El frío puede ayudar a curar el cerebro de los pacientes sumidos en un coma tras sufrir un episodio cardiaco. De hecho, cada vez son más las Unidades de Cuidados Intensivos (UCI) de todo el mundo que recurren a la denominada hipotermia terapéutica para frenar los posibles daños neurológicos. Se trata de disminuir la temperatura corporal a unos 32 ó 34 grados y mantenerla durante 24 horas, siempre que sea posible. Durante este periodo de tiempo, el organismo entrará en una suerte de modo de ahorro de energía favorable para la salud cognitiva.
A grandes rasgos, la secuencia de hechos podría ser la siguiente. Un hombre adulto sufre una fibrilación ventricular, que impide que su corazón se contraiga y lata adecuadamente (las fibras musculares de este órgano dejan de coordinarse). Cae inconsciente en plena calle y, tras realizársele distintas maniobras de reanimación, recupera el pulso pero su cerebro no despierta. En la ambulancia, mientras lo desplazan al hospital, los sanitarios comienzan a disminuir poco a poco su temperatura corporal –no conviene bajar más de un grado cada hora–. Para ello, sitúan bolsas frías en zonas estratégicas, como la cabeza, el cuello, el torso y los muslos.
Al ingresar por Urgencias, los intensivistas deciden continuar con la hipotermia. Pero antes anestesian y sedan al hombre. De esta forma, consiguen reducir un posible sufrimiento y, principalmente, logran evitar tiritonas o convulsiones, que pueden mermar la eficacia de este tratamiento ya que, entre otros efectos, aumentan el consumo de oxígeno o la temperatura corporal.
En 2002, dos ensayos realizados en Australia y Europa demostraron la eficacia de enfriar a este tipo de pacientes. El primero, centrado en 77 comatosos tras padecer una fibrilación ventricular, mostró un 49% de supervivencia entre los hipotérmicos, en comparación con un 26% de los que mantuvieron su temperatura habitual. El segundo, basado en 275 casos, arrojó mejores cifras: un 55% frente a un 39%. Como destacan ahora los especialistas, ambas evidencias fueron esenciales para el establecimiento de la técnica en la rutina diaria de las UCI.
El daño neurológico que sufren con frecuencia los citados enfermos cardiacos suele originarse en dos momentos clave: cuando el corazón se para, y la sangre deja de llegar al cerebro, y al volver a fluir (daño de reperfusión). El efecto protector de la bajada de temperatura, como explica Francisco del Río, internista del Hospital Clínico San Carlos (Madrid), se consigue porque "el cuerpo consume menos energía, se frena gran parte del metabolismo y se palia el efecto de varias sustancias nocivas".
De hecho, estas alteraciones cerebrales pueden llegar a dañar las células y precipitar su muerte (apoptosis), tal y como explica Michael Holzer, de la Universidad Médica de Viena y autor de un artículo sobre este tema, publicado recientemente en 'The New England Journal of Medicine (NEJM)'.
-Sin muchos riesgos
Pedro Galdos, jefe del servicio de Cuidados Intensivos del Hospital Puerta de Hierro de Majadahonda (Madrid), sostiene que estos niveles de hipotermia no suelen ser especialmente peligrosos, pero es esencial controlar muy de cerca a estos enfermos. Entre otras consecuencias, pueden sufrir cambios metabólicos que puedan desequilibrar la presencia de electrolitos (como el potasio) o incrementar la glucosa. "Existen una serie de riesgos que son asumibles, teniendo en cuenta el beneficio esperable", recalca del Río.
Originalmente, tal y como reflejaron los dos estudios de 2002, la técnica se mostró eficaz para adultos que han padecido una fibrilación ventricular y, tras reponerse, se han quedado en coma. En la actualidad, aunque todavía no está plenamente extendida en España –ya que requiere un periodo de formación–, los intensivistas echan mano de ella en otros casos, como en las asistolias (en las que se para el corazón). Como añade Galdos, ahora se emplea en niños y, también, en algunas operaciones.
"En una cirugía cardiaca infantil puede ser eficaz recurrir al frío en lugar de optar por las máquinas extra corpóreas (que bombean y oxigenan la sangre mientras el corazón está parado). Sus usos, por tanto, van aumentando en función del mayor conocimiento y manejo de la técnica, y de los riesgos y beneficios que se desprenden de ella".
No obstante, esta estrategia terapéutica no funciona en todos los casos. Como aclara Michael Holzer en NEJM, de los pacientes que ingresan con este cuadro cardiaco y sobreviven, cerca de la mitad recupera correctamente su función neurológica.
