Inmigración y factores asociados con la lactancia materna. Estudio CALINA / Immigration and factors associated with breastfeeding. CALINA study

OBJETIVO: Identificar las características socioculturales, obstétricas y perinatales asociadas con la lactancia materna completa (LMC) durante 4 meses, en dependencia del origen materno. MATERIAL Y MÉTODOS: Estudio de una cohorte representativa de la población de lactantes aragoneses (n = 1.452). Se han evaluado las variables socioculturales, obstétricas y perinatológicas asociadas a la modalidad de lactancia materna, en dependencia del origen de la madre. RESULTADOS: La prevalencia de LMC en nuestro medio es más alta en las madres inmigrantes que en las de origen español. El 37,2% de las de origen español mantienen la LMC a los 4 meses frente al 43% de las inmigrantes (p = 0,039) (RR españolas/inmigrantes=0,76; IC del 95%, 0,58-0,99); a los 6 meses, esto ocurre en un 13,9% vs. 23,8%, respectivamente (p < 0,001) (RR españolas/inmigrantes=0,52; IC del 95%, 0,37-0,72). Los factores que se asocian a la LMC a los 4 meses son diferentes entre ambos grupos. Las madres de origen español tienen más edad (p = 0,002), nivel educativo (p = 0,001), paridad (p = 0,003) y mayor probabilidad de parto vaginal (p = 0,005), y sus hijos presentan mayores valores antropométricos al nacimiento. Sin embargo, en las madres inmigrantes, el mantenimiento de LMC se asocia a un mayor índice de masa corporal materno y a no trabajar fuera del domicilio. En ambos grupos, la LMC se mantiene con más frecuencia en aquellas madres que no fuman (p = 0,001). CONCLUSIONES: La prevalencia de LMC durante los primeros meses de edad es más alta en las madres inmigrantes que en las madres de origen español y los factores socioculturales, obstétricos y perinatales que se asocian a la misma son distintos en función del origen materno

OBJECTIVE: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin. MATERIAL AND METHODS: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452). RESULTS: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=0.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<0.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=0.002), have higher academic level (P=0.001), greater parity (P=0.003), and a higher probability of vaginal delivery (P=0.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=0.001). CONCLUSIONS: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin

[Immigration and factors associated with breastfeeding. CALINA study]. / Inmigración y factores asociados con la lactancia materna. Estudio CALINA.

OBJECTIVE: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin. MATERIAL AND METHODS: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452). RESULTS: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=.002), have higher academic level (P=.001), greater parity (P=.003), and a higher probability of vaginal delivery (P=.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=.001). CONCLUSIONS: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin.

Prevalencia de la lactancia materna durante el primer año de vida en Aragón. Estudio CALINA / Breastfeeding prevalence during the first year of life in Aragon. CALINA study

Objetivos: Estudiar la prevalencia actual de la lactancia materna (LM) hasta los 12 meses de edad en Aragón, analizando los aspectos demográficos, perinatales y sociales que la modifican. Material y métodos: Estudio observacional longitudinal en una cohorte representativa de la población de lactantes aragoneses, nacidos desde marzo del 2009 a marzo del 2010, y controlados hasta los 12 meses de edad (N=1.602). Se han evaluado sus variables obstétricas, perinatológicas y de alimentación. Resultados: La LM exclusiva o predominante fue superior al resto de modalidades de alimentación durante los 4 primeros meses de vida. El mantenimiento conjunto de la LM en cualquiera de sus modalidades fue del 82,5% al mes de edad, el 71,8% al tercero, el 54,3% al sexto y 27,8% al año. Las variables maternas que se asociaron significativamente al mantenimiento de la LM, tanto al mes como a los 6 meses de edad fueron: tipo de parto (mayor probabilidad si el parto es vaginal), el nivel de estudios (mayor probabilidad si tienen estudios superiores), la procedencia (mayor probabilidad en las madres de origen africano), la adiposidad (mayor probabilidad en las madres que tienen un peso adecuado o sobrepeso frente a las obesas) y no fumar durante la gestación. Conclusiones: La prevalencia de LM en Aragón durante los primeros 12 meses de vida es alta y ha aumentado respecto a los datos que previamente se disponían. La LM se mantiene en más de la mitad de los lactantes de 6 meses y en una cuarta parte al año de edad. Los condicionantes maternos que influyen significativamente en el inicio y mantenimiento de la LM en nuestro medio son el tipo de parto, el nivel de estudios, la procedencia (inmigración), la adiposidad y el hábito tabáquico (AU)

