Estado nutricional y prevalencia de disfagia en parálisis cerebral infantil. Utilidad del cribado mediante la escala Eating and Drinking Ability Classification System y su relación con el grado de afectación funcional según el Gross Motor Function Classification System / Nutritional status and prevalence of dysphagia in cerebral palsy: Usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System

Introducción y objetivos: La enfermedad digestiva es una de las comorbilidades más frecuentes en niños con parálisis cerebral infantil (PCI). Nuestro objetivo es analizar el estado nutricional de los pacientes con PCI, la prevalencia de disfagia según la afectación motriz (GMFCS) y su repercusión en la calidad de vida.Material y métodosEstudio descriptivo transversal y abierto en pacientes con PCI seguidos en un hospital terciario de la Comunidad de Madrid mediante una entrevista estructurada y la clasificación de la disfagia según la escala Eating and Drinking Ability Classification System (EDACS). Recogimos datos demográficos y antropométricos y relacionamos el nivel de disfagia con el nivel funcional según el Gross Motor Function Classification System (GMFCS).ResultadosLa muestra incluyó 44 pacientes (65,9% varones), con una edad media de 9,34 ± 5 años y un IMC de 18,5 ± 4,9. El 43% tenía limitaciones en seguridad y/o eficiencia (EDACS > II). El porcentaje de pacientes afectados fue mayor cuanto más extensa desde el punto de vista topográfico fue la PCI (tetraparesia 60%), más variada la semiología clínica (87% en formas mixtas) y peor el nivel funcional (100% en GMFCS V). La repercusión nutricional aumentó con puntuaciones más altas en EDACS y GMFCS.ConclusionesPresentamos el primer estudio sobre la utilidad de la escala EDACS en una muestra representativa de niños y adolescentes españoles con PCI. Los resultados deben hacernos reflexionar sobre la importancia del cribado de disfagia en estos pacientes, independientemente del grado de afectación motriz y la necesidad de una intervención precoz para evitar sus principales consecuencias: desnutrición (hipocrecimiento, déficit de micronutrientes, osteopenia, etc.), microaspiraciones o infecciones de repetición que empeoran el estado neurológico. (AU)

Introduction and objectives: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life.Material and methodsWe conducted a descriptive, cross-sectional, open-label study of outpatients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS).ResultsOur sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level > II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores.ConclusionsThis is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients’ neurological status. (AU)

Nutritional status and prevalence of dysphagia in cerebral palsy: usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System.

INTRODUCTION AND OBJECTIVES: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life. MATERIAL AND METHODS: We conducted a descriptive, cross-sectional, open-label study of out-patients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS). RESULTS: Our sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level > II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores. CONCLUSIONS: This is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients' neurological status.

Nutritional status and prevalence of dysphagia in cerebral palsy: Usefulness of the Eating and Drinking Ability Classification System scale and correlation with the degree of motor impairment according to the Gross Motor Function Classification System. / Estado nutricional y prevalencia de disfagia en parálisis cerebral infantil. Utilidad del cribado mediante la escala Eating and Drinking Ability Classification System y su relación con el grado de afectación funcional según el Gross Motor Function Classification System.

INTRODUCTION AND OBJECTIVES: Digestive disorders are one of the most common comorbidities among children with cerebral palsy (CP). The aim of this study is to examine the nutritional status of patients with CP, the prevalence of dysphagia by degree of motor impairment, and the impact of digestive disorders on quality of life. MATERIAL AND METHODS: We conducted a descriptive, cross-sectional, open-label study of outpatients with CP from a tertiary hospital in the Region of Madrid using a structured interview, classifying dysphagia using the Eating and Drinking Ability Classification System (EDACS). We gathered demographical and anthropometric data, and analysed the correlation between severity of dysphagia and functional status as measured with the Gross Motor Function Classification System (GMFCS). RESULTS: Our sample included 44 patients (65.9% boys), with a mean (standard deviation) age of 9.34 (5) years and a mean BMI of 18.5 (4.9). Forty-three percent presented safety and efficiency limitations (EDACS level>II). Safety and efficiency limitations were associated with more extensive motor involvement (60% had tetraparesis), more varied clinical manifestations (87% had mixed forms) and poorer functional capacity (100% on GMFCS V). The impact on nutritional status increased with higher EDACS and GMFCS scores. CONCLUSIONS: This is the first study into the usefulness of the EDACS scale in a representative sample of Spanish children and adolescents with CP. Our findings underscore the importance of screening for dysphagia in these patients, regardless of the level of motor impairment, and the need for early treatment to prevent the potential consequences: malnutrition (impaired growth, micronutrient deficiencies, osteopaenia, etc.), microaspiration, or recurrent infections that may worsen patients' neurological status.

