[Assessment of the immigrant child]. / Valoración del niño inmigrante.

In the last twenty years Spain has turned into one of the principal countries recipients of foreign population. As consequence of this massive entry of people, our country is among the first ones of Europe for interannual increase of population. The concept of immigrant child is very wide and includes minors of very diverse characteristics, as the proceeding from international adoptions, the children coming from developing countries or those that come from other developed countries. The immigrant children do not represent health risk for the autochthonous population, on the contrary, they are in situation of defenselessness for their scanty vaccination coverages, their situation of marginality and the precarious sanitary systems of the countries of origin. At the moment of offering medical paediatric attention to foreign children, we must individualize our actions in conformity with the characteristics of each patient. It is not possible to simplify in one unique protocol the best studies to resolve a problem of health in an immigrant child. The attention of these children implies an overstrain for the pediatrician and the sanitary personnel that receives them, because it is necessary to conquer idiomatic, cultural and social barriers to optimize the level of health of these patients. The syndromic initial description can help to prioritize the studies in each case (according to the most probable diagnoses). The children who return to the native land of their parents meet in a special situation of risk, for not being prepared to resist the attack of pathogen that do not exist or are rare in Spain.

Valoración del niño inmigrante / Assessment of the immigrant child

En los últimos veinte años España se ha convertido en uno de los principales países receptores de población extranjera. Como consecuencia de esa entrada masiva de personas, nuestro país se encuentra entre los primeros de Europa en cuanto a incremento interanual de población. El concepto de niño inmigrante es muy amplio y engloba a menores de características muy diversas, como los procedentes de adopciones internacionales, los hijos de familias provenientes de países en vías de desarrollo o aquellos que vienen de otros países desarrollados. Los niños inmigrantes no representan un riesgo de salud para la población autóctona, muy al contrario, suelen estar en situación de desprotección por sus escasas coberturas vacunales, su situación de marginalidad y los precarios sistemas sanitarios de los países de los que proceden.A la hora de brindar atención médica pediátrica a niños extranjeros, debemos individualizar nuestras actuaciones conforme a las características de cada paciente. No se puede simplificar en un protocolo único los estudios a realizar ante un problema de salud en un niño inmigrante. La atención de estos niños implica un sobreesfuerzo para el pediatra y el personal sanitario que los recibe, pues hay que vencer barreras idiomáticas, culturales y sociales para conseguir optimizar el estado de salud de estos pacientes. La descripción sindrómica inicial puede ayudar a priorizar los estudios a realizar en cada caso (según los diagnósticos más probables).Los niños que regresan al país de origen de sus padres se ven en una especial situación de riesgo, por no estar preparados para defenderse de patógenos que no existen o son raros en España

In the last twenty years Spain has turned into one of the principal countries recipients of foreign population. As consequence of this massive entry of people, our country is among the first ones of Europe for interannual increase of population. ;;The concept of immigrant child is very wide and includes minors of very diverse characteristics, as the proceeding from international adoptions, the children coming from developing countries or those that come from other developed countries. ;;The immigrant children do not represent health risk for the autochthonous population, on the contrary, they are in situation of defenselessness for their scanty vaccination coverages, their situation of marginality and the precarious sanitary systems of the countries of origin. ;;At the moment of offering medical paediatric attention to foreign children, we must individualize our actions in conformity with the characteristics of each patient. It is not possible to simplify in one unique protocol the best studies to resolve a problem of health in an immigrant child. The attention of these children implies an overstrain for the pediatrician and the sanitary personnel that receives them, because it is necessary to conquer idiomatic, cultural and social barriers to optimize the level of health of these patients. ;;The syndromic initial description can help to prioritize the studies in each case (according to the most probable diagnoses). ;;The children who return to the native land of their parents meet in a special situation of risk, for not being prepared to resist the attack of pathogen that do not exist or are rare in Spain

Midazolam in neonatal seizures with no response to phenobarbital.

The outcome of 45 neonates with EEG-confirmed seizures (ESz) was analyzed with regard to treatment. ESz persisted in 17 of 32 neonates receiving phenobarbital/phenytoin (13 had a poor outcome, 4 died). In contrast, ESz were rapidly controlled in 13 of 13 nonresponders to phenobarbital/phenytoin treated with midazolam (4 had poor outcome, 2 died). Nonresponders to phenobarbital/phenytoin had a significantly worse outcome than responders did. Midazolam effectively controlled ESz in nonresponders to phenobarbital/phenytoin and correlated with significantly improved long-term neurodevelopment.

Assessing the relative quality of anesthesiology and critical care medicine Internet mailing lists.

UNLABELLED: We studied the relative quality of a subset of anesthesiology and critical care medicine Internet mailing lists regarding the publishing capacity of their members to compare them with the major journals and conferences regarding these specialties. Using systematic searches on MEDLINE and according to the Science Citation Index 1995, we investigated the impact factor of mailing list subscribers, of the first authors of the selected articles, and of the first authors of published abstracts from conferences. We studied six mailing lists, seven journals, and four conferences. Journals and conferences showed a higher percentage of published authors and higher average impact factor among their first authors than the mailing lists did per subscriber. However, when only the subset of publishing authors from the three media was considered, no significant differences were found. We conclude that qualified authors may be found among the subscribers of Internet medical mailing lists on anesthesiology and critical care medicine. These professional discussion groups could complement peer-reviewed publications and conferences in professional information exchange and continuing medical education. IMPLICATIONS: Internet publishing is not governed by rules that assure certain basic quality standards. Methods for assessing these standards are needed. We compared discussion groups with medical journals and conferences on anesthesiology and critical care medicine by calculating the impact factor of their members and first authors, respectively. Our study shows that qualified authors may be found in all three media.

