[Families of the economic crisis in paediatric Primary Care clinics: descriptive observational study]

OBJECTIVE

To study the impact of the economic crisis on the families of the children who attend Primary Health Care and its relationship with their socioeconomic status.

PATIENTS AND METHODS

Observational descriptive study was conducted by analysing the results of 453 questionnaires, given to the parents of children between 1 and 7 years old who attended 4 paediatric clinics in Madrid. The raw data was analysed, and comparisons between groups and multivariate analysis were performed.

RESULTS

In the multivariate analysis, the variables related to the non-acquisition of prescribed medication are: lower income level OR=0.118, p<.0001 and lower educational level OR=0.464, p<.001; the variables related to the reduction of food expenditure are: lower income level OR=0.100, p<.0001 and a higher number of family members OR=1.308, p=.045; the variables related to anti-pneumococcal vaccination without public funding are: higher income level OR=2.170, p=.0001, higher educational level OR=1.835, p=.013, and not being an immigrant OR=0.532, p=.037. The presence of health problems from the beginning of the economic crisis is related to unemployment OR=4.079, p=.032, lower educational level R=0.678, p=.042, and income level OR=0.342, p<.0001. In all cases, the models achieved a statistical significance of p<.0001.

CONCLUSIONS

The economic crisis has greater impact on the group with the lowest income level in all analysed variables. The lower educational level and higher number of family members has an impact on the reduction in food expenditure. The fact of being an immigrant has an impact on not receiving the anti-pneumococcal and rotavirus vaccination. Unemployment leads to an increase in health problems in the family. To sum up, the economic crisis has increased inequalities according to socioeconomic status.

[Chest physiotherapy and bronchiolitis in the hospitalised infant. Double-blind clinical trial]

OBJECTIVE

[corrected] To study the utility of chest physiotherapy by increased exhalation technique with assisted cough in the acute bronchiolite of the hospitalized new-born babys.

PATIENTS AND METHODS

Double-blind clinical trial accomplished on 236 patients of age lower than 7 months and hospitalizad with diagnosis of acute bronchiolitis, first episode, in a pediatric department in Madrid.The patients were randomized in two groups: those who have received maneuvers of chest physiotherapy and those who have received maneuvers placebo. Only physiotherapist were aware of the allocation group of the infants. The days of hospitalization and the hours of oxygentherapy were used like result measurement.

RESULTS

From the totality of the studied children 57,6% received maneuvers of chest physiotherapy and 42,4% remaining received maneuvers placebo. In the group that received chest physiotherapy the average stay in the hospital was 4,56 days (95% confidence interval [CI] 4,36-6,06) and the average time of oxygentherapy was 49,98 (95% CI 43,64-67,13) hours opposite to 4,54 days (95%CI 3,81-5,73) and 53,53 hours (95% CI 48,03-81,40) respectively in the group that did not receive chest physiotherapy. In the patients with analytical print for VRS and that received chest physiotherapy less hours of oxygen therapy were needed 48,80 hours (95% CI 42,94-55,29) opposite to 56,68 hours (95% CI 55,46-65,52) respectively, being the only one turned out as per statistics significantly (P=.042).

CONCLUSIONS

Results show that chest physiotherapy has not been effective in reducing hospital stay or length of oxygentherapy in patients with acute bronchiolitis, but in the positive study of children with respiratory syncytial virus in nasopharyngeal aspirate showed a reduced need hours of oxygen. hours (P=.042).

[Can vesicoureteral reflux be predicted in infants with urinary infection?]

AIMS

To look forward for a formulae able to predict the presence of vesicoureteral reflux (VUR) in the first urinary tract infection (UTI) in infants.

SUBJECTS AND METHODS

We had studied all the diagnosticated first UTI in breast-fed babies in our hospital along 21/2 years. All had been subjects of a renal ultrasound scan, VCUG and CRP test. We have analyzed the result by diagnosis test and logistic regression.

RESULTS

We have studied 267 infants aged between 2 days and 24 months old.17,33% manifested UTI caused by germs different than E Coli, 40 subjects presented anomalies in the ultrasound scan and 108 manifested VUR. Oostenbruck s score had been useless in detecting VUR subjects. In the multivariable analysis the two variables of anomalies in the ultrasonographic scan and non E Coli caused UIT were the only ones to presented statistical significance to sign the presence of VUR and of the likeness of VUR of grade > or = 3. The negative probability coefficients for infants with ultrasonographics anomalies and/or UTI non E Coli produced were of 0,78 (IC 0,67-0,90) for all degrees of VUR, 0,25 (IC 0,10-0,52) for VUR with degree > or = 3 and 0 (IC 0-0,67) for VUR with degree > or = 4.

