RESUMEN PAPPS Infancia y Adolescencia 2020

En este documento de actualización presentamos cuatro temas trascendentes para la infancia y la adolescencia en nuestra actividad de atención primaria: el apoyo a la lactancia materna, la promoción de la actividad física, la prevención de lesiones infantiles por accidente de tráfico y el cribado de depresión mayor. Four important topics about children and adolescents in our Primary Care activity are presented in this update document: support for breastfeeding, promotion of physical activity, prevention of child injuries due to traffic accidents, and screening for major depressio

Dietary α‐Linolenic Acid, Marine ω‐3 Fatty Acids, and Mortality in a Population With High Fish Consumption: Findings From the PREvención con DIeta MEDiterránea (PREDIMED) Study

Background: Epidemiological evidence suggests a cardioprotective role of α‐linolenic acid (ALA), a plant‐derived ω‐3 fatty acid. It is unclear whether ALA is beneficial in a background of high marine ω‐3 fatty acids (long‐chain n‐3 polyunsaturated fatty acids) intake. In persons at high cardiovascular risk from Spain, a country in which fish consumption is customarily high, we investigated whether meeting the International Society for the Study of Fatty Acids and Lipids recommendation for dietary ALA (0.7% of total energy) at baseline was related to all‐cause and cardiovascular disease mortality. We also examined the effect of meeting the society's recommendation for long‐chain n‐3 polyunsaturated fatty acids (≥500 mg/day). Methods and Results: We longitudinally evaluated 7202 participants in the PREvención con DIeta MEDiterránea (PREDIMED) trial. Multivariable‐adjusted Cox regression models were fitted to estimate hazard ratios. ALA intake correlated to walnut consumption (r=0.94). During a 5.9‐y follow‐up, 431 deaths occurred (104 cardiovascular disease, 55 coronary heart disease, 32 sudden cardiac death, 25 stroke). The hazard ratios for meeting ALA recommendation (n=1615, 22.4%) were 0.72 (95% CI 0.56–0.92) for all‐cause mortality and 0.95 (95% CI 0.58–1.57) for fatal cardiovascular disease. The hazard ratios for meeting the recommendation for long‐chain n‐3 polyunsaturated fatty acids (n=5452, 75.7%) were 0.84 (95% CI 0.67–1.05) for all‐cause mortality, 0.61 (95% CI 0.39–0.96) for fatal cardiovascular disease, 0.54 (95% CI 0.29–0.99) for fatal coronary heart disease, and 0.49 (95% CI 0.22–1.01) for sudden cardiac death. The highest reduction in all‐cause mortality occurred in participants meeting both recommendations (hazard ratio 0.63 [95% CI 0.45–0.87]). Conclusions: In participants without prior cardiovascular disease and high fish consumption, dietary ALA, supplied mainly by walnuts and olive oil, relates inversely to all‐cause mortality, whereas protection from cardiac mortality is limited to fish‐derived long‐chain n‐3 polyunsaturated fatty acids. Clinical Trial Registration URL: http://www.Controlled-trials.com/. Unique identifier: ISRCTN35739639

Perforación gástrica de causa inesperada

Entendemos por bezoar un acúmulo de sustancias extrañas en el tracto gastrointestinal. Su composición es muy variada, desde material orgánico como pelo, hasta inorgánico, como metales. En Pediatría los más frecuentes son el Tricobezoar (compuesto de pelo) y el fitofezoar (de fibras vegetales o semillas). Generalmente son asintomáticos o presentan una sintomatología inespecífica, como anorexia, dispepsia o halitosis. Si evoluciona puede producir complicaciones malabsortivas/obstructivas o incluso perforación del tubo digestivo

Seguimiento en las consultas de Pediatría de Atención Primaria de los grandes prematuros: Nacidos con menos de 32 semanas de gestación o menos de 1500 gramos

Introduction: almost 20% of premature babies abandons follow-up in hospitals and they have worse outcomes than those who continue the program. Obtaining data on the involvement of Primary Care pediatricians (PAPs) in monitoring premature babies born at less than 32 weeks or weighing < 1500 g is necessary to propose strategies for improvement. Methods: it is an observational, transversal, descriptive study, in the area of the 17 Spanish autonomous communities through PAPenRED network (304 PAPs). Data were collected by questionnaires filled out online about the number of premature babies by pediatrician, the type of monitoring and the difficulties found in their attention. Frequency distributions, percentages, qualitative variables are described. Results: 870 very premature infants were included with an average of 3.8 per pediatrician. 68.84% of PAPs do not share a common monitoring program between hospitals and Primary Care centers, despite the fact that 99% of the pediatricians would like to have it. 84.27% say that these children have more complex problems. The diseases that occur more frequently compared to those born at term are family anxiety, respiratory disease and problems in relation to growth, feeding, motor development and cognitive and behavioral issues. Conclusions: PAPs believe necessary commmon programs between hospitals and Primary Care centers for monitoring the very premature babies

Manual de trabajo del Grupo PrevInfad [Group Prevlnfad workbook]

