Waist-to-height ratio as a risk marker for metabolic syndrome in childhood. A meta-analysis.

BACKGROUND: Individuals with abdominal obesity have a higher cardiovascular risk, regardless of the degree of global overweight. OBJECTIVE: To estimate the accuracy of the Waist/height ratio (WtHR) as a risk marker for metabolic syndrome (MS) in children or adolescents. METHODS: Published cohort or cross-sectional studies (Pubmed, Embase-SCOPUS and CINAHL) were searched, with no limits of time. Studies providing Waist/height ratio and clustered criteria of metabolic syndrome were included. RESULTS: Thirty-one studies (66,912 subjects) were selected. Overall, a high WtHR (≥0.5) was associated with a four-fold increased risk of clustered criteria of MS (odds ratio [OR] 4.15, 95% confidence interval [95% CI]: 2.69 to 6.42) and two-fold increased risk when adjusted by general obesity (adjusted OR 2.26, 95% CI: 1.29 to 3.98). The WtHR, as a quantitative measure, showed a pooled area under the curve of 0.76 (95% CI: 0.71 to 0.80) and, as a dichotomous measure, with a cut-off point close to 0.5, a sensitivity of 60% (95% CI: 50% to 68.8%) and a specificity of 79% (95% CI: 71.6% to 83.9%). CONCLUSIONS: Measuring WtHR may be considered in regular health checks of children and adolescents, as it can measure cardiovascular risk regardless of the degree of general obesity.

Continuum, la plataforma de Formación Basada en Competencias / Continuum, the continuing education platform based on a competency matrix

La Formación Basada en Competencias es una modalidad formativa que ha cambiado el enfoque tradicional centrado en la enseñanza por otro basado en el aprendizaje. Los alumnos son el centro del proceso, en el que deben aprender a aprender, a resolver problemas y a adaptarse a los cambios en su entorno. El objetivo es lograr un aprendizaje que integre el saber, el saber hacer, el saber ser y el saber estar. A este conjunto de saberes se les denomina competencias. Es fundamental disponer de una referencia de las competencias requeridas para identificar la necesidad de las mismas. Su adquisición se aborda a través de módulos docentes en los que se pueden adquirir una o más competencias. Esta estrategia docente ha sido adoptada por Continuum, la plataforma de formación a distancia de la Asociación Española de Pediatría, que ha desarrollado una matriz de competencias, basada en el programa de formación del Global Pediatric Education Consortium. En este artículo repasaremos los fundamentos de la Formación Basada en Competencias y cómo se aplica en Continuum

Competency-Based Education is a learning method that has changed the traditional teaching-based focus to a learning-based one. Students are the centre of the process, in which they must learn to learn, solve problems, and adapt to changes in their environment. The goal is to provide learning based on knowledge, skills (know-how), attitude and behaviour. These sets of knowledge are called competencies. It is essential to have a reference of the required competencies in order to identify the need for them. Their acquisition is approached through teaching modules, in which one or more skills can be acquired. This teaching strategy has been adopted by Continuum, the distance learning platform of the Spanish Paediatric Association, which has developed a competency matrix based on the Global Paediatric Education Consortium training program. In this article, a review will be presented on the basics of Competency-Based Education and how it is applied in Continuum

Revisión sistemática de la validez de los urocultivos recogidos con bolsa estéril perineal / Systematic review of the validity of urine cultures collected by sterile perineal bags