CONCLUSIONS

We deduced that in children younger of 24 months old that suffer their first UTI the indication to proceeded with a VCUG could be limited to the subjects with present anomalies in the renal ultrasound scan and/or UTI non E Coli, thought there will precised more studies to confirm this findings.

Relación entre el perfil lipídico y el índice de masa corporal. Seguimiento de los 6 a los 11 años. Estudio Rivas-Vaciamadrid

BACKGROUND

To study the relationship between lipid profile and body mass index (BMI) in children after a 5-year follow-up.

METHOD

A total of 281 children were evaluated at the ages of 6 and 11 years. Total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), and apoproteins A1 (Apo A) and B100 (Apo B) were measured. Low-density lipoprotein cholesterol (LDL-C) was determined and the Apo B/Apo A, TC/HDL-C, LDL-C/HDL-C indexes, and the atherogenic index were calculated. BMI was also calculated (BMI 5 kg/m2). Evolution parameters were calculated (EVO 5 value 11 years - value 6 years). Associations between BMI and lipid profile were studied.

RESULTS

The prevalence of obesity (according to the criteria of the International Obesity Task Force) was 4.98 % (6 years) and 16,72 % (11 years). In children who were in the fourth BMI quartile at the age of 11 years, LDL-C/HDL-C and TC/HDL-C levels were significantly higher and than those in children in the first quartile but HDL-C and Apo A levels were lower. A significant positive correlation was found between the evolution of BMI and the four indexes studied and TG, but this correlation was negative for HDL-C and Apo A. The evolution of the indexes was positive in 11-year-old obese children and negative in nonobese children.

CONCLUSIONS

Lipid profile was worse in 11-year-old children in the fourth BMI quartile than in the remaining children. Obese children had higher values of the indexes studied, supporting the importance of obesity as a cardiovascular risk factor.

[Ecographic study of kidney size in children]

OBJECTIVE

The objective of this study is the determination of the normal kidney size in children analysing the variables that have a good correlation with it. With these correlations the normal kidney size can be established and a diagnose of possible diseases set.

METHODS

The data was obtained through ecographies taken in 474 children between 0 and 18 years old that were under control for several reasons differently from the suspicion of a kidney disease. The information related to age, sex, weight, height and corporal surface was also taken.

RESULTS

We studied 265 girls and 209 boys. No difference was obtained between the size of the girls and boys kidneys. The regression analysis of the left kidney shows correlations of 0.911 for the height, 0.896 for the corporal surface, 0.863 for the weight and 0.857 for the age; while the one of the right kidney shows correlations of 0.921 for the height, 0.902 for the corporal surface, 0.872 for the age and 0.871 for the weight. The determination coefficients were 0.83 for the left kidney and 0.85 for the right one. The multivariant analysis shows that for both kidneys the height and the age are variables statistically significant as well as the corporal surface for the left kidney.

CONCLUSIONS

The size parameters measured in the kidneys show a statistically significance correlation with certain parameters of the growing. The maximum correlation appears for the height of the patient, which allows establishing regression equations with the kidney size and the height and therefore to detect any deviations from these regression curve.

[Birth weight and familial smoking]

INTRODUCTION

Tobacco smoking during pregnancy is an important risk factor in the pediatric population and has been associated with an increase in low birth weight (LBW) infants.

PATIENTS AND METHODS

We carried out a retrospective case-control study of infants admitted to the Infants Department of the Hospital Universitario Infantil Niño Jesús in Madrid. Data from 2370 infants admitted to the hospital between 2002 and 2004 were collected.

RESULTS

The odds ratio (OR) for having a LBW infant was 1.42 (95 % CI: 1.017-1.985) among mothers who smoked during pregnancy and was 1.37 (95 % CI: 1.014-1.863) among women whose partners smoked. Gestational age was also a predictive factor of birth weight: the OR was 0.585 (95 % CI: 0.545-0.628). No significant differences for risk of LBW were found between sexes (OR: 1.25; 95 % CI: 0.934-1.671).

CONCLUSIONS

Our results should reinforce the importance of smoking prevention during and after pregnancy in both parents, which could reduce many complications in children's health with a high medical, social and economic cost.

Nivel socioeconómico y consumo de recursos sanitarios en atención primaria

OBJECTIVE

To determine the influence of socioeconomic status on healthcare demand and resource consumption in our population.

PATIENTS AND METHODS

We performed a cross sectional, retrospective study of socioeconomic status and healthcare and pharmaceutical consumption in randomly selected patients from five primary care pediatric clinics in Madrid. The chi-square test was used to compare percentages. For the remaining analyses, nonparametric tests were used after confirming that the data followed non-normal distribution.

