[Health impact of the community intervention programme "Health education in adolescence"]. / Impacto en la salud del programa de intervención comunitaria «Educación para la salud en la adolescencia¼.

OBJECTIVE: To measure the impact of the community health programme "Education for health in adolescence" carried out in the Parquesol neighborhood, Valladolid (Spain), during the years 2015-2019. METHOD: Community-based quasi-experimental pre- and post-test analytical intervention trial with control group. A total of 407 adolescent surveys were collected. The CHIP-AE test validated for Spain was used. Pre- and post-test results were analyzed and compared with the control group. RESULTS: Improvements were found in the female intervention group compared to the control group in the variables resilience (3.68 vs. 3.41; p <0.01), health and safety at home (4.30 vs. 4.00; p <0.01), physical activities (3.16 vs. 2.60; p <0.01) and self-esteem (3.17 vs. 2.79; p <0.05). CONCLUSIONS: The community intervention carried out improves the health profile of adolescents. The baseline perception of health presents differences by gender, with higher scores in males. Post-intervention improvement is substantial in females in resilience, physical activities and health and safety at home. In addition, the worsening due to the passage of time described in previous studies is corrected in the variables self-esteem, satisfaction and well-being.

Pelvic Venous Congestion Secondary to a Circumaortic Renal Collar in an Adolescent Female: Report of a Case.

We report a 13-year-old girl who presented with a recurrent abdominal pain that started after her menarche. The abdominal palpation revealed tenderness over the left ovarian point. The laboratory study, ultrasonography, and abdominal X-ray were normal. The computed tomography and magnetic resonance imaging showed a double left renal vein with a retroaortic component, an increased left parauterine circulation, and ipsilateral ovarian vein engorgement. A diagnostic and therapeutic phlebography allowed a selective catheterization of a group of pelvic varicose veins draining to the left ovarian and to the internal iliac veins. There were no complications during the procedure and the symptoms disappeared 2 days later. Circumaortic left renal vein may cause hematuria, proteinuria, pelvic congestion syndrome, and massive hemorrhage during surgery. A conservative treatment is recommended for patients without gynecourological/renal symptoms or with mild hematuria. The endovascular treatment by gonadal venous embolization is safe and effective.

Zinc Nutritional Status in Patients with Cystic Fibrosis.

BACKGROUND: Zinc is an essential nutrient for all forms of life and its deficiency affects the normal growth and development of human beings. OBJECTIVE: The main aim was to investigate zinc nutritional status by serum zinc concentration (SZC) and dietary zinc intake and their association in cystic fibrosis (CF) patients. METHODS: A cross-sectional study was conducted in CF patients. Anthropometric measurements and respiratory and pancreatic tests were conducted. Hypozincemia was determined by SZC while using atomic absorption spectrophotometry and dietary zinc deficiency by prospective 72-h dietary surveys. RESULTS: Mean SZC (87.2 ± 16.7 µg/dL) and dietary zinc intake (97 ± 26.9% Dietary Reference Intake) were normal. Three of 17 patients with CF (17.6%) had hypozincemia and four (23.5%) had a dietary zinc deficiency. No patient with dietary zinc deficiency had hypozincemia. A positive and significant association was observed between SZC and Z-score of BMI-for-age (p = 0.048) and weight-for-height (p = 0.012) and between dietary zinc intake and energy intake (EI, p = 0.036) and Z-score of weight-for-high (p = 0.029). CONCLUSION: SZC was associated with the nutritional status, expressed as BMI (Body Mass Index) and weight-for-height Z score, and dietary zinc intake with EI and weight-for-height Z-score. No patient with hypozincemia had dietary zinc deficiency. This situation should alert us to a marginal zinc deficiency and it may explain why there were no overlapping cases between the two groups. We suggest that probably 41% of the cases in this study would be at elevated risk of zinc deficiency and a zinc supplementation may be considered.

Bioelectrical impedance vector analysis in obese and overweight children.

INTRODUCTION: BMI is the most commonly used indicator to evaluate overweight and obesity, but it cannot distinguish changes in body composition. Over recent years, it has been demonstrated that bioelectrical impedance analysis (BIA) is a more accurate method for analyzing body composition. Bioelectrical impedance vector analysis (BIVA) has revealed its effectiveness as an indicator of nutritional status and hydration. OBJECTIVE: To assess the usefulness of bioimpedance analysis on the study of body composition in a group of children with overweight and obesity. MATERIALS AND METHODS: Cross-sectional observational study. The anthropometric parameters of 167 (79 were older than 12 years) overweight and obese children were recorded. Their body composition was analyzed using BIA and BIVA, and was classified based on different criteria. Concordance was analyzed (intraclass correlation coefficient, Bland-Altman analysis and weighted Kappa coefficient). The BIVA of the subgroups was compared using the Mahalanobis distance and Hotelling's T2. Statistical significance was considered for p<0.05. RESULTS: The BMI revealed that the majority of the assessed subjects were obese, although 12% had a normal percentage of fat mass (%FM). The classification by Z-BMI and Z-%FM significantly discriminate between subjects with different levels of adiposity. In children over the age of 12, the classification of fat mass index also discriminates significantly between obesity and non-obesity. As anticipated, in the tolerance ellipses, most of the individual vectors were situated in the left lower quadrant. CONCLUSIONS: BIVA reflects differences in the bioelectric patterns of children who are classified as being overweight or obese (BMI) and who have different levels of %FM and FMI. BIVA permits a fast and easy monitoring of the evolution of the nutritional state and changes associated with body composition, and it identifies those children whose body compartments may be precisely estimated using traditional BIA methods.