Desde su creación, el Grupo PrevInfad ha trabajado con los objetivos de formular y mantener actualizadas las recomendaciones sobre actividades preventivas a realizar en la población infantil y adolescente española y mejorar la práctica clínica y promover la salud pública en el ámbito de la Atención Primaria. Las recomendaciones de PrevInfad van dirigidas principalmente a los pediatras de Atención Primaria, personal de enfermería y otros profesionales de la salud. En este trabajo presentamos una versión resumida del manual de trabajo del Grupo PrevInfad, que se ha actualizado recientemente. Para mayor detalle recomendamos a las personas interesadas consultar la versión íntegra, que se encuentra en la página web del grupo. Los métodos descritos están destinados a garantizar que las recomendaciones de PrevInfad sean metodológicamente sólidas, científicamente defendibles, reproducibles y bien documentadas. The working group PrevInfad has faced since its beginning the objectives of formulating and updating recommendations on preventive activities for Spanish children and adolescents, improving clinical practice and promoting public health in Primary Care. Previnfad recommendations address mainly to Primary Care paediatricians, nurses and other health professionals. In this paper, we present a resumed version of PrevInfad procedure manual, recently updated. We recommend to consult the complete version available in PrevInfad web site. The described methods are intended to ensure that the recommendations of PrevInfad are methodo-logically solid, scientifically defendable, reproducible and well documented. The working group Prevlnfad has faced since its beginning the objectives of formulating and updating recommendations on preventive activities for Spanish children and adolescents, improving clinical practice and promoting public health in Primary Care. Previnfad recommendations address mainly to Primary Care paediatricians, nurses and other health professionals. In this paper, we present a resumed version of Prevlnfad procedure manual, recently updated. We recommend to consult the complete version available in Prevlnfad web site. The described methods are intended to ensure that the recommendations of Prevlnfad are methodologically solid, scientifically defendable, reproducible and well documented

Prevención de lesiones infantiles por accidente de tráfico

La prevención de los accidentes de tráfico es un tema de gran trascendencia social y un asunto de primera magnitud en salud pública. El grupo PrevInfad presenta en este documento la actualización de sus recomendaciones para la prevención de las lesiones por accidente de tráfico en niños y adolescentes, publicando en este caso un documento totalmente nuevo, que puede ser consultado en su versión íntegra en la página web del grupo (previnfad.aepap.org). La metodología incluye el diseño de un marco analítico, la formulación de preguntas estructuradas, la búsqueda y el análisis de la bibliografía. Dentro del apartado de accidentes de tráfico se van a considerar los ocasionados en vehículos a motor con el niño como pasajero o con el adolescente como conductor de ciclomotores u otros vehículos, los sufridos por peatones y las lesiones por caídas de bicicleta o por colisión de estas con vehículos a motor. También se incluye a los niños que se inician en la competición de ciclomotor. Es evidente que gran parte de las acciones preventivas corresponden a otros estamentos, si bien el pediatra tiene el deber de actuar como consejero y como grupo científico. Traffic accident prevention is an issue of social relevance and a very important public health matter. The working group PrevInfad presents in this document the update of its recommendations for traffic injury prevention in children and adolescents. The published document is brand new and can be consulted in full on the group’s website (previnfad.aepap.org). The methodology includes the design of an analytic framework, the formulation of structured questions, the search of the evidence and the analysis of the bibliography. Traffic accidents are considered those caused in motor vehicles with the child as a passenger or with the adolescent as a driver of motorcycles or other vehicles, the accidents suffered by pedestrians and the injuries by falls from bicycles or from collision of bicycles with motor vehicles. The document also includes children that initiate into motorcycle competition. Many of the preventive actions concern to other levels, nevertheless the pediatricians must act as advisers and as scientific group

Identification key for the genera of Syrphidae (Diptera) from the Brazilian Amazon and new taxon records

Identification keys are essential to properly recognize taxa, and a photographic key not only addresses that issue but can also attract the interest of the general public if designed correctly. Syrphidae is one of the largest families of Diptera, and the Brazilian Amazon holds more taxon records from this family than currently reported. The aim of the current study was to provide an updated photographic identification key, of easy use and access, to the genera of Syrphidae (Diptera) from the Brazilian Amazon region, and identify previously unrecorded taxa. Through a literature review and study of collection material from several institutions, I found 36 new taxon records for the Brazilian Amazon (15 are first records for Brazil) and provided a list of references with identification keys to species from each genus. The online version of this manuscript has a photographic identification key, with diagnostic pages for each genus, as supplementary material.Chaves de identificação são essenciais para reconhecer táxons, e uma chave pictórica material suplementar. atende a essa demanda e também desperta o interesse do público em geral, se for desenhada apropriadamente. Syrphidae é uma das maiores famílias de Diptera, e a Amazônia brasileira possui mais táxons dessa família do que registrado atualmente. O objetivo deste estudo foi prover uma chave de identificação pictórica atualizada, de fácil uso e acesso, para os gêneros de Syrphidae (Diptera) da Amazônia brasileira, e identificar táxons ainda não registrados. Através de uma revisão da literatura e estudo de material de diversas coleções, eu encontrei 36 novas ocorrências de táxons para a Amazônia brasileira (15 sendo primeiros registros para o Brasil) e disponibilizei uma lista de referências com chaves de identificação para as espécies de cada gênero. A versão online desse manuscrito possui uma chave de identificação pictórica como material suplementar