[Analysis of pediatric «short stays¼ in a second-level hospital throughout 25 years]. / Análisis de las «estancias cero¼ pediátricas en un hospital de nivel 2 a lo largo de 25 años.

INTRODUCTION: It is essential to admit patients to hospital in an efficient way in order to use resources rationally. Short hospitalary stays are hospitalizations which does not include 00:00h and are considered avoidable. This study describes trends and characteristics of short stays throughout 25 years in our hospital. PATIENTS AND METHODS: We analyzed hospital pediatric discharges in a second-level hospital through the registration system «conjunto mínimo básico de datos¼. We categorized pediatric patients and newborn patients in two groups according to length of hospital stay: «short stays¼ and «prolonged stays¼. We analyzed and compared the following variables: gender, age, type of admission, month, diagnosis-related groups (DRG) and admission service. Binary logistic regression analysis and assessment of trends through joinpoint regression analysis were performed. RESULTS: From 1993 to 2017, 45710 children were admitted to our hospital, of which 7.3% were short stays. The trend analysis showed a point of change upwards-downwards at the beginning of the millennium. Pediatric short stays: the most important variables were emergency admissions (89%), urgent transfers (9%), month December (11%) and main diagnosis category: nervous system (18%). Mean diagnosis-related groups cost was 2432±1115€ in short stays group and 2549±1065€ in prolonged stays. CONCLUSIONS: Short stays and prolonged stays show a falling trend in our hospital. Short stays percentage in our environment is similar to other neighbor countries. Some of our short stays are urgent transfers and admissions for clinical observation. We did not find clinical significance in weight or cost of pediatric patients' DRG comparing to prolonged stays.

Repercusión clínica de la aparición de eventos cardiovasculares precoces en pacientes críticos en ventilación mecánica / Clinical repercussion of early cardiovascular events appearance in critically ill patients in mechanical ventilation

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[Children's and adolescents' perception of their quality of life in cases of attention deficit hyperactivity disorder with and without pharmacological treatment and in controls]. / Percepcion de niños y adolescentes sobre la calidad de vida en casos de trastorno por deficit de atencion/hiperactividad con y sin tratamiento farmacologico y en controles.

INTRODUCTION: Health-related quality of life perceived by children and teenagers is important to assess the effects of therapeutic intervention. AIM: To analyze quality of life, comparing cases of attention deficit hyperactivity disorder (ADHD) treated with methylphenidate, untreated cases and controls. SUBJECTS AND METHODS: Sampling of 228 participants between 8 and 14 years-old. Consecutive sampling in ADHD according to DSM-IV criteria (ADHD Rating Scales IV) and random sampling of matched controls by sex and age. Evaluation of quality of life using KIDSCREEN-52 (children version). ANOVA with Bonferroni correction was used. RESULTS: There is a moderate significant correlation between greater intensity of ADHD symptoms and worse quality of life, except in the dimension of physical well-being. Cases of untreated ADHD have significantly worse quality of life than controls on psychic well-being, mood, autonomy school environment and social acceptance. Cases of treated ADHD present similar results, except in the school environment and psychological well-being. The cases of ADHD treated only differ significantly from ADHD not treated in having a better school environment. CONCLUSIONS: The cases of ADHD present dimensions of KIDSCREEN-52 with worse quality of life than controls and the cases of ADHD treated with methylphenidate only differ significantly from those not treated in presenting better results in the school environment.

TITLE: Percepcion de niños y adolescentes sobre la calidad de vida en casos de trastorno por deficit de atencion/hiperactividad con y sin tratamiento farmacologico y en controles.Introduccion. La calidad de vida relacionada con la salud percibida por niños y adolescentes es un factor importante para valorar los efectos de una intervencion terapeutica. Objetivo. Analizar la calidad de vida comparando casos con trastorno por deficit de atencion/hiperactividad (TDAH) tratados farmacologicamente con metilfenidato, casos no tratados y controles. Sujetos y metodos. Muestra de 228 participantes de 8-14 años. Muestreo consecutivo de casos de TDAH segun los criterios del Manual diagnostico y estadistico de los trastornos mentales, cuarta edicion, y muestreo aleatorio de controles emparejados por sexo, edad y zona sociodemografica. Evaluacion de la calidad de vida mediante el KIDSCREEN-52 (version niños y adolescentes). Para responder al objetivo se utilizo ANOVA con correccion de Bonferroni. Resultados. Observamos una correlacion significativa moderada entre mayor intensidad de sintomas de TDAH y peor calidad de vida, excepto en el bienestar fisico. Los casos de TDAH no tratados tienen significativamente peor calidad de vida que los controles en bienestar psiquico, autonomia, estado de animo, entorno escolar y aceptacion social. Los casos de TDAH tratados observan similares resultados excepto en el entorno escolar y el bienestar psiquico, que no presentan diferencias significativas con los controles. Los casos de TDAH tratados por comparacion con los de TDAH no tratados solo presentan significativamente mejor calidad de vida en el entorno escolar. Conclusion. Los casos de TDAH presentan dimensiones del KIDSCREEN-52 con peor calidad de vida que los controles y los casos de TDAH tratados con metilfenidato solo se diferencian significativamente de los no tratados porque presentan mejores resultados en el entorno escolar.

