[Evaluation of isometric force in lower limbs and body composition in preterm infants]. / Valoración de fuerza isométrica en extremidades inferiores y composición corporal en prematuros.

INTRODUCTION: Strength is a physical quality with a clear influence on quality of life. It is determined by the structure of the musculoskeletal system, and depends on the muscular structure. It has been described that prematurity conditions both qualities. The aims of this study are to determine whether prematurity is associated with strength or body composition and evaluate the relationship between prematurity, strength and muscle mass. MATERIAL AND METHODS: Case-control study. Participants were premature 7-to-11 year-old children and full-term birth controls. Strength was measured by a strength gauge and body composition from DEXA (duel-energy X-ray absorptiometry) scans. A total of 89 subjects were included and divided into three groups: 30 prematures with birth-weight ≤ 1500g, 29 prematures with birth-weight 1500-2000g, and 30 controls. RESULTS: Weight and BMI z-score was lower in the premature group. No differences were found in muscular mass or strength between groups. A ratio was established between strength and weight or muscular mass. It was observed that it was possible for them to move four times their weight, without finding any differences between groups or a relationship with birth-weight. CONCLUSIONS: Between 7 and 11 years of age, children who were premature have lower weight and BMI than the rest of the children. However, there were no differences in body composition or strength between preterm children and controls.

[Treatment of obesity in a hospital endocrinology clinic. Influence of parental body mass index]. / Tratamiento de la obesidad en la consulta de endocrinología de un hospital. Influencia del índice de masa corporal de los padres.

INTRODUCTION: Parental obesity is a risk factor for childhood obesity. The aim of this study was to determine if parental obesity influences the adherence and success of obesity treatment in a hospital paediatric endocrinology clinic. MATERIAL AND METHODS: An analytical, prospective, longitudinal study was conducted on obese children aged 4-14. An initial body mass index (BMI), and again at 6 months after receiving health, hygiene and dietary recommendations. Success was considered as a decrease of 0.5 in the BMI Z-score, and adherence to attending the 6-month review. Parental BMI was determined to identify overweight. The χ(2) test was used for qualitative variables and the T-Student test for quantitative (significance, p<<.05). RESULTS: The study included 100 children (52 male), 9.9±2.7 years old, BMI 28.1± 4.5kg/m(2) and BMI Z-Score 3.11±0.98. (85% had a BMI Z-score>3). More than half (59%) of the children had one or both parents obese (41 fathers and 37 mothers were obese). Treatment was not adhered to by 25 children. Adherence was worse if both parents were obese OR 3.65 (1.3 to 10.5) (P<=.01) and adherence was better if the mother was not obese, although the father was (P=.01). The treatment had significant success in 40 patients. If the mother was the only obese one in the family, the possibility of treatment failure was greater OR 5.6 (1.4 to 22.4) (P<.01) CONCLUSIONS: A high percentage of children with severe obesity have obese parents. The mother has an important influence on adherence and response to treatment for the severely obese child.

[Amount of sleep and changes in its patterns in children less than two years old]. / Cuantificación del sueño y presencia de alteraciones en la duración del sueño en niños menores de 2 años.

OBJECTIVES: The aim is to study the sleep duration and the 24-hour sleep distribution pattern in children under 2 years-old from two different areas of Spain, as well as to determine the prevalence of abnormal sleep duration and the influence of age on this prevalence, and compare them with the already published data. MATERIAL AND METHODS: An observational, descriptive and cross-sectional study on children from two health centers: one in Castilla y León and the other in Asturias. Their parents completed the Brief Infant Sleep Questionnaire (BISQ). Daytime and nighttime sleep duration was assessed, with percentiles being used to evaluate the results. Two groups were created: one according to the age (children under or above 6 months), and the other according to the area. RESULTS: A total of 125 children were studied (73 males). The nighttime sleep duration increased from 8.28±2.06 hours to 10.43±1.21 hours (P=.0001) and the daytime sleep decreased from 4.61±2.66 to 1.96±0.79 hours (P=.0001) for children under 6 months and above 6 months, respectively. The children from Castilla y León slept more during daytime than those from Asturias (3.91±2.67 vs 3.00±2.09 hours, P=.041). Nineteen children had a total sleep duration below the 2nd percentile. A sleep duration below normal percentiles was observed in children under 6 months (14/72 vs 5/53, P=.006). CONCLUSIONS: As children grow older, they substitute daytime sleep for nighttime sleep. Approximately 15% of the children under 2 years-old may have changes in sleep duration, and is more common in children under 6 months.

