Comorbilidad psiquiátrica en niños con epilepsia benigna de la infancia / Psychiatric comorbidity in children with benign childhood epilepsy

La epilepsia es una enfermedad crónica que en ocasiones puede afectar el funcionamiento emocional, cognitivo y lingüístico del niño e impactar en su funcionamiento intra-psíquico e interpersonal incluyendo a su familia y al medio académico y social. Si bien en el ámbito internacional se han realizado numerosos estudios que han podido demostrar que muchos niños con epilepsia ven afectadas sus funciones mentales, sus emociones y conducta, muy pocas investigaciones se propusieron explorar la relación existente entre psicopatología y tipo de epilepsia. Es frecuente que la epilepsia se acompañe de síntomas y cuadros psicológicos y psiquiátricos, causados ya sea por los efectos neurofisiológicos de la misma enfermedad, como consecuencia de las condiciones de vida que la enfermedad impone, por las características constitucionales de los sujetos, por la dinámica que se establece en el plano familiar y también como efectos adversos de la medicación. El predominio de problemas del comportamiento en niños con epilepsia se muestra dos veces superior al considerado en niños con enfermedades crónicas que no implican el SNC y cuatro veces superior al de niños sanos. Estudios más recientes señalan la presencia de disturbios del comportamiento en 21-32% de niños con epilepsia usando la lista de comprobación del comportamiento del niño, en 23-26% con el inventario de la depresión del niño, en el 48% con la escala de Rutter. Es objetivo de esta investigación, determinar la distribución de los trastornos mentales asociados a epilepsia benigna de la infancia en un grupo de pacientes de entre 6 y 13 años y comparar esta distribución con la de un grupo de niños de entre 6 y 13 años de la población escolar general (AU)

Epilepsy is a chronic disease that may affect emotional, cognitive, and linguistic, as well as inter-psychic and intrapersonal functioning including the family and academic and social environments. Although numerous international studies have been conducted showing that in children with epilepsy cognitive function, emotions, and behavior are often impaired, few investigations have proposed to assess the correlation between psychopathology and type of epilepsy. Epilepsy is commonly associated with psychological and psychiatric features caused either by the neurophysiological effects of the disease or by the conditions of life related to the disease, due to constitutional characteristics of the patients, family dynamics, and adverse effects of the antiepileptic drugs. Predominance of behavioral difficulties of children with epilepsy are two-fold higher than in children with other chronic diseases not involving the CNS and four-fold higher than in healthy children. More recent studies have found the presence of behavioral disturbances in 21-32% of children with epilepsy using a checklist of child behavior, with the Child Depression Inventory in 23-26% and the Rutter Scale in 48%. The aim of this study was to determine the distribution of mental disorders associated with benign childhood epilepsy in a group of patients between 6 and 13 years of age compared with that in a group of children between 6 and 13 years of age from the general school-age population (AU)

El impacto familiar en pacientes con epilepsia benigna de la infancia / Family impact on children with benign childhood epilepsy

La epilepsia constituye un factor de estrés en la vida del niño y su familia. Ambos deben desarrollar estrategias de afrontamiento dentro de un sistema que incluye al niño, a su familia y al entorno social, educativo y médico, y que no siempre resultan adaptativas. Si bien en el ámbito internacional se han realizado numerosos estudios que han podido demostrar que muchos niños con epilepsia ven afectadas sus funciones mentales, sus emociones y conducta; muy pocas investigaciones se propusieron explorar la relación existente entre psicopatología y tipo de epilepsia. En el caso de la Epilepsia Benigna de la Infancia (E.B.I.), no se dispone información sistemática que permita esclarecer su relación con trastornos psicopatológicos en niños, ni tampoco la repercusión de la enfermedad en la familia. El impacto que los trastornos epilépticos pueden tener sobre la vida del niño y su familia es un dato de observación clínica hallado en forma frecuente, durante el seguimiento de estos pacientes. Es común encontrar que muchos padres de niños epilépticos se vuelven sobreprotectores, restringiendo la actividad del niño y su autonomía. La falta de exposición a situaciones sociales así como una disminución de las expectativas y demandas hacia estos niños pueden dificultar el desarrollo de herramientas adecuadas de interacción social, lo cual repercute negativamente en la autoestima. En algunas ocasiones el status que asume el paciente en esta situación lo limita más aún que la propia epilepsia. Varios estudios han demostrado que el funcionamiento familiar es un poderoso predictor del funcionamiento psicológico en niños con enfermedades crónicas. Este trabajo se propone conocer el impacto de la enfermedad en el grupo de pacientes con epilepsia benigna de la infancia (AU)

