Evaluar el tratamiento con una pauta insulínica con análogo glargina en niños y adolescentes y valorar el grado de satisfacción de los pacientes y sus padres con esta nueva pauta.
Estudio prospectivo ...de 18 meses de duración con 42 pacientes con diabetes mellitus tipo 1, 27 mujeres y 15 varones, con edad media al inicio de 6,8 años (rango: 1,2-13,2), edad media al inicio del tratamiento con glargina 12,8 años (rango: 7,0-17,7), tiempo de evolución medio 6,1 años (rango: 2,0-11,9). Las indicaciones de la nueva pauta fueron mal control metabólico o hipoglucemias frecuentes con la pauta intensiva con 3 dosis de insulina de acción intermedia (NPH), que fueron sustituidas por una dosis de glargina. El nivel de hemoglobina A
1c (HbA
1c), la dosis diaria de insulina, el índice de masa corporal (IMC) y la satisfacción de pacientes y padres con el tratamiento de la diabetes se valoraron. Pruebas ANOVA (análisis de la varianza), t de Student, Mann-Whitney y Fisher.
Tras 18 meses de tratamiento con la nueva pauta, se observó una disminución del nivel de HbA
1c (7,65
±
0,74% frente a 8,03
±
0,69 %; p
=
0,001), sin cambios significativos en la dosis de insulina (1,03 ± 0,19 U/kg/día frente a 1,08
±
0,21
U/kg/día; p
=
0,052) ni en la EDE (escala de desviación estándar) del IMC (+0,51
±
0,96 frente a ±0,61
±
1,02; p
=
0,11), mientras que aumentó el grado de satisfacción con el tratamiento de los niños (+44,5
±
18,8 puntos en la escala frente a −9,9
±
26,8; p
=
0,001) y de sus padres (+42,0
±
17,9 puntos en la escala frente a −20,8
±
29,1; p
=
0,001).
1. La pauta insulínica con glargina mejora el control metabólico en niños y adolescentes con diabetes mellitus tipo 1 en tratamiento intensivo.
2. También mejora el grado de satisfacción de pacientes y padres con el tratamiento de la diabetes.
To evaluate the use of insulin glargine in intensively-treated children and adolescents. To assess the degree of patient and parent satisfaction with this treatment.
We studied 42 patients with type 1 diabetes. There were 27 girls and 15 boys. The mean age at diagnosis was 6.8 years (range 1.2-13.2), the mean age at initiation of glargine therapy was 12.8 years (range 7.0-17.7), and the mean duration of diabetes was 6.1 years (range 2.0-11.9). Glargine indications were poor metabolic control or frequent hypoglycemia with multiple daily injections of NPH insulin, which were substituted by one dose of glargine. Patient and parent satisfaction with diabetes treatment was assessed with the scale published by Boot. ANOVA, Student's t test, Mann-Whitney and Fisher tests were applied.
Variables are reported as mean ± standard deviation. After 18 months, glargine reduced hemoglobin A
1c levels (7.65%
±
0.74 vs. 8.03%
±
0.69; p
=
0.001), with no significant changes in insulin dose (1.03
±
0.19
U/kg/day vs. 1.08
±
0.21; p
=
0.052) or body mass index SDS (standard deviation score) (+0.51
±
0.96 vs. +0.61
±
1.02; p
=
0.11).Glargine also increased patient satisfaction (+44.5
±
18.8 points vs. −9.9
±
26.8; p
=
0.001) and parent satisfaction (+42.0
±
17.9 points vs. −20.8
±
29.1; p
=
0.001) with diabetes treatment.
1. Glargine insulin improves metabolic control in intensively- treated children and adolescents with type 1 diabetes.
2. Glargine also improves patient and parent satisfaction with diabetes treatment.
Malnutrition among hospitalized patients has clinical implications, and interest has arisen to find screening tools able to identify subjects under risk. At present, there is no consensus about the ...most suitable nutrition screening tool for pediatric patients.
To validate STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) pediatric screening tool in Spain.
