Evaluación de un test de detección antigénica rápido para el diagnóstico de urgencias de gripe A H1N1 pandémica en la población pediátrica / Evaluation of a rapid antigen detection test for the diagnosis of emergency influenza A H1N1 pandemic in a pediatric population

Introduction: The immunochromatographic capillary method (ICC) provides rapid results that can help the individual treatment of patients. The aim was to evaluate the diagnostic accuracy of an ICC rapid test for detection of influenza virus in pediatric emergencies. Material and methods: 225 samples were collected from pediatric patients and tested by ICC and RT-PCR (as gold standard).Results: Overall, the ICC sensitivity and specificity values were 51% and 100%, respectively. Sensitivity in throat swabs and nasal aspirates was 46.6% and 52.6% respectively. In regards to gernder, flu was diagnosed by PCR in 21 out of 110males (19.1%) and 32 out of 115 females (27.8%).Conclusion: Although the ICC displayed limited sensitivity, the excellent positive predictive value it could be useful in the presumptive diagnosis of emergency(AU)

Introducción: La inmunocromatografía capilar (ICC) ofrece resultados rápidos que pueden ayudar al tratamiento individual de los pacientes. El objetivo ha sido evaluar la eficacia diagnóstica de un test rápido de ICC para la detección virus gripales y su aplicación en urgencias pediátricas. Material y métodos: Se analizaron 225 muestras mediante ICC y RT-PCR (método de referencia) procedentes de pacientes pediátricos. Resultados: La sensibilidad y especificidad media hallada para la ICC en el conjunto de muestras fue del 51 y 100%, respectivamente. La sensibilidad en frotis faríngeos fue del 46,6% y en aspirados nasales fue del 52,6%. En relación con el sexo, mediante PCR se diagnostica la gripe en 21/110 hombres (19,1%) y 32/115 mujeres (27,8%).Conclusión: La ICC presenta una sensibilidad limitada, aunque por su excelente especificidad sería útil su uso en el diagnóstico presuntivo de urgencias(AU)

[Quality control of nosocomial infection in PICU]. / Control de calidad en la infección nosocomial en la UCIP.

INTRODUCTION: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. OBJECTIVE: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. MATERIAL AND METHODS: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. RESULTS: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 (NNISS 7.3 ) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 , with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). CONCLUSIONS: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality.

Control de calidad en la infección nosocomial en la UCIP / Quality control of nosocomial infection in PICU

Introducción: La infección nosocomial representa un problema de salud dada su elevada morbimortalidad y el incremento de costes que ocasiona al sistema sanitario. Objetivo: Analizar la infección nosocomial relacionada con las principales técnicas invasivas realizadas en la unidad de cuidados intensivos pediátricos de nuestro hospital. Material y métodos: Recogida prospectiva de datos epidemiológicos (número de días de ingreso, de colocación de dispositivos, intravasculares y sondaje urinario cerrado y ventilación mecánica) y aparición de infecciones nosocomiales (bacteriemias, neumonías, infecciones de orina) en los pacientes ingresados durante los años 2000-2004. Resultados: Se analizaron un total de 302 pacientes y se encontró una incidencia acumulada de infección nosocomial del 9,76 %. Los microorganismos aislados con mayor frecuencia fueron los gramnegativos (46,60 %), seguidos de Candida sp. (33,30 %) y cocos grampositivos (20,01 %). Su localización predominante fue la bacteriemia, con una incidencia acumulada parcial del 4,09 %, predominando las primarias frente a las relacionadas a dispositivo intravascular (el 2,99 frente al 1,10 %). La tasa media de incidencia de bacteriemias asociadas con dispositivos intravasculares (BADV) fue del 8,92 ‰ (National Nosocomial Infectious Surveillance System [NNISS] 7,3 ‰) con una tasa media de utilización del dispositivo de 0,65 (> Pc90 del NNISS). La neumonía asociada a ventilación mecánica (NAVM) presentó una tasa media de incidencia del 1,80 ‰ partiendo de una tasa media de utilización del 0,27 (< Pc25 del NISS). La infección urinaria asociada con el sondaje urinario cerrado presentó una tasa media de incidencia del 2,63 ‰, con una tasa media de utilización del sondaje del 0,37 (Pc75). Conclusiones: La infección nosocomial representa un problema importante en las UCIP. Los datos obtenidos de este estudio nos permiten conocer la incidencia de la infección nosocomial en nuestra unidad de cuidados intensivos pediátricos (UCIP) y dirigir las estrategias de mejora para disminuir la mortalidad y morbilidad (AU)