Epilepsy is a factor of stress for the child and his or her family. Both need to develop coping strategies within a system that includes the child, the family, and the social, educational, and medical environment, which do not always adapt to the situation. Although multiple international studies have been conducted showing that in many children with epilepsy cognitive function, emotion, and behavior are affected, few studies have evaluated the association between psychopathology and type of epilepsy. In benign childhood epilepsy (BCI) there are no systematic data to clarify its association with psychopathological disorders in children or the impact of the disease on the family. The impact these epileptic disorders have on the life of the child and their family is an often observed clinical finding in the follow-up of these patients. The parents of children with epilepsy often become overprotective, limiting the activities and autonomy of the child. The lack of exposure in social settings as well as decreased expectations and demands from the parents affect the development of adequate social interaction tools with a negative impact on self-esteem. The latter of which may limit the patient more than the epilepsy itself. Several studies have shown that family functioning is a powerful predictor of psychological performance of children with chronic diseases. The aim of the present study was to evaluate the impact of the disease in a cohort of patients with BCE (AU)

When is "emergency" contraception the right name for postcoital treatment?

PIP: Postcoital contraception includes natural methods, barrier methods, steroidal methods, insertion of IUDs, and uterine aspiration. Natural methods withdrawal, which is associated with a contraceptive efficiency of about 98% and protects women against HIV infection. Advice for the rare occasions when condoms break is to immediately insert a vaginal spermicide. Genital washing with soap and water could also reduce the risk of pregnancy or infection. Douching or genital washing would be about 80% effective as a contraceptive, whereas precoital spermicidal use would be about 96.5% effective. The Yuzpe regimen of postcoital hormonal contraception has been renamed from "the morning after pill" to "emergency contraception." However, the relative effectiveness of the regimen has not been quantified by postcoital time lag. It may be most effective if initiated 12-24 hours after unprotected intercourse, and it may be at least 50% effective up to 120 hours postcoitally. In fact, its efficiency is 60-90% and is, thus, comparable to postcoital genital washing. IUD insertion 5-7 days after the event has been found to be 99% effective in preventing pregnancy. Uterine aspiration or menstrual regulation can be undertaken within two weeks of a missed period, but the safest time for aspiration is 7-8 weeks after last menstrual period to avoid incomplete abortion. Medical abortion can be induced using RU-486 up to 9 weeks since last menstrual period. "Emergency contraception" is a misleading term for postcoital contraception because unprotected coitus is an emergency only in terms of the possibility of HIV infection, not in terms of the small possibility of pregnancy occurring. After 20 years of use, more should be known about the time-lag effectiveness of the Yuzpe regimen, and men and women should be provided with more information on the risks of unprotected coitus and the remedies available to them before and after coitus.^ieng

Efficacy of the simultaneous use of condoms and spermicides.

PIP: The topic of this paper is the demonstration of the combined effectiveness of condom and spermicide use. It is reasoned that 2 methods, which separately provide only moderate efficacy, act together independently and the probability of both failing is the product of the 2 probabilities of failure. Spermicides have a typical user failure rate of 21% and condoms 12%; combined, the 1st year probability of failure among typical users is 2.5%. Under perfect use, where there is correct use for every act of intercourse, the assumption of independence is very likely, and efficacy would be a high as steroidal implants. In addition to highly efficacious protection from pregnancy, there is protection form HIV and other sexually transmitted infections (STD). Spermicides referred to are rubber compatible, not oil based, and conform to the IPPF Agreed Test for Total Spermicidal Power. Condoms are defined as good quality which resist breakage and conform to the International Condom Standard, 1990. It is also advised that, in the event of condom breakage without spermicide, genitalia be washed immediately with soap and water to minimize risk. Also, proper douching that directs liquid sideways, not toward the cervix, should further reduce risk, It is underscored that contraceptive efficacy is not an effectiveness rate, but a failure rate. Effectiveness is the proportionate reduction in the risk of conception per cycle or infection per coitus caused by use of a method. The per cycle probability of conception is fecundability. The model described for combined use and STD use; it is based on the assumption that 1) the probability of conception and effectiveness and thus the per cycle probability of failure for the method is constant over time, and 2) there are 13 cycles per year. What is ignored is that failure rates decline among typical users with duration of use, so that life table procedures are not necessary. The annual probability of failure during perfect use of condoms and spermicides would by .00045, and if failure doubled, the probability would still be only .00186. Any lubricant also helps to reduce breakage of condoms, thereby enhancing efficacy. The probability of failure for spermicidally lubricated condoms during perfect use would be .005. If the annual probability of condom failure were doubled to 4% and spermicide effectiveness were the lowest at 73%, then the failure rate would be only 1%.^ieng

Did I remember to squeeze the teat? A critical view of condom instruction.

