I. Riaño Galán

Epidemiología de las fisuras labiales y palatinas durante los años 1990–2004 en Asturias

INTRODUCTION Cleft lip and palate (oral clefts) are the most common congenital facial defects. OBJECTIVE To assess the prevalence of oral clefts and to describe the associated malformations in a geographically defined population. METHOD Data from the Asturias Registry of Congenital Defects were used to investigate the epidemiology of congenital facial clefts over the period 1990-2004 among the 103,452 births in the region. The results were also compared with data from EUROCAT and other Spanish registries. RESULTS Out of 145 oral clefts recorded, cleft lip was 26.9%, cleft lip and palate 28.3% and cleft palate 44.8%. Total prevalence of oral clefts was 14.4 per 10,000 births. Other associated defects were found in 18.6% of the total cases, with skeletal, cardiovascular and central nervous systems being the the most common anomalies. Syndromes or sequences were found in 22% of clefts. A prenatal diagnosis was made in 12.4%. CONCLUSION The prevalence of oral clefts in Asturias over this period fell within the range reported for other European registries. An exhaustive prenatal ultrasound and examination of the affected newborns to look for other malformations should be considered in infants with clefts, due to the high association with them.

Epidemiología de las cardiopatías congénitas en Asturias durante el período 1990–2004

INTRODUCTION Congenital heart diseases (CHDs) are the most common type of birth defect. OBJECTIVE The purpose of this investigation was to assess the prevalence and trends of CHDs, and to describe the associated malformations and syndromes or sequences in a geographically defined population. MATERIAL AND METHODS Data were collected from the Asturias Registry of Congenital Defects. The period studied was from 1990 to 2004, and the study population was the 103,452 births of mothers living in the region. Total prevalence and birth prevalence were calculated. RESULTS A total of 3035 cases with congenital defects were recorded, of these 778 had CHDs. The total prevalence was 75.2 per 10,000 births, with an upward trend during this period. The most common CHDs were: ventricular septal defects (28.8 per 10,000 births), atrial septal defects (10.3 per 10,000 births) and patent ductus arteriosus (6.0 per 10,000 births). A total of 73.6% of CHDs occurred as isolated defects, 12.5% with other congenital defects and 14% were syndromes or sequences. Prenatal diagnosis was effective in only 7.3% (3.8% in isolated cases). CONCLUSIONS The prevalence of CHDs in Asturias over this period falls within the range reported for other European registries. The apparent increase in prevalence of CHD results mainly from improved diagnosis of minor defects, but there has been no change over time in birth prevalence of more serious defects.

Recomendaciones para la toma de decisiones ante la negativa de los padres a la vacunación de sus hijos: análisis ético

Vaccinating children is the most effective primary prevention activity and many lives have been saved due to vaccines. Anti-vaccine movements have spread doubts about the safety and effectiveness of childhood vaccines, leading to some parents refusing to vaccinate their children. This refusal raises a conflict of values between the right of parents to the upbringing of their children according to their beliefs and justice, putting the immunity of the group at risk. In Spain, the law protects this ability for parents to decide not to comply with the official vaccine program. Pediatricians play an essential role in a parents decision, and must provide accurate information about vaccination. It is necessary to explore The values of the parents, their concerns need to be empathetically examined, in order to reach an agreement. Respect for freedom does not exempt us from using discussion and persuasion to achieve attitudes and healthy choices for children. Our commitment to responsability promotion is essential for maintaining high vaccination levels that protect the health of children.Vaccinating children is the most effective primary prevention activity and many lives have been saved due to vaccines. Anti-vaccine movements have spread doubts about the safety and effectiveness of childhood vaccines, leading to some parents refusing to vaccinate their children. This refusal raises a conflict of values between the right of parents to the upbringing of their children according to their beliefs and justice, putting the immunity of the group at risk. In Spain, the law protects this ability for parents to decide not to comply with the official vaccine program. Pediatricians play an essential role in a parents decision, and must provide accurate information about vaccination. It is necessary to explore The values of the parents, their concerns need to be empathetically examined, in order to reach an agreement. Respect for freedom does not exempt us from using discussion and persuasion to achieve attitudes and healthy choices for children. Our commitment to responsability promotion is essential for maintaining high vaccination levels that protect the health of children.

