Differences in the use of primary care services between Spanish national and immigrant patients.

UNLABELLED: Knowing what real use is made of health services by immigrant population is of great interest. The objectives are to analyze the use of primary care services by immigrants compared to Spanish nationals and to analyze these differences in relation to geographic origin. Retrospective observational study of all primary care visits made in 26 urban health centers. Main variable: total number of health centre visits/year. DEPENDENT VARIABLES: type of clinician requested; type of attention, and origin of immigrants. The independent variable was nationality. Statistics were obtained from the electronic medical records. The 4,933,521 appointments made in 2007 were analyzed for a reference population of 594,145 people (11.15% immigrants). The adjusted annual frequency for nationals was 8.3, versus whereas 4.6 for immigrants. The immigrant population makes less use of primary care services than national population. This is evident for all age groups and regardless of the immigrants' countries of origin. This result is important when planning health care resources for immigrant population.

Competencia cultural y población inmigrante: un reto cotidiano en nuestras consultas / Cultural competence and immigrant population: a daily challenge in our clinical offices

Los últimos años, en España, ha habido un gran aumento de la población inmigrante. Este fenómeno ha supuesto un reto para los pediatras que han tenido que adaptarse a esta nueva realidad. En la actualidad, muchas de las dificultades y retos que nos plantea el niño inmigrante tienen más que ver con problemas de comunicación y diferentes concepciones de la salud y la enfermedad, que con patologías importadas o problemas de salud concretos. En la línea de lo anterior, se habla de la competencia cultural como un conjunto de habilidades, actitudes y comportamientos, en los que el profesional debería estar entrenado para proporcionar unos cuidados sensibles, empáticos, flexibles y respetuosos con el paciente, que implican una comunicación centrada en el paciente efectiva. Son pilares básicos de la competencia cultural, la sensibilidad hacia las diferencias y hacia el otro, y la capacidad de escucha y saber preguntar. No se trata de habilidades diferentes a las necesarias para hacer una atención adecuada a nuestros pacientes en general, sino de aplicar las habilidades necesarias para un enfoque centrado en el paciente a la población inmigrante. Por lo tanto profundizar en estas habilidades nos hará mejorar nuestra atención a la población autóctona. En nuestra atención al inmigrante, nos encontramos con dificultades y barreras para superar estas dificultades. Dentro de estas barreras nos encontramos con problemas de actitud, prejuicios, recelos, barreras lingüísticas, escaso tiempo en las consultas, falta de formación en temas específicos de la población inmigrante, etc. Identificar estas barreras y buscar soluciones a esas dificultades son los objetivos de la presente revisión (AU)

In recent years, Spain has experienced a large increase in the immigrant population. This phenomenon has been a challenge for pediatricians who have had to adapt to this new reality. Today, many of the difficulties and challenges regarding immigrant children have more to do with communication problems and different conceptions of health and disease, than with imported diseases or specific health problems. According to this, we speak of cultural competence as a set of skills, attitudes and behaviours in which the practitioner should be trained in order to provide a sensitive, empathetic, flexible and patient friendly care, which also includes an effective patient-centred communication. They are cornerstones of cultural competence, together with sensitivity to differences and to others, and the ability to listen and to know how to ask. Those abilities and skills are not different from the necessary ones to take appropriate care of our patients in general, but to apply them is necessary for a patient-centred approach to the immigrant population. Therefore the further development of these skills will improve our attention to the local population. In our attention to immigrants we encounter difficulties and barriers to overcome. Within these barriers we face problems of attitude, prejudice, mistrust, language barriers, short time in consultations, lack of training in specific areas of the immigrant population, etc. Identifying these barriers and seeking solutions to these difficulties is the target of this review (AU)

[Wolfram syndrome. Clinical and genetic study in two families]. / Síndrome de Wolfram. Estudio clínico y genético en dos familias.

