ABSTRACT
Objetivo: Analizar la eficacia y la seguridad del tratamiento con hormona de crecimiento (GH) durante 3 años en niños pequeños para la edad gestacional (PEG) sin crecimiento recuperador, diagnosticados y tratados en el Servicio de Endocrinología del Hospital Infantil Universitario Niño Jesús de Madrid entre 2003 y 2011. Sujetos y métodos: Se estudiaron retrospectivamente los datos antropométricos y analíticos de 52 pacientes PEG tratados con GH (dosis media: 0,035mg/kg/día), determinando su influencia sobre el crecimiento, composición corporal, maduración ósea, metabolismo de carbohidratos y lípidos, perfilhormona tiroideo y tensión arterial. Resultados: El tratamiento con GH determinó un incremento significativo de la velocidad de crecimiento, máximo en los primeros 12 meses de su administración y en niños menores de 5 años de edad. Los niveles de IGF-I aumentaron significativamente, junto con una aceleración de la maduración ósea, permaneciendo ambos dentro de los límites de la normalidad. Se evidenció un aumento progresivo de los niveles de glucemia en ayunas, HbA1c, insulina basal e índice HOMA (homeostasis model assessment). Se constató una disminución significativa de c-LDL y un aumento de c-HDL. Asimismo, los cocientes colesterol total/c-HDL y c-LDL/c-HDL descendieron de forma significativa. Conclusión: El tratamiento con GH, además de promover el crecimiento físico en pacientes PEG, genera una cierta resistencia a la acción de la insulina y una mejoría de los cocientes de riesgo aterogénico a lo largo del seguimiento, tras 3 años de terapia. Es necesario un seguimiento a talla adulta (AU)
Aim: To analyze the effectiveness and safety of growth hormone (GH) treatment, administered over a 3 year period to children small for gestational age (SGA) without catch-up growth, followed up in the Department of Endocrinology at the University Hospital Niño Jesús in Madrid between 2003 and 2011. Patients and methods: Anthropometric and analytical data from 52 SGA patients receiving GH therapy (mean dose: 0.035mg/kg/day) were retrospectively examined in order to determine its influence on linear growth, body composition, bone maturation, carbohydrate and lipid metabolism, thyroid hormone profile and blood pressure. Results: GH treatment induced a significant increase in growth velocity, with the highest rise occurring during the first 12 months of its administration and in children under 5 years of age. Insulin-like growth factor-I levels increased significantly, along with a significant acceleration in bone maturation, with both parameters remaining within normal limits. A progressive rise in fasting glucose levels, glycosylated hemoglobin, baseline insulin, and homeostasis model assessment index, were also found. Low density lipoprotein cholesterol (LDL-c) levels decreased and high density lipoprotein cholesterol levels (HDL-c) increased significantly. The atherogenic ratios of total-cholesterol/HDL-c and LDL-c/HDL-c also decreased significantly. Conclusion: GH treatment promotes physical growth in SGA patients, generates certain resistance to the action of insulin, and improves atherogenic risk ratios after 3 years of therapy. Long-term monitoring is required until adult height is reached (AU)
Subject(s)
Humans , Male , Female , Child, Preschool , Child , Growth Hormone/therapeutic use , Infant, Small for Gestational Age/growth & development , Growth Disorders/drug therapy , Treatment Outcome , Retrospective Studies , Lipoproteins/analysis , Insulin Resistance , Risk Factors , Cardiovascular Diseases/epidemiologyABSTRACT
AIM: To analyze the effectiveness and safety of growth hormone (GH) treatment, administered over a 3 year period to children small for gestational age (SGA) without catch-up growth, followed up in the Department of Endocrinology at the University Hospital Niño Jesús in Madrid between 2003 and 2011. PATIENTS AND METHODS: Anthropometric and analytical data from 52 SGA patients receiving GH therapy (mean dose: 0.035mg/kg/day) were retrospectively examined in order to determine its influence on linear growth, body composition, bone maturation, carbohydrate and lipid metabolism, thyroid hormone profile and blood pressure. RESULTS: GH treatment induced a significant increase in growth velocity, with the highest rise occurring during the first 12 months of its administration and in children under 5 years of age. Insulin-like growth factor-I levels increased significantly, along with a significant acceleration in bone maturation, with both parameters remaining within normal limits. A progressive rise in fasting glucose levels, glycosylated hemoglobin, baseline insulin, and homeostasis model assessment index, were also found. Low density lipoprotein cholesterol (LDL-c) levels decreased and high density lipoprotein cholesterol levels (HDL-c) increased significantly. The atherogenic ratios of total-cholesterol/HDL-c and LDL-c/HDL-c also decreased significantly. CONCLUSION: GH treatment promotes physical growth in SGA patients, generates certain resistance to the action of insulin, and improves atherogenic risk ratios after 3 years of therapy. Long-term monitoring is required until adult height is reached.
