[Influence of out-of-home day care on the incidence of infectious processes in 0-3-year-olds]. / Escolarización precoz e incidencia de enfermedades infecciosas en niños menores de 3 años.

INTRODUCTION: A number of studies have shown that out-of-home day care in very young children increases the incidence of infectious processes in comparison with that in children cared for in a family environment. The aim of this study was to assess the influence of the type of childcare (family environment vs. collective care) and the age at which schooling begins on morbidity due to infectious processes and to determine the repercussions on the health system (frequency of visits and antibiotic consumption). PATIENTS AND METHODS: The study population was composed of a cohort of children born between 1st January 2001 and 31st December 2003, drawn from five pediatric clinics. Infectious processes and health service use were recorded prospectively by the pediatrician over the 10 months of the study. The mean number and incidence of infectious processes in children attending day care and those cared for at home were compared. RESULTS: A total of 764 children were studied, of which 47% attended day care centers. Compared with children cared for at home, children attending day care had a significantly higher mean number of infectious episodes (6.7 vs. 4.1), antibiotic use (1.3 vs. 0.4), visits to the pediatrician (10.3 vs. 6.3) and hospital emergency visits (0.6 vs. 0.4) (p<0.0001). For each age group, the greatest difference between children in day care and those kept at home was found in the first year of schooling. This difference was largest in the youngest age group (RR=2.3). CONCLUSIONS: If parents request advice, pediatricians should inform them of the increase in infectious morbidity that children can be predicted to experience during the first year of schooling.

[Tumoral markers and acute-phase reactants in the diagnosis of pancreatic cancer]. / Marcadores tumorales y reactantes de fase aguda en el diagnóstico del cáncer de páncreas.

OBJECTIVE: To analyze the diagnostic accuracy of the following parameters in the diagnosis of pancreatic cancer: carcinoembryonic antigen (CEA), tissue plasminogen activator (TPA), carbohydrate antigen 19-9 (CA 19-9), carbohydrate antigen 50 (CA 50), alpha-1-antitrypsin (AAT), alpha-2 macroglobulin (AMG), and ceruloplasmin (CP). PATIENTS AND MENTOD: We prospectively studied 58 patients with pancreatic cancer, 40 with alcoholic pancreatitis and 40 healthy controls, in whom the above-mentioned parameters were analyzed. Receiver operating characteristic curves (ROC curves) were analyzed. RESULTS: The specificity of TPA, CA 19-9 and CA 50 in the differential diagnosis between pancreatic cancer and chronic pancreatitis was 87.5%, 90% and 95% respectively, with a sensitivity of nearly 90%. Although levels of AAT, AMG and CP were higher in patients with cancer than in those with pancreatitis, their specificity was lower, approximately 65%. CEA and TPA showed a positive association with the presence of metastases. CONCLUSION: TPA, CA 19-9 and CA 50 were useful in the differential diagnosis between pancreatic cancer and chronic pancreatitis.

[The role of the day-care nursery and early schooling on the incidence of infectious diseases]. / Papel de la guardería y de la escolarización precoz en la incidencia de enfermedades infecciosas.

OBJECTIVE: The purpose of this study was to study if early care away from home of infants and young children increases the incidence and severity of infectious disease episodes and to define the age group in which the infection risk is highest. MATERIAL AND METHODS: A prospective cohort study was conducted in three pediatric clinics of a primary health care center. RESULTS: The mean number of infectious disease episodes was 7.2 (< 2 years of age), 6.3 (2-3 years) and 5.05 (> 3 years) in children attending school for the first year and 4.0, 3.1 and 2.7 for children of the same age groups not attending school. For the first year of schooling, the relative risk (RR) and 95% confidence intervals (CI) for some specific diseases, in children between 6-24 months of age were 1.99 (1.03-3.83) for more than two episodes of otitis media and 4.59 (1.97-10.7) for more than three episodes of bronchial asthma. Children between 24 and 36 months of age had RR and CI of 4.63 (1.51-14.8) for more than two episodes of otitis media. CONCLUSION: Infants and small children cared for outside of the home environment have a greater number of acute infectious disease episodes than those cared for at home. The risk is higher during the first year of schooling, particularly in those less than two years of age.

[Learning disorders in adolescents and associated social and health risk factors]. / Fracaso escolar en adolescentes y factores sociosanitarios asociados.

