Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna / Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine

Objetivo: Analizar la actividad de interconsulta (IC) realizada por los servicios de medicina interna (MI), sus aspectos formales, el perfil de la atención clínica requerida y cuantificar la carga de trabajo que supone. Material y método: Estudio multicéntrico, observacional, prospectivo, sobre enfermos consecutivos hospitalizados atendidos por servicios de MI mediante IC entre el 15 de mayo y el 15 de junio del año 2016. Se estimó la carga de trabajo relacionada con dicha actividad (1UT=10min). Resultados: Se registraron 1.141 IC procedentes de 43 hospitales, edad 69,4 (DE: 16,2) años, 51,2% hombres. El índice de Charlson fue 2,3 (DE: 2,2). Los motivos de consulta más frecuentes fueron: valoración general (27,4%), fiebre (18,1%), disnea (13,6%), trastorno metabólico (9,6%), HTA (6,3%) y síndrome confusional (5,3%). Las UT estimadas fueron 4 (DE: 5,9) para la primera visita y 7,3 (DE: 21,5) para la suma de las sucesivas. Los pacientes quirúrgicos fueron mayores (70,6 [DE: 15,9] vs 64,4 [DE: 16,3]; p=0,0001) y precisaron más días de seguimiento (5 [DE: 7,3] vs 3,5 [DE: 4,2]; p=0,009). Los siguientes aspectos fueron más frecuentes en el formato de las IC realizadas por servicios médicos: número de IC ordinarias (respuesta >24h), especificación del motivo de IC, datos mínimos referentes a la historia clínica y coincidencia de la adecuación en el tiempo con el consultor. Conclusión: Los pacientes atendidos mediante IC por los servicios de MI representan una carga de trabajo importante. La adecuación al formato de solicitud de IC es mayor en las procedentes de servicios médicos

Objective: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. Material and method: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). Results: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. Conclusion: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format

Analysis of the activity of interconsultations conducted by the departments of internal medicine. REINA-SEMI study: Registry of Interconsultations and Shared Care of the Spanish Society of Internal Medicine. / Análisis de la actividad de interconsulta realizada por los servicios de medicina interna. Estudio REINA-SEMI: Registro de Interconsultas y Asistencia Compartida de la Sociedad Española de Medicina Interna.

OBJECTIVE: To analyse the activity of interconsultations conducted by internal medicine (IM) departments, their formal aspects and the profile of clinical care required and to quantify the workload they represent. MATERIAL AND METHOD: A multicentre, observational prospective study was conducted with consecutive hospitalised patients treated by IM departments using interconsultations between May 15 and June 15, 2016. We estimated the workload related to this activity (1time unit [TU]=10min). RESULTS: We recorded 1,141 interconsultations from 43 hospitals. The mean age of the patients involved was 69.4 years (SD: 16.2), and 51.2% were men. The mean Charlson index was 2.3 (SD: 2.2). The most common reasons for the consultations were general assessments (27.4%), fever (18.1%), dyspnoea (13.6%), metabolic disorder (9.6%), arterial hypertension (6.3%) and delirium (5.3%). The duration of the first visit was 4 TUs (SD: 5.9) and 7.3 (SD: 21.5) for the sum of all subsequent visits. The surgical patients were older (70.6 [SD, 15.9] vs. 64.4 [SD, 16.3] years; P=.0001) and required more follow-up time (5 [SD, 7.3] vs. 3.5 [SD, 4.2] days; P=.009). The following issues were more common in the interconsultation format performed by medical services: number of regular interconsultations (response >24h), specification of the reason for the interconsultation, minimal data regarding the medical history and agreement on the appropriateness of the time spent with the consultant. CONCLUSION: The patients treated through interconsultations by the IM departments represented a significant workload. The interconsultations from the medical departments were more in line with the request format.

Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica / Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology

Antecedentes: Tras la finalización y análisis de resultados del estudio CIVIC, la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas (SECPCC) plantea la necesidad de revisar sus recomendaciones para la prevención del VRS en niños con cardiopatías congénitas. Para considerar tanto la valoración de las nuevas evidencias disponibles como la experiencia preventiva acumulada por los cardiólogos infantiles, se propone efectuar dicha actualización mediante un método estructurado de consenso profesional. Objetivos: Desarrollar un consenso clínico español sobre la prevención de la infección por virus respiratorio sincitial, bajo el auspicio de la Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Métodos: Consenso Delphi modificado en 2 rondas. El estudio se efectuó en 4 fases: 1) constitución de un comité científico, impulsor del proyecto y responsable de la revisión bibliográfica y de la formulación de las recomendaciones a debate; 2) constitución de un panel experto multicéntrico con 75 representantes de la especialidad; 3) encuesta postal en 2 rondas con procesamiento intermedio de opiniones e informe a los panelistas, y 4) discusión de resultados en sesión presencial del comité científico. Resultados: Cincuenta y cinco expertos consultados completaron las 2 rondas de evaluación del cuestionario. En la primera ronda se lograron consensuar 44 de las 70 cuestiones analizadas. Tras la interacción del panel, se aumentó el consenso hasta un total de 54 ítems de la encuesta (el 77% de los contenidos propuestos). En las 16 cuestiones restantes no se consiguió un consenso suficientemente unánime, bien por disparidad de opiniones entre los profesionales, bien por falta de criterio establecido en la mayoría de los expertos. Conclusiones: Se presenta y actualiza una lista de recomendaciones profilácticas frente al virus respiratorio sincitial, cualificadas según el grado de acuerdo profesional en que se sustentan, que pueden considerarse vigentes hasta la aparición de nueva información científica que justifique su revisión (AU)

Background: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. Objectives: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. Methods: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. Results: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. Conclusions: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review (AU)

[Clinical consensus on respiratory syncytial virus (RSV) infection prophylaxis and the use of palivizumab in paediatric cardiology.]. / Consenso clínico sobre la profilaxis de la infección por virus respiratorio sincitial y el uso del palivizumab en cardiología pediátrica.

BACKGROUND: Following the results of the CIVIC study, the SECPCC proposes to revise its recommendations for the prevention of RSV, taking into account the new evidence, as well as the preventive experience of paediatric cardiologists. For this purpose a structured method of professional consensus has been chosen. OBJECTIVES: To develop a Spanish clinical consensus on preventing infection by RSV under the auspices of the Sociedad Española de Cardiología Pediátrica y Cardiopatías Congénitas. METHODS: Delphi Consensus modified in two rounds. The study was conducted in four phases: 1) constitution of a Scientific Committee for bibliographic review and submission of the recommendations for discussion, 2) constitution of an Expert Panel with 75 representatives in the speciality, 3) postal survey organised in two rounds and intermediate processing of opinions, and issuing of a report to the panellists, and 4) discussion of the results in a face-to-face meeting of the Scientific Committee. RESULTS: Consensus was reached on 54 of the 70 preventive recommendations analysed. With respect to the 16 remaining issues, no consensus was reached, due to differences in professional opinion and the absence of established criteria among the majority of the experts. CONCLUSIONS: A set of recommendations for RSV prophylaxis in cardiology was developed and updated, rated in accordance with the degree of professional consensus on which they were based. These can be considered valid until such time as new scientific information emerges that warrants a further review.

Infecciones respiratorias, síndrome de Down y cardiopatías congénitas: Estudio CIVIC 21 / Respiratory infections, Down's syndrome and congenital heart disease: The CIVIC 21 study