Objectives: To study the current prevalence of breastfeeding (BF) in Aragon (Spain) during the first 12 months of life, and analyse its demographic, perinatal and social influential factors. Material and methods: Obstetric, perinatal and feeding aspects were evaluated in a longitudinal and observational study, in a representative cohort of infant population from Aragon born between March 2009 to March 2010, controlled until 12 months of age (N=1.602). Results: Exclusive or predominant BF was more frequent than the rest of feeding modalities during the first 4 months of life. Maintenance prevalence of any BF modality was 82.5% at 1stmonth of age, 71.8% at 3rd, 54.3% at 6th, and 27.8% at 12 months of age. Maternal variables that were significantly associated with BF maintenance both at 1 and 6 months of age were: delivery modality (higher probability in case of vaginal delivery), academic level (higher probability if university studies), origin (higher probability in mothers from Africa), adiposity (higher probability of normal weight or overweight mothers compared with obese ones), and not to smoke during gestation. Conclusions: BF prevalence in Aragon (Spain) during the first 12 months of age is high and has increased compared with previous data. BF continues in more than half of infants at six months and in a quarter of infants at 12 months of age. Maternal factors that significantly influence BF initiation and maintenance are, delivery modality, academic level, origin (immigration), adiposity and smoking habit (AU)

[Breastfeeding prevalence during the first year of life in Aragon. CALINA study]. / Prevalencia de la lactancia materna durante el primer año de vida en Aragón. Estudio CALINA.

OBJECTIVES: To study the current prevalence of breastfeeding (BF) in Aragon (Spain) during the first 12 months of life, and analyse its demographic, perinatal and social influential factors. MATERIAL AND METHODS: Obstetric, perinatal and feeding aspects were evaluated in a longitudinal and observational study, in a representative cohort of infant population from Aragon born between March 2009 to March 2010, controlled until 12 months of age (N=1.602). RESULTS: Exclusive or predominant BF was more frequent than the rest of feeding modalities during the first 4 months of life. Maintenance prevalence of any BF modality was 82.5% at 1(st) month of age, 71.8% at 3(rd), 54.3% at 6(th), and 27.8% at 12 months of age. Maternal variables that were significantly associated with BF maintenance both at 1 and 6 months of age were: delivery modality (higher probability in case of vaginal delivery), academic level (higher probability if university studies), origin (higher probability in mothers from Africa), adiposity (higher probability of normal weight or overweight mothers compared with obese ones), and not to smoke during gestation. CONCLUSIONS: BF prevalence in Aragon (Spain) during the first 12 months of age is high and has increased compared with previous data. BF continues in more than half of infants at six months and in a quarter of infants at 12 months of age. Maternal factors that significantly influence BF initiation and maintenance are, delivery modality, academic level, origin (immigration), adiposity and smoking habit.

