Enfrentamiento terapéutico del trastorno por déficit atencional en una población infantil escolar perteneciente a la Región Metropolitana de Chile

Indexación: ScieloAn evaluation was made of a retrospective evolution presented by the patients from to 14 years and 11 month old (average 9,2 years old), with a diagnostic of attentional hyperactive disorder (AHD), treated with metilfenidate in Huechuraba during the year 2007. A revision of every clinic history showed the principal results: a high positive response (higher than the 76% of the measured parameters). The evaluated parameters were, academic response, self report of subjective opinion from the patient, opinion from the tutor of the child in relationships with his/her conduct at home and teacher's evaluations of the child conduct at school. No differences were found between the evolution of the clinic parameters, in children with and without comorbilities. It was found a 52, 7% of comorbility. Specific learning disease, adaptative disorder, anxious disorder, and depression were more frequent diagnoses. This study concludes that the high percent of success in the treatment of the student group is similar to the one found in literature. The presence of comorbility won't cause to down of the treatment efficiency. This is conditioned by the presence of psychosocial factors like maternal psychopathology and familiar violence.Se realizó una evaluación restrospectiva de la evolución presentada por los pacientes desde 6 a 14 años 11 meses de edad (edad media de 9,2 años) con diagnóstico de Trastorno por déficit atencional (TDA) bajo tratamiento con metilfenidato en la comuna de Huechuraba durante el año 2007. Se hizo la revisión y el análisis de cada ficha clínica, encontrándose como principales resultados el alto porcentaje de mejoría, igual o mayor al 76% de los parámetros medidos, consistentes en evolución del rendimiento académico; autoreporte de sensación subjetiva del niño; reporte del cuidador principal en relación a la conducta del niño (a) en el hogar y evaluación del profesor en cuanto su conducta en el colegio. No se encontraron diferencias entre la evolución de los parámetros clínicos entre los niños con comorbilidad y sin comorbilidad, se encontró un 52,7% de esta, siendo los diagnósticos más frecuentes Trastorno específico del aprendizaje, trastorno adaptativo, trastorno ansioso y del ánimo. Se concluye que el alto porcentaje de éxito del tratamiento en el grupo estudiado es similar al encontrado en la literatura; que la presencia de comorbilidad no condiciona la disminución de la eficiencia del tratamiento y que esta es condicionada por presencia de factores psicosociales como psicopatología materna y violencia intrafamiliar.http://www.scielo.cl/scielo.php?script=sci_arttext&pid=S0717-92272009000100005&nrm=is

Association of kidney disease measures with risk of renal function worsening in patients with type 1 diabetes

Background: Albuminuria has been classically considered a marker of kidney damage progression in diabetic patients and it is routinely assessed to monitor kidney function. However, the role of a mild GFR reduction on the development of stage 653 CKD has been less explored in type 1 diabetes mellitus (T1DM) patients. Aim of the present study was to evaluate the prognostic role of kidney disease measures, namely albuminuria and reduced GFR, on the development of stage 653 CKD in a large cohort of patients affected by T1DM. Methods: A total of 4284 patients affected by T1DM followed-up at 76 diabetes centers participating to the Italian Association of Clinical Diabetologists (Associazione Medici Diabetologi, AMD) initiative constitutes the study population. Urinary albumin excretion (ACR) and estimated GFR (eGFR) were retrieved and analyzed. The incidence of stage 653 CKD (eGFR < 60 mL/min/1.73 m2) or eGFR reduction > 30% from baseline was evaluated. Results: The mean estimated GFR was 98 \ub1 17 mL/min/1.73m2 and the proportion of patients with albuminuria was 15.3% (n = 654) at baseline. About 8% (n = 337) of patients developed one of the two renal endpoints during the 4-year follow-up period. Age, albuminuria (micro or macro) and baseline eGFR < 90 ml/min/m2 were independent risk factors for stage 653 CKD and renal function worsening. When compared to patients with eGFR > 90 ml/min/1.73m2 and normoalbuminuria, those with albuminuria at baseline had a 1.69 greater risk of reaching stage 3 CKD, while patients with mild eGFR reduction (i.e. eGFR between 90 and 60 mL/min/1.73 m2) show a 3.81 greater risk that rose to 8.24 for those patients with albuminuria and mild eGFR reduction at baseline. Conclusions: Albuminuria and eGFR reduction represent independent risk factors for incident stage 653 CKD in T1DM patients. The simultaneous occurrence of reduced eGFR and albuminuria have a synergistic effect on renal function worsening

Effects of race and ethnicity on perinatal outcomes in high-income and upper-middle-income countries: an individual participant data meta-analysis of 2 198 655 pregnancies

Background: Existing evidence on the effects of race and ethnicity on pregnancy outcomes is restricted to individual studies done within specific countries and health systems. We aimed to assess the impact of race and ethnicity on perinatal outcomes in high-income and upper-middle-income countries, and to ascertain whether the magnitude of disparities, if any, varied across geographical regions. Methods: For this individual participant data (IPD) meta-analysis we used data from the International Prediction of Pregnancy Complications (IPPIC) Network of studies on pregnancy complications; the full dataset comprised 94 studies, 53 countries, and 4 539 640 pregnancies. We included studies that reported perinatal outcomes (neonatal death, stillbirth, preterm birth, and small-for-gestational-age babies) in at least two racial or ethnic groups (White, Black, south Asian, Hispanic, or other). For our two-step random-effects IPD meta-analysis, we did multiple imputations for confounder variables (maternal age, BMI, parity, and level of maternal education) selected with a directed acyclic graph. The primary outcomes were neonatal mortality and stillbirth. Secondary outcomes were preterm birth and a small-for-gestational-age baby. We estimated the association of race and ethnicity with perinatal outcomes using a multivariate logistic regression model and reported this association with odds ratios (ORs) and 95% CIs. We also did a subgroup analysis of studies by geographical region. Findings: 51 studies from 20 high-income and upper-middle-income countries, comprising 2 198 655 pregnancies, were eligible for inclusion in this IPD meta-analysis. Neonatal death was twice as likely in babies born to Black women than in babies born to White women (OR 2·00, 95% CI 1·44-2·78), as was stillbirth (2·16, 1·46-3·19), and babies born to Black women were at increased risk of preterm birth (1·65, 1·46-1·88) and being small for gestational age (1·39, 1·13-1·72). Babies of women categorised as Hispanic had a three-times increased risk of neonatal death (OR 3·34, 95% CI 2·77-4·02) than did those born to White women, and those born to south Asian women were at increased risk of preterm birth (OR 1·26, 95% CI 1·07-1·48) and being small for gestational age (1·61, 1·32-1·95). The effects of race and ethnicity on preterm birth and small-for-gestational-age babies did not vary across regions. Interpretation: Globally, among underserved groups, babies born to Black women had consistently poorer perinatal outcomes than White women after adjusting for maternal characteristics, although the risks varied for other groups. The effects of race and ethnicity on adverse perinatal outcomes did not vary by region. Funding: National Institute for Health and Care Research, Wellbeing of Women