INTRODUCCIÓN: La bolsa adhesiva perineal es el método más usado en nuestro medio para la recogida de orina para cultivo en el lactante, a pesar de que presenta un alto riesgo de contaminación y de resultados falsos positivos. Nos proponemos cuantificar ambos riesgos a través de una revisión sistemática. MÉTODOS: Búsqueda actualizada a mayo del 2014 en PUBMED, SCOPUS (incluye EMBASE), IBECS; CINHAL, LILACS Y CUIDEN, sin límites de idioma ni tiempo. Se extrajeron porcentajes de orinas contaminadas, falsos positivos, sensibilidad y especificidad (respecto cateterismo o punción vesical). RESULTADOS: Se seleccionaron 21 artículos de calidad media (7.659 muestras). El porcentaje agrupado de orinas contaminadas fue del 46,6% (15 estudios; 6.856 muestras; intervalo de confianza del 95% [IC del 95%], 35,6 a 57,8%; I2: 97,3%). El porcentaje agrupado de falsos positivos fue del 61,1% (12 estudios; 575 muestras; IC del 95%, 37,9 a 82,2%; I2: 96,2%). En 5 estudios se pudieron estimar la sensibilidad (88%; IC del 95%, 81 a 93%; I2: 55,2%) y especificidad (82%; IC del 95%, 75 a 89%; I2: 41,3%), aunque en los recuentos no se incluyeron orinas contaminadas. CONCLUSIÓN: La bolsa adhesiva perineal no es un método suficientemente válido para cultivo de orina porque casi la mitad resultarán contaminados y de los positivos 2 de cada 3 serán falsos. Aun siendo estimaciones imprecisas, por su gran heterogeneidad, deben ser tenidas en cuenta en la elección del método de recogida de orina. Las estimaciones de sensibilidad y especificidad no son aplicables por no considerar el riesgo de contaminación

INTRODUCTION: The perineal adhesive bag is the most used method in our country for urine culture collection in infants, despite having a high risk of contamination and false-positive results. We aim to quantify both types of risks through a systematic review. METHODS: Search updated in May 2014 in PUBMED, SCOPUS (includes EMBASE), IBECS; CINAHL, LILACS AND CUIDEN, without language or time limits. Percentages of contaminated urines, false positives, sensitivity and specificity (with respect to catheterization or bladder puncture) were recorded. RESULTS: A total of 21 studies of medium quality (7,659 samples) were selected. The pooled percentage of contaminated urines was 46.6% (15 studies; 6856 samples; 95% confidence interval [95% CI]: 35.6 to 57.8%; I2: 97.3%). The pooled percentage of false positives was 61.1% (12 studies; 575 samples; 95% CI: 37.9 to 82.2%; I2: 96.2%). Sensitivity (88%; 95% CI: 81-93%; I2: 55.2%), and specificity (82%; 95% CI: 75-89%; I2: 41.3%) were estimated in five studies, but without including contaminated urines. CONCLUSION: The perineal adhesive bag is not a valid enough method for urine culture collection, because almost half are contaminated and, if they are positive, two out of three are false. Although these estimates are imprecise, because of their great heterogeneity, they should be considered when choosing the method of urine collection. The estimates of sensitivity and specificity are not applicable because they do not take into account the risk of contamination

[Continuum, the continuing education platform based on a competency matrix]. / Continuum, la plataforma de Formación Basada en Competencias.

Competency-Based Education is a learning method that has changed the traditional teaching-based focus to a learning-based one. Students are the centre of the process, in which they must learn to learn, solve problems, and adapt to changes in their environment. The goal is to provide learning based on knowledge, skills (know-how), attitude and behaviour. These sets of knowledge are called competencies. It is essential to have a reference of the required competencies in order to identify the need for them. Their acquisition is approached through teaching modules, in which one or more skills can be acquired. This teaching strategy has been adopted by Continuum, the distance learning platform of the Spanish Paediatric Association, which has developed a competency matrix based on the Global Paediatric Education Consortium training program. In this article, a review will be presented on the basics of Competency-Based Education and how it is applied in Continuum.

[Systematic review of the validity of urine cultures collected by sterile perineal bags]. / Revisión sistemática de la validez de los urocultivos recogidos con bolsa estéril perineal.