Aunque algunos estudios indican que los pacientes con niveles adecuados de glucosa son más propensos a curarse, lo cierto es que la recuperación no podrá demostrarse hasta que el enfermo vuelva a su temperatura normal -incrementando medio grado cada hora- y, en último caso, hasta que logre despertarse.
**Publicado en "El mundo"
Diario digital con noticias de actualidad relacionadas con el mundo de la salud. Novedades, encuestas, estudios, informes, entrevistas. Con un sencillo lenguaje dirigido a todo el mundo. Y algunos consejos turísticos para pasarlo bien
Traductor
04 October 2010
Are pre-teen babysitters able to deal with emergencies?
Nearly all (98 percent) of 11- to 13-year-old babysitters know who to contact in the event of an intruder or if a child is sick or injured (96 percent) or poisoned (85 percent), according to research presented Sunday, Oct. 3, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco. However, 40 percent of younger babysitters reported that they had left children unattended while babysitting, and 20 percent opened the door to strangers.
In the study, "Babysitter Safety Training: Are Children Aged 11-13 Years Prepared to Deal with Emergencies While Caring for Younger Children?" researchers surveyed 727 pre-teens who have cared for a younger infant or child as a babysitter.
Fifty-one percent of the children interviewed had taken a first-aid training class; 47 percent, a class in cardio-pulmonary resuscitation, and 19 percent, the American Red Cross Safe Sitter or other babysitter class. Ninety-two percent of pre-teen babysitters were familiar with the location of first aid supplies and 64 percent with the location of a fire extinguisher. Ten percent of pre-teen babysitters have had a personal experience with an emergency requiring 911 activation: 10 respondents called 911 after a child sustained injuries from a significant fall, eight because of a house fire, six because a child had profuse bleeding from a laceration, and six for a significant head trauma.
The study provided a snapshot of pre-teen babysitter strengths and weaknesses, said lead study author Nicole M. Hackman, MD, FAAP, of Penn State Hershey Children's Hospital. "By identifying the unsafe behaviors, we have the opportunity to design specific educational programs to prepare pre-teen babysitters to safely respond to common emergency situations."
**Published by American Academy of Pediatrics
In the study, "Babysitter Safety Training: Are Children Aged 11-13 Years Prepared to Deal with Emergencies While Caring for Younger Children?" researchers surveyed 727 pre-teens who have cared for a younger infant or child as a babysitter.
Fifty-one percent of the children interviewed had taken a first-aid training class; 47 percent, a class in cardio-pulmonary resuscitation, and 19 percent, the American Red Cross Safe Sitter or other babysitter class. Ninety-two percent of pre-teen babysitters were familiar with the location of first aid supplies and 64 percent with the location of a fire extinguisher. Ten percent of pre-teen babysitters have had a personal experience with an emergency requiring 911 activation: 10 respondents called 911 after a child sustained injuries from a significant fall, eight because of a house fire, six because a child had profuse bleeding from a laceration, and six for a significant head trauma.
The study provided a snapshot of pre-teen babysitter strengths and weaknesses, said lead study author Nicole M. Hackman, MD, FAAP, of Penn State Hershey Children's Hospital. "By identifying the unsafe behaviors, we have the opportunity to design specific educational programs to prepare pre-teen babysitters to safely respond to common emergency situations."
**Published by American Academy of Pediatrics
Are pre-teen babysitters able to deal with emergencies?
Nearly all (98 percent) of 11- to 13-year-old babysitters know who to contact in the event of an intruder or if a child is sick or injured (96 percent) or poisoned (85 percent), according to research presented Sunday, Oct. 3, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco. However, 40 percent of younger babysitters reported that they had left children unattended while babysitting, and 20 percent opened the door to strangers.
In the study, "Babysitter Safety Training: Are Children Aged 11-13 Years Prepared to Deal with Emergencies While Caring for Younger Children?" researchers surveyed 727 pre-teens who have cared for a younger infant or child as a babysitter.
Fifty-one percent of the children interviewed had taken a first-aid training class; 47 percent, a class in cardio-pulmonary resuscitation, and 19 percent, the American Red Cross Safe Sitter or other babysitter class. Ninety-two percent of pre-teen babysitters were familiar with the location of first aid supplies and 64 percent with the location of a fire extinguisher. Ten percent of pre-teen babysitters have had a personal experience with an emergency requiring 911 activation: 10 respondents called 911 after a child sustained injuries from a significant fall, eight because of a house fire, six because a child had profuse bleeding from a laceration, and six for a significant head trauma.
