ABSTRACT
No disponible
Subject(s)
Humans , Infant , Antibiotic Prophylaxis/methods , Vesico-Ureteral Reflux/microbiology , Urinary Tract Infections/prevention & control , Risk FactorsABSTRACT
No disponible
Subject(s)
Humans , Child , Renal Insufficiency, Chronic/complications , Iron/therapeutic use , Anemia, Iron-Deficiency/drug therapy , 16595/drug therapyABSTRACT
Background Maternal postpartum depression (PPD) could affect children's emotional development, increasing later risk of child psychological problems. The aim of our study was to assess the association between child's emotional and behavioural problems and mother's PPD, considering maternal current mental health problems (CMP). Methods This is a secondary analysis from the EU-Childhood Obesity Project (NCT00338689). Women completed the Edinburgh Postnatal Depression Scale (EPDS) at, 2, 3 and 6 months after delivery and the General Health Questionnaire (GHQ-12) to assess CMP once the children reached the age of 8 years. EPDS scores > 10 were defined as PPD and GHQ-12 scores > 2 were defined as CMP. The psychological problems of the children at the age of eight were collected by mothers through the Child's Behaviour Checklist (CBCL). Results 473, 474 and 459 mothers filled in GHQ-12 and CBCL tests at 8 years and EPDS at 2, 3 and 6 months, respectively. Anxiety and depression was significantly increased by maternal EPDS. Children whose mothers had both PPD and CMP exhibited the highest levels of psychological problems, followed by those whose mothers who had only CMP and only PPD. PPD and CMP had a significant effect on child's total psychological problems (p = 0.033, p < 0.001, respectively). Children whose mothers had PPD did not differ from children whose mothers did not have any depression. Conclusions Maternal postpartum depression and current mental health problems, separately and synergistically, increase children's psychological problems at 8 years.
Subject(s)
Anxiety/complications , Child Behavior Disorders/epidemiology , Child of Impaired Parents , Depression, Postpartum/psychology , Emotions , Mothers/psychology , Anxiety/psychology , Child , Depression , Depression, Postpartum/diagnosis , Depression, Postpartum/epidemiology , Female , Humans , Mental Health , Mother-Child Relations , Pregnancy , Problem Behavior , Psychiatric Status Rating Scales , Surveys and Questionnaires , Time FactorsABSTRACT
La aparición de las guías K/DOQI en el año 2002 sobre definición, evaluación y clasificación en estadios de la enfermedad renal crónica (ERC) han supuesto un cambio importante en la forma de evaluar la función renal en adultos y en niños. Estas guías, recientemente actualizadas, recomiendan que el estudio de la función renal se realice a partir de la medida de la concentración sérica de creatinina y de la estimación del filtrado glomerular (FG) obtenido mediante una ecuación. Sin embargo, la implementación de esta recomendación en los informes del laboratorio clínico en población pediátrica ha sido casi nula. Los estudios aparecidos en los últimos años sobre la importancia de la detección y seguimiento de los pacientes con ERC, la aparición de nuevas ecuaciones de estimación del FG y los avances en los laboratorios clínicos respecto a los métodos de medida de creatinina y de cistatina C han determinado la colaboración entre los servicios de pediatría y de los laboratorios clínicos con objeto de establecer recomendaciones homogéneas y basadas en la mejor evidencia científica sobre la utilización de las ecuaciones de estimación del FG en este grupo de población. El objetivo de este documento es proporcionar recomendaciones sobre la evaluación de la función renal y la utilización de ecuaciones de estimación del FG en niños. Los destinatarios de estas recomendaciones son los pediatras, nefrólogos, bioquímicos clínicos, analistas clínicos y todos los profesionales de la salud relacionados con el estudio y la evaluación de la función renal de este grupo de pacientes (AU)