INTRODUCTION: The perineal adhesive bag is the most used method in our country for urine culture collection in infants, despite having a high risk of contamination and false-positive results. We aim to quantify both types of risks through a systematic review. METHODS: Search updated in May 2014 in PUBMED, SCOPUS (includes EMBASE), IBECS; CINAHL, LILACS AND CUIDEN, without language or time limits. Percentages of contaminated urines, false positives, sensitivity and specificity (with respect to catheterization or bladder puncture) were recorded. RESULTS: A total of 21 studies of medium quality (7,659 samples) were selected. The pooled percentage of contaminated urines was 46.6% (15 studies; 6856 samples; 95% confidence interval [95% CI]: 35.6 to 57.8%; I(2): 97.3%). The pooled percentage of false positives was 61.1% (12 studies; 575 samples; 95% CI: 37.9 to 82.2%; I(2): 96.2%). Sensitivity (88%; 95% CI: 81-93%; I(2): 55.2%), and specificity (82%; 95% CI: 75-89%; I(2): 41.3%) were estimated in five studies, but without including contaminated urines. CONCLUSION: The perineal adhesive bag is not a valid enough method for urine culture collection, because almost half are contaminated and, if they are positive, two out of three are false. Although these estimates are imprecise, because of their great heterogeneity, they should be considered when choosing the method of urine collection. The estimates of sensitivity and specificity are not applicable because they do not take into account the risk of contamination.

¿Juega algún papel la vitamina D en las otitis de repetición? / Role of vitamin D in recurrent otitis of children

El papel de la vitamina D en las otitis de repetición en la infancia, o mejor dicho, discernir si juega alguno, es un claro ejemplo de la función que cumple la medicina basada en la evidencia, puesto que trazar la línea entre la mera especulación o hipótesis y lo recientemente demostrado, ya aplicable, aunque con escasas pruebas, convierte nuestra profesión en arte (AU)

The role of vitamin D in recurrent otitis in childhood is a clear example of the evidence based medicine's function. It is the ability to separate hypothesis from recently demonstrated stuff, already applicable, but with poor evidences, which makes of our profession an art (AU)

Réplica al artículo: «Contribución de la neuroestimulación a la seguridad en la extubación traqueal tras tiroidectomía total. Estudio prospectivo con electrodos de aguja» / Reply to article: “Contribution of neuromonitoring to the safety of tracheal extubation after total thyroidectomy. Prospective study with needle electrodes”

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Antecedentes perinatales y familiares en trastornos del espectro autista / Perinatal and family history in autism spectrum disorders

OBJETIVO: evaluar los factores de riesgo perinatales y las características parentales en los Trastornos del Espectro Autista (TEA). MÉTODO: Se compararon las condiciones obstétricas y las características parentales entre los TEA y dos grupos control sin TEA (unos del servicio de urgencias y el otro de las consultas de psiquiatría del niño y adolescente y del Hospital de Día). RESULTADOS: Hubo 20 pacientes en cada grupo (17 varones y 3 mujeres), con edades de 6-18 años. En el grupo de Trastornos Generalizados del Desarrollo (TGD) hubo 4 Trastorno Autista, 11 Trastorno de Asperger y 5 Trastorno del Espectro Autista no especificado (TGDNE). Técnicas de reproducción asistida en 20% del grupo TGD y 5% en el grupo control B. Todos los del grupo control A fueron gestaciones espontánea (p = 0.039). Hubo diferencias estadísticamente significativas en las enfermedades maternas entre grupo de casos y control A (p = 0.041). Parto fue por cesárea en el 65% del grupo TGD, 35% en el grupo control A y 25% en el grupo control B (p = 0.039). Hubo diferencias estadísticamente significativas en la historia psiquiátrica maternal y familiar entre los 3 grupos (p = 0.008 y p = 0.001). TGD fueron diagnosticados en el 30% de los familiares del grupo de TGD y en ninguno de los grupos controles (p = 0.01). CONCLUSIONES: Este estudio ha encontrado factores de riesgo obstétricos y características parentales relacionadas con TDG de acuerdo con la literatura. Futuro estudios deberían tratar de identificar factores obstétricos y entender su relación con procesos genéticamente influenciados en el desarrollo temprano

OBJECTIVE: To evaluate perinatal risk factors and parental characteristics in Autistic Spectrum Disorder (ASD). METHOD: Obstetric conditions and parental characteristics were compared between ASD and two control groups without ASD (one from emergency room and the other from psychiatry outpatient service and day-care hospital). RESULT: There were 20 patients in each group (17 boys and 3 girls), ages 6-18. The pervasive developmental disorder (PDD) case group had 4 Autistic, 11 Asperger's and 5 pervasive developmental disorder not otherwise specified (PDD-NOS). Assisted pregnancies in 20% of PDD case group and 5% of control group B. All control group A were spontaneous pregnancies (p = 0.039). Statistically significant differences in maternal disease between PDD case and control group A (p = 0.041). Delivered by cesarean section in 65% of PDD case group, against 35% control A group and 25% of control B group (p = 0.039). Statistically significant differences in family and maternal psychiatry history between three groups (p = 0.008 and p = 0.001). ASD has been diagnosed in 30% of relatives in PDD case group and none in control groups (p = 0.01). CONCLUSION: This study found some obstetric and parental risk factors related with ASD, according to the literature. Future research should attempt to identify obstetric factors and understand their relationship with different genetically influenced processes in early development