Estudio a 2 años para medir la eficacia del fentanilo intranasal en pectina en el dolor irruptivo en enfermos con dolor no oncológico de edad avanzada / A two-year study to measure the efficacy of fentanyl pectin nasal spray in breakthrough pain in elderly patients with non-cancer pain

Los enfermos con dolor de moderado a intenso en patologías no oncológicas reciben habitualmente opioides para el control de su dolor. Muchos de ellos también padecen dolor irruptivo de las mismas características que el oncológico, sobre todo incidental a la deambulación, que en este estudio tratamos con fentanilo nasal en pectina. Se trata de 22 enfermos en la visita basal -20 mujeres (M) y 2 varones (V)- con dolor crónico no oncológico, de edad avanzada 74,7 (60-88), en un seguimiento de 24 meses. Constatamos la ausencia de problemas de abusos probablemente por la adecuada selección de los pacientes y la educación sanitaria que les permitió distinguir las reagudizaciones del dolor de base, del dolor irruptivo y su tratamiento específico. El fentanilo nasal en pectina demostró buena tolerancia y mejoró en más de 4 puntos el alivio del dolor irruptivo a la deambulación, la calidad de vida y del sueño en nuestro seguimiento a 24 meses en pacientes no oncológicos (AU)

Patients with moderate-to-severe pain in non-cancer conditions usually receive opioids for pain control. Many of these patients also suffer breakthrough pain, with the same characteristics as cancer pain. Their breakthrough pain is mainly related to wandering and walking, which in this study we treated with fentanyl pectin nasal spray. The study initially included 22 elderly patients (20 men and 2women) with non chronic cancer pain with a mean age of 74.7 (60-88) years in a 24 month follow-up. Lack of problems of abuse of these drugs was confirmed probably by the proper selection of patients and health education that enabled them to distinguish exacerbations of their baseline pain from the breakthrough pain episodes and its specific treatment. Fentanyl pectin nasal spray showed good tolerability, and improved in more than 4 points relief of breakthrough pain due to wandering and walking, also improved quality of life and sleep in our 24 months study in non-cancer patients (AU)

Incidence, risk and evolution of ostheoporotic hip fractures in Spanish women using a Markov type model. / Incidencia, riesgo y evolución de las fracturas osteoporóticas de cuello de fémur en las mujeres en España, a partir de un modelo de Markov.

BACKGROUND: To estimate osteoporotic hip fracture incidence rates, by age and gender, and lifetime fracture risk of women of different age groups over 45 in Spain, and to determine the expected number of fractures and fracture-related person-years of functional impairment, as a basis for estimating the social costs of osteoporosis in Spain and the avoided costs of fractures in future cost-effectiveness analyses. MATERIAL AND METHODS: The natural history of disease, recognized from fractures, is described using a Markov model and MonteCarlo simulations. Four cohorts of 10,000 women, each of a different age group, were simulated. Data were obtained from six hospitals of different size and geographical setting, to allow for differences in hospital service structure. Patients included were all new cases of hip fracture who were attended in those hospitals in 1995. Results are extrapolated to the Spanish population based on 1991 census. RESULTS: We can predict in the group of women aged 50 an over in Spain 968,000 osteoporotic hip fractures during their remaining lifetime, with a total amount of 1,013,000 fractures. Some 135,000 will become functionally impaired due to the fractures, accounting for 1,177,000 person-years of functional impairment. CONCLUSIONS: The study provides a prototype for estimating avoided costs of fractures in future cost-effectiveness analyses.

Food supply versus household survey data: nutrient consumption trends for Spain, 1958-1988.