RESULTS

We compared 684 questionnaires. Patients in the most disadvantaged socioeconomic levels consumed a greater number of drugs than those in more privileged levels (mean 0.79 vs. 0.47, p = 0.04). The mean pharmacological expenditure was also higher in the lowest socioeconomic levels than in the highest levels (5.28 Euros vs. 2.21 Euros, respectively; p = 0.001). No significant differences were found among socioeconomic levels in the number of consultations or diagnostic tests requested. The number of consultations was higher in younger patients (p < 0.001) or in those with chronic diseases (p = 0.001). Drug consumption was increased in the most disadvantaged levels (p = 0.002) and in patients with chronic diseases (p < 0.001). Lastly, pharmacological expenditure expressed in Euros was also higher in the lowest socioeconomic levels (p = 0.001) and in patients with chronic diseases (p < 0.001) but was lower if one of the parents was a foreigner (p = 0.031).

CONCLUSIONS

We found a relationship between socioeconomic level and drug consumption and its attributable cost. These data should be confirmed by broader studies.

[Pre and postnatal tobacco exposure and bronchiolitis]

OBJECTIVES

To determine the influence of pre- and postnatal tobacco exposure in the development of bronchiolitis.

PATIENTS AND METHODS

A questionnaire was given to the parents of children hospitalized between August 2001 and August 2002. It included items on parental smoking habits and maternal smoking during pregnancy. Clinical, analytical and radiological criteria were used to diagnose bronchiolitis.

RESULTS

Of 450 children, 123 (27.3 %) were diagnosed with bronchiolitis. The control group was composed of 327 children. A total of 61.6 % of the children had at least one parent who smoked and 32.9 % of these children developed bronchiolitis; 39.1 % had non-smoking parents and 18.2 % were hospitalized with bronchiolitis (OR 2.20 [1.39-3.47]). Of the entire group of children studied, 35.3 % had mothers who smoked and 37.7 % of these children had bronchiolitis compared with 21.4 % of children whose mothers were non-smokers (OR 2.22 [1.45-3.39]). A total of 49.6 % had fathers who smoked, and 32.3 % of these children were diagnosed with bronchiolitis compared with 22 % of children whose fathers were non-smokers (OR 1.65 [1.10-2.57]). Forty-four percent of children whose mothers smoked during pregnancy were hospitalized with bronchiolitis compared with only 20.9 % of non-exposed children (OR 2.96 [1.90-4.62]). The large number of mothers who smoked during pregnancy (27.8 %) was notable. Multivariant analysis with logistic regression was performed and the only variable that remained statistically significant was smoking during pregnancy (p < 0.00001; OR 3.27 [1.39-7.71]).

CONCLUSIONS

Maternal smoking during pregnancy seems to be the main risk factor for the subsequent development of bronchiolitis

[Evolution of the prevalence of smoking among female physicians and nurses in the Autonomous Community of Madrid, Spain]

BACKGROUND

Smoking is a major cause of mortality in Spain. Tobacco smoking by health care workers has a negative influence on the general population. In Spain, the prevalence of smoking is high and is increasing among women. The aim of this study was to identify tobacco consumption among female physicians and nurses in the Community of Madrid, as well as to determine their knowledge about smoking and whether smoke-free areas are available in health centers.

METHODS

A cross-sectional, descriptive study was performed in 1998 and 2001 through survey of smoking habits in the female medical staff in the Community of Madrid. Multi-stage sampling with conglomerates was used.

RESULTS

We studied 1235 health professionals (435 doctors and 800 nurses) in 1998 and 1000 in 2001 (400 doctors and 600 nurses); 43.1% were smokers in 1998 and 43% were smokers in 2001. In both years smoking was more prevalent among nurses (47.6% and 47%) than doctors (34.7% and 37%). Smoking was also more prevalent among health professionals working in hospitals (46.6% and 46.7%) than in those working in primary care (35.3% and 37.3%). When both years were compared, no significant differences in smoking prevalence according to profession were found. In both surveys, the prevalence of smoking was lowest among younger (< 30 years) doctors (22.9% and 23.6%). A similar situation was found in 2001 among nurses (43.8% of those aged < 30 years smoked). The percentage of exsmokers was higher in 2001 (18.9% vs. 27.8%). The percentage of health workers who smoked in front of patients decreased (2.9% vs. 1%) as did the percentage of those who thought smoking should be allowed smoke in waiting rooms (14.9% vs. 7.4%). The percentage of workers who smoked in staff rooms decreased (90.6% vs. 87.1%) and that of health professionals who worked in centers with a specific smoking area increased (30.4% vs. 59.4%).

CONCLUSIONS

The prevalence of smoking among female physicians and nurses in the Community of Madrid is very high, and in the case of nurses, it higher than among the general population. No substantial changes were observed between the two surveys. Smoking is more frequent among nurses than among doctors, and is more frequent in hospitals than in primary care. In the second survey, those who smoked less were the younger members of both professions, which allows a certain optimism. Although it has improved, observance of current legislation in health centers continues to be very low.

