Prevención y diagnóstico precoz de osteoporosis infantil: ¿estamos haciendo lo correcto? / Prevention and early diagnosis of childhood osteoporosis: are we doing the right thing?

Objetivos: Evaluar la prevención, el diagnóstico precoz y la formación recibida de la osteoporosis en la Pediatría de nuestro medio. Material y métodos: Encuesta dirigida a facultativos de Pediatría de Atención Primaria (AP) y Atención Especializada (AE) que valora su actividad en prevención, detección y formación recibida en osteoporosis, y que fue difundida a través de las sociedades científicas pertinentes. Resultados: Participaron 420 pediatras (324 de AP y 96 de AE). El 93,5% de los pediatras de AP y el 89,6% de los de AE valoraban la actividad física de los pacientes; el 85,19% y 35,4% de ellos, respectivamente, la ingesta de lácteos. El 45,68% de AP y el 70,2% de AE suplementaban con calcio y vitamina D ante aporte nutricional bajo, realizándoles seguimiento el 39,2% de AP y el 47,2% de AE. El 39,6% de pediatras de AE solicitaba densitometría ósea ante enfermedad o tratamiento de riesgo, y el 47,9% medía los niveles de 25-OH-vitamina D. El 25,93% de AP y el 45,3% de AE preguntaban por la existencia de fracturas, el 90,4% y 96,8% valoraban el mecanismo etiopatogénico. El 40% de AP y el 86,2% de AE solicitaban una densitometría ósea o derivaban al especialista ante fracturas por traumatismos de baja energía, con criterios específicos en el 13,7% y 5,86%, respectivamente. El 92% de AP y el 82,3% de AE no habían recibido formación reciente en osteoporosis infantil. Conclusión: La detección, los circuitos de derivación y la formación de los pediatras respecto a la salud ósea en nuestro país es mejorable. Optimizar estos aspectos es fundamental para favorecer el pico de masa ósea en nuestra población

Objectives: To assess prevention, early diagnosis and training received regarding osteoporosis among the pediatrics professionals in our area. Material and methods: Survey directed to physicians of pediatricians of Primary Care (PC) and Specialized Care (SC) in order to evaluate their activity in prevention, detection and training received in osteoporosis. The survey was disseminated through the relevant scientific societies. Results: 420 pediatricians participated (324 from PC and 96 from SC). 93.5% of PC pediatricians and 89.6% of SC pediatricians valued the physical activity of the patients; 85.19% and 35.4% of them, respectively, the intake of dairy products. 45.68% of PC and 70.2% of SC recommended calcium and vitamin D supplements in the case of low nutritional intake, whereas 39.2% of PC and 47.2% of SC favored follow-up. 39.6% of SC pediatricians requested bone densitometry for this disease or risk treatment, and 47.9% measured the levels of 25-OH-vitamin D. 25.93% of PC and 45.3% of SC asked about the existence of fractures, 90.4% and 96.8% requested etiopathogenic mechanism. 40% of PC and 86.2% of SC requested a bone densitometry or referred to the specialist for fractures due to low trauma energy, with specific criteria in 13.7% and 5.86%, respectively. 92% of PC and 82.3% of SC had not received recent training in childhood osteoporosis. Conclusion: Detection, derivation circuits and the training of pediatricians regarding bone health in our country can be improved. Optimizing these aspects is essential to favor the peak of bone mass in our population

El coste del ingreso prolongado del paciente crítico / The cost of prolonged hospital stay of the critical patient

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Monitorización de la calidad en un servicio de medicina intensiva / Monitoring quality in an intensive medicine department

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Influencia de la edad en la duración de la estancia y en la mortalidad de los pacientes que permanecen de forma prolongada en una Unidad de Cuidados Intensivos / Influence of age in the duration of the stay and mortality of patients who remain in an Intensive Care Unit for a prolonged time