Anales de Pediatría: una nueva etapa / Anales de Pediatría: A new phase

No disponible

[Evaluation of the capacity of elderly patients to make decisions about their health]. / Evaluación de la capacidad de toma de decisiones sobre su salud en pacientes ancianos.

OBJECTIVE: To assess the decision-making capacity and variables related to this, in elderly patients in a home care program. MATERIAL AND METHODS: A cross-sectional study was conducted on 130 patients assigned to home care program or in social welfare residences of an urban health centre. Demographic variables, as well as comorbidities, social support, institutionalisation, number of drugs used, degree of dependence (Barthel Index), cognitive function (Pfeiffer) were collected. The primary endpoint was the capacity for decision-making about their health assessed using the Aid to Capacity Evaluation (ACE) tool. RESULTS: There was a prevalence of 58.5% capacity. There was an association between ability and independence for activities of daily living (odds ratio (OR): 12.214; Confidence interval 95% (95% CI): 3.90 to 32.29, P <.0001) and function intellectual intact (OR: 282.750, 95% CI 34.0 to 2351.2, P <.0001). Numeric variables associated with the capacity for decision-making that had a more important effect size were the Barthel index (d: -1.398) and Pfeiffer index (d: 3.084). CONCLUSIONS: The prevalence of incapacity to make decisions about their health in elderly patients who are cared for in their homes is high. The level of dependence in activities of daily living and the deterioration of intellectual function are factors associated with the presence of this capacity.

Evaluación de la capacidad de toma de decisiones sobre su salud en pacientes ancianos / Evaluation of the capacity of elderly patients to make decisions about their health

Objetivo. Evaluar la prevalencia de capacidad para la toma de decisiones y las variables relacionadas con ella, en pacientes ancianos de un programa de atención domiciliaria. Material y métodos. Se realiza un estudio descriptivo transversal en 130 pacientes adscritos al programa de atención domiciliaria o residentes en instituciones sociosanitarias de un centro de salud urbano. Se recogen las variables demográficas, las comorbilidades, el apoyo social, la institucionalización, el número de fármacos utilizados, el grado de dependencia (índice de Barthel), la función cognitiva (test de Pfeiffer) y la variable principal que es la capacidad para la toma de decisiones sobre su salud evaluada mediante el instrumento Aid to Capacity Evaluation (ACE). Resultados. Prevalencia de capacidad de 58,5%. Se encontró una asociación entre capacidad e independencia para las actividades de la vida diaria (odds ratio [OR]: 12.214; intervalo de confianza al 95% (IC 95%): 3,90-32,29; p < 0,0001) y función intelectual intacta (OR: 282.750; IC 95%: 34,0-2351,2; p < 0,0001). Las variables numéricas asociadas a la capacidad para la toma de decisiones que presentaron una magnitud de efecto más importante fueron el índice de Barthel (d: −1.398) y el índice de Pfeiffer (d: 3.084). Conclusiones. La prevalencia de incapacidad para la toma de decisiones sobre su salud en pacientes ancianos que son atendidos domiciliariamente es elevada. El grado de dependencia para las actividades de la vida diaria y del deterioro de la función intelectual son factores asociados a la presencia de esta capacidad (AU)

Objective. To assess the decision-making capacity and variables related to this, in elderly patients in a home care program. Material and methods. A cross-sectional study was conducted on 130 patients assigned to home care program or in social welfare residences of an urban health centre. Demographic variables, as well as comorbidities, social support, institutionalisation, number of drugs used, degree of dependence (Barthel Index), cognitive function (Pfeiffer) were collected. The primary endpoint was the capacity for decision-making about their health assessed using the Aid to Capacity Evaluation (ACE) tool. Results. There was a prevalence of 58.5% capacity. There was an association between ability and independence for activities of daily living (odds ratio (OR): 12.214; Confidence interval 95% (95% CI): 3.90 to 32.29, P <.0001) and function intellectual intact (OR: 282.750, 95% CI 34.0 to 2351.2, P <.0001). Numeric variables associated with the capacity for decision-making that had a more important effect size were the Barthel index (d: −1.398) and Pfeiffer index (d: 3.084). Conclusions. The prevalence of incapacity to make decisions about their health in elderly patients who are cared for in their homes is high. The level of dependence in activities of daily living and the deterioration of intellectual function are factors associated with the presence of this capacity (AU)

