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¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË ™. ∞Ó‰ÚÔÓ›ÎÔ˘ ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ °. µ·ÚÏ¿Ì˘ ∂. °·Ï·Ó¿Î˘ §. £ˆÌ·˝‰Ô˘ ª. ∫·Ó¿ÚÈÔ˘ A. K·ÙÙ¿Ì˘ ™. K›ÙÛÈÔ˘-∆˙¤ÏË ∞. ¶··‰ÔÔ‡ÏÔ˘ µ. ¶··Â˘·ÁÁ¤ÏÔ˘ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∂. ÷ÚÌ·Ó‰¿ÚË ÀÔ‚ÔÏ‹ ∂ÚÁ·ÛÈÒÓ e-mail: hps@ath.forthnet.gr
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¶ƒ∞∫∆π∫√ £∂ª∞
417 ¶ÈÛÙÔÔÈËÙÈο ˘Á›·˜ ·È‰È΋˜ ËÏÈΛ·˜: ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·fi ·È‰›·ÙÚÔ Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ π. °ÂÚÌ·Ó¿Î˘, I. ¶··ÁÈ¿ÓÓ˘, °. µ·ÚÏ¿Ì˘
482 ™ÙÔÌ·ÙÈΤ˜ ¤ÍÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜: Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ °. ∆ÛfiÏ·˜
426 ∏ ›‰Ú·ÛË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ ∞. ¶Ú·ÛÔ‡ÏË, ∞. ∞ÙÙÈÏ¿ÎÔ˜, π. ∞ÓÙˆÓÈ¿‰Ô˘ 434 ∂ıÈÛÌfi˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· ∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯·
∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ 486 M·ÛÙÔ΢ÙÙ¿ÚˆÛË ÛÙ· ·È‰È¿: ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ µ. ∞ÁÁÂÏ¿ÎÔ˘, ª. ∫Ô˘ÙÏ‹, ¡. ¶··‰fiÔ˘ÏÔ˜, ∂. ª·ÓÔ˘Û¿Î˘, ¶. •Â··‰¿ÎË, π. ÷ڈӛÙË, º. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘
∂ƒ∂À¡∏∆π∫∂™ ∂ƒ°∞™π∂™ √‰ËÁ›Â˜ ÚÔ˜ ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜: http://www.e-child.gr/Instructions_ to_Authors_GR.pdf ºÈÏÔÏÔÁÈ΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ∫. ¶··¯Ú‹ÛÙÔ˘ EÈ̤ÏÂÈ· ·ÁÁÏÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ™. ¡¿ÎÔ˘ EΉfiÙ˘ K. °ÚÈ‚¤·˜ ™˘ÓÙÔÓÈÛÙ‹˜ ∂ΉfiÛˆ˜ E¶I™THMONIKE™ EK¢O™EI™ E.¶.E. ¶ÈÂÚ›·˜ 1∞ 144 51 MÂÙ·ÌfiÚʈÛË TËÏ.: 210 87 78 810 Fax: 210 87 78 822 I‰ÈÔÎÙ‹Ù˘ EÏÏËÓÈ΋ ¶·È‰È·ÙÚÈ΋ EÙ·ÈÚ›·© Mȯ·Ï·ÎÔÔ‡ÏÔ˘ 92 Aı‹Ó· 115 28 TËÏ.: 210 7771 140 210 7771 663 Fax: 210 7758 354 e-mail: hps@ath.forthnet.gr EÙ‹ÛÈ· ™˘Ó‰ÚÔÌ‹: 40 € EȉÈ΢fiÌÂÓÔÈ, ºÔÈÙËÙ¤˜: 20 € ∫ˆ‰ÈÎfi˜ ¢È‡ı˘ÓÛ˘ ∂ÔÙ›·˜ ªª∂: 3889
ISSN 0377-2551
441 ªÂϤÙË Ù˘ ¯Ú‹Û˘ Î·È Î·Ù¿¯ÚËÛ˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜ ∞. ∆Û›ÙÛÈη, ∂. ∫ÚÈÙÛ¤ÏË, ∂. ∫ˆÓÛÙ·ÓÙÔ˘Ï¿ÎË, °. ∫ÔÚÌ¿˜, ∞. ºÈÏÈÔÔ‡ÏÔ˘, ¢. ∆Ô˘ÓÈÛÛ›‰Ô˘, ∞. ºÚ¤ÛÎÔ˘, £. ™ËÏÈÔÔ‡ÏÔ˘, ∞. §Ô˘›˙Ô˘, A. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜, ¢. ∫·ÊÂÙ˙‹˜
∫§π¡π∫√ ∫√Àπ∑ 493 ª. ∫·ÏÏÈÒÚ·, ª. ª·˘Ú›ÎÔ˘ ™À¡∆√ª∞ ¶∞π¢π∞∆ƒπ∫∞ ¡∂∞ 494 K·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ 2008 E. °·Ï·Ó¿Î˘
449 ∏ ¯Ú‹ÛË ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ˘ÔÏÔÁÈÛÙÒÓ Î·È ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ·fi ·È‰È¿-ÂÊ‹‚Ô˘˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ ∞. ¶··‰ÔÔ‡ÏÔ˘, °. ª›¯·˜, º. ª›¯·˜, ∞. ∑ÂÚ‚Ô˘‰¿ÎË, ∫. ∆ÛÔ˘Ì¿Î·˜, ¶. °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯·
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458 ∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜: ∞’ ∆∂™∆ ™. ª·ÓÙÔ‡‰Ë˜, §. £ˆÌ·˝‰Ô˘
502 ∂Àƒ∂∆∏ƒπ√ ™À°°ƒ∞º∂ø¡ ∆√À ∆√ª√À 71
469 ¶ÚfiÙ˘Ô ÚfiÁÚ·ÌÌ· ·ÁˆÁ‹˜ Î·È ÚÔ·ÁˆÁ‹˜ ˘Á›·˜ Û ·ÛÙÈ΋ ÎÔÈÓfiÙËÙ· ·fi ÊÔÚ¤· ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ ∞. •ÂηϿÎË, ¢. ª¤ÓÂÁ·˜, ∞ÈÎ. ∑ÔÏÒÙ·, ∑. ∏ÏÈÔ‰ÚÔÌ›ÙË, ∞. ¶Ú·ÛÔ‡ÏË, ∂. ∆˙›ÓË, ¶. ª·˘Ú›Î·, ∞ÈÎ. ¢ËÌÔÔ‡ÏÔ˘, ∞. ª¿ÚÁ·ÚË, π. ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘ 475¢ÈÂÚ‡ÓËÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÓÔÌÔıÂÛ›·˜ ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÎÔÈÓÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÈÏÂÁ̤ӷ ÂÏÏËÓÈο ÙÚfiÊÈÌ· ∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ∂. ™ÙÚÔ˘Ì‹, ¡.°. ¶··‰fiÔ˘ÏÔ˜, µ. ∫·Ú·ı¿ÓÔ˜
496 πÛÙÔÛÂÏ›‰Â˜ ÁÂÓÂÙÈ΋˜ ∂. °È·ÓÓ¿ÙÔ˘, ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË 501 ∂Àƒ∂∆∏ƒπ√ ∫ƒπ∆ø¡ ∆√À ∆√ª√À 71
505 ∂Àƒ∂∆∏ƒπ√ §∂•∂ø¡-∫§∂π¢πø¡ ∆√À ∆√ª√À 71
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Bimonthly Publication of the Greek Paediatric Society
Paediatriki
President A. Constantopoulos Editorial Board Editor-in-Chief C. Stefanidis
Volume 71 ñ Number 6 ñ November-December 2008
Members S. Andronikou ª. ∞nthracopoulos P. Augoustides-Savvopoulou G. Varlamis ∂. Galanakis L. Thomaidou M. Kanariou A. Kattamis S. Kitsiou-Tzeli ∞. Papadopoulou V. Papaevagelou A. Siamopoulou-Mavridou A. Syrigou-Papavasiliou E. Charmandari
REVIEW ARTICLES
PRACTICAL ISSUE
417 Child health certificates: cardiovascular examination by the paediatrician guidelines I. Germanakis, π. Papagiannis, G. Varlamis
482 Non-nutritive sucking habits: their influence on children’s health G. Tsolas
426 The effect of childhood epilepsy on cognitive function and behaviour A. Prassouli, A. Attilakos, I. Antoniadou
CASE REPORT
Manuscript submission
434 Internet addiction in adolescence ∞. Papadopoulou, P. Georgiopoulou-Micha
486 Mastocytosis in children: a report of two cases V. Aggelakou, M. Koutli, N. Papadopoulos, E. Manoussakis, P. Xepapadaki, I. Charoniti
ORIGINAL ARTICLES
CLINICAL QUIZ
441 Study on the use and misuse of internet among Greek adolescents ∞. Tsitsika, ∂. Kritseli, ∂. Konstantoulaki, G. Kormas, ∞. Filippopoulou, D. Tounissidou, ∞. Freskou, T. Spiliopoulou, ∞. Louizou, A. Constantopoulos, D. Kafetzis
493 ª. Kalliora, ª. Mavrikou
e-mail: hps@ath.forthnet.gr Instructions to authors: http://www.e-child.gr/paediatriki/ iae.pdf Manuscript Editing Greek Editing K. Papachristou English Editing S. Nakou Publisher
Contents
449 Computer and internet use by school age children in Athens A. Papadopoulou, G. Michas, F. Michas, A. Zervoudakis, K. Tsoumakas, P. Georgiopoulou-Miha
K. Griveas
458 The A TEST; assessment of school readiness S. Mantoudis, L. Thomaidis
Publishing Coordinator
469 Model health promotion program in an urban community by a primary health care setting A. Xekalaki, D. Menegas, K. Zolota, Z. Iliodromiti, A. Prasouli, E. Tzini, P. Mavrika, K. Dimopoulou, A. Margari, I. Antoniadou-Koumatou
SCIENTIFIC PUBLICATIONS Ltd. 1∞ Pierias St. GR - 144 51, Metamorfossi Tel.: +30 210 87 78 810 Fax: +30 210 87 78 822 Owner Greek Paediatric Society© 92 Michalakopoulou St. GR - 115 28, Athens Tel.: +30 210 7771 140 +30 210 7771 663 Fax: +30 210 7758 354 e-mail: hps@ath.forthnet.gr Annual Subscription All foreign countries: US $ 50
475 Application of the legislation on allergen labelling for selected food products in the Greek market ∞. Vassilopoulou, ∂. Stroumpi, ¡.G. Papadopoulos, V. Karathanos
PAEDIATRIC NEWS IN BRIEF 494 Guidelines 2008 E. Galanakis NEWS FROM THE INTERNET 496 Genetics Sites E. Giannatou, S. Kitsiou-Tzeli 501 REVIEWERS OF MANUSCRIPTS INDEX, VOLUME 71 502 AUTHORS INDEX, VOLUME 71 505 KEY WORDS INDEX, VOLUME 71
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™À¡∆∞∫∆π∫∏ E¶π∆ƒ√¶∏
EDITORIAL BOARD
¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘
Editor-in-Chief
∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜, ∞ı‹Ó·
Constantinos Stefanidis, Athens
∂ȉÈÎÔ› ™˘ÓÙ¿ÎÙ˜
Section Editors
™Ù¤ÏÏ· ∞Ó‰ÚÔÓ›ÎÔ˘, ¡ÂÔÁÓÔÏÔÁ›·, πˆ¿ÓÓÈÓ·
Stella Andronikou, Neonatology, Ioannina
ªÈ¯·‹Ï ∞ÓıÚ·ÎfiÔ˘ÏÔ˜, ¶Ó¢ÌÔÓÔÏÔÁ›·, ¶¿ÙÚ·
Michael Anthracopoulos, Pneumonology, Patras
¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘, MÂÙ·‚ÔÏÈο ÓÔÛ‹Ì·Ù·, £ÂÛÛ·ÏÔÓ›ÎË
Persefoni Avgoustides-Savvopoulou, Metabolic Disorders, Thessaloniki
°ÂÒÚÁÈÔ˜ µ·ÚÏ¿Ì˘, ∫·Ú‰ÈÔÏÔÁ›·, £ÂÛÛ·ÏÔÓ›ÎË
George Varlamis, Cardiology, Thessaloniki
∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘, ∏ıÈ΋ Î·È ¢ÂÔÓÙÔÏÔÁ›·, ∏Ú¿ÎÏÂÈÔ
Emmanouil Galanakis, Ethics and Deontology, Heraklion
§ˆÚ¤ÙÙ· £ˆÌ·˝‰Ô˘, ∞Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜, ∞ı‹Ó·
Loretta Thomaidou, Developmental Pediatrics, Athens
ª·Ú›· ∫·Ó¿ÚÈÔ˘, ∞ÓÔÛÔÏÔÁ›·, ∞ı‹Ó·
Maria Kanariou, Immunology, Athens
∞ÓÙÒÓ˘ ∫·ÙÙ¿Ì˘, ∞ÈÌ·ÙÔÏÔÁ›· - OÁÎÔÏÔÁ›·, ∞ı‹Ó·
Antonis Kattamis, Haematology - √ncology, Athens
™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË, °ÂÓÂÙÈ΋, ∞ı‹Ó·
Sophia Kitsiou-Tzeli, Genetics, Athens
∞ÏÂÍ¿Ó‰Ú· ¶··‰ÔÔ‡ÏÔ˘, °·ÛÙÚÂÓÙÂÚÔÏÔÁ›· - ¢È·ÙÚÔÊ‹, ∞ı‹Ó·
Alexandra Papadopoulou, Gastroenterology - Nutrition, Athens
µ·ÛÈÏÈ΋ ¶··Â˘·ÁÁ¤ÏÔ˘, §ÔÈ̈ÍÈÔÏÔÁ›·, ∞ı‹Ó·
Vassiliki Papaevagelou, Infectious Diseases, Athens
∞ÓÙÈÁfiÓË ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘, ƒÂ˘Ì·ÙÔÏÔÁ›·, πˆ¿ÓÓÈÓ·
Antigoni Siamopoulou-Mavridou, Rheumatology, Ioannina
∞ÓÙÈÁfiÓË ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ, ¡Â˘ÚÔÏÔÁ›·, ∞ı‹Ó·
Antigone Syrigou-Papavasiliou, Neurology, Athens
∂˘·ÁÁÂÏ›· ÷ÚÌ·Ó‰¿ÚË, ∂Ó‰ÔÎÚÈÓÔÏÔÁ›·, ∞ı‹Ó·
Evangelia Charmandari, Endocrinology, Athens
ª¤ÏË Ù˘ ¢ÈÂıÓÔ‡˜ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ ñ Members of the International Editorial Board Alexis Arzimanoglou, Paris, France
Peter Hoyer, Essen, Germany
Ellis D. Avner, Milwaukee, USA
Jan Janda, Prague, Czech Republic
Swati Bhave, New Delhi, India
Jan Kimpen, Ultrecht, Netherlands
Alberto Bissot, Panama, Panama
Craig B. Langman, Chicago, USA
David Branski, Jerusalem, Israel
John Manis, Boston, USA
Francesco Chiarelli, Chieti, Italy
Manuel Moya, Alicante, Spain
Chok-Wan Chan, Hong Kong, China
Hugh O'Brodovich, Toronto, Canada
Denis Daneman, Toronto, Canada
Ross Petty, Vancouver, Canada
Jochen Ehrich, Hannover, Germany
Willem Proesmans, Leuven, Belgium
Demetrius Ellis, Pittsburgh, USA
Jose Ramet, Antwerp, Belgium
Yoshikatsu Eto, Tokyo, Japan
Nikolai Shabalov, St. Petersburg, Russia
Richard N. Fine, Stony Brook, USA
Alan Sinaiko, Minneapolis, USA
Margaret C. Fisher, Philadelphia, USA
Nick J. Spencer, Coventry, UK
Raif Geha, Boston, USA
Alfred Tenore, Udine, Italy
Adenike Grange, Lagos, Nigeria
Alkis Togias, Bethesda, USA
Judith G. Hall, Vancouver, Canada
Eva Tsalikian, Iowa City, USA
Patricia Hamilton, London, UK
Catherine Weil-Olivier, Paris, France
Enver Hasanoglu, Ankara, Turkey
Max Zach, Graz, Austria
Christer Holmberg, Helsinki, Finland
Zheng-Yan Zhao, Hangzhou, China
Lewis B. Holmes, Boston, USA
Johannes Zschocke, Heidelberg, Germany
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EDITORIAL
∞Á·ËÙÔ› Û˘Ó¿‰ÂÏÊÔÈ, ∂Π̤ÚÔ˘˜ Ù˘ ™˘ÓÙ·ÎÙÈ΋˜ ∂ÈÙÚÔ‹˜ Ù˘ “¶·È‰È·ÙÚÈ΋˜” Û·˜ ‡¯ÔÌ·È Î·Ï¿ ÃÚÈÛÙÔ‡ÁÂÓÓ· Î·È ¤Ó· ¯·ÚÔ‡ÌÂÓÔ Î·È ‰ËÌÈÔ˘ÚÁÈÎfi ηÈÓÔ‡ÚÁÈÔ ¯ÚfiÓÔ. ªÂ ÙËÓ Â˘Î·ÈÚ›· ·˘Ù‹, ı· ı¤Ï·Ì ӷ Û·˜ ¢¯·ÚÈÛÙ‹ÛÔ˘Ì ÁÈ· ÙÔ Û˘Ó¯¤˜ ÂӉȷʤÚÔÓ Û·˜ ÁÈ· ÙÔ ÂÚÈÔ‰ÈÎfi Î·È ÂÚÈ̤ÓÔ˘Ì ÙȘ ÚÔÙ¿ÛÂȘ Û·˜ ÁÈ· ÌÂÏÏÔÓÙÈΤ˜ ·ÏÏ·Á¤˜ Î·È ‚ÂÏÙÈÒÛÂȘ. π‰È·›ÙÂÚ· ¢¯·ÚÈÛÙԇ̠ÙÔ˘˜ Û˘ÁÁÚ·Ê›˜, ÙÔ˘˜ ÎÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Î·È fiÏÔ˘˜ fiÛÔ˘˜ Û˘ÓÂÈÛ¤ÊÂÚ·Ó ÛÙËÓ ÂÈÙ˘¯›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∂›Ì·È Û›ÁÔ˘ÚÔ˜ fiÙÈ Ì ÙË ‰È΋ Û·˜ Û˘Ì‚ÔÏ‹ Î·È Ô ÂfiÌÂÓÔ˜ ¯ÚfiÓÔ˜ ı· Â›Ó·È ‰ËÌÈÔ˘ÚÁÈÎfi˜ ÁÈ· ÙËÓ “¶·È‰È·ÙÚÈ΋”.
ªÂ ıÂÚÌÔ‡˜ ¯·ÈÚÂÙÈÛÌÔ‡˜,
∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘
Dear colleagues, On behalf of the Editorial Board of “Paediatriki”, I wish you Merry Christmas and a happy and creative new year. On this occasion, we would like to thank you for your continuous participation to the journal and we look forward for your advice and feedback. We would especially like to thank the authors, the reviewers and each one of you who has contributed to the success of the journal. I am sure that with your contributions the New Year will also prove to be creative for “Paediatriki”. Warm greetings, Constantinos Stefanidis Editor-in-Chief
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∞¡∞™∫√¶∏™∏
REVIEW ARTICLE
417
¶ÈÛÙÔÔÈËÙÈο ˘Á›·˜ ·È‰È΋˜ ËÏÈΛ·˜: ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ·fi ·È‰›·ÙÚÔ - ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ π. °ÂÚÌ·Ó¿Î˘1, I. ¶··ÁÈ¿ÓÓ˘2, °. µ·ÚÏ¿Ì˘3 ¶ÂÚ›ÏË„Ë: √ ¤ÏÂÁ¯Ô˜ Î·È Ë ÈÛÙÔÔ›ËÛË Ù˘ ηډȷÁÁÂȷ΋˜ ˘Á›·˜ Â›Ó·È ˘Ô¯ÚˆÙÈ΋ ‰È·‰Èηۛ· ÛÙË ¯ÒÚ· Ì·˜ ÁÈ· fiÏ· Ù· ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜, Ì ÛÙfi¯Ô ÙËÓ ·ÛÊ·Ï‹ ÙÔ˘˜ Û˘ÌÌÂÙÔ¯‹ ÛÙȘ Û¯ÔÏÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ÂÓÒ ÚfiÛıÂÙË ÈÛÙÔÔ›ËÛË ˙ËÙÂ›Ù·È ·fi ÔÚÁ·ÓˆÌ¤ÓÔ˘˜ ·ıÏËÙÈÎÔ‡˜ Û˘ÏÏfiÁÔ˘˜. ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÙfiÛÔ Ô ıÂÛÌÔıÂÙË̤ÓÔ˜ ηډȷÁÁÂÈ·Îfi˜ ¤ÏÂÁ¯Ô˜, ÛÙ· Ï·›ÛÈ· ÙÔ˘ ∞ÙÔÌÈÎÔ‡ ¢ÂÏÙ›Ô˘ ÀÁ›·˜ ÙˆÓ Ì·ıËÙÒÓ, fiÛÔ Î·È Ë Û˘Ó‹ı˘ Ú·ÎÙÈ΋ ÚÔ-·ÁˆÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÛÙ· Ï·›ÛÈ· Â͈ۯÔÏÈÎÒÓ ·ıÏËÙÈÎÒÓ ‰Ú·ÛÙËÚÈÔًوÓ. ªÂ ‚¿ÛË ÙȘ ÚfiÛÊ·Ù˜ ‰ÈÂıÓ›˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜, Ô ıÂÛÌÔıÂÙË̤ÓÔ˜ ¤ÏÂÁ¯Ô˜ ÌÔÚ› Ó· Á›ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔ˜, Ì ÙËÓ ÚÔÛı‹ÎË ÂÚ·ÈÙ¤Úˆ ÏËÚÔÊÔÚÈÒÓ ÙÔ˘ ·ÙÔÌÈÎÔ‡ ηÈ, ȉ›ˆ˜, ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ÙË Û˘Ó˘Â˘ı˘ÓfiÙËÙ· ÙˆÓ ÎˉÂÌfiÓˆÓ ÛÙËÓ ÂÁ΢ÚfiÙËÙ· ÙˆÓ ÏËÚÔÊÔÚÈÒÓ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, ÙËÓ ÚÔÙ˘ÔÔÈË̤ÓË ÎÏÈÓÈ΋ ÂͤٷÛË Î·È, Èı·ÓÒ˜, ÙËÓ ÂÈÙ¤ÏÂÛË ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ Û ÂÚÈÙÒÛÂȘ Û˘ÌÌÂÙÔ¯‹˜ Û ÔÚÁ·ÓˆÌ¤ÓË ·ÓÙ·ÁˆÓÈÛÙÈ΋ ¿ıÏËÛË. ∫·ıÒ˜, fï˜, ηӤӷ Û‡ÛÙËÌ· ÂϤÁ¯Ô˘ ‰ÂÓ ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ Ìˉ·ÌÈÓfi ΛӉ˘ÓÔ Î·Ù¿ ÙË Û˘ÌÌÂÙÔ¯‹ Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· ˘„ËÏ‹˜ ¤ÓÙ·Û˘, Ë ÏÂÙÔÌÂÚ‹˜ Ï‹„Ë ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Î·È Ë ÎÏÈÓÈ΋ ÂͤٷÛË ·Ú·Ì¤ÓÔ˘Ó ÙÔ ‚·ÛÈÎfi ̤ÛÔ ÂϤÁ¯Ô˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ·ıÏÔ‡ÓÙ·È, Ô˘ ȉˆ‰Ò˜ ı· Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ·ÔÎÏÂÈÛÙÈο Î·È ÌfiÓÔ ·fi ηϿ ÂÎ·È‰Â˘Ì¤ÓÔ ÁÂÓÈÎfi ·È‰›·ÙÚÔ.
1 π·ÙÚÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ 2 ¶·È‰ÔηډÈÔÏÔÁÈ΋ ∫ÏÈÓÈ΋, °ÂÓÈ΋ ª·È¢ÙÈ΋/°˘Ó·ÈÎÔÏÔÁÈ΋ & ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ “ªËÙ¤Ú·” 3 π·ÙÚÈ΋ ™¯ÔÏ‹, ∞ÚÈÛÙÔÙ¤ÏÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ AÏÏËÏÔÁÚ·Ê›·: πˆ¿ÓÓ˘ °ÂÚÌ·Ó¿Î˘ germjohn@med.uoc.gr ¶·È‰ÔηډÈÔÏÔÁÈ΋ ªÔÓ¿‰·, ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi °.¡. ∏Ú·ÎÏ›Ԣ µÔ‡Ù˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘
§¤ÍÂȘ ÎÏÂȉȿ: ∞ıÏËÙÈÛÌfi˜, ·È‰›, ÈÛÙÔÔ›ËÛË ˘Á›·˜, ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜, ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜.
Child health certificates: cardiovascular examination by the paediatrician - guidelines I. Germanakis1, π. Papagiannis2, G. Varlamis3 Abstract: Preparticipation cardiovascular evaluation is obligatory for all children in Greece before participation in school athletic activities, while additional evaluation is requested by individual sports clubs. The current policy regarding preparticipation screening in Greece was reviewed. According to recent practice guidelines, the current screening practices could be improved by the addition of further details of the personal and family history, parental confirmation of the accuracy of the history provided, the use of a standardized physical evaluation and possibly the performance of an electrocardiogram before participation in competitive sports. However, as none of the current preparticipation screening systems can guarantee a ‘zero risk’ state during high intensity competitive sports, effective screening continues to be based on a detailed personal and family history and physical evaluation performed by a well trained general paediatrician.
Key words: Sports, child, preparticipation screening, cardiac evaluation, guidelines.
∏ ۈ̷ÙÈ΋ ¿ÛÎËÛË ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ Û˘ÓÈÛÙÒÛ· οı ÂÎ·È‰Â˘ÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜, ‹‰Ë ·fi ÙËÓ ÎÏ·ÛÈ΋ ·Ú¯·ÈfiÙËÙ·. π‰Â҉˘ ÌÔÚÊ‹ ¿ıÏËÛ˘ ÁÈ· Ù· ·È‰È¿ Â›Ó·È Ë Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ Û ‰Ú·ÛÙËÚÈfiÙËÙ˜ Û˘Ì‚·Ù¤˜ Ì ÙË ÛˆÌ·ÙÈ΋ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋ ÙÔ˘˜ ·Ó¿Ù˘ÍË, Ì ÙË ÌÔÚÊ‹ ÂχıÂÚÔ˘ ·È¯ÓȉÈÔ‡, fiÔ˘ ÂÈ‚Ú·‚‡ÂÙ·È Ë ÚÔÛ¿ıÂÈ· Î·È Ë Û˘ÌÌÂÙÔ¯‹ (1). ¢˘ÛÙ˘¯Ò˜ Ô Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜ ¤¯ÂÈ ÛÙÂÚ‹ÛÂÈ ÛËÌ·ÓÙÈο ÙË ‰˘Ó·ÙfiÙËÙ· ÂχıÂÚ˘ „˘¯·ÁˆÁÈ΋˜ ¿ıÏËÛ˘ (recreational-leisure activities) ÛÂ Â›Â‰Ô ÁÂÈÙÔÓÈ¿˜ Î·È ˆ˜ ÌfiÓË ÂÓ·ÏÏ·ÎÙÈ΋ χÛË ÚÔ‚¿ÏÏÂÈ Ë Û˘ÌÌÂÙÔ¯‹ ÛÙË Û¯ÔÏÈ΋ Á˘-
1 Medical School, University of Crete, Crete, Greece 2 Pediatric Cardiologic Clinic, “Mitera” General, Maternity & Children’s Hospital 3 Medical School, Aristotelio University of Thessaloniki, Thessaloniki, Greece Correspondence: Ioannis Germanakis germjohn@med.uoc.gr Paediatric Cardiology Unit, Department of Paediatrics, University Hospital of Heraklion, Crete, Greece
ÌÓ·ÛÙÈ΋ ‹ Û ÔÚÁ·ÓˆÌ¤Ó˜ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜. √ÏÔ¤Ó· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿, fiÏÔ Î·È ÌÈÎÚfiÙÂÚ˘ ËÏÈΛ·˜, Û˘ÌÌÂÙ¤¯Ô˘Ó Û ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, ·ÙÔÌÈΤ˜ ‹ ÔÌ·‰ÈΤ˜, ÔÈ Ôԛ˜ ·ÔÎÏ›ÓÔ˘Ó ·fi ÙË ÊÈÏÔÛÔÊ›· ÙÔ˘ „˘¯·ÁˆÁÈÎÔ‡ ·ÈÁÓȉÈÔ‡, ··ÈÙÒÓÙ·˜ Û˘ÛÙËÌ·ÙÈ΋ ÚÔfiÓËÛË Î·È ·ÓÙ·ÁˆÓÈÛÙÈÎfi Ó‡̷, Ì ÛÙfi¯Ô ÙËÓ ¿ÚÈÛÙË ·ıÏËÙÈ΋ ›‰ÔÛË (competitive sports) (1-5). ŒÙÛÈ, Ô ÚÔ-·ÁˆÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ë ÈÛÙÔÔ›ËÛË Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÙÔ˘˜ Û ۯÔÏÈΤ˜ Î·È Â͈ۯÔÏÈΤ˜ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Â›Ó·È ÌÈ· ÛËÌ·ÓÙÈ΋ ¢ı‡ÓË ÙÔ˘ Û‡Á¯ÚÔÓÔ˘ ¶·È‰È·ÙÚÈ΋ 2008;71:417-425
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·418
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π. °ÂÚÌ·Ó¿Î˘ Î·È Û˘Ó.
·È‰›·ÙÚÔ˘. ªÔÏÔÓfiÙÈ Ô ¤ÏÂÁ¯Ô˜ Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ·ÍÈÔÏfiÁËÛË fiÏˆÓ ÙˆÓ Û˘ÛÙËÌ¿ÙˆÓ (6), Ë ·ÍÈÔÏfiÁËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ ÁÈ· ÙËÓ ·ÛÊ·Ï‹ ·Ó›¯Ó¢ÛË Î·Ù·ÛÙ¿ÛÂˆÓ ·˘ÍË̤ÓÔ˘ ÎÈÓ‰‡ÓÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ηٿ ÙËÓ ¿ÛÎËÛË (7). H ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·ÔÛÎÔ› ÛÙËÓ ·ÚÔ˘Û›·ÛË ÙÔ˘ ıÂÛÌÈÎÔ‡ Ï·ÈÛ›Ô˘ Î·È ÙÔ˘ Û˘Ó‹ıÔ˘˜ ÙÚfiÔ˘ ÂϤÁ¯Ô˘ Ù˘ ηډȷÁÁÂȷ΋˜ ˘Á›·˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙË ¯ÒÚ· Ì·˜, ÛÙËÓ ·ÍÈÔÏfiÁËÛ‹ ÙÔ˘ Û ۯ¤ÛË Ì ÙË Û‡Á¯ÚÔÓË ÁÓÒÛË Î·È ÙȘ ‰ÈÂıÓ›˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ηÈ, Ù¤ÏÔ˜, ÛÙËÓ Î·Ù¿ıÂÛË ÚÔÙ¿ÛˆÓ-ηÙ¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ ÁÈ· ÙË ¯ÒÚ· Ì·˜, ÁÈ· ÙË ‚ÂÏÙ›ˆÛË ÙÔ˘ ˘¿Ú¯ÔÓÙÔ˜ Û˘ÛÙ‹Ì·ÙÔ˜.
∞. ∆Ô ıÂÛÌÈÎfi Ï·›ÛÈÔ ÛÙË ¯ÒÚ· Ì·˜ ∞ÙÔÌÈÎfi ¢ÂÏÙ›Ô ÀÁ›·˜ Ì·ıËÙÒÓ ∏ È·ÙÚÈ΋ ÂͤٷÛË ÙˆÓ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È ÓÔÌÔıÂÙÈο ÂȂ‚ÏË̤ÓË, Ì ÎÔÈÓ‹ ·fiÊ·ÛË ÙˆÓ ÀÔ˘ÚÁ›ˆÓ ∂ıÓÈ΋˜ ¶·È‰Â›·˜ Î·È £ÚËÛÎÂ˘Ì¿ÙˆÓ - ÀÁ›·˜ Î·È ∫ÔÈÓˆÓÈ΋˜ ∞ÏÏËÏÂÁÁ‡Ë˜ [º∂∫ 859, 23 πÔ˘Ó›Ô˘ 2005, ∞ÚÈıÌ. 58410/°4, “∫·ıÔÚÈÛÌfi˜ Ù‡Ô˘, ÂÚȯÔ̤ÓÔ˘ Î·È ÙÚfiÔ˘ ÂÓË̤ڈÛ˘ ÙÔ˘ ∞ÙÔÌÈÎÔ‡ ¢ÂÏÙ›Ô˘ ÀÁ›·˜ (∞.¢.À.)”]. ∏ Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ∞.¢.À., ηıÒ˜ ÛÙԯ‡ÂÈ ÛÙËÓ ÚÔÛÙ·Û›· Ù˘ ˙ˆ‹˜ ÙˆÓ Ì·ıËÙÒÓ, ·ÔÙÂÏ› ·fiÏ˘ÙË ÚÔ¸fiıÂÛË ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÛÙȘ Û¯ÔÏÈΤ˜ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜, Ì ÔÈÓ‹ Ì¿ÏÈÛÙ· ·ÔÎÏÂÈÛÌÔ‡ Î·È ·‰ÈηÈÔÏfiÁËÙ˘ ·Ô˘Û›·˜ ·fi ÙÔ Ì¿ıËÌ· Ù˘ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜ Û ÂÚ›ÙˆÛË ÌË ¤ÁηÈÚ˘ Û˘ÌÏ‹ÚˆÛ‹˜ ÙÔ˘ ηٿ ÙËÓ ÂÁÁÚ·Ê‹ ·) ÛÙÔ ÓËÈ·ÁˆÁÂ›Ô ‚) ÛÙȘ ∞ã, °ã Î·È ∂ã Ù¿ÍÂȘ ‰ËÌÔÙÈÎÔ‡ Á) ÛÙËÓ ∞ã Ù¿ÍË Á˘ÌÓ·Û›Ô˘ Î·È ‰) ÛÙËÓ ∞ã Ù¿ÍË Ï˘Î›Ԣ. ∆· ‰ÂÏÙ›· Û˘ÌÏËÚÒÓÔÓÙ·È ÛÙËÓ ·Ú¯‹ οı ۯÔÏÈ΋˜ ¯ÚÔÓÈ¿˜ ·fi “…È·ÙÚÔ‡˜ ÙˆÓ ÔÈΛˆÓ ∫¤ÓÙÚˆÓ ÀÁ›·˜ ‹ ¶ÂÚÈÊÂÚÈÎÒÓ °ÂÓÈÎÒÓ ¡ÔÛÔÎÔÌ›ˆÓ ‹ ÙˆÓ ·ÛÊ·ÏÈÛÙÈÎÒÓ ÊÔÚ¤ˆÓ ÙˆÓ ÁÔÓ¤ˆÓ ‹ ·fi ȉÈÒÙ˜ ·È‰›·ÙÚÔ˘˜ Î·È È·ÙÚÔ‡˜ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÙËÓ Î·Ù¿ÛÙ·ÛË Ù˘ ˘Á›·˜ ÙˆÓ Ì·ıËÙÒÓ”. √ ¤ÏÂÁ¯Ô˜ ÂȉÈÎfiÙÂÚ· Ù˘ ηډȷÁÁÂȷ΋˜ ˘Á›·˜ ÂÚÈÏ·Ì‚¿ÓÂÈ 6 Û˘ÓÔÏÈο ÛËÌ›·, 3 ·fi ÙÔ ·ÙÔÌÈÎfi ÈÛÙÔÚÈÎfi (ηٷÁÚ¿ÊÔÓÙ·È ·fi ÙÔÓ È·ÙÚfi) Î·È 3 ·fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË: - ¶ÏËÚÔÊÔڛ˜ ·ÙÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ (‰›Ô 7 ∞.¢.À.): ªÂÙ¿ ·fi ¿ÛÎËÛË ·) ÏÈÔı˘Ì›·, ‚) ÚÔοډÈÔ ¿ÏÁÔ˜ Î·È Á) ‡ÎÔÏË ÎfiˆÛË - ∞ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË (‰›Ô 8 ∞.¢.À.): ·) ̤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ‚) „ËÏ¿ÊËÛË ÌËÚÈ·›ˆÓ, Á) Ê˘Û‹Ì·Ù· (·ÚÔ˘Û›·). ∂¿Ó ‰ÂÓ ‰È·ÈÛÙˆı› οÙÈ ·ıÔÏÔÁÈÎfi, Ô È·ÙÚfi˜ ˘ÔÁÚ¿ÊÂÈ: “Ô Ì·ıËÙ‹˜ ÌÔÚ› Ó· ¿ÚÂÈ Ì¤ÚÔ˜ Û fiϘ ÙȘ Û¯ÔÏÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜”. Paediatriki 2008;71:417-425
ª·ıËÙÈ΋-∞ıÏËÙÈ΋ ∆·˘ÙfiÙËÙ· °È· ÙË Û˘ÌÌÂÙÔ¯‹ Û ۯÔÏÈÎÔ‡˜ ·ÁÒÓ˜ Û˘ÌÏËÚÒÓÂÙ·È Ë ª·ıËÙÈ΋-∞ıÏËÙÈ΋ ∆·˘ÙfiÙËÙ·, ÛÙËÓ ÔÔ›· ·Ó·ÁÚ¿ÊÔÓÙ·È ÌfiÓÔ Ù· ÛÙÔȯ›· ÙÔ˘ Ì·ıËÙ‹ Î·È ÙÔ ¿ıÏËÌ· Û˘ÌÌÂÙÔ¯‹˜, ÂÓÒ Ô È·ÙÚfi˜ (‰ÂÓ ÚÔÛ‰ÈÔÚ›˙ÂÙ·È ÂȉÈÎfiÙËÙ·) ˘ÔÁÚ¿ÊÂÈ Î¿Ùˆ ·fi ÚÔÙ˘ÔÔÈË̤ÓË È·ÙÚÈ΋ ÁÓˆÌÔ‰fiÙËÛË: “O ·Ú·¿Óˆ ·ıÏËÙ‹˜-Ì·ıËÙ‹˜ ÌÔÚ› Ó· Û˘ÌÌÂÙ¤¯ÂÈ Û ۯÔÏÈÎÔ‡˜ ·ÁÒÓ˜ ¯ˆÚ›˜ ΛӉ˘ÓÔ ÁÈ· ÙËÓ ˘Á›· ÙÔ˘”. √ÚÁ·ÓˆÌ¤ÓË Â͈ۯÔÏÈ΋ ¿ıÏËÛË ∫¿ı ÔÚÁ·ÓˆÌ¤ÓÔ˜ ·ıÏËÙÈÎfi˜ Û‡ÏÏÔÁÔ˜ ‹ ÔÌÔÛÔÓ‰›· ¯ÔÚËÁ› Î·È ‰È·ÊÔÚÂÙÈÎfi ¤ÓÙ˘Ô È·ÙÚÈ΋˜ ÁÓˆÌÔ‰fiÙËÛ˘, ÛÙÔ ÔÔ›Ô Û˘Ó‹ıˆ˜ ˙ËÙÂ›Ù·È ÂÓ˘fiÁÚ·ÊË ÈÛÙÔÔ›ËÛË ·fi ÙÔÓ È·ÙÚfi fiÙÈ Ô ·ıÏËÙ‹˜ ÌÔÚ› Ó· ·ıÏÂ›Ù·È ¯ˆÚ›˜ ΛӉ˘ÓÔ ‹, Û·ÓÈfiÙÂÚ·, fiÙÈ Â›Ó·È ·Ï¿ ˘ÁÈ‹˜. ∫¿ÔÙ ˙ËÙÂ›Ù·È ÁÓˆÌÔ‰fiÙËÛË ·fi ÂȉÈÎfi ηډÈÔÏfiÁÔ ‹ Î·È Ú·ÁÌ·ÙÔÔ›ËÛË ¤Á¯ÚˆÌÔ˘ ˘ÂÚ˯ÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ (ÙÚ›ÏÂÍ) (Û˘¯Ó¿ ¯ˆÚ›˜ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ·).
µ. ∏ ‰ÈÂıÓ‹˜ Ú·ÎÙÈ΋ √ ÚÔ-·ÁˆÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ Ó¤ˆÓ ·ıÏËÙÒÓ Î·È ÔÈ ·ÓÙ›ÛÙÔȯ˜ ‰ÈÂıÓ›˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ‚·Û›˙ÔÓÙ·È ÛÙË Û·Ê‹ ‰È¿ÎÚÈÛË ÙˆÓ ·ıÏËÙÈÎÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Û ‰‡Ô ‰È·ÎÚÈÙ¤˜ ÔÌ¿‰Â˜: - AÓÙ·ÁˆÓÈÛÙÈ΋ ¿ıÏËÛË (competitive): ™˘ÌÌÂÙÔ¯‹ Û ÔÚÁ·ÓˆÌ¤ÓË ÔÌ¿‰· ‹ ·ÙÔÌÈÎfi ¿ıÏËÌ·, ÌÂ Û˘ÛÙËÌ·ÙÈ΋ ÚÔfiÓËÛË Î·È Ù·ÎÙÈÎfi ·ÓÙ·ÁˆÓÈÛÌfi ·¤Ó·ÓÙÈ Û ¿ÏÏÔ˘˜, Ì ¤ÌÊ·ÛË ÛÙË ‚¤ÏÙÈÛÙË Î·È ¿ÚÈÛÙË Â›‰ÔÛË. ™˘¯Ó¿ ÔÈ ·ıÏËÙ¤˜ Êı¿ÓÔ˘Ó ÛÙ· fiÚÈ· ÙˆÓ ÛˆÌ·ÙÈÎÒÓ ÙÔ˘˜ ·ÓÙÔ¯ÒÓ (8). - ªË Û˘ÛÙËÌ·ÙÈ΋ ¿ıÏËÛË (informal, recreational): ∞Ô˘Û›· Û˘ÛÙËÌ·ÙÈ΋˜ ÚÔfiÓËÛ˘, Ì¿ÏÏÔÓ ÂÓ·Û¯fiÏËÛË „˘¯·ÁˆÁÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·, Ì ·Ô˘Û›· ÎÈÓ‹ÙÚÔ˘ ¿ÚÈÛÙˆÓ ÂȉfiÛÂˆÓ (9). H ‰È¿ÎÚÈÛË ·˘Ù‹ Â›Ó·È ÛËÌ·ÓÙÈ΋, ηıÒ˜ Ô Î›Ó‰˘ÓÔ˜ ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ ·˘Í¿ÓÂÈ ·Ó¿ÏÔÁ· Ì ÙËÓ ¤ÓÙ·ÛË Ù˘ ¿ıÏËÛ˘, ȉ›ˆ˜ Û ·fiÙÔÌË Î·È ÌÂÁ¿Ï˘ ¤ÓÙ·Û˘ Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Î·È ·Ô˘Û›· ÚÔËÁÔ‡ÌÂÓ˘ Ù·ÎÙÈ΋˜ ¿ıÏËÛ˘ (10). √È ·ÈÌÔ‰˘Ó·ÌÈΤ˜ ·ÏÏ·Á¤˜ Ô˘ Û˘ÓÔ‰Â‡Ô˘Ó ÙËÓ ¤ÓÙÔÓË ¿ÛÎËÛË ÌÔÚ› Ó· ·Ô‚Ô‡Ó ÌÔÈÚ·›Â˜ ·ÚÔ˘Û›· ·‰È¿ÁÓˆÛÙ˘ ˘ÔΛÌÂÓ˘ ηډÈÔ¿ıÂÈ·˜ (11,12). ™˘¯ÓfiÙÂÚÔ ·›ÙÈÔ ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ Û ӤԢ˜ ·ıÏËÙ¤˜ (·fi 12 ¤ˆ˜ 25-40 ÂÙÒÓ) ·ÔÙÂÏ› Ë ·ÚÔ˘Û›· ÁÂÓÂÙÈÎÒÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÓÔÛËÌ¿ÙˆÓ, fiˆ˜ ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, ·ÚÚ˘ıÌÈÔÁfiÓÔ˜ ‰ÂÍÈ¿ ÎÔÈÏ›·, ·ÓˆÌ·Ï›Â˜ ¤ÎÊ˘Û˘ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ, ÎÏËÚÔÓÔÌÈο Û‡Ó‰ÚÔÌ· ·ÚÚ˘ıÌÈÔÁ¤ÓÂÛ˘ Î.Ù.Ï. (11-15). ∏ Û˘ÌÌÂÙÔ¯‹ Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· ›Ù ··ÁÔÚ‡ÂÙ·È Ï‹Úˆ˜ ›Ù ÂÈÙÚ¤ÂÙ·È Ì ÂÚÈÔÚÈÛÌÔ‡˜ ·Ó ˘¿Ú¯ÂÈ ˘ÔΛÌÂÓË ÛÔ‚·Ú‹
Pediatri Nov-Dec 08 new
19-12-08
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¶ÈÛÙÔÔ›ËÛË Î·Ú‰È·Î‹˜ ˘Á›·˜ Û ·È‰È¿ - ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜
ηډȷÁÁÂȷ΋ ÓfiÛÔ˜ (16,17). ∞ÓÙ›ıÂÙ·, Ë ‹È· ¿ıÏËÛË ÂÈÙÚ¤ÂÙ·È ·ÎfiÌ· Î·È Û ·ÛıÂÓ›˜ Ì ÁÂÓÂÙÈο ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·, Ô˘ ÌÔÚÔ‡Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó Ì ·ÛÊ¿ÏÂÈ· ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÌË Û˘ÛÙËÌ·ÙÈÎÒÓ ÌÔÚÊÒÓ ¿ıÏËÛ˘ ‹È·˜ ¤ÓÙ·Û˘ (9). ∆¤ÏÔ˜, Ë Ê˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÛÙ· Ï·›ÛÈ· Ù˘ ÁÂÈÙÔÓÈ¿˜ ‹ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Û¯ÔÏ›Ԣ ıˆÚÂ›Ù·È ÁÂÓÈο ¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ˆ˜ Ù¤ÙÔÈ· Ú¤ÂÈ Ó· ÂÈÙÚ¤ÂÙ·È ˆ˜ ¤Ó· ÙÌ‹Ì· ÙˆÓ Î·ıËÌÂÚÈÓÒÓ ‰Ú·ÛÙËÚÈÔًوÓ, ·ÎfiÌ· Î·È Û ·ÛıÂÓ›˜ Ì ÁÂÓÂÙÈο ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù· (9,17). ¢ÈÂıÓ›˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô Ù˘ ηډȷÁÁÂȷ΋˜ ˘Á›·˜ Ó¤ˆÓ ·ıÏËÙÒÓ ∫ÔÈÓ¿ ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ‰ÈÂıÓÒÓ Ô‰ËÁÈÒÓ Â›Ó·È fiÙÈ ·ÊÔÚÔ‡Ó ·ÔÎÏÂÈÛÙÈο Û ·ıÏËÙ¤˜ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· (Û˘ÌÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Î·È ÔÈ Û¯ÔÏÈÎÔ› ·ÁÒÓ˜) (18,19). ∆· ÚÔÙÂÈÓfiÌÂÓ· Û˘ÛÙ‹Ì·Ù· Ì·˙ÈÎÔ‡ ÂϤÁ¯Ô˘ (screening) ‚·Û›˙ÔÓÙ·È ÛÙË ¯Ú‹ÛË ÚÔÙ˘ÔÔÈË̤ÓÔ˘ ·ÙÔÌÈÎÔ‡ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Î·È ÛÙË ÏÂÙÔÌÂÚ‹ ÎÏÈÓÈ΋ ÂͤٷÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜. ∂ÓÒ ˘¿Ú¯ÂÈ ‰È¯ÔÁӈ̛· Û¯ÂÙÈο Ì ÙË ¯ÚËÛÈÌfiÙËÙ· Ù˘ Ì·˙È΋˜ ¯Ú‹Û˘ ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜, Ô ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ıÏËÙÒÓ ¯ˆÚ›˜ Ó· ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ ·fi ÙÔ ÈÛÙÔÚÈÎfi Î·È ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË ‰ÂÓ Û˘ÓÈÛٿٷÈ. ¶·Ú¿ÏÏËÏ·, ÙÔÓ›˙ÂÙ·È fiÙÈ, ÂÓÒ Ë ÌË Û˘ÌÌfiÚʈÛË ÙˆÓ È·ÙÚÒÓ Ì ÙȘ Ô‰ËÁ›Â˜ ‰ÂÓ ÛÙÔȯÂÈÔıÂÙ› È·ÙÚÈ΋ ·Ì¤ÏÂÈ·, Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜ ·ÔÙÂÏ› ÛÙÔÈ¯Â›Ô Î·Ï‹˜ È·ÙÚÈ΋˜ Ú·ÎÙÈ΋˜ Ô˘ Ú¤ÂÈ Ó· Ï·Ì-
‚¿ÓÂÙ·È ıÂÙÈο ˘fi„Ë Û ÂΉ›Î·ÛË Û¯ÂÙÈÎÒÓ ˘Ôı¤ÛÂˆÓ (18,19). 1. ∞ÌÂÚÈηÓÈΤ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ (∞∏∞, 2007) √È Î·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ (∞∏∞) ·ÊÔÚÔ‡Ó ÛÙÔÓ ¤ÏÂÁ¯Ô Ó¤ˆÓ >12 ÂÙÒÓ, ·ÏÏ¿ ÌÔÚÔ‡Ó Ó· ¤¯Ô˘Ó ÈÛ¯‡ Î·È ÁÈ· ÓÂfiÙÂÚ˜ ËÏÈ˘, ηıÒ˜ Î·È ÁÈ· ÌÂÌÔӈ̤Ó˜ ·ÍÈÔÏÔÁ‹ÛÂȘ Û ȷÙÚÂ›Ô (19). ™ÙȘ ∏¶∞ ‰ÂÓ ˘¿Ú¯ÂÈ ÓÔÌÈÎfi-ıÂÛÌÈÎfi Ï·›ÛÈÔ ÁÈ· ÙȘ ˘Ô¯ÚÂÒÛÂȘ ÙˆÓ ÛˆÌ·Ù›ˆÓ Û¯ÂÙÈο Ì ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ·ıÏËÙÒÓ, ÙÔ ÎfiÛÙÔ˜ ÙÔ˘ ÚÔ-·ÁˆÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ ‰ÂÓ Î·Ï‡ÙÂÙ·È ·fi ÙȘ ·ÛÊ·ÏÈÛÙÈΤ˜ ÂÙ·ÈÚ›˜, ÂÓÒ 35% ÙˆÓ ÂϤÁ¯ˆÓ Á›ÓÔÓÙ·È ·fi ÌË È·ÙÚÈÎfi ÚÔÛˆÈÎfi (¯ÂÈÚÔÚ·ÎÙÈÎÔ› Î.Ù.Ï.). √È Ô‰ËÁ›Â˜ ·ÍÈÔÏÔÁÔ‡ÓÙ·È ˆ˜ ‰˘ÓËÙÈο ·ÔÙÂÏÂÛÌ·ÙÈΤ˜ ÛÙËÓ ÚfiÏË„Ë ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘, ÂÓÒ ÙÔÓ›˙ÂÙ·È Ì ¤ÌÊ·ÛË fiÙÈ ‰ÂÓ Â›Ó·È ‰˘Ó·Ùfi Ó· ÂÈÙ¢¯ı› ÌˉÂÓÈÎfi˜ ΛӉ˘ÓÔ˜ Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù·. ªÂ ‚¿ÛË ÙËÓ ˘ÔÏÔÁÈ˙fiÌÂÓË Èı·ÓfiÙËÙ· ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ 1 ÂÚÈÛÙ·ÙÈÎfi ·Ó¿ 200.000 ·ıÏËÙ¤˜, Ë ÂÈÙ¤ÏÂÛË ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ ‰ÂÓ Û˘ÓÈÛٿٷÈ, ηıÒ˜ ÙÔ ÎfiÛÙÔ˜ ı· ·ÓÂÚ¯fiÙ·Ó Û 333.000 ‰ÔÏ¿ÚÈ· ÁÈ· οı ·ÓȯÓ¢fiÌÂÓÔ ·ıÏËÙ‹ Ì ηډÈÔ¿ıÂÈ·, ÌÂ Û˘ÓÔÏÈÎfi ÂÙ‹ÛÈÔ ÎfiÛÙÔ˜ ÁÈ· ÙÔÓ Û˘ÓÔÏÈÎfi ÏËı˘ÛÌfi 2 ‰ÈÛÂηÙÔÌ̇ÚÈ· ‰ÔÏ¿ÚÈ·, Ô˘ ıˆÚÂ›Ù·È ··ÁÔÚ¢ÙÈÎfi (19). √ Û˘ÓÈÛÙÒÌÂÓÔ˜ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ 12 ÛËÌ›·: 8 ·fi ÙÔ ÈÛÙÔÚÈÎfi (·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi) Î·È 4 ·fi ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË (¶›Ó·Î·˜ 1). ø˜ ˘Ô¯ÚˆÙÈ΋ ıˆÚÂ›Ù·È Ë ÂȂ‚·›ˆÛË ·fi ÙÔ˘˜ ÁÔÓ›˜ Ù˘ ÔÚıfiÙËÙ·˜ ÙˆÓ ··ÓÙ‹ÛÂˆÓ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ Û ·È‰È¿-·ıÏËÙ¤˜,
¶›Ó·Î·˜ 1. ∞ÌÂÚÈηÓÈΤ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ (2007) ÚÔ·ÁˆÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÁÈ· Û˘ÌÌÂÙÔ¯‹ Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· (19) ∞∆√ªπ∫√ π™∆√ƒπ∫√* (1-5) 1. £ˆÚ·ÎÈÎfi ¿ÏÁÔ˜-‰˘ÛÊÔÚ›· ÛÙËÓ ÎfiˆÛË 2. ∞ÓÂÍ‹ÁËÙË Û˘ÁÎÔ‹ - ·Ú’ ÔÏ›ÁÔÓ Û˘ÁÎÔ‹** 3. ∂‡ÎÔÏË ÎfiˆÛË / ‰‡ÛÓÔÈ· ηٿ ÙËÓ ¿ÛÎËÛË 4. ¶ÚÔËÁÔ‡ÌÂÓË ‰È·›ÛÙˆÛË Ê˘Û‹Ì·ÙÔ˜ 5. °ÓˆÛÙ‹ ˘¤ÚÙ·ÛË √π∫√°∂¡∂π∞∫√ π™∆√ƒπ∫√ (6-8) 6. ¶ÚÒÈÌÔ˜ ı¿Ó·ÙÔ˜ (·ÈÊÓ›‰ÈÔ˜) Û ËÏÈΛ· <50 ÂÙÒÓ ·fi ηډÈÔ¿ıÂÈ· Û ≥1 Û˘ÁÁÂÓ‹ 7. ™Ô‚·Ú‹ ÓÔÛËÚfiÙËÙ·-·Ó·ËÚ›· ·fi ηډȷ΋ ÓfiÛÔ Û ÛÙÂÓfi Û˘ÁÁÂÓ‹ < 50 ÂÙÒÓ 8. °ÓÒÛË ‡·Ú͢ ÂȉÈÎfiÙÂÚˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Û ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜: ˘ÂÚÙÚÔÊÈ΋ ‹ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ LQT ‹ ¿ÏÏˆÓ Î·Ó·ÏÔ·ıÂÈÒÓ, Û‡Ó‰ÚÔÌÔ Marfan ‹ ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜ ·ÚÚ˘ı̛˜ ∞¡∆π∫∂πª∂¡π∫∏ ∂•∂∆∞™∏ (9-12) 9. ∫·Ú‰È·Îfi ʇÛËÌ·*** 10. æËÏ·ÊËÙ¤˜ ÌËÚÈ·›Â˜ 11. º·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο Û˘Ó‰ÚfiÌÔ˘ Marfan 12. ª¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÙÔÓ ‚Ú·¯›ÔÓ· (ηıÈÛÙ‹ ı¤ÛË) * ÂȂ‚·›ˆÛË Ù˘ ·ÎÚ›‚ÂÈ·˜ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ ÈÛÙÔÚÈÎÔ‡ ·fi ÙÔ˘˜ ÁÔÓ›˜ ** Ô˘ ·ÍÈÔÏÔÁÂ›Ù·È ˆ˜ ÌË Ó¢ÚÔηډÈÔÁÂÓ‹˜, ȉȷ›ÙÂÚ· ·ÓËÛ˘¯ËÙÈ΋ Â¿Ó Û¯ÂÙ›˙ÂÙ·È Ì ¿ıÏËÛË *** ηډȷ΋ ·ÎÚfi·ÛË Î·È Û ‡ÙÈ· Î·È Û fiÚıÈ· ı¤ÛË (‹ Ì ÂÈÙ¤ÏÂÛË Valsava) ÂȉÈο ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ê˘ÛËÌ¿ÙˆÓ ·fi ‰˘Ó·ÌÈ΋ ·fiÊÚ·ÍË ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ¶·È‰È·ÙÚÈ΋ 2008;71:417-425
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·420
420
π. °ÂÚÌ·Ó¿Î˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 2. ∂˘Úˆ·˚Τ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ (2005) ÚÔ·ÁˆÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘ ÁÈ· Û˘ÌÌÂÙÔ¯‹ Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· (18) ∞∆√ªπ∫√ π™∆√ƒπ∫√ (1-4) 1. £ˆÚ·ÎÈÎfi ¿ÏÁÔ˜-‰˘ÛÊÔÚ›· ÛÙËÓ ÎfiˆÛË 2. ∞ÓÂÍ‹ÁËÙË Û˘ÁÎÔ‹ - ·Ú’ ÔÏ›ÁÔÓ Û˘ÁÎÔ‹ 3. ∂‡ÎÔÏË ÎfiˆÛË / ‰‡ÛÓÔÈ· ηٿ ÙËÓ ¿ÛÎËÛË 4. πÛÙÔÚÈÎfi ¿ÚÚ˘ıÌ˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹ ·ÏÌÒÓ √π∫√°∂¡∂π∞∫√ π™∆√ƒπ∫√ (5-6) 5. ¶ÚÒÈÌÔ Î·Ú‰È·Îfi ÂÂÈÛfi‰ÈÔ ‹ ı¿Ó·ÙÔ˜ (·ÈÊÓ›‰ÈÔ˜) Û ËÏÈΛ· <55 ÂÙÒÓ (¿Ó‰Ú˜) <65 ÂÙÒÓ (Á˘Ó·›Î˜) 6. °ÓÒÛË ‡·Ú͢ ÂȉÈÎfiÙÂÚˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Û ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜: ˘ÂÚÙÚÔÊÈ΋ ‹ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ LQT ‹ Brugada, Marfan ‹ ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜ ·ÚÚ˘ı̛˜ ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ∞¡∆π∫∂πª∂¡π∫∏ ∂•∂∆∞™∏ (7-13) 7. ∫·Ú‰È·Îfi ʇÛËÌ· (‰È·ÛÙÔÏÈÎfi ‹ Û˘ÛÙÔÏÈÎfi ¤ÓÙ·Û˘ > 2/6) 8. ™˘ÛÙÔÏÈο ÎÏÈΘ (ÌÂÛÔ-ÙÂÏÔÛ˘ÛÙÔÏÈο) 9. ªÔÓ‹Ú˘ ‹ ¢ڇ˜ Î·È ÛÙ·ıÂÚfi˜ ‰È¯·ÛÌfi˜ 2Ô˘ ηډȷÎÔ‡ ÙfiÓÔ˘ 10. ∞ÚÚ˘ıÌ›· 11. æËÏ·ÊËÙ¤˜ ÌËÚÈ·›Â˜ 12. º·ÈÓÔÙ˘Èο ¯·Ú·ÎÙËÚÈÛÙÈο Û˘Ó‰ÚfiÌÔ˘ Marfan 13. ª¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ∏§∂∫∆ƒ√∫∞ƒ¢π√°ƒ∞º∏ª∞ (14)
ÂÓÒ ÔÈ ·ıÏËÙ¤˜ ıˆÚÔ‡ÓÙ·È Û˘Ó˘Â‡ı˘ÓÔÈ ·Ó·ÊÔÚÈο Ì ÙËÓ ·ÎÚ›‚ÂÈ· ÙˆÓ ··ÓÙ‹ÛˆÓ. 2. ∂˘Úˆ·˚Τ˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ (ESC, 2005) ∫‡ÚÈ· ‰È·ÊÔÚ¿ ÙˆÓ Ô‰ËÁÈÒÓ Ù˘ ∂˘Úˆ·˚΋˜ ∫·Ú‰ÈÔÏÔÁÈ΋˜ ∂Ù·ÈÚ›·˜ (ESC) Â›Ó·È Ë Û‡ÛÙ·ÛË ÁÈ· ÁÂÓÈÎÂ˘Ì¤ÓË ¯Ú‹ÛË ÙÔ˘ ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ (∏∫°) 12 ··ÁˆÁÒÓ ÛÙÔÓ ¤ÏÂÁ¯Ô fiÏˆÓ ·ÓÂÍ·ÈÚ¤Ùˆ˜ ÙˆÓ ·ıÏËÙÒÓ (18). ∫˘Ú›·Ú¯Ë ı¤ÛË ÛÙË ‰È·ÌfiÚʈÛË ÙˆÓ Â˘Úˆ·˚ÎÒÓ Ô‰ËÁÈÒÓ Â›¯Â Ë Ì·ÎÚÔ¯ÚfiÓÈ· ÂÌÂÈÚ›· Ù˘ πÙ·Ï›·˜, ÛÙËÓ ÔÔ›· ¤¯ÂÈ ÂÈ‚ÏËı› ÓÔÌÔıÂÙÈο (·fi ÙÔ 1982) Ô ÚÔ-·ÁˆÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ·ıÏËÙÒÓ Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· Ì ÙËÓ ÚÔÛı‹ÎË ∏∫°Ì·ÙÔ˜. √ Ì·˙ÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ 6 ÂηÙÔÌÌ˘Ú›ˆÓ ·ıÏËÙÒÓ (10% ÙÔ˘ ÏËı˘ÛÌÔ‡) ÂÙËÛ›ˆ˜ Â›Ó·È ÂÊÈÎÙfi˜ ¯¿ÚË ÛÙËÓ Â·Ú΋ ÛÙÂϤ¯ˆÛË Ì ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ È·ÙÚÔ‡˜ Ô˘, ÌÂÙ¿ ·fi 4ÂÙ‹ Âȉ›Î¢ÛË ÛÙËÓ ∞ıÏËÙÈ·ÙÚÈ΋, Â›Ó·È ·ÔÎÏÂÈÛÙÈο ˘Â‡ı˘ÓÔÈ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ·ıÏËÙÒÓ. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ó›¯Ó¢Û˘ ·Ô‰Â›¯ıËΠ̠ÙË Ì›ˆÛË Î·Ù¿ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ Û ·ıÏËÙ¤˜ 12-35 ÂÙÒÓ, ΢ڛˆ˜ ¯¿ÚË ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˘ÂÚÙÚÔÊÈ΋˜ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ∏∫°Ì·ÙÔ˜ (20,21). ∂ÎÙfi˜ ·fi ÙË ¯Ú‹ÛË ÙÔ˘ ∏∫°Ì·ÙÔ˜, ÔÈ Â˘Úˆ·˚Τ˜ Ô‰ËÁ›Â˜ ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ·Ó·Ï˘ÙÈÎfiÙÂÚÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi, ηıÒ˜ Î·È ÂÈÌÂϤÛÙÂÚË ÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË, fiˆ˜ ·Ó·Ï˘ÙÈο ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2. √ ·Ú¯ÈÎfi˜ ¤ÏÂÁ¯Ô˜ Á›ÓÂÙ·È Ì ÙËÓ Â›ÛÔ‰Ô ÙÔ˘ ·ıÏËÙ‹ Û ÔÚÁ·ÓˆÌ¤Ó· ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· Û ËÏÈΛ· 12-14 ÂÙÒÓ Î·È Ô Â·Ó¤ÏÂÁ¯Ô˜ ÙÔ˘Ï¿¯ÈÛÙÔÓ ·Ó¿ ‰ÈÂÙ›·. Paediatriki 2008;71:417-425
3. ÕÏÏ· Û˘ÛÙ‹Ì·Ù· ÂϤÁ¯Ô˘ ηډȷÁÁÂȷ΋˜ ˘Á›·˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ªÔÏÔÓfiÙÈ ÏÈÁfiÙÂÚÔ ÁÓˆÛÙfi, ·fi ÙÔ 1973 ÛÙËÓ π·ˆÓ›· ¤¯ÂÈ ıÂÛÌÔıÂÙËı› ÚfiÁÚ·ÌÌ· Ì·˙ÈÎÔ‡ ÂϤÁ¯Ô˘ ηډȷÁÁÂȷ΋˜ ˘Á›·˜ Û fiÏ· Ù· ·È‰È¿ ηٿ ÙËÓ Â›ÛÔ‰fi ÙÔ˘˜ ÛÙÔ ‰ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô (7 ÂÙÒÓ) Î·È ÛÙÔ Á˘ÌÓ¿ÛÈÔ (13 ÂÙÒÓ) (22-24). √ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ ÏËÚÔÊÔڛ˜ ·fi ÙÔ ÈÛÙÔÚÈÎfi (Û˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÓfiÛËÛ˘ ·fi ÓfiÛÔ Kawasaki ‹ ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi), ÂÈÙ¤ÏÂÛË ·ÏÔÔÈË̤ÓÔ˘ ∏∫°Ì·ÙÔ˜ (4 ··ÁˆÁÒÓ) Î·È ÊˆÓÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ (Û ‰‡Ô ı¤ÛÂȘ ÛÙÔ ÚÔοډÈÔ). ªÂ ‚¿ÛË ÙÔ Û‡ÛÙËÌ· ·˘Ùfi, 10% ÙˆÓ ·È‰ÈÒÓ ·Ú·¤ÌÔÓÙ·È ÂÚ·ÈÙ¤Úˆ ÁÈ· ÂÍÂȉÈÎÂ˘Ì¤ÓÔ ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ·, ÂÓÒ Ë Û˘¯ÓfiÙÂÚË Û˘ÁÁÂÓ‹˜ ηډÈÔ¿ıÂÈ· Ô˘ ·ÓȯÓ‡ÂÙ·È Â›Ó·È Ë ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›· (0,02%) (24). ¶ÈÏÔÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ηډÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ì ¯Ú‹ÛË ÚÔÙ˘ÔÔÈË̤ÓÔ˘ ÈÛÙÔÚÈÎÔ‡, ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ Î·È „ËÊÈ·ÎÔ‡ ʈÓÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜, Ì ÙËÓ ¤ÁÎÚÈÛË ÙÔ˘ ¶·È‰·ÁˆÁÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ Î·È ÙÔ˘ ÀÔ˘ÚÁ›Ԣ ¶·È‰Â›·˜, ¤¯ÂÈ ‹‰Ë ÙÂı› Û ÂÊ·ÚÌÔÁ‹ ÛÙËÓ ¶ÂÚÈʤÚÂÈ· ∫Ú‹Ù˘. ™ÙËÚ›˙ÂÙ·È ÌÂٷ͇ ¿ÏÏˆÓ ÛÙËÓ ÂÍ ·ÔÛÙ¿Ûˆ˜ ·ÍÈÔÏfiÁËÛË ÙˆÓ Ë¯ÔÁÚ·ÊËÌ¤ÓˆÓ ‹¯ˆÓ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜, Ì ÈηÓfiÙËÙ· ·Ó›¯Ó¢Û˘ ÙˆÓ ·ÈÌÔ‰˘Ó·ÌÈο ÛËÌ·ÓÙÈÎÒÓ Î·Ú‰ÈÔ·ıÂÈÒÓ Î·Ù¿ 96% Î·È ÙˆÓ ÏÂÈÙÔ˘ÚÁÈÎÒÓ Ê˘ÛËÌ¿ÙˆÓ Î·Ù¿ 93-95%, ηٿ ÙËÓ ÈÏÔÙÈ΋ ·ÍÈÔÏfiÁËÛË Ù˘ ÌÂıfi‰Ô˘ (25).
°. ™˘ÁÎÚÈÙÈ΋ ·ÍÈÔÏfiÁËÛË ÚÔÙ˘ÔÔÈË̤ÓÔ˘ ¤ÓÙ˘Ô˘ ∞.¢.À. - ¶ÚÔÙ¿ÛÂȘ ‚ÂÏÙ›ˆÛ˘ ∏ ıÂÛÌÔıÂÙË̤ÓË Î·È ˘Ô¯ÚˆÙÈ΋ ·ÍÈÔÏfiÁËÛË
Pediatri Nov-Dec 08 new
19-12-08
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¶ÈÛÙÔÔ›ËÛË Î·Ú‰È·Î‹˜ ˘Á›·˜ Û ·È‰È¿ - ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜
¶›Ó·Î·˜ 3. ™˘ÁÎÚÈÙÈ΋ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ·ÙÔÌÈÎÔ‡ ‰ÂÏÙ›Ô˘ ˘Á›·˜ Ì·ıËÙÒÓ (∞.¢.À.) Û ۯ¤ÛË Ì ÙȘ ·ÌÂÚÈηÓÈΤ˜ (∞∏∞) Î·È Â˘Úˆ·˚Τ˜ (∂SC) ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ À¶∂À£À¡√™ °π∞ ∆∏¡ ∞∫ƒπµ∂π∞ ∆√À π™∆√ƒπ∫√À ñ √ È·ÙÚfi˜ (Î·È fi¯È ÔÈ ÁÔÓ›˜) ¤¯ÂÈ ÙËÓ Â˘ı‡ÓË Î·Ù·ÁÚ·Ê‹˜ ÙÔ˘ ·ÙÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ A∆√ªπ∫√ π™∆√ƒπ∫√ ∞Ô˘ÛÈ¿˙Ô˘Ó Ù· ·ÎfiÏÔ˘ı· ÛÙÔȯ›·: ñ ÚÔËÁÔ‡ÌÂÓË ‡·ÚÍË Ê˘Û‹Ì·ÙÔ˜ (∞∏∞) ñ ÚÔËÁÔ‡ÌÂÓË ‰È·›ÛÙˆÛË ˘¤ÚÙ·Û˘ (∞∏∞) ñ ÚÔËÁÔ‡ÌÂÓË ‰È·›ÛÙˆÛË ·ÚÚ˘ıÌ›·˜ (∂SC) ñ ÏÈÔı˘Ì›· (Û˘ÁÎÔ‹) Î·È ·˘ÙfiÌ·Ù·, fi¯È ÌfiÓÔ ÌÂÙ¿ ·fi ¿ÛÎËÛË (ESC, AHA) √π∫√°∂¡∂π∞∫√ π™∆√ƒπ∫√ ∞Ô˘ÛÈ¿˙ÂÈ Ï‹Úˆ˜ οı ÏËÚÔÊÔÚ›· ÁÈ·: ñ √ÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ÚÒÈÌÔ˘ ı·Ó¿ÙÔ˘ (·ÈÊÓ›‰ÈÔ˘): Û ËÏÈΛ· <50 ÂÙÒÓ ·fi ηډÈÔ¿ıÂÈ· Û >1 Û˘ÁÁÂÓ‹ (AHA) / ı·Ó¿ÙÔ˘ ‹ ÚÒÈÌÔ˘ ηډȷÎÔ‡ ÂÂÈÛÔ‰›Ô˘ Û ËÏÈΛ· <55 ÂÙÒÓ (¿Ó‰Ú˜) <65 ÂÙÒÓ (Á˘Ó·›Î˜) (ESC) ñ ™Ô‚·Ú‹ ÓÔÛËÚfiÙËÙ·-·Ó·ËÚ›· ·fi ηډȷ΋ ÓfiÛÔ Û ÛÙÂÓfi Û˘ÁÁÂÓ‹ <50 ÂÙÒÓ (AHA) ñ °ÓÒÛË ‡·Ú͢ ÂȉÈÎfiÙÂÚˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Û ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜: ˘ÂÚÙÚÔÊÈ΋ ‹ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ LQT ‹ ¿ÏÏˆÓ Î·Ó·ÏÔ·ıÂÈÒÓ, Û‡Ó‰ÚÔÌÔ Marfan ‹ ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜ ·ÚÚ˘ı̛˜ (AHA, ESC) ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ (ESC) ∞¡∆π∫∂πª∂¡π∫∏ ∂•∂∆∞™∏ ∞Ô˘ÛÈ¿˙Ô˘Ó Ù· ·ÎfiÏÔ˘ı· ÛÙÔȯ›·: ñ ∞ÍÈÔÏfiÁËÛË Ê˘Û‹Ì·ÙÔ˜ Û ‰È¿ÊÔÚ˜ ı¤ÛÂȘ (‡ÙÈ·, fiÚıÈ·) (∞∏∞) ñ ¶ÂÚÈÁÚ·Ê‹ Ê˘Û‹Ì·ÙÔ˜ ˆ˜ ‰È·ÛÙÔÏÈÎfi ‹ ¤ÓÙÔÓÔ (> 2/6) Û˘ÛÙÔÏÈÎfi (∂SC) ñ ¶ÂÚÈÁÚ·Ê‹ ÚfiÛıÂÙˆÓ ‹¯ˆÓ (ÎÏÈÎ) ‹ ·ÓˆÌ·ÏÈÒÓ 2Ô˘ ÙfiÓÔ˘ (∂SC) ñ ¶ÂÚÈÁÚ·Ê‹ ·ÚÔ˘Û›·˜ ·ÚÚ˘ıÌ›·˜ (ESC) ñ ¶ÂÚÈÁÚ·Ê‹ ·ÚÔ˘Û›·˜ Ê·ÈÓfiÙ˘Ô˘ Marfan (∂SC, ∞∏∞) ∏§∂∫∆ƒ√∫∞ƒ¢π√°ƒ∞º∏ª∞ ñ ¢ÂÓ ÂÚÈÏ·Ì‚¿ÓÂÙ·È (Ô‡ÙÂ Î·È ÛÙËÓ ·ıÏËÙÈ΋-Ì·ıËÙÈ΋ Ù·˘ÙfiÙËÙ·) (ESC)
Ù˘ ˘Á›·˜ ÙˆÓ Ì·ıËÙÒÓ ÛÙË ¯ÒÚ· Ì·˜ ·ÔÙÂÏ› ÛËÌ·ÓÙÈ΋ ÔÏÈÙÈ΋ ‰ËÌfiÛÈ·˜ ˘Á›·˜. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ Ë ·ÍÈÔÏfiÁËÛË Á›ÓÂÙ·È ·ÔÎÏÂÈÛÙÈο ·fi È·ÙÚÔ‡˜ Ì ÙË ¯Ú‹ÛË ÚÔÙ˘ÔÔÈË̤ÓÔ˘ ÂÓÙ‡Ô˘ (∞.¢.À.) ·ÔÙÂÏ› ÂÚ·ÈÙ¤Úˆ ÂÁÁ‡ËÛË ÁÈ· ÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÂϤÁ¯Ô˘. ∫ÔÈÓ¿ Ì ÙȘ ‰ÈÂıÓ›˜ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Â›Ó·È Ù· 3 ÂÚˆÙ‹Ì·Ù· ·ÙÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Î·È Ù· 3 ÎÏÈÓÈο ÛËÌ›· ÚÔ˜ ·ÍÈÔÏfiÁËÛË. ™˘ÁÎÚÈÙÈο, fï˜, Ì ٷ ·ÓÙ›ÛÙÔȯ· ÚÔÙ˘ÔÔÈË̤ӷ ‰ÈÂıÓ‹ ÂÚˆÙËÌ·ÙÔÏfiÁÈ·: ·) ·Ô˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ÏËÚÔÊÔڛ˜ ÙÔ˘ ·ÙÔÌÈÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ‚) ‰ÂÓ ˘¿Ú¯Ô˘Ó ηıfiÏÔ˘ ÏËÚÔÊÔڛ˜ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, Á) Ë ÂÚÈÁÚ·Ê‹ ÙˆÓ ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ ·fi ÙÔ Î·Ú‰È·ÁÁÂÈ·Îfi ‰ÂÓ Â›Ó·È ÏÂÙÔÌÂÚ‹˜, ÂÓÒ ‰) ÔÈ ÁÔÓ›˜ ‰ÂÓ Û˘Ó˘ÔÁÚ¿ÊÔ˘Ó ÁÈ· ÙËÓ ·ÎÚ›‚ÂÈ· ÙÔ˘ ÈÛÙÔÚÈÎÔ‡. ™ÙÔÓ ¶›Ó·Î· 3 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Û˘ÁÎÚÈÙÈ΋ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ∞.¢.À. ·Ó·ÊÔÚÈο Ì ÙȘ ·ÓÙ›ÛÙÔȯ˜ Â˘Úˆ·˚Τ˜ (ESC) Î·È ·ÌÂÚÈηÓÈΤ˜ (∞∏∞) Ô‰ËÁ›Â˜. ¶·Ú¿ÏÏËÏ·, ¯ÚÂÈ¿˙ÔÓÙ·È ÙÚÔÔÔÈ‹ÛÂȘ Î·È ÚÔÛı‹Î˜, Èı·ÓÒ˜ Î·È Ù· ‰›· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ˘fiÏÔÈˆÓ Û˘ÛÙËÌ¿ÙˆÓ (6). ∏ ÂȂ‚ÏË̤ÓË ÚÔÛı‹ÎË ÏËÚÔÊÔÚÈÒÓ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÌÔÚ› Ó· Á›ÓÂÈ ÂÊÈÎÙ‹ ÌfiÓÔ Ì ÙËÓ ÂÁÁ‡ËÛË ÙÔ˘ È·ÙÚÈÎÔ‡ ·ÔÚÚ‹ÙÔ˘ (›ӷÈ
·ÌÊ›‚ÔÏË Ë ÂÍ·ÛÊ¿ÏÈÛ‹ ÙÔ˘ Ì ÙË Ê‡Ï·Í‹ ÙˆÓ ÂÓÙ‡ˆÓ ÛÙÔ Û¯ÔÏ›Ô) Î·È Ì ÙË ÛˆÛÙ‹ ‰È·Ù‡ˆÛË ÙˆÓ ÂÚˆÙ‹ÛˆÓ. ªÂ ‚¿ÛË ÙËÓ ÚÔÛˆÈ΋ Ì·˜ ÂÌÂÈÚ›·, ˘¿Ú¯ÂÈ Û˘¯Ó¿ ·‰˘Ó·Ì›· ηٷÓfiËÛ˘ (.¯. Ë ˘ÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ· ·Ó·Ê¤ÚÂÙ·È ˆ˜ ηډÈÔÌÂÁ·Ï›·) ‹ ¿ÁÓÔÈ· ‡·Ú͢ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ‰È·ÁÓÒÛÂˆÓ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È Î¿ÔÙ ÂÈʇϷÍË ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ È·ÙÚÈÎÔ‡ ·ÔÚÚ‹ÙÔ˘, ÌÂ Û˘Ó·ÎfiÏÔ˘ıË ÛÎfiÈÌË ·fiÎÚ˘„Ë ÏËÚÔÊÔÚÈÒÓ. ∏ ·ÎÚÈ‚‹˜ Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Èı·ÓfiÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Î·È ·ÛʷϤÛÙÂÚË Â¿Ó Û˘ÌÏËÚÒÓÂÙ·È ˘fi ÙËÓ Î·ıÔ‰‹ÁËÛË-›‚ÏÂ„Ë ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ·È‰È¿ÙÚÔ˘, Ô ÔÔ›Ô˜ ı· Ú¤ÂÈ Ó· Â›Ó·È Î·È Ô ÌfiÓÔ˜ ˘Â‡ı˘ÓÔ˜ ÁÈ· ÙËÓ Ù‹ÚËÛË ÙÔ˘ È·ÙÚÈÎÔ‡ ·ÔÚÚ‹ÙÔ˘. ™ÙÔÓ ¶›Ó·Î· 4 ·ÚÔ˘ÛÈ¿˙ÂÙ·È ÚÔÙÂÈÓfiÌÂÓÔ ÚfiÙ˘Ô ·ÙÔÌÈÎÔ‡ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Î·È ÛÙÔÓ ¶›Ó·Î· 5 ÚÔÙÂÈÓfiÌÂÓÔ ¤ÓÙ˘Ô ÎÏÈÓÈ΋˜ ·ÍÈÔÏfiÁËÛ˘, Ì ‚¿ÛË ÙË Û‡ÓıÂÛË ÙˆÓ ‰ÈÂıÓÒÓ Ô‰ËÁÈÒÓ Ô˘ ÚԷӷʤÚıËηÓ.
¢. ¶ÚÔÙ¿ÛÂȘ ÁÈ· ÙËÓ Ú·ÎÙÈ΋ ÂÊ·ÚÌÔÁ‹ Ô‰ËÁÈÒÓ Ì·˙ÈÎÔ‡ Û¯ÔÏÈÎÔ‡ ÂϤÁ¯Ô˘ ∫·ıÔÚÈÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂÈÙ˘¯›· οıÂ Û˘ÛÙ‹Ì·ÙÔ˜ Ì·˙ÈÎÔ‡ ÚÔÏËÙÈÎÔ‡ ÂϤÁ¯Ô˘ Â›Ó·È Ë ¶·È‰È·ÙÚÈ΋ 2008;71:417-425
Pediatri Nov-Dec 08 new
19-12-08
16:31
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422
π. °ÂÚÌ·Ó¿Î˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 4. ∫·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ - ŒÓÙ˘Ô ∞ÙÔÌÈÎÔ‡ Î·È √ÈÎÔÁÂÓÂÈ·ÎÔ‡ πÛÙÔÚÈÎÔ‡ (Û˘ÌÏËÚÒÓÂÙ·È ·fi ÁÔÓ›˜ Î·È ·Ú·‰›‰ÂÙ·È ÛÙÔÓ ·È‰›·ÙÚÔ - fi¯È ÛÙÔ Û¯ÔÏ›Ô) ¶ÚfiÙ˘Ô πÛÙÔÚÈÎfi (·ÙÔÌÈÎfi-ÔÈÎÔÁÂÓÂÈ·Îfi) ∞ÍÈÔÏfiÁËÛ˘ πηÓfiÙËÙ·˜ ™˘ÌÌÂÙÔ¯‹˜ ¶·È‰ÈÒÓ Û ∞ıÏËÙÈΤ˜ ¢Ú·ÛÙËÚÈfiÙËÙ˜ ¶·Ú·Î·ÏÒ, ··ÓÙ‹ÛÂÙ ¡∞π ‹ √Ãπ ÛÙ· ÂÚˆÙ‹Ì·Ù· Ô˘ ·ÎÔÏÔ˘ıÔ‡Ó ∞∆√ªπ∫√ π™∆√ƒπ∫√ 1. £ˆÚ·ÎÈÎfi ¿ÏÁÔ˜-‰˘ÛÊÔÚ›· ÛÙËÓ ÎfiˆÛË Œ¯ÂÈ ÔÙ¤ ·Ú·ÔÓÂı› ÙÔ ·È‰› Û·˜ ÁÈ· fiÓÔ ‹ ‰˘ÛÊÔÚ›· ÛÙÔÓ ıÒڷη ηٿ ÙË ‰È¿ÚÎÂÈ· ۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘ ‹ Û‡ÓÙÔÌ· ÌÂÙ¿ ·fi ·˘Ù‹Ó; ¡∞π √Ãπ 2. ∞ÓÂÍ‹ÁËÙË Û˘ÁÎÔ‹ - ·Ú’ ÔÏ›ÁÔÓ Û˘ÁÎÔ‹ Œ¯ÂÈ ÔÙ¤ ÙÔ ·È‰› Û·˜ ÏÈÔı˘Ì‹ÛÂÈ, ¯¿ÛÂÈ ÙȘ ·ÈÛı‹ÛÂȘ ÙÔ˘ ‹ ÂÌÊ·Ó›ÛÂÈ ÂÂÈÛfi‰ÈÔ Û·ÛÌÒÓ; ¡∞π √Ãπ 3. ∂‡ÎÔÏË ÎfiˆÛË / ‰‡ÛÓÔÈ· ηٿ ÙËÓ ¿ÛÎËÛË ∫Ô˘Ú¿˙ÂÙ·È Â˘ÎÔÏfiÙÂÚ· ÙÔ ·È‰› Û·˜ ηٿ ÙËÓ ¿ÛÎËÛË, Û˘ÁÎÚÈÙÈο Ì ٷ ¿ÏÏ· ·È‰È¿, ‹ ¤¯ÂÈ ·Ú·ÔÓÂı› ÁÈ· ‰‡ÛÓÔÈ· Î·È ·‰˘Ó·Ì›· Ó· ¿ÚÂÈ ·¤Ú· ηٿ ÙËÓ ¿ÛÎËÛË; ¡∞π √Ãπ 4. πÛÙÔÚÈÎfi ¿ÚÚ˘ıÌ˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹ ·ÏÌÒÓ Œ¯ÂÈ ÔÙ¤ ÙÔ ·È‰› Û·˜ ·Ú·ÔÓÂı› ÁÈ· “¯Ù˘‹Ì·Ù·” ‹ ¿ÚÚ˘ıÌË ÏÂÈÙÔ˘ÚÁ›· Ù˘ ηډȿ˜ ÙÔ˘; Œ¯ÂÈ ÂÏÂÁ¯ı› ÔÙ¤ ÁÈ· ·ÚÚ˘ıÌ›·; ¡∞π √Ãπ 5. ¶ÚÔËÁÔ‡ÌÂÓË ‰È·›ÛÙˆÛË Ê˘Û‹Ì·ÙÔ˜ °ÓˆÚ›˙ÂÙÂ Â¿Ó ¤¯ÂÈ ‰È·ÈÛÙˆı› ·ÚÔ˘Û›· ηډȷÎÔ‡ Ê˘Û‹Ì·ÙÔ˜ ·fi ÙÔÓ ·È‰›·ÙÚÔ ‹ οÔÈÔ ÁÈ·ÙÚfi ÛÙÔ ·È‰› Û·˜; ¡∞π √Ãπ Œ¯ÂÈ ÂÏÂÁ¯ı› ·fi ηډÈÔÏfiÁÔ ÙÔ ·È‰› Û·˜ ÁÈ· ʇÛËÌ· ˆ˜ ÙÒÚ·; ¡∞π √Ãπ 6. πÛÙÔÚÈÎfi ˘¤ÚÙ·Û˘ Œ¯ÂÈ ÙÔ ·È‰› Û·˜ ÁÓˆÛÙ‹ ˘¤ÚÙ·ÛË; ¡∞π √Ãπ √π∫√°∂¡∂π∞∫√ π™∆√ƒπ∫√ 7. ¶ÚÒÈÌÔ Î·Ú‰È·Îfi ÂÂÈÛfi‰ÈÔ ‹ ı¿Ó·ÙÔ˜ (·ÈÊÓ›‰ÈÔ˜) Û ËÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 55 ÂÙÒÓ (¿Ó‰Ú˜) Î·È ÙˆÓ 65 ÂÙÒÓ (Á˘Ó·›Î˜) À¿Ú¯ÂÈ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ¿ Û·˜ (ÁÔÓ›˜, ·Ô‡‰Â˜, ·‰¤ÚÊÈ·) ÈÛÙÔÚÈÎfi ηډȷÎÔ‡ ÂÂÈÛÔ‰›Ô˘ ‹ ηډȷÎÔ‡ (·ÈÊÓ›‰ÈÔ˘) ı·Ó¿ÙÔ˘ Û ¿ÙÔÌ· ÌÈÎÚfiÙÂÚ· ÙˆÓ ËÏÈÎÈÒÓ ·˘ÙÒÓ; ¡∞π √Ãπ 8. °ÓÒÛË ‡·Ú͢ ÂȉÈÎfiÙÂÚˆÓ Î·Ú‰È·ÁÁÂÈ·ÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Û ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, fiˆ˜ ˘ÂÚÙÚÔÊÈ΋ ‹ ‰È·Ù·ÙÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·, Û‡Ó‰ÚÔÌÔ LQT ‹ Brugada, Marfan ‹ ÎÏÈÓÈο ÛËÌ·ÓÙÈΤ˜ ·ÚÚ˘ı̛˜ ‹ ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ˜ ¶¿Û¯ÂÈ Î¿ÔÈÔ ·fi Ù· ̤ÏË Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ Û·˜ ·fi οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ÓÔÛ‹Ì·Ù·; ¡∞π √Ãπ ¢ËÏÒÓˆ ˘Â‡ı˘Ó· fiÙÈ ÔÈ ·ÓˆÙ¤Úˆ ÏËÚÔÊÔڛ˜ Â›Ó·È ·ÏËı›˜. √ ÎˉÂÌfiÓ·˜ ∏ÌÂÚÔÌËÓ›·: √ÓÔÌ·ÙÂÒÓ˘ÌÔ - ÀÔÁÚ·Ê‹ ∆ËϤʈÓÔ ÂÈÎÔÈÓˆÓ›·˜ ÁÔÓ¤ˆÓ:
‰˘Ó·ÙfiÙËÙ· ¯ÚËÌ·ÙÔ‰fiÙËÛ˘, Ô Û·Ê‹˜ ηıÔÚÈÛÌfi˜ ÙˆÓ ·ÓȯÓ¢ÙÈÎÒÓ ÌÂıfi‰ˆÓ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó, Ë ‰È·ıÂÛÈÌfiÙËÙ· ÁÈ· ÙÔÓ ÛÎÔfi ·˘Ùfi ÂÍÂȉÈÎÂ˘Ì¤ÓˆÓ È·ÙÚÒÓ ÙfiÛÔ ÁÈ· ÙÔÓ ÚˆÙÔ‚¿ıÌÈÔ fiÛÔ Î·È ÁÈ· ÙÔÓ ‰Â˘ÙÂÚÔ‚¿ıÌÈÔ ¤ÏÂÁ¯Ô (·È‰ÔηډÈÔÏfiÁˆÓ), ηıÒ˜ Î·È Ë ÔÚÁ¿ÓˆÛË Û˘ÛÙ‹Ì·ÙÔ˜ ÎÂÓÙÚÈ΋˜ ηٷÁÚ·Ê‹˜ Î·È ·ÍÈÔÏfiÁËÛ˘ Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜. ∫·ıÒ˜ οı ۯÔÏÈ΋ Ù¿ÍË ÛÙËÓ ∂ÏÏ¿‰· ÈÛÔ‰˘Ó·Ì› ·ÚÈıÌËÙÈο ηٿ ÚÔÛ¤ÁÁÈÛË Ì ÙÔÓ ÂÙ‹ÛÈÔ ·ÚÈıÌfi ÁÂÓÓ‹ÛÂˆÓ (101.823 ηٿ ÙËÓ ·ÔÁÚ·Ê‹ 2001), Ë ˘Ô¯ÚˆÙÈ΋ ·ÍÈÔÏfiÁËÛË 6 Û¯ÔÏÈÎÒÓ Ù¿ÍˆÓ, Ô‰ËÁ› ÛÙËÓ ·Ó¿ÁÎË ÂϤÁ¯Ô˘ 600.000 ÙÔ˘Ï¿¯ÈÛÙÔÓ ·È‰ÈÒÓ ÛÙËÓ ·Ú¯‹ οı ۯÔÏÈÎÔ‡ ¤ÙÔ˘˜. ªÂ ‚¿ÛË ÙË ‰È·ıÂÛÈÌfiÙËÙ· ÂÚ›Ô˘ 3.000 ·È‰È¿ÙÚˆÓ ÛÙË ¯ÒÚ· Ì·˜ (2.700 ÙÔ 2000), ·ÓÙÈÛÙÔÈPaediatriki 2008;71:417-425
¯Ô‡Ó 200 ·ÍÈÔÏÔÁ‹ÛÂȘ ·Ó¿ ·È‰›·ÙÚÔ. ¶·Ú¿ÏÏËÏ·, Ì ‰Â‰Ô̤ÓË ÙËÓ ·Ú·ÔÌ‹ ÙÔ˘Ï¿¯ÈÛÙÔÓ 10% ÙˆÓ ·È‰ÈÒÓ (26), ÚÔ·ÙÂÈ Ë ÂÚ·ÈÙ¤Úˆ ·Ó¿ÁÎË ‰Â˘ÙÂÚÔ‚¿ıÌÈÔ˘ ÂϤÁ¯Ô˘ 60.000 ·È‰ÈÒÓ ÂÙËÛ›ˆ˜. ∆ËÓ Â˘ı‡ÓË (Î·È ÔÈÎÔÓÔÌÈ΋ ÂÈ‚¿Ú˘ÓÛË) ÙÔ˘ ÂϤÁ¯Ô˘ ¤¯Ô˘Ó ˆ˜ ÙÒÚ· ÔÈ ÁÔÓ›˜, ÂÓÒ Û ÂÚÈÙÒÛÂȘ ·Ó·ÛÊ¿ÏÈÛÙˆÓ, ·ÏÏÔ‰·ÒÓ Î·È ·fiÚˆÓ, ÚԂϤÂÙ·È Ô ‰ˆÚÂ¿Ó ¤ÏÂÁ¯Ô˜ ·fi Ù· ‰ËÌfiÛÈ· ÓÔÛÔÎÔÌ›·. ∂Ó‰ÂÈÎÙÈο, Â¿Ó 10% ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡ ·Ó‹ÎÔ˘Ó ÛÙËÓ ÙÂÏÂ˘Ù·›· ηÙËÁÔÚ›·, ÚÔ·ÙÂÈ Ë ·Ó¿ÁÎË ·ÍÈÔÏfiÁËÛ˘ 60.000 ·È‰ÈÒÓ ·fi ÙÔ ‰ËÌfiÛÈÔ Û‡ÛÙËÌ· ˘Á›·˜ ÛÙËÓ ·Ú¯‹ οı ¤ÙÔ˘˜. ∂ÓÒ ÛÙËÓ Â·Ú¯›· ˘¿Ú¯Ô˘Ó ·È‰›·ÙÚÔÈ ÛÙ· ∫¤ÓÙÚ· ÀÁ›·˜, Ë ·Ô˘Û›· ·ÛÙÈÎÒÓ ∫¤ÓÙÚˆÓ ÀÁ›·˜ ÛÙȘ fiÏÂȘ ¤¯ÂÈ Û·Ó ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÂÈÙ¤ÏÂÛË ÙÔ˘ Ì·˙ÈÎÔ‡ ÂϤÁ¯Ô˘ ÙˆÓ
Pediatri Nov-Dec 08 new
19-12-08
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™ÂÏ›‰·423
423
¶ÈÛÙÔÔ›ËÛË Î·Ú‰È·Î‹˜ ˘Á›·˜ Û ·È‰È¿ - ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜
¶›Ó·Î·˜ 5. ∫·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ - ŒÓÙ˘Ô ∫ÏÈÓÈ΋˜ ∞ÍÈÔÏfiÁËÛ˘ (Û˘ÌÏËÚÒÓÂÙ·È ·fi ·È‰›·ÙÚÔ) ¶ÚfiÙ˘Ô ŒÓÙ˘Ô ∫ÏÈÓÈ΋˜ ∞ÍÈÔÏfiÁËÛ˘ ∫·Ú‰È·ÁÁÂÈ·ÎÔ‡ ™˘ÛÙ‹Ì·ÙÔ˜ ÁÈ· πηÓfiÙËÙ· ™˘ÌÌÂÙÔ¯‹˜ ¶·È‰ÈÒÓ Û ∞ıÏËÙÈΤ˜ ¢Ú·ÛÙËÚÈfiÙËÙ˜ ∞ÓÙÈÎÂÈÌÂÓÈ΋ ÂͤٷÛË 1.∫·Ú‰È·Îfi ʇÛËÌ·* ·. §ÂÈÙÔ˘ÚÁÈÎfi ʇÛËÌ·** ‚. ¶·ıÔÏÔÁÈÎfi ʇÛËÌ·*** 2.™˘ÛÙÔÏÈο ÎÏÈÎ 3.∞ӈ̷ϛ˜ 2Ô˘ ηډȷÎÔ‡ ÙfiÓÔ˘ ·. ªÔÓ‹Ú˘ ¤ÓÙÔÓÔ˜ 2Ô˜ ÙfiÓÔ˜ ‚. ∂˘Ú‡˜ Î·È ÛÙ·ıÂÚfi˜ ‰È¯·ÛÌfi˜ 2Ô˘ ÙfiÓÔ˘ 4.æËÏ·ÊËÙ¤˜ ÌËÚÈ·›Â˜ 5.º·ÈÓfiÙ˘Ô˜ Û˘Ó‰ÚfiÌÔ˘ Marfan 6.ª¤ÙÚËÛË ·ÚÙËÚȷ΋˜ ›ÂÛ˘ ÛÙÔÓ ‚Ú·¯›ÔÓ· (ηıÈÛÙ‹ ı¤ÛË)
NAI NAI ¡∞π ¡∞π ¡∞π ¡∞π ¡∞π
OXI OXI √Ãπ √Ãπ √Ãπ √Ãπ √Ãπ
¡∞π ¡∞π
√Ãπ √Ãπ
* ηډȷ΋ ·ÎÚfi·ÛË Î·È Û ‡ÙÈ· Î·È Û fiÚıÈ· ı¤ÛË (‹ Ì ÂÈÙ¤ÏÂÛË Valsava) ÂȉÈο ÁÈ· ÙËÓ ·Ó›¯Ó¢ÛË Ê˘ÛËÌ¿ÙˆÓ ·fi ‰˘Ó·ÌÈ΋ ·fiÊÚ·ÍË ¯ÒÚÔ˘ ÂÍfi‰Ô˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ** ‹È·˜ ¤ÓÙ·Û˘ (<2/6 ÌÂÛÔÛ˘ÛÙÔÏÈÎfi ʇÛËÌ·, ‡˯ÔÌÔ˘ÛÈÎfi, ·ÓÙÈÏËÙfi ÛÙËÓ Î·ÙÒÙÂÚË ·ÚÈÛÙÂÚ‹ ·Ú·ÛÙÂÚÓÈ΋ ¯ÒÚ·, ¯ˆÚ›˜ ¿ÏÏ· Û˘ÓÔ‰¿ ·ıÔÏÔÁÈο ·ÎÚÔ·ÛÙÈο Â˘Ú‹Ì·Ù·, ÎÏÈÓÈο ÛËÌ›· ‹ Û˘ÌÙÒÌ·Ù·) *** ‰È·ÛÙÔÏÈÎfi ‹ Û˘Ó¯¤˜ ʇÛËÌ· ‹ Û˘ÛÙÔÏÈÎfi ʇÛËÌ· Ô˘ ‰ÂÓ ·ÓÙ·ÔÎÚ›ÓÂÙ·È Û ÏÂÈÙÔ˘ÚÁÈÎfi
·È‰ÈÒÓ ·fi Ù· ‰ËÌfiÛÈ· ÓÔÛÔÎÔÌ›·, Ô˘ ¯ˆÚ›˜ ÚfiÛıÂÙË ÛÙÂϤ¯ˆÛË ·‰˘Ó·ÙÔ‡Ó Ó· ·ÓÙÂÂͤÏıÔ˘Ó Â·ÚÎÒ˜. ∏ ·Ó¿ÁÎË ÔÈÎÔÓÔÌÈ΋˜ ÛÙ‹ÚÈ͢ Î·È ÛÙÂϤ¯ˆÛ˘ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÂϤÁ¯Ô˘ Â›Ó·È ÂÌÊ·Ó‹˜, ÂÓÒ ÚÔ·ÙÔ˘Ó Î·È ¿ÏÏ· Ô˘ÛÈ·ÛÙÈο ÂÚˆÙ‹Ì·Ù· Ô˘ Ú¤ÂÈ Ó· ··ÓÙËıÔ‡Ó: ∞) ¶ÔÈÔ˜ Â›Ó·È ˘Â‡ı˘ÓÔ˜ ÁÈ· ÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ Ì·ıËÙÒÓ; ∏ ÈÛÙÔÔ›ËÛË ˘Á›·˜ ÙˆÓ Ì·ıËÙÒÓ ÛÙÔ Û‡ÓÔÏfi Ù˘ ı· Ú¤ÂÈ Ó· Â›Ó·È ·ÔÎÏÂÈÛÙÈÎfi ¤ÚÁÔ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ·È‰È¿ÙÚÔ˘, ηıÒ˜ Ë Û˘ÌÏ‹ÚˆÛË ÙˆÓ ∞.¢.À. ·ÔÙÂÏ› ÌÔÓ·‰È΋ ¢ηÈÚ›· Ù·ÎÙÈ΋˜ Û˘ÓÔÏÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ Ù˘ ˘Á›·˜ Î·È ·Ó¿Ù˘Í˘ ÙÔ˘ ·È‰ÈÔ‡. √ ¤ÁηÈÚÔ˜ ÚÔÁÚ·ÌÌ·ÙÈÛÌfi˜ ÙÔ˘ ÂϤÁ¯Ô˘ (.¯. ¯ÔÚ‹ÁËÛË ∞.¢.À. ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÚÔËÁÔ‡ÌÂÓˆÓ ıÂÚÈÓÒÓ ‰È·ÎÔÒÓ) ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÂÈÌÂÏ‹ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ì·ıËÙÒÓ. ªÔÏÔÓfiÙÈ Û ÁˆÁÚ·ÊÈΤ˜ ÂÚÈÔ¯¤˜ Ì ¤ÏÏÂÈ„Ë ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘ ·È‰È¿ÙÚÔ˘ ‹ ÛÙ· Ï·›ÛÈ· ÂϤÁ¯Ô˘ ·fi ‰ËÌfiÛȘ ˘ËÚÂۛ˜ ˘Á›·˜, Ë Û˘Ì‚ÔÏ‹ Î·È ÂÍÂȉÈÎÂ˘Ì¤ÓˆÓ ÁÂÓÈÎÒÓ È·ÙÚÒÓ ÌÔÚ› Ó· Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Î·È ·fiÏ˘Ù· ÂȂ‚ÏË̤ÓË, ηÌÈ¿ ¿ÏÏË È·ÙÚÈ΋ ÂȉÈÎfiÙËÙ· ‰ÂÓ ı· Ú¤ÂÈ Ó· Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙËÓ ·Ú¯È΋ ÈÛÙÔÔ›ËÛË Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ. µ) ¶ÔÈ· Â›Ó·È Ë ÂÏ¿¯ÈÛÙË ··ÈÙÔ‡ÌÂÓË Âη›‰Â˘ÛË; H ·Ú΋˜ Âη›‰Â˘ÛË ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ
Û˘Ó‹ıˆÓ ηٷÛÙ¿ÛÂˆÓ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Û ·ıÏËÙ¤˜, ηıÒ˜ Î·È Ë ÎÏÈÓÈ΋ ¿ÚÎÂÈ· ÛÙËÓ ·È‰È·ÙÚÈ΋ ηډȷ΋ ·ÎÚfi·ÛË Î·È ÛËÌÂÈÔÏÔÁ›· Â›Ó·È ··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÂÈÙ˘¯›·˜ ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜. ¢˘ÛÙ˘¯Ò˜, ÔÈ Êı›ÓÔ˘Û˜ ÎÏÈÓÈΤ˜ ÈηÓfiÙËÙ˜ ÙˆÓ Ó¤ˆÓ È·ÙÚÒÓ (27,28) ‰ÈÂıÓÒ˜, Ô‰ËÁÔ‡Ó ÙfiÛÔ Û ·ÔÙ˘¯›· ·Ó›¯Ó¢Û˘ ÛËÌ·ÓÙÈÎÒÓ ·ıÔÏÔÁÈÎÒÓ Î·Ù·ÛÙ¿ÛÂˆÓ fiÛÔ Î·È Û ‰··ÓËÚ¤˜ ÂÍÂÙ¿ÛÂȘ Ô˘ ‰ÂÓ Â›Ó·È ·Ó·Áη›Â˜. ∞ӷʤÚÂÙ·È fiÙÈ Ô ÁÂÓÈÎfi˜ ·È‰›·ÙÚÔ˜ ¤¯ÂÈ Â˘·ÈÛıËÛ›· 80% Î·È ÂȉÈÎfiÙËÙ· 65% ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ·ıÔÏÔÁÈÎÒÓ Î·Ú‰È·ÎÒÓ Ê˘ÛËÌ¿ÙˆÓ, ÂÓÒ ÔÈ ÂȉÈ΢fiÌÂÓÔÈ Î·È ÔÈ ÊÔÈÙËÙ¤˜ È·ÙÚÈ΋˜ ·ÎfiÌ· ¯·ÌËÏfiÙÂÚË ÎÏÈÓÈ΋ ·ÎÚ›‚ÂÈ· (29). ∏ ·ÛÊ·Ï‹˜ Âη›‰Â˘ÛË ÌÔÚ› Ó· ÂÍ·ÛÊ·ÏÈÛı› ÌfiÓÔ Ì ÙËÓ Â·Ú΋ ÎÏÈÓÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË (ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Âȉ›Î¢Û˘ ÛÙËÓ ¶·È‰È·ÙÚÈ΋) ÔÚÁ·ÓˆÌ¤ÓˆÓ ·È‰ÔηډÈÔÏÔÁÈÎÒÓ È·ÙÚ›ˆÓ Î·È ÙËÓ ··Ú·›ÙËÙË ıˆÚËÙÈ΋ ηٿÚÙÈÛË ÛÙ· Ï·›ÛÈ· ÂÎ·È‰Â˘ÙÈÎÒÓ ÛÂÌÈÓ·Ú›ˆÓ, Ì ¯Ú‹ÛË ÔÏ˘Ì¤ÛˆÓ Î.Ù.Ï. (30). °) ¶Ò˜ Á›ÓÂÙ·È Ô ÚˆÙÔ‚¿ıÌÈÔ˜ ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜; ¢ÈÂıÓÒ˜, Ô ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˜ ηډÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ÙˆÓ ·È‰ÈÒÓ Ú·ÁÌ·ÙÔÔÈÂ›Ù·È ·ÔÎÏÂÈÛÙÈο ·fi ·È‰›·ÙÚÔ˘˜ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙÔ ÁÓˆÛÙÈÎfi ·ÓÙÈΛÌÂÓÔ Ù˘ ·È‰ÔηډÈÔÏÔÁ›·˜ Î·È ÈÛÙÔÔÈË̤ÓË Â¿ÚÎÂÈ· Û ۯÂÙÈΤ˜ ‰È·ÁÓˆÛÙÈΤ˜ Ù¯ÓÈΤ˜. ™ÙË ¯ÒÚ· Ì·˜, fiÔ˘ Ë ·È‰ÔηډÈÔÏÔÁ›· ‰ÂÓ Â›Ó·È ÂÈۋ̈˜ ·Ó·ÁÓˆÚÈṲ̂ÓË ÂÍÂȉ›Î¢ÛË Ù˘ ·È‰È·ÙÚÈ΋˜, Ô ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ÂÈÙÂÏÂ›Ù·È Ôχ Û˘¯Ó¿ Î·È ·fi ÌË ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙËÓ ·È‰ÔηډÈÔÏÔÁ›· ηډÈÔÏfiÁÔ˘˜ ÂÓËϛΈÓ. ∂›Ó·È ÂÈÙ·ÎÙÈ΋ Ë ·Ó¿ÁÎË ÈÛÙÔÔ›ËÛ˘ Ù˘ ·È‰ÔηډÈÔÏÔÁ›·˜ ˆ˜ ÁÓˆÛÙÈÎÔ‡ ·ÓÙÈÎÂÈ̤ÓÔ˘ Ù˘ ¶·È‰È·ÙÚÈ΋˜, ÒÛÙ ӷ Û˘Ì‚¿ÏÂÈ ÂÓÂÚÁ¿ ÛÙË ‰È·ÌfiÚʈÛË ÔÚıÒÓ ÔÏÈÙÈÎÒÓ ˘Á›·˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ Î·Ú‰È·ÁÁÂȷ΋ ˘Á›· ÙˆÓ ·È‰ÈÒÓ. ¢) ¶ÔÈÔ˜ ηıÔÚ›˙ÂÈ ÙÔÓ ‚·ıÌfi Û˘ÌÌÂÙÔ¯‹˜ ÙÔ˘ Ì·ıËÙ‹ ÛÙË Û¯ÔÏÈ΋ Á˘ÌÓ·ÛÙÈ΋; ∏ ÂÓÂÚÁfi˜ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ ıÂÚ¿ÔÓÙÔ˜ ·È‰È¿ÙÚÔ˘ ‹ ·È‰ÔηډÈÔÏfiÁÔ˘ ηÈ, Èı·ÓÒ˜, ÙˆÓ ÎˉÂÌfiÓˆÓ ÛÙË Û¯ÔÏÈ΋ ÂÈÙÚÔ‹ Ô˘ ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙËÓ ··ÏÏ·Á‹ Ì·ıËÙÒÓ ·fi ÙÔ Ì¿ıËÌ· Ù˘ Á˘ÌÓ·ÛÙÈ΋˜ ÎÚ›ÓÂÙ·È ÂȂ‚ÏË̤ÓË (1) (ηıÒ˜ ÚԂϤÂÙ·È ·ÔÎÏÂÈÛÙÈο Ë Û˘ÌÌÂÙÔ¯‹ 3 ÂÎ·È‰Â˘ÙÈÎÒÓ ÌfiÓÔ), ÒÛÙ ӷ Û˘Ì‚¿ÏÂÈ ÛÙËÓ ·ÔÊ˘Á‹ ÙÔ˘ ÔÏÔÎÏËÚˆÙÈÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ Î·È Ù˘ ÂÚÈıˆÚÈÔÔ›ËÛ˘ ÙˆÓ ·È‰ÈÒÓ Ô˘ ¿Û¯Ô˘Ó ·fi ηډȷÁÁÂȷο ÚÔ‚Ï‹Ì·Ù·. π‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Â›Ó·È Î·È Ë ÌÂÙÂη›‰Â˘ÛË ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ Î·È È‰È·›ÙÂÚ· ÙˆÓ Î·ıËÁËÙÒÓ Ê˘ÛÈ΋˜ ·ÁˆÁ‹˜ ÛÙȘ ȉȷ›ÙÂÚ˜ ·Ó¿ÁΘ ÙˆÓ Î·Ú‰ÈÔ·ıÒÓ ·È‰ÈÒÓ, ȉȷ›ÙÂÚ· Â¿Ó Ë Î·Ú‰ÈÔ¿ıÂÈ· Â›Ó·È ÂΉ‹ÏˆÛË ÁÂÓÂÙÈÎÒÓ Û˘Ó‰ÚfïÓ, ÒÛÙ ӷ Â›Ó·È ÂÊÈÎÙ‹ Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ Û ÂÍ·ÙÔÌÈÎÂ˘Ì¤Ó· ÚÔÁÚ¿ÌÌ·Ù· ¿ıÏËÛ˘ (31). ¶·È‰È·ÙÚÈ΋ 2008;71:417-425
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·424
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π. °ÂÚÌ·Ó¿Î˘ Î·È Û˘Ó.