The appearance of the K/DOQI guidelines in 2002 on the definition, evaluation and staging of chronic kidney disease (CKD) have led to a major change in how to assess renal function in adults and children. These guidelines, recently updated, recommended that the study of renal function is based, not only on measuring the serum creatinine concentration, but this must be accompanied by the estimation of glomerular filtration rate (GFR) obtained by an equation. However, the implementation of this recommendation in the clinical laboratory reports in the paediatric population has been negligible. Numerous studies have appeared in recent years on the importance of screening and monitoring of patients with CKD, the emergence of new equations for estimating GFR, and advances in clinical laboratories regarding the methods for measuring plasma creatinine and cystatin C, determined by the collaboration between the departments of paediatrics and clinical laboratories to establish recommendations based on the best scientific evidence on the use of equations to estimate GFR in this population. The purpose of this document is to provide recommendations on the evaluation of renal function and the use of equations to estimate GFR in children from birth to 18 years of age. The recipients of these recommendations are paediatricians, nephrologists, clinical biochemistry, clinical analysts, and all health professionals involved in the study and evaluation of renal function in this group of patients (AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Glomerular Filtration Rate/physiology , Kidney Function Tests/methods , Renal Insufficiency, Chronic/diagnosis , Cystatin C/analysis , Creatinine/analysis , Reference Values , Biomarkers/analysis , Practice Patterns, Physicians'ABSTRACT
The appearance of the K/DOQI guidelines in 2002 on the definition, evaluation and staging of chronic kidney disease (CKD) have led to a major change in how to assess renal function in adults and children. These guidelines, recently updated, recommended that the study of renal function is based, not only on measuring the serum creatinine concentration, but this must be accompanied by the estimation of glomerular filtration rate (GFR) obtained by an equation. However, the implementation of this recommendation in the clinical laboratory reports in the paediatric population has been negligible. Numerous studies have appeared in recent years on the importance of screening and monitoring of patients with CKD, the emergence of new equations for estimating GFR, and advances in clinical laboratories regarding the methods for measuring plasma creatinine and cystatin C, determined by the collaboration between the departments of paediatrics and clinical laboratories to establish recommendations based on the best scientific evidence on the use of equations to estimate GFR in this population. The purpose of this document is to provide recommendations on the evaluation of renal function and the use of equations to estimate GFR in children from birth to 18 years of age. The recipients of these recommendations are paediatricians, nephrologists, clinical biochemistry, clinical analysts, and all health professionals involved in the study and evaluation of renal function in this group of patients.
Subject(s)
Glomerular Filtration Rate , Kidney Function Tests/standards , Renal Insufficiency, Chronic/diagnosis , Biomarkers/blood , Child , Creatinine/blood , Cystatin C/blood , Humans , Mathematical Concepts , Renal Insufficiency, Chronic/blood , Renal Insufficiency, Chronic/physiopathologyABSTRACT
Introducción: El principal pilar del tratamiento de la obesidad infantil es la promoción de cambios conductuales, especialmente difíciles durante la adolescencia. Este trabajo propone y evalúa un nuevo protocolo terapéutico de base motivacional, estructurado en objetivos, aplicable desde una consulta pediátrica. Pacientes y métodos: Se estudió a 110 adolescentes obesos. El protocolo terapéutico constaba de 12 visitas mensuales, en 2 fases: motivacional y de intervención, en las que se proponían cambios y se pactaban objetivos, que fueron evaluados en términos de dificultades y logros. Se midieron el peso y la talla en cada visita, y la presión arterial, el perímetro de cintura, la glucosa, la insulina y el perfil lipídico al inicio y al final. Resultados: Se produjo una reducción media de 0,5 SDS del IMC z-score en los adolescentes que finalizaron la intervención (78,2%), esta disminución fue de 0,8 SDS en el grupo de pacientes con buena respuesta al tratamiento (75,6%). Este grupo bajó de forma significativa el colesterol total, LDL, triglicéridos, insulina e índice HOMA. El principal factor pronóstico de buena respuesta fue el éxito en la fase motivacional con un valor predictivo positivo del 95% (83-98%). Conclusiones: Los descensos en el IMC z-score y el control de los parámetros antropométricos y bioquímicos sitúan a OBEMAT como un método altamente eficaz entre los publicados anteriormente. La respuesta a la fase motivacional determina en gran medida el éxito o el fracaso de la intervención(AU)