Comparison study between colorimetric method and flame atomic absorption spectrophotometry in serum zinc status / Estudio comparativo entre la espectrofotometría de absorción atómica de llama y el método colorimétrico en el estado del zinc sérico

Background: There is no study that examined the association between nutrients patterns and obesity in adolescents. Goal: The aim of the present study was to identify the major nutrient patterns in adolescents and to assess their relationship with obesity. Methods: This is a nationwide cross-sectional study. Usual dietary intakes were collected using validated 168-item semi-quantitative food frequency questionnaire (FFQ). FFQ was used to evaluate nutrient patterns by factor analysis. Data on anthropometric measures were collected through standard protocols. Results: Dietary data were analyzed in 4288 subjects aged 11.43±3.23 years. Three major nutrient patterns were identified. Subjects in the fourth quartile of the first nutrient pattern tended to have higher weight, body mass index (BMI), waist circumference (WC) and hip circumference than those in the first quartile. Individuals in the fourth quartile of the second nutrient pattern had significantly lower means of weight, WC and hip circumference than those in the first quartile. The third nutrient pattern was not associated with any changes in BMI and wrist circumference in boys as well as in BMI, waist circumference and wrist circumference among girls. Conclusion: findings indicated that second nutrient pattern which mostly characterized by high consumption in mono-unsaturated fatty acid, poly-unsaturated fatty acid, potassium, calcium, vitamin E, biotin and vitamin K was associated with lower risk of obesity, while first pattern of nutrient intake with high amounts of carbohydrate, thiamin, iron and manganese was associated with greater risk of obesity

Introducción: el zinc es un oligoelemento esencial para la vida de los humanos y su deficiencia afecta al crecimiento y al desarrollo humano. La concentración de zinc en suero (SZnC) proporciona información útil en la categorización clínica de la deficiencia y en estados de toxicidad. Objetivos: Este artículo presenta un estudio comparativo de La Espectrometría de Absorción Atómica de Llama (FASS) y El Método colorimétrico en el análisis de SZnC e hipozincemia. Métodos: las concentraciones séricas de zinc de 93 pacientes (1 a 31 años) con enfermedades crónicas se utilizaron para el análisis. Análisis estadístico: para SZnC fueron valorados el coeficiente de correlación de Pearson, El análisis de regresión lineal simple, el método Bland & Altman (B & A) y el coeficiente de correlación de concordancia (CCC); y para la hipozincemia, las diferencias fueron estudiadas empleando el índice Kappa de Cohen. Resultados: los principales resultados indican que la medición del SZnC por ambos métodos no presentaron diferencias significativas (p = 0.328) ni relación lineal (R = 0.18, p = 0.077). Además, el porcentaje de casos de hipozincemia por el el método colorimétrico fue casi el doble (13%) que el FASS (8%). Solo hubo un caso coincidente en ambos métodos a <70 μg / dl. Discusión: el método colorimétrico en hipozincemia pronostica valores mayores que FASS. Esta baja concordancia entre ambos métodos fue corroborado con un coeficiente de correlación de concordancia (CCC) bajo de 0.17. Además, el índice Kappa de Cohen (-0.013) mostró una concordancia baja entre ambos métodos también. En otros estudios la variabilidad de SZnC mediante el método colorimétrico es mayor que con FASS. Conclusión: En resumen, a pesar de ello, la media de las concentraciones séricas de zinc por ambos métodos son similares, aunque el diagnóstico de casos con hipozincemia no lo es. El grado de similitud entre los métodos es bajo, con una baja fuerza de concordancia en el diagnóstico de hipozincemia. Por lo tanto, recomendamos el uso de FASS para evaluar El estado de zinc y el diagnóstico de hipozincemia, en lugar del método colorimétrico

[Excess weight in patients with cystic fibrosis: is it always beneficial?]

