Instrument-based screening for amblyopia risk factors in a primary care setting in children aged 18 to 30 months.

Amblyopia is the leading cause of vision impairment in children, and its early detection can avoid irreversible consequences for a child's visual ability. In this prospective study, to detect amblyopia risk factors, we examined patients aged 18 to 30 months in primary care settings. Patients were referred to an ophthalmologist for confirmation. The main aims were to detect amblyogenic risk factors and to assess the usefulness of a photoscreener in such settings. Out of 453 patients, 42 (9.3%) presented visual alterations according to the photoscreener, with astigmatism being the most common. The instrument had good sensitivity (89%) and specificity (91%), with a positive predictive value of 76% and a negative predictive value of 96%. Overall, 38% of the patients required follow-up, and 47% needed glasses. The automated screening device allowed these children to be diagnosed at an early stage.Conclusions: The use of a photoscreener to screen 2-year-old children in primary care settings was helpful and accurate. What is Known: • Early detection of amblyopic risk factors is important to avoid vision defects. However, it is very difficult to measure visual acuity using visual charts in children younger than 4 years old. What is New: • Instrument-based screening in children aged 18 to 30 months allows excellent detection of early amblyopia risk factors in primary care settings.

Growth Hormone Treatment and Papilledema: A Prospective Pilot Study

Objective: To investigate the incidence of pseudotumor cerebri syndrome (PTCS) in children treated with growth hormone (GH) in a paediatric hospital and to identify risk factors for this complication. Methods: Prospective pilot study of paediatric patients treated with recombinant human GH, prescribed by the Paediatric Endocrinology Department, between February 2013 and September 2017. In all these patients, a fundus examination was performed before starting treatment and 3-4 months later. Results: Two hundred and eighty-nine patients were included, of whom 244 (84.4%) had GH deficiency, 36 (12.5%) had short stature associated with small for gestational age, six (2.1%) had a mutation in the SHOX gene and three (1.0%) had Prader-Willi syndrome. Five (1.7%) developed papilledema, all were asymptomatic and had GH deficiency due to craniopharyngioma (n=1), polymalformative syndrome associated with hypothalamic-pituitary axis anomalies (n=2), a non-specified genetic disease with hippocampal inversion (n=1) and one with normal magnetic resonance imaging who had developed a primary PTCS years before. Conclusion: GH treatment is a cause of PTCS. In our series, at risk patients had GH deficiency and hypothalamic-pituitary anatomic anomalies or genetic or chromosomal diseases. Fundus examination should be systematically screened in all patients in this at-risk group, irrespective of the presence or not of symptoms.

Psychosocial and physiological risks of shift work in nurses: a cross-sectional study.

OBJECTIVES: Many jobs are associated with psychological or social risk factors. Knowledge of occupational diseases is essential for adopting rational control measures. The aim was to study and describe frequent social, psychological and physiological risk factors for nurses. METHODS: Psychological and social risks were evaluated in nurses with regular or irregular shifts. In addition, differences between nurses or nursing assistants were studied. The Copenhagen Psychosocial Questionnaire, Eating Attitudes Test, Profile of Mood State, Athens Insomnia Scale, Trait Anxiety Inventory, and Minnesota Leisure Time were administered. RESULTS: Nursing assistants presented higher levels of body mass index and food restriction than nurses, nevertheless, nurses showed increasing tension in work. In nursing, shift work increases psychosocial risks, insomnia, eating disorders, and trait anxiety. CONCLUSIONS: In conclusion, nurses and nursing assistants in health centres and hospitals show high levels of exposure to psychological and psychosocial risks that are unfavourable to their health.

Intracranial Hypertension in Cystinosis Is a Challenge: Experience in a Children's Hospital.

