Nelson A Vargas C

Recién nacido hijo de madre diabética

Some features as well as pathological findings in 63 infants born to diabetic mothers (IDM) under control in a diabetes unit of a general hospital at metropolitan Santiago, Chile, from 1985 through 1988 are presented. Out of 63 newborns, 22 came from mothers with pregestational diabetes mellitus (PGDM) and 41 were born to mothers with gestational diabetes mellitus (GDM). Significant differences were detected among PGDM and GDM groups of newborns in the following features: mean gestational age (GE) premature (54.5% vs. 26.8% 37 weeks GE or less), jaundice (40.9% vs. 17.1%) and congenital malformations (18.2% vs. 0%). No significant differences were found in fetal distress, hypoglycemia, respiratory distress syndrome and birth trauma although as a whole these last were more frequently recorded among infant born to insulin dependent diabetic mothers. It is concluded that in spite of an appropriate control, morbidity remains higher in IDM, particularly in IDM PGDM.

Epidemiología, nueva morbilidad pediátrica y rol del pediatra

Proposito: Describir y analizar los principales cambios de la salud infantil durante las ultimas decadas, reconocer nuevos desafios y relacionarlos con el rol del pediatra en este escenario. Material y Metodo: Revision de literatura biomedica y de estadisticas nacionales relacionadas con la salud infanta juvenil. Resultados: Los indicadores biodemograficos, de salud y atencion han tenido una evolucion favorable que refleja el exito de los programas de prevencion y control de salud materno infantil aunque subsisten inequidades cuya magnitud se acentua al comparar unidades administrativas de menor tamano y grupos etnicos determinados. Las principales causas de muerte han cambiado dando paso a enfermedades emergentes, trastornos nutricionales por exceso y patologias cronicas. A futuro, es probable que las muertes infantiles se concentren en las afecciones congenitas, perinatales y en otras mal definidas del periodo neonatal precoz. El consumo de alcohol y drogas, asi como la actividad sexual, son cada vez mas tempranos; mientras el sedentarismo llega a magnitudes importantes y hay una alta proporcion de nacidos fuera del matrimonio, en especial en adolescentes. La mayor sobrevida aumenta el numero y complejidad de quienes deben recibir atencion, incrementando la necesidad de capacitacion y los costos asociados al avance tecnologico. Rol: Se sugiere que el Pediatra -abogado de los derechos del Nino- debe detectar y dar a conocer las desigualdades, pesquisar patologias y liderar un equipo de salud multidisciplinario amplio que trabaje en red y sea capaz de promover la salud infantil y adolescente; prevenir enfermedades y diagnosticar, tratar y rehabilitar los enfermos. Estas ultimas misiones deben reforzarse en algunos riesgos especificos. La meta final es contribuir a producir ancianos sanos y con buena calidad de vida. Todo ello obliga a mantener una capacitacion permanente y, por la alta exigencia de trabajo, a protegerse del agotamiento personal

Transición al cuidado de la vida adulta, de niños y adolescentes con necesidades especiales de atención en salud: recomendaciones del comité NANEAS de la Sociedad Chilena de Pediatría

ABSTRACTTransition for young adults with special health care needs: recommendations of the Committee on NANEAS of Pediatric Chilean Society Medicine in the world has changed, and Chile hasn’t been left out of this reality. Advances in therapies for chronic diseases, neonatal intensive care, and critical care, have made children survive and impro-ve infant mortality rates, with an increase in the number of children and adolescents with chronic illnes-ses and special health care needs. The special pediatric care of these patients has been developed in re-cent years, however, the transition to an adult health care model is a diffi cult experience for the patient, family and medical teams. The purpose of this document is to provide recommendations for the health personnel and authorities in Chile, to deliver an adequate and healthy transfer from the pediatric to the adult health care teams, which is called “Transition”( Key words: Transition, Special health care needs, chronic diseases, adolescents).Rev Chil Pediatr 2011; 82 (3): 238-244

Hijo no deseado después del parto: medición de frecuencia y análisis de tendencia