Comunicaciones científicas en los congresos de la Asociación Española de Nefrología Pediátrica(AENP), 1988-2007 / Scientific Presentations at the meetings of the Spanish Paediatric Nephrology Association (AENP), 1988-2007

Objetivos : Revisar las comunicaciones científicas presentadas en los congresos de la Asociación Española de Nefrología Pediátrica (AENP) . Material y métodos : En los programas científicos (1988-2007) de los congresos de la AENP se revisaron: número de presentaciones ,centros participantes y con el mayor número de comunicaciones , forma de presentación, estudios experimentales y temas elegidos. Resultados: En los últimos20 años, 91 centros presentaron 1.119 comunicaciones. El Hospital La Paz (Madrid) fue el que más comunicaciones presentó. Desde el año 1995 comenzaron a admitirse comunicaciones tipo póster y 369 de las 815 comunicaciones presentadas tuvieron ese formato. Dieciséis comunicaciones informaron de investigación animal. El tema más frecuente fue la enfermedad glomerular (203). Se presentaron 51 comunicaciones sobre diálisis. Trataron sobre trasplante renal 123 comunicaciones. Sólo una comunicación sobre genética fue presentada antes de 1998. Conclusiones : El formato póster es un método útil para las presentaciones científicas . El tema más habitual fue la enfermedad glomerular. En la última década han aparecido comunicaciones sobre genética, pero sobre experimentación animal son todavía excepcionales (AU)

Objectives and study: To find out that characteristics of the scientific presentations given at the AENP’s meetings in the past 20 years. Material and Methods: We reviewed in the scientific programs of the AENP’s meetings of the past 20years: number of presentations, number of participating institutions, institutions that provided the majority of the presentations, presentation format, number of studies involving experimental nephrology, topics most commonly presented. Results: There have been 1,119 presentations in the past 20 years, 45/year between 88-92 and 67/year between 03-07. Ninety-one institutions participated in the meetings, 17/year between 88-92 and 34/year between 03-07. Pediatric Nephrology unit from the H. La Paz (Madrid)contributed the most presentations. Poster presentations were accepted at the ANEP meetings after 1995. Since then,369 of the 815 presentations followed this format. Between88-07 only 16 presentations dealt with experimental nephrology. The most common topics of presentation waere glomerular disease (203) and urinary tract infection/VUR(132). Fifty-one presentations dealt with dialysis (almost2/3 peritoneal). Transplantation was the topic of 123presentations. Of the 21 presentations on molecular genetics only one happened before 1998. Conclusions: The poster is a useful alternative in scientific presentations which has allowed an increase in presentations, authors and institutions participating in the ANEP meetings. The main topic of presentation was glomerular disease. The frequency of presentations dealing with transplantation has increased in the last years. The past decade has seen more presentations on molecular genetics, but presentations dealing with experimental nephrology are still infrequent (AU)

[Scientific Presentations at the meetings of the Spanish Pediatric Nephrology Association (AENP), 1988-2007]. / Comunicaciones científicas en los congresos de la Asociación Española de Nefrología Pediátrica (AENP), 1988-2007.

UNLABELLED: OBJECTIVES AND STUDY: To find out that characteristics of the scientific presentations given at the AENP's meetings in the past 20 years. METHODS: We reviewed in the scientific programs of the AENP's meetings of the past 20 years: number of presentations, number of participating institutions, institutions that provided the majority of the presentations, presentation format, number of studies involving experimental nephrology, topics most commonly presented. RESULTS: There have been 1,119 presentations in the past 20 years, 45/year between 88-92 and 67/year between 03-07. Ninety-one institutions participated in the meetings, 17/year between 88-92 and 34/year between 03-07. Pediatric Nephrology unit from the H. La Paz (Madrid) contributed the most presentations. Poster presentations were accepted at the ANEP meetings after 1995. Since then, 369 of the 815 presentations followed this format. Between 88-07 only 16 presentations dealt with experimental nephrology. The most common topics of presentation were glomerular disease (203) and urinary tract infection/VUR (132). Fifty-one presentations dealt with dialysis (almost 2/3 peritoneal). Transplantation was the topic of 123 presentations. Of the 21 presentations on molecular genetics only one happened before 1998. CONCLUSIONS: The poster is a useful alternative in scientific presentations which has allowed an increase in presentations, authors and institutions participating in the ANEP meetings. The main topic of presentation was glomerular disease. The frequency of presentations dealing with transplantation has increased in the last years. The past decade has seen more presentations on molecular genetics, but presentations dealing with experimental nephrology are still infrequent.