Introduction: The mainstay of the treatment of childhood obesity is the promotion of behavioural changes, which are especially difficult during adolescence. This paper proposes and evaluates a new motivation-based therapeutic protocol, structured in objectives, which is applicable from paediatric practice. Patients and methods: A total of 110 obese adolescents were studied. The therapeutic protocol consisted of 12 monthly visits, in two phases: Motivational and Interventional, in which changes were proposed and objectives were agreed, and later evaluated taking into account the difficulties and achievements. Weight and height was measured in each visit, and blood pressure, waist circumference, glucose, insulin and lipid profile were measured at the beginning and at the end. Results: There was a mean decrease of 0.5 SDS in BMI z-score in the adolescents who completed the intervention (78.2%), with this decrease being 0.8 SDS in the group of patients with good response to treatment (75.6%). This group had a significantly lower total cholesterol, LDL, triglycerides, insulin and HOMA index. The main predictor of good response was the success of the motivational phase, with a positive predictive value of 95% (83-98%). Conclusions: BMI z-score decreases and the control of anthropometric and biochemical parameters, show that OBEMAT is a highly effective method compared to those published previously. The response to the motivational phase largely determines the success or failure of the intervention(AU)
Subject(s)
Humans , Male , Female , Adolescent , Obesity/therapy , Motivation , Weight Loss , Evaluation of Results of Therapeutic Interventions , Treatment Outcome , Prospective Studies , Body Mass IndexABSTRACT
INTRODUCTION: The mainstay of the treatment of childhood obesity is the promotion of behavioural changes, which are especially difficult during adolescence. This paper proposes and evaluates a new motivation-based therapeutic protocol, structured in objectives, which is applicable from paediatric practice. PATIENTS AND METHODS: A total of 110 obese adolescents were studied. The therapeutic protocol consisted of 12 monthly visits, in two phases: Motivational and Interventional, in which changes were proposed and objectives were agreed, and later evaluated taking into account the difficulties and achievements. Weight and height was measured in each visit, and blood pressure, waist circumference, glucose, insulin and lipid profile were measured at the beginning and at the end. RESULTS: There was a mean decrease of 0.5 SDS in BMI z-score in the adolescents who completed the intervention (78.2%), with this decrease being 0.8 SDS in the group of patients with good response to treatment (75.6%). This group had a significantly lower total cholesterol, LDL, triglycerides, insulin and HOMA index. The main predictor of good response was the success of the motivational phase, with a positive predictive value of 95% (83-98%). CONCLUSIONS: BMI z-score decreases and the control of anthropometric and biochemical parameters, show that OBEMAT is a highly effective method compared to those published previously. The response to the motivational phase largely determines the success or failure of the intervention.
Subject(s)
Motivation , Pediatric Obesity/metabolism , Pediatric Obesity/therapy , Psychotherapy/methods , Adolescent , Child , Female , Humans , Male , Prospective Studies , Treatment OutcomeABSTRACT
AIMS: To analyse the effect of early puberty (onset between 7.5 and 8.5 y) on pubertal growth and adult height in girls, and the implications of this effect for the age limit for normal onset of puberty. METHODS: Longitudinal study in Reus (Spain) of 32 girls with early puberty until they reached adult height. Data from these girls were compared with longitudinal data from girls (116) from the same population with normal onset at 10 (n = 37), 11 (n = 47), 12 (n = 19) and 13 (n = 13)y. We analysed height, target height, adult height, pubertal height increase, duration of pubertal growth, age at menarche and time to menarche. RESULTS: The adult height of girls with early puberty (160.9 +/- 5.4cm) was similar to that of girls with onset at later ages (p = not significant). In these girls, puberty lasted 5.4 +/- 0.7 y and the mean growth during puberty was 31.1 +/- 3.5 cm. As the age of onset of puberty increases, the duration of puberty and mean growth during puberty progressively decreased (p < 0.001). Girls with early puberty reached menarche at a mean age of 10.9 +/- 1.0 y, 3.2 +/- 0.9 y after onset of puberty, and this time span was greater than in the other groups. CONCLUSION: Girls with onset of puberty at 8 y show all the compensatory phenomena related to height at onset, pubertal duration and height increase during puberty. These phenomena cause their adult height to be similar to that of girls who begin puberty at the age of 10 to 13 y.