[Birth rates evolution in Spain. Birth trends in Spain from 1941 to 2010]. / Evolución de la natalidad en España. Análisis de la tendencia de los nacimientos entre 1941 y 2010.

OBJECTIVES: The aim of this study was to analyse trends of births in Spain and its Autonomous Communities (CCAA) over a 70 year period (1941-2010). METHODS: The crude birth rates per 1,000 inhabitants/year were calculated by CCAA using Joinpoint regression models. Change points in trend and annual percentage of change (APC) were identified. RESULTS: The distribution of 38,160,305 births between 1941 and 2010 shows important changes in trends both nationally and among the CCAA. There is a general pattern for the whole country, with 5 turning points being identified with changes in trend and annual percentage change (APC). Differences are also found among regions. CONCLUSION: The analysis of trends in birth rates and the annual rates of change should enable public health authorities to properly plan pediatric care resources in our country.

Automatic detection of wakefulness and rest intervals in actigraphic signals: a data-driven approach.

Actigraphy is an useful tool for evaluating the activity pattern of a subject; activity registries are usually processed by first splitting the signal into its wakefulness and rest intervals and then analyzing each one in isolation. Consequently, a preprocessing stage for such a splitting is needed. Several methods have been reported to this end but they rely on parameters and thresholds which are manually set based on previous knowledge of the signals or learned from training. This compromises the general applicability of this methods. In this paper we propose a new method in which thresholds are automatically set based solely on the specific registry to be analyzed. The method consists of two stages: (1) estimation of an initial classification mask by means of the expectation maximization algorithm and (2) estimation of a final refined mask through an iterative method which re-estimates both the mask and the classifier parameters at each iteration step. Results on real data show that our methodology outperforms those so far proposed and can be more effectively used to obtain derived sleep quality parameters from actigraphy registries.

Resultados de un protocolo de manejo sobre la vía aérea artificial en pacientes críticos sometidos a ventilación mecánica / Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation

Objetivo: Conocer los resultados de la implantación de un protocolo de actuación en una unidad de cuidados intensivos (UCI), sobre pacientes críticos que precisan una vía aérea artificial prolongada. Diseño: Estudio de cohorte prospectivo y observacional. Intervención: Se establecieron estrategias de manejo sobre la vía aérea, mediante intubación endotraqueal (IET) o traqueotomía y se elaboraron pautas de actuación sobre el proceso de decanulación. Ámbito: Unidad de Cuidados Intensivos polivalente. Pacientes: Se estudiaron 169 pacientes sometidos a ventilación mecánica (VM); 67 con IET ≥ 10 días de VM y 102 con traqueotomía percutánea (TP) o quirúrgica (TQ). Variables de interés: Estancias UCI y hospitalaria, días de IET y VM, mortalidad, traqueotomía, factores de riesgo anatómicos, complicaciones quirúrgicas, postquirúrgicas y período de decanulación. Resultados: La IET presentó menos días de VM (17 vs. 30 días, p < 0,001), menor estancia en UCI (20 vs. 35 días, p < 0,001) y hospitalaria (34 vs. 51 días, p < 0,001) frente a traqueotomía. Se realizaron más TQ en pacientes con factores de riesgo (47 TP vs. 89% TQ, p < 0,001). La hemorragia leve intraoperatoria fue la complicación más frecuente asociándose a TQ (31 vs. 11%, p = 0,03). La TP se asoció a un menor período con cánula (25 días vs. 34 días, p < 0,04). Conclusiones: Las variantes de actuación del protocolo no presentaron diferencias en cuanto a complicaciones y mortalidad, orientando a su utilidad en el manejo de pacientes de características similares

Objective: To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. Design: A prospective, observational cohort study was carried out. Intervention: Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. Setting: A polyvalent ICU. Patients: We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). Variables of interest: ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. Results: ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). Conclusions: The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics

Moduladores cronobiológicos en la efectividad de la trombolisis prehospitalaria / Circadian modulation of effectiveness in prehospital thrombolysis

