Serum melatonin concentration in the child with non-organic failure to thrive: comparison with other types of stress.

Human beings must adapt both to novel, unfavourable conditions and to circumstances of physical or psychological isolation. The initial response to stress depends fundamentally on the activation of the HPA axis. In regaining homeostatic equilibrium, melatonin plays a role due to its synchronising and anti-stress properties. To study the role of melatonin and the pineal gland in the organic and/or behavioural response to acute or chronic stress, 311 children were divided into two large groups: 1) Control Group - 121 healthy children classified, in turn, into 4 control subgroups, one for each pathology being studied; 2) Problem Groups, classified as traumatic stress (n=58), surgical stress (n=38), psychic stress (n=64) and febrile stress (n=30), according to pre-established clinical criteria. These groups were sub-classified according to the degree (low or high) and duration (acute or chronic) of the stress. This study used a case controlled, cross sectional design. Serum melatonin was measured by radioimmunoassay (RIA). In all the situations of acute stress, melatonin increased at a rate directly proportional to the severity and/or duration of the stress-causing stimulus. In contrast, in chronic stress, i.e. the Affective Deprivation Syndrome (or Psychological Dwarfism) with or without non-organic failure to thrive, resulted in the opposite response with a significant reduction of melatonin. In conclusion, in acute stress an increase in the bioavailability of melatonin could contribute to maintaining homeostatic balance. The lack of an appropriate response to acute stress could make some groups of patients (Affective deprivation syndrome with or without growth failure) predisposed to suffer depressive symptoms associated with a wide range of neurological, endocrinological or immunological consequences.

Maltrato en la infancia discapacitada / Maltreatment in disabled children

El problema del maltrato y abuso sexual a los niños con una discapacidad física, psíquica o sensorial (por acción u omisión), es más frecuente que el maltrato a los niños considerados normales, a la vista de los estudios realizados en este colectivo. En el presente trabajo se realiza una revisión y actualización de los conocimientos que sobre este problema social hay publicados en la literatura más reciente. Se hace una revisión sobre la frecuencia, el tipo de maltrato que afecta a este grupo de niños, de causa multifactorial. Se valoran los factores protectores, factores de riesgo, formas específicas de maltrato, indicadores del mismo, diagnóstico y diagnóstico diferencial y prevención primaria y secundaria sobre este problema (AU)

Abuses to children with physical, psychological and sensorial disabilities are more frequent tan to children considered normal, according to the studies carried out on this subject. The present paper reviews and actualizes the current knowledge on this problem, usually caused by multiple factors. Frequency, kind of abuse, clinic findings, risk and protect factors, diagnosis, differential diagnosis and the primary and secondary prevention strategies are revised (AU)

El adolescente normal. Desarrollo físico, psíquico y social / The abnormal adolescent. Physical, psychic and social development

Al ser la adolescencia un periodo variable y crítico de desarrollo de la edad pediátrica y de transición a la vida adulta, se hace una revisión conceptual y actualización del mismo en nuestro entorno. Se resalta la importancia de este grupo etáreo en la vida adulta, la frecuencia de los problemas propios a este periodo de edad, en el que no son niños ni adultos. Se analizan con extensión la características del crecimiento y desarrollo físico, las modificaciones propias de la pubertad, la maduración sexual y se analizan los principales características del desarrollo psíquico y social (AU)

This paper reviews the main characteristics of the adolescence, a vulnerable and critical age period, which represent the transition to the adult life. Concepts are revised and actualized. The great importance of the adolescence, the frequency of the typical problems at this period, in which subjects are neither adults nor child, are studied. Characteristics of growing and physical development, pubertal life style habits changes, sexual maturation and social and psychological development are analyzed (AU)

Total antioxidant capacity of plasma in asymptomatic carrier state of Neisseria meningitidis.