Subject(s)
Body Height/physiology , Puberty/physiology , Adult , Age Factors , Child , Female , Humans , Longitudinal Studies , SpainABSTRACT
BACKGROUND: Many treatment errors in neonatal intensive care units are caused by the need to carry out a sequence of calculations to determine the dose and dilution of the drugs used. OBJECTIVES: To help in this task, we designed a spreadsheet (Neodosis) that helps clinicians and nurses to calculate the doses and standardize the dilutions of some of the drugs most commonly used in resuscitation and neonatal intensive care units. The aim of this study was to verify the usefulness and reliability of this software package. METHODS: A randomized, cross-over, controlled trial was conducted through simulated clinical cases in which the number of errors in the prescription data and the amount of time spent in making calculations, with and without the program, were evaluated. Fifty-four tests were performed by pediatricians, third- and fourth-year pediatric residents, and nurses. RESULTS: Without computer support, all three groups made errors (residents, pediatricians and nurses in descending order). When Neodosis was used, all the medical staff made significantly fewer errors. The greatest reduction was found in errors made by pediatric residents: minor errors decreased from 16 % to 2 % and major errors from 1.6 % to zero. When using the spreadsheet, the time spent by all groups in making the calculations was reduced by between one-third and one-half. CONCLUSIONS: The tests performed with simulated clinical cases revealed that the number of errors made by the healthcare personnel who participated in this study was not inconsiderable. The use of Neodosis helped physicians and nurses to make markedly fewer errors and also saved them time.
Subject(s)
Drug Therapy, Computer-Assisted , Intensive Care Units, Neonatal , Medication Errors/prevention & control , Cross-Over Studies , Drug Prescriptions , Humans , Infant, Newborn , Reproducibility of ResultsABSTRACT
Antecedentes: Muchos de los errores de tratamiento producidos en las unidades de cuidados intensivos neonatales (UCIN) tienen su origen en la necesidad de efectuar secuencias de cálculos para determinar dosis y diluciones de fármacos. Objetivos: Para ayudar en estas tareas se diseñó una hoja de cálculo (neodosis) que facilita los cálculos y estandariza las diluciones de algunas de las terapias más usadas en reanimación y UCIN. Para evaluar su utilidad se diseñó este trabajo. Métodos: Se efectuó un estudio controlado, cruzado y aleatorizado mediante simulaciones clínicas en las que se evaluó el número de errores y tiempo utilizado en su resolución, con y sin el programa. Fueron realizadas un total de 54 pruebas en las que intervinieron médicos (residentes de tercer y cuarto año y pediatras) y personal de enfermería. Resultados: Sin ayuda de ordenador todos los estamentos cometieron errores (en orden decreciente: residentes, pediatras y enfermería). El conjunto del estamento médico experimentó una reducción significativa de errores con la ayuda informática. El grupo de residentes fue el más beneficiado con su utilización: su porcentaje de errores "menores" pasó del 16 al 2% y el de errores "mayores" del 1,6% a 0. El tiempo empleado por todos los grupos se redujo entre un tercio y la mitad. Conclusiones: El personal asistencial probado cometió un número no insignificante de errores en pruebas de simulación sobre cálculos típicos de UCIN. Neodosis ayudó a médicos y enfermeras a reducir muy sensiblemente estos errores y a emplear menos tiempo en su resolución (AU)
Subject(s)
Infant, Newborn , Humans , Drug Therapy, Computer-Assisted , Intensive Care Units, Neonatal , Reproducibility of Results , Cross-Over Studies , Medication Errors , Drug PrescriptionsABSTRACT
No disponible
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Female , Male , Child , Humans , Calcium/urine , Calcium Metabolism Disorders/diet therapy , Calcium Metabolism Disorders/physiopathology , Calcium Metabolism Disorders/complications , Diagnosis, DifferentialABSTRACT
INTRODUCTION: Pupil asymmetry is an alarm signal which should lead to investigation to rule out severe underlying neurological disorders. Among its causes are tumors, aneurysms and hernia of the uncus. The differential diagnosis should also include other conditions such as Adie's tonic pupil, the Pourfour de Petit syndrome and local disorders such as closed angle glaucoma or segmental spasm of the iris dilator muscle. In practice however, exposure to mydriatic substance is one of the commonest causes. Another cause of this sign is benign episodic unilateral mydriasis. This uncommon condition has been defined as an isolated benign cause of pupil asymmetry. The underlying physiopathology is not always clear and may involve either parasympathetic deficiency or sympathetic hyperactivity affecting the iris. Usually related to migraine, some authors classify it as a limited form of ophthalmoplegic migraine, although some cases have been described with no accompanying headache. CLINICAL CASE: We describe a case of benign episodic unilateral mydriasis in a six-year-old girl who presented with intermittent episodes of pupil asymmetry with no other neurological symptoms. CONCLUSION: We underline the rarity of this condition in children with no simultaneous headache.