INTRODUCTION: The primary objective of this study was to find out the prevalence of overweight and obese status, as well as their association to pulmonary function, total cholesterol and vitamin D in patients with cystic fibrosis (CF). MATERIALS AND METHODS: This is a multicenter descriptive and cross-sectional study. Twelve Spanish hospitals participated. 451 patients with CF were included. Adults were classified according to body mass index (BMI) and children were classified according to BMI percentiles (WHO tables). Pearson's correlation, Anova, Student's t-test and multiple linear regression were conducted. RESULTS: Mean age was 12.3 (range 4-57) years old, 51% were male and 18% had pancreatic sufficiency. Participants were classified in five nutritional status categories: 12% were malnourished; 57%, at nutritional risk; 24%, normally nourished; 6%, overweight; and 1%, obese. Pulmonary function in overweight or obese patients (91 ± 19%) was better than in malnourished patients (77 ± 24%) (p = 0.017). However, no difference was observed between those at nutritional risk (86 ± 19%) or normally nourished (90 ± 22%) groups. Overweight and obese patients had higher levels of total cholesterol (p = 0.0049), a greater proportion of hypercholesterolemia (p = 0.001), as well as lower levels of 25 OH vitamin D (p = 0.058). CONCLUSIONS: Prevalence of overweight and obese was 6 and 1%. Excess weight status does not offer any benefit in pulmonary function in comparison to normally nourished patients.

Excess weight in patients with cystic fibrosis: is it always beneficial? / Incremento de peso en pacientes con fibrosisquística: ¿es siempre beneficioso?

Introduction: The primary objective of this study was to find out the prevalence of overweight and obese status, as well as their association to pulmonary function, total cholesterol and vitamin D in patients with cystic fibrosis (CF). Materials and methods: This is a multicenter descriptive and cross-sectional study. Twelve Spanish hospitals participated. 451 patients with CF were included. Adults were classified according to body mass index (BMI) and children were classified according to BMI percentiles (WHO tables). Pearson’s correlation, Anova, Student’s t-test and multiple linear regression were conducted. Results: Mean age was 12.3 (range 4-57) years old, 51% were male and 18% had pancreatic sufficiency. Participants were classified in five nutritional status categories: 12% were malnourished; 57%, at nutritional risk; 24%, normally nourished; 6%, overweight; and 1%, obese. Pulmonary function in overweight or obese patients (91 ± 19%) was better than in malnourished patients (77 ± 24%) (p = 0.017). However, no difference was observed between those at nutritional risk (86 ± 19%) or normally nourished (90 ± 22%) groups. Overweight and obese patients had higher levels of total cholesterol (p = 0.0049), a greater proportion of hypercholesterolemia (p = 0.001), as well as lower levels of 25 OH vitamin D (p = 0.058). Conclusions: Prevalence of overweight and obese was 6 and 1%. Excess weight status does not offer any benefit in pulmonary function in comparison to normally nourished patients (AU)

Introducción y objetivos: conocer la prevalencia de sobrepeso y obesidad, así como su asociación con la función pulmonar, el colesterol total y la vitamina D en pacientes con fibrosis quística (FQ). Material y métodos: estudio multicéntrico descriptivo y transversal. Participaron 12 hospitales españoles. Fueron incluidos 451 pacientes con FQ, clasificados según el índice de masa corporal (IMC) en adultos y el IMC percentilado (tablas OMS) en niños. Análisis estadístico: C.Pearson, Anova, t de Student y regresión lineal múltiple. Resultados: la mediana de edad fue 12,3 (rango 4-57) años. Un 51% eran varones y el 18%, suficientes pancreáticos (SP). El 12% estaba desnutrido; el 57%, en riesgo nutricional; el 24%, normonutrido; el 6% presentaba sobrepeso; y un 1%, obesidad. La función pulmonar en los pacientes con sobrepeso (91 ± 19%) era mejor que en los desnutridos (77 ± 24%) (p = 0,017), sin embargo, no se observaron diferencias con respecto a los que estaban en riesgo nutricional (86 ± 19%) o normonutridos (90 ± 22%). Los pacientes con sobrepeso tenían más elevado el colesterol total (p = 0,0049), mayor proporción de hipercolesterolemia (p = 0,001), así como niveles más bajos de 25 OH vitamina D (p = 0,058). Conclusiones: la prevalencia de sobrepeso y obesidad fue del 6 y el 1%. El sobrepeso y la obesidad no ofrecen beneficio sobre la función pulmonar en comparación con los normonutridos (AU)

Cuando lo funcional se torna orgánico / When the functional becomes organic

Los vómitos persistentes en pediatría son frecuentes, fundamentalmente en edades tempranas, no tanto durante la adolescencia. Las causas son variadas, y entre ellas destacan las psicógenas, siendo difícil el diagnóstico diferencial. Presentamos el caso de un niño de 12 años que ingresa en psiquiatría desde el servicio de pediatría de su hospital de referencia para estudio por cuadro de vómitos persistentes, ante la sospecha de un cuadro psicógeno. Previamente fue valorado por numerosos especialistas en pediatría y psiquiatría de diferentes hospitales, resultando todas las pruebas complementarias negativas. El paciente empezó a vomitar a los 5 años de forma repetida, precisando múltiples ingresos. En los 3 últimos años presentó una mayor incidencia de los vómitos, con pruebas complementarias normales. En el último mes requirió 4 ingresos seguidos por empeoramiento; en seguimiento en salud mental y tratamiento con aripiprazol y clonazepam sin mejoría. Tras permanecer ingresado un mes, persistieron epigastralgia y vómitos. No mejoró con el tratamiento psicofarmacológico, conductual, ni respondió al placebo. Ante la intensidad del cuadro, se consultó con el servicio de pediatría, que reiniciaron exploraciones complementarias, objetivándose una grave patología gastroesofágica. El paciente mejoró al iniciar una pauta de tratamiento con omeprazol. Se trata de un caso de difícil diagnóstico diferencial. Es importante replantearse el diagnóstico ante cuadros con escasa mejoría clínica o ante un empeoramiento. Recordar siempre que al diagnóstico psiquiátrico se suele llegar a través de un diagnóstico de exclusión, una vez descartadas el resto de patologías médicas (AU)

