La prevalencia del CL es muy variable, se estima entre un 8 y un 40%. Esto se debe a la falta de cri
Aim The number of primary care paediatricians is decreasing in Europe without a justifiable reason. We aimed to compare the clinical practice of paediatricians and family doctors attending children and adolescents in primary care. Methods MEDLINE, Embase, CENTRAL, TRIP and Google Scholar were searched from December 2008 to February 2018. No language or study design restrictions were applied. Three reviewers assessed eligibility of the studies. Seven pairs of reviewers performed the data extraction and assessed the methodological quality independently. Discrepancies were resolved by consensus. Results Fifty‐four, out of 1150 studies preselected, were included. We found that paediatricians show more appropriate pharmacology prescription patterns for the illness being treated; they achieve higher vaccination rates and have better knowledge of vaccines and fewer doubts about vaccine safety; their knowledge and implementation of different screening tests are better; they prescribe psychoactive drugs more cautiously and more in line with current practice guidelines; their evaluation and treatment of obesity and lipid disorders follow criteria more consistently with current clinical practice guidelines; and they perform fewer diagnostic test, show a more suitable use of the test and request fewer referrals to specialists. Conclusion According to published data, in developed countries, paediatricians provide higher quality care to children than family doctors.
How can melatonin be useful to school age children and adolescents with sleep onset delay? Conclusiones de los autores: la melatonina demostró eficacia (parámetros de sueño) en escolares y adolescentes con retrasos de fase, adelantando el inicio, acortando la latencia y otros. Parece mayor el efecto administrando el fármaco en horas tempranas. Hubo pocos efectos adversos, ninguno de importancia. En vigilia (cognición, estado general, ánimo…), se encontraron pocas mejoras. Comentario de los revisores: los resultados prueban que la melatonina superó al placebo. Podría usarse, en casos seleccionados, con retrasos crónicos de la hora de inicio del sueño. Beneficio pequeño (dudosa significancia clínica) y desaparece tras periodos cortos de tratamientos. Faltan datos específicos para retrasos elevados de la hora de inicio del sueño. Aún no queda probado lo siguiente: tratamientos prolongados (seguridad, etc.), beneficios en vigilia, recomendar administración temprana. Las evidencias proceden de pocos estudios con muestras pequeñas; muchas procedentes de niños no sanos (elevados porcentajes de trastorno por déficit de atención e hiperactividad, comorbilidades y tratamientos estimulantes). Authors' conclusions: melatonin demonstrated efficacy (sleep parameters) in school aged children and adolescents whit delayed sleep phase disorders: advancing sleep onset time, delayed latency, and others. An earlier time of administration could increase the effect. The adverse events rates were: low (none serious). Results in waking hours (cognition, general health, mood…): few improvements. Reviewers' commentary: the results evidenced that melatonin did better than placebo. It could be used in selected cases of chronic sleep onset insomnia. Small benefit (doubtful clinical significance) that disappears after short-term treatment periods. Remain unproved: prolonged treatments (safety…); benefits in waking hours; recommendation of earlier time of administration. Patients with longer times of delay: not specifically investigated. Evidences coming from few studies of small sample size, most of them not from healthy children (high percentages of: ADHD, comorbidities and stimulants drugs). ESCENARIO CLÍNICO Consultan unos padres cuyo hijo de 12 años tiene problemas para quedarse dormido a una hora apropiada. No suele dormirse hasta la una de la madrugada aunque se acueste sobre las 22:00 horas. Es un niño sano, le va bien en el colegio, no tiene problemas de comportamiento, es deportista y no tiene antecedentes médicos relevantes (adenoidectomía a los tres años, sin problemas respira-Este artículo se publica simultáneamente con la revista electrónica Evidencias en Pediatría (www.evidenciasenpediatria.es). Barroso Espadero D, et al. ¿Qué puede aportar el tratamiento con melatonina a niños mayores y adolescentes con retraso de inicio de sueño?
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