Subject(s)
Mydriasis/physiopathology , Periodicity , Child, Preschool , Female , Humans , Neurologic ExaminationABSTRACT
Introducción. La asimetría pupilar es un signo de alarma que debe llevar a descartar patología neurológica grave subyacente. Entre las posibles causas de este hallazgo se encuentran tumoraciones, aneurismas y herniación uncal. En el diagnóstico diferencial deben incluirse también otros cuadros como la pupila tónica de Adie, el síndrome de Pourfour du Petit y patologías locales como el glaucoma de ángulo cerrado o el espasmo segmentario del dilatador del iris. En la práctica, sin embargo, la exposición a sustancias midriáticas es una de sus causas más frecuentes. Otra causa de este hallazgo es la midriasis unilateral benigna episódica. Esta entidad poco frecuente, se ha definido como causa aislada y benigna de asimetría pupilar. La fisiopatología del cuadro no es siempre clara, en ella podría intervenir tanto un déficit parasimpático como una hiperactividad simpática sobre el iris. Generalmente relacionada con la migraña, ha sido catalogada por algunos autores como una forma limitada de migraña oftalmopléjica, a pesar de haberse descrito algunos casos no acompañados de cefalea. Caso clínico. Se expone un caso de midriasis unilateral benigna episódica en una niña de 6 años que ha presentado episodios intermitentes de asimetría pupilar sin otra sintomatología neurológica. Conclusión. Destacamos la rareza del cuadro por aparecer en edad pediátrica y sin cefalea acompañante (AU)
No disponible
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Child, Preschool , Female , Humans , Periodicity , Mydriasis , Neurologic ExaminationABSTRACT
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Pregnancy , Adult , Male , Infant, Newborn , Female , Humans , Spain , Sulfonylurea Compounds , Diabetes, Gestational , Hyperinsulinism , Hypoglycemia , Hypoglycemic Agents , EntamoebiasisSubject(s)
Foreign Bodies/complications , Movement Disorders/etiology , Rectum , Walking , Foreign Bodies/diagnostic imaging , Humans , Infant , Male , RadiographyABSTRACT
OBJECTIVE: The purpose of this study was to investigate the clinical manifestations, outcome and risk factors for urolithiasis of untreated idiopathic hypercalciuria (IH) in children. PATIENTS AND METHODS: During a 5 year period, all children with hematuria, lower urinary tract symptoms (LUS), or abdominal pain who were observed to have IH (urinary calcium > 4 mg/kg/day) were included in the study. The relationship between some variables (age, gender, hypercalciuria subtype, and clinical features) and urolithisis was analyzed. RESULTS: We studied 76 children with IH (9 with renal IH, 49 with absorptive IH and 18 with undetermined IH). Hematuria (46%), LUS (27.6%), lumbar pain (22%) and abdominal pain (15.7%) were the most common initial symptoms. We found a significant difference between age and clinical presentation. LUS were found more frequently in young children (46.4%) and flank pain in older patients (47.8%). Hematuria was age dependent. Eighteen (23%) patients developed urolithiasis. These 18 patients tended to be older (9.3 vs 6 years) than the other 58 children. Age at diagnosis presented a linear relationship with the development of urolithiasis (p < 0.001). Significant relative risk for urolithiasis (4.3) was found in those children who initially presented with lumbar pain. In all other parameters measured (calciuria, uricosuria, oxaluria, citraturia) and clinical characteristics analyzed, there were no statistically significant differences between those with and without stones. CONCLUSIONS: An age-dependent clinical pattern can be established for children with hypercalciuria. Significant risk for urolithiasis accompanies those children who are diagnosed later (> 9 years) and who initially present with lumbar pain.
Subject(s)
Urinary Calculi/diagnosis , Abdominal Pain/etiology , Adolescent , Back Pain/etiology , Child , Child, Preschool , Female , Hematuria/etiology , Humans , Infant , Male , Polyuria/etiology , Retrospective Studies , Urinary Calculi/complicationsABSTRACT
This study was designed to determine the influence of lactose malabsorption on the consumption of dairy products. We studied 157 children and 43 adults. The Breath-hydrogen test was used to define their level of lactose digestion. The prevalence of lactose maldigesters was 12%. We found a large relationship between the consumption of milk and milk products and age. Malabsorbers consumed more fermented dairy products (ripened cheese and yogurt) than did absorbers (p < 0.05). Subjects with normal lactose absorption consumed more milk, butter, cream cheese and global lactose than the maldigesters (p < 0.05). Lactose intolerance, familiar consumption and geographic origins had little influence on an individual's consumption habits.