Persistent vomiting is common in Paediatrics, particularly at early ages, but not so much during adolescence. The causes are varied, with psychogenic causes being the most difficult in the differential diagnosis. The case is presented of a 12 year-old boy, suspected of a psychogenic disorder, who was admitted to psychiatry for the study of persistent vomiting. He was previously assessed by numerous specialists in paediatrics and psychiatry in different hospitals, with all tests being negative. The patient began to vomit repeatedly at 5 years old, requiring many hospital admissions. There has been an increased incidence of vomiting past three years, with normal laboratory tests. He was admitted four times in the last month, followed by worsening. He was assessed in Mental Health clinics and was treated with aripiprazole and clonazepam, with no improvement. He was hospitalised for a month, with epigastric pain and vomiting persisting during this time. He did not improve with the psychopharmacological or behavioural therapy. The intensity of the symptom has currently increased. Paediatrics was consulted, and they asked for further examinations, in which they discovered a severe gastroesophageal disease. The patient improved when starting a treatment with omeprazole. This is a case of difficult differential diagnosis. It is important to rethink the diagnosis in patients with little clinical improvement or worsening. Always remember that the psychiatric diagnosis is usually reached through a diagnosis of exclusion, once is discarded other medical conditions are ruled out (AU)

Ingesta dietética y adherencia a la dieta mediterránea en un grupo de estudiantes universitarios en función de la práctica deportiva.

Introducción: la alimentación de los jóvenes universitarios se aleja cada vez más de la dieta mediterránea (DM). El binomio alimentación-actividad física es fundamental para mantener un adecuado estado de salud.Objetivo: comparar la ingesta en un grupo de estudiantes universitarios deportistas frente a otro que no realiza deporte habitualmente.Sujetos y métodos:estudio observacional transversal realizado en 49 voluntarios de la Universidad de Valladolid. Se determinaron peso, talla y actividad física (cuestionario GPAQ). La ingesta se evaluó a partir de un cuestionario de frecuencia de consumo y un registro de alimentos de 3 días. La adherencia a la DM se estimó con el Mediterranean Diet Score. Las diferencias entre las variables en función del sexo y la práctica deportiva se analizaron con la t de Student o la U-Mann-Whitney. Significación estadística: p < 0,05.Resultados: todos los sujetos presentaron normopeso, sin diferencias en función de la práctica deportiva. El nivel de actividad física fue inferior en las mujeres. En todos los estudiantes la dieta fue ligeramente hiperproteica, rica en grasas y colesterol, con un inadecuado perfil lipídico y deficiente en hidratos de carbono y fibra. Se cubren los requerimientos de micronutrientes. Destaca un escaso consumo de frutas-verdurashortalizas, cereales, aceite de oliva, pescado y frutos secos; y un exceso de carne, mantequilla, bollería-industrial, dulces, snacksy refrescos. El 50% de la muestra tiene una adherencia baja o muy baja a la DM.Conclusión: las dietas de los jóvenes universitarios no cumplen los objetivos nutricionales para la población española y presentan una adherencia media-baja a la DM, independientemente de la práctica deportiva.

Ingesta dietética y adherencia a la dieta mediterránea en un grupo de estudiantes universitarios en función de la práctica deportiva / Dietary intake and adherence to the Mediterranean diet in a group of university students depending on the sports practice

Introducción: la alimentación de los jóvenes universitarios se aleja cada vez más de la dieta mediterránea (DM). El binomio alimentación-actividad física es fundamental para mantener un adecuado estado de salud. Objetivo: comparar la ingesta en un grupo de estudiantes universitarios deportistas frente a otro que no realiza deporte habitualmente. Sujetos y métodos: estudio observacional transversal realizado en 49 voluntarios de la Universidad de Valladolid. Se determinaron peso, talla y actividad física (cuestionario GPAQ). La ingesta se evaluó a partir de un cuestionario de frecuencia de consumo y un registro de alimentos de 3 días. La adherencia a la DM se estimó con el Mediterranean Diet Score. Las diferencias entre las variables en función del sexo y la práctica deportiva se analizaron con la t de Student o la U-Mann-Whitney. Significación estadística: p < 0,05. Resultados: todos los sujetos presentaron normopeso, sin diferencias en función de la práctica deportiva. El nivel de actividad física fue inferior en las mujeres. En todos los estudiantes la dieta fue ligeramente hiperproteica, rica en grasas y colesterol, con un inadecuado perfil lipídico y deficiente en hidratos de carbono y fibra. Se cubren los requerimientos de micronutrientes. Destaca un escaso consumo de frutas-verdurashortalizas, cereales, aceite de oliva, pescado y frutos secos; y un exceso de carne, mantequilla, bollería-industrial, dulces, snacks y refrescos. El 50% de la muestra tiene una adherencia baja o muy baja a la DM. Conclusión: las dietas de los jóvenes universitarios no cumplen los objetivos nutricionales para la población española y presentan una adherencia media-baja a la DM, independientemente de la práctica deportiva (AU)

