La enfermedad de Graves Basedow en la infancia

La enfermedad de Graves Basedow es la causa más frecuente de hipertiroidismo en los niños. Se trata de una enfermedad que se presenta con mucha menor frecuencia que en el adulto. Los aspectos clínicos y de tratamiento tienen algunas diferencias que merecen ser tenidas en cuenta y que se pretenden revisar. El tratamiento con fármacos antitiroideos como terapia inicial, sigue siendo el preferido por la mayoría de los endocrinólogos pediátricos, a pesar de sus efectos secundarios y una alta tasa de recaídas. No obstante, cuando se debe interrumpir el tratamiento con antitiroideos o después de una recaída, debe elegirse un modo definitivo de terapia. Las terapias definitivas (cirugía o I131) tampoco están exentas de efectos secundarios. Actualmente existe una tendencia creciente a abogar por el yodo radiactivo como una opción de tratamiento en niños mayores de cinco años que logran una alta tasa de remisión. Aunque los riesgos relativamente bajos, el bajo costo y la viabilidad del tratamiento con yodo radioactivo han favorecido esta terapia para los niños, al igual que para los adultos en los Estados Unidos, sigue siendo menos atractivo para los médicos europeos. El progreso en la comprensión inmunológica de la enfermedad de Graves y de sus antecedentes genéticos se espera elucidar las vías que conducen a la enfermedad de Graves, así como los factores que determinan quién está en alto riesgo de desarrollar enfermedad de Graves, y puede, en última instancia, promover nuevas estrategias para una terapia más exitosa y segura. Se presentan dos casos con la enfermedad de Graves en niños con el fin de subrayar La importancia de su diagnóstico y las dificultades en el seguimiento de esta enfermedad durante la infancia

Differences in children's exposure to television advertising of unhealthy foods and beverages in Spain by socio-economic level

Background: The influence of food advertising on food preferences and consumption could also contribute to the socio-economic inequalities among Spanish children in terms of eating habits and childhood obesity. Although the main food advertising channel targeted at children in Spain is television, available studies estimate exposure indirectly by combining content data with audience data. The aim of this study was therefore to describe the frequency of exposure to television advertising of unhealthy foods and drinks, measured directly, among Spanish children and adolescents, and analyse its socio-economic inequalities. Methods: Observational study of television advertising impacts in a sample of 1590 children aged 4 to 16 years drawn from a consumer panel representative of the Spanish population in this age group, over the course of a full week of broadcasting in February 2022. The sample was obtained through stratified random sampling by Autonomous Region, with quotas being set by reference to socio-demographic variables. Exposure was measured with an audiometer, and the nutrient content of the food and drink advertised was analysed using the nutrient profile of the WHO Regional Office for Europe. We used the Chi-squared test to analyse possible differences in advertising coverage by socio-economic level. Results: The participants saw a weekly mean of 82.4 food and drink commercials, 67.4 of which were for unhealthy products (81.8%), mostly outside the child-protection time slot. On average, low-social class participants received 94.4% more impacts from unhealthy food and drink advertising than did high-class participants (99.9 vs. 51.4 respectively). The mean advertising coverage of unhealthy foods and drinks was 71.6% higher in low-class than in high-class participants (10.9% vs. 18.7%; p = 0.01). Conclusion: Spanish children and adolescents received an average of 10 impacts per day from television spots for unhealthy foods and drinks. The exposure of low-class children is double that of high-class children, a finding compatible with the high prevalence of childhood obesity in Spain and the related socio-economic inequalities. To protect Spanish minors from the harmful effects of food advertising and reduce the related social health inequalities would require the implementation of a 24:00 watershed for unhealthy food advertising on television.This study was funded by the Spanish Health Research Fund, Carlos III Institute of Health (Project ENPY 337/22).S

Public Opinion on Food Policies to Combat Obesity in Spain

(1) Introduction: Poor diet is the fourth-leading cause of mortality in Spain, where adherence to the Mediterranean diet has declined in recent decades. To remedy this situation, a series of food policies have been proposed that would be easier to implement if they had public support. (2) Material and methods: Cross-sectional study covering a representative sample of the Spanish population (n = 1002), using telephone interviews that addressed nine food policies under four headings, namely, advertising, labeling, composition, and provision and sale. The sociodemographic determinants of support for these policies were analyzed using the chi-squared (χ2) test and Poisson multiple regression models with robust variance. (3) Results: All the proposed measures received more than 60% support. The policies that received greatest support were those targeting labeling at 96.6%, while the policies that received the least support were those directed at banning free refills at restaurants, at 63%. Support for policies was higher among women, older adults, and persons professing left-wing ideological affiliations. Compared with men, women’s support for advertising policies was 21% higher: similarly, compared with the youngest age group (18–29 years), support by the over-65 segment for provision and sale policies was 52% higher. Support for composition policies was 28% lower among persons with right-wing as opposed to left-wing political sympathies. (4) Conclusions: The authorities enjoy the support of the Spanish public as regards implementing food policies proposed by experts and overcoming the resistance of sectors opposed to such measures

Differences in children’s exposure to television advertising of unhealthy foods and beverages in Spain by socio-economic level

Abstract Background The influence of food advertising on food preferences and consumption could also contribute to the socio-economic inequalities among Spanish children in terms of eating habits and childhood obesity. Although the main food advertising channel targeted at children in Spain is television, available studies estimate exposure indirectly by combining content data with audience data. The aim of this study was therefore to describe the frequency of exposure to television advertising of unhealthy foods and drinks, measured directly, among Spanish children and adolescents, and analyse its socio-economic inequalities. Methods Observational study of television advertising impacts in a sample of 1590 children aged 4 to 16 years drawn from a consumer panel representative of the Spanish population in this age group, over the course of a full week of broadcasting in February 2022. The sample was obtained through stratified random sampling by Autonomous Region, with quotas being set by reference to socio-demographic variables. Exposure was measured with an audiometer, and the nutrient content of the food and drink advertised was analysed using the nutrient profile of the WHO Regional Office for Europe. We used the Chi-squared test to analyse possible differences in advertising coverage by socio-economic level. Results The participants saw a weekly mean of 82.4 food and drink commercials, 67.4 of which were for unhealthy products (81.8%), mostly outside the child-protection time slot. On average, low-social class participants received 94.4% more impacts from unhealthy food and drink advertising than did high-class participants (99.9 vs. 51.4 respectively). The mean advertising coverage of unhealthy foods and drinks was 71.6% higher in low-class than in high-class participants (10.9% vs. 18.7%; p = 0.01). Conclusion Spanish children and adolescents received an average of 10 impacts per day from television spots for unhealthy foods and drinks. The exposure of low-class children is double that of high-class children, a finding compatible with the high prevalence of childhood obesity in Spain and the related socio-economic inequalities. To protect Spanish minors from the harmful effects of food advertising and reduce the related social health inequalities would require the implementation of a 24:00 watershed for unhealthy food advertising on television