∂. ∞Ó¿ÁÎË ÂÓÈ·›Ô˘ ıÂÛÌÈÎÔ‡ Ï·ÈÛ›Ô˘ ·ÓÙ·ÁˆÓÈÛÙÈ΋˜ ¿ıÏËÛ˘ ¢˘ÛÙ˘¯Ò˜, Û ·ÓÙ›ıÂÛË Ì ÙË ıÂÛÌÔıÂÙË̤ÓË ·ÍÈÔÏfiÁËÛË ÁÈ· ÙË Û˘ÌÌÂÙÔ¯‹ ÛÙȘ Û˘Ó‹ıÂȘ (¯·ÌËÏÔ‡ ÎÈÓ‰‡ÓÔ˘) Û¯ÔÏÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ÙȘ ·ÈÛÈfi‰Ô͘ ÚÔÔÙÈΤ˜ ÂÚ·ÈÙ¤Úˆ ‚ÂÏÙ›ˆÛ‹˜ Ù˘, Ë (˘„ËÏfiÙÂÚÔ˘ ÎÈÓ‰‡ÓÔ˘) Û˘ÌÌÂÙÔ¯‹ ÙfiÛÔ Û ۯÔÏÈο fiÛÔ Î·È Û Â͈ۯÔÏÈο ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· ‰ÂÓ Î·Ï‡ÙÂÙ·È ·fi ÂÓÈ·›Ô ıÂÛÌÈÎfi Ï·›ÛÈÔ Ì ‚¿ÛË ÙȘ ‰ÈÂıÓ›˜ Ô‰ËÁ›Â˜. ∏ ¤ÏÏÂÈ„Ë ·˘Ù‹ Ô‰ËÁ› ÛÙÔÓ ·˘ÙÔۯ‰ȷÛÌfi ÙˆÓ ÛˆÌ·Ù›ˆÓ, Ô˘, ·ÔÛÎÔÒÓÙ·˜ ΢ڛˆ˜ ÛÙË ÓÔÌÈ΋ ÙÔ˘˜ ÚÔÛÙ·Û›·, ÂÚÈÔÚ›˙ÔÓÙ·È Û ·Ó·˙‹ÙËÛË ÂÓ˘fiÁÚ·ÊˆÓ ‚‚·ÈÒÛÂˆÓ “ÌˉÂÓÈÎÔ‡ ÎÈÓ‰‡ÓÔ˘”, ¯ˆÚ›˜ Ó· ÚÔÛ‰ÈÔÚ›˙ÔÓÙ·È Ô‡Ù ÙÔ Â›‰Ô˜ Î·È Ë ¤ÎÙ·ÛË ÙÔ˘ ··ÈÙÔ‡ÌÂÓÔ˘ ÂϤÁ¯Ô˘ Ô‡ÙÂ Î·È Ë ÂȉÈÎfiÙËÙ· ÙÔ˘ È·ÙÚÔ‡. ∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ Ó¤ˆÓ ·ıÏËÙÒÓ Ú¤ÂÈ Î·È Û ·˘Ù‹ ÙËÓ ÂÚ›ÙˆÛË Ó· ‚·Û›˙ÂÙ·È ÛÙȘ ‰ÈÂıÓ›˜ Ô‰ËÁ›Â˜, Ë Èı·ÓfiÙËÙ· ·Ú¿ÓÔÌ˘ Ï‹„˘ Ê·Ú̷΢ÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È ÔÈ Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ·˘Ù‹Ó ΛӉ˘ÓÔÈ Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÔÓÙ·È ˘fi„Ë (32,33), ÂÓÒ Ë ·Ó¿ÁÎË ÂÈÙ¤ÏÂÛ˘ Î·È ∏∫°Ì·ÙÔ˜ ÛÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô Ê·›ÓÂÙ·È ÂȂ‚ÏË̤ÓË, ȉ›ˆ˜ Û ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ ·È‰È¿ (>12 ÂÙÒÓ) (18). ∫·È ÛÙËÓ ÂÚ›ÙˆÛË ·˘Ù‹ Ô ÁÂÓÈÎfi˜ ·È‰›·ÙÚÔ˜ ÔÊ›ÏÂÈ Ó· ¤¯ÂÈ ÚˆÙ·Ú¯ÈÎfi Î·È ÎÔÌ‚ÈÎfi ÚfiÏÔ ÛÙÔ Û‡ÛÙËÌ· ÚÔ-·ÁˆÓÈÛÙÈÎÔ‡ ÂϤÁ¯Ô˘, ÂÓÒ Ë ÎÏÈÓÈ΋ ÙÔ˘ ÈηÓfiÙËÙ· ÛÙËÓ Î·Ú‰È·Î‹ ·ÎÚfi·ÛË Î·È ÛÙË ‰È¿ÁÓˆÛË ÙÔ˘ ·È‰ÈÎÔ‡ ∏∫°Ì·ÙÔ˜ ηıÔÚ›˙Ô˘Ó Î·È ÙËÓ ÂÈÙ˘¯›· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÂϤÁ¯Ô˘. ™˘ÌÂÚ¿ÛÌ·Ù· √ ıÂÛÌÔıÂÙË̤ÓÔ˜ ¤ÏÂÁ¯Ô˜ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ÛÙË ¯ÒÚ· Ì·˜ Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈÎfi ̤ÙÚÔ ÚÔÛÙ·Û›·˜ Ù˘ ˙ˆ‹˜ Î·È Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ, Ì ÛËÌ·ÓÙÈο fï˜ ÂÚÈıÒÚÈ· ‚ÂÏÙ›ˆÛ˘. ¶·Ú¿ÏÏËÏ· ‰È·ÈÛÙÒÓÂÙ·È ¤ÏÏÂÈ„Ë ÂÓÈ·›·˜ ÔÏÈÙÈ΋˜ Û¯ÂÙÈο Ì ÙÔÓ ¤ÏÂÁ¯Ô ·È‰ÈÒÓ Ô˘ Û˘ÌÌÂÙ¤¯Ô˘Ó Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù·. ∏ ‚ÂÏÙ›ˆÛË Ù˘ Âη›‰Â˘Û˘ ÙˆÓ ·È‰È¿ÙÚˆÓ ÛÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜, Ë Â·Ú΋˜ ÛÙÂϤ¯ˆÛË ÙˆÓ ‰ËÌfiÛÈˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ Î·È Ë ÔÚıÔÏÔÁÈ΋ ¯Ú‹ÛË ÙˆÓ ‰Â˘ÙÂÚÔ‚¿ıÌÈˆÓ ˘ËÚÂÛÈÒÓ ˘Á›·˜ ÌÔÚÔ‡Ó Ó· ÂÍ·ÛÊ·Ï›˙Ô˘Ó ÙËÓ ·ÛʷϤÛÙÂÚË Û˘ÌÌÂÙÔ¯‹ fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ Î·È ÂÊ‹‚ˆÓ ÛÙȘ ·ıÏËÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜. ∆· ÚÔÙÂÈÓfiÌÂÓ· ÚfiÙ˘· ¤ÓÙ˘· ÈÛÙÔÚÈÎÔ‡ Î·È ÎÏÈÓÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ (¶›Ó·Î˜ 4 Î·È 5), ·ÔÙÂÏÔ‡Ó Û‡ÓıÂÛË ÙˆÓ ‰ÈÂıÓÒÓ Î·Ù¢ı˘ÓÙ‹ÚÈˆÓ Ô‰ËÁÈÒÓ Î·È ÌÔÚÔ‡Ó Ó· ·ÔÙÂϤÛÔ˘Ó ÙË ‚¿ÛË Ù˘ ÔÚı‹˜ ηډÈÔÏÔÁÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ·ıÏÔ‡ÌÂÓˆÓ ·È‰ÈÒÓ ·fi ÙÔÓ ·È‰›·ÙÚÔ, ÙÔÓ ·ÎÚÔÁˆÓÈ·›Ô Ï›ıÔ ÙÔ˘ οıÂ Û˘ÛÙ‹Ì·ÙÔ˜ ÂϤÁ¯Ô˘. Paediatriki 2008;71:417-425
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REVIEW ARTICLE
∏ ›‰Ú·ÛË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ ¢È‡ı˘ÓÛË ∫ÔÈÓˆÓÈ΋˜ Î·È ∞Ó·Ù˘Íȷ΋˜ ¶·È‰È·ÙÚÈ΋˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∞ÏÂÍ›· ¶Ú·ÛÔ‡ÏË prasouli@hotmail.com ¢È‡ı˘ÓÛË ∫ÔÈÓˆÓÈ΋˜ Î·È ∞Ó·Ù˘Íȷ΋˜ ¶·È‰È·ÙÚÈ΋˜, πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·” £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, 115 27, ∞ı‹Ó·
∞. ¶Ú·ÛÔ‡ÏË, ∞. ∞ÙÙÈÏ¿ÎÔ˜, π. ∞ÓÙˆÓÈ¿‰Ô˘ ¶ÂÚ›ÏË„Ë: ∏ ÂÈÏË„›· Â›Ó·È Ì›· ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ Ó¢ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∆· ·È‰È¿ Ì ÂÈÏË„›· ‚Ú›ÛÎÔÓÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, Û ۇÁÎÚÈÛË ÙfiÛÔ Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi fiÛÔ Î·È Ì ٷ ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ¿ÏÏ· ¯ÚfiÓÈ· ÓÔÛ‹Ì·Ù· Ô˘ ‰ÂÓ ·ÊÔÚÔ‡Ó ÙÔ ÎÂÓÙÚÈÎfi Ó¢ÚÈÎfi Û‡ÛÙËÌ·. √È ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È Ù· ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ ÌÔÚ› Ó· ÚÔËÁËıÔ‡Ó Ù˘ ‰È¿ÁÓˆÛË Ù˘ ÂÈÏË„›·˜, Ó· ÂÌÊ·ÓÈÛıÔ‡Ó Ù·˘Ùfi¯ÚÔÓ· Ì ·˘Ù‹Ó ‹ Ó· ÙËÓ ·ÎÔÏÔ˘ı‹ÛÔ˘Ó . ¶ÔÏÏÔ› ÂÚ¢ÓËÙ¤˜ ¤¯Ô˘Ó ÚÔÛ·ı‹ÛÂÈ Ó· ·Ó·ÁÓˆÚ›ÛÔ˘Ó ÂȉÈÎÔ‡˜ ·ÈÙÈÔÏÔÁÈÎÔ‡˜ Î·È ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÁÓˆÛÙÈÎÒÓ Î·È Û˘ÌÂÚÈÊÔÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Û ÂÈÏËÙÈο ·È‰È¿, Ì ·ÓÙÈÎÚÔ˘fiÌÂÓ· fï˜ ·ÔÙÂϤÛÌ·Ù·. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ÂÂȉ‹ Ë ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙËÓ ·ÎÚÈ‚‹ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÈÏË„›·˜ Î·È ÁÓˆÛÙÈ΋˜/Û˘ÌÂÚÈÊÔÚÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÂËÚ¿˙ÂÙ·È ·fi ÔÏϤ˜ ÌÂÙ·‚ÏËÙ¤˜, fiˆ˜ Ë ‡·ÚÍË Û·ÛÌÒÓ ‰È·ÊfiÚˆÓ Ù‡ˆÓ, ÙÔ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi ˘fiÛÙڈ̷ Ù˘ ÂÈÏË„›·˜, Ë ˘ÔΛÌÂÓË ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, Ë ÂÌÊ¿ÓÈÛË ˘ÔÎÏÈÓÈÎÒÓ ÂÈÏËÙÈÎÒÓ ÂÎÊÔÚÙ›ÛˆÓ, Ë Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È ·Ú¿ÁÔÓÙ˜ Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. √ Ù‡Ô˜ Ù˘ ÂÈÏË„›·˜, Ë ËÏÈΛ· ¤Ó·Ú͢, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ Û·ÛÌÒÓ Î·È ÔÈ ˘ÔÎÏÈÓÈΤ˜ ÂÈÏËÙÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÁÓˆÛÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÂÓÒ Ù· ÂÈÚfiÛıÂÙ· Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù·, Ë ·ÓıÂÎÙÈ΋ ÛÙ· Ê¿Ú̷η ÂÈÏË„›· Î·È ·Ú¿ÁÔÓÙ˜ Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›·. ™Â οı ÂÚ›ÙˆÛË, Ë Ó¢ÚÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛı› Ë Î·Ù¿ÏÏËÏË ·Ú¤Ì‚·ÛË, fiÔ˘ ·˘Ù‹ ¯ÚÂÈ¿˙ÂÙ·È. §¤ÍÂȘ ÎÏÂȉȿ: ¶·È‰È΋ ÂÈÏË„›·, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Û˘ÌÂÚÈÊÔÚ¿.
The effect of childhood epilepsy on cognitive function and behaviour Department of Social and Developmental Paediatrics, Institute of Child Health, “Aghia Sophia” Children’s Hospital, Athens Correspondence: Alexia Prassouli prasouli@hotmail.com Department of Social and Developmental Paediatrics, Institute of Child Health, “Aghia Sophia” Children’s Hospital Thivon & Levadias St., 115 27, Athens
A. Prassouli, A. Attilakos, I. Antoniadou Abstract: Epilepsy is one of the most common neurological disorders in childhood. Children with epilepsy are at increased risk of cognitive dysfunction and behavioural problems, compared with normal children or children with other chronic diseases not involving the central nervous system. Cognitive dysfunction and behavioural problems may precede, coincide with or follow the diagnosis of childhood epilepsy. Numerous investigators have attempted to identify specific factors contributing to or predictive of cognitive and behavioural impairment in epileptic children, with conflicting results. The investigation of the precise relationship between epilepsy and cognitive/behavioural dysfunction is confounded by several variables, including the type of seizures, the pathophysiology of the epilepsy, the underlying brain damage, the occurrence of subclinical epileptiform discharges, the effect of antiepileptic drug treatment and family-related parameters. Epilepsy type, age at onset, seizure frequency, and subclinical epileptiform disharges have been associated with the occurrence of cognitive impairment, while additional neurological deficits, drug-resistant epilepsy, and family-related factors have been associated with the occurrence of behavioural disturbance in epileptic children. In any case, the neurological monitoring of children with epilepsy should include evaluation of cognitive and behavioural functions, and provision of appropriate intervention when needed.
Key words: Childhood epilepsy, cognitive function, behaviour.
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Paediatriki 2008;71:426-433
ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Û‡Ó‰ÚÔÌÔ ÂÏÏÂÈÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·
∂ÈÛ·ÁˆÁ‹ ∏ ÂÈÏË„›· Â›Ó·È Ì›· ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ ¯ÚfiÓȘ Ó¢ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ 4 ¤ˆ˜ 6 ÛÙ· 1000 ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÈÏË„›· (1).
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·427
427
∂ÈÏË„›·, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È Û˘ÌÂÚÈÊÔÚ¿
™ÙËÓ ÙÚ¤¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯ÂÈ ¤Ó· ÔÏ˘‰È¿ÛÙ·ÙÔ Â‰›Ô ¤Ú¢ӷ˜ Û¯ÂÙÈο Ì ÙȘ ÁÓˆÛÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ Î·È Ù· Ó¢ÚÔ„˘¯ÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›·. ∆· ·ÔÙÂϤÛÌ·Ù· ÙˆÓ Û¯ÂÙÈÎÒÓ ÌÂÏÂÙÒÓ, fï˜, Â›Ó·È Û˘¯Ó¿ ·ÓÙÈÎÚÔ˘fiÌÂÓ·, ·ÊÂÓfi˜ ‰ÈfiÙÈ ¿ÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ·Û¯ÔÏ‹ıËÎ·Ó Ì ÙȘ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜, ¿ÏÏÔÈ Ì ÙË ÓÔËÌÔÛ‡ÓË Î·È ¿ÏÏÔÈ Ì ٷ ÁÓˆÛÙÈο ÂÏÏ›ÌÌ·Ù·, Î·È ·ÊÂÙ¤ÚÔ˘ ‰ÈfiÙÈ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È·ÊÔÚÂÙÈΤ˜ „˘¯ÔÌÂÙÚÈΤ˜ ‰ÔÎÈ̷ۛ˜. ∂›Ó·È, ¿ÓÙˆ˜, ·Ô‰ÂÎÙfi fiÙÈ Ù· ·È‰È¿ Ì ÂÈÏË„›· ‚Ú›ÛÎÔÓÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó ‰È·Ù·Ú·¯¤˜ Ì¿ıËÛ˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ (2-5). ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ì¿ıËÛ˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋ (2-4). ¶·Ú¿ÌÂÙÚÔÈ Ô˘ ÌÔÚ› Ó· ¢ı‡ÓÔÓÙ·È Â›Ó·È Ë ›‰È· Ë ÓfiÛÔ˜, Ë ˘ÔΛÌÂÓË Ó¢ÚÔÏÔÁÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ ÚÔηÏ› ÙfiÛÔ ÙÔ˘˜ Û·ÛÌÔ‡˜ fiÛÔ Î·È ÙȘ ‰È·Ù·Ú·¯¤˜ ·˘Ù¤˜, Ë Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·ÓÙ›‰Ú·ÛË ÙÔ˘ ·È‰ÈÔ‡ Î·È Ù˘ ÔÈÎÔÁ¤ÓÂÈ¿˜ ÙÔ˘ ÛÙË ÓfiÛÔ ‹/Î·È ¿ÏÏ· ·›ÙÈ· Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È Ì ÙËÓ ›‰È· Û˘¯ÓfiÙËÙ· Î·È Û ÌË ÂÈÏËÙÈο ·È‰È¿. ∂ÈÚfiÛıÂÙ·, Ë Ê·Ú̷΢ÙÈ΋ ıÂڷ›· Ù˘ ÂÈÏË„›·˜ Âȉڿ ÛËÌ·ÓÙÈο ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·Ú·¿Óˆ ‰È·Ù·Ú·¯ÒÓ, ηıÒ˜ Ù· ÂÚÈÛÛfiÙÂÚ· ‰È·ı¤ÛÈÌ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÂËÚ¿˙ÔÓÙ·˜ ÙËÓ ÂÁÚ‹ÁÔÚÛË, ÙȘ ÓÂ˘Ì·ÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿. ∆·˘Ùfi¯ÚÔÓ·, fï˜, Ê·›ÓÂÙ·È fiÙÈ Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η (∞∂º) ÌÔÚÔ‡Ó Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, ÌÂÈÒÓÔÓÙ·˜ ÙÔÓ ·ÚÈıÌfi ÙfiÛÔ ÙˆÓ ÎÏÈÓÈÎÒÓ fiÛÔ Î·È ÙˆÓ ˘ÔÎÏÈÓÈÎÒÓ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ·ÊÈÎÒÓ (∏∂°) ÂÎÊÔÚÙ›ÛÂˆÓ (6,7).
¢È·Ù·Ú·¯¤˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿ Ì ÂÈÏË„›· ™ÙË ‚È‚ÏÈÔÁÚ·Ê›·, ÔÏϤ˜ ÂÈÚ·Ì·ÙÈΤ˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙȘ Û˘Ó¤ÂȘ ÙˆÓ Û·ÛÌÒÓ ÛÙËÓ ÚÒÈÌË ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ηıÒ˜ Î·È ÛÙËÓ ÂÁÎÂÊ·ÏÈ΋ ‰ÔÌ‹ Î·È ÏÂÈÙÔ˘ÚÁ›· (8). ∏ ˘ÔÙÚÔÈ¿˙Ô˘Û· ÂÈÏËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ‰È·Ù·Ú·¯¤˜ ÂÁÎÂÊ·ÏÈÎÒÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·‰ÈηÛÈÒÓ Â˘Ú¤Ô˜ Ê¿ÛÌ·ÙÔ˜. ¢È·‰Èηۛ˜ fiˆ˜ Ô Û¯ËÌ·ÙÈÛÌfi˜ ÙˆÓ Û˘Ó¿„ˆÓ, Ë ÌÂÙ·Ó¿ÛÙ¢ÛË ÙˆÓ Ó¢ÚÒÓˆÓ, Ë ‰È·ÎÏ¿‰ˆÛË ÙˆÓ ‰ÂÓ‰ÚÈÙÒÓ, Ë ‰È·‰Ô¯È΋ ¤ÎÊÚ·ÛË ÙˆÓ ˘Ô‰Ô¯¤ˆÓ Î·È Ë ÂÈÏÔÁ‹/·Ê·›ÚÂÛË ÙˆÓ Û˘Ó‰¤ÛÂˆÓ ÌÔÚ› Ó· ‰È·ÎÔÔ‡Ó, Ó· ÂÈ‚Ú·‰˘ÓıÔ‡Ó ‹ Ó· ÂÈÙ·¯˘ÓıÔ‡Ó, ÚÔηÏÒÓÙ·˜ ‰È·Ù·Ú·¯‹ ‹/Î·È ÌfiÓÈÌË ‚Ï¿‚Ë ÛÙÔ ÂÌÏÂÎfiÌÂÓÔ ÂÁÎÂÊ·ÏÈÎfi ÓÂ˘ÚˆÓÈÎfi ·Îψ̷ (8,9). ∏ ›‰È· Ë ÂÈÏË„›·, Ë ˘ÔΛÌÂÓË ÂÁÎÂÊ·ÏÈ΋ ·ıÔÏÔÁ›·, ÔÈ „˘¯ÔÏÔÁÈΤ˜ Û˘Ó¤ÂȘ Ù˘ ÓfiÛÔ˘ Î·È Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ¤¯Ô˘Ó ÚÔÙ·ı› ÁÈ· ÙËÓ ÂÚÌËÓ›· fiÏˆÓ ‹ ̤ÚÔ˘˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ Î·È Û˘ÌÂÚÈ-
ÊÔÚÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· (24). ∫·ı¤Ó·˜ ·fi ÙÔ˘˜ ·Ú·¿Óˆ ·Ú¿ÁÔÓÙ˜ ÌÔÚ› Ó· ‰È·ÈÚÂı› Û ÔÏÏ¿ ÂÈ̤ÚÔ˘˜ ÛÙÔȯ›·. ∂›Ó·È ÌÂıÔ‰ÔÏÔÁÈο ‰‡ÛÎÔÏÔ, ·Ó fi¯È ·Ó¤ÊÈÎÙÔ, Ó· ·ÔÌÔÓÒÛÔ˘Ì ̛· ·fi ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ÂÈÏË„›·˜ ˆ˜ ÙËÓ Î‡ÚÈ· Î·È ÌÔÓ·‰È΋ ·ÈÙ›· ÁÈ· Ù· ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Î·È Ì¿ıËÛ˘ ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›·.
∂ÈÏË„›· Î·È ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ √È ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ·ÊÔÚÔ‡Ó ÙȘ „˘¯ÔÏÔÁÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ Ù˘ ·ÓÙ›Ï˄˘, Ù˘ ÚÔÛÔ¯‹˜, Ù˘ ÌÓ‹Ì˘, Ù˘ ÈηÓfiÙËÙ·˜ ÁÈ· Â›Ï˘ÛË ÚÔ‚ÏËÌ¿ÙˆÓ, Ù˘ ÏÔÁÈ΋˜ ·ÊËÚË̤Ó˘ ÛΤ„˘, ·ÏÏ¿ Î·È Ù˘ ÁψÛÛÈ΋˜ ÈηÓfiÙËÙ·˜. √È ÁÓˆÛÙÈΤ˜ ‰ÈÂÚÁ·Û›Â˜ ÂÓÙÔ›˙ÔÓÙ·È Û ‰È·ÊÔÚÂÙÈΤ˜ ÂÚÈÔ¯¤˜ ÙÔ˘ ÊÏÔÈÔ‡ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ Î·È Û˘Ó‰¤ÔÓÙ·È ¿ÌÂÛ· ‹ ¤ÌÌÂÛ· Ì ÙË Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÙˆÓ ÂÚÈÔ¯ÒÓ ·˘ÙÒÓ. √È ÂÚÈÛÛfiÙÂÚ˜ Ó¢ÚÔ„˘¯ÔÏÔÁÈΤ˜ ÌÂϤÙ˜ Û ·È‰È¿ Ì ÂÈÏË„›· ·Ó·Ê¤ÚÔÓÙ·È ÛÙȘ ÂÈÙÒÛÂȘ Ù˘ ÓfiÛÔ˘ ÛÙË ÓÔËÌÔÛ‡ÓË, ÙË Ì·ıËÛȷ΋ ÈηÓfiÙËÙ· Î·È ÙË Û¯ÔÏÈ΋ ÙÔ˘˜ ›‰ÔÛË (10-16). ∫¿ÔȘ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ÓÔËÙÈΤ˜ ÂȉfiÛÂȘ ÙˆÓ ÂÈÏËÙÈÎÒÓ ·È‰ÈÒÓ, ·ÎfiÌ· Î·È ·˘ÙÒÓ Ì ȉÈÔ·ı‹ ÂÈÏË„›·, ˘ÔÏ›ÔÓÙ·È ÛËÌ·ÓÙÈο ·fi ·˘Ù¤˜ ÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔ‡ ÏËı˘ÛÌÔ‡ (15,16). ™Â ¿ÏϘ, fï˜, ÌÂϤÙ˜ ·Ó·Ê¤ÚÂÙ·È Ê˘ÛÈÔÏÔÁÈÎfi˜ ‰Â›ÎÙ˘ ÓÔËÌÔÛ‡Ó˘ ÙˆÓ ·È‰ÈÒÓ Ì ȉÈÔ·ı‹ ÂÈÏË„›· (2,14). √ ΛӉ˘ÓÔ˜ ÁÈ· Û¯ÔÏÈ΋ ·ÔÙ˘¯›· Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·È‰È¿ ÌÂ Û˘Ìو̷ÙÈ΋ ‹ ÎÚ˘ÙÔÁÂÓ‹ ÂÈÏË„›· (2,13), ÂÓÒ ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó Ê˘ÛÈÔÏÔÁÈ΋ ›‰ÔÛË ÛÙ· ·È‰È¿ Ì ÌÈÎÚfiÙÂÚ˘ ÎÏÈÓÈ΋˜ ÛÔ‚·ÚfiÙËÙ·˜ ÂÈÏË„›· (2,3). ∂ÓÙÔ‡ÙÔȘ, Û ÌÈ· ÚÔÔÙÈ΋ ÌÂϤÙË ·È‰ÈÒÓ Ì ȉÈÔ·ı‹ ÂÈÏË„›· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÓÔËÌÔÛ‡ÓË (12) ‚Ú¤ıËΠÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ ÔÛÔÛÙfi ·ӿÏ˄˘ Ù˘ Û¯ÔÏÈ΋˜ Ù¿Í˘ (34%) Î·È ÂȉÈ΋˜ Âη›‰Â˘Û˘ (19%) ÛÙ· ·È‰È¿ ·˘Ù¿, fiÙ·Ó Û˘ÁÎÚ›ıËÎ·Ó Ì ٷ ·‰¤ÚÊÈ· ÙÔ˘˜, Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ Ì¿ÚÙ˘Ú˜. ∂ÈϤÔÓ, Ù· ·È‰È¿ Ì ȉÈÔ·ı‹ ÂÈÏË„›· ›¯·Ó ¯·ÌËÏfiÙÂÚË Â›‰ÔÛË ÛÙȘ ÂÈ̤ÚÔ˘˜ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, fiÙ·Ó ÂÎÙÈÌ‹ıËÎ·Ó Û˘ÁÎÚÈÙÈο Ì ٷ ·‰¤ÚÊÈ· ÙÔ˘˜. ∞ӷʤÚÂÙ·È Â›Û˘ fiÙÈ ÔÈ ·ÛıÂÓ›˜ Ì ȉÈÔ·ı‹ ÂÈÏË„›· Î·È ÂȉÈÎfiÙÂÚ· Ì ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›·, Ë ÔÔ›· Â›Ó·È Ë Î·ÏÔËı¤ÛÙÂÚ˘ ÚfiÁÓˆÛ˘ ÂÈÏË„›·, ¤¯Ô˘Ó ηٿ ̤ÛÔÓ fiÚÔ Ê˘ÛÈÔÏÔÁÈÎfi ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ (17). ŸÌˆ˜, ·ÎfiÌ· Î·È ÛÙË ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›· ¤¯Ô˘Ó ·Ó·ÊÂÚı› ‰˘ÛÎÔϛ˜ ÛÙË Û˘ÁΤÓÙÚˆÛË Î·È ÛÙË Ì¿ıËÛË (18). º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ·ÎfiÌË Î·È Ù· ·È‰È¿ Ì ȉÈÔ·ı‹ ÂÈÏË„›· ‚Ú›ÛÎÔÓÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó Ì·ıËÛȷο ÚÔ‚Ï‹Ì·Ù· Î·È Û¯ÔÏÈ΋ ·ÔÙ˘¯›·. ™˘ÁÎÂÎÚÈ̤ӷ ηÎÔ‹ıË ÂÈÏËÙÈο Û‡Ó‰ÚÔÌ· Ê·›ÓÂÙ·È fiÙÈ Û˘Ó‰¤ÔÓÙ·È Ì ÂÍÂÏÈÎÙÈΤ˜ ÁÓˆÛÙÈΤ˜ ¶·È‰È·ÙÚÈ΋ 2008;71:426-433
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·428
428
∞. ¶Ú·ÛÔ‡ÏË Î·È Û˘Ó.
‰È·Ù·Ú·¯¤˜, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Landau-Kleffner, fiÔ˘ Ë ÚfiÁÓˆÛË Ù˘ ÁÓˆÛÙÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È ÊÙˆ¯‹, ·ÎfiÌË Î·È Û ÂÈÙ˘¯‹ ıÂڷ›·, Ì ·‡ÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Î·È Â·Ó·ÊÔÚ¿ ÙÔ˘ ∏∂° ÛÂ Ê˘ÛÈÔÏÔÁÈο ›‰· (19). À¿Ú¯Ô˘Ó ·ÎfiÌË ¤Ú¢Ó˜ Ô˘ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ Û˘ÁÎÂÎÚÈ̤Ó˜ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È Û ·È‰È¿ Ì ÂÈÏË„›·. ŒÙÛÈ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· ÂÈÏËÙÈο ·È‰È¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î·ı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó·ÁÓˆÛÙÈ΋ ÈηÓfiÙËÙ· (20), ÂÓÒ ¿ÏÏÔÈ Û˘ÁÁÚ·Ê›˜ ÂÚÈÁÚ¿ÊÔ˘Ó ‰˘ÛÎÔϛ˜ ÛÙËÓ ÈηÓfiÙËÙ· ÚÔÛÔ¯‹˜, ÛÙË ‚Ú·¯˘¯ÚfiÓÈ· ÌÓ‹ÌË, ÛÙËÓ Ù·¯‡ÙËÙ· ÂÂÍÂÚÁ·Û›·˜ ÏËÚÔÊÔÚÈÒÓ Î·È ÛÙÔÓ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi (21-23). ∏ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÂÈÏËÙÈ΋˜ ÓfiÛÔ˘ Ê·›ÓÂÙ·È Ó· ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ÁÓˆÛÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ. √È ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Â›Ó·È Û˘¯ÓfiÙÂÚ˜ Û ÂÈÏËÙÈο ·È‰È¿ ÙˆÓ ÔÔ›ˆÓ ÔÈ ÎÚ›ÛÂȘ ¿Ú¯ÈÛ·Ó ÚÈÓ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ (2). º·›ÓÂÙ·È ˆ˜ Ù· 2 ÚÒÙ· ¯ÚfiÓÈ· Ù˘ ˙ˆ‹˜ ÙÔ˘ ·ÙfiÌÔ˘ ·ÔÙÂÏÔ‡Ó ÎÚ›ÛÈÌË ÂÚ›Ô‰Ô ÁÈ· ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ. √È ·fi„ÂȘ ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÙÔ˘ Ù‡Ô˘ Î·È Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÂÈÏËÙÈÎÒÓ Û·ÛÌÒÓ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯ÒÓ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ˜. °ÂÓÈο, ÔÈ ÁÂÓÈÎÂ˘Ì¤ÓÔÈ ÙÔÓÈÎÔÎÏÔÓÈÎÔ› Û·ÛÌÔ› Û¯ÂÙ›˙ÔÓÙ·È Ì ÌÂÁ·Ï‡ÙÂÚË ÁÓˆÛÙÈ΋ ‰È·Ù·Ú·¯‹ ·fi fi,ÙÈ ÔÈ ÂÛÙȷΤ˜ ÂÈÏË„›Â˜, ÂÓÒ ÌÂÁ·Ï‡ÙÂÚÔ˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È Ô Î›Ó‰˘ÓÔ˜ ÛÙËÓ ÂÈÏËÙÈ΋ ηٿÛÙ·ÛË (status epilepticus) (24). Œ¯ÂÈ ·Ó·ÊÂÚı› ·ÚÓËÙÈ΋ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ Ù˘ Û˘¯ÓfiÙËÙ·˜ ÙˆÓ ÁÂÓÈÎÂ˘Ì¤ÓˆÓ ÙÔÓÈÎÔ-ÎÏÔÓÈÎÒÓ Û·ÛÌÒÓ Î·È Ù˘ ›‰ÔÛ˘ ÛÙËÓ „˘¯ÔÌÂÙÚÈ΋ ‰ÔÎÈÌ·Û›· WISC-III (Wechsler Intelligence Scale for Children) (20,24), ÂÓÒ Ù· ·È‰È¿ Ì ÁÂÓÈÎÂ˘Ì¤ÓÔ˘˜ Û·ÛÌÔ‡˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚ˜ ‰˘ÛÎÔϛ˜ ÛÙÔÓ ÙÔ̤· Ù˘ ÚÔÛÔ¯‹˜, Û ۇÁÎÚÈÛË Ì ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÂÛÙȷΤ˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ (25). ∂›Û˘, ·ÛıÂÓ›˜ Ì ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ ¤¯ÂÈ ‚ÚÂı› fiÙÈ ÂÌÊ·Ó›˙Ô˘Ó ‰È·Ù·Ú·¯¤˜ ÙfiÛÔ ÛÙË ÏÂÎÙÈ΋ fiÛÔ Î·È ÛÙË ÌË ÏÂÎÙÈ΋ ÌÓ‹ÌË (26). ¶·È‰È¿ Ì ÂÈÏËÙÔÁfiÓÔ ÂÛÙ›· ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ ÂÌÊ·Ó›˙Ô˘Ó Û˘¯Ó¿ ‰˘ÛÎÔÏ›· ÛÙËÓ ·ÔÌÓËÌfiÓ¢ÛË ÏÂÎÙÈÎÒÓ ÏËÚÔÊÔÚÈÒÓ, ÂÓÒ ·È‰È¿ Ì ÂÈÏËÙÔÁfiÓÔ ÂÛÙ›· ÛÙÔ ‰ÂÍÈfi ËÌÈÛÊ·›ÚÈÔ ¤¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÛÙË ¯ˆÚÔ-ÔÙÈ΋ ÌÓ‹ÌË (27). ∆¤ÏÔ˜, ÔÈ ˘ÔÙÚÔÈ¿˙ÔÓÙ˜ ·Ú¿ ÙË Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹ Û·ÛÌÔ› ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÌÂÁ·Ï‡ÙÂÚË ‰È·Ù·Ú·¯‹ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ (24). ¶Ú¤ÂÈ, ¿ÓÙˆ˜, Ó· ÛËÌÂȈı› fiÙÈ Ë ÚÔÁÓˆÛÙÈ΋ ·Í›· ÙÔ˘ Ù‡Ô˘ Î·È ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÂÈÏËÙÈ΋˜ ÓfiÛÔ˘, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›·, ‰ÂÓ ¤¯ÂÈ ·ÎfiÌ· Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ› (2,3). ∏ Û˘Û¯¤ÙÈÛË ÙˆÓ ˘ÔÎÏÈÓÈÎÒÓ ÂÈÏËÙÈÎÒÓ ÎÚ›Paediatriki 2008;71:426-433
ÛÂˆÓ Ì ÙËÓ Â›‰ÔÛË ÙˆÓ ·ÛıÂÓÒÓ ÛÙȘ Ó¢ÚÔ„˘¯ÔÏÔÁÈΤ˜ ‰ÔÎÈ̷ۛ˜ ¤¯ÂÈ Â›Û˘ ·ÔÙÂϤÛÂÈ ·ÓÙÈΛÌÂÓÔ ÂȉÈ΋˜ ÌÂϤÙ˘ (28). ∏ Û˘¯Ó‹ ÂÌÊ¿ÓÈÛË ÂÈÏËÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÛÙÔ ∏∂° ıˆÚÂ›Ù·È ‰˘ÛÌÂÓ¤˜ ÚÔÁÓˆÛÙÈÎfi ÛÙÔÈ¯Â›Ô ÁÈ· ÙË ÁÓˆÛÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·ÙfiÌÔ˘. ™‹ÌÂÚ· Â›Ó·È ·Ô‰ÂÎÙfi fiÙÈ ÔÈ ·ÛıÂÓ›˜ ·˘ÙÔ› ·ı·›ÓÔ˘Ó Û˘¯Ó¤˜ ˘ÔÎÏÈÓÈΤ˜ ÎÚ›ÛÂȘ, ÔÈ Ôԛ˜ ÂËÚ¿˙Ô˘Ó ·ÚÓËÙÈο ÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ÙÔ˘˜. ∆· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÔÈ ÂÚ¢ÓËÙ¤˜ ÂÚÈÁÚ¿ÊÔ˘Ó ¤Ó·Ó ηÈÓÔ‡ÚÁÈÔ fiÚÔ ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÈÎÒÓ ·ÓˆÌ·ÏÈÒÓ, Ô˘ ÔÓÔÌ¿˙ÂÙ·È “¶·ÚÔ‰È΋ °ÓˆÛÙÈ΋ ¢È·Ù·Ú·¯‹” (Transient Cognitive Impairment) (29). ¶ÚfiÎÂÈÙ·È ÁÈ· ·ÚÔ‰ÈΤ˜ ·ÓˆÌ·Ï›Â˜ Ú˘ıÌÔ‡ ÛÙÔ ∏∂°, ·ÓÂÍ·Úًو˜ ÂÓÙfiÈÛ˘, Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÚÔ‰ÈΤ˜ ÁÓˆÛÙÈΤ˜ ‰˘ÛÎÔϛ˜ ˆ˜ ÙÔ ÌfiÓÔ ÎÏÈÓÈÎfi Û‡Ìو̷. ∏ ›‰Ú·ÛË Ù˘ “¶·ÚÔ‰È΋˜ °ÓˆÛÙÈ΋˜ ¢È·Ù·Ú·¯‹˜” ÌÂ Û˘ÓÔ‰¤˜ ˘ÔÎÏÈÓÈΤ˜ ∏∂° ÂÎÊÔÚÙ›ÛÂȘ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ· Â›Ó·È ·ÎfiÌ· ·‚¤‚·ÈË Î·È ¯ÚÂÈ¿˙ÂÙ·È ÂÚ·ÈÙ¤Úˆ ‰ÈÂÚ‡ÓËÛË. ¶·Ú’ fiÏ· ·˘Ù¿, ˘¿Ú¯ÂÈ ÂÈÚ·Ì·ÙÈ΋ ¤Ó‰ÂÈÍË fiÙÈ ÔÈ ˘ÔÎÏÈÓÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ÌÔÚ› Ó· Û˘Óԉ‡ÔÓÙ·È ·fi ‰È·Ù·Ú·¯‹ ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ÈηÓÔÙ‹ÙˆÓ ÛÙ· ·È‰È¿, ÂÓÒ Ë Î·Ù·ÛÙÔÏ‹ ·˘ÙÒÓ ÙˆÓ ÂÎÊÔÚÙ›ÛÂˆÓ Ì ٷ ∞∂º Û˘Ó‰¤ÂÙ·È Ì ‚ÂÏÙ›ˆÛË ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÙÔ˘˜ ÏÂÈÙÔ˘ÚÁÈÒÓ (29,30). ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ‰Â›¯ÓÔ˘Ó fiÙÈ Û Ó¢ÚÔÏÔÁÈο Î·È ÓÔËÙÈο Ê˘ÛÈÔÏÔÁÈο ·È‰È¿ Ì ÂÈÏË„›·, ÔÈ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ηÈ/‹ ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ ÚÔËÁÔ‡ÓÙ·È ¯ÚÔÓÈο Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ Û·ÛÌÒÓ (31-33). ∏ ÎÏÈÓÈ΋ ÂÌÂÈÚ›· ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ Ù· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ‚ÂÏÙÈÒÓÔÓÙ·È ‹ ÂÍ·Ê·Ó›˙ÔÓÙ·È Ì ÙËÓ ·ÓÙÈÂÈÏËÙÈ΋ ıÂڷ›·. ∞˘Ù¤˜ ÔÈ ÂÚÈÙÒÛÂȘ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ˘fiıÂÛË fiÙÈ Û ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ë ÂÈÏË„›· Â›Ó·È ÌÈ· ÁÂÓÈÎfiÙÂÚË Î·Ù¿ÛÙ·ÛË Ô˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ ÙfiÛÔ Û·ÛÌÔ‡˜ fiÛÔ Î·È Ì·ıËÛȷο-Û˘ÌÂÚÈÊÔÚÈο ÚÔ‚Ï‹Ì·Ù· (33). ™ÙË ÌÂϤÙË ÙˆÓ Schouten Î·È Û˘Ó. (31), 69 ·È‰È¿ Ì ÚfiÛÊ·ÙË ‰È¿ÁÓˆÛË ÂÈÏË„›·˜ ÂÎÙÈÌ‹ıËÎ·Ó Û˘ÁÎÚÈÙÈο Ì ÌÈ· ÔÌ¿‰· ÂϤÁ¯Ô˘. ¶ÚÈÓ ÙË ‰È¿ÁÓˆÛË, 22% ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· ›¯·Ó ·ӷϿ‚ÂÈ Ù¿ÍË, ÂÓÒ ÛÙÔ 54% ˙ËÙ‹ıËΠÂÓÈÛ¯˘ÙÈ΋ ‰È‰·Ûηϛ· (ÙÔ ·ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi ÛÙÔ˘˜ ˘ÁÈ›˜ Û˘ÌÌ·ıËÙ¤˜ ÙÔ˘˜ ‹Ù·Ó 23%). ™ËÌÂÈÒÓÂÙ·È fiÙÈ Ù· ·È‰È¿ Ì ÂÈÏË„›· ‰ÂÓ ‰È¤ÊÂÚ·Ó ÛËÌ·ÓÙÈο ÛÙË ÓÔËÌÔÛ‡ÓË ·fi ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ¶·ÚÔÌÔ›ˆ˜, ÔÈ Aldenkamp A Î·È Û˘Ó. (34), Û ۯÂÙÈ΋ ÌÂϤÙË ÙÔ˘˜, ¤‰ÂÈÍ·Ó fiÙÈ ÌÈ· Í·ÊÓÈ΋ Î·È ÌË ·Ó·ÌÂÓfiÌÂÓË ¤ÎÙˆÛË Ù˘ Û¯ÔÏÈ΋˜ ›‰ÔÛ˘ ÌÔÚ› Ó· Â›Ó·È ÙÔ ÚÒÙÔ Û‡Ìو̷ Ù˘ ¤Ó·Ú͢ Ù˘ ÂÈÏËÙÈ΋˜ ÓfiÛÔ˘. ∆¤ÏÔ˜, Û ÂÈÏËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÔÚÁ·ÓÈ΋ ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, ·Ú·ÙËÚ›ٷÈ, Û˘Ó‹ıˆ˜, ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÓÙfiÈÛË Î·È ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ‚Ï¿‚˘ (35). ŒÙÛÈ, ·ÛıÂÓ›˜ Ì ‰ÔÌÈΤ˜ ‹
Pediatri Nov-Dec 08 new
19-12-08
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∂ÈÏË„›·, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È Û˘ÌÂÚÈÊÔÚ¿
ÂÛÙȷΤ˜ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (.¯. ÊÏÔÈÒ‰ÂȘ ‚Ï¿‚˜, ÁÏÔ›ˆÛË) ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ (36).
∂ÈÏË„›· Î·È Û˘ÌÂÚÈÊÔÚ¿ ¶·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì ÂÈÏË„›· ‚Ú›ÛÎÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ÂΉËÏÒÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ ·fi fi,ÙÈ ·È‰È¿ Ì ¿ÏϘ ¯ÚfiÓȘ ·ı‹ÛÂȘ ÛÙ· ÔÔ›· ¯ÔÚËÁÂ›Ù·È Ì·ÎÚÔ¯ÚfiÓÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, fiˆ˜ ÙÔ ¿ÛıÌ· Î·È Ô ‰È·‚‹Ù˘ (4,37). ™Â Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂÈÏËÙÈ΋ ÓfiÛÔ, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÈıÂÙÈÎfiÙËÙ· (ۈ̷ÙÈ΋ Î·È ÏÂÎÙÈ΋), Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·ÛÙ¿ıÂÈ·, Ó¢ÚÈÎfiÙËÙ·, ·ÚÔÚÌËÙÈÎfiÙËÙ·, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È ·˘ÙÔÙÚ·˘Ì·ÙÈΤ˜ Û˘ÌÂÚÈÊÔÚ¤˜ (3,4,32,33). ∂ÈϤÔÓ, ÔÈ Û·ÛÌÔ› Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÌÔÚ› Ó· ‰È·Ù·Ú¿ÍÔ˘Ó ÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ‡ÓÔ˘ Î·È ÙȘ ÂÓ‰ÔÎÚÈÓÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Ì ·ÔÙ¤ÏÂÛÌ· ·ÏÏ·Á‹ Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ (38). ∏ ‰ÈÂÈÛ‰˘ÙÈ΋ Î·È Û˘Ó¯‹˜ ›‰Ú·ÛË Ù˘ ÂÈÏË„›·˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔÓ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙȘ ÌÂϤÙ˜ ÙˆÓ Austin Î·È Û˘Ó. (39), fiˆ˜ Î·È Dunn Î·È Û˘Ó. (40), fiÔ˘ Ë ·Ó‡ÚÂÛË ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿ 6 Ì‹Ó˜ ÚÈÓ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Û·ÛÌÒÓ ‰Â›¯ÓÂÈ fiÙÈ Ë „˘¯Ô·ıÔÏÔÁ›· Î·È Ë ÂÈÏË„›· Û˘Ó‰¤ÔÓÙ·È ·Ó·fiÛ·ÛÙ·. ŒÙÛÈ, Ë ÂÈÏË„›· ÌÔÚ› Ó· ÂÚÌËÓ¢Ù› ˆ˜ ÌÈ· Û‡ÓıÂÙË Ó¢ÚÔ„˘¯È·ÙÚÈ΋ ‰È·Ù·Ú·¯‹. §·Ì‚¿ÓÔÓÙ·˜ ˘fi„Ë ÙÔ ˘„ËÏfi ÔÛÔÛÙfi „˘¯Ô·ıÔÏÔÁ›·˜ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Ì ÂÈÏË„›· (¤ˆ˜ 80%), Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÔÈ ‰˘ÛÎÔϛ˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÌÔÚ› Ó· ·Ó·Ù˘¯ıÔ‡Ó ÛÙËÓ ÚÒÈÌË ·È‰È΋ ËÏÈΛ· Î·È Ó· ÂÈÌ›ÓÔ˘Ó ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÂÈÏË„›· (5,41). ∂ȉÈο ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, fiˆ˜ ‰È·Ù·Ú·¯¤˜ ‰È¿Û·Û˘ Ù˘ ÚÔÛÔ¯‹˜ Î·È ÌÂÙ·‚ÔϤ˜ ÛÙË ‰È¿ıÂÛË, ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ÙËÓ ·ÚÔ˘Û›· Û·ÛÌÒÓ ÛÙ· ·È‰È¿. ¶ÂÚÈÛÛfiÙÂÚÔ ˘ÔÛÙËÚ›˙ÂÙ·È Ë Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÈÏË„›·˜ Î·È Û˘Ó‰ÚfiÌÔ˘ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· (™∂¶À). √È McDermott Î·È Û˘Ó. (42) ·Ó¤ÊÂÚ·Ó ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Û ÔÛÔÛÙfi 28% ·È‰ÈÒÓ Ì ÂÈÏË„›·, ÂÓÒ ÔÈ Semrud-Clikeman Î·È Wical (43) ‚Ú‹Î·Ó fiÙÈ ÔÛÔÛÙfi 33% ÙˆÓ ·È‰ÈÒÓ Ì ۇÓıÂÙÔ˘˜ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ›¯·Ó ™∂¶À. ∏ ·˘ÍË̤ÓË Û˘ÓÔÛËÚfiÙËÙ· ÙÔ˘ ™∂¶À Î·È Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ˘fiıÂÛË fiÙÈ Ë Â›‰Ú·ÛË Ù˘ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ∫¡™ Î·È Ù˘ ÂÈÏË„›·˜ ÛÙË ÏÂÈÙÔ˘ÚÁ›· Ù˘ ÚÔÛÔ¯‹˜ ‰ËÌÈÔ˘ÚÁ› ÌÈ· ÂȉÈ΋ Ó¢ÚÔ„˘¯ÔÏÔÁÈ΋ ¢·ÈÛıËÛ›·, Ô˘ Ì ÙË ÛÂÈÚ¿ Ù˘ Ô‰ËÁ› Û ÌÂÁ·Ï‡ÙÂÚË ÚԉȿıÂÛË ÁÈ· Û˘ÌÂÚÈÊÔÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ì ÙË ÌÔÚÊ‹ ÙÔ˘ ™∂¶À (44). º·›ÓÂÙ·È, ›Û˘, Ó· ˘¿Ú¯ÂÈ Û¯¤ÛË ÌÂٷ͇ ÂÈÏË„›·˜ Î·È ·˘ÙÈÛÙÈ΋˜ ‰È·Ù·Ú·¯‹˜, Ì ÙËÓ ÂΉ‹ÏˆÛË Û·ÛÌÒÓ ÛÙÔ 1/3 ÙˆÓ ·È‰ÈÒÓ Ì ·˘ÙÈÛÌfi (45). ∏
‡·ÚÍË „‡¯ˆÛ˘ ÛÙËÓ ·È‰È΋ ÂÈÏË„›· Â›Ó·È Û¿ÓÈ·, ·Ó Î·È ¤¯ÂÈ ·Ó·ÊÂÚı› ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ‰È·Ù·Ú·¯‹˜ Ù˘ ÛΤ„˘ Û ·È‰È¿ Ì ۇÓıÂÙÔ˘˜ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ (46). ™˘Û¯¤ÙÈÛË ¤¯ÂÈ ·Ó·ÊÂÚı›, ›Û˘, ÌÂٷ͇ ηٿıÏȄ˘ Î·È ÂÈÏË„›·˜, ·Ó Î·È ÛÙÔÓ ÙÔ̤· ·˘Ùfi ÔÈ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ˜ (4). √È Dunn Î·È Û˘Ó. (47) ·Ú·Ù‹ÚËÛ·Ó fiÙÈ ÔÛÔÛÙfi 23% Û ‰Â›ÁÌ· ÂÈÏËÙÈÎÒÓ ÂÊ‹‚ˆÓ ›¯Â Û˘ÌÙÒÌ·Ù· ηٿıÏȄ˘, ÂÓÒ ÔÈ Oguz Î·È Û˘Ó. (48) ‚Ú‹Î·Ó ÂÚÈÛÛfiÙÂÚ· Û˘ÌÙÒÌ·Ù· ηٿıÏȄ˘ Û ÂÊ‹‚Ô˘˜ Ì ÂÈÏË„›· ËÏÈΛ·˜ 12-18 ÂÙÒÓ, Û ۇÁÎÚÈÛË Ì ·ÛıÂÓ›˜ ËÏÈΛ·˜ 9-11 ÂÙÒÓ Î·È ˘ÁÈ›˜ Ì¿ÚÙ˘Ú˜. ∏ ηٿıÏÈ„Ë Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È Ï›ÁÔ ÈÔ Û˘¯Ó‹ Û ·ÛıÂÓ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Û‡ÓıÂÙÔ˘˜ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ·fi fi,ÙÈ Û ·ÛıÂÓ›˜ Ì ÁÂÓÈÎÂ˘Ì¤ÓÔ˘ Ù‡Ô˘ Û·ÛÌÔ‡˜ (49). ∏ ›وÛË Ù˘ ·Á¯Ò‰Ô˘˜ ‰È·Ù·Ú·¯‹˜ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹, ·ÏÏ¿ Ë Ê‡ÛË ÙˆÓ Û·ÛÌÒÓ, Ì ÙÔÓ ·Úfi‚ÏÂÙÔ ¯·Ú·ÎÙ‹Ú· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÙËÓ ·ÒÏÂÈ· ÂϤÁ¯Ô˘ Ô˘ ÚÔηÏ›, ÌÔÚ› Ó· ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ·˘ÍË̤ÓÔ ¿Á¯Ô˜ ÛÙ· ·È‰È¿ Î·È ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜ (50). À¿Ú¯ÂÈ ¤Ó‰ÂÈÍË fiÙÈ ÔÈ Û·ÛÌÔ› Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ÂÚÈÔ¯‹ ÙˆÓ ·Ì˘Á‰·ÏÒÓ ÌÔÚ› Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì Êfi‚Ô ‹ ¿Á¯Ô˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘, Ô˘ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ Ô‰ËÁÔ‡Ó Û ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (51). ∫Ú›ÛÂȘ ·ÓÈÎÔ‡ Î·È ÊÔ‚›Â˜ Â›Ó·È ÔÈ ÈÔ Û˘¯Ó¤˜ „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ Û·ÛÌÒÓ (52). ø˜ ·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿ Ì ÂÈÏË„›· ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ Ù· ÂÈÚfiÛıÂÙ· Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù·, ÔÈ ·ÓıÂÎÙÈÎÔ› Û·ÛÌÔ› Î·È ·Ú¿ÌÂÙÚÔÈ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· (4,32,33,48). ªÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· ·È‰È¿ Ì ÂÈÏË„›· ¤¯Ô˘Ó ÂÈÚfiÛıÂÙ· Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù·, fiˆ˜ ÓÂ˘Ì·ÙÈ΋ ηı˘ÛÙ¤ÚËÛË Î·È ÂÁÎÂÊ·ÏÈ΋ ·Ú¿Ï˘ÛË, Û ÔÛÔÛÙfi 15-30%, Î·È fiÙÈ ÙÔ ÔÛÔÛÙfi ·˘Ùfi ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÚ›Ô˘ ‰ÈÏ¿ÛÈÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜, Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ÌË ÂÈÏÂÁ̤ÓË ÂÈÏË„›· (53). ™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÌË Î·Ï¿ ÂÏÂÁ¯fiÌÂÓˆÓ Û·ÛÌÒÓ Î·È ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜ ¤¯ÂÈ Â›Û˘ ÂÚÈÁÚ·Ê› Û ·ÚÎÂÙ¤˜ ¤Ú¢Ó˜ (4,53-55). √È ·Ú¿ÌÂÙÚÔÈ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿ Ì ÂÈÏË„›· ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ÙËÓ ¤ÏÏÂÈ„Ë ÔÚÁ¿ÓˆÛ˘ ̤۷ ÛÙËÓ ÔÈÎÔÁ¤ÓÂÈ·, ÙÔ ÂÓ‰ÔÔÈÎÔÁÂÓÂÈ·Îfi ÛÙÚ˜, ÙËÓ ÚÔÛ·ÚÌÔÁ‹ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ÛÙË ÓfiÛÔ Ù˘ ÂÈÏË„›·˜, ÙË Û¯¤ÛË ·È‰ÈÔ‡-ÁÔÓ¤ˆÓ Î·È ÙË ÌËÙÚÈ΋ ηٿıÏÈ„Ë (4,5,55). √È ‰ËÌÔÁÚ·ÊÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ê·›ÓÂÙ·È fiÙÈ ‰ÂÓ ·ÔÙÂÏÔ‡Ó, ÛÙȘ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜, ÛÙ·ıÂÚÔ‡˜ ÚÔÁÓˆÛÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ Ù˘ „˘¯Ô·ıÔÏÔÁ›·˜ ÛÙ· ¶·È‰È·ÙÚÈ΋ 2008;71:426-433
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·430
430
∞. ¶Ú·ÛÔ‡ÏË Î·È Û˘Ó.
·È‰È¿ Ì ÂÈÏË„›·. ŒÙÛÈ, ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ Û˘ÌÂÚÈÊÔÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ ¤¯ÂÈ ·Ó·ÊÂÚı› ÙfiÛÔ Û ·ÁfiÚÈ· fiÛÔ Î·È Û ÎÔÚ›ÙÛÈ·. ¶·ÚfiÌÔÈ· ·ÓÙÈÎÚÔ˘fiÌÂÓ· Â˘Ú‹Ì·Ù· ¤¯Ô˘Ó ·Ó·ÊÂÚı› ·Ó·ÊÔÚÈο Ì ÙËÓ ÚÔÁÓˆÛÙÈ΋ ·Í›· Ù˘ ËÏÈΛ·˜ ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· ÛÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ (4,41,55,56). ∞Ó·ÊÔÚÈο Ì ÙÔÓ ÚfiÏÔ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÂÈÏË„›·˜ (Ù‡Ô˜ Û·ÛÌÒÓ, ËÏÈΛ· ¤Ó·Ú͢, ‰È¿ÚÎÂÈ· ÂÈÏË„›·˜, ¤ÏÂÁ¯Ô˜ Û·ÛÌÒÓ Î.Ï..) ÛÙËÓ ÂÌÊ¿ÓÈÛË ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜, Ù· ‚È‚ÏÈÔÁÚ·ÊÈο ‰Â‰Ô̤ӷ Â›Ó·È Â›Û˘ ·ÓÙÈÊ·ÙÈο (4,41,55). ∆· ·È‰È¿ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó Û‡ÓıÂÙÔ˘˜ ÂÛÙÈ·ÎÔ‡˜ Û·ÛÌÔ‡˜ ηٿ ηÓfiÓ· ÂÚÈÁÚ¿ÊÔÓÙ·Ó ˆ˜ ·ÓÙÈÎÔÈÓˆÓÈο Î·È ÂÈıÂÙÈο, ÂÓÒ Ù· ·È‰È¿ Ì ÁÂÓÈÎÂ˘Ì¤Ó˜ ÙÔÓÈÎÔÎÏÔÓÈΤ˜ ÎÚ›ÛÂȘ Î·È ·Ê·ÈÚ¤ÛÂȘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·Ó ˆ˜ ÓÂ˘ÚˆÙÈο (57). ŸÌˆ˜, ÌÂÙ·ÁÂÓ¤ÛÙÂÚ˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ Ù· ·È‰È¿ Ì ÙÔ˘˜ 2 ·Ú·¿Óˆ Ù‡Ô˘˜ Û·ÛÌÒÓ ÂÌÊ·Ó›˙Ô˘Ó ·ÚfiÌÔÈ· ÔÛÔÛÙ¿ Î·È Ù‡Ô˘˜ „˘¯Ô·ıÔÏÔÁ›·˜, ÂÓÒ ¿ÏϘ ÌÂϤÙ˜ ‰ÂÓ Û˘Û¯ÂÙ›˙Ô˘Ó ÙÔÓ Ù‡Ô ÙˆÓ Û·ÛÌÒÓ Ì ٷ ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ (4,58). ™Â ÚfiÛÊ·ÙË ÌÂϤÙË ÛÙËÓ ∂ÏÏ¿‰·, ‚Ú¤ıËΠfiÙÈ ·ÎfiÌ· Î·È ·È‰È¿ Ì ȉÈÔ·ı‹ ÂÈÏË„›· Î·È Î·Ï¿ ÂÏÂÁ¯fiÌÂÓÔ˘˜ Û·ÛÌÔ‡˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ (45,9%), Û ۯ¤ÛË Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi (59). ∂›Û˘, ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÔÈ ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· ·ÔÙÂÏÔ‡Ó ¤Ó·Ó ›Û˘ ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· Û˘Û¯ÂÙÈ˙fiÌÂÓÔ Ì ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (4,22,33). ŒÙÛÈ, ·fi ÙË Ì›· ÏÂ˘Ú¿ ÔÈ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ‹ ‰È¿ıÂÛ˘ Û ·È‰È¿ Ì ÂÈÏË„›· ÌÔÚ› Ó· Â›Ó·È ÂΉ‹ÏˆÛË Ù˘ ÁÓˆÛÙÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜, ÂÓÒ, ·fi ÙËÓ ¿ÏÏË, ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· Ù˘ ÌÂȈ̤Ó˘ ÈηÓfiÙËÙ·˜ Ì¿ıËÛ˘. ¶·Ú¿ÏÏËÏ· Ì ٷ ·Ú·¿Óˆ, ÛÙÔ ÂÈÏËÙÈÎfi ·È‰› ÂÌÊ·Ó›˙ÔÓÙ·È ·ÓÙȉڷÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÔÈ Ôԛ˜ ÔÊ›ÏÔÓÙ·È ÛÙË ¯ÚÔÓÈfiÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È Ù˘ ıÂڷ¢ÙÈ΋˜ ·ÁˆÁ‹˜. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ¤Ó· ·È‰› ·›ÚÓÂÈ Î·ıËÌÂÚÈÓ¿ Ê¿ÚÌ·ÎÔ Û˘¯Ó¿ ÙÔ ‚¿˙ÂÈ Û “ÚfiÏÔ ·ÛıÂÓÔ‡˜”. ∫·È ÌfiÓÔ ÙÔ ÁÂÁÔÓfi˜ ·˘Ùfi ÌÔÚ› Ó· ·ÏÏ¿ÍÂÈ ÙËÓ ÂÈÎfiÓ· Ô˘ ¤¯ÂÈ ÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ Î·È ÙÔ ›‰ÈÔ ÙÔ ·È‰› ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘. ∂ÈϤÔÓ, Ô Êfi‚Ô˜ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÂÈÏËÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, Ô˘ ·˘Ùfi ηı·˘Ùfi ÌÔÚ› ·Ó¿ ¿Û· ÛÙÈÁÌ‹ ·Úfi‚ÏÂÙ· Ó· ÂΉËψı› ÛÙÔ ÛÙÂÓfi ‹ ¢ڇÙÂÚÔ ÂÚÈ‚¿ÏÏÔÓ, ÛÙÈÁÌ·Ù›˙ÂÈ ÙÔ ·È‰› ÎÔÈÓˆÓÈο, ÌÂÈÒÓÂÈ ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘ Î·È ÚÔηÏ› ÂÈÚfiÛıÂÙË „˘¯È΋ ÂÈ‚¿Ú˘ÓÛË (60). ∞ÚÁfiÙÂÚ·, ÛÙËÓ ÂÚ›Ô‰Ô Ù˘ ÂÊ˂›·˜, ÔÈ „˘¯ÔÏÔÁÈΤ˜ Î·È ÎÔÈÓˆÓÈΤ˜ ÚÔÂÎÙ¿ÛÂȘ Ù˘ ÂÈÏË„›·˜ ÌÂÙ·ÙÚ¤Ô˘Ó ÙËÓ ÂÈÏË„›· Û ÌÈ· ‰˘Û‚¿ÛÙ·ÎÙË Î·Ù¿ÛÙ·ÛË ÁÈ· ÙÔ ÓÂPaediatriki 2008;71:426-433
·Úfi ¿ÙÔÌÔ (60,61). °È’ ·˘Ùfi, ÙÔ ÂÈÏËÙÈÎfi ·È‰› Ú¤ÂÈ Ó· ÙÔ ‚Ï¤Ô˘Ì ÛÙÔ Û‡ÓÔÏfi ÙÔ˘.
∞ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ∆· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η (∞∂º) ‰ÚÔ˘Ó ÌÂÈÒÓÔÓÙ·˜ ÙË ÌÂÌ‚Ú·ÓÈ΋ ‰ÈÂÁÂÚÛÈÌfiÙËÙ·, ·˘Í¿ÓÔÓÙ·˜ ÙË ÌÂÙ·Û˘Ó·ÙÈ΋ ·Ó·ÛÙÔÏ‹ ‹ ÙÚÔÔÔÈÒÓÙ·˜ ÙÔÓ Û˘Á¯ÚÔÓÈÛÌfi ÙˆÓ ÓÂ˘ÚˆÓÈÎÒÓ ‰ÈÎÙ‡ˆÓ, ÒÛÙ ӷ ÌÂȈı› Ë ·˘ÍË̤ÓË ÓÂ˘ÚˆÓÈ΋ ‰ÈÂÁÂÚÛÈÌfiÙËÙ· Ô˘ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË Û·ÛÌÒÓ. ∆· ·È‰È¿ Â›Ó·È ‰˘ÓËÙÈο ÈÔ Â˘·›ÛıËÙ· ÛÙȘ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ∞∂º, ÏfiÁˆ ÙˆÓ Èı·ÓÒÓ ÂȉڿÛÂÒÓ ÙÔ˘˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (7,62). MÂϤÙ˜ Û ıËÏ·ÛÙÈο ¤¯Ô˘Ó ‰Â›ÍÂÈ ‰˘ÛÌÂÓ›˜ ÂȉڿÛÂȘ ÙˆÓ ∞∂º ÛÙÔÓ ·Ó·Ù˘ÛÛfiÌÂÓÔ ÂÁΤʷÏÔ, ̤ۈ ‰È·Ù·Ú·¯‹˜ ÙÔ˘ ÔÏÏ·Ï·ÛÈ·ÛÌÔ‡ Î·È Ù˘ ÌÂÙ·Ó¿ÛÙ¢Û˘ ÙˆÓ Î˘ÙÙ¿ÚˆÓ, Ù˘ ‰È·ÎÏ¿‰ˆÛ˘ ÙˆÓ ‰ÂÓ‰ÚÈÙÒÓ, Ù˘ Û˘Ó·ÙÔÁ¤ÓÂÛ˘, Ù˘ Ï·ÛÙÈÎfiÙËÙ·˜ ÙˆÓ Î˘ÙÙ¿ÚˆÓ Î·È Ù˘ Ê˘ÛÈÔÏÔÁÈ΋˜ ÓÂ˘ÚˆÓÈ΋˜ ·fiÙˆÛ˘ (8,9,63). °ÂÓÈο, ÔÈ ÂȉڿÛÂȘ ÙˆÓ ∞∂º ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÂÍ·ÙÔÌÈ·ÔÓÙ·È. ªÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÙfiÛÔ ıÂÙÈΤ˜ fiÛÔ Î·È ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ. ∆· ∞∂º (ÎÏ·ÛÈο Î·È ÓÂfiÙÂÚ·) ÌÔÚÔ‡Ó ¿ÌÂÛ· Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙË ÁÓˆÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ÂÊfiÛÔÓ Ë ÂÛÙȷ΋ ÂÈÏËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Ô˘ ·ÚÂÌ‚·›ÓÂÈ ÛÙÔ Û¯ÂÙÈÎfi ÓÂ˘ÚˆÓÈÎfi ‰›ÎÙ˘Ô ÂϤÁ¯ÂÙ·È ·ÔÙÂÏÂÛÌ·ÙÈο ·fi ÙÔ Ê¿ÚÌ·ÎÔ (7). ¶·Ú¿ÏÏËÏ·, Ù· ∞∂º ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ·ÓÙÈηٷıÏÈÙÈ΋ ‹ ·Á¯ÔÏ˘ÙÈ΋ ‰Ú¿ÛË (6,64). ∆· ·È‰È¿ Ì ÂÈÏË„›·, fiˆ˜ ·Ó·Ê¤ÚıËÎÂ, Û˘¯Ó¿ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¿Á¯Ô˜ ‹ ‰È·Ù·Ú·¯¤˜ ‰È¿ıÂÛ˘, ›Ù ÏfiÁˆ ·ÓÙ›‰Ú·Û˘ ÛÙË ÓfiÛÔ Â›Ù ˆ˜ ÂΉ‹ÏˆÛË Ù˘ ÂÁÎÂÊ·ÏÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜. ∞˘Ù¤˜ ÔÈ ‰È·Ù·Ú·¯¤˜ ÌÔÚ› Ó· ÂËÚ·ÛÙÔ‡Ó ıÂÙÈο ·fi Ù· ∞∂º, Ì ·ÎfiÏÔ˘ıË ıÂÙÈ΋ ›‰Ú·ÛË ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿. ŒÙÛÈ, fiÙ·Ó Ë ÂÈÏË„›· ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÁÓˆÛÙÈΤ˜ ‹ Û˘ÌÂÚÈÊÔÚÈΤ˜ ÂȉڿÛÂȘ Î·È Ë ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋, ÙfiÙ ٷ ÔʤÏË ÌÔÚ› Ó· ÍÂÂÚ¿ÛÔ˘Ó ÙȘ Ù˘¯fiÓ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ∞∂º. ∞ÓÙ›ıÂÙ·, Û’ ¤Ó· ˘„ËÏ¿ ÏÂÈÙÔ˘ÚÁÈÎfi ·È‰› ÛÙÔ ÔÔ›Ô Ë ÂÈÏË„›· ‰ÂÓ ¤¯ÂÈ Â›‰Ú·ÛË, ·ÎfiÌ· Î·È ‹È˜ ·ÚÂÓ¤ÚÁÂȘ ·fi Ù· ∞∂º ı· Á›ÓÔ˘Ó ·ÓÙÈÏËÙ¤˜ (6,7,64). √È ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ ÙˆÓ ∞∂º ÛÙË ÁÓˆÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È ›Ûˆ˜ ÔÈ ÈÔ ÁÓˆÛÙ¤˜ Î·È ÈÔ Û˘˙ËÙË̤Ó˜, ȉȷ›ÙÂÚ· ÔÈ ÂȉڿÛÂȘ ÙÔ˘˜ ÛÙËÓ ÂÁÚ‹ÁÔÚÛË, ÙËÓ ÚÔÛÔ¯‹, ÙË ÌÓ‹ÌË Î·È ÙËÓ Ù·¯‡ÙËÙ· ÂÂÍÂÚÁ·Û›·˜ (7,64). ¢˘ÛÌÂÓ›˜ ÁÓˆÛÙÈΤ˜ ÂȉڿÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È Û˘¯ÓfiÙÂÚ· Ì ʿÚ̷η fiˆ˜ Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È ÔÈ ‚ÂÓ˙ԉȷ˙›Ó˜, Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ıÂڷ¢ÙÈο Û‹ÌÂÚ· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈ΋ Ú¿ÍË (7,64). OÈ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ Î·Ú‚·Ì·˙›ÓË Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ˜, Ë
Pediatri Nov-Dec 08 new
19-12-08
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™ÂÏ›‰·431
431
∂ÈÏË„›·, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È Û˘ÌÂÚÈÊÔÚ¿
ÔÍηڂ·Ì·˙›ÓË Ê·›ÓÂÙ·È ˆ˜ ‰ÂÓ ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, ÂÓÒ ÁÈ· ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ÔÈ ÂȉڿÛÂȘ ‰Â›¯ÓÔ˘Ó Ó· Â›Ó·È ‰ÔÛÔÂÍ·ÚÙÒÌÂÓ˜ (64-67). ™Â fiÙÈ ·ÊÔÚ¿ Ù· ÓÂfiÙÂÚ· ∞∂º, ÔÈ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ Â›Ó·È ÂÚÈÔÚÈṲ̂Ó˜. ™ÙË ÌfiÓË Î·Ï¿ ۯ‰ȷṲ̂ÓË ÌÂϤÙË Û ·È‰È¿, ÔÈ Pressler Î·È Û˘Ó. (67) ‰ÂÓ ‚Ú‹Î·Ó ÛËÌ·ÓÙÈ΋ ›‰Ú·ÛË Ù˘ Ï·ÌÔÙÚÈÁ›Ó˘ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜. ∆¤ÏÔ˜, Ë ÔÏ˘ıÂڷ›· Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ Ë ÌÔÓÔıÂڷ›· Û ̤ÙÚȘ ‰fiÛÂȘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙ÂÈ ÙȘ Û˘Ó‹ıˆ˜ ÌÂÙÚÔ‡ÌÂÓ˜ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ÁÓˆÛÙÈ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ (7,68,69). ¶Ú¤ÂÈ, ¿ÓÙˆ˜, Ó· ÙÔÓÈÛÙ› fiÙÈ ÔÈ ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙȘ ÁÓˆÛÙÈΤ˜ ÂȉڿÛÂȘ ÙˆÓ ∞∂º ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· ÂÚÈÔÚ›˙ÔÓÙ·È ÛÙË Ì¤ÙÚËÛË ÙÔ˘ ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ (πQ) Î·È ‰ÂÓ ÂÎÙÈÌÔ‡Ó ÂȉÈΤ˜ Ó¢ÚÔ„˘¯ÔÏÔÁÈΤ˜ ·Ú·Ì¤ÙÚÔ˘˜, ÛËÌ·ÓÙÈΤ˜ ÁÈ· ÙË ‰È·‰Èηۛ· Ù˘ Ì¿ıËÛ˘, fiˆ˜ Ë ÚÔÛÔ¯‹ Î·È Ë ÓÔËÙÈ΋ ÎfiˆÛË. ∏ ‰˘ÛÎÔÏ›· ÂÎÙ›ÌËÛ˘ Ù˘ ‰Ú¿Û˘ ÙˆÓ ∞∂º Ê·›ÓÂÙ·È ÛÙÔ Û˘Ì¤Ú·ÛÌ· Ù˘ ÌÂϤÙ˘ ÙˆÓ Vermeulen Î·È Û˘Ó. (70). √È Û˘ÁÁÚ·Ê›˜, ·ÊÔ‡ ·Ó·ÛÎfiËÛ·Ó 90 ÌÂϤÙ˜ Ô˘ ¤ÁÈÓ·Ó Û ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÁ·Ï‡ÙÂÚÔ ÙˆÓ 25 ¯ÚfiÓˆÓ, Û¯ÂÙÈο Ì ÙËÓ Â›‰Ú·ÛË ÙˆÓ ∞∂º ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, η٤ÏËÍ·Ó fiÙÈ ‰ÂÓ ‹Ù·Ó Û ı¤ÛË Ó· ··ÓÙ‹ÛÔ˘Ó ¿ÌÂÛ· ÛÙÔ ÈÔ ÎÚ›ÛÈÌÔ ÂÚÒÙËÌ·, ‰ËÏ. Â¿Ó Ù· ∞∂º ¤¯Ô˘Ó ıÂÙÈΤ˜ ‹ ·ÚÓËÙÈΤ˜ ÁÓˆÛÙÈΤ˜ ÂȉڿÛÂȘ ÛÙȘ Û˘Ó‹ıÂȘ ıÂڷ¢ÙÈΤ˜ ‰fiÛÂȘ. ∆¤ÏÔ˜, Ù· ∞∂º ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ¤Ó· ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜. ∫·Ù¿ıÏÈ„Ë, Ì·Ó›·, „‡¯ˆÛË, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÂÈıÂÙÈÎfiÙËÙ·, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È ·ÚÔÚÌËÙÈÎfiÙËÙ· ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙË ¯ÔÚ‹ÁËÛË ·Ï·ÈfiÙÂÚˆÓ ‹ ÓÂfiÙÂÚˆÓ ∞∂º (4,6). ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ·Ú·¿Óˆ ‰È·Ù·Ú·¯ÒÓ Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È Ë ÔÏ˘ıÂڷ›·, ÔÈ ˘„ËϤ˜ ‰fiÛÂȘ ÙˆÓ ∞∂º Î·È ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi „˘¯Ô·ıÔÏÔÁ›·˜ (4).
™˘Ì¤Ú·ÛÌ· ∞fi Ù· ·Ú·¿Óˆ ÚÔ·ÙÂÈ fiÙÈ Ù· ·È‰È¿ Ì ÂÈÏË„›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Û ÛËÌ·ÓÙÈο ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi Û ۯ¤ÛË Ì ÙÔÓ ÁÂÓÈÎfi ÏËı˘ÛÌfi. √È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Â›Ó·È ÔÏÏ·ÏÔ› Î·È ÂÚÈÏ·Ì‚¿ÓÔ˘Ó ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ›‰È·˜ Ù˘ ÓfiÛÔ˘, ÙËÓ ˘ÔΛÌÂÓË Ó¢ÚÔÏÔÁÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ô˘ ÚÔηÏ› ÙÔ˘˜ Û·ÛÌÔ‡˜ Î·È ÙȘ ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜, ÙËÓ Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·Ú̿ΈÓ, ηıÒ˜ Î·È ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. º·›ÓÂÙ·È, fï˜, fiÙÈ ÔÈ ·Ú·¿Óˆ ·Ú¿ÁÔÓÙ˜ ‰ÂÓ ÌÔÚÔ‡Ó Ó· ¤¯Ô˘Ó Û·Ê‹ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ì¿ıËÛ˘ Î·È Û˘ÌÂÚÈÊÔ-
Ú¿˜ Û fiÏ· Ù· ·È‰È¿ Ì ÂÈÏË„›·. °È’ ·˘Ùfi Î·È Ë Û˘ÛÙËÌ·ÙÈ΋ Ó¢ÚÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛı› Ë Î·Ù¿ÏÏËÏË ·Ú¤Ì‚·ÛË, fiÔ˘ Î·È fiÔÙ ·˘Ù‹ ¯ÚÂÈ¿˙ÂÙ·È.
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¶ÂÚ›ÏË„Ë: √ ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜, ÓfiÛËÌ· ÂÍ¿ÚÙËÛ˘ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰ÂηÂÙ›·˜, ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÂÊ‹‚ˆÓ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË Î·È ÂÍ·ÚÙÒÌÂÓË Û˘ÌÂÚÈÊÔÚ¿, Ë ÔÔ›· ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙË ÛˆÌ·ÙÈ΋, ·Î·‰ËÌ·˚΋, ÎÔÈÓˆÓÈ΋, ÔÈÎÔÓÔÌÈ΋ Î·È Â·ÁÁÂÏÌ·ÙÈ΋ ˙ˆ‹ ÙÔ˘ ¯Ú‹ÛÙË. √ ÂÚÈÔÚÈÛÌfi˜ Ù˘ ¯Ú‹Û˘ ÚÔηÏ› Û˘ÌÙÒÌ·Ù· ÛÙ¤ÚËÛ˘, fiˆ˜ ·ÓËÛ˘¯›·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÙÚfiÌÔ, ¿Á¯Ô˜, Ê·ÓÙ·ÛÈÒÛÂȘ Î·È ÂÈıÂÙÈÎfiÙËÙ·, Ù· ÔÔ›· ˘Ô¯ˆÚÔ‡Ó ÌÂÙ¿ ·fi Ó¤· ¯Ú‹ÛË. √Ê›ÏÂÙ·È ÛÂ Û˘Ó‰˘·ÛÌfi ÎÔÈÓˆÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÚÔÛˆÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ηٿıÏÈ„Ë. ∏ ›وÛË ÙÔ˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÂıÈÛÌÔ‡ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Î˘Ì·›ÓÂÙ·È ·fi 1% ¤ˆ˜ 9% Î·È ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËı› ÂȉÈο ΤÓÙÚ· ·ÂÍ¿ÚÙËÛ˘ Ì ÛÎÔfi ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÙˆÓ ·Û¯fiÓÙˆÓ Î·È ÙËÓ ·Ó¿Ù˘ÍË ¿ÏÏˆÓ ‰Ú·ÛÙËÚÈÔًوÓ, ÂËÚ¿˙ÔÓÙ·˜ ÚˆÙ›ÛÙˆ˜ ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ. ∆Ô ‰È·‰›ÎÙ˘Ô ·ÔÙÂÏ› ÌÈ· ‚È‚ÏÈÔı‹ÎË ÛÙÔ Û›ÙÈ, ¤Ó· ·Ú¿ı˘ÚÔ ÛÙÔÓ ÎfiÛÌÔ Î·È, ȉȷ›ÙÂÚ· ÁÈ· ¤Ó· ·È‰›, ·ÔÙÂÏ› ÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ı· ·Ó·Ù‡ÍÂÈ ÔÏϤ˜ ·fi ÙȘ ‰ÂÍÈfiÙËÙ¤˜ ÙÔ˘. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, Ë ¯Ú‹ÛË ı· Ú¤ÂÈ Ó· Â›Ó·È ÏÔÁÈ΋, ÌÂ Û˘ÁÎÂÎÚÈ̤ÓÔ ÛÎÔfi Î·È ÁÈ· Û˘ÁÎÂÎÚÈ̤ÓÔ ¯ÚfiÓÔ, Ì ÂÈÙ‹ÚËÛË, ÂÓÒ fiÏÔÈ ÔÈ ·ÚÌfi‰ÈÔÈ ÊÔÚ›˜ ÔÈ ÔÔ›ÔÈ ÂÌϤÎÔÓÙ·È ÛÙËÓ „˘¯Ôۈ̷ÙÈ΋ ·Ó¿Ù˘ÍË ÙÔ˘ ·È‰ÈÔ‡ (ÁÔÓ›˜, ‰¿ÛηÏÔÈ, ·È‰›·ÙÚÔÈ, ÂȉÈÎÔ› „˘¯È΋˜ ˘Á›·˜) ı· Ú¤ÂÈ Ó· Â›Ó·È ÂÓ‹ÌÂÚÔÈ Î·È ÚÔÛÂÎÙÈÎÔ› ÁÈ· ÙËÓ ¤ÁηÈÚË ·Ó›¯Ó¢ÛË Úfi‰ÚÔÌˆÓ Û˘ÌÙˆÌ¿ÙˆÓ Î·È ÂÈÚÚÂÒÓ ÂÚÈÙÒÛˆÓ.