Introduction: Nosocomial infection represents a problem of public health given his high morbidity and mortality, and the cost that it causes to the sanitary system. Objective: To analyze the nosocomial infection related to the principal invasive techniques realized in the paediatric intensive care unit of our hospital. Material and methods: We prospectively analyzed the epidemiological information (days of hospitalization, days of placement of devices, intravascular and closed drainage system, and mechanical ventilation) and the incidence of nosocomial infections (bacteriemias, pneumonias, urinary tract infections) in the patients admitted during the years 2000-2004. Results: There was analyzed a total of 302 patients finding an accumulated incidence of nosocomial infection of 9.76 %. The microorganisms isolated with major frequency were the gramnegative stain (46.60 %), followed by Candida sp. (33.30 %) and grampositive cocci (20.01 %). The predominant location of infection was the bacteriemia, with an incidence of 4.09 % (2.99 % of primary bacteraemia Vs 1.10 % of catheter related infection). The mean rate of incidence of bacteriemias associated to intravasculares devices (BADV) was 8.92 ‰ (NNISS 7.3 ‰) with mean rate of utilization of the device of 0.65 (> Pc90 of the NNISS). The pneumonia associated with mechanical ventilation (NAVM) presented a mean rate of incidence of 1.80 ‰ departing from a mean rate of utilization of 0.27 (< Pc25 of the NNISS). The urinary infection associated with the closed drainage system presented an average rate of effect of 2.63 ‰, with a mean rate of utilization of the closed drainage system of 0.37 (Pc75). Conclusions: Nosocomial infection represents an important problem in PICU. These data allow us the knowledge of the incidence of nosocomial infection in our PICU and target the strategies for reducing morbidity and mortality (AU)

[Assessment of the nutritional value of the menus served in school canteens on the island of Tenerife, Spain]. / Valoración nutricional de los menús escolares de los colegios públicos de la isla de Tenerife.

OBJECTIVE: To study the nutritional characteristics of the menus provided in the state primary schools of Tenerife and to assess whether they are adequate for the different age groups of school children. SCOPE AND METHODS: The study is conducted in 52 school canteens, with a population of 8,411 diners aged between 4 and 12 years old. 27 of the 52 school dinner services were managed directly and 25 were contracted out to catering companies. They were selected through a random sampling that was stratified by the different geographic areas of the island. A full menu was taken from each of them: first course, second course and dessert (in some cases, a dairy product, normally a piece of fruit). The food was recorded by weight. For assessing the nutritional input in the directly managed dining rooms, we took information on the menu, how it was prepared, the ingredients used and the proportion of each of these in each dish, the amount of oil and salt added, etc. Hence we calculate the proportion of each ingredient. We then weigh the different rations offered to the school children. In the case of the menus offered by catering companies, the quantity of the ration is weighed in the school dining room and, as the catering company supplies us with the breakdown of all the ingredients used in the dishes, we can determine the composition of the menus. To convert the food into nutrients, we used the Dietsource V 1.0 programme. The school menu is broken down using the diet, dish and food management plan, to give the proportions of active ingredients used, and the Recommended Inputs for the Spanish population are used as a reference for evaluating the nutritional quality of the diet, taking the average of the recommended value for the different age groups for each of the parameters. RESULTS: The carbohydrates account for 54% of the total energy, lipids 27% and proteins 19%. The mean content and standard error for cholesterol is 77.53 +/- 64.30 mg, so the mean cholesterol input per 1,000 kcal is 109 mg/1,000 kcal. Saturated fatty acids contribute 8.6% of the calorie input, monounsaturated fatty acids 11.7% and polyunsaturated fatty acids 9.7%. The fibre input per 1,000 kcal is 11 g. CONCLUSIONS: The energy value of the school menu is adequate, the percentage content of proteins is slightly high and the lipid and carbohydrate contents are within the limits. The percentage content of fatty acids is adequate, as are the percentage contents of cholesterol and fibre. The vitamin and mineral contents are appropriate, with the exception of iodine, zinc, iron and vitamins D, E and riboflavin, where there is a deficit, especially for the older children.