Aspectos perinatales, crecimiento y tipo de lactancia de los nacidos pequeños para su edad gestacional / Perinatal aspects, growth and feeding of infants born small for gestational age

Introducción: El haber nacido pequeño para la edad gestacional (PEG) conlleva riesgos a corto y a largo plazo. El objetivo del estudio es describir las características perinatológicas y socioculturales, el patrón de crecimiento y el tipo de alimentación de los nacidos PEG en nuestro medio durante sus primeros 6 meses de vida. Materiales y métodos: Se ha evaluado durante 6 meses la antropometría y alimentación en una muestra de 1.596 lactantes representativa de la población aragonesa. Resultados: Las madres de los PEG (n=94) ganaron menos peso durante la gestación (10,5±5,8 vs 12,0±5,07kg; p=0,012), el embarazo duró menos (37,84±1,7 vs 39,06±1,6semanas; p<0,001) y se les realizaron más cesáreas (37,2 vs 20,5%; p=0,001). La talla de la madre fue menor en el grupo de PEG (1,61±0,58 vs 1,63±0,06 metros; p = 0,004), pero su índice de masa corporal fue similar. No se encontraron diferencias entre grupos en los aspectos sociales o culturales. Las madres de los PEG fumaron más durante la gestación (32,3 vs 18,5%; p = 0,003) (RR = 1,92; IC 95%: 1,31-3,02). Los PEG mantuvieron un menor peso y longitud durante los 6 primeros meses de vida y la ganancia ponderal mensual fue similar al resto. La prevalencia de lactancia materna fue menor en los PEG, 54,9 vs 68,2% a los 4 meses (RR=0,58; IC 95%: 0,38-0,89). Conclusión: En los nacidos PEG confluyen una serie de características que deben ser consideradas, ya que en conjunto confieren riesgos para la salud. Los nacidos PEG en nuestro medio no presentan un patrón de crecimiento recuperador rápido y su menor tamaño persiste a los 6 meses de vida(AU)

Introduction: Being born small for gestational age (SGA) has short and long term risks. The aim of this study was to describe perinatal and socio-cultural characteristics, and the pattern of growth and diet of SGA infants during their first 6 months of life. Materials and methods: Anthropometry and diet were evaluated during six months in a representative sample of 1596 newborns the population of Aragon (Spain). Results: Mothers of SGA (N=94) infants gained less weight during pregnancy (10.5±5.8 vs 12.0±5.07kg, P=.012), gestational age at birth was lower (37.84±1.7 vs 39.06±1.6 weeks, P<.001), and the probability of cesarean delivery was higher (37.2% vs 20.5%, P=.001). The height of the mother was lower in the SGA group (1.61±0.58 vs 1.63±0.06 metres, P=.004), but their body mass index was similar. No differences were found between groups in social or cultural aspects. Mothers of SGA infants smoked more during pregnancy (32.3% vs 18.5%, P=.003) (RR = 1.92; 95% CI; 1.31 to 3.02). Infants born SGA remained smaller during the first 6 months of life, and the monthly weight gain was similar to the rest. In the SGA group, the prevalence of breastfeeding was lower at 4 months of age (54.9% vs 68.2%, RR = 0.58, 95% CI; 0.38 to 0.89). Conclusions: Infants born SGA are more likely to converge a number of characteristics that must be considered together because they may lead to health risks. SGA do not show a rapid recovery pattern of postnatal growth, and their smaller size persists at six months(AU)

[Perinatal aspects, growth and feeding of infants born small for gestational age]. / Aspectos perinatales, crecimiento y tipo de lactancia de los nacidos pequeños para su edad gestacional.

INTRODUCTION: Being born small for gestational age (SGA) has short and long term risks. The aim of this study was to describe perinatal and socio-cultural characteristics, and the pattern of growth and diet of SGA infants during their first 6 months of life. MATERIALS AND METHODS: Anthropometry and diet were evaluated during six months in a representative sample of 1596 newborns the population of Aragon (Spain). RESULTS: Mothers of SGA (N=94) infants gained less weight during pregnancy (10.5±5.8 vs 12.0±5.07 kg, P=.012), gestational age at birth was lower (37.84±1.7 vs 39.06±1.6 weeks, P<.001), and the probability of cesarean delivery was higher (37.2% vs 20.5%, P=.001). The height of the mother was lower in the SGA group (1.61±0.58 vs 1.63±0.06 metres, P=.004), but their body mass index was similar. No differences were found between groups in social or cultural aspects. Mothers of SGA infants smoked more during pregnancy (32.3% vs 18.5%, P=.003) (RR = 1.92; 95% CI; 1.31 to 3.02). Infants born SGA remained smaller during the first 6 months of life, and the monthly weight gain was similar to the rest. In the SGA group, the prevalence of breastfeeding was lower at 4 months of age (54.9% vs 68.2%, RR = 0.58, 95% CI; 0.38 to 0.89). CONCLUSIONS: Infants born SGA are more likely to converge a number of characteristics that must be considered together because they may lead to health risks. SGA do not show a rapid recovery pattern of postnatal growth, and their smaller size persists at six months.