§¤ÍÂȘ ÎÏÂȉȿ: ¢È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜, ÂÊ˂›·
Internet addiction in adolescence Department of Pediatrics, “KAT” General Hospital, Athens, Greece Correspondence: Athina Papadopoulou athinapap@yahoo.com Department of Pediatrics, “KAT” General Hospital, Athens, Greece
∞. Papadopoulou, P. Georgiopoulou-Micha Abstract: Internet addiction has been diagnosed increasingly in the last decade and it is a recognized phenomenon in adolescence in developed countries. It is characterized by compulsive use and addictive behaviour, to a degree which interrupts personal, social, academic, economic and occupational activities and is associated with withdrawal symptoms, such as anxiety, trembling, tremors, aggressiveness and fantasies, which are relieved by re-use of the internet. Internet addiction is the combined result of many social factors and personal characteristics and is often associated with depression. Its prevalence in adolescence ranges from 1% to 9%. A few internet addiction recovery centres have been organized, with their main task that of changing the subjects’ everyday life, encouraging them to create other activities and trying to influence the family environment in a positive way. The internet offers an on-line updated library in the home, an open window to the world knowledge, and a means for children to improve their talents. However, for children and adolescents its use must be logical, with specific purposes and for certain time periods, supervised by adults; all persons responsible for children’s biopsychosocial development (parents, teachers, paediatricians, mental health professionals) should be aware of the problem of internet addiction and be able to identify prodromal symptoms and recognize children and adolescents who are at risk.
Key words: Internet addiction, adolescence.
∂ÈÛ·ÁˆÁ‹ ™ÙËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· ÙÔ˘ 20Ô‡ ·ÈÒÓ·, Û ÌÈ· ÂÚ›Ô‰Ô Ô˘ ÔÈ ËÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ ›¯·Ó ‰ÈÂÈÛ‰‡ÛÂÈ ÛÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ· ÙˆÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ÎÔÈÓˆÓÈÒÓ, Ô „˘¯›·ÙÚÔ˜ Goldberg I. ·Ú·Ù‹ÚËÛ ÂÚÈÙÒÛÂȘ Ì ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË Î·È ÂÍ·ÚÙÒÌÂÓË Û˘ÌÂÚÈÊÔÚ¿ Î·È ‰È·Ù‡ˆÛ ÙÔÓ fiÚÔ ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ (1). √ fiÚÔ˜, ·Ú¯Èο, ·ÓÙÈÌÂÙˆ›ÛÙËΠ·fi Ù· ̤۷ ÂÓË̤ڈÛ˘ Î·È ÙËÓ ÂÈÛÙËÌÔÓÈ΋ ÎÔÈÓfiPaediatriki 2008;71:434-440
ÙËÙ· Û·Ó ¤Ó· ηÎfiÁÔ˘ÛÙÔ ·ÛÙ›Ô, ·ÓÙ›ÁÚ·ÊÔ ÙÔ˘ ÌÔÓÙ¤ÏÔ˘ ÂÚÈÁÚ·Ê‹˜ ·ÙfiÌˆÓ Ì ·ıÔÏÔÁÈ΋ ÂÍ¿ÚÙËÛË ·fi Ù˘¯ÂÚ¿ ·È¯Ó›‰È·, Ô˘, Û ·ÓÙ›ıÂÛË Ì ÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ Î·È ÚÔÛˆÈ΋ ÚÔÛÊÔÚ¿ ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ˘ÔÏÔÁÈÛÙÒÓ, ‹Ù·Ó ÌÈ· ·ÓÙÈÎÔÈÓˆÓÈ΋ Ú¿ÍË (2). °Ú‹ÁÔÚ·, fï˜, Ë Û˘Ó¯Ҙ ·˘Í·ÓfiÌÂÓË ·Ó¿ÁÎË Ù˘ on line ËÁ‹˜ ÏËÚÔÊfiÚËÛ˘ Î·È Ë ¯Ú‹ÛË ÛÙËÓ ·ÓÒÚÈÌË ·È‰È΋ ËÏÈΛ· ·Ó¤‰ÂÈÍ ¿ÙÔÌ· Ô˘ ·ÚÔ˘Û›·˙·Ó ÂıÈÛÌfi ÌÂ Û˘ÌÙÒÌ·Ù· ÛÙ¤ÚËÛ˘
Pediatri Nov-Dec 08 new
19-12-08
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¢È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ ÛÙËÓ ÂÊ˂›·
¶›Ó·Î·˜ 1. ÀÔηÙËÁÔڛ˜ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÂıÈÛÌÔ‡ ¢È·‰ÈÎÙ˘·Îfi˜ ÛÂÍÔ˘·ÏÈÎfi˜ ÂıÈÛÌfi˜
¢È·‰ÈÎÙ˘·Î¤˜ Û¯¤ÛÂȘ ÂıÈÛÌÔ‡
¢È·‰ÈÎÙ˘·Îfi˜ „˘¯·Ó·ÁηÛÌfi˜
ÀÂÚÊfiÚÙˆÛË ÏËÚÔÊÔÚÈÒÓ
ÀÂÚ‚ÔÏÈ΋ ÂÓ·Û¯fiÏËÛË Ì ÙËÓ ÚÔ‚ÔÏ‹, ÙË Ï‹„Ë Î·È ÂÌÔÚ›· ÔÚÓÔÁÚ·ÊÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙÔ ‰È·‰›ÎÙ˘Ô ‹ ÂÌÏÔ΋ Û ÛÂÍÔ˘·ÏÈΤ˜ Ê·ÓÙ·ÛÈÒÛÂȘ Î·È ·›ÍÈÌÔ ÚfiÏˆÓ ÛÙ· chat rooms. ÀÂÚ‚ÔÏÈ΋ Û˘ÌÌÂÙÔ¯‹ Û ‰È·‰ÈÎÙ˘·Î¤˜ Û¯¤ÛÂȘ. √È Ôn line Ê›ÏÔÈ Â›Ó·È ÛËÌ·ÓÙÈÎfiÙÂÚÔÈ ·fi ÙȘ Û¯¤ÛÂȘ Ù˘ Ú·ÁÌ·ÙÈ΋˜ ˙ˆ‹˜ (ÔÈÎÔÁ¤ÓÂÈ·, Ê›ÏÔÈ) Î·È ÙÔ ¿ÙÔÌÔ Ô‰ËÁÂ›Ù·È ÛÂ Û˘˙˘ÁÈ΋ ‰È·ÊˆÓ›· Î·È ÔÈÎÔÁÂÓÂȷ΋ ·ÛÙ¿ıÂÈ·. EıÈÛÌfi˜ ÁÈ· on line gaming, online Ù˘¯ÂÚ¿ ·È¯Ó›‰È· Î·È eBay, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˘ÂÚ‚ÔÏÈΤ˜ ÔÛfiÙËÙ˜ ¯ÚËÌ¿ÙˆÓ Î·È ‰È·Ù·Ú¿ÛÛÔÓÙ·˜ ÙÔÓ Î·Ù·ÌÂÚÈÛÌfi ÙˆÓ ÔÈÎÔÓÔÌÈÎÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ ‹ ÙˆÓ ÂÚÁ·ÛÈ·ÎÒÓ Î·ıËÎfiÓÙˆÓ. √ ÏÔ‡ÙÔ˜ ÙˆÓ ‰È·ı¤ÛÈÌˆÓ ‰Â‰ÔÌ¤ÓˆÓ ÛÙÔ World Wide Web ¤¯ÂÈ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ¤Ó· Ó¤Ô Â›‰Ô˜ Û˘ÌÂÚÈÊÔÚ¿˜ Î·È ˘ÂÚ‚ÔÏÈ΋˜ ·Ó·˙‹ÙËÛ˘ (web surfing) ‰Â‰Ô̤ӈÓ. ∆· ¿ÙÔÌ· ÍÔ‰Â‡Ô˘Ó Ôχ ¯ÚfiÓÔ ÛÙËÓ ·Ó·˙‹ÙËÛË, Û˘ÏÏÔÁ‹ Î·È ÔÚÁ¿ÓˆÛË ÏËÚÔÊÔÚÈÒÓ ·fi ÙÔ ‰È·‰›ÎÙ˘Ô, ¯ˆÚ›˜ Ó· Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙËÓ ÂÚÁ·Û›· ÙÔ˘˜, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ¤¯Ô˘Ó ÌÂȈ̤ÓË Â·ÁÁÂÏÌ·ÙÈ΋ ·Ú·ÁˆÁÈÎfiÙËÙ·.
(3). ™‹ÌÂÚ· ·Ó·ÁÓˆÚ›˙ÂÙ·È ˆ˜ ÓfiÛÔ˜ ÂÍ¿ÚÙËÛ˘ Î·È ·ÔÊ·Û›ÛÙËÎÂ Ë ·Ó·ÁÚ·Ê‹ Ù˘ ÛÙËÓ ÂfiÌÂÓË ¤Î‰ÔÛË ÙÔ˘ DSM-V (Diagnostic and Statistic Manual of Mental Disorders) (4). ∆ËÓ ›‰È· ÂÚ›Ô‰Ô, ·Ú’ fiϘ ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ·ÓÙÈı¤ÛÂȘ, Ë „˘¯›·ÙÚÔ˜ Kimberly Young ‰ËÌÈÔ‡ÚÁËÛ ÛÙËÓ ¶ÂÓÛ˘Ï‚¿ÓÈ· ÙˆÓ ∏¶∞ ÙÔ ÚÒÙÔ Î¤ÓÙÚÔ ·ÔÙÔ͛ӈÛ˘ ÁÈ· ÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÂıÈÛÌfi Î·È ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ ÙÔ ‰È·‰›ÎÙ˘Ô ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ·ÚÓËÙÈο ÙËÓ ·Î·‰ËÌ·˚΋, ÎÔÈÓˆÓÈ΋, ÔÈÎÔÓÔÌÈ΋ Î·È Â·ÁÁÂÏÌ·ÙÈ΋ ˙ˆ‹ ÂÓfi˜ ·ÓıÚÒÔ˘, ηٿ ÙÔÓ ›‰ÈÔ ÙÚfiÔ Ô˘ ÂËÚ¿˙ÂÈ Ô ·ÏÎÔÔÏÈÛÌfi˜ (5). ™‹ÌÂÚ· ϤÔÓ, Ë “ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ›ÓË” ‰ÂÓ ·ÔÙÂÏ› Úfi‚ÏËÌ· ÌfiÓÔ Ù˘ ÂÓ‹ÏÈ΢ ˙ˆ‹˜, ·ÏÏ¿ Î·È Ù˘ ÂÊË‚È΋˜, Î·È ·ÚÎÂÙ¿ ΤÓÙÚ· ·ÔÙÔ͛ӈÛ˘ ¤¯Ô˘Ó ‰ËÌÈÔ˘ÚÁËı› Û ‰È¿ÊÔÚ˜ ¯ÒÚ˜, fiˆ˜ Ë Î·Ù·Û΋ӈÛË ÁÈ· ·È‰È¿ Ì ‰È·‰ÈÎÙ˘·Îfi ÂıÈÛÌfi ÙÔ 2001 ÛÙÔ Boltenhagen, ÙÔ “ΤÓÙÚÔ ·ÂÍ¿ÚÙËÛ˘” ÙÔ 2004 ·fi ÙËÓ ÎÈÓÂ˙È΋ ΢‚¤ÚÓËÛË Î·È ÙÔ “ΤÓÙÚÔ ·ÂÍ¿ÚÙËÛ˘ ·fi ‚ÈÓÙÂԷȯӛ‰È·” ÚÔ ¤ÙÔ˘˜ ÛÙÔ Amsterdam (6).
¢È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· √ ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ ‰È·ÁÈÁÓÒÛÎÂÙ·È Û ¿ÙÔÌ· Ô˘ ÏËÚÔ‡Ó Ù· ÂÍ‹˜ ÎÚÈÙ‹ÚÈ·, fiˆ˜ ·˘Ù¿ ÔÚ›ÛÙËÎ·Ó ·fi ÙËÓ ∞ÌÂÚÈηÓÈ΋ æ˘¯ÔÏÔÁÈ΋ ∂Ù·ÈÚ›· (7): ·) ·ÓÔ¯‹, ‰ËÏ·‰‹ ·Ó¿ÁÎË ·‡ÍËÛ˘ ÙÔ˘ ¯ÚfiÓÔ˘ Û‡Ó‰ÂÛ˘ Ì ÙÔ ‰È·‰›ÎÙ˘Ô ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÈÙ¢¯ı› Ë ›‰È· ÈηÓÔÔ›ËÛË ‹ ÌÂȈ̤ÓË ÈηÓÔÔ›ËÛË ÌÂÙ¿ ·fi ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ Û‡Ó‰ÂÛ˘, ‚) ·Ó¿Ù˘ÍË ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙ¤ÚËÛ˘ ÌÂÙ¿ ·fi ‰È·ÎÔ‹ ‹ Ì›ˆÛË ¯Ú‹Û˘ ̤۷ Û ‰È¿ÛÙËÌ· ÂÓfi˜ ÌËÓfi˜, Û˘ÌÙÒÌ·Ù· Ô˘ ÚÔηÏÔ‡Ó Î·Ù·fiÓËÛË ‹ ‰È·Ù·Ú·¯‹ Ù˘ ÎÔÈÓˆÓÈ΋˜, ÚÔÛˆÈ΋˜ Î·È Â·ÁÁÂÏÌ·ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ (·ÓËÛ˘¯›·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÙÚfiÌÔ, ¿Á¯Ô˜, Ê·ÓÙ·ÛÈÒÛÂȘ, ·ÎÔ‡ÛȘ ‹ ÂÎÔ‡ÛȘ ÎÈÓ‹ÛÂȘ ‰·ÎÙ˘ÏÔÁÚ¿ÊËÛ˘), Á) ˘Ô¯ÒÚËÛË ÙˆÓ ÈÔ ¿Óˆ Û˘ÌÙˆÌ¿ÙˆÓ ÌfiÓÔ ÌÂÙ¿ ·fi ¯Ú‹ÛË, ‰) ¯Ú‹ÛË ‰È·‰ÈÎÙ‡Ô˘ ÁÈ· Ôχ ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿-
ÛÙËÌ· ·fi fi,ÙÈ ÙÔ ¿ÙÔÌÔ Â›¯Â ÚfiıÂÛË, Â) ÂÈÏÔÁ‹ ÔÏÏÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Ì¤Ûˆ ‰È·‰ÈÎÙ‡Ô˘ (·ÁÔÚ¿, ÂÈÎÔÈÓˆÓ›·, ·È¯Ó›‰È·) Î·È ÛÙ) ‰È·ÎÔ‹ ‹ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÎÔÈÓˆÓÈ΋˜, ÚÔÛˆÈ΋˜, ‰ËÌÈÔ˘ÚÁÈ΋˜ Î·È Â·ÁÁÂÏÌ·ÙÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ ÏfiÁˆ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘. ∏ ‰È¿ÁÓˆÛË Ù›ıÂÙ·È ·Ó Û ‰È¿ÛÙËÌ· ÂÓfi˜ ¯ÚfiÓÔ˘ ÂΉËψıÔ‡Ó ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚ›· ÎÚÈÙ‹ÚÈ·. ∞fi ÙÔ 2004, ÔÈ Nichols Î·È Û˘Ó. ·Ó¤Ù˘Í·Ó ¤Ó· ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ (internet addiction scale) Ì ˘„ËÏ‹ ÂȉÈÎfiÙËÙ· Î·È Â˘·ÈÛıËÛ›· (specificity, sensitivity), ÙÔ ÔÔ›Ô ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ·Ó›¯Ó¢Û˘ ·ÙfiÌˆÓ Ì ÛÔ‚·Ú‹ ÂÍ¿ÚÙËÛË Î·È ·ÓÙÈÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿. §›ÁÔ ·ÚÁfiÙÂÚ·, Ô Ko ‰ËÌÔÛ›Â˘Û ÙÚÔÔÔÈ‹ÛÂȘ ·˘ÙÔ‡, ÚÔÛ·ÚÌfi˙ÔÓÙ·˜ ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÈ· ÙÔ˘˜ ÂÊ‹‚Ô˘˜ (810). ™ÙÔ ‰È·‰›ÎÙ˘Ô Î˘ÎÏÔÊÔÚ› ¢ڤˆ˜ ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÙˆÓ 20 ÂÚˆÙ‹ÛÂˆÓ Ù˘ Young, Û ÌÈ· ÚÔÛ¿ıÂÈ· ¢·ÈÛıËÙÔÔ›ËÛ˘ ÙˆÓ ¯ÚËÛÙÒÓ Î·È ¤ÁηÈÚ˘ ·Ó·ÁÓÒÚÈÛ˘ ÙˆÓ ·ÙfiÌˆÓ Û ΛӉ˘ÓÔ (11). ¢È·ÎÚ›ÓÔÓÙ·È Ù¤ÛÛÂÚȘ Ù‡ÔÈ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÂıÈÛÌÔ‡ (¶›Ó·Î·˜ 1). ™ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ·Ó·ÁÓˆÚ›˙ÔÓÙ·È Û˘¯ÓfiÙÂÚ· ÔÈ ¢È·‰ÈÎÙ˘·Î¤˜ ™¯¤ÛÂȘ ∂ıÈÛÌÔ‡ Î·È Ô ¢È·‰ÈÎÙ˘·Îfi˜ æ˘¯·Ó·ÁηÛÌfi˜ (12,13). √È ¤ÊË‚ÔÈ ¤ÏÎÔÓÙ·È ·fi ÙË ‰È·‰ÈÎÙ˘·Î‹ ÂÈÎÔÈÓˆÓ›· Û chat rooms ‹ ÛÙÔ MSN, ·ÓÙ·ÏÏ¿ÛÛÔÓÙ·˜ Û˘ÁÎÂÎÚÈ̤Ó˜ ÂÎÊÚ¿ÛÂȘ ‹ ·ÂÈÎÔÓ›ÛÂȘ. ∞ÈÛı¿ÓÔÓÙ·È fiÙÈ ¤¯Ô˘Ó ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ÂÎÊÚ¿˙ÔÓÙ·È ¯ˆÚ›˜ ÂÚÈÔÚÈÛÌÔ‡˜ Î·È Î˘Ú›ˆ˜ Ó· Û˘Ó‰È·Ï¤ÁÔÓÙ·È Ì ÔÏÏÔ‡˜ ¯Ú‹ÛÙ˜ ÙËÓ ›‰È· ÛÙÈÁÌ‹, ÂÙ˘¯·›ÓÔÓÙ·˜ ‰È·ÊÔÚÂÙÈ΋ ÚÔ‚ÔÏ‹ Û οıÂ Û˘Ó‰È·ÏÂÁfiÌÂÓÔ. ∏ ¢ÎÔÏ›· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ·˘Ù¤˜ ÙȘ ÌË Ô˘ÛÈ·ÛÙÈΤ˜ Î·È ·ÚÔ‰ÈΤ˜ Û¯¤ÛÂȘ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙÔ˘˜ Ôn line “Ê›ÏÔ˘˜” ˆ˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ·fi ÙȘ Û¯¤ÛÂȘ Ù˘ Ú·ÁÌ·ÙÈ΋˜ ˙ˆ‹˜ (ÔÈÎÔÁ¤ÓÂÈ·, Ê›ÏÔÈ) Î·È Ô ¤ÊË‚Ô˜ ÁÚ‹ÁÔÚ· ·Ó·Ù‡ÛÛÂÈ ÂıÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿. ™˘¯Ó¿, ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ Û ‰È·‰ÈÎÙ˘·Î¤˜ Û¯¤ÛÂȘ, ·ÏÏ¿ ÂÂÎÙ›ÓÂÈ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘ Û on line gaming, on line Ù˘¯ÂÚ¿ ·È¯Ó›‰È· Î·È ·ÁÔÚ¤˜/eBay, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¶·È‰È·ÙÚÈ΋ 2008;71:434-440
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·436
436
∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯·
˘ÂÚ‚ÔÏÈΤ˜ ÔÛfiÙËÙ˜ ¯ÚËÌ¿ÙˆÓ, ‰È·Ù·Ú¿ÛÛÔÓÙ·˜ ÙÔÓ Î·Ù·ÌÂÚÈÛÌfi ÙˆÓ ÔÈÎÔÓÔÌÈÎÒÓ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜ Î·È ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ÙÔ˘ ˘Ô¯ÚÂÒÛÂˆÓ Î·È Î·Ù·Ï‹ÁÔÓÙ·˜ Û „˘¯·Ó·ÁηÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿. ¶Úfi‰ÚÔÌ· ÛËÌ›·, fiˆ˜ ˘ÂÚ‚ÔÏÈÎfi˜ ¯ÚfiÓÔ˜ ÂÓ·Û¯fiÏËÛ˘, Ì›ˆÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÂÈÎÔÈÓˆÓ›·˜ Ì ʛÏÔ˘˜ Î·È ¿ÏϘ ÎÔÈÓˆÓÈΤ˜ Û˘Ó·Ó·ÛÙÚÔʤ˜, ·Ú·Ì¤ÏËÛË ˘Ô¯ÚÂÒÛˆÓ, ÛËÌ·ÓÙÈ΋ ÙÒÛË Ù˘ Û¯ÔÏÈ΋˜ ›‰ÔÛ˘, ÌÂÙ·‚ÔϤ˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ Î·È ·‰È·ÊÔÚ›· ÁÈ· Ú¿ÁÌ·Ù· Ô˘ ÚÈÓ ıˆÚÔ‡ÓÙ·Ó Â˘¯¿ÚÈÛÙ·, ÍËÚfiÙËÙ· ÔÊı·ÏÌÒÓ Î·È ÔÓÔΤʷÏÔÈ, fi¯È Ï›Á˜ ÊÔÚ¤˜, ÂÌÊ·Ó›˙ÔÓÙ·È ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 10 ÂÙÒÓ Î·È Ë ¤ÁηÈÚË ·Ó·ÁÓÒÚÈÛË Î·È ÚÔÛ¿ıÂÈ· ·ÓÙÈÌÂÙÒÈÛ˘ ÚÔÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÁηٿÛÙ·ÛË ÛÔ‚·ÚÔ‡ ÂıÈÛÌÔ‡.
¶·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› Œ¯Ô˘Ó ·Ó·Ù˘¯ı› Ù¤ÛÛÂÚȘ ‰È·ÊÔÚÂÙÈΤ˜ ıˆڛ˜ ÁÈ· ÙÔÓ ÂıÈÛÙÈÎfi Ì˯·ÓÈÛÌfi (14): ∞) æ˘¯Ô‰˘Ó·ÌÈ΋ ıˆڛ· Î·È ıˆڛ˜ ÚÔÛˆÈÎfiÙËÙ·˜ ∏ ıˆڛ· ·˘Ù‹ ÛÙËÚ›˙ÂÙ·È ÛÙË ı¤ÛË fiÙÈ Ô ÂıÈÛÌfi˜ ·Ó·Ù‡ÛÛÂÙ·È Û ÂÊ‹‚Ô˘˜ Ì ÈÛÙÔÚÈÎfi ÙÚ·‡Ì·ÙÔ˜ ÛÙËÓ ·È‰È΋ ËÏÈΛ· Î·È Ì ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ Úԉȷı¤ÙÔ˘Ó. ∆· ¿ÙÔÌ· ·˘Ù¿ Â›Ó·È ‰˘Ó·ÙfiÓ Ó· ‰È¿ÁÔ˘Ó fiÏË ÙË ˙ˆ‹ ÙÔ˘˜ ¯ˆÚ›˜ Ó· ·Ó·Ù‡ÍÔ˘Ó ÂıÈÛÌfi. ¶·ÚÔ˘ÛÈ¿˙Ô˘Ó, fï˜, ÌÂȈ̤Ó˜ ·ÓÙÔ¯¤˜ ηÈ, ·Ó ÂÎÙÂıÔ‡Ó Û ÛÙÚÂÛÔÁfiÓÔ˘˜ ·Ú¿ÁÔÓÙ˜, Â›Ó·È ÂÈÚÚ‹ ÛÙËÓ ·Ó¿Ù˘ÍË ÂıÈÛÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜. ™˘ÓÔ„›˙ÔÓÙ·˜, Û‡Ìʈӷ Ì ÙË ıˆڛ· ·˘Ù‹, ÂıÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ÂΉËÏÒÓÂÙ·È fiÙ·Ó ÛËÌÂȈı› Û˘Ó‰˘·ÛÌfi˜ ÙÔ˘ ηٿÏÏËÏÔ˘ ·ÙfiÌÔ˘ Ì ÙËÓ Î·Ù¿ÏÏËÏË ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹ Î·È ÙÔ Î·Ù¿ÏÏËÏÔ ÁÂÁÔÓfi˜. µ) £ÂˆÚ›· ÙÔ˘ ÎÔÈÓˆÓÈÎÔ‡ ÔÏÈÙÈÛÌÈÎÔ‡ ˘ÔÛÙÚÒÌ·ÙÔ˜ (ÎÔ˘ÏÙÔ‡Ú·˜) √ ÂıÈÛÌfi˜ ÔÈΛÏÏÂÈ ·Ó¿ÏÔÁ· Ì ÙÔ Ê‡ÏÔ, ÙËÓ ËÏÈΛ·, ÙËÓ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË, ÙËÓ ÂıÓÈÎfiÙËÙ·, ÙË ıÚËÛΛ· Î·È ÙË ¯ÒÚ· ‰È·ÌÔÓ‹˜. ªÂÚÈΤ˜ ηÙËÁÔڛ˜ ·ÓıÚÒˆÓ Â›Ó·È ÈÔ ÂÈÚÚ›˜ Û οÔȘ ÌÔÚʤ˜ ÂıÈÛÌÔ‡. °È· ·Ú¿‰ÂÈÁÌ·, Ô ·ÏÎÔÔÏÈÛÌfi˜ ·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· ÛÙË ÌÂÛ·›· ÎÔÈÓˆÓÈ΋ Ù¿ÍË, ÛÙÔ˘˜ Ï¢ÎÔ‡˜ ∞ÌÂÚÈηÓÔ‡˜ Î·È ÛÙÔ˘˜ ηıÔÏÈÎÔ‡˜. ∏ Ï¢΋ Ê˘Ï‹ Â›Ó·È ÈÔ ÂÈÚÚ‹˜ ÛÙË ¯Ú‹ÛË ·Ú·ÈÛıËÛÈÔÁfiÓˆÓ, ·ÏÏ¿ ÏÈÁfiÙÂÚÔ ÂÈÚÚ‹˜ ÛÙË ¯Ú‹ÛË ËÚˆ›Ó˘, Û ۯ¤ÛË Ì ÙË Ì·‡ÚË Ê˘Ï‹ Î·È ÙÔ˘˜ §·ÙÈÓÔ·ÌÂÚÈηÓÔ‡˜. °) £ÂˆÚ›· Û˘ÌÂÚÈÊÔÚ¿˜ ∫¿ı ¿ÙÔÌÔ ·Ì›‚ÂÙ·È ‹ ÙÈ̈ÚÂ›Ù·È ÁÈ· οıÂ Û˘ÌÂÚÈÊÔÚ¿ Ô˘ ÂΉËÏÒÓÂÈ. ŒÓ· ÓÙÚÔ·Ïfi ·È‰› Ô˘ ÊÔ‚¿Ù·È ÙË Û˘Û¯¤ÙÈÛË Ì ӤԢ˜ ·ÓıÚÒÔ˘˜ ·ÔÌÔPaediatriki 2008;71:434-440
ÓÒÓÂÙ·È, Ì ÛÎÔfi Ó· ·ÔʇÁÂÈ ÙÔ ¿Á¯Ô˜ Ô˘ Û˘Óԉ‡ÂÈ Î¿ı ÎÔÈÓˆÓÈ΋ Û˘Ó·Ó·ÛÙÚÔÊ‹. ∏ ·ÔÊ˘Á‹ ÙÔ˘ ¿Á¯Ô˘˜ Â›Ó·È ÙÂÏÈο Ë ·ÌÔÈ‚‹ Ô˘ ÂÈÛÚ¿ÙÙÂÈ Î·È Ë ÔÔ›· ÂÓÈÛ¯‡ÂÈ ·ÚfiÌÔȘ Û˘ÌÂÚÈÊÔÚ¤˜. ∆· Ó·ÚΈÙÈο, ÙÔ ·ÏÎÔfiÏ, Ù· Ù˘¯ÂÚ¿ ·È¯Ó›‰È·, ÙÔ ‰È·‰›ÎÙ˘Ô ÚÔÛʤÚÔ˘Ó ·ÌÔÈ‚‹-ÂÈ‚Ú¿‚¢ÛË, Ì ÙË ÌÔÚÊ‹ ËÚÂÌ›·˜, ·Á¿Ë˜, ‰˘Ó·ÌÈÛÌÔ‡, Ê˘ÛÈ΋˜ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ Î¿Ï˘„˘ ηÈ, ΢ڛˆ˜, ÙÔÓ ÙÚfiÔ ·ÔÊ˘Á‹˜ Ù˘ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜. ŒÙÛÈ, Ù· ¿ÙÔÌ· ÂÈ˙ËÙÔ‡Ó ÙË ¯Ú‹ÛË ÒÛÙ ӷ ¤¯Ô˘Ó ÙËÓ ·ÌÔÈ‚‹ Î·È Ô Î‡ÎÏÔ˜ Û˘Ó¯›˙ÂÙ·È. ¢) µÈÔ˚·ÙÚÈ΋ ıˆڛ· ∏ ıˆڛ· ·˘Ù‹ ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ô ÂıÈÛÌfi˜ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· ÎÏËÚÔÓÔÌÈÎÒÓ Î·È Û˘ÁÁÂÓÒÓ ‰È·Ù·Ú·¯ÒÓ Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ·ÓÈÛÔÚÚÔ›· ¯ËÌÈÎÒÓ Ó¢Úԉȷ‚È‚·ÛÙÒÓ. ∏ ¯Ú‹ÛË Ô˘ÛÈÒÓ ‹ Û˘ÁÎÂÎÚÈ̤Ó˜ Û˘ÌÂÚÈÊÔÚ¤˜ ¤Ú¯ÔÓÙ·È Ó· ηχ„Ô˘Ó ÎÂÓ¿ ÛÙȘ Ó¢ÚÈΤ˜ Û˘Ó¿„ÂȘ, ÚÔÛʤÚÔÓÙ·˜ ¢ÂÍ›· ÛÙÔ ¿ÙÔÌÔ Î·È ·Ó·˙‹ÙËÛË Í·Ó¿ Ù˘ ›‰È·˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜, Ì ÛÎÔfi ÙÔ ›‰ÈÔ Î·Ïfi ·ÔÙ¤ÏÂÛÌ·. ∆Ô ÁÂÁÔÓfi˜ fiÙÈ ÙÔ ‰È·‰›ÎÙ˘Ô ÚÔÛʤÚÂÈ ‰È·ÛΤ‰·ÛË Î·È Û˘ÁÎÈÓ‹ÛÂȘ ›Ûˆ˜ ÂÓ Ì¤ÚÂÈ ÂÍËÁ› ÙËÓ ·Ó¿Ù˘ÍË ÂıÈÛÌÔ‡. ™ÙËÓ ÂÚ›ÙˆÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘, ‰ÂÓ ÂÈÛ¿ÁÔÓÙ·È Û˘ÁÎÂÎÚÈ̤Ó˜ Ô˘Û›Â˜, ·ÏÏ¿ ÈÛÙ‡ÂÙ·È fiÙÈ ÂÎÎÚ›ÓÔÓÙ·È ÌÈÎÚÔÚˆÙ½Ó˜ ·fi ÙÔÓ ›‰ÈÔ ÙÔÓ ÔÚÁ·ÓÈÛÌfi, ÒÛÙÂ Û˘ÁÎÂÎÚÈ̤Ó˜ Ú¿ÍÂȘ Ó· ¤¯Ô˘Ó ˆ˜ ·ÔÙ¤ÏÂÛÌ· ¢¯¿ÚÈÛÙ· Û˘Ó·ÈÛı‹Ì·Ù·.
∞ÈÙÈÔÏÔÁ›· ÂıÈÛÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ ∏ ·ÈÙÈÔÏÔÁ›· Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋ Î·È Î·ÌÈ¿ ıˆڛ· ‰ÂÓ Â›Ó·È ·fiÏ˘Ù· Û˘Ì‚·Ù‹ Ì ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·. º·›ÓÂÙ·È fiÙÈ Ë ÂıÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Û˘Ó‰˘·ÛÌÔ‡ ÎÔÈÓˆÓÈÎÒÓ ·ÈÙÈÒÓ Î·È ÚÔÛˆÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ (¶›Ó·Î·˜ 2). ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ, Ì ÙËÓ ¤ÌÊ˘ÙË ÂÚȤÚÁÂÈ· Î·È ¤ÏÍË ÚÔ˜ ÙÔ Î·ÈÓÔ‡ÚÁÈÔ Ô˘ ‰È·ı¤ÙÔ˘Ó, Â›Ó·È ÂÈÚÚ‹ ÛÙËÓ ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË (15). π‰È·›ÙÂÚ·, fï˜, ·È‰È¿ ÓÙÚÔ·Ï¿, ÌË ‰ËÌÔÊÈÏ‹, ‰‡ÛÎÔÏ· ÛÙËÓ ·Ó¿Ù˘ÍË ÊÈÏÈÎÒÓ Û¯¤ÛˆÓ, ÚÔÙÈÌÔ‡Ó ÙËÓ ·fiÎÙËÛË Ê›ÏˆÓ Ì¤Û· ·fi ÙÔ ‰È·‰›ÎÙ˘Ô Î·È ÔÏϤ˜ ÊÔÚ¤˜ Ó¤ˆÓ Ù·˘ÙÔÙ‹ÙˆÓ Û ËÏÂÎÙÚÔÓÈΤ˜ ÎÔÈÓfiÙËÙ˜, ¤ÙÛÈ ÒÛÙ fi¯È ÌfiÓÔ Ó· ·ÔʇÁÔ˘Ó ÙÔ ¿Á¯Ô˜ Ù˘ ÎÔÈÓˆÓÈ΋˜ Û˘Ó·Ó·ÛÙÚÔÊ‹˜ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ Û¯ÔÏ›Ԣ, ·ÏÏ¿ Î·È Ó· ÂÈÙ˘Á¯¿ÓÔ˘Ó Ó· ˘Ô‰‡ÔÓÙ·È ÚfiÏÔ˘˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ·ÏÏ¿ ÙÔ˘˜ ÔÔ›Ô˘˜ ÂÈı˘ÌÔ‡Ó (16,17). ∆· ·È‰È¿ Ì ÎÔÈÓˆÓÈΤ˜ ·Ó·ÛÊ¿ÏÂȘ ÂȉÈÒÎÔ˘Ó ÙË ¯Ú‹ÛË, ÈÛÙ‡ÔÓÙ·˜ fiÙÈ ¤ÙÛÈ ı· ÍÂÂÚ¿ÛÔ˘Ó ÙË ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË Ô˘ ‰È·ı¤ÙÔ˘Ó Î·È ı· ·Ó·Ù‡ÍÔ˘Ó ÙÚfiÔ˘˜ ÂÈÎÔÈÓˆÓ›·˜ Ì ÙÔ˘˜ Û˘ÓÔÌ‹ÏÈÎÔ˘˜ (18). ∞ÓÙ›ıÂÙ·, fï˜, Ë ·ÔÌ¿ÎÚ˘ÓÛË ·fi ÙȘ Ú·ÁÌ·ÙÈΤ˜ Û¯¤ÛÂȘ ¢ԉÒÓÂÈ ÙÔ ÎÔÈÓˆÓÈÎfi ¿Á¯Ô˜ ÙÔ˘ Û¯ÂÙ›˙ÂÛı·È ηÈ
Pediatri Nov-Dec 08 new
19-12-08
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¶›Ó·Î·˜ 2. ∞ÙÔÌÈÎÔ› Î·È ÎÔÈÓˆÓÈÎÔ› ÚԉȷıÂÛÈÎÔ› ·Ú¿ÁÔÓÙ˜ ∞ÙÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο
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∞ÁfiÚÈ ¡ÙÚÔ·Ïfi ¢˘ÛÎÔÏ›· ÛÙËÓ ·fiÎÙËÛË Ê›ÏˆÓ Ã·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË ∫·Ù¿ıÏÈ„Ë ∫·Î‹ Û¯¤ÛË Ì ÙÔ˘˜ ÁÔÓ›˜ ∞Á¯Ò‰Ë˜ Î·È Â˘·›ÛıËÙË ÚÔÛˆÈÎfiÙËÙ· ÀÂÚÎÈÓËÙÈÎfiÙËÙ· ¢È·Ù·Ú·¯¤˜ Û˘ÁΤÓÙÚˆÛ˘ ∞Ó·˙‹ÙËÛË Û˘Ó¯Ҙ ÙÔ˘ ηÈÓÔ‡ÚÁÈÔ˘ ∆¿ÛË ˘¤Ú‚·Û˘ ÙˆÓ ÔÚ›ˆÓ ∫·Î‹ ·ÓÙ›ÏË„Ë ÙÔ˘ ¯ÚfiÓÔ˘ æ˘¯·Ó·ÁηÛÙÈ΋ ÚÔÛˆÈÎfiÙËÙ·
¢È·Ù·Ú·¯‹ ÛÙËÓ ÔÈÎÔÁÂÓÂȷ΋ Û˘ÓÔ¯‹ ªÔÓÔÁÔÓÂ˚΋ ÔÈÎÔÁ¤ÓÂÈ· ∂ÏÏÈ‹˜ ÔÈÎÔÁÂÓÂȷ΋ ÛÙ‹ÚÈÍË ∂ÏÏÈ‹˜ ÂÔÙ›· ∂χıÂÚË ¯Ú‹ÛË, ¯ˆÚ›˜ ¯ÚÔÓÈÎÔ‡˜ Î·È ÔÈÔÙÈÎÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÀÂÚÚÔÛٷ٢ÙÈÎfi ‹ ·˘ÛÙËÚfi ÂÚÈ‚¿ÏÏÔÓ ¶·ÚÔ˘Û›· ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹ ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡ ªÂȈ̤Ó˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÂÎÙfi˜ ÛÈÙÈÔ‡ ™˘¯Ó¤˜ ÂÈÛΤ„ÂȘ Û internet café
·˘Í¿ÓÂÈ ÙËÓ ·ÔÌfiÓˆÛË (19). ¶ÔÏϤ˜ ¤Ú¢Ó˜ ¤‰ÂÈÍ·Ó fiÙÈ ·È‰È¿ Ì „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ηٿıÏÈ„Ë, „˘¯·Ó·ÁηÛÙÈÎfiÙËÙ·-ηٷӷÁηÛÙÈÎfiÙËÙ·, ÊÔ‚›Â˜, ·Ó·Ù‡ÛÛÔ˘Ó Â˘ÎÔÏfiÙÂÚ· ÂıÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Î·È ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ ÚÔ¸¿Ú¯ÂÈ Î¿ÔÈÔ˘ ‚·ıÌÔ‡ ηٿıÏÈ„Ë (20-22). ∞Ó¿ÏÔÁ· ·ÔÙÂϤÛÌ·Ù· ·Ú·ÙËÚ‹ıËÎ·Ó Û ·È‰È¿ Ì ‰È·Ù·Ú·¯¤˜ Û˘ÁΤÓÙÚˆÛ˘ Î·È ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·, ¯ˆÚ›˜ fï˜ Ó· ‰È¢ÎÚÈÓÈÛÙ› ·Ó ÙÔ ¤Ó· Â›Ó·È ·ÈÙ›· ÙÔ˘ ¿ÏÏÔ˘ ‹ ·ÓÙ›ÛÙÚÔÊ· (23,24). √ ÎÔÈÓˆÓÈÎfi˜ ÂÚ›Á˘ÚÔ˜ ‰Ú· Û˘ÓÂÚÁÈο Û ÂÊ‹‚Ô˘˜ Ì ¯·Ú·ÎÙËÚÈÛÙÈο Ô˘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚԉȿıÂÛË. ∏ ‰ÔÌ‹ Ù˘ Û‡Á¯ÚÔÓ˘ ÎÔÈÓˆÓ›·˜ ·ÚÔÙÚ‡ÓÂÈ Ù· ·È‰È¿ ÛÙË ¯Ú‹ÛË ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ˘ÔÏÔÁÈÛÙÒÓ ˆ˜ ·ÛÊ·Ï‹ ÙÚfiÔ ··Û¯fiÏËÛ˘ Î·È „˘¯·ÁˆÁ›·˜ ÛÙÔ Û›ÙÈ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ ÂÎÙfi˜ ÛÈÙÈÔ‡ ‰Ú·ÛÙËÚÈfiÙËÙ˜, fi¯È ÌfiÓÔ Â›Ó·È ÂÈΛӉ˘Ó˜, ·ÏÏ¿ ··ÈÙÔ‡Ó Î·È ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÁÔÓ¤ˆÓ Ô˘, ÏfiÁˆ ÔχˆÚ˘ ·ÁÁÂÏÌ·ÙÈ΋˜ ÂÚÁ·Û›·˜, Û˘¯Ó¿ ‰ÂÓ Û˘ÌÌÂÙ¤¯Ô˘Ó ÛÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ· ÙˆÓ ÂÊ‹‚ˆÓ Î·È ‰ÂÓ ‚ÔËıÔ‡Ó ÛÙËÓ ÂÎÙfiÓˆÛË Ù˘ ÂÓ¤ÚÁÂÈ·˜ Î·È ‰ËÌÈÔ˘ÚÁÈÎfiÙËÙ·˜ Ô˘ ‰È·ı¤ÙÔ˘Ó. ∂ÈϤÔÓ, Ë ·Ô˘Û›· ÙˆÓ ÁÔÓ¤ˆÓ ‹ ÔÈ ·ÛÙ·ı›˜ ÔÈÎÔÁÂÓÂȷΤ˜ ‰Ô̤˜ (‰È·˙‡ÁÈÔ, ηٿ¯ÚËÛË ·ÏÎÔfiÏ Î·È Î·Ó›ÛÌ·ÙÔ˜) Ô‰ËÁÔ‡Ó Û˘¯Ó¿ Û ηΤ˜ Û¯¤ÛÂȘ ·È‰ÈÔ‡-ÁÔÓ¤·, ÁÂÁÔÓfi˜ Ô˘ ·ÔÙÂÏ› ÛÔ‚·Úfi ÂÈ‚·Ú˘ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ·Ó¿Ù˘ÍË ÂıÈÛÌÔ‡ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ (25-26). ∆· ›ÓÙÂÚÓÂ٠ηʤ Î·È Ë ·ÚÔ˘Û›· ÙÔ˘ ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹ Û ÌË ÎÔÈÓfi¯ÚËÛÙÔ˘˜ ¯ÒÚÔ˘˜ ÛÙÔ Û›ÙÈ (.¯. ˘ÓÔ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡) ‰È¢ÎÔχÓÔ˘Ó ÙË ¯Ú‹ÛË ¯ˆÚ›˜ ÂÔÙ›· Î·È ¯ˆÚ›˜ ¯ÚÔÓÈο fiÚÈ·. √ ¯ÚfiÓÔ˜ Î·È Ë ÔÈfiÙËÙ· Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ·Ô‰Â›¯ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÂÈÚfiÛıÂÙ˜ ·Ú¿ÌÂÙÚÔÈ. ∆· on line ·È¯Ó›‰È· Î·È Ù· chat rooms ·ÔÙÂÏÔ‡Ó ÙÚfiÔ Â‡ÎÔÏ˘ Û˘Ó¿ÓÙËÛ˘ ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÂÏ΢ÛÙÈÎfi ̤ÛÔ ÂÈÎÔÈÓˆÓ›·˜ Î·È ·ÓÙ·ÁˆÓÈÛÙÈÎfiÙËÙ·˜, Ù· ÔÔ›· ÁÚ‹ÁÔÚ· Ô‰ËÁÔ‡Ó Û ·ÏfiÁÈÛÙË Î·È ÔχˆÚË ¯Ú‹ÛË,
Û ·Ú·Ì¤ÏËÛË Î·ıËÎfiÓÙˆÓ Î·È Û ÂÍ·ÚÙË̤ÓË Û˘ÌÂÚÈÊÔÚ¿ (27-28).
∂ȉËÌÈÔÏÔÁ›· √ ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ ·Ó·ÁÓˆÚ›˙ÂÙ·È Û ÔÏϤ˜ ¯ÒÚ˜ Î·È ¤¯Ô˘Ó Á›ÓÂÈ ·ÚÎÂÙ¤˜ ÏËı˘ÛÌȷΤ˜ ÌÂϤÙ˜ ÁÈ· ÙËÓ Î·Ù·ÁÚ·Ê‹ Ù˘ ›وÛ˘. √È ÂÚÈÛÛfiÙÂÚ˜ ·ÊÔÚÔ‡Ó ÙȘ ÂÚÈÔ¯¤˜ ηٷÛ΢‹˜ Ù˘ ËÏÂÎÙÚÔÓÈ΋˜ Ù¯ÓÔÏÔÁ›·˜, fiˆ˜ Ë ∫›Ó· Î·È Ë ∫ÔÚ¤·. ™ÙÔÓ ¶›Ó·Î· 3 ·ÚÔ˘ÛÈ¿˙ÂÙ·È Ë Â›ÙˆÛË ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜. À„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ¤¯Ô˘Ó ·Ó·ÊÂÚı› ÛÙË °ÂÚÌ·Ó›· Î·È ÛÙȘ ∏¶∞, ÂÓÒ ¯·ÌËÏfiÙÂÚ· ÛÙËÓ ∂ÏÏ¿‰·. ∂›Û˘, ·Ú·ÙËÚÂ›Ù·È ˘ÂÚÔ¯‹ ÙˆÓ ·ÁÔÚÈÒÓ ¤Ó·ÓÙÈ ÙˆÓ ÎÔÚÈÙÛÈÒÓ (20,23,27-35). ∞·ÈÙÔ‡ÓÙ·È, fï˜, ÂÚÈÛÛfiÙÂÚ˜ ÌÂϤÙ˜ ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÎÙËı› ÌÈ· ÛÊ·ÈÚÈ΋ ÂÈÎfiÓ· ÙÔ˘ ÚÔ‚Ï‹Ì·ÙÔ˜. ™˘ÓÔ‰¤˜ ÂÈÏÔΤ˜ ∏ ‰È¿ÁÓˆÛË Û˘¯Ó¿ ηı˘ÛÙÂÚ› ›Ù ÁÈ·Ù› Ô ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ ‰‡ÛÎÔÏ· ·Ó·ÁÓˆÚ›˙ÂÙ·È ·fi ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜ ›Ù ÁÈ·Ù› ÔÈ ËÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ ·ÔÙÂÏÔ‡Ó Â˘ÂÚÁÂÛ›· ÛÙË ˙ˆ‹ Ù˘ Û‡Á¯ÚÔÓ˘ ÎÔÈÓˆÓ›·˜ (36,37). ø˜ ÂÎ ÙÔ‡ÙÔ˘, ÔÏÏÔ› ¤ÊË‚ÔÈ ‰È·ÁÈÁÓÒÛÎÔÓÙ·È fiÙ·Ó ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ·ÓËÛ˘¯›· ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, fiˆ˜ ·ÓÙÈÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ·fiÚÚÈ„Ë Ù˘ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜, ·‰È·ÊÔÚ›· ÁÈ· ÙË Ì¿ıËÛË Î·È ÙËÓ Â·ÁÁÂÏÌ·ÙÈ΋ ·ÔηٿÛÙ·ÛË, ·Ô˘Û›Â˜ ·fi ÙÔ Û¯ÔÏÂ›Ô Î·È ÔχˆÚ˜ ÂÈÛΤ„ÂȘ Û ›ÓÙÂÚÓÂ٠ηʤ, ÎÏÔ‹ ÚÔ˜ ÂÍ·ÛÊ¿ÏÈÛË ÙˆÓ ··Ú·›ÙËÙˆÓ ¯ÚËÌ¿ÙˆÓ, ÂÏÏÈ‹ ÍÂÎÔ‡Ú·ÛË Î·È ‰È·ÙÚÔÊ‹ Î·È ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Û οı ÚÔÛ¿ıÂÈ· Ì›ˆÛ˘ Ù˘ ¯Ú‹Û˘ (38-39). °Ú‹ÁÔÚ· Ô‰ËÁÔ‡ÓÙ·È ÛÙËÓ Ï‹ÚË ·ÔÌfiÓˆÛË Î·È Û˘¯Ó¿ ÂÌϤÎÔÓÙ·È Û ÛÂÍÔ˘·ÏÈΤ˜ ÚÔÛÎÏ‹ÛÂȘ Î·È ·˘ÙÔÎÙÔÓ›· (40-44). ™Â ÌÈ· ·Ó·ÛÎfiËÛ‹ ÙÔ˘, Ô Naito ·Ó·Ê¤ÚÂÈ fiÙÈ Î¿ı ¯ÚfiÓÔ ÛÙËÓ π·ˆÓ›· ÛËÌÂÈÒÓÔÓÙ·È ¶·È‰È·ÙÚÈ΋ 2008;71:434-440
Pediatri Nov-Dec 08 new
19-12-08
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∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯·
¶›Ó·Î·˜ 3. ∂›ÙˆÛË ÙÔ˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÂıÈÛÌÔ‡ ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜
Yoo (Korea) Hur MH (Korea) Jang KS (Korea) June KJ (Korea) Deng YX (China) Cao F (China) Nalwa K (India) Stefanescu C (Romania) Johansson A (Norway) Grusser SM (Germany) MÔÓ¿‰· EÊË‚È΋˜ ÀÁ›·˜ (∞ı‹Ó·)
∞ÚÈıÌfi˜ ∂Ê‹‚ˆÓ
∏ÏÈΛ· (¤ÙË)
¶Èı·Ófi˜ ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ %
¢È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ %
535 240 912 1529 5760 2620 100 69 3237 323 529
9-15 11-15 14-18 15-18 12-15 12-18 16-18 11-18 12-18 11-14 15
14 50 30 20 18 8,6 18
0,9 2 4,3 5,5 2 1,4 1,9 9,3 1
ÂÚÈÛÛfiÙÂÚ˜ ·fi 60 ÂÚÈÙÒÛÂȘ ‰È·‰ÈÎÙ˘·Î‹˜ ·˘ÙÔÎÙÔÓ›·˜ (net suicide) (45), ÂÓÒ ÛÙËÓ πÓ‰›· ÚÔ ‰ÈÂÙ›·˜ ··ÁÔÚ‡ÙËÎÂ Ë ¯Ú‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙÔ˘˜ ÎÔÈÙÒÓ˜ ÙˆÓ ÊÔÈÙËÙÒÓ, ÌÂÙ¿ ÙËÓ ·˘ÙÔÎÙÔÓ›· ÊÔÈÙËÙ‹ (6). ∆ÂÏÈο, ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ηÚÈ·›Ô˘ ۈϋӷ ›Ûˆ˜ Â›Ó·È Ë ÈÔ ·Ï‹ ÂÈÏÔ΋, Ô˘ ‡ÎÔÏ· ·Ôηı›ÛٷٷÈ.
£Âڷ›· £Âڷ¢ÙÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ Á›ÓÔÓÙ·È ÌfiÓÔ Û ÂȉÈο ΤÓÙÚ·, Ì ÂȉÈÎÔ‡˜ „˘¯È΋˜ ˘Á›·˜ (·È‰Ô„˘¯›·ÙÚÔ˘˜, ·È‰Ô„˘¯ÔÏfiÁÔ˘˜ Î·È „˘¯oıÂÚ·Â˘Ù¤˜), ÁÓÒÛÙ˜ ÙÔ˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÂıÈÛÌÔ‡ (46). ∏ ıÂڷ›· ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·ÈÙÂÚfiÙËÙ˜, Û ۯ¤ÛË Ì ¿ÏÏ· ›‰Ë ÂıÈÛÌÔ‡. µ·ÛÈ΋ ‰È·ÊÔÚ¿ ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ÂÓÔ¯ÔÔÈÂ›Ù·È Î¿ÔÈ· ÙÔÍÈ΋ Ô˘Û›· ·ÏÏ¿ οÔÈÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜ Î·È Ë ·Ú¤Ì‚·ÛË ı· Ú¤ÂÈ Ó· ÂÛÙÈ¿˙ÂÙ·È ÛÙËÓ ·ÏÏ·Á‹ Ù˘ ηıËÌÂÚÈÓfiÙËÙ·˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜. √È ‹È˜ ÂÚÈÙÒÛÂȘ ·Ú·ÎÔÏÔ˘ıÔ‡ÓÙ·È Ì ÛÂÈÚ¿ Û˘Ó‰ÚÈÒÓ Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, ÂÓÒ ÔÈ ÛÔ‚·Ú¤˜ ··ÈÙÔ‡Ó “ÓÔÛËÏ›·” Û ÂȉÈο ΤÓÙÚ· ÛÙ· ÔÔ›· ÂÊ·ÚÌfi˙ÂÙ·È Ë ÁÓˆÛȷ΋ Û˘ÌÂÚÈÊÔÚÈ΋ ıÂڷ›· (47). ∆Ô ÚÒÙÔ Î¤ÓÙÚÔ Ô˘ ‰ÈÔÚÁ·ÓÒıËΠ̠ÙË ÌÔÚÊ‹ ηٷÛ΋ӈÛ˘ ÁÈ· ÂÊ‹‚Ô˘˜ Â›Ó·È ÛÙËÓ ·Ú·Ïȷ΋ ΈÌfiÔÏË Boltenhagen ÛÙËÓ ÂÚÈÔ¯‹ Mecklenburg ÛÙË ¢˘ÙÈ΋ Pomerania (°ÂÚÌ·Ó›·), ÙÔ ÔÔ›Ô ÂȉÈÒÎÂÈ Ó· ‚ÔËı‹ÛÂÈ Ù· ·È‰È¿ Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙȘ Û¯¤ÛÂȘ Ì ʛÏÔ˘˜, Ó· ÂÈϤÁÔ˘Ó ‰È·ÊÔÚÂÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ‰È·ÊÔÚÂÙÈ΋ ηٷÓÔÌ‹ ÙˆÓ ˆÚÒÓ ÙÔ˘ 24ÒÚÔ˘. ∆Ô Î¤ÓÙÚÔ ÂȉÈÒÎÂÈ ÂÈϤÔÓ ÙËÓ ·Ú¤Ì‚·ÛË ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡, Ô˘ ÔÏϤ˜ ÊÔÚ¤˜ ıˆÚÂ›Ù·È ˘Â‡ı˘ÓÔ. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ, Â›Ó·È ··Ú·›ÙËÙË Ë ¯Ú‹ÛË ·ÓÙÈηٷıÏÈÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ. KÚÈÙÈ΋ À¿Ú¯ÂÈ ·ÚÎÂÙfi˜ ÛÎÂÙÈÎÈÛÌfi˜ Û¯ÂÙÈο Ì ٷ ÎÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛ˘ Î·È ÙÔ ·Ó ÙÔ ‰È·‰›ÎÙ˘Ô Â›Ó·È ÊÔPaediatriki 2008;71:434-440
Ú¤·˜ ÎÈÓ‰‡ÓˆÓ (48-49). °È· ÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÓıÚÒÔ˘˜ ·ÔÙÂÏ› ¤Ó· ·Î›Ó‰˘ÓÔ ÊÈÏÈÎfi ÂÚÁ·Ï›Ô, ÙÔ ÔÔ›Ô ÚÔÛʤÚÂÈ ÏËÚÔÊÔڛ˜, Ê›ÏÔ˘˜ Î·È ‰È·ÛΤ‰·ÛË. √ „˘¯›·ÙÚÔ˜ Grohol ˘ÔÛÙËÚ›˙ÂÈ fiÙÈ Ô ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ Â›Ó·È ÌÈ· ıˆÚËÙÈ΋ ÓfiÛÔ˜ Î·È ˆ˜, ηٿ ÙÔÓ ›‰ÈÔ ÙÚfiÔ, ÂıÈÛÌfi˜ ı· ÌÔÚÔ‡Û ӷ ıˆÚËı› Î·È Ë ˘ÂÚ‚ÔÏÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙËÏÂfiÚ·Û˘, ÔÈ ·ÙÂÏ›ˆÙ˜ ÒÚ˜ ÔÌÈÏ›·˜ ÛÙÔ ÙËϤʈÓÔ, ÙÔ ˘ÂÚ‚ÔÏÈÎfi ‰È¿‚·ÛÌ· ‹ Ë „˘¯·Ó·ÁηÛÙÈ΋ ÂÚÁ·Û›·, Û˘ÌÂÚÈÊÔÚ¤˜ ηٿ ÙȘ Ôԛ˜ Ù· ¿ÙÔÌ· ·ÔÔÈÔ‡ÓÙ·È ÔÈÎÔÁÂÓÂȷΤ˜ ·Ó¿ÁΘ, Ê›ÏÔ˘˜ ‹ ÎÔÈÓˆÓÈΤ˜ ÂΉËÏÒÛÂȘ (50). ∏ ¢¯·Ú›ÛÙËÛË ·fi ÙË ¯Ú‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ‰ÂÓ ÌÔÚ› Ó· Û˘ÁÎÚÈı› Ô‡Ù ÛÙÔ ÂÏ¿¯ÈÛÙÔ Ì ÙË ¯Ú‹ÛË ÎÔη˝Ó˘ ‹ ËÚˆ›Ó˘. √‡Ù ÌÔÚ› Ó· Û˘ÁÎÚÈı› Ì ÙËÓ ·ıÔÏÔÁÈ΋ ÂÍ¿ÚÙËÛË ·fi Ù˘¯ÂÚ¿ ·È¯Ó›‰È·, Ë ÔÔ›· ·ÔÙÂÏ› ÌÂÌÔӈ̤ÓË ·ÓÙÈÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿. ∞ÓÙ›ıÂÙ·, ÙÔ ‰È·‰›ÎÙ˘Ô ¤¯ÂÈ Ì¤ÁÈÛÙÔ ·ÙÔÌÈÎfi Î·È ÎÔÈÓˆÓÈÎfi fiÊÂÏÔ˜. ∞ÔÙÂÏ› ÙÔ ··Ú·›ÙËÙÔ Ì¤ÛÔ ÏÂÈÙÔ˘ÚÁ›·˜ ÔÏÏÒÓ ÂȯÂÈÚ‹ÛÂˆÓ Î·È ¿ÌÂÛ˘ ÚfiÛ‚·Û˘ Û Ï›ÛÙ· ˘ÏÈο ·Á·ı¿, ÚÔÛʤÚÂÈ ÙÔÓ ÙÚfiÔ Â‡ÎÔÏ˘ ·ÁÁÂÏÌ·ÙÈ΋˜ ‹ ÚÔÛˆÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ Î·È ÏÂÈÙÔ˘ÚÁ› ˆ˜ ÙÔ ·Ú¿ı˘ÚÔ ÚfiÛ‚·Û˘ ÛÙËÓ ÔÏÔÎÏËڈ̤ÓË Î·È ·ÁÎfiÛÌÈ· ÁÓÒÛË. ø˜ ÂÎ ÙÔ‡ÙÔ˘, ˘ÔÛÙËÚ›˙ÂÈ Ô Grohol, Ë Ù¯ÓÔÏÔÁ›· ·˘Ù‹ ηı·˘Ù‹ ‰ÂÓ Â›Ó·È ˘Â‡ı˘ÓË ÁÈ· ÙËÓ ÂÁηٿÛÙ·ÛË ÂıÈÛÌÔ‡, ·ÏÏ¿ ¿ÙÔÌ· ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ Û˘ÌÂÚÈÊÔÚ¤˜ ÌÔÚÔ‡Ó Ó· ÂÚȤÛÔ˘Ó Û ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË (50). ∆Ô ÂÚÒÙËÌ· Ô˘ Ù›ıÂÙ·È Â›Ó·È ÙÈ ÚÔηÏ› ·ÏÏ·Á¤˜ ÛÙËÓ ÈÛÔÚÚÔ›· Ù˘ ·ÓıÚÒÈÓ˘ „˘¯ÔÛ‡ÓıÂÛ˘. ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÎÔÈÓˆÓÈΤ˜ Î·È Â·ÁÁÂÏÌ·ÙÈΤ˜ ··ÈÙ‹ÛÂȘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚÔÛˆÈÎfiÙËÙ˜ ÌÔÓ·¯ÈΤ˜, ÊÔ‚ÈṲ̂Ó˜, ·Ó·ÛÊ·Ï›˜, ηٷıÏÈÙÈΤ˜, ¯ˆÚ›˜ ηÏÏȤÚÁÂÈ· Î·È ÛÙ·ıÂÚfiÙËÙ·, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ ‰È·‰›ÎÙ˘Ô Ó· Â›Ó·È Ô ÙÚfiÔ˜ ‡ÎÔÏ˘ ‰È·Ê˘Á‹˜. ÿÛˆ˜ ÙÂÏÈο Ó· Â›Ó·È ÙÔ Ì¤ÛÔ ÙÔ ÔÔ›Ô ·ıfiÚ˘‚· Î·È fiÌÔÚÊ· ÂÈÛ¤Ú¯ÂÙ·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹ ÂÓfi˜ ÎfiÛÌÔ˘ Ô˘ fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ‰ËÌÈÔ˘ÚÁ›
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·ÔÌÔӈ̤ÓÔ˘˜ ·ÓıÚÒÔ˘˜, ÔÈ ÔÔ›ÔÈ ¤¯Ô˘Ó ·Ó¿ÁÎË Ó· ·ÊÔÛȈıÔ‡Ó ‹ Ó· ÂÍ·ÚÙËıÔ‡Ó ·fi οÙÈ Ô˘ ı· ‰ÒÛÂÈ ÂӉȷʤÚÔÓ ÛÙË ˙ˆ‹ ÙÔ˘˜. ªÂ ·˘Ù¿ Ù· ‰Â‰Ô̤ӷ, Ê·›ÓÂÙ·È fiÙÈ Ë ÚfiÏË„Ë Ù˘ ·Ó¿Ù˘Í˘ ÂıÈÛÌÔ‡ ÛÙËÚ›˙ÂÙ·È ÛÙË ÛˆÛÙ‹ Û¯¤ÛË Ô˘ ı· ¤¯Ô˘Ó ÔÈ ¤ÊË‚ÔÈ Ì ÙÔ˘˜ ÁÔÓ›˜ Î·È ÙÔ˘˜ Ê›ÏÔ˘˜ ÙÔ˘˜. ∏ ÛˆÛÙ‹ Û¯¤ÛË Û˘Ó›ÛÙ·Ù·È Û ÛÙÂÓ‹, Ì ηٷÓfiËÛË Î·È ·Á¿Ë, ·Ú·ÎÔÏÔ‡ıËÛË Ù˘ ηıËÌÂÚÈÓfiÙËÙ¿˜ ÙÔ˘˜, ÛˆÛÙ‹ ·ÍÈÔÏfiÁËÛË ÙˆÓ ·Ó·ÁÎÒÓ ÙÔ˘˜, Û˘ÓÂÙ¤˜ ·ÁÁÂÏÌ·ÙÈΤ˜ ··ÈÙ‹ÛÂȘ ·Ó¿ÏÔÁ· Ì ÙȘ ÈηÓfiÙËÙ˜ Î·È ÙËÓ ÚÔÛˆÈÎfiÙËÙ¿ ÙÔ˘˜ Î·È ·˘ÍË̤Ó˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÂÎÙfi˜ ÛÈÙÈÔ‡. ¶ÈÛÙ‡ԢÌ fiÙÈ ÔÈ ·ÏËıÈÓ¤˜ Û¯¤ÛÂȘ-ÊÈϛ˜ Î·È Ë Â·Ó-·ʋ ÙˆÓ ÂÊ‹‚ˆÓ Ì ÙË Ê‡ÛË Î·È ÙË ¢ËÌÈÔ˘ÚÁ›· ı· ·ÔÙÚ¤„Ô˘Ó ÂıÈÛÙÈΤ˜ Û˘ÌÂÚÈÊÔÚ¤˜ Î·È ı· Ô‰ËÁ‹ÛÔ˘Ó Û ÈÛÔÚÚÔË̤Ó˜ Û¯¤ÛÂȘ Ì ÙÔ˘˜ Á‡Úˆ Û˘Ó·ÓıÚÒÔ˘˜ ÙÔ˘˜ Î·È ÙÔÓ £Âfi. ÿÛˆ˜ ÙfiÙ ٷ ·È‰È¿ Ó· ÈÛÔÚÚÔ‹ÛÔ˘Ó ·Ó¿ÌÂÛ· ÛÙÔ Â·˘Ùfi ÙÔ˘˜ Î·È ÙËÓ Ù¯ÓÔÏÔÁ›· Î·È Ó· ı¤ÛÔ˘Ó Ù· fiÚÈ· Ù˘ ÛˆÛÙ‹˜ ¯Ú‹Û˘.
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42. Ng BD, Wiemer-Hastings P. Addiction to the internet and online gaming. Cyberpsychol Behav 2005;8:110-113. 43. Van den Bulck J. Television viewing, computer game playing, and Internet use and self-reported time to bed and time out of bed in secondary-school children. Sleep 2004;27:101-104. 44. Kim K, Ryu E, Chon MY, Yeun EJ, Choi SY, Seo JS, et al. Internet addiction in Korean adolescents and its relation to depression and suicidal ideation: a questionnaire survey. Int J Nurs Stud 2006;43:185-192. 45. Naito A. Internet suicide in Japan: implications for child and adolescent mental health. Clin Child Psychol Psychiatry 2007;12:583-597. 46. Stein DJ. Internet addiction, Internet psychotherapy. Am J Psychiatry 1997;154:890. 47. Young KS. Cognitive behavior therapy with Internet addicts: treatment outcomes and implications. Cyberpsychol Behav 2007;10:671-679. 48. Widyanto L, Griffiths M. ‘Internet Addiction’: A Critical Review. Int J Mental Health and Addiction 2006;4:31-51. 49. Chien C, Linda C, Belland JC. A Review of the Research on Internet Addiction. Educational Psychology Review 2005; 17:363-388. 50. Grohol JM. Internet addiction guide. Psychcentral [Internet]. 2005 Apr: Webpage: http://psychcentral.com/ netaddiction
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ORIGINAL ARTICLE
441
ªÂϤÙË Ù˘ ¯Ú‹Û˘ Î·È Î·Ù¿¯ÚËÛ˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜ ∞. ∆Û›ÙÛÈη1, ∂. ∫ÚÈÙÛ¤ÏË2, ∂. ∫ˆÓÛÙ·ÓÙÔ˘Ï¿ÎË1, °. ∫ÔÚÌ¿˜1, ∞. ºÈÏÈÔÔ‡ÏÔ˘1, ¢. ∆Ô˘ÓÈÛÛ›‰Ô˘1, ∞. ºÚ¤ÛÎÔ˘1, £. ™ËÏÈÔÔ‡ÏÔ˘1, ∞. §Ô˘›˙Ô˘1, A. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜1, ¢. ∫·ÊÂÙ˙‹˜2 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∆Ô ‰È·‰›ÎÙ˘Ô ·ÔÙÂÏ› ϤÔÓ ·Ó·Áη›Ô ÂÚÁ·ÏÂ›Ô ÂÓË̤ڈÛ˘, ÎÔÈÓˆÓÈ΋˜ ·ʋ˜ Î·È „˘¯·ÁˆÁ›·˜ ÁÈ· ÙÔ˘˜ ÂÊ‹‚Ô˘˜. øÛÙfiÛÔ, Ë ˘ÂÚ‚ÔÏÈ΋ ÂÓ·Û¯fiÏËÛË Ì ÙÔ Ì¤ÛÔ ·˘Ùfi ‰ËÌÈÔ˘ÚÁ› ÎÈÓ‰‡ÓÔ˘˜ ·Ó¿Ù˘Í˘ ·ÎÚ·›ˆÓ Û˘ÌÂÚÈÊÔÚÒÓ Û¯ÂÙÈο Ì ÙË ¯Ú‹ÛË ÙÔ˘. √È ÛÙfi¯ÔÈ Ù˘ ÌÂϤÙ˘ ›ӷÈ: (1) Ó· ÂÎÙÈÌËı› Ë ¤ÎÙ·ÛË Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ (2) Ó· ·ÍÈÔÏÔÁËıÔ‡Ó Ù· ÔÈÔÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ·˘Ù‹˜ Ù˘ ¯Ú‹Û˘ Î·È (3) Ó· ˘ÔÏÔÁÈÛÙ› Ë Â›ÙˆÛË ·ıÔÏÔÁÈ΋˜ ¯Ú‹Û˘. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: √ ÏËı˘ÛÌfi˜ Ô˘ ÌÂÏÂÙ‹ıËΠ(¡=897) ‹Ù·Ó Ù˘¯·›Ô ‰Â›ÁÌ· ÂÊ‹‚ˆÓ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ∞ı‹Ó·, Ì ‰È·ÛÙڈ̿وÛË Û‡Ìʈӷ Ì ÙËÓ ÏËı˘ÛÌȷ΋ ˘ÎÓfiÙËÙ·. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·ÓÒÓ˘Ì· ÂÚˆÙËÌ·ÙÔÏfiÁÈ·, Ù· ÔÔ›· ·ÊÔÚÔ‡Û·Ó ÛÙ· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ÚfiÛ‚·Û˘ ÛÙÔ ‰È·‰›ÎÙ˘Ô, ηıÒ˜ Î·È ÙÔ ÂÚÁ·ÏÂ›Ô ·ÍÈÔÏfiÁËÛ˘ Ù˘ ηٿ¯ÚËÛ˘ Young Internet Addiction Score (YIAS). ∞ÔÙÂϤÛÌ·Ù·: ∏ ÌÂϤÙË ·Ó¤‰ÂÈÍ fiÙÈ ÔÈ ÈÔ ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·Ó¿Ù˘ÍË ·ıÔÏÔÁÈ΋˜ ¯Ú‹Û˘ ‹Ù·Ó Ë ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ, Ë Û˘ÌÌÂÙÔ¯‹ Û ‰È·‰ÈÎÙ˘·Î¿ ·È¯Ó›‰È·, ηıÒ˜ Î·È ÏfiÁÔÈ ÎÔÈÓˆÓÈÎÔÔ›ËÛ˘ (.¯. e-mail, chat rooms). ∏ ÚfiÛ‚·ÛË ÛÙÔ ‰È·‰›ÎÙ˘Ô Ì¤Ûˆ Û¯ÔÏÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·ÔÙ¤ÏÂÛ ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· ÚÔÛÙ·Û›·˜ ¤Ó·ÓÙÈ Ù˘ ˘ÂÚ‚ÔÏÈ΋˜ ¯Ú‹Û˘, ÂÓÒ Ë ÚfiÛ‚·ÛË Ì¤Ûˆ ÙˆÓ ›ÓÙÂÚÓÂ٠ηʤ Û˘Û¯ÂÙ›ÛÙËΠ̠ÔχˆÚË ¯Ú‹ÛË (11-20 ÒÚ˜/‚‰ÔÌ¿‰·). ™‡Ìʈӷ Ì ÙÔ YIAS, 1% ÙˆÓ ÂÊ‹‚ˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ›¯Â Û˘ÌÂÚÈÊÔÚ¿ ÂıÈÛÌÔ‡, ÂÓÒ 12,8% ·ÚÔ˘Û›·˙ ÔÚȷ΋ ¯Ú‹ÛË (ÚÔ‚Ï‹Ì·Ù· Ô˘ ‰˘ÓËÙÈο ı· ÌÔÚÔ‡Û·Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÂıÈÛÌfi). ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ηٿ¯ÚËÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Â›Ó·È ÂÌÊ·Ó‹˜ ÛÙÔ˘˜ ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜ Î·È ··ÈÙ› ·Ú¤Ì‚·ÛË Î·È ÚÔÁÚ¿ÌÌ·Ù· ÚfiÏ˄˘.
1 ªÔÓ¿‰· ∂ÊË‚È΋˜ ÀÁ›·˜ (ª.∂.À.), µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶.& ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ÕÚÙÂÌȘ ∆Û›ÙÛÈη info@youth-health.gr ªÔÓ¿‰· ∂ÊË‚È΋˜ ÀÁ›·˜ (ª.∂.À.), µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
§¤ÍÂȘ ÎÏÂȉȿ: ∂Ê˂›·, ‰È·‰›ÎÙ˘Ô, ηٿ¯ÚËÛË ‰È·‰ÈÎÙ‡Ô˘, “ÂıÈÛÌfi˜” ÛÙÔ ‰È·‰›ÎÙ˘Ô.
Study on the use and misuse of internet among Greek adolescents ∞. Tsitsika1, ∂. Critselis2, ∂. Konstantoulaki1, G. Kormas1, ∞. Filippopoulou1, D. Tounissidou1, ∞. Freskou1, T. Spiliopoulou1, ∞. Louizou1, A. Constantopoulos1, D. Kafetzis2 Abstract Background: The internet is an integral tool for information, social communication, and entertainment among adolescents. However, the risk of adopting pathological internet use behaviour is inherent. The aim of this study was: (1) to evaluate the prevalence and (2) to assess the characteristics and predictors of internet use, and (3) to measure the prevalence of pathological internet use among Greek adolescents. Methods: A cross-sectional study design was applied. The source population (N=897) consisted of a random sample, stratified according to locality and population density, of adolescents residing in Athens, Greece. Self-completed questionnaires, pertaining to internet access characteristics, and the Young Internet Addiction Score (YIAS) were utilized in order to assess the predictors of internet use and the prevalence of pathological internet use. Results: Multivariate logistic regression analysis indicated that the most significant predictors of all categories of internet use included accessing the internet via one’s own home portal and internet access for on-line games and social interaction (i.e. e-mail and chat room use). Internet access via the school environment was a significant protective factor against the development of misuse. Access via internet cafés was a significant predictor for high (11-20 hours/week) internet users. According to the YIAS, 1% of the study population reported Addictive Internet Use and 12.8% recorded problems of use that could potentially lead to future pathology (Borderline Internet Use). Conclusions: Internet misuse is apparent among Greek adolescents and calls for intervention and preventive public health programmes.
1 Adolescent Health Unit (AHU), 2nd Department of Paediatrics, Medical School, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece 2 2nd Department of Paediatrics, Medical School, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece Correspondence: Artemis Tsitsika info@youth-health.gr Adolescent Health Unit (AHU), 2nd Department of Paediatrics, Medical School, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
Key words: Adolescence, internet use, internet misuse, internet addiction.
¶·È‰È·ÙÚÈ΋ 2008;71:441-448
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·442
442
∞. ∆Û›ÙÛÈη Î·È Û˘Ó.
∂ÈÛ·ÁˆÁ‹ ∆Ô ‰È·‰›ÎÙ˘Ô ·ÔÙÂÏ› ··Ú·›ÙËÙÔ ÂÚÁ·ÏÂ›Ô ÂÓË̤ڈÛ˘, ÂÈÎÔÈÓˆÓ›·˜ Î·È „˘¯·ÁˆÁ›·˜. √È ¤ÊË‚ÔÈ, ‰Â‰Ô̤Ó˘ Ù˘ ÂÍÔÈΛˆÛ‹˜ ÙÔ˘˜ Ì ÙȘ Ù¯ÓÔÏÔÁ›Â˜, ηٷӷÏÒÓÔ˘Ó ÛËÌ·ÓÙÈÎfi ¯ÚfiÓÔ ··Û¯ÔÏÔ‡ÌÂÓÔÈ Ì ÙÔ ‰È·‰›ÎÙ˘Ô (1), ÙÔ ÔÔ›Ô ·ÔÙÂÏ› ÊıËÓfi Î·È Â‡ÎÔÏ· ÚÔÛ‚¿ÛÈÌÔ Â‰›Ô ÎÔÈÓˆÓÈÎÔÔ›ËÛ˘ (2) Î·È ÂÓ·Û¯fiÏËÛ˘ Ì ÔÈΛϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (3). √È ıÂÙÈΤ˜ ÂȉڿÛÂȘ Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ·Ó¿Ù˘ÍË Î·È Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÂÊ‹‚ˆÓ ·ÊÔÚÔ‡Ó ÛÙËÓ ÎÔÈÓˆÓÈÎÔÔ›ËÛ‹ ÙÔ˘˜ (4), ÛÙË Ì›ˆÛË ÙÔ˘ ¿Á¯Ô˘˜ (5) Î·È ÛÙË ‰È·ÌfiÚʈÛË Ù˘ Ù·˘ÙfiÙËÙ¿˜ ÙÔ˘˜ (4). øÛÙfiÛÔ, Ë Î·ıËÌÂÚÈÓ‹ ¯Ú‹ÛË ÂÌÂÚȤ¯ÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÚÓËÙÈÎÒÓ ÂȉڿÛÂˆÓ (1,6,7), ÔÈ Ôԛ˜ ÂӉ¯Ô̤ӈ˜ ·Ô‰›‰ÔÓÙ·È Û ÚÔËÁÔ‡ÌÂÓË ¤ÏÏÂÈ„Ë „˘¯ÔÎÔÈÓˆÓÈ΋˜ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ (8). ∫·ıÒ˜ ÔÈ ¤ÊË‚ÔÈ Â›Ó·È ·Ó·Ù˘Íȷο ¢¿ÏˆÙÔÈ Û ÂıÈÛÌÔ‡˜, Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ (9,10,11), Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· ˘ÈÔıÂÙ‹ÛÔ˘Ó Û˘ÌÂÚÈÊÔÚ¤˜ ηٿ¯ÚËÛ˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘. ∏ ·ıÔÏÔÁÈ΋ ¯Ú‹ÛË ·ÊÔÚ¿ ÙfiÛÔ ÛÙË Û˘¯ÓfiÙËÙ· fiÛÔ Î·È ÛÙË ‰È¿ÚÎÂÈ·, ȉȷ›ÙÂÚ· fiÙ·Ó ÂÚÈÏ·Ì‚¿ÓÂÈ Û˘ÌÌÂÙÔ¯‹ Û ·È¯Ó›‰È· ‹ ÂÈÎÔÈÓˆÓ›· ̤ۈ e-mails Î·È chat rooms (12). ™ËÌ·ÓÙÈΤ˜ ÂÈÙÒÛÂȘ Â›Ó·È Ë Û¯ÔÏÈ΋ ·ÔÙ˘¯›· (13), ηıÒ˜ Î·È ÔÈ ‰˘ÛÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·ÚÔÛˆÈΤ˜ Û¯¤ÛÂȘ (14,15). ∏ ·ÚÔ‡Û· ÌÂϤÙË ÛÙԯ‡ÂÈ ÛÙËÓ ÂÎÙ›ÌËÛË Ù˘ ¤ÎÙ·Û˘ Î·È ÙˆÓ ÔÈÔÙÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘, ηıÒ˜ Î·È Ù˘ ›وÛ˘ Ù˘ ·ıÔÏÔÁÈ΋˜ ¯Ú‹Û˘ Û ÏËı˘ÛÌfi ∂ÏÏ‹ÓˆÓ ÂÊ‹‚ˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ™¯¤‰ÈÔ Î·È ÏËı˘ÛÌfi˜ Ù˘ ÌÂϤÙ˘ ∏ ÌÂϤÙË Ú·ÁÌ·ÙÔÔÈ‹ıËΠηٿ ÙË ‰È¿ÚÎÂÈ· ÂÓfi˜ ¤ÙÔ˘˜ (π·ÓÔ˘¿ÚÈÔ˜ 2007 - π·ÓÔ˘¿ÚÈÔ˜ 2008), ηÙfiÈÓ ¤ÁÎÚÈÛ˘ ÙÔ˘ π·ÙÚԷȉ·ÁˆÁÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘, ηıÒ˜ Î·È ÙÔ˘ ∂ÈÛÙËÌÔÓÈÎÔ‡ ™˘Ì‚Ô˘Ï›Ô˘ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & A. ∫˘ÚÈ·ÎÔ‡”. √È ÁÔÓ›˜ ÙˆÓ ·È‰ÈÒÓ ÂÓËÌÂÚÒıËÎ·Ó ·fi ÙË ¢È‡ı˘ÓÛË ÙˆÓ ™¯ÔÏ›ˆÓ ÁÈ· ÙËÓ ¤Ú¢ӷ. √ ÏËı˘ÛÌfi˜ ·ÔÙÂÏ› Ù˘¯·›Ô ‰Â›ÁÌ· ‰ËÌfiÛÈˆÓ Á˘ÌÓ·Û›ˆÓ Î·È Ï˘Î›ˆÓ Ù˘ ¢ڇÙÂÚ˘ ÂÚÈÔ¯‹˜ Ù˘ ∞ÙÙÈ΋˜, Ì ‰È·ÛÙڈ̿وÛË Û‡Ìʈӷ Ì ÙËÓ ÂÚÈÔ¯‹ Î·È ÙËÓ ÏËı˘ÛÌȷ΋ ˘ÎÓfiÙËÙ·. ™˘ÌÌÂÙ›¯·Ó Ì·ıËÙ¤˜ Ù˘ °ã Á˘ÌÓ·Û›Ô˘ Î·È Ù˘ ∞ã Ï˘Î›Ԣ (N=953). √ ˘fi ÌÂϤÙË ÏËı˘ÛÌfi˜ ·ÔÙÂÏÂ›Ù·È ·fi 438 ·ÁfiÚÈ· Î·È 499 ÎÔÚ›ÙÛÈ·, Ì ̤ÛË ËÏÈΛ· 15,21 ¤ÙË. ¢Âη¤ÍÈ (16) Û˘ÌÌÂÙ¤¯ÔÓÙ˜ (1,7%) ‰ÂÓ ÚÔÛ‰ÈfiÚÈÛ·Ó Ê‡ÏÔ Î·È ·ÔÎÏ›ÛÙËÎ·Ó ·fi ÙËÓ ÂÚ·ÈÙ¤Úˆ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. ™ÙÔ ˘fiÏÔÈÔ Î·Ù¿ÏÏËÏÔ ‰Â›ÁÌ· (¡=937), Ô ‚·ıÌfi˜ ·ÓÙ·fiÎÚÈÛ˘ ÁÈ· ÙÔÓ ÚÔÛ‰ÈÔÚÈÛÌfi ÙÔ˘ Û˘ÓÔÏÈÎÔ‡ ‚‰ÔÌ·‰È·›Ô˘ ¯ÚfiÓÔ˘ ¯Ú‹Û˘ ÙÔ˘ ›ÓÙÂÚÓÂÙ Û ÒÚ˜ ‹Ù·Ó 95,37% (¡=897). ™˘ÏÏÔÁ‹ ÛÙÔȯ›ˆÓ ™Â fiÏÔ˘˜ ÙÔ˘˜ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ‰È·ÓÂÌ‹ıËÎ·Ó ·ÓÒÓ˘Ì· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ì 5 ‚·ÛÈΤ˜ ÂÓfiÙËÙ˜: (1) ̤ÛÔ˜ fiÚÔ˜ Û˘ÓÔÏÈÎÒÓ ˆÚÒÓ ¯Ú‹Û˘ ›ÓÙÂÚÓÂÙ ·Ó¿ ‚‰ÔÌ¿‰·, (2) ‰ËÌÔÁÚ·Paediatriki 2008;71:441-448
ÊÈο ÛÙÔȯ›·, (3) ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ ‰È·‰ÈÎÙ‡Ô˘, (4) ¯·Ú·ÎÙËÚÈÛÙÈο ¯Ú‹Û˘, (5) ÂÚÁ·ÏÂ›Ô ·ÍÈÔÏfiÁËÛ˘ Ù˘ ηٿ¯ÚËÛ˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ - Young Internet Addiction Scale (YIAS). ¢ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ¤ÓÙ (5) ÔÌ¿‰Â˜: (1) ÌË ¯Ú‹ÛÙ˜ (ÔÌ¿‰· ÂϤÁ¯Ô˘): 0-1 ÒÚ·/‚‰ÔÌ¿‰·, (2) ¯·ÌËÏÔ› ¯Ú‹ÛÙ˜ (ÔÌ¿‰· 1): 1-3 ÒÚ˜/‚‰ÔÌ¿‰·, (3) ̤ÙÚÈÔÈ ¯Ú‹ÛÙ˜ (ÔÌ¿‰· 2): 410 ÒÚ˜/‚‰ÔÌ¿‰·, (4) ˘„ËÏÔ› ¯Ú‹ÛÙ˜ (ÔÌ¿‰· 3): 11-20 ÒÚ˜/‚‰ÔÌ¿‰·, (5) ˘ÂÚ‚ÔÏÈÎÔ› ¯Ú‹ÛÙ˜ (ÔÌ¿‰· 4): >20 ÒÚ˜/‚‰ÔÌ¿‰·. √È ÂÍÂÙ·˙fiÌÂÓ˜ ‰ËÌÔÁÚ·ÊÈΤ˜ ÌÂÙ·‚ÏËÙ¤˜ ÂÚÈÏ¿Ì‚·Ó·Ó ÙËÓ ËÏÈΛ·, ÙÔ Ê‡ÏÔ, ÙÔÓ ‰Â›ÎÙË Ì¿˙·˜ ÛÒÌ·ÙÔ˜ (¢ª™) Î·È ÙÔÓ ÚfiÛÊ·ÙÔ Ì¤ÛÔ fiÚÔ ‚·ıÌÔÏÔÁ›·˜ ÛÙÔ Û¯ÔÏÂ›Ô (ª√µ). ∆Ô ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ ÙÔ˘ ›ÓÙÂÚÓÂÙ ÂÎÙÈÌ‹ıËΠ̠‚¿ÛË ÙÔ fiÙ ÔÈ Û˘ÌÌÂÙ¤¯ÔÓÙ˜ ÍÂΛÓËÛ·Ó ÙËÓ ÚfiÛ‚·ÛË ÛÙÔ ‰È·‰›ÎÙ˘Ô. ¢ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ÙÚÂȘ (3) ÔÌ¿‰Â˜: (1) 0-6 Ì‹Ó˜, (2) 6-12 Ì‹Ó˜, (3) >12 Ì‹Ó˜. ªÂ ‚¿ÛË ÙÔ˘˜ ¯ÒÚÔ˘˜ ÚfiÛ‚·Û˘, ‰ËÌÈÔ˘ÚÁ‹ıËÎ·Ó ¤ÓÙ (5) ÔÌ¿‰Â˜: (1) ÙÔ Û›ÙÈ, (2) ÊÈÏÈÎfi Û›ÙÈ, (3) Û¯ÔÏ›Ô, (4) ‚È‚ÏÈÔı‹ÎË, (5) ›ÓÙÂÚÓÂ٠ηʤ. ∆Ô Â›‰Ô˜ ÙˆÓ ÈÛÙÔÛÂÏ›‰ˆÓ Ô˘ ÂÈÛΤÙÔÓÙ·Ó ÔÈ ¯Ú‹ÛÙ˜ ηıfiÚÈÛ ÙȘ ·Ú·Î¿Ùˆ ηÙËÁÔڛ˜: (1) ·ÏÏËÏÔÁÚ·Ê›· e-mail, (2) ·Ó·˙‹ÙËÛË ÂÊËÌÂÚ›‰ˆÓ, ÂÚÈÔ‰ÈÎÒÓ, (3) ›ÛÔ‰Ô˜ Û chat rooms, (4) Û˘ÌÌÂÙÔ¯‹ Û ·È¯Ó›‰È·, (5) ·Ó·˙‹ÙËÛË ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈο Ì ˘ËÚÂۛ˜, (6) ·Ó·˙‹ÙËÛË ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈο Ì ÂÚÁ·Û›· Î·È Âη›‰Â˘ÛË, (7) ·Ó·˙‹ÙËÛË ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈο Ì ÛÂÍÔ˘·ÏÈ΋ ‰È··È‰·ÁÒÁËÛË, (8) ·ÁÔÚ¤˜ ÚÔ˚fiÓÙˆÓ. ∆Ô YIAS ÂÊ·ÚÌfiÛÙËΠ̠ÛÎÔfi Ó· ÂÎÙÈÌËı› Ë Â›ÙˆÛË Ù˘ ÔÚȷ΋˜ Î·È ÂıÈÛÙÈ΋˜ ¯Ú‹Û˘ ÙÔ˘ ›ÓÙÂÚÓÂÙ, fiˆ˜ ·˘Ù‹ ÚÔÛÂÁÁ›˙ÂÙ·È ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (16). ∏ ‚·ıÌÔÏÔÁ›· Û‡Ìʈӷ Ì ÙÔ YIAS Î˘Ì·›ÓÂÙ·È ·fi 1 ¤ˆ˜ 100. √È ¤ÊË‚ÔÈ Î·Ù·Ù¿¯ıËÎ·Ó ÛÙȘ ·Ú·Î¿Ùˆ ηÙËÁÔڛ˜: (1) º˘ÛÈÔÏÔÁÈ΋ ÃÚ‹ÛË: 0-39, (2) √Úȷ΋ ÃÚ‹ÛË (‰ËÏ. ÚÔ‚Ï‹Ì·Ù· ÛÙË ¯Ú‹ÛË Ô˘ ‰˘ÓËÙÈο ÌÔÚ› Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÂıÈÛÌfi: 40-69, (3) ∂ıÈÛÌfi˜: 70-100. ™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË √È ÛÙ·ÙÈÛÙÈΤ˜ ·Ó·Ï‡ÛÂȘ Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ SAS, ¤Î‰ÔÛË 9.0 ( SAS Inc., USA). ∏ ÔÌ¿‰· ÂϤÁ¯Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠˆ˜ ‚¿ÛË Û‡ÁÎÚÈÛ˘, ÂÓÒ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ıˆڋıËÎÂ Ë ÙÈÌ‹ ÙÔ˘ p<0,05. ∂Ê·ÚÌfiÛÙËÎÂ Ë Ì¤ıÔ‰Ô˜ Mantel- Haenszel ÚÔÎÂÈ̤ÓÔ˘ Ó· ˘ÔÏÔÁÈÛÙÔ‡Ó Ô Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ (Odds Ratios, OR) Î·È Ù· fiÚÈ· ·ÍÈÔÈÛÙ›·˜ 95% (Confidence Intervals, 95% CI). ÀÔÏÔÁ›ÛÙËÎ·Ó ÔÈ Î·Ù¿ Pearson Û˘Û¯ÂÙ›ÛÂȘ (Pearson Correlation Coefficients, r) ÌÂٷ͇ ÙˆÓ ‰ËÌÔÁÚ·ÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ Î·È ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ¯Ú‹Û˘ ÙÔ˘ ›ÓÙÂÚÓÂÙ ÁÈ· ÙȘ ¤ÓÙ ÔÌ¿‰Â˜ ¯ÚËÛÙÒÓ. ∂ÈϤÔÓ, ÔÈ ·Ú¿ÁÔÓÙ˜ Û˘Û¯¤ÙÈÛ˘ (r) ˘ÔÏÔÁ›ÛÙËÎ·Ó ·Ó¿ÌÂÛ· Û οı ÔÌ¿‰· ¯ÚËÛÙÒÓ YIAS Î·È fiϘ ÙȘ ηÙËÁÔڛ˜ ¯Ú‹Û˘ ÙÔ˘ ›ÓÙÂÚÓÂÙ. ∂Ê·ÚÌfiÛÙËΠ·Ï›Ó‰ÚÔÌË ·Ó¿Ï˘ÛË ÔÏÏ·ÏÒÓ ÌÂÙ·‚ÏËÙÒÓ (¶∞¶ª) (multivariate regression analysis), Ì ÛÙfi¯Ô Ó· ÂÎÙÈÌËı› Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ÂÈÏÂÁÌ¤ÓˆÓ ‰ËÌÔÁÚ·ÊÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ Î·È ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙËÓ Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÔÈ ¤ÊË‚ÔÈ ¯·ÌËÏ‹ (1-3 ÒÚ˜/‚‰ÔÌ¿‰·), ̤ÛË (4-10 ÒÚ˜/‚‰ÔÌ¿‰·), ˘„ËÏ‹ (11-20 ÒÚ˜/‚‰ÔÌ¿‰·) ‹ ˘ÂÚ‚ÔÏÈ΋ (>20 ÒÚ˜/‚‰ÔÌ¿‰·) ¯Ú‹ÛË.