Effectiveness and tolerability of ibuprofen-arginine versus paracetamol in children with fever of likely infectious origin

The aim of this multicentre, double-blind, randomized study was to assess the paediatric antipyretic efficacy of a new ibuprofen formulation containing L-arginine for gastric protection, compared with the efficacy of paracetamol. For this purpose 100 patients were given ibuprofen-arginine (1 drop/kg: 6.67 mg/kg) and 99 paracetamol (4 drops/kg: 10.65 mg/kg). The main efficacy endpoint was the mean change in tympanic temperature 4 h after drug intake. Twelve patients were excluded because of early vomiting or spitting out the medication. The resulting efficacy analysis population included a total of 88 patients treated with ibuprofen-arginine and 87 with paracetamol. Mean change in tympanic temperature (degrees C) showed no difference between groups (p = 0.527) but more patients in the ibuprofen-arginine group attained a temperature reduction greater than 2 degrees C (p = 0.043). A total of 107 patients required antipyretic rescue medication, with a smaller proportion in the ibuprofen-arginine group. Although this was not statistically significant, a trend towards improved activity was observed (p = 0.100). Overall efficacy was judged from the recovery or improvement in 68.8% of patients in the ibuprofen-arginine group compared with 65.5% in the paracetamol group. Nineteen patients reported adverse events, with vomiting being the most common complaint, but no differences were detected between treatments.

CONCLUSION

Based on the present results, ibuprofen-arginine oral drops have shown to be a safe, well-tolerated and potent paediatric antipyretic agent. Hence, ibuprofen-arginine should be considered as an adequate choice for the control of paediatric fever of likely infectious aetiology.

[Pattern of the distribution of total cholesterol and cHDL cholesterol Spanish children and adolescents: RICARDIN Study]

BACKGROUND

The RICARDIN Study multicenter study of cardiovascular risk factors in children and adolescents has described the standards of normality of blood cholesterol levels in the Spanish school population. The objective of the present study was to compare mean values of cholesterol between different regions of Spain, and to compare the global mean with a pool international study. Also, the pattern of total cholesterol and cHDL by age and sex using mathematical model is described, and comparison with two international studies carried out in USA and Japan is performed.

SUBJECTS AND METHODS

10,683 children aged 6 to 18 were selected from 7 different Spanish provinces (Madrid, Vizcaya, Lugo, Badajoz, Murcia, Asturias and Barcelona). Blood samples were obtained by capilar puncture (Reflotron).

RESULTS

Mean values of total cholesterol was different among provinces, and globally, were lower than the international pooled population, although the pattern observed in each population was very similar. Total cholesterol curve for Spanish boys showed a curvilinear trend that can be estimated through a cubic function that explains 89% of observed data, while for girls the best estimate was obtained through an inverse function (R2 = 0.40). cHDL for boys showed a cubic function as the best estimate (R2 = 0.90), while for girls the best estimate was obtained through a quadratic function (R2 = 0.59).

CONCLUSIONS

There are important physiological variations of total cholesterol level by age and sex in children and adolescents. The pattern of cholesterol does not follow a linear model but a curvilinear one, that need to be considered in clinically assessing individual determinations of cholesterol, since highest percentiles can vary by age and sex.

[Lipid profile in children from Rivas-Vaciamadrid. Two-year follow-up]

AIM

Evaluate the lipid profiles in children after two years of follow-up.

METHODS

Longitudinal cohort study. A two years follow-up of a group of children since they were 6 years old. Blood analysis were carried in every children measuring total cholesterol, triglycerides, cLDL, cHDL, apoproteins A and B. It also included TD/cHDL, cLDL/cHDL, Apo B/A ratios and atherogenic index.

RESULTS

200 mg/dl, cLDL > 135 mg/dl and Apo B > 100 mg/dl in the follow-up was of 9.51, 5.18 and 8 for those children who had in the initial study these same values. The values of lipid profile and of the index studied improved in the two years of follow-up. This improvement has an statistical signification only in men.

CONCLUSIONS

There is a significant correlation between the values of the lipid profile and the index measured in those children who were six years old in the beginning of the two years follow-up.

[Lipoprotein (a) and family history in 6-year-old children from Rivas-Vaciamadrid]

OBJECTIVE

The purpose of this study was to evaluate levels of lipoprotein(a) as a marker of family history of cardiovascular risk.

PATIENTS AND METHODS

We have studied 673 six-year old children. Lipoprotein(a) was determined and previous family history of cardiovascular risk (hypercholesterolemia and cardiovascular disease under 55 years) was collected.