Características socioculturales, obstétricas y antropométricas de los recién nacidos hijos de madre fumadora / Socio-cultural, obstetric and anthropometric characteristics of newborn children of mothers who smoke in spain

Introducción: En España, una de cada tres mujeres fuma al inicio del embarazo; de ellas, un 25-50% dejan de fumar durante la gestación y la mayoría reinicia el consumo tras el parto. Entre los efectos del tabaquismo materno en el recién nacido, destaca el bajo peso al nacimiento con su consecuente morbilidad. El objetivo del estudio es comparar las características antropométricas y socioculturales de los hijos de gestante no fumadora con respecto a los de madre fumadora en nuestro medio. Materiales y métodos: Se han evaluado los hábitos de tabaquismo y las características socioculturales de una muestra de 1.499 embarazadas y las variables antropométricas de sus recién nacidos durante el año 2009 en Aragón. Resultados: Se observó en las 1.499 gestantes estudiadas una prevalencia de tabaquismo en la gestación de 19,6%; entre las españolas el 23% fumó durante la gestación frente al 11% de las extranjeras. Las madres fumadoras fueron más jóvenes y con un nivel educativo menor que las no fumadoras; sin embargo no se hallaron diferencias en sus características antropométricas. Los nacidos en Aragón hijos de madre fumadora tuvieron un menor peso al nacer respecto a los de no fumadoras (3.155 g vs 3.295 g: p < 0,001) y un riesgo relativo de nacer con bajo peso para su edad gestacional de 2,1 (IC 95%: 1,35-2,97). La longitud y resto de variables antropométricas del recién nacido también se vieron afectadas. Conclusiones: La prevalencia de tabaquismo durante la gestación en Aragón es alta. Las madres que fuman son más jóvenes y con características socioculturales diferentes a las no fumadoras. El hábito tabáquico materno repercute negativamente en el estado nutricional del recién nacido, suponiendo un riesgo evitable de bajo peso al nacer (AU)

Introduction: One in every four women smoke at the beginning of the pregnancy in Spain; of these, 25-50% give up smoking during gestation and most of them smoke again after child birth. Maternal smoking has harmful effects on babies, such as low birth-weight with its resulting morbidity. The objective of this study is to compare the anthropometric and socio-cultural characteristics between newborns from smoking mothers and those from non- smoking ones. Materials and methods: Smoking habits and the socio-cultural characteristics were assessed from a sample of 1499 pregnant women, as well as their newborn anthropometric variables of their newborn babies during 2009 in the Aragon region of Spain. Results: In the sample of 1499 pregnant women the prevalence of smoking during pregnancy was 19.6%; among the Spanish women, 23% of them smoked during the gestation compared with only 11% in women from other countries. The smoker mothers were younger and they had a lower educational level than the non smoker ones; however, there were no statistical differences between their anthropometric characteristics. Newborns from smoker women in Aragon had a lower weigh at delivery (3155 vs. 3295 grams: p < .001) and a relative risk of low weight at birth for their gestational age of 2.1 (95% CI: 1.35 --- 2.97). The length and the rest of newborn anthropometric variables were also affected. Conclusion: The prevalence of smoking during gestation is high in Aragon. The mothers who smoke are younger and have different socio-cultural characteristics compared with non-smoker mothers. Maternal smoking habits have a harmful effect on newborn nutritional status, representing an avoidable risk of low weight at birth (AU)

[Socio-cultural, obstetric and anthropometric characteristics of newborn children of mothers who smoke in Spain]. / Características socioculturales, obstétricas y antropométricas de los recién nacidos hijos de madre fumadora.