Actuaciones quirúrgicas en nuestro medio / Surgical actions in our setting

Objetivo del estudio: Conocer la frecuencia con la que la población pediátrica perteneciente al Área Sanitaria de Leónes sometida a tratamiento quirúrgico, analizar las características del mismo y comparar, en los casos de cirugía programada, la adecuación al calendario quirúrgico recomendado. Material y métodos: Estudio observacional, descriptivo y transversal llevado a cabo mediante encuesta realizada a los padres de 2.577 niños que acudieron a la Unidad de Urgencias de Pediatría del Complejo Asistencial de León entre el 25 de enero y el 20 de marzo de 2007. Se analizó la existencia de antecedente quirúrgico, así como las características del mismo en cuanto a carácter urgente o programado, edad a la que tuvo lugar, tipo de especialista (cirujanopediátrico o de adultos), lugar elegido para su realización y tipo de intervención. En los casos de cirugía programadas e comparó la edad a la que fue practicada con la recomendada en la literatura médica y por la Sociedad Española de Cirugía Pediátrica. Resultados: Habían sido intervenidos 176 niños (6,8%del total), de los cuales el 68,9% eran varones. La cirugía fue urgente en el 18,1% de los casos. Ninguno de los pacientes fue intervenido en el período neonatal, mientras que el 13,7%de los escolares y el 9,7% de los niños que se encontraban en la primera adolescencia ya habían sido sometidos a cirugía. El 57,4 % de los pacientes fue intervenido por un cirujano de adultos en nuestra provincia; el resto tuvo que desplazarse a otros hospitales como Salamanca (30 casos),Madrid (17) u Oviedo (16) entre otros. El tipo de cirugía más frecuentemente practicada fue la adenoidectomía y/o amigdalectomía(27,3%), seguida de la corrección de herniasinguinales (12,5%) y de la cirugía traumatológica y ortopédica(8,5%). La criptorquidia y el estrabismo habían sido intervenidos en nuestro medio a una edad más tardía quela recomendada en los calendarios quirúrgicos. Discusión: Más del 5% de la población en edad pediátrica es sometida a tratamiento quirúrgico en nuestro medio. En la mayoría de las ocasiones se trata de cirugía programada realizada en niños mayores de 2 años. Sin embargo, en más de la mitad de la ocasiones son intervenidos por servicios especializados en cirugía de adultos. En los casos de cirugía programada, la edad de realización se ajusta en buena medida a los calendarios quirúrgicos recomendados, salvo en el caso de la criptorquidia y el estrabismo (AU)

Study objective: Know the frequency with which the pediatric population belonging to the Leon Health care Area undergoes surgical treatment, analyze its characteristics and compare adaptation to the recommended surgical calendar in the cases of scheduled surgery. Material and methods: An observational, descriptive and cross-sectional study conducted by means of a survey to the parents of 2.577 children who came to the Pediatric Emergency Unit of the Complejo Asistencial of Leon between January 25 and March 20, 2007. The existence of surgical background and its characteristics in regards to being urgent or scheduled, age when it occurred, type of specialist(pediatric or adult surgeon), site chosen to perform it and type of intervention were analyzed. In the case of scheduled surgery, age when it was performed was compared with that recommended in the medical literature and by the Spanish Society of Pediatric Surgery. Results: A total of 176 children (6.8% of the total), 68.9% of whom were male, underwent surgery. The surgery was urgent in 18.1% of the cases. None of the patients were operated on in the neonatal period while 13.7% of the school children and9.7% of the children in the early adolescence had already undergone surgery. A total of 75.4% of the patients were operated on by a surgeon for adults in our province. The rest had to go to other hospitals such as Salamanca (30 cases), Madrid (17)or Oviedo (16), among others. The most frequent type of surgery performed was adenoidectomy and/or tonsillectomy(27.3%), followed by inguinal hernias (12.5%) and traumatological and orthopedic surgery (8.5%). Cryptorchism and strabismus were operations in our setting that occurred at a later age than that recommended in the surgical schedules. Discussion: More than 5% of the pediatric age population undergoes surgery in our setting. Most of the times, it is scheduled surgery performed in children over 2 years of age. However, in more than half of the occasions, they are operated on by departments specialized in adult surgery. In the case of scheduled surgery, the age of the child is greatly adapted to the recommended surgical schedules, except in the case of cryptorchism and strabismus (AU)