∞ÔÙÂϤÛÌ·Ù· ÷ÌËÏ‹ ¯Ú‹ÛË ›ÓÙÂÚÓÂÙ (1-3 ÒÚ˜/‚‰ÔÌ¿‰·) – √Ì¿‰· 1 √ ›Ó·Î·˜ 1 ·Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ÔÌ¿‰· 1 ‰ÂÓ Û˘Û¯ÂÙ›˙ÂÙ·È Ì ËÏÈΛ·, ʇÏÔ, ¢ª™ Î·È ª√µ. øÛÙfiÛÔ,
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·443
443
ÃÚ‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜
¶›Ó·Î·˜ 1. ¢ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙÔ˘˜ ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜, Û‡Ìʈӷ Ì ÙÔÓ ·ÚÈıÌfi Û˘ÓÔÏÈÎÒÓ ˆÚÒÓ ¯Ú‹Û˘ ‰È·‰ÈÎÙ‡Ô˘ ·Ó¿ ‚‰ÔÌ¿‰· (N=897) 0-1 ÒÚ·/ ‚‰ÔÌ¿‰· (N=277) N (%) ∏ÏÈΛ· <15 ¤ÙË 193 (69,7) 15-15,9 ¤ÙË 63 (22,7) >16 ¤ÙË 8 (2,9) º‡ÏÔ ÕÚÚÂÓ 98 (35,4) £‹Ï˘ 177 (63,9) BMI <18,5 kg/m2 169 (61,0) 18,5-24,9 kg/m2 82 (29,6) 5 (1,8) >25,0 kg/m2 ª√µ <C+ 74 (26,7) B- - B+ 116 (41,9) A- - A+ 70 (25,3) πÛÙÔÚÈÎfi ¯Ú‹Û˘ ‰È·‰ÈÎÙ‡Ô˘ 0-6 Ì‹Ó˜ 181 (65,3) 6-12 Ì‹Ó˜ 18 (6,5) >12 Ì‹Ó˜ 72 (26,0)
1-3 ÒÚ˜/‚‰ÔÌ¿‰· (N=318) N (%)
OR
4-10 ÒÚ˜/‚‰ÔÌ¿‰· (N=191)
95% CI
N (%)
OR
95% CI
11-20 ÒÚ˜/‚‰ÔÌ¿‰· (N=55)
>20 ÒÚ˜/‚‰ÔÌ¿‰· (N=56)
N (%)
N (%)
OR
95% CI
OR
95% CI
207 (65,1) 0,71 0,49-1,03 104 (32,7) 7 (2,2) 0,58 0,20-1,68
112 (58,6) 0,59 62 (32,5) 8 (4,2) 1,02
0,39-0,90 0,36-2,88
31 (56,4) 0,48 21 (38,2) 1 (1,8) 0,38
0,26-0,90 0,04-3,18
31 (55,4) 0,60 17 (30,4) 3 (5,4) 1,39
0,31-1,15 0,33-5,81
132 (41,5) 183 (57,5) 0,77 0,55-1,07
107 (56,0) 84 (44,0) 0,43
0,30-0,63
38 (69,1) 18 (32,7) 0,27
0,14-0,50
48 (85,7) 8 (14,3) 0,09
0,04-0,20
194 (61,0) 0,95 0,66-1,36 99 (31,1) 5 (1,6) 0,83 0,23-2,96
104 (54,4) 0,71 71 (37,2) 4 (2,1) 0,92
0,48-1,06 0,24-3,57
27 (49,1) 0,69 0,36-1,31 19 (34,5) 4 (7,3) 3,45 0,85-14,09
26 (46,4) 0,52 24 (42,8) 3 (5,4) 2,05
0,28-0,97 0,46-9,20
83 (26,1) 131 (41,2) 1,01 0,67-1,50 87 (27,4) 1,11 0,71-1,73
51 (26,7) 79 (41,4) 0,99 51 (26,7) 1,06
0,62-1,56 0,64-1,76
15 (27,3) 24 (43,6) 1,02 13 (23,6) 0,92
16 (28,6) 27 (48,2) 1,08 9 (16,1) 0,59
0,54-2,13 0,25-1,43
101 (31,8) 50 (15,7) 4,98 2,76-8,99 163 (51,2) 4,06 2,80-5,87
30 (15,7) 34 (17,8) 11,40 5,72-22,71 127 (66,5) 10,64 6,57-17,24
0,50-2,07 0,41-2,06
5 (9,1) 5 (9,1) 10,06 2,66-38,05 45 (81,8) 22,62 8,63-59,29
3 (5,4) 4 (7,1) 13,41 2,78-64,66 48 (85,7) 40,22 12,14-133,27
OR: Unadjusted Odds Ratio, 95% CI: 95% Confidence Interval for Unadjusted Odds Ratio
Û˘Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ÙÔ ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ ›ÓÙÂÚÓÂÙ. √È ¯Ú‹ÛÙ˜ Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· ¤¯Ô˘Ó ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ ÙÔ˘˜ (OR: 2,90, 95% CI: 2,06-4,10) ‹ Ù· ›ÓÙÂÚÓÂ٠ηʤ (OR: 1,49, 95% CI: 1,05-2,10). ∞Ó·ÊÔÚÈο Ì ÙÔ Â›‰Ô˜ ÙˆÓ ÈÛÙÔÛÂÏ›‰ˆÓ, Ë ¯·ÌËÏ‹ ¯Ú‹ÛË Û¯ÂÙ›˙ÂÙ·È Ì ÈÛÙfiÙÔÔ˘˜ Ô˘ ·ÊÔÚÔ‡Ó ·ÏÏËÏÔÁÚ·Ê›· Î·È chat rooms (¶›Ó·Î·˜ 2). ™¯ÂÙÈο Ì ÙÔ YIAS, Ë ÔÌ¿‰· 1 Û¯ÂÙ›˙ÂÙ·È Ì √Úȷ΋ ÃÚ‹ÛË (OR: 2,58, 95% CI: 1,13-5,86), ¯ˆÚ›˜ ˆÛÙfiÛÔ Ó· ηٷÁÚ·Ê› ÂıÈÛÌfi˜ (¶›Ó·Î·˜ 2). ™‡Ìʈӷ Ì ÙËÓ ·Ï›Ó‰ÚÔÌË ·Ó¿Ï˘ÛË ÔÏÏ·ÏÒÓ ÌÂÙ·‚ÏËÙÒÓ (¶∞¶ª), ÔÈ ÈÔ ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÔÌ¿‰· 1 Â›Ó·È Ë ÚfiÛ‚·ÛË Ì ÛÎÔfi ÙËÓ ·ÏÏËÏÔÁÚ·Ê›· (adjusted OR: 2,10, 95% CI: 1,37-3,23) ‹ ÙË ¯Ú‹ÛË chat rooms (adjusted OR: 1,91, 95% CI: 1,25-2,93), Ë ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ (adjusted OR 1,22, 95% CI: 1,22-2,77) Î·È ÙÔ ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓ˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ (adjusted OR: 1,53, 95% CI: 1,23-1,89). ª¤ÙÚÈ· ¯Ú‹ÛË ›ÓÙÂÚÓÂÙ (4-10 ÒÚ˜/‚‰ÔÌ¿‰·) – √Ì¿‰· 2 H √Ì¿‰· 2 Û¯ÂÙ›˙ÂÙ·È ÙfiÛÔ Ì ÙÔ Ê‡ÏÔ (˘ÂÚÙÂÚÔ‡Ó Ù· ·ÁfiÚÈ·) fiÛÔ Î·È Ì ÙÔ ÈÛÙÔÚÈÎfi ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ (¶›Ó·Î·˜ 1). ™ÙÔÓ ¶›Ó·Î· 2 Ê·›ÓÂÙ·È fiÙÈ ÔÈ Ì¤ÙÚÈÔÈ ¯Ú‹ÛÙ˜ Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· ¤¯Ô˘Ó ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ ÙÔ˘˜ (OR: 5,61, 95% CI: 3,588,80) ‹ ·fi ÙÔ ›ÓÙÂÚÓÂ٠ηʤ (OR: 1,77, 95% CI : 1,202,61). ∏ ÔÌ¿‰· 1 Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì ÙË ¯Ú‹ÛË e-
mail (OR: 6,98, 95% CI: 4,57-10,67), ÙËÓ ·ÁÔÚ¿ ÚÔ˚fiÓÙˆÓ (OR: 4,28, 95% CI: 2,02-9,04), Ù· chat rooms (OR: 4,17, 95% CI: 2,76-6,30) Î·È ÙËÓ ·Ó·˙‹ÙËÛË ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈÎÒÓ Ì ÙË ÛÂÍÔ˘·ÏÈ΋ ‰È··È‰·ÁÒÁËÛË (OR: 2,77, 95% CI: 1,40-5,48), ÂÓÒ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ÙËÓ ·Ó·˙‹ÙËÛË ÏËÚÔÊÔÚÈÒÓ ÁÈ· ÂÚÁ·Û›· ‹ Âη›‰Â˘ÛË (OR: 0,59, 95% CI: 0,40-0,89) (¶›Ó·Î·˜ 2). ™‡Ìʈӷ Ì ÙÔ YIAS, ÔÈ Ì¤ÙÚÈÔÈ ¯Ú‹ÛÙ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÓÓ¤· ÊÔÚ¤˜ ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· Â›Ó·È ÔÚÈ·ÎÔ› ¯Ú‹ÛÙ˜ (OR: 8,96, 95% CI: 4,08-19,69), Û˘ÁÎÚÈÓfiÌÂÓÔÈ Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∂ÈϤÔÓ, Â›Ó·È ÂÓÙ˘ˆÛÈ·Îfi fiÙÈ 44,5% (n=4) ÙˆÓ ÂıÈÛÌ¤ÓˆÓ ¯ÚËÛÙÒÓ ·Ó‹ÎÔ˘Ó Û ·˘Ù‹ ÙËÓ ÔÌ¿‰· (¶›Ó·Î·˜ 2). ∏ ¶∞¶ª ÂȂ‚·›ˆÛ fiÙÈ ÔÈ ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ ÁÈ· ÙËÓ ÔÌ¿‰· 2 Â›Ó·È Ë ÚfiÛ‚·ÛË ÁÈ· ·ÏÏËÏÔÁÚ·Ê›· (adjusted OR: 4,14, 95% CI: 2,39-7,19) ‹ chat rooms (adjusted OR: 2,80, 95% CI: 1,62-4,84), Ë ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ (adjusted OR: 2,74, 95% CI: 1,47-5,10) Î·È ÙÔ ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓ˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ (adjusted OR: 2,19, 95% CI: 1,63-2,93). À„ËÏ‹ ¯Ú‹ÛË ›ÓÙÂÚÓÂÙ (11-20 ÒÚ˜/‚‰ÔÌ¿‰·) – √Ì¿‰· 3 ∏ ÔÌ¿‰· 3 Û˘Û¯ÂÙ›˙ÂÙ·È ·ÓÙÈÛÙÚfiʈ˜ ·Ó¿ÏÔÁ· Ì ÙÔ Á˘Ó·ÈÎÂ›Ô Ê‡ÏÔ (¶›Ó·Î·˜ 1), ÂÓÒ ÂÈÚÔÛı¤Ùˆ˜ ÔÈ ˘„ËÏÔ› ¯Ú‹ÛÙ˜ Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· ¤¯Ô˘Ó ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ ÙÔ˘˜ (OR: 19,57, 95% CI: 5,96-64,24) ‹ Ù· ›ÓÙÂÚÓÂ٠ηʤ (OR: 3,45, 95% CI: 1,89-6,29). ¶·È‰È·ÙÚÈ΋ 2008;71:441-448
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∞. ∆Û›ÙÛÈη Î·È Û˘Ó.
¶›Ó·Î·˜ 2. ÷ڷÎÙËÚÈÛÙÈο Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Î·È Ù˘ Young Internet Addiction Scale (YIAS) ÛÙÔ˘˜ ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜, Û‡Ìʈӷ Ì ÙÔÓ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ˆÚÒÓ ¯Ú‹Û˘ ›ÓÙÂÚÓÂÙ ·Ó¿ ‚‰ÔÌ¿‰· (N=897) 0-1 ÒÚ·/ ‚‰ÔÌ¿‰· (N=277) N (%)
1-3 ÒÚ˜/‚‰ÔÌ¿‰· (N=318) N (%)
OR
95% CI
4-10 ÒÚ˜/‚‰ÔÌ¿‰· (N=191) N (%)
¶ÚˆÙ·Ú¯ÈÎfi˜ ÙfiÔ˜ ÚfiÛ‚·Û˘ ™›ÙÈ 124 (44,8) 229 (72,0) 2,90 2,06-4,10 159 (83,2) ºÈÏÈÎfi Û›ÙÈ 63 (22,7) 87 (27,4) 1,20 0,82-1,75 37 (19,4) ™¯ÔÏÂ›Ô 79 (28,5) 49 (15,4) 0,43 0,28-0,64 25 (13,1) µÈ‚ÏÈÔı‹ÎË 14 (5,0) 9 (2,8) 0,52 0,22-1,22 1 (0,5) ÿÓÙÂÚÓÂ٠ηʤ 80 (28,9) 125 (39,3) 1,49 1,05-2,10 83 (43,4) ¶ÚˆÙ·Ú¯ÈÎfi ·ÓÙÈΛÌÂÓÔ ÂӉȷʤÚÔÓÙÔ˜ ̤ۈ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ E-mail 52 (18,8) 147 (46,2) 3,46 2,38-5,04 121 (63,4) ªª∂ 43 (15,5) 51 (16,0) 0,97 0,62-1,51 38 (19,9) Chat room 54 (19,5) 118 (37,1) 2,26 1,55-3,30 100 (52,4) ¶·È¯Ó›‰È· 131 (47,3) 181 (56,9) 1,31 0,94-1,82 113 (59,2) ÀËÚÂۛ˜ 51 (18,4) 74 (23,3) 1,25 0,83-1,86 48 (25,1) ∂ÚÁ·Û›· & 100 (36,1) 103 (32,4) 0,77 0,54-1,08 52 (27,2) Âη›‰Â˘ÛË ™ÂÍÔ˘·ÏÈ΋ 14 (5,0) 31 (9,7) 1,88 0,97-3,61 26 (13,6) ‰È··È‰·ÁÒÁËÛË ∞ÁÔÚ¤˜ 10 (3,6) 24 (7,5) 2,05 0,96-4,36 28 (14,6) ÚÔ˚fiÓÙˆÓ Young Internet Addiction Score º˘ÛÈÔÏ. ¯Ú‹ÛË 251 (90,6) 280 (88,0) 140 (73,3) √Úȷ΋ ¯Ú‹ÛË 8 (2,9) 23 (7,2) 2,58 1,13-5,86 40 (20,9) ∂ıÈÛÙÈ΋ ¯Ú‹ÛË 0 (0) 0 (0) 4 (2,1)
11-20 ÒÚ˜/‚‰ÔÌ¿‰· (N=55)
>20 ÒÚ˜/‚‰ÔÌ¿‰· (N=56)
OR
95% CI
N (%)
OR
95% CI
N (%)
OR
95% CI
5,61 0,77 0,35 0,09 1,77
3,58-8,80 0,48-1,21 0,21-0,58 0,01-0,72 1,20-2,61
52 (94,5) 14 (25,4) 10 (18,2) 2 (3,6) 33 (60,0)
19,57 1,09 0,52 0,67 3,45
5,96-64,24 0,56-2,13 0,25-1,08 0,15-3,05 1,89-6,29
50 (89,3) 12 (21,4) 6 (10,7) 3 (5,4) 30 (53,6)
9,41 0,87 0,28 1,01 2,65
3,90-22,70 0,43-1,75 0,12-0,68 0,28-3,64 1,48-4,77
6,98 1,25 4,17 1,42 1,37 0,59
4,57-10,67 0,77-2,02 2,76-6,30 0,97-2,06 0,87-2,14 0,40-0,89
37 (67,3) 10 (18,2) 37 (67,3) 41 (74,5) 17 (30,9) 12 (21,8)
8,66 4,52-16,59 1,14 0,53-2,44 8,26 4,32-15,79 3,08 1,58-6,02 1,87 0,98-3,59 0,45 0,23-0,90
42 (75,0) 11 (19,6) 35 (62,5) 52 (92,8) 23 (41,1) 18 (32,1)
11,94 6,07-23,50 1,26 0,60-2,62 6,32 3,41-11,74 12,70 4,46-36,14 2,84 1,54-5,25 0,75 0,41-1,39
2,77 1,40-5,48
8 (14,5) 2,95
1,17-7,45
15 (26,8) 6,40
2,86-14,32
4,28 2,02-9,04
10 (18,2) 5,66
2,22-4,39
14 (0,25) 8,30
3,46-19,91
8,96 4,08-19,69
36 (65,4) 18 (32,7) 15,69 6,36-38,70 0 (0)
22 (39,3) 26 (46,4) 37,08 15,01-91,60 5 (8,9)
OR: Unadjusted Odds Ratio, 95% CI: 95% Confidence Interval for Unadjusted Odds Ratio
∞Ó·ÊÔÚÈο Ì ÙÔ Â›‰Ô˜ ÙˆÓ ÈÛÙÔÛÂÏ›‰ˆÓ, Ë ÔÌ¿‰· Û˘Û¯ÂÙ›˙ÂÙ·È ÛËÌ·ÓÙÈο Ì e-mail (OR: 8,66, 95% CI: 4,52-16,59), chat rooms (OR: 8,26, 4,32-15,79), ·ÁÔÚ¿ ÚÔ˚fiÓÙˆÓ (OR: 5,66, 95% CI: 2,22-4,39), ·È¯Ó›‰È· (OR: 3,08, 95% CI: 1,58-6,02) Î·È ·Ó·˙‹ÙËÛË ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈÎÒÓ Ì ÙË ÛÂÍÔ˘·ÏÈ΋ ‰È··È‰·ÁÒÁËÛË (OR: 2,95, 95% CI: 1,17-7,45), ÁÂÁÔÓfi˜ Ô˘ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙËÓ ÔÈÎÈÏÔ-
ÌÔÚÊ›· ÙˆÓ ÂӉȷÊÂÚfiÓÙˆÓ ÙˆÓ ¯ÚËÛÙÒÓ ·˘Ù‹˜ Ù˘ ÔÌ¿‰·˜. ∞fi Ù· Â˘Ú‹Ì·Ù· ÙÔ˘ YIAS, ÔÈ ˘„ËÏÔ› ¯Ú‹ÛÙ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ÔÚȷ΋ ¯Ú‹ÛË ›ÓÙÂÚÓÂÙ (OR: 15,69, 95% CI: 6,36-38,70), Û˘ÁÎÚÈÓfiÌÂÓÔÈ Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∫·Ì›· ÂÚ›ÙˆÛË ÂıÈÛÌÔ‡ ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÙ·È Û’ ·˘Ù‹ ÙËÓ ÔÌ¿‰· (¶›Ó·Î·˜ 2).
¶›Ó·Î·˜ 3. Pearson Correlation Coefficients (r) ÁÈ· Ù· ‰ËÌÔÁÚ·ÊÈο ¯·Ú·ÎÙËÚÈÛÙÈο Î·È ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙÔ˘˜ ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜, Û‡Ìʈӷ Ì ÙÔÓ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ˆÚÒÓ ¯Ú‹Û˘ ›ÓÙÂÚÓÂÙ ·Ó¿ ‚‰ÔÌ¿‰· (N=897) 1-3 ÒÚ˜/‚‰ÔÌ¿‰· (N=318)
∏ÏÈΛ· <15 ¤ÙË (¤Ó·ÓÙÈ 15-15,9 ÂÙÒÓ) >16 ¤ÙË (¤Ó·ÓÙÈ 15-15,9 ÂÙÒÓ) º‡ÏÔ £‹Ï˘ (¤Ó·ÓÙÈ ÕÚÚÂÓÔ˜) ¢ª™ <18,5 kg/m2 (¤Ó·ÓÙÈ 18,5-24,9 kg/m2) >25,0 kg/m2 (¤Ó·ÓÙÈ 18,5-24,9 kg/m2) ª√µ B- - B+ (¤Ó·ÓÙÈ <C+) A- - A+ (¤Ó·ÓÙÈ <C+) πÛÙÔÚÈÎfi ¯Ú‹Û˘ ‰È·‰ÈÎÙ‡Ô˘ 6-12 Ì‹Ó˜ (¤Ó·ÓÙÈ 0-6 ÌËÓÒÓ) >12 Ì‹Ó˜ (¤Ó·ÓÙÈ 0-6 ÌËÓÒÓ)
Paediatriki 2008;71:441-448
4-10 ÒÚ˜/‚‰ÔÌ¿‰· (N=191) ¡
r
∆ÈÌ‹ p
11-20 ÒÚ˜/‚‰ÔÌ¿‰· (N=55)
¡
r
∆ÈÌ‹ p
558 173
-0,07574 -0,07700
0,0738 0,3140
430 -0,11915 0,0134 141 0,00254 0,9762
308 -0,13269 0,0198 93 -0,09662 0,3569
304 -0,08949 0,1195 91 0,04741 0,6554
590
-0,06412
0,1198
466 -0,20197 <0,0001
330 -0,23980 <0,0001
331 -0,37813
544
-0,01184
0,7829
426 -0,08103 0,0948
297 -0,06595 0,2572
301 -0,11946 0,0383
191
-0,02100
0,7730
162 -0,00901 0,9094
110
114
404 314
0,00166 0,02557
0,9734 0,6518
320 -0,00285 0,9595 246 0,01369 0,8309
229 0,00375 0,9550 172 -0,01612 0,8337
233 0,01385 0,8335 169 -0,08974 0,2459
350 517
0,30128 0,33415
<0,0001 <0,0001
263 410
209 303
206 304
0,47491 <0,0001 0,50997 <0,0001
¡
r
∆ÈÌ‹ p
>20 ÒÚ˜/‚‰ÔÌ¿‰· (N=56)
0,17276 0,0711
0,27933 <0,0001 0,46921 <0,0001
¡
r
0,08928
∆ÈÌ‹ p
0,3449
0,28215 <0,0001 0,50193 <0,0001
Pediatri Nov-Dec 08 new
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ÃÚ‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜
¶›Ó·Î·˜ 4. Pearson Correlation Coefficients (r) ÁÈ· Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Î·È ÙË Young Internet Addiction Scale (YIAS) ÛÙÔ˘˜ ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜, Û‡Ìʈӷ Ì ÙÔÓ Û˘ÓÔÏÈÎfi ·ÚÈıÌfi ˆÚÒÓ ¯Ú‹Û˘ ›ÓÙÂÚÓÂÙ ·Ó¿ ‚‰ÔÌ¿‰· (N=897) 1-3 ÒÚ˜/‚‰ÔÌ¿‰· (N=318)
4-10 ÒÚ˜/‚‰ÔÌ¿‰· (N=191)
¡
¡
r
∆ÈÌ‹ p
¶ÚˆÙ·Ú¯ÈÎfi˜ ÙfiÔ˜ ÚfiÛ‚·Û˘ ™›ÙÈ 582 0,25521 <0,0001 ºÈÏÈÎfi Û›ÙÈ 582 0,03978 0,3381 ™¯ÔÏÂ›Ô 582 -0,17447 <0,0001 µÈ‚ÏÈÔı‹ÎË 582 -0,06319 0,1278 ÿÓÙÂÚÓÂ٠ηʤ 582 0,09386 0,0236 ¶ÚˆÙ·Ú¯ÈÎfi ·ÓÙÈΛÌÂÓÔ ÂӉȷʤÚÔÓÙÔ˜ ̤ۈ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ E-mail 575 0,27654 <0,0001 ªª∂ 575 -0,00623 0,8815 Chat room 575 0,17921 <0,0001 ¶·È¯Ó›‰È· 575 0,06691 0,1090 ÀËÚÂۛ˜ 575 0,04495 0,2819 ∂ÚÁ·Û›· & Âη›‰Â˘ÛË 575 -0,06262 0,1337 ™ÂÍÔ˘·ÏÈ΋ ‰È··È‰·ÁÒÁËÛË 540 0,08199 0,0569 ∞ÁÔÚ¤˜ ÚÔ˚fiÓÙˆÓ 575 0,07876 0,0591 Young Internet Addiction Score º˘ÛÈÔÏÔÁÈ΋ ¯Ú‹ÛË √Úȷ΋ ¯Ú‹ÛË 561 0,09830 0,0198 ∂ıÈÛÙÈ΋ ¯Ú‹ÛË
∏ ¶∞¶ª ηıfiÚÈÛ ÙÔ˘˜ ÛËÌ·ÓÙÈÎfiÙÂÚÔ˘˜ ·Ú¿ÁÔÓÙ˜ Û˘Û¯¤ÙÈÛ˘: ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ (adjusted OR: 11,26, 95% CI: 2,60-48,73), ¯Ú‹ÛË chat rooms (adjusted OR: 4,30, 95% CI: 1,78-10,41), ¯Ú‹ÛË e-mail (adjusted OR: 3,96, 95% CI: 1,61-9,76), ÚfiÛ‚·ÛË ·fi Ù· ›ÓÙÂÚÓÂ٠ηʤ (adjusted OR: 3,09, 95% CI: 1,22-7,78) Î·È ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓ˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ (adjusted OR: 2,19, 95% CI: 1,30-3,71). ∆Ô ·Ó‰ÚÈÎfi ʇÏÔ ‹Ù·Ó ›Û˘ ÈÛ¯˘Úfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ÀÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË ›ÓÙÂÚÓÂÙ (>20 ÒÚ˜/‚‰ÔÌ¿‰·) - √Ì¿‰· 4 ∏ ÔÌ¿‰· Û¯ÂÙ›˙ÂÙ·È ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈο Ì ÙÔ ¿ÚÚÂÓ Ê‡ÏÔ Î·È ÙÔ ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓ˘ ‰È·‰ÈÎÙ˘·Î‹˜ ¯Ú‹Û˘ (¶›Ó·Î·˜ 1). ∂ÈϤÔÓ, ÔÈ ¯Ú‹ÛÙ˜ Â›Ó·È Èı·ÓfiÙÂÚÔ Ó· ¤¯Ô˘Ó ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ ÙÔ˘˜ (OR: 9,41, 95% CI: 3,90-32,70) ‹ ·fi Ù· ›ÓÙÂÚÓÂ٠ηʤ (OR: 2,65, 95% CI: 1,48-4,77) (¶›Ó·Î·˜ 2). ∏ ÚfiÛ‚·ÛË ·fi ÙÔ Û¯ÔÏÂ›Ô Î·È/‹ ·fi ÙȘ ‚È‚ÏÈÔı‹Î˜ ‰ÂÓ Ê·›ÓÂÙ·È Ó· Û˘Û¯ÂÙ›˙ÂÙ·È ·ÚÓËÙÈο, ÙÔ˘Ï¿¯ÈÛÙÔÓ Û ÛÙ·ÙÈÛÙÈÎÒ˜ ÛËÌ·ÓÙÈÎfi ‚·ıÌfi, Ì ÙËÓ ÔÌ¿‰· ·˘Ù‹ (¶›Ó·Î·˜ 2). ™ÎÔfi˜ Ù˘ ÚfiÛ‚·Û˘ ‹Ù·Ó Ù· ·È¯Ó›‰È· (OR: 12,70, 95% CI: 4,46-36,14), Ë ·ÏÏËÏÔÁÚ·Ê›· (OR: 11,94, 95% CI: 6,07-23,50), Ë ·ÁÔÚ¿ ÚÔ˚fiÓÙˆÓ (OR: 8,30, 95% CI: 3,46-19,91), Ë ÛÂÍÔ˘·ÏÈ΋ ‰È··È‰·ÁÒÁËÛË (OR: 6,40, 95% CI: 2,86-14,32), Ù· chat rooms (OR: 6,32, 95% CI: 3,41-11,74) Î·È Ë ·Ó·˙‹ÙËÛË ˘ËÚÂÛÈÒÓ (OR: 2,84, 95% CI: 1,54-5,25). µ¿ÛÂÈ ÙˆÓ Â˘ÚËÌ¿ÙˆÓ ÙÔ˘ YIAS, ÔÈ ˘ÂÚ‚ÔÏÈÎÔ›
r
∆ÈÌ‹ p
11-20 ÒÚ˜/‚‰ÔÌ¿‰· (N=55) ¡
r
∆ÈÌ‹ p
>20 ÒÚ˜/‚‰ÔÌ¿‰· (N=56) ¡
r
∆ÈÌ‹ p
455 455 455 455 455
0,36922 <0,0001 -0,05353 0,2544 -0,19786 <0,0001 -0,13211 0,0048 0,13538 0,0038
319 319 319 319 319
0,36136 0,01404 -0,09890 -0,02884 0,23454
<0,0001 0,8027 0,0778 0,6078 <0,0001
320 0,32281 <0,0001 320 -0,02184 0,6971 320 -0,16526 0,0030 320 0,00092 0,9870 320 0,18615 0,0008
449 450 450 450 450 450 419 450
0,44270 <0,0001 0,04236 0,3699 0,32822 <0,0001 0,08515 0,0711 0,06490 0,1693 -0,11898 0,0115 0,14799 0,0024 0,19195 <0,0001
313 313 313 313 313 313 293 313
0,40574 0,01930 0,39663 0,19248 0,10803 -0,12917 0,13883 0,22644
<0,0001 0,7337 <0,0001 0,0006 0,0562 0,0223 0,0174 <0,0001
315 0,45892 <0,0001 315 0,03422 0,5457 315 0,35368 <0,0001 315 0,32760 <0,0001 315 0,19281 0,0006 315 -0,05108 0,3662 294 0,28998 <0,0001 315 0,30463 <0,0001
439 395
0,30156 <0,0001 0,13354 0,0079
313 0,41406 <0,0001
307 278
0,59113 0,41263
<0,0001 <0,0001
¯Ú‹ÛÙ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈÛ¯˘Ú‹ Û˘Û¯¤ÙÈÛË Ì ÙËÓ ÔÚȷ΋ ¯Ú‹ÛË ›ÓÙÂÚÓÂÙ (OR: 37,08, 95% CI: 15,0191,60), Û˘ÁÎÚÈÓfiÌÂÓÔÈ Ì ÙËÓ ÔÌ¿‰· ÂϤÁ¯Ô˘. ∂ÈϤÔÓ, 55,5% (n=5) ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÂıÈÛÌÔ‡ ·Ó‹ÎÔ˘Ó Û’ ·˘Ù‹Ó ÙËÓ ÔÌ¿‰· (¶›Ó·Î·˜ 2). ∏ ¶∞¶ª ¤‰ÂÈÍ fiÙÈ ÔÈ ÈÔ ÛËÌ·ÓÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Â›Ó·È Ë ÚfiÛ‚·ÛË Ì ÛÎÔfi ÙË Û˘ÌÌÂÙÔ¯‹ Û ·È¯Ó›‰È· (adjusted OR: 8,26, 95% CI: 2,16-31,49), Ë ÚfiÛ‚·ÛË ·fi ÙÔ Û›ÙÈ (adjusted OR: 6,96, 95% CI: 1,72-28,27), Ë ÚfiÛ‚·ÛË Ì ÛÎÔfi ÙËÓ ·ÏÏËÏÔÁÚ·Ê›· (adjusted OR: 5,52, 95% CI: 2,01-15,21), Ë ¯Ú‹ÛË chat rooms (adjusted OR: 3,37, 95% CI: 1,24-9,12) Î·È ÙÔ ÈÛÙÔÚÈÎfi ÚÔËÁÔ‡ÌÂÓ˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ (adjusted OR: 3,63, 95% CI: 1,84-7,15). ∆Ô Á˘Ó·ÈÎÂ›Ô Ê‡ÏÔ ‹Ù·Ó ·ÚÓËÙÈÎfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜, fiˆ˜ Ê·›ÓÂÙ·È ÛÙÔÓ ¶›Ó·Î· 5.
™˘˙‹ÙËÛË ŸÛÔÓ ·ÊÔÚ¿ ÙȘ ‰È·ÊÔÚ¤˜ ÌÂٷ͇ ÙˆÓ ‰‡Ô ʇψÓ, ÙÔ ı‹Ï˘ ʇÏÔ Û˘Û¯ÂÙ›˙ÂÙ·È ·ÚÓËÙÈο Ì ÙË Ì¤ÛË, ˘„ËÏ‹ Î·È ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË - ·ÚfiÌÔÈ· Â˘Ú‹Ì·Ù· ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (17,18). √ ¯ÒÚÔ˜ ÚfiÛ‚·Û˘ ÛÙÔ ‰È·‰›ÎÙ˘Ô ·ÔÙÂÏ› ÛËÌ·ÓÙÈÎfi ÚÔÁÓˆÛÙÈÎfi ·Ú¿ÁÔÓÙ·. ¶ÚÒÙÔ Û ÚÔÙ›ÌËÛË ¤Ú¯ÂÙ·È ÙÔ Û›ÙÈ ÙÔ˘ ÂÊ‹‚Ô˘ Î·È ‰Â˘ÙÂÚ¢fiÓÙˆ˜ Ù· ›ÓÙÂÚÓÂ٠ηʤ. ™ÙÔ Û›ÙÈ, Î·È È‰È·›ÙÂÚ· Â¿Ó Ô ˘ÔÏÔÁÈÛÙ‹˜ Â›Ó·È ÙÔÔıÂÙË̤ÓÔ˜ Û ÚÔÛˆÈÎfi ¯ÒÚÔ (‰ˆÌ¿ÙÈÔ), Ô/Ë ¤ÊË‚Ô˜ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·ÔÌÔÓÒÓÂÙ·È, Ó· ¯·Ï·ÚÒÓÂÈ, Ó· ÂÈÎÔÈÓˆÓ› Î·È ÁÂÓÈο Ó· ‚ÈÒÓÂÈ ÂÌÂÈڛ˜ ¯ˆÚ›˜ ¤ÏÂÁ¯Ô ‹ ÂÈÛÙ·Û›· ·fi ÙÔ˘˜ ÁÔÓ›˜. ¶·È‰È·ÙÚÈ΋ 2008;71:441-448
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·446
446
∞. ∆Û›ÙÛÈη Î·È Û˘Ó.
¶›Ó·Î·˜ 5. Multivariate ·Ó¿Ï˘ÛË ÁÈ· ÙË Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÚÔÁÓˆÛÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ÙˆÓ Û˘ÓÔÏÈÎÒÓ ˆÚÒÓ ¯Ú‹Û˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙÔ˘˜ ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜ (N=897) 1-3 ÒÚ˜/‚‰ÔÌ¿‰· (N=524) Maximum Likelihood Estimates
Intercept ∏ÏÈΛ· º‡ÏÔ
4-10 ÒÚ˜/‚‰ÔÌ¿‰· (N=381)
Wald CI for Adj. OR
Maximum Likelihood Estimates
‚
Wald x2 (p-value)
OR (95% CI)
‚
-0,8417
19,1807 (<0,0001) NS NS
-
-2,1441
-
-0,7748
-
¢ª™ NS πÛÙÔÚÈÎfi 0,4238 15,2940 1,53 0,7828 ÃÚ‹Û˘ (<0,0001) (1,23-1,89) ¶ÚˆÙ·Ú¯ÈÎfi˜ ÙfiÔ˜ ÚfiÛ‚·Û˘ ÛÙÔ ¢È·‰›ÎÙ˘Ô ™›ÙÈ 0,6069 8,3896 1,84 1,0081 (0,0038) (1,22-2,77) ™¯ÔÏÂ›Ô -0,5296 4,8503 0,59 (0,0276) (0,37-0,94) µÈ‚ÏÈÔı‹ÎË NE ÿÓÙÂÚÓÂ٠ηʤ NS -
Wald x2 (p-value)
Maximum Likelihood Estimates
Wald CI for Adj. OR
OR (95% CI)
µ
OR (95% CI)
40,9821 (<0,0001) NS 7,8604 0,46 (0,0051) (0,27-0,79) NS 27,2983 2,19 (<0,0001) (1,63-2,93)
-
NE
-
-0,6945
-
NE NE
-
-
10,3217 (0,3251)
Wald x2 (p-value)
2,4214
NS NS
-
0,50 (0,28-0,91) -
8,0697 (0,4267)
Maximum Likelihood Estimates ‚
Wald x2 (p-value)
Wald CI for Adj. OR OR (95% CI)
38,2116 -7,0210 33,7661 (<0,0001) (<0,0001) NS NS -1,0876 5,6553 0,34 -1,8725 11,2225 0,15 (0,0174) (0,14-0,83) (0,0008) (0,05-0,46) NS NS 0,7852 8,5656 2,19 1,2880 13,7951 3,63 (0,0034) (1,30-3,71) (0,0002) (1,84-7,15)
2,74 (1,47-5,10) -
5,1862 (0,0228) NS NS
>20 ÒÚ˜/‚‰ÔÌ¿‰· (N=264)
-5,6427
10,0930 (0,0015) NS
¶ÚˆÙ·Ú¯ÈÎfi ·ÓÙÈΛÌÂÓÔ ÂӉȷʤÚÔÓÙÔ˜ ̤ۈ ¯Ú‹Û˘ ¢È·‰ÈÎÙ‡Ô˘ E-mail 0,7438 11,6111 2,10 1,4216 25,6120 4,14 (0,0007) (1,37-3,23) (<0,0001) (2,39-7,19) Chat room 0,6489 8,9436 1,91 1,0284 13,4852 2,80 (0,0028) (1,25-2,93) (0,0002) (1,62-4,84) ¶·È¯Ó›‰È· NE NE ∂ÚÁ·Û›· & Âη›‰Â˘ÛË ™ÂÍ. ‰È··È‰. ∞ÁÔÚ¤˜ HosmerLemeshow Goodness of Fit (p-value)
11-20 ÒÚ˜/‚‰ÔÌ¿‰· (N=262)
Wald CI for Adj. OR
10,4970 (0,0012) NS
11,26 1,9409 (2,60-48,73) -
1,1267
NS 5,7015 (0,0170)
3,09 (1,22-7,78)
1,3772
-
8,9792 (0,0027) 10,4891 (0,0012) NS
3,96 1,7089 (1,61-9,76) 4,30 1,2144 (1,78-10,41) 2,1111
-
NS
-
-
-
NS NS
-
-
-
1,4594
11,4314 (0,1209)
-
7,3744 6,96 (0,0066) (1,72-28,27) NS NS NS
-
10,9370 5,52 (0,0009) (2,01-15,21) 5,7035 3,37 (0,0169) (1,24-9,12) 9,5530 8,26 (0,0020) (2,16-31,49) NE NS NS
-
3,8133 (0,9233)
‚: Point Estimate, Wald x2: Wald x2 Test, Adj. OR: ¶ÚÔÛ·ÚÌÔṲ̂ÓÔ˜ ™¯ÂÙÈÎfi˜ ∫›Ó‰˘ÓÔ˜, 95% CI: 95% ŸÚÈ· ∞ÍÈÔÈÛÙ›·˜, NE: ∏ ÌÂÙ·‚ÏËÙ‹ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p-value < 0,0500) Î·È ‰ÂÓ Û˘ÌÂÚÈÏ‹ÊıËΠÛÙÔ ÌÔÓÙ¤ÏÔ ·ÏÈÓ‰ÚfiÌËÛ˘, NS: ∏ ÌÂÙ·‚ÏËÙ‹ Û˘ÌÂÚÈÏ‹ÊıËΠÛÙÔ ÌÔÓÙ¤ÏÔ ·ÏÈÓ‰ÚfiÌËÛ˘, ·ÏÏ¿ ÏfiÁˆ ¤ÏÏÂȄ˘ ÛÙ·ÙÈÛÙÈ΋˜ ÛËÌ·ÓÙÈÎfiÙËÙ·˜ ‰ÂÓ ‰È·ÙËÚ‹ıËÎÂ.
√ Û¯ÂÙÈÎfi˜ ΛӉ˘ÓÔ˜ ÁÈ· Ù¤ÙÔÈ· ÚfiÛ‚·ÛË ·˘Í¿ÓÂÙ·È ÏÔÁ·ÚÈıÌÈο ·fi ÙȘ ¯·ÌËÏfiÙÂÚ˜ ÛÙȘ ˘„ËÏfiÙÂÚ˜ ηÙËÁÔڛ˜ ¯ÚËÛÙÒÓ, ·ÚÔ˘ÛÈ¿˙ÔÓÙ·˜ ÎÔÚ˘Ê·›Â˜ ÙÈ̤˜ ÛÙËÓ ÔÌ¿‰· ˘„ËÏ‹˜ ¯Ú‹Û˘ ›ÓÙÂÚÓÂÙ. ∞˘Ù‹ Â›Ó·È Ë ÚÒÙË ÌÂϤÙË Ô˘ Û˘Û¯ÂÙ›˙ÂÈ ÙÔ Û›ÙÈ ˆ˜ ¯ÒÚÔ ÚfiÛ‚·Û˘ Ì ÙËÓ Î·Ù¿¯ÚËÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘, ÂÓÒ ÁÈ· Ù· ›ÓÙÂÚÓÂ٠ηʤ ˘¿Ú¯ÂÈ Û¯ÂÙÈ΋ ·Ó·ÊÔÚ¿ ÛÙË ‰ÈÂıÓ‹ ‚È‚ÏÈÔÁÚ·Ê›· (19). ∂Í·ÈÚÂÙÈÎÔ‡ ÂӉȷʤÚÔÓÙÔ˜ Â›Ó·È Ù· Â˘Ú‹Ì·Ù· Ô˘ ηٷ‰ÂÈÎÓ‡Ô˘Ó fiÙÈ Ë ÚfiÛ‚·ÛË ÛÙÔ Û¯ÔÏÈÎfi ÂÚÈ‚¿ÏÏÔÓ ·ÔÙÚ¤ÂÈ ÙËÓ ÂͤÏÈÍË Û ÔÔÈ·‰‹ÔÙ ·fi ÙȘ ηÙËÁÔڛ˜ ·ıÔÏÔÁÈ΋˜ ¯Ú‹Û˘ ÙÔ˘ ›ÓÙÂÚÓÂÙ (¶›Ó·Î·˜ 4). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙÔÓ Û¯ÂÙÈÎfi ÂÚÈÔÚÈÛÌfi ÙˆÓ ÂÈÙÚÂfiÌÂÓˆÓ ÈÛÙÔÙfiˆÓ ‹ Î·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌÂÚÈο ·fi Ù· ·È‰È¿ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÙÔ ‰È·‰›ÎÙ˘Ô ÛÙÔ Û¯ÔÏÂ›Ô ÂÓ‰¤¯ÂÙ·È Ó· ÌË ‰È·ı¤ÙÔ˘Ó Û‡Ó‰ÂÛË ÛÙÔ Û›ÙÈ. Paediatriki 2008;71:441-448
∞Ó·ÊÔÚÈο Ì ÙÔ Â›‰Ô˜ ÙˆÓ ÈÛÙÔÛÂÏ›‰ˆÓ Ô˘ ÂÈÛΤÙÔÓÙ·È ÔÈ ¤ÊË‚ÔÈ, ÔÈ ÈÛÙfiÙÔÔÈ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÈÎÔÈÓˆÓ›· (.¯. e-mail Î·È chat rooms) ·ÔÙÂÏÔ‡Ó ÛÙ·ıÂÚfi ·Ú¿ÁÔÓÙ· Û fiϘ ÙȘ ÔÌ¿‰Â˜ ¯ÚËÛÙÒÓ. øÛÙfiÛÔ, Ë ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË Û¯ÂÙ›˙ÂÙ·È Î˘Ú›ˆ˜ ÌÂ Û˘ÌÌÂÙÔ¯‹ Û ·È¯Ó›‰È· Î·È ‰Â˘ÙÂÚ¢fiÓÙˆ˜ Ì ٷ sites Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÎÔÈÓˆÓÈ΋ ·ʋ. º·›ÓÂÙ·È fiÙÈ Ù· ‰È·‰ÈÎÙ˘·Î¿ ·È¯Ó›‰È· -Î·È È‰È·›ÙÂÚ· ÂΛӷ Ô˘ ηÏÔ‡Ó ÙÔ˘˜ ¯Ú‹ÛÙ˜ Ó· ·Ó·Ï·Ì‚¿ÓÔ˘Ó ÚfiÏÔ˘˜ (20)- ·ÔÙÂÏÔ‡Ó ·ÓÂÍ¿ÚÙËÙÔ ·Ú¿ÁÔÓÙ· ·Ó¿Ù˘Í˘ ÂıÈÛÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜ (21,22). ∆¤ÙÔÈ· Û˘ÌÂÚÈÊÔÚ¿ ÌÔÚ› Ó· ÂÈÙÂÏÂ›Ù·È Ì Ì˯·ÓÈÛÌfi ·ÚfiÌÔÈÔ ·˘ÙÔ‡ Ù˘ ·ıÔÏÔÁÈ΋˜ ÂÓ·Û¯fiÏËÛ˘ ÌÂ Ù˘¯ÂÚ¿ ·È¯Ó›‰È· (gambling) (23,24). ∞˘Ù‹ Ë Û˘Û¯¤ÙÈÛË ·Ú·ÙËÚÂ›Ù·È Î˘Ú›ˆ˜ Û ¿ÚÚÂÓ˜ ÂÊ‹‚Ô˘˜ (25,26), fiˆ˜ ¿ÏψÛÙ ·Ô‰ÂÈÎÓ‡ÂÙ·È Î·È ·fi ÙËÓ ·ÚÔ‡Û· ¤Ú¢ӷ.
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·447
447
ÃÚ‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜
√ ÈÔ ÚfiÛÊ·ÙÔ˜ ÔÚÈÛÌfi˜ ÙˆÓ Kaplan Î·È Sadock ÁÈ· ÙÔÓ ÂıÈÛÌfi ÛÙÔ ‰È·‰›ÎÙ˘Ô (27) ··ÈÙ› ¤ÓÙ ·fi Ù· ¤ÍÈ ·Ú·Î¿Ùˆ ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË: 1) ·Ú·ÌÔÓ‹ on-line ÁÈ· fiÏÔ Î·È ÂÚÈÛÛfiÙÂÚÔ ¯ÚfiÓÔ, 2) ·ÔÙ˘¯›· ‰È·¯Â›ÚÈÛ˘ ÙÔ˘ ÂÂÚ¯fiÌÂÓÔ˘ ·ÈÛı‹Ì·ÙÔ˜ ‰È¤ÁÂÚÛ˘ ‹/Î·È Î·Ù¿ıÏȄ˘, 3) ·Ú·ÌÔÓ‹ on-line ÁÈ· ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ÚÔÙÈı¤ÌÂÓÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, 4) ΛӉ˘ÓÔ˜ ·ÒÏÂÈ·˜ Û¯¤Û˘ ‹ ¢ηÈÚ›·˜ ÂÍ·ÈÙ›·˜ Ù˘ ¯Ú‹Û˘, 5) „‡‰Ë ÚÔÎÂÈ̤ÓÔ˘ Ó· Î·Ï˘Êı› Ë ·ÏËı‹˜ ¤ÎÙ·ÛË Ù˘ ¯Ú‹Û˘ Î·È 6) ¯Ú‹ÛË ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÏÂÁ¯ıÔ‡Ó Ù· ·ÚÓËÙÈο Û˘Ó·ÈÛı‹Ì·Ù·. ∆· ¿ÙÔÌ· Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÌÂÚÈο, fi¯È fï˜ Ù· ··ÈÙÔ‡ÌÂÓ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÂıÈÛÌÔ‡ ÎÚÈÙ‹ÚÈ·, ·Ó‹ÎÔ˘Ó ÛÙËÓ Î·ÙËÁÔÚ›· √Úȷ΋˜ ÃÚ‹Û˘ (27) Î·È ÂÌ›ÙÔ˘Ó ÛÙËÓ ·ÓÙ›ÛÙÔÈ¯Ë Î·ÙËÁÔÚ›· ÙÔ˘ YIAS. ŒÓ· ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi Û˘ÌÌÂÙ¯fiÓÙˆÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó √Úȷ΋ ÃÚ‹ÛË, Û‡Ìʈӷ Ì ÙÔ YIAS, (n=115, 12,8%), Ë ÔÔ›· ·˘Í¿ÓÂÙ·È ÁˆÌÂÙÚÈο fiÛÔ ·˘Í¿ÓÂÙ·È Ô Û˘ÓÔÏÈÎfi˜ ·ÚÈıÌfi˜ ˆÚÒÓ ¯Ú‹Û˘ ›ÓÙÂÚÓÂÙ ·Ó¿ ‚‰ÔÌ¿‰·. øÛÙfiÛÔ, ÂıÈÛÌfi˜ ·Ú·ÙËÚÂ›Ù·È Û 9 (1%) ÂÊ‹‚Ô˘˜ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜, ÛÙȘ ηÙËÁÔڛ˜ ̤ÙÚÈˆÓ (n=4) Î·È ˘ÂÚ‚ÔÏÈÎÒÓ ¯ÚËÛÙÒÓ (n=5). ∂ÓÙ‡ˆÛË ÚÔηÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠÂÚ›ÙˆÛË ÂıÈÛÌÔ‡ ÛÙËÓ ÔÌ¿‰· 3 (˘„ËÏ‹˜ ¯Ú‹Û˘). ∞˘Ùfi ÂÓ‰¤¯ÂÙ·È Ó· ÔÊ›ÏÂÙ·È ÛÙÔ fiÙÈ Ë ÂıÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ‰ÂÓ ·ÊÔÚ¿ ·ÔÎÏÂÈÛÙÈο ÛÙË ‰È¿ÚÎÂÈ· ¯Ú‹Û˘, ·ÏÏ¿ ÛÙÔ Â›‰Ô˜ Ù˘ Û¯¤Û˘ Ô˘ ·Ó·Ù‡ÛÛÂÙ·È Ì ÙÔ ‰È·‰›ÎÙ˘Ô (.¯. οÔÈÔ˜ ¤ÊË‚Ô˜ Ì ÂıÈÛÌfi ÌÔÚ› Ó· ÌËÓ ·Û¯ÔÏÂ›Ù·È ÔÏϤ˜ ÒÚ˜, ˆÛÙfiÛÔ Ó· ¤¯ÂÈ ¤ÌÌÔÓË ÛΤ„Ë ÁÈ· ÙÔ ›ÓÙÂÚÓÂÙ, ·Ú·ÌÂÏÒÓÙ·˜ ¿ÏÏÔ˘˜ ÙÔÌ›˜ Ù˘ ˙ˆ‹˜ ÙÔ˘) (11,27). ∏ ›وÛË ÙÔ˘ ÂıÈÛÌÔ‡ ÛÙËÓ ∂ÏÏ¿‰· Â›Ó·È ¯·ÌËÏfiÙÂÚË ·fi fi,ÙÈ Û ¿ÏϘ Â˘Úˆ·˚Τ˜ [¡ÔÚ‚ËÁ›·: 1,98% (28), µÚÂÙ·Ó›·, Û ‰Â›ÁÌ· ÊÔÈÙËÙÒÓ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ÙÔ˘ Nottingham: 18,3% (29), ƒÔ˘Ì·Ó›·: 1,4% (30), πÙ·Ï›·-ºÏˆÚÂÓÙ›·: 5,4% (9)] Î·È ·ÛÈ·ÙÈΤ˜ ¯ÒÚ˜ [πÓ‰›·: 18% (31), ∫ÔÚ¤·: 18,4% (32), ∫›Ó·: 2,4% (33)]. øÛÙfiÛÔ, ı· Ú¤ÂÈ Ó· ÏËÊı› ˘fi„Ë fiÙÈ Ë ¯ÒÚ· Ì·˜ ¤¯ÂÈ Î·ı˘ÛÙÂÚ‹ÛÂÈ Û¯ÂÙÈο Ì ÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘, Û ۯ¤ÛË Ì ÙȘ ˘fiÏÔȘ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ Î·È ‚¤‚·È· ÙȘ ·ÛÈ·ÙÈΤ˜ (34). ∆Ô Â›‰Ô˜ ÙˆÓ ÂÈÛÎÂÙfiÌÂÓˆÓ ÛÂÏ›‰ˆÓ Â›Ó·È ·ÚfiÌÔÈÔ Ì ·˘Ù¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙË ‚È‚ÏÈÔÁÚ·Ê›· (35). °›ÓÂÙ·È Û·Ê¤˜ ·fi ÙËÓ ¤Ú¢ӷ ·˘Ù‹ fiÙÈ ÔÈ ¯Ú‹ÛÙ˜ Ù˘ ÔÌ¿‰·˜ 3 Î·È 4 (>10 ÒÚ˜ ‚‰ÔÌ·‰È·›· ¯Ú‹ÛË) ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ΛӉ˘ÓÔ ·Ó¿Ù˘Í˘ ·ıÔÏÔÁÈÎÒÓ Û˘ÌÂÚÈÊÔÚÒÓ ¯Ú‹Û˘, ‰ËÏ·‰‹ ÔÚȷ΋ ¯Ú‹ÛË Î·È ÂıÈÛÌfi. ∆Ô Â‡ÚËÌ· ·˘Ùfi ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ÙȘ ηÙ¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∞η‰ËÌ›·˜ ÁÈ· Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹-
‚Ô˘˜, Ô˘ ı¤ÙÂÈ ˆ˜ fiÚÈ· ËÌÂÚ‹ÛÈ·˜ ¯Ú‹Û˘ ÔıfiÓ˘ (ÙËÏÂfiÚ·ÛË, ˘ÔÏÔÁÈÛÙ‹˜, ‰È·‰›ÎÙ˘Ô) ÙȘ 2 ÒÚ˜ (36). ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ ·ÔÙÂϤÛÌ·Ù·, ı· ‹Ù·Ó ȉȷ›ÙÂÚ· ¯Ú‹ÛÈÌÔ˜ Ô Û¯Â‰È·ÛÌfi˜ Î·È Ë ÂÊ·ÚÌÔÁ‹ ̤ÙÚˆÓ ‰ËÌfiÛÈ·˜ ˘Á›·˜, Ì ÛÙfi¯Ô ÙÔÓ ÂÚÈÔÚÈÛÌfi Î·È ÙËÓ ÚfiÏË„Ë Ù˘ ˘ÂÚ‚ÔÏÈ΋˜ ¯Ú‹Û˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙÔ˘˜ ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜. ∏ Û˘ÁÎÂÎÚÈ̤ÓË ¤Ú¢ӷ Â›Ó·È Ë ÚÒÙË (Û‡Ìʈӷ Ì fiÛ· ¤ˆ˜ ÙÒÚ· ÁÓˆÚ›˙Ô˘ÌÂ) Ô˘ ‰ÈÂÍ‹¯ıË ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÎÙÈÌËıÔ‡Ó Î·È Ó· ÚÔÛ‰ÈÔÚÈÛÙÔ‡Ó ÔÈ ÚÔÁÓˆÛÙÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û ŒÏÏËÓ˜ ÂÊ‹‚Ô˘˜. §fiÁˆ Ù˘ Ù˘¯·ÈÔÔ›ËÛ˘ ÛÙË Û˘ÏÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ Î·È Ù˘ ·ÓÒÓ˘Ì˘ ÌÂıÔ‰ÔÏÔÁ›·˜ Ô˘ ÂÊ·ÚÌfiÛÙËÎÂ, ÔÈ Èı·ÓfiÙËÙ˜ Û˘ÛÙËÌ·ÙÈÎÔ‡ ÛÊ¿ÏÌ·ÙÔ˜ ÂÈÏÔÁ‹˜ Î·È ·Ó·ÊÔÚ¿˜ ÂÏ·¯ÈÛÙÔÔÈ‹ıËηÓ. √È ÂÚÈÔÚÈÛÌÔ› Ù˘ ÌÂϤÙ˘ Â›Ó·È ÔÈ ·Ú·Î¿Ùˆ: ·) §fiÁˆ ÙÔ˘ ÂȉËÌÈÔÏÔÁÈÎÔ‡ ۯ‰›Ô˘, Ë ¤Ú¢ӷ ·ÔÙ˘Á¯¿ÓÂÈ Ó· ÂÎÙÈÌ‹ÛÂÈ ÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ηٿÛÙ·ÛË ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ ÚÈÓ ·fi ÙËÓ ·ÚÔ‡Û· ¯Ú‹ÛË ›ÓÙÂÚÓÂÙ. ‚) §fiÁˆ ÙÔ˘ ÂÚÈÔÚÈÛÌÔ‡ Ù˘ ÌÂϤÙ˘ ÛÙÔÓ ÏËı˘ÛÌfi Ù˘ ∞ÙÙÈ΋˜, ı· Ú¤ÂÈ Ó· Ú·ÁÌ·ÙÔÔÈËı› ·Ó¿ÏÔÁË ÌÂϤÙË Û ÂıÓÈÎfi ›‰Ô, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·¯ıÔ‡Ó Ù· ·Ó¿ÏÔÁ· Û˘ÌÂÚ¿ÛÌ·Ù·.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Süss D. Impacts of computer- and media usage on the personality development of children and young people. Ther Umsch 2007;64:103-108. 2. Paul B, Bryant JA. Adolescents and the internet. Adolesc Med Clin 2005;16:413-426. 3. Dannon PN, Iancu I. Internet addiction. Harefuah 2007; 146:549-553, 573, 572. 4. Bradley K. Internet lives: social context and moral domain in adolescent development. New Dir Youth Dev 2005;108: 11-12. 5. Valaitis RK. Computers and the internet: tools for youth empowerment. J Med Internet Res 2005;7:e51. 6. Bremer J. The internet and children: advantages and disadvantages. Child Adolesc Psychiatr Clin N Am 2005;14: 405-428. 7. Yan Z. What influences children’s and adolescents’ understanding of the complexity of the Internet? Dev Psychol 2006;42:418-428. 8. Caplan SE. Relations among loneliness, social anxiety, and problematic Internet use. Cyberpsychol Behav 2007;10: 234-242. 9. Pallanti S, Bernardi S, Quercioli L. The Shorter PROMIS Questionnaire and the Internet Addiction Scale in the assessment of multiple addictions in a high-school population: prevalence and related disability. CNS Spectr 2006;11: 966-974. 10. Leung L. Stressful life events, motives for Internet use, and social support among digital kids. Cyberpsychol Behav 2007;10:204-214. 11. Shapira NA, Goldsmith TD, Keck PE Jr, Khosla UM, McElroy SL. Psychiatric features of individuals with problematic internet use. J Affect Disord 2000;57:267-272. ¶·È‰È·ÙÚÈ΋ 2008;71:441-448
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12. Chak K, Leung L. Shyness and locus of control as predictors of internet addiction and internet use. Cyberpsychol Behav 2004;7:559-570. 13. Ng BD & Wiemer-Hastigs P. Addiction to the internet and online gaming. Cyberpsychol Behav 2005;8:110-113. 14. Suhail K, Bargees Z. Effects of excessive internet use on undergraduate students in Pakistan. Cyberpsychol Behav 2006;9:297-307. 15. Borzekowski DL. Adolescents’ use of the Internet: a controversial, coming of age resource. Adolesc Med Clin 2006;17:205-216. 16. Widyanto L, McMurran M. The psychometric properties of the internet addiction test. Cyberpsychol Behav 2004;7: 443-450. 17. Madell D, Muncer S. Back from the beach but hanging on the telephone? English adolescents’ attitudes and experiences of mobile phones and the internet. Cyberpsychol Behav 2004;7:359-367. 18. Rees H, Noyes JM. Mobile telephones, computers, and the internet: sex differences in adolescents’ use and attitudes. Cyberpsychol Behav 2007;10:482-484. 19. Wu CS, Cheng FF. Internet café addiction of Taiwanese adolescents. Cyberpsychol Behav 2007;10:220-225. 20. Lee MS, Ko YH, Song HS, Kwon KH, Lee HS, Nam M, et al. Characteristics of Internet use in relation to game genre in Korean adolescents. Cyberpsychol Behav 2007;10:278-285. 21. Griffiths MD, Hunt N. Dependence on computer games by adolescents. Psychol Rep 1998;82:475-480. 22. Grusser SM, Thalemann R, Albrecht U, Thalemann CN. Excessive computer usage in adolescents - results of a psychometric evaluation. Wien Klin Wochenschr 2005;117: 188-195. 23. Johansson A, Gotestam KG. Problems with computer games without monetary reward: similarity to pathological gambling. Psychol Rep 2004;95:641-650. 24. Skinner H, Biscope S, Murray M, Koru D. Dares to addiction: youth definitions and perspectives on gambling. Can J Public Health 2004;95:264-267. 25. Ko CH, Yen JY, Chen CC, Chen SH, Yen CF. Gender
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∏ ¯Ú‹ÛË ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ˘ÔÏÔÁÈÛÙÒÓ Î·È ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ·fi ·È‰È¿-ÂÊ‹‚Ô˘˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ ∞. ¶··‰ÔÔ‡ÏÔ˘, °. ª›¯·˜, º. ª›¯·˜, ∞. ∑ÂÚ‚Ô˘‰¿ÎË, ∫. ∆ÛÔ˘Ì¿Î·˜, ¶. °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯·
π·ÙÚÂ›Ô ∂ÊË‚È΋˜ π·ÙÚÈ΋˜, ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆
¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∆· ·È‰È¿ ·fi ÌÈÎÚ‹ ËÏÈΛ· ¤Ú¯ÔÓÙ·È Û ·ʋ Ì ÙÔ˘˜ ËÏÂÎÙÚÔÓÈÎÔ‡˜ ˘ÔÏÔÁÈÛÙ¤˜ (∏À) Î·È Ì ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ·˘ÙÔ› ÂÁ΢ÌÔÓÔ‡Ó. ™ÎÔfi˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë Î·Ù·ÁÚ·Ê‹ Ù˘ ¯Ú‹Û˘ ÙÔ˘˜ ·fi Ù· ·È‰È¿ Ù˘ ∞ı‹Ó·˜ Î·È Ë ·Ó¿Ï˘ÛË ÙˆÓ ·ÈÙÈÔÏÔÁÈÎÒÓ ·Ú·ÁfiÓÙˆÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: 213 ·È‰È¿ (46% ·ÁfiÚÈ·, ̤ÛË ËÏÈΛ· 12,3 ÂÙÒÓ) ‰ËÌÔÙÈÎÔ‡ Î·È Á˘ÌÓ·Û›Ô˘ Ù˘ ÂÚÈÔ¯‹˜ Ù˘ ∞ı‹Ó·˜ Û˘ÌÏ‹ÚˆÛ·Ó ÂȉÈÎfi ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ™Â٤̂ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2007. ∞ÔÙÂϤÛÌ·Ù·: ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, 90,1% ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ∏À Î·È 69,9% ‰È·‰›ÎÙ˘Ô, Ì ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ ¯Ú‹Û˘ Ù· 8,5 ¤ÙË. ø˜ ·ÚÈÔÈ ÂÎ·È‰Â˘Ù¤˜ ·Ó·Ê¤ÚıËÎ·Ó ÔÈ ÁÔÓ›˜ Î·È Ù· ·‰¤ÏÊÈ· (44,6%), ÙÔ ÊÚÔÓÙÈÛÙ‹ÚÈÔ (22%) Î·È ÙÔ Û¯ÔÏÂ›Ô (14,5%). √ ·Ù¤Ú·˜ ›¯Â ÁÓÒÛÂȘ ∏À Û ÔÛÔÛÙfi 70%, ÂÓÒ Ë ÌËÙ¤Ú· Û ÔÛÔÛÙfi 55,3%, Û ¿ÌÂÛË Û˘Û¯¤ÙÈÛË Ì ÙÔ Â¿ÁÁÂÏÌ¿ ÙÔ˘˜ [OR (95% CI): 3,11 (1,556,26) Î·È 2,37 (1,31-4,28)]. 46,4% ÙˆÓ ·È‰ÈÒÓ Â›¯·Ó ∏À ÛÙÔ ‰ˆÌ¿ÙÈfi ÙÔ˘˜ Î·È Ë ¯Ú‹ÛË ‹Ù·Ó ηıËÌÂÚÈÓ‹ ÛÙÔ 52,6% Î·È 26,2% ÙˆÓ ·È‰ÈÒÓ ÁÈ· ÙÔÓ ∏À Î·È ÙÔ ‰È·‰›ÎÙ˘Ô, ·ÓÙ›ÛÙÔȯ·. √ ÛÎÔfi˜ Ù˘ ¯Ú‹Û˘ ‹Ù·Ó Ë ‰È·ÛΤ‰·ÛË Û ÔÛÔÛÙfi 70% Î·È Ë Âη›‰Â˘ÛË Û ÔÛÔÛÙfi 29%. ªfiÓÔ ÛÙÔ 51,6% ÙˆÓ ·È‰ÈÒÓ ÔÈ ÁÔÓ›˜ ¤‚ÏÂ·Ó ÙË ¯Ú‹ÛË. 32,3% ÙˆÓ ·È‰ÈÒÓ ÂÈÛΤÙÔÓÙ·Ó Û˘¯Ó¿ ›ÓÙÂÚÓÂ٠ηʤ (̤ÛË ËÏÈΛ· 13 ÂÙÒÓ) Î·È 37,8% ÔÚÓÔÁÚ·ÊÈÎÔ‡˜ ‰È·‰ÈÎÙ˘·ÎÔ‡˜ ÙfiÔ˘˜ (̤ÛË ËÏÈΛ· 12,5 ÂÙÒÓ). ∂ÈϤÔÓ, 43 ·È‰È¿ (22,3%) ·Ó¤ÊÂÚ·Ó ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ÌÂÙ¿ ·fi ÔχˆÚË ¯Ú‹ÛË. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ¯Ú‹ÛË ÙˆÓ ∏À Î·È ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ·fi ÙËÓ ÚÒÙË Û¯ÔÏÈ΋ ËÏÈΛ· ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ ‹Ù·Ó ˘„ËÏ‹, ÌÂ Û˘¯ÓfiÙÂÚÔ ÏfiÁÔ ÙËÓ „˘¯·ÁˆÁ›·. √È ÁÔÓ›˜ ‹Ù·Ó Ô Î‡ÚÈÔ˜ ÂÎ·È‰Â˘Ù‹˜, ¯ˆÚ›˜ fï˜ ·Ú΋ ÂÈÙ‹ÚËÛË, Î·È Ù· ·È‰È¿ ‹Ù·Ó ÂÎÙÂıÂÈ̤ӷ ÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘.
AÏÏËÏÔÁÚ·Ê›·: ∞ıËÓ¿ ¶··‰ÔÔ‡ÏÔ˘ athinapap@yahoo.com π·ÙÚÂ›Ô ∂ÊË‚È΋˜ π·ÙÚÈ΋˜, ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆
§¤ÍÂȘ ÎÏÂȉȿ: ∏ÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜, ‰È·‰›ÎÙ˘Ô, ·È‰È¿, ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘.
Computer and internet use by school age children in Athens A. Papadopoulou, G. Michas, F. Michas, A. Zervoudakis, K. Tsoumakas, P. Georgiopoulou-Miha Abstract Background: Children are attracted to computer and internet early in life, which may make them vulnerable to adopting high risk behaviour. The aim of this study was to investigate the prevalence of internet use in school age children and to determine risk factors. Methods: The population sample comprised 213 children (46% boys, mean age 12.3 years) from primary and secondary public schools in Athens, who answered an anonymous questionnaire. Results: Among children in the study, 90.1% used a computer and 69.9% had access to internet, with a mean age of initiation 8.5 years. Children were instructed mainly by parents and siblings (44.6%), only 14.5% by school teachers, while 22% attended private tutorial centres. In their families, 70% of fathers and 55.3% of mothers used a computer, with significant relationship to their occupation [OR (95% CI): 3.11 (1.55-6.26) and 2.37 (1.31-4.28), respectively]. The computer was located in the child’s bedroom in 46.4% of the cases, and daily use was reported to be 52.6% for computer and 26.2% for internet. The main reasons given for the use were recreation (70%) and education (29%). Only 51.6% of parents regularly supervised their children’s use of internet. Among the study children, 32.3% reported visiting an internet café (mean age 13 years) and 37.8% pornographic sites (mean age 12.5 years). Health problems due to overuse were reported by 43 children (22.3%). Conclusions: The majority of school age children in Athens use computer and internet, mainly for recreation. The family is reported to be the main educator; however, parental supervision is inadequate and many children have opportunities to visit “garbage sites”.
Adolescent Medicine Clinic, Paediatric Department, KAT General Hospital Correspondence: Athina Papadopoulou athinapap@yahoo.com Adolescent Medicine Clinic, Paediatric Department, KAT General Hospital
Key words: Computer, internet, children, risk factors
¶·È‰È·ÙÚÈ΋ 2008;71:449-457
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·450
450
∞. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.
∂ÈÛ·ÁˆÁ‹ √ ËÏÂÎÙÚÔÓÈÎfi˜ ˘ÔÏÔÁÈÛÙ‹˜ (∏À) Â›Ó·È Ë Û˘Û΢‹ Ô˘, ÂÚÈÛÛfiÙÂÚÔ ·fi ÔÔÈ·‰‹ÔÙ ¿ÏÏË, ¯·Ú·ÎÙËÚ›˙ÂÈ ÙËÓ ÂÔ¯‹ Ì·˜. Œ¯ÔÓÙ·˜ ‰ÈÂÈÛ‰‡ÛÂÈ Û fiÏÔ˘˜ ÙÔ˘˜ ÙÔÌ›˜ Ù˘ ηıËÌÂÚÈÓ‹˜ Ì·˜ ˙ˆ‹˜, ‰ÂÓ Â›Ó·È ·ÏÒ˜ ÌÈ· Û˘Û΢‹ ÂÎÙ¤ÏÂÛ˘ ˘ÔÏÔÁÈÛÌÒÓ, ·ÏÏ¿ ·ÔÙÂÏ› ··Ú·›ÙËÙÔ ÂÚÁ·ÏÂ›Ô Ù˘ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ï›ÛÙˆÓ Â·ÁÁÂÏÌ¿ÙˆÓ, Ù˘ ·fiÎÙËÛ˘, ÌÂÙ¿‰ÔÛ˘ Î·È ·Ó¿Ï˘Û˘ ÏËÚÔÊÔÚÈÒÓ Î·È ÁÓÒÛÂˆÓ Î·È Ù˘ ÔÏÈÙÈÛÌÈ΋˜ Î·È „˘¯·ÁˆÁÈ΋˜ ‰Ú·ÛÙËÚÈfiÙËÙ·˜ Ù˘ Û‡Á¯ÚÔÓ‹˜ ˙ˆ‹˜. ∆· ·È‰È¿ ·fi ÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ· ¤Ú¯ÔÓÙ·È Û ¿ÌÂÛË ‹ ¤ÌÌÂÛË Â·Ê‹ Ì ÙÔ˘˜ ∏À, ·Ú¯Èο ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Î·È ·ÚÁfiÙÂÚ· ÛÙÔ Û¯ÔÏ›Ô. ∏ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÓÔÈÎÔ΢ÚÈÒÓ ÛÙȘ ‰˘ÙÈΤ˜ ÎÔÈӈӛ˜ ‰È·ı¤ÙÂÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ∏À Î·È ÔÈ ÁÔÓ›˜ ÂÈ˙ËÙÔ‡Ó ÙËÓ ÂÍÔÈΛˆÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Ì ÙËÓ Î·ÈÓÔ‡ÚÁÈ· Ù¯ÓÔÏÔÁ›·, ̤۷ ·fi ÙËÓ ÔÔ›· ÌÔÚÔ‡Ó Ó· ·ÔÎÙ‹ÛÔ˘Ó ÁÓÒÛÂȘ. ∂ÈϤÔÓ, Ë ·Ó·ÛÊ·Ï‹˜ Î·È ··ÈÙËÙÈ΋ Û‡Á¯ÚÔÓË ÎÔÈÓˆÓ›·, Ë ÔÔ›· ÂÁ΢ÌÔÓ› ÁÈ· Ù· ·È‰È¿ ÛÔ‚·ÚÔ‡˜ ÎÈÓ‰‡ÓÔ˘˜ Î·È ÂÁÎψ‚›˙ÂÈ ÙÔ˘˜ ÁÔÓ›˜ Û ·Ú·ÙÂٷ̤ӷ ˆÚ¿ÚÈ· ÂÚÁ·Û›·˜ Î·È ·Ô˘Û›·˜ ·fi ÙÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ÛÈÙÈÔ‡, ¤‰ˆÛ ÂÚÈÛÛfiÙÂÚË ¤ÌÊ·ÛË ÛÙÔ˘˜ ∏À ˆ˜ ÙÚfiÔ ··Û¯fiÏËÛ˘ Î·È ‰ËÌÈÔ˘ÚÁÈ΋˜ „˘¯·ÁˆÁ›·˜ ÙˆÓ ·È‰ÈÒÓ. ªÂ ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ∏À Î·È ÙÔ˘ ÙËÏÂÊÒÓÔ˘ Â›Ó·È ‰˘Ó·Ù‹ Ë Ù·¯‡Ù·ÙË Û‡Ó‰ÂÛË Ì οı ‰ÈÂıÓ‹ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ (internet). ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÙÔ ¯ÚËÛÈÌÔÔÈÔ‡Ó ˆ˜ ̤ÛÔ ÂÈÎÔÈÓˆÓ›·˜, ·Ó·˙‹ÙËÛ˘ ÏËÚÔÊÔÚÈÒÓ ÁÈ· Û¯ÔÏÈΤ˜ ÂÚÁ·Û›Â˜, ÁÈ· Âȉ‹ÛÂȘ, ÌÔ˘ÛÈ΋, Ù·Èӛ˜, ·ıÏËÙÈÛÌfi, ˘Á›·, ·ÁÔÚ¤˜ Î·È ÚfiÛ‚·ÛË Û ËÏÂÎÙÚÔÓÈο ·È¯Ó›‰È·. ∆Ô ‰È·‰›ÎÙ˘Ô ·ÔÙÂÏ› ÌÈ· ‚È‚ÏÈÔı‹ÎË ÛÙÔ Û›ÙÈ, ¤Ó· ·Ú¿ı˘ÚÔ ÛÙÔÓ ÎfiÛÌÔ Î·È, ȉȷ›ÙÂÚ· ÁÈ· ¤Ó· ·È‰›, ·ÔÙÂÏ› ÙÔÓ ÙÚfiÔ Ì ÙÔÓ ÔÔ›Ô ı· ·Ó·Ù‡ÍÂÈ ÔÏϤ˜ ·fi ÙȘ ‰ÂÍÈfiÙËÙ¤˜ ÙÔ˘. ŸÌˆ˜, ·ÓËÛ˘¯›· ÚÔηÏ› Ë ÚfiÛ‚·ÛË Û ·È¯Ó›‰È· Ô˘ ¯·Ú·ÎÙËÚ›˙ÔÓÙ·È ÔÏÂÌÈο ‹ ‚›·È·. √ ۯ‰ȷÛÌfi˜ ·˘ÙÒÓ Â›Ó·È Ù¤ÙÔÈÔ˜ ÒÛÙ ӷ ·È¯Ì·ÏˆÙ›˙Ô˘Ó ÙËÓ ÂÚȤÚÁÂÈ·, ÙË ‰˘Ó·ÌÈÎfiÙËÙ· Î·È ÙË ‰ËÌÈÔ˘ÚÁÈÎfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ Î·È ÔÏϤ˜ Â›Ó·È ÔÈ ·Ó·ÊÔÚ¤˜ Ù· ÙÂÏÂ˘Ù·›· ¯ÚfiÓÈ· ÁÈ· ÙËÓ ·ÚÓËÙÈ΋ ›‰Ú·Û‹ ÙÔ˘˜ (1,2). ¶·Ú·ÙËÚ‹ıËΠfiÙÈ Ù· ·È‰È¿ Ô˘ ·›˙Ô˘Ó ‚›·È· ·È¯Ó›‰È· ·Ó·Ù‡ÛÛÔ˘Ó ‚›·È˜ ÛΤ„ÂȘ, ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Î·È Ì›ˆÛË ÙÔ˘ Ô˘‰Ô‡ ·ÓÙÔ¯‹˜ Û ÂÚÈ‚·ÏÏÔÓÙÈο ÂÚÂı›ÛÌ·Ù· (‡ÎÔÏÔ˜ Î·È ˘¤ÚÌÂÙÚÔ˜ ı˘Ìfi˜). ∆· ·È‰È¿ Â›Ó·È ÌÈÌËÙÈο fiÓÙ· Î·È ¤Ó·˜ ‚·ÛÈÎfi˜ ÙÚfiÔ˜ Âη›‰Â˘Û‹˜ ÙÔ˘˜ Â›Ó·È Ì¤Û· ·fi ÙËÓ ·Ú·Ù‹ÚËÛË Î·È ÙË Ì›ÌËÛË. ŒÙÛÈ, ÙÂÏÈο, Ë Û˘Ó¯‹˜ ·ʋ Ì ÛÎËÓ¤˜ ‚›·˜ ÛÙ¤ÏÓÂÈ ÛÙ· ·È‰È¿ ÙÔ Ì‹Ó˘Ì· fiÙÈ Ë ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Â›Ó·È ÎÔÈÓˆÓÈο ·Ô‰ÂÎÙ‹ Î·È Ù· ·Â˘·ÈÛıËÙÔÔÈ› Paediatriki 2008;71:449-457
ÛÂ Û˘ÌÂÚÈÊÔÚ¤˜ Ô˘ Ô ÔÏÈÙÈÛÌfi˜ Î·È Ô ·ÓıÚˆÈÛÌfi˜ ηٷ‰Èο˙Ô˘Ó (3). ∂ÈÚfiÛıÂÙ·, Â›Ó·È ·ÓËÛ˘¯ËÙÈ΋ Ë ·˘ÍË̤ÓË ‰˘Ó·ÙfiÙËÙ· ÚfiÛ‚·Û˘ Û ÔÚÓÔÁÚ·ÊÈÎÔ‡˜, ÚÔÛ‚ÏËÙÈÎÔ‡˜ Î·È ·Î·Ù¿ÏÏËÏÔ˘˜ ‰È·‰ÈÎÙ˘·ÎÔ‡˜ ÙfiÔ˘˜ Î·È Ë fi¯È Û¿ÓÈ· ÛÂÍÔ˘·ÏÈ΋ ÂÎÌÂÙ¿ÏÏ¢ÛË ÙˆÓ ·È‰ÈÒÓ ·fi ·È‰fiÊÈÏÔ˘˜ ÂÚ·ÛÙ¤˜. ∂›Ó·È ‰‡ÛÎÔÏÔ Ó· ÂÎÙÈÌËı› Ë ¤ÎÙ·ÛË Ù˘ ·È‰È΋˜ ÔÚÓÔÁÚ·Ê›·˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ˘¿Ú¯Ô˘Ó 14 ÂηÙÔÌ̇ÚÈ· ‰È·‰ÈÎÙ˘·ÎÔ› ÙfiÔÈ ÔÈ ÔÔ›ÔÈ ·Ú¤¯Ô˘Ó ‡ÎÔÏË ÚfiÛ‚·ÛË. ªÂϤÙ˜ ·fi ÙȘ ∏¶∞ Î·È ÙË ª. µÚÂÙÙ·Ó›· ‰Â›¯ÓÔ˘Ó fiÙÈ 20-25% ÙˆÓ ·È‰ÈÒÓ Î·È 70% ÙˆÓ ÂÊ‹‚ˆÓ ËıÂÏË̤ӷ ‹ Ù˘¯·›· ¤Ú¯ÔÓÙ·È Û ·ʋ Ì ÔÚÓÔÁÚ·ÊÈÎÔ‡ ÂÚȯÔ̤ÓÔ˘ ˘ÏÈÎfi, ÂÓÒ 19% ÂÍ ·˘ÙÒÓ ¤¯Ô˘Ó ‰Â¯ı› ÛÂÍÔ˘·ÏÈ΋ ÚfiÛÎÏËÛË (4). √ ÌÂÁ·Ï‡ÙÂÚÔ˜ fï˜ ΛӉ˘ÓÔ˜ Ù˘ ¯Ú‹Û˘ Â›Ó·È Ô ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜, o ÔÔ›Ô˜ ·Ó·Ù‡ÛÛÂÙ·È ÌÂÙ¿ ·fi ÔχˆÚË Î·ıËÌÂÚÈÓ‹ ¯Ú‹ÛË. √ fiÚÔ˜ ˘ÈÔıÂÙ‹ıËΠÚÒÙ· ·fi ÙÔÓ „˘¯›·ÙÚÔ I. Goldberg ÙÔ 1994 ηÈ, Ï›ÁÔ ·ÚÁfiÙÂÚ·, Ë Dr KS Young ‰ËÌÈÔ‡ÚÁËÛ ÙÔ ∫¤ÓÙÚÔ ∞ÂÍ¿ÚÙËÛ˘ ·fi ÙÔÓ ¢È·‰ÈÎÙ˘·Îfi ∂ıÈÛÌfi (Centre of Internet Addiction Recovery) ÛÙËÓ ¶ÂÓÛÈÏ‚¿ÓÈ· (5,6). ™‹ÌÂÚ·, Ë ÓfiÛÔ˜ ·Ó·ÁÓˆÚ›˙ÂÙ·È ·ÁÎÔÛÌ›ˆ˜ Î·È Á›ÓÔÓÙ·È ÔÏϤ˜ ÚÔÛ¿ıÂȘ ÁÈ· ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ¯ÚËÛÙÒÓ (7). ∏ ÍËÚÔÊı·ÏÌ›·, ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ηÚÈ·›Ô˘ ۈϋӷ Î·È ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ÙˆÓ ‰·ÎÙ‡ÏˆÓ ·fi ÙȘ ÌÔÓfiÙÔÓ˜ ÎÈÓ‹ÛÂȘ Â›Ó·È Û˘¯Ó¿ Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù·, ÂÓÒ Ô ÂıÈṲ̂ÓÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÁÂÓÈ΋ ·Ì¤ÏÂÈ· ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ Î·È Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘ Î·È ¿ÚÓËÛË ÁÈ· ‡ÓÔ Î·È ÎÔÈÓˆÓÈΤ˜ ·ʤ˜. °È· ÙÔ˘˜ ÏfiÁÔ˘˜ ·˘ÙÔ‡˜, Â›Ó·È ÂȂ‚ÏË̤ÓÔ Î¿ı ¯ÒÚ· Ó· ηٷÁÚ¿„ÂÈ ÙËÓ Â›ÙˆÛË Ù˘ ¯Ú‹Û˘ Î·È Ó· ηıÔÚ›ÛÂÈ ÙËÓ ¤ÎÙ·ÛË ÙˆÓ ·ÚÓËÙÈÎÒÓ ÂȉڿÛˆÓ, ÒÛÙ ӷ ÏËÊıÔ‡Ó ÚÔÏËÙÈο ̤ÙÚ·. ™ÙËÓ ∂ÏÏ¿‰· Ù· ‰Â‰Ô̤ӷ Â›Ó·È ÂÏÏÈ‹. °È’ ·˘Ùfi, Ë ·ÚÔ‡Û· ÌÂϤÙË Â›¯Â ˆ˜ ÛÎÔfi ÙËÓ Î·Ù·ÁÚ·Ê‹ Ù˘ ¯Ú‹Û˘ ÙˆÓ ∏À Î·È ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Û ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ Î·È ÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó ÙË ¯Ú‹ÛË.
ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ∏ Û˘ÏÏÔÁ‹ ÛÙÔȯ›ˆÓ ¤ÁÈÓ ·fi ‰ËÌfiÛÈ· Û¯ÔÏ›· Ô˘ ÂÈϤ¯ıËÎ·Ó ÌÂÙ¿ ·fi Ù˘¯·ÈÔÔ›ËÛË Ì ‚¿ÛË ÙË ¯ˆÚÔı¤ÙËÛË. ∏ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ ¯ˆÚ›ÛÙËΠ۠ÎÂÓÙÚÈÎfi, ‚fiÚÂÈÔ Î·È ÓfiÙÈÔ ÚÔ·ÛÙÈ·Îfi ÙÌ‹Ì· Î·È ÂÈϤ¯ıËÎ·Ó ‰‡Ô Û¯ÔÏ›· (¤Ó· ‰ËÌÔÙÈÎfi Î·È ¤Ó· Á˘ÌÓ¿ÛÈÔ) ·fi οı ÙÌ‹Ì·. ªÂÙ¿ ·fi ÂÓË̤ڈÛË Î·È ¤ÁÎÚÈÛË ÙˆÓ Û˘ÏÏfiÁˆÓ ÁÔÓ¤ˆÓ ÙˆÓ Û¯ÔÏ›ˆÓ, ¯ÔÚËÁ‹ıËΠÛÙ· ·È‰È¿ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ Ù¿ÍÂˆÓ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ (¢ã, ∂ã, ™∆ã) Î·È ÙˆÓ Ù¿ÍÂˆÓ ÙˆÓ Á˘ÌÓ·Û›ˆÓ ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ηٿ ÙËÓ ÂÚ›Ô‰Ô ™Â٤̂ÚÈÔ˜-¢ÂΤ̂ÚÈÔ˜ 2007. ∆Ô Û˘ÓÔÏÈÎfi ÔÛÔÛÙfi Û˘ÌÌÂÙÔ¯‹˜ ‹Ù·Ó 69% Î·È 41%, ·ÓÙ›ÛÙÔȯ·, ÁÈ· Ù· ‰ËÌÔÙÈο Î·È Ù· Á˘ÌÓ¿ÛÈ· Î·È ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙ· ¯ˆÚÔÙ·ÍÈο ÙÌ‹Ì·Ù·. ™˘ÏϤ¯ıËÎ·Ó 213
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·451
451
∏ÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ ÛÙ· ·È‰È¿
¶›Ó·Î·˜ 1. ∫ÔÈÓˆÓÈÎÔÈÎÔÓÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ - ™‡ÁÎÚÈÛË ÌÂٷ͇ ‰ËÌÔÙÈÎÔ‡ Î·È Á˘ÌÓ·Û›Ô˘ ∞ÁfiÚÈ· (%)
°˘ÌÓ¿ÛÈÔ ∫ÔÚ›ÙÛÈ· (%)
™‡ÓÔÏÔ (%)
™‡ÓÔÏÔ
p
71 (51,01) 139 (100) 11,0 11,1
30 (40,5) 14,3
44 (59,5) 14,7
74 (100) 14,6
213 (100) 12,3
0,31 0,001
17 (25) 51 (75)
19 (27,8) 52 (73,2)
36 (25,8) 103 (74,2)
16 (53,3) 14 (46,6)
19 (43,1) 25 (56,8)
35 (47,3) 39 (52,6)
71 (33,3) 0,001 142 (66,6)
10 (14,7) 31 (45,8) 7 (10,3) 20 (29,8)
15 (21,1) 26 (36,9) 4 (5,6) 26 (36,6)
25 (18) 57 (41) 11 (7,9) 46 (33)
4 (13,4) 8 (26,6) 2 (6,6) 16 (53,3)
7 (15,9) 16 (36,7) 6 (13,6) 15 (34,4)
11 (14,9) 24 (32,4) 8 (10,8) 31 (41,9)
36 (16,9) 81 (38) 19 (8,9) 77 (36,2)
62 (91,6) 11 (17,5) 7 (10,3) 3 (4,5)
71 (100) 9 (12,6) 7 (10) 4 (5,6)
134 (96,4) 16 (11,5) 14 (10) 7 (5,0)
29 (96,7) 6 (23,2) 3 (10,3) 3 (10,3)
43 (97,7) 5 (11,3) 1 (2,5) 6 (13,6)
72 (97,3) 11 (14,8) 4 (5,4) 9 (12,1)
204 (96,0) 31 (15) 18 (8,5) 16(7,5)
20 (29,4) 23 (34,2) 17 (25,5) 8 (12,1)
24 (33,8) 30 (42,7) 14 (19,7) 3 (4,5)
44 (31,6) 53 (38,1) 31 (22,3) 11 (8)
13 (43,3) 5 (16,7) 10 (33,3) 2 (6,6)
17 (38,9) 18 (40,9) 8 (18,1) 1 (2,2)
30 (40,5) 23 (31) 18 (24,3) 3 (4,1)
74 (34,7) 76 (35,8) 49 (23) 14 (6,6)
7 (10,3) 23 (33,9) 4 (5,8) 27 (39,7)* 7 (10,3)
12 (16,9) 29 (41) 14 (19,7) 13 (18,5) 3 (4,4)
19 (13,6) 52 (37,4) 18 (12,9) 40 (28,7) 10 (7,1)
4 (13,3) 12 (40,4) 8 (26,6) 7 (23,3) 1 (3,3)
7 (15,9) 16 (36,7) 9 (20,4) 9 (20,4) 1 (2,2)
11 (14,8) 28 (37,8) 17 (22,9) 16 (21,6) 2 (2,7)
30 (14,2) 80 (37,5) 35 (16,4) 56 (26,3) 12 (5,7)
∞ÁfiÚÈ· (%) N ª¤ÛË ËÏÈΛ· (¤ÙË) ∆ÔÔıÂÛ›· Û¯ÔÏ›Ԣ - ΤÓÙÚÔ - ÚÔ¿ÛÙÈ· ™ÂÈÚ¿ Á¤ÓÓËÛ˘ - ÌÔÓ·¯Ô·›‰È - ÚÒÙÔ - ÌÂÛ·›Ô - ÙÂÏÂ˘Ù·›Ô °ÓÒÛÂȘ - ·ÁÁÏÈ΋˜ ÁÏÒÛÛ·˜ - Á·ÏÏÈ΋˜ ÁÏÒÛÛ·˜ - ÁÂÚÌ·ÓÈ΋˜ ÁÏÒÛÛ·˜ ª·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ∂¿ÁÁÂÏÌ· ÌËÙ¤Ú·˜ - ÔÈÎȷο - ˘¿ÏÏËÏÔ˜ - ÂÈÛÙ‹ÌÔÓ·˜ - ÂȯÂÈÚËÌ·Ù›·˜ ∂¿ÁÁÂÏÌ· ·Ù¤Ú· - ÂÚÁ¿Ù˘ - ˘¿ÏÏËÏÔ˜ - ÂÈÛÙ‹ÌÔÓ·˜ - ÂȯÂÈÚËÌ·Ù›·˜ - Û˘ÓÙ·ÍÈÔ‡¯Ô˜
68 (48,9) 11,2
¢ËÌÔÙÈÎfi ∫ÔÚ›ÙÛÈ· (%)
™‡ÓÔÏÔ (%)
0,39
0,18 0,10
0,31
0,30
* ¢ÂÓ ÛËÌÂÈÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ, ÏËÓ Ù˘ ·ÚÔ˘Û›·˜ ÂÚÈÛÛfiÙÂÚˆÓ ·ÁÔÚÈÒÓ ÛÙÔ ‰ËÌÔÙÈÎfi Ì ·Ù¤Ú˜ ÂȯÂÈÚË̷ٛ˜
··ÓÙË̤ӷ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (46% ·ÁfiÚÈ·, ̤ÛË ËÏÈΛ· 12,3 ÂÙÒÓ), Ù· ÔÔ›· ηٷ¯ˆÚ‹ıËÎ·Ó Î·È ·Ó·Ï‡ıËÎ·Ó Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÛÙ·ÙÈÛÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ SPSS 12.0. ÃÚËÛÈÌÔÔÈ‹ıËΠÙÔ ÙÂÛÙ χ2 Î·È ÙÔ t ÙÂÛÙ ÁÈ· ÙË Û‡ÁÎÚÈÛË ÙˆÓ ÔÛÔÙÈÎÒÓ Î·È ÔÈÔÙÈÎÒÓ ÌÂÙ·‚ÏËÙÒÓ ·Ó¿ÌÂÛ· ÛÙÔ ‰ËÌÔÙÈÎfi Î·È ÙÔ Á˘ÌÓ¿ÛÈÔ Î·È ·Ó¿ÌÂÛ· ÛÙ· ·È‰È¿ Ô˘ ηÙÔÈÎÔ‡Û·Ó ÛÙÔ Î¤ÓÙÚÔ Î·È ÛÙ· ÚÔ¿ÛÙÈ· ÙˆÓ ∞ıËÓÒÓ. ∆· Odds Ratios Î·È 95% Confidence Intervals ˘ÔÏÔÁ›ÛÙËÎ·Ó Ì ÙË ‚Ô‹ıÂÈ· Ù˘ ÏÔÁÈÛÌÈ΋˜ ÔÏÏ·Ï‹˜ ·Ú·ÁÔÓÙÔÔ›ËÛ˘ (forward logistic regression) Î·È ·Ó·˙ËÙ‹ıËÎ·Ó ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ Î·È Û˘Û¯ÂÙ›ÛÂȘ ÌÂٷ͇ ÙˆÓ ‰Â‰Ô̤ӈÓ.
∞ÔÙÂϤÛÌ·Ù· ∆· ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. ∆· ÂÚÈÛÛfiÙÂÚ· ·È‰È¿ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ÙÔ Û¯ÔÏÂ›Ô Ù˘ ÁÂÈÙÔÓÈ¿˜ ÙÔ˘˜ (33,3% ÛÙÔ Î¤ÓÙÚÔ Î·È 66,6% Û ÚÔ¿ÛÙÈ· ÙˆÓ ∞ıËÓÒÓ) Î·È Û¯Â‰fiÓ fiÏ· (96%) ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó ·ÁÁÏÈο ˆ˜ ͤÓË ÁÏÒÛÛ·. ¶·Ú·ÙËÚ‹ıËΠ˘„ËÏfiÙÂÚÔ ÔÛÔÛÙfi Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ÛÙÔ Á˘ÌÓ¿ÛÈÔ (12,1% ¤Ó·ÓÙÈ 5%), ¯ˆÚ›˜ fï˜ ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ [OR (95% CI): 2,44 (0,87-6,88)]. ™Â ÔÛÔÛÙfi 16,9%, Ù· ·È‰È¿ ‰ÂÓ Â›¯·Ó ¿ÏÏ· ·‰¤ÏÊÈ·, ÂÓÒ 38% ‹Ù·Ó ÚÒÙ· Î·È 36,2% ÙÂÏÂ˘Ù·›· ÛÙË
ÛÂÈÚ¿ Á¤ÓÓËÛ˘. ∆Ô Â¿ÁÁÂÏÌ· ÙˆÓ ÁÔÓ¤ˆÓ, ˆ˜ ‰Â›ÎÙ˘ Âη›‰Â˘Û˘ Î·È ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂȤ‰Ô˘ Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ¤‰ÂÈÍ fiÙÈ 42,7% ÙˆÓ ·Ù¤ÚˆÓ Î·È 29,6% ÙˆÓ ÌËÙ¤ÚˆÓ ·Ó‹Î·Ó Û ˘„ËÏ‹ ÎÔÈÓˆÓÈ΋ Ù¿ÍË, ÂÓÒ 1/3 ÙˆÓ ÌËÙ¤ÚˆÓ Â›¯·Ó ˆ˜ ··Û¯fiÏËÛË Ù· ÔÈÎȷο. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙ· ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Î·È ÙÔ˘ Á˘ÌÓ·Û›Ô˘. ™ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ΤÓÙÚÔ˘ Î·È ÙˆÓ ÚÔ·ÛÙ›ˆÓ (¶›Ó·Î·˜ 2), ‰È·ÈÛÙÒıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÛÙËÓ ÂÎÌ¿ıËÛË Ù˘ Á·ÏÏÈ΋˜ ÁÏÒÛÛ·˜ Î·È ÛÙÔ ÔÛÔÛÙfi ÂȯÂÈÚËÌ·ÙÈÒÓ (p<0,05). ¶ÔÛÔÛÙfi 90,1% ÙˆÓ ·È‰ÈÒÓ (85,6% ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Î·È 98,6% ÙÔ˘ Á˘ÌÓ·Û›Ô˘ [OR (95% CI): 1,15 (1,07-1,24)] ‹ÍÂÚ ӷ ¯ÚËÛÈÌÔÔÈ› ∏À, Ì ̤ÛË ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÂÎÌ¿ıËÛ˘ Ù· 8,5 ¤ÙË (¶›Ó·Î·˜ 3). ™ËÌ·ÓÙÈο ÌÈÎÚfiÙÂÚË ËÏÈΛ· ¤Ó·Ú͢ ·Ú·ÙËÚ‹ıËΠÛÙ· ·È‰È¿ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ [OR (95% CI): 1,55 (1,261,92)], ÛÙ· ·ÁfiÚÈ· [OR (95% CI): 1,20 (1,03-1,43)], ÛÙ· ·È‰È¿ ÙˆÓ ÚÔ·ÛÙ›ˆÓ [OR (95% CI): 1,29 (1,061,56)] Î·È ÛÙ· ·È‰È¿ Ì ÁÔÓ›˜ (·Ù¤Ú·˜ ‹/Î·È ÌËÙ¤Ú·) ÁÓÒÛÙ˜ Ù˘ ¯Ú‹Û˘ ∏À [OR (95% CI): 0,77 ¶·È‰È·ÙÚÈ΋ 2008;71:449-457
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·452
452
∞. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 2. ∫ÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ - ™‡ÁÎÚÈÛË ÌÂٷ͇ ÙˆÓ ÙÌËÌ¿ÙˆÓ Ù˘ ∞ı‹Ó·˜
ª¤ÛË ËÏÈΛ· (¤ÙË) ™ÂÈÚ¿ Á¤ÓÓËÛ˘ - ÌÔÓ·¯Ô·›‰È - ÚÒÙÔ - ÌÂÛ·›Ô - ÙÂÏÂ˘Ù·›Ô °ÓÒÛÂȘ - ·ÁÁÏÈ΋˜ ÁÏÒÛÛ·˜ - Á·ÏÏÈ΋˜ ÁÏÒÛÛ·˜ - ÁÂÚÌ·ÓÈ΋˜ ÁÏÒÛÛ·˜ ª·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ∂¿ÁÁÂÏÌ· ÌËÙ¤Ú·˜ - ÔÈÎȷο - ˘¿ÏÏËÏÔ˜ - ÂÈÛÙ‹ÌÔÓ·˜ - ÂȯÂÈÚËÌ·Ù›·˜ ∂¿ÁÁÂÏÌ· ·Ù¤Ú· - ÂÚÁ¿Ù˘ - ˘¿ÏÏËÏÔ˜ - ÂÈÛÙ‹ÌÔÓ·˜ - ÂȯÂÈÚËÌ·Ù›·˜ - Û˘ÓÙ·ÍÈÔ‡¯Ô˜
∞ÁfiÚÈ· ¡=35 (%)
∫¤ÓÙÚÔ ∫ÔÚ›ÙÛÈ· ¡=36 (%)
™‡ÓÔÏÔ ¡=71 (%)
∞ÁfiÚÈ· ¡=64 (%)
¶ÚÔ¿ÛÙÈ· ∫ÔÚ›ÙÛÈ· ¡=78 (%)
™‡ÓÔÏÔ ¡=142 (%)
p
12,7
12,5
12,6
11,9
12,4
12,15
0,12
5 (14,2) 12 (34,2) 2 (5,7) 16 (45,7)
8 (22,2) 14 (38,8) 1 (2,7) 13 (36,1)
13 (18,3) 26 (36,8) 3 (4,7) 29 (40,9)
9 (14,0) 27 (42,4) 7 (11,6) 21 (32,9)
14 (17,9) 28 (36,1) 9 (12,0) 27 (34,7)
23 (16,1) 55 (38,8) 16 (11,2) 48 (33,8)
33 (95,5) 1 (2,8) 3 (8,5) 2 (5,8)
35 (97,2) 2 (5,5) 2 (5,5) 3 (8,3)
68 (95,7) 3 (4,2) 5 (7,1) 5 (7,1)
58 (91,1) 16 (26,4) 7 (11,3) 4 (6,4)
78 (100) 12 (15,3) 6 (7,6) 7 (9,0)
136 (95,7) 28 (19,7) 13 (9,1) 11 (7,8)
15 (42,8) 8 (22,8) 9 (25,7)* 3 (8,5)
12 (33,3) 19 (52,7)* 3 (8,3) 2 (5,5)
27 (38,1) 27 (38,1) 12 (17,4) 5 (7,1)
18 (28,2) 20 (31,6) 19 (29,6) 7 (11,3)
29 (37,4) 29 (37,4) 18 (23,0) 2 (2,5)
47 (33) 49 (34,5) 37 (26,0) 9 (6,3)
7 (2,0) 17 (48,2) 4 (11,4) 6 (17,1) 1 (2,8)
9 (25,0) 13 (36,1) 6 (16,6) 4 (11,1) 4 (11,1)
16 (22,6) 30 (42,5) 10 (14,0) 10 (14,0) 5 (7,1)
6 (9,8) 18 (28,2) 10 (16,0) 26 (40,8) 4 (6,8)
8 (10,2) 32 (41,1) 15 (19,2) 20 (25,6) 3 (3,8)
14 (9,8) 50 (35,2) 25 (17,6) 46 (32,3) 7 (4,9)
0,29
0,04 0,9
0,44
0,05
* ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ
(0,64-0,93)]. ¶ÔÛÔÛÙfi 70% ÙˆÓ ·Ù¤ÚˆÓ Î·È 55,4% ÙˆÓ ÌËÙ¤ÚˆÓ ‹ÍÂÚ ӷ ¯ÚËÛÈÌÔÔÈ› ∏À Î·È Ë ¯Ú‹ÛË Â›¯Â ¿ÌÂÛË Û˘Û¯¤ÙÈÛË Ì ÙÔ Â¿ÁÁÂÏÌ· [OR (95% CI): 3,11 (1,55-6,26) Î·È 2,37(1,31-4,28), ·ÓÙ›ÛÙÔȯ·]. ¶·ÚfiÏ· ·˘Ù¿, 62,7% ÙˆÓ ÌËÙ¤ÚˆÓ Ô˘ ‰‹ÏˆÛ·Ó ˆ˜ ··Û¯fiÏËÛË Ù· ÔÈÎȷο ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ∏À.