Introducción: Se comparan las tasas de hospitalización por infección respiratoria aguda en niños con cardiopatías congénitas significativas sin síndrome de Down y en niños con síndrome de Down, con y sin cardiopatías, menores de 24 meses. Material y métodos: Estudio epidemiológico, multicéntrico (53 hospitales), observacional y prospectivo, de octubre de 2006 a abril de 2007. Se siguió a 1.085 pacientes; 806 sin síndrome de Down y con cardiopatía significativa y 279 con síndrome de Down: 135 con cardiopatía significativa, 38 con cardiopatías leves y 105 sin cardiopatía. Resultados: Ingresaron 147 (13,1%) pacientes (intervalo de confianza del 95%, 11,2 15,2%) por infecciones respiratorias. Las tasas en niños sin y con síndrome de Down fueron del 11 frente al 19,1%. Entre los últimos, el 26,3%, con cardiopatías no significativas; el 23%, con cardiopatías significativas, y el 11,4%, sin cardiopatía. El diagnóstico principal (59,4%) fue bronquiolitis. Se identificó algún germen en el 36,2%. La tasa de ingreso específica por virus respiratorio sincitial fue del 4,4%, con diferencias entre los niños sin y con síndrome de Down (el 3,2 frente al 7,8%) y entre los grupos con síndrome de Down con cardiopatías no significativas (15,8%), cardiopatías significativas (9,3%) y sin cardiopatía (3%). Había recibido profilaxis contra el virus respiratorio sincitial el 83,4 frente al 39,9% de los niños sin y con síndrome de Down. No hubo diferencias en el tiempo ni en la gravedad de las estancias. Conclusiones: Las hospitalizaciones por infecciones respiratorias y específicamente por virus respiratorio sincitial predominan en los niños con síndrome de Down, y entre ellos, en los que tienen cardiopatías leves y escasa inmunoprofilaxis frente al virus respiratorio sincitial (AU)

Introduction: We compare hospitalisation rates for acute respiratory tract infection in children youngerth an 24 months with significant congenital heart disease without Down’s syndrome with those with Down’s syndrome with or without congenital heart disease. Material and methods: This was an epidemiological, multicentre (53 Spanish hospitals), observation al and prospective study, from October 2006 to April 2007. A total of 1085 patients were followed-up, of which 806 did not have Down’s syndrome and 279 with Down’s syndrome: 135 with significant, 38 with non significant and 105 without congenital heart disease. Results: A total of 147 patients (13.1%; 95% CI, 11.2–15.2%) required hospitalisation due to respiratory infection. Rates in patients without and with Down’s syndrome were 11% vs 19.1%. In the Down’s group, 26.3%had no significant, a 23% had significant and 11.4% had no congenital heart disease. The main diagnosis was bronchiolitis (59.4%). An infectious agent was found in 36.2% cases. The specificad mission rate due to respiratory syncytial virus was 4.4%, with differences in children without vs with Down’s syndrome (3.2% vs 7.8%). In the Down’s patients we found rates of 15.8%, 9.3% and 3% in the non-significant, significant and no congenital heart disease. Immunoprophylaxis against respiratory syncytial virus rates were 83.4%vs 39.9%in no Down’s versus Down’s syndrome patients. No differences were found in hospital stay or the severity. Conclusions: Hospital admission rates due to respiratory infection, and specifically respiratory syncytial virus, were higher in the Down’s patients, particularly in the group with no significant congenital heart disease and low immunoprophylaxis against respiratory syncytial virus (AU)

[Respiratory infections, Down's syndrome and congenital heart disease: the CIVIC 21 study]. / Infecciones respiratorias, síndrome de Down y cardiopatías congénitas: Estudio CIVIC 21.

INTRODUCTION: We compare hospitalisation rates for acute respiratory tract infection in children younger than 24 months with significant congenital heart disease without Down's syndrome with those with Down's syndrome with or without congenital heart disease. MATERIAL AND METHODS: This was an epidemiological, multicentre (53 Spanish hospitals), observational and prospective study, from October 2006 to April 2007. A total of 1085 patients were followed-up, of which 806 did not have Down's syndrome and 279 with Down's syndrome: 135 with significant, 38 with non significant and 105 without congenital heart disease. RESULTS: A total of 147 patients (13.1%; 95% CI, 11.2-15.2%) required hospitalisation due to respiratory infection. Rates in patients without and with Down's syndrome were 11% vs 19.1%. In the Down's group, 26.3% had no significant, a 23% had significant and 11.4% had no congenital heart disease. The main diagnosis was bronchiolitis (59.4%). An infectious agent was found in 36.2% cases. The specific admission rate due to respiratory syncytial virus was 4.4%, with differences in children without vs with Down's syndrome (3.2% vs 7.8%). In the Down's patients we found rates of 15.8%, 9.3% and 3% in the non-significant, significant and no congenital heart disease. Immunoprophylaxis against respiratory syncytial virus rates were 83.4% vs 39.9% in no Down's versus Down's syndrome patients. No differences were found in hospital stay or the severity. CONCLUSIONS: Hospital admission rates due to respiratory infection, and specifically respiratory syncytial virus, were higher in the Down's patients, particularly in the group with no significant congenital heart disease and low immunoprophylaxis against respiratory syncytial virus.