INTRODUCTION: One in every four women smoke at the beginning of the pregnancy in Spain; of these, 25-50% give up smoking during gestation and most of them smoke again after childbirth. Maternal smoking has harmful effects on babies, such as low birth-weight with its resulting morbidity. The objective of this study is to compare the anthropometric and socio-cultural characteristics between newborns from smoking mothers and those from non- smoking ones. MATERIALS AND METHODS: Smoking habits and the socio-cultural characteristics were assessed from a sample of 1499 pregnant women, as well as their newborn anthropometric variables of their newborn babies during 2009 in the Aragon region of Spain. RESULTS: In the sample of 1499 pregnant women the prevalence of smoking during pregnancy was 19.6%; among the Spanish women, 23% of them smoked during the gestation compared with only 11% in women from other countries. The smoker mothers were younger and they had a lower educational level than the non smoker ones; however, there were no statistical differences between their anthropometric characteristics. Newborns from smoker women in Aragon had a lower weigh at delivery (3155 vs. 3295 grams: p<.001) and a relative risk of low weight at birth for their gestational age of 2.1 (95% CI: 1.35 - 2.97). The length and the rest of newborn anthropometric variables were also affected. CONCLUSION: The prevalence of smoking during gestation is high in Aragon. The mothers who smoke are younger and have different socio-cultural characteristics compared with non-smoker mothers. Maternal smoking habits have a harmful effect on newborn nutritional status, representing an avoidable risk of low weight at birth.

Serum transaminases concentrations in obese children and adolescents.

The aim of the study was to investigate the relationship between liver transaminase levels and metabolic syndrome (MS) features in obese children and adolescents. A total of 132 children and adolescents (73 males and 59 females) aged 8 - 16, participated in the study. All were studied at the department of Paediatrics, University Hospital of Zaragoza (Spain). Inclusion criteria were the existence of obesity as defined by body mass index (BMI) according to Cole cut-off values (when BMI was higher than the age and sex specific equivalent to 30 kg/m2). The definition of metabolic syndrome was according to the International Diabetes Federation criteria. Weight (kg), height (cm), waist circumference (cm), blood pressure and BMI were measured. Laboratory determinations after overnight fasting included: transaminases (ALT, AST, GGT), fasting glucose, insulin, triglycerides and HDL-C. The MS was found in 21.6% of the obese children and adolescents and the prevalence was higher in males (25.9%) than in females (15.9%). Serum transaminases (ALT, AST and GGT) mean concentrations were higher in males than in females, and decreased during pubertal development. The obese children and adolescents with the MS did not show higher transaminases concentrations when compared with those without the MS. Some MS manifestations (mainly waist circumference) showed a correlation with ALT, although all transaminases values were normal according to adult references. Liver transaminases, a surrogate marker of NAFLD, did not show an early and consistent manifestation of abnormalities in the obese children and adolescents studied. In order to define the presence of the disease, it would be necessary to obtain aminotransferase reference standards for children and adolescents, considering pubertal stage and gender.

Concentraciones séricas de transaminasas en niños y adolescentes obesos / Serum transaminases concentrations in obese children and adolescents

