Anales Espanoles De Pediatria最新文献

The aim of this article was to provide an update that would serve to increase knowledge of health problems among juvenile delinquents before and during incarceration in juvenile correctional centers. Recommendations are made for the care of mental and physical health and for the health education of these teenagers that could be useful for health professionals providing health care to these teenagers while in custody as well as for those seeing them in the ambulatory setting. From the literature consulted, 63 % of studies have been performed in the United States, 24 % in Western Europe (Spain, United Kingdom, Holland, Belgium, Sweden, Finland), 8 % in Australia and 5 % in Canada. These studies show no appreciable qualitative differences in the health problems most frequently presented by these teenagers and there is agreement that the areas that should be prioritized are the provision of preventive and/or therapeutic dental care, as well as programs for psychiatric care, immunization, infectious diseases and health education. Failure to identify the health requirements of these teenagers and to provide early interventions can not only adversely effect their quality of life and their future physical, emotional and intellectual development but can also make their rehabilitation and reintegration into society more difficult.

Despite its potential toxicity, the use of star anise infusions for the treatment of infant colic is firmly rooted in our culture. In the last year, several cases of infants with acute neurological and gastrointestinal symptoms related to the ingestion of large quantities of star-shaped anise have been reported in Spain. We report a 1-month old girl who was admitted to our emergency room with convulsive status after ingesting a considerable amount of star anis administered to relieve possible infant colic. The patient required three repeat doses of diazepam to control the seizures. Because no abnormalities were found and outcome was favorable without anticonvulsant therapy, the clinical symptoms can be attributed to star anise ingestion, which contains potent neurotoxins such as veranisatins. The etiopathogenesis of this process and star anise toxicity are discussed and the need for the regulation of natural products with pharmacological effects which are freely dispensed from drug stores is stressed. Finally, the regulations of the Ministry of Health and Consumption for 2001 concerning the withdrawal of all anise-containing products are presented.

Background: Epidemiological studies have shown a high prevalence of silent celiac disease (CD) among unselected pediatric populations and a low ratio of diagnosed to undiagnosed CD.

Objectives: To quantify the prevalence of silent CD, to assess the clinical features of subclinical CD and to determine the total prevalence of CD (silent plus symptomatic cases).

Methods: We determined total serum IgA, IgA antiendomysial antibodies (EMA) and IgG antigliadin antibodies (IgG AGA), if IgA deficiency was found, in schoolchildren aged 10-12 years from health district IX in Madrid.

Results: A total of 3,378 schoolchildren (47.8 % of the eligible population) were studied. Fifteen were EMA-positive and one child with IgA deficiency was IgG AGA-positive. CD was confirmed by intestinal biopsy in 12 children, representing a prevalence of undiagnosed CD of 1/281. Of these 12 children, 7 showed clinical features of CD. The most frequent symptom was iron-deficiency, followed by recurrent aphthous stomatitis and mild malnutrition. Before the start of this study, CD had been diagnosed in seven children from the same population, which would increase the total prevalence of the disease to 1/220 with an estimated ratio of diagnosed to undiagnosed CD of 1 to 3.5.

Conclusions: We confirm the high prevalence of silent celiac disease among the school-aged population. This ratio is one of the highest published and could be due to a high diagnostic suspicion for CD among pediatricians in our health district. Greater awareness of the minor symptoms of CD would reduce the number of patients with undiagnosed CD.

Becoming a regular smoker is a process that begins even before the first cigarette, and ends in lifelong physical and psychological dependence. Various psychological and behavioral factors contribute to this process. This article discusses smoking initiation from a comprehensive perspective, including the physiological and addictive effects of nicotine, and the personal and environmental factors that lead to smoking. Because smoking usually begins in adolescence, special emphasis is placed on this developmental stage and on the situations that encourage teenagers to smoke the first cigarette. Finally, this article analyzes the importance of the initiation process in the epidemiology and prevention of smoking. This approach may prove to be particularly useful to clinicians interested in interventions aimed to curb smoking.

Background: The longer follow-up programs last, the greater the loss to follow-up. These losses to follow-up may undermine the completion of health care goals and the validity of study results.

Objectives: 1) To compare neonatal characteristics in children easily followed-up and in those lost to follow-up. 2) To trace and assess children lost to follow-up. 3) To estimate the occurrence of cerebral palsy in children easily followed-up and in those lost to follow-up.

Methods: From 1991 to 1997, 601 neonates with a birth weight under 1,500 g were admitted to the Neonatology Department. At discharge, 447 infants were included in the follow-up program. Moderate-to-severe cerebral palsy was assessed when the children were aged 2 years. A specific search strategy was implemented to find those children lost to follow-up. Data on the development of those traced were updated through a standardized telephone questionnaire.

Results: Twenty percent of the children were lost to follow-up before the age of 2 years. Fifty-seven percent of those not available at this age were assessed by telephone interview. No differences were found in the neonatal characteristics of infants easily followed-up and those lost to follow-up except in situations of critical social disadvantage: 10 % in followed-up infants, 41 % in infants lost to follow-up. Disabling cerebral palsy was observed in 7 % of children easily followed-up and in 23 % of those lost and traced (relative risk: 3.1, 1.5-5.5).

Conclusions: The risk of having disabling cerebral palsy is three times higher in children lost to follow-up than in those easily followed-up. Dismissing this source of bias may underestimate disability rates when assessing health care programs or when interpreting study results.

Renal cell carcinoma is infrequent in children; consequently it is important to communicate its diagnosis and follow up. The behavior of this type of tumor is better characterized in adults and in this setting the treatment of choice is surgical resection. However, chemo- and radiotherapy for metastatic tumors has not been well defined. Our objective was to report the experience of a single pediatric institution in the diagnosis and treatment of renal cell carcinoma and to review the literature on this subject. We retrospectively reviewed patients diagnosed with renal cell carcinoma in the last twenty years. Only three patients were found, and we describe their clinical features and therapeutic approach. Although renal cell carcinoma is rare in children, clinical suspicion of this disease in children older than 5 years with renal masses is very important since the diagnostic and therapeutic approach differs from that for Wilms' tumor. The main prognostic factors seem to be staging and complete resection. Multicenter collaboration is required to standardize the treatment of tumors in advanced stages and to define the role of allogeneic stem cell transplantation in metastatic tumors.