Probable neuroborreliosis con parálisis de los nervios hipogloso y vago / Probable neuroborreliosis with paralysis of hypoglossal and vagus nerves

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Overuse of bronchodilators and steroids in bronchiolitis of different severity

BACKGROUND: In the management of acute bronchiolitis there is a generalised use of treatments that have not been shown to be useful or efficacious in clinical studies. The objective of this study was to determine the appropriateness in the treatment of acute bronchiolitis of different severity within different clinical care settings. METHODS: This is a cross-sectional, descriptive study of 5647 cases of acute bronchiolitis in 91 Spanish hospitals and primary care centres. We classified the appropriateness of the treatments according to the recommendations of a consensus conference. RESULTS: There was an inappropriate use of treatments in 58.3% of the cases during the acute phase and in 45.4% during the maintenance phase. There was a generalised use of inhaled beta 2 agonists, regardless of the severity of the patients (hospitalised patients 69.3%, emergency care 63.2% and ambulatory 64.1%). Adrenaline was used in 30.1% of hospitalised cases and in 80.2% of intensive care patients. Systemic corticosteroids were not only used in one-third of hospitalised patients but also in 25.8% of ambulatory cases. CONCLUSIONS: In acute bronchiolitis in Spain there is a wide use of treatments that are not recommended by the available clinical practice guidelines. Beta 2 agonist bronchodilators and corticosteroids are widely used and maintained, regardless of the severity of the patients

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Overuse of bronchodilators and steroids in bronchiolitis of different severity: bronchiolitis-study of variability, appropriateness, and adequacy.

BACKGROUND: In the management of acute bronchiolitis there is a generalised use of treatments that have not been shown to be useful or efficacious in clinical studies. The objective of this study was to determine the appropriateness in the treatment of acute bronchiolitis of different severity within different clinical care settings. METHODS: This is a cross-sectional, descriptive study of 5647 cases of acute bronchiolitis in 91 Spanish hospitals and primary care centres. We classified the appropriateness of the treatments according to the recommendations of a consensus conference. RESULTS: There was an inappropriate use of treatments in 58.3% of the cases during the acute phase and in 45.4% during the maintenance phase. There was a generalised use of inhaled beta 2 agonists, regardless of the severity of the patients (hospitalised patients 69.3%, emergency care 63.2% and ambulatory 64.1%). Adrenaline was used in 30.1% of hospitalised cases and in 80.2% of intensive care patients. Systemic corticosteroids were not only used in one-third of hospitalised patients but also in 25.8% of ambulatory cases. CONCLUSIONS: In acute bronchiolitis in Spain there is a wide use of treatments that are not recommended by the available clinical practice guidelines. Beta 2 agonist bronchodilators and corticosteroids are widely used and maintained, regardless of the severity of the patients.

Contribución de la neuroestimulación a la seguridad en la extubación traqueal tras tiroidectomía total. Estudio prospectivo con electrodos de aguja / Contribution of neuromonitoring to the safety of tracheal extubation after total thyroidectomy. Prospective study with needle electrodes