OBJECTIVES: To determine the prevalence of learning disorders, defined as repeating a year, in adolescents and associated social and health risk factors. PATIENTS AND METHODS: A prospective cross-sectional study of a cohort of 14-year-olds was performed. Data (medical, social and family history and anthropometric data) were collected by pediatricians and a self-administered questionnaire on school progress, health-related self-image, physical activity, leisure-time activities, family and social relationships, drug and alcohol consumption, and self-esteem was given to the adolescents. RESULTS: Of 287 adolescents, three were excluded because of mental deficiency. Of the 284 adolescents included in the study (135 girls and 149 boys), 48 (16.9 %) had learning disorders. No significant differences were found between sexes (18.1 % in boys vs. 15.55 % in girls). Learning disorders increased with the number of siblings (p 0.003). The prevalence was greater in the lower social classes (classes I, II, III: 6 %; class IV: 15.9 %; class V: 33 %; p 0.019) and in families with psychosocial risk factors (48.4 % vs. 12.7 %; p > 0.0001). Adolescents with learning disorders participated less in sports (50 % vs. 60.6 %; p 0.03), read less frequently (8.3 % vs. 27.1 %; p 0.005) and watched more TV on working days (2.4 hours/day vs. 1.6 hours/day; p 0.033). Girls with learning disorders were less aware of contraceptive methods (71.4 % vs. 95.6 %; p 0.0002) and of sexually transmitted diseases (71.4 % vs. 93 %; p 0.003). Adolescents with learning disorders started smoking earlier (39.6 % vs. 20.8 %, p 0.0053) but no differences were found in regular smoking. CONCLUSIONS: Learning disorders constitute a common problem requiring pediatric care due to their influence on adolescents' overall health and their relationship with risk factors such as lower awareness of birth control and sexually transmitted diseases, greater sedentariness, and earlier initiation of smoking.

[Spanish version of ECBI (Eyberg Child Behavior Inventory): measurement of validity]. / Versión española del ECBI (Eyberg Child Behavior Inventory): medida de validez.

OBJECTIVES: To translate into Castilian (Spanish) and measure the validity of the ECBI (Eyberg Child Behaviour Inventory), a questionnaire to screen behavioural disorders in pre-school children. DESIGN: Translation and back-translation of the ECBI. A descriptive crossover study. SETTING: Primary Care Paediatrics. PATIENTS: All the 3, 4 and 5-year olds from 4 paediatric clinics at 4 Health Centres (n = 527). One refusal. MEASUREMENTS AND MAIN RESULTS: The questionnaire was filled in by the children's mothers and was repeated 20 days afterwards for 35 children. High coefficients of internal consistency (Cronbach's alpha = 0.87) and stability (intragroup correlation = 0.89 [0.78-0.94]) were obtained. There was good factorial validity, as 84% of the variance was explained by the four factors with value greater than 1. CONCLUSIONS: The Spanish version of the ECBI is a brief and easy questionnaire with good results in psychometric assessment. Therefore, it can be recommended for use in paediatric Primary Care in order to detect children with behavioural problems.

[Anemia and depletion of iron reserves in healthy 12-month-old infants]. / Anemia y deplección de depósitos de hierro en lactantes sanos de 12 meses de edad.

A prospective study was made which included 287 infants, 12 months of age and patients of two Vizcaya Health Centers, in order to determine the prevalence of anemia and/or depletion of iron stores. The study design included somatometry and a review of the clinical records, dietary habits and the socio-economic status of the family. Laboratory tests included: hematocrit, hemoglobin, mean corpuscular volume, number of erythrocytes, serum iron, transferrin, iron saturation percentage and serum ferritin. Anemia was present in 9.3% of these children and 6.9% had iron-deficiency anemia. Depletion of iron stores was found in 12.4%. Prematurity, socio-economic status, infants fed low-iron milk, early introduction of cow's milk and the weight at 12 months were all variables that correlated significantly with the anemic or iron deficient states. However, the number of infections during the first year of life did not show a significant correlation. A question about the necessity of routine screening is raised and recommendation is made for iron supplementation in the infants in the high risk group.

Escolarización precoz e incidencia de enfermedades infecciosas en niños menores de 3 años / Influence of out-of-home day care on the incidence of infectious processes in 0-3-year-olds

