Multicenter prospective study analysing the role of rotavirus on acute gastroenteritis in Spain.

BACKGROUND: Paediatric rotavirus gastroenteritis is the most frequent cause of acute gastroenteritis (AGE) in children up to 5 years of age worldwide. AIM: To analyse the clinical characteristics of AGE caused by rotavirus comparing to AGE caused by other agents. METHODS: The study was conducted in 30 health-care centers in Spain (25 hospitals and five primary centers) between January and March 2006. Children with AGE up to 2 years of age were included. Stool samples were analysed using immunochromatographic test to identify rotavirus infection. Clinical and epidemiological data were analysed. RESULTS: A total of 1192 children were enrolled (mean age: 11.2 months). Fever, Vomiting, weakness and dehydration were more frequent in rotavirus-positive AGE cases. Severity score was higher and hospitalization was likely in AGE caused by rotavirus. Family AGE illness was more frequent in children with rotavirus-positive AGE. Breastfeeding was found as a protective factor against Rotavirus AGE. CONCLUSION: Rotavirus is the primary causal agent of AGE in children under 2 years of age in Spain, causing more severe symptoms and more hospital admissions than other causal agents. Our data support the interest of the introduction of the available rotavirus vaccines in the Spanish immunization schedule.

Trombosis arteriales y venosas en la infancia (y II): profilaxis y tratamiento / Arterial and venous thrombosis in childhood (II): prophylaxis and treatment

El tratamiento antitrombótico en los pacientes pediátricos se realiza utilizando guías extrapoladas de adultos, a pesar de su diferente condición hemostática. En el tratamiento con heparinas,la heparina no fraccionada (HNF) se utiliza en perfusión continua en dosis adecuada a la edad y el peso corporal (en niños menores de un año 28 UI/kg/h, y en los mayores de dos años 20 UI/kg/h). En las heparinas de bajo peso molecular(HBPM), a veces alternativas a los anticoagulantes orales, la dosis varía en función de la edad, el peso corporal y el tipo de heparina, con el objetivo terapéutico de conseguir un nivel de anti-Xa entre 0,5 y 1 UI/mL a las 4 horas de administración. En cuanto al tratamiento anticoagulante oral, su aplicación es problemática debido a las diferentes condiciones hemostáticas de los niños; en un 2% de los casos las complicaciones son las hemorragias graves; la duración es variable según sea una tromboembolia por trombofilia (6 meses) o secundaria a una enfermedad(mínimo 3 meses). En las trombosis venosas agudas se debe iniciar el tratamiento con HNF seguido de tratamiento anticoagulante oral. En el tratamiento antiagregante, utilizado en los procesos tromboembólicos arteriales, el fármaco más utilizado es el ácido acetil salicílico (1-5 mg/kg/día), seguido del dipiridamol en dosis de 2-5 mg/kg/día. La utilización de trombolíticos requiere una evaluación escrupulosa de los riesgos potenciales debido a la disminución de la capacidad total del sistema fibrinolítico; los dos más utilizados son la urocinasa y el activador tisular del plasminógeno (AU)

The antithrombotic therapy in paediatric patients is carried out using guides extrapolated from adults, in spite of their different haemostatic condition. In the treatment with heparins, the unfractionated heparin (UH) is used in a continuous infusion in a dose suitable to the patient’s age and body weight (in children under the age of one 28 U/kg/h and in children over the age of two 20 U/kg/h). In low-molecular-weight heparins (LMWH), sometimes alternatives to oral anticoagulants, the dose varies according to the age, body weight and type of heparin with the therapeutic objective of achieving an anti-Xa level of between 0.5-1 U/mL 4 hours after administration. As regards the oral anticoagulant therapy, its application is problematic because of the different haemostatic conditions of children, with serious hemorrhagic complications accounting for 2% of the cases; the duration varies depending on whet herit is a thromboembolism because of thrombophilia (6 months)or whether it is secondary to a disease (minimum 3 months). In acute venous thrombosis a therapy with UH must be started followed by an OAT. In the antiplatelet therapy, used in the arterial thromboembolic processes, the most commonly used drug is aspirin (1-5 mg/kg/day), followed by dipiridamol in doses of 2-5 mg/kg/day. The use of thrombolytics requires a detailed evaluation of the potential risks due to the decrease of the total capacity of the fibrinolytic system. The two most commonly used thrombolytics are urokinase and the tissue plasminogen activator (AU)

Trombosis arteriales y venosas en la infancia (I): incidencia, etiopatogenia y diagnóstico / Arterial and venous thromboses in childhood (I): incidence, etiopathogeny and diagnosis