Objetivo: Investigar si la hora del día influye en la efectividad de la terapia trombolítica prehospitalaria en pacientes con infarto agudo de miocardio con elevación del segmento ST (IAMCEST). Método: Estudio observacional de cohortes retrospectivo con pacientes diagnosticados de IAMCEST a quienes se les realizó trombolisis precoz prehospitalaria. Se analizaron, como variables predictoras independientes de la efectividad de la terapia trombolítica, la hora del día de administración de la terapia trombolítica (variable principal), divididos en periodos horarios de 6 h y de 12 h, la edad, el sexo, la hora inicio del dolor torácico, tiempo de evolución del infarto, los factores de riesgo cardiovascular y el área de localización del infarto. Los datos se obtuvieron de la historia clínica y del seguimiento de preavisos hospitalarios a las 24 h. Resultados: Se incluyó a 206 pacientes. Dos variables se muestran como predictores independientes de la efectividad de la trombolisis prehospitalaria: la hora del día de administración de la terapia trombolítica, en el rango de cronorriesgo cardiovascular de 6a 12 h, con respecto al resto de franjas horarias (0-6 h, 12-18 h, 18-24 h) [p = 0,005odds ratio (OR) = 2,46; intervalo de confianza (IC) del 95%, 1,30-4,64] y presentar cardiopatía isquémica previa) (p = 0,003, OR = 5,30; IC del 95%, 1,74-16,15).Conclusiones: Encontramos variaciones circadianas clínicamente significativas en la efectividad del tratamiento trombolítico prehospitalario administrado a los pacientes con IAMCEST, independientemente del agente trombolítico empleado, de manera que existe una tromborresistencia matinal (6-12 am) al tratamiento y una mayor efectividad de reperfusión coronaria cuando se administra en el resto de franjas horarias diurnas ,especialmente en la de tarde (12-18 h) (AU)

Objective: To study whether time of day influences the effectiveness of prehospital thrombolysis in patients who have had acute myocardial infarction with ST-segment elevation (STEMI).Methods: Observational study of retrospective cohorts. We included patients diagnosed with STEMI who received early application of prehospital thrombolytic therapy. The main variable studied as an independent predictor of effectiveness was the time of day the thrombolytic agent was administered; this variable was studied in 6-hour periods and 12-hourperiods. Additional independent variables were patient age and sex, onset of chest pain, duration of pain from onset until administration of the thrombolytic agent, cardiovascular risk factors, and location of infarction. Data were extracted from patient records and ambulance pre-alert calls in the next 24 hours. Results: Two hundred six patients were studied. The 2 independent variables that predicted the effectiveness of prehospital thrombolysis were administration of the thrombolytic agent at a time of day within the period of greatest cardiovascular risk (6 AM to 12 noon) in comparison with the other time frames (12 midnight to 6 AM, 12 noon to 6 PM and 6 PM to midnight) (odds ratio [OR], 2.46; 95% CI, 1.30-4.64; P=.005) and history of ischemic heart disease (OR,5.30; 95% CI, 1.74-16.15; P=.003).Conclusions: We found that circadian rhythm had a clinically significant effect on the effectiveness of prehospital thrombolysis in STEMI patients. The effect was present regardless of which thrombolytic agent was used. The greatest resistance to therapy was observed in the morning hours between 6 AM and 12 noon. The response was greater in the remaining time frames and greatest in the hours between noon and 6 PM (AU)

[Results of an artificial airway management protocol in critical patients subjected to mechanical ventilation]. / Resultados de un protocolo de manejo sobre la vía aérea artificial en pacientes críticos sometidos a ventilación mecánica.

OBJECTIVE: To determine the results of the implementation of a protocol in an intensive care unit (ICU) referred to critically ill patients requiring a prolonged artificial airway. DESIGN: A prospective, observational cohort study was carried out. INTERVENTION: Management strategies were established on the airway by endotracheal intubation (ETI) or tracheostomy, and guidelines were developed for action in the decannulation process. SETTING: A polyvalent ICU. PATIENTS: We studied 169 patients subjected to mechanical ventilation (MV), 67 with ETI ≥ 10 days of MV and 102 with percutaneous (PT) or surgical tracheostomy (TQ). VARIABLES OF INTEREST: ICU and hospital stays, days of ETI and MV, mortality, tracheostomy, anatomical risk factors, surgical complications, and postoperative decannulation period. RESULTS: ETI versus tracheotomy involved fewer days of MV (17 vs. 30 days, p<0.001), a shorter ICU stay (20 vs. 35 days, p<0.001), and a shorter hospital stay (34 vs. 51 days, p<0.001).There were more TQ procedures in patients with risk factors (47% TP vs. 89% TQ, p<0.001). Intraoperative minor bleeding was the most common complication, being associated with TQ (31% vs. 11%, p = 0.03). TP was associated with a shorter cannulationperiod (25 days vs. 34 days, p<0.04). CONCLUSIONS: The protocol variants showed no differences in terms of complications and mortality, when orienting application to patients with similar characteristics.

Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario / Circadian rhythm and time variations in out-hospital sudden cardiac arrest

Objetivos: Analizar las características cronobiológicas y las variaciones temporales del paro cardiaco extrahospitalario (PCEH). Diseño: Estudio descriptivo retrospectivo. Pacientes: Todos los casos de PCEH de origen cardíaco registrados en la base de datos del servicio de emergencias médicas (SEM) de la Comunidad Autónoma de Castilla y León (España) durante 18 meses. Variables de interés principales: Edad, sexo, recuperación de la circulación espontánea, primer ritmo monitorizado (desfibrilable /no desfibrilable), lugar de alerta [(hogar, lugar público, centro atención primaria (AP)], testigo (familiar, transeúnte, fuerzas de seguridad, personal AP), hora de alerta (0-8; 8-16; 16-24), hora de activación del equipo de emergencias, hora de atención y día de la semana. Análisis univariante mediante Chi2, varianza y tests no paramétricos. Análisis cronobiológico mediante transformada rápida de Fourier y test Cosinor. Resultados: Se estudiaron 1.286 casos registrados entre enero 2007 y junio 2008. Se observaron diferencias estadísticas significativas en menor edad (p<0,05), mayor incidencia en el hogar (p<0,001) y mayor frecuencia de familiares-convivientes como testigos (p<0,001) en el periodo de 0-8h. El análisis cronobiológico mostró ritmo diario (circadiano) con acrofase a las 11:16h (p<0,001) y ritmo semanal (circaseptano) con acrofase en miércoles (p<0,05). Las medianas de intervalos alerta-atención y activación-atención fueron respectivamente 11,7min y 8,0min, sin diferencias entre periodos horarios. Conclusiones: Se demuestra la presencia de un ritmo diario de aparición del PCEH con pico matinal y un ritmo semanal con pico en miércoles. Estos resultados orientan al ajuste preventivo y a la planificación de recursos y mejoras en la respuesta, en determinados periodos horarios (AU)

Objectives: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). Design: A retrospective descriptive study was made. Patients: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous Community of Castilla y León (Spain) were evaluated. Variables analyzed: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. Results: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16h (p<0.001) and weekly rhythm (circaseptan) with acrophase on Wednesday (p<0.05). The median alert time-care time interval and emergency team activation time-care time were 11.7min and 8.0min, respectively, without differences between periods. Conclusions: We have demonstrated the presence of a daily rhythm of emergence of OHCA with a morning peak and a weekly rhythm with a peak on Wednesdays. These results can guide the planning of resources and improvements in response in certain time periods (AU)

Nonlinear analysis of actigraphic signals for the assessment of the attention-deficit/hyperactivity disorder (ADHD).

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder in children and adolescents; however, its etiology is still unknown, which hinders the existence of reliable, fast and inexpensive standard diagnostic methods. In this paper, we propose a novel methodology for automatic diagnosis of the combined type of ADHD based on nonlinear signal processing of 24h-long actigraphic registries. Since it relies on actigraphy measurements, it constitutes an inexpensive and non-invasive objective diagnostic method. Our results on real data reach 96.77% sensitivity and 84.38% specificity by means of multidimensional classifiers driven by combined features from different time intervals. Our analysis also reveals that, if features from a single time interval are used, the whole 24-h interval is the only one that yields classification figures with practical diagnostic capabilities. Overall, our figures overcome those obtained by actigraphy-based methods reported and are comparable with others based on more expensive (and not so convenient) adquisition methods.

Características generales de la parada cardiaca extrahospitalaria registrada por un servicio de emergencias médicas / General characteristics out of hospital cardiac arrest of cardiac origin recorded by an emergency medical service