Background: A significant proportion of pregnancies occurring in Metropolitan Santiago are unplanned and unwanted. It is reasonable to postulate that the frequency of unwanted children must be high. Aim: To measure the frequency of unwanted children in newborns of a public hospital of Santiago. Material and methods: In a period of fourteen months a score assigning survey to detect unwanted children was applied, after birth, to 741 women delivering at San Juan de Dios Hospital in Metropolitan Santiago. Women whose newborns were hospitalized or had congenital malformations were excluded from the survey. Results: Forty children (5.4%) scored as unwanted while 52 (7%) qualified as being in a doubtful situation. When compared to desired children, unwanted infants had a lower frequency of suitable pregnancy controls (p <0.0002) and a higher incidence of mothers declaring bad relations with children’s father (p <0.0002). A trend towards higher frequency of single mothers (p: 0.044) was observed. A lower frequency of first born children (p: 0.017) and a higher frequency of children born in the fourth place, was observed among unwanted newborns (p <0.002). Conclusions: In the last 15 years, previous studies, carried out with similar methodologies, have showed a comparable frequency of unwanted children. These condition seems to be associated with poor pregnancy control, high birth order and bad relations with the child’s father (Rev Med Chile 2002; 130: 638-643)

Consejería a adolescentes: descripción epidemiológica y motivos de consulta

Seventy percent of women and 50% of mencame from nuclear families. More than two thirds were primogenital. Most adolescents wereaccompanied by their mother, that were the main adult raw model. Fifty percent haddysfunctional families. All were attending school regularly and 21% of women and 29% of menhad repeated a school level. Sixty eight percent of women and 62% of men declared to have a lifeproject. Twenty percent were worried about their physical appearance. Seventy seven percent ofwomen and 62% of men considered themselves as “happy”. Thirty six percent of women and 14%of men smoked. The figures for alcohol consumption were 21% and 14%, respectively. The causesfor consultation were obesity, overweight, unspecific symptoms, behavioral problems, bad schoolachievement, communication problems or pregnancy. Reasons for counseling were familydysfunction, low self esteem, bad school achievement and information about sexuality.

Cambio de pareja progenitora en puérperas de un hospital de la Región Metropolitana: Frecuencia y factores asociados

Background: Previus studies in Metropolitan Santiago, showed that at least 10% of mothers changed their reproductive partner. Aim. To study the frequency of reproductive partner change and its associated factors among women delivering in a public hospital. Subjects and methods: We interviewed 859 non primiparous women that gave birth to a child in a public hospital of Metropolitan Santiago, between March 2001 and February 2002. Results: Mean maternal age rose according to birth order from 27.4 to 33.6 years from the second to the fourth sibling. Married women were the largest group and single ones decreased from the second to the third sibling. Twenty two percent had some activity out of home and those with a high birth order (fourth or more) exhibited poorer schooling. Unwanted pregnancies increased with birth order, reaching 55% among «fourth and over» births. Thirty four percent of women delivering their second child, changed their partner. Among women delivering their third child, 38.6% had one sibling with a different father; 20.4% had changed partner during their second pregnancy and 20% during the current one. Among those in the «fourth and over» group, 56.1% had at least one sibling with a different father; 18.3% had changed partner in the second sibling; 15%, in the third and 27.8%, in the fourth and over. In all birth orders, mothers with activity out of home exhibited a higher frequency of partner change. The most common reasons to change partner were infidelity, abandon or a personal decision, while economic reasons were uncommon. Conclusions: A great number of children are exposed to bonding ruptures and to the consequential mental health or behavioral problems (Rev Med Chile 2004; 132: 719-24)

Enfermedades crónicas en pacientes pediátricos hospitalizados: frecuencia y tipo de enfermedad

Frequency and type of illness were studied in patients under fifteen years of age, discharged from the pediatricwards of a university associated public hospital at metropolitan Santiago, Chile. From cpril through September 1 992,.patients discharged from hospital sections for infants, infectious diseases, child surgery, critical care and medicinewere classified as acute, confirmed chronic or unconfirmed chronic disease. Oncohematologic, multiple trauma andemergency cases were excluded. Diagnosis given by treating physician were recorded and any illness lasting over sixmonths was defined as a chronic disease. Chronicity reached 35.2% among whole hospital discharges and 32.9%among children discharges, increasing gradually according to age to reach 47.1% in children aged 10 years ormore. Unconfirmed diagnosis among 137 chronic children reached 13.1% (n=18). Highe r uncertainty in diagnosiswas recorded under six months of age (25%). Median age at hospital cischarge was 18 months in children withchronic diseases and only 10 months in acute cases. Most common groups of diagnosis were respiratory infections,congenital abnormalities and genitourinary tract diseases.[Keywords: chronic diseases, children morbidity, health care.)