Introduction: University students eating habits are moving away increasingly from the Mediterranean Diet (MD) Both nutrition and physical activity are essential to preserve an appropriate health. Objective: To compare food intake between athletes and sedentary University students. Subjects and methods: Cross-sectional study conducted on 49 students from the University of Valladolid. The weight and height were determined. The physical activity was evaluated by the GPAQ questionnaire. A food frequency questionnaire and a three-day food record were completed for the food intake analysis. The MD adherence was estimated by the Mediterranean Diet Score (MDS). Differences by sex and sport practice were analyzed with the T-test or with the Mann-Whitney-test. Statistical significance was reached at p < 0.05. Results: All subjects had normal weight with no significant differences depending on the sports practice. Women had a lower physical activity level than men. The diet in the whole sample was slightly hyperproteic, rich in fats and cholesterol, with an inadequate fat profile and poor in carbohydrates and fiber. Generally, the students covered the micronutrients requirements. There was a scarce consumption of fruits and vegetables, cereals, olive oil, fish and nuts; and an excessive intake of meat, butter, processed bakery foods, sweets, snacks and soft drinks. Around 50% of the sample had a low or very low MD adherence. Conclusion: The University student food pattern does not accomplish the nutritional objectives within the Spanish population and have a medium-low Mediterranean diet adherence, and there are no differences depending on the sports practice (AU)

[Not Available]. / Nutritional approach of inpatients with anorexia nervosa.

Anorexia nervosa (AN) is the most prevalent of eating disorders in children and adolescents, and its treatment is long and complex, involving a multidisciplinary team. Nutritional rehabilitation and restoration of a healthy body weight is one of the central goals in the initial stages of inpatient treatment. However, current recommendations on initial energy requirements for these patients are inconsistent, with a clear lack of controlled studies, available scientific evidence and global consensus on the most effective and safe refeeding practices in hospitalized adolescents with anorexia nervosa (AN). Conservative refeeding recommendations have been classically established in order to prevent the refeeding syndrome. Nevertheless, various works have recently appeared advocating a higher initial caloric intake, without observing more complications or refeeding syndrome, and allowing a shorter average stay. We present our experience in the treatment of restricting AN with a conservative progressive treatment. We have obtained good results with this approach, which was well tolerated by patients, with no observing complications. As a consequence, the medical team could establish a pact about the therapeutic goals with the patients in an easier way.

Nutritional approach of inpatients with anorexia nervosa / Abordaje nutricional de pacientes ingresados con anorexia nerviosa

Anorexia nervosa (AN) is the most prevalent of eating disorders in children and adolescents, and its treatment is long and complex, involving a multidisciplinary team. Nutritional rehabilitation and restoration of a healthy body weight is one of the central goals in the initial stages of inpatient treatment. However, current recommendations on initial energy requirements for these patients are inconsistent, with a clear lack of controlled studies, available scientific evidence and global consensus on the most effective and safe refeeding practices in hospitalized adolescents with anorexia nervosa (AN). Conservative refeeding recommendations have been classically established in order to prevent the refeeding syndrome. Nevertheless, various works have recently appeared advocating a higher initial caloric intake, without observing more complications or refeeding syndrome, and allowing a shorter average stay. We present our experience in the treatment of restricting AN with a conservative progressive treatment. We have obtained good results with this approach, which was well tolerated by patients, with no observing complications. As a consequence, the medical team could establish a pact about the therapeutic goals with the patients in an easier way (AU)

La anorexia nerviosa (AN) es el trastorno del comportamiento alimentario más prevalente en niños y adolescentes; su tratamiento es largo y complejo, e involucra a múltiples profesionales. La rehabilitación nutricional y la recuperación de un peso corporal normal es uno de los objetivos centrales en las fases iniciales del tratamiento del paciente ingresado. Sin embargo, las recomendaciones actuales sobre los requerimientos energéticos iniciales para estos pacientes son inconsistentes, con una clara ausencia de estudios controlados, evidencia científica disponible y consenso global sobre la forma de realimentación más efectiva y segura en adolescentes ingresados con anorexia nerviosa (AN). Clásicamente se han recomendado una realimentación conservadora para prevenir el síndrome de realimentación. No obstante, han aparecido recientemente varios trabajos recomendado una ingesta calórica inicial más elevada, sin observar más complicaciones ni síndrome de realimentación, y asociadas a estancias medias más cortas. Presentamos aquí nuestra experiencia en el tratamiento de la AN restrictiva con un tratamiento progresivo conservador. Hemos obtenido buenos resultados con este abordaje, bien tolerando por los pacientes, y sin observar complicaciones. Gracias a él, el equipo médico pudo establecer más fácilmente un acuerdo sobre los objetivos terapéuticos con el paciente (AU)

