[Perceived needs regarding school health care]. / Necesidades percibidas sobre atención a la salud escolar.

BACKGROUND AND OBJECTIVE: Changes in infant morbidity require adaptations to preserve their proper development and academic performance. The objective of this study was to know the perceived needs of teachers, pediatricians and pediatric nurses regarding the training of schools to deal with emergences related to chronic pathology and accidents. METHOD: Cross-sectional study using an ad hoc validated questionnaire on digital support (Google Forms) that included sociodemographic variables and a structured survey that collected information on chronic pathology, health care and safety in case of emergency in the school. RESULTS: Data from 266 questionnaires (134 teachers, 132 pediatricians and pediatric nurses) were analyzed. 73.9% of the teachers stated that they have had students with chronic pathology during the last year and 45.5% confirmed the existence of protocols for their assistance, although 68.7% did not receive specific training for their care. 25% of pediatricians and nurses stated that the parents of children with chronic disease always notify the schools and 17.4% stated that they knew about the existence of specific protocols. 35.6% collaborated in training related to specific pathology or emergencies in schools, with a greater predominance of primary health care (P<.001). 50.7% of the pediatricians and 79.7% of the nurses stated as a medium-high priority the need to have a school nurse in the centers. CONCLUSIONS: The health care of students with chronic diseases in schools can be improved for teachers, pediatricians and pediatric nurses, considering the figure of school nurse as the main improvement measure.

Mas allá de las cifras y de los nombres / No disponible

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Utilidad de un preparado lácteo con fibra en el estreñimiento funcional infantil / Utility of lactic product with fiber in infant functional constipation

Objetivo: Evaluar la eficacia de un preparado lácteo suplementado con fibra en niños con estreñimiento funcional. Material y métodos: Ensayo clínico, aleatorizado, doble ciego, controlado con placebo. Se incluyeron 19 niños de entre 4 y 12 años con criterios de Roma III para estreñimiento funcional. El grupo de intervención recibió durante 4 semanas 200 ml al día de leche con fibra, mientras los controles recibieron una ración similar de leche sin suplementar. Resultados: Tras 4 semanas no se encontraron diferencias estadísticamente significativas entre grupos respecto a la realización de al menos 3 deposiciones a la semana (88,9% en tratados frente a 100% en controles, p = 0,474), número de deposiciones semanales, consistencia de deposiciones o presencia de conductas de retención, dolor con la defecación e incontinencia fecal, o la salud autopercibida. En ambos se observó tendencia al aumento en el número de deposiciones; en el grupo de tratamiento de 3,6 ± 1,9 a 5,8 ± 2,0 deposiciones/semana (p = 0,059) y en el grupo placebo de 3,3 ± 1,3 a 5,8 ± 1,3 deposiciones/semana (p = 0,001). También disminuyó la presencia de dolor con la defecación en el grupo de tratamiento del 77,8% al 11,1% (p = 0,031) y en placebo del 80,0% al 20,0% (p = 0,031). Conclusiones: No se ha podido confirmar la eficacia de un preparado lácteo con fibra para el estreñimiento funcional infantil. Son necesarios estudios bien diseñados y de mayor tamaño muestral para determinar el papel de los suplementos de fibra en los niños con estreñimiento

Objective: To assess the effectiveness of a fibre-fortified milk in children with chronic functional constipation. Patients and methods: Randomised, double-blind, placebo-controlled clinical trial involving 19 children, 4 to 12-year-old, who were diagnosis with functional constipation according to Rome III Criteria. Intervention group received 200 ml of fibre-fortified milk daily for 4 weeks, while the other group received a similar portion of nonfortified milk. Results: At the end of the intervention there were no statistically significant differences between groups with respect to having at least three bowel movements a week (88.9% in intervention group vs. 100% in control group, p = 0.474), frequency of bowel movements, stool consistency, presence of painful defecation, retentive posturing, or fecal incontinence, or self-reported perceived health. Both groups tended to increase bowel movements. Fibre group increased from 3.6 ± 1.9 to 5.8 ± 2.0 bowel movements/week (p = 0.059), while control group increased from 3.3 ± 1.3 to 5.8 ± 1.3 bowel movements/week (p = 0.001). Presence of painful defecation decreased both in fibre group, 77.8% to 11.1% (p = 0.031), and in control group, 80.0% to 20,0% (p = 0.031). Conclusions: Effectiveness of a fibre-fortified milk was not confirmed in children with chronic functional constipation. High quality clinical trials are required to know the efficacy of fibre supplements in children with functional constipation