Objetivo: Analizar las características generales de la parada cardiaca extrahospitalaria(PCEH) en una comunidad autónoma y los factores asociados a la recuperación de la circulación espontánea (RCE).Método: Estudio descriptivo retrospectivo de las PCEH de origen cardiaco incluidas en la base de datos del servicio de emergencias (SEM) de Castilla y León en un periodo de18 meses. El objetivo primario fue la RCE. Las variables analizadas fueron la edad, sexo, ritmo desfibrilable (DF), lugar del paro, testigo, intervalo alerta-atención inicial e intervalo despacho SEM-atención inicial. Resultados: Se estudiaron 1.286 PCEH, que representan 0,34 casos/1.000 habitantes/año. La mediana de edad fue de 73,0 años (rango intercuartílico 21,0), y el66,5% fueron hombres. Se consiguió RCE en el 22,2%. Las características de la PCEH fueron: ritmo DF 15,3%; en el hogar 72,2%, en un lugar público 21,3%, en un centro atención primaria (AP) 6,5%; presenciada por un familiar 49,1%, por un transeúnte 31,6%, por fuerzas seguridad 2,6% y por personal AP 15,7%. Fueron variables independientes asociadas a la RCE: edad inferior a 50 años [OR 1,6 (IC 95%: 1,03; 2,4)],ritmo DF [OR 3,8 (IC 95%: 2,7; 5,3)], lugar del paro en centro AP [OR 2,7 (IC 95%:1,4; 4,9)] y en lugar público [OR 1,8 (IC 95%: 1,2; 2,7)].Conclusiones: La incidencia de PCEH fue similar a otras series europeas. Destaca el bajo porcentaje de ritmos DF. Se confirma el hogar como lugar de más frecuente presentación, y una menor edad, la presencia de ritmos DF y la presentación en lugares públicos o centros sanitarios, como factores independientes asociados a RCE (AU)

Objective: To analyze the general characteristics out of hospital cardiac arrest (OHCA) including the frecuency of return of spontaneous circulation and related factors. Methods: Retrospective descriptive analysis of cases of OHCA in the records of the emergency medical service of Castile-Leon covering a period of 18 months. The main independent outcome analyzed was return of spontaneous circulation. Independent variables analyzed were age, sex, presence of shockable rhythm, location of cardiac arrest, witness, time between emergency call and initiation of care, and time between ambulance dispatch and initiation of care. Results: The EMS attended a total of 1286 cases of OHCA, representing an annual incidence of 0.34 cases per 1000 population. The median age (interquartile range) was 73.0 (21.0) years; 66.5% of the patients were men, spontaneous circulation returned in 22.2%, and a shockable rhythm was present in 15.3%. Cardiac arrest occurred in the home in72.2% of the cases, in a public place in 21.3%, and at a primary health care clinic in 6.5%. Witnesses were a familymember (49.1%), a passer-by (31.6%), a member of a security force (2.6%), and a primary care staff member (15.7%).Independent variables related to return of spontaneous circulation were age under 50 years (odds ratio [OR], 1.6; 95% confidence interval [CI], 1.03-2.4), presence of a shockable rhythm (OR, 3.8; 95% CI, 2.7-5.3); cardiac arrest at a primary health care clinic (OR, 2.7; 95% CI, 1.4-4.9) or in a public place (OR, 1.8; 95% CI, 1.2-2.7).Conclusions: The incidence of OHCA was similar to that reported for other European series. The low percentage of shockable rhythm was noteworthy. The home was confirmed as the most common setting for cardiac arrest; lower age, presence of shockable rhythm, occurrence of cardiac arrest in a public place or at a primary care clinic were confirmed as variables independently associated with return of spontaneous circulation (AU)

[Circadian rhythm and time variations in out-hospital sudden cardiac arrest]. / Ritmo circadiano y variaciones temporales en el paro cardiaco súbito extrahospitalario.

OBJECTIVES: To analyze the chronobiological and time variations of out- hospital cardiac arrest (OHCA). DESIGN: A retrospective descriptive study was made. PATIENTS: All cases of OHCA of cardiac origin registered over 18 months in the database of the emergency medical service (EMS) of the Autonomous Community of Castilla y León (Spain) were evaluated. VARIABLES ANALYZED: Age, sex, recovery of spontaneous circulation (ROSC), first monitored rhythm (amenable / not amenable to defibrillation), alert site [(home, public place, primary care (PC) center], alerting person (family, witness, law enforcement member, PC center staff), alert time (0-8; 8-16; 16-24), emergency team activation time, care time and day of the week. Univariate analysis (chi-squared), variance, and nonparametric tests comparing the variables in three periods of 8 hours. Chronobiological analysis by fast Fourier transform and Cosinor testing. RESULTS: We studied 1286 cases reported between January 2007 and June 2008. Statistically significant differences were observed in terms of younger age, higher incidence in the victim's home, and greater frequency of family-cohabiting persons as witnesses in the period between 0 and 8 hours. Chronobiological analysis found daily rhythm (circadian) with acrophase at 11.16 h (p<0.001) and weekly rhythm (circaseptan) with acrophase on Wednesday (p<0.05). The median alert time-care time interval and emergency team activation time-care time were 11.7 min and 8.0 min, respectively, without differences between periods. CONCLUSIONS: We have demonstrated the presence of a daily rhythm of emergence of OHCA with a morning peak and a weekly rhythm with a peak on Wednesdays. These results can guide the planning of resources and improvements in response in certain time periods.