El estado nutricional de niñas chinas adoptadas en España / Nutritional status in chinese adopted girls in Spain

Introducción: Frente al creciente número de adopciones chinas en algunos países como España, se planteó un estudio para conocer y evaluar el perfil nutricional a la llegada y su probable implicación en el estado general de salud, crecimiento y desarrollo de niñas chinas adoptadas. Pacientes y métodos: Se estudiaron 85 niñas chinas adoptadas en España en el periodo de 2002 a 2003, con edades comprendidas entre 7 y 33 meses de vida, remitidas a la Unidad de Pediatría Social del Hospital Niño Jesús, Madrid. Se recogieron datos referentes a la institución de procedencia, parámetros nutricionales (antropométricos y bioquímicos), presencia de enfermedades asociadas y retrasos de desarrollo (psicomotor/ edad-ósea). Resultados: El índice nutricional de Waterlow reflejó un 11% de malnutrición basándose en las tablas de referencia china, frente a un 58% obtenido por las tablas españolas, del cual el 82% era malnutrición aguda. Comparando la eficacia de dos métodos de valoración nutricional, propuestos por Waterlow y Gómez, no hubo diferencias en la detección de malnutrición, a pesar de que este último autor prioriza el índice peso/edad como indicador nutricional en edades por debajo de los 2 años. El 18% de las niñas fueron consideradas en grupo de riesgo (talla/edad < p10) para padecer desnutrición crónica, pero esto sólo se confirmó en el 67% del grupo, según criterios de Waterlow. Entre los parámetros plasmáticos valorados, destaca la disminución de la prealbúmina, linfocitos, hierro y transferrina. Los hallazgos patológicos predominantes fueron la talasemia, dermatitis, retraso psicomotor y anemia ferropénica. Conclusiones: Estos resultados nos llevan a creer en una posible mejoría en las condiciones ofrecidas en los orfanatos chinos. La baja edad en el momento de la adopción, podría justificar la pequeña incidencia de deficiencias nutricionales de carácter crónico. En general, las alteraciones antropométricas/nutricionales encontradas pueden relacionarse con las consecuencias del abandono y la vulnerabilidad del proceso de adopción. De cualquier manera, el diagnóstico precoz y la instauración de un tratamiento adecuado lo antes posible, como se viene haciendo, es fundamental para proporcionar un adecuado crecimiento y desarrollo de estas niñas

Introduction: Given the increasing number of adoptions from China in countries such as Spain, a study was designed to know and assess the nutritional profile at arrival and its likely implication in global health status, growth, and development of adopted Chinese girls. Patients and methods: Eighty-five Chinese girls adopted in Spain during the 2002-2003 period and ages ranging 7-33 months of life were studied at the Social Pediatrics Unit of the “Niño Jesús” Hospital, Madrid. Datas regarding institution of origin, nutritional parameters (anthropometrical and biochemical), presence of associated diseases, and developmental retardations (psychomotor/ bone age) were gathered. Results: Waterlow’s nutritional index showed a malnourishment rate of 11% based on Chinese reference tables, as compared to 58% based on Spanish tables, of which 82% was acute malnourishment. When comparing the efficacy of both nutritional assessment methods proposed by Waterlow and Gomez, there were no differences in detection of malnourishment in spite of the fact that the latter author gives priority to the weight/age index as a nutritional indicator at ages lower than 2 years. Eighteen percent of the girls were considered at (height/age < p10) of suffering chronic malnourishment, but this was only confirmed in 67% of the group according to Waterlow’s criteria. Among assessed plasma parameters, decreased prealbumin, lymphocytes, iron, and transferrin stand out. The predominant pathological findings were thalassemia, dermatitis, psychomotor retardation, and ferropenic anemia. Conclusions: These results make us believe in a possible in the conditions at Chinese orphanages. The low age at the time of adoption may justify the low incidence of chronic nutritional deficiencies. As a whole, anthropometrical / nutritional impairments found may be related with the consequences of carelessness and vulnerability of the adoption process. In any case, early diagnosis and implementation of appropriate therapy as soon as possible, as it is being done, is essential to provide appropriate growth and development of these girls