Situación actual de la formación sanitaria especializada en España / Current situation of specialist medical training in Spain

La formación de especialistas en ciencias de la salud se ha mantenido casi inalterada durante varias décadas, pero a partir de la publicación del Real Decreto de Troncalidad, de reespecialización troncal y áreas de capacitación específica, el clásico sistema MIR puede sufrir profundos cambios. Repasamos en este artículo la evolución del mismo en nuestro país

Specialist medical training through the Internal Medical Resident system has remained almost unchanged for several decades, but now it is due to experience profound changes since the publication of the "Troncalidad" and specific training areas ordinance. In this article, we review its evolution in our country

[VITAMIN D AND CHRONIC LUNG COLONIZATION IN PEDIATRIC AND YOUNG ADULTS CYSTIC FIBROSIS PATIENTS]. / VITAMINA D Y COLONIZACIONES PULMONARES CRÓNICAS EN PACIENTES PEDIÁTRICOS Y ADULTOS JÓVENES CON FIBROSIS QUÍSTICA.

INTRODUCTION AND OBJECTIVES: evaluate vitamin D status and its association with chronic lung colonisation in Cystic Fibrosis patients. MATERIAL AND METHODS: descriptive cross-sectional multicenter study. From November 2012 to April 2014, at 12 national hospitals, 377 patients with Cystic Fibrosis were included. Vitamin D levels < 30 ng/ml were classified as insufficient. Chronic colonisation was considered if they had at least two positive cultures in the past year. RESULTS: the median age was 8.9 years (2 months to 20 years). 65% had insufficient levels of vitamin D. There was an inverse correlation between age and vitamin D levels (r = -0.20 p < 0.001). Those diagnosed by screening, were younger and had higher levels of vitamin D. There was an inverse correlation between the number of colonisations and vitamin D levels (r = -0.16 p = 0.0015). Adjusting for age, pancreatic status and diagnosis by screening, colonization by S. aureus in 6 years, increased the risk of insufficient levels of vitamin D: OR 3.17 (95% CI 1.32 to 7.61) (p = 0.010) and OR 3.77 (95% CI 1.37 to 10 , 37) (p = 0.010), respectively. CONCLUSIONS: despite adequate supplementation, more than half of our patients did not achieve optimal levels of vitamin D. Regardless of age, diagnosis by screening or pancreatic status, chronic colonization by Pseudomonas sp. in children and adolescents and S. Aureus in infants and preschoolars increases the risk of developing vitamin D deficiency in these patients.

Introducción y objetivos: conocer la situación en la que se encuentran los pacientes con fibrosis quística en relación con sus niveles de vitamina D y su asociación con las colonizaciones pulmonares crónicas. Material y métodos: estudio multicéntrico transversal. Participaron 12 hospitales nacionales. De noviembre a abril del 2012 al 2014 se incluyeron 377 pacientes con fibrosis quística. Se consideraron insuficientes niveles de vitamina D < 30 ng/ml. Presentar al menos dos cultivos positivos en el último año fue considerado un criterio de colonización crónica. Resultados: los pacientes tenían una mediana de edad de 8,9 años (2 meses­20 años). Un 65% presentaban niveles insuficientes de vitamina D. Se observó una correlación inversa entre edad y niveles de vitamina D (r = -0,20 p < 0,001). Los diagnosticados por cribado eran más jóvenes y tenían niveles de vitamina D más altos. Los niveles de vitamina D presentaron una correlación inversa con el número de colonizaciones pulmonares (r = -0,16 p = 0,0015). Ajustando por edad, función pancreática y diagnóstico mediante cribado, la colonización por S. Aureus en menores de seis años y por Pseudomonas sp. en los mayores de esa edad, incrementaban el riesgo de presentar niveles insuficientes de vitamina D: OR 3,17 (IC95% 1,32-7,61) (p=0,010) y OR 3,77 (IC95% 1,37- 10,37)(p = 0,010), respectivamente. Conclusiones: a pesar de una suplementación adecuada, más de la mitad de nuestros pacientes no alcanzan niveles óptimos de vitamina D. La colonización crónica por Pseudomonas sp. en escolares y adolescentes y por S. Aureus en lactantes y preescolares se asocia de forma independiente con la deficiencia de vitamina D.