Introducción y objetivos. La parálisis laríngea bilateral provoca graves complicaciones respiratorias. En cirugía de tiroides, la neuromonitorización ayuda en la identificación del nervio laríngeo recurrente, informa de su función al finalizar la cirugía, apoya en la toma de decisiones y puede reducir el riesgo de parálisis bilateral. Nuestro objetivo fue evaluar la influencia de la neuromonitorización en la estrategia operatoria y en la seguridad de la extubación en tiroidectomía total. Métodos. Estudio prospectivo no aleatorizado en 210 pacientes sometidos a tiroidectomía total (420 nervios laríngeos estimulados incluidos). Se recogieron las variables cualitativas de la neuromonitorización (presencia o ausencia de señal final tras estimulación en el nervio vago) y de la laringoscopia indirecta postoperatoria (motilidad normal o parálisis) realizada hasta en el tercer día postoperatorio. Resultados. La exactitud de la prueba fue del 99,5% (IC 95% 98,3 a 99,9). El valor predictivo positivo fue del 100% (IC 95% 99,1 a 100), lo que indica alta capacidad de la neuromonitorización para predecir parálisis en caso de pérdida de señal, y el valor predictivo negativo fue del 99,5% (IC 95% 98,3 a 99,9), lo que indica su capacidad de predicción de motilidad normal cuando hubo señal normal. Conclusiones. En nuestra serie de pacientes, la monitorización del nervio laríngeo recurrente fue útil en la tiroidectomía total, ya que aportó información sobre el pronóstico de la motilidad laríngea y nos ayudó intraoperatoriamente a tomar decisiones cuando se produjo pérdida de la señal. Debido al riesgo de serias complicaciones respiratorias por parálisis bilateral del nervio laríngeo recurrente, optamos por la realización de la tiroidectomía total en 2 etapas en caso de pérdida de señal en la primera lobectomía. De este modo la neuromonitorización contribuyó a la seguridad de la vía aérea en la extubación traqueal, ayudando en la prevención de una posible parálisis laríngea bilateral (AU)

Introduction and objectivesBilateral laryngeal paralysis cause serious respiratory complications. In thyroid surgery, neuromonitoring helps in identifying the recurrent laryngeal nerve, reports on its functioning at the end of surgery, supports decision making, and may reduce the risk of bilateral paralysis. Our objective was to estimate the influence of neuromonitoring in operative strategy and extubation safety in total thyroidectomy.MethodsA non-randomized prospective study was conducted on 210 patients undergoing total thyroidectomy (420 laryngeal nerves stimulated included). We collected qualitative neuromonitoring variables (presence or absence of final signal after stimulation of the vagus nerve), and postoperative indirect laryngoscopy (normal motility or paralysis), performed until 3rd day after the surgery.ResultsThe accuracy of the test was 99.5% (95% CI 98.3 to 99.9). The positive predictive value was 100% (95% CI 99.1 to 100), which showed the high ability of neuromonitoring to predict paralysis in case of loss of signal, and the negative predictive value was 99.5% (95% CI 98.3 to 99.9), which indicated its predictive capacity for normal motility when there is a normal signal.ConclusionsIn our group of patients, recurrent laryngeal nerve monitoring was useful in total thyroidectomy as it provided information on the prognosis of laryngeal motility, and helped in making decisions during surgery when there was signal loss. Due to the risk of serious respiratory complications due to bilateral recurrent laryngeal nerve paralysis, we opted for the performing of the 2-stage total thyroidectomy in case of signal loss in the first lobectomy. Thereby, neuromonitoring contributed to the safety of the airway in tracheal extubation, aiding in the prevention of a possible bilateral laryngeal paralysis (AU)

[Contribution of neuromonitoring to the safety of tracheal extubation after total thyroidectomy. Prospective study with needle electrodes]. / Contribución de la neuroestimulación a la seguridad en la extubación traqueal tras tiroidectomía total. Estudio prospectivo con electrodos de aguja.