Efectividad de una intervención escolar contra la obesidad / Effectiveness of a school-based program to prevent obesity

INTRODUCCIÓN: Las intervenciones sobre la obesidad infantil son una prioridad para la salud pública. El objetivo de este estudio fue evaluar la efectividad de un programa de intervención contra la obesidad en un colegio de Educación Primaria. MATERIAL Y MÉTODOS: Estudio de intervención controlado no aleatorizado en alumnos de primero a quinto cursos de Educación Primaria en 2 colegios públicos de Avilés (España). La intervención se desarrolló durante 2 cursos escolares, incluyendo talleres sobre alimentación saludable, charlas educativas, material informativo escrito y promoción de la actividad física. La variable de resultado principal fue la puntuación z del índice de masa corporal (IMC). Como variables de resultado secundarias se consideraron: prevalencia de obesidad y sobrepeso, perímetro abdominal, hábitos de dieta y actividad física. RESULTADOS: Fueron incluidos en el estudio 382 (177 niñas, 205 niños) de 526 alumnos de ambos colegios. En 340 individuos se obtuvieron datos antropométricos completos. A diferencia del grupo control, los pertenecientes al grupo de intervención disminuyeron la puntuación z del IMC desde 1,14 a 1,02 (p = 0,017), mejoraron el índice KIDMED de adhesión a la dieta mediterránea de 7,33 a 7,71 puntos (p = 0,045) y aumentaron la proporción de estudiantes con una dieta óptima del 42,6% al 52,3% (p = 0,021). No se encontraron diferencias estadísticamente significativas en la prevalencia de obesidad y sobrepeso, ni en el perímetro abdominal, entre los grupos de intervención y control. CONCLUSIONES: Este programa escolar consiguió pequeñas mejoras en el IMC y la calidad de la dieta

INTRODUCTION: Intervention for childhood obesity is a public health priority. The purpose of this study was to evaluatethe effectiveness of an elementary school-based intervention against obesity in children. MATERIAL AND METHODS: Non-randomised controlled trial was conducted on children from first to fifth grade from two public schools of Avilés (Spain). The intervention lasted for 2 school years comprising healthy diet workshops, educational chats, educational meetings, informative written material, and promotion of physical activities. Primary outcome measure was body mass index z-score. Secondary outcomes included: obesity and overweight prevalence, waist circumference, dietary habits, and physical activity. RESULTS: A total of 382 (177 girls, 205 boys) out of 526 pupils of both schools were included in the study. Complete anthropometric data were obtained in 340 of the 382 individuals. Compared to children in control group, those in intervention group decreased body mass index z-score from 1.14 to 1.02 (P=.017), and improved KIDMED score from 7.33 to 7.71 points (P=.045). The percentage of students who carried on an optimal diet increased from 42.6% to 52.3% (P=.021). There were no statistical differences in the prevalence of obesity and overweight, or in waist circumference between the intervention and control groups. CONCLUSIONS: This school-based program resulted in modest beneficial changes in body mass index and diet quality

Salud infantil y cooperación internacional: una aproximación pediátrica / Child health and international cooperation: A paediatric approach

La cooperación internacional al desarrollo en salud infantil despierta un especial interés en el ámbito pediátrico. En los últimos decenios se han ido revelando nuevas evidencias en torno al análisis de los factores vinculados a la morbimortalidad en las primeras etapas de la vida en los países menos adelantados. Este mayor conocimiento del origen de los problemas de salud y las posibles respuestas en forma de intervenciones con impacto determina la necesidad de su divulgación entre los profesionales de Pediatría interesados. Se hacen necesarios mayores esfuerzos para profundizar en materias relacionadas con salud global infantil y favorecer el que los pediatras conozcan y participen en estos procesos. Este artículo pretende ofrecer un acercamiento pediátrico social hacia los elementos relacionados con cooperación internacional y salud infantil

The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters

[Effectiveness of a school-based program to prevent obesity]. / Efectividad de una intervención escolar contra la obesidad.