Mochilas escolares y dolor de espalda en la población infantil / School backpacks and back pain in child population

Introducción: el peso de las mochilas preocupa por el esfuerzo físico que realizan los niños y su relación con problemas de espalda. El objetivo es conocer los hábitos del uso de mochilas y su relación con el dolor de espalda en población escolar. Material y métodos: estudio observacional en 4 consultas pediátricas. Se analizan variables demográficas, antropométricas y se administra un cuestionario. Resultados: son 159 niños, 80 varones y 79 mujeres, de 11 y 14 años, que cursan 5º de Educación Primaria (EP) y 2º de Educación Secundaria (ESO). El 69% acude al colegio andando, el 80% lleva la mochila en ambos hombros, el 59% se cansa y el 62,3% refiere dolor de espalda. La puntuación del dolor es 5 (escala 0-10). La mochila pesa 6,3 ± 2 kg. El peso relativo (porcentaje de peso en relación al peso del niño) es 13,4% ± 5,5 y no difiere entre sexos, medio urbano o rural, pero sí entre grupos de edad (15,5% en EP, 11,6% en ESO, p < 0,001) y centro (público: 14,3%; concertado: 12,3%; p = 0,02). No encontramos diferencias en el peso con o sin dolor (13,8% versus 12,7%; p = 0,19) ni en la presencia de dolor por sexo o edad. No se encuentra asociación entre dolor y horas de tele/ videojuegos pero sí entre dolor y horas de deporte extraescolar (más horas, menos dolor: OR [odds ratio]: 0,23; IC [intervalo de confianza] 95%: 0,08-0,7). Existe diferencia en la puntuación de síntomas psicosomáticos, mayor en los que sufren dolor (OR 1,37; IC 95%: 1,2-1,6). Conclusiones: el peso de las mochilas es el 13,4% ± 5,5 del peso del niño. Aunque no encontramos asociación entre dolor y peso, este influye en la sensación de malestar en la infancia y debe considerarse un problema de salud(AU)

Análisis cronobiológico de los ingresos de fracturas de la extremidad superior en los hospitales dem SACYL 1999-2004 / Chronobiological analysis of patients admitted with upper limb fractures to hospitals in Castile-Leon between 1999 and 2004

Objetivo. Valoración de la relación entre las fracturas de la extremidad superior y la dimensión temporal.Material y método. Se estudiaron 16.736 pacientes ingresados en hospitales del sistema público de salud de Castilla y León con fracturas de la extremidad superior, de 1999 a 2004. Se realizó un análisis univariante y una regresión logística, estudio ritmométrico con análisis espectral (transformada de Fourier) y método cosinor, para indagar la existencia de ritmo.Resultados. La edad media de los enfermos fue de 45,1 ±25,7 años, con un 57,9% de varones. La fractura se produjo en el ámbito urbano en un 62,8% y por accidente de tráfico en un 21,7%. Fue tratado con cirugía el 63,1%, con una mortalidad del 1,6%. La estancia media fue de 7,21 días. La regresión logística mostró menor riesgo para mujeres, ámbito urbano y aumento de la edad. Análisis espectral: período dominante de 365 días. Análisis de cosinor: ritmo significativo (acrofase: 13/8 y batifase: 31/12). Todos los subgrupos, excepto exitus y mayores de 84 años, mostraron ritmo (acrofasesde 19/7 a 8/9).Conclusiones. Este grupo de fracturas y la mayoría de subgrupos muestran ritmo con acrofases en verano. Tráfico y no tráfico tienen ritmos semejantes. Los datos del estudio cronobiológico se pueden aplicar en la clínica, mediante la planificación de los recursos con sentido temporal

Purpose. To assess the relationship between fractures of the upper limb and the time dimension.Materials and methods. A study was conducted of 16,736patients admitted to Castile-Leon hospitals with a fracture of their upper limb between 1999 and 2004. The following analyses were performed to investigate the existence of rhythm: an univariate analysis performed together with a logistic regression, a rhythmometric study with spectral analysis (Fourier transform) and cosinor method.Results. Patients’ mean age was 45.1 ± 25.7 years, with57.9% of males. The fracture was sustained in an urban milieu in 62.8% of cases and as a result of a road accident in 21.7%. Surgery was performed in 63.1% of cases, with a mortality rate of 1.6%. Mean hospitalization time was 7.21 days. Logistic regression showed a lower risk for older females, in the urban setting. Spectral analysis: dominant periodof 365 days. Cosinor analysis: significant rhythm(acrophase: 13/8 and batiphase: 31/12). All subgroups except for deceased patients and those over 84 years showed rhythm (acrophases: 19/7 to 8/9).Conclusions. This group of fractures, as well as the majority of subgroups, shows rhythm with acrophases in the summer. Traffic and non-traffic have similar rhythms. The data from the chronobiological study can be applied to clinical practice by planning resources with time-based criteria (AU)