La incidencia de las trombosis en la población infantil es de 0,07/10.000, en el 5,3/10.000 de los casos, durante el ingreso hospitalario, y en el 2,4 de los casos durante la admisión en la Unidad de Cuidados Intensivos. En el primer año de vida, la prevalencia de tromboembolia venosa es 40 veces superior a la de otras edades de la infancia. La trombosis espontánea, sin causa etiológica que la justifique, precisa uno o más factores de riesgo protombóticos para su aparición. Existen factores de riesgo congénitos, debidos a alteraciones de la hemostasia, que suponen un riesgo mayor si se asocian a otros factores genéticos. El correcto diagnóstico mediante el estudio de los signos clínicos y de las técnicas de diagnóstico no invasivas e invasivas, así como de las pruebas de laboratorio, en las que el dimero-D ha demostrado una alta sensibilidad, son imprescindibles antes de iniciar cualquier tipo de tratamiento antitrómbico(AU)

The incidence of thromboses among the childhoos population is 0.07/10,000, in 5.3/10,000 of the cases during the stay in hospital and in 2.4% of the cases of admissions to the Intensive Care Unit. During the first year of life, the prevalence of venous thromboembolism is 40 items higher that at other childhood ages. Spontaneous thrombosis, without a justifying etiological cause, requires one or more prothombotic risk factors for its onset. There are certain congenital risk factors, due to alterations of the haemostasis, that imply a greater risk if they are associated with other genetic factors. The correct diagnosis through a study of the clinical signs and of the non-invasive and invasive diagnostic techniques, as well as the laboratory tests, in which the D. dimer has proven to be highly sensitive, are indispensable before starting any type of antithrombotic treatment(AU)

La evolución obligada del calendario de vacunación de la Asociación Española de Pediatría. ¿Debe la AEP seguir haciendo sus recomendaciones vacunales? / Obligatory updates of the vaccination calendar of the Spanish association of pediatrics. Should the association continue making vaccination recommendations?

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[Family impact of rotavirus gastroenteritis in children under two years]. / Impacto familiar de la gastroenteritis por rotavirus en menores de dos años.

INTRODUCTION: Acute gastroenteritis (AGE) in infants has a significant impact on the quality of life of their parents. MATERIAL AND METHODS: Cross-sectional study on the sociological family impact related to rotavirus AGE in children under 2 years. The study was carried out in 25 hospitals and 5 primary care centres in Spain. Sociodemographic, epidemiological and clinical data were recorded, as well as the symptomatology of AGE and its severity measured by the Clark scale. Stool samples were tested to determine rotavirus positive (RV+) or negative (RV-). The parents were asked to complete a a family impact questionnaire. RESULTS: Stool specimens were tested in 1087 AGE cases (584 RV+ vs 503 RV-). The 99.5 % of parents whose children were RV+ reported more worries vs. the 97.7 % of RV-, and RV+ had a higher importance score (p < 0.05). A higher percentage of RV+ parents and those with a high importance score reported more time dedicated to dehydration treatment (p < 0.05). The 82.5 % vs. 73.9 % had disruption of their household tasks, with more importance scores (p < 0.05). RV+ had a higher percentage and importance score than RV- ones in all aspects of their child's AGE symptoms, except loss of appetite. CONCLUSION: AGE produces important dysfunctional experiences in daily family life. According to parental perceptions, RV+ produces greater worries and dysfunctions in child behaviour.

Consenso Nacional sobre otitis media aguda / National Consensus on acute otitis media

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Consenso Nacional sobre otitis media aguda / National consensus on acute otitis media (OMA)

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Epidemiology of obesity in Spain. Dietary guidelines and strategies for prevention.

Obesity is considered a major Public Health issue in most developed countries nowadays for its wide spread across population groups, as well as its contribution to the development of chronic diseases, particularly cardiovascular diseases and diabetes. Available population data in Spain from the SEEDO'2000 study show a prevalence of obesity (BMI > or = 30 kg/m(2)) of 14,5% in adults aged 25-60 years, estimates based on individual measurement of body weight and height. Obesity rates are higher among women aged 45 years and older, low social class, living in semi-urban places. Geographical distribution of the problem shows a trend for higher rates towards the South- SouthEast of the country, i.e. Andalucía, Murcia and the Canary Islands. Population data for Spanish children and young people based on the enKid study--cross-sectional study on a random national sample of the population aged 2-24 years--estimate a prevalence of obesity of 13.9% for the whole group. Geographical distribution draws a similar pattern to that described for adults. Higher peaks of the problem are identified between 9-13 years among boys from a low socioeconomical background. The analysis of determinants of obesity in Spanish children and young people show that overweight and obesity is related to absence of breastfeeding, low consumption of fruit and vegetables; high consumption of cakes and buns, soft drinks and butchery products, low physical activity levels and a positive association with time spent watching TV. The joint consensus document produced by the Spanish Association of Pediatrics (AEP), Spanish Society of Community Nutrition (SENC) and Spanish Society for the Study of Obesity (SEEDO) considers a global strategy for the prevention of obesity from early stages in life. The important role of the family and the school setting as well as the responsibility of the Health Administration and Pediatric care in the prevention of obesity is highlighted in the document.

Salud ambiental pediátrica en España. ¿Dónde están los pediatras? / Pediatric environmental health in Spain. Where are the pediatricians?