∫‡ÚÈÔÈ ÂÎ·È‰Â˘Ù¤˜ (44,6%) ‹Ù·Ó ÔÈ ÁÔÓ›˜ Î·È Ù· ·‰¤ÚÊÈ· ηÈ, Û ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi, ÙÔ Û¯ÔÏÂ›Ô (14,5%). 22% ÙˆÓ ·È‰ÈÒÓ ‰‹ÏˆÛ·Ó fiÙÈ ·Ú·ÎÔÏÔ‡ıËÛ·Ó È‰ÈˆÙÈο Ì·ı‹Ì·Ù·. ™ÙÔ Î¤ÓÙÚÔ Ù˘ ∞ı‹Ó·˜, ÙÔ Û¯ÔÏÂ›Ô ÂÈÙÂÏÔ‡Û ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ Âη›‰Â˘ÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ Î·È Ë ÔÈÎÔÁ¤ÓÂÈ·
¶›Ó·Î·˜ 3. ¶ÔÛÔÛÙ¿ Î·È OR (95% CI) ÁÈ· ÙË ¯Ú‹ÛË ÙˆÓ ∏À ÛÙ· ·È‰È¿ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Î·È ÙÔ˘ Á˘ÌÓ·Û›Ô˘ Î·È ÛÙ· ‰‡Ô ʇϷ ™‡ÓÔÏÔ ¢ËÌÔÙÈÎfi °˘ÌÓ¿ÛÈÔ ¡=213 (%) ¡=139 (%) ¡=74 (%) ÃÚ‹ÛË ∏À 192 (90,1) ∏ÏÈΛ· ¤Ó·Ú͢ ¯Ú‹Û˘ (ÂÙÒÓ) 8,5 ∂Î·È‰Â˘Ù‹˜ - ÔÈÎÔÁ¤ÓÂÈ· 95 (44,6) - Û¯ÔÏÂ›Ô 31 (14,5) - ÊÚÔÓÙÈÛÙ‹ÚÈÔ 47 (22,0) ∫·ÙÔ¯‹ ∏À ÛÙÔ Û›ÙÈ 185 (86,8) £¤ÛË ∏À ÛÙÔ Û›ÙÈ - ˘ÓÔ‰ˆÌ¿ÙÈÔ ·È‰ÈÔ‡ 99 (46,4) - Û·ÏfiÓÈ 46 (21,6) - ÁÚ·ÊÂ›Ô 75 (35,2) ∏ÏÈΛ· ÂÈÛfi‰Ô˘ ÙÔ˘ ∏À ÛÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡ (¤ÙË) 9,5 ∫·ıËÌÂÚÈÓ‹ ¯Ú‹ÛË ∏À 101 (52,6) ÃÚ‹ÛË ∏À ·fi ·Ù¤Ú· 149 (70) ÃÚ‹ÛË ∏À ·fi ÌËÙ¤Ú· 118 (55,3) * p<0,05 Paediatriki 2008;71:449-457
OR (95% CI)
∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ¡=98 (%) ¡=115 (%)
OR (95% CI)
119 (85,6) 7,7
73 (98,6) 1,15 (1,07-1,24)* 90 (91,8) 9,6 1,55 (1,26-1,92)* 8,0
102 (88,7) 0,81 (0,46-1,43) 8,9 1,28 (1,01-1,43)
76 (54,6) 8 (5,7) 24 (17,2) 124 (89,2)
19 (25,6) 0,28 (0,15-0,53)* 51 (52,0) 23 (31,0) 5,53 (2,50-12,2)* 10 (10,2) 23 (31,0) 2,21 (1,12-4,36)* 20 (20,4) 62 (83,8) 0,62 (0,27-1,41) 89 (90,8
44 (38,2) 21 (18,2) 27 (23,4) 96 (83,4)
59 (42,4) 33 (23,7) 45 (32,4)
40 (54,0) 2,04 (1,11-3,72)* 48 (48,9) 13 (17,5) 2,56 (0,95-6,84) 26 (26,5) 30 (40,5) 3,42 (1,41-8,29)* 39 (39,7)
51 (44,3) 20 (17,3) 36 (31,3)
0,98 (0,56-1,73) 0,82 (0,38-1,78) 0,94 (0,46-1,93)
8,5 55 (46,2) 106 (76,2) 80 (57,5)
10,7 1,82 (1,30-2,53)* 9,6 46 (63,0) 2,51 (1,36-4,62)* 51 (56,6) 43 (58,1) 0,40 (0,21-0,75)* 68 (69,3) 38 (51,4) 0,77 (0,43-1,37) 57 (58,1)
9,5 50 (49,0) 80 (69,5) 61 (53,0)
0,78 (0,48-1,28) 1,16 (0,86-1,56) 0,48 (0.08-2,9) 1,15 (0,20-6,48)
0,84 (0,5-1,42) 0,69 (0,40-1,2)
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·453
453
∏ÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ ÛÙ· ·È‰È¿
¶›Ó·Î·˜ 4. ¶ÔÛÔÛÙ¿ Î·È OR (95% CI) ÁÈ· ÙË ¯Ú‹ÛË ÙˆÓ ∏À ·Ó¿ÌÂÛ· ÛÙ· ÙÌ‹Ì·Ù· Ù˘ ∞ı‹Ó·˜
ÃÚ‹ÛË ∏À ∏ÏÈΛ· ¤Ó·Ú͢ ¯Ú‹Û˘ (¤ÙË) ∂Î·È‰Â˘Ù‹˜ - ÔÈÎÔÁ¤ÓÂÈ· - Û¯ÔÏÂ›Ô - ÊÚÔÓÙÈÛÙ‹ÚÈÔ ∫·ÙÔ¯‹ ∏À ÛÙÔ Û›ÙÈ £¤ÛË ∏À ÛÙÔ Û›ÙÈ - ˘ÓÔ‰ˆÌ¿ÙÈÔ ·È‰ÈÔ‡ - Û·ÏfiÓÈ - ÁÚ·ÊÂ›Ô ∏ÏÈΛ· ÂÈÛfi‰Ô˘ ÙÔ˘ ∏À ÛÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡ (¤ÙË) ∫·ıËÌÂÚÈÓ‹ ¯Ú‹ÛË ∏À ÃÚ‹ÛË ∏À ·fi ·Ù¤Ú· ÃÚ‹ÛË ∏À ·fi ÌËÙ¤Ú·
™‡ÓÔÏÔ ¡=213 (%)
∫¤ÓÙÚÔ ¡=71 (%)
¶ÚÔ¿ÛÙÈ· ¡=142 (%)
OR (95% CI)
192 (90,1) 8,5
67 (94,3) 9,1
125 (88,0) 8,2
0,93 (0,85-1,01) 1,07 (0,76-1,50)
95 (44,6) 31 (14,5) 47 (22,0) 185 (86,8)
26 (36,6) 18 (25,3) 18 (25,3) 54 (76,0)
69 (48,5) 13 (9,1) 29 (20,4) 131 (92,2)
1,39 (1,01-1,90)* 0,48 (0,23-0,99)* 0,90 (0,53-1,52) 1,2 (1,06-1,39)*
99 (46,4) 46 (21,6) 75 (35,2)
30 (42,2) 18 (25,3) 33 (47,1)
69 (48,5) 28 (19,7) 42 (29,5)
1,18 (0,85-1,65) 0,70 (0,45-1,07) 1,38 (0,94-2,04)
9,5 101 (52,6) 149 (70) 118 (55,3)
10,7 27 (40,0) 42 (59,1) 35 (49,2)
9,0 74 (59,2) 107 (76,4) 83 (58,4)
1,43 (1,02-2,00)* 1,38 (0,97-1,97) 1,29 (1,04-1,61)* 1,16 (0,88-1,53)*
* p<0,05
ÏÈÁfiÙÂÚÔ [OR (95% CI): 0,48 (0,23-0,99)] Î·È ·˘Ùfi Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ·ÚÔ˘Û›· ·Ù¤ÚˆÓ ÌË ¯ÚËÛÙÒÓ ÙˆÓ ∏À (¶›Ó·Î·˜ 4). ∫·ÙÔ¯‹ ∏À ÛÙÔ Û›ÙÈ ·Ú·ÙËÚ‹ıËΠ۠ÔÛÔÛÙfi 86,8% Î·È Û¯Â‰fiÓ Ù· ÌÈÛ¿ Û›ÙÈ· ›¯·Ó ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi 1 ∏À (44,7%). ¶·Ú·ÙËÚ‹ıËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ÌÂٷ͇ ΤÓÙÚÔ˘ Î·È ÚÔ·ÛÙ›ˆÓ [OR (95% CI): 1,2 (1,06-1,39)] (¶›Ó·Î˜ 3 Î·È 4). √ ‹ ÔÈ ∏À ‹Ù·Ó ÙÔÔıÂÙË̤ÓÔÈ Û ÔÛÔÛÙfi 21,6% ÛÙÔ Û·ÏfiÓÈ ÙÔ˘ ÛÈÙÈÔ‡, 35,2% ÛÙÔ ÁÚ·ÊÂ›Ô Î·È 46,4% ÛÙÔ ˘ÓÔ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡. ∆· ·È‰È¿ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ ›¯·Ó Û˘¯ÓfiÙÂÚ· ∏À ÛÙÔ ˘ÓÔ‰ˆÌ¿ÙÈfi ÙÔ˘˜ [OR (95% CI): 2,04 (1,11-3,72)]. ŸÌˆ˜, Ë Ì¤ÛË ËÏÈΛ· ÂÈÛfi‰Ô˘ ÙÔ˘ ∏À ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ ‹Ù·Ó ÛÙ·ÙÈÛÙÈο ÌÈÎÚfiÙÂÚË ÁÈ· Ù· ·È‰È¿
ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ ·fi fi,ÙÈ ÁÈ· Ù· ·È‰È¿ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ [OR (95% CI): 1,82 (1,30-2,53)] Î·È ÁÈ· Ù· ÚÔ¿ÛÙÈ· Û ۯ¤ÛË Ì ÙÔ Î¤ÓÙÚÔ [OR (95% CI): 1,43 (1,022,00)]. ∫·ıËÌÂÚÈÓ‹ ¯Ú‹ÛË ∏À ·Ó¤ÊÂÚ ÙÔ 62,1% ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ Î·È ÙÔ 39,5% ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ [OR (95% CI): 2,51 (1,36-4,62)]. ∏ ηıËÌÂÚÈÓ‹ ¯Ú‹ÛË Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ·ÚÔ˘Û›· ∏À ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡ [OR (95% CI): 2,51 (1,364,62)] Î·È ‹Ù·Ó ·ÓÂÍ¿ÚÙËÙË ·fi ÙËÓ ÂÚÈÔ¯‹ ‰È·ÌÔÓ‹˜ (p=0,06) Î·È ÙÔ Â¿ÁÁÂÏÌ· ÙˆÓ ÁÔÓ¤ˆÓ (p=0,58). ∆Ô 69,9% ÙˆÓ ·È‰ÈÒÓ ‰‹ÏˆÛ ¯Ú‹ÛË ‰È·‰ÈÎÙ‡Ô˘, ÂÎ ÙˆÓ ÔÔ›ˆÓ 90,6% ÛÙÔ Û›ÙÈ (¶›Ó·Î˜ 5 Î·È 6). ∆Ô 20,1% Î·È ÙÔ 37,8% ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Î·È ÙÔ˘ Á˘ÌÓ·Û›Ô˘, ·ÓÙ›ÛÙÔȯ·, ‰‹ÏˆÛ ηıËÌÂÚÈÓ‹
¶›Ó·Î·˜ 5. ¶ÔÛÔÛÙ¿ Î·È OR (95% CI) ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ›ÓÙÂÚÓÂÙ ·fi Ù· ·È‰È¿ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Î·È ÙÔ˘ Á˘ÌÓ·Û›Ô˘ Î·È ÛÙ· ‰‡Ô ʇϷ ™‡ÓÔÏÔ ¢ËÌÔÙÈÎfi °˘ÌÓ¿ÛÈÔ ¡=213 (%) ¡=139 (%) ¡=74 (%) ÃÚ‹ÛË ‰È·‰ÈÎÙ‡Ô˘ ÃÚ‹ÛË ‰È·‰ÈÎÙ‡Ô˘ ÛÙÔ Û›ÙÈ ÃÚ‹ÛË ‰È·‰ÈÎÙ‡Ô˘ ηıËÌÂÚÈÓ¿ ∂›ÛÎÂ„Ë Û ›ÓÙÂÚÓÂ٠ηʤ ª¤ÛË ËÏÈΛ· ·È‰ÈÒÓ ÛÙ· ›ÓÙÂÚÓÂ٠ηʤ (¤ÙË) ™˘¯ÓfiÙËÙ· ›Û΄˘ (1-2 ÊÔÚ¤˜/‚‰ÔÌ¿‰·) ∂›ÛÎÂ„Ë Û sites Ì ÔÚÓÔÁÚ·ÊÈÎfi ÂÚȯfiÌÂÓÔ ª¤ÛË ËÏÈΛ· ·È‰ÈÒÓ ÛÙ· ÈÔ ¿Óˆ sites (¤ÙË) ¶·Ú·ÎÔÏÔ‡ıËÛË ·fi ÁÔÓ›˜
OR (95% CI) 1,13 (0,92-1,39) 0,85 (0,47-1,53) 1,21 (1,07-1,43)* 1,20 (0,72-2,01)
∞ÁfiÚÈ· ∫ÔÚ›ÙÛÈ· ¡=98 (%) ¡=115 (%) 73 (74,4) 65 (66,3) 30 (30,6) 25(34,2)
149 (69,9) 135 (63,3) 56 (26,2) 48 (32,3)
94 (67,6) 90 (64,7) 28 (20,1) 28 (29,7)
55 (74,3) 45 (60,8) 28 (37,8) 20 (36,3)
13 27 (56,3)
11,6 16 (56,2)
14,9 6,99 (2,8-17,2)* 11 (55,0) 1,10 (0,70-1,35)
56 (37,8)
25 (26,6)
21 (38,1) 1,02 (0,53-1,57) 30 (41,0)
26 (34,2) 1,45 (0,89-2,35)
12,5 77 (51,6)
11,28 50 (53,1)
14,6 6,81 (3,8-18,4)* 12,7 27 (49,0) 0,60 (0,32-1,13) 21 (43,8)
12,2 1,04 (0,66-1,78) 56 (48,6) 0,88 (0,63-1,21)
13,2 19 (76)
76 (66,0) 70 (60,8) 26 (22,6) 23 (30,2)
OR (95% CI) 1,12 (0,94-1,33) 1,12 (0,91-1,37) 1,08 (0,87-1,43) 1,24 (0,80-1,92)
13,1 0,89 (0,42-1,21) 8 (34,7) 2,46 (1,24-4,86)*
* p<0,05 ¶·È‰È·ÙÚÈ΋ 2008;71:449-457
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∞. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 6. ¶ÔÛÔÛÙ¿ Î·È OR (95% CI) ÁÈ· ÙË ¯Ú‹ÛË ÙÔ˘ ›ÓÙÂÚÓÂÙ ÛÙ· ÙÌ‹Ì·Ù· Ù˘ ∞ı‹Ó·˜
ÃÚ‹ÛË ‰È·‰ÈÎÙ‡Ô˘ ÃÚ‹ÛË ‰È·‰ÈÎÙ‡Ô˘ ÛÙÔ Û›ÙÈ ÃÚ‹ÛË ‰È·‰ÈÎÙ‡Ô˘ ηıËÌÂÚÈÓ¿ ∂›ÛÎÂ„Ë Û ›ÓÙÂÚÓÂ٠ηʤ ª¤ÛË ËÏÈΛ· ·È‰ÈÒÓ ÛÙ· ›ÓÙÂÚÓÂ٠ηʤ (¤ÙË) ™˘¯ÓfiÙËÙ· ›Û΄˘ (1-2 ÊÔÚ¤˜/‚‰ÔÌ¿‰·) ∂›ÛÎÂ„Ë Û sites Ì ÔÚÓÔÁÚ·ÊÈÎfi ÂÚȯfiÌÂÓÔ ª¤ÛË ËÏÈΛ· ·È‰ÈÒÓ ÛÙ· ÈÔ ¿Óˆ sites (¤ÙË) ¶·Ú·ÎÔÏÔ‡ıËÛË ·fi ÁÔÓ›˜
™‡ÓÔÏÔ ¡=213 (%)
∫¤ÓÙÚÔ ¡=71 (%)
¶ÚÔ¿ÛÙÈ· ¡=142 (%)
OR (95% CI)
149 (69,9) 135 (63,3) 39 (26,2) 48 (32,3) 13 27 (56,3) 56 (37,8) 12,5 77 (51,6)
41 (57,7) 31 (43,6) 18 (25,3) 14 (34,1) 14,6 11 (78,5) 17 (41,4) 13,5 19 (46)
108 (76,0) 104 (73,2) 21 (19,4) 34 (31,4) 12,4 16 (47,0) 40 (36,0) 12 58 (53,7)
1,32 (1,07-1,64) 1,64 (1,24-2,16) 0,98 (0,63-1,59) 3,25 (1,49-7,06)* 0,61 (0,39-0,94)* 0,89 (0,56-1,41) 0,29 (0,10-0,84) 0,81 (0,54-1,32)
* p<0,05
™˘˙‹ÙËÛË ∏ ¯Ú‹ÛË ÙˆÓ ∏À ·fi Ù· ·È‰È¿ Ù˘ ∞ı‹Ó·˜ ·ÁÁ›˙ÂÈ ÙÔ 85,6% ÁÈ· ÙÔ ‰ËÌÔÙÈÎfi Î·È ÙÔ 98,6% ÁÈ· ÙÔ Á˘ÌÓ¿ÛÈÔ, ÂÓÒ Ë ¯Ú‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ÙÔ 67,6% Î·È 74,3%, ·ÓÙ›ÛÙÔȯ·, ¯ˆÚ›˜ Ó· ‰È·ÈÛÙˆı› ‰È·ÊÔÚ¿ ˆ˜ ÚÔ˜ ÙÔ Ê‡ÏÔ. √ ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘, fiˆ˜ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ Û¯ÔÏ›ˆÓ, Â›Ó·È ÌÈÎÚfi˜ Î·È ‰ÂÓ Â›Ó·È ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi˜ ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ Ù˘ ∞ı‹Ó·˜. ¶·ÚfiÏ· ·˘Ù¿, ·Ó¿ÏÔÁ· ÔÛÔÛÙ¿ ¤¯Ô˘Ó ‰ËÌÔÛÈ¢Ù› ·fi ÙÔ NCES (National Paediatriki 2008;71:449-457
Center of Education Statistics) ÛÙȘ ∏¶∞ ÁÈ· Ù· ·È‰È¿ ›‰È·˜ ËÏÈΛ·˜ Î·È ÂÈϤÔÓ ÂÈÛËÌ·›ÓÂÙ·È Ë ·˘ÍË̤ÓË ¯Ú‹ÛË Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜: Ù· 3/4 Î·È ÙÔ 1/4 ¯ÚËÛÈÌÔÔÈÔ‡Ó ∏À Î·È ‰È·‰›ÎÙ˘Ô, ·ÓÙ›ÛÙÔȯ· (8). ∏ ÌÂϤÙË Ì·˜ ‰ÂÓ ÂÚÈÂÏ¿Ì‚·Ó ·È‰È¿ ÌÈÎÚfiÙÂÚ· ÙˆÓ 9 ÂÙÒÓ, ·ÍÈÔÏÔÁÒÓÙ·˜ fï˜ ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ ¯Ú‹Û˘, Ô˘ ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÂÚÈÁÚ¿ÊÂÈ ÙË ¯Ú‹ÛË ÚÈÓ ·fi ÙÔ˘Ï¿¯ÈÛÙÔÓ 5 ¤ÙË (2002-3), ‰È·ÈÛÙÒıËΠÔχ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi (1/5), Û ۇÁÎÚÈÛË Ì ÙÔ ÔÛÔÛÙfi ¯Ú‹Û˘ ÛÙȘ ∏¶∞, ÂÓ‰ÂÈÎÙÈÎfi Ù˘ ηı˘ÛÙÂÚË̤Ó˘ ÂÁηٿÛÙ·Û˘ ÙˆÓ ∏À ÛÙËÓ Î·ıËÌÂÚÈÓfiÙËÙ· Ù˘ ÂÏÏËÓÈ΋˜ ÎÔÈÓˆÓ›·˜. ∂ÈϤÔÓ, ‚¿ÛÂÈ Ù˘ ‰È·ÊÔÚ¿˜ Ô˘ ·Ú·ÙËÚ‹ıËΠÛÙË Ì¤ÛË ËÏÈΛ· ¤Ó·Ú͢ ¯Ú‹Û˘ ÛÙ· ·È‰È¿ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Î·È ÙÔ˘ Á˘ÌÓ·Û›Ô˘ (7,7 ÂÙÒÓ ¤Ó·ÓÙÈ 9,6 ÂÙÒÓ), ‰È·ÎÚ›ÓÂÙ·È ÌÈ· ·˘ÍËÙÈ΋ Ù¿ÛË ¤ÎıÂÛ˘ ÙˆÓ ·È‰ÈÒÓ ÛÙÔ˘˜ ∏À Û Ó·ÚfiÙÂÚË ËÏÈΛ·. ∆· ÌÈÛ¿ ۯ‰fiÓ ·ıËÓ·˚ο Û›ÙÈ· ›¯·Ó ÂÚÈÛÛfiÙÂÚÔ˘˜ ·fi ¤Ó·Ó ∏À, fï˜ Ë Î·ÙÔ¯‹ ∏À ÛÙÔ Û›ÙÈ ‰È¤ÊÂÚ ÌÂٷ͇ ÙÔ˘ ΤÓÙÚÔ˘ Î·È ÙˆÓ ÚÔ·ÛÙ›ˆÓ Ù˘ ∞ı‹Ó·˜, ÁÂÁÔÓfi˜ Ô˘ ›Ûˆ˜ Ó· ÔÊ›ÏÂÙ·È ÛÙË ‰È·ÊÔÚÂÙÈ΋ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË ÙˆÓ 70 60 50 40 %
¯Ú‹ÛË [OR (95% CI): 1,21 (1,07-1,43)]. ∆Ô 32,3% ÙˆÓ ·È‰ÈÒÓ Ô˘ ‰‹ÏˆÛ·Ó ¯Ú‹ÛË ÂÈÛΤÙÂÙ·È Ù· ›ÓÙÂÚÓÂ٠ηʤ (̤ÛË ËÏÈΛ· 13 ÂÙÒÓ), ÂÎ ÙˆÓ ÔÔ›ˆÓ Ù· ÌÈÛ¿ (56,3%) ÙÔ˘Ï¿¯ÈÛÙÔÓ 1-2 ÊÔÚ¤˜/ ‚‰ÔÌ¿‰·. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÂÈÛΤ„ÂˆÓ ·Ó¿ÌÂÛ· ÛÙ· ·È‰È¿ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ Î·È ÙÔ˘ ‰ËÌÔÙÈÎÔ‡. ™ËÌÂÈÒıËÎÂ, fï˜, ÌÂÁ·Ï‡ÙÂÚË ÚÔۤϢÛË ÛÙ· ›ÓÙÂÚÓÂ٠ηʤ ·fi Ù· ·È‰È¿ ÙÔ˘ ΤÓÙÚÔ˘ Ù˘ ∞ı‹Ó·˜ [OR (95% CI): 0,61 (0,39-0,94)] Î·È ·fi Ù· ·ÁfiÚÈ· [OR (95% CI): 2,46 (1,24-4,86)]. ∆Ô 87% ÙˆÓ ·È‰ÈÒÓ ÁÓÒÚÈ˙ ÁÈ· Ù· “ÛÎÔ˘›‰È·” ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ Î·È ÙÔ 37,8% Ù· ¤¯ÂÈ ¯ÚËÛÈÌÔÔÈ‹ÛÂÈ ¤ÛÙˆ ÁÈ· Ì›· ÊÔÚ¿, ÂÓÒ ‰ÂÓ ‰È·ÈÛÙÒıËΠ‰È·ÊÔÚ¿ ·Ó¿ÌÂÛ· ÛÙ· ·È‰È¿ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ Î·È ÙÔ˘ ‰ËÌÔÙÈÎÔ‡, ÛÙ· ÙÌ‹Ì·Ù· Ù˘ ∞ı‹Ó·˜ Î·È ÛÙ· ‰‡Ô ʇϷ. ∏ ›ÛÔ‰Ô˜ ÙˆÓ ·È‰ÈÒÓ Û ‰È·‰ÈÎÙ˘·ÎÔ‡˜ ÙfiÔ˘˜ Ì ÔÚÓÔÁÚ·ÊÈÎfi ˘ÏÈÎfi Û˘Û¯ÂÙ›ÛÙËΠÛËÌ·ÓÙÈο Ì ÙËÓ Â›ÛÎÂ„Ë Û ›ÓÙÂÚÓÂ٠ηʤ [OR (95% CI): 3,29 (1,358,01)] (¶›Ó·Î·˜ 6). ™·Ú¿ÓÙ· ÙÚ›· ·È‰È¿ (22,3%) ·Ó¤ÊÂÚ·Ó ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ÌÂÙ¿ ·fi ÔχˆÚË ¯Ú‹ÛË (>3 ÒÚ·/Ë̤ڷ): ÎÂÊ·Ï·ÏÁ›· 7%, ˙¿ÏË 10,9%, Ì˘˚Îfi ¿ÏÁÔ˜ 7,8%. √È ·Èٛ˜ ¯Ú‹Û˘ ÙÔ˘ ∏À Î·È ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ‹Ù·Ó ΢ڛˆ˜ Ë ‰È·ÛΤ‰·ÛË Î·È Ôχ ÏÈÁfiÙÂÚÔ Ë Âη›‰Â˘ÛË (∂ÈÎfiÓ· 1). ŸÌˆ˜, ÙÔ 79% ÙˆÓ ·È‰ÈÒÓ ı· ÚÔÙÈÌÔ‡Û ̛· ÒÚ· ‰È·ÛΤ‰·Û˘ Ì ¤Ó·Ó ηÏfi Ê›ÏÔ ·Ú¿ Ì ¤Ó·Ó ∏À.
30 20 10 0
‰È·ÛΤ‰·ÛË Âη›‰Â˘ÛË ÂÚȤÚÁÂÈ· ÂÈÎÔÈÓˆÓ›· Âȉ‹ÛÂȘ Ì ʛÏÔ˘˜
∂ÈÎfiÓ· 1. ∞ÈÙÈÔÏÔÁ›· Ù˘ ¯Ú‹Û˘ ∏À Î·È ‰È·‰ÈÎÙ‡Ô˘ ·fi Ù· ·È‰È¿ Ô˘ ηÙÔÈÎÔ‡Ó ÛÙËÓ ∞ı‹Ó·.
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∏ÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ ÛÙ· ·È‰È¿
¶›Ó·Î·˜ 7. ÃÚ‹ÛË ÔÚÓÔÁÚ·ÊÈÎÒÓ sites Î·È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ - ÔÏÏ·Ï‹ ·Ú·ÁÔÓÙÔÔ›ËÛË Î·È OR (95% CI) OR 95% CI º‡ÏÔ ¢ËÌÔÙÈÎfi / Á˘ÌÓ¿ÛÈÔ ∂¿ÁÁÂÏÌ· ÌËÙ¤Ú·˜ (ÔÈÎȷο) ∂¿ÁÁÂÏÌ· ·Ù¤Ú· (ÂÚÁ¿Ù˘) ∏À ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡ ÃÚ‹ÛË ∏À ηıËÌÂÚÈÓ¿ ∂ÈÙ‹ÚËÛË ÁÔÓ¤ˆÓ ηٿ ÙË ¯Ú‹ÛË ∂›ÛÎÂ„Ë Û ›ÓÙÂÚÓÂ٠ηʤ ∫¤ÓÙÚÔ / ÚÔ¿ÛÙÈ·
0,50 (0,21-1,19) 0,69 (0,27-1,75) 0,71 (0,28-1,79) 0,18 (0,03-1,06) 1,42 (0,59-3,40) 0,92 (0,36-2,32) 0,60 (0,25-1,45) 3,29 (1,35-8,01)* 1,92 (0,69-5,29)
* p<0,05
ÔÈÎÔÁÂÓÂÈÒÓ. ∂›Ó·È ÁÓˆÛÙfi˜ Ô ÌÂÁ·Ï‡ÙÂÚÔ˜ ·ÚÈıÌfi˜ ÌÂÙ·Ó·ÛÙÒÓ ÛÙÔ Î¤ÓÙÚÔ Ù˘ ∞ı‹Ó·˜, ηıÒ˜ Î·È Ù· ˘„ËÏ¿ ÔÛÔÛÙ¿ ÙˆÓ ·È‰ÈÒÓ ·˘ÙÒÓ ÛÙ· Û¯ÔÏ›· ÙÔ˘ ΤÓÙÚÔ˘ Ù˘ ∞ı‹Ó·˜. ∆· ·È‰È¿ ·˘Ù¿ Û˘ÌÂÚÈÏ‹ÊıËÎ·Ó ÛÙË ÌÂϤÙË, ¯ˆÚ›˜ Ó· Â›Ó·È ÂÊÈÎÙfi Ó· ηıÔÚÈÛÙ› ÙÔ ·ÎÚÈ‚¤˜ ÔÛÔÛÙfi ÙÔ˘˜, ·ÊÔ‡ ÙÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ‹Ù·Ó ·ÓÒÓ˘ÌÔ. ∞ÓÙ›ıÂÙ·, ÛÙ· ÚÔ¿ÛÙÈ· Ù· ·È‰È¿ ÁÓÒÚÈ˙·Ó ÂÓˆÚ›ÙÂÚ· ∏À, ÁÂÁÔÓfi˜ Ô˘ Û˘Û¯ÂÙ›ÛÙËΠ̠ÙËÓ ·ÚÔ˘Û›· ÁÔÓ¤ˆÓ ÂȯÂÈÚËÌ·ÙÈÒÓ. √ ·ÚÈÔ˜ ÂÎ·È‰Â˘Ù‹˜ ÙˆÓ ·È‰ÈÒÓ ‹Ù·Ó ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ Î·È Î˘Ú›ˆ˜ ÔÈ ÁÔÓ›˜. ∏ ·ÚÔ˘Û›· ÁÔÓ¤ˆÓ Ô˘ ‹Ù·Ó ¯Ú‹ÛÙ˜, ›Ù ÁÈ· ·ÁÁÂÏÌ·ÙÈÎÔ‡˜ ›Ù ÁÈ· ÚÔÛˆÈÎÔ‡˜ ÏfiÁÔ˘˜ (60% ÂÚ›Ô˘ ÙˆÓ ÓÔÈÎÔ΢ÚÒÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ∏À), ÂËÚ¤·Û ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÂÎÌ¿ıËÛ˘, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ·ÚÔ˘Û›· ÌÂÁ·Ï‡ÙÂÚˆÓ ·‰ÂÏÊÒÓ, Ô˘ ‰ÂÓ Ê¿ÓËΠӷ Âȉڿ ıÂÙÈο. ∞ÓÙ›ıÂÙ·, ÙÔ 14% ÙˆÓ ÂÊ‹‚ˆÓ Ô˘ ‰ÂÓ Â›¯·Ó ÔÈÎÔÁÂÓÂȷ΋ ·ÚÔ¯‹ ∏À ‰‹ÏˆÛ ¯Ú‹ÛË ÛÙÔ Û¯ÔÏÂ›Ô Î·È Û ›ÓÙÂÚÓÂ٠ηʤ. √ Becker HJ ‰ËÌÔÛ›Â˘Û fiÙÈ Ù· ·È‰È¿ ÔÈÎÔÁÂÓÂÈÒÓ Ì ÂÙ‹ÛÈÔ ÂÈÛfi‰ËÌ· οو ÙˆÓ 20.000 ‰ÔÏ·Ú›ˆÓ Û˘Ó‹ıˆ˜ ‰ÂÓ ¤¯Ô˘Ó ∏À ÛÙÔ Û›ÙÈ Î·È Î·Ù·Ê‡ÁÔ˘Ó ÛÙÔ Û¯ÔÏÂ›Ô ÁÈ· ÂÎÌ¿ıËÛË Î·È ¯Ú‹ÛË (9). ™ÙËÓ ·ÚÔ‡Û· ÌÂϤÙË, ‰ÂÓ ÂÎÙÈÌ‹ıËΠ·ÎÚÈ‚Ò˜ Ë ÔÈÎÔÓÔÌÈ΋ ηٿÛÙ·ÛË Ù˘ ÔÈÎÔÁ¤ÓÂÈ·˜, ¤ÌÌÂÛ· fï˜ ‰È·ÈÛÙÒıËΠfiÙÈ Ë ·Ô˘Û›· ∏À ·fi ÙÔ Û›ÙÈ ¯·Ú·ÎÙ‹ÚÈ˙ ÙȘ ÔÈÎÔÁ¤ÓÂȘ Ì ¤Ó·Ó ·ÚÈÔ ÌÈÛıfi (·˘Ù¤˜ ‰ËÏ·‰‹ Ô˘ ÙÔ Â¿ÁÁÂÏÌ· Ù˘ ÌËÙ¤Ú·˜ ‹Ù·Ó ÔÈÎȷο) ‹ Ì ·Ù¤Ú· ÂÚÁ¿ÙË. ™Ù· ·È‰È¿ ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ·˘ÙÒÓ (ÙÔ˘ ΤÓÙÚÔ˘ Î·È ÙÔ˘ Á˘ÌÓ·Û›Ô˘ ΢ڛˆ˜), ÙÔ Û¯ÔÏÂ›Ô Â›¯Â ηıÔÚÈÛÙÈÎfi ÂÎ·È‰Â˘ÙÈÎfi ÚfiÏÔ. °È· ÙÔ ÏfiÁÔ ·˘Ùfi, ÙÔ Û¯ÔÏÂ›Ô ı· Ú¤ÂÈ Ó· Â›Ó·È Û ı¤ÛË Ó· ·Ú¤¯ÂÈ ∏À Î·È Ó· Âηȉ‡ÂÈ ÛÙË Ó¤· Ù¯ÓÔÏÔÁ›· Ù· ÌË ÚÔÓÔÌÈÔ‡¯· ·È‰È¿, ÒÛÙ ӷ ·Ì‚χÓÂÈ ÙȘ ÎÔÈÓˆÓÈΤ˜ ‰È·ÊÔÚ¤˜. ŸÌˆ˜, Ë ÌË Î·ÙÔ¯‹ ∏À ÛÙÔ Û›ÙÈ Ô‰ËÁ› Û˘¯ÓfiÙÂÚ· Ù· ·È‰È¿ ·˘Ù¿ ÛÙ· ›ÓÙÂÚÓÂ٠ηʤ. ∆fiÛÔ ÛÙÔ˘˜ ¯ÒÚÔ˘˜ ·˘ÙÔ‡˜ fiÛÔ Î·È ÛÙÔ Û›ÙÈ, Ë ÂÈÙ‹ÚËÛË ÙˆÓ ÁÔÓ¤ˆÓ ‹Ù·Ó ·Ó·Ú΋˜. ∆· ÌÈÛ¿ ·È-
‰È¿ ÌÂÙ¿ ÙËÓ Âη›‰Â˘Û‹ ÙÔ˘˜ ÂÁηٷÏ›ÊÙËÎ·Ó ÛÙËÓ ¤ÏÍË Ù˘ Ó¤·˜ Ù¯ÓÔÏÔÁ›·˜ Î·È ÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ·˘Ù‹ ÂÁ΢ÌÔÓ›. ™ÙÔ ‹ÌÈÛ˘ ÙˆÓ ÂÚÈÙÒÛˆÓ, Ô ∏À ‹Ù·Ó ÙÔÔıÂÙË̤ÓÔ˜ ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙˆÓ ·È‰ÈÒÓ, Ù· ÔÔ›· ÙÔÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó Î·ıËÌÂÚÈÓ¿, ΢ڛˆ˜ ÁÈ· „˘¯·ÁˆÁ›·. ™ÙË ÌÂϤÙË ‰ÂÓ Î·ıÔÚ›ÛÙËΠÙÈ ıˆÚÂ›Ù·È „˘¯·ÁˆÁ›· Î·È ·Ó Û ·˘Ù‹ ÂÚÈÏ·Ì‚¿ÓÂÙ·È Ë ¯Ú‹ÛË ÔÚÓÔÁÚ·ÊÈÎÒÓ sites. To ÁÂÁÔÓfi˜ fiÙÈ ÙÔ 25% ¤Î·Ó ηıËÌÂÚÈÓ‹ ¯Ú‹ÛË ‰È·‰ÈÎÙ‡Ô˘ Î·È Á‡Úˆ ÛÙÔ 1/3 (·ÓÂÍ·Úًو˜ ËÏÈΛ·˜) ›¯Â ÂÈÛÎÂÊı› ‰È·‰ÈÎÙ˘·ÎÔ‡˜ ÙfiÔ˘˜ Ì ÔÚÓÔÁÚ·ÊÈÎfi ˘ÏÈÎfi, ΢ڛˆ˜ Û ›ÓÙÂÚÓÂ٠ηʤ, ı¤ÙÂÈ ˘Ô„›Â˜ fiÙÈ Ì¤ÚÔ˜ Ù˘ „˘¯·ÁˆÁ›·˜ Â›Ó·È Î·È ÔÈ ÛÂÏ›‰Â˜ ·˘Ù¤˜. ¶·ÚfiÏÔ Ô˘ ‰ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ‹ ÛÙËÓ ÔÈfiÙËÙ· Ù˘ ¯Ú‹Û˘ ÛÙÔ Î¤ÓÙÚÔ Î·È ÛÙ· ÚÔ¿ÛÙÈ·, ÛÙ· ‰Â‡ÙÂÚ· ‰È·ÈÛÙÒıËÎ·Ó ÏÈÁfiÙÂÚ˜ ÂÈÛΤ„ÂȘ Û ›ÓÙÂÚÓÂ٠ηʤ, ‚·ÛÈÎfi˜ ·ÓÂÍ¿ÚÙËÙÔ˜ ˘Â‡ı˘ÓÔ˜ ·Ú¿ÁÔÓÙ·˜ Ù˘ ¯Ú‹Û˘ ÔÚÓÔÁÚ·ÊÈÎÒÓ ÛÂÏ›‰ˆÓ, Ë ÔÔ›· Û˘¯Ó¿ Á›ÓÂÙ·È ·ÎÔ‡ÛÈ·. ™‡Ìʈӷ Ì ¤Ú¢ӷ Ù˘ ∂∫∞∆√ (∂ÏÏËÓÈ΋ ∫·Ù·Ó·ÏˆÙÈ΋ √ÚÁ¿ÓˆÛË), 26 ‰È¿ÛËÌÔÈ ‹ÚˆÂ˜cartoon ÂÓÙÔ›ÛÙËÎ·Ó Ó· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ Û˘Ó‰¤ÛÂȘ Û ÔÚÓÔÁÚ·ÊÈΤ˜ ÛÂÏ›‰Â˜ Î·È 70% ÙˆÓ ·È‰ÈÒÓ Û˘Ó·ÓÙ‹ıËÎ·Ó Ì ·˘Ù¤˜ ηٿ Ï¿ıÔ˜ (10). ∂Í›ÛÔ˘ ÂÈΛӉ˘Ó· Â›Ó·È Ù· chat rooms (ÈÛÙÔ·›ıÔ˘Û˜ Û˘˙ËÙ‹ÛˆÓ), ÛËÌ›· ‰ËÌÈÔ˘ÚÁ›·˜ Î·È Û˘ÌÌÂÙÔ¯‹˜ Û ËÏÂÎÙÚÔÓÈΤ˜ ÎÔÈӈӛ˜, fiÔ˘ ÔÌ¿‰Â˜ ·ÓıÚÒˆÓ ·ÓÙ·ÏÏ¿ÛÛÔ˘Ó ·fi„ÂȘ ÁÈ· οÔÈÔ ˙‹ÙËÌ·. ∆Ô ·Á·Ë̤ÓÔ ı¤Ì· ÔÏÏÒÓ ËÏÂÎÙÚÔÓÈÎÒÓ Û˘Ó·ÓÙ‹ÛÂˆÓ Â›Ó·È ÙÔ ÛÂÍ. ª¤Û· ÛÙ· chat rooms, Ô Î¿ıÂ Û˘Ó‰È·ÏÂÁfiÌÂÓÔ˜ ÌÔÚ› Ó· ˘Ô‰‡ÂÙ·È fiÔÈÔ Ù‡Ô ·ÓıÚÒÔ˘ ı¤ÏÂÈ Î·È fiÔÈ· ËÏÈΛ· ÚÔÙÈÌ¿. ŒÙÛÈ, ÂÓÒ ÌÔÈ¿˙ÂÈ Û˘˙‹ÙËÛË ÌÂٷ͇ ÂÊ‹‚ˆÓ, ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÌÔÚ› Ó· Â›Ó·È Û˘˙‹ÙËÛË ÌÂٷ͇ ÂÊ‹‚Ô˘ Î·È ÂÓ‹ÏÈη. ∏ Î·Ï˘Ì̤ÓË Ê‡ÛË ÙˆÓ chat rooms ÂÈÙÚ¤ÂÈ Û ÂÈΛӉ˘ÓÔ˘˜ Ù‡Ô˘˜ Ó· ‚Ú›ÛÎÔ˘Ó Ï›· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ 1/5 ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ ¤ˆ˜ 17 ÂÙÒÓ ¤¯ÂÈ ‰Â¯ı› ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË ‹ ÚÔÛ¤ÁÁÈÛË ·fi ¿ÏÏÔ˘˜ ¯Ú‹ÛÙ˜, ÂÓÒ ÙÔ 3% ¤¯ÂÈ ‰Â¯ı› ¤ÓÙÔÓË ·ÚÂÓfi¯ÏËÛË Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÂÈÛÙÔϤ˜ Î·È ·ÔÛÙÔÏ‹ ¯ÚËÌ¿ÙˆÓ Î·È ‰ÒÚˆÓ (4,10). ŸÌˆ˜, ÌfiÏȘ 17% ·fi ·˘Ù¿ ÙÔ ·Ó¤ÊÂÚ·Ó ÛÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘˜, ÁÂÁÔÓfi˜ Ô˘ ‰Â›¯ÓÂÈ ÙËÓ ÂÏÏÈ‹ ·ʋ ÙˆÓ ÁÔÓ¤ˆÓ Ì ٷ ·È‰È¿ ÙÔ˘˜ Î·È ÙËÓ ·Ó·ÁηÈfiÙËÙ· ηχÙÂÚ˘ ÂÓË̤ڈÛ˘ Î·È ÂÈÙ‹ÚËÛ˘ (10). ÃÚ‹ÛË ÁÈ· ÏfiÁÔ˘˜ Âη›‰Â˘Û˘ ·Ó·Ê¤ÚÂÙ·È Û ÌÈÎÚfi ÔÛÔÛÙfi. ¶·ÚfiÏÔ Ô˘ ÛÙÔ ·Ó·Ï˘ÙÈÎfi ÚfiÁÚ·ÌÌ· Ì·ıËÌ¿ÙˆÓ ÙÔ˘ Á˘ÌÓ·Û›Ô˘ ˘¿Ú¯ÂÈ ÙÔ Ì¿ıËÌ· Ù˘ ÏËÚÔÊÔÚÈ΋˜, ÙÔ ÂÎ·È‰Â˘ÙÈÎfi Û‡ÛÙËÌ· ÛÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ÚÔˆı› ÙËÓ ¯Ú‹ÛË Ù˘ Ù¯ÓÔÏÔÁ›·˜ ÁÈ· ·fiÎÙËÛË ÁÓÒÛˆÓ. √È ∏À Ô˘ ˘¿Ú¯Ô˘Ó ÛÙ· ‰ËÌfiÛÈ· Û¯ÔÏ›· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌfiÓÔ ÁÈ· ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Ì¿ıËÌ·, ÂÓÒ ‰ÂÓ ÂÈÙÚ¤ÂÙ·È Ë ¯Ú‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ·fi ÙÔ˘˜ Ì·ıËÙ¤˜ ̤۷ ÛÙÔÓ ¶·È‰È·ÙÚÈ΋ 2008;71:449-457
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·456
456
∞. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.
¯ÒÚÔ ÙÔ˘ Û¯ÔÏ›Ԣ. ∂ÓÒ ÙÔ ›ÓÙÂÚÓÂÙ ·ÔÙÂÏ› ·Ú¿ı˘ÚÔ ÛÙË ÁÓÒÛË Î·È ÛÙËÓ Âη›‰Â˘ÛË Î·È ¤¯ÂÈ ÙË ‰˘Ó·ÌÈ΋ Ó· ÙÂÏÂÈÔÔÈ‹ÛÂÈ fiϘ ÙȘ ‰ÂÍÈfiÙËÙ˜ ÂÓfi˜ ·È‰ÈÔ‡, ηٷÓÙ¿ ÙÂÏÈο ̤ÛÔ ÂÊ·ÚÌÔÁ‹˜ ‚›·ÈˆÓ ·È¯ÓȉÈÒÓ ÛÙÚ·ÙËÁÈ΋˜, ¿Ï˘ ͈ÙÈÎÒÓ Î·È ÙÂÚ¿ÙˆÓ ‹ ηٷÛ΢‹˜ ·ÛÙÂÚÈÒÓ-ÌÔÓÙ¤ÏˆÓ (10). ∆Ô 48% ÙˆÓ ·È‰ÈÒÓ Ù˘ µÔÛÙfiÓ˘ ·›˙ÂÈ Û˘¯Ó¿ ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· ‚›·ÈÔ ·È¯Ó›‰È (ÙÔ 30% ÙˆÓ ·ÁÔÚÈÒÓ Î·ıËÌÂÚÈÓ¿ ηÈ, fi¯È Û¿ÓÈ·, Ì ·ÁÓÒÛÙÔ˘˜, ̤ۈ ›ÓÙÂÚÓÂÙ) Î·È ¯ÚËÛÈÌÔÔÈ› Ù· ·È¯Ó›‰È· ÁÈ· Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙÔ ı˘Ìfi ÙÔ˘ (1). √È Subrahmanyam K. et al. ‰È·›ÛÙˆÛ·Ó fiÙÈ Ù· ·È¯Ó›‰È· ·˘Ù¿ ·˘Í¿ÓÔ˘Ó ÙËÓ ÂÈıÂÙÈÎfiÙËÙ·, ·Â˘·ÈÛıËÙÔÔÈÔ‡Ó Ù· ·È‰È¿ ÛÙÔÓ fiÓÔ Î·È ÚÔηÏÔ‡Ó Û‡Á¯˘ÛË Ù˘ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜ Ì ÙË Ê·ÓÙ·Û›· (11). ™‡Ìʈӷ Ì ÙȘ ÙÂÏÂ˘Ù·›Â˜ ıˆڛ˜, ˘¿Ú¯ÂÈ Ë ¿ÌÂÛË Î·È Ë fi„ÈÌË ·ÚÓËÙÈ΋ ›‰Ú·ÛË. ÕÌÂÛË Â›Ó·È Ë ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Ô˘ ÂΉËÏÒÓÂÙ·È Û ¿ÌÂÛË ¯ÚÔÓÈ΋ Û¯¤ÛË Ì ÙÔ ·È¯Ó›‰È Î·È Û˘Ó‹ıˆ˜ Â›Ó·È ·ÚÔ‰È΋. ∞ÓÙ›ıÂÙ·, fi„ÈÌË Â›Ó·È Ë ÂÈıÂÙÈÎfiÙËÙ· Ô˘ ÂÁηı›ÛÙ·Ù·È ÌfiÓÈÌ· Û ¤Ó· ·È‰› Ô˘ Û˘ÛÙËÌ·ÙÈο ·Ú·ÎÔÏÔ˘ı› Î·È ·ÓÙÈÁÚ¿ÊÂÈ ‚›·È˜ ÂΉËÏÒÛÂȘ. ∆· ·È‰È¿ ‰È·ı¤ÙÔ˘Ó “Ó¢ÚÒÓ˜ ηıÚ¤Ù˜” Ô˘ ÏÂÈÙÔ˘ÚÁÔ‡Ó ÌÈÌËÙÈο, ¯ˆÚ›˜ ‰˘Ó·ÙfiÙËÙ· ÊÈÏÙÚ·Ú›ÛÌ·ÙÔ˜ Î·È Â›Ó·È ÈÔ ÂÈÚÚ‹ ÛÙÔ Ó· ·ÓÙÈÁÚ¿„Ô˘Ó Û˘ÌÂÚÈÊÔÚ¤˜ (12,13). ∏ ÔχˆÚË ¯Ú‹ÛË (ÂÚÈÛÛfiÙÂÚ˜ ·fi 3 ÒÚ˜/Ë̤ڷ) ÂÁ΢ÌÔÓ› ÙÔÓ Î›Ó‰˘ÓÔ ·Ó¿Ù˘Í˘ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÂıÈÛÌÔ‡, Ë ÛÔ‚·ÚfiÙËÙ· ÙÔ˘ ÔÔ›Ô˘ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Î·È ·ÓËÛ˘¯‹ÛÂÈ ÔÏϤ˜ ¯ÒÚ˜. ¶Úfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· ·ÔÙÂÏÔ‡Ó Ô ˘ÂÚ‚ÔÏÈÎfi˜ ¯ÚfiÓÔ˜ ÂÓ·Û¯fiÏËÛ˘, Ë ·Ú·Ì¤ÏËÛË ˘Ô¯ÚÂÒÛˆÓ, Ë ·fiÙÔÌË ÙÒÛË Ù˘ Û¯ÔÏÈ΋˜ ›‰ÔÛ˘, Ë ·ÔÌfiÓˆÛË Î·È Ë ¿ÚÓËÛË Û˘Ó¿ÓÙËÛ˘ Ì ʛÏÔ˘˜, Ë ÂÈıÂÙÈÎfiÙËÙ·, Ë ·ÏÏ·Á‹ ÛÙË Û˘ÌÂÚÈÊÔÚ¿, ÔÈ ÔÓÔΤʷÏÔÈ Î·È Ë ÍËÚÔÊı·ÏÌ›· (14-16). ªÂÙ¿ ·fi ÔχˆÚË ¯Ú‹ÛË, 22% ÙˆÓ ·È‰ÈÒÓ Ù˘ ÌÂϤÙ˘ ·Ó¤ÊÂÚ·Ó ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜, ΢ڛˆ˜ ÎÂÊ·Ï·ÏÁ›·, Ì˘˚Îfi fiÓÔ Î·È ˙¿ÏË, Û˘ÌÙÒÌ·Ù· ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Ô˘ ¯·Ú·ÎÙËÚ›˙Ô˘Ó Î·Ù¿ÛÙ·ÛË ÚÔ-ÂıÈÛÌÔ‡. ∞ÓÙ›ÛÙÔÈ¯Ô ÔÛÔÛÙfi (18%) ¤¯ÂÈ ‰È·ÈÛÙˆı› Î·È ÛÙË ªÔÓ¿‰· ∂ÊË‚È΋˜ ÀÁ›·˜ Ù˘ ¶·ÓÂÈÛÙËÌȷ΋˜ ¶·È‰È·ÙÚÈ΋˜ ∫ÏÈÓÈ΋˜ ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ “∞ÁÏ·˝· ∫˘ÚÈ·ÎÔ‡” (17). ∆Ô Ê·ÈÓfiÌÂÓÔ Â›Ó·È Û˘¯ÓfiÙÂÚÔ ÛÙ· ·ÁfiÚÈ·, Û ÌÔÓÔÁÔÓÂ˚Τ˜ ‹ ‰˘ÛÏÂÈÙÔ˘ÚÁÈΤ˜ ÔÈÎÔÁ¤ÓÂȘ, Û ˘ÂÚÎÈÓËÙÈο ‹ ηٷıÏÈÙÈο ·È‰È¿, Û ÂÚ›ÙˆÛË ÂÏÏÈÔ‡˜ ›‚Ï„˘ ÙˆÓ ÁÔÓ¤ˆÓ ‹ ÌÂÙ¿ ·fi ÔχˆÚË ¯Ú‹ÛË ÙˆÓ chat rooms (18-20). ¶ÔÛÔÛÙ¿ 20-37% ‹ÈÔ˘ ‹ ̤ÙÚÈÔ˘ ÂıÈÛÌÔ‡ ¤¯Ô˘Ó ·Ó·ÎÔÈÓˆı› ·fi ·ÚÎÂÙ¤˜ ¯ÒÚ˜, ÂÓÒ Ù· ÔÛÔÛÙ¿ ‚·Ú¤Ô˜ ÂıÈÛÌÔ‡ ·Ó¤Ú¯ÔÓÙ·È Û 9,3% ÛÙÔ µÂÚÔÏ›ÓÔ, 5,5% ÛÙËÓ ∫›Ó·, 2-4% ÛÙËÓ ∫ÔÚ¤·, 2% ÛÙË ¡ÔÚ‚ËÁ›·, 1,4% ÛÙË ƒÔ˘Ì·Ó›· Î·È 1% Paediatriki 2008;71:449-457
ÛÙËÓ ∂ÏÏ¿‰· (17,21-27). ∏ ·ÂÍ¿ÚÙËÛË ·fi ÙÔ˘˜ ∏À ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·›ÙÂÚ˜ ‰˘ÛÎÔϛ˜, ÁÈ·Ù› Û˘Ó‹ıˆ˜ Ù· ¿ÙÔÌ· ‰ÂÓ ·Ô‰¤¯ÔÓÙ·È ÙË ÓÔÛËÚfiÙËÙ· Ù˘ ηٿÛÙ·Û˘ Î·È ··ÈÙÔ‡ÓÙ·È ÂȉÈο ıÂÚ·Â˘Ù‹ÚÈ· Ô˘ Ï›Á˜ ¯ÒÚ˜ ‰È·ı¤ÙÔ˘Ó. ∂›Ó·È ·Ó·ÌÊÈÛ‚‹ÙËÙÔ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ∏À ‚ÂÏÙÈÒÓÔ˘Ó ÙËÓ ·ÓÙÈÏËÙÈ΋ ÈηÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ, ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÙÔÓ Ù·˘Ùfi¯ÚÔÓÔ ¯ÂÈÚÈÛÌfi ÔÏÏÒÓ ÂÈÎfiÓˆÓ, fï˜ ÂÈÚfiÛıÂÙ· ÚÔηÏÔ‡Ó ·›ÛıËÌ· ÌÔÓ·ÍÈ¿˜ Î·È ÌÂÏ·Á¯ÔÏ›·˜ (11,25). ∂›Ó·È ¤Ó· ÌÔÓ·¯ÈÎfi “¿ıÏËÌ·”. ∞ÎfiÌ· Î·È Ë ÂÈÎÔÈÓˆÓ›· Ì ʛÏÔ˘˜ ̤ۈ ›ÓÙÂÚÓÂÙ ·Ó·ÈÚ› ÙËÓ ÚÔÛˆÈ΋ Î·È ÔÙÈ΋ ·ʋ, ÙË ÛˆÌ·ÙÈ΋ Î·È ·ÈÛıËÙÈ΋ Û˘Û¯¤ÙÈÛË, ÂÓÒ Û˘¯Ó¿ ‰ËÌÈÔ˘ÚÁ› „‡ÙÈÎË ÂÈÎfiÓ· ÙÔ˘ ÂÈÎÔÈÓˆÓÔ‡ÓÙÔ˜. º·›ÓÂÙ·È fiÙÈ ·˘Ùfi Á›ÓÂÙ·È ·ÓÙÈÏËÙfi ·fi Ù· ·È‰È¿ Ù˘ ∞ı‹Ó·˜ Î·È Â›Ó·È ·ÈÛÈfi‰ÔÍÔ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÂÚÈÛÛfiÙÂÚ· ·fi Ù· 3/4 ÙˆÓ ·È‰ÈÒÓ ÚÔÙÈÌÔ‡Ó ¤Ó·Ó ηÏfi Ê›ÏÔ ·fi ¤Ó·Ó ∏À. ∆· ‰Â‰Ô̤ӷ Ù˘ ÌÂϤÙ˘, ·ÚfiÏÔ Ô˘ ÙÔ ‰Â›ÁÌ· ‹Ù·Ó ÌË ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi, ·Ó·‰ÂÈÎÓ‡Ô˘Ó ÙËÓ Ù·¯¤ˆ˜ ·˘Í·ÓfiÌÂÓË ¯Ú‹ÛË ÙˆÓ ∏À Î·È ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙËÓ ∞ı‹Ó· Î·È Â›Ó·È ·Ó¿ÏÔÁ· Ì ٷ ÔÛÔÛÙ¿ ¿ÏÏˆÓ ·ÓÂÙ˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ. √È ÁÔÓ›˜ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ Âη›‰Â˘ÛË ÙˆÓ ·È‰ÈÒÓ, ·ÏÏ¿ ˘ÛÙÂÚÔ‡Ó ÛÙËÓ ÂÈÙ‹ÚËÛË Ù˘ ¯Ú‹Û˘ Î·È Ù· ·È‰È¿ Â›Ó·È ÂÎÙÂıÂÈ̤ӷ Î·È ÂÈÚÚ‹ Û ÎÈÓ‰‡ÓÔ˘˜, fiˆ˜ Ë ·Ó¿Ù˘ÍË ÂÈıÂÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜, Ë ÛÂÍÔ˘·ÏÈ΋ ·ÚÂÓfi¯ÏËÛË Î·È Ô ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜. ∆· ‰Â‰Ô̤ӷ Â›Ó·È ·ÓËÛ˘¯ËÙÈο Î·È ··ÈÙÂ›Ù·È ¿ÌÂÛË ÂÓË̤ڈÛË ÙˆÓ ÁÔÓ¤ˆÓ, ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ Î·È ÙˆÓ ·È‰È¿ÙÚˆÓ Î·È ‰ËÌÈÔ˘ÚÁ›· Û˘Ì‚Ô˘Ï¢ÙÈÎÒÓ ˘ËÚÂÛÈÒÓ Î·È ÊÔÚ¤ˆÓ ηıÔÚÈÛÌÔ‡ ÔÌ¿‰ˆÓ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ Î·È ¤ÁηÈÚ˘ ·ÓÙÈÌÂÙÒÈÛ˘.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Olson CK, Kutner LA, Warner DE, Almerigi JB, Baer L, Nicholi AM 2nd, et al. Factors correlated with violent video game use by adolescent boys and girls. J Adolesc Health 2007;41:77-83. 2. Bushman BJ, Huesmann LR. Short-term and long-term effects of violent media on aggression in children and adults. Arch Pediatr Adolesc Med 2006;160:348-352. 3. Wood W, Wong FY, Chachere JG. Effects of media violence on viewers’ aggression in unconstrained social interaction. Psychol Bull 1991;109:371-383. 4. Mitchell KJ, Finkelhor D, Wolak J. Risk factors for and impact of online sexual solicitation of youth. JAMA 2001;285:3011-3014. 5. Young KS. Psychology of computer use: XL. Addictive use of the Internet: a case that breaks the stereotype. Psychol Rep 1996;79:899-902. 6. Young KS. Cognitive behavior therapy with Internet addicts: treatment outcomes and implications. Cyberpsychol Behav 2007;10:671-679. 7. Ng BD, Wiemer-Hastings P. Addiction to the internet and online gaming. Cyberpsychol Behav 2005;8:110-113.
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8. US Department of Education, National Centre for Education Statistics. Rates of computer and internet use by children in nursery school and students in kindergarten through twelfth grade: 2003. [Internet]. 2005 Oct: Webpage: http://nces.ed.gov/pubs2005/2005111rev.pdf 9. Becker HJ. Who’s wired and who’s not: children’s access to and use of computer technology. The Future of Children 2000;10:44-75. 10. ∂ÏÏËÓÈ΋ ∫·Ù·Ó·ÏˆÙÈ΋ √ÚÁ¿ÓˆÛË (E.KAT.O.). ŒÚ¢ӷ Ù˘ ∂.∫∞∆.√. ÁÈ· ÙȘ Û˘Ó‹ıÂȘ Î·È ÙË ¯Ú‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ·fi ÙÔ˘˜ Ó¤Ô˘˜. [Internet]. 2006: Webpage: http:// www.ekato.org/gr/research/2006/Internet_Use_survey.pdf 11. Subrahmanyam K, Kraut RE, Greenfield PM, Gross EF. The impact of home computer use on children’s activities and development. Future Child 2000;10:123-144. 12. Rizzolatti G, Fadiga L, Gallese V, Fogassi L. Premotor cortex and the recognition of motor actions. Brain Res Cogn Brain Res 1996;3:131-141. 13. Meltzoff AN, Moore MK. Imitation of facial and manual gestures by human neonates: resolving the debate about early imitation. In: Muir D, Slater A, editors. Infant Development: The Essential Readings. Malden, MA: Blackwell Publishers; 2000. p. 167-181. 14. Ko CH, Yen JY, Chen CC, Chen SH, Yen CF. Proposed diagnostic criteria of Internet addiction for adolescents. J Nerv Ment Dis 2005;193:728-733. 15. Dannon PN, Iancu I. Internet addiction. Harefuah 2007; 146:549-553. 16. Nichols LA, Nicki R. Development of a psychometrically sound internet addiction scale: a preliminary step. Psychol Addict Behav 2004;18:381-384. 17. ªÔÓ¿‰· ∂ÊË‚È΋˜ ÀÁ›·˜ (ª.∂.À.), ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”. SOS: ¢È·‰ÈÎÙ˘·Îfi˜ ∂ıÈÛÌfi˜, ¢È¿ÁÓˆÛË ˘ÂÚ‚ÔÏÈ΋˜ ¯Ú‹Û˘, ™˘Ì‚Ô˘Ï¤˜ ÚfiÏ˄˘, ¶Úfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù·. ∂ÊËÌÂÚ›‰· “∂Ï¢ıÂÚÔÙ˘›·”, ʇÏÏÔ 18/1/2008.
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ORIGINAL ARTICLE
∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜: ∞’ ∆∂™∆* π·ÙÚÂ›Ô ∞Ó·Ù˘Íȷ΋˜ ¶·È‰È·ÙÚÈ΋˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: §ˆÚ¤ÙÙ· £ˆÌ·˝‰Ô˘ developmental-health@ yahoo.gr π·ÙÚÂ›Ô ∞Ó·Ù˘Íȷ΋˜ ¶·È‰È·ÙÚÈ΋˜, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
™. ª·ÓÙÔ‡‰Ë˜, §. £ˆÌ·˝‰Ô˘ ¶ÂÚ›ÏË„Ë ™ÎÔfi˜: ∏ ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Û‡ÓÙÔÌÔ˘, ¢¤ÏÈÎÙÔ˘ Î·È ·ÍÈfiÈÛÙÔ˘ ÂÚÁ·Ï›Ԣ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÚÒÈÌˆÓ ‰ÂÈÎÙÒÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ‰‡Ô ·ÓÙÈÚÔÛˆÂ˘ÙÈο ‰Â›ÁÌ·Ù· ·È‰ÈÒÓ: ÙÔ ‰Â›ÁÌ· ÈÏÔÙÈ΋˜ ¤Ú¢ӷ˜ (¡=322), ËÏÈΛ·˜ 4-7 ÂÙÒÓ, Î·È ÙÔ ‰Â›ÁÌ· ÙÂÏÈ΋˜ ÛÙ¿ıÌÈÛ˘ (¡=2002), Ì ̤ÛË ËÏÈΛ· 5 ¯ÚfiÓÈ· Î·È 8 Ì‹Ó˜. °È· ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÂÈ̤ÚÔ˘˜ ÎÏÈÌ¿ÎˆÓ Ù˘ ‰ÔÎÈÌ·Û›·˜ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ‰ÔÎÈÌ¿ÛıËÎ·Ó ÔÏÏ¿ ‰È·ÁÓˆÛÙÈο ÂÚÁ·Ï›· ·Ó·Ù˘Íȷ΋˜ ÂÎÙ›ÌËÛ˘, fiˆ˜ ‰ÔÎÈ̷ۛ˜ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡, ÔÙÈ΋˜ ·ÓÙ›Ï˄˘, ÁψÛÛÈ΋˜ ÂͤÏÈ͢, ÓÔËÌÔÛ‡Ó˘ Î·È Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ. ∂ÂϤÁËÛ·Ó ÔÈ ÙÔÌ›˜ ÂΛÓÔÈ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·fiÎÏÈÛË ÌÂÁ·Ï‡ÙÂÚË ‹ ›ÛË ÙˆÓ 2 ÛÙ·ıÂÚÒÓ ·ÔÎϛۈÓ. ªÂÙ¿ ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË, Ë ÙÂÏÈ΋ Û‡ÓıÂÛË ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ Ô˘ ÂÂϤÁËÛ·Ó Ô‰‹ÁËÛ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ 7 ‚·ÛÈÎÒÓ ÎÏÈÌ¿ÎˆÓ Ù˘ ‰ÔÎÈÌ·Û›·˜ ∞’ ∆∂™∆. ∞ÔÙÂϤÛÌ·Ù·: ªÂÙ¿ ÙËÓ ÚÒÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ∞’ ∆∂™∆, ηıÔÚ›ÛÙËÎ·Ó Ù· ›‰· ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ÈηÓÔÙ‹ÙˆÓ ÙˆÓ ·È‰ÈÒÓ (∂Í·ÈÚÂÙÈ΋ ›‰ÔÛË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘, º˘ÛÈÔÏÔÁÈ΋ ›‰ÔÛË, √Úȷ΋ ›‰ÔÛË Î·È Ã·ÌËÏ‹ ›‰ÔÛË). ∆Ô ∞’ ∆∂™∆ ‚Ú¤ıËΠӷ ¤¯ÂÈ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙËÓ Îϛ̷η TVƒS (r=0,895, p=0,000) Ô˘ ÌÂÙÚ¿ ·ÔÎÏÂÈÛÙÈο √ÙÈ΋ ∞ÓÙ›ÏË„Ë Î·È ÙËÓ Îϛ̷η TVªS (r=0,599, p=0,000) Ô˘ ÌÂÙÚ¿ ·ÔÎÏÂÈÛÙÈο ÙÔÓ √ÙÈÎÔÎÈÓËÙÈÎfi ™˘ÓÙÔÓÈÛÌfi. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ·ÍÈÔÈÛÙ›· Ù˘ ‰ÔÎÈÌ·Û›·˜ ∞’ ∆∂™∆ ‚Ú¤ıËΠfiÙÈ Â›Ó·È 99,8% Î·È Ë ÂÁ΢ÚfiÙËÙ· 97%. ∆Ô ∞’ ∆∂™∆ ·ÓȯÓ‡ÂÈ ·ÍÈfiÈÛÙ· ÙfiÛÔ Ù· ·È‰È¿ Ô˘ ‰È·ı¤ÙÔ˘Ó ÙȘ ··Ú·›ÙËÙ˜ ‰ÂÍÈfiÙËÙ˜ ÁÈ· ÙË ÊÔ›ÙËÛ‹ ÙÔ˘˜ ÛÙÔ Û¯ÔÏÂ›Ô fiÛÔ Î·È ·˘Ù¿ Ô˘ ‰ÂÓ ÙȘ ‰È·ı¤ÙÔ˘Ó.
§¤ÍÂȘ ÎÏÂȉȿ: ∞’ ∆∂™∆, Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ·.
The A TEST; assessment of school readiness Department of Developmental Paediatrics, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece Correspondence: Loretta Thomaidis developmental-health@ yahoo.gr Department of Developmental Paediatrics, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
S. Mantoudis, L. Thomaidis Abstract Objectives: The development of a reliable, flexible, short instrument for the detection of early learning disabilities. Methods: Two representative samples of children were studied: a sample aged 4-7 years for a pilot study (N=322), and a sample with an average age of 5 years and 8 months, that of the final study (¡=2002). In order to decide on the final scales to be included in the test, many developmental assessment instruments were used, such as: hand-eye coordination, visual perception, linguistic development tasks, intelligence scales and learning ability tests. The sectors that showed a deviation of equal to or more than two standard deviations were selected. The final composition of the 7 scales which comprise the test was based on the statistical analysis. Results: The assessment standards of children’s abilities were determined according to the first administration of the A TEST (Excellent, Normal, Borderline and Low performance). The A TEST was found to be positively correlated with the TVPS scale (r=0.895, p=0.000), which is used exclusively for the assessment of Visual Perception, and with the TVMS scale (r=0.599, p=0.000), which is used exclusively for the assessment of hand-eye coordination. Conclusions: The reliability and validity of the ∞ TEST were found to be 99.8% and 97%, respectively; the A TEST thus detects effectively both those children who have all the essential skills to start primary school and those who do not.
Key words: A ∆∂S∆, school readiness.
*∏ ÂÚÁ·Û›· ¤¯ÂÈ ‚Ú·‚¢ı› Ì ÙÔ Œ·ıÏÔ ¢ÔÍÈ¿‰Ë
Paediatriki 2008;71:458-468
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·459
459
∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜
∂ÈÛ·ÁˆÁ‹ ∆· ÙÂÏÂ˘Ù·›· 30 ¯ÚfiÓÈ·, Ô ·È‰›·ÙÚÔ˜ ηÏÂ›Ù·È Ó· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙË “Û‡Á¯ÚÔÓË ÓÔÛËÚfiÙËÙ·” Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, fiˆ˜ ÙË ¯·Ú·ÎÙËÚ›˙ÂÈ Ë ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜, Ô˘ ÔÊ›ÏÂÙ·È ÛÙË ÌÂÙ·‚·ÏÏfiÌÂÓË ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Ù˘ ÂÔ¯‹˜ Ì·˜. ŒÙÛÈ Ô ·È‰›·ÙÚÔ˜, ¤Ú·Ó Ù˘ ·Ú·‰ÔÛȷ΋˜ ÂÓ·Û¯fiÏËÛ‹˜ ÙÔ˘ Ì ٷ Â̇ÚÂÙ· Î·È ¿ÏÏ· ÎÏ·ÛÈο ÓÔÛ‹Ì·Ù· Ù˘ ·È‰È΋˜ ËÏÈΛ·˜, ηÏÂ›Ù·È Ó· ·Û¯ÔÏËı› Î·È Ì ÚÔ‚Ï‹Ì·Ù· fiˆ˜ ÔÈ ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÏfiÁÔ˘, Ù˘ ÔÌÈÏ›·˜ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, Ô˘ Â›Ó·È Ôχ Û˘¯Ó¤˜ ÛÙËÓ ÚÔÛ¯ÔÏÈ΋ ËÏÈΛ·, Î·È Ï›ÁÔ ·ÚÁfiÙÂÚ· Ì ÚÔ‚Ï‹Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÙȘ ÂȉfiÛÂȘ ÙˆÓ ·È‰ÈÒÓ ÛÙÔ Û¯ÔÏ›Ô. ∏ ¤Ó·ÚÍË Ù˘ Û¯ÔÏÈ΋˜ ÊÔ›ÙËÛ˘ ·ÔÙÂÏ› ‚·ÛÈÎfi ·Ó·Ù˘ÍÈ·Îfi ÔÚfiÛËÌÔ Ô˘ ÛËÌ·ÙÔ‰ÔÙ›, fi¯È ÌfiÓÔ ÙËÓ ·Î·‰ËÌ·˚΋ ÔÚ›· ÙˆÓ ·È‰ÈÒÓ, ·ÏÏ¿ Î·È ÙË ÁÂÓÈÎfiÙÂÚË ÎÔÈÓˆÓÈ΋ ÙÔ˘˜ ηٷ͛ˆÛË Î·È ÂÈÙ˘¯›· ÛÙË ˙ˆ‹. ™‹ÌÂÚ· ÛÙËÓ ∂ÏÏ¿‰·, ÙÔ ÌÔÓ·‰ÈÎfi ÎÚÈÙ‹ÚÈÔ ÁÈ· ÙËÓ ¤Ó·ÚÍË Ù˘ Û¯ÔÏÈ΋˜ ÊÔ›ÙËÛ˘ ·ÔÙÂÏ› ·ÔÎÏÂÈÛÙÈο Î·È ÌfiÓÔ Ë ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ·. ∏ ËÏÈΛ·, fï˜, ÌfiÓË ‰ÂÓ ·ÚΛ ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ ÔÌ·Ï‹˜ Û¯ÔÏÈ΋˜ ÊÔ›ÙËÛ˘. ∆Ô Â˘Ú‡ Ê¿ÛÌ· ÙˆÓ ËÏÈÎÈÒÓ ¤Ó·Ú͢ ÙÔ˘ Û¯ÔÏ›Ԣ Û ‰È·ÊÔÚÂÙÈΤ˜ ¯ÒÚ˜ ·ÔηχÙÂÈ ÙËÓ ÔÏ˘ÏÔÎfiÙËÙ· ÙÔ˘ ˙ËÙ‹Ì·ÙÔ˜ (1,2). ™ÙË µÚÂÙ·Ó›·, ÙËÓ √ÏÏ·Ó‰›· Î·È ÙËÓ ∞˘ÛÙÚ·Ï›·, Ë Û¯ÔÏÈ΋ ÊÔ›ÙËÛË ·Ú¯›˙ÂÈ ÛÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ, ÛÙË °ÂÚÌ·Ó›· ÛÙËÓ ËÏÈΛ· ÙˆÓ 6 ÂÙÒÓ, ÂÓÒ ÛÙË ™Ô˘Ë‰›·, ÙË ¡ÔÚ‚ËÁ›· Î·È ÙË ºÈÓÏ·Ó‰›· Ù· ·È‰È¿ ÂÁÁÚ¿ÊÔÓÙ·È ÛÙÔ Û¯ÔÏÂ›Ô fiÙ·Ó Û˘ÌÏËÚÒÓÔ˘Ó ÙÔ 7Ô ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜ ÙÔ˘˜ (3). ™ÙȘ ∏.¶.∞., fiÔ˘ ¤¯Ô˘Ó Á›ÓÂÈ ÌÂÁ¿Ï˜ ÏËı˘ÛÌȷΤ˜ Î·È ‰È·¯ÚÔÓÈΤ˜ ÌÂϤÙ˜, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ¤Ó· ÛÙ· ÙÚ›· ·È‰È¿ ÙÔ˘ ÓËÈ·ÁˆÁ›Ԣ ÛÙÂÚÂ›Ù·È ÙˆÓ ÁψÛÛÈÎÒÓ ÈηÓÔÙ‹ÙˆÓ Ô˘ Â›Ó·È ··Ú·›ÙËÙ˜ ÁÈ· ÙËÓ Î·Ù¿ÎÙËÛË ÙÔ˘ ÁÚ·ÙÔ‡ ÏfiÁÔ˘, ‰ËÏ·‰‹ ÙËÓ ·Ó¿ÁÓˆÛË Î·È ÙË ÁÚ·Ê‹, Ì ·ÔÙ¤ÏÂÛÌ· ·ÚÁfiÙÂÚ· ·Ó¿ÏÔÁÔ ÔÛÔÛÙfi (25%-30%) ÙˆÓ Ì·ıËÙÒÓ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Ó· ÂÌÊ·Ó›˙Ô˘Ó Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ (4). ™ÙË ¯ÒÚ· Ì·˜, ‰ÂÓ ¤¯Ô˘Ó Á›ÓÂÈ ·Ó¿ÏÔÁ˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, Ô‡Ù ‰È·ı¤ÙÔ˘Ì οÔÈÔ ÂȉÈÎfi Î·È ¤Á΢ÚÔ ÙÂÛÙ ·Ó›¯Ó¢Û˘ Ù˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜. ∏ ›ÛËÌË ‰È¿ÁÓˆÛË ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Á›ÓÂÙ·È ·fi ÙÔ˘˜ ·ÚÌfi‰ÈÔ˘˜ ÊÔÚ›˜ ÌÂÙ¿ ·fi ‰‡Ô ÙÔ˘Ï¿¯ÈÛÙÔÓ ¯ÚfiÓÈ· ÌÂȈ̤Ó˘ Û¯ÔÏÈ΋˜ ·fi‰ÔÛ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ù· ·È‰È¿ Ó· ¤¯Ô˘Ó ‹‰Ë ‚ÈÒÛÂÈ ÙË Û¯ÔÏÈ΋ ·ÔÙ˘¯›·, Ì fiϘ ÙȘ ·ÚÓËÙÈΤ˜ ÂÈÙÒÛÂȘ Ô˘ ·˘Ù‹ Û˘Ó¿ÁÂÙ·È (5). ∏ ÌÂÙ¿‚·ÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Û¯ÔÏÂ›Ô Î·È Ë ÂÈÙ˘¯‹˜ Û¯ÔÏÈ΋ ÙÔ˘ ÊÔ›ÙËÛË Î·ıÔÚ›˙ÂÙ·È ·fi ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ ÁÓˆÛÙÈÎÔ‡˜, ÁÂÓÂÙÈÎÔ‡˜, ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜, ÎÔÈÓˆÓÈÎÔ‡˜ Î·È ÔÏÈÙÈÛÙÈÎÔ‡˜
(6). °È’ ·˘ÙfiÓ ÙÔ ÏfiÁÔ, ‡ÎÔÏ· Á›ÓÂÙ·È Î·Ù·ÓÔËÙfi fiÙÈ Ë ·fiÎÙËÛË fiÏˆÓ ÙˆÓ ÈηÓÔÙ‹ÙˆÓ Î·È ‰ÂÍÈÔÙ‹ÙˆÓ Ô˘ ··ÈÙÔ‡ÓÙ·È ÁÈ· ÙË Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ·ÔÙÂÏ› ¢ı‡ÓË ÙfiÛÔ ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ fiÛÔ Î·È Ù˘ ÔÏÈÙ›·˜ (4). ∂›Ó·È Ôχ ÛËÌ·ÓÙÈÎfi Ó· ÌÔÚԇ̠ӷ ÂϤÁ¯Ô˘Ì Ì ·ÓÙÈÎÂÈÌÂÓÈÎfi Î·È ·ÛÊ·Ï‹ ÙÚfiÔ ÙË Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· Î·È Â¿ÚÎÂÈ· ÙˆÓ ·È‰ÈÒÓ ÚÈÓ ·Ú¯›ÛÔ˘Ó ÙÔ Û¯ÔÏ›Ô, ÒÛÙ ӷ ¤¯Ô˘Ì ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·Ó·ÁÓˆÚ›˙Ô˘Ì ¤ÁηÈÚ· Ù· ·È‰È¿ ÂΛӷ Ô˘ ‰ÂÓ Â›Ó·È ·ÎfiÌË ¤ÙÔÈÌ· ‹ ÒÚÈÌ· Ó· ·Ú¯›ÛÔ˘Ó ÙÔ Û¯ÔÏÂ›Ô Î·È Ó· ÚÔÏ·‚·›ÓÔ˘Ì ÙËÓ ÂΉ‹ÏˆÛË Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ·ÚÁfiÙÂÚ· (7,8). ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Û‡ÓÙÔÌÔ˘, ¢¤ÏÈÎÙÔ˘ Î·È ·ÍÈfiÈÛÙÔ˘ ÂÚÁ·Ï›Ԣ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÚÒÈÌˆÓ ‰ÂÈÎÙÒÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Ô˘ Ó· ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙÔÓ ·È‰›·ÙÚÔ Ó· ÂϤÁ¯ÂÈ ÚÔÏËÙÈο, Ì ·ÓÙÈÎÂÈÌÂÓÈÎfi Î·È ·ÛÊ·Ï‹ ÙÚfiÔ, ÙË Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ °È· ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÂÈ̤ÚÔ˘˜ ÎÏÈÌ¿ÎˆÓ Ù˘ ‰ÔÎÈÌ·Û›·˜ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ‰ÔÎÈÌ¿ÛıËÎ·Ó ÔÏÏ¿ ‰È·ÁÓˆÛÙÈο ÂÚÁ·Ï›· ·Ó·Ù˘Íȷ΋˜ ÂÎÙ›ÌËÛ˘, fiˆ˜ ‰ÔÎÈ̷ۛ˜ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡, ÔÙÈ΋˜ ·ÓÙ›Ï˄˘, ÁψÛÛÈ΋˜ ÂͤÏÈ͢, ÓÔËÌÔÛ‡Ó˘ Î·È Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ (9,10,11,12). ∂ÂϤÁËÛ·Ó ÔÈ ÙÔÌ›˜ ÂΛÓÔÈ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ·fiÎÏÈÛË ÌÂÁ·Ï‡ÙÂÚË ‹ ›ÛË ÙˆÓ 2 ÛÙ·ıÂÚÒÓ ·ÔÎϛۈÓ. ¶ÈÏÔÙÈ΋ ¤Ú¢ӷ ™ÙËÓ ÚÔηٷÚÎÙÈ΋ Ê¿ÛË, ÙÔ ∞ã ∆∂™∆ ¯ÔÚËÁ‹ıËΠ۠ÏËı˘ÛÌÈ·Îfi ‰Â›ÁÌ· 322 ·È‰ÈÒÓ ËÏÈΛ·˜ 4 ¤ˆ˜ 7 ¯ÚÔÓÒÓ, Ù· ÔÔ›· ÊÔÈÙÔ‡Û·Ó Û ۯÔÏ›· (ÓËÈ·ÁˆÁ›· Î·È ‰ËÌÔÙÈο) ÙˆÓ ∞ıËÓÒÓ. ∆Ô Â‡ÚÔ˜ ÙˆÓ ËÏÈÎÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÂÂÎÙ¿ıËΠοو ·fi ÙÔ ¯·ÌËÏfiÙÂÚÔ Î·È ¿Óˆ ·fi ÙÔ ˘„ËÏfiÙÂÚÔ fiÚÈÔ Î·Ù¿ ¤Ó· ¤ÙÔ˜ (·fi 4 ¤ˆ˜ 7 ¯ÚÔÓÒÓ ·ÓÙ› 5 ˆ˜ 6 ¯ÚÔÓÒÓ), ÚÔÎÂÈ̤ÓÔ˘ Ó· ·ÔÊ¢¯ı› Èı·Ó‹ ›‰Ú·ÛË ÙˆÓ Ê·ÈÓÔÌ¤ÓˆÓ “‚¿Û˘” Î·È “ÔÚÔÊ‹˜”. ∆Ô ‰Â›ÁÌ· ·Ú¯È΋˜ ÛÙ¿ıÌÈÛ˘ ·ÔÙ¤ÏÂÛ·Ó 322 ·È‰È¿ (161 ·ÁfiÚÈ· Î·È 161 ÎÔÚ›ÙÛÈ·) ËÏÈΛ·˜ 4 ¯ÚÔÓÒÓ (ÚÔÓ‹ÈÔ), 5 ¯ÚÔÓÒÓ (Ó‹ÈÔ), 6-7 ¯ÚÔÓÒÓ (∞ã ‰ËÌÔÙÈÎÔ‡). ∆· Ó‹È· Î·È ÔÈ Ì·ıËÙ¤˜ ÊÔÈÙÔ‡Û·Ó Û ۯÔÏ›· Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ Âη›‰Â˘Û˘ Û ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ∞ÙÙÈ΋˜. ∏ ÂÈÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ¤ÁÈÓ ÌÂ Ù˘¯·›Ô ÙÚfiÔ ·fi Ù· ·È‰È¿ Ô˘ ÊÔÈÙÔ‡Û·Ó Û οı ÙÌ‹Ì· (ÌÔÓfi˜ ‹ ˙˘Áfi˜ ·ÚÈıÌfi˜ ÛÙÔÓ ·ÏÊ·‚ËÙÈÎfi ηٿÏÔÁÔ Ù˘ Ù¿Í˘). ∆Ô ‰Â›ÁÌ· ‰È·ÌÔÚÊÒıËΠ¤ÙÛÈ ÒÛÙ ӷ ˘¿Ú¯ÂÈ ›ÛË Î·Ù·ÓÔÌ‹ ·ÁÔÚÈÒÓ-ÎÔÚÈÙÛÈÒÓ, ‰ËÏ·‰‹ ·fi οı ÙÌ‹Ì· ÂÂϤÁË ›ÛÔ˜ ·ÚÈıÌfi˜ ·ÁÔÚÈÒÓ-ÎÔÚÈÙÛÈÒÓ ÌÂ Ù˘¯·›Ô ÙÚfiÔ. ™ÙÔ ‰Â›ÁÌ· Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÌfiÓÔ ·È‰È¿ Ì ÂÏÏËÓÈ΋ ˘ËÎÔfiÙËÙ·. √È ÁÔÓ›˜ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙÔ Â›‰Ô˜ Î·È ÙÔÓ ÛÎÔfi Ù˘ ÂͤٷÛ˘ Î·È Û˘ÌÊÒÓËÛ·Ó Ó· Û˘ÌÌÂÙ¿Û¯Ô˘Ó Ù· ·È‰È¿ ÙÔ˘˜ Û ·˘Ù‹. ∏ ÚÔηٷÚÎÙÈ΋ Ê¿ÛË Ù˘ ÌÂϤÙ˘ ÂÚÈÂÏ¿Ì‚·ÓÂ: ∞. ∆ËÓ ÂÈÏÔÁ‹ ÙˆÓ ÎÏÈÌ¿ÎˆÓ Ô˘ ı· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó. µ. ∆ËÓ ÂÈÏÔÁ‹ ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ Ô˘ ı· ‹Ù·Ó ηٷÓÔËÙ¤˜ Î·È ÙËÓ Î·Ù·ÁÚ·Ê‹ Ô‰ËÁÈÒÓ Û¯ÂÙÈÎÒÓ Ì ÙË ¯ÔÚ‹ÁËÛË Î·È ÙË ‚·ıÌÔÏfiÁËÛË ÙˆÓ ÎÏÈ̿ΈÓ. ¶·È‰È·ÙÚÈ΋ 2008;71:458-468
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·460
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°. ∆ÔÓ ÂÓÙÔÈÛÌfi ÂÓ‰ÂÈÎÙÈÎÒÓ ··ÓÙ‹ÛÂˆÓ ÁÈ· ÙË ‚·ıÌÔÏfiÁËÛË ÙˆÓ ÏÂÎÙÈÎÒÓ ÎÏÈÌ¿ÎˆÓ Î·È ÙÔÓ ÔÚÈÛÌfi ÎÚÈÙËÚ›ˆÓ ·ÓÙÈÎÂÈÌÂÓÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ ÁÈ· ÙȘ ··ÓÙ‹ÛÂȘ ÙÔ˘ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡. ¢. ∆ËÓ ÈÏÔÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÂÈ̤ÚÔ˘˜ ÎÏÈÌ¿ÎˆÓ Ù˘ ‰ÔÎÈÌ·Û›·˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÓÙÔÈÛÙÔ‡Ó ÛËÌ›· Ô˘ Èı·ÓfiÓ Ó· ··ÈÙÔ‡Ó ÂÚ·ÈÙ¤Úˆ ·ÔÛ·Ê‹ÓÈÛË Î·È ‰ÈfiÚıˆÛË ÚÈÓ ÙËÓ ÙÂÏÈ΋ ÛÙ¿ıÌÈÛË. ∂ÈÏÔÁ‹ ÂÚˆÙ‹ÛÂˆÓ - ™Ù·ÙÈÛÙÈ΋ ∞Ó¿Ï˘ÛË ªÂÙ¿ ÙË ‚·ıÌÔÏfiÁËÛË ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ ÙˆÓ 7 ÎÏÈ̿ΈÓ, ·ÎÔÏÔ‡ıËÛ ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË. ∆· ÛÙ·ÙÈÛÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÛÙ· ÔÔ›· ‚·Û›ÛÙËÎÂ Ë ÂÈÏÔÁ‹ ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ ‹Ù·Ó: 1) Ô ‚·ıÌfi˜ ‰˘ÛÎÔÏ›·˜ Ù˘ οı ÂÚÒÙËÛ˘ ÛÂ Û˘Ó¿ÚÙËÛË Ì ÙËÓ ËÏÈÎȷ΋ ÔÌ¿‰· 2) Ô ‰Â›ÎÙ˘ Û˘Ó¿ÊÂÈ·˜ ÌÂٷ͇ ÙÔ˘ ‚·ıÌÔ‡ ÛÙȘ ÌÂÌÔӈ̤Ó˜ ÂÚˆÙ‹ÛÂȘ Î·È ÙÔ˘ ‚·ıÌÔ‡ Û ÔÏfiÎÏËÚË ÙËÓ Îϛ̷η. ¶ÚÔÎÂÈ̤ÓÔ˘ ÌÈ· ÂÚÒÙËÛË Ó· Û˘ÌÂÚÈÏËÊı› ÛÙËÓ Îϛ̷η ı· ¤Ú ӷ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ‰È·ÎÚ›ÓÂÈ ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈ˘, ‰ËÏ·‰‹ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÈÙ˘¯ËÌ¤ÓˆÓ ··ÓÙ‹ÛÂˆÓ ÛÙËÓ ÂÚÒÙËÛË ·˘Ù‹ Ó· ·˘Í¿ÓÂÙ·È Ì ÙËÓ ËÏÈΛ·. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÚˆÙ‹ÛÂȘ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ÈηÓfiÙËÙ· ·Ó·Ù˘Íȷ΋˜ ‰È¿ÎÚÈÛ˘. ∏ ËÏÈÎȷ΋ ÔÌ¿‰· ÁÈ· ÙËÓ ÔÔ›· ıˆڋıËΠηٿÏÏËÏË ÌÈ· ÂÚÒÙËÛË Î·ıÔÚ›ÛÙËΠ̠‚¿ÛË ÙË ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· ÛÙËÓ ÔÔ›· Ë Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÒÙËÛË ··ÓÙ‹ıËΠÂÈÙ˘¯Ò˜ ·fi ÙÔ 50% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜. ∂Ï‹ÊıË ÚfiÓÔÈ· ÒÛÙ Û fiϘ ÙȘ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ Ó· ˘¿Ú¯ÂÈ ÈηÓfi˜ ·ÚÈıÌfi˜ ÂÚˆÙ‹ÛÂˆÓ Ì ÔÛÔÛÙfi ÂÈÙ˘¯›·˜ 50%. ªÂ ÙËÓ ÈÛÔÌÂÚ‹ ·˘Ù‹ ηٷÓÔÌ‹ ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ ÛÙȘ ‰È¿ÊÔÚ˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ÂȉÈÒÍ·Ì ӷ ÂÍ·ÛÊ·Ï›ÛÔ˘Ì ›ÛË ‰È·ÎÚÈÙÈ΋ ÈηÓfiÙËÙ· Û fiÏÔ ÙÔ Ê¿ÛÌ· ÙˆÓ ËÏÈÎÈÒÓ ·fi 3 ¤ˆ˜ 7 ¯ÚÔÓÒÓ. ∏ ÂÍ·ÛÊ¿ÏÈÛË Ù˘ Û˘Ó¿ÊÂÈ·˜ ¤ÁÈÓ ·Ó¿ÌÂÛ· ÛÙËÓ Â›‰ÔÛË Û οı ÂÚÒÙËÛË Î·È ÛÙËÓ Â›‰ÔÛË ÛÙÔ Û‡ÓÔÏÔ Ù˘ Îϛ̷η˜ Î·È ¤‰ÂȯÓ ηٿ fiÛÔ Ù· ˘„ËÏfi‚·ıÌ· Ó‹È· (˘„ËÏfi‚·ıÌ· ÛÙËÓ Îϛ̷η), Û ۇÁÎÚÈÛË Ì ٷ ¯·ÌËÏfi‚·ıÌ· Ó‹È· (¯·ÌËÏfi‚·ıÌ· ÛÙËÓ Îϛ̷η), ··ÓÙÔ‡Û·Ó ÛˆÛÙ¿ Û οı ÂÚÒÙËÛË. ™ÙȘ Îϛ̷Θ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÔÈ ‰‡ÛÎÔϘ ÂÚˆÙ‹ÛÂȘ Ì ˘„ËÏ‹ Û˘Ó¿ÊÂÈ·, ‰ËÏ·‰‹ ÂÚˆÙ‹ÛÂȘ ÛÙȘ Ôԛ˜ ηٿ ηÓfiÓ· Ù· ˘„ËÏfi‚·ıÌ· Ó‹È· ··ÓÙÔ‡Û·Ó ÛˆÛÙ¿ ÂÓÒ Ù· ¯·ÌËÏfi‚·ıÌ· Ó‹È· ··ÓÙÔ‡Û·Ó Ï·Óı·Ṳ̂ӷ. ∫·Ù¿ ÙËÓ ÈÏÔÙÈ΋ ¤Ú¢ӷ ¤ÁÈÓ ηٷÁÚ·Ê‹ fiÏˆÓ ÙˆÓ ‰È¢ÎÚÈÓÈÛÙÈÎÒÓ ÂÚˆÙ‹ÛˆÓ, ηıÒ˜ Î·È Î·Ù·ÁÚ·Ê‹ fiÏˆÓ ÙˆÓ ··ÓÙ‹ÛˆÓ. ∂ȉÈÒÍ·Ì ӷ ¤¯Ô˘Ì fiÛÔ ÙÔ ‰˘Ó·ÙfiÓ ÂÚÈÛÛfiÙÂÚ˜ Èı·Ó¤˜ ··ÓÙ‹ÛÂȘ. ªÂ ·ÚÈÔ ÎÚÈÙ‹ÚÈÔ ÙË Û˘¯ÓfiÙËÙ· ÙˆÓ ÛˆÛÙÒÓ ··ÓÙ‹ÛÂˆÓ Û fiÏÔ Ù˘ ÙÔ Ê¿ÛÌ·, ¤ÁÈÓÂ Ë ÂÈÏÔÁ‹ ÙˆÓ ÂÓ‰ÂÈÎÙÈÎÒÓ ÛˆÛÙÒÓ ··ÓÙ‹ÛÂˆÓ Ì ‚¿ÛË ÙȘ Ôԛ˜ ·ÍÈÔÏÔÁ‹ıËÎÂ Ë Â›‰ÔÛË Î¿ı ·È‰ÈÔ‡ ÛÙËÓ ÚÔηٷÚÎÙÈ΋ ·˘Ù‹ Ê¿ÛË. ™Â ‰Â‡ÙÂÚÔ ÛÙ¿‰ÈÔ, ¤ÁÈÓÂ Ë ‰È¿ÎÚÈÛË ÌÂٷ͇ ··ÓÙ‹ÛÂˆÓ Ô˘ ·›ÚÓÔ˘Ó 1 ÌÔÓ¿‰· Î·È ··ÓÙ‹ÛÂˆÓ Ô˘ ·›ÚÓÔ˘Ó 2 ÌÔÓ¿‰Â˜. ªÂ ‚¿ÛË ÙȘ ·Ú·¿Óˆ ÛÙ·ÙÈÛÙÈΤ˜ ÌÂÙÚ‹ÛÂȘ ÚԤ΢„·Ó ÔÈ ÙÂÏÈΤ˜ Îϛ̷Θ ÔÈ Ôԛ˜ ¯ÔÚËÁ‹ıËÎ·Ó ÛÙËÓ Î‡ÚÈ· ¤Ú¢ӷ. ∏ ¯ÔÚ‹ÁËÛË ÙÔ˘ ∞ã ∆∂™∆ ¤ÁÈÓ οı ÊÔÚ¿ Û ȉȷ›ÙÂÚÔ ¯ÒÚÔ Ì ηٿÏÏËϘ Û˘Óı‹Î˜ (¯ˆÚ›˜ ıÔÚ‡‚Ô˘˜ Î·È Â͈ÙÂÚÈΤ˜ ·ÚÂÌ‚¿ÛÂȘ ‹ ÂÓԯϋÛÂȘ), ÒÛÙ ӷ ÂÍ·ÛÊ·ÏÈÛÙ› Ë ·ÓÙÈÎÂÈÌÂÓÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ. ™˘ÌÏËÚˆÓfiÙ·Ó ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓÈÒÓ Î·È ÙÔ Â¿ÁÁÂÏÌ¿ ÙÔ˘˜. ∞fi ÙÔÓ ÓËÈ·ÁˆÁfi ‹ ‰¿ÛηÏÔ Ù˘ Ù¿Í˘ ˙ËÙ‹ıËΠӷ ‚·ıÌÔÏÔÁ‹ÛÂÈ ÙË ÁÂÓÈ΋ ›‰ÔÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙËÓ Ù¿ÍË ˆ˜: ηϋ ̤ÙÚÈ· - ¯·ÌËÏ‹. ™Â οı ÂÚ›ÙˆÛË, ›¯Â ÚÔËÁËı› ÂÓË̤Paediatriki 2008;71:458-468
ÚˆÛË ·fi ÙÔÓ ‰¿ÛηÏÔ, ÒÛÙ ٷ ·È‰È¿ Ó· ÁÓˆÚ›˙Ô˘Ó Î·È Ó· Â›Ó·È Î·Ù¿ÏÏËÏ· ÚÔÂÙÔÈÌ·Ṳ̂ӷ ÁÈ· ÙË ‰È·‰Èηۛ· ¯ÔÚ‹ÁËÛ˘ Ù˘ ‰ÔÎÈÌ·Û›·˜. ∫‡ÚÈ· ¤Ú¢ӷ - ∆ÂÏÈ΋ ™Ù¿ıÌÈÛË ∏ ÂfiÌÂÓË Î·È ÙÂÏÈ΋ Ê¿ÛË Ù˘ ÛÙ¿ıÌÈÛ˘ ÙÔ˘ ∞ã ∆∂™∆ ›¯Â ˆ˜ ÛÙfi¯Ô ·ÊÂÓfi˜ ÌÂÓ ÙËÓ ÂȂ‚·›ˆÛË ÙˆÓ Î·ÓfiÓˆÓ ¯ÔÚ‹ÁËÛ˘ Î·È ‚·ıÌÔÏfiÁËÛ˘ Ô˘ ÚԤ΢„·Ó ·fi ÙËÓ ÈÏÔÙÈ΋ ¤Ú¢ӷ Î·È ·ÊÂÙ¤ÚÔ˘ ‰Â ÙË ‰ËÌÈÔ˘ÚÁ›· ÈÓ¿ÎˆÓ ÁÈ· ÙÔÓ ˘ÔÏÔÁÈÛÌfi ÙˆÓ ‚·ıÌÒÓ ·ÍÈÔÈÛÙ›·˜ Î·È ÂÁ΢ÚfiÙËÙ·˜ ÙˆÓ ÎÏÈ̿ΈÓ. ªÂÙ¿ ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË, Ë ÙÂÏÈ΋ Û‡ÓıÂÛË ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ Ô˘ ÂÂϤÁËÛ·Ó Ô‰‹ÁËÛ ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÙˆÓ 7 ÎÏÈÌ¿ÎˆÓ Ì ÙËÓ ·ÎfiÏÔ˘ıË Û‡ÓıÂÛË: ∫ÚÈÙÈ΋ ÈηÓfiÙËÙ·: ∏ ÚÒÙË Îϛ̷η ÂϤÁ¯ÂÈ ÙË Û‡ÓıÂÙË ÛΤ„Ë. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ ÙÚÂȘ ÂÚˆÙ‹ÛÂȘ, Ô˘ ÂÎÙÈÌÔ‡Ó ÙË ‰˘Ó·ÙfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Ó· ÂÂÍÂÚÁ·Ûı› Î·È Ó· Û˘ÁÎÚ›ÓÂÈ Û‡ÓıÂÙ˜ ¤ÓÓÔȘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷϋÍÂÈ Û ÏÔÁÈο Û˘ÌÂÚ¿ÛÌ·Ù·. √È ÂÚˆÙ‹ÛÂȘ Â›Ó·È ÎÏÈÌ·ÎÔ‡ÌÂÓÔ˘ ‚·ıÌÔ‡ ‰˘ÛÎÔÏ›·˜. ∫¿ı ·¿ÓÙËÛË ‚·ıÌÔÏÔÁÂ›Ù·È Ì 2 ÌÔÓ¿‰Â˜ ·Ó ··ÓÙËı› ÛˆÛÙ¿, Ì 1 ÌÔÓ¿‰· ·Ó ··ÓÙËı› Ì ‚Ô‹ıÂÈ· ·fi ÙÔÓ ÂÍÂÙ·ÛÙ‹ Î·È Ì 0 ·Ó ··ÓÙËı› Ï·Óı·Ṳ̂ӷ. °ÏˆÛÛÈΤ˜ ∞Ó·ÏÔÁ›Â˜: ∏ Îϛ̷η ·˘Ù‹ ÂÎÙÈÌ¿ ÙË Û‡ÓıÂÙË ·ÏÏ¿ Î·È Â·ÁˆÁÈ΋ ÛΤ„Ë. ∞ÔÙÂÏÂ›Ù·È ·fi ÙÚÂȘ ÂÚˆÙ‹ÛÂȘ. ∆Ô ·È‰› ηÏÂ›Ù·È Ó· ÛÎÂÊÙ› ÙË ÛˆÛÙ‹ Û˘ÌÌÂÙÚ›·, Ô˘ ηıÔÚ›˙ÂÈ ÙÔ ÓfiËÌ· Î·È ÙË ÛËÌ·Û›· Ù˘ ÚfiÙ·Û˘. ∂ϤÁ¯ÂÙ·È Ë ÈηÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Ó· ηٷÓÔ› Ì·ıËÌ·ÙÈΤ˜ Î·È Ê˘ÛÈΤ˜ ¤ÓÓÔȘ. ∫¿ı ۈÛÙ‹ ·¿ÓÙËÛË ·›ÚÓÂÈ 2 ÌÔÓ¿‰Â˜, Ë ·¿ÓÙËÛË Ì ‚Ô‹ıÂÈ· ‚·ıÌÔÏÔÁÂ›Ù·È Ì 1 Î·È Ë Ï·Óı·Ṳ̂ÓË ·¿ÓÙËÛË Ì 0. ¶ÚÒÈÌË ∞Ê·ÈÚÂÙÈ΋ ™Î¤„Ë: ∏ Îϛ̷η ·˘Ù‹, Ô˘ ·ÔÙÂÏÂ›Ù·È ·fi ‰‡Ô ÂÚˆÙ‹ÛÂȘ, ÂÎÙÈÌ¿ ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡ Ó· ·ÔÌÔÓÒÓÂÈ Ù· ÎÔÈÓ¿ ÛËÌ›· ·ÓÙÈÎÂÈÌ¤ÓˆÓ ‹ ÂÓÓÔÈÒÓ, ÂÓÒ Ù·˘Ùfi¯ÚÔÓ· ·ÓÙÈÏ·Ì‚¿ÓÂÙ·È ÙÔ ÁÂÓÈÎfi Û‡ÓÔÏÔ. √ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜: ∏ Îϛ̷η ·˘Ù‹ ·ÔÙÂÏÂ›Ù·È ·fi ¤ÓÙ ۯ‹Ì·Ù·. ∑ËÙ¿Ì ·fi ÙÔ ·È‰› Ó· Ù· ·ÓÙÈÁÚ¿„ÂÈ. ∂ÎÙÈÌ¿Ù·È Ë ÈηÓfiÙËÙ¿ ÙÔ˘ Ó· ·ÓÙÈÏËÊı› ÙÔ Û¯‹Ì·, Ó· ¯ÂÈÚÈÛÙ› ÙÔ ÌÔχ‚È Î·È Ó· ·Ô‰ÒÛÂÈ ÛˆÛÙ¿ ÙË Û˘ÌÌÂÙÚ›· ÙˆÓ ÁÚ·ÌÌÒÓ. ∂ϤÁ¯ÂÈ ÙË ÌÂÏÏÔÓÙÈ΋ ÙÔ˘ ÈηÓfiÙËÙ· ÛÙË ÁÚ·Ê‹ Î·È ÙËÓ ÔÚıÔÁÚ·Ê›·. ∫¿ı ۯ‹Ì· ·ÓÙÈÚÔۈ‡ÂÈ ‰È·ÊÔÚÂÙÈÎfi ·Ó·Ù˘ÍÈ·Îfi ›‰Ô. ∆· ÙÚ›· ÚÒÙ· Û¯‹Ì·Ù· Ï·Ì‚¿ÓÔ˘Ó ¤ˆ˜ 2 ÌÔÓ¿‰Â˜ ‚·ıÌÔÏfiÁËÛ˘, ÂÓÒ Ù· ‰‡Ô ÙÂÏÂ˘Ù·›· ¤ˆ˜ 3 ÌÔÓ¿‰Â˜. √ÙÈ΋ ∞ÓÙ›ÏË„Ë: ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È 10 οÚÙ˜ Ì ۯ‹Ì·Ù· ÔÙÈ΋˜ ·ÓÙ›Ï˄˘, ÎÏÈÌ·ÎÔ‡ÌÂÓ˘ ÔÙÈ΋˜ Î·È ÁÓˆÛÙÈ΋˜ ‰˘ÛÎÔÏ›·˜. ∆Ô ·È‰› ηÏÂ›Ù·È Ó· ·Ó·ÁÓˆÚ›ÛÂÈ Ù· fiÌÔÈ· Û¯‹Ì·Ù·. ∂ÎÙÈÌ¿Ù·È Ë ÈηÓfiÙËÙ¿ ÙÔ˘ ÁÈ· ÔÙÈ΋ ‰È¿ÎÚÈÛË, ·ÓÙ›ÏË„Ë Î·È ÌÓ‹ÌË ÁψÛÛÈÎÒÓ Î·È Ì·ıËÌ·ÙÈÎÒÓ Û˘Ì‚fiψÓ. ∞‰Ú‹ ∫ÈÓËÙÈÎfiÙËÙ·: ∏ ¤ÎÙË Îϛ̷η ·ÔÙÂÏÂ›Ù·È ·fi 3 ÎÈÓËÙÈΤ˜ ·Û΋ÛÂȘ ¯ÚÔÓÈο ÔÚÈÔıÂÙË̤Ó˜, Ô˘ ÂϤÁ¯Ô˘Ó ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ ÙÔ˘ ÛÒÌ·ÙÔ˜ Î·È ÙËÓ ÈÛÔÚÚÔ›·. ∂ÎÙÈÌ¿ ÙË Ó¢ÚÔÏÔÁÈ΋ ˆÚÈÌfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡. ∂ϤÁ¯ÂÈ ·‰Ú¤˜ ÎÈÓ‹ÛÂȘ, ÙËÓ ÈηÓfiÙËÙ· Û˘ÓÙÔÓÈÛÌÔ‡ ‰È·ÊÔÚÂÙÈÎÒÓ Ì˘˚ÎÒÓ ÔÌ¿‰ˆÓ, ηıÒ˜ Î·È ÙËÓ ÈÛÔÚÚÔ›·. ∞ÎÔÏÔ˘ı›Â˜: ∏ ¤‚‰ÔÌË Îϛ̷η ·ÊÔÚ¿ ÙËÓ ÙÔÔı¤ÙËÛË ÂÈÎfiÓˆÓ ÛÙË ÛˆÛÙ‹ ÙÔ˘˜ ÛÂÈÚ¿. ∞ÔÙÂÏÂ›Ù·È ·fi ÙÚÂȘ οÚÙ˜ Ô˘ fiϘ Ì·˙›, Ì ۈÛÙ‹ ÛÂÈÚ¿, ÂÚÈÁÚ¿ÊÔ˘Ó ÌÈ· ·˘ÙÔÙÂÏ‹ ÈÛÙÔÚ›·. ¢Â›ÁÌ· ∆ÂÏÈ΋˜ ™Ù¿ıÌÈÛ˘ ∆Ô ∞ã ∆∂™∆ ¯ÔÚËÁ‹ıËΠ۠2002 ·È‰È¿, ·fi Ù· ÔÔ›· Ù· 1069 ‹Ù·Ó ·ÁfiÚÈ· Î·È Ù· 933 ‹Ù·Ó ÎÔÚ›ÙÛÈ·. ∏ ËÏÈΛ· ÙˆÓ ·È‰ÈÒÓ Î˘Ì·ÈÓfiÙ·Ó ·fi 5 ÂÙÒÓ Î·È 2 ÌËÓÒÓ ¤ˆ˜ 6 ÂÙÒÓ Î·È 2
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·461
461
∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜
¶›Ó·Î·˜ 1. ∫·Ù·ÓÔÌ‹ ‰Â›ÁÌ·ÙÔ˜ ·Ó¿ ÂÚÈÔ¯‹ Î·È Û¯ÔÏÂ›Ô ∞ÚÈıÌfi˜ ·È‰ÈÒÓ ™¯ÔÏÂ›Ô µ‡ÚˆÓ·˜ æ˘¯ÈÎfi ºÈÏÔı¤Ë ¡. ∏Ú¿ÎÏÂÈÔ ∑ˆÁÚ¿ÊÔ˘ ∞ı‹Ó· ∞ÌÂÏfiÎËÔÈ ∞Á. ¶·Ú·Û΢‹ °Ï˘Î¿ ¡ÂÚ¿ ªÂÙ·ÌfiÚʈÛË °¤Ú·Î·˜ ∏ÏÈÔ‡ÔÏË ¶ÂÚÈÛÙ¤ÚÈ ∫·Ì›ÓÈ· ÕÓ‰ÚÔ˜ ¶ÂÚÈʤÚÂÈ· ∞ÙÙÈ΋˜ ™‡ÓÔÏÔ
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198 12
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24
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150 28
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24 182
ÌËÓÒÓ (̤ÛË ËÏÈΛ·: 5 ¯ÚfiÓÈ· Î·È 8 Ì‹Ó˜). ∆· ·È‰È¿ ÊÔÈÙÔ‡Û·Ó Û ÓËÈ·ÁˆÁ›· ÙÔ˘ ÓÔÌÔ‡ ∞ÙÙÈ΋˜ (¶›Ó·Î·˜ 1).