Wolfram syndrome (WS), also known as DIDMOAD (due to its association with diabetes insipidus, diabetes mellitus, optic atrophy and deafness), is an infrequent cause of diabetes mellitus. This syndrome is included among the genetic disorders associated with diabetes in the American Diabetes Association's classification. WS is an autosomal recessive neurodegenerative disease characterized by various clinical manifestations such as diabetes mellitus, optic atrophy, diabetes insipidus, deafness, neurological symptoms, renal tract abnormalities, psychiatric disorders and gonadal disorders. The most frequent of these disorders is early onset diabetes mellitus, with a low prevalence of ketoacidosis, and optic atrophy, which is considered a key diagnostic criterion in this syndrome. Diabetes insipidus usually develops later. This syndrome manifests in childhood, hampering diagnosis and treatment. Morbidity and mortality are high and quality of life is impaired due to neurological and urological complications. This article describes the clinical characteristics and outcome in three patients with WS. All three patients had antecedents of consanguinity. Genetic study was performed in all patients. One was homozygotic for the WFS1 gene that encodes the WFS1 G736A mutation in exon 8 and the remaining two patients, who were siblings, were homozygotic for the 425ins16 mutation in exon 4.

Síndrome de Wolfram. Estudio clínico y genético en dos familias / Wolfram syndrome. Clinical and genetic study in two families

El síndrome de Wolfram, también conocido con la denominación DIDMOAD (por asociar diabetes insípida, diabetes mellitus [DM], atrofia óptica y sordera), es una causa muy poco frecuente de diabetes mellitus. Se encuentra dentro de los síndromes genéticos que pueden asociarse con diabetes en la clasificación de la American Diabetes Association (ADA). Es un cuadro neurodegenerativo con transmisión autosómica recesiva. Cursa con diversas manifestaciones clínicas, como la DM, la atrofia óptica, la diabetes insípida (DI), la sordera, la dilatación de las vías urinarias, alteraciones en el sistema nervioso central, alteraciones psiquiátricas y alteraciones gonadales; entre las más frecuentes destaca la DM, que es de aparición precoz y con poca prevalencia de cetoacidosis, y la atrofia óptica, la cual se considera el criterio diagnóstico fundamental en este síndrome. La DI suele aparecer más tarde. Este síndrome se presenta en la infancia, lo que da lugar a una mayor dificultad diagnóstica y terapéutica, con una elevada morbimortalidad y deterioro de la calidad de vida por las afectaciones neurológicas y urológicas. En el presente artículo describimos las características clínicas de 3 pacientes con síndrome de Wolfram y su evolución. En todos ellos existían antecedentes de consanguinidad. Se practicó análisis genético en los tres casos, uno presentó en homocigosis la mutación del gen WFS1 G736A en el exón 8, y los otros dos, que eran hermanos, homocigosis con la mutación del gen 425ins16 en el exón 4

Wolfram syndrome (WS), also known as DIDMOAD (due to its association with diabetes insipidus, diabetes mellitus, optic atrophy and deafness), is an infrequent cause of diabetes mellitus. This syndrome is included among the genetic disorders associated with diabetes in the American Diabetes Association's classification. WS is an autosomal recessive neurodegenerative disease characterized by various clinical manifestations such as diabetes mellitus, optic atrophy, diabetes insipidus, deafness, neurological symptoms, renal tract abnormalities, psychiatric disorders and gonadal disorders. The most frequent of these disorders is early onset diabetes mellitus, with a low prevalence of ketoacidosis, and optic atrophy, which is considered a key diagnostic criterion in this syndrome. Diabetes insipidus usually develops later. This syndrome manifests in childhood, hampering diagnosis and treatment. Morbidity and mortality are high and quality of life is impaired due to neurological and urological complications. This article describes the clinical characteristics and outcome in three patients with WS. All three patients had antecedents of consanguinity. Genetic study was performed in all patients. One was homozygotic for the WFS1 gene that encodes the WFS1 G736A mutation in exon 8 and the remaining two patients, who were siblings, were homozygotic for the 425ins16 mutation in exon 4

[Shwachman-Diamond syndrome. A case report]. / Síndrome de Shwachman-Diamond.

Shwachman-Diamond syndrome is a rare autosomal recessive disorder characterized by exocrine pancreatic insufficiency, bone marrow dysfunction, skeletal abnormalities, and short stature. We describe the clinical characteristics, laboratory data, and treatment in a 14-month-old boy diagnosed with this syndrome in our unit.

[Epidemic outbreak of tuberculosis in a daycare centre in Zaragoza (Spain)]. / Brote epidémico de tuberculosis en una guardería de Zaragoza.