Descriptive cross-sectional study of patients admitted to a 3rd level children's hospital with both medical and surgical specialities. During the first 24 hours of admission, STAMP screening tool was applied. For its validation, results were compared with those obtained from a nutritional assessment performed by specialist staff, which included clinical, anthropometric and body composition data.
A sample of 250 children was studied. Nutritional assessment identified 64 patients (25.6%) under risk, 40 of whom were malnourished (16%). STAMP classified 48.4% of the patients as being under nutritional risk. This tool showed 75% sensitivity and 60.8% specificity when identifying patients under risk according to nutritional assessment. It showed 90% sensitivity and 59.5% specificity when identifying malnourished patients.
Malnutrition was less frequent than that reported in other European countries, although diagnosis technique was different. STAMP is a simple and useful tool for nutritional screening, avoiding the need to assess all patients on admission in order to identify those under nutritional risk.
Introducción: La malnutrición en los pacientes hospitalizados tiene implicaciones clínicas y evolutivas, por lo que existe interés en desarrollar métodos de cribado que identifiquen los individuos de ...riesgo. En la actualidad no existe consenso acerca de la herramienta de cribado nutricional más apropiada para aplicar en población pediátrica. Objetivo: Validar en España la herramienta de cribado nutricional pediátrico STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics). Métodos: Estudio descriptivo transversal en pacientes ingresados en un hospital pediátrico de tercer nivel con diferentes especialidades médicas y quirúrgicas. En las primeras 24 horas de ingreso se aplicó el método de cribado nutricional STAMP. Para la validación de sus resultados se llevó a cabo una valoración del estado nutricional que incluyó datos clínicos, antropométricos y de composición corporal realizada por personal especializado en nutrición. Resultados: Fueron estudiados 250 niños. La valoración nutricional detectó 64 pacientes (25,6%) considerados de riesgo, de los cuales 40 (16%) estaban ya malnutridos. STAMP clasificó un 48,4% de la muestra como de riesgo nutricional elevado. Dicho método mostró una sensibilidad del 75% y una especificidad del 60,8% para identificar los pacientes considerados de riesgo en la valoración nutricional, y una sensibilidad del 90% y especificidad del 59,5% para detectar los malnutridos. Comentarios: La frecuencia de malnutrición fue algo inferior a la de otros países de nuestro entorno, aunque el método diagnóstico fue diferente. El método STAMP es una herramienta sencilla y útil para el cribado nutricional, que evitaría la necesidad de valorar a todos los pacientes al ingreso para detectar los sujetos de riesgo.
Introducción: La malnutrición en los pacientes hospitalizados tiene implicaciones clínicas y evolutivas, por lo que existe interés en desarrollar métodos de cribado que identifiquen los individuos de ...riesgo. En la actualidad no existe consenso acerca de la herramienta de cribado nutricional más apropiada para aplicar en población pediátrica. Objetivo: Validar en España la herramienta de cribado nutricional pediátrico STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics). Métodos: Estudio descriptivo transversal en pacientes ingresados en un hospital pediátrico de tercer nivel con diferentes especialidades médicas y quirúrgicas. En las primeras 24 horas de ingreso se aplicó el método de cribado nutricional STAMP. Para la validación de sus resultados se llevó a cabo una valoración del estado nutricional que incluyó datos clínicos, antropométricos y de composición corporal realizada por personal especializado en nutrición. Resultados: Fueron estudiados 250 niños. La valoración nutricional detectó 64 pacientes (25,6%) considerados de riesgo, de los cuales 40 (16%) estaban ya malnutridos. STAMP clasificó un 48,4% de la muestra como de riesgo nutricional elevado. Dicho método mostró una sensibilidad del 75% y una especificidad del 60,8% para identificar los pacientes considerados de riesgo en la valoración nutricional, y una sensibilidad del 90% y especificidad del 59,5% para detectar los malnutridos. Comentarios: La frecuencia de malnutrición fue algo inferior a la de otros países de nuestro entorno, aunque el método diagnóstico fue diferente. El método STAMP es una herramienta sencilla y útil para el cribado nutricional, que evitaría la necesidad de valorar a todos los pacientes al ingreso para detectar los