RESULTS

Of the children studied, 7.42% had positive antecedents of cardiovascular risk in the parents, 51.8% in grandparents and 9.21% in parents and grandparents. The lipoprotein(a) levels were higher in these groups than in those without any family history of cardiovascular risk. Likewise, the percentage of children with lipoprotein(a) levels higher than 30 mg/dl was 15.69% in the group without a family history of problems and 25.8% and 25.69%, in the group with hypercholesterolemia antecedents and cardiovascular disease, respectively. The sensitivity, specificity and positive predictive value test did not prove that a positive family history could be used to detect the majority of children with lipoprotein higher than 30 mg/dl.

CONCLUSIONS

Lipoprotein(a) levels in children are higher in those with a family history of cardiovascular disease or hypercholesterolemia, but these antecedents cannot be used as a determinant factor to detect the majority of children with lipoprotein(a) higher than 30 mg/dl.

[Prevalence of smoking by women physicians and nurses in the community of Madrid]

BACKGROUND

Tobacco is a major cause of morbidity and mortality in our country. The tobacco smoking by the sanitary staff has a negative influence in the rest of the population. In Spain women smoke more than men. The subject of our study is to identify the tobacco consume in the female sanitary staff in the Community of Madrid.

METHODS

Transversal descriptive study in the female sanitary staff in the Community of Madrid, using a conglomerate polystage sampling.

RESULTS

We studied 1,235 professionals (435 medicine doctors and 800 nurses). 43.07% of them were smokers, with the higher rate in nurses (47.68%) that are working at hospitals (46.68%). On one hand the tobacco consumption was smaller in medicine doctors between 20-30 years old (22.88%). On the other hand it turned out that nurses in their twenties formed a large group of smokers. A 18.3% of the total sample were actually smokers and a 64.65% had tried to give it up. A 2.93% of woman smoked without taking care if patients was close and 14.94% thought that it had to be allowed to smoke in the hospitals halls. 27.46% of smokers thought that smoking was allowed in their hospitals and 90.84% said that they usually smoked in the sanitary staff rooms, and 30.37% of them answered that specific rooms for smokers were available in their working places.

CONCLUSIONS

The prevalence of smoking in the health professionals in the Community of Madrid is very high. Medicine doctors smoke more than nurses, but young nurses smoke than young medicine doctors. Sanitary staff do not obey the no-smoking law in hospitals. The observance of this law is very low.

[The value of lipid profile and of CT/C-HDL, C-LDL/C-HDl, Apo B/A indexes and atherogenic index in 6-year-old children from Rivas- Vaciamadrid]

OBJECTIVE

The purpose of this study was to analyze the lipid profiles in children six years of age according to sex and to compare this with other Spanish studies.

PATIENTS AND METHODS

A transverse epidemiological study was performed. All six year old children in our area were studied. The following tests were performed in all children: total cholesterol (TC), triglycerides, LDL-C, HDL-C, apoproteins A and B after fasting for ten hours. In addition, TC/HDL-C, LDL-C/HDL-C, and Apo B/A ratios and atherogenic index (ATI) were calculated.

RESULTS

A population of 673 subjects (352 males and 321 females) were studied. The value of TC, triglycerides, LDL-C, Apo B, LDL-C/HDL-C and TC/HDL-C were significantly greater in females compared to males. Males had higher levels of HDL-C and ApoA. The values were similar to those obtain in Madrid in 1992, except that the values of HL-C were significantly higher in both sexes.

CONCLUSIONS

In six year old children, the lipid profile in girls is worse than in boys. The data from our study do not show that the lipidic risk is getting worse during the past years in Spanish children.

[A longitudinal study of physical exercise practice in children. The influence of age, gender and socioeconomic level. The Working Group on Cardiovascular Risk Factors in Childhood and Adolescence]

OBJECTIVE

Physical exercise is recommended in order to reduce cardiovascular risk factors.

PATIENTS AND METHODS

A longitudinal study was carried out. During the periods of 1989-1990 an 1995-1996, a questionnaire concerning extrascholastic physical exercise was given to 345 children of both sexes (188 males and 157 females), classifying them into two groups according to their parents' socioeconomical status.

RESULTS

We found and increase in the number of schoolchildren who did physical exercise (initial 17.97% and final 44.34%) in both sexes and both socioeconomical groups, as well as in the number of hours per week they spent exercising. Boys did physical exercise more frequently (initial study: 27.89% versus 13.37%, final study: 52.65% vs 40.86%) and they spent more hours per week than did girls. The same behavior was observed in the group of higher socioeconomical status. The probability of men doing physical exercise with respect to women was found to be statistically significant (initial study: p < 0.001, final study: p < 0.05), as well as in logistical regression between the non-performance of physical exercise and socioeconomical status (p < 0.001).