OBJECTIVE: To describe the clinical and radiological features, diagnosis, and treatment of an epidemic outbreak of tuberculosis in a daycare centre in Zaragoza. MATERIAL AND METHODS: The index case was a teaching assistant with a late diagnosis of bacilliferous tuberculosis. Mantoux testing was carried out in all children. In those with a positive Mantoux test, a chest X-ray was performed. Children with an abnormal chest X-ray underwent microbiological investigations. RESULTS: Among all the children in the daycare center, the Mantoux test was positive in 11 children. Chest X-ray was abnormal in 10 children. Of these, seven (70 %) were symptomatic. Chest X-ray showed dense opacification in nine children (90 %) and mediastinal lymph adenopathy in five (50 %). Three children (30 %) had lobar atelectasis requiring bronchoscopy and subsequent steroid therapy. Bacilloscopy was positive in only one child. Gastric juice culture was positive in seven children and the amplified Mycobacterium tuberculosis direct test was positive in a further seven. All microbiological investigations were negative in only one child. CONCLUSIONS: Establishing a definitive diagnosis of tuberculosis in children remains difficult and frequently relies on a constellation of clinical findings, radiology and epidemiology in children with a positive Mantoux test. The amplified Mycobacterium tuberculosis direct test has high sensitivity and provides fast results. Epidemic outbreaks continue to be frequent in Spain. Study of contacts shows high efficiency in controlling outbreaks.

Brote epidémico de tuberculosis en una guardería de Zaragoza / Epidemic outbreak of tuberculosis in a daycare centre in Zaragoza (Spain)

Objetivo Describir la clínica, radiología, diagnóstico y tratamiento en los niños afectados por un brote de tuberculosis en una guardería de Zaragoza. Material y métodos El caso índice fue una cuidadora que fue diagnosticada tardíamente de tuberculosis activa. Se realizó Mantoux a todos los niños, a los positivos se hizo radiografía de tórax. En aquéllos con radiografía patológica se procedió al diagnóstico microbiológico. Resultados De todos los niños de la guardería, 11 presentaron un Mantoux positivo. La radiografía fue patológica en 10. De ellos, 7 (70 %) estaban sintomáticos. Las imágenes radiológicas mostraban en 9 (90 %) casos una condensación parenquimatosa y en 5 (50 %) una adenopatía parahiliar. Tres niños (30 %) presentaron atelectasia lobular y precisaron broncoscopia y administración posterior de corticoides. La baciloscopia fue positiva solamente en un niño, el cultivo en siete y la detección de muestra directa para el complejo tuberculosis en otros siete. Únicamente en un niño toda la investigación fue negativa. Conclusiones El diagnóstico de tuberculosis en la infancia es difícil, y a veces debe hacerse en base a unos criterios clínicos, radiológicos y epidemiológicos en niños con Mantoux positivo. Los test de detección de muestra directa para el complejo tuberculosis tienen una sensibilidad muy alta y proporcionan resultados muy rápidos. La aparición de brotes epidémicos continúa siendo un hecho frecuente en nuestro medio. El estudio de contactos en los mismos presenta un elevado rendimiento en el control de los brotes

Objective To describe the clinical and radiological features, diagnosis, and treatment of an epidemic outbreak of tuberculosis in a daycare centre in Zaragoza. Material and methods The index case was a teaching assistant with a late diagnosis of bacilliferous tuberculosis. Mantoux testing was carried out in all children. In those with a positive Mantoux test, a chest X-ray was performed. Children with an abnormal chest X-ray underwent microbiological investigations. Results Among all the children in the daycare center, the Mantoux test was positive in 11 children. Chest X-ray was abnormal in 10 children. Of these, seven (70 %) were symptomatic. Chest X-ray showed dense opacification in nine children (90 %) and mediastinal lymph adenopathy in five (50 %). Three children (30 %) had lobar atelectasis requiring bronchoscopy and subsequent steroid therapy. Bacilloscopy was positive in only one child. Gastric juice culture was positive in seven children and the amplified Mycobacterium tuberculosis direct test was positive in a further seven. All microbiological investigations were negative in only one child. Conclusions Establishing a definitive diagnosis of tuberculosis in children remains difficult and frequently relies on a constellation of clinical findings, radiology and epidemiology in children with a positive Mantoux test. The amplified Mycobacterium tuberculosis direct test has high sensitivity and provides fast results. Epidemic outbreaks continue to be frequent in Spain. Study of contacts shows high efficiency in controlling outbreaks