Conocimientos culturales y de trivia en dos grupos universitarios de Chile

Background: Culture is defined by the Websters dictionary as acquaintance with and taste infine arts, humanities, and broad aspects ofscience as distinguished from vocational and technical skills. Aim: To assess the general cultural knowledge of university students. Material andMethods: A test containing 58 questions about art, national and universal literature, national and universal history, mythology science and trivial national issues was designed and applied to 251 medical students in Santiago (149 from first year and 86 from fifth year, Universidad de Chile) and 138 agronomy students in Valdivia (61 from first year and 77 from fifth year, Universidad Austral de Chile). Results: All students answered the test. Medical students from first and fifth year omitted 19 and 15% of questions respectively The figures for first and fifth year agronomy students were 23% each. The percentage of corred answers among first and fifth year medical students was 50 and 59% respectively. The figures for first and fifth year agronomy students were 39 and 44% respectively. The questions with higher rates of corred answers were those about trivial issues. Conclusions: There was a high rate of omissions and wrong answers about general cultural issues among university students particularly in national cultural subjects.

Conocimiento y percepciones culturales de los padres sobre los juguetes apropiados para sus hijos: Encuesta en dos Consultorios de Atención Primaria de Santiago Metropolitano

Objetivo: Precisar el conocimiento parental sobre los juguetes apropiados para los hijos. Material y Metodo: Encuesta (cuantitativa y cualitativa) con preguntas cerradas y abiertas, entre marzo 2002 - mayo 2003 a 80 padres de ninos entre 6 y 24 meses, en control de salud en dos consultorios. Resultados: Un 55% de los hijos era mujer y la edad promedio fue 13,3 meses (DE: 5,7) con mediana de 13. Los entrevistados fueron madres (97,5%) jovenes (edad promedio: 26,6 anos) y de nivel educacional satisfactorio. Un 75% era duena de casa, con ingreso bajo, predominando la relacion estable de pareja. Un 78,8% dijo no haber sido instruido por el equipo de salud sobre la seleccion de juegos o juguetes, que incluso podian ser objetos caseros (58,8%). Un 35% de los ninos veia television y 37,5% jugaba con personas. Los juguetes eran regalados por familiares o padres o heredados. El 70,5% afirmo que la interaccion con la familia era fundamental en la entretencion y 6,2% no atribuia importancia al juguete como agente estimulador. La caracteristica mas buscada era la seguridad y 93,8% considero eran importantes para el desarrollo. 65% revisaba la advertencia del envase, especialmente buscando seguridad; pero solo 46,2% dijo respetarla. Al preguntar si comprarian un juguete solicitado por el nino, a pesar de la edad, costo y advertencias, 15% respondio que si. Conclusiones: El uso de juguetes es considerado importante para el desarrollo de los ninos, siendo la seguridad de los juegos la caracteristica mas importante considerada por los padres. Parece necesario crear conciencia educativa sobre este aspecto en el personal de atencion pediatrica y, muy en especial, en aquellos que brindan esta en el nivel primario

Características recomendadas de los juguetes: Encuesta de opinión a expertos chilenos

Para reunir ideas de personas formadoras de opinion acerca de los roles y recomendaciones que deben cumplir los juguetes se realizo una encuesta, con metodologia cualitativa, a personalidades destacadas –arbitrariamente seleccionadas– del ambiente pediatrico y de instituciones relacionadas con el cuidado de los ninos. Los entrevistados son personas formadoras de opinion o encargadas de tomar decisiones en el area del cuidado infantil. Con sus opiniones se presenta una lista de caracteristicas que deben tener los juguetes para cumplir los roles que se les atribuyen y se formulan recomendaciones que se solicita difundir