Can examination of WWW usage statistics and other indirect quality indicators distinguish the relative quality of medical web sites?

BACKGROUND: The Internet offers a great amount of health related websites, but concern has been raised about their reliability. Several subjective evaluation criteria and websites rating systems have been proposed as a help for the Internet users to distinguish among web resources with different quality, but their efficacy has not been proven. OBJECTIVES: To evaluate the agreement of a subset of Internet rating systems editorial boards regarding their evaluations of a sample of pediatric websites. To evaluate certain websites characteristics as possible quality indicators for pediatric websites. METHODS: Comparative survey of the Results of systematic evaluations of the contents and formal aspects of a sample of pediatric websites, with the number of daily visits to those websites, the time since their last update, the impact factor of their authors or editors, and the number of websites linked to them. RESULTS: 363 websites were compiled from eight rating systems. Only 25 were indexed and evaluated by at least two rating systems. This subset included more updated and more linked websites. There was no correlation among the Results of the evaluation of these 25 websites by the rating systems. The number of inbound links to the websites significantly correlated with their updating frequency (p<.001), with the number of daily visits (p=.005), and with the Results of their evaluation by the largest rating system, HealthAtoZ (p<.001). The websites updating frequency also significantly correlated with the RESULTS of the websites evaluation by HealthAtoZ, both about their contents (p=.001) and their total values (p<.05). The number of daily visits significantly correlated (p<.05) with the Results of the evaluations by Medical Matrix. CONCLUSIONS: Some websites characteristics as the number of daily visits, their updating frequency and, overall, the number of websites linked to them, correlate with their evaluation by some of the largest rating systems on the Internet, what means that certain indexes obtained from the usage analysis of pediatric websites could be used as quality indicators. On the other hand, the citation analysis on the Web by the quantification of inbound links to medical websites could be an objective and feasible tool in rating great amounts of websites.

Are medical mailing lists reliable sources of professional advice?

Professional mailing lists are one of the more useful and popular medical resources on the Internet. Some concern has been raised about the reliability of these uncontrolled forums. We have studied some quality aspects of a subset of Internet mailing lists on nephrology. From November 1996 to March 1997 the mailing lists NEPHROL, PDIAL-L and HYPERTEL were studied. The subscribers that posted, and a representative sample of the total number of subscribers of each list, were searched in the Medline Silver-Platter database, and their individual impact factors were obtained from the Science Citation Index. In addition, the first authors of the original articles, and short communications from the more established nephrology journals, were searched similarly, in order to compare the mailing lists with the journals. NEPHROL was the most active list (7 postings/day on average). HYPERTEL had the best average impact factor among the subscribers who posted (6.6). In general, the journals showed higher average impact factors than the mailing lists, but without statistically significant differences. HYPERTEL, PDIAL-L and NEPHROL are high quality nephrology mailing lists, and can be considered as a complement to the specialized nephrology journals.

Comparative analysis of pediatric mailing lists on the Internet.

OBJECTIVE: To analyze quantitative aspects and the relative quality of various pediatric discussion groups on the Internet and to contrast them with qualitative aspects of a selected number of pediatric journals. MATERIAL AND METHODS: An extensive number of mailing lists on the Internet of interest to pediatricians was compiled. Twelve of them concerned with pediatric specialties were selected. Six representative journals of pediatric specialties were also analyzed and compared with the corresponding mailing lists. From the list of subscribers we studied the potential quality of each mailing list. The postings sent by each member to the on-line discussions were also analyzed. As an estimate of the standing as author of each list member as well as of each first author of the selected journals, we calculated several indexes of quality using the 1995 Medline database and the impact factors of the biomedical journals reported by the 1994 Science Citation Index. RESULTS: The most popular lists were NICU-NET and PICU, both having more than 1100 subscribers. PEDPATH and PEDIHEART had the highest percentage of subscribers who were published authors, and their papers also yielded the highest impact factors. The most active lists were NICU-NET and PICU. The most participative ones were CHILD-NEURO and PED-LUNG. CHILD-NEURO had the highest percentage of authors among the participants. PEDPATH and CHILD-NEURO had the authors with the highest impact factors among the people who participated in the discussions. These latter two lists also showed the highest impact factor per posting. Those which had the highest yield (highest activity with highest quality per posting) were CHILD-NEURO and PEDIHEART. The average impact factor per first author of the analyzed journals was always higher than the average impact factor per participant of the lists. CONCLUSIONS: The electronic-mail discussion groups on the Internet are new nonacademic forums in which knowledge and experience in pediatrics can be shared. They cannot replace but they complement other more academic sources such as medical journals.