Subject(s)
Growth/drug effects , Human Growth Hormone/therapeutic use , Infant, Small for Gestational Age/metabolism , Child, Preschool , Female , Human Growth Hormone/pharmacology , Humans , Infant , Infant, Newborn , Male , Retrospective Studies , Thyroid Hormones/blood , Time Factors , Treatment OutcomeABSTRACT
OBJECTIVE: To provide a comprehensive and detailed overview of the burden of disease in Spain for 2008. Implications for public health policies are discussed. STUDY DESIGN: Cross-sectional population-based study. METHODS: Disability-adjusted life years (DALYs) were calculated at country level using the methodology developed in the Global Burden of Disease study. DALYs were divided into years of life lost and years of life lived with disability. Results were obtained using Spanish mortality data for 2008 and morbidity data estimated previously by the World Health Organization for Euro-A. RESULTS: In 2008, DALYs lost due to all diseases and injuries were estimated at 5.1 million. Non-communicable diseases accounted for 89.2% of the total DALYs. The leading causes of DALYs were neurological and mental disorders (29.9%), malignant neoplasms (15.8%) and cardiovascular diseases (12.5%). The main specific causes included depression (5.5%), ischaemic heart disease (5.5%), lung cancer (5.3%) and alcohol abuse (4.7%) among males; and depression (11.7%), dementias (10.0%), hearing loss (4.2%) and cerebrovascular disease (3.5%) among females. CONCLUSIONS: Measuring DALYs specifically for Spain represents a systematic analysis of population health losses, and also provides an important measure to track the outcomes of future health interventions.
Subject(s)
Cost of Illness , Disabled Persons/statistics & numerical data , Quality-Adjusted Life Years , Wounds and Injuries/epidemiology , Adolescent , Adult , Aged , Cause of Death , Child , Child, Preschool , Cross-Sectional Studies , Female , Health Policy , Humans , Infant , Male , Middle Aged , Spain/epidemiology , Wounds and Injuries/mortality , Young AdultSubject(s)
Cardiovascular Diseases/economics , Cost-Benefit Analysis/statistics & numerical data , Cardiac Rehabilitation , Cardiovascular Diseases/diagnosis , Cardiovascular Diseases/prevention & control , Cardiovascular Diseases/therapy , Clinical Trials as Topic/economics , Clinical Trials as Topic/statistics & numerical data , Cost-Benefit Analysis/methods , Decision Support Techniques , Health Facilities/economics , Health Facilities/statistics & numerical data , Humans , Models, Theoretical , Research Design , Spain , Treatment OutcomeABSTRACT
Objetivo: describir las actividades realizadas con la población adolescente en un centrode salud.Pacientes y métodos: estudio descriptivo retrospectivo de la actividad realizada con lapoblación adolescente en un centro de salud durante dos años. Se seleccionaron a 434 pacientescon edades comprendidas entre 11 y 18 años. Se registraron los datos sociodemográficos,el número de visitas, los diagnósticos, los exámenes de salud, consejos acerca del consumode alcohol, tabaco, drogas, advertencias sobre sexualidad, nutrición y accidentes,petición de pruebas complementarias, consultas a otras especialidades, estado vacunal, rendimientoescolar, relaciones familiares e ingresos hospitalarios.Resultados: durante el período de estudio acudieron al menos una vez a la consulta 353adolescentes (el 81% del total de la muestra). El número medio de visitas fue 3,97 + 4,6 (IC95% = 3,53-4,41) y el número medio de exámenes de salud fue 0,57 + 0,64 (IC 95% =0,51-0,63). Los diagnósticos más frecuentes fueron infecciones respiratorias de las vías altas,seguidas de enfermedades de la piel, osteoarticulares y ginecológicas. En 212 adolescentes(49%) se realizó al menos un examen de salud durante ese período; la proporciónmayor tuvo lugar en el grupo de menores de 16 años.El 69% de los pacientes recibió consejo de prevención de riesgos (alcohol, tabaco, drogas,educación sexual, nutrición y accidentes). En un 98% de los pacientes las recomendacionesfueron realizadas en las consultas de pediatría.Conclusiones: la eliminación de barreras favorece la asistencia de los adolescentes alcentro de salud y su inclusión en actividades preventivas
Purpose: to examine the adolescents (age 11-18) utilization of ambulatory care.Methods: prospective study of the activity in a Primary Care Health Centre over twoyears. 434 adolescents were included (age 11-18). Visit characteristics consisted of gender,age, country, number of visits, morbidity, health supervision visits, counselling on six selectedtopics: alcohol consumption, tobacco, and other illicit drugs, diet and exercise, injuryprevention, sex advice, other explorations and specialty consultation, immunization status,family relationship and school performance, hospital admissions.Results: 353 adolescents (81%) attended at least once the physicianoffice during this period. The mean number of visits was 3.97 + 4.6 (CI 95% = 3.53-4.41)and the mean number of check-ups was 0.57 + 0.64 (CI 95% = 0.51-0.63). The leading reasonsfor both male and female visits were respiratory, dermatological and musculoskeletalconditions. 212 adolescents (49%) had at least one check-up during this period, most of themamong the group younger than 16. 69% of the adolescents received behavioural counsellingregarding drinking, drugs, tobacco use, sexual education and nutrition. 98% of counsellingwas in the pediatric office.Conclusions: decreasing barriers to accessing Primary Care increases adolescent visitsand their inclusion in preventive activities (AU)