Factores de riesgo cardiovascular clásicos y emergentes en escolares asturianos

INTRODUCTION Classic cardiovascular risk factors are present in infancy. C-reactive protein, leptin and adiponectin are the most important inflammatory cardiovascular risk markers. PATIENTS AND METHODS A descriptive, cross-sectional study, including children aged 6-12 years old from two local primary schools in the city of Avilés. Body measurements were made to determine the prevalence of obesity and overweight. Systolic and diastolic blood pressure was measured and the presence of metabolic syndrome was determined. Family income, dietary, and life-style habits were collected using the questionnaires GRAFFAR, KIDMED and Self-report instruments for measuring physical activity, respectively. Blood analysis included lipid profile, insulin resistance profile, liver profile, C-reactive protein, leptin and adiponectin. RESULTS A total of 459 schoolchildren were included of whom 31% were overweight and 10.9% were obese. Obese children were heavier with higher levels of body mass index, waist circumference, blood pressure, C- reactive protein, leptin, and lower levels of HDL-cholesterol and apolipoprotein A than non-obese children. No differences were found in physical and sedentary activities, but obese children had a worse quality diet than non-obese children. CONCLUSIONS Prevalence of obesity and overweight is reaching worrying levels in school age children. Obesity is associated with other classic and inflammatory cardiovascular risk factors. Obese children have a worse quality diet, although they do not do any less physical activities or any more sedentary than non-obese children.

Prevención cuaternaria. La contención como imperativo ético

The growing capacity of medicine to generate more iatrogenic events than ever, and the risk of unsustainability of health systems have led to new prevention concept: quaternary prevention aimed at restraining medicalization. Quaternary prevention is essential in the phenomenon called disease mongering, which could be translated as commercialization of disease. Encouraging this sort of prevention and halting the consequences of disease mongering requires the development of all the institutional potential for prevention, as well as all the personal willingness for restraint; it involves separating us from the unnecessary auspices of industry, being critical of our work, not being maleficent, respecting the principle of justice as managers of the limited public resources and making ourselves feel responsible for the social cost resulting from medical decisions. From this point of view, this work analyses neonatal screening, developments in the area of neonatology and primary health care.

Frecuencia y presentación clínica de los defectos oculares congénitos en Asturias (1990–2004)

INTRODUCTION Congenital ocular anomalies (COAs) can produce serious disability. OBJECTIVE The purpose of this investigation was to assess the prevalence of COAs, their trends and to describe the associated malformations and syndromes in a geographically defined population. METHOD Data from the Asturias Registry of Congenital Defects were used. The period studied was from 1990 to 2004 and the study population the 103,452 births of mothers living in the region. Total prevalence was calculated. RESULTS A total of 3035 cases with congenital defects were recorded, of these 70 had COAs. The total prevalence was 6.8 per 10000 births, with a stable trend during this period. The most common COAs were: congenital cataract (2.0 per 10000 births), anophthalmos/microphthalmos (1.4 per 10000 births) and coloboma (1.3 per 10000 births). 40% of COAs occurred as isolated defects, 37% were syndromes and 23% were associated with other congenital defects. CONCLUSIONS The prevalence of COAs in Asturias over this period had a stable trend and the congenital cataract was the commonest COAs. COAs, particularly the anophthalmos/microphthalmos were associated with other congenital anomalies.

Salud infantil y cooperación internacional: una aproximación pediátrica

The international development cooperation in child health arouses special interest in paediatric settings. In the last 10 10 years or so, new evidence has been presented on factors associated with morbidity and mortality in the first years of life in the least developed countries. This greater knowledge on the causes of health problems and possible responses in the form of interventions with impact, leads to the need to disseminate this information among concerned professional pediatricians. Serious efforts are needed to get a deeper insight into matters related to global child health and encourage pediatricians to be aware and participate in these processes. This article aims to provide a social pediatric approach towards international cooperation and child health-related matters.