INTRODUCTION: Intervention for childhood obesity is a public health priority. The purpose of this study was to evaluate the effectiveness of an elementary school-based intervention against obesity in children. MATERIAL AND METHODS: Non-randomised controlled trial was conducted on children from first to fifth grade from two public schools of Avilés (Spain). The intervention lasted for 2 school years comprising healthy diet workshops, educational chats, educational meetings, informative written material, and promotion of physical activities. Primary outcome measure was body mass index z-score. Secondary outcomes included: obesity and overweight prevalence, waist circumference, dietary habits, and physical activity. RESULTS: A total of 382 (177 girls, 205 boys) out of 526 pupils of both schools were included in the study. Complete anthropometric data were obtained in 340 of the 382 individuals. Compared to children in control group, those in intervention group decreased body mass index z-score from 1.14 to 1.02 (P=.017), and improved KIDMED score from 7.33 to 7.71 points (P=.045). The percentage of students who carried on an optimal diet increased from 42.6% to 52.3% (P=.021). There were no statistical differences in the prevalence of obesity and overweight, or in waist circumference between the intervention and control groups. CONCLUSIONS: This school-based program resulted in modest beneficial changes in body mass index and diet quality.

[Child health and international cooperation: A paediatric approach]. / Salud infantil y cooperación internacional: una aproximación pediátrica.

The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters.

Ética en las publicaciones científicas pediátricas / Ethics in pediatric scientific publications

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Prevención cuaternaria. La contención como imperativo ético / Quaternary prevention: Containment as an ethical necessity

La creciente capacidad de la medicina para producir más iatrogenia que nunca y el riesgo de insostenibilidad de los sistemas sanitarios han generado en los países desarrollados un nuevo concepto de prevención: la prevención cuaternaria, cuyo objetivo es contener la medicalización. La prevención cuaternaria es imprescindible en el fenómeno llamado disease mongering, que podría traducirse por mercantilización de las enfermedades. Potenciar este tipo de prevención y frenar las consecuencias del disease mongering requiere desarrollar todo el potencial institucional de la prevención y toda la voluntad personal de la contención; implica separarnos de la tutela innecesaria de la industria, ser críticos con nuestro trabajo, no ser maleficentes, respetar el principio de justicia sabiéndonos gestores de los limitados recursos públicos, y sentirnos responsables del coste social de oportunidad de las decisiones médicas En este trabajo analizamos desde este punto de vista los cribados en los recién nacidos, los avances en el área de la neonatología y la atención primaria de salud

The growing capacity of medicine to generate more iatrogenic events than ever, and the risk of unsustainability of health systems have led to new prevention concept: quaternary prevention aimed at restraining medicalization. Quaternary prevention is essential in the phenomenon called disease mongering, which could be translated as commercialization of disease. Encouraging this sort of prevention and halting the consequences of disease mongering requires the development of all the institutional potential for prevention, as well as all the personal willingness for restraint; it involves separating us from the unnecessary auspices of industry, being critical of our work, not being maleficent, respecting the principle of justice as managers of the limited public resources and making ourselves feel responsible for the social cost resulting from medical decisions. From this point of view, this work analyses neonatal screening, developments in the area of neonatology and primary health care

Prevalencia de anquiloglosia en recién nacidos en el Principado de Asturias / Prevalence of ankyloglossia in newborns In Asturias (Spain)

INTRODUCCIÓN: La prevalencia de anquiloglosia ha sido estimada alrededor del 4% de los recién nacidos vivos. Se desconoce la situación a nivel nacional. MATERIAL Y MÉTODOS: Estudio multicéntrico, observacional, prospectivo en el que participaron 6 hospitales asturianos. Durante 3 meses se exploró a todos los recién nacidos los días domingo, martes y jueves. Para el diagnóstico de anquiloglosia se utilizaron los criterios de Coryllos y Hazelbaker. RESULTADOS: Se exploró a 667 recién nacidos. La prevalencia de anquiloglosia fue del 12,11% (IC 95%: 9,58-14,64). El 62% eran varones. Uno de cada 4 niños con anquiloglosia tenía antecedentes familiares de frenillo lingual corto. Según la clasificación de Coryllos el tipo II fue el más frecuente (54%). CONCLUSIONES: La prevalencia de anquiloglosia en Asturias fue 2 o 3 veces superior a la esperada. Es necesario unificar los criterios diagnósticos, así como realizar estudios para conocer su asociación con dificultades en la lactancia u otros problemas posteriores