CONCLUSIONS

In this longitudinal study it was found that with age there is an increment in the practice of physical exercise and in the hours spent on it. It was also found that males and individuals with a higher socioeconomical status do more physical exercise than females and those with a lower socioeconomical status.

[HDL cholesterol in children. Its influence on the diagnosis of hypercholesterolemia]

OBJECTIVE

The purpose of this study was to evaluate HDL-C values and their relationship to high total cholesterol values during childhood.

PATIENTS AND METHODS

We have studied 4,547 children and adolescents of both sexes between 4 and 6 years of age.

RESULTS

We found HDL-C values > 50, 65 and 75 mg/dl in 66.28%, 26.17% and 7.81%, respectively. Of the cases studied, 44.8% had TC > 174.9 mg/dl and 15.17% higher than 199.9 mg/dl. The positive predictive value (PPV) to detect LDL-C > 129.9 mg/dl was 67.1 and 26.4 for values of TC > 199.9 and 174.9, respectively. The PPV to detect a LDL-C/HDL-C > 2.19 of the TC > 199.9 and 174.9 mg/dl was 54.78 and 23.95, respectively.

CONCLUSIONS

The HDL-C of children and adolescents is often high and this could be responsible for the high TC values. Most of the children with TC values between 174.9 and 199.9 mg/dl have neither an increase in LDL-C nor in the LDL-C/HDL-C ratio.

[Complications and course of Kawasaki disease in 23 patients]

OBJECTIVES

A comprehensive description of clinical data, cardiological complications, evolution and treatment of patients who were diagnosed with Kawasaki disease in our hospital is presented.

MATERIAL AND METHODS

A retrospective study of clinical and cardiological data, as well as laboratory tests collected from 23 patients who suffered from Kawasaki disease and were treated between January 1989 and December 1995 was performed.

RESULTS

The mean age of the patients was 3 years and 6 months of age, ranging from 5 months to 6 years old. The ratio male/female was 1.5/1. Clinical features were typical of the disease: persistent fever (100%), bilateral conjunctivitis (87%), changes in lips and oropharynx (100%), rash (91%), periungual desquamation (83%) and laterocervical adenopathy (74%). The diagnosis was delayed in 7 cases due to some symptoms that appeared as the beginning of the illness: hydrops of the gallbladder (one case), adenophlegmon (two cases), aseptic meningitis (two cases), diarrhoea (one case) and "sunburn-like" skin rash (one case). Five patients (22%) showed cardiological sequelae, three of them also had coronary artery aneurysms. One of these, whose diameter measured more than 8 mm, was several times complicated with coronary thrombus. Every patient was treated with salicylates and 19 of them were also treated with intravenous gamma globulins. As of December 1995, no deaths had been reported.

CONCLUSIONS

Whenever the first symptoms and the evolution of the disease are not classical, it is more difficult to diagnose the disease.

[Lipoprotein(a) in children with hypercholesterolemia as a marker of the familial history of cardiovascular risk. The Working Group on Cardiovascular Risk Factors in Childhood and Adolescence]

OBJECTIVE

To evaluate the levels of lipoprotein (a) (Lp(a)) as a marker of familiar history of cardiovascular risk.

MATERIAL AND METHODS

We have studied 176 children and adolescents between the ages of 3 and 18 years with hypercholesterolemia. In these children we determined Lp(a) levels and collected the family history concerning cardiovascular risk factors (hypercholesterolemia and cardiovascular disease under 55 years of age).

RESULTS

Of the cases studied, 67.04% had a family history of cardiovascular risk. In this group, levels of Lp(a) were significantly higher than in the group without a family history of cardiovascular risk. Lp(a) levels higher than 30 mg/dl were found in 3.44% of the patients without a family history of cardiovascular risk in contrast to 28,43% and 37.5% of the cases with familiar history of hypercholesterolemia and cardiovascular disease, respectively.

CONCLUSIONS

The levels of lipoprotein (a) in children and adolescents with hypercholesterolemia are a marker of family history of cardiovascular disease and hypercholesterolemia.

[The effect of the socioeconomic level on the lipid pattern in children and adolescents]

BACKGROUND

The aim of this study was to evaluate the association between socioeconomic status and the presence of cardiovascular risk factors in children from Madrid.

METHODS

We studied 2224 boys and girls, ages 2-18 years, attending five different school centers. They were divided into three socioeconomic groups: low class, middle-low class and middle high class, in regard to their parent's occupation and educational attainment. The evaluation included a blood analysis of serum triglycerides (TG), total cholesterol (CT), low density lipoprotein cholesterol (LDL), high density lipoprotein cholesterol (HDL), apolipoprotein A1 (ApoA), apolipoprotein B100 (Apo B), and the Apo A/Apo B and LDL/HDL ratios.