Valoración nutricional de los menús escolares de los colegios públicos de la isla de Tenerife / Assessment of the nutritional value of the menus served in school canteens on the island of Tenerife, Spain

Objetivo: Conocer las características nutricionales de los menús ofertados en los colegios públicos de Tenerife y valorar si son adecuados para los escolares, según los distintos grupos de edad. Ámbito y métodos: El estudio se realiza en 52 comedores escolares, con una población de 8.411 comensales, con edades comprendidos entre 4 y 12 años. Del total de colegios 27 eran de gestión directa y 25 de gestión contratada, seleccionados mediante un muestreo aleatorio estratificado según las distintas zonas geográficas de la isla. En cada uno de ellos se recogió un menú completo: primer plato, segundo plato y postre (en algunas ocasiones un lácteo, normalmente una pieza de fruta). El registro de alimentos se realizó por pesada. Para la valoración de la ingesta en los centros de gestión directa, recogimos información acerca del menú, la forma de preparación, los ingredientes utilizados y la proporción de los mismos en cada plato, la cantidad de aceite y sal añadidos, etc. Se calcula así la proporción de los distintos ingredientes. Posteriormente se procede a la pesada de las distintas raciones ofrecidas a los escolares. En el caso de los menús ofertados por catering se pesa la cantidad de la ración en el comedor escolar y al aportarnos, el propio catering el desglose de todos los ingredientes de los platos podemos conocer la composición de los menú. Para la conversión de los alimentos en nutrientes hemos utilizado el programa Dietsource V 1.0. Con la gestión de dietas, platos y alimentos se desglosa el menú escolar dando las proporciones en principios activos y utilizando como referencia las Ingestas Recomendadas para la población española se evalúa la calidad nutricional de la dieta, tomando en cada uno de los parámetros, la media del valor recomendado para los distintos grupos de edad. Resultados: Los hidratos de carbono representan un 54% de la energía total, los lípidos un 27% y las proteínas un 19%. El contenido medio y desviación estándar del colesterol es de 77,53 ± 64,30 mg, por lo que el aporte medio de colesterol por 1.000 kcal es de 109 mg/1.000 kcal. Los ácidos grasos saturados contribuyen en un 8,6% a la ingesta calórica, los ácidos grasos monoinsaturados con un 11,7% y los poliinsaturados con un 9,7%. La ingesta de fibra por 1.000 kcal se sitúa en 11 g. Conclusiones: El aporte de energía del menú escolar es adecuado, el contenido porcentual de proteínas es algo elevado y de lípidos y carbohidratos están dentro de los límites. El contenido porcentual de ácidos grasos es adecuado, así como el colesterol y fibra. El aporte de vitaminas y minerales es apropiado, con excepción del yodo, zinc y hierro, vitaminas D, E y riboflavina que son deficitarios, sobre todo para los niños de mayor edad (AU)

Objective: To study the nutritional characteristics of the menus provided in the state primary schools of Tenerife and to assess whether they are adequate for the different age groups of school children. Scope and methods: The study is conducted in 52 school canteens, with a population of 8,411 diners aged between 4 and 12 years old. 27 of the 52 school dinner services were managed directly and 25 were contracted out to catering companies. They were selected through a random sampling that was stratified by the different geographic areas of the island. A full menu was taken from each of them: first course, second course and dessert (in some cases, a dairy product, normally a piece of fruit). The food was recorded by weight. For assessing the nutritional input in the directly managed dining rooms, we took information on the menu, how it was prepared, the ingredients used and the proportion of each of these in each dish, the amount of oil and salt added, etc. Hence we calculate the proportion of each ingredient. We then weigh the different rations offered to the school children. In the case of the menus offered by catering companies, the quantity of the ration is weighed in the school dining room and, as the catering company supplies us with the breakdown of all the ingredients used in the dishes, we can determine the composition of the menus. To convert the food into nutrients, we used the Dietsource V 1.0 programme. The school menu is broken down using the diet, dish and food management plan, to give the proportions of active ingredients used, and the Recommended Inputs for the Spanish population are used as a reference forevaluating the nutritional quality of the diet, taking the average of the recommended value for the different age groups for each of the parameters. Result: The carbohydrates account for 54% of the total energy, lipids 27% and proteins 19%. The mean content and standard error for cholesterol is 77.53 ± 64.30 mg, so the mean cholesterol input per 1,000 kcal is 109 mg/1,000 kcal. Saturated fatty acids contribute 8.6% of the calorie input, monounsaturated fatty acids 11.7% and polyunsaturated fatty acids 9.7%. The fibre input per 1,000 kcal is 11 g. Conclusion: The energy value of the school menu is adequate, the percentage content of proteins is slightly high and the lipid and carbohydrate contents are within the limits. The percentage content of fatty acids is adequate, as are the percentage contents of cholesterol and fibre. The vitamin and mineral contents are appropriate, with the exception of iodine, zinc, iron and vitamins D, E and riboflavin, where there is a deficit, especially for the older children (AU)