sujetos de riesgo.Background: Malnutrition among hospitalized patients has clinical implications, and interest has arisen to find screening tools able to identify subjects under risk. At present, there is no consensus about the most suitable nutrition screening tool for pediatric patients. Aim: To validate STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) pediatric screening tool in Spain. Methods: Descriptive cross-sectional study of patients admitted to a 3rd level children's hospital with both medical and surgical specialities. During the first 24 hours of admission, STAMP screening tool was applied. For its validation, results were compared with those obtained from a nutritional assessment performed by specialist staff, which included clinical, anthropometric and body composition data. Results: A sample of 250 children was studied. Nutritional assessment identified 64 patients (25.6%) under risk, 40 of whom were malnourished (16%). STAMP classified 48.4% of the patients as being under nutritional risk. This tool showed 75% sensitivity and 60.8% specificity when identifying patients under risk according to nutritional assessment. It showed 90% sensitivity and 59.5% specificity when identifying malnourished patients. Comments: Malnutrition was less frequent than that reported in other European countries, although diagnosis technique was different. STAMP is a simple and useful tool for nutritional screening, avoiding the need to assess all patients on admission in order to identify those under nutritional risk.
To evaluate the use of insulin glargine in intensively-treated children and adolescents. To assess the degree of patient and parent satisfaction with this treatment.
We studied 42 patients with type ...1 diabetes. There were 27 girls and 15 boys. The mean age at diagnosis was 6.8 years (range 1.2-13.2), the mean age at initiation of glargine therapy was 12.8 years (range 7.0-17.7), and the mean duration of diabetes was 6.1 years (range 2.0-11.9). Glargine indications were poor metabolic control or frequent hypoglycemia with multiple daily injections of NPH insulin, which were substituted by one dose of glargine. Patient and parent satisfaction with diabetes treatment was assessed with the scale published by Boot. ANOVA, Student's t test, Mann-Whitney and Fisher tests were applied.
Variables are reported as mean 6 standard deviation. After 18 months, glargine reduced hemoglobin A1c levels (7.65 % +/- 0.74 vs. 8.03 % +/- 0.69; p = 0.001), with no significant changes in insulin dose (1.03 +/- 0.19 U/kg/day vs. 1.08 +/- 0.21; p = 0.052) or body mass index SDS (standard deviation score) (+0.51 +/- 0.96 vs. 10.61 +/- 1.02; p = 0.11). Glargine also increased patient satisfaction (+44.5 +/- 18.8 points vs. -9.9 +/- 26.8; p < 0.001) and parent satisfaction (+42.0 +/- 17.9 points vs. -20.8 +/- 29.1; p < 0.001) with diabetes treatment.
1. Glargine insulin improves metabolic control in intensively-treated children and adolescents with type 1 diabetes. 2. Glargine also improves patient and parent satisfaction with diabetes treatment.
The structure of fish assemblages accounted for by different sampling methods (namely fyke net, seine nets, visual census) applied to vegetated and unvegetated lagoon habitats was investigated in ...terms of species composition, functional groups (ecological and trophic guilds), and fish size distribution. Significant differences were detected among methods, even among similar ones (seine nets). Visual census and fyke net detected more easily pelagic species, allowing the sampling of larger fish, whereas seine nets targeted more efficiently benthic-demersal species, with a dominance of 2–10 cm size classes in the fish catches. Differences were detected also among habitats, reflecting the different fish assemblages associated to vegetated and unvegetated habitats in coastal lagoons and transitional waters. However a different ability of discriminating between habitat-associated fish assemblages was recorded for the sampling methods. The different selectivity and functioning of the tested sampling methods confirm the importance of considering the targeted scale at which the research is being carried out, as well as the method that will be used to assess the ecological status of lagoon fish assemblages when choosing the most appropriate sampling method. A cross-validation of fish sampling methodologies in transitional waters is necessary to cope with the mandatory of the Water Framework Directive of standardization and comparability of monitoring methods.
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