Salud ambiental y sus repercusiones en la infancia / Environmental health and its repercussions in childhood

En los últimos años se ha producido una respuesta mundial a los cambios sociales y a los avances tecnológicos, que ha alterado la posición de la medicina y ha obligado a plantearse reflexiones, fundamentales sobre los valores, conceptos y símbolos que guían la asistencia médica. El término de salud ambiental acuñado en 1993 está muy unido al desarrollo de la medicina social, y los descubrimientos de las relaciones entre: lo laboral, económico y ambiental, con el modo de enfermar. La OMS dice que quienes más sufren los peligros del mundo y la carga de la enfermedad relacionada con el medio ambiente son los niños menores de cinco años. Actualmente más de 80.000 sustancias químicas sintéticas se distribuyen en el medio y pueden ingresar en sus organismos a través de la ingestión, inhalación y la absorción cutánea. Los niños pequeños son especialmente vulnerables a las toxinas ambientales debido a su inmadurez anatómica funcional, al mayor consumo energético-metabólico, su comportamiento social, sus mayores expectativas de vida y a su nula capacidad de decisión; y como consecuencia puede provocar trastornos pediátricos. Los riesgos en la actividad médica es otra cuestión a tener en cuenta, ya que los residuos sanitarios son algunos de los contaminantes biosanitarios que generan sustancias peligrosas, tóxicas y cancerígenas. Las causas de la denominada “crisis infantil” son los agentes medioambientales, biológicos y químicos que contaminan el aire, agua, alimentos y suelos, y la carencia doméstica a los recursos naturales básicos como agua potable, alimentos sanos y combustibles, La soluciones consisten en medidas políticas, económicas y tecnológicas de prevención y corrección, basadas en la solidaridad, dignidad y justicia social (AU)

In recent years, there has been a worldwide response to social changes and technological advances that has altered the position of medicine and made it necessary to give considerations to and establish the bases of values, concepts and symbols that guide medical care. The term of environmental health, coined in 1993, is greatly bond to the development of social medicine and to the discoveries of the relationships between work, economics and environmental with the way of becoming ill. The WHO states that those who most suffer the dangers of the world and the disease burden related with the environmental setting are children under five years of age. At present, more that 80,000 synthetic chemical substances are distributed in the environment and may enter their bodies through intake, inhalation and cutaneous absorption. Small children are especially vulnerable to environmental toxins because of their functional anatomical immaturity, greater energetic-metabolic consumption, social behavior, greater life expectancy and null decision-making capacity. Consequently, this may cause pediatric disorders. Risks in the medical activity is another question to keep in mind since he health care residues are some of the biohealth contaminants that generate dangerous, toxic and cancerigenic substances. The causes of the so-called “child crisis” are environmental biological chemical agents that contaminate the air, water, food and floors and the lack of access of the home to basic natural resources such as drinking water, healthy food and fuel. The solutions consist in political, economical and technological measures of prevention and correction, based on solidarity, dignity and social justice (AU)

La convención sobre los derechos del Niño y su aplicación en la práctica pediátrica / The convention on the Rights of Children and its application in the pediatric practice

Los Derechos de los Niños no son un tema científico, no se encuentran en los libros de Pediatría, y sin embargo, lo que ocurre con los derechos de los niños es algo que atañe a los pediatras. Revisar algunos artículos de la Convención a la luz de la práctica pediátrica puede ayudarnos a encontrar formas más adecuadas de defensa de los derechos de los niños desde el ejercicio profesional. Los pediatras, desde su ámbito profesional, pueden contribuir a la mejora de los servicios sanitarios de atención a niños y adolescentes y así trabajar por la defensa de los derechos de los niños. Preparándose y manteniéndose actualizados en la pediatría; brindando un servicio de calidad; luchando por una adecuada financiación médica, investigando sobre los problemas de salud; enseñando a los colegas; predicando con el ejemplo; trabajando por los derechos de los niños en las instituciones científicas y tratando de comprender los fenómenos sociales y políticos para tener una visión más holística de las problemáticas de los derecho de los niños y niñas (AU)