Valoración de la composición corporal mediante cienantropometría e impedancia en escolares canarios / Assessment of body composition among school children from the Canary Islands by means of kinanthropometry and impedance

Antecedentes: La evolución de los estudios cineantropométricos ha permitido determinar que para obtener la composición corporal de un sujeto sólo sea necesario estudiar los componentes graso y muscular. El presente estudio tiene por objetivo valorar la composición corporal en escolares canarios mediante cineantropometría e impedancia, y comparar ambas técnicas de medida. Métodos: Diseño: estudio transversal. Sujetos: escolares canarios de entre 6 y 16 años de edad residentes en Gran Canaria y Tenerife. Selección de la muestra: muestreo, aleatorio estratificado simple, a partir de una población infinita de niños entre 6 y 16 años de edad, con un nivel de significación del 95% y un margen de error del 5%, y de p=q=0,5. El tamaño de la muestra obtenido a justado en función del porcentaje esperado de pérdidas es de 549 alumnos. Tratamiento estadístico: paquete informático SPSS 11.0. Se considera significativo el valor de p>=0,5. Comparación de los sistemas de medida mediante un modelo de regresión no lineal (método de Marquardt). Resultados: Hemos estudiado a 563 escolares: 254 niños y 309 niñas. Los dos procedimientos tienden a coincidir asintóticamente. El coeficiente de determinación para el porcentajede grasa ( A2) es de 0,93 y paral a masal ibre de grasa el A2 es de 0,63. Conclusiones: El modelo de regresión no lineal aplicado a un programa informático permite estimar la composición corporal corregida mediante datos obtenidos por impedancia, método con buena reproducibilidad a diferencia de la cineantropometría

Background: Kinanthropometric studies affirm that, to assess an individual's body composition, it is only necessary to establish his or her fat and muscle components. The purpose of this study was to assess body composition among school children from the Canary Islands by means of kinanthropometry and impedance, and to compare the two measuringte chniques. Methods: Design: Cross-sectional study. Subjects: Canary Island school children between the ages of 6 and 16 living on Gran Canaria and Tenerife. Sample selection: Stratified simple random sampling, from an infinite population of children between the ages of 6 and 16, with a level of significance of 95% and amargin of error of 5%,assuming that p=q=0.5. The required sample size, after adjustment for expected losses, was 549 school children. Statistical treatment: SPSS 11.0 statistical analysis application. A p value less than or equal to 0.5 was considered significant. The measuring systems were compared by means of a nonlinear regression model (the Marquardtm ethod). Results: We assessed 563 school children: 254 boys and 309 girls. The two procedure stended to coincide asymptotically. The coefficient of determination (A2) was 0.93 for the percentage of body fat and 0.63 for tal-free body mass. Conclusion: The application of the nonlinear regression model to a software application enables the estimation of corrected body composition on the basis of data obtained by means of impedance, which, unlike kinanthropometry, is a method with good reproducibility

[Conclusions of the Canary Islands Nutrition Survey (1997-98). Foundations for a nutrition policy in Canary Islands]. / Conclusiones de la Encuesta de Nutrición de Canarias (1997-98). Bases para una política de nutrición en Canarias.