The aim of the study was to investigate the relationship between liver transaminaselevels and metabolic syndrome (MS) features in obese children and adolescents.A total of 132 children and adolescents (73 males and 59 females) aged 8 – 16, participatedin the study. All were studied at the department of Paediatrics, UniversityHospital of Zaragoza (Spain). Inclusion criteria were the existence of obesity asdefined by body mass index (BMI) according to Cole cut-off values (when BMI washigher than the age and sex specific equivalent to 30 kg/m2). The definition of metabolicsyndrome was according to the International Diabetes Federation criteria.Weight (kg), height (cm), waist circumference (cm), blood pressure and BMI weremeasured. Laboratory determinations after overnight fasting included: transaminases(ALT, AST, GGT), fasting glucose, insulin, triglycerides and HDL-C. The MSwas found in 21.6% of the obese children and adolescents and the prevalence washigher in males (25.9%) than in females (15.9%). Serum transaminases (ALT, ASTand GGT) mean concentrations were higher in males than in females, and decreasedduring pubertal development. The obese children and adolescents with the MS didnot show higher transaminases concentrations when compared with those withoutthe MS. Some MS manifestations (mainly waist circumference) showed a correlationwith ALT, although all transaminases values were normal according to adult references.Liver transaminases, a surrogate marker of NAFLD, did not show an earlyand consistent manifestation of abnormalities in the obese children and adolescentsstudied. In order to define the presence of the disease, it would be necessary to obtainaminotransferase reference standards for children and adolescents, consideringpubertal stage and gender(U)

Se valora en el estudio la concentración de transaminasas en niños y adolescentes obesos y se investiga la relación entre enzimas hepáticas y marcadores de síndrome metabólico (SM). Un total de 132 niños y adolescentes (73 chicos y 59 chicas), de 8-16 años, participaron en el estudio. El criterio de inclusión fue la existencia de obesidad definida mediante el índice de masa corporal (IMC) de acuerdo con los valores de Cole et. al. (IMC mayor que el equivalente a 30 kg/m2 para una edad y sexo específico). Para definir el síndrome metabólico (MS), se eligieron los criterios de la Federación Internacional de Diabetes. Se realizaron medidas del peso (Kg), altura (cm), perímetro de la cintura y tensión arterial y determinaciones de laboratorio en ayunas de las transaminasas (ALT, AST, GGT), glucosa, insulina, triglicéridos y HDL-C. Presentaron síndrome metabólico el 21,6% de los niños y adolescentes obesos y la prevalencia fue mayor en chicos (25,9%) que en chicas (15,9%). Los componentes más frecuentes del síndrome metabólico fueron la obesidad abdominal (exceso de circunferencia de cintura, 93%) y la tensión arterial elevada (34,3%). Los valores medios de las concentraciones séricas de transaminasas (ALT, AST, GGT) fueron mayores en chicos que en chicas, y disminuyeron según el desarrollo puberal(AU)

Los niños y adolescentes obesos con síndrome metabólico no presentaron mayores concentraciones de transaminasas en comparación con los que no tenían síndrome metabólico. Algunas manifestaciones de SM (en particular el perímetro de la cintura) se asociaron con ALT, aunque los valores de transaminasas fueron normales según las referencias usadas para adultos. En los niños estudiados, las transaminasas, un marcador secundario de hígado graso no-alcohólico (NAFLD), no fueron una manifestación temprana y consistente de estas anomalías. Para definir la presencia de la enfermedad, sería necesario obtener valores de referencia de transaminasas para niños y adolescentes, considerando el estadío puberal y el sexo(AU)

Trastorno obsesivo-compulsivo / Obsessive-compulsive disorder

Se presenta el caso de un niño con conducta acumuladora, episodios de agitación psicomotriz y ansiedad, así como ideas autolíticas cuando se pone freno a estas conductas. Durante su estancia en el hospital, se observa una tendencia a recoger desperdicios y basura, incluso sus propias heces. Las pruebas complementarias no detectan ningún signo orgánico ni infeccioso. Con el diagnóstico de trastorno obsesivo-compulsivo, se instaura tratamiento con sertralina y risperidona (AU)

We report the case of a child with hoarding behavior, agitation and anxiety, as well as self-injurious urges when these behaviors were stopped. While he was in the hospital, he was observed to have a tendency to pick up wastes and rubbish, even his own feces. Supplementary tests revealed no organic or infectious alterations. With the diagnosis of obsessive-compulsive disorder, treatment with sertraline and risperidone was initiated (AU)