∞ÔÙÂϤÛÌ·Ù· ∆ÂÏÈ΋˜ ™Ù¿ıÌÈÛ˘ ∆· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ∞ã ∆∂™∆ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙÔÓ ¶›Ó·Î· 2 Î·È ÛÙËÓ ∂ÈÎfiÓ· 1. Ÿˆ˜ ÚÔ·ÙÂÈ ·fi ÙÔÓ ¶›Ó·Î· 2 Î·È ÙËÓ ∂ÈÎfiÓ· 1, ÛÙÔÓ ÙÔ̤· ÙˆÓ ∞ÎÔÏÔ˘ıÈÒÓ, 73,8% ÙˆÓ ·È‰ÈÒÓ Ô˘ Û˘ÌÌÂÙ›¯·Ó ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù˘È΋ ·Ó¿Ù˘ÍË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜, 8,2% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î¿ÔÈÔ Èı·Ófi Úfi‚ÏËÌ· ÛÙËÓ ·Ó¿Ù˘ÍË Î·È 17,9% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ¯ˆÚË̤ÓË ·Ó¿Ù˘ÍË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ™ÙÔÓ ÙÔ̤· Ù˘ √ÙÈ΋˜ ∞ÓÙ›Ï˄˘, 75,2% ÙÔ˘ Û˘ÓfiÏÔ˘ ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù˘È΋ ·Ó¿Ù˘ÍË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ∫¿ÔȘ ‰˘ÛÎÔϛ˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÛÙÔÓ Û˘ÁÎÂÎÚÈ̤ÓÔ ÙÔ̤· ·ÚÔ˘ÛÈ¿˙Ô˘Ó 16,7% ÙˆÓ ·È‰ÈÒÓ. ™˘ÁÎÂÎÚÈ̤ӷ, 8,3% ·ÚÔ˘ÛÈ¿˙Ô˘Ó Èı·Ófi Úfi‚ÏËÌ·, 6,5% ‹È· ‰˘ÛÎÔÏ›· Î·È ÈÔ ·ÚÁ‹ ·Ó¿Ù˘ÍË Î·È, Ù¤ÏÔ˜, 1,9% ÛÔ‚·Úfi Úfi‚ÏËÌ· Î·È ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË. ¶ÚÔ¯ˆÚË̤ÓË ·Ó¿Ù˘ÍË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ ÂÌÊ·Ó›˙Ô˘Ó 8,2% ÙˆÓ ·È‰ÈÒÓ.
24 144
60 141
72 232
46 284
47 290
24 300
™ÙÔÓ ÙÔ̤· ÙÔ˘ √ÙÈÎÔÎÈÓËÙÈÎÔ‡ ™˘ÓÙÔÓÈÛÌÔ‡, ¤Ó· Ôχ ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ, Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÚÔËÁÔ‡ÌÂÓÔ˘˜ ÙÔÌ›˜ Ù˘ ·Ó¿Ù˘Í˘, ·ÚÔ˘ÛÈ¿˙ÂÈ Ù˘È΋ ·Ó¿Ù˘ÍË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ (58,6%) Î·È 9,6% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Î¿ÔÈ· ‰˘ÛÎÔÏ›· ÛÙËÓ ·Ó¿Ù˘ÍË. ∂ȉÈÎfiÙÂÚ·, 3,5% ·ÚÔ˘ÛÈ¿˙Ô˘Ó Èı·Ófi Úfi‚ÏËÌ·, 5,5% ‹È˜ ‰˘ÛÎÔϛ˜ Î·È ÈÔ ·ÚÁ‹ ·Ó¿Ù˘ÍË Î·È 0,6% ÛÔ‚·Úfi Úfi‚ÏËÌ· Î·È ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË. ∆¤ÏÔ˜, ·Í›˙ÂÈ Ó· ÛËÌÂȈı› fiÙÈ ÛÙÔÓ ÙÔ̤· ·˘Ùfi ¤Ó· Û˘ÁÎÚÈÙÈο ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·È‰ÈÒÓ (31,9%) ·ÚÔ˘ÛÈ¿˙ÂÈ ÚÔ¯ˆÚË̤ÓË ·Ó¿Ù˘ÍË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ™ÙÔÓ ÙÔ̤· Ù˘ ∞Ê·ÈÚÂÙÈ΋˜ ™Î¤„˘, ·Ú·ÙËÚԇ̠fiÙÈ 71,7% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈηÓfiÙËÙ˜ Ù˘ÈΤ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜, 15,5% ÈηÓfiÙËÙ˜ ÚÔ¯ˆÚË̤Ó˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ Î·È 12,9% ÈηÓfiÙËÙ˜ ¯·ÌËÏfiÙÂÚ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ∂ȉÈÎfiÙÂÚ·, 6,5% ·ÚÔ˘ÛÈ¿˙Ô˘Ó Èı·Ófi Úfi‚ÏËÌ· ÛÙÔÓ ÙÔ̤· ·˘Ùfi Ù˘ ·Ó¿Ù˘Í˘, 3% ‹È˜ ‰˘ÛÎÔϛ˜ Î·È 3,4% ÛÔ‚·Úfi Úfi‚ÏËÌ·. ™ÙÔÓ ÙÔ̤· ÙˆÓ °ÏˆÛÛÈÎÒÓ ∞Ó·ÏÔÁÈÒÓ, ·Ú·ÙËÚԇ̠fiÙÈ ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ, Û ۇÁÎÚÈÛË Ì ÙÔ˘˜ ÚÔËÁÔ‡ÌÂÓÔ˘˜ ÙÔÌ›˜ Ù˘ ·Ó¿Ù˘Í˘,
¶›Ó·Î·˜ 2. µ·ıÌÔÏfiÁËÛË (%) ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÙÔÌ›˜ Ù˘ ·Ó¿Ù˘Í˘ (¡=2002) ∂›‰ÔÛË 1. ÷ÌËÏ‹ 2. ◊È· ‰˘ÛÎÔÏ›· 3. ¶Èı·Ófi Úfi‚ÏËÌ· 4. º˘ÛÈÔÏÔÁÈ΋ 5. ∂Í·ÈÚÂÙÈ΋
∫ÚÈÙÈ΋ ÈηÓfiÙËÙ·
°ÏˆÛÛÈΤ˜ ·Ó·ÏÔÁ›Â˜
∞Ê·ÈÚÂÙÈ΋ ÛΤ„Ë
OÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜
√ÙÈ΋ ·ÓÙ›ÏË„Ë
1,9 5,0 2,7 78,2 12,1
1,5 6,0 2,4 79,5 10,8
3,4 3,0 6,5 71,7 15,5
0,6 5,5 3,5 58,6 31,9
1,9 6,5 8,3 75,2 8,2
∞ÎÔÏÔ˘ı›Â˜
8,2 73,8 17,9 ¶·È‰È·ÙÚÈ΋ 2008;71:458-468
Pediatri Nov-Dec 08 new
19-12-08
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™ÂÏ›‰·462
462
™. ª·ÓÙÔ‡‰Ë˜, §. £ˆÌ·˝‰Ô˘
8,2
∞ÎÔÏÔ˘ı›Â˜
√ÙÈ΋ ∞ÓÙ›ÏË„Ë 1,9
6,5
73,8
8,3
75,2
√ÙÈÎÔÎÈÓËÙÈÎfi˜ 0,6 3,5 5,5 Û˘ÓÙÔÓÈÛÌfi˜
∆ÔÌ›˜
17,9
8,2
58,6
31,9
1. ™Ô‚·Úfi Úfi‚ÏËÌ· 2. ◊È· ‰˘ÛÎÔÏ›·
3,4 6,5 3,0
∞Ê·ÈÚÂÙÈ΋ ÛΤ„Ë
71,7
15,5
3. ¶Èı·Ófi Úfi‚ÏËÌ· 4. ∆˘ÈÎfi
°ÏˆÛÛÈΤ˜ 1,5 2,4 6,0 ·Ó·ÏÔÁ›Â˜
79,5
10,8
1,9 2,7 5,0
78,2
12,1
∫ÚÈÙÈ΋ ÈηÓfiÙËÙ·
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
5. ¶ÚÔ¯ˆÚË̤ÓÔ
100%
¶ÔÛÔÛÙfi % ∂ÈÎfiÓ· 1. ∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜ (∞ã ∆∂™∆). µ·ıÌÔÏfiÁËÛË ÛÙÔ˘˜ ÙÔÌ›˜ ·Ó¿Ù˘Í˘. µ¿ÛË: Û‡ÓÔÏÔ Ì·ıËÙÒÓ (¡=2000).
·ÚÔ˘ÛÈ¿˙ÂÈ Ù˘È΋ ·Ó¿Ù˘ÍË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ (79,5%), ÂÓÒ 10,8% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÚÔ¯ˆÚË̤Ó˜ ÈηÓfiÙËÙ˜ Î·È 9,9% ·ÚÔ˘ÛÈ¿˙Ô˘Ó ¯·ÌËÏfiÙÂÚ˜ ÈηÓfiÙËÙ˜ ·fi ÙȘ ·Ó·ÌÂÓfiÌÂÓ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ∂ȉÈÎfiÙÂÚ·, 2,4% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Èı·Ófi Úfi‚ÏËÌ·, 6% ¤¯Ô˘Ó ‹È˜ ‰˘ÛÎÔϛ˜ Î·È ÈÔ ·ÚÁfi Ú˘ıÌfi ·Ó¿Ù˘Í˘ Î·È 1,5% ¤¯Ô˘Ó ÛÔ‚·Ú‹ ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË. ∆¤ÏÔ˜, ÛÙÔÓ ÙÔ̤· Ù˘ ∫ÚÈÙÈ΋˜ πηÓfiÙËÙ·˜, 78,2% ÙˆÓ ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÈηÓfiÙËÙ˜ Ù˘ÈΤ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜, 12,1% ÈηÓfiÙËÙ˜ ÚÔ¯ˆÚË̤Ó˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜ Î·È 9,6% ÈηÓfiÙËÙ˜ ¯·ÌËÏfiÙÂÚ˜ ·fi ÙȘ ·Ó·ÌÂÓfiÌÂÓ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ∞Ó·Ï˘ÙÈÎfiÙÂÚ·, 2,7% ·ÚÔ˘ÛÈ¿˙Ô˘Ó Èı·Ófi Úfi‚ÏËÌ· ÛÙÔÓ ÙÔ̤· ·˘Ùfi Ù˘ ·Ó¿Ù˘Í˘, 5% ‹È˜ ‰˘ÛÎÔϛ˜ Î·È 1,9% ÛÔ‚·Úfi Úfi‚ÏËÌ·. ∞fi Ù· ·Ú·¿Óˆ ÚÔ·ÙÂÈ fiÙÈ ÔÈ ÙÔÌ›˜ ÙˆÓ ∞ÎÔÏÔ˘ıÈÒÓ, ÙÔ˘ √ÙÈÎÔÎÈÓËÙÈÎÔ‡ ™˘ÓÙÔÓÈÛÌÔ‡,
ÙˆÓ °ÏˆÛÛÈÎÒÓ ∞Ó·ÏÔÁÈÒÓ Î·È Ù˘ ∫ÚÈÙÈ΋˜ πηÓfiÙËÙ·˜ Â›Ó·È ÔÈ ÙÔÌ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÌÈÎÚfiÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ Ì ¯·ÌËÏfiÙÂÚ˜ ÂȉfiÛÂȘ ·fi ÙȘ ·Ó·ÌÂÓfiÌÂÓ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ∞ÓÙ›ıÂÙ·, ÔÈ ÙÔÌ›˜ √ÙÈ΋ ∞ÓÙ›ÏË„Ë Î·È ∞Ê·ÈÚÂÙÈ΋ ™Î¤„Ë Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ÔÈ ÙÔÌ›˜ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ Ì ¯·ÌËÏfiÙÂÚ˜ ÂȉfiÛÂȘ ·fi ÙȘ ·Ó·ÌÂÓfiÌÂÓ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ªÂ ÛÎÔfi ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ·Ú¿ÏÏËÏ· Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ∞ã ∆∂™∆ ¯ÔÚËÁ‹ıËÎ·Ó ÛÙ· ·È‰È¿ Î·È ‰‡Ô ÂÈÚfiÛıÂÙ˜ Îϛ̷Θ, Ë ∫ϛ̷η TVPS Ô˘ ÌÂÙÚ¿ ·ÔÎÏÂÈÛÙÈο √ÙÈ΋ ∞ÓÙ›ÏË„Ë Î·È Ë ∫ϛ̷η TVMS Ô˘ ÌÂÙÚ¿ ·ÔÎÏÂÈÛÙÈο ÙÔÓ √ÙÈÎÔÎÈÓËÙÈÎfi ™˘ÓÙÔÓÈÛÌfi (13,14). √È ÙÈ̤˜ Ù˘ Îϛ̷η˜ TVPS Î˘Ì·›ÓÔÓÙ·È ·fi 010 (1: ÛÔ‚·Ú‹ ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 4 ÂÙÒÓ, 2: ÛÔ‚·Ú‹ ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 4 ÂÙÒÓ Î·È 3 ÌËÓÒÓ, 3: ‹È· ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 4
¶›Ó·Î·˜ 3. ™˘ÁÎÚÈÙÈο ∞ÔÙÂϤÛÌ·Ù· ÌÂٷ͇ ∞ã ∆∂™∆ Î·È ∆VPS ∆·ÍÈÓfiÌËÛË ™Ô‚·Ú‹ ‰˘ÛÎÔÏ›· ◊È· ‰˘ÛÎÔÏ›· ¶Èı·Ó‹ ‰˘ÛÎÔÏ›· ª¤ÛË Â›‰ÔÛË ¶ÚÔ¯ˆÚË̤ÓË Â›‰ÔÛË ™‡ÓÔÏÔ Paediatriki 2008;71:458-468
TVPS Frequency
Valid percent
85 98 485 1102 228 1998
4,3 4,9 24,3 55,2 11,5 100
Aã TEST Frequency Valid percent 100 82 747 812 261 2002
4,9 4,2 37,2 40,7 13,0 100
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∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜
¶›Ó·Î·˜ 4. √È ‰È·ÊÔÚ¤˜ ÙÔ˘ ʇÏÔ˘ ÛÙȘ ̤Û˜ ÙÈ̤˜ ÙÔ˘ TVPS Î·È Ù˘ √ÙÈ΋˜ ∞ÓÙ›Ï˄˘ ÙÔ˘ ∞ã ∆∂™∆ ∫ϛ̷η ·ÍÈÔÏfiÁËÛ˘ TVPS Aã TEST
∞ÁfiÚÈ·
∫ÔÚ›ÙÛÈ·
T-test
6,64 12,65
6,85 13,09
t(1996) = -2,576, p=0,010 t(2000) = -2,909, p=0,004
ÂÙÒÓ Î·È 6 ÌËÓÒÓ, 4: ‹È· ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 4 ÂÙÒÓ Î·È 9 ÌËÓÒÓ, 5: Èı·Ó‹ ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 5 ÂÙÒÓ, 6: Èı·Ó‹ ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 5 ÂÙÒÓ Î·È 3 ÌËÓÒÓ, 7: Ù˘ÈÎfi, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 5 ÂÙÒÓ Î·È 6 ÌËÓÒÓ, 8: Ù˘ÈÎfi, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 5 ÂÙÒÓ Î·È 9 ÌËÓÒÓ, 9: ÚÔ¯ˆÚË̤ÓÔ, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 6 ÂÙÒÓ, 10: ÚÔ¯ˆÚË̤ÓÔ, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 6 ÂÙÒÓ Î·È 3 ÌËÓÒÓ). ¶ÚÔÎÂÈ̤ÓÔ˘ Ó· Û˘ÁÎÚ›ÓÔ˘Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ù˘ Îϛ̷η˜ ∆VPS Ì ÙËÓ ˘ÔÎϛ̷η Ù˘ √ÙÈ΋˜ ∞ÓÙ›Ï˄˘ ÙÔ˘ ∞ã ∆∂™∆, ηÙËÁÔÚÈÔÔÈ‹Û·Ì ÙȘ ÙÈ̤˜ ˆ˜ ÂÍ‹˜: 0-2: ÛÔ‚·Ú‹ ‰˘ÛÎÔÏ›·, 3-4: ‹È· ‰˘ÛÎÔÏ›·, 5-6 Èı·Ó‹ ‰˘ÛÎÔÏ›·, 7-8: Ù˘ÈÎfi, 9-10: ÚÔ¯ˆÚË̤ÓÔ. ™Â Ï‹ÚË ·ÓÙÈÛÙÔȯ›·, ÔÈ ÙÈ̤˜ Ù˘ ˘ÔÎϛ̷η˜ √ÙÈ΋ ∞ÓÙ›ÏË„Ë ÙÔ˘ ∞ã ∆∂™∆, Ô˘ Â›Ó·È 0-20 ηÙËÁÔÚÈÔÔÈ‹ıËÎ·Ó Û ¤ÓÙ ηÙËÁÔڛ˜ ˆ˜ ÂÍ‹˜ 0-4: ÛÔ‚·Ú‹ ‰˘ÛÎÔÏ›·, 5-8: ‹È· ‰˘ÛÎÔÏ›·, 9-12: Èı·Ó‹ ‰˘ÛÎÔÏ›·, 13-16: Ù˘ÈÎfi, 17-20: ÚÔ¯ˆÚË̤ÓÔ. ªÂ ‚¿ÛË ÙËÓ ·Ú·¿Óˆ ηÙËÁÔÚÈÔÔ›ËÛË ÙˆÓ ÙÈÌÒÓ ÚԤ΢„·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ô˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. £¤ÏÔÓÙ·˜ Ó· ‰ÈÂÚ¢ӋÛÔ˘Ì Èı·Ó¤˜ ‰È·ÊÔÚ¤˜ ÛÙȘ ÂȉfiÛÂȘ ÌÂٷ͇ ·ÁÔÚÈÒÓ/ÎÔÚÈÙÛÈÒÓ ÛÙËÓ √ÙÈ΋ ∞ÓÙ›ÏË„Ë, ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙË ÛÙ·ÙÈÛÙÈ΋ ̤ıÔ‰Ô ÙÔ˘ t-test. ™ÙÔÓ ¶›Ó·Î· 4 ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Ì¤Û˜ ÙÈ̤˜ Ô˘ ÛËÌ›ˆÛ·Ó Ù· ·ÁfiÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ· ÛÙÔ TVPS Î·È ÛÙËÓ √ÙÈ΋ ∞ÓÙ›ÏË„Ë ÙÔ˘ ∞ã ∆∂™∆. Ÿˆ˜ Ê·›ÓÂÙ·È ·fi ÙÔÓ ¶›Ó·Î· 4, Ù· ÎÔÚ›ÙÛÈ· ÂÌÊ·Ó›˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ¤Ó·ÓÙÈ ÙˆÓ ·ÁÔÚÈÒÓ ÛÙË ‚·ıÌÔÏÔÁ›· Ô˘ ÛËÌÂÈÒÓÔ˘Ó ÙfiÛÔ ÛÙÔ TVPS fiÛÔ Î·È ÛÙËÓ ˘ÔÎϛ̷η ÙÔ˘ ∞ã ∆∂™∆. ™˘ÁÎÂÎÚÈ̤ӷ, Ù· ÎÔÚ›ÙÛÈ· ÛËÌÂÈÒÓÔ˘Ó Î·Ï‡ÙÂÚË Â›‰ÔÛË Î·È ˘„ËÏfiÙÂÚË Ì¤ÛË ‚·ıÌÔÏÔÁ›· ·fi Ù· ·ÁfiÚÈ·. ∂›Û˘, Ë Îϛ̷η ∆VPS Î·È Ë ˘ÔÎϛ̷η √ÙÈ΋ ∞ÓÙ›ÏË„Ë ÙÔ˘ ∞ã ∆∂™∆ ÂÌÊ·Ó›˙Ô˘Ó ÛÙ·ÙÈÛÙÈο
ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË (r=0,895, p=0,000). ŸÛÔÓ ·ÊÔÚ¿ ÙËÓ Îϛ̷η TVªS, ηÙËÁÔÚÈÔÔÈ‹Û·Ì ÙȘ ÙÈ̤˜ Ù˘, fiˆ˜ Î·È ÚÈÓ, ÒÛÙ ӷ ÌÔÚ¤ÛÔ˘Ì ӷ Û˘ÁÎÚ›ÓÔ˘Ì ٷ ·ÔÙÂϤÛÌ·Ù· Ì ·˘Ù¿ Ù˘ ˘ÔÎϛ̷η˜ √ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜ ÙÔ˘ ∞ã ∆∂™∆. √È ÙÈ̤˜ Ù˘ Îϛ̷η˜ TVªS Â›Ó·È 022, (0-7: ÛÔ‚·Ú‹ ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 4 ÂÙÒÓ Î·È 3 ÌËÓÒÓ, 8-13: ‹È· ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 4 ÂÙÒÓ Î·È 9 ÌËÓÒÓ, 14-16: Èı·Ó‹ ‰˘ÛÎÔÏ›·, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 5 ÂÙÒÓ Î·È 3 ÌËÓÒÓ, 17-19: Ù˘ÈÎfi, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 5 ÂÙÒÓ Î·È 9 ÌËÓÒÓ, 20-22: ÚÔ¯ˆÚË̤ÓÔ, ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· 6 ÂÙÒÓ Î·È 3 ÌËÓÒÓ). ™Â ·ÓÙÈÛÙÔȯ›·, ÔÈ ÙÈ̤˜ Ù˘ ˘ÔÎϛ̷η˜ √ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜ ÙÔ˘ ∞ã ∆∂™∆ Â›Ó·È 012 (0-2: ÛÔ‚·Ú‹ ‰˘ÛÎÔÏ›·, 3-4: ‹È· ‰˘ÛÎÔÏ›·, 5-6: Èı·Ó‹ ‰˘ÛÎÔÏ›·, 7-9: Ù˘ÈÎfi, 10-12: ÚÔ¯ˆÚË̤ÓÔ). ªÂ ‚¿ÛË ÙËÓ ·Ú·¿Óˆ Ù·ÍÈÓfiÌËÛË, ÚԤ΢„·Ó Ù· ·ÔÙÂϤÛÌ·Ù· Ô˘ ·ÂÈÎÔÓ›˙ÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 5. £¤ÏÔÓÙ·˜ Ó· ‰ÈÂÚ¢ӋÛÔ˘Ì ÙȘ ‰È·ÊÔÚ¤˜ ÙÔ˘ ʇÏÔ˘ ÛÙËÓ ÔÙÈ΋ ·ÓÙ›ÏË„Ë, ¯ÚËÛÈÌÔÔÈ‹Û·Ì ÙË ÛÙ·ÙÈÛÙÈ΋ ̤ıÔ‰Ô ÙÔ˘ t-test. ™ÙÔÓ ¶›Ó·Î· 6 ·Ó·Ê¤ÚÔÓÙ·È ÔÈ Ì¤Û˜ ÙÈ̤˜ Ô˘ ÛËÌ›ˆÛ·Ó Ù· ·ÁfiÚÈ· Î·È Ù· ÎÔÚ›ÙÛÈ· ÛÙÔ TVªS Î·È ÛÙËÓ ˘ÔÎϛ̷η √ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜ ÙÔ˘ ∞ã ∆∂™∆. Ÿˆ˜ ·Ú·ÙËÚԇ̠ÛÙÔÓ ·Ú·¿Óˆ ›Ó·Î·, Ù· ÎÔÚ›ÙÛÈ· ÂÌÊ·Ó›˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ‰È·ÊÔÚ¿ ¤Ó·ÓÙÈ ÙˆÓ ·ÁÔÚÈÒÓ ÛÙË ‚·ıÌÔÏÔÁ›· Ô˘ ÛËÌÂÈÒÓÔ˘Ó ÙfiÛÔ ÛÙÔ TVªS fiÛÔ Î·È ÛÙËÓ ˘ÔÎϛ̷η ÙÔ˘ ∞ã ∆∂™∆. ™˘ÌÂÚ·ÛÌ·ÙÈο, Ù· ÎÔÚ›ÙÛÈ· ÛËÌÂÈÒÓÔ˘Ó Î·Ï‡ÙÂÚË Â›‰ÔÛË Î·È ˘„ËÏfiÙÂÚË Ì¤ÛË ‚·ıÌÔÏÔÁ›· ·fi Ù· ·ÁfiÚÈ·. ∂›Û˘, Ë Îϛ̷η ∆VªS Î·È Ë ˘ÔÎϛ̷η √ÙÈÎÔÎÈÓËÙÈÎfi˜ ™˘ÓÙÔÓÈÛÌfi˜ ÙÔ˘ ∞ã ∆∂™∆ ÂÌÊ·Ó›˙Ô˘Ó ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ıÂÙÈ΋ Û˘Û¯¤ÙÈÛË (r=0,599, p=0,000).
¶›Ó·Î·˜ 5. ™˘ÁÎÚÈÙÈο ∞ÔÙÂϤÛÌ·Ù· ÌÂٷ͇ ∞ã ∆∂™∆ Î·È ∆VªS ∆·ÍÈÓfiÌËÛË ™Ô‚·Ú‹ ‰˘ÛÎÔÏ›· ◊È· ‰˘ÛÎÔÏ›· ¶Èı·Ó‹ ‰˘ÛÎÔÏ›· ª¤ÛË Â›‰ÔÛË ¶ÚÔ¯ˆÚË̤ÓË Â›‰ÔÛË ™‡ÓÔÏÔ
TVMS Frequency
Valid percent
37 95 47 526 1295 2000
1,9 4,8 2,3 26,3 64,7 100
Aã TEST Frequency Valid percent 13 110 48 440 1391 2002
0,6 5,5 2,4 22,0 69,5 100 ¶·È‰È·ÙÚÈ΋ 2008;71:458-468
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·464
464
™. ª·ÓÙÔ‡‰Ë˜, §. £ˆÌ·˝‰Ô˘
¶›Ó·Î·˜ 6. √È ‰È·ÊÔÚ¤˜ ÙÔ˘ ʇÏÔ˘ ÛÙȘ ̤Û˜ ÙÈ̤˜ ÙÔ˘ TVªS Î·È ÙÔ˘ √ÙÈÎÔÎÈÓËÙÈÎÔ‡ ™˘ÓÙÔÓÈÛÌÔ‡ ÙÔ˘ ∞ã ∆∂™∆ ∫ϛ̷η ·ÍÈÔÏfiÁËÛ˘ TVªS Aã TEST
∞ÁfiÚÈ·
∫ÔÚ›ÙÛÈ·
T-test
19,05 9,55
19,52 10,03
t(1998) = -3,210, p=0,001 t(2000) = -3,545, p=0,000
∏ Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙˆÓ ÎÏÈÌ¿ÎˆÓ ∆VPS Î·È TVMS Ì ٷ ·ÔÙÂϤÛÌ·Ù· ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ˘ÔÎÏÈÌ¿ÎˆÓ ÙÔ˘ ∞ã ∆∂™∆ ¤‰ÂÈÍ fiÙÈ ÙÔ ∞ã ∆∂™∆ ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ìʈӛ· Ì ÙȘ ÁÓˆÛÙ¤˜ Îϛ̷Θ, ·ÊÔ‡ ÔÈ ‰È·ÊÔÚ¤˜ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ‰ÂÓ Â›Ó·È ÛËÌ·ÓÙÈΤ˜. ™ÙÔÓ ¶›Ó·Î· 7, ·Ó·Ê¤ÚÂÙ·È Ô ·ÚÈıÌfi˜ ÙˆÓ ·È‰ÈÒÓ Ô˘, Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË ·ÏÏ¿ Î·È ÙË ‚·ıÌÔÏÔÁ›· ÛÙÔ ∞ã ∆∂™∆, ›¯·Ó Ê˘ÛÈÔÏÔÁÈΤ˜ ÈηÓfiÙËÙ˜, ÔÚȷΤ˜ ÈηÓfiÙËÙ˜ Î·È ÛÔ‚·Ú‹ ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË. ∆· ·È‰È¿ ηÙËÁÔÚÈÔÔÈ‹ıËÎ·Ó ÛÙȘ ÙÚÂȘ ηÙËÁÔڛ˜ Ì ÎÚÈÙ‹ÚÈÔ ÙË Û˘ÓÔÏÈ΋ ÙÔ˘˜ ‚·ıÌÔÏÔÁ›· ÛÙÔ ∞ã ∆∂™∆. ™˘ÁÎÂÎÚÈ̤ӷ, ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ Ê˘ÛÈÔÏÔÁÈÎÒÓ ˘¿ÁÔÓÙ·Ó fiÏ· Ù· ·È‰È¿ ÌÂ Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÌÂÁ·Ï‡ÙÂÚË ‹ ›ÛË ÙÔ˘ 33, ÛÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ ÔÚÈ·ÎÒÓ ÈηÓÔÙ‹ÙˆÓ ˘¿ÁÔÓÙ·Ó Ù· ·È‰È¿ ÌÂ Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÌÂÁ·Ï‡ÙÂÚË ‹ ›ÛË ÙÔ˘ 26 Î·È ÌÈÎÚfiÙÂÚË ‹ ›ÛË ÙÔ˘ 32, ÂÓÒ ÛÙËÓ Î·ÙËÁÔÚ›· Ù˘ ÛÔ‚·Ú‹˜ ·Ó·Ù˘Íȷ΋˜ ηı˘ÛÙ¤ÚËÛ˘ ˘¿ÁÔÓÙ·Ó fiÏ· Ù· ·È‰È¿ ÌÂ Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÌÈÎÚfiÙÂÚË ‹ ›ÛË ÙÔ˘ 25. ∂ÈϤÔÓ, ·fi ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· Ô˘ ÛËÌ›ˆÛ·Ó Ù· ·È‰È¿ ÛÙÔ ∞ã ∆∂™∆ Î·È ·fi ÙËÓ ·Ú¯È΋ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Ô˘ ¤ÁÈÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ ÚԤ΢„·Ó Ù· ÔÛÔÛÙ¿ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 8. ∞fi ÙÔ˘˜ ¶›Ó·Î˜ 7 Î·È 8 ÌÔÚԇ̠ӷ ·Ú·ÙËÚ‹ÛÔ˘Ì fiÙÈ ˘¿Ú¯ÂÈ Ù·‡ÙÈÛË ·Ó¿ÌÂÛ· ÛÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Î·È ÛÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· Ô˘ ÛËÌ›ˆÛ·Ó Ù· ·È‰È¿ ÛÙÔ ∞ã ∆∂™∆. ∞ÍÈÔÈÛÙ›· Î·È ÂÁ΢ÚfiÙËÙ· Ù˘ ‰ÔÎÈÌ·Û›·˜ ∞’ ∆∂™∆ ¢‡Ô ¯ÚfiÓÈ· ÌÂÙ¿ ÙËÓ ·Ú¯È΋ ÛÙ¿ıÌÈÛË Ù˘ ‰ÔÎÈÌ·Û›·˜ ∞ã ∆∂™∆, ·fi ÙÔ ·Ú·¿Óˆ ‰Â›ÁÌ· ÙˆÓ 2002 ·È‰ÈÒÓ Â·ÓÂÍÂÙ¿Û·Ì 240 ·È‰È¿ (120 ·È‰È¿ Ù˘
ηÙËÁÔÚ›·˜ Ê˘ÛÈÔÏÔÁÈο, 30 ·È‰È¿ Ù˘ ηÙËÁÔÚ›·˜ ÔÚȷΤ˜ ÈηÓfiÙËÙ˜ Î·È 90 ·È‰È¿ Ù˘ ηÙËÁÔÚ›·˜ ÛÔ‚·Ú‹ ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË). ∆· ·È‰È¿ Ô˘ ›¯·Ó ÂÏÂÁ¯ı› Ì ÙË ‰ÔÎÈÌ·Û›· ∞ã ∆∂™∆ ÛÙËÓ ËÏÈΛ· 5-6 ¯ÚfiÓˆÓ ÊÔÈÙÔ‡Û·Ó Ï¤ÔÓ ÛÙË µã ‰ËÌÔÙÈÎÔ‡. ∞fi ·˘Ù¿ ÌÔÚ¤Û·Ì ӷ ¤ÚıÔ˘Ì ÙÂÏÈο Û ·ʋ Ì 201 ·È‰È¿ (100 ·È‰È¿ ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ ÈηÓfiÙËÙ˜, 20 ·È‰È¿ Ì ÔÚȷΤ˜ ÈηÓfiÙËÙ˜ Î·È 81 ·È‰È¿ Ì ÛÔ‚·Ú‹ ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË). ∞fi Ù· 201 ·È‰È¿, Ù· 123 Â›Ó·È ·ÁfiÚÈ· (61,2%) Î·È Ù· 78 ÎÔÚ›ÙÛÈ· (38,8%). ∆· ·ÔÙÂϤÛÌ·Ù· ÙÔ˘ ∞ã ∆∂™∆ ÙˆÓ 201 ·È‰ÈÒÓ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ·Ó·Ï˘ÙÈο ÛÙËÓ ∂ÈÎfiÓ· 2 Î·È ÛÙÔÓ ¶›Ó·Î· 9. Ÿˆ˜ ·Ú·ÙËÚԇ̠ÛÙËÓ ∂ÈÎfiÓ· 2 Î·È ÛÙÔÓ ¶›Ó·Î· 9, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËÏfiÙÂÚ˜ ÈηÓfiÙËÙ˜ ÛÙÔ˘˜ ÂÈ̤ÚÔ˘˜ ÙÔÌ›˜ Ù˘ ·Ó¿Ù˘Í˘ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ ·fi fi,ÙÈ ÛÙÔ Û˘ÓÔÏÈÎfi ‰Â›ÁÌ·, ÏfiÁˆ ÙÔ˘ fiÙÈ ÙÔ ÌÈÛfi ‰Â›ÁÌ· ·ÔÙÂÏÂ›Ù·È ·fi ¿ÙÔÌ· Ì ¯·ÌËÏfiÙÂÚ˜ ÈηÓfiÙËÙ˜ ·fi ÙȘ ·Ó·ÌÂÓfiÌÂÓ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ∂›Û˘, ·Ó Û˘ÁÎÚ›ÓÔ˘Ì ÙÔÓ ¶›Ó·Î· 8 Ì ÙÔÓ ¶›Ó·Î· 1 Î·È ÙËÓ ∂ÈÎfiÓ· 2 Ì ÙËÓ ∂ÈÎfiÓ· 1, ηٷϋÁÔ˘Ì ÛÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ ÔÈ ÙÔÌ›˜ √ÙÈ΋ ∞ÓÙ›ÏË„Ë Î·È ∞Ê·ÈÚÂÙÈ΋ ™Î¤„Ë Ê·›ÓÂÙ·È ˆ˜ ÂÌÊ·Ó›˙Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ·È‰ÈÒÓ Ì ÈηÓfiÙËÙ˜ ¯·ÌËÏfiÙÂÚ˜ ·fi ÙȘ ·Ó·ÌÂÓfiÌÂÓ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ◊Úı·Ì Û ·ʋ Ì ÙÔÓ ‰¿ÛηÏÔ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ (¡=201) Î·È ÙÔ˘ ˙ËÙ‹Û·Ì ӷ Û˘ÌÏËÚÒÛÂÈ ÂȉÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂϤÁÍÔ˘Ì ηٿ fiÛÔ Ù· ·È‰È¿ Ô˘ ηٿ ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Î·È ÙË ‚·ıÌÔÏÔÁ›· ÛÙÔ ∞ã ∆∂™∆ ›¯·Ó ¯·ÌËÏfiÙÂÚ˜ ÈηÓfiÙËÙ˜ ¯ÚÂÈ¿˙ÔÓÙ·Ó, Û‡Ìʈӷ Ì ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ‰·ÛοÏÔ˘, ÙËÓ ·Ú¤Ì‚·ÛË ÂȉÈÎÔ‡ ‹ ÙËÓ ¤ÓÙ·ÍË Û ÙÌ‹Ì· ÂÓÈÛ¯˘ÙÈ΋˜ ‰È‰·Ûηϛ·˜. ∞fi Ù· ‰Â‰Ô̤ӷ Ô˘ Û˘ÁÎÂÓÙÚÒıËÎ·Ó ·fi Ù· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Ô˘ Û˘ÌÏ‹ÚˆÛ·Ó ÔÈ ‰¿ÛηÏÔÈ,
¶›Ó·Î·˜ 7. ¢È·ÛÙ·‡ÚˆÛË ÙˆÓ ·È‰ÈÒÓ Ô˘ ˘¿ÁÔÓÙ·Ó ÛÙËÓ Î¿ı ηÙËÁÔÚ›·, Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Î·È ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ÛÙÔ ∞ã ∆∂™∆ ¢Â›ÎÙ˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜ (Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›·) º˘ÛÈÔÏÔÁÈÎfi ™Ô‚·Ú‹ ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË √ÚȷΤ˜ πηÓfiÙËÙ˜ ™‡ÓÔÏÔ Paediatriki 2008;71:458-468
¢Â›ÎÙ˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜ (ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË) ™Ô‚·Ú‹ ·Ó·Ù˘Íȷ΋ √ÚȷΤ˜ º˘ÛÈÔÏÔÁÈÎfi ηı˘ÛÙ¤ÚËÛË πηÓfiÙËÙ˜ 1817 3 5 1825
129 129
27 19 46
™‡ÓÔÏÔ
1817 159 24 2000
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·465
465
∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜
¶›Ó·Î·˜ 8. ¶ÔÛÔÛÙfi ·È‰ÈÒÓ (%) Ô˘ ˘¿ÁÔÓÙ·Ó ÛÙËÓ Î¿ı ηÙËÁÔÚ›·, Ì ‚¿ÛË ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Î·È ÙË Û˘ÓÔÏÈ΋ ‚·ıÌÔÏÔÁ›· ¢Â›ÎÙ˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜ º˘ÛÈÔÏÔÁÈÎfi ™Ô‚·Ú‹ ·Ó·Ù˘Íȷ΋ ηı˘ÛÙ¤ÚËÛË √ÚȷΤ˜ ÈηÓfiÙËÙ˜
¶ÔÛÔÛÙfi (%) ∫ÏÈÓÈ΋ ÂÎÙ›ÌËÛË
¶ÔÛÔÛÙfi (%) ™˘ÓÔÏÈ΋ µ·ıÌÔÏÔÁ›·
91,3
90,9
6,5 2,3
8,0 1,2
ÚԤ΢„ fiÙÈ: 95 ·È‰È¿ (47,3% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜) ·ÍÈÔÏÔÁ‹ıËÎ·Ó fiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È Î·È 106 ·È‰È¿ (52,7% ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜) fiÙÈ ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·È ÙËÓ ·Ú¤Ì‚·ÛË ÂÓfi˜ ÂȉÈÎÔ‡ ‹ ÙËÓ ¤ÓÙ·ÍË Û ÙÌ‹Ì· ÂÓÈÛ¯˘ÙÈ΋˜ ‰È‰·Ûηϛ·˜. ™ÙÔÓ ¶›Ó·Î· 10 ·Ó·Ê¤ÚÂÙ·È Ë ‰È·ÛÙ·‡ÚˆÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ Ù˘ ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ‰·ÛÎ¿ÏˆÓ ÁÈ· ÙËÓ ÙˆÚÈÓ‹ Û¯ÔÏÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ Ì ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Ô˘ ‰ÈÂÍ‹¯ıË ÛÙÔ ·ÚÂÏıfiÓ ÛÙ· ·È‰È¿ ÙÔ˘ ˘fi ÌÂϤÙË ‰Â›ÁÌ·ÙÔ˜ Ì ÙË ‰ÔÎÈÌ·Û›· ∞ã ∆∂™∆, fiÙ·Ó ·˘Ù¿ ›¯·Ó ̤ÛË ËÏÈΛ· 5 ÂÙÒÓ Î·È 8 ÌËÓÒÓ. º˘ÛÈÔÏÔÁÈο Â›Ó·È Ù· ·È‰È¿ Ô˘ Ë ·Ó¿Ù˘ÍË ÙÔ˘˜ ÛÙÔ˘˜ ‰È¿ÊÔÚÔ˘˜ ÙÔÌ›˜ Ù˘ ·Ó¿Ù˘Í˘ Â›Ó·È Ê˘ÛÈÔÏÔÁÈ΋ Î·È ÔÈ ÈηÓfiÙËÙ˜ ÙÔ˘˜ Ù˘ÈΤ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ¶·ıÔÏÔÁÈο Â›Ó·È Ù· ·È‰È¿ Ô˘ ¤¯Ô˘Ó ÈÔ ·ÚÁfi Ú˘ıÌfi ·Ó¿Ù˘Í˘ Î·È ÔÚȷΤ˜ ÈηÓfiÙËÙ˜ ‹ ÛÔ‚·Ú‹ ηı˘ÛÙ¤ÚËÛË ÛÙËÓ ·Ó¿Ù˘ÍË Î·È ÈηÓfiÙËÙ˜ ¯·ÌËÏfiÙÂÚ˜ ·fi ·˘Ù¤˜ Ô˘ ı· ¤Ú ӷ ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ Û‡Ìʈӷ Ì ÙËÓ ËÏÈΛ· ÙÔ˘˜. ™ÙÔÓ ›Ó·Î· 10 ·Ú·ÙËÚԇ̠ˆ˜ Ë ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË Ì ÙÔ ∞ã ∆∂™∆ Ù·˘Ù›˙ÂÙ·È Ì ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ‰·ÛÎ¿ÏˆÓ ÁÈ· ÙË ÌÂÙ¤ÂÈÙ· ÔÚ›· ÙˆÓ ·È‰ÈÒÓ ÛÙÔ Û¯ÔÏ›Ô. ™˘ÁÎÂÎÚÈ̤ӷ, 98,9% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÎÙÈÌ‹ıËΠ·fi ÙÔ˘˜ ‰·ÛοÏÔ˘˜ fiÙÈ ¯ÚÂÈ¿˙ÔÓÙ·È ÙËÓ ·Ú¤Ì‚·ÛË ÂȉÈÎÔ‡ ıÂÚ·Â˘Ù‹ ‹ ¤ÓÙ·ÍË Û ÙÌ‹Ì· ÂÓÈÛ¯˘ÙÈ΋˜ ‰È‰·Ûηϛ·˜ ›¯·Ó ·ÍÈÔÏÔÁËı› ·fi ÙÔ ∞ã ∆∂™∆ ˆ˜ ·ıÔÏÔÁÈο Î·È 93,4% ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÎÙÈÌ‹ıËΠ·fi ÙÔ˘˜ ‰·ÛοÏÔ˘˜ fiÙÈ ‰ÂÓ ¯Ú‹˙Ô˘Ó Î¿ÔÈ·˜ ÂȉÈ΋˜ ·Ú¤Ì‚·Û˘ ›¯·Ó ·ÍÈÔÏÔÁËı› ·fi ÙÔ ∞ã ∆∂™∆ ˆ˜ Ê˘ÛÈÔÏÔÁÈο. ¶ÈÔ ·Ó·Ï˘ÙÈο, ÌfiÓÔ ¤Ó· ·È‰› ÙÔ˘ ÔÔ›Ô˘ Ë ÎÏÈ-
ÓÈ΋ ÂÎÙ›ÌËÛË ‹Ù·Ó fiÙÈ Â›¯Â Ê˘ÛÈÔÏÔÁÈ΋ ·Ó¿Ù˘ÍË, ÂÎÙÈÌ‹ıËΠ·fi ÙÔÓ ‰¿ÛηÏfi ÙÔ˘ fiÙÈ ¯ÚÂÈ¿˙ÂÙ·È Î¿ÔÈ· ÂȉÈ΋ ·Ú¤Ì‚·ÛË. ∫·È ÌfiÓÔ ÂÊÙ¿ ·È‰È¿ Ô˘ ›¯·Ó οÔȘ ‰˘ÛÎÔϛ˜ ÛÙËÓ ·Ó¿Ù˘Í‹ ÙÔ˘˜, Û‡Ìʈӷ Ì ÙËÓ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË, ·ÍÈÔÏÔÁ‹ıËÎ·Ó ·fi ÙÔ˘˜ ‰·ÛοÏÔ˘˜ fiÙÈ ‰ÂÓ ¯ÚÂÈ¿˙ÔÓÙ·Ó Î¿ÔÈ· ·Ú¤Ì‚·ÛË. ™˘ÓÂÒ˜, ÚÔ·ÙÂÈ ÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË, Ë ÔÔ›·, fiˆ˜ ¤¯Ô˘Ì ‹‰Ë ·Ó·Ê¤ÚÂÈ, Ù·˘Ù›˙ÂÙ·È ıÂÙÈο Ì ÙË ‚·ıÌÔÏÔÁ›· ÙˆÓ ·È‰ÈÒÓ ÛÙÔ ∞ã ∆∂™∆ (‚Ï. ¶›Ó·Î· 4), ‚Ú›ÛÎÂÙ·È ÛÂ Û˘Ìʈӛ· Î·È Ì ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ‰·ÛÎ¿ÏˆÓ ÁÈ· ÙË Û¯ÔÏÈ΋ ›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ.
™˘˙‹ÙËÛË ∏ ÌÂÙ¿‚·ÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Û¯ÔÏÂ›Ô ·ÔÙÂÏ› Ì›˙ÔÓ· ·ÏÏ·Á‹ ÛÙË ˙ˆ‹ ÙÔ˘. ¶Ú¤ÂÈ ÏÔÈfiÓ Ó· Â›Ó·È ¤ÙÔÈÌÔ Î·È Î·Ï¿ ÚÔÂÙÔÈÌ·Ṳ̂ÓÔ ÁÈ’ ·˘Ùfi. ™¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ÛËÌ·›ÓÂÈ “ÙÈ Ú¤ÂÈ Ó· ͤÚÂÈ Î·È ÙÈ ÌÔÚ› Ó· οÓÂÈ ¤Ó· ·È‰›” ÚÔÎÂÈ̤ÓÔ˘ Ó· ·Ú¯›ÛÂÈ Î·Ï¿ Î·È Ó· ÊÔÈÙ‹ÛÂÈ ÔÌ·Ï¿ ÛÙÔ Û¯ÔÏ›Ô. ™ËÌ·›ÓÂÈ Ù·˘Ùfi¯ÚÔÓ· ÙË ‰˘Ó·ÙfiÙËÙ¿ ÙÔ˘ Ó· ‰Â¯ı› Ӥ˜ ÁÓÒÛÂȘ, Û ‰ÔÌË̤ÓÔ fï˜ Ï·›ÛÈÔ Î·È Ì ηıÔÚÈṲ̂ÓÔ Ú˘ıÌfi. ∞ÔÙÂÏ› Û‡ÓıÂÙË ÏÂÈÙÔ˘ÚÁ›· Ô˘ ÚÔ¸Ôı¤ÙÂÈ ÂÈ̤ÚÔ˘˜ ÂÙÔÈÌfiÙËÙ˜ fiˆ˜: °ÓˆÛÙÈ΋, °ÏˆÛÛÈ΋, ∫ÈÓËÙÈ΋, ™˘Ó·ÈÛıËÌ·ÙÈ΋ Î·È °Ú·ÊÈ΋. ∂ÈϤÔÓ, Ô fiÚÔ˜ ™¯ÔÏÈ΋ ∂ÙÔÈÌfiÙËÙ· ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ ÛÙËÓ ÂÙÔÈÌfiÙËÙ· ÙÔ˘ ·È‰ÈÔ‡. ∂ÂÎÙ›ÓÂÙ·È Î·È ·ÊÔÚ¿ ÂÍ›ÛÔ˘ Î·È ÙÔ Û¯ÔÏÂ›Ô Î·È ÙËÓ ÔÈÎÔÁ¤ÓÂÈ· Î·È ÙËÓ ÔÏÈÙ›·. Œ¯ÂÈ Ï¤ÔÓ ·Ô‰Âȯı› fiÙÈ Ë ‰È·‰Èηۛ· ÂÎÌ¿ıËÛ˘ ÙÔ˘ ÁÚ·ÙÔ‡ ÏfiÁÔ˘ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Ë Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ·Ú¯›˙ÂÈ ·fi Ôχ ÓˆÚ›˜. ∆· ·È‰È¿ ˙Ô˘Ó Î·È ÌÂÁ·ÏÒÓÔ˘Ó Û ÂÁÁÚ¿ÌÌ·Ù˜ ÎÔÈӈӛ˜, fiÔ˘ ΢Úȷگ› Ô ¤ÓÙ˘Ô˜ ÏfiÁÔ˜, Ì ÙÔÓ ÔÔ›Ô ÂÍÔÈÎÂÈÒÓÔÓÙ·È ·fi ÌÈÎÚ‹ ËÏÈΛ· Î·È ÙÔÓ ÔÔ›Ô ÛÙ·‰È·Î¿ ÚÔÛ·ıÔ‡Ó Ó· ·ÔΈ‰ÈÎÔÔÈ‹ÛÔ˘Ó. ™¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ÏÔÈfiÓ ÛËÌ·›ÓÂÈ: ∂›Ó·È ÙÔ ·È‰› ¤ÙÔÈÌÔ Ó· ·Ú¯›ÛÂÈ ÙÔ Û¯ÔÏ›Ô; ∂›Ó·È fï˜ Î·È ÙÔ Û¯ÔÏÂ›Ô ¤ÙÔÈÌÔ Ó· ‰Â¯ı›, Ó· Âηȉ‡ÛÂÈ Î·È Ó· ηχ„ÂÈ ÙȘ ·Ó¿ÁΘ ÙÔ˘ ·È‰ÈÔ‡; ∫·È ·ÎfiÌË, Â›Ó·È Ë ÔÈÎÔÁ¤ÓÂÈ· ¤ÙÔÈÌË Ó· ‰È¢ÎÔχÓÂÈ Î·È Ó· ÛÙËÚ›ÍÂÈ ÙË ÌÂÙ¿‚·ÛË ÙÔ˘ ·È‰ÈÔ‡ Û ¤Ó· ‰ÔÌË̤ÓÔ ÂÎ·È‰Â˘ÙÈÎfi Ï·›ÛÈÔ; ∫·È Ù¤ÏÔ˜, Â›Ó·È Ë ÔÏÈÙ›· ·ÚÎÒ˜ ÔÚÁ·ÓˆÌ¤ÓË ÒÛÙ ӷ ÛÙËÚ›ÍÂÈ fiÏÔ ·˘Ùfi ÙÔ Û‡ÛÙËÌ·; √È Î·Ï¿ ÔÚÁ·ÓˆÌ¤Ó˜ ÎÔÈӈӛ˜ ÌÂÚÈÌÓÔ‡Ó Î·È
¶›Ó·Î·˜ 9. µ·ıÌÔÏfiÁËÛË (%) ÛÙÔ˘˜ ÂÈ̤ÚÔ˘˜ ÙÔÌ›˜ ·Ó¿Ù˘Í˘ (¡=201) ∫ÏÈÓÈ΋ ∂ÎÙ›ÌËÛË 1. ™Ô‚·Úfi Úfi‚ÏËÌ· 2. ◊È· ‰˘ÛÎÔÏ›· 3. ¶Èı·Ófi Úfi‚ÏËÌ· 4. ∆˘ÈÎfi 5. ¶ÚÔ¯ˆÚË̤ÓÔ
∫ÚÈÙÈ΋ ÈηÓfiÙËÙ·
°ÏˆÛÛÈΤ˜ ·Ó·ÏÔÁ›Â˜
∞Ê·ÈÚÂÙÈ΋ ÛΤ„Ë
OÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜
√ÙÈ΋ ·ÓÙ›ÏË„Ë
9,0 30,3 6,0 49,3 5,5
10,9 27,4 7,5 47,3 7,0
12,4 21,4 15,4 40,8 10,0
4,5 26,9 15,4 38,3 14,9
9,5 35,3 8,5 42,8 4,0
∞ÎÔÏÔ˘ı›Â˜
44,8 42,8 12,4 ¶·È‰È·ÙÚÈ΋ 2008;71:458-468
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·466
466
™. ª·ÓÙÔ‡‰Ë˜, §. £ˆÌ·˝‰Ô˘
44,8
∞ÎÔÏÔ˘ı›Â˜
√ÙÈ΋ ∞ÓÙ›ÏË„Ë
∆ÔÌ›˜
√ÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜
9,5
4,5
12,4
42,8
35,3
26,9
8,5
4,0
42,8
15,4
38,3
14,9
1. ™Ô‚·Úfi Úfi‚ÏËÌ· 2. ◊È· ‰˘ÛÎÔÏ›·
12,4
∞Ê·ÈÚÂÙÈ΋ ÛΤ„Ë
21,4
15,4
40,8
10,0
3. ¶Èı·Ófi Úfi‚ÏËÌ· 4. ∆˘ÈÎfi
°ÏˆÛÛÈΤ˜ ·Ó·ÏÔÁ›Â˜
10,9
9,0
∫ÚÈÙÈ΋ ÈηÓfiÙËÙ· 0%
27,4
7,5
47,3
7,0
30,3
6,0
49,3
5,5
20%
40%
60%
80%
5. ¶ÚÔ¯ˆÚË̤ÓÔ
100%
¶ÔÛÔÛÙfi % ∂ÈÎfiÓ· 2. µ·ıÌÔÏfiÁËÛË ÛÙÔ˘˜ ÙÔÌ›˜ ·Ó¿Ù˘Í˘. µ¿ÛË: fiÏÔ ÙÔ ‰Â›ÁÌ· (¡=201).
‹ ¢ÂÓ ∂›Ó·È ŒÙÔÈÌÔ ÁÈ· ÙÔ Û¯ÔÏ›Ô). ∂›Ó·È ۯ‰ȷṲ̂Ó˜ ¤ÙÛÈ ÒÛÙ ӷ ÂÓÙÔ›˙Ô˘Ó ÁÚ‹ÁÔÚ· Î·È ¤ÁηÈÚ· Ù· ·È‰È¿ ˘„ËÏÔ‡ ÎÈÓ‰‡ÓÔ˘ ÁÈ· Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ Î·È Û¯ÔÏÈ΋ ·ÔÙ˘¯›·. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÚÔÏËÙÈÎfi ÏËı˘ÛÌÈ·Îfi ¤ÏÂÁ¯Ô fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÓËÈ·ÁˆÁ›·, ÒÛÙ ¤ÁηÈÚ· Ó· ·ÓȯÓ‡ÔÓÙ·È fiÛ· ·fi ·˘Ù¿ ‰ÂÓ Â›Ó·È ¤ÙÔÈÌ· Ó· ·Ú¯›ÛÔ˘Ó ÙÔ Û¯ÔÏ›Ô. √È ‰È·ÁÓˆÛÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ Â›Ó·È ¯ÚÔÓÔ‚fiÚ˜ ‰È·‰Èηۛ˜. ∂ϤÁ¯Ô˘Ó ÔÏÏÔ‡˜ Ì·ıËÛÈ·ÎÔ‡˜ Î·È ÁÓˆÛÙÈÎÔ‡˜ ÙÔÌ›˜ Î·È ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ fiÙ·Ó ˘¿Ú¯ÂÈ ·ÓËÛ˘¯›· ·fi ÙÔ˘˜ ÁÔÓ›˜ ‹ ÙÔ˘˜ ‰·ÛοÏÔ˘˜ ‹ Û ·È‰È¿ Ô˘ ¤¯Ô˘Ó ·ÔÙ‡¯ÂÈ ÛÙȘ ·ÓȯÓ¢ÙÈΤ˜ ‰ÔÎÈ̷ۛ˜ (4,6). ™ÙË ¯ÒÚ· Ì·˜, ‰ÂÓ Á›ÓÂÙ·È Û˘ÛÙËÌ·ÙÈο ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜. ŒÓ·˜ ÏfiÁÔ˜ Ô˘ Û˘Ó‹ıˆ˜ ÚÔ‚¿ÏÏÂÙ·È Â›Ó·È fiÙÈ ·˘Ùfi Á›ÓÂÙ·È ÁÈ· Ó· ÌËÓ ÂÊ·ÚÌfi˙ÔÓÙ·È ‰È·ÎÚ›ÛÂȘ ÛÙ· ·È‰È¿ ·fi ÌÈÎÚ‹ ËÏÈΛ·. ™Â ÂÚÈÔÚÈṲ̂ÓË Îϛ̷η, ¿ÓÙˆ˜,
ÂϤÁ¯Ô˘Ó ÙË Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· Î·È Â¿ÚÎÂÈ· ÙˆÓ ·È‰ÈÒÓ, ηıÒ˜ ¤¯ÂÈ ·Ô‰Âȯı› fiÙÈ Ë Û¯ÔÏÈ΋ ·ÔÙ˘¯›· ‰ËÌÈÔ˘ÚÁ› ÛÙ· ·È‰È¿ η΋ ÂÈÎfiÓ· ÁÈ· ÙÔÓ Â·˘Ùfi ÙÔ˘˜, Ô˘ Ù· Ô‰ËÁ› Û ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË Î·È ·ÚÓËÙÈ΋ ı¤ÛË, fi¯È ÌfiÓÔ ÁÈ· ÙÔ Û¯ÔÏ›Ô, ·ÏÏ¿ ÁÈ· ÙË Ì¿ıËÛË ÁÂÓÈÎfiÙÂÚ·, ηıÒ˜ Î·È Û ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜. ∂¿Ó ·˘Ù¿ Ù· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛıÔ‡Ó ¤ÁηÈÚ·, Ù· ·È‰È¿ ¤¯Ô˘Ó ˘„ËÏfi ΛӉ˘ÓÔ Ó· ÂÁηٷÏ›„Ô˘Ó ÚfiˆÚ· ÙÔ Û¯ÔÏÂ›Ô Î·È ÙË Ì¿ıËÛË, Ó· ÂÌÊ·Ó›ÛÔ˘Ó ·Ú·‚·ÙÈΤ˜ Û˘ÌÂÚÈÊÔÚ¤˜, Ó· Ô‰ËÁËıÔ‡Ó Û ¯Ú‹ÛË ÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Û ÂÊË‚È΋ ÂÁ΢ÌÔÛ‡ÓË (15,7,16). ∏ Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ·, fiˆ˜ Î·È fiÏ· Ù· ·Ó·Ù˘Íȷο ÌÂÁ¤ıË, ÌÂÙÚÒÓÙ·È Ì ÚfiÙ˘Â˜ Î·È ÛÙ·ıÌÈṲ̂Ó˜ ·Ó·Ù˘ÍȷΤ˜ ‰ÔÎÈ̷ۛ˜. √È ‰ÔÎÈ̷ۛ˜ Ô˘ ÂϤÁ¯Ô˘Ó ÙË Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ‰È·ÎÚ›ÓÔÓÙ·È Û ·ÓȯÓ¢ÙÈΤ˜ Î·È Û ‰È·ÁÓˆÛÙÈΤ˜. √È ·ÓȯÓ¢ÙÈΤ˜ Â›Ó·È Û‡ÓÙÔ̘ Î·È ·Ï¤˜ ‰È·‰Èηۛ˜ Ì ۷ʋ ÎÚÈÙ‹ÚÈ· ·Ú·ÔÌ‹˜ (∂›Ó·È ŒÙÔÈÌÔ ÁÈ· ÙÔ Û¯ÔÏ›Ô
¶›Ó·Î·˜ 10. ∂·Ó¤ÏÂÁ¯Ô˜ Î·È ‰È·ÛÙ·‡ÚˆÛË Ì ÙËÓ ·Ú¯È΋ ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË ‚¿ÛÂÈ ÙÔ˘ ∞ã ∆∂™∆ (¡=201) ¢Â›ÎÙ˘ ™¯ÔÏÈ΋˜ ∂ÙÔÈÌfiÙËÙ·˜
£· ¯ÚÂÈ·˙fiÙ·Ó ·Ú¤Ì‚·ÛË ÂȉÈÎÔ‡ ‹ ¤ÓÙ·ÍË Û ÙÌ‹Ì· ÂÓÈÛ¯˘ÙÈ΋˜ ‰È‰·Ûηϛ·˜;
Paediatriki 2008;71:458-468
™‡ÓÔÏÔ
º˘ÛÈÔÏÔÁÈÎfi
¶·ıÔÏÔÁÈÎfi
¡∞π
1
94
95
√Ã𠙇ÓÔÏÔ
99 100
7 101
106
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·467
467
∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜
Á›ÓÂÙ·È ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜ Û ϛÁ· ÌÂÁ¿Ï· ȉȈÙÈο Û¯ÔÏ›· Ô˘ ‰È·ı¤ÙÔ˘Ó ÔÚÁ·ÓˆÌ¤Ó˜ ˘ËÚÂۛ˜ ÂȉÈ΋˜ ·ÁˆÁ‹˜. ŒÙÛÈ ÛÙË ¯ÒÚ· Ì·˜, Ô ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Á›ÓÂÙ·È fi¯È ÛÙȘ ÔÈÎÔÓÔÌÈο ·‰‡Ó·Ì˜ ÎÔÈÓˆÓÈΤ˜ ÔÌ¿‰Â˜ Ô˘ ¤¯Ô˘Ó Î·È ˘„ËÏfiÙÂÚÔ Î›Ó‰˘ÓÔ ÁÈ· Û¯ÔÏÈ΋ ·ÔÙ˘¯›·, ·ÏÏ¿ Ì¿ÏÏÔÓ Û ‡ڈÛÙ˜ ÔÈÎÔÓÔÌÈο ÎÔÈÓˆÓÈΤ˜ ÔÌ¿‰Â˜ Ô˘ ÂÈϤÁÔ˘Ó Ù· ȉȈÙÈο ÓËÈ·ÁˆÁ›·. ∆· ·ÓȯÓ¢ÙÈο ÙÂÛÙ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ, ·ÚfiÙÈ ‰ÂÓ Â›Ó·È ÛÙ·ıÌÈṲ̂ӷ, Â›Ó·È ¯Ú‹ÛÈÌ· ˘fi ÙËÓ ¤ÓÓÔÈ· fiÙÈ ÌÔÚ› οÔȘ ÊÔÚ¤˜ Ó· ÂÓÙÔ›ÛÔ˘Ó ÁÓˆÛÙÈΤ˜ ÌÂÈÔÓÂ͛˜ Î·È Ó· ‰ÒÛÔ˘Ó ÙËÓ Â˘Î·ÈÚ›· ÛÙÔ˘˜ ÁÔÓ›˜ Ó· ÙȘ ‰ÈÔÚıÒÛÔ˘Ó Ì ÂȉÈ΋ ·ÁˆÁ‹, ÚÈÓ Ù· ·È‰È¿ ·Ú¯›ÛÔ˘Ó ÙË ÊÔ›ÙËÛË. ∂ÓÒ fï˜ ÛÙË ¯ÒÚ· Ì·˜ ‰ÂÓ ‰È·ı¤ÙÔ˘Ì ·ÓȯÓ¢ÙÈο ÙÂÛÙ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜, ‰È·ı¤ÙÔ˘Ì ‰È·ÁÓˆÛÙÈο ÙÂÛÙ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ. ∞fi ÙË ºÈÏÔÛÔÊÈ΋ ™¯ÔÏ‹ ÙÔ˘ ¶·Ó/Ì›Ô˘ ∞ıËÓÒÓ ¤¯ÂÈ ÛÙ·ıÌÈÛÙ› Û ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi ÙÔ ÙÂÛÙ «∞ıËÓ¿», Ô˘ ۯ‰ȿÛÙËΠÁÈ· ÙË ‰È¿ÁÓˆÛË ÙˆÓ ‰˘ÛÎÔÏÈÒÓ Ì¿ıËÛ˘ Î·È ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› Î·È ÁÈ· ÙÔÓ ‰È·ÁÓˆÛÙÈÎfi ¤ÏÂÁ¯Ô Ù˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜ (17). ∆Ô ∞ã ∆∂™∆ ¤¯ÂÈ ÛÙ·ıÌÈÛÙ› ·ÔÎÏÂÈÛÙÈο Û ÂÏÏËÓÈÎfi ÏËı˘ÛÌfi (¡=2000 ·È‰È¿ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Û·Ó 50 ÓËÈ·ÁˆÁ›·, ΢ڛˆ˜ Ù˘ ∞ÙÙÈ΋˜). ™Ùfi¯Ô˜ Ì·˜ Â›Ó·È Ó· ÂÂÎÙ›ÓÔ˘Ì ÙË ‰ÔÎÈÌ·Û›· Î·È Ó· ÌÂÏÂÙ‹ÛÔ˘ÌÂ Î·È ÏËı˘ÛÌÔ‡˜ ·fi ËÌÈ·ÛÙÈΤ˜ Î·È ·ÁÚÔÙÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ∂ÏÏ¿‰·˜, ÒÛÙ ٷ ·ÔÙÂϤÛÌ·Ù· Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ÓÙÈÚÔÛˆÂ˘ÙÈο. ∆Ô ∞ã ∆∂™∆ Â›Ó·È ¤Ó· ·Ïfi, Û‡ÓÙÔÌÔ Î·È Â‡ÎÔÏÔ ÛÙË ¯ÔÚ‹ÁËÛË ÙÂÛÙ ·Ó›¯Ó¢Û˘ Ù˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜, Ô˘ ··ÓÙ¿ Ì ·ÓÙÈÎÂÈÌÂÓÈÎfi ÙÚfiÔ ÛÙÔ ÂÚÒÙËÌ· “∂›Ó·È ÙÔ ·È‰› ¤ÙÔÈÌÔ Ó· ÊÔÈÙ‹ÛÂÈ ÛÙÔ ™¯ÔÏ›Ô;”, “¡∞π ‹ √Ãπ”. ∆Ô È‰È·›ÙÂÚÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘, ÙÔ ÔÔ›Ô ÂÈ‚¿ÏÏÂÙ·È Ó· ÛËÌÂȈı›, Â›Ó·È Ë ÈηÓfiÙËÙ¿ ÙÔ˘ Ó· ÂϤÁ¯ÂÈ ÔÏ˘Â›Â‰· ÙË Ì·ıËÛȷ΋ ÈηÓfiÙËÙ·. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ 4 Ú·ÎÙÈΤ˜ Î·È 4 ÏÂÎÙÈΤ˜ ÈηÓfiÙËÙ˜. ŒÙÛÈ, ÂϤÁ¯ÔÓÙ·È Ë ÔÙÈ΋ ·ÓÙ›ÏË„Ë Î·È Ô ÔÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜, Ë ÌÓ‹ÌË Î·È Ë ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·, ηıÒ˜ ›Û˘ ÔÈ ÁψÛÛÈΤ˜ ÈηÓfiÙËÙ˜, Ë ÚÒÈÌË ·Ê·ÈÚÂÙÈ΋ Ì·ıËÌ·ÙÈ΋ ÛΤ„Ë, Ë ÎÚ›ÛË Î·È Ô Û˘ÏÏÔÁÈÛÌfi˜. ¶·Ú¿ÏÏËÏ· ‰È·ı¤ÙÂÈ 2 Û˘ÌÏËڈ̷ÙÈΤ˜ Îϛ̷Θ. ∏ ÚÒÙË ·ÊÔÚ¿ ÛÙ· ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· Ù˘ ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·˜ Î·È Ù˘ ‰È·Ù·Ú·¯‹˜ ÂÏÏÂÈÌÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜. ∏ ‰Â‡ÙÂÚË Îϛ̷η ÂϤÁ¯ÂÈ ÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ·È‰ÈÔ‡ ηٿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ‰ÔÎÈÌ·Û›·˜, ·Ú¤¯ÔÓÙ¿˜ Ì·˜ ÙË ‰˘Ó·ÙfiÙËÙ· ÂÓÙÔÈÛÌÔ‡ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙Ô˘Ó Î·È Î·ıÔÚ›˙Ô˘Ó ÙÔÓ ‚·ıÌfi Ù˘ „˘¯ÔÛ˘Ó·ÈÛıËÌ·ÙÈ΋˜ ˆÚÈÌfiÙËÙ·˜ ÙÔ˘ ·È‰ÈÔ‡. ∏ ‰È¿ÚÎÂÈ· ¯ÔÚ‹ÁËÛ‹˜ ÙÔ˘ ‰ÂÓ ÍÂÂÚÓ¿ Ù· 15 ÏÂÙ¿. ŒÙÛÈ, ÌÔÚ› Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÁÚ‹ÁÔÚ· Î·È ÛÂ
ÔÏÏ¿ ·È‰È¿ ÛÙÔÓ ¯ÒÚÔ ÙÔ˘ ÓËÈ·ÁˆÁ›Ԣ. ∏ ‚·ıÌÔÏfiÁËÛ‹ ÙÔ˘ Á›ÓÂÙ·È ·˘ÙfiÌ·Ù· Û ËÏÂÎÙÚÔÓÈÎfi ˘ÔÏÔÁÈÛÙ‹, ÁÂÁÔÓfi˜ Ô˘ ÂÍ·ÛÊ·Ï›˙ÂÈ ÙËÓ ·ÓÙÈÎÂÈÌÂÓÈÎfiÙËÙ· ÙÔ˘ ·ÔÙÂϤÛÌ·ÙÔ˜. ¢È·ı¤ÙÂÈ ˘„ËÏ‹ ¢·ÈÛıËÛ›· Î·È ÂÍÂȉ›Î¢ÛË, ÒÛÙ ӷ ÌË ‰›ÓÂÈ „¢‰Ò˜ ıÂÙÈο ‹ ·ÚÓËÙÈο ·ÔÙÂϤÛÌ·Ù·. ∂ÓÙÔ›˙ÂÈ ÛˆÛÙ¿ Ù· ·È‰È¿ ÂΛӷ Ô˘ ‰ÂÓ Â›Ó·È ¤ÙÔÈÌ· Ó· ·Ú¯›ÛÔ˘Ó ÙÔ Û¯ÔÏ›Ô, ¯ˆÚ›˜ Ó· ·ÓËÛ˘¯Â› ·Ó·›ÙÈ· ÙÔ˘˜ ÁÔÓ›˜. ¶Ú¤ÂÈ Ó· ÙÔÓÈÛı› fiÙÈ ÙÔ ∞ã ∆∂™∆ ‰ÂÓ ÌÂÙÚ¿ÂÈ ÙÔ IQ, Ô‡Ù ÙËÓ Â˘Ê˘˝· ÁÂÓÈο, Ô‡Ù ·ÛÊ·ÏÒ˜ ‚¿˙ÂÈ Î¿ÔÈ· ‰È¿ÁÓˆÛË. ∞Ï¿ ÂϤÁ¯ÂÈ Ì ·ÓÙÈÎÂÈÌÂÓÈÎfi ÙÚfiÔ ÙË Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ÛÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ·Ó·Ê¤ÚıËηÓ. ¶ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ ÙÔ˘ Â͈ÙÂÚÈÎÔ‡. ∏ ηıȤڈۋ ÙÔ˘ Î·È ÛÙË ¯ÒÚ· Ì·˜, ÛÙ· Ï·›ÛÈ· Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ˘Á›·˜, Û fiÏ· Ù· Ê˘ÛÈÔÏÔÁÈο ·È‰È¿, Ï›ÁÔ ÚÈÓ ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÊÔ›ÙËÛ‹˜ ÙÔ˘˜ ÛÙËÓ ∞ã ‰ËÌÔÙÈÎÔ‡ ı· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÚfiÏË„Ë ÙˆÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Î·È ÛÙÔÓ ÛˆÛÙfi ÚÔÁÚ·ÌÌ·ÙÈÛÌfi ÙˆÓ ˘ËÚÂÛÈÒÓ ÚfiÓÔÈ·˜ Î·È Âη›‰Â˘Û˘ (7,8).
µÈ‚ÏÈÔÁÚ·Ê›· 1. Crnic K, Lamberty G. Reconsidering school readiness: conceptual and applied perspectives. Early education and development 1994;5:91-105. 2. De Lemos MM, Mellor EJ. A longitudinal study of developmental maturity, school entry age and school progress. Journal of Australian Research in Early Childhood Education 1994;1:42-50. 3. Routley V, De Lemos MM. Changing trends in school entry age in Victoria. Australian Journal of Early Education 199; 18:30-38. 4. Janus M, Offord DR. Reporting on readiness to learn at school in Canada. Canadian Journal of Policy Research 2000;1:71-75. 5. Erikson E. ∏ ·È‰È΋ ËÏÈΛ· Î·È Ë ÎÔÈÓˆÓ›·, ∞ı‹Ó·: ∂ΉfiÛÂȘ ∫·ÛÙ·ÓÈÒÙ˘; 1990. 6. Meisels SJ. Assessing Readiness. In: Pianta RC and Cox M, editors. The transition to Kindergarten. Baltimore: Paul Brookers Press; 1999. p. 39-66. 7. Moffit TE. Adolescence-limited and life-course-persistent antisocial behaviour: a developmental taxonomy. Psychological Review 1993;100:674-701. 8. Barnett S. Economics of early childhood intervention. In: Meisels SJ, editor. Handbook of early childhood intervention. 2nd ed. New York, NY: Cambridge University Press; 2000. p. 589-610. 9. Kolb B, Fantie B. Development of the child’s brain and behaviour. In: Reynolds CE, Fletcher-Janzen E, editors. Handbook of clinical child neuropsychology. New York: Plenum Press; 1997. p. 17-41. 10. Ayres AJ. Sensory Integration and Praxis Tests. Los Angeles: Western Psychological Services; 1989. p 52-78. 11. Kamphaus RW, Kaufman AS. The assessment of preschool children with the Kaufman Assessment Battery for Children. In: Bracken BA, editor. The Psychoeducational Assessment ¶·È‰È·ÙÚÈ΋ 2008;71:458-468
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of Preschool Children. 2nd ed. Needham Heights, MA: Allyn & Bacon; 1991. 12. Hresko W, Reid DK, Hammill DD. Test of Early Language Development. 2nd ed. Austin, TX: PRO-ED; 1991. 13. Gardner MF. Test of visual-perceptual skills TVPS (nonmotor) (upper level). Burlingame, CA: Psychological and Educational Publications; 1992. 14. Gardner MF. Test of visual-motor skills TVMS - revised. Burlingame, CA: Psychological and Educational Publications; 1996. 15. Shaw DS, Gilliom M, Giovanelli J. Aggressive behaviour disorders. In: Zeanah CH, editor. Handbook of infant mental health. 2nd ed. New York: Guilford; 2000. p. 397-411.
Paediatriki 2008;71:458-468
16. Moffit TE. Adolescent limited and life course persistent anti-social behaviour. A developmental taxonomy. Psychological Review 1993;100:674-701. 17. Richman N, Stevenson J, Graham P. Preschool to school: a behavioural study. Academic Press; 1982. p. 12-56. 18. ¶·Ú·Û΢fiÔ˘ÏÔ˜ π¡, ∫·Ï·ÓÙ˙‹-∞˙›˙È ∞, °È·ÓÓ›ÙÛ·˜ ¡¢. ∞ıËÓ¿ ∆ÂÛÙ ¢È¿ÁÓˆÛ˘ ¢˘ÛÎÔÏÈÒÓ ª¿ıËÛ˘. ∞ı‹Ó·: ∂ÏÏËÓÈο °Ú¿ÌÌ·Ù·; 1999.
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ORIGINAL ARTICLE
469
¶ÚfiÙ˘Ô ÚfiÁÚ·ÌÌ· ·ÁˆÁ‹˜ Î·È ÚÔ·ÁˆÁ‹˜ ˘Á›·˜ Û ·ÛÙÈ΋ ÎÔÈÓfiÙËÙ· ·fi ÊÔÚ¤· ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ ∞. •ÂηϿÎË1, ¢. ª¤ÓÂÁ·˜1, ∞ÈÎ. ∑ÔÏÒÙ·1, ∑. ∏ÏÈÔ‰ÚÔÌ›ÙË1, ∞. ¶Ú·ÛÔ‡ÏË1, ∂. ∆˙›ÓË1, ¶. ª·˘Ú›Î·1, ∞ÈÎ. ¢ËÌÔÔ‡ÏÔ˘1, ∞. ª¿ÚÁ·ÚË2, π. ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: √ ÚfiÏÔ˜ Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ ÛÂ Â›Â‰Ô ÎÔÈÓfiÙËÙ·˜ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛı› ˆ˜ ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡. ∏ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÎÔÈÓfiÙËÙ·˜ ·ÔÙÂÏ› ÚÔ¸fiıÂÛË ÛÙ· Û‡Á¯ÚÔÓ· ÌÔÓ٤Ϸ ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜. ∆Ô ∫¤ÓÙÚÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ∫·ÈÛ·ÚÈ·Ó‹˜ (∫.À.¶.∫.), Ô˘ ÂÔÙ‡ÂÙ·È ÂÈÛÙËÌÔÓÈο ·fi ÙÔ πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ۯ‰›·ÛÂ Î·È ÂÊ¿ÚÌÔÛ ¤Ó· ÚfiÁÚ·ÌÌ· ·ÁˆÁ‹˜-ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ Ì ı¤Ì· “¶ÂÚÈ‚¿ÏÏÔÓ Î·È ÀÁ›·”. ™Ùfi¯Ô˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‹Ù·Ó: ·) Ë ·ÚÔ¯‹ ¤ÁÎ˘ÚˆÓ ÁÓÒÛÂˆÓ Û ̷ıËÙ¤˜ ÁÈ· ÙËÓ Â›‰Ú·ÛË Ù˘ Ú‡·ÓÛ˘ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÛÙËÓ ˘Á›·, ÒÛÙ ӷ Û˘ÓÂȉËÙÔÔÈ‹ÛÔ˘Ó fiÙÈ Ë ÊÚÔÓÙ›‰· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ¤¯ÂÈ ˆ˜ ¿ÌÂÛÔ Î·È Ì·ÎÚÔÚfiıÂÛÌÔ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜, Î·È ‚) Ë ÚÔÙ˘ÔÔ›ËÛË ÙÔ˘ ۯ‰ȷÛÌÔ‡ Î·È Ë ·Ú·ÁˆÁ‹ ÂÔÙÈÎÔ‡ ˘ÏÈÎÔ‡, ÒÛÙ ÙÔ ÚfiÁÚ·ÌÌ· Ó· ÌÔÚ› Ó· ·Ó··Ú·¯ı› Î·È ·fi ¿ÏÏÔ˘˜ ÊÔÚ›˜. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ¶ÏËı˘ÛÌfi˜ ÛÙfi¯Ô˜ ‹Ù·Ó ÔÈ Ì·ıËÙ¤˜ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ, ‰ËÌÔÙÈÎÒÓ Î·È Á˘ÌÓ·Û›ˆÓ Ù˘ ÂÚÈÔ¯‹˜. √ ۯ‰ȷÛÌfi˜ ÂÚÈÂÏ¿Ì‚·ÓÂ: ·) ÎÔÈÓÔÙÈ΋ Û˘ÌÌÂÙÔ¯‹, ‚) ‰Ú¿ÛÂȘ ¢·ÈÛıËÙÔÔ›ËÛ˘-Âη›‰Â˘Û˘ ·ÁÁÂÏÌ·ÙÈÒÓ Î·È ÂÎ·È‰Â˘ÙÒÓ, Á) ·ÁˆÁ‹ ˘Á›·˜ ÛÙ· Û¯ÔÏ›·, ‰) ·ÁˆÁ‹ ˘Á›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ·, Â) ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ì ÂÚˆÙËÌ·ÙÔÏfiÁÈ· Û ̷ıËÙ¤˜ Î·È Û ÂÎ·È‰Â˘ÙÈÎÔ‡˜. ∞ÔÙÂϤÛÌ·Ù·: ∫·Ù·ÁÚ¿ÊËΠÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ ÌÂÙ·ÙfiÈÛË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÙˆÓ Ì·ıËÙÒÓ (p<0,01) ÚÔ˜ ÙËÓ Î·ÙËÁÔÚ›· Ô˘ ·ÓÙÈÚÔۈ‡ÂÈ ÙËÓ ¿ÚÈÛÙË Â›‰ÔÛË ÛÂ Â›Â‰Ô ÁÓÒÛˆÓ. ∆Ô ÂÚȯfiÌÂÓÔ ÙˆÓ ·ÚÔ˘ÛÈ¿ÛÂˆÓ ·ÍÈÔÏÔÁ‹ıËΠ·fi ÂÍ·ÈÚÂÙÈÎfi ¤ˆ˜ Ôχ ηٿÏÏËÏÔ, ·Ó¿ ËÏÈÎȷ΋ ÔÌ¿‰·, ·fi 89,6% ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ÛÙ· ‰ËÌÔÙÈο Î·È 84,2% ÛÙ· Á˘ÌÓ¿ÛÈ·. √ ÙÚfiÔ˜ ·ÚÔ˘Û›·Û˘ ·fi ÙÔ˘˜ ÔÌÈÏËÙ¤˜ ÂÎÙÈÌ‹ıËΠ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ·fi Ôχ ˆ˜ ÂÍ·ÈÚÂÙÈο Û·Ê‹˜, ˙ˆÓÙ·Ófi˜ Î·È Â˘¤ÏÈÎÙÔ˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÎÔÈÓfiÙËÙ·˜ ·fi ¤Ó·Ó ÊÔÚ¤· ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ ·ÔÙÂÏ› ηÈÓÔÙfiÌÔ ÚÔÛ¤ÁÁÈÛË ÁÈ· Ù· ÂÏÏËÓÈο ‰Â‰Ô̤ӷ.