Fundamentos y objetivo: No se conoce cuál es el verdadero papel de la edad en el pronóstico de los pacientes ingresados en las Unidades de Cuidados Intensivos (UCI). En este trabajo se analiza la influencia de la edad en la duración de la estancia y en la mortalidad de los pacientes que permanecen de forma prolongada en una UCI. Pacientes y método: Estudio retrospectivo observacional, con pacientes ingresados ≥14 días en UCI. Se establecieron 3 grupos de edad: menores de 50, entre 50-70 y mayores de 70 años. Se estudió la influencia de diferentes factores en la relación existente entre estancia y edad; además se analizó la estancia y la supervivencia en las UCI, hospitalaria y al año en función de los grupos. Resultados: Se incluyeron 707 pacientes. No se encontraron diferencias significativas entre los 3 grupos en la estancia hospitalaria (p=0,183). El grupo de mayor edad, que presentaba una mayor gravedad al ingreso, fue el que se sometió a más traqueotomías (74,7%) y de depuración extrarrenal (HDF) (10,8%). Al analizar la influencia de factores tales como el APACHE II, la estancia pre-UCI, la procedencia, la traqueotomía o las HDF, no se encontró relación alguna entre la estancia y la edad del paciente. La supervivencia decrecía a medida que se incrementaba la edad. Conclusiones: No se hallaron diferencias en la estancia en función de la edad, aunque sí en la mortalidad (AU)

Backgrounds and objective: The true role of the age in the prognosis of patients admitted in the ICU is not known. This work analyzes the influence of age on the duration of the stay and mortality of patients who remain in an Intensive Care Unit (ICU) for a long period of time. Patients and method: A retrospective, observational study was performed with patients hospitalized ≥14 days in the ICU. Three age groups were established: <50, 50-70 and >70 years. The influence of different factors on the relationship existing between stay and age was studied. In addition, stay and survival in the ICU, hospital and at one year were analyzed based on the groups. Results: A total of 707 patients were included. Significant differences in hospital stay (P=0.183) were not found among the three groups. The older group, which showed greater severity on admission, was the group undergoing the most tracheostomies (74.7%) and extrarenal purification (HDF) (10.8%). When the influence of factors such as APACHE II, pre-ICU stay, origin, tracheostomy or hemodiafiltration (HDF) were analyzed, no relation was found between stay and age of patient. Survival decreased as age increased. Conclusions: No differences were found in stay based on age, although a difference was found in mortality (AU)

Pronóstico de los pacientes médicos según la duración de su estancia en la unidad de cuidados intensivos / Prognosis of clinical patients according to length of stay in the intensive care unit

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Influence of age in the duration of the stay and mortality of patients who remain in an Intensive Care Unit for a prolonged time.

BACKGROUNDS AND OBJECTIVE: The true role of the age in the prognosis of patients admitted in the ICU is not known. This work analyzes the influence of age on the duration of the stay and mortality of patients who remain in an Intensive Care Unit (ICU) for a long period of time. PATIENTS AND METHOD: A retrospective, observational study was performed with patients hospitalized ≥14 days in the ICU. Three age groups were established: <50, 50-70 and >70 years. The influence of different factors on the relationship existing between stay and age was studied. In addition, stay and survival in the ICU, hospital and at one year were analyzed based on the groups. RESULTS: A total of 707 patients were included. Significant differences in hospital stay (P=.183) were not found among the three groups. The older group, which showed greater severity on admission, was the group undergoing the most tracheostomies (74.7%) and extrarenal purification (HDF) (10.8%). When the influence of factors such as APACHE II, pre-ICU stay, origin, tracheostomy or hemodiafiltration (HDF) were analyzed, no relation was found between stay and age of patient. Survival decreased as age increased. CONCLUSIONS: No differences were found in stay based on age, although a difference was found in mortality.

Factores pronósticos en los pacientes con síndrome coronario agudo que ingresaron en una unidad de cuidados intensivos / Prognostic factors in patients with acute coronary syndrome admitted to an intensive care unit

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Atención de calidad en un servicio de medicina intensiva / Quality health care in an intensive care unit

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Nutrición de calidad para el enfermo crítico / Quality nutrition for the critically ill

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