INTRODUCTION AND OBJECTIVES: Bilateral laryngeal paralysis cause serious respiratory complications. In thyroid surgery, neuromonitoring helps in identifying the recurrent laryngeal nerve, reports on its functioning at the end of surgery, supports decision making, and may reduce the risk of bilateral paralysis. Our objective was to estimate the influence of neuromonitoring in operative strategy and extubation safety in total thyroidectomy. METHODS: A non-randomized prospective study was conducted on 210 patients undergoing total thyroidectomy (420 laryngeal nerves stimulated included). We collected qualitative neuromonitoring variables (presence or absence of final signal after stimulation of the vagus nerve), and postoperative indirect laryngoscopy (normal motility or paralysis), performed until 3rd day after the surgery. RESULTS: The accuracy of the test was 99.5% (95% CI 98.3 to 99.9). The positive predictive value was 100% (95% CI 99.1 to 100), which showed the high ability of neuromonitoring to predict paralysis in case of loss of signal, and the negative predictive value was 99.5% (95% CI 98.3 to 99.9), which indicated its predictive capacity for normal motility when there is a normal signal. CONCLUSIONS: In our group of patients, recurrent laryngeal nerve monitoring was useful in total thyroidectomy as it provided information on the prognosis of laryngeal motility, and helped in making decisions during surgery when there was signal loss. Due to the risk of serious respiratory complications due to bilateral recurrent laryngeal nerve paralysis, we opted for the performing of the 2-stage total thyroidectomy in case of signal loss in the first lobectomy. Thereby, neuromonitoring contributed to the safety of the airway in tracheal extubation, aiding in the prevention of a possible bilateral laryngeal paralysis.

Manejo de la bronquiolitis aguda en atención primaria: análisis de variabilidad e idoneidad (proyecto aBREVIADo) / Management of acute bronchiolitis in spanish emergency wards: variability and appropriateness analysis (aBREVIADo project)

Introducción: El manejo de la bronquiolitis aguda (BA) es controvertido. Con frecuencia se emplean en ella procedimientos diagnósticos y terapéuticos no sustentados en evidencia científica. El objetivo de este estudio multicéntrico nacional en España es conocer la variabilidad y la idoneidad del manejo de la BA en atención primaria. Métodos: Se realizó un estudio transversal descriptivo (de octubre del 2007 a marzo del 2008) de todos los casos de BA (criterios de McConnochie) tratados en una muestra de 60 centros de salud pertenecientes a 11 comunidades autónomas de España, que no precisaron ingreso. Se realizó una comparación por comunidades autónomas. Resultados: Se recogieron 940 casos. Encontramos un uso restringido de pruebas diagnósticas, aunque con diferencias significativas entre comunidades. Se constata un amplio uso de beta-2-adrenérgicos inhalados (63,2%) u orales (17,4%), y en menor grado de corticoides orales (24,6%) y otros tratamientos de eficacia no aclarada (antibióticos, corticoides inhalados, bromuro de ipratropio, etc.), observando una variabilidad significativa entre comunidades. En la fase aguda hay un uso inadecuado de tratamientos en el 74,8% y en la fase de mantenimiento en el 47,4%. Conclusiones: Hay discrepancias entre la práctica clínica habitual y el manejo basado en la evidencia de las BA ambulatorias, empleándose de forma mayoritaria tratamientos considerados inadecuados. La variabilidad en la indicación de broncodilatadores o corticoides entre comunidades ilustra acerca de la falta de fundamento y el margen de mejora (AU)

Introduction: The management of acute bronchiolitis (AB) is controversial. The aim of this multicenter nationwide study in Spain is to determine the variability in the management of AB in Primary Care centers. Methods: A cross-sectional observational study (from October 2007 to March 2008) was conducted on all cases of AB (McConnochie criteria) seen in a sample of 60 Health Care Centers from 11 regions of Spain, who did not require hospital admission. A comparison between autonomous communities was made. Results: A total of 940 cases were collected. It was found that there was a low use of diagnostic tests, although with significant differences between communities. There was an excessive use of inhaled (64.1%) or oral (17.8%) beta 2-adrenergics, and to a lesser degree of corticosteroids (25%) and other treatments of unclear efficacy (antibiotics, bronchodilators, oral, inhaled corticosteroids, ipratropium bromide, etc...). The treatment methods in the different communities varied significantly. In the acute phase there was an inappropriate use of treatments in 74.8% of cases, and in 47.4% in the maintenance phase. Conclusions: There are discrepancies between routine practice and evidence-based management of outpatient AB, due to a wide use of inappropriate treatments. The variability in the prescription of bronchodilators or steroids between communities shows the lack of justification and there is scope for improvement (AU)

Adecuación de los hábitos de introducción del gluten a las recomendaciones actuales / The suitability of the current recommendations for introducing gluten to the diet

