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Introducción: desde la Junta Directiva de la Asociación Española de Pediatría de Atención Primaria (AEPap) nos planteamos realizar un análisis comparativo de la situación de la asistencia a la población infantojuvenil en Atención Primaria en las distintas comunidades autónomas españolas a través de los datos aportados por las diferentes sociedades autonómicas federadas. Material y métodos: en la primavera de 2010 realizamos una encuesta utilizando la tecnología Web 2.0 a 16 pediatras expertos conocedores de la situación de la asistencia a la población infantojuvenil en España, uno por cada una de las comunidades autónomas federadas en la AEPap. Han contestado a 39 preguntas consensuadas seleccionadas que buscan diferencias organizativas y asistenciales intercomunitarias. Resultados: se han encontrado importantes discrepancias en la manera de organizar las consultas de Atención Primaria entre las distintas regiones, que generan inequidades para los niños, sus familias y los profesionales. Discusión y conclusiones: hemos denominado "puntos negros" a las características más desfavorables, como plazas de Pediatría de Atención Primaria cubiertas por profesionales sin la especialidad, escasez de personal de Enfermería Pediátrica, horarios de trabajo vespertinos, sueldos bajos y dificultades en el acceso a Internet. Las comunidades más deficientes en la calidad de la asistencia pediátrica son Andalucía y Madrid con tres de estos puntos negros; seguidas de Cataluña y Murcia, con dos. Corresponde a la Administración sanitaria mejorar estas diferencias, o se crearán divergencias insalvables en los recursos adjudicados a la asistencia sanitaria de los niños y adolescentes en función del lugar donde residan (AU)

Introduction: the board of directors of the Spanish Association of Primary Care Paediatrics (AEPap) decided to address an analysis comparing the situation of child and adolescent assistance in primary care in different regions through the data provided by the corresponding regional federated societies. Material and methods: in spring 2010 we conducted a survey using Web 2.0 technology with 16 expert paediatricians on the status of child and adolescent primary health care in Spain, we chose one paediatrician for each of the Spanish autonomous region. They answered 39 selected consensuated questions seeking organizational and intercommunity health care differences. Results: we found significant discrepancies in the way of organizing the consultations in primary care among different regions. It generates iniquities to children, their families and professionals. We defined weak points as the posts with the most unfavourable features, such as general practitioners in paediatric offices, shortage of paediatric nursing, long work hours (work in the evening), low wages and lack of access to the Internet. The worst communities in this regard are Andalucia and Madrid with three of these weak points, followed by Catalonia and Murcia. We have only found four communities without weak points of care. Conclusion: to reduce these differences in order to avoid important gaps in health resources devoted to children and adolescents falls on health authorities (AU)

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Introducción: la Junta Directiva de la Asociación Española de Pediatría de Atención Primaria (AEPap) nos planteamos realizar un análisis comparativo de la situación de la asistencia a la población infantojuvenil en Atención Primaria en las distintas comunidades autónomas españolas a través de los datos aportados por las diferentes sociedades autonómicas federadas. En este artículo se expone la segunda parte del estudio. Material y métodos: en la primavera de 2010 realizamos una encuesta utilizando la tecnología de la Web 2.0 a 16 pediatras expertos conocedores de la situación de la asistencia a la población infantojuvenil en España, uno por cada una de las comunidades autónomas federadas en la AEPap. Han contestado a 39 preguntas consensuadas seleccionadas que buscaban diferencias organizativas y asistenciales intercomunitarias. Resultados: se han encontrado importantes discrepancias en la manera de organizar las consultas de Atención Primaria entre las distintas regiones que generan inequidades para los niños, sus familias y los profesionales. Discusión y conclusiones: hemos denominado "puntos negros" a las características más desfavorables, como plazas de Pediatría de Atención Primaria cubiertas por profesionales sin la especialidad, escasez de Enfermería Pediátrica, horarios de trabajo vespertinos, sueldos bajos y dificultades en el acceso a Internet. Las comunidades más deficientes en la calidad de la asistencia pediátrica son Andalucía y Madrid, con tres de estos puntos negros; las siguen Cataluña y Murcia con dos. Corresponde a la Administración sanitaria mejorar estas diferencias o se crearán divergencias insalvables en los recursos adjudicados a la asistencia sanitaria de los niños y adolescentes en función del lugar donde residan (AU)

Introduction: The board of directors of the Spanish Association of Primary Care Paediatrics (AEPap) decided to address an analysis comparing the situation of child and adolescent assistance in primary care in different regions through the data provided by the corresponding regional federated societies. Material and methods: In spring 2010 we conducted a survey using Web 2.0 technology with 16 expert paediatricians on the status of child and adolescent primary health care in Spain, we chose one paediatrician for each of the Spanish autonomous region. They answered 39 selected consensuated questions seeking organizational and intercommunity health care differences. Results: We found significant discrepancies in the way of organizing consultations in primary care between different regions. It generates iniquities to children, their families and professionals. We defined weak points as the posts with most unfavourable features such as general practitioners in paediatric offices, shortage of paediatric nursing, long work hours (work in the evening), low wages and lack of access to the Internet. The worst communities in this regard are Andalucia and Madrid with three of these weak points, followed by Catalonia and Murcia. We have only found four communities without weak points of care. Conclusion: To reduce these differences in order to avoid important gaps in health resources devoted to children and adolescents falls on health authorities (AU)