PIP: The method-effectiveness of the oral contraceptive pill is believed to be 100%. Studies have, however, also found proper, consistent use of condoms to effectively prevent pregnancy. One could even assume the method-effectiveness of the condom to be at least 98%. Spermicides, when used alone, are perhaps 95% effective as a contraceptive. Combining condom use with spermicides must therefore confer protection against pregnancy of about 99.9%. Moreover, water-based spermicides lubricate coitus, thereby reducing stress on the condom, while both condoms and spermicides offer considerable protection against sexually transmitted diseases; the oral pill does not offer these added benefits. Acknowledging these merits, the author considers condom failure, standards, user failure, the timing of placement, the need to squeeze the tip of the condom before placement on the erect penis, withdrawal after ejaculation, disposal, and storage. In the interest of maximizing the level and quality of condom use, the author recommends that instructions be kept as simple and clear as possible. Before penetration, unroll the condom onto the erect penis carefully; during withdrawal after ejaculation, hold the condom rim to the base of the penis; and store unused condoms in cool, dark, and dry places away from oil-based products. There is no need to put on the condom immediately after erection and before the man touches his sex partner. Likewise, there is no need to pinch the tip of the condom to create a reservoir for ejaculate, and there is no need to withdraw the penis immediately after orgasm. For maximum contraceptive effectiveness and lubrication, consumers may be advised to use condoms with non-oil-based spermicides. Insistence upon spermicidal supplementation is, however, unwarranted since consumers can judge the importance of avoiding the risk of pregnancy.^ieng

Contraception in Europe.

PIP: A summary is presented of information on contraceptive use in Great Britain, Denmark, Sweden, Belgium, Italy, and Poland. Data from England and Wales compare 1) methods used by fathers to those used by mothers of different legitimate births in 1973 and 2) methods used by mothers to those used by ever-married women 16-40 years old in 1975. Oral contraceptives were most often used, followed by condoms. The last contraceptive used by pregnant women in Denmark in 1977-1978 was most likely the condom (37%) followed by oral contraceptives (30%). Women 14-45 years old in Sweden in 1977 favored oral contraceptives (31%), the condom (20%), and the IUD (19%), with 25% using no method. Married, Dutch-speaking Belgium women age 16-44 years in 1975-1976 used withdrawal (33%), oral contraceptives (32%), and the rhythm method (16%). When analyzed by age, younger women favored oral contraceptives (43% versus 32% nonappliance) whereas older women favored nonappliance methods (59% versus 25% oral contraceptives). People 18-64 years old in Italy used withdrawal as the main contraceptive method (29%) followed by oral contraceptives (22%), and condoms (16%). Of Polish women, 43% used no method, 51% nonappliance methods, and 12% barrier methods. A greater number of rural women used no method (51% as compared to 39% of urban women). Addresses from which to obtain more detailed information in each country are given.^ieng

Legal abortion mortality.

PIP: Statistics on legal abortion in Britain between 1968-1974 are presented. There was a mortality rate of 10+ or -2 per 100,000 abortions: 27+ or -11 in 1968-1969, 12+ or -4 in 1970-1972, and 6+ or -3 in 1973-1974. Legal abortion mortality increased from 4+ or -3 when performed at gestation under 9 weeks to 5+ or -2 at 9-12 weeks, 13+ or -7 at 13-16 weeks, and 62+ or -33 at 17 weeks and over. The ratio was 11+ or -6 for women under 20 years of age, increasing to 5+ or -3 at age 20-29, 10+ or -6 at age 30-39, and 23+ or -19 at age 40 and over. The parity had little influence on abortion mortality, but the technique used had a great influence. Hysterotomy, hypertonic saline, and abortifacient paste were the most dangerous, in increasing order, with mortality rates of 39+ or -30, 106+ or -75, and 152+ or -89, respectively. The rates for aspiration and curretage were 4+ or -2 and 4+ or -3, respectively. There was a higher mortality risk with abortion with sterilization. The main causes of legal abortion mortality were infection, pulmonary embolism, and complications of general anesthesia. The high incidence of mortality associated with legal abortion in Britain is partially caused by: 1) high incidence of concurrent sterilization, 2) former use of dangerous techniques, 3) significant incidence of second trimester abortion, 4) routine use of general anesthesia, and 5) previous ill health of some of the women.^ieng

Condom testing: part 2.

PIP: Various government standards required for testing condoms to be sold are described. A minimum tensile strength of 200 kg/sq cm and a minimum elongation at breaking of 600 to 700% are required by some countries. Bursting volume by U.S. standards is over 1 cubic foot before and after aging. To test for holes condoms are filled with water and rolled on absorbent paper. Mean thickness by U.S. standards must be between .004 and .002 cm with no reading exceeding .009 cm. The weight of each of 20 condoms per batch must not exceed 1.7 gm. A minimum length of 16 cm is required. Minimum width standards vary from 4.4 cm to 4.9 cm and maximum from 5.4 to 5.6 cm. Dates of manufacture and time of expiration of guarantee are required by some countries. Instructions for use may be required. No laboratory test has been devised to predict the chance of a condom bursting in practice. Faulty handling or lubication may be the cause. A supplementary spermicide would reduce the risk of pregnanc y or of infection should the condom burst.^ieng