Comparación de la utilidad de la fiebre y de algunos parámetros analíticos para el diagnóstico de pielonefritis aguda en niños / Comparison of the utility of fever and some laboratory parameters to diagnose acute pyelonephritis in children

Objetivo. Comparar la utilidad de un parámetro clínico como la fiebre, con parámetros analíticos en el diagnóstico temprano de pielonefritis aguda. Material y Métodos. Se estudiaron un total de 35 niños (10 varones) con el diagnóstico de infección urinaria, hospitalizados en el Servicio de Pediatría del hospital de León y a los que se les practicó una gammagrafía renal con DMSA como prueba de referencia para el diagnóstico de pielonefritis aguda. En el momento del ingreso se midió la temperatura axilar y se realizó extracción sanguínea para determinar velocidad de sedimentación globular, niveles séricos de proteína C-reactiva y de interleuquina-6. Se comparó la utilidad de la fiebre y de los parámetros analíticos para el diagnóstico de pielonefritis aguda calculando para cada uno de ellos sensibilidad, especificidad, valor predictivo positivo y negativo, coeficiente de probabilidad e índice de Youden. Resultados. Se demostró la existencia de pielonefritis aguda en 18 (51,5%) pacientes con edad media de 55,6 + 50,5 meses. El 100% presentaron fiebre al diagnóstico. En 17 (48,5%) pacientes, con edad media de 39,1+55,1 meses, la gammagrafía renal fue normal y 8 (47,06%) presentaban fiebre al diagnóstico. La sensibilidad para detectar la localización de las infecciones urinarias de la temperatura axilar > 38º, velocidad de sedimentación globular > 20, proteína –C-.reactiva > 5 mg/l e interleuquina-6>4 pg/ml fue de uno y la especificada de la proteína –C-reactiva > 70 mg/l y de la interleuquina -6>15 pg/ml fue próxima a uno. Conclusiones. El diagnóstico de pielonefritis aguada puede ser casi totalmente descartado en los niños con infección urinaria que no tienen fiebre. Los parámetros analíticos estudiados no tienen más sensibilidad que la fiebre para diagnosticar pielonefritis aguda y sólo tienen una alta especificidad cuando sus niveles séricos son muy elevados (AU)

Aim: To compare the use of a clinical parameter such as fever with analytical parameters for early diagnosis of acute pyelonephritis. Material and methods. The study was conducted in 35 children (10 male) diagnosed with urinary infection and hospitalized in the Paediatric Department in the Leon Hospital, who underwent DMSA renal scintigraphy to test for acute pyelonephritis. Auxiliary temperature was read on admission and a blood sample take to determine the rate of globular sedimentation, serum levels of C-reactive protein and interleukin-6. The usefulness of fever was compared with analytical parameters in diagnosing acute pyelonephritis and in each case sensitivity, specificity, positive and negative predictive values, probability co-efficient and the Youden index were calculated. Results. There was evidence of acute pyelonephritis in 18 (51,5%) patient, with an average age of 55.6+50.5 months. Of these 100% registered fever at diagnosis. Seventeen 17 (48,5%) patients with an average age of 39.1+55.1 months, the renal gammagraphy was normal, and 8 (47,06%) registered fever at diagnosis. Sensitivity for detecting urinary tract infection localization in auxiliary temperature > 38º globular sedimentation rate > 20, C-reactive protein > 5 mg/l and interleukin-6>4pg/ml was 1 and the specificity in C-reactive protein > 70 mg/l and interleuking-6>15 pg/ml was close to 1. Conclusion. Diagnosis of acute pyelonephritis is extremely unlikely in children with urinary infection who do not register high temperature. The analytic parameters studied do not register more sensitivity than high temperature in diagnosing acute pyelonephritis, and only show high specificity in the case of very high serum levels (AU)

Publicaciones en el Boletín de Pediatría / Publications in the Pediatrics Bulletin

No disponible