Introducción: Hemos evaluado los hábitos de introducción de gluten y el cumplimiento de las recomendaciones de ESPGHAN-2008 en nuestro medio. Material y métodos: Estudio de cohortes retrospectivo en 2011 mediante encuesta rellenada por padres de niños que acuden al pediatra entre 12-18 meses, que contenía diversas variables epidemiológicas y de alimentación complementaria. Para las variables cuantitativas se calcularon medidas de centralización y tendencia, y tests no paramétricos para comparación de medias (Mann-Whitney y Kruskal-Wallis), y para las variables cualitativas, análisis de frecuencias, y comparación mediante χ2 o pruebas exactas. Se utilizaron técnicas de ajuste multivariante para las variables significativas. Resultados: Han colaborado 46 pediatras de atención primaria que recogieron 1.015 encuestas. La edad media de introducción de gluten fue 6,99 meses (desviación estándar 1,46, mediana 7). Solo el 45,1% (intervalo de confianza del 95% [IC 95%]: 41,8-48,3%) lo introdujo entre 4-6 meses, 0,2% antes de los 4, y 54,7% tras cumplir 7 meses. Solamente el 13,9% (IC 95%: 11,6-16,1%) lo hace entre 4-6 meses con lactancia materna. El análisis multivariante demuestra que las variables ligadas a un menor cumplimiento de la introducción entre 4-6 meses son madres de 35 años o mayores (OR ajustada [ORa] 1,44; IC 95%: 1,11-1,88), familiar celíaco (ORa 2,04; IC 95%: 1,11-3,72) y lactancia materna (ORa 1,55; IC 95%: 1,06-2,26), y para la introducción entre los 4-6 meses coincidiendo con lactancia al pecho, la lactancia materna y estudios universitarios maternos (OR 1,72; IC 95%: 1,17-2,53). Conclusiones: Aún no está suficientemente implantada la recomendación de la ESPGHAN sobre introducción de gluten entre los pediatras de nuestro entorno (AU)

Introduction: The habits of introducing gluten and the implementation of the ESPGHAN-2008 recommendations are evaluated. Materials and methods: A retrospective cohort study was conducted in 2011 using a questionnaire containing various epidemiological variables and supplementary feeding that was completed by the parents of children between 12-18 months who were seen by the pediatrician. Central tendency measures were calculated for the quantitative variables, and non-parametric tests used for comparison of means (Mann-Whitney and Kruskal-Wallis). The Chi-squared or exact tests were used for analyzing the qualitative variables, analysis of frequencies and comparisons. Multivariate adjustment techniques were used for the significant variables. Results: A total of 46 primary care pediatricians, who collected 1,015 questionnaires, collaborated. The mean age of the introduction of gluten was 6.99 months (standard deviation 1.46, median 7). Only 45.1% (95% confidence interval [CI 95%]: 41.8-48.3) introduced it between 4-6 months, 0.2% before 4 months, and 54.7% after 7 months. Only 13.9% (CI 95% 11.6-16.1) introduced gluten between 4-6 months with breastfeeding. Multivariate analysis showed that the variables linked to lower compliance with the introduction between 4-6 months are mothers of 35 years of age or older (adjusted Odds ratio (aOR 1.44; CI95%: 1.11-1.88), celiac family (aOR 2.04; CI 95%: 1.11-3.72) and breastfeeding (aOR 1.55; CI 95%: 1.06-2.26), and for the introduction between 4-6 months coinciding with breastfeeding, breastfeeding and mothers who had studied at university (aOR 1.72; CI 95%: 1.17-2.53). Conclusions: The ESPGHAN recommendation on the introduction of gluten among pediatricians in our sector has not yet been sufficiently implemented (AU)

[Management of acute bronchiolitis in spanish emergency wards: variability and appropriateness analysis (aBREVIADo project)]. / Manejo de la bronquiolitis aguda en atención primaria: análisis de variabilidad e idoneidad (proyecto aBREVIADo).