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Gripe en el niño. Una enfermedad prevenible / Childhood influenza. A preventable disease

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[Food habits of students using school dining rooms in Spain. "Tell Me How You Eat" Study]. / Hábitos alimentarios de los alumnos usuarios de comedores escolares en España. Estudio "Dime Cómo Comes"

OBJECTIVE: To describe food habits of school-aged population having school meals and to evaluate perceived quality of the service. STUDY DESIGN: Descriptive cross-sectional study. SETTING: Community School lunchrooms in different Spanish regions. PARTICIPANTS: Random population sample of children and young people (3-16 year) having school meals in Spain. MEASUREMENTS: The study protocol included socio-economical data, food consumption and dietary habits at the school and out of the school. Information was collected by means of two questionnaires: one completed by children at school and a second one completed by the family at home. RESULTS: Valid response was collected from 322 children and 212 families, a response rate of 96.1% children and 63.3% of the families. 88% of the children reported daily consumption of breakfast, 45% used to have a midmorning snack, which consisted of a sandwich (29%); sweet bakery products (27%) or biscuits (15%). 45% of the 12-16-year-old old group reported eating only half of the portion served at lunch in the school, mainly due to disgusting taste or preparation (50%). In the school menus vegetables and fish were offered less frequently than other food groups. 81% of the children referred having an after-school snack in the afternoon, consisting of a sandwich (65%); bakery products (20%); bread and chocolate (20%); yoghurt or fruit (20%). CONCLUSIONS: School meals provide a wonderful opportunity to widen the variety of foods in the daily diet of children. Recommendations about school meals should address the quality and variety of the foods served for a healthy diet and stress the educational dimension.

Hábitos alimentarios de los alumnos usuarios de comedores escolares en España. Estudio "Dime Cómo Comes" / Food habits of students using school dining rooms in Spain. "Tell me how you wat" study

Objetivo. Analizar los hábitos alimentarios de la población usuaria del servicio de comedor en su centro docente, evaluar la calidad percibida y el resto de las raciones de consumo doméstico. Diseño. Estudio epidemiológico, descriptivo, de diseño transversal. Emplazamiento. Comunitario. Comedores escolares de distintas comunidades autónomas. Participantes. Muestra aleatoria de alumnos usuarios de comedores escolares con edades entre 3 y 16 años, ubicados en 12 centros docentes de distintas comunidades autónomas. Mediciones principales. Datos socioeconómicos, hábitos alimentarios de los usuarios en el comedor y fuera del comedor mediante dos cuestionarios, uno que completaban los niños en el colegio y un segundo cuestionario que completaban los padres en casa. Resultados. Se obtuvieron respuestas válidas de 322 niños y 212 familias (tasa de participación: el 96,1 por ciento de los alumnos y el 63,3 por ciento de las familias). El 88 por ciento de los niños manifestó consumir a diario el desayuno, un 45 por ciento consumía algún alimento a media mañana, con más frecuencia bocadillo de embutido (29 por ciento), bollería (27 por ciento) o galletas (15 por ciento). El 45 por ciento del colectivo entre 12 y 16 años consumía sólo la mitad de la ración servida en el comedor, principalmente por desagrado del sabor y características organolépticas del plato (50 por ciento). Las verduras y el pescado fueron las preparaciones menos frecuentes en el perfil de los menús ofertados. El 81 por ciento de los niños consumía habitualmente algún alimento como merienda, fundamentalmente bocadillo (65 por ciento), bollería (20 por ciento), pan con chocolate (20 por ciento) o yogur y fruta (20 por ciento).Conclusiones. El comedor escolar constituye una excelente oportunidad para ampliar el repertorio de alimentos introducidos en la alimentación y configurar, bajo supervisión profesional, una dieta variada, educativa y saludable (AU)

Varicela: una enfermedad prevenible. Conclusiones / No disponible

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Implementación de la vacuna hexavalente en calendario vacunal / No disponible

En la actualidad disponemos de un número de vacunas que son cada día más numerosas, seguras y eficaces. Este hecho, que supone un gran avance, también plantea problemas de aceptación por el gran número de pinchazos y otros inconvenientes que supone su administración. La disponibilidad de vacunas hexavalentes (DTPa/VPI/Hib/HB) no sólo combina 6 vacunas en una sola, con lo que mejora la aceptación por parte de los padres y las tasas de cobertura, sino que también permite abandonar la VPO para sustituirla por la VPI evitando el riesgo de poliomielitis paralítica asociada a vacuna (PPAV) y, por otra parte, incluir la anti-pertussis acelular (Pa) con que disminuye muy significativamente la reactogenicidad de este componente. Sin ninguna duda, la disposición de vacunas hexavalentes supone un avance extraordinariamente importante en el campo de las inmunizaciones y permitirá con su incorporación en los calendarios vacunales que éstos sean más completos, eficaces y cómodos de aplicar. El CAV de la AEP propondrá en un futuro muy próximo un nuevo calendario vacunal en el que la vacuna hexavalente supondrá una mejora de enorme trascendencia (AU)

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