Various methods of estimating food consumption, such as food balance sheets (FBS) and household surveys (HS), have been developed over the years and have been used to inform, monitor and evaluate nutrition policies. Because these methods vary in their objectives and data collection procedures, the objective of this study has been to elaborate FBS data for Spain and to study the consistency of fat, carbohydrate and protein intake trends, as measured by FBS and HS, for the period 1958 to 1988. Food balance sheets were elaborated by the authors according to the methodology of FAO using all available data sources for the 1958-1988 period. This data considered every major food item contributing to the total energy intake of the spanish population. Household survey data were taken from three similar national household budget surveys carried out on a representative sample of the Spanish population in 1958, 1964-1965, and 1980-1981. Estimates of food consumption were transformed into macronutrient intake by applying standard food tables. When macronutrient intake were expressed in absolute amounts, an unexpected finding was the tendency of the household surveys to overestimate food balance sheet data for fat, and to a lesser extent protein and carbohydrate, intake during the first years in the series. Also, the slopes of the trends of macronutrient intake were significantly (p < 0.05) greater for food balance sheets than for household survey data, specially for fat. When macronutrient intake were expressed as percent of total energy, differences between the two types of data tended to diminish and heterogeneity of slopes disappeared. We conclude that household survey and food supply data provide partially different information on macronutrient intake trends in the Spanish population for the period 1958-1988. The discrepancy is particularly noticeable for fat intake and when data are expressed in absolute amounts.

[Food and nutrient consumption in Spain in the period 1940-1988. Analysis of its consistency with the Mediterranean diet]. / El consumo de alimentos y nutrientes en España en el período 1940-1988. Análisis de su consistencia con la dieta mediterránea.

BACKGROUND: Not enough information is available regarding Spanish alimentation from the Civil War up to the present. Furthermore, there are some evidence that the Spaniards are leaving behind their traditional, healthy Mediterranean diet. The aim of this study was therefore to describe the food and nutrient intake trends of the Spanish population from 1940-1988 and establish to what extent the pattern of the Mediterranean diet has been maintained. METHODS: New food balance sheets for the Spanish population have been elaborated using all the information available and consistently applying the methodology of the European Union over the period from 1940-1988. RESULTS: Total caloric intake and that of all the macronutrients increased over the study period although this increase was greater after 1960. The contribution of lipids to total caloric intake has increased (30% in 1960-1968 and 42% from 1980-1988), protein contribution has remained the same (13% 1960-1968 and 13% 1980-1988) and carbohydrate intake has decreased (58% from 1960-1968 to 45% from 1980-1988). These changes are the result of an important increase in the consumption of meat, eggs, milk and derivatives. Nonetheless the high intake of fruit and vegetables, fish and olive and seed oils has been maintained. Thus, from 1980-1988 the ingestion of monounsaturated/saturated fatty acids and polyunsaturated/saturated fatty acids was 1.3 and 0.5, respectively. CONCLUSIONS: The first systematic reconstruction of the alimentary and nutritional history of the Spanish population over the last fifty years has been carried out. The Spanish diet has undergone typical changes associated with economic development but continues to be consistent with the pattern of the Mediterranean diet. These changes in diet are, however, of worry because of their deviation from optimum nutritional patterns.

[The contribution of tobacco and other life-style habits to mortality from lung cancer in Spain from 1940 to 1988]. / La contribución del tabaco y de otros hábitos de vida a la mortalidad por cáncer de pulmón en España de 1940 a 1988.

Because the causal relationship between tobacco smoking and lung cancer has been clearly established, we have set out to measure its magnitude among the Spanish population in the time period 1940-1988 using observational methods. To do so, we have carried a time series study of ecological data. Information on lung cancer mortality, tobacco smoking and other potential predictors of lung cancer has been elaborated from official statistics. Data analysis has been performed by graphical methods and multiple linear regression techniques. Lung cancer mortality, tobacco smoking, total lipid intake and the Spanish wealth, as measured by national per caput income and gross domestic product, have increased very importantly over the study period. After controlling for the effect of lipids and alcohol intake, for every gram/per caput/day of increase in tobacco smoking in the period 1940-1988, there has been a 19% increase in lung cancer mortality with a 15 year lag. We conclude that tobacco smoking has fueled the lung cancer epidemic in Spain during the study period. This finding provides additional arguments for the implementation of tobacco control programmes in our country.