BACKGROUND: Cystinosis is a rare systemic lysosomal disease affecting mainly the kidney and eye. Ocular involvement in cystinosis is universal being the presence of cystine crystals in the cornea a diagnostic criterion and one of the earliest manifestations of the disease. Neuro-ophthalmologic manifestations are considered a rare and late complication in these patients. The aim of this article is to report the unexpectedly high incidence of intracranial hypertension in children with cystinosis at our centre. METHODS: This study included eight children (0-16 years of age) with cystinosis seen at the paediatric ophthalmology department, Hospital Universitari Vall d'Hebron (Barcelona, Spain), a tertiary hospital, over the last 5 years. RESULTS: Three girls and five boys, mean age: 9.6 years (range: 5-14 years), were studied. During follow-up, 4 out of 8 developed papilledema and confirmed high cerebrospinal fluid (CSF) pressure. The only symptomatic child presented an Arnold-Chiari anomaly with enlarged ventricles, whereas the other three, all asymptomatic, were diagnosed by scheduled fundoscopy and had normal neuroimaging studies. All four patients had at least one known risk factor for developing intracranial hypertension: initiation of growth hormone therapy, tapering of corticosteroids, acute renal failure and Arnold-Chiari malformation. Two of them required a ventriculoperitoneal shunt. CONCLUSIONS: Our results show that intracranial hypertension can occur more frequently than expected in patients with cystinosis. Furthermore, visual prognosis depends on early diagnosis and prompt treatment. A multidisciplinary approach is necessary, and we recommend fundoscopic examinations in all paediatric patients with cystinosis whether or not they present symptoms.

Revisión de las herramientas en español para la detección de los trastornos del comportamiento alimentario en adultos / Review of tools in adult Spanish population for detection of eating disorders

Fundamentos: Los trastornos del comportamiento alimentario (TCA) son uno de los principales temas de interés del siglo XXI. El creciente interés en el tratamiento y la investigación de los TCA ha fomentado el desarrollo de los métodos de evaluación, y ahora se pueden encontrar diversos cuestionarios para la evaluación de TCA, centrados tanto en las características de los hábitos alimentarios como de los aspectos psicológicos. Este trabajo pretende revisar los instrumentos de detección y evaluación que se utilizan ampliamente en la práctica clínica y la investigación en materia de TCA. Métodos: Las bases de datos científicas que se utilizaron para llevar a cabo la búsqueda bibliográfica fueron: MEDLINE , Cochrane , Scopus , PsycINFO , Psicodoc y Web of Science. Resultados: Los instrumentos descritos incluyen cuestionarios de evaluación y herramientas de medición para los síntomas específicos de los TCA. Discusión: Se discuten los factores que influyen en la validez diagnóstica de las diferentes herramientas de evaluación de los TCA. Estos problemas aparecen a causa de las dificultades asociadas a una detección del trastorno parte de los sujetos analizados. Conclusiones: Los TCA son enfermedades psiquiátricas complejas asociadas a aspectos nutricionales, que pueden derivar en complicaciones médicas importantes (AU)

Background: Eating disorders are one of the principal interest issue of the twenty-first century. The growing interest in the treatment and research of eating disorders has stimulated the development of assessment methods, and there are now many questionnaires for evaluating behavioral and attitudinal characteristics of eating pathology. Objectives: This work sets out to review the assessment tools that are widely used in clinical practice and research over eating disorders. In particular, it covers self-report measures with summaries of their psychometric properties. Method: MEDLINE , Cochrane , Scopus, PsycINFO, Psicodoc and Web of Science were searched up until nowadays for tools assessing the detection of eating disorders. Results: The instruments described include screening questionnaires and measurement tools for specific eating disorder symptoms. Discussion: There is also a discussion of distorting factors that decrease the authenticity of assessment tools. These problems arise from the definition of some constructs and from the phenomena of denial and concealment, which are frequent among eating-disordered individuals. Conclusion: Eating disorders are complex psychiatric and nutritional disorders with significant medical complications (AU)

Embarazo en hemodiálisis, a propósito de un caso / Pregnancy and haemodialyisis: a case study

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