RESULTS

There was a positive correlation between socioeconomic status and total cholesterol, Apo A, Apo B and Apo A/Apo B, whereas socioeconomic status and triglycerides were inversely related. The LDL/HDL ratio varied according to age.

CONCLUSIONS

Unlike some previously published studies, we found that children belonging to high socioeconomic status have a more atherogenic lipid profile than those of middle low or low socioeconomic levels.

[Lipid profiles of children and adolescents in Madrid]

We have studied 2,224 children and adolescents of both sexes, ranging between 2 and 18 years of age, at five schools in the city of Madrid. We determined the lipid profile: total cholesterol (T-C), cholesterol bound to high density lipoproteins (HDL-C), cholesterol bound to low density lipoproteins (LDL-C), cholesterol bound to very low density lipoproteins (VLDL-C), triglycerides (TG), apolipoprotein AI and apolipoprotein B100 (Apo A1 and Apo B100, respectively). In relationship to age and sex, in males, as age increases, there is an elevation in LDL-C and TG and a diminution in T-C, HDL-C, Apo AI and Apo B100. There are no changes in VLDL-C. In females, there is a diminution in LDL-C, TG, Apo-B100 and an increase in HDL-C, Apo AI and T-C, with the increase in T-C being found only in those older than 15 years.

[Evaluation of vesico-ureteral reflux in infants under 6 months of age]

Forty-five infants less than 6 months old with vesicoureteral reflux have been evaluated in the Neonatology Unit of Niño Jesus Hospital. All of them have received medical treatment. We found bilateral vesicoureteral reflux in 55.6%, predominantly degree II (70%). Clinical symptoms were not specific, but it was evident that urine cultures were negative in 31.12%. After a mean follow-up of 31.5 months, kidney status was evaluated with echographic procedures. We found good growth in all but one case which was initially hypoplastic. New lesions were not demonstrated in the kidneys. We report a good prognosis for vesicoureteral reflux in infants of less than 6 months of age that have received only medical treatments. Therefore, we emphasize the importance of recognizing this pathology in infants, including those with negative urine cultures.

[Variations in the excretion of N-acetyl-glucosaminidase in the first year of life]

We have studied 122 patients, all younger than 12 months of age, to whom we check the N-acetylglucosaminidase/creatinine (NAG/creatinine) ratio in the first morning urine. The NAG/creatinine values were decreasing with age increase of the patients, being significantly different (p less than 0.001) in the younger 3 months of age comparative with the older than six months of age. The NAG/creatinine values were inversely correlated with age, height and weight. We have made normal values percentils of the NAG/creatinine ratio for each age group.

[Usefulness of sectorization of pediatric hospital emergency units in the community of Madrid]

We have studied the procedence of the children that came to the Emergency Department of the Niño Jesús Hospital, analyzing if they belonged to the pediatric emergency area corresponding to this hospital, the procedence from the different postal districts of Madrid, from other localities of the Madrid Community, or from the Health Areas of this Community. We found that only 12.42% of the children came from the corresponding area of the emergency care sectorization, and that they came from very disperse zones, having no clear relation with any of the Health Care Areas. We conclude that current sectorization of the pediatric emergencies in hospitals is not being usefull, and we suggest alternative solutions.

[Demand for care in the emergency service department of a pediatric hospital]

We have done a prospective study of the emergencies that arrived to a Children's Hospital from 8 to 15 hours in labour day 987 enquires were filled, which represents 53.53% of those who came. Males were predominant and also the younger ones with 24.58% less than 1 year of age, and progressively diminishing with age. Frequency was higher on Mondays, Thursdays and Fridays, with a significant reduction on Tuesdays. The hourly distribution demonstrated an accumulation in the intermediate hours in the morning, with a reduction before 10 and after 14 hours. 83.58% arrived due to personal initiative, and 22.28% of them had been with their pediatrician in the previous 48 hours. 3.64% of patients were admitted to hospital; considering a justified reason for hospital emergency care in 14.69% of the cases, and dubious reasons in 16.61%. The socioeconomic status was slightly higher than that of the Madrid Community in which the hospital is situated. Our data show that the majority of children that come to the emergency department present problems that could have been solved in another level of care. We also found indirect signs, may evidentiate that the family members are conscious in many cases that they are making an unjustified use of this level of care.

[Arterial pressure in children and adolescents]

Nine thousand three hundred and twenty three children and adolescents from different parts of the Spanish State have been studied, with the purpose of identifying blood pressure normal values and determining its correlation with anthropometric variables and age. We have found, according to what has already been stated in the literature, a statistically significant (p less than 0.001) correlation with age, weight, height, and body surface. The values obtained have been compared with the results of the two Task Force's Reports (USA) and with Andre's (France), finding similar values to those presented in the Task Force Second Report. It is stated that age is the most suitable parameter for establishing blood pressure normal values in childhood, because of its availability and also for having a slightly better correlation than the other investigated parameters.