Children´s Rights are not a scientific subject. They are not found in books on Paediatrics. And yet what happens with their rights concerns Paediatricians. The review of some articles of the Convention from a paediatrician’s point of view can help us find the most suitable ways of defending children´s rights through the profession. In their professional field, paediatricians can contribute to improving the attention of health services to children and adolescents and in doing so, work in defense of their rights. Being well prepared and up to date in paediatrics will contribute quality service: paediatricians can insist on adequate medical financing, research health problems, teach colleagues, set an example, work for children´s rights in scientific institutions and try to understand the social and political phenomena in order to gain a or HOLISTIC vision of Children’s Rights (AU)

Adopción internacional: atención al niño y orientación a los padres / International adoption: childcare and orientation to the parents

España se ha convertido en el segundo país que más niños adopta fuera de sus fronteras. Este proceso suele ser largo y complejo e implica no solo a la propia familia, sino también a la escuela, la sanidad y toda la sociedad, El objetivo de los diferentes profesionales implicados debe centrarse en ofrecer la adecuada información a los padres durante la asignación, interpretar los informes médicos, asesorarles durante el viaje, valorar el material gráfico (vídeos y fotografías) y prevenir riesgos durante la estancia en el país de origen. Pero la adopción no finaliza con la llegada del menor al territorio español. Nuestra misión, como médicos, se completa más tarde con la valoración y seguimiento del menor, garantizando una buena integración y adaptación a nuestro mundo (AU)

Spain has become the second international adoption country. This process usually is long and complex and implies not only the own family, but also the school, health and all the society. The objective of the implied professionals must be focused in offering the suitable information to the parents during the allocation, to interpret the medical information, to advise to them during the trip, to value the audiovisual information (videos and photographies) and to prevent risks during the stay in the destination country. But the adoption does no finalize with the arrival to the Spanish territory, our mission completes later with the evaluation and pursuit of the minor, guaranteeing a good integration and adaptation to our world (AU)

Situación vacunal de niños procedentes de adopción internacional a su llegada a España / Vaccine situation of children from international adoption on their arrival in Spain

Muchas familias españolas han adoptado en los últimos años a niños que han nacido en otros países. Los niños adoptados internacionalmente son una población vulnerable ya que, habitualmente, proceden de naciones poco desarrolladas, con recursos sanitarios insuficientes. Alguna de las dudas que plantea la atención a este grupo de niño a su llegada tiene que ver con su situación vacunal y la decisión de iniciar o completar el calendario de inmunizaciones. Para conocer la cobertura vacunal de los niños nacidos en el extranjero adoptados por familias españolas se realizó un estudio aleatorio retrospectivo incluyendo a 557 niños adoptados en Madrid entre los años 2000 y 2005. La edad media de los niños fue de 2,58 años ± 2,24. Los resultados sexológicos demostraron anticuerpos protectores frente a difteria en el 53% de los casos, tétanos: 54%, polio1: 79%, polio 2: 2,87%, polio 3: 82%, sarampión. 62%, rubéola: 35%, parotiditis: 28% (AU)

Many Spain families have adopted children in the last years born in other countries. The children adopted internationally are a vulnerable population, habitually; they come form undeveloped nations, with insufficient sanitary resources. Attention to this group of children at arrival make some doubts like vacunal situation and the need to initiate or to complete the immunization’s schedule. In order to know the vacunal cover to children adopted by Spanish families a retrospective random study including 557 adopted children was made in Madrid Between years 2000 y 2005. The average age was 2,58 years ± 2,24. The serologic test demonstrated protective antibodies to difteria in 53% of the cases, tetanus: 54%, polio1: 79%, polio 2: 2,87%, polio 3: 82%, measles: 62%, rubella: 35% mumps: 28% (AU)

Nuevas adicciones sociales: la infancia en la sociedad multipantallas / New social addictions: children in the multiscreen society

