Search

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 depression., (Copyright © 2020 The Author(s). Publicado por Elsevier España, S.L.U. All rights reserved.)

Introduction: Self-prescribing or medicating 'by proxy' is not an autonomous, free and voluntary decision in the case of children. On the contrary, in this case it is based on the subjective interpretation of symptoms made by the mother or by a third person who is legally responsible for the minor. In our opinion, to analyse this situation is of great importance in order to know the determining factors, perceptions, and realities related to this problem., Methods: Our proposal is to perform a prospective observational study for analysing maternal and familiar determinant factors related to self-prescribing and self-medicating 'by proxy' in paediatrics. A validated survey was developed to be applied to mothers of children aged 0 to 14 who are users of the Paediatric Emergency Department in a hospital., Results: A total of 1,714 mothers were recruited in a random period of time. This sample included 345 mothers who exclusively self-medicated their children (case group), and 1,369 mothers (control group) who did not meet this requirement. The overall percentage of medicating 'by proxy' was 32.8%. There is a significant association between self-medicating and educational level of the mother, the number of children, and the birth order among siblings. Neither maternal age nor social-occupational level are related to this problem. Most frequently used drugs include antipyretics and 'anticatharrals', usually administered as a monotherapy., Conclusions: Our results seem to indicate that the educational level and the parental experience acquired with previous children could generate the required confidence in parents to choose the medication by themselves. Almost 85% of these drugs come from the 'home first-aid kit.', (Copyright © 2016 Asociación Española de Pediatría. Publicado por Elsevier España, S.L.U. All rights reserved.)

Objective: To find the validity of the clinical and radiological methods used within Primary Care in the early diagnosis of Congenital Hip Luxation (CHL)., Design: A prospective observation study., Setting: Zaidín-Sur Basic Health Area (HA), Granada. An urban Health Centre., Patients: All new-born and nursing babies born in our HA between October 1991 and March 1993 (N = 352), followed and studied over an average period of 22.4 months (SD = 5.6) (Range, 12 to 30 months)., Results: The prevalence of clinically and/or radiologically-based suspected CHL was 19% (Cl 95%; 12.7-25.3%) and the prevalence of confirmed CHL was 4.2% (Cl 95%; 1.96-6.44%). Ortolani-Barlow sensitivity (O-B) was 46.7%, specificity 85.2%; positive predictive value 12.3%, negative predictive value 97.6%, false positives 14.8% and false negatives 53.3%. When positive O-B and/or other positive clinical signs were taken into consideration, sensitivity rose to 73.3% and false negatives went down to 26.7%. If we had not performed radiologies systematically on all the nursing children, we would have missed CHL diagnosis in 1.14% of our basic HA's population-group., Conclusion: We question the clinical diagnosis of CHL due to its low sensitivity and an excessive number of false negatives. We recommended systematic testing by means of a diagnostic image method, which could be X-Rays at 3 to 5 months.

Of a total population of a pediatric office of the Zaidin South Health Care Center, all of the mothers that were frequent users (69) were chosen and compared with a random sample of normal users (82). Both groups carried out the anxiety scale STAI. Significant differences were found in that the high users have greater levels of anxiety about trait (p = 0.0003), as well as state (p = 0.000). The high levels of anxiety of trait are associated with being a house wife, having a child with a chronic illness, non maternal lactation, low levels of studies, health education and family income. Family income was the variable with the greatest association with the anxiety of trait (multiple regression). When we took into consideration the variables of predisposition, availability and ease of use, the maternal anxiety continued to have a significant influence. We point out the importance of maternal anxiety in the high frequency of pediatric health care use and we underline the modifiable characteristics of the anxiety factor, and therefore the possibility of reducing the high use of health care services addressed.

Objective: To find the nature of the relationship between the general level of mothers' health knowledge and the over-use of paediatric facilities at the Primary Care level., Design: A crossover study with a control group. SITE. Zaidin-Sur Health Centre (Granada)., Patients or Others Participants: We selected all the over-users (69) of a Paediatric office and compared them to a random sample, grouped by age, of normal users (82); n = 151., Main Measurements and Results: To control confusion, we measured a total of 31 variables, grouped as to need, predisposition and expediting factors. After validating the scales, the average scores for general health understanding and the score for clinical attitudes and knowledge were significantly lower in the over-user group (p = 0.017 and p = 0.000). The scale for attitudes to and knowledge of prevention did not attain any importance (p = 0.104). We worked out a model of multiple logistical regression which included in the equation the scale of clinical attitudes and knowledge (p less than 0.005)., Conclusions: We emphasised the importance of mothers' health knowledge to the question of over-use of paediatric facilities. It is desirable to attempt to intervene on this question in order to lessen excessive use of health facilities.