INTRODUCTION: The prevalence of ankyloglossia has been estimated at around 4% of live births. Its prevalence at national level is unknown. MATERIAL AND METHODS: Multicenter, prospective observational study. Six hospitals in Asturias took part. All newborns were examined on Sundays, Tuesdays and Thursdays for 3 months. Coryllos and Hazelbaker criteria were used to diagnose ankyloglossia. RESULTS: The prevalence in the 667 newborns examined was 12.11% (95% CI: 9.58 to 14.64), of whom 62% were male. One in 4 children with ankyloglossia had a family history. According to Coryllos' classification, type II was the most common (54%). CONCLUSIONS: The prevalence of ankyloglossia in Asturias was 2 to t3 times higher than expected. The diagnostic criteria for ankyloglossia needs to be unified, and further studies are required to determine the association with breastfeeding difficulties and other health problems

[Quaternary prevention: containment as an ethical necessity]. / Prevención cuaternaria. La contención como imperativo ético.

The growing capacity of medicine to generate more iatrogenic events than ever, and the risk of unsustainability of health systems have led to new prevention concept: quaternary prevention aimed at restraining medicalization. Quaternary prevention is essential in the phenomenon called disease mongering, which could be translated as commercialization of disease. Encouraging this sort of prevention and halting the consequences of disease mongering requires the development of all the institutional potential for prevention, as well as all the personal willingness for restraint; it involves separating us from the unnecessary auspices of industry, being critical of our work, not being maleficent, respecting the principle of justice as managers of the limited public resources and making ourselves feel responsible for the social cost resulting from medical decisions. From this point of view, this work analyses neonatal screening, developments in the area of neonatology and primary health care.

La bioética en la formación de los pediatras / Bioethics in paediatric training

No disponible

[Prevalence of ankyloglossia in newborns in Asturias (Spain)]. / Prevalencia de anquiloglosia en recién nacidos en el Principado de Asturias.

INTRODUCTION: The prevalence of ankyloglossia has been estimated at around 4% of live births. Its prevalence at national level is unknown. MATERIAL AND METHODS: Multicenter, prospective observational study. Six hospitals in Asturias took part. All newborns were examined on Sundays, Tuesdays and Thursdays for 3 months. Coryllos and Hazelbaker criteria were used to diagnose ankyloglossia. RESULTS: The prevalence in the 667 newborns examined was 12.11% (95% CI: 9.58 to 14.64), of whom 62% were male. One in 4 children with ankyloglossia had a family history. According to Coryllos' classification, type II was the most common (54%). CONCLUSIONS: The prevalence of ankyloglossia in Asturias was 2 to t3 times higher than expected. The diagnostic criteria for ankyloglossia needs to be unified, and further studies are required to determine the association with breastfeeding difficulties and other health problems.

Recomendaciones para la toma de decisiones ante la negativa de los padres a la vacunación de sus hijos: análisis ético / Recommendations for making decisions when parents refuse to vaccinate their children: ethical analysis

Vacunar a los niños es la actividad de prevención primaria más efectiva que se conoce y gracias a las vacunas se han salvado muchas vidas. Los movimientos antivacunas siembran dudas acerca de la seguridad y la efectividad de las vacunas infantiles provocando la negativa de algunos padres a vacunar a sus hijos. Dicha negativa plantea un conflicto de valores entre el derecho de los padres a la crianza de sus hijos según sus creencias y el de justicia, al poner en riesgo la inmunidad del grupo. En España, la ley protege esta capacidad de decisión de los padres al no obligar al cumplimiento del calendario oficial. Los pediatras tenemos un papel esencial en la decisión de los padres y debemos informar con rigor y claridad. Es necesario explorar los valores de los padres y sus preocupaciones, desde la empatía, buscando acuerdos. El respeto a la autonomía no nos exime de argumentar e intentar persuadir para conseguir actitudes y decisiones saludables para los niños. Nuestro compromiso desde el fomento de la responsabilidad es esencial para lograr mantener altos niveles de vacunación que protejan la salud infantil (AU)