Vitamina D y colonizaciones pulmonares crónicas en pacientes pediátricos y adultos jóvenes con fibrosis quística / Vitamin D and chronic lung colonization in pediatric and young adults cystic fibrosis patients

Introducción y objetivos: conocer la situación en la que se encuentran los pacientes con fibrosis quística en relación con sus niveles de vitamina D y su asociación con las colonizaciones pulmonares crónicas. Material y métodos: estudio multicéntrico transversal. Participaron 12 hospitales nacionales. De noviembre a abril del 2012 al 2014 se incluyeron 377 pacientes con fibrosis quística. Se consideraron insuficientes niveles de vitamina D < 30 ng/ml. Presentar al menos dos cultivos positivos en el último año fue considerado un criterio de colonización crónica. Resultados: los pacientes tenían una mediana de edad de 8,9 años (2 meses-20 años). Un 65% presentaban niveles insuficientes de vitamina D. Se observó una correlación inversa entre edad y niveles de vitamina D (r = -0,20 p < 0,001). Los diagnosticados por cribado eran más jóvenes y tenían niveles de vitamina D más altos. Los niveles de vitamina D presentaron una correlación inversa con el número de colonizaciones pulmonares (r = -0,16 p = 0,0015). Ajustando por edad, función pancreática y diagnóstico mediante cribado, la colonización por S. Aureus en menores de seis años y por Pseudomonas sp. en los mayores de esa edad, incrementaban el riesgo de presentar niveles insuficientes de vitamina D: OR 3,17 (IC95% 1,32-7,61) (p=0,010) y OR 3,77 (IC95% 1,37- 10,37)(p = 0,010), respectivamente. Conclusiones: a pesar de una suplementación adecuada, más de la mitad de nuestros pacientes no alcanzan niveles óptimos de vitamina D. La colonización crónica por Pseudomonas sp. en escolares y adolescentes y por S. Aureus en lactantes y preescolares se asocia de forma independiente con la deficiencia de vitamina D (AU)

Introduction and objectives: evaluate vitamin D status and its association with chronic lung colonisation in Cystic Fibrosis patients. Material and methods: descriptive cross-sectional multicenter study. From November 2012 to April 2014, at 12 national hospitals, 377 patients with Cystic Fibrosis were included. Vitamin D levels < 30 ng/ml were classified as insufficient. Chronic colonisation was considered if they had at least two positive cultures in the past year. Results: the median age was 8.9 years (2 months to 20 years). 65% had insufficient levels of vitamin D. There was an inverse correlation between age and vitamin D levels (r = -0.20 p < 0.001). Those diagnosed by screening, were younger and had higher levels of vitamin D. There was an inverse correlation between the number of colonisations and vitamin D levels (r = -0.16 p = 0.0015). Adjusting for age, pancreatic status and diagnosis by screening, colonization by S. aureus in <6 years and Pseudomonas sp. in > 6 years, increased the risk of insufficient levels of vitamin D: OR 3.17 (95% CI 1.32 to 7.61) (p = 0.010) and OR 3.77 (95% CI 1.37 to 10,37) (p = 0.010), respectively. Conclusions: despite adequate supplementation, more than half of our patients did not achieve optimal levels of vitamin D. Regardless of age, diagnosis by screening or pancreatic status, chronic colonization by Pseudomonas sp. in children and adolescents and S. Aureus in infants and preschoolars increases the risk of developing vitamin D deficiency in these patients (AU)

Diseño y aplicación de un cuestionario de calidad dietética de los menús escolares / Design and implementation of a questionnaire to evaluate the dietary quality of school meals

Introducción: El comedor escolar es el centro de comida habitual para muchos niños. Aunque actualmente se dispone de guías y recomendaciones para los menús escolares, resulta difícil evaluar su calidad dietética. Objetivos: Diseñar un cuestionario para evaluar la calidad desde el punto de vista dietético de los menús escolares de forma rápida y sencilla. Material y métodos: Partiendo de las recomendaciones, se ha diseñado un cuestionario (COMES) de 15 ítems que hacen referencia a la frecuencia de consumo de alimentos y otras características de los menús escolares. A continuación se realizó un estudio longitudinal prospectivo en el que se analizaron con este cuestionario 36 planillas de menús de 4 empresas de restauración colectiva que prestaban l servicio de comedor escolar en Castilla y León durante los cursos 2006-2007 a 2010-2011. Se analizaron las diferencias en función del sistema de gestión de las empresas mediante la prueba U de Mann-Whitney y el test de Kruskal- Wallis. La significación se alcanzó con una p<0,05. Resultados: Se observó un incumplimiento de la recomendación de ingesta de derivados cárnicos, lácteos y precocinados por exceso en el 97,2%, 94,4% y 27,8% de los menús analizados, respectivamente; y un incumplimiento por defecto en la ingesta de pescado, fruta, legumbre y guarniciones de verduras y hortalizas en el 83,3%, 94,4%, 91,7% y 75% de los menús, respectivamente, aunque sí cumplían las recomendaciones del consenso de comedores para todos los grupos excepto frutas y lácteos. La variedad de alimentos y de técnicas culinarias fue adecuada. No se encontraron diferencias estadísticamente significativas en la puntuación del COMES en función del tipo de gestión (p=0,87), aunque se observó que el sistema de catering ofrece mayor calidad dietética. Conclusiones: Se ha propuesto una herramienta que permite valorar la calidad dietética de los menús escolares de forma rápida y sencilla. La valoración de la frecuencia de consumo de los alimentos más problemáticos para la edad escolar con esta escala es mucho más exigente que las de las recomendaciones actuales. Aún así, los menús analizados presentaban una calidad aceptable en cuanto a variedad de alimentos y técnicas culinarias, pero una excesiva oferta de lácteos a expensas de un déficit de fruta fresca. Por otra parte, el sistema de gestión transportado (catering caliente y línea fría) ofrece menús más acordes con las recomendaciones dietéticas (AU)