1 πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∫¤ÓÙÚÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ∫·ÈÛ·ÚÈ·Ó‹ 2 √ÈÎÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ¢‹ÌÔ˘ ∫·ÈÛ·ÚÈ·Ó‹˜ AÏÏËÏÔÁÚ·Ê›·: πˆ¿ÓÓ· ∞ÓÙˆÓÈ¿‰Ô˘∫Ô˘Ì¿ÙÔ˘ inchildh@otenet.gr πÓÛÙÈÙÔ‡ÙÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∏ ∞Á›· ™ÔÊ›·” £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜ 11527, ∞ı‹Ó·
§¤ÍÂȘ ÎÏÂȉȿ: ∞ÁˆÁ‹ ˘Á›·˜, ÂÚÈ‚¿ÏÏÔÓ, ÎÔÈÓfiÙËÙ·.
Model health promotion program in an urban community by a primary health care setting A. Xekalaki1, D. Menegas1, K. Zolota1, Z. Iliodromiti1, A. Prasouli1, E. Tzini1, P. Mavrika1, K. Dimopoulou1, A. Margari2, I. Antoniadou-Koumatou1 Abstract Background: The role of primary health care has been identified as very important for improving the health of the population. Community participation is a prerequisite in contemporary health promotion models. The Child Health Centre of Kessariani, an urban primary health care centre scientifically supervised by the Institute of Child Health, designed and implemented a health education-promotion programme in the community, on the issue of “Health and the Environment”. The aims of the programme were: a) to enable the children to understand how the pollution of the environment affects health, and that health is protected when environment is protected, and b) to create a model programme which can be implemented by various settings. Methods: The target population comprised the pupils of the kindergartens and the elementary and secondary schools of the area. The action plan included: 1) community participation, 2) education of professionals and educators, 3) health education sessions in schools, 4) community health education, and 5) evaluation of the programme using questionnaires completed by pupils and teachers. Results: Data from the analysis of the questionnaires showed a statistically significant difference (p<0.01) in the level of relevant knowledge after the interventions, which was demonstrated to be excellent. The content of the electronic presentations was evaluated as from exceptional to very appropriate for each age
1 Institute of Child Health, Health Care Centre of Kessariani, Athens, Greece 2 Ecological Workshop of Municipality of Kessariani, Athens, Greece Correspondence: Ioanna AntoniadouKoumatou inchildh@otenet.gr Institute of Child Health “Aghia Sophia” Children’s Hospital Thivon and Levadias St. 11527, Athens, Greece
¶·È‰È·ÙÚÈ΋ 2008;71:469-474
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group by 89.6% of the elementary school teachers and 84.2% of the secondary school teachers. The mode of presentation was evaluated by the teachers as very accurate, vivid and flexible. Conclusions: Promoting community participation in health education-promotion by a primary health care team is an innovative approach in Greece, since it requires a health care system based on primary care. It is suitable for standard work practice in the primary care setting.
Key words: Health education, environment, community.
∂ÈÛ·ÁˆÁ‹ ∏ ·ÁˆÁ‹ ˘Á›·˜ ·ÔÙÂÏ› ÌÈ· ÌÔÚÊ‹ ÂÈÎÔÈÓˆÓ›·˜ Ô˘ ÛÙԯ‡ÂÈ ÛÙË ÌÂÙ¿‰ÔÛË ¤ÁÎ˘ÚˆÓ ÁÓÒÛˆÓ, ÛÙËÓ ÔÈÎÔ‰fiÌËÛË ·˘ÙÔÂÎÙ›ÌËÛ˘ Î·È ÛÙËÓ ·Ó¿Ù˘ÍË ‰ÂÍÈÔÙ‹ÙˆÓ ÛÙË Ï‹„Ë ·ÔÊ¿ÛÂˆÓ ÁÈ· ÙËÓ ˘Á›· (1), Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÙÚÔÔÔ›ËÛË ÌÈ·˜ Û˘ÌÂÚÈÊÔÚ¿˜ ‹ ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ ¢ڇÙÂÚÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ∏ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Â›Ó·È Â˘Ú‡ÙÂÚË Î·È ÂÌÂÚȤ¯ÂÈ ÙÔÌ›˜ fiˆ˜ Ë ÚfiÏË„Ë, Ë ‰ËÌfiÛÈ· ˘Á›·, Ë Û¯ÂÙÈ΋ ÓÔÌÔıÂÛ›·, ·ÏÏ¿ Î·È Ë ·ÁˆÁ‹ ˘Á›·˜. ø˜ ÚÔ·ÁˆÁ‹ ˘Á›·˜ ÔÚ›˙ÔÓÙ·È ÔÈ ÔÈΛϘ ÂÓ¤ÚÁÂȘ Î·È ·ÚÂÌ‚¿ÛÂȘ Ô˘ Á›ÓÔÓÙ·È ÁÈ· ÙËÓ Î·Ï˘Ù¤Ú¢ÛË Ù˘ ˘Á›·˜ (2). Œ¯ÂÈ ‰È·ÈÛÙˆı› fiÙÈ ÔÏÏ¿ ·fi Ù· ÓÔÛ‹Ì·Ù· Ô˘ ·ÔÙÂÏÔ‡Ó ÙȘ ‚·ÛÈÎfiÙÂÚ˜ ·Èٛ˜ ıÓËÛÈÌfiÙËÙ·˜ Î·È ÓÔÛËÚfiÙËÙ·˜ Ù˘ ÂÔ¯‹˜ Ì·˜ ¤¯Ô˘Ó ÔÏ˘·Ú·ÁÔÓÙÈ΋ ·ÈÙÈÔÏÔÁ›· (3). √ ÎÏ·ÛÈÎfi˜ ÔÚÈÛÌfi˜ Ù˘ ˘Á›·˜ ·fi ÙÔÓ ¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈÛÌfi ÀÁ›·˜ (¶.√.À.) ·Ó·Ê¤ÚÂÙ·È ÛÙËÓ Î·Ù¿ÛÙ·ÛË Ù˘ Ï‹ÚÔ˘˜ ۈ̷ÙÈ΋˜, „˘¯È΋˜, Î·È ÎÔÈÓˆÓÈ΋˜ ¢ÂÍ›·˜ Î·È fi¯È ÌfiÓÔ ÛÙËÓ ·Ô˘Û›· ·Ûı¤ÓÂÈ·˜ ‹ ·Ó·ËÚ›·˜ (4). ∏ ÚÔÛˆÈ΋ ‰È¿ÛÙ·ÛË Ù˘ ˘Á›·˜ Â›Ó·È ÔÚ·Ù‹ Û ·˘ÙfiÓ ÙÔÓ ÔÚÈÛÌfi Î·È Â›Ó·È ‚È‚ÏÈÔÁÚ·ÊÈο ‰È·ÈÛو̤ÓÔ fiÙÈ ˘Á›· ÛËÌ·›ÓÂÈ ‰È·ÊÔÚÂÙÈο Ú¿ÁÌ·Ù· Û ‰È·ÊÔÚÂÙÈÎÔ‡˜ ·ÓıÚÒÔ˘˜ ‹ ÔÌ¿‰Â˜ Î·È ÔˆÛ‰‹ÔÙ ÛËÌ·ÙÔ‰ÔÙ› ÌÈ· ‰˘Ó·ÌÈ΋ ·ÏÏËÏ›‰Ú·ÛË ÙÔ˘ ·ÙfiÌÔ˘ Ì ÙÔ Â˘Ú‡ÙÂÚÔ ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘. √ ¶.√.À., ÛÙË ‰È·Î‹Ú˘ÍË "ÀÁ›· ÁÈ· fiÏÔ˘˜ ̤¯ÚÈ ÙÔ ¤ÙÔ˜ 2000" (5), ·Ó¤‰ÂÈÍ ·˘Ù‹Ó ÙË ‰˘Ó·ÌÈ΋ Û¯¤ÛË. ∏ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Û˘ÌÂÚȤϷ‚Â Î·È ÙËÓ ÚÔÛ¤ÁÁÈÛË Ù˘ ÎÔÈÓÔÙÈ΋˜ ·Ó¿Ù˘Í˘, Ô˘ Ú·ÎÙÈο ÛËÌ·›ÓÂÈ ÙËÓ ˘ÔÛÙ‹ÚÈÍË ‰Ú¿ÛÂˆÓ ÙˆÓ Î·ÙÔ›ÎˆÓ Ù˘ ÎÔÈÓfiÙËÙ·˜ Ì ÛÙfi¯Ô ÙË ‚ÂÏÙ›ˆÛË ÙˆÓ Û˘ÓıËÎÒÓ ÙÔ˘ ¢ڇÙÂÚÔ˘ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ∂ÓÒ, ·fi ÙËÓ ¿ÏÏË, Ë ‰˘Ó·ÙfiÙËÙ· ÙÔ˘ ·ÙfiÌÔ˘ Ó· ÂÈϤÍÂÈ ÙËÓ ÂÚÈÛÛfiÙÂÚÔ "˘ÁÈ‹" Û˘ÌÂÚÈÊÔÚ¿ ("healthier choices, easier choices") (6) ÂÓÈÛ¯‡ÂÙ·È fiÙ·Ó ÙÔ ÂÚÈ‚¿ÏÏÔÓ Â›Ó·È Â˘ÓÔ˚ÎfiÙÂÚÔ. ∆Ô ∫¤ÓÙÚÔ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡ ÛÙËÓ ∫·ÈÛ·Paediatriki 2008;71:469-474
ÚÈ·Ó‹ (∫.À.¶.K.), ÙÔ ÔÔ›Ô È‰Ú‡ıËÎÂ Î·È ÂÔÙ‡ÂÙ·È ÂÈÛÙËÌÔÓÈο ·fi ÙË ¢È‡ı˘ÓÛË ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¤¯ÂÈ Ì·ÎÚ¿ ÂÌÂÈÚ›· ÛÙËÓ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ·ÌÌ¿ÙˆÓ ·ÁˆÁ‹˜ Î·È ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ· Ù˘ ∫·ÈÛ·ÚÈ·Ó‹˜. ™ÙÔÓ Û¯Â‰È·ÛÌfi ÙˆÓ ÎÔÈÓÔÙÈÎÒÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Á›ÓÂÙ·È ÂÊ·ÚÌÔÁ‹ ÙˆÓ Û‡Á¯ÚÔÓˆÓ Ù¿ÛÂˆÓ ÛÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜, Ô˘ ÚÔ¸Ôı¤ÙÔ˘Ó ÙËÓ ÂÓÂÚÁÔÔ›ËÛË Î·È ÙË Û˘ÌÌÂÙÔ¯‹ Ù˘ ÎÔÈÓfiÙËÙ·˜ ÛÙÔÓ Î·ıÔÚÈÛÌfi ÙˆÓ ÚÔÙÂÚ·ÈÔًوÓ, ÙÔÓ Û¯Â‰È·ÛÌfi Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘˜. (∫·Ù·ÛÙ·ÙÈÎfi˜ ¯¿ÚÙ˘ Ù˘ √Ù¿‚·, ¶.√.À, 1986) (6). ™Ùfi¯Ô˜ Â›Ó·È Ë ÚÔÙ˘ÔÔ›ËÛË ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ, ÒÛÙ ӷ ÌÔÚÔ‡Ó Ó· ·Ó··Ú·¯ıÔ‡Ó. √ ÛÎÔfi˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ·ÁˆÁ‹˜ Î·È ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ ÁÈ· ÙÔ 2007 ‹Ù·Ó “¶ÂÚÈ‚¿ÏÏÔÓ Î·È ÀÁ›·”. ∆Ô Ê˘ÛÈÎfi ÂÚÈ‚¿ÏÏÔÓ ÙˆÓ ·È‰ÈÒÓ, ÂΛ ‰ËÏ·‰‹ Ô˘ Ù· ·È‰È¿ ˙Ô˘Ó, ·›˙Ô˘Ó Î·È Ì·ı·›ÓÔ˘Ó, ·ÔÙÂÏ› ηıÔÚÈÛÙÈÎfi ·Ú¿ÁÔÓÙ· ÁÈ· ÙËÓ ˘Á›· ÙÔ˘˜ Î·È ÙËÓ ÔÈfiÙËÙ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜. ∏ Ú‡·ÓÛË fï˜ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÌÔÚ› Ó· ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ Û˘Ó¤ÂȘ ÛÙËÓ ˘Á›· ÙˆÓ ·È‰ÈÒÓ Û fiÏÔ ÙÔÓ Ï·Ó‹ÙË (7,8,9,10,11). ∆· ·È‰È¿ ÛÙËÓ ∂ÏÏ¿‰· ‰ÂÓ ·ÔÙÂÏÔ‡Ó ÂÍ·›ÚÂÛË. ∏ ÚÔÛÙ·Û›· ÙˆÓ ·È‰ÈÒÓ ·fi ÙÔ˘˜ ‚Ï·ÙÈÎÔ‡˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ··ÈÙ› ¤Ú¢ӷ, ηٿÏÏËÏË Û¯ÂÙÈ΋ ÓÔÌÔıÂÛ›· Î·È ·ÚÂÌ‚¿ÛÂȘ, ·ÏÏ¿ Î·È Û˘ÛÙËÌ·ÙÈ΋ ÂÓË̤ڈÛË ÙˆÓ ÁÔÓÈÒÓ Î·È ÙˆÓ ·È‰ÈÒÓ. ªÂ ÙÂÏÈÎfi ÛÙfi¯Ô ÙËÓ ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜ ÙÔ˘, ÙÔ ¿ÙÔÌÔ Ì·ı·›ÓÂÈ, fi¯È ÌfiÓÔ Ó· ·Ó·ÁÓˆÚ›˙ÂÈ Î·È Ó· ·ÔʇÁÂÈ ÙÔ˘˜ ‚Ï·ÙÈÎÔ‡˜ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜, ·ÏÏ¿ Î·È Ó· ÚÔÛٷهÂÈ ÂÓÂÚÁËÙÈο ÙÔ ÂÚÈ‚¿ÏÏÔÓ ·fi ÂÚ·ÈÙ¤Úˆ ÌfiÏ˘ÓÛË. ∆· ·È‰È¿ ‰ÂÓ Â›Ó·È “ÌÈÎÚÔ› ÂÓ‹ÏÈΘ”. ∂ÎÙ›ıÂÓÙ·È, fiˆ˜ Î·È ÔÈ ÂÓ‹ÏÈΘ, Û ڇԢ˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔÓ ·¤Ú·, ÙÔ ¤‰·ÊÔ˜ ‹ ÙÔ ÓÂÚfi, Ô˘ ÙÔ˘˜ ¤ÙÔ˘Ó, ÙÔ˘˜ ÂÈÛÓ¤Ô˘Ó ‹ ÙÔ˘˜ ·ÔÚÚÔÊÔ‡Ó ·fi ÙÔ ‰¤ÚÌ· ÙÔ˘˜. √È ·Ó·Ù˘ÛÛfiÌÂÓÔÈ,
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fï˜, ÔÚÁ·ÓÈÛÌÔ› ÙˆÓ ·È‰ÈÒÓ Â›Ó·È È‰È·›ÙÂÚ· ¢¿ÏˆÙÔÈ, ‰ÈfiÙÈ (7,8,9,10,11): 1. √ ÌÂÙ·‚ÔÏÈÛÌfi˜ Î·È ÙÔ ·ÓÔÛÔÔÈËÙÈÎfi ÙÔ˘˜ Û‡ÛÙËÌ· ‰ÂÓ ¤¯Ô˘Ó Ï‹Úˆ˜ ·Ó·Ù˘¯ı› Î·È ‰ÂÓ ÚÔÛÙ·ÙÂ‡Ô˘Ó Â·ÚÎÒ˜. 2. √È ·ÓÒÚÈÌÔÈ ÈÛÙÔ› Î·È Ù· ·Ó·Ù˘ÛÛfiÌÂÓ· fiÚÁ·Ó· Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ Â˘·›ÛıËÙ· Û ÙÔÍÈΤ˜ ÂȉڿÛÂȘ. 3. ¶¤ÙÔ˘Ó, ÂÈÛÓ¤Ô˘Ó, ›ÓÔ˘Ó Î·È ·ÔÚÚÔÊÔ‡Ó ÌÂÁ·Ï‡ÙÂÚ˜ ·Ó·ÏÔÁÈο ÔÛfiÙËÙ˜ Ê·ÁËÙÔ‡, ÓÂÚÔ‡ Î·È ·¤Ú· ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∆Ô ÌÈÎÚfi ̤ÁÂıÔ˜ ÙÔ˘ ÛÒÌ·Ùfi˜ ÙÔ˘˜ ¤¯ÂÈ ˆ˜ ·ÔÙ¤ÏÂÛÌ· ÌÂÁ·Ï‡ÙÂÚÔ ‚·ıÌfi ¤ÎıÂÛ˘ Î·È ÚfiÛÏ˄˘ ·Ó¿ kg ۈ̷ÙÈÎÔ‡ ‚¿ÚÔ˘˜ Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ. 4. Œ¯Ô˘Ó ‰È·ÊÔÚÂÙÈΤ˜ Û˘Ó‹ıÂȘ. Œ¯ÂÈ ˘ÔÏÔÁÈÛı› fiÙÈ Ù· ·È‰È¿ ËÏÈΛ·˜ 1-5 ¯ÚÔÓÒÓ “ÙÚÒÓ” 40200 mg ¯ÒÌ·ÙÔ˜ ηıËÌÂÚÈÓ¿, ÂÂȉ‹ ·›˙Ô˘Ó Û Â͈ÙÂÚÈÎÔ‡˜ ¯ÒÚÔ˘˜, ‰ÂÓ Ï¤ÓÔ˘Ó Û˘¯Ó¿ Ù· ¯¤ÚÈ· ÙÔ˘˜, Ù· ÔÔ›· ‚¿˙Ô˘Ó ÛÙÔ ÛÙfiÌ· ÙÔ˘˜, ÂÓÒ ÌÂÚÈΤ˜ ÊÔÚ¤˜ “ÙÚÒÓ” ›Ùˉ˜ ¯ÒÌ·. 5. ∆· ·È‰È¿ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿ÛÙËÌ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜ Â›Ó·È ÌÚÔÛÙ¿ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ı· ÂÎÙÂıÔ‡Ó ÁÈ· ÌÂÁ·Ï‡ÙÂÚÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ·, Ì ÌÂÁ·Ï‡ÙÂÚË Èı·ÓfiÙËÙ· Ó· ·ÚÔ˘ÛÈ¿ÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜. ªÂ ‚¿ÛË Ù· ·Ú·¿Óˆ ‰Â‰Ô̤ӷ, Â›Ó·È ÚÔÊ·Ó‹˜ Ë ·Ó¿ÁÎË ÁÈ· ÂÓË̤ڈÛË ÙˆÓ ·È‰ÈÒÓ, ÒÛÙ ӷ ‰È·ÌÔÚÊÒÛÔ˘Ó ÎÚÈÙÈ΋ ÛÙ¿ÛË ÁÈ· ÙȘ ·ÚÂÌ‚¿ÛÂȘ ÙÔ˘ ·ÓıÚÒÔ˘ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ, ·ÏÏ¿ Î·È Ó· ˘ÈÔıÂÙ‹ÛÔ˘Ó Ú·ÎÙÈΤ˜ Ô˘ ÚÔÛÙ·ÙÂ‡Ô˘Ó ÙÔ ÂÚÈ‚¿ÏÏÔÓ Î·È Î·Ù¿ Û˘Ó¤ÂÈ· ÙËÓ ˘Á›· ÙÔ˘˜. ™Ùfi¯Ô˜ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ‹Ù·Ó: ·) Ë ·ÚÔ¯‹ ¤ÁÎ˘ÚˆÓ ÁÓÒÛÂˆÓ Û ̷ıËÙ¤˜ ÁÈ· ÙËÓ Â›‰Ú·ÛË Ù˘ Ú‡·ÓÛ˘ ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ÛÙËÓ ˘Á›·, ÒÛÙ ӷ Û˘ÓÂȉËÙÔÔÈ‹ÛÔ˘Ó fiÙÈ Ë ÊÚÔÓÙ›‰· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ¤¯ÂÈ ˆ˜ ¿ÌÂÛÔ Î·È Ì·ÎÚÔÚfiıÂÛÌÔ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜ Î·È ‚) Ë ÚÔÙ˘ÔÔ›ËÛË ÙÔ˘ ۯ‰ȷÛÌÔ‡ Î·È Ë ·Ú·ÁˆÁ‹ ÂÔÙÈÎÔ‡ ˘ÏÈÎÔ‡, ÒÛÙ ÙÔ ÚfiÁÚ·ÌÌ· Ó· ÌÔÚ› Ó· ·Ó··Ú·¯ı› Î·È ·fi ¿ÏÏÔ˘˜ ÊÔÚ›˜.
ªÂıÔ‰ÔÏÔÁ›· √ ۯ‰ȷÛÌfi˜ Î·È Ë ÂÊ·ÚÌÔÁ‹ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ¤ÁÈÓ ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· 2006-2007, Ì ÏËı˘ÛÌfi ÛÙfi¯Ô fiÏ· Ù· ·È‰È¿ ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ, ‰ËÌÔÙÈÎÒÓ Î·È Á˘ÌÓ·Û›ˆÓ Ù˘ ÂÚÈÔ¯‹˜. √ ۯ‰ȷÛÌfi˜ ÂÚÈÂÏ¿Ì‚·ÓÂ: 1. ∫ÔÈÓÔÙÈ΋ Û˘ÌÌÂÙÔ¯‹ ¢fiıËΠ‚·Ú‡ÙËÙ· ÛÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ, ÒÛÙ ӷ ‰È·ÌÔÚʈı› ÎÔÈÓ‹ ÛÙ¿ÛË Î·È ‰˘Ó·ÙfiÙËÙ· ÂÓÂÚÁÔ‡ ÂÌÏÔ΋˜. ™ÙÔ Ï·›ÛÈÔ ·˘Ùfi, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û˘Ó·ÓÙ‹ÛÂȘ ÌÂ: ·) ÙÔÈÎÔ‡˜ ÊÔÚ›˜, fiˆ˜ ÔÈ ‰ËÌÔÙÈΤ˜ ·Ú¯¤˜ Ù˘ fiÏ˘, ÙÔ √ÈÎÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈ ÙÔ˘ ‰‹ÌÔ˘ Î·È ÔÈ ÚfiÛÎÔÔÈ. ∞Ô-
Ù¤ÏÂÛÌ· ÙˆÓ Û˘Ó·ÓÙ‹ÛÂˆÓ ‹Ù·Ó Ë ÂÓÂÚÁfi˜ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ √ÈÎÔÏoÁÈÎÔ‡ EÚÁ·ÛÙËÚ›Ô˘, ‰Ú¿ÛË Ë ÔÔ›· ¯ÚËÌ·ÙÔ‰ÔÙ‹ıËΠ·fi ÙÔ ÀÊ˘Ô˘ÚÁÂ›Ô ¡¤·˜ °ÂÓÈ¿˜. ∆· ̤ÏË ÙÔ˘ ÔÈÎÔÏÔÁÈÎÔ‡ ÂÚÁ·ÛÙËÚ›Ô˘ Â›Ó·È Ó¤ÔÈ-˜, ÊÔÈÙËÙ¤˜ Î·È Ì·ıËÙ¤˜, Ô˘ ‰ÚÔ˘Ó ÂıÂÏÔÓÙÈο. ‚) ÙÔ˘˜ ‰È¢ı˘ÓÙ¤˜ Î·È ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÙˆÓ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ, ÓËÈ·ÁˆÁ›ˆÓ, ‰ËÌÔÙÈÎÒÓ Û¯ÔÏ›ˆÓ Î·È Á˘ÌÓ·Û›ˆÓ Ù˘ ÂÚÈÔ¯‹˜. Á) ÙÔ˘˜ Û˘ÏÏfiÁÔ˘˜ ÁÔÓ¤ˆÓ Î·È ÎˉÂÌfiÓˆÓ fiÏˆÓ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ‚·ıÌ›‰ˆÓ, Ì ÛÙfi¯Ô ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛ‹ ÙÔ˘˜ Î·È ÙËÓ ˘ÈÔı¤ÙËÛË ˘ÁÈÒÓ Ú·ÎÙÈÎÒÓ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ. 2. ¢Ú¿ÛÂȘ ¢·ÈÛıËÙÔÔ›ËÛ˘-Âη›‰Â˘Û˘ ·ÁÁÂÏÌ·ÙÈÒÓ Î·È ÂÎ·È‰Â˘ÙÒÓ ªÂ ·˘ÙfiÓ ÙÔÓ ÛÙfi¯Ô: ·) ¢ÈÔÚÁ·ÓÒıËΠÂÎ·È‰Â˘ÙÈÎfi ÛÂÌÈÓ¿ÚÈÔ Ì ı¤Ì· "¶ÂÚÈ‚¿ÏÏÔÓ Î·È ÀÁ›·: ™‡Á¯ÚÔÓ· ‰Â‰Ô̤ӷ Î·È ÚÔÁÚ¿ÌÌ·Ù· ·ÁˆÁ‹˜-ÚÔ·ÁˆÁ‹˜ ˘Á›·˜ ÛÙ· Û¯ÔÏ›·", Ô˘ ·Â˘ı˘ÓfiÙ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÚˆÙÔ‚¿ıÌÈ·˜ Î·È ‰Â˘ÙÂÚÔ‚¿ıÌÈ·˜ Âη›‰Â˘Û˘, Ì ÙË Û˘ÓÂÚÁ·Û›· ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ °Ú·Ê›ˆÓ ∂η›‰Â˘Û˘. ∆Ô ÛÂÌÈÓ¿ÚÈÔ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ Â›¯Â ÛÙfi¯Ô ·ÊÂÓfi˜ ÙËÓ ÂÓË̤ڈÛË Î·È ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË Î·È ·ÊÂÙ¤ÚÔ˘ ÙËÓ ˘ÔÛÙ‹ÚÈÍË ÙÔ˘ ı¤Ì·ÙÔ˜ ̤۷ ÛÙËÓ Ù¿ÍË, ̤ۈ Ù˘ ‰È·ıÂÌ·ÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ ÁÓÒÛ˘. ∏ ‰È·ıÂÌ·ÙÈ΋ ÚÔÛ¤ÁÁÈÛË ‚·Û›˙ÂÙ·È ÛÙËÓ ·Ó·˙‹ÙËÛË ÂÓÓÔÈÔÏÔÁÈÎÒÓ ‰È·Û˘Ó‰¤ÛÂˆÓ ÌÂٷ͇ ÙˆÓ Ì·ıËÌ¿ÙˆÓ Î¿ı ٿ͢. ∂ÍÂÙ¿˙ÂÙ·È ÙÔ ı¤Ì· ·fi ÔÏϤ˜ ÔÙÈΤ˜-ÂÈÛÙËÌÔÓÈΤ˜ ÁˆÓ›Â˜ Î·È Î·ÏÏÈÂÚÁÔ‡ÓÙ·È Û¯ÂÙÈΤ˜ ‰ÂÍÈfiÙËÙ˜, ÛÙ¿ÛÂȘ Î·È ·Í›Â˜ (12,13). ∏ ÚÔÛ¤ÁÁÈÛË ·˘Ù‹ ·Ó¿ÁÂÈ ÙËÓ ·ÔÛ·ÛÌ·ÙÈ΋ ÁÓÒÛË, Ô˘ Û˘Ó¿ÁÂÙ·È Ô Ï‹Ú˘ ‰È·¯ˆÚÈÛÌfi˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ·ÓÙÈÎÂÈ̤ӈÓ, Û ÔÏÈÛÙÈ΋ Î·È Ú·ÁÌ·ÙÈ΋ ÁÓÒÛË Ô˘, Û˘Ó‰ÂfiÌÂÓË Ì ÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ·ÍÈÔÔÈÂ›Ù·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹ (14). £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÂÚÈ‚·ÏÏÔÓÙÈ΋ Âη›‰Â˘ÛË ÛÙ· Ï·›ÛÈ· Ù˘ ¢¤ÏÈÎÙ˘ ˙ÒÓ˘ ¤¯ÂÈ ıÂÛÌÔıÂÙËı› ÛÙË ¯ÒÚ· Ì·˜ Ì ÙÔ ÓfiÌÔ ¡.1892/90 ¿ÚıÚÔ 111, ·ÏÏ¿ ‰ÂÓ ¤¯ÂÈ Ù‡¯ÂÈ Û˘ÛÙËÌ·ÙÈ΋˜ ÂÊ·ÚÌÔÁ‹˜ (15). ‚) ŒÁÈÓ Âη›‰Â˘ÛË ÂÎ·È‰Â˘ÙÒÓ Û ‰‡Ô ÛÙ¿‰È·: ÙÔ ÚÒÙÔ Â›¯Â ˆ˜ ÛÙfi¯Ô Ó· ÂÓËÌÂÚˆıÔ‡Ó ÁÈ· ÙȘ ¿ÌÂÛ˜ Î·È ·ÒÙÂÚ˜ ÂÈÙÒÛÂȘ ÙˆÓ Ú‡ˆÓ ÛÙËÓ ˘Á›·, ·ÏÏ¿ Î·È ÁÈ· ÙȘ ‰È·ÊÔÚ¤˜ Ô˘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Ù· ·È‰È¿ ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∆Ô ‰Â‡ÙÂÚÔ ÛÙ¿‰ÈÔ Â›¯Â ˆ˜ ÛÙfi¯Ô ÙËÓ Âη›‰Â˘Û‹ ÙÔ˘˜ ÛÙÔÓ ÙÚfiÔ ·ÚÔ˘Û›·Û˘, ÏfiÁˆ ÙˆÓ È‰È·ÈÙÂÚÔÙ‹ÙˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∆ÔÓ›ÛıËηÓ, ÏÔÈfiÓ, ÛËÌ›· Î·È Ù¤ıËÎ·Ó fiÚÔÈ Î·Ï‹˜ Ú·ÎÙÈ΋˜, ÒÛÙÂ Ë ·ÚÔ˘Û›·ÛË Ó· Â›Ó·È Û·Ê‹˜, ˙ˆÓÙ·Ó‹, ¢¤ÏÈÎÙË, ·ÏÏ¿ Î·È Ó· ÂÓÈÛ¯‡ÂÈ ÙË Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·È‰ÈÒÓ, ÒÛÙ ӷ ÂÎÊÚ¿ÛÔ˘Ó ‰Â‰Ô̤Ó˜ ÁÓÒÛÂȘ Î·È ·fi„ÂȘ. 3. ∞ÁˆÁ‹ ˘Á›·˜ ÛÙ· Û¯ÔÏ›· ·) ¢ËÌÔÙÈο Î·È °˘ÌÓ¿ÛÈ·: ∏ ÂÓË̤ڈÛË ÛÙ· ·È‰È¿ ÙˆÓ ‰ËÌÔÙÈÎÒÓ Î·È ÙˆÓ Á˘ÌÓ·Û›ˆÓ ¤ÁÈÓ Ì ËÏÂÎÙÚÔÓÈΤ˜ ·ÚÔ˘ÛÈ¿ÛÂȘ. ¢fiıËΠ¤ÌÊ·ÛË ÛÙ· ȉȷ›ÙÂÚ· ·Ó·Ù˘Íȷο ¯·Ú·ÎÙËÚÈÛÙÈο (ÓÔËÙÈο Î·È Û˘Ó·ÈÛıËÌ·ÙÈο) ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ ËÏÈÎÈÒÓ, ÒÛÙ ӷ ˘¿Ú¯ÂÈ Î·Ù¿ÏÏËÏÔ Ì¤ÙÚÔ ÛÙÔ Ï‹ıÔ˜ Î·È ÛÙÔ Â›‰Ô˜ ÙˆÓ ÏËÚÔÊÔÚÈÒÓ. ¢ËÌÈÔ˘ÚÁ‹ıËÎ·Ó 3 ÛÂÈÚ¤˜ ËÏÂÎÙÚÔÓÈÎÒÓ ·ÚÔ˘ÛÈ¿ÛÂˆÓ (PowerPoint) ÁÈ· ÙȘ Ù¿ÍÂȘ ∞ãµã, °ã-¢ã, ∂ã-™∆ã ‰ËÌÔÙÈÎÔ‡ Î·È Ì›· ÁÈ· Ù· ·È‰È¿ ÙÔ˘ Á˘ÌÓ·Û›Ô˘. √È ·ÚÔ˘ÛÈ¿ÛÂȘ Î¿Ï˘Ù·Ó ÙȘ ÂÓfiÙËÙ˜ “¢È·ÙÚÔÊ‹, ÂÚÈ‚¿ÏÏÔÓ Î·È ˘Á›·” Î·È “∞ÁÁ›˙ˆ-∞Ó·Ó¤ˆ-¶›Óˆ”. ∏ ÂÈÏÔÁ‹ Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÌËӇ̷ÙÔ˜ ̤ۈ Ù˘ ÂÈÎfiÓ·˜ ‚·Û›ÛÙËΠÛÙÔ ‚È‚ÏÈÔÁÚ·ÊÈÎfi ‰Â‰Ô̤ÓÔ fiÙÈ ÔÈ ÂÈÎfiÓ˜ Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·Ô‰ÔÙÈΤ˜ Î·È ·Ú¿ÏÏËÏ· ‰‡Ó·ÓÙ·È Ó· ·Ó··Ú·¯ıÔ‡Ó. ¶·È‰È·ÙÚÈ΋ 2008;71:469-474
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∂ÈÎfiÓ· 1. ∫·Ù·ÓÔÌ‹ ÁÓˆÛÙÈÎÔ‡ ÂȤ‰Ô˘ ·È‰ÈÒÓ ∂ã Î·È ™∆ã ‰ËÌÔÙÈÎÔ‡ ÌÂÙ¿ ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ.
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16-17
∂ÈÎfiÓ· 2. ∫·Ù·ÓÔÌ‹ ÛˆÛÙÒÓ ··ÓÙ‹ÛÂˆÓ ÚÈÓ Î·È ÌÂÙ¿ ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ.
√È ÔÌÈϛ˜ ÛÙÔ ‰ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô ¤ÁÈÓ·Ó ·fi Ù· ̤ÏË ÙÔ˘ √ÈÎÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘, ÛÂ Û˘ÓÂÚÁ·Û›· Ì ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ ÙÔ˘ ∫.À.¶.∫., ÂÓÒ ÔÈ ÔÌÈϛ˜ ÛÙÔ Á˘ÌÓ¿ÛÈÔ ¤ÁÈÓ·Ó ·fi ÙÔ˘˜ ·È‰›·ÙÚÔ˘˜ ÙÔ˘ ∫.À.¶.∫. ªÂÙ¿ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜, ÙÔ ÂÔÙÈÎfi ˘ÏÈÎfi ‰fiıËΠ۠ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹ ÛÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ fiÏˆÓ ÙˆÓ Û¯ÔÏ›ˆÓ. ‚) ¶·È‰ÈÎÔ› ÛÙ·ıÌÔ› Î·È ÓËÈ·ÁˆÁ›·: ™Ù· ·È‰È¿ ÙˆÓ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ Î·È ÙˆÓ ÓËÈ·ÁˆÁ›ˆÓ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó Ù· ›‰È· ı¤Ì·Ù· -ÚÔÛ·ÚÌÔṲ̂ӷ ÛÙËÓ ËÏÈΛ· ÙÔ˘˜- Ì ÙË ÌÔÚÊ‹ ÎÔ˘ÎÏÔı¤·ÙÚÔ˘. ∆· ΛÌÂÓ· Î·È ÙËÓ ·ÚÔ˘Û›·ÛË Ú·ÁÌ·ÙÔÔ›ËÛ·Ó Ì¤ÏË ÙÔ˘ √ÈÎÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘, Ì ÙËÓ ˘ÔÛÙ‹ÚÈÍË Î·È ÙËÓ ÂÔÙ›· ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ÙÔ˘ ∫.À.¶.∫. √È ·È‰·ÁˆÁÔ› Û˘ÌÌÂÙ›¯·Ó Ì ۯÂÙÈΤ˜ Û˘˙ËÙ‹ÛÂȘ Î·È ÂÚÁ·Û›Â˜ ÛÙËÓ Ù¿ÍË. 4. ∞ÁˆÁ‹ ˘Á›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ· ∂ΉfiıËÎ·Ó 4 Ê˘ÏÏ¿‰È· ÁÈ· ÙËÓ ÂÓË̤ڈÛË Î·È ÙËÓ Â˘·ÈÛıËÙÔÔ›ËÛË ÙÔ˘ ¢ڇÙÂÚÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡/ÎÔÈÓˆÓÈÎÔ‡ ÂÚÈ‚¿ÏÏÔÓÙÔ˜, Ô˘ ÌÔÈÚ¿ÛÙËÎ·Ó Û fiÏ· Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Ù˘ ÂÚÈÔ¯‹˜. ∏ ıÂÌ·ÙÔÏÔÁ›· ÙÔ˘˜ ÂÚÈÂÏ¿Ì‚·Ó ˙ËÙ‹Ì·Ù· ‰È·ÙÚÔÊ‹˜, ÔÈfiÙËÙ·˜ Î·È Â¿ÚÎÂÈ·˜ ÙÔ˘ fiÛÈÌÔ˘ ÓÂÚÔ‡, ÙÔ˘ ÙÈ ·ÁÁ›˙Ô˘ÌÂ Î·È ÙÈ ·Ó·Ó¤Ô˘Ì ηÈ, Ù¤ÏÔ˜, ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ÙË ÊÚÔÓÙ›‰· Ù˘ ˘Á›·˜ Ì·˜ Î·È ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ∂›Û˘, ‰ËÌÈÔ˘ÚÁ‹ıËΠÌÈ· ÌÈÎÚ‹ ÔÈÎÔÏÔÁÈ΋ ‚È‚ÏÈÔı‹ÎË Ì ÂχıÂÚË ÚfiÛ‚·ÛË, ÁÈ· ÂÚÈÛÛfiÙÂÚ˜ ÏËÚÔÊÔڛ˜. 5. ∞ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ŒÁÈÓ ÚÔÛ¿ıÂÈ· ·ÍÈÔÏfiÁËÛ˘ ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Ì ÙÚÂȘ ÙÚfiÔ˘˜: ·) ∫·Ù·Û΢¿ÛıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÓÒÛˆÓ, ÙÔ ÔÔ›Ô ‰fiıËΠ۠fiÏÔ˘˜ ÙÔ˘˜ Ì·ıËÙ¤˜ Ù˘ ∂ã Î·È ™Tã ‰ËÌÔÙÈÎÔ‡ ÌÂ-
Ù¿ ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ Î·È Û ¤Ó· ̤ÚÔ˜ ÙˆÓ Ì·ıËÙÒÓ Î·È ·fi ÚÈÓ. ∆· ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ‹Ù·Ó ·ÓÒÓ˘Ì· Î·È ‚·Û›ÛÙËÎ·Ó ÛÙÔ ˘ÏÈÎfi ÙˆÓ ·ÚÔ˘ÛÈ¿ÛˆÓ. ™Ùfi¯Ô˜ ‹Ù·Ó Ó· ·ÔÙ˘ˆı› Ë ·ÏÏ·Á‹ Û ‰Â‰Ô̤Ó˜ ÁÓÒÛÂȘ Î·È ¤ÌÌÂÛ· Ó· ·ÍÈÔÏÔÁËı› Ë ¿ÌÂÛË ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· Ù˘ ·ÚÔ˘Û›·Û˘. ‚) ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ ‰fiıËΠ›Û˘ ÛÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ·ÚÔ˘ÛÈ¿ÛˆÓ, Ì ÛÙfi¯Ô Ó· ·ÍÈÔÏÔÁËı› ÙÔ ÂÚȯfiÌÂÓÔ Ù˘ ÔÌÈÏ›·˜, Ô ÙÚfiÔ˜ Ù˘ ·ÚÔ˘Û›·Û˘, Ë ÚÔÛÔ¯‹ Î·È Ë Û˘ÌÌÂÙÔ¯‹ ÙˆÓ ·È‰ÈÒÓ. Á) ªÂ ÙËÓ ÔÏÔÎÏ‹ÚˆÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û˘Ó·ÓÙ‹ÛÂȘ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ÙÔ˘ ∫.À.¶.∫. Ì ٷ ̤ÏË ÙÔ˘ √ÈÎÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ Î·È ÂÎÚÔÛÒÔ˘˜ ÙˆÓ ÊÔÚ¤ˆÓ, Ì ÛÙfi¯Ô ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Û˘ÓÔÏÈ΋˜ ÂÌÂÈÚ›·˜.
∞ÔÙÂϤÛÌ·Ù· ¶Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó ·ÚÔ˘ÛÈ¿ÛÂȘ ·Ó¿ ÙÌ‹Ì· Û οı ‰ËÌÔÙÈÎfi Û¯ÔÏÂ›Ô Î·È ÛÙ· ‰‡Ô Á˘ÌÓ¿ÛÈ· Ù˘ ÂÚÈÔ¯‹˜ (Û‡ÓÔÏÔ ·ÚÔ˘ÛÈ¿ÛÂˆÓ 120 Î·È 28, ·ÓÙ›ÛÙÔȯ·). ∏ ·ÍÈÔÏfiÁËÛË Ù˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚÔ˘ÛÈ¿ÛÂˆÓ ¤ÁÈÓ Ì 3 ÙÚfiÔ˘˜: 1. ™ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ Ù˘ ∂ã-™∆ã ‰ËÌÔÙÈÎÔ‡ (Ó=363) ¯ÔÚËÁ‹ıËÎ·Ó ÌÂÙ¿ ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· ÁÓÒÛˆÓ, Ì ··ÓÙ‹ÛÂȘ ÛˆÛÙfi-Ï¿ıÔ˜, Ì ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÁÓˆÛÙÈÎÔ‡ ÙÔ˘˜ ÂȤ‰Ô˘ ÛÙȘ ıÂÌ·ÙÈΤ˜ ÂÓfiÙËÙ˜ ¢È·ÙÚÔÊ‹ / ∞ÁÁ›˙ˆ-∞Ó·Ó¤ˆ-¶›Óˆ. ™ÙËÓ Î·Ù·ÓÔÌ‹ (∂ÈÎfiÓ· 1) Ê·›ÓÂÙ·È fiÙÈ Ë ‰È·ÌfiÚʈÛË ÙÔ˘ ÁÓˆÛÙÈÎÔ‡ ÂȤ‰Ô˘
¶›Ó·Î·˜ 1. ∞ÍÈÔÏfiÁËÛË ÙÔ˘ ı¤Ì·ÙÔ˜ ÙˆÓ ·ÚÔ˘ÛÈ¿ÛÂˆÓ ÛÙ· ‰ËÌÔÙÈο Î·È ÛÙ· Á˘ÌÓ¿ÛÈ·
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∫·Ù¿ÏÏËÏÔ ÂÚȯfiÌÂÓÔ ™ËÌ·ÓÙÈÎfi ∂ӉȷʤÚÔÓ ÃÚ‹ÛÈÌÔ ∫·Ù¿ÏÏËÏÔ ÂÚȯfiÌÂÓÔ ™ËÌ·ÓÙÈÎfi ∂ӉȷʤÚÔÓ ÃÚ‹ÛÈÌÔ
33,3% 73,7% 46,9% 69,5% 47,4% 66,7% 60% 76,2%
56,3% 25,3% 45,8% 28,4% 36,8% 33,3% 35% 23,8%
9,4% 1,1% 6,3% 2,1% 15,8% 5% -
1% 1% -
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Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·473
473
∞ÁˆÁ‹ Î·È ÚÔ·ÁˆÁ‹ ˘Á›·˜
¶›Ó·Î·˜ 2. ∞ÍÈÔÏfiÁËÛË ÙÔ˘ ÙÚfiÔ˘ ·ÚÔ˘Û›·Û˘ ÛÙ· ‰ËÌÔÙÈο Î·È ÛÙ· Á˘ÌÓ¿ÛÈ·
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™·Ê‹˜ ∑ˆÓÙ·Ó‹ ∂˘¤ÏÈÎÙË ™·Ê‹˜ ∑ˆÓÙ·Ó‹ ∂˘¤ÏÈÎÙË
39,2% 23,7% 22,1% 57,1% 45,0% 45,5%
41,2% 51,5% 46,3% 33,3% 35% 18,2%
18,6% 16,5% 21,1% 9,5% 20,0% 31,8%
1,0% 8,2% 9,5% 4,5%
1,1% -
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ÌÂÙ¿ Î·È ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ (ÚÔ¸¿Ú¯Ô˘Û˜ Î·È Ó¤Â˜ ÁÓÒÛÂȘ) ‚Ú›ÛÎÂÙ·È ÛÂ Â›Â‰Ô ÈηÓÔÔÈËÙÈÎfi ¤ˆ˜ ¿ÚÈÛÙÔ (91,5% Î·È 78,0% ÁÈ· ÙȘ ‰˘Ô ÂÓfiÙËÙ˜ ·ÓÙ›ÛÙÔȯ·). ¶·Ú·ÙËÚÂ›Ù·È Î·Ï‡ÙÂÚÔ Â›Â‰Ô ÁÓÒÛÂˆÓ ÛÙËÓ ÂÓfiÙËÙ· Ù˘ ‰È·ÙÚÔÊ‹˜, ÙÔ ÔÔ›Ô ı· ÌÔÚÔ‡Û ӷ ·Ô‰Ôı› ÛÙË Û˘¯ÓfiÙÂÚË ÚÔÛ¤ÁÁÈÛË ÙÔ˘ ı¤Ì·ÙÔ˜ ·fi ÙÔ Û¯ÔÏÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ. 2. ªÂ ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ¿ÌÂÛ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚÔ˘ÛÈ¿ÛˆÓ, ‰ÈÂÚ¢ӋıËÎÂ Ë ÌÂÙ·ÙfiÈÛË ÁÓÒÛˆÓ, Ì ¯ÔÚ‹ÁËÛË ·Ó¿ÏÔÁˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Û ·ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ‰Â›ÁÌ· (200/363, 55%) ·È‰ÈÒÓ Ù˘ ∂ã Î·È ™∆ã ‰ËÌÔÙÈÎÔ‡, ÚÈÓ Î·È ÌÂÙ¿ ÙË ‰ÈÂÓ¤ÚÁÂÈ· ÙˆÓ ·ÚÔ˘ÛÈ¿ÛˆÓ. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2, ·Ú·ÙËÚÂ›Ù·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÚÔ˜ ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ 1617 ÛˆÛÙÒÓ ··ÓÙ‹ÛˆÓ, Ô˘ ·ÓÙÈÚÔۈ‡ÂÈ ÙËÓ ¿ÚÈÛÙË Â›‰ÔÛË. ∏ ÌÂÙ·ÙfiÈÛË ·˘Ù‹ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p<0,01). 3. ∞ÍÈÔÏÔÁ‹ıËÎ·Ó ÔÈ ·ÚÔ˘ÛÈ¿ÛÂȘ ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Î·È ÙÔ˘ Á˘ÌÓ·Û›Ô˘ Ì ÙË ¯ÔÚ‹ÁËÛË ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ (¶›Ó·Î˜ 1,2,3). ªÂ ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù·: I. ∆Ô ÂÚȯfiÌÂÓÔ ÙˆÓ ·ÚÔ˘ÛÈ¿ÛÂˆÓ ÎÚ›ıËΠÂÍ·ÈÚÂÙÈο ¤ˆ˜ Ôχ ηٿÏÏËÏÔ ·Ó¿ ËÏÈÎȷ΋ ÔÌ¿‰· ·fi 89,6% ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ ÛÙ· ‰ËÌÔÙÈο Î·È 84,2% ÛÙ· Á˘ÌÓ¿ÛÈ·. ∂›Û˘, ÙÔ ı¤Ì· ÙˆÓ ·ÚÔ˘ÛÈ¿ÛÂˆÓ ·ÍÈÔÏÔÁ‹ıËΠˆ˜ ÛËÌ·ÓÙÈÎfi, ¯Ú‹ÛÈÌÔ Î·È ÂӉȷʤÚÔÓ Û ·ÓÙ›ÛÙÔÈ¯Ô ‚·ıÌfi, ·fi ÙË Û˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ (¶›Ó·Î·˜ 1). II. √ ÙÚfiÔ˜ ·ÚÔ˘Û›·Û˘ ·fi ÙÔ˘˜ ÔÌÈÏËÙ¤˜ ÂÎÙÈÌ‹ıËΠ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ˆ˜ Ôχ ¤ˆ˜ ÂÍ·ÈÚÂÙÈο Û·Ê‹˜, ˙ˆÓÙ·Ófi˜ Î·È Â˘¤ÏÈÎÙÔ˜ (¶›Ó·Î·˜ 2). III. ∏ ·ÍÈÔÏfiÁËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Ù˘ Ù¿Í˘ ÂÎÙÈÌ‹ıËΠ̠‚¿ÛË ÙÔÓ ‚·ıÌfi ÚÔÛÔ¯‹˜ Î·È Û˘ÌÌÂ-
ÙÔ¯‹˜, Ô˘ ıˆڋıËÎ·Ó ·ÚÎÂÙ¿ ¤ˆ˜ Ôχ ÈηÓÔÔÈËÙÈΤ˜ ·fi ÙÔ Û‡ÓÔÏÔ Û¯Â‰fiÓ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ (¶›Ó·Î·˜ 3). ¶·Ú·ÙËÚ‹ıËΠÌÈ· ‰È·ÊÔÚ¿ ÛÙÔ ‚·ıÌfi Û˘ÌÌÂÙÔ¯‹˜ ÌÂٷ͇ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰ËÌÔÙÈÎÔ‡ Î·È ÙÔ˘ Á˘ÌÓ·Û›Ô˘, Ô˘ fï˜ ‰ÂÓ ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛÔ¯‹˜ ‹ ÂӉȷʤÚÔÓÙÔ˜, ·ÏÏ¿ ı· ÌÔÚÔ‡Û ›Ûˆ˜ Ó· ÂÚÌËÓ¢Ù› ·fi Ù· ‰È·ÊÔÚÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ οı ËÏÈÎȷ΋˜ ÔÌ¿‰·˜.
™˘˙‹ÙËÛË ∏ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÎÔÈÓfiÙËÙ·˜ ·ÔÙÂÏ› ÚÔ¸fiıÂÛË ÛÙ· Û‡Á¯ÚÔÓ· ÌÔÓ٤Ϸ ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ (16), ÂÓÒ Ô ÚfiÏÔ˜ Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ ÛÂ Â›Â‰Ô ÎÔÈÓfiÙËÙ·˜ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛı› ˆ˜ ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡ (17). ¶ÚÔ¸Ôı¤ÙÂÈ, fï˜, Û‡ÛÙËÌ· ˘Á›·˜ ÚÔÛ·Ó·ÙÔÏÈṲ̂ÓÔ ÛÙËÓ ÚˆÙÔ‚¿ıÌÈ· ÊÚÔÓÙ›‰·, ηٿÏÏËÏË Âη›‰Â˘ÛË Î·È ¯ÚfiÓÔ, ÒÛÙ ӷ ηٷÓÔ‹ÛÔ˘Ó ÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ÙȘ ·Ó¿ÁΘ ˘Á›·˜ Ù˘ ÂοÛÙÔÙ ÎÔÈÓfiÙËÙ·˜, Ó· ıÂÌÂÏÈÒÛÔ˘Ó Û¯¤ÛÂȘ ÂÌÈÛÙÔÛ‡Ó˘ Î·È Ó· ÚÔ·Á¿ÁÔ˘Ó ÙËÓ ÎÔÈÓÔÙÈ΋ Û˘ÌÌÂÙÔ¯‹. ¶·Ú¿ÏÏËÏ·, Ù· ̤ÏË Ù˘ ÎÔÈÓfiÙËÙ·˜ ¯ÚÂÈ¿˙ÔÓÙ·È Û˘ÛÙËÌ·ÙÈ΋ ÂÓı¿ÚÚ˘ÓÛË Î·È ‰˘Ó·ÙfiÙËÙ·, ÒÛÙ ӷ ÌÔÚ¤ÛÔ˘Ó ÂÓÂÚÁ¿ Ó· Û˘ÌÌÂÙ¤¯Ô˘Ó Î·È Ó· ÌËÓ Â›Ó·È ·ıËÙÈÎÔ› ‰¤ÎÙ˜ ·ÔÊ¿ÛˆÓ. ™ÙËÓ ∂ÏÏ¿‰·, ÔÈ Â·ÁÁÂÏ̷ٛ˜ ˘Á›·˜ ‰ÂÓ ¤¯Ô˘Ó Âη›‰Â˘ÛË Û¯ÂÙÈ΋ Ì ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Î·È ‰ÂÓ ÌÔÚÔ‡Ó Â‡ÎÔÏ· Ó· ·ÔÛÙ·ÛÈÔÔÈËıÔ‡Ó ·fi ÙÔÓ ·Ú·‰ÔÛÈ·Îfi ÙÔ˘˜ ÚfiÏÔ, ÂÓÒ Ù· ̤ÏË Ù˘ ÎÔÈÓfiÙËÙ·˜, ›Ù ÁÈ·Ù› ¤¯Ô˘Ó Û˘ÓËı›ÛÂÈ Â›Ù ÁÈ·Ù› ̤¯ÚÈ ÙÒÚ· ‰ÂÓ Â›¯·Ó ¿ÏÏË ÂÈÏÔÁ‹, Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ıËÙÈÎÔ› ‰¤ÎÙ˜ ·ÔÊ¿ÛÂˆÓ Î·È ÏËÚÔÊÔÚÈÒÓ ÁÈ· ÙËÓ ˘Á›·. ŒÙÛÈ, Ë ÂÌÂÈÚ›· Ù˘ ÔÌ¿‰·˜ Ì·˜ Ì ÙÔ˘˜ ÊÔÈÙËÙ¤˜-̤ÏË ÙÔ˘ √ÈÎÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘
¶›Ó·Î·˜ 3. ∞ÍÈÔÏfiÁËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Ù˘ Ù¿Í˘ ηٿ ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ ÛÙ· ‰ËÌÔÙÈο Î·È ÛÙ· Á˘ÌÓ¿ÛÈ·
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ªÂ ÚÔÛÔ¯‹ ªÂ Û˘ÌÌÂÙÔ¯‹ ªÂ ÚÔÛÔ¯‹ ªÂ Û˘ÌÌÂÙÔ¯‹
15,5% 15,3% 35% 15%
45,4% 38,8% 25% 25%
34,0% 34,7% 40% 20%
5,2% 11,2% 35%
5%
¶·È‰È·ÙÚÈ΋ 2008;71:469-474
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∞. •ÂηϿÎË Î·È Û˘Ó.
‹Ù·Ó ÌÈ· ÚfiÎÏËÛË Î·È ÌÈ· ¤ÎÏËÍË Û ÔÏÏ¿ ›‰·, Ô˘ ÎÚ›ıËΠ·fi fiÏÔ˘˜ ˆ˜ ıÂÙÈ΋. ªÂ ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜, ÌÔÚ› ηÓ›˜ Ì ۯÂÙÈ΋ ·ÛÊ¿ÏÂÈ· Ó· Û˘ÌÂÚ¿ÓÂÈ fiÙÈ ÙÔ ı¤Ì· Î·È Ô ÙÚfiÔ˜ ÚÔÛ¤ÁÁÈÛ˘ ‹Ù·Ó ·Ô‰ÂÎÙ¿ ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜, ÔÈ ÔÔ›ÔÈ ÂÈÚfiÛıÂÙ· ·ÍÈÔÏfiÁËÛ·Ó ¤ÌÌÂÛ· Î·È ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ Ì·ıËÙÒÓ, Ô˘ Û ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ‹Ù·Ó ÚÔÛÂÎÙÈÎÔ› Î·È Ì ÈηÓÔÔÈËÙÈ΋ Û˘ÌÌÂÙÔ¯‹. ∂›Ó·È ›Û˘ ÛÎfiÈÌÔ Ó· ÙÔÓÈÛı› fiÙÈ ÙÔ ÂÚȯfiÌÂÓÔ ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ·ÚÔ˘ÛÈ¿ÛÂˆÓ ·Ó¿ ËÏÈÎȷ΋ ÔÌ¿‰· ÎÚ›ıËΠηٿÏÏËÏÔ ·fi ÂÎ·È‰Â˘ÙÈÎÔ‡˜ Ù˘ ·ÓÙ›ÛÙÔȯ˘ ‚·ıÌ›‰·˜. ∏ ·ÏÏ·Á‹ ÛÙÔ ¿ÌÂÛÔ ÁÓˆÛÙÈÎfi Â›Â‰Ô ÙˆÓ Ì·ıËÙÒÓ ‹Ù·Ó Ôχ ÈηÓÔÔÈËÙÈ΋. ∏ ÏËÚÔÊÔÚ›·, fï˜, Ú¤ÂÈ Ó· ·ӷϷ̂¿ÓÂÙ·È Î·È Ó· Û˘ÌÏËÚÒÓÂÙ·È, ÒÛÙ ÙÂÏÈο Ó· Ẩˆı› ·fi Ù· ·È‰È¿. ∞˘Ùfi ÌÔÚ› Ó· ÂÈÙ¢¯ı› Ì ÙËÓ Â·Ó¿ÏË„Ë ·ÓÙ›ÛÙÔȯˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ Û ٷÎÙ¿ ¯ÚÔÓÈο ‰È·ÛÙ‹Ì·Ù·, ηıÒ˜ Î·È Ì¤Ûˆ Ù˘ ‰È·ıÂÌ·ÙÈ΋˜ ÚÔÛ¤ÁÁÈÛ˘ Ù˘ ÁÓÒÛ˘ (12,13,14,18). ∏ ÁÓÒÛË ‰ÂÓ ·Ó·Ì¤ÓÂÙ·È Ó· Û˘Óԉ‡ÂÙ·È ·fi ·ÓÙ›ÛÙÔȯ· ÈηÓÔÔÈËÙÈ΋ ·ÏÏ·Á‹ ÛÙ¿Û˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜, ‰ÈfiÙÈ ·˘Ù¿ ‰È·ÌÔÚÊÒÓÔÓÙ·È ·fi ÙËÓ Â›‰Ú·ÛË ÔÏÏÒÓ ·Ú·Ì¤ÙÚˆÓ. ∏ ·ÚÔ¯‹ Ù˘ ÏËÚÔÊÔÚ›·˜ Î·È Ë Â˘·ÈÛıËÙÔÔ›ËÛË Â›Ó·È ÛËÌ·ÓÙÈΤ˜, ·ÏÏ¿ ÂÍ›ÛÔ˘ ÛËÌ·ÓÙÈΤ˜ Â›Ó·È ÔÈ ÂÔÈı‹ÛÂȘ Î·È ÔÈ ‰˘Ó·ÙfiÙËÙ˜ ÙÔ˘ ·ÙfiÌÔ˘, ¤ÙÛÈ fiˆ˜ ‰È·ÌÔÚÊÒÓÔÓÙ·È ·fi ÙÔ ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎfi Î·È ÔÏÈÙÈÛÌÈÎfi ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓ (19,20). ∆Ô ÂÚÈ‚¿ÏÏÔÓ, ‰ËÏ·‰‹, Ú¤ÂÈ Ó· ÂÓÈÛ¯‡ÂÈ ÙÔ ·È‰› Ó· ÂÈϤÍÂÈ ÙËÓ ÂÚÈÛÛfiÙÂÚÔ “˘ÁÈ‹” Û˘ÌÂÚÈÊÔÚ¿ (6) Î·È ÁÈ’ ·˘Ùfi ¯ÚÂÈ¿˙ÂÙ·È ·Ú¤Ì‚·ÛË Û ¢ڇÙÂÚÔ ÎÔÈÓˆÓÈÎfi/ÓÔÌÔıÂÙÈÎfi Ï·›ÛÈÔ. ¶¿ÓÙˆ˜, Ê·›ÓÂÙ·È fiÙÈ ÙÔ Î·Ï‡ÙÂÚÔ Â›Â‰Ô Û¯ÂÙÈ΋˜ ÁÓÒÛ˘ Â›Ó·È ÚÔ¸fiıÂÛË ÁÈ· ηχÙÂÚË ÛÙ¿ÛË ·¤Ó·ÓÙÈ ÛÙÔ ÂÚÈ‚¿ÏÏÔÓ (21). ŸÏ· Ù· ·Ú·¿Óˆ ‰È·ÌÔÚÊÒÓÔ˘Ó ÙÔÓ ÛÙfi¯Ô, ·ÏÏ¿ Î·È ÙÔ ÛÙÔ›¯ËÌ· Ù˘ ÔÌ¿‰·˜ ÙÔ˘ ∫.À.¶.∫. ÁÈ· ÙÔ ÂfiÌÂÓÔ ÚfiÁÚ·ÌÌ· ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ ÛÙËÓ ÎÔÈÓfiÙËÙ·.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Sidell M. Educating for Health. In: Katz J, Peberby A, Douglas J, editors. Promoting Health: Knowledge and Practice. London: Palgrave Macmillan; 2000. p. 161-180. 2. Jones L. Promoting health: everybody’s business? In: Katz J, Peberby A, Douglas J, editors. Promoting Health: Knowledge and Practice. London: Palgrave Macmillan; 2000. 3. ∆Ô‡ÓÙ·˜ °∫. ¶ÚÔ·ÁˆÁ‹ ÀÁ›·˜. ∞ÛÎÏËÈÂ›Ô ¶¿ÚÎÔ ∞ıËÓÒÓ, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ [Internet]. 2002: Webpage: http://asclepieion.mpl.uoa.gr/pubASPIS/ ∞ÁˆÁ‹_ηÈ_¶ÚÔ·ÁˆÁ‹.htm 4. World Health Organization. Report of the Working Group on Concepts and Principles of Health Promotion, Copenhagen, 1984.
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5. World Health Organization. Health for All by the Year 2000, 1977. 6. World Health Organization. Ottawa Charter for Health Promotion. [Internet]. 1986: Webpage: http://www.who.int/ healthpromotion/conferences/previous/ottawa/en/ 7. World Health Organization (WHO). Children’s Health and the Environment in Europe: A baseline assessment. [Internet]. 2007: Webpage: http://www.euro.who.int/ Document/E90767.pdf 8. Commission for Environmental Cooperation. Children’s Health and the Environment in North America: A First Report on Available Indicators and Measures. [Internet]. 2006: Webpage: http://www.cec.org/files/pdf/pollutants/ CEH-Indicators-fin_en.pdf 9. Doll R. Health and the Environment in the 1990s. Public Health Forum. Am J Public Health 1992;82:933-941. 10. Health Protection Agency. Children’s Environment and Health Action Plan for Europe. [Internet]. 2007: Webpage: http://www.hpa.org.uk/cehape/ 11. Canadian Association of Physicians for the Environment. Children’s Environmental Health Project. [Internet]. 2000: Webpage: www.cape.ca/children/ 12. ∞Ï·¯ÈÒÙ˘ ™¡. °È· ¤Ó· Û‡Á¯ÚÔÓÔ ÂÎ·È‰Â˘ÙÈÎfi Û‡ÛÙËÌ·. ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ∂ÈıÂÒÚËÛË ∂Î·È‰Â˘ÙÈÎÒÓ £ÂÌ¿ÙˆÓ 2002;7:7-18. 13. ª·ÙÛ·ÁÁÔ‡Ú·˜ ∏. ∂˘¤ÏÈÎÙË ∑ÒÓË ¢È·ıÂÌ·ÙÈÎÒÓ ¶ÚÔÛÂÁÁ›ÛˆÓ: ªÈ· ÂÎ·È‰Â˘ÙÈ΋ ηÈÓÔÙÔÌ›· Ô˘ ·ÏÏ¿˙ÂÈ ÙÔ Û¯ÔÏ›Ô. ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ∂ÈıÂÒÚËÛË ∂Î·È‰Â˘ÙÈÎÒÓ £ÂÌ¿ÙˆÓ 2001;6:15-30. 14. ∫·Ú·Ù˙È¿-™Ù·˘ÏÈÒÙË ∂. ∏ ‰È·ıÂÌ·ÙÈÎfiÙËÙ· ÛÙ· ∞Ó·Ï˘ÙÈο ¶ÚÔÁÚ¿ÌÌ·Ù· ™Ô˘‰ÒÓ: ¶·Ú·‰Â›ÁÌ·Ù· ·fi ÙËÓ Â˘Úˆ·˚΋ ÂÌÂÈÚ›· Î·È Ú·ÎÙÈ΋. ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ∂ÈıÂÒÚËÛË ∂Î·È‰Â˘ÙÈÎÒÓ £ÂÌ¿ÙˆÓ 2002;7:52-65. 15. ™˘ÚÔÔ‡ÏÔ˘ ¢. ∏ ÂÚÈ‚·ÏÏÔÓÙÈ΋ Âη›‰Â˘ÛË ÛÙÔ Ï·›ÛÈÔ Ù˘ ∂˘¤ÏÈÎÙ˘ ∑ÒÓ˘: ∫·ÈÚfi˜ Î·È Îϛ̷ - ¶ÚÔÛÙ·Û›· Ù˘ ·ÙÌfiÛÊ·ÈÚ·˜. ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ ∂ÈıÂÒÚËÛË ∂Î·È‰Â˘ÙÈÎÒÓ £ÂÌ¿ÙˆÓ 2001;6:160-171. 16. Sidell M. Community action for health. In: Jones L, Sidell M, Douglas J, editors. The Challenge of Promoting Health: Exploration and Action. London: Palgrave Macmillan; 2002. 17. World Health Organization. Declaration of Alma-Ata. [Internet]. 1978: Webpage: http://www.who.int/hpr/NPH/ docs/declaration_almaata.pdf 18. Paraskevopoulos S, Padeliadu S, Zafiropoulos K. Environmental knowledge of elementary school students in Greece. Journal of Environmental Education 1998;29:55-60. 19. Sidell M. Supporting individuals and facilitating change: the role of counseling skills. In: Katz J, Peberby A, Douglas J, editors. Promoting Health: Knowledge and Practice. London: Palgrave Macmillan; 2000. p. 140-160. 20. Bonnett M, Williams J. Environmental education and primary children’s attitudes towards nature and the environment. Cambridge Journal of Education 1998;28: 159-174. 21. Campbell Bradley J, Waliczek TM, Zajicek M. Relationship between environmental knowledge and environmental attitude of high school students. Journal of Environmental Education 1999;30:17-21.
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ORIGINAL ARTICLE
475
¢ÈÂÚ‡ÓËÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÓÔÌÔıÂÛ›·˜ ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÎÔÈÓÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÈÏÂÁ̤ӷ ÂÏÏËÓÈο ÙÚfiÊÈÌ· ∞. µ·ÛÈÏÔÔ‡ÏÔ˘1, ∂. ™ÙÚÔ˘Ì‹2, ¡.°. ¶··‰fiÔ˘ÏÔ˜1, µ. ∫·Ú·ı¿ÓÔ˜2 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ ı¤ÛÈÛË ÓÔÌÔıÂÛ›·˜ ·fi ÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË Û¯ÂÙÈο Ì ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ ÛÙԯ‡ÂÈ ÛÙËÓ Â›Ù¢ÍË ÂÓfi˜ ˘„ËÏÔ‡ ÂȤ‰Ô˘ ÚÔÛÙ·Û›·˜ Ù˘ ˘Á›·˜ Î·È ÛÙË ‰È·ÛÊ¿ÏÈÛË ÙÔ˘ ‰ÈηÈÒÌ·ÙÔ˜ Ô˘ ¤¯Ô˘Ó Î·È ÔÈ ·ÏÏÂÚÁÈÎÔ› ηٷӷψ٤˜ ÛÙËÓ ÂÓË̤ڈÛË. ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ô ¤ÏÂÁ¯Ô˜ Î·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ÂÈÛ‹Ì·ÓÛ˘ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Î·È ·Ú·ÁÒÁˆÓ ÙÔ˘˜ Û 198 ÂÈÏÂÁ̤ӷ ÙÚfiÊÈÌ· (ÌÈÛÎfiÙ·, ÛÔÎÔÏ¿Ù˜ ˘Á›·˜ Î·È Á¿Ï·ÎÙÔ˜, „ˆÌ› Û˘Û΢·Ṳ̂ÓÔ) Ù˘ ÂÏÏËÓÈ΋˜ ·ÁÔÚ¿˜, ηْ ÂÊ·ÚÌÔÁ‹ Ù˘ ÈÛ¯‡Ô˘Û·˜ ÓÔÌÔıÂÛ›·˜ Î·È ÙˆÓ ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÂÈÌfiÏ˘ÓÛ˘ ÙˆÓ ÚÔ˚fiÓÙˆÓ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁÈ΋ ‰È·‰Èηۛ·. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ∞Ó·Ï˘ÙÈ΋ ‰ÈÂÚ‡ÓËÛË Î·È Î·Ù·ÁÚ·Ê‹ Ù˘ ÈÛ¯‡Ô˘Û·˜ ÓÔÌÔıÂÛ›·˜ ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ. ∞ÍÈÔÏfiÁËÛË ÙˆÓ ÂÙÈÎÂÙÒÓ ÂÈÏÂÁÌ¤ÓˆÓ ÙÚÔÊ›ÌˆÓ fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ Î·ÓfiÓˆÓ ·fi ÙȘ ‚ÈÔÌ˯·ÓÈΤ˜ ÌÔÓ¿‰Â˜, ηıÒ˜ Î·È ÙˆÓ Ì¤ÙÚˆÓ ÚfiÏ˄˘ ÁÈ· ÂÈÌÔχÓÛÂȘ, Ì ¯Ú‹ÛË ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Î·È ÚfiÙ˘Ë˜ ÊfiÚÌ·˜ ηٷÁÚ·Ê‹˜ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û˘ÛÙ·ÙÈÎÒÓ. ∞ÔÙÂϤÛÌ·Ù·: ∆· ÙÚÔÊÈο ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ·Ó·ÁÚ¿ÊÔÓÙ·Ó ÛÙȘ ÂÙÈΤÙ˜ Ì ÔÏÏÔ‡˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜ (7 ÁÈ· ÙÔ ÛÈÙ¿ÚÈ, 29 ÁÈ· ÙÔ Á¿Ï·, 6 ÁÈ· ÙÔ ·‚Áfi, 8 ÁÈ· ÙÔ˘˜ ÍËÚÔ‡˜ ηÚÔ‡˜ ‰¤Ó‰ÚˆÓ, 2 ÁÈ· ÙÔ ·Ú¿ÈÎÔ ÊÈÛÙ›ÎÈ, 5 ÁÈ· ÙË ÛfiÁÈ·), ÂÓÒ Û˘¯Ó‹ ‹Ù·Ó Î·È Ë ¯Ú‹ÛË Ù¯ÓÈÎÒÓ fiÚˆÓ Î·È ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘ ÁÈ· ÙË ‰‹ÏˆÛË Ù˘ Èı·Ó‹˜ ·ÚÔ˘Û›·˜ ÙÔ˘˜. √È ÂÎÚfiÛˆÔÈ ÙˆÓ ÂÙ·ÈÚÈÒÓ ·Ó¤ÊÂÚ·Ó ·‰˘Ó·Ì›· ηٷÁÚ·Ê‹˜ Û·ÊÔ‡˜ Û‡ÛÙ·Û˘ Î·È ÔÛÔÙÈÎÔÔ›ËÛ˘ ÙˆÓ Ù˘¯·›ˆÓ ÚÔÛÌ›ÍÂˆÓ Ô˘ ÚÔ·ÙÔ˘Ó Î·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹. ™˘ÌÂÚ¿ÛÌ·Ù·: √ ÌË ÂÓÈ·›Ô˜ ÙÚfiÔ˜ ηٷÁÚ·Ê‹˜ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ÚÔ˚fiÓÙ· Î·È Ë ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ÏfiÁˆ Èı·ÓÒÓ ÚÔÛÌ›ÍÂˆÓ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁÈ΋ ‰È·‰Èηۛ· ‰˘ÛÎÔÏÂ‡Ô˘Ó ÙÔÓ ·ÏÏÂÚÁÈÎfi ηٷӷψً Ó· ‚ÚÂÈ Î·È Ó· ÂÓÙ¿ÍÂÈ ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ ÙÔ˘ ÙÚfiÊÈÌ· ·ÛÊ·Ï‹ ·fi ÙȘ ÂÓ ÏfiÁˆ ηÙËÁÔڛ˜.
1 ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∂Ú¢ÓËÙÈÎfi ∫¤ÓÙÚÔ & ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, µ’ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 ∆Ì‹Ì· ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∞ÈÌÈÏ›· µ·ÛÈÏÔÔ‡ÏÔ˘ evassil@allergy.gr ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∂Ú¢ÓËÙÈÎfi ∫¤ÓÙÚÔ & ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, µ’ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
§¤ÍÂȘ ÎÏÂȉȿ: ∂ÏÏËÓÈ΋ ·ÁÔÚ¿, ÂÈÛ‹Ì·ÓÛË, ÂÙÈΤÙ˜, ÙÚÔÊÈÎfi ·ÏÏÂÚÁÈÔÁfiÓÔ, ÓÔÌÔıÂÛ›·.
Application of the legislation on allergen labelling for selected food products in the Greek market ∞. Vassilopoulou1, ∂. Stroumpi2, ¡.G. Papadopoulos1, V. Karathanos2 Abstract Introduction: Food labelling legislation has been established by the European Union (EU) for the protection of the health of consumers, in particular those who have food allergies, and to guarantee their right to be reliably informed about the food they consume. The aim of this study was to evaluate the labelling of food products available in the Greek market for certain allergens and their derivatives in 198 selected foods (biscuits, dark chocolate, milk, and packaged bread), with respect to the application of the EU legislation and the precautionary measures taken to avoid cross-contamination during production and sale. Methods: The EU legislation on food labelling was reviewed in detail. Its application on selected food products was assessed by a detailed record of the terms used on packages to describe common allergens (milk, egg, wheat, peanuts, tree-nuts, soya). A standard questionnaire was used to evaluate the precautionary measures taken by the manufacturers to avoid cross contamination. Results: Food allergens and their derivatives were recorded in a variety of ways on food packaging labels (7 for wheat, 29 for milk, 6 for egg, 8 for tree-nuts, 2 for peanuts and 5 for soya). The frequent use of complex terms to describe food allergens and the extensive use of precautionary labelling (65.66%) makes it impossible for the consumer to recognise a specific allergen. Companies report inability to avoid crosscontamination during production. Conclusion: The use of complicated, non-specific terminology and precautionary labelling in the majority of products sold in the Greek market make it difficult to characterise a product as “allergen free”. It is
1 Allergology Research Center & Department of Allergology, 2nd University Department, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece 2 Department of Nutrition, Harokopio University, Athens, Greece Correspondence: Emilia Vassilopoulou evassil@allergy.gr Allergology Research Center & Department of Allergology, 2nd University Department, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
¶·È‰È·ÙÚÈ΋ 2008;71:475-481
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∞. µ·ÛÈÏÔÔ‡ÏÔ˘ Î·È Û˘Ó.
almost impossible for the patient with food allergy to find and safely consume commercial products from the categories selected for evaluation.
Key words: Food allergen, food label, Greek market, labelling, legislation.
∂ÈÛ·ÁˆÁ‹ √ ÂÈÔÏ·ÛÌfi˜ Ù˘ ÙÚÔÊÈ΋˜ ·ÏÏÂÚÁ›·˜ ‰ÂÓ Â›Ó·È Û·Ê‹˜. øÛÙfiÛÔ, ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ‰ÂηÂÙÈÒÓ, Ë ÙÚÔÊÈ΋ ·ÏÏÂÚÁ›· ¤¯ÂÈ ·Ó·‰Âȯı› ˆ˜ ¤Ó· ÛÔ‚·Úfi Úfi‚ÏËÌ· ‰ËÌfiÛÈ·˜ ˘Á›·˜, Ì ·˘ÍË̤ÓË Â›ÙˆÛË (1). ¢Â‰ÔÌ¤ÓˆÓ ÙˆÓ ÂӉ¯Ô̤ӈ˜ ·ÂÈÏËÙÈÎÒÓ ÁÈ· ÙË ˙ˆ‹ Û˘ÓÂÂÈÒÓ ÙˆÓ ÙÚÔÊÈÎÒÓ ·ÏÏÂÚÁÈÒÓ, Ù· ·ÏÏÂÚÁÈο ¿ÙÔÌ· ÛÙËÚ›˙ÔÓÙ·È Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ÛÙȘ ‰›·ÈÙ˜ ·ÔÊ˘Á‹˜. ªÈ· ·˘ÛÙËÚ‹ ÚÔÛÎfiÏÏËÛË Û ‰›·ÈÙ· ·ÔÊ˘Á‹˜ Â›Ó·È ÙÔ ÛËÌ·ÓÙÈÎfiÙÂÚÔ ÚÔÏËÙÈÎfi ̤ÙÚÔ Î·È ÛÙԯ‡ÂÈ ÛÙÔÓ ·fiÏ˘ÙÔ ·ÔÎÏÂÈÛÌfi ÙˆÓ ˘Â‡ı˘ÓˆÓ ÁÈ· ·ÓÙȉڿÛÂȘ ÙÚÔʛ̈Ó. ∆· ·ÏÏÂÚÁÈο ¿ÙÔÌ· Î·È ÔÈ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ ˘Ô¯ÚÂÔ‡ÓÙ·È Ó· ·ÁÚ˘ÓÔ‡Ó, ÒÛÙ ٷ ÙÚfiÊÈÌ· Ô˘ ·ÁÔÚ¿˙Ô˘Ó Î·È Î·Ù·Ó·ÏÒÓÔ˘Ó Ó· Â›Ó·È ÂχıÂÚ· ·ÏÏÂÚÁÈÔÁfiÓˆÓ. ∞˘Ùfi ÛÙËÓ Ú¿ÍË ‰ÂÓ ÂÈÙ˘Á¯¿ÓÂÙ·È Â‡ÎÔÏ· Î·È ‰˘Û¯ÂÚ·›ÓÂÙ·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û ÔÏϤ˜ ¯ÒÚ˜ Ë ÓÔÌÔıÂÛ›· ‰ÂÓ ÂÈ‚¿ÏÏÂÈ ÙËÓ Ï‹ÚË ÂÈÛ‹Ì·ÓÛË ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ Ô˘ ÂÌÂÚȤ¯ÔÓÙ·È ÛÙ· ÂÂÍÂÚÁ·Ṳ̂ӷ ÙÚfiÊÈÌ·. ø˜ Û˘Ó¤ÂÈ·, Ë Ù˘¯·›· ηٷӿψÛË ÙÚÔÊ›ÌˆÓ Ì ÎÚ˘Ì̤ӷ ·ÏÏÂÚÁÈÔÁfiÓ· ¤¯ÂÈ ·Ô‚› ÔÏϤ˜ ÊÔÚ¤˜ ÌÔÈÚ·›· (2). °È’ ·˘ÙfiÓ ÙÔÓ ÏfiÁÔ, Â›Ó·È ÂÍ·ÈÚÂÙÈο ÛËÌ·ÓÙÈÎfi ÁÈ· ÙÔÓ ·ÏÏÂÚÁÈÎfi ηٷӷψً Ù· ÂÌÔÚÈο ÙÚfiÊÈÌ· Ó· ¤¯Ô˘Ó ·ÎÚÈ‚‹ Î·È ·Ó·ÌÊÈÛ‚‹ÙËÙË ÂÈÛ‹Ì·ÓÛË. ™Â ¯ÒÚ˜ ÂÎÙfi˜ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘, ·Ú’ fiÏÔ Ô˘ ¤¯Ô˘Ó ·Ó·Ù˘¯ı› ‰È·ÊÔÚÂÙÈΤ˜ ÓÔÌÔıÂۛ˜ Î·È Ô‰ËÁ›Â˜ ·fi ‰È¿ÊÔÚÔ˘˜ ÂıÓÈÎÔ‡˜ Î·È ‰ÈÂıÓ›˜ ÔÚÁ·ÓÈÛÌÔ‡˜, ÔÏϤ˜ ÊÔÚ¤˜ ˘¿Ú¯Ô˘Ó ÔÌÔÈfiÙËÙ˜. ™ÙË ¡. ∑ËÏ·Ó‰›·, ÙÔ 2002, Ù· ÚfiÙ˘· ÙÚÔÊ›ÌˆÓ ·Ó·Ê¤ÚÔ˘Ó fiÙÈ ˘¿Ú¯Ô˘Ó ÔÎÙÒ ‚·ÛÈο ·ÏÏÂÚÁÈÔÁfiÓ· (ı·Ï·ÛÛÈÓ¿, Á¿Ï·, ÊÈÛÙ›ÎÈ·, ÍËÚÔ› ηÚÔ›, ÛÔ˘Û·ÌfiÛÔÚÔÈ, ÛfiÁÈ·, ÛÈÙËÚ¿ Î·È ·‚Á¿), Ù· ÔÔ›· ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·›ÓÔÓÙ·È ¿Óˆ ÛÙȘ ÂÙÈΤÙ˜ ÙˆÓ ÙÚÔʛ̈Ó, ·ÓÂÍ·Úًو˜ ÔÛfiÙËÙ·˜ (3). ™ÙËÓ ∞ÌÂÚÈ΋, Û‡Ìʈӷ Ì ÙÔÓ ÓfiÌÔ ÚÔÛÙ·Û›·˜ ηٷӷψÙÒÓ (4) ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÙÚÔʛ̈Ó, Â›Ó·È ˘Ô¯ÚˆÙÈÎfi Ó· ÂÈÛËÌ·›ÓÂÙ·È Û ·Ï‹ ÁÏÒÛÛ· Ë ·ÚÔ˘Û›· ÔÔÈÔ˘‰‹ÔÙ ·fi Ù· ÔÎÙÒ ‚·ÛÈο ·ÏÏÂÚÁÈÔPaediatriki 2008;71:475-481
ÁfiÓ·, ·ÎfiÌ· Î·È fiÙ·Ó ·˘Ù¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ·ÚÒÌ·Ù·, ÚfiÛıÂÙ· Î·È ¯ÚˆÛÙÈΤ˜ (5). ∏ ·ÚÔ‡Û· ÌÂϤÙË ·ÔÛÎÔ› ÛÙÔÓ ¤ÏÂÁ¯Ô Î·È ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ › ÙÔ˘ ·ÚfiÓÙÔ˜ ÂÈÛ‹Ì·ÓÛ˘ ÂÈÏÂÁÌ¤ÓˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙËÓ ÂÏÏËÓÈ΋ ·ÁÔÚ¿, ÁÓˆÛÙÒÓ ÁÈ· ÙË Û˘¯Ó‹ ÚfiÎÏËÛË ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛˆÓ, ΢ڛˆ˜ Û ·È‰È¿ Ó·ڋ˜ ËÏÈΛ·˜, ηıÒ˜ Î·È ÙˆÓ ·Ú·ÁÒÁˆÓ ÙÔ˘˜, Û ÂÈÏÂÁ̤ӷ ÙÚfiÊÈÌ· (ÛÔÎÔÏ¿Ù˜ ˘Á›·˜ Î·È Á¿Ï·ÎÙÔ˜, ÌÈÛÎfiÙ·, „ˆÌ› Û˘Û΢·Ṳ̂ÓÔ), ·fi ÏÂ˘Ú¿˜: - ÓÔÌÔıÂÛ›·˜ (ÂÏÏËÓÈ΋˜ Î·È Â˘Úˆ·˚΋˜) - ¤Ú¢ӷ˜ ·ÁÔÚ¿˜ Û 2 ÌÂÁ¿Ï· ηٷÛÙ‹Ì·Ù· ÙÚÔÊ›ÌˆÓ - ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÙˆÓ ‚ÈÔÌ˯·ÓÈÒÓ, ÚÔ˜ ·ÔÊ˘Á‹ ÂÈÌfiÏ˘ÓÛ˘ ÙˆÓ ÚÔ˚fiÓÙˆÓ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁÈ΋ ‰È·‰Èηۛ· ™ÎÔfi˜ Â›Ó·È Ë ‰ÈÂÚ‡ÓËÛË Ù˘ ÈÛ¯‡Ô˜ ÙˆÓ Ì¤ÙÚˆÓ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ Î·Ù·Ó·ÏˆÙÒÓ, ηıÒ˜ Î·È Ù˘ ‰È·ıÂÛÈÌfiÙËÙ·˜ ÚÔ˚fiÓÙˆÓ Â˘Ú›·˜ ηٷӿψÛ˘ ÁÈ· ÙÔ˘˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜ ·ÛıÂÓ›˜.
ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ ¢ÈÂÚ‡ÓËÛË ÈÛ¯‡Ô˘Û·˜ ÓÔÌÔıÂÛ›·˜ ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙËÓ ÂÏÏËÓÈ΋ ·ÁÔÚ¿ ∏ ÈÛ¯‡Ô˘Û· ÓÔÌÔıÂÛ›· ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙÚÔÊÈÎÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Â›Ó·È ÎÔÈÓ‹ Ì ÙËÓ Â˘Úˆ·˚΋. ™ÙÔ Ï·›ÛÈÔ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ë ÓÔÌÔıÂÛ›· ‰ÈÂÚ¢ӋıËΠ̤ۈ Ù˘ ›ÛËÌ˘ ÈÛÙÔÛÂÏ›‰·˜ Ù˘ Â˘Úˆ·˚΋˜ ÓÔÌÔıÂÛ›·˜ (6), ·ÏÏ¿ Î·È ÙÔ˘ ∂ÓÈ·›Ô˘ ºÔÚ¤· ∂ϤÁ¯Ô˘ ∆ÚÔÊ›ÌˆÓ (∂º∂∆). ŒÏÂÁ¯Ô˜ ÂÊ·ÚÌÔÁ‹˜ ÓÔÌÔıÂÙÈÎÒÓ Ú˘ıÌ›ÛÂˆÓ Û ÂÈÏÂÁ̤ӷ ÚÔ˚fiÓÙ· ∏ ·ÍÈÔÏfiÁËÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÓÔÌÔıÂÛ›·˜ Û ÚÔ˚fiÓÙ· Ù˘ ÂÏÏËÓÈ΋˜ ·ÁÔÚ¿˜ ¤ÁÈÓ ÁÈ· ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ·, ˘Â‡ı˘Ó· ÁÈ· ÚfiÎÏËÛË ·ÏÏÂÚÁÈÎÒÓ ·ÓÙȉڿÛÂˆÓ Î˘Ú›ˆ˜ Û ·ÏÏÂÚÁÈο ·È‰È¿ (7), ηıÒ˜ Î·È ‚¿ÛÂÈ ÙˆÓ ÎÏÈÓÈÎÒÓ ÂÚÈÛÙ·ÙÈÎÒÓ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔ ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ÙÌ‹Ì· ÙÔ˘ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ ∞ıËÓÒÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡” . ∏ ÂÈÏÔÁ‹ ÙˆÓ ˘fi ÌÂϤÙË ÚÔ˚fiÓÙˆÓ ¤ÁÈÓ Ì ‚¿ÛË ÁÓˆÛÙ¤˜ ÚÔÙÈÌ‹ÛÂȘ ·ÙfiÌˆÓ Ó·ڋ˜ ËÏÈΛ·˜, fiˆ˜ Â›Ó·È ÔÈ ÛÔÎÔÏ¿Ù˜ ˘Á›·˜ Î·È Á¿Ï·ÎÙÔ˜, Ù· ÌÈÛÎfiÙ· Î·È Ù· Û˘Û΢·Ṳ̂ӷ „ˆÌÈ¿. ∏ ¤Ú¢ӷ ·ÁÔÚ¿˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠2 ÌÂÁ¿Ï· ÔÏ˘Î·Ù·ÛÙ‹Ì·Ù· ÙÚÔʛ̈Ó, ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· √ÎÙˆ‚Ú›Ô˘-ª·˝Ô˘ 2007, fiÔ˘ ηٷÁÚ¿ÊËΠ̠ÏÂÙÔ̤ÚÂÈ· Ë Û‡ÛÙ·ÛË ÙˆÓ ÂÈÏÂÁÌ¤ÓˆÓ ÙÚÔʛ̈Ó, fiˆ˜ ·˘Ù‹ ·Ó·ÊÂÚfiÙ·Ó ÛÙËÓ ÂÙÈΤٷ ÙÔ˘˜.
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·477
477
∞ÍÈÔÏfiÁËÛË ÂÈÛ‹Ì·ÓÛ˘ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÏÏËÓÈο ÙÚfiÊÈÌ·
¶›Ó·Î·˜ 1. ºfiÚÌ· ηٷÁÚ·Ê‹˜ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÁÈ· ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ Ì¤ÙÚˆÓ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È ·fi ·Ú·ÁˆÁÔ‡˜ Î·È ÚÔÌËıÂ˘Ù¤˜ ÙÚÔÊ›ÌˆÓ ŸÓÔÌ· ÚÔ˚fiÓÙÔ˜:
UPC#
™˘ÌÏËÚÒÛÙ ٷ ·Ú·Î¿Ùˆ ÁÈ· οı ÚÔ˚fiÓ. ∏ ÛÙ‹ÏË π ˘Ô‰ËÏÒÓÂÈ Ù· ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ÌÔÚ› Ó· ‚ÚÂıÔ‡Ó ÛÙÔ ÚÔ˚fiÓ ·fi ÚÔÛı‹ÎË ‹ ÂÈÌfiÏ˘ÓÛË (·fi ¿ÏÏ· ÚÔ˚fiÓÙ·). ∏ ÛÙ‹ÏË ππ ˘Ô‰ËÏÒÓÂÈ Ù· ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó Û ¿ÏÏ· ÚÔ˚fiÓÙ· ÁÈ· Ù· ÔÔ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ô ›‰ÈÔ˜ ÂÍÔÏÈÛÌfi˜, Û ‰È·ÊÔÚÂÙÈ΋ ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹. ∏ ÛÙ‹ÏË πππ ˘Ô‰ËÏÒÓÂÈ ·Ó ˘¿Ú¯Ô˘Ó ÔÔÈ·‰‹ÔÙ ·ÏÏÂÚÁÈÔÁfiÓ· ÛÙÔ Ï¿ÓÔ Û·˜. ™˘ÌÏËÚÒÛÙ ٷ ÎÂÏÈ¿ Ì ¤Ó· ¡∞π ‹ √Ãπ ηÈ, fiÙ·Ó Ú¤ÂÈ, Ì ÙÔ fiÓÔÌ· ÙÔ˘ Û˘ÛÙ·ÙÈÎÔ‡. ªËÓ ·Ê‹ÛÂÙ ¿‰ÂÈ· ÎÂÏÈ¿.
™˘ÛÙ·ÙÈο
™Ù‹ÏË π
™Ù‹ÏË ππ
™Ù‹ÏË πππ
¶·ÚfiÓ ÛÙÔ ÚÔ˚fiÓ
¶·ÚfiÓ Û ¿ÏÏ· ÚÔ˚fiÓÙ· Ô˘ ÚÔ¤Ú¯ÔÓÙ·È ·fi ÙËÓ ›‰È· ÁÚ·ÌÌ‹ ·Ú·ÁˆÁ‹˜
¶·ÚfiÓ ÛÙÔ ›‰ÈÔ ‚ÈÔÌ˯·ÓÈÎfi Ï¿ÓÔ
°ÂÓÈο ºÈÛÙ›ÎÈ ‹ ·Ú¿ÁˆÁ¿ ÙÔ˘ ∫·ÚÔ› ‰¤ÓÙÚˆÓ (·Ì‡Á‰·Ï·, ηڇ‰È·, οÛÈÔ˘˜, ÊÔ˘ÓÙÔ‡ÎÈ·, Î.·.) Î·È ·Ú¿ÁˆÁ¿ ÙÔ˘˜ ™Ô˘Û¿ÌÈ ‹ ·Ú¿ÁˆÁ¿ ÙÔ˘ °¿Ï· ‹ ·Ú¿ÁˆÁ¿ ÙÔ˘ ∞‚Á¿ ‹ ·Ú¿ÁˆÁ¿ ÙÔ˘˜ æ¿ÚÈ· ‹ ·Ú¿ÁˆÁ¿ ÙÔ˘˜ √ÛÙÚ·ÎÔÂȉ‹ ‹ ·Ú¿ÁˆÁ¿ ÙÔ˘˜ ™fiÁÈ· ‹ ·Ú¿ÁˆÁ¿ Ù˘, .¯. ÏÂÎÈı›ÓË ™ÈÙ¿ÚÈ ‹ ·Ú¿ÁˆÁ¿ ÙÔ˘, .¯. ·Ï‡ÚÈ ™Ô˘ÏÊ›‰Â˜, .¯. ˆ˜ Ê˘ÛÈÎfi Û˘ÛÙ·ÙÈÎfi ·Ì˘ÏÔ‡¯Ô˘ ÙÚÔÊ›ÌÔ˘, fiˆ˜ ·Ù¿Ù·, ‹ ˆ˜ Û˘ÛÙ·ÙÈÎfi ˘ÏÈÎfi Û˘Û΢·Û›·˜ (cellophane) ÕÏÏ· Ô˘ ıˆÚÔ‡ÓÙ·È ¯Ú‹ÛÈÌ· Œ¯ÂÙ ‰È·‰Èηۛ˜ ·ÔÊ˘Á‹˜ Ù˘ ÂÈÌfiÏ˘ÓÛ˘ ÙÔ˘ ÚÔ˚fiÓÙÔ˜ Ì ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ‰ÂÓ Â›Ó·È ·ÚfiÓÙ· ÛÙÔ ÚÔ˚fiÓ, ·ÏÏ¿ Â›Ó·È ÛËÌÂȈ̤ӷ ÛÙȘ ÛًϘ ππ Î·È πππ; ¡∞π √Ãπ ¶·Ú·Î·ÏÒ ÂÈÛ˘Ó¿„Ù ÙËÓ ÂÙÈΤٷ ÂÓfi˜ ¤ÙÔÈÌÔ˘ ÚÔ˚fiÓÙÔ˜ Û ·˘Ù‹ ÙË ÊfiÚÌ·. ∞Ó ÁÈ· ÔÔÈÔ‰‹ÔÙ ÏfiÁÔ ˘¿ÚÍÔ˘Ó ·ÏÏ·Á¤˜ ÛÙÔ ÚÔ˚fiÓ, ›ÛÙ ˘Â‡ı˘ÓÔÈ ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Û·˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ¿ÌÂÛË ÂÓË̤ڈۋ Ì·˜. ¢È‡ı˘ÓÛË ÚÔÌËıÂ˘Ù‹: ∆ÚfiÔ˜ ·ʋ˜ Ì ÙÔÓ ÚÔÌËıÂ˘Ù‹: ÀÔÁÚ·Ê‹ ∏ÌÂÚÔÌËÓ›·
∞ÎÔÏÔ‡ıËÛ ÂÈÎÔÈÓˆÓ›· (› ÙfiÔ˘ ›ÛÎÂ„Ë ‹ ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›·) Ì 3 ‚ÈÔÌ˯·Ó›Â˜ ÙÚÔʛ̈Ó, ·fi ÙȘ Ôԛ˜ ÚÔ¤Ú¯ÔÓÙ·Ó Ù· Û˘ÁÎÂÎÚÈ̤ӷ ÚÔ˚fiÓÙ·. ∏ ·ÍÈÔÏfiÁËÛË ÙˆÓ Ì¤ÙÚˆÓ Ô˘ Ï·Ì‚¿ÓÔÓÙ·È Î·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹ ¤ÁÈÓ ÌÂ Û˘ÁÎÂÎÚÈ̤ÓË ÊfiÚÌ· ηٷÁÚ·Ê‹˜ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÁÈ· ÚÔÌËıÂ˘Ù¤˜ Î·È ·Ú·ÁˆÁÔ‡˜ ÙÚÔÊ›ÌˆÓ (¶›Ó·Î·˜ 1) (8). ªÂ ·˘Ù‹ ‰ÈÂÚ¢ӋıËÎÂ Ë ‡·ÚÍË Èı·ÓÒÓ “ÎÚ˘ÊÒÓ” ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ÚÔ˚fiÓÙ· Î·È Ë Èı·Ó‹ ÂÈÌfiÏ˘ÓÛ‹ ÙÔ˘˜ ·fi Ù˘¯·›· ÚfiÛÌÈÍË ÏfiÁˆ ·ÚÔ˘Û›·˜ ÛÙÔÓ ‚ÈÔÌ˯·ÓÈÎfi ¯ÒÚÔ ‹ ¯Ú‹Û˘ ÎÔÈÓ‹˜ ·Ú·ÁˆÁÈ΋˜ ÁÚ·ÌÌ‹˜, ÂÏÏÈÔ‡˜ ÂϤÁ¯Ô˘ ÙˆÓ ÚÒÙˆÓ ˘ÏÒÓ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹ ‹ ÛÊ¿ÏÌ· ÙÔ˘ ÚÔÌËıÂ˘Ù‹. ∏ ‰ÈÂÚ‡ÓËÛË Ù˘ ηٿÚÙÈÛ˘ ÙˆÓ ·ÙfiÌˆÓ Ô˘ ÂÚÁ¿˙ÔÓÙ·È ÛÙȘ ‚ÈÔÌ˯·Ó›Â˜ ÙÚÔÊ›ÌˆÓ ÁÈ· ÙË Û¯ÂÙÈ΋ ÓÔÌÔıÂÛ›· fiÛÔÓ ·ÊÔÚ¿ ÛÙ· ·ÏÏÂÚÁÈÔÁfiÓ· Î·È Ù˘ ÈηÓfiÙËÙ¿˜ ÙÔ˘˜ Ó· Ï·Ì‚¿ÓÔ˘Ó Ì¤ÙÚ· ÁÈ· ÙËÓ ÂÍ·ÛÊ¿ÏÈÛË ·ÛÊ·ÏÒÓ ÚÔ˚fiÓÙˆÓ, ÂχıÂÚˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ, ¤ÁÈÓ Ì ۯÂÙÈÎfi ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, fiˆ˜ ÂÌÊ·Ó›˙ÂÙ·È ÛÙÔÓ ¶›Ó·Î· 2.