Variabilidad en la hospitalización de lactantes con gastroenteritis / Variability among infants admitted to the hospital with gastroenteritis

Introducción: El estudio tiene como objetivo analizar la variabilidad de presentación de las gastroenteritis agudas en nuestro medio. Pacientes y métodos: La población de estudio estuvo constituida por 2.309 pacientes menores de 24 meses de edad, ingresados con diagnóstico de gastroenteritis. Se realizó un cultivo de heces en todos los casos y fueron clasificados, según la etiología, mediante la CIE-9-MC, como infecciosas, víricas, bacterianas y no infecciosas. Se tuvieron en cuenta las siguientes variables: sexo (hombre/mujer), edad (meses), días de estancia, fecha de ingreso y fallecimiento. Se llevó a cabo un análisis descriptivo y, además, el test de Kolmogorov-Smirnov, la prueba de la t de Student y de la ji al cuadrado con prueba exacta de Fisher. El análisis ritmométrico se llevó a cabo mediante la transformada rápida de Fourier, con ajuste de modelos mediante método cosinor con varios armónicos. Resultados: Ingresaron por gastroenteritis el 18,9% de los pacientes; eran de tipo infecciosa el 35% y vírica el 25,5%.La edad media de presentación de las gastroenteritis víricas fue de 10,84 meses, mientras que en las no víricas fue de11,74 meses, con un día más de estancia hospitalaria en el primer grupo. El análisis cosinor muestra un componente rítmico con un periodo de 12 meses en el global de las gastroenteritis, subgrupo de víricas y no víricas, con acrofase a finales de marzo. Conclusiones: Las gastroenteritis presentan un patrón estacional, con ritmo circanual y periodo de 12 meses, más patente en las gastroenteritis víricas que en las no víricas(AU)

Background: The aim of this study was to analyze the variability of epidemiological and clinical findings in gastroenteritis in our setting. Methods: We studied 2,309 patients, aged between 0 and24 months, admitted with a diagnosis of acute gastroenteritis. Stools were cultured and examined for a variety of enteropathogens, which were classified as infectious, viral, bacterial and noninfectious (CIE-9-MC). We considered the following variables: sex (male/female), age (months), hospital stay (days),date of admission and mortality. A descriptive analysis was carried out, and the Kolmogorov-Smirnov test, Student’s t test and the chi-square test with Fisher’s exact test were applied. Rhythmicity was analyzed using fast Fourier transform, and variations in rhythm were assessed by the cosinor model, with different harmonics. Results: Overall, 18.9% of the hospital admissions were dueto gastroenteritis (35% of infectious etiology and 25.5% of viral etiology). The mean age of infants with viral gastroenteritis was10.84 months, whereas in cases produced by non viral pathogens, it was 11.74 months. Patients with viral gastroenteritis were hospitalized one day longer than those with gastroenteritis due to non viral agents. The cosinor analysis revealed the presence of a rhythmic component, with 12-month duration in overall cases of gastroenteritis, and in viral and non viral gastroenteritis. The acrophase was around the 12th week of the year. Conclusions: Gastroenteritis exhibits a seasonal pattern, with a 12-month circannual rhythm, which is more evident in viral gastroenteritis than in cases produced by non viral pathogens (AU)

[Estimation of the prevalence of cerebral palsy in the Autonomous Community of Castilla y León (Spain) using a disabilities register]. / Estimación de la prevalencia de parálisis cerebral en la comunidad de Castilla y León mediante el registro de minusvalías.

INTRODUCTION: The prevalence of cerebral palsy in Western countries is estimated to be around 2 cases/1,000 inhabitants. The objective of this study was to estimate the prevalence of cerebral palsy in the Autonomous Community of Castilla y León and to assess potential differences among the nine provinces of this region. PATIENTS AND METHODS: The number of patients with CP in 1999, separated by provinces and by age groups, was obtained from the Community Sectorial Program for Persons with Disabilities. These data originally came from handicap evaluations carried out in each base center. Prevalences were calculated using population data from the National Institute of Statistics. RESULTS: A total of 335 patients aged 0-13 years were registered as having a diagnosis of cerebral palsy in 1999. The prevalence of cerebral palsy was 1.05 cases/1,000 inhabitants aged 0-13 years. Statistically significant differences were found in the prevalence of cerebral palsy among provinces (p < 0.0001). The highest prevalence was found in Salamanca, with 1.87 cases/1,000 inhabitants, while the lowest prevalence was found in Segovia, with 0.33 cases/ 1,000 inhabitants. CONCLUSIONS: The prevalence of cerebral palsy in childhood in Castilla y León was lower than that reported in western countries. Substantial differences were found among provinces. The prevalence of cerebral palsy is probably underreported in some provinces. These differences could be due to a disparity in diagnostic criteria, especially in young children.