Los maestros hablan de alumnos que no pueden quedarse quietos en sus asientos y concentrarse; que reaccionan de forma agresiva frente a pequeñeces; que carecen de creatividad y capacidad de desarrollar pensamientos propios: ¿todo por culpa de las nuevas tecnologías? Tal vez, el nerviosismo y la agresividad de muchos chicos que frecuentan los medios audiovisuales tengan otro origen. Si los niños no tienen contención interior y carecen de mecanismos de protección con que poder aislarse frente a sucesos desagradables e hirientes, si se sienten descuidados o son objeto de abusos no es sólo a causa de los ordenadores y la televisión. Las causas del comportamiento violento no provienen exclusivamente del uso –o abuso- de las nuevas tecnologías, en general provienen de experiencias traumáticas reales a las que ha sido expuesto el menor y que, por su situación emocional particular, no encuentran otra forma de ser canalizadas que la exteriorización puesta en acción de forma violenta y agresiva (AU)

Teachers talk of students who cannot keep still in their seats and concentrate, who react aggressively to matters of Little importance, who lack the creativity and the capacity to develop their own thoughts: Can this all be blamed on new technology? Perhaps the nervousness and aggression of many children who frequently use audiovisuals has another source. If the children do not have self control or lack self protection mechanisms to use against disagreeable hurtful experiences, if they feel abandoned or are abused, it is not just the fault of computers and televisions. The causes of violent behavior do not come exclusively from the use – or abuse- of new technology. They generally come instead from real life, traumatic experiences they have been exposed to which, owing to the children´s particular emotional make-up, they can find no other way of channeling except through violent and aggressive actions (AU)

[Nutritional status of adopted Chinese girls in Spain]. / El estado nutricional de niñas chinas adoptadas en España.

INTRODUCTION: Given the increasing number of adoptions from China in countries such as Spain, a study was designed to know and assess the nutritional profile at arrival and its likely implication in global health status, growth, and development of adopted Chinese girls. PATIENTS AND METHODS: Eighty-five Chinese girls adopted in Spain during the 2002-2003 period and ages ranging 7-33 months of life were studied at the Social Pediatrics Unit of the "Niño Jesús" Hospital, Madrid. Datas regarding institution of origin, nutritional parameters (anthropometrical and biochemical), presence of associated diseases, and developmental retardations (psychomotor/bone age) were gathered. RESULTS: Waterlow's nutritional index showed a malnourishment rate of 11% based on Chinese reference tables, as compared to 58% based on Spanish tables, of which 82% was acute malnourishment. When comparing the efficacy of both nutritional assessment methods proposed by Waterlow and Gomez, there were no differences in detection of malnourishment in spite of the fact that the latter author gives priority to the weight/age index as a nutritional indicator at ages lower than 2 years. Eighteen percent of the girls were considered at (height/age < p10) of suffering chronic malnourishment, but this was only confirmed in 67% of the group according to Waterlow's criteria. Among assessed plasma parameters, decreased prealbumin, lymphocytes, iron, and transferrin stand out. The predominant pathological findings were thalassemia, dermatitis, psychomotor retardation, and ferropenic anemia. CONCLUSIONS: These results make us believe in a possible improvement in the conditions at Chinese orphanages. The low age at the time of adoption may justify the low incidence of chronic nutritional deficiencies. As a whole, anthropometrical / nutritional impairments found may be related with the consequences of carelessness and vulnerability of the adoption process. In any case, early diagnosis and implementation of appropriate therapy as soon as possible, as it is being done, is essential to provide appropriate growth and development of these girls.

Determinación de la edad en menores indocumentados / Age determination in not-documented childrens

La aparición de nuevos fenómenos sociales en los países desarrollados, como la inmigración de menores y la adopción internacional, está favoreciendo situaciones en las que resulta necesario calcular la edad del individuo, bien sea para admitir el asilo, tramitar la repatriación, juzgar delitos aplicando la Ley de Menores o, sencillamente, valorar su desarrollo físico e intelectual. Aunque clásicamente se han utilizado técnicas radiológicas (óseas y dentales) como la única aproximación objetiva al problema, ninguna de ellas está exenta de un grado significativo de error. Para mitigarlo, debemos referir los datos a los estándares de cada grupo de población y, en todo caso, conviene fijar, junto con la edad de desarrollo, los márgenes de confianza de cada prueba (AU)