Introducción. Diversos estudios han documentado que la escolarización de los niños de muy corta edad supone un aumento en la incidencia de patología infecciosa respecto a los niños cuidados en el medio familiar. El objetivo del estudio es evaluar la influencia del tipo de cuidado infantil (ámbito familiar frente al cuidado colectivo) y de la edad de inicio de escolarización en la morbilidad por procesos infecciosos y su repercusión sobre aspectos del consumo sanitario: frecuentación pediátrica y consumo de antibióticos. Pacientes y métodos. Cohorte de niños nacidos entre el 1 de enero de 2001 y el 31 de diciembre de 2003 correspondientes a cinco consultas pediátricas. Registro prospectivo (realizado por el pediatra) a lo largo de los 10 meses lectivos del curso 2003-2004 de los procesos infecciosos y el consumo de servicios sanitarios. Se ha comparado la media e incidencia de procesos infecciosos de niños escolarizados y no escolarizados. Resultados. Se estudian 764 niños, el 47 % escolarizados. Los escolarizados presentaron frente a los no escolarizados una media significativamente superior de episodios infecciosos (6,7 frente a 4,1), uso de antibióticos (1,3 frente a 0,4), visitas al pediatra (10,3 frente a 6,3) y visitas a urgencias hospitalarias (0,6 frente a 0,4) (p < 0,0001). Para cada grupo de edad, la diferencia mayor entre escolarizados y no escolarizados se da en el primer año de escolarización. Esta diferencia es máxima en el grupo de menor edad (riesgo relativo [RR]: 2,3). Conclusiones. A la solicitud de consejo por parte de los padres, el pediatra debe responder informando del aumento de morbilidad infecciosa que previsiblemente el niño experimentará el primer año como resultado de la escolarización

Introduction. A number of studies have shown that out-of-home day care in very young children increases the incidence of infectious processes in comparison with that in children cared for in a family environment. The aim of this study was to assess the influence of the type of childcare (family environment vs. collective care) and the age at which schooling begins on morbidity due to infectious processes and to determine the repercussions on the health system (frequency of visits and antibiotic consumption). Patients and methods. The study population was composed of a cohort of children born between 1st January 2001 and 31st December 2003, drawn from five pediatric clinics. Infectious processes and health service use were recorded prospectively by the pediatrician over the 10 months of the study. The mean number and incidence of infectious processes in children attending day care and those cared for at home were compared. Results. A total of 764 children were studied, of which 47 % attended day care centers. Compared with children cared for at home, children attending day care had a significantly higher mean number of infectious episodes (6.7 vs. 4.1), antibiotic use (1.3 vs. 0.4), visits to the pediatrician (10.3 vs. 6.3) and hospital emergency visits (0.6 vs. 0.4) (p < 0.0001). For each age group, the greatest difference between children in day care and those kept at home was found in the first year of schooling. This difference was largest in the youngest age group (RR 5 2.3). Conclusions. If parents request advice, pediatricians should inform them of the increase in infectious morbidity that children can be predicted to experience during the first year of schooling

Fracaso escolar en adolescentes y factores sociosanitarios asociados / Learning disorders in adolescents and associated social and health risk factors

Objetivos: Estudio sobre prevalencia del fracaso escolar, definido como repetir uno o más cursos, en adolescentes y factores sociosanitarios asociados. Pacientes y métodos: Estudio transversal prospectivo de una cohorte de adolescentes de 14 años de edad de 5 centros de salud, mediante recogida de datos (antecedentes médicos, sociofamiliares y antropométricos) por los pediatras y realización de un cuestionario autocumplimentado sobre rendimiento escolar, autopercepción de salud, actividad física, empleo de tiempo libre, relaciones familiares y sociales, consumo de tóxicos y autoestima. Resultados: Del total de 287 adolescentes, tres fueron excluidos por retraso mental. Participaron 284 (135 mujeres y 149 varones) de los que 48 (16,9%) presentaron fracaso escolar. No hubo diferencias significativas por sexos (18,1% varones frente a 15,55% mujeres) aumentando conforme aumenta el número de hermanos (p = 0,003). Se presenta más en clases sociales desfavorecidas (clases I-II-III, 6%; clase IV, 15,9%; clase V, 33,3%; p = 0,019) y en familias con factores de riesgo psicosocial (48,4% frente a 12,7%; p < 0,0001). Los adolescentes con fracaso escolar practican menos deporte (50% frente a 60,6%; p = 0,03), leen menos (8,3% frente a 27,1%; p = 0,005) y ven más televisión en días laborables (2,4 h/día frente a 1,6; p = 0,033). Las niñas con fracaso escolar tienen menos conocimiento sobre prevención de embarazo (71,4% frente a 95,6%; p = 0,0002) y sobre transmisión sexual de enfermedades (71,4% frente a 93%; p = 0,003). Los adolescentes con fracaso escolar prueban antes el tabaco (39,6% frente a 20,8%; p = 0,0053) pero no hay diferencias en cuanto al consumo habitual. Conclusiones: El fracaso escolar es un problema frecuente que precisa atención pediátrica por su influencia en la salud global del adolescente y su relación con factores de riesgo, como menor información sobre prevención de embarazo y enfermedades de transmisión sexual, mayor sedentarismo e inicio más temprano del contacto con el tabaco (AU)