Estimación de la prevalencia de parálisis cerebral en la comunidad de Castilla y León mediante el registro de minusvalías / Estimation of the prevalence of cerebral palsy in the Autonomous Community of Castilla y León (Spain) using a disabilities register

Introducción La prevalencia de parálisis cerebral en países occidentales se estima en torno a 2 casos/1.000 habitantes. El objetivo de este estudio es estimar la prevalencia de parálisis cerebral en Castilla y León, y sus posibles diferencias entre las nueve provincias de la comunidad autónoma. Pacientes y métodos Se obtuvo el número de casos de parálisis cerebral en el año 1999, por provincia, y estratificados por grupos de edad, provenientes del Plan Regional Sectorial de Atención a las Personas con Discapacidad. Estos datos proceden originalmente de las evaluaciones para el reconocimiento de minusvalía realizadas en cada centro base correspondiente. Se calcularon las prevalencias con los datos de población provenientes del Instituto Nacional de Estadística. Resultados Existían 335 pacientes de 0 a 14 años registrados con diagnóstico de parálisis cerebral en el año 1999. La prevalencia de parálisis cerebral en ese grupo de edad fue de 1,05 casos/1.000 habitantes. Existen diferencias estadísticamente significativas en la cuantía de las prevalencias entre provincias (p < 0,0001). La que tenía mayor prevalencia fue Salamanca, con 1,87 casos/1.000 habitantes, mientras que Segovia, con 0,33, fue la de menor prevalencia registrada. Conclusiones La prevalencia en edad pediátrica de parálisis cerebral en Castilla y León, muestra una cifra inferior a las referidas en países occidentales. Existen importantes diferencias entre provincias. Es probable que los datos infravaloren la prevalencia de parálisis cerebral, en particular, en ciertas provincias. La disparidad de los criterios diagnósticos puede ser fuente de estas diferencias, sobre todo en edades tempranas

Introduction The prevalence of cerebral palsy in Western countries is estimated to be around 2 cases/1,000 inhabitants. The objective of this study was to estimate the prevalence of cerebral palsy in the Autonomous Community of Castilla y León and to assess potential differences among the nine provinces of this region. Patients and methods The number of patients with CP in 1999, separated by provinces and by age groups, was obtained from the Community Sectorial Program for Persons with Disabilities. These data originally came from handicap evaluations carried out in each base center. Prevalences were calculated using population data from the National Institute of Statistics. Results A total of 335 patients aged 0-13 years were registered as having a diagnosis of cerebral palsy in 1999. The prevalence of cerebral palsy was 1.05 cases/1,000 inhabitants aged 0-13 years. Statistically significant differences were found in the prevalence of cerebral palsy among provinces (p < 0.0001). The highest prevalence was found in Salamanca, with 1.87 cases/1,000 inhabitants, while the lowest prevalence was found in Segovia, with 0.33 cases/ 1,000 inhabitants. Conclusions The prevalence of cerebral palsy in childhood in Castilla y León was lower than that reported in western countries. Substantial differences were found among provinces. The prevalence of cerebral palsy is probably underreported in some provinces. These differences could be due to a disparity in diagnostic criteria, especially in young children

Guía de orientaciones psicoeducativas para padres de niños con TDAH / Guide of psychoeducational orientations for children’s parents with Attention Deficit Hyperactivity Disorder ADHD

El trabajo expone orientaciones psicoeducativas para padres de niños con trastorno por déficit de atención con hiperactividad (TDAH), basadas en criterios empíricos, teóricos y clínicos. Se abordan las siguientes dimensiones: ambiente familiar, modelado, refuerzo de conducta, normas, autonomía y autoestima, aprender a pensar y saber esperar, atención, relación con compañeros, grupo familiar, adolescencia y una reflexión sobre el tratamiento. El documento incluye información básica sobre TDAH (AU)

This work presents psychoeducational orientations for children's parents with attention deficit hyperactivity disorder (ADHD). The orientations are based in empiric, theoretical and clinical approaches. The following dimensions are presented: Family environment, modelling, behaviour reinforcement, norms, autonomy and self-esteem, to learn how to think and to wait, attention, relationship with partners, family group, adolescence and treatment reflection. This document includes basic information on ADHD (AU)