[Recurrent infection of the urinary tract in girls]

A group of 18 girls, studied in a period between 1979 and 1985 with recurrent urinary tract infections (RUTI), with at least three culture documented episodes of bacteriuria in the previous year and without radiologic evidence of urinary tract abnormality is described. Incidence was 6.1% amount a selected group of 295 girls with urinary tract infection. The period of follow-up was between 2 and 6 years (X 3.33). Symptomatology was light. No predominance of urinary symptoms were found. E. coli was the most frequent germ isolated. The number of recurrences/year/girl were significantly lower with prophylactic treatment and with years of evolution. Renal damage was not found. Vesicoureteral reflux appeared in two girls only. They had a benign course and a good prognosis. Reduction of aggressive investigation in this group of patients is proposed.

[Incidence of urocystographic abnormalities in urinary infection in the neonatal period]

Fifty-six children with ages between 3 hours and 45 days of life (median age 13.9 days), 39 of which were males and 17 females, have been studied. Urinary tract infection was diagnosed after two consecutive urine cultures with more than 100,000 colonies of the same pathogen obtained by sterile plastic bag. Whole urocystographic study was practised to every one of them, finding abnormalities in 17 of the patients (30.35%). Pathologic findings in 8 of them were considered important abnormalities (ureterohydronephrosis and/or vesicoureteral reflux grade IV) which makes 14.28% of the total. From their sample authors conclude that it is mandatory to practice whole urocystographic study to all children diagnosed of urinary tract infection in the neonatal period.

[Impact of anthropometric variables and socioeconomic level in arterial pressure in childhood]

2,069 children of both sexes (1,172 males and 897 females) with ages between two and fifteen years old, from Majadahonda (Madrid) have been studied. We registered the age, weight, height and arterial pressure of all of them, as well as their parents' occupation. The percentage of initial high blood pressure (2.41%) was similar to that reported so far in the literature, with a higher incidence within the males, and also higher values recorded in the levels of blood pressure among the four socioeconomic groups in which the children were classified, but we did find a higher percentage of initial high blood pressure in the group defined as high-middle class (p less than 0.05). The correlation indexes between arterial pressure and weight, body surface, height and years of age, were studied being all of them statistically significant, with values ranging from higher to lower in this same order (p less than 0.001). No statistically significant difference was found between the correlation indexes of blood pressure/height and blood pressure/age. We conclude that this last variant is the most useful one to establish the normal values of blood pressure in childhood.

[Choice of treatment in recurrent urinary infections in childhood]

Forty-two cases of children showing recurrent urinary tract infection were treated. Three treatment guides were used: the first group of children were given trimetoprim-sulphametoxazole (TMP-SMZ) only, the second and third ones were treated with TMP-SMZ and alternative nitrofurantoine in the former or nalidixic acid in the latter. After treatment a meaning reduction in frequency of urinary tract infection cases (p less than 0.001) were observed. Best results (lesser percentage of failures and lesser number of urinary tract infection cases per month of observation) were achieved in the second and third groups, probably due to a high percentage of resistance cases against TMP-SMZ found during prophylactic treatment (72.07).

[Normal blood pressure values in Spanish children]

Authors study 2,953 children with a range of age between 2 and 14 years, of both sexes, from schools in Madrid, Zaragoza, Lugo, Andújar, Archena and in rural areas of Guadalajara and Segovia. Blood pressure was measures three times in every child according to recommendations of the Expert Committee of WHO in respect to the method. Results are expressed in percentiles according to age and sex. Their findings indicate that both diastolic and systolic blood pressures were lower than those reported by Task Force (USA), Cassimos (Greece) and Andre (France) (p less than 0.001) with higher differences being present in the diastolic blood pressure.

[Idiopathic hematuria in childhood (author's transl)]

Idiopathic hematuria is a clinical condition of unknown etiology; it is defined as persistent or recurrent, macro or microscopic hematuria in the absence of systemic or local disease and with normal renal function. Six patients who had these criterions were studied. There were all girls. The age of the first episode was between one and four years. There was no other family or personal history of renal disease or deafness. Only two patients had their episodes of macroscopic hematuria within flu-like illness or exercise. All had normal renal function and no proteinuria was found. Serum C'3 and C'4 were normal. Microscopic and immunofluorescence studies were negative. We remark the convenience of a triple criteria clinical, histopathologic and evolutive to select a patient into the "idiopathic hematuria" group. We comment the usefullness of renal biopsy in the investigation of unexplained hematuria.