Actitud de los padres ante la fiebre. Alternancia de antitérmicos / Parent's attitude towards fever. Alternating antipyretics

Objetivo: Averiguar cómo perciben los padres la fiebre, los métodos que utilizan para su tratamiento y la frecuencia con que alternan antitérmicos. Pacientes y métodos: Encuesta de 13 preguntas realizada a los padres que consultaron en el Servicio de Urgencias Pediátricas del Hospital Niño Jesús de Madrid en junio de 1999. Resultados: Se analizaron 376 encuestas. La mayoría (88,29 por ciento) considera que la fiebre puede ser peligrosa si alcanza determinados valores. Las convulsiones (40,16 por ciento) y la meningitis (16,22 por ciento) son los principales temores; el 11 por ciento no siente ningún miedo. Utilizan medidas físicas para bajar la fiebre el 67,28 por ciento de los encuestados, casi siempre asociadas a antipiréticos. Habitualmente se administra antitérmico a partir de 38° (61,96 por ciento). El paracetamol es el medicamento más utilizado. El 34,57 por ciento alternan antitérmicos, habitualmente o cuando la temperatura no baja con un solo fármaco. La combinación ibuprofeno-paracetamol es la más empleada (76,92 por ciento). Hasta el 44,07 por ciento de las personas que utilizan un solo antitérmico administran dosis incorrectas, y hasta el 58,91 por ciento cuando los alternan. Conclusiones: La alternancia de antitérmicos es una práctica frecuente. Un número importante de padres utiliza dosis inadecuadas, sobre todo cuando los combina. Muchos temen que la persistencia de la fiebre provoque convulsiones o meningitis (AU)

Lupus eritematoso sistémico, con síndrome antifosfolípido asociado / Systemic lupus erythematosus with antiphospholipid syndrome

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Nutrient toxicity in pancreatic beta-cell dysfunction.

Nutrients, such as glucose and fatty acids, have a dual effect on pancreatic beta-cell function. Acute administration of high glucose concentrations to pancreatic beta-cells stimulates insulin secretion. In addition, short term exposure of this cell type to dietary fatty acids potentiates glucose-induced insulin release. On the other hand, long-term exposure to these nutrients causes impaired insulin secretion, characterized by elevated exocytosis at low concentrations of glucose and no response when glucose increases in the extracellular medium. In addition, other phenotypic changes are observed in these conditions. One major step in linking these phenotypic changes to the diabetic pathology has been the recognition of both glucose and fatty acids as key modulators of beta-cell gene expression. This could explain the adaptative response of the cell to sustained nutrient concentration. Once this phase is exhausted, the beta-cell becomes progressively unresponsive to glucose and this alteration is accompanied by the irreversible induction of apoptotic programs. The aim of this review is to present actual data concerning the development of the toxicity to the main nutrients glucose and fatty acids in the pancreatic beta-cell and to find a possible link to the development of type 2 diabetes.

[Children of heroin-addicted parents: a risk group. Study of 110 cases]. / Hijos de padres heroinómanos: un grupo de riesgo. Estudio de 119 casos.

In order to know the medical and social problems of children of heroin addicted parents (one or both), one-hundred and nineteen patients were studied. All children had been hospitalized suffering from different diseases. The age of these children ranged from 1 day to 17.3 years (19.6 +/- 30.9 months). Seventy-four of the children were less than 1 year old. The total number of admissions was 159 (range 1-14), representing 2.575 days of hospitalization. The most frequent diagnoses were infectious diseases (gastrointestinal and respiratory), deficiency related diseases (malnutrition and anemia) and parental neglect. Maltreatment was suspected in 44 children (physical: 10, severely neglected: 26, abandonment: 8). Eight children died during the study (AIDS: 4, maltreatment: 2, other causes: 2). Nine parents also died (4 from heroin overdose). The social and family environment of these children, with an increased risk for delinquency and marginality, as well as frequent hospitalizations, make these children a special group at risk for social and health problems which demands multidisciplinary attention and understanding.