Reduction of the antioxidant capacity of plasma has been linked with the impairment of an effective immune response and so we hypothesized that the carriage rate of Neisseria meningitidis in asymptomatic subjects might correlate with the levels of antioxidants in plasma. To this end we took pharyngeal swabs from 339 children in Marquesado Basic Health Zone, Granada, Spain and in addition determined the total antioxidant capacity (TAC) in plasma samples from these subjects. The overall prevalence of N. meningitidis carriage was 5.9% (mean age 7.1 years) with rates of 10.3% in children aged 3 < or =years, 3.9% between 4 and 7 years and 2.4% in older subjects. Plasma TAC for the < or =3-year-olds was 0.13 for carriers and 1.10 for non-carrier controls (P=0.04), 0.13 for carriers aged 4-7 years (controls 0.63) and 0.28 for carriers aged >7 years (controls 0.52). We analysed the association between TAC in plasma (<0.37 - 2 S.D.) and the carrier state of N. meningitidis. In the carrier state, the odds ratio for this association (TAC in plasma <0.25) was 8.44 (95% CI 1.5-48.9). These findings may suggest a reduced immune response in the host favourable to nasopharyngeal persistence of meningococci.

Institutional childcare and the affective deficiency syndrome: consequences on growth, nutrition and development.

It is generally accepted that, in the face of certain family and social circumstances, a minor may need to be taken into care within an institution, a course of action that provides, at least, an alternative to the risks of abandonment and life "on the street". Nevertheless, the reality of life in childcare centres can lead to children undergoing an additional trauma after escaping the miserable situation of the family home. After the advances made in recent years (economic, healthcare, social, legal, etc.), it has been suggested that the institutionalization of a minor, as a rule, does not in itself represent a negative factor for the child's wellbeing. In order to test this hypothesis, we studied two groups of children in care. The first group comprised 101 children being cared for in a large traditional institution during 1986. The second group was composed of 66 children studied in 1996, resident in a smaller, charitable institution, providing a more family-like atmosphere. Growth evaluation methods were applied, including anthropometry (weight, height, weight/height ratio, body mass index, Rorer index and weight index), nutrition (skin folds, body density, percentage of body fat and weight of the fat) and development (psychometry: Boehm test, CMMS, Raven and EIT). The data were analyzed by means of the Student's t-test. The most important result obtained was the demonstration that the second group of children presented results that were clearly higher in nearly all the studied variables, thus showing that institutionalization in itself does not have a negative influence on child development.

Situación de salud entre niños gitanos y no gitanos de una comarca granadina / Health status of gypsy and non-gypsy children in a health district in granada (spain)

OBJETIVO: Evaluar la situación del estado de salud, comparando 2 poblaciones de niños, gitanos y no gitanos, y valorar la necesidad del abandono de los "tópicos" y estereotipos para mejorar la toma de decisiones. El objetivo de esta investigación surge de la observación de diferentes comportamientos de la población de una zona básica de salud de la provincia de Granada y la aparente concentración de determinadas patologías en la población infantil minoritaria gitana. MATERIAL Y MÉTODOS: Para ello se analizan y comparan los datos de las historias clínicas y las fichas de control de salud del Programa Materno-Infantil del Centro de Salud de Iznalloz. De estas historias, 149 (38,40 por ciento) pertenecían a niños gitanos y 239 (61,59 por ciento) a niños no gitanos. RESULTADOS: Dentro de las variables estudiadas destacan: a) el inicio de la lactancia materna y su continuación al tercer mes es igual para ambos grupos; b) los ingresos en la unidad neonatal pueden ser hasta 3,53 veces más probables en los niños gitanos que en los no gitanos; c) las enfermedades metabólicas o degenerativas muestran una significación del 1,4 por ciento en la relación, y d) los niños gitanos realizan un seguimiento incompleto en los controles de salud de hasta 3,24 veces más probable que los niños no gitanos (AU)

[Adverse reactions caused by drugs in pediatrics]. / Reacciones adversas causadas por medicamentos en pediatría.

The present study describes the results obtained in a screening program aimed at detecting adverse reactions to medication in children aged 1-8 years admitted to the Pediatrics Service of the University of Granada Hospital (Spain). The program is based on monitoring the patients for a period of 12 months. Of a total of 597 patients, adverse reactions were recorded in 4.4%. Within this group the reactions were classified as confirmed in 33.3%, probable in 30% and possible in 36.6%. Based on organs and systems, the CNS was most frequently affected (40%), followed in decreasing order by the digestive (37%) and cardiovascular systems (10%), skin (10%) and endocrine system (3%). The drugs most frequently involved were bronchodilators (40%), antibiotics (30%) and antiepileptics (20%). Among risk factors, polytherapy, hospitalization time and type of drug administered were the most important.