 years old and the other between 41-50 years. Of the participants, 99% believed it was necessary to rotate, with a duration of 6 months proposed by the PHC (73.3%) while PR considered 1 or 2 months (56.9%), (P<0001), preferably performed in two periods (65.1% of PHC). Of the PHC, 75.5% believed that the PR who were going to work in Primary Care should work 6 months more in their last year of residency (P<0001). Of the PR, 63,9% hoped to improve their training in the rotation into Primary Health Care. CONCLUSIONS: The need to rotate into Primary Health Care was almost unanimous and three months are insufficient for the majority of respondents and PHC believe it should be 6 months. There appears to be two preferences for rotation: in a period in any year of residence or in two periods. Those PR who are thinking of working in a Primary Health Care should rotate 6 months during the fourth year of residency. The PR expect rotation to improve their training.

El residente en Atención Primaria. Cómo planificar su rotación / The residents in Primary Care. How to plan their training

En España la formación como médico interno y residente (MIR) para acceder a la especialidad, comenzó en 1978. Aunque en teoría, nuestra política de salud esta dirigida hacia el modelo de Atención Primaria (AP), la formación de los residentes de Pediatría ha estado pobremente orientada en esa dirección. Los MIR de Pediatría deberían de aprender en centros de salud, pero lo más frecuente es que esta formación no tenga lugar y cuando se hace lo es de una forma más o menos voluntaria, sin criterios unificados o no sujetos a alguna forma de control. La obligatoriedad de rotar por AP ha sido aprobada por la comisión nacional de la especialidad y publicada en octubre de 2006. En este artículo revisamos el actual programa de formación de Pediatría y sus Áreas Específicas, y basados en la reciente resolución exponemos los circuitos a seguir en la acreditación de centros de salud para formación en Pediatría por parte de los tutores pediatras. Exponemos un plan de cómo y cuándo ha de ser la rotación de los residentes por la consulta del centro de Atención Primaria, incluyendo una guía de tutorización para tutores pediatras y, finalmente, un apoyo y reconocimiento para su labor de enseñanza en su trabajo (AU)

In Spain, the training as Medical Internal Resident (MIR) to access to medical specialization, began in 1978. Although in theory, our health policy is directed towards the model of Primary Health Care (PHC), the training of Pediatrics residents has been poorly oriented in that direction. The MIR Pediatrics should be training in healthcare centres, but more often than not, this training does not take place and when it does it is more or less voluntarily, without unified criteria or subjected to any form of control. The compulsory training in PHC has been approved by the National Commission on Specialization and published in October 2006. In this article we review the current pediatrics programme and its specific areas, and based on this recent resolution we explain the circuits to follow in the accreditation of health centres for pediatric teaching as well as for Pediatrics tutors. It outlines how to plan the resident?s stay in Primary Health Care, including a tutorization guide for pediatrics? tutors and finally a note of support and acknowledgement for the training work (AU)

Tumoración submandibular / Submandibular tumor

No disponible

[Outbreak of hepatitis A in day nursery: diagnosis and follow-up in a pediatric clinic]. / Brote de hepatitis por virus A en una guardería infantil: diagnóstico y seguimiento en un consultorio pediátrico.

We describe one of four epidemic known outbreaks of type "A" hepatitis during the year 1987 in Jaén, and whose focal point was a day nursery placed in our sanitary area. We identify 75 cases; we followed 48 from a pediatric surgery (PS), 33 of them were from a day nursery (attack rate, 31.73%). To the 48 children from PS, antibodies IgM and IgG against type "A" hepatitis virus were detected. No case was treated with drugs and in every case it was suggested that hygienic rules be observed and a knowledge of the disease be given to the parents. It had a good evolution in all cases, and only two of them were hospitalized, one of the parents' request and the other with thrombopenia. The remaining cases till 75, were diagnosed in other surgeries (OS) and in Hospitals (H).