The study provided a snapshot of pre-teen babysitter strengths and weaknesses, said lead study author Nicole M. Hackman, MD, FAAP, of Penn State Hershey Children's Hospital. "By identifying the unsafe behaviors, we have the opportunity to design specific educational programs to prepare pre-teen babysitters to safely respond to common emergency situations."
**Published by American Academy of Pediatrics
In the study, "Babysitter Safety Training: Are Children Aged 11-13 Years Prepared to Deal with Emergencies While Caring for Younger Children?" researchers surveyed 727 pre-teens who have cared for a younger infant or child as a babysitter.
Fifty-one percent of the children interviewed had taken a first-aid training class; 47 percent, a class in cardio-pulmonary resuscitation, and 19 percent, the American Red Cross Safe Sitter or other babysitter class. Ninety-two percent of pre-teen babysitters were familiar with the location of first aid supplies and 64 percent with the location of a fire extinguisher. Ten percent of pre-teen babysitters have had a personal experience with an emergency requiring 911 activation: 10 respondents called 911 after a child sustained injuries from a significant fall, eight because of a house fire, six because a child had profuse bleeding from a laceration, and six for a significant head trauma.
The study provided a snapshot of pre-teen babysitter strengths and weaknesses, said lead study author Nicole M. Hackman, MD, FAAP, of Penn State Hershey Children's Hospital. "By identifying the unsafe behaviors, we have the opportunity to design specific educational programs to prepare pre-teen babysitters to safely respond to common emergency situations."
**Published by American Academy of Pediatrics
Are pre-teen babysitters able to deal with emergencies?
Nearly all (98 percent) of 11- to 13-year-old babysitters know who to contact in the event of an intruder or if a child is sick or injured (96 percent) or poisoned (85 percent), according to research presented Sunday, Oct. 3, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco. However, 40 percent of younger babysitters reported that they had left children unattended while babysitting, and 20 percent opened the door to strangers.
In the study, "Babysitter Safety Training: Are Children Aged 11-13 Years Prepared to Deal with Emergencies While Caring for Younger Children?" researchers surveyed 727 pre-teens who have cared for a younger infant or child as a babysitter.
Fifty-one percent of the children interviewed had taken a first-aid training class; 47 percent, a class in cardio-pulmonary resuscitation, and 19 percent, the American Red Cross Safe Sitter or other babysitter class. Ninety-two percent of pre-teen babysitters were familiar with the location of first aid supplies and 64 percent with the location of a fire extinguisher. Ten percent of pre-teen babysitters have had a personal experience with an emergency requiring 911 activation: 10 respondents called 911 after a child sustained injuries from a significant fall, eight because of a house fire, six because a child had profuse bleeding from a laceration, and six for a significant head trauma.
The study provided a snapshot of pre-teen babysitter strengths and weaknesses, said lead study author Nicole M. Hackman, MD, FAAP, of Penn State Hershey Children's Hospital. "By identifying the unsafe behaviors, we have the opportunity to design specific educational programs to prepare pre-teen babysitters to safely respond to common emergency situations."
**Published by American Academy of Pediatrics
In the study, "Babysitter Safety Training: Are Children Aged 11-13 Years Prepared to Deal with Emergencies While Caring for Younger Children?" researchers surveyed 727 pre-teens who have cared for a younger infant or child as a babysitter.
Fifty-one percent of the children interviewed had taken a first-aid training class; 47 percent, a class in cardio-pulmonary resuscitation, and 19 percent, the American Red Cross Safe Sitter or other babysitter class. Ninety-two percent of pre-teen babysitters were familiar with the location of first aid supplies and 64 percent with the location of a fire extinguisher. Ten percent of pre-teen babysitters have had a personal experience with an emergency requiring 911 activation: 10 respondents called 911 after a child sustained injuries from a significant fall, eight because of a house fire, six because a child had profuse bleeding from a laceration, and six for a significant head trauma.
The study provided a snapshot of pre-teen babysitter strengths and weaknesses, said lead study author Nicole M. Hackman, MD, FAAP, of Penn State Hershey Children's Hospital. "By identifying the unsafe behaviors, we have the opportunity to design specific educational programs to prepare pre-teen babysitters to safely respond to common emergency situations."
**Published by American Academy of Pediatrics
Unemployment linked with child maltreatment
The stresses of poverty have long been associated with child abuse and neglect. In a study presented Sunday, Oct. 3, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco, researchers directly linked an increased unemployment rate to child maltreatment one year later.