INTRODUCTION: The management of acute bronchiolitis (AB) is controversial. The aim of this multicenter nationwide study in Spain is to determine the variability in the management of AB in Primary Care centers. METHODS: A cross-sectional observational study (from October 2007 to March 2008) was conducted on all cases of AB (McConnochie criteria) seen in a sample of 60 Health Care Centers from 11 regions of Spain, who did not require hospital admission. A comparison between autonomous communities was made. RESULTS: A total of 940 cases were collected. It was found that there was a low use of diagnostic tests, although with significant differences between communities. There was an excessive use of inhaled (64.1%) or oral (17.8%) beta 2-adrenergics, and to a lesser degree of corticosteroids (25%) and other treatments of unclear efficacy (antibiotics, bronchodilators, oral, inhaled corticosteroids, ipratropium bromide, etc...). The treatment methods in the different communities varied significantly. In the acute phase there was an inappropriate use of treatments in 74.8% of cases, and in 47.4% in the maintenance phase. CONCLUSIONS: There are discrepancies between routine practice and evidence-based management of outpatient AB, due to a wide use of inappropriate treatments. The variability in the prescription of bronchodilators or steroids between communities shows the lack of justification and there is scope for improvement.

Fuentes de información bibliográfica (XX). Revistas biomédicas: una visión de su «historia clínica» (I) / Source of bibliographic information (XX). Biomedical journals: a vision of his “medical record” (I)

Las revistas son el medio más utilizado para el intercambio y la difusión de información científica en medicina, y se publica en ellas para validar, difundir, evaluar y comparar la investigación científica. Por ello, es importante conocer bien las revistas científicas y plantear estrategias para un correcto aprovechamiento de ellas. En este artículo nos adentrarnos en el mundo de las revistas biomédicas a través de un recorrido simbólico, como si se tratara de una «historia clínica» que describiera una entidad médica. En esta primera parte hablamos de los antecedentes(historia de las revistas pediátricas), epidemiología (¿qué se publica?), fisiopatogenia (¿cómo se publica?) y clínica (¿qué problemas tienen las revistas biomédicas?)(AU)

Journals are the most widely used way for the exchange and dissemination of scientific information in medicine. Researchers publish in journals to validate, disseminate, evaluate and compare scientific research. It is therefore important to know well the scientific journals and propose strategies for a proper use of them. In this article we enter into the world of medical journals through a symbolic journey, as if it were a “medical record” to describe a medical entity. In this first part we discussed the background (history of pediatric journals), epidemiology (what is published?), pathophysiology (how is it published?) and clinical (what problems have biomedical journals?)(AU)

[The suitability of the current recommendations for introducing gluten to the diet]. / Adecuación de los hábitos de introducción del gluten a las recomendaciones actuales.

INTRODUCTION: The habits of introducing gluten and the implementation of the ESPGHAN-2008 recommendations are evaluated. MATERIALS AND METHODS: A retrospective cohort study was conducted in 2011 using a questionnaire containing various epidemiological variables and supplementary feeding that was completed by the parents of children between 12-18 months who were seen by the pediatrician. Central tendency measures were calculated for the quantitative variables, and non-parametric tests used for comparison of means (Mann-Whitney and Kruskal-Wallis). The Chi-squared or exact tests were used for analyzing the qualitative variables, analysis of frequencies and comparisons. Multivariate adjustment techniques were used for the significant variables. RESULTS: A total of 46 primary care pediatricians, who collected 1,015 questionnaires, collaborated. The mean age of the introduction of gluten was 6.99 months (standard deviation 1.46, median 7). Only 45.1% (95% confidence interval [CI 95%]: 41.8-48.3) introduced it between 4-6 months, 0.2% before 4 months, and 54.7% after 7 months. Only 13.9% (CI 95% 11.6-16.1) introduced gluten between 4-6 months with breastfeeding. Multivariate analysis showed that the variables linked to lower compliance with the introduction between 4-6 months are mothers of 35 years of age or older (adjusted Odds ratio (aOR 1.44; CI95%: 1.11-1.88), celiac family (aOR 2.04; CI 95%: 1.11-3.72) and breastfeeding (aOR 1.55; CI 95%: 1.06-2.26), and for the introduction between 4-6 months coinciding with breastfeeding, breastfeeding and mothers who had studied at university (aOR 1.72; CI 95%: 1.17-2.53). CONCLUSIONS: The ESPGHAN recommendation on the introduction of gluten among pediatricians in our sector has not yet been sufficiently implemented.