Introduction: The school canteen provides a substantial proportion of the daily nutritional intake for manychildren. There are nutritional standards for school meals, however, it is still difficult to assess the dietary quality. Aims: To design a questionnaire for assessing the dietary quality of school meals, quickly and easily. Methods: A dietary questionnaire (COMES) was designed on the basis of the current recommendations. COMES consist of 15 items related to the foodfrequency and to other characteristics of school meals. Then, a longitudinal prospective study was performed in order to analyze, with COMES, 36 school meals of 4 catering companies from Castilla y León during the academic years 2006-2007 to 2010-2011. Differences in dietary quality menus according to the management system of catering companies (in situ vs. transported) were analyzed by using the Mann-Whitney and the Kruskal-Wallis tests. The significance was reached at p <0,05. Results: The frequency intake of meat, dairy and prepared products was higher to the recommended in 97,2%, 94,4% and 27,8% of the analyzed menus, respectively. By contrast, the frequency intake of fish, fruit, legume, and vegetable garnishes were lower to the recommended in 83,3%, 94,4%, 91,7% and 75% of menus, respectively. Nevertheless, recommendations established by our consensus document for school meals are complied for all food groups, except for dairy and fruits. The variety of foods and culinary techniques were appropriate. No significant differences were found in the COMES score according to the management system (p=0,87), although catering system provides higher dietary quality. Conclusions: A new tool to assess quickly and easily the nutritional quality of school meals has been proposed. The assessment of the frequency intake of the most problematic foods for schoolchildren with this scale is much more demanding than the current recommendations. Even so, menus analyzed showed an acceptable quality in terms of variety of foods and culinary techniques, although milk frequency in the menus was excessive at the expense of fresh fruit. On the other hand, the transported system (i.e. catering, both hot and cold-holding) provides menus more consistent with the dietary recommendations (AU)

[Design and implementation of a questionnaire to evaluate the dietary quality of school meals]. / Diseño y aplicación de un cuestionario de calidad dietética de los menús escolares.

INTRODUCTION: The school canteen provides a substantial proportion of the daily nutritional intake for many children. There are nutritional standards for school meals, however, it is still difficult to assess the dietary quality. AIMS: To design a questionnaire for assessing the dietary quality of school meals, quickly and easily. METHODS: A dietary questionnaire (COMES) was designed on the basis of the current recommendations. COMES consist of 15 items related to the food-frequency and to other characteristics of school meals. Then, a longitudinal prospective study was performed in order to analyze, with COMES, 36 school meals of 4 catering companies from Castilla y León during the academic years 2006-2007 to 2010-2011. Differences in dietary quality menus according to the management system of catering companies (in situ vs. transported) were analyzed by using the Mann-Whitney and the Kruskal-Wallis tests. The significance was reached at p <0,05. RESULTS: The frequency intake of meat, dairy and prepared products was higher to the recommended in 97,2%, 94,4% and 27,8% of the analyzed menus, respectively. By contrast, the frequency intake of fish, fruit, legume, and vegetable garnishes were lower to the recommended in 83,3%, 94,4%, 91,7% and 75% of menus, respectively. Nevertheless, recommendations established by our consensus document for school meals are complied for all food groups, except for dairy and fruits. The variety of foods and culinary techniques were appropriate. No significant differences were found in the COMES score according to the management system (p=0,87), although catering system provides higher dietary quality. CONCLUSIONS: A new tool to assess quickly and easily the nutritional quality of school meals has been proposed. The assessment of the frequency intake of the most problematic foods for schoolchildren with this scale is much more demanding than the current recommendations. Even so, menus analyzed showed an acceptable quality in terms of variety of foods and culinary techniques, although milk frequency in the menus was excessive at the expense of fresh fruit. On the other hand, the transported system (i.e. catering, both hot and cold-holding) provides menus more consistent with the dietary recommendations.

Introducción: El comedor escolar es el centro de comida habitual para muchos niños. Aunque actualmente se dispone de guías y recomendaciones para los menús escolares, resulta difícil evaluar su calidad dietética. Objetivos: Diseñar un cuestionario para evaluar la calidad desde el punto de vista dietético de los menús escolares de forma rápida y sencilla. Material y métodos: Partiendo de las recomendaciones, se ha diseñado un cuestionario (COMES) de 15 ítems que hacen referencia a la frecuencia de consumo de alimentos y otras características de los menús escolares. A continuación se realizó un estudio longitudinal prospectivo en el que se analizaron con este cuestionario 36 planillas de menús de 4 empresas de restauración colectiva que prestaban el servicio de comedor escolar en Castilla y León durante los cursos 2006-2007 a 2010-2011. Se analizaron las diferencias en función del sistema de gestión de las empresas mediante la prueba U de Mann-Whitney y el test de Kruskal- Wallis. La significación se alcanzó con una p.