Researchers reviewed state-level unemployment statistics from the Bureau of Labor Statistics, and compared them with child maltreatment data from the National Child Abuse and Neglect Data System (NCANDS), during the years 1990 to 2008. Each 1 percent increase in unemployment was associated with at least a 0.50 per 1,000 increase in confirmed child maltreatment reports one year later. In addition, higher levels of unemployment appeared to raise the likelihood of child maltreatment, as it was not only the lagged change in unemployment, but also the previous year's unemployment level that influenced the number of child abuse cases.
According to the study, a prolonged rise in unemployment rates is not only detrimental to the economic health of the country but also to the physical and mental health of children. Maltreated children suffer the immediate physical consequences of abuse, including physical injury and even death, and are also at increased risk of physical and mental health effects, often lasting for decades.
Unemployment in the U.S. has risen from 4.5 percent in 2007 to a current level of 9.5 percent.
"When times are bad, children suffer," said study author Robert Sege, MD, PhD, FAAP, professor of pediatrics, Boston University School of Medicine, and director, Division of Ambulatory Pediatrics, Boston Medical Center. "These results suggest that programs to strengthen families and prevent maltreatment should be expanded during economic downturns."
Researchers reviewed state-level unemployment statistics from the Bureau of Labor Statistics, and compared them with child maltreatment data from the National Child Abuse and Neglect Data System (NCANDS), during the years 1990 to 2008. Each 1 percent increase in unemployment was associated with at least a 0.50 per 1,000 increase in confirmed child maltreatment reports one year later. In addition, higher levels of unemployment appeared to raise the likelihood of child maltreatment, as it was not only the lagged change in unemployment, but also the previous year's unemployment level that influenced the number of child abuse cases.
According to the study, a prolonged rise in unemployment rates is not only detrimental to the economic health of the country but also to the physical and mental health of children. Maltreated children suffer the immediate physical consequences of abuse, including physical injury and even death, and are also at increased risk of physical and mental health effects, often lasting for decades.
Unemployment in the U.S. has risen from 4.5 percent in 2007 to a current level of 9.5 percent.
"When times are bad, children suffer," said study author Robert Sege, MD, PhD, FAAP, professor of pediatrics, Boston University School of Medicine, and director, Division of Ambulatory Pediatrics, Boston Medical Center. "These results suggest that programs to strengthen families and prevent maltreatment should be expanded during economic downturns."
1 in 8 parents forgoes pediatrician-recommended care
One in eight parents reported that his or her child had not received pediatrician-recommended care – medication, laboratory testing and/or appointments with specialists – during the previous 12 months due to concerns over cost and payment, according to a study, presented Sunday, Oct. 3, at the American Academy of Pediatrics (AAP) National Conference and Exhibition in San Francisco.
For the study, "Parents Perspectives on their Children's Health Insurance: The Plight of the Underinsured," 1,978 southwest Ohio parents were queried regarding the impact of their children's health insurance on their ability to follow pediatric recommendations, as well as on their child's health. Children were considered "underinsured" if their parents had not been able to follow at least one recommendation from a pediatrician during the previous 12 months due to insufficient insurance coverage.
Forty-two percent of parents with underinsured children agreed with the statement their "child's health had suffered because of not being able to afford the cost of the needed care," compared to less than 2 percent of parents who were not underinsured
The study also found that private insurance is a risk factor for underinsurance. After controlling, for annual family income and health status, children with private insurance were about twice as likely as children with public insurance to be underinsured. In addition, children with poorer health or from poorer families (those with household incomes between $15,000 and $34,999) were at greater risk for underinsurance than children who were healthier or from wealthier families (household earning more than $75,000 annually).
"These results serve to highlight a major public health problem pediatricians have observed for years," said John M. Pascoe, MD, MPH, FAAP. The investigators believe that the explanation for the high level of child underinsurance among lower income families whose children do not qualify for public insurance is the high deductibles and co-pays imposed by their private insurance companies. Many parents believe their children's health has suffered as a direct result of their inability to afford recommended care for their underinsured children."
**Published in "Eurekalert.org"
For the study, "Parents Perspectives on their Children's Health Insurance: The Plight of the Underinsured," 1,978 southwest Ohio parents were queried regarding the impact of their children's health insurance on their ability to follow pediatric recommendations, as well as on their child's health. Children were considered "underinsured" if their parents had not been able to follow at least one recommendation from a pediatrician during the previous 12 months due to insufficient insurance coverage.