The principal findings of the Canary Island Nutrition survey (ENCA). 1997-98 are presented. This survey was realised to obtain the following objectives: to evaluate eating habits and nutritional status utilising dietary, anthropometric and biochemical indicators in the Canary Island population along with determining lifestyle factors and the prevalence of the main cardiovascular risk factors. Additionally, a survey evaluating food-related knowledge and attitudes was also carried out. To attain this end, a cross-sectional study was realised in a representative sample of the Canary Island population aged 6 to 75 years (n = 1,747). This article summarises the key findings related to study objectives as well as study-derived recommendations to be realised within a Canary Island health and nutrition policy framework. For this purpose, the development of food based dietary guidelines addressed to meet target nutrients is needed.

[Usefulness of a gene amplification technique (LCx MTB) in the diagnosis of tuberculosis: preliminary results with different sputum samples]. / Utilidad de una técnica de amplificación genética (LCx MTB) para el diagnóstico de tuberculosis: resultados preliminares con muestras diferentes al esputo.

OBJECTIVE: To evaluate the use in non-sputum samples of a commercial molecular amplification kit (LCx MTB, Abbott Diagnostica) (LCx) for the diagnosis of tuberculosis. MATERIAL AND METHOD: Ninety-nine non-sputum samples from the same number of patients (bronchoalveolar, pleural and ascitic fluid, fecal samples, blood cultures, biopsies from different sites, cerebrospinal fluid, urine and gastric juices) and 14 sputum samples (10 from patients clinically suspected of having tuberculosis and 4 from patients diagnosed of tuberculosis and undergoing appropriate treatment for at least one month). All samples were LCx processed according to the manufacturer's instructions. The reference diagnosis was obtained by the Löwestein-jensen method and when results were inconsistent, we took into account the degree of clinical suspicion, response to treatment and histology. RESULTS: Seven of the 99 samples were positive by the LCx technique, and 6 of the 7 were also LJ positive; 1 could not be evaluated because of culture contamination. One LJ positive culture was LCx negative. Only one sample was positive by Ziehl-Neelsen (ZN) staining. Ninety-two samples were LCx negative, with 91 showing no growth at all. Sensitivity was 86% and specificity 98%. Atypical mycobacteria were detected in 4 cases, all of which were LCx negative. CONCLUSIONS: Diagnosis of tuberculosis by applying the LCx system to various types of samples other than sputum is simple, rapid, sensitive and specific.

[Detection of psychopathology in two populations of institutionalized elderly using a questionnaire]. / Detección de psicopatología en dos poblaciones de ancianos institucionalizados a partir de un cuestionario.

Simple instruments to detect psychiatric pathology in the elderly patients are sorely needed. We assessed 222 old patients living in nursing homes by means of the Spanish version of the Pfeiffer's Functional Assessment Inventory. The results of the mental health section of the inventory, which includes the Short Psychiatric Evaluation Schedule and four questions about self-perception of mental health, are presented. There were no statistical differences between those who need help in most of the activities of daily living and those who need not. The only exception was that the feeling of loneliness was more frequent among the most able (p = 0.023). Almost half of the 173 patients who completed the evaluation scored in the range of definite psychopathology. Nearly another 10% scored in the range of severe psychopathology or hypochondriasis. This assessment instrument allows and easier study of the prevalence of psychopathology in nursing home residents. It also makes feasible the detection of latent needs for psychiatric care in the elderly living in nursing homes.

[Mortality indicators in a small community]. / Indicades de mortalidad en una comunidad reducida.

The death rates have been much used in Public Health thanks to the ease in obtaining them. But our Primary Health Care Teams encounter the obstacle of a low denominator in that the populations of the basic health areas are small and the rates appear unstable. This means that they are often not produced in those cases where the calculation might be of use. We present our experience in the calculation of these indicators for the community of San Matías de Taco on Tenerife Island. It is a small township in very deteriorated surroundings and with very low socio-economic conditions. The death rates, which we have calculated, and the life expectancy show clearly the existence of a community with a health level much below that of the province as a whole. We have resorted to the use of a few large age groups and to the calculation of mean values over long periods of time. We Believe that methodology employed may be useful in Health care Centres.