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Los pediatras que trabajamos en el primer nivel asistencial estamos de acuerdo con los expertos que los países con una Atención Primaria (AP) de calidad, presentan mejores índices de salud, son más eficientes y reparten de forma más equitativa los recursos sanitarios entre la población. La Pediatría de AP (PAP) en nuestra Comunidad Autónoma tiene en este momento déficit de profesionales, que es más acusado en las zonas rurales. Esto supone una amenaza para el actual modelo de asistencia infantil, relegando a un segundo plano aspectos tan importantes como son la calidad de la asistencia pediátrica, las expectativas de las familias y las opiniones de los profesionales sanitarios. El pediatra se ha visto aislado dentro de los Equipos de Atención Primaria y apenas ha recibido apoyo del resto de profesionales del mismo. Es necesario que se consigan “equipos de profesionales” que compartan una población, en un entorno geográfico delimitado, que la estructura y organización de los centros de salud posibilite espacios temporales y físicos para el trabajo en equipo y que se avance en fórmulas más actuales de gestión de la demanda, que impliquen a cada uno de los miembros del equipo en la respuesta a las demandas de la ciudadanía. La PAP debe orientar su práctica hacia la calidad asistencial y en la consecución de objetivos. Se deben establecer criterios e indicadores de calidad y de buenas prácticas (AU)

The pediatricians who work in the first level of care agree with experts that countries with a high quality Primary Health Care (AP), have better health rates, are more efficient and distribute health resources more equitably among the population. Primary Care Pediatrics in our region has at present a shortage of professionals, which is more pronounced in rural areas. This poses a threat to the current model of child care, relegating to the background such important issues as the quality of pediatric care, family expectations and the health professionals’ opinions. The pediatrician has been isolated within the Primary Care Teams and has hardly received support from other professionals of it. It is necessary to get "professional teams" that share a population in a defined geographical environment, that the structure and organization of health centers enable temporal and physical spaces for team work and that progress on current formulas of demand management are made, involving each of the team members in responding to the demands of citizenship. The AP Pediatrics should aim its practice to the quality of care and to the achieving of goals. Criteria and indicators of quality and good practice should be established (AU)

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We review the cases of 148 children with Henoch-Schönlein purpura diagnosed in a period of seventeen years (from 1975 to 1992). Thirteen cases (8.7%) of unusual clinical manifestations were found: testicular affection in six cases (7.6% of the males); IgA nephropathy in four (2.7%); exudative enteropathy in two (1.3%); duodenal syndrome in two; previous abdominal manifestation which led to surgical procedures in one (0.7%) and another case with detachment of the retina. These clinical findings are analyzed and the possibility of unnecessary therapeutic acts is discussed.

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Kidney disease Prevention in childhood can be made from three levels. In the first level or Primary Prevention one must prevent kidney disease taking steps for "Kidney Health" promotion: environmental factors, nourishing, sanitary education and preventive pediatrics. Secondary Prevention lies in the correct diagnostic during first years in life and in a suitable treatment of the kidney diseases, especially in children to have a kidney failure risk: obstructive uropathy and vesicoureteral reflux. Tertiary Prevention deals with aggravating factors in an established Kidney chronic failure, and its prevention includes: normoproteic diet, phosphorus restriction, arterial hypertension control and nutritional and pharmacological steps to reduce the hyperlipidemia.

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Hypouricaemia due to an isolated renal tubular defect is a rare condition. Several members from an affected family are described. The propositus is a 12-year-old girl with hypouricaemia (0.7-1.1 mg/dl) and increased fractional excretion of uric acid (50%). Pyrazinamide and sulphinpyrazone tests revealed an attenuated response in this subject to both drugs. The mother and one of the propositus' two brothers have the same defect. The other brother has uric acid levels at the lower limit of normal and increased fractional excretion of uric acid. These results suggest familial hypouricaemia due to a pre-secretory reabsorptive tubular defect, transmitted by autosomal dominant inheritance.

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Eight-hundred and nine consecutive admissions have been reexamined by means of analysis of record cards made out at the moment of discharge from the ICU, in which, among other data, the TISS and PSI maximum for the first six hours from admission are included. The results obtained are the following: 50% of the admissions were classified as medium care (PSI < 5, TISS < 20), 28% were grade IV (PSI > 12, TISS > 40), and half were of grade III with a PSI of 9.38 and a TISS of 20.29. The overall mortality was 8.9%. However, the mortality for grades III+IV was 13.4% and gave a good correlation with the PSI, but not with the TISS. The PSI/TISS ratio was 0.45 and the predicted mortality rate according to the PSI was 6.1% for grade III and greater than 12% for grade IV. We conclude the following: (1) Of the illness, 28% were grade IV. (2) We observed a deficient PSI/TISS ratio. (3) The evaluation has to be done by objective means in which the capability of carrying out different methodologies has not been taken into account.

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