Forty-two percent of parents with underinsured children agreed with the statement their "child's health had suffered because of not being able to afford the cost of the needed care," compared to less than 2 percent of parents who were not underinsured
The study also found that private insurance is a risk factor for underinsurance. After controlling, for annual family income and health status, children with private insurance were about twice as likely as children with public insurance to be underinsured. In addition, children with poorer health or from poorer families (those with household incomes between $15,000 and $34,999) were at greater risk for underinsurance than children who were healthier or from wealthier families (household earning more than $75,000 annually).
"These results serve to highlight a major public health problem pediatricians have observed for years," said John M. Pascoe, MD, MPH, FAAP. The investigators believe that the explanation for the high level of child underinsurance among lower income families whose children do not qualify for public insurance is the high deductibles and co-pays imposed by their private insurance companies. Many parents believe their children's health has suffered as a direct result of their inability to afford recommended care for their underinsured children."
**Published in "Eurekalert.org"
El tiempo de espera en la consulta es un buen momento para que “Pensemos en la salud”
En el último número de la revista médico divulgativa “Pensemos en la salud”, editada por la Fundación Doctor Pascual, se ofrece información de salud especialmente pensada para hacerla llegar a los pacientes en esos minutos previos a ser atendidos en la consulta.
Se habla, por ejemplo, de las miopatías, y se explica cómo los ,músculos son muy sensibles al efecto tóxico de diversas sustancias de tipo industrial, vegetal o animal. Se recuerda a los pacientes que en la asistencia clínica suelen aparecer procesos de difícil diagnóstico, lo que explica la necesidad de preguntar en muchas ocasiones al paciente, por los hábitos alimenticos que haya podido seguir o por algún tipo de alimento que haya podido ingerir y que pudiera ser la causa de la dolencia.
En esta misma línea, se dan consejos sobre el anisakis, un gusano parásito del pescado que podemos ingerir sobre todo si la compra se ha hecho en sitios dudosos o de muy bajo precio. Para extremar las medidas de prevención se recomienda no comer pescado crudo o poco hecho, y si se congela, hacerlo a -20ºC por lo menos durante tres días y quitándole todas las vísceras.
En pleno inicio del curso escolar, se recuerdan los consejos impartidos recientemente en la sede de la Organización Médica Colegial (OMC) sobre la prevención de dolores de espalda en los niños. Se hace un llamamiento para que el peso que soporten los mismos no supere el 10% del peso corporal y se dan consejos como dejar el material en las taquillas del colegio, utilizar mochilas con ruedas, y trasladar a diario sólo el material escolar que se vaya a utilizar en ese día a fin de reducir la carga en todo lo posible.
“Pensemos en la salud” ofrece igualmente informaciones u consejos sobre las más diversas cuestiones relacionadas con la salud, como la diverticulosis, sinusitis, menopausia y terapia hormonal, calzado deportivo, etc.
**Publicado en "Médicos y pacientes"
Se habla, por ejemplo, de las miopatías, y se explica cómo los ,músculos son muy sensibles al efecto tóxico de diversas sustancias de tipo industrial, vegetal o animal. Se recuerda a los pacientes que en la asistencia clínica suelen aparecer procesos de difícil diagnóstico, lo que explica la necesidad de preguntar en muchas ocasiones al paciente, por los hábitos alimenticos que haya podido seguir o por algún tipo de alimento que haya podido ingerir y que pudiera ser la causa de la dolencia.
En esta misma línea, se dan consejos sobre el anisakis, un gusano parásito del pescado que podemos ingerir sobre todo si la compra se ha hecho en sitios dudosos o de muy bajo precio. Para extremar las medidas de prevención se recomienda no comer pescado crudo o poco hecho, y si se congela, hacerlo a -20ºC por lo menos durante tres días y quitándole todas las vísceras.
En pleno inicio del curso escolar, se recuerdan los consejos impartidos recientemente en la sede de la Organización Médica Colegial (OMC) sobre la prevención de dolores de espalda en los niños. Se hace un llamamiento para que el peso que soporten los mismos no supere el 10% del peso corporal y se dan consejos como dejar el material en las taquillas del colegio, utilizar mochilas con ruedas, y trasladar a diario sólo el material escolar que se vaya a utilizar en ese día a fin de reducir la carga en todo lo posible.
“Pensemos en la salud” ofrece igualmente informaciones u consejos sobre las más diversas cuestiones relacionadas con la salud, como la diverticulosis, sinusitis, menopausia y terapia hormonal, calzado deportivo, etc.
**Publicado en "Médicos y pacientes"
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