Defectos de reducción de extremidades en Asturias, 1986–1997: prevalencia y presentación clínica

Objetivo Conocer la prevalencia y forma de presentacion clinicade los defectos por reduccion de extremidades en la poblacionasturiana. Pacientes y metodos Estudio de ninos con defectos de reduccion de extremidadesentre los 91.300 nacidos vivos, nacidos muertosmayores de 500 g y abortos inducidos por defectos congenitos, de mujeres residentes en Asturias, controladospor el Registro de Defectos Congenitos de Asturias (registrode base poblacional) en el periodo 1986-1997. La frecuenciase expresa como prevalencia total por 10.000 nacidos. Resultados Durante el periodo estudiado, se registraron 73 casos, siendo la prevalencia total de 8 por 10.000 (intervalo deconfianza del 95%, 6,2-9,8). El 65,7% de las anomaliasobservadas afectaban a las extremidades superiores, el23,3% a las inferiores y el 11% a ambas. El 49,3% presentabaun defecto terminal transverso, el 16,4% un defectointercalar, el 8,2% longitudinal preaxial, el 9,6%longitudinal postaxial, el 9,6% mano o pie hendido, y enel 6,8% el defecto era multiple. El 52% eran formas aisladasy el 48% se manifestaron como defecto asociado aotras malformaciones. En 4 existia alteracion cromosomica, y en 20 la reduccion de extremidades formabaparte de un sindrome, asociacion o secuencia definida. El 31,5% presentaba bajo peso para la edad de gestacion. En tres madres se constato ingestion importante de alcohol. Conclusiones El estudio detallado de los defectos congenitos por reduccionde extremidades permite un mejor conocimientode sus formas clinicas de presentacion, ademas de acercarnos a un diagnostico etiopatogenico, con posibilidadde actuar sobre los factores de riesgo.

Tumoración blanda en cráneo

CASO CLÍNICO Niño de 10 años de edad, previamente sano, que acudió al servicio de urgencias por una historia de dolor en la región posteroinferior del parietal izquierdo de 3 semanas de evolución. Quince días antes de venir al hospital se había notado una tumoración creciente en esa región. Aunque no había antecedentes de traumatismo, su pediatra le había drenado pensando que se trataba de un hematoma traumático. Como la tumoración reapareció, el paciente acudió al hospital para valoración. No había otros datos de interés en la historia clínica. La exploración física mostraba un niño afebril, con un desarrollo normal, con una masa parietal tensa y no pulsátil de 4 cm de diámetro. Se palpaban adenopatías aumentadas de tamaño en las regiones cervical y supraclavicular izquierdas. El resto de la exploración era anodina. Los resultados de los análisis de laboratorio sistemáticos se encontraban dentro de los límites normales, salvo una velocidad de sedimentación globular (VSG) de 44 mm/h. La radiografía de cráneo mostró una lesión lítica ovalada, con bordes limpios, no esclerosados, en la región posteroinferior del hueso parietal izquierdo. La citología de una muestra de la masa, obtenida mediante punción-aspiración con aguja fina (PAAF) mostró un infiltrado de eosinófilos, linfocitos y muchos histiocitos (fig. 1). Se completaron los estudios con radiografías de tórax, esqueleto y la ecografía abdominal que no revelaron datos patológicos. La tomografía computarizada (TC) demostró una lesión osteolítica ovalada de 2 × 2,5 cm de diámetro de bordes biselados. Se apreció afectación de los tejidos blandos adyacentes por encima de la lesión y una ligera compresión de la duramadre (fig. 2).

Efectividad de una intervención escolar contra la obesidad

INTRODUCTION Intervention for childhood obesity is a public health priority. The purpose of this study was to evaluate the effectiveness of an elementary school-based intervention against obesity in children. MATERIAL AND METHODS Non-randomised controlled trial was conducted on children from first to fifth grade from two public schools of Avilés (Spain). The intervention lasted for 2 school years comprising healthy diet workshops, educational chats, educational meetings, informative written material, and promotion of physical activities. Primary outcome measure was body mass index z-score. Secondary outcomes included: obesity and overweight prevalence, waist circumference, dietary habits, and physical activity. RESULTS A total of 382 (177 girls, 205 boys) out of 526 pupils of both schools were included in the study. Complete anthropometric data were obtained in 340 of the 382 individuals. Compared to children in control group, those in intervention group decreased body mass index z-score from 1.14 to 1.02 (P=.017), and improved KIDMED score from 7.33 to 7.71 points (P=.045). The percentage of students who carried on an optimal diet increased from 42.6% to 52.3% (P=.021). There were no statistical differences in the prevalence of obesity and overweight, or in waist circumference between the intervention and control groups. CONCLUSIONS This school-based program resulted in modest beneficial changes in body mass index and diet quality.