™Ù·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË ∆· ‰Â‰Ô̤ӷ ηٷÁÚ¿ÊËÎ·Ó Î·È ·Ó·Ï‡ıËÎ·Ó Ì ¯Ú‹ÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜ Microsoft Excel. ∫·Ù·ÚÙ›ÛÙËÎ·Ó ÔÛÔÛÙÈ·›ÔÈ ›Ó·Î˜ ÁÈ· ÙËÓ ·ÚÔ˘Û›· ‹ ‰˘Ó·Ù‹ ·ÚÔ˘Û›· ¤Î·ÛÙÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ¯ˆÚÈÛÙ¿ ÛÙ· ˘fi ÌÂϤÙË ÚÔ˚fiÓÙ·, ηıÒ˜ Î·È fiÏÔ˘˜ ÙÔ˘˜ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜ ηٷÁÚ·Ê‹˜ ÙÔ˘˜.
∞ÔÙÂϤÛÌ·Ù· πÛ¯‡Ô˘Û· ÓÔÌÔıÂÛ›· ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÛÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË ™ÙȘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘, Ë ÓÔÌÔıÂÛ›· Û¯ÂÙÈο Ì ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ ÛÙԯ‡ÂÈ ÛÙËÓ Â›Ù¢ÍË ÂÓfi˜ ˘„ËÏÔ‡ ÂȤ‰Ô˘ ÚÔÛÙ·Û›·˜ Ù˘ ˘Á›·˜ ÙˆÓ Î·Ù·Ó·ÏˆÙÒÓ Î·È ÛÙË ‰È·ÛÊ¿ÏÈÛË ÙÔ˘ ‰ÈηÈÒÌ·Ùfi˜ ÙÔ˘˜ ÛÙËÓ ÂÓË̤ڈÛË. ∫·ıÔÚ›˙ÂÈ Ù· ÙÚÔÊÈο ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ÂÙÈΤٷ ÂÓfi˜ ÙÚÔÊ›ÌÔ˘, fiÙ·Ó ·˘Ù¿ ‹ Ù· ¶·È‰È·ÙÚÈ΋ 2008;71:475-481
Pediatri Nov-Dec 08 new
19-12-08
16:31
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∞. µ·ÛÈÏÔÔ‡ÏÔ˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 2. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËΠηٿ ÙË Û˘Ó¤ÓÙ¢ÍË ÙˆÓ ·Ú·ÁˆÁÒÓ Î·È ÚÔÌËı¢ÙÒÓ ÙÚÔÊ›ÌˆÓ Ô˘ ‰È·Ù›ıÂÓÙ·È Â˘Ú¤ˆ˜ ÛÙËÓ ÂÏÏËÓÈ΋ ·ÁÔÚ¿ 1. ∆È ÁÓˆÚ›˙ÂÙ ÁÈ· ÙË ÓÔÌÔıÂÛ›· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ; 2. ¶·›ÚÓÂÙ οÔÈ· Û˘ÁÎÂÎÚÈ̤ӷ ̤ÙÚ· ÁÈ· ÙËÓ ·ÏÏÂÚÁÈÔÁÔÓÈÎfiÙËÙ·; 3. ¶Ò˜ ηı·Ú›˙ÂÙ ÙË ÁÚ·ÌÌ‹ ·Ú·ÁˆÁ‹˜; 4. À¿Ú¯ÂÈ Î¿ÔÈÔ ÚÔ˚fiÓ Ô˘ Ó· ¤¯ÂÈ Í¯ˆÚÈÛÙ‹ ÁÚ·ÌÌ‹; 5. ¶fiÛÔ ·ÛÊ·Ï‹ Â›Ó·È Ù· ÚÔ˚fiÓÙ· Û·˜; £· Û˘ÓÈÛÙÔ‡Û·Ù ÙËÓ Î·Ù·Ó¿ÏˆÛ‹ ÙÔ˘˜ Û ¿ÙÔÌ· Ì ·ÏÏÂÚÁ›Â˜;
·Ú¿ÁˆÁ¿ ÙÔ˘˜ Â›Ó·È ·ÚfiÓÙ· Î·È Ù· ÙÚfiÊÈÌ· ˆÏÔ‡ÓÙ·È ÚÔÛ˘Û΢·Ṳ̂ӷ, ηıÒ˜ Î·È fiÙ·Ó Ù· ·ÏÏÂÚÁÈÔÁfiÓ· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ÚfiÛıÂÙ· Û ‰È·Ï‡Ù˜, ·ÚÒÌ·Ù· ‹ ·ÏÎÔÔÏÔ‡¯· ÔÙ¿ ηٿ ÙËÓ ÂÂÍÂÚÁ·Û›· ÙÚÔʛ̈Ó. ∏ √‰ËÁ›· 2003/89/ EC (11) ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÂÊ·ÚÌfiÛÙËΠÛÙ· ÎÚ¿ÙË Ì¤ÏË Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘ ÙÔ 2004, ηٷÚÁÒÓÙ·˜ ÙÔ˘˜ ηÓfiÓ˜ ÂÈÛ‹Ì·ÓÛ˘ ÙÚÔÊ›ÌˆÓ ÙÔ˘ 1996 (9,10), fiÔ˘ ›Û¯˘Â Ô Î·ÓfiÓ·˜ ÙÔ˘ 25% (12), ηıÒ˜ Î·È ¿ÏÏÔ˘˜ ÙÚfiÔ˘˜ ηٷÁÚ·Ê‹˜. °È· ·Ú¿‰ÂÈÁÌ·, ˘‹Ú¯Â Ë ‰˘Ó·ÙfiÙËÙ· ηٷÁÚ·Ê‹˜ οÔÈˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÌfiÓÔ ˆ˜ ηÙËÁÔÚ›·, .¯. Ê˘ÙÈο ¤Ï·È·. ªÂ ÙÔÓ ·ÚfiÓÙ· ÓfiÌÔ, ··ÈÙÂ›Ù·È Ë ·ÎÚÈ‚‹˜ ˘fi‰ÂÈÍË Ù˘ ËÁ‹˜ fiÏˆÓ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û˘ÛÙ·ÙÈÎÒÓ, ÒÛÙÂ, ÁÈ· ·Ú¿‰ÂÈÁÌ·, fiÙ·Ó ¤Ó· Ê˘ÙÈÎfi ¤Ï·ÈÔ ÂÚȤ¯ÂÈ ÊÈÛÙÈΤϷÈÔ, ·˘Ùfi Ó· ‰È¢ÎÚÈÓ›˙ÂÙ·È ÛÙËÓ ÂÙÈΤٷ. ¶·ÚÔÌÔ›ˆ˜, Ë ËÁ‹ ÂÓfi˜ Ê˘ÛÈÎÔ‡ ·ÚÒÌ·ÙÔ˜, .¯. ¤Ó·˜ ÍËÚfi˜ ηÚfi˜, ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·›ÓÂÙ·È Û·ÊÒ˜ Î·È Ó· ÌËÓ ·Ó·Ê¤ÚÂÙ·È Ì ÁÂÓÈÎÔ‡˜ fiÚÔ˘˜ fiˆ˜ “Ê˘ÛÈÎfi ¿ÚˆÌ·” . ™ÙÔ ·Ú¿ÚÙËÌ· πππ· Ù˘ √‰ËÁ›·˜ 2003/89/ EC, ηıÔÚ›˙ÔÓÙ·È Â›Û˘ Ù· ‰Ò‰Âη ·ÏÏÂÚÁÈÔÁfiÓ· ÙÚfiÊÈÌ· Î·È Û˘ÛÙ·ÙÈο ÙÚÔÊ›ÌˆÓ Ô˘ Ú¤ÂÈ ··Ú·›ÙËÙ· Ó· ÂÈÛËÌ·›ÓÔÓÙ·È Î·È ÛÙ· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ Á¿Ï·, ÙÔ ·‚Áfi, Ù· ÛÈÙËÚ¿, ÔÈ ÍËÚÔ› ηÚÔ› Î·È ÙÔ „¿ÚÈ (11).
™‡Ìʈӷ Ì ÙËÓ √‰ËÁ›· ·˘Ù‹, ‰›‰ÂÙ·È Ë ‰˘Ó·ÙfiÙËÙ· ÌÈ·˜ ÌÂÙ·‚·ÙÈ΋˜ ÂÚÈfi‰Ô˘ ‰È¿ÚÎÂÈ·˜ ÂÓfi˜ ¤ÙÔ˘˜ ¤ˆ˜ ÙËÓ Ï‹ÚË ÂÊ·ÚÌÔÁ‹ Ù˘, ÒÛÙ ÔÈ ·Ú·Û΢·ÛÙ¤˜ ÙÚÔÊ›ÌˆÓ Ó· Ú·ÁÌ·ÙÔÔÈ‹ÛÔ˘Ó ÙȘ ··Ú·›ÙËÙ˜ ·ÏÏ·Á¤˜ ÛÙȘ ÂÙÈΤÙ˜ (11). ∆· ÚÔ˚fiÓÙ· Ô˘ ·Ú‹¯ıËÛ·Ó ÌÂÙ¿ ÙËÓ 25Ë ¡ÔÂÌ‚Ú›Ô˘ 2005 ‰ÂÓ ÂÈÙÚ¤ÂÙ·È Ó· ˆÏÔ‡ÓÙ·È ¯ˆÚ›˜ ÛˆÛÙ‹ ÂÈÛ‹Ì·ÓÛË, ÂÓÒ Ù· ÚÔ˚fiÓÙ· Ô˘ ›¯·Ó ‹‰Ë ·Ú·¯ı› ÚÈÓ ÙËÓ ·Ú·¿Óˆ ËÌÂÚÔÌËÓ›· ÌÔÚÔ‡Ó Ó· ˆÏÔ‡ÓÙ·È Ì¤¯ÚÈ Ù¤ÏÔ˘˜ ÙˆÓ ·ÔıÂÌ¿ÙˆÓ (11). ∆¤ÏÔ˜, Û‡Ìʈӷ Ì ÙËÓ Ô‰ËÁ›·, “ÙÔ Û˘ÛÙ·ÙÈÎfi ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·›ÓÂÙ·È ÛÙËÓ ÂÙÈΤٷ Ì ۷ʋ Î·È ·ÎÚÈ‚‹ ÙÚfiÔ Î·È Ë ÂÈÛ‹Ì·ÓÛË ‰ÂÓ Â›Ó·È ··Ú·›ÙËÙË fiÙ·Ó ÙÔ fiÓÔÌ· ÙÔ˘ ÚÔ˚fiÓÙÔ˜ ˘Ô‰ËÏÒÓÂÈ Û·ÊÒ˜ ÙËÓ ·ÚÔ˘Û›· ÂÓfi˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ Û˘ÛÙ·ÙÈÎÔ‡”. ¶·ÚfiÏ· ·˘Ù¿, Ë ‰‹ÏˆÛË ·˘Ù‹ ·Ê‹ÓÂÈ ÂÚÈıÒÚÈ· ·Û¿ÊÂÈ·˜, ·ÊÔ‡ ‰ÂÓ ÔÚ›˙ÂÈ ¤Ó· Û˘ÁÎÂÎÚÈ̤ÓÔ ÙÚfiÔ ÂÈÛ‹Ì·ÓÛ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘¿Ú¯Ô˘Ó ‰È·ÊÔÚ¤˜ ÛÙË ‰È·Ù‡ˆÛË Î·È ÛÙ· ۇ̂ÔÏ· ‹ ÙÔÓ ÙÚfiÔ Ô˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙȘ ÂÙÈΤÙ˜ Ù· ·ÏÏÂÚÁÈÔÁfiÓ·. ¢È·ÊÔÚÔÔÈ‹ÛÂȘ ÛÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ˘fi ÌÂϤÙË ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙ· ÂÈÏÂÁ̤ӷ ÚÔ˚fiÓÙ· √ ·Î·ıfiÚÈÛÙÔ˜ ÙÚfiÔ˜ ·Ó·ÁÚ·Ê‹˜ ÙˆÓ ÙÚÔÊ›ÌˆÓ ÛÙȘ ÂÙÈΤÙ˜ ·fi ÙË ÓÔÌÔıÂÛ›· ·Ê‹ÓÂÈ ÂÚÈıÒÚÈ· ·Û¿ÊÂÈ·˜ Î·È ÚÔ‚ÏËÌ¿ÙˆÓ. ™ÙÔÓ ¶›Ó·Î· 3, ·Ó·Ê¤ÚÔÓÙ·È fiÏÔÈ ÔÈ ÙÚfiÔÈ ·Ó·ÁÚ·Ê‹˜ ÙˆÓ ˘fi ÂͤٷÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ÚÔ˚fiÓÙ· Ô˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË. ™ÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛˆÓ, ÙÔ ÛÈÙ¿ÚÈ Î·È Ù· ·Ú¿ÁˆÁ¿ ÙÔ˘ ·Ó·Ê¤ÚÔÓÙ·Ó ˆ˜ “ÛÈÙ¿Ï¢ÚÔ” (89 ÊÔÚ¤˜), “·Ï‡ÚÈ Û›ÙÔ˘” (39 ÊÔÚ¤˜) ‹ ÛÈÙ¿ÚÈ (10 ÊÔÚ¤˜). ™˘ÓÔÏÈο, Ù· ÛÈÙËÚ¿ ‚Ú¤ıËÎ·Ó Î·Ù·ÁÂÁÚ·Ì̤ӷ Ì 45 ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜, fiˆ˜ “ÁÏÔ˘Ù¤ÓË” (8 ÊÔÚ¤˜), “‚‡ÓË” (12 ÊÔÚ¤˜), “Natural Oat Bran” (3 ÊÔÚ¤˜), “ÚÔ˙‡ÌÈ” (9 ÊÔÚ¤˜).
¶›Ó·Î·˜ 3. ∆ÚfiÔÈ ‰‹ÏˆÛ˘ ÎÔÈÓÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ˘fi ÌÂϤÙË ÚÔ˚fiÓÙ· Ù˘ ÂÏÏËÓÈ΋˜ ·ÁÔÚ¿˜, fiˆ˜ ·˘ÙÔ› ·Ó¢ڤıËÛ·Ó ÛÙȘ ÂÙÈΤÙ˜ ÂÈÛ‹Ì·ÓÛ˘ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ∫ÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· ÙÚfiÊÈÌ·
∆ÚfiÔ˜ ·Ó·ÁÚ·Ê‹˜ ÙÔ˘˜ ÛÙȘ ÂÙÈΤÙ˜ ÙˆÓ ˘fi ÌÂϤÙË ÙÚÔʛ̈Ó
™ÈÙ¿ÚÈ
ÛÈÙ¿ÚÈ, ·Ï‡ÚÈ Û›ÙÔ˘/ ÛÈÙ·ÚÈÔ‡, ÚˆÙ½Ó˜ Û›ÙÔ˘, ·Ï‡ÚÈ Û›Î·Ï˘, ‚‡ÓË, ¿Ì˘ÏÔ, ÚÔ˙‡ÌÈ
°¿Ï·
Á¿Ï·, ÔÚfi˜ Á¿Ï·ÎÙÔ˜, ÛÙÂÚ¿ Á¿Ï·ÎÙÔ˜, ÚÔ˚fiÓÙ· Á¿Ï·ÎÙÔ˜, ÚˆÙ½Ó˜ Á¿Ï·ÎÙÔ˜, ·Ê·Ï·ÙˆÌ¤ÓË ÛÎfiÓË Á¿Ï·ÎÙÔ˜, ˙·¯·ÚÔ‡¯Ô Á¿Ï·, ÁÈ·Ô‡ÚÙÈ, Ù˘Ú›, ÔÚfi˜ ÚˆÙ½Ó˘ Á¿Ï·ÎÙÔ˜, Ï·ÎÙfi˙Ë, ÏÈ·Ú¿ Á¿Ï·ÎÙÔ˜, ·Û‚¤ÛÙÈÔ, ‚Ô‡Ù˘ÚÔ/ ‚Ô‡Ù˘ÚÔ ·ÁÂÏ¿‰Ô˜/ ¿Ó˘‰ÚÔ ‚Ô‡Ù˘ÚÔ, Ù˘ÚfiÁ·Ï·, ‚¿ÊÏ·, Îڤ̷ Á¿Ï·ÎÙÔ˜, ÎÂÊ›Ú, ÛÂṲ́ÙÈ, ÚfiÛıÂÙÔ ˘„ËÏ‹˜ Û˘ÁΤÓÙÚˆÛ˘ ÚˆÙ½Ó˘, ˘ÙÈ¿, ·Ï‡ÚÈ ˘„ËÏ‹˜ Û˘ÁΤÓÙÚˆÛ˘ ÚˆÙ½Ó˘, ڷϛӷ, ηڷ̤Ϸ, η˙½ÓË, Ï·ÎÙÈÎfi Ô͇, Ï·ÎÙ·Ï‚Ô˘Ì›ÓË/ Ï·ÎÙÔÛÊ·ÈÚ›ÓË
∞‚Áfi
·‚Áfi, ·‚Áfi Û ÛÎfiÓË, ÚˆÙ½Ó˜ ·‚ÁÔ‡, ·Ï‚Ô˘Ì›ÓË, ÏÂÎÈı›ÓË, ·ÛÚ¿‰È
•ËÚÔ› ηÚÔ›
ÍËÚÔ› ηÚÔ›, ÊÔ˘ÓÙÔ‡ÎÈ·, ·Ì‡Á‰·Ï·, ÊÔ˘ÓÙÔ˘Îfi·ÛÙ·, ‚¿ÊÏ·, ηڇ‰È·, ¿ÚˆÌ· ÊÔ˘ÓÙÔ‡ÎÈ, ÔÏÙfi˜ ÍËÚÒÓ Î·ÚÒÓ
ºÈÛÙ›ÎÈ ·Ú¿ÈÎÔ
ÊÈÛÙ›ÎÈ ·Ú¿ÈÎÔ, ·Ú·¯›‰Â˜
™fiÁÈ·
ÏÂÎÈı›ÓË ÛfiÁÈ·˜, ÛfiÁÈ·, ÛÔÁÈ¿Ï¢ÚÔ, ·Ï‡ÚÈ ÛfiÁÈ·˜, ÏÂÎÈı›ÓË
Paediatriki 2008;71:475-481
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·479
479
∞ÍÈÔÏfiÁËÛË ÂÈÛ‹Ì·ÓÛ˘ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÏÏËÓÈο ÙÚfiÊÈÌ·
¶›Ó·Î·˜ 4. ∞Û·Ê‹˜ ÂÈÛ‹Ì·ÓÛË Û˘ÛÙ·ÙÈÎÒÓ ÙÚÔÊ›ÌˆÓ ¿ÁÓˆÛÙ˘ ÚÔ¤Ï¢Û˘
¶›Ó·Î·˜ 5. ∆ÚfiÔÈ ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘ ÛÙ· ˘fi ÌÂϤÙË ÙÚfiÊÈÌ·
™˘ÛÙ·ÙÈο ÙÚÔÊ›ÌˆÓ ¿ÁÓˆÛÙ˘ ÚÔ¤Ï¢Û˘ ÏfiÁˆ ÂÏÏÈÔ‡˜ ÂÈÛ‹Ì·ÓÛ˘
∆‡Ô˜ ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘
∞ÚÈıÌfi˜ ÚÔ˚fiÓÙˆÓ ÛÙ· ÔÔ›· ·Ó¢ڤıËÛ·Ó Ù· ÂÓ ÏfiÁˆ Û˘ÛÙ·ÙÈο
Õڈ̷/ ·ÚˆÌ·ÙÈΤ˜ ‡Ï˜ ª·ÁÈ¿/ Ì·ÁÈ¿ Óˆ‹ §ÂÎÈı›ÓË µÔ‡Ù˘ÚÔ µÔ‡Ù˘ÚÔ Û˘Ì˘Îӈ̤ÓÔ ºÒÛÊÔÚÔ˜ ∞Û‚¤ÛÙÈÔ ºˆÛÊÔÚÈÎfi ·Û‚¤ÛÙÈÔ µÔ‡Ù˘ÚÔ ˙·¯·ÚÔÏ·ÛÙÈ΋˜ º˘ÙÈÎfi/¿ ¤Ï·ÈÔ/· º˘ÙÈÎfi/¿ ÏÈ·Úfi/¿ º˘ÙÈÎfi ÏÈ·Úfi ˘‰ÚÔÁÔӈ̤ÓÔ/ÌÂÚÈÎÒ˜ À‰ÚÔÁÔӈ̤ÓÔ Ê˘ÙÈÎfi ¤Ï·ÈÔ ‹ ÏÈ·Ú‹ ‡ÏË
70 43 20 11 9 6 6 2 1 76 33 27 14
∆Ô Á¿Ï· Î·È Ù· ·Ú¿ÁˆÁ¿ ÙÔ˘ ·Ó·Ê¤ÚÔÓÙ·Ó Î˘Ú›ˆ˜ ˆ˜ “ÔÚfi˜ Á¿Ï·ÎÙÔ˜” ‹ ˆ˜ “Á¿Ï·”. ¶·ÚfiÏ· ·˘Ù¿, Ë ·ÚÔ˘Û›· ÙÔ˘ ‰ËÏÒıËΠ25 ÊÔÚ¤˜ Ì ÙÔÓ fiÚÔ Ï·ÎÙfi˙Ë. ™˘ÓÔÏÈο ηÙÂÁÚ¿ÊËÛ·Ó 29 ‰È·ÊÔÚÂÙÈÎÔ› fiÚÔÈ, οÔÈÔÈ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ·Ê‹ÓÔ˘Ó ÂÚÈıÒÚÈ· ·ÚÂÍËÁ‹ÛÂˆÓ Î·È ÌË ·Ó·ÁÓÒÚÈÛ˘ Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘, fiˆ˜ ÔÈ fiÚÔÈ Ï·ÎÙfi˙Ë, ·Û‚¤ÛÙÈÔ, ‚Ô‡Ù˘ÚÔ, ‚¿ÊÏ·, Îڤ̷ Á¿Ï·ÎÙÔ˜, ÎÂÊ›Ú, ÛÂṲ́ÙÈ, ÚfiÛıÂÙÔ ˘„ËÏ‹˜ Û˘ÁΤÓÙÚˆÛ˘ ÚˆÙ½Ó˘, ˘ÙÈ¿, ·Ï‡ÚÈ ˘„ËÏ‹˜ Û˘ÁΤÓÙÚˆÛ˘ ÚˆÙ½Ó˘, ڷϛӷ, ηڷ̤Ϸ, η˙½ÓË, Ï·ÎÙÈÎfi Ô͇, Ï·ÎÙ·Ï‚Ô˘Ì›ÓË/ Ï·ÎÙÔÛÊ·ÈÚ›ÓË. ∆Ô ·‚Áfi Î·È Ù· ·Ú¿ÁˆÁ¿ ÙÔ˘ ηٷÁÚ¿ÊËÎ·Ó Û˘ÓÔÏÈο Ì 6 ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜, Ì ÂÈÎÚ·Ù¤ÛÙÂÚÔ˘˜ ÙÔ˘˜ fiÚÔ˘˜ ·‚Áfi, ÛÎfiÓË ·‚ÁÔ‡, ÚˆÙ½Ó˜ ·‚ÁÔ‡, ·ÛÚ¿‰È, ·ÏÏ¿ Î·È ·Ï‚Ô˘Ì›ÓË Î·È ÏÂÎÈı›ÓË. ∆· ÊÈÛÙ›ÎÈ· ·Ó·Ê¤ÚÔÓÙ·Ó Ì ÙÔ˘˜ fiÚÔ˘˜ ÊÈÛÙ›ÎÈ· Î·È ·Ú·¯›‰Â˜. ∏ ÛfiÁÈ· ‰ËψÓfiÙ·Ó Ì ÙÔ˘˜ fiÚÔ˘˜ ÛfiÁÈ·, ÏÂÎÈı›ÓË ÛfiÁÈ·˜ (127 ÊÔÚ¤˜) Î·È ·Ï‡ÚÈ ÛfiÁÈ·˜/ÛÔÁÈ¿Ï¢ÚÔ (20 ÊÔÚ¤˜). ∆¤ÏÔ˜, ÔÈ Î·ÚÔ› ‰¤Ó‰ÚˆÓ ·Ó·Ê¤ÚÔÓÙ·Ó Î˘Ú›ˆ˜ Ì ÙÔÓ ÁÂÓÈÎfi fiÚÔ ÍËÚÔ› ηÚÔ› (93 ÊÔÚ¤˜) Î·È ÏÈÁfiÙÂÚÔ Ì ·Ó·ÊÔÚ¿ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ›‰Ô˘˜ ÙÔ˘ ÂÌÂÚȯfiÌÂÓÔ˘ ηÚÔ‡, fiˆ˜ ÊÔ˘ÓÙÔ‡ÎÈ (39 ÊÔÚ¤˜) Î·È ·Ì‡Á‰·Ï· (28 ÊÔÚ¤˜). ∂ӉȷʤÚÔ˘Û· ‰È·›ÛÙˆÛË ·ÔÙ¤ÏÂÛ ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙȘ ÂÙÈΤÙ˜ ÙˆÓ ÚÔ˚fiÓÙˆÓ Û˘¯Ó¿ ·Ó·Ê¤ÚÔÓÙ·Ó ÛÙ· Û˘ÛÙ·ÙÈο › ̤ÚÔ˘˜ Û‡ÓıÂÙ· ˘ÏÈο ¿ÁÓˆÛÙ˘ Û‡ÛÙ·Û˘, ¯ˆÚ›˜ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘ÛË (¶›Ó·Î·˜ 4), fiˆ˜: - “‚¿ÊÏ·” Û ¤Ó· ÚÔ˚fiÓ, Ù˘ ÔÔ›·˜ Ë Èı·Ó‹ Û‡ÛÙ·ÛË, fiˆ˜ ηٷÁÚ¿ÊËΠ۠¿ÏÏÔ ÚÔ˚fiÓ Ù˘ ›‰È·˜ ÂÙ·ÈÚ›·˜, ›ӷÈ: ·Ï‡ÚÈ Û›ÙÔ˘, ˙¿¯·ÚË, Á¿Ï· ¿·¯Ô, Ê˘ÙÈο ¤Ï·È·, Á·Ï·Îو̷ÙÔÔÈËÙ‹˜: ÏÂÎÈı›-
∫·Ì›· ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ∆Ô ÚÔ˚fiÓ ÌÔÚ› Ó· ÂÚȤ¯ÂÈ ›¯ÓË ·fi ¶Èı·ÓfiÓ Ó· ÂÚȤ¯ÂÈ ›¯ÓË/ ›¯ÓË ·fi ¶·Ú·Û΢¿˙ÂÙ·È/ ·Ú¿ÁÂÙ·È Û ÂÚÁÔÛÙ¿ÛÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈ› ∂Ó‰¤¯ÂÙ·È Ó· ÂÚȤ¯ÔÓÙ·È ›¯ÓË ·fi ∂Ӊ¯fiÌÂÓË ·ÚÔ˘Û›·
% ¯Ú‹ÛË Û˘ÁÎÂÎÚÈ̤Ó˘ ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘ ÛÙ· ˘fi ÌÂϤÙË ÚÔ˚fiÓÙ· 34,34% 49,98% 7,57% 6,06% 1,51% 0,50%
ÓË ÛfiÁÈ·˜ (∂322), ·Ï¿ÙÈ, ‚·ÓÈÏÏ›ÓË, ¿ÚˆÌ·, ‰È·ÎfiÛÌËÛË: ˙¿¯·ÚË, ÛÈÙ¿ÚÈ, Î·Î¿Ô Û ÛÎfiÓË, ÊÔÈÓÈΤϷÈÔ, Ì¿˙· Î·Î¿Ô - “Ì·ÁÈ¿/Ì·ÁÈ¿ Óˆ‹”, Ë ÔÔ›· Èı·ÓfiÓ Â›Ó·È Ì‡ÎËÙ·˜ ·ÓÂÙ˘Á̤ÓÔ˜ Û Á¿Ï·, ÂÓÒ ÌÔÚ› Ó· ÂÚȤ¯ÂÈ ›¯ÓË ÛÈÙËÚÒÓ (‚‡Ó˘) (13) - “‚Ô‡Ù˘ÚÔ/‚Ô‡Ù˘ÚÔ ˙·¯·ÚÔÏ·ÛÙÈ΋˜/‚Ô‡Ù˘ÚÔ Û˘Ì˘Îӈ̤ÓÔ”, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· Â›Ó·È ˙ˆÈ΋˜ ‹ Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È Ó· ÂÚȤ¯ÂÈ ÚˆÙ½Ó˜ Á¿Ï·ÎÙÔ˜ (14) - “ÏÂÎÈı›ÓË”, Ë ÔÔ›· ÌÔÚ› Ó· Â›Ó·È ÚˆÙ½ÓË ·‚ÁÔ‡ ‹ ÛfiÁÈ·˜ (9) - “·Û‚¤ÛÙÈÔ”, “ÊÒÛÊÔÚÔ˜”, “ʈÛÊÔÚÈÎfi ·Û‚¤ÛÙÈÔ”, Ô˘ Èı·ÓÒ˜ ÚÔ¤Ú¯ÔÓÙ·È ·fi Á¿Ï· (15) - “Ê˘ÙÈο ¤Ï·È·”, ÛÙ· ÔÔ›· ·Ó‹ÎÔ˘Ó ÙÔ ÂÏ·ÈfiÏ·‰Ô, ÙÔ ÛÔÁȤϷÈÔ, ÙÔ ËÏȤϷÈÔ, ÙÔ ÛË۷̤ϷÈÔ ‹ Î·È ¿ÏÏ· ¤Ï·È· ÍËÚÒÓ Î·ÚÒÓ, fiˆ˜ ÙÔ ÊÈÛÙÈΤϷÈÔ (1). ¶ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÙÚfiÊÈÌ· Ù˘ ÂÏÏËÓÈ΋˜ ·ÁÔÚ¿˜ ™ÙÔ 65% ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ˘‹Ú¯Â ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË Ù˘ ·ÚÔ˘Û›·˜ ·ÏÏÂÚÁÈÔÁfiÓˆÓ. ™¯Â‰fiÓ Û fiÏ· ·Ó·ÊÂÚfiÙ·Ó fiÙÈ ÂÚȤ¯Ô˘Ó ‹ ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó ÛÈÙËÚ¿ ‹ ÚÔ˚fiÓÙ· ÙÔ˘˜ (196), Á¿Ï· ‹ ÚÔ˚fiÓÙ· ÙÔ˘ (192) Î·È Î·ÚÔ‡˜ ‰¤Ó‰ÚˆÓ ‹ ÚÔ˚fiÓÙ· ÙÔ˘˜ (190). ¶ÂÚÈÛÛfiÙÂÚ· ·fi 2/3 ÂÚȤ¯Ô˘Ó ‹ ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó ÛfiÁÈ· ‹ ÚÔ˚fiÓÙ· Ù˘ (144) Î·È ÛÔ˘Û¿ÌÈ (126). ∆¤ÏÔ˜, ÂÚ›Ô˘ Ù· ÌÈÛ¿ ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó ·‚Á¿, ÂÓÒ 26 ÚÔ˚fiÓÙ· ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó ÊÈÛÙ›ÎÈ· ‹ ÚÔ˚fiÓÙ· ÙÔ˘˜. ∏ Èı·Ó‹ ·ÚÔ˘Û›· ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ÛÙ· ÚÔ˚fiÓÙ· ‰ËÏÒıËΠ̠¤ÓÙ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜ (¶›Ó·Î·˜ 5), Û˘¯ÓfiÙÂÚ· fï˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó Ë ÊÚ¿ÛË (49,89%) “ÙÔ ÚÔ˚fiÓ ÌÔÚ› Ó· ÂÚȤ¯ÂÈ ›¯ÓË/ ›¯ÓË ·fi”. ∫·Ù¿ ‰‹ÏˆÛË ÙˆÓ ·Ú·ÁˆÁÒÓ Ô˘ ÂÚˆÙ‹ıËÎ·Ó ÛÙ· Ï·›ÛÈ· Ù˘ ÌÂϤÙ˘, Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ·ÔÛÎÔÔ‡Ó ÛÙÔ Ó· ·Ú¤¯Ô˘Ó ÛÙÔÓ Î·Ù·Ó·ÏˆÙ‹ ÌÈ· ¶·È‰È·ÙÚÈ΋ 2008;71:475-481
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·480
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∞. µ·ÛÈÏÔÔ‡ÏÔ˘ Î·È Û˘Ó.
ÎÏÈ̷Έً ÂÈÎfiÓ· ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ (18). √È ·Ú·ÁˆÁÔ› ‰‹ÏˆÛ·Ó ›Û˘ fiÙÈ Ù· ÚÔ˚fiÓÙ· ¯ˆÚ›˜ ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ‹Ù·Ó ·Ï·ÈÔ‡ ·Ôı¤Ì·ÙÔ˜ Î·È fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ Ë ÂÈÛ‹Ì·ÓÛË ı· ÚÔÛÙÂı› ·ÎfiÌ· Î·È ÛÂ Û˘Û΢·Û›Â˜ ·fi ÙȘ Ôԛ˜ Ï›ÂÈ Â› ÙÔ˘ ·ÚfiÓÙÔ˜, ÁÂÁÔÓfi˜ Ô˘ ·˘Í¿ÓÂÈ ÙÔ ÚÔ·Ó·ÊÂÚı¤Ó ÔÛÔÛÙfi.
™˘˙‹ÙËÛË ™Ùfi¯Ô˜ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ÈÂÚ‡ÓËÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ·ÚÔ‡Û·˜ ÓÔÌÔıÂÛ›·˜ ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÈÏÂÁ̤ӷ ÚÔ˚fiÓÙ· Ù˘ ÂÏÏËÓÈ΋˜ ·ÁÔÚ¿˜. ¢È·ÈÛÙÒıËΠfiÙÈ, ·ÚfiÙÈ ¤¯Ô˘Ó ‹‰Ë ·Ú¤ÏıÂÈ ‰‡Ô ¤ÙË ·fi ÙËÓ ¤Ó·ÚÍË Ù˘ ÈÛ¯‡Ô˜ Ù˘, ‰ÂÓ ˘¿Ú¯ÂÈ ÂÓÈ·›Ô˜ ÙÚfiÔ˜ ηٷÁÚ·Ê‹˜ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ‰ËÌÈÔ˘ÚÁÂ›Ù·È Û‡Á¯˘ÛË ÁÈ· ÙË Û‡ÛÙ·ÛË ÙˆÓ ÚÔ˚fiÓÙˆÓ Û ηٷӷψ٤˜, ·ÎfiÌ· Î·È fiÙ·Ó ·˘ÙÔ› ·Ó‹ÎÔ˘Ó Û ÔÌ¿‰Â˜ ÂȉÈÎÒÓ ÂÈÛÙËÌfiÓˆÓ (ÁÈ·ÙÚÔ›, ‰È·ÈÙÔÏfiÁÔÈ). ∏ ÂÎÙÂٷ̤ÓË ¯Ú‹ÛË ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘ ·fi ÙȘ ÂÙ·Èڛ˜, ÂÍ·ÈÙ›·˜ Ù˘ ‰˘ÛÎÔÏ›·˜ Ó· ‰È·ÛÊ·Ï›ÛÔ˘Ó ¯ÒÚÔ˘˜ ·Ú·ÁˆÁ‹˜ ÂχıÂÚÔ˘˜ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Î·È ÂÔ̤ӈ˜ ÚÔ˚fiÓÙ· ··ÏÏ·Á̤ӷ ·fi ·ÏÏÂÚÁÈÔÁfiÓ·, ‰ËÌÈÔ˘ÚÁ› ÂÈϤÔÓ ÚÔ‚Ï‹Ì·Ù·. ∏ ÙÚ¤¯Ô˘Û· ÓÔÌÔıÂÛ›· ηıÔÚ›˙ÂÈ ÔÈ· ·ÏÏÂÚÁÈÔÁfiÓ· Û˘ÛÙ·ÙÈο Ú¤ÂÈ Ó· ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙËÓ ÂÙÈΤٷ ÙˆÓ ÙÚÔʛ̈Ó. ¶·ÚfiÏ· ·˘Ù¿, ˘¿Ú¯Ô˘Ó ¿ÙÔÌ· ·ÏÏÂÚÁÈο Û ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ‰ÂÓ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙË Ï›ÛÙ· ·˘Ù‹. ∂Ô̤ӈ˜, ÎÚ›ÓÂÙ·È ÛËÌ·ÓÙÈ΋ Ë Ù·ÎÙÈ΋ ·ÓÂͤٷÛË Î·È Ë ·Ó·Ó¤ˆÛ‹ Ù˘ Û‡Ìʈӷ Ì ٷ ÎÚÈÙ‹ÚÈ· Ù˘ ∂˘Úˆ·˚΋˜ ∞Ú¯‹˜ ∞ÛÊ¿ÏÂÈ·˜ ∆ÚÔÊ›ÌˆÓ (5). ∞ӷʤÚÂÙ·È Â›Û˘ fiÙÈ Ù· ·ÏÏÂÚÁÈÔÁfiÓ· Ú¤ÂÈ Ó· ÂÈÛËÌ·›ÓÔÓÙ·È Ì fiÚÔ˘˜ ·ÏÔ‡˜ Î·È Î·Ù·ÓÔËÙÔ‡˜, ¯ˆÚ›˜ fï˜ ·˘ÙÔ› Ó· ηıÔÚ›˙ÔÓÙ·È Û˘ÁÎÂÎÚÈ̤ӷ. ¢È·ÈÛÙÒÛ·Ì fiÙÈ Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È fiÚÔÈ Ù¯ÓÈÎÔ› Î·È ÂÈÛÙËÌÔÓÈÎÔ› Ô˘ Â›Ó·È ·Û·Ê›˜, fiˆ˜ “ÁÏÔ˘Ù¤ÓË” Î·È “¡atural Oat Bran” ÁÈ· Ù· ÛÈÙËÚ¿, “Ï·ÎÙfi˙Ë”, “η˙½ÓË” Î·È “Ï·ÎÙ·Ï‚Ô˘Ì›ÓË” ÁÈ· ÙÔ Á¿Ï·, “·Ú·¯›‰Â˜” ÁÈ· Ù· ÊÈÛÙ›ÎÈ· Î·È “ÏÂÎÈı›ÓË” ÁÈ· ÙÔ ·‚Áfi Î·È ÙË ÛfiÁÈ·. ∂ÈϤÔÓ, ÂÓÒ ıˆÚÂ›Ù·È ˘Ô¯ÚˆÙÈ΋ Ë ·Ó·ÁÚ·Ê‹ Ù˘ ËÁ‹˜ ÚÔ¤Ï¢Û˘ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ (11), Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÂÓÈÎÔ› fiÚÔÈ fiˆ˜ “¿ÚˆÌ·/·ÚˆÌ·ÙÈΤ˜ ‡Ï˜”, “Ê˘ÙÈÎfi ¤Ï·ÈÔ”, “·Û‚¤ÛÙÈÔ”, “ÏÂÎÈı›ÓË”, “‚Ô‡Ù˘ÚÔ” Î·È “ÍËÚÔ› ηÚÔ›”. √ ÙÚfiÔ˜ Ô˘ Ô ·ÏÏÂÚÁÈÎfi˜ ηٷӷψً˜ ı· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙËÓ ·Û¿ÊÂÈ· ÛÙËÓ ÂÈÛ‹Ì·ÓÛË ‰È·ÊÔÚÔÔÈÂ›Ù·È Î·Ù¿ ÂÚ›ÙˆÛË, fiˆ˜ ¤¯ÂÈ Ê·Ó› Î·È ·fi ¿ÏϘ ÌÂϤÙ˜ (16-19). ¢‡Ó·Ù·È Ó· ÂÚÈÔÚ›ÛÂÈ ÛËÌ·ÓÙÈο ÙȘ ÂÈÏÔÁ¤˜ ÙÚÔʛ̈Ó, ηıÒ˜, ÁÈ· ·Ú¿‰ÂÈÁÌ·, ¤Ó· ¿ÙÔÌÔ Ì ·ÏÏÂÚÁ›· ÛÙÔ ·Ì‡Á‰·ÏÔ ÌfiÓÔ ·Ó·Áο˙ÂÙ·È Ó· ·ÔÎÏ›ÛÂÈ fiÏ· Ù· ÚÔ˚fiÓÙ· Ì ÙË ÁÂÓÈ΋ ÂÈÛ‹Ì·ÓÛË “ÍËÚÔ› ηÚÔ›”, ÂÓÒ ¤Ó· ¿ÙÔPaediatriki 2008;71:475-481
ÌÔ Ì ·ÏÏÂÚÁ›· ÛÙÔ ·‚Áfi ·ÔÎÏ›ÂÈ ¤Ó· ÚÔ˚fiÓ Ì ÂÈÛ‹Ì·ÓÛË ÁÈ· ÏÂÎÈı›ÓË, Ù˘ ÔÔ›·˜ Ë ÚԤϢÛË ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È Ë ÛfiÁÈ· (16). √ ·˘ÛÙËÚfi˜ ·ÔÎÏÂÈÛÌfi˜ ÙÚÔÊÒÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÛËÌ·ÓÙÈΤ˜ ‰È·ÙÚÔÊÈΤ˜ ·Ó¿ÚÎÂȘ Î·È ·ÓÈÛÔÚÚԛ˜ ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ (17). ∞fi ÙËÓ ¿ÏÏË, Ô Î·Ù·Ó·ÏˆÙ‹˜, ¤¯ÔÓÙ·˜ ÂÚÈÔÚÈṲ̂Ó˜ ÂÈÏÔÁ¤˜ ÙÚÔʛ̈Ó, ‰‡Ó·Ù·È Ó· ·ÁÓÔ‹ÛÂÈ ÙËÓ ÂÈÛ‹Ì·ÓÛË, ı¤ÙÔÓÙ·˜ Û ΛӉ˘ÓÔ ÙË ˙ˆ‹ ÙÔ˘, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÌÈ· ·ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË ÌÔÚ› Ó· ÚÔÎÏËı› ·ÎfiÌ· Î·È Ì ›¯ÓË ÙÔ˘ ˘Â‡ı˘ÓÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ (16). ∂‰Ò ·Í›˙ÂÈ Ó· ·Ó·ÊÂÚıԇ̠ÛÙÔÓ ‰È·ÊÔÚÂÙÈÎfi “ηÙÒÊÏÈÔ Ô˘‰fi” ·ÓÙ›‰Ú·Û˘ ·ÙfiÌˆÓ ·ÏÏÂÚÁÈÎÒÓ ÛÙÔ ›‰ÈÔ ÙÚfiÊÈÌÔ, Ô˘ οÓÂÈ ÂÈÙ·ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË, fi¯È ÌfiÓÔ ÏÂÙÔÌÂÚÔ‡˜ ÂÈÛ‹Ì·ÓÛ˘, ·ÏÏ¿ Î·È ÔÛÔÙÈÎÔÔ›ËÛ˘ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ (19). ∂ÈÚfiÛıÂÙË ·Û¿ÊÂÈ· ÚÔ·ÙÂÈ ·fi ÙËÓ ÂÎÙÂٷ̤ÓË ¯Ú‹ÛË ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘ ÂÍ·ÈÙ›·˜ ÂӉ¯fiÌÂÓ˘ ÚfiÛÌÈ͢ Ì ·ÏÏÂÚÁÈÔÁfiÓ· ηٿ ÙË ‰È¿ÚÎÂÈ· ·Ú·ÁˆÁ‹˜ ÙˆÓ ÙÚÔʛ̈Ó. ∞˘Ù‹ ÔÊ›ÏÂÙ·È ÛÙË ¯Ú‹ÛË ÎÔÈÓ‹˜ ·Ú·ÁˆÁÈ΋˜ ÁÚ·ÌÌ‹˜ ‹ ·Ú·ÁˆÁ‹˜ ÛÙÔÓ ›‰ÈÔ ¯ÒÚÔ ÙÚÔÊ›ÌˆÓ ‰È·ÊÔÚÂÙÈ΋˜ Û‡ÛÙ·Û˘ Ô˘ ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó οÔÈÔ ·ÏÏÂÚÁÈÔÁfiÓÔ. √È ÂÚÈÛÛfiÙÂÚ˜ ‚ÈÔÌ˯·Ó›Â˜, ÌË ‰È·ı¤ÙÔÓÙ·˜ Ù· ηٿÏÏËÏ· Û˘ÛÙ‹Ì·Ù· ÂϤÁ¯Ô˘ Î·È Úfi‚Ï„˘ ÙˆÓ Î·ÙÒÙ·ÙˆÓ ÔÚ›ˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÈηÓÒÓ Ó· ÚÔηϤÛÔ˘Ó ·ÓÙ›‰Ú·ÛË Î·È ÂÌÊ·Ó›˙ÔÓÙ·˜ ¤ÏÏÂÈ„Ë Û‡Á¯ÚÔÓˆÓ Ì˯·ÓËÌ¿ÙˆÓ ÂϤÁ¯Ô˘ Î·È ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ È¯ÓÒÓ/˘ÔÏÂÈÌÌ¿ÙˆÓ ÚˆÙÂ˚ÓÒÓ, ‰˘ÛÎÔχÔÓÙ·È Ó· ‰ËÏÒÛÔ˘Ó Û·ÊÒ˜ ÙË Û‡ÛÙ·ÛË ÙˆÓ ÚÔ˚fiÓÙˆÓ ÙÔ˘˜ (20). ∏ ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ Ù˘¯·›·, ·ÎÔ‡ÛÈ· ·˘Ù‹ ·ÚÔ˘Û›· ·‰‹ÏˆÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ÙÚfiÊÈÌ· (1). ∂ÈϤÔÓ, ‰ÂÓ ˘Ê›ÛÙ·Ù·È Û˘ÁÎÂÎÚÈ̤ÓË ÓÔÌÈ΋ ··›ÙËÛË Î·È Ô‰ËÁ›· ÁÈ· ÙÔÓ ÙÚfiÔ Î·È ÙÔÓ ‚·ıÌfi ¯Ú‹Û˘ Ù˘ Î·È ·˘Ùfi ¤¯ÂÈ ‰ËÌÈÔ˘ÚÁ‹ÛÂÈ ÚÔ‚Ï‹Ì·Ù· ‰ÈÂıÓÒ˜ (1,11,18). Œ¯ÔÓÙ·˜ ˆ˜ ‰Â‰Ô̤ÓË ÙËÓ ÂÏÏÈ‹ ÏËÚÔÊfiÚËÛË ÙÔ˘ ηٷӷψً ÁÈ· ÙȘ ÂÁηٷÛÙ¿ÛÂȘ ·Ú·ÁˆÁ‹˜ Î·È ÙȘ Ù¯ÓÈΤ˜ ‰È·¯ˆÚÈÛÌÔ‡ Î·È Î·ı·ÚÈÛÌÔ‡, Â›Ó·È ·Ó·Áη›· Ë Û·Ê‹˜ Î·È Ì ̤ÙÚÔ ¯Ú‹ÛË Ù˘ ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘, ÒÛÙÂ Ô Î·Ù·Ó·ÏˆÙ‹˜ Ó· ÌÔÚ› Ó· ÙËÓ ·ÍÈÔÏÔÁ› ÛˆÛÙ¿ (1) Î·È Ó· ÌËÓ Ô‰ËÁÂ›Ù·È Û ·ÎÚ·›Ô˘˜ ‰È·ÙÚÔÊÈÎÔ‡˜ ·ÔÎÏÂÈÛÌÔ‡˜ ‹ Û ·‰È·ÊÔÚ›· ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË Î·È Û Èı·Ófi ΛӉ˘ÓÔ ÁÈ· ÙË ˙ˆ‹ ÙÔ˘. ¶¤Ú·Ó fiÏˆÓ ÙˆÓ ¿ÏψÓ, ÎÚ›ÓÔÓÙ·È ·Ó·Áη›Â˜ Î·È ‚ÂÏÙÈÒÛÂȘ ÛÙȘ ÂÙÈΤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙÔ Ì¤ÁÂıÔ˜ Ù˘ ÁÚ·ÌÌ·ÙÔÛÂÈÚ¿˜ Î·È ÛÙÔ ¯ÚÒÌ· ÂÁÁÚ·Ê‹˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ÙÔ ¯ÚÒÌ· ÙÔ˘ ˘Ô‚¿ıÚÔ˘ (18). ™Ù· ÚÔ˚fiÓÙ· Ù˘ ÌÂϤÙ˘, Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈ‹ıËΠÌÂÁÂı˘ÓÙÈÎfi˜ Ê·Îfi˜ ÁÈ· Ó· ‰È·‚·ÛÙÔ‡Ó ÔÈ ÂÙÈΤÙ˜ Î·È Î¿ÔȘ ÊÔÚ¤˜ Ô Û˘Ó‰˘·ÛÌfi˜ ÙˆÓ ¯ÚˆÌ¿ÙˆÓ ¤Î·Ó ·‰‡Ó·ÙË ÙËÓ ·Ó¿ÁÓˆÛ‹ ÙÔ˘˜. ∂Ӊ‰ÂÈÁ̤ӷ, ¤¯ÂÈ ÚÔÙ·ı› Ù· ·ÏÏÂÚÁÈÔÁfiÓ·
Pediatri Nov-Dec 08 new
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∞ÍÈÔÏfiÁËÛË ÂÈÛ‹Ì·ÓÛ˘ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÏÏËÓÈο ÙÚfiÊÈÌ·
Ó· ηٷÁÚ¿ÊÔÓÙ·È ¯ˆÚÈÛÙ¿, ÌÂÙ¿ ÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ Î·È ÛÙÔ Ù¤ÏÔ˜ Ó· ·Ó·Ê¤ÚÂÙ·È Ë ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË. π‰·ÓÈ΋ ¿ÓÙˆ˜ ı· ‹Ù·Ó Ë ¯Ú‹ÛË Îˆ‰ÈÎÔÔÈËÌ¤ÓˆÓ ¯ÚˆÌ¿ÙˆÓ ‹ Û˘Ì‚fiÏˆÓ Ô˘ Ó· ‰ËÏÒÓÔ˘Ó ÙËÓ ·ÚÔ˘Û›· Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ·ÏÏÂÚÁÈÔÁfiÓÔ˘ (1). ¢˘ÛÙ˘¯Ò˜, ÛÙËÓ ·ÚÔ‡Û· ÌÂϤÙË ‰ÂÓ Î·Ù·Ê¤Ú·Ì ӷ Û˘ÏϤÍÔ˘Ì ÏËÚÔÊÔڛ˜ ÁÈ· fiÏ· Ù· ÚÔ˚fiÓÙ· ÙˆÓ ÂÈÏÂÁÌ¤ÓˆÓ Î·ÙËÁÔÚÈÒÓ. ∫·È ·˘Ùfi ÁÈ·Ù› ÔÈ ÂÙ·Èڛ˜ ·‰˘Ó·ÙÔ‡Û·Ó Ó· Ì·˜ ·Ú¿Û¯Ô˘Ó ‰Â›ÁÌ·Ù· ÙˆÓ Û˘Û΢·ÛÈÒÓ ÙÔ˘˜, ÔfiÙÂ Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ¤ÁÈÓ ·Â˘ı›·˜ ·fi Ù· Ú¿ÊÈ· ÙˆÓ Î·Ù·ÛÙËÌ¿ÙˆÓ ÙÚÔʛ̈Ó. ∞Ó·fiÊ¢ÎÙ· ·ÓÙÈÌÂÙˆ›Û·Ì ʷÈÓfiÌÂÓ· ÚÔηٿÏ˄˘ Î·È Î·¯˘Ô„›·˜ ·fi ÙÔ˘˜ ηٷÛÙË̷ٿگ˜ ηٿ ÙËÓ Î·Ù·ÁÚ·Ê‹. ∂›Û˘, ‰ÂÓ ¤ÁÈÓ ·Ô‰ÂÎÙfi ÙÔ ·›ÙËÌ· ÁÈ· ›ÛÎÂ„Ë ÛÙÔÓ ¯ÒÚÔ ·Ú·ÁˆÁ‹˜ ÙˆÓ ‚ÈÔÌ˯·ÓÈÒÓ ÙÚÔÊ›ÌˆÓ Î·È ÔÈ ·Ú·ÁˆÁÔ› Ê¿ÓËÎ·Ó È‰È·›ÙÂÚ· ÂÈÊ˘Ï·ÎÙÈÎÔ› Û οı ›‰Ô˘˜ ¤Ú¢ӷ. ŒÙÛÈ, ¯¿Û·Ì ÙËÓ Â˘Î·ÈÚ›· ÁÈ· ÏËÚ¤ÛÙÂÚË Î·È Û·Ê‹ ÂÈÙfiÈ· ·ÍÈÔÏfiÁËÛË Èı·ÓÒÓ ÚÔÛÌ›ÍÂˆÓ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹. ™˘ÌÂÚ·ÛÌ·ÙÈο, ÛÙ· Ï·›ÛÈ· Ù˘ ÌÂϤÙ˘ ·˘Ù‹˜ ‰È·ÈÛÙÒÛ·Ì fiÙÈ, ·Ú¿ ÙȘ ÓÔÌÔıÂÙÈΤ˜ Ú˘ıÌ›ÛÂȘ, ··ÈÙÔ‡ÓÙ·È ÂÚ·ÈÙ¤Úˆ ÚÔÛ¿ıÂȘ ÙfiÛÔ ÁÈ· ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÚÔÙÂÈÓfiÌÂÓˆÓ Ì¤ÙÚˆÓ fiÛÔ Î·È ÁÈ· οÔȘ ·ÏÏ·Á¤˜ ÛÙÔÓ ÙÚfiÔ ÂÈÛ‹Ì·ÓÛ˘ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙËÓ ÂÙÈΤٷ ÙˆÓ ÙÚÔʛ̈Ó, ÒÛÙ ӷ ‰È·ÛÊ·Ï›˙ÂÙ·È Ë Ì¤ÁÈÛÙË ÂÓË̤ڈÛË Î·È ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜ ÙˆÓ ·ÏÏÂÚÁÈÎÒÓ Î·Ù·Ó·ÏˆÙÒÓ.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Van Hengel AJ. Declaration of allergens on the label of food products purchased on the European market. Trends in Food Science and Technology 2007;18:96-100. 2. Bock SA, Mun~oz-Furlong A, Sampson HA. Fatalities due to anaphylactic reactions to foods. J Allergy Clin Immunol 2001;107:191-193. 3. Food Standards Australia New Zealand [Webpage, Internet]. Australia New Zealand Food Standards Code; 2002: http://www.foodstandards.gov.au/thecode/ 4. US Food and Drug Administration, Center for Food Safety and Applied Nutrition [Webpage, Internet]. Food Allergen Labelling and Consumer Protection Act of 2004; 2004: http://www.cfsan.fda.gov/~dms/alrgact.html 5. Boden M, Dadswell R, Hattersley S. Review of statutory and voluntary labelling of food allergens. Proc Nutr Soc 2005;64:475-480. 6. Gateway to the European Union [Webpage, Internet]. http://europa.eu/ 7. Niggemann B, Beyer K. Diagnosis of food allergy in children: toward a standardization of food challenge. J Pediatr Gastroenterol Nutr 2007;45:399-404.
8. Food standards Agency [Webpage, Internet]. http://www. food.gov.uk/ 9. Official Journal of the European Communities [Webpage, Internet]. Regulation (EC) No 178/2002/EC of the European Parliament and of the Council of 28 January 2002, laying down the general principles and requirements of food law, establishing the European Food Safety Authority and laying down procedures in matters of food safety; 2002: http://eur-lex.europa.eu/pri/en/oj/ dat/2002/l_031/l_03120020201en00010024.pdf 10. Official Journal of the European Union [Webpage, Internet]. Commission communication in the framework of the implementation of the directive 2001/95/EC of the European Parliament and of the Council of 3 December 2001 on general product safety; 2001: http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:C:2006: 171:0023:0026:EN:PDF 11. Official Journal of the European Union [Webpage, Internet]. Directive 2003/89/EC of the European Parliament and of the Council of 10 November 2003 amending Directive 2000/13/EC as regards indication of the ingredients present in foodstuffs; 2003: http://eurlex.europa.eu/LexUriServ/LexUriServ.do?uri=OJ:L:2003: 308:0015:0018:EN:PDF. 12. Official Journal of the European Communities [Webpage, Internet]. Directive 2000/13/EC of the European Parliament and of the Council of 20 March 2000 on the approximation of the laws of the Member States relating to the labelling, presentation and advertising of foodstuffs; 2000: http://eur-lex.europa.eu/LexUriServ/LexUriServ. do?uri=OJ:L:2000:109:0029:0042:EN:PDF 13. Canadian Food Inspection Agency [Webpage, Internet]. Yeast production and use in food industry. http://www. inspection.gc.ca/ 14. University of Guelph, Canada [Webpage, Internet]. Butter manufacture - Overview of the butter making process; http://www.foodsci.uoguelph.ca/dairyedu/butter. html 15. Eastridge ML. Major advances in applied dairy cattle nutrition. J Dairy Sci 2006;89:1311-23. 16. UK Food Standards Agency [Webpage, Internet]. Nut Allergy Labelling - Report of Research into the Consumer Response; 2002: http://www.foodstandards.gov.uk/ multimedia/pdfs/nutallergyresearch.pdf 17. Laitinen K, Isolauri E. Allergic infants: growth and implications while on exclusion diets. Nestle Nutr Workshop Ser Pediatr Program 2007;60:157-167; discussion 167-169. 18. Mills EN, Valovirta E, Madsen C, Taylor SL, Vieths S, Anklam E, et al. Information provision for allergic consumers - where are we going with food allergen labelling? Allergy 2004;59:1262-1268. 19. Said M, Weiner JM. “May contain traces of...”: hidden food allergens in Australia. Med J Aust 2004;181:183-184. 20. Crevel R. Industrial dimensions of food allergy. Proc Nutr Soc 2005;64:470-474.
¶·È‰È·ÙÚÈ΋ 2008;71:475-481
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™ÙÔÌ·ÙÈΤ˜ ¤ÍÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜: Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: °ÂÒÚÁÈÔ˜ ∆ÛfiÏ·˜ geotsol@otenet.gr µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
°. ∆ÛfiÏ·˜ ¶ÂÚ›ÏË„Ë: √ÚÈṲ̂Ó˜ ÛÙÔÌ·ÙÈΤ˜ Û˘Ó‹ıÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜, ȉȷ›ÙÂÚ· Ì ÔÚıÔ‰ÔÓÙÈΤ˜ ·ÓˆÌ·Ï›Â˜. √ ıËÏ·ÛÌfi˜ ‰·ÎÙ‡ÏÔ˘, Û˘ÓËı¤ÛÙÂÚ· ÙÔ˘ ·ÓÙ›¯ÂÈÚ·, ‹ țϷ˜, Ô˘ Û˘¯Ó¿ ·Ú¯›˙Ô˘Ó ÓˆÚ›˜ ÛÙË ‚ÚÂÊÈ΋ ËÏÈΛ·, Û˘Ì‚¿ÏÏÔ˘Ó ÛÙËÓ ËÚÂÌ›· ÙÔ˘ ‚Ú¤ÊÔ˘˜, ÂÓÒ ˘¿Ú¯Ô˘Ó ÂӉ›ÍÂȘ fiÙÈ Ë È›Ï· ÚÔÛٷهÂÈ ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ‚ÚÂÊÈÎÔ‡ ı·Ó¿ÙÔ˘. ¶ÚÔ‚Ï‹Ì·Ù· ·Ó·Î‡ÙÔ˘Ó fiÙ·Ó ÔÈ ¤ÍÂȘ ·˘Ù¤˜ ·Ú·Ù›ÓÔÓÙ·È Î·È È‰È·›ÙÂÚ· ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 6 ¤ˆ˜ 8 ¯ÚfiÓˆÓ, ÔfiÙ ·Ú·ÙËÚÔ‡ÓÙ·È Î·È Ù· ϤÔÓ ÛÔ‚·Ú¿ ÚÔ‚Ï‹Ì·Ù· ·fi ÙÔ ÛÙÔÌ·ÙÔÁÓ·ıÈÎfi Û‡ÛÙËÌ·. ∂Âȉ‹, fï˜, ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÔÈ Û˘Ó‹ıÂȘ ·˘Ù¤˜ ‰È·ÎfiÙÔÓÙ·È ¤ÁηÈÚ· ·fi Ù· ›‰È· Ù· ·È‰È¿, ı· Ú¤ÂÈ Ó· ηıËÛ˘¯¿˙ÔÓÙ·È ÔÈ ÁÔÓ›˜ Î·È Ó· ÙÔ˘˜ ÙÔÓ›˙ÂÙ·È fiÙÈ Ë ¿ÛÎËÛË ›ÂÛ˘ ÛÙÔ ·È‰› ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰È·Îfi„ÂÈ ÙË Û˘Ó‹ıÂÈ·, fi¯È ÌfiÓÔ ‰ÂÓ ˆÊÂÏ›, ·ÏÏ¿ ÂÓ›ÔÙ ÂÓ‰¤¯ÂÙ·È Î·È Ó· ‚Ï¿„ÂÈ.
§¤ÍÂȘ ÎÏÂȉȿ: ¶È›Ï·, ‰¿ÎÙ˘ÏÔ, ·ÓÙ›¯ÂÈÚ·˜, ÔÚıÔ‰ÔÓÙÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÛÙÔÌ·ÙÈΤ˜ ¤ÍÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜.
Non-nutritive sucking habits: their influence on children’s health 2nd Department of Paediatrics, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece Correspondence: Georgios Tsolas geotsol@otenet.gr 2nd Department of Paediatrics, University of Athens, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
G. Tsolas Abstract: Certain oral habits in infants have been linked to medical conditions or adverse outcomes, especially related to orofacial structures. Most children suck their thumbs, fingers, or a pacifier at some time in their early life. These habits are very common and have a soothing and calming effect. There is also evidence that pacifiers may help reduce the risk of sudden infant death syndrome (SIDS). The only time sucking habits might be a concern is if they continue beyond the age of 6 to 8 years or affect the shape of the child’s mouth or teeth pattern. The good news is that most children stop their sucking habits before they get very far in school. This means that parents may be assured that their child will eventually stop the habit on his/her own, and they should know that putting too much pressure on their child to stop the habit may cause more harm than good.
Key words: Pacifiers, thumbs, fingers, dental effects of sucking behaviours, non-nutritive sucking habits.
∂ÈÛ·ÁˆÁ‹ £ËÏ·ÛÙÈΤ˜ ÎÈÓ‹ÛÂȘ Ô˘ ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙË Ï‹„Ë ÙÚÔÊ‹˜ ·Ú·ÙËÚÔ‡ÓÙ·È ‹‰Ë ·fi ÙËÓ ÂÓ‰ÔÌ‹ÙÚÈ· ˙ˆ‹ ÙÔ˘ ·ÓıÚÒÔ˘. √È ÎÈÓ‹ÛÂȘ ·˘Ù¤˜ Â›Ó·È Â‡ÎÔϘ ÛÙËÓ ÂÎÙ¤ÏÂÛ‹ ÙÔ˘˜, Û˘Ó¯›˙ÔÓÙ·È ÁÈ· ÌÂÁ¿ÏÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· ÌÂÙ¿ ÙË Á¤ÓÓËÛË Î·È ‰ÂÓ ÂÍ·ÚÙÒÓÙ·È ·fi ÙËÓ Â›Ó· Î·È ÙËÓ ¤ÓÙ·Û‹ Ù˘. ¶Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ·ÓÙÈÛÙÔÈ¯Ô‡Ó Û ‰Ú·ÛÙËÚÈfiÙËÙ· Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÈ ÙÔÓ ·ÓÒÚÈÌÔ ÂÁΤʷÏÔ Î·È ÚÔ¿ÁÂÈ ÙËÓ ÈηÓfiÙËÙ· ÙÔ˘ ıËÏ·ÛÌÔ‡. √È Ï¤ÔÓ Û˘Ó‹ıÂȘ ÛÙÔÌ·ÙÈΤ˜ Û˘Ó‹ıÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜ Â›Ó·È Ô ıËÏ·ÛÌfi˜ ‰·ÎÙ‡ÏÔ˘, ηٿ ηÓfiÓ· ÙÔ˘ ·ÓÙ›¯ÂÈÚ·, Î·È Ô ıËÏ·ÛÌfi˜ țϷ˜, ÂÓÒ Û·ÓÈfiÙÂÚ· ·Ó·Ê¤ÚÔÓÙ·È ıËÏ·ÛÌfi˜ ·È¯ÓȉÈÒÓ, ÙÌ‹Ì·ÙÔ˜ ÎÔ˘‚¤ÚÙ·˜ Î.Ï. ∏ Û˘¯ÓfiÙËÙ¿ ÙÔ˘˜ ÌÂÙ·‚¿ÏÏÂÙ·È Ì ÙËÓ ÚfiÔ‰Ô Ù˘ ËÏÈΛ·˜, Ì ÙË ¯Ú‹ÛË È›Ï·˜ Ó· Â›Ó·È Û˘¯ÓfiÙÂÚË ÛÙȘ ÌÈÎÚfiÙÂÚ˜ ËÏÈ˘, ÂÓÒ ÌÂÙ¿ ÙÔÓ ÙÚ›ÙÔ Paediatriki 2008;71:482-485
¯ÚfiÓÔ ˙ˆ‹˜ ·˘Í¿ÓÂÙ·È Ë Û¯ÂÙÈ΋ Û˘¯ÓfiÙËÙ· ÙÔ˘ ıËÏ·ÛÌÔ‡ ‰·ÎÙ‡ÏÔ˘. √È ÛÙÔÌ·ÙÈΤ˜ ·˘Ù¤˜ ¤ÍÂȘ, ÔÈ Ôԛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ 70-90% ÙˆÓ ‚ÚÂÊÒÓ, ıˆÚÔ‡ÓÙ·È ˆ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ·È‰È¿ ‚ÚÂÊÈ΋˜ ‹ ÓËȷ΋˜ ËÏÈΛ·˜, ηıÒ˜ ÚÔÛʤÚÔ˘Ó Û ·˘Ù¿ ·›ÛıËÌ· ·ÛÊ¿ÏÂÈ·˜ Î·È ËÚÂÌ›· (1). ∏ ·Ú¿Ù·Û‹ ÙÔ˘˜ ¤Ú·Ó Ù˘ ËÏÈΛ·˜ ÙˆÓ 4-5 ÂÙÒÓ ıˆÚÂ›Ù·È fiÙÈ ÂÓ‰¤¯ÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ Û ÚÔ‚Ï‹Ì·Ù· Î·È È‰È·›ÙÂÚ· Û ÔÚıÔ‰ÔÓÙÈΤ˜ ·ÓˆÌ·Ï›Â˜. √È ¤Ú¢Ó˜ Ô˘ ·ÊÔÚÔ‡Ó ÛÙËÓ ÂȉËÌÈÔÏÔÁ›· ÙˆÓ Û˘ÓËıÂÈÒÓ ·˘ÙÒÓ ¤¯Ô˘Ó ‰Â›ÍÂÈ fiÙÈ ÙÔ ÌÂÁ·Ï‡ÙÂÚÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ÙȘ ¤¯Ô˘Ó ÂΉËÏÒÛÂÈ ÛÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ˘˜ ÙȘ ‰È·ÎfiÙÔ˘Ó Î·Ù¿ ηÓfiÓ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 2-4 ÂÙÒÓ. À¿Ú¯ÂÈ, ˆÛÙfiÛÔ, ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·È‰ÈÒÓ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ Ù· ÔÔ›· ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ÙȘ ·ÚÔ˘ÛÈ¿˙Ô˘Ó, Û·Ó›ˆ˜ ¤ˆ˜ Î·È ÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ (2).
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™ÙÔÌ·ÙÈΤ˜ ¤ÍÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜
¶›Ó·Î·˜ 1. ¶·Ú¿ÁÔÓÙ˜ Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ÚfiÎÏËÛË ·ÓˆÌ·ÏÈÒÓ ÛÙË Û‡ÁÎÏÂÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ 1. ∏ ÛÎÂÏÂÙÈ΋ ÌÔÚÊÔÏÔÁ›· Î·È ÁÂÓÈο Ë ÚԉȿıÂÛË ÙÔ˘ ·ÙfiÌÔ˘ 2. ∏ ¤ÓÙ·ÛË Ì ÙËÓ ÔÔ›· Á›ÓÂÙ·È Ô ıËÏ·ÛÌfi˜ 3. ∏ ËÌÂÚ‹ÛÈ· ‰È¿ÚÎÂÈ· Î·È Ô ÙÚfiÔ˜ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ‹ Ù˘ țϷ˜ ÛÙÔ ÛÙfiÌ· 4. √ ¯ÚfiÓÔ˜ ¤Ó·Ú͢ Î·È Ë ‰È¿ÚÎÂÈ· ‰È·Ù‹ÚËÛ˘ Ù˘ Û˘Ó‹ıÂÈ·˜ 5. ∏ ı¤ÛË ÙËÓ ÔÔ›· ·›ÚÓÂÈ Ë Î¿Ùˆ ÁÓ¿ıÔ˜ 6. ∏ Û˘Ó‡·ÚÍË ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ÛÙ¿ÛË Ù˘ ÎÂÊ·Ï‹˜, Ô ÙÚfiÔ˜ ·Ó·ÓÔ‹˜ Î.Ï. 7. √ ÙfiÓÔ˜ ÙˆÓ ÂÚÈÛÙÔÌ·ÙÈÎÒÓ Ì˘ÒÓ , ΢ڛˆ˜ ÙÔ˘ ÛÊÈÁÎÙ‹Ú· ÙÔ˘ ÛÙfiÌ·ÙÔ˜
™¯ÂÙÈο Ì ÙȘ ÂÈÙÒÛÂȘ ÙˆÓ Û˘ÓËıÂÈÒÓ ·˘ÙÒÓ ÛÙË Û‡ÁÎÏÂÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ, ˘¿Ú¯ÂÈ ÌÂÓ ÛËÌ·ÓÙÈ΋ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ÙË ‰ËÌÈÔ˘ÚÁ›· ·ÓˆÌ·ÏÈÒÓ, ˘¿Ú¯Ô˘Ó fï˜ Î·È ÔÏÏ¿ ·È‰È¿ Ù· ÔÔ›·, ÂÓÒ ¤¯Ô˘Ó Ì›· ·fi ÙȘ ¤ÍÂȘ ·˘Ù¤˜, ‰ÂÓ ÂÌÊ·Ó›˙Ô˘Ó Î·Ó¤Ó· Úfi‚ÏËÌ· ÛÙË Û‡ÁÎÏÂÈÛË. ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ·Ô‰ÂÈÎÓ‡ÂÈ fiÙÈ Ë ÚfiÎÏËÛË ‹ ÌË ·ÓˆÌ·Ï›·˜, ηıÒ˜ Î·È ÙÔ Â›‰Ô˜ Î·È Ë ‚·Ú‡ÙËÙ¿ Ù˘, ÂÍ·ÚÙÒÓÙ·È ·fi ÙÔ˘˜ ·Ú¿ÁÔÓÙ˜ Ô˘ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 1. √È ·ÓˆÌ·Ï›Â˜ ÛÙË Û‡ÁÎÏÂÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙË Û˘Ó‹ıÂÈ· ıËÏ·ÛÌÔ‡ ‰·ÎÙ‡ÏÔ˘ ‹ țϷ˜ Â›Ó·È Û˘Ó‹ıˆ˜ Ë ¯ÂÈÏÈ΋ ·fiÎÏÈÛË Î·È ·Ú·ÈÔ‰ÔÓÙ›· ÙˆÓ ¿Óˆ ÙÔ̤ˆÓ, Ë ÁψÛÛÈ΋ ·fiÎÏÈÛË ÙˆÓ Î¿Ùˆ ÙÔ̤ˆÓ Î·È Ë ÚfiÛıÈ· ·ÓˆÁ̤ÓË ‰‹ÍË (¯·ÛÌÔ‰ÔÓÙ›·), Û˘ÌÌÂÙÚÈ΋ ‹ ·Û‡ÌÌÂÙÚË. ™˘¯Ó¿ ·Ú·ÙËÚÂ›Ù·È Â›Û˘ Ô›ÛıÈ· ÛÙ·˘ÚÔÂȉ‹˜ Û‡ÁÎÏÂÈÛË, ÂÙÂÚfiÏ¢ÚË ‹ ·ÌʛϢÚË. ∂¿Ó Ë ¤ÍË ‰È·ÎÔ› ÓˆÚ›˜ Î·È ¿ÓÙˆ˜ ̤¯ÚÈ ÙËÓ ËÏÈΛ· ÙˆÓ 3-4 ÂÙÒÓ ÂÚ›Ô˘, ¤ÛÙˆ Î·È Â¿Ó ¤¯Ô˘Ó ÚÔÎÏËı› ·ÔÎÏ›ÛÂȘ ÙˆÓ ÙÔ̤ˆÓ, ˘¿Ú¯ÂÈ Èı·ÓfiÙËÙ· ÁÈ· ÙÔ˘˜ ÌfiÓÈÌÔ˘˜ ÙÔÌ›˜ Ó· ·Ó·Ù›ÏÔ˘Ó Û ÈηÓÔÔÈËÙÈΤ˜ ı¤ÛÂȘ Î·È Ì ·ÚÌÔÓÈ΋ Û¯¤ÛË ÌÂٷ͇ ÙÔ˘˜ (2).
ÃÚ‹ÛË È›Ï·˜ – ∆· ˘¤Ú Î·È Ù· ηٿ ∆Ô ÔÛÔÛÙfi ÙˆÓ ‚ÚÂÊÒÓ Ù· ÔÔ›· ¯ÚËÛÈÌÔÔÈÔ‡Ó È›Ï· ·Ó¤Ú¯ÂÙ·È Û 75-85% ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ (3). ∏ ¯Ú‹ÛË È›Ï·˜ ·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· ÛÙ· ‚Ú¤ÊË Ù· ÔÔ›· ›Ù ‰ÂÓ ı‹Ï·Û·Ó ηıfiÏÔ˘ ›Ù ‰È¤ÎÔ„·Ó ÓˆÚ›˜ ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. ∆· ıÂÙÈο ÛÙÔȯ›· ·fi ÙË ¯Ú‹ÛË Ù˘ țϷ˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. √È ·ÚÓËÙÈΤ˜ Â͈ԉÔÓÙÈΤ˜ Û˘Ó¤ÂȘ Ù˘ țϷ˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 3. ∏ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ Û ·È‰È¿ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó È›Ï· ·ÌÊÈÛ‚ËÙ›ٷÈ, ÂÍ·ÈÙ›·˜ ÙÔ˘ ÂÚÈÔÚÈṲ̂ÓÔ˘ ·ÚÈıÌÔ‡ ÌÂÏÂÙÒÓ Î·È Ù˘ ÔÈÎÈÏ›·˜ ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ ÙÔ˘˜.
¶›Ó·Î·˜ 2. £ÂÙÈο ÛÙÔȯ›· ·fi ÙË ¯Ú‹ÛË Ù˘ țϷ˜ 1. ∏ ËÚÂÌ›· Î·È ÙÔ ·›ÛıËÌ· ·ÛÊ¿ÏÂÈ·˜ Ô˘ ·Ú¤¯ÂÈ ÛÙÔ ‚Ú¤ÊÔ˜ 2. ∏ ˘Ô‚Ô‹ıËÛË Ù˘ Ó¢ÚÔÏÔÁÈ΋˜ ˆÚ›Ì·ÓÛ˘ ÙˆÓ ÚÔÒÚˆÓ, ηıÒ˜ Î·È Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÙÔ˘˜ Âη›‰Â˘Û˘, Ì ·ÔÙ¤ÏÂÛÌ· ÙËÓ Î·Ï‡ÙÂÚË Û›ÙÈÛË 3. ∏ ÌË Ì›ˆÛË Ù˘ ‰È¿ÚÎÂÈ·˜ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÙfiÛÔ ÙˆÓ ÚÔÒÚˆÓ fiÛÔ Î·È ÙˆÓ ÙÂÏÂÈÔÌ‹ÓˆÓ ÌÂÙ¿ ÙÔÓ ÚÒÙÔ Ì‹Ó· ˙ˆ‹˜ 4. ∏ Èı·Ó‹ Ì›ˆÛË ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÈÊÓ›‰ÈÔ˘ ‚ÚÂÊÈÎÔ‡ ı·Ó¿ÙÔ˘ 5. ∏ ¯Ú‹ÛË È›Ï·˜ ˘ÂÚÙÂÚ› ¤Ó·ÓÙÈ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÙÔ˘ ‰·ÎÙ‡ÏÔ˘, ÂÂȉ‹ ÙÔ ·È‰› ··ÏÏ¿ÛÛÂÙ·È ·fi ·˘Ù‹Ó ¢ÎÔÏfiÙÂÚ·
∏ ¯Ú‹ÛË È›Ï·˜, ·fi ÙËÓ ¿ÏÏË ÏÂ˘Ú¿, ¤¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ ÚÔÛٷهÂÈ ·fi ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ ÙˆÓ ‚ÚÂÊÒÓ (SIDS) (3). ∞ÚÎÂÙ¤˜ ÌÂϤÙ˜ ·Ú¤¯Ô˘Ó ÂӉ›ÍÂȘ ˘¤Ú Ù˘ Ì›ˆÛ˘ ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ ÂÌÊ¿ÓÈÛ˘ SIDS ÛÙ· ‚Ú¤ÊË Ù· ÔÔ›· ¯ÚËÛÈÌÔÔÈÔ‡Ó È›Ï·, ÂӉ¯Ô̤ӈ˜ ÏfiÁˆ Ù˘ ¢ÎÔÏfiÙÂÚ˘ ·Ê‡ÓÈÛ˘, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ù· ÂÚÈÛÛfiÙÂÚ· ‚Ú¤ÊË ¯¿ÓÔ˘Ó ÙËÓ È›Ï· ÌÂÙ¿ ·fi Ï›Á· ÏÂÙ¿ Û˘Ó¯ԇ˜ ‡ÓÔ˘, Ì ·ÔÙ¤ÏÂÛÌ· ‡ÎÔÏ· Ó· ·Ê˘Ó›˙ÔÓÙ·È. π‰È·›ÙÂÚË ·Ó·ÊÔÚ¿ ı· Ú¤ÂÈ Ó· Á›ÓÂÈ ÛÙËÓ ·ÚÓËÙÈ΋ › ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ ›‰Ú·ÛË Ù˘ țϷ˜, ȉȷ›ÙÂÚ· ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ˙ˆ‹˜, Ô˘ Â›Ó·È Î·È Ë Ô˘ÛÈ·ÛÙÈ΋ ÂÚ›Ô‰Ô˜ ‰ڷ›ˆÛ‹˜ ÙÔ˘. °È’ ·˘Ùfi Î·È Ô ¶·ÁÎfiÛÌÈÔ˜ √ÚÁ·ÓÈÛÌfi˜ ÀÁ›·˜ ·Ôı·ÚÚ‡ÓÂÈ ÙË ¯Ú‹ÛË Ù˘, Û ÌÈ· ÚÔÛ¿ıÂÈ· ÚÔÒıËÛ˘ ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡. ∏ ·ÚÓËÙÈ΋ ·˘Ù‹ ›‰Ú·ÛË Èı·ÓÔÏÔÁÂ›Ù·È fiÙÈ ÔÊ›ÏÂÙ·È Î˘Ú›ˆ˜ Û ۇÁ¯˘ÛË ıËÏÒÓ, ÛÙËÓ ˘ÈÔı¤ÙËÛË, ‰ËÏ·‰‹, ·fi ÙÔ ‚Ú¤ÊÔ˜ Ï·Óı·Ṳ̂Ó˘ Ù¯ÓÈ΋˜ ıËÏ·ÛÌÔ‡ fiÙ·Ó ÙÔ˘ ÚÔÛʤÚÂÙ·È ·fi ÓˆÚ›˜ țϷ, Ì ÙÂÏÈÎfi ·ÔÙ¤ÏÂÛÌ· ÙÔÓ ÚfiˆÚÔ ·ÔÁ·Ï·ÎÙÈÛÌfi. £· Ú¤ÂÈ Â›Û˘ Ó· Á›ÓÂÈ È‰È·›ÙÂÚË ÌÓ›· ÛÙË Û‡ÛÙ·ÛË Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ (2006) Ó· ÌË ¯ÚËÛÈÌÔÔÈÂ›Ù·È È›Ï· ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ˙ˆ‹˜ ÙˆÓ ıËÏ·˙fiÓÙˆÓ ‚ÚÂÊÒÓ, ÔfiÙÂ Î·È ÂÈÙ˘Á¯¿ÓÂÙ·È, fiˆ˜ ÚԷӷʤÚıËÎÂ, Ë Â‰Ú·›ˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ·ÏÏ¿ ¶›Ó·Î·˜ 3. ∞ÚÓËÙÈΤ˜ Â͈ԉÔÓÙÈΤ˜ Û˘Ó¤ÂȘ Ù˘ țϷ˜ 1. ∏ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂΉ‹ÏˆÛ˘ ÂÂÈÛÔ‰›ˆÓ ̤Û˘ ˆÙ›Ùȉ·˜ 2. ∏ ˘ÔÓfiÌ¢ÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ 3. ∏ ·˘ÍË̤ÓË Û˘¯ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ÏÔÈÌÒÍÂˆÓ ÙÔ˘ ·Ó·Ó¢ÛÙÈÎÔ‡ Î·È ÙÔ˘ Á·ÛÙÚÂÓÙÂÚÈÎÔ‡ 4. √ ·ÔÈÎÈÛÌfi˜ Ù˘ ÛÙÔÌ·ÙÈ΋˜ ÎÔÈÏfiÙËÙ·˜ Ì Candida albicans 5. ∏ ηı˘ÛÙ¤ÚËÛË Ù˘ ÔÌÈÏ›·˜ 6. ∏ ‰ËÌÈÔ˘ÚÁ›· ÂÏÎÒÓ Ù˘ ̷Ϸ΋˜ ˘ÂÚÒ·˜, ÏfiÁˆ οΈÛ˘ ·fi ÙÔ ÛÎÏËÚfi ÎÂÓÙÚÈÎfi ÙÌ‹Ì·, ȉȷ›ÙÂÚ· fiÙ·Ó Ë È›Ï· ¤¯ÂÈ ÍÂÊÔ˘ÛÎÒÛÂÈ ¶·È‰È·ÙÚÈ΋ 2008;71:482-485
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·484
484
°. ∆ÛfiÏ·˜
Ó· ¯ÔÚËÁÂ›Ù·È È›Ï· ÛÙÔ ‚Ú¤ÊÔ˜ ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË ÂÈÙ˘¯Ô‡˜ ıËÏ·ÛÌÔ‡, ‰Â‰Ô̤ÓÔ˘ fiÙÈ Ë ¯Ú‹ÛË È›Ï·˜ ÌÂÙ¿ ÙÔÓ 1Ô Ì‹Ó· ˙ˆ‹˜ ‰ÂÓ ˘ÔÓÔ̇ÂÈ ÙË ‰È·‰Èηۛ· Î·È ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ıËÏ·ÛÌÔ‡, ÙfiÛÔ ÛÙ· ÙÂÏÂÈfiÌËÓ· fiÛÔ Î·È ÛÙ· ÚfiˆÚ· ‚Ú¤ÊË (1).
£ËÏ·ÛÌfi˜ ‰·ÎÙ‡ÏÔ˘ √ ıËÏ·ÛÌfi˜ ‰·ÎÙ‡ÏÔ˘, Û˘ÓËı¤ÛÙÂÚ· ÙÔ˘ ·ÓÙ›¯ÂÈÚ·, ·ÔÙÂÏ› Û˘Ó‹ıË Î·È, ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· Ù· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È·, ÌÈ· ·Ôχو˜ Ê˘ÛÈÔÏÔÁÈ΋ ÏÂÈÙÔ˘ÚÁ›·. ™˘Ì‚¿ÏÏÂÈ ÛÙËÓ ËÚÂÌ›· ÙÔ˘ ·È‰ÈÔ‡ Î·È ÙÔ˘ ·Ú¤¯ÂÈ ·›ÛıËÌ· ·ÛÊ¿ÏÂÈ·˜, ·ÏÏ¿ Î·È Â˘¯·Ú›ÛÙËÛË. ÀÔÏÔÁ›˙ÂÙ·È, Ì ‚¿ÛË Ù· ÛÙÔȯ›· ‰È·ÊfiÚˆÓ ÌÂÏÂÙÒÓ, fiÙÈ 15% ÙˆÓ ÓË›ˆÓ ËÏÈΛ·˜ 2 ÂÙÒÓ ÚÔ‚·›ÓÔ˘Ó Û ıËÏ·ÛÌfi ‰·ÎÙ‡ÏÔ˘ (4). ¢ÂÓ ˘¿Ú¯ÂÈ ‰È·ÊÔÚ¿, fiÛÔÓ ·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ·, ·Ó¿ÌÂÛ· ÛÙ· ‰‡Ô ʇϷ, fï˜ ‰È·ÎfiÙÂÙ·È ‰˘ÛÎÔÏfiÙÂÚ· ÛÙ· ÎÔÚ›ÙÛÈ· Î·È Î·Ù¿ ηÓfiÓ· ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ (1). ÀÔÏÔÁ›˙ÂÙ·È, fï˜, fiÙÈ 4% ÙˆÓ ·È‰ÈÒÓ ËÏÈΛ·˜ 8 ÂÙÒÓ ÂÍ·ÎÔÏÔ˘ıÔ‡Ó Ó· ıËÏ¿˙Ô˘Ó ÙÔÓ ·ÓÙ›¯ÂÈÚ¿ ÙÔ˘˜ (4). ∏ ·Ú¿Ù·ÛË ·˘Ù‹ ÂÓ‰¤¯ÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ Û ÚÔ‚Ï‹Ì·Ù·, ΢ڛˆ˜ ÔÚıÔ‰ÔÓÙÈο. ∏ ÚÔÛ¿ıÂÈ·, fï˜, ÚfiˆÚ˘ ‹ Î·È ‚›·È˘ ‰È·ÎÔ‹˜ Ù˘ Û˘Ó‹ıÂÈ·˜ ÌÔÚ› Ó· ‚Ï¿„ÂÈ ·Ú¿ Ó· ˆÊÂÏ‹ÛÂÈ, ηıÒ˜ ÂÓ‰¤¯ÂÙ·È Ó· Ô‰ËÁ‹ÛÂÈ Û ÂÌÊ¿ÓÈÛË ÂÓÔ‡ÚËÛ˘, ‰È·Ù·Ú·¯ÒÓ ÛÙÔÓ ‡ÓÔ ‹ Ó· Ô‰ËÁ‹ÛÂÈ ÛÙÔ ·ÎÚÈ‚Ò˜ ·ÓÙ›ıÂÙÔ ·fi ÙÔ ÂȉȈÎfiÌÂÓÔ ·ÔÙ¤ÏÂÛÌ·, ‰ËÏ·‰‹ ÛÙËÓ ·Ú¿Ù·Û‹ Ù˘ ‹ ÙËÓ ·ÓÙÈηٿÛÙ·Û‹ Ù˘ Ì ¿ÏϘ Û˘Ó‹ıÂȘ, ÙÈÎ Î.Ï. (4). ∞Í›˙ÂÈ Ó· ·Ó·ÊÂÚı›, ÛÙÔ ÛËÌÂ›Ô ·˘Ùfi, fiÙÈ Ô ıËÏ·ÛÌfi˜ ‰·ÎÙ‡ÏÔ˘ ‰ÂÓ ÂÓÔ¯ÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜, fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ÙË ¯Ú‹ÛË È›Ï·˜. ∆· ÚÔ‚Ï‹Ì·Ù· Ù· ÔÔ›· ·Ó·Î‡ÙÔ˘Ó fiÙ·Ó Ë Û˘Ó‹ıÂÈ· ›ÙÂ Â›Ó·È Ôχ ¤ÓÙÔÓË Â›Ù ·Ú·Ù›ÓÂÙ·È ¤Ú·Ó Ù˘ ËÏÈΛ·˜ ÙˆÓ 6-8 ÂÙÒÓ, ÔfiÙ Ϸ̂¿ÓÂÈ ¯ÒÚ· Î·È Ë ·Ó·ÙÔÏ‹ Ù˘ ÌfiÓÈÌ˘ Ô‰ÔÓÙÔÊ˘˝·˜, Â›Ó·È Ù· ÂÍ‹˜: 1. √ÚıÔ‰ÔÓÙÈο ÚÔ‚Ï‹Ì·Ù· Î·È Û˘ÁÎÂÎÚÈ̤ӷ ¯·ÛÌÔ‰ÔÓÙ›·, ·ÓˆÌ·Ï›· Ô˘ ÛÙËÓ ÂÚÈÔ¯‹ ΢ڛˆ˜ ÙˆÓ ÚÔÛı›ˆÓ Ô‰fiÓÙˆÓ ·Ú·ÙËÚÂ›Ù·È ·ÚÎÂÙ¿ Û˘¯Ó¿ ηٿ ÙËÓ ÂÚ›Ô‰Ô ÙÔ˘ ÓÂÔÁÈÏÔ‡ Î·È ÙÔ˘ ÚÒÈÌÔ˘-ÌÈÎÙÔ‡ ÊÚ·ÁÌÔ‡. ™Â ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, fiÙ·Ó ÙÔ ·È‰› ‰È·Îfi„ÂÈ ÙË Û˘Ó‹ıÂÈ·, ·Ú·ÙËÚÂ›Ù·È ÛÙ·‰È·Î‹ Î·È ·˘ÙfiÌ·ÙË ‚ÂÏÙ›ˆÛË Ù˘ ηٿÛÙ·Û˘, Ì ٷ ‰fiÓÙÈ· Î·È ÙȘ Ê·ÙÓȷΤ˜ ·ÔʇÛÂȘ Ó· ·ӷÎÙÔ‡Ó Î·ÓÔÓÈÎfi ‡„Ô˜ Î·È Û¯¤ÛÂȘ Ì ٷ ·Ú·Î›ÌÂÓ· Î·È Ù· ·ÓÙ·ÁˆÓÈÛÙÈο ‰fiÓÙÈ·. 2. √›ÛıÈ· ÛÙ·˘ÚÔÂȉ‹˜ Û‡ÁÎÏÂÈÛË, ·ÓˆÌ·Ï›· Ô˘ ·ÊÔÚ¿ ΢ڛˆ˜ ÛÙȘ ·ÚÂÈÔÁψÛÛÈΤ˜ Û¯¤ÛÂȘ ÙˆÓ ÔÈÛı›ˆÓ Ô‰fiÓÙˆÓ. ∏ ·ÓˆÌ·Ï›· ·˘Ù‹ ÌÔÚ›, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, Ó· ηٷÛÙ·Ï› Ì ÙȘ ÂÓ‰ÂÈÎÓ˘fiÌÂÓ˜ ηٿ ÂÚ›ÙˆÛË ·ÚÂÌ‚¿ÛÂȘ ÙÔ˘ ÎÏÈÓÈÎÔ‡ Ô‰ÔÓÙÈ¿ÙÚÔ˘. ∂¿Ó fï˜ ‰ÂÓ ·Ó·ÁÓˆÚÈPaediatriki 2008;71:482-485
ÛÙ› Î·È ·ÓÙÈÌÂÙˆÈÛÙ› Ì ÙÔÓ Î·Ù¿ÏÏËÏÔ ÙÚfiÔ ÂÁη›Úˆ˜, ÂÓ‰¤¯ÂÙ·È Ó· ¤¯ÂÈ ‰˘ÛÌÂÓ›˜ Û˘Ó¤ÂȘ ÛÙËÓ ·‡ÍËÛË ÙˆÓ ÁÓ¿ıˆÓ Î·È ÛÙËÓ ÙÂÏÈ΋ ‰È·ÌfiÚʈÛË Ù˘ Û‡ÁÎÏÂÈÛ˘. 3. ¶·Ú·ÌfiÚʈÛË Ô‰ÔÓÙÈÎÒÓ ÙfiÍˆÓ / ∞˘ÍË̤ÓË ÔÚÈ˙fiÓÙÈ· ÚfiÙ·ÍË (5,6). 4. ¶ÚÔ‚Ï‹Ì·Ù· ÔÌÈÏ›·˜, fiˆ˜ Ë ÌË Î·Ï‹ ÚÔÊÔÚ¿ ‰ÈÏÒÓ Û˘ÌÊÒÓˆÓ