Vaccinating children is the most effective primary prevention activity and many lives have been saved due to vaccines. Anti-vaccine movements have spread doubts about the safety and effectiveness of childhood vaccines, leading to some parents refusing to vaccinate their children. This refusal raises a conflict of values between the right of parents to the upbringing of their children according to their beliefs and justice, putting the immunity of the group at risk. In Spain, the law protects this ability for parents to decide not to comply with the official vaccine program. Pediatricians play an essential role in a parent's decision, and must provide accurate information about vaccination. It is necessary to explore The values of the parents, their concerns need to be empathetically examined, in order to reach an agreement. Respect for freedom does not exempt us from using discussion and persuasion to achieve attitudes and healthy choices for children. Our commitment to responsability promotion is essential for maintaining high vaccination levels that protect the health of children (AU)

[Recommendations for making decisions when parents refuse to vaccinate their children: ethical analysis]. / Recomendaciones para la toma de decisiones ante la negativa de los padres a la vacunación de sus hijos: análisis ético.

Vaccinating children is the most effective primary prevention activity and many lives have been saved due to vaccines. Anti-vaccine movements have spread doubts about the safety and effectiveness of childhood vaccines, leading to some parents refusing to vaccinate their children. This refusal raises a conflict of values between the right of parents to the upbringing of their children according to their beliefs and justice, putting the immunity of the group at risk. In Spain, the law protects this ability for parents to decide not to comply with the official vaccine program. Pediatricians play an essential role in a parent's decision, and must provide accurate information about vaccination. It is necessary to explore The values of the parents, their concerns need to be empathetically examined, in order to reach an agreement. Respect for freedom does not exempt us from using discussion and persuasion to achieve attitudes and healthy choices for children. Our commitment to responsability promotion is essential for maintaining high vaccination levels that protect the health of children.

Factores de riesgo cardiovascular clásicos y emergentes en escolares asturianos / Classic and emergent cardiovascular risk factors in schoolchildren in Asturias

Introducción: Los factores de riesgo cardiovascular clásicos son detectables en la infancia. La proteína C reactiva ultrasensible, la leptina y la adiponectina constituyen los factores de riesgo cardiovascular inflamatorio más importantes. Pacientes y métodos: Estudio transversal, descriptivo. Se seleccionó a alumnos de entre 6 y 12 años de dos colegios de la ciudad de Avilés. Se determinaron datos somatométricos y de prevalencia de obesidad y sobrepeso. Asimismo, se determinaron la presión arterial sistólica y diastólica y la presencia de síndrome metabólico. El nivel de ingresos familiares, los hábitos alimentarios y de estilo de vida se calcularon mediante las encuestas GRAFFAR, KIDMED y Self Report Instrument of Measuring Physical Activity, respectivamente. Analíticamente se determinaron el perfil lipídico, de insulinorresistencia, hepático, proteína C reactiva ultrasensible, leptina y adiponectina. Resultados: Se incluyó a 459 alumnos. El 31% presentaba sobrepeso y un 10,9% obesidad. Los individuos obesos presentaron valores más elevados de peso, índice de masa corporal, perímetro abdominal, presión arterial, proteína C reactiva ultrasensible y leptina, y más bajos de colesterol unido a lipoproteínas de alta densidad y apolipoproteína A que los no obesos. No se observaron diferencias en las actividades físicas y sedentarias; por el contrario, los obesos siguieron una dieta de peor calidad que los no obesos. Conclusiones: La prevalencia de obesidad y sobrepeso está alcanzando valores preocupantes en escolares. La obesidad se asocia de forma consistente a otros factores de riesgo cardiovascular clásicos y emergentes. Los escolares obesos presentan peor calidad en su alimentación aunque no realizan menos actividades físicas ni más actividades sedentarias que sus compañeros no obesos (AU)

Introduction: Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponect in are the most important inflammatory cardiovascular risk markers. Patients and methods: A descriptive, cross-sectional study, including children aged 6-12 years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin. Results: A total of 459 schoolchildren were included of whom 31% were overweight and 10.9%were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children. Conclusions: Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children (AU)

[Classic and emergent cardiovascular risk factors in schoolchildren in Asturias]. / Factores de riesgo cardiovascular clásicos y emergentes en escolares asturianos.

INTRODUCTION: Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponectin are the most important inflammatory cardiovascular risk markers. PATIENTS AND METHODS: A descriptive, cross-sectional study, including children aged 6-12 years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin. RESULTS: A total of 459 schoolchildren were included of whom 31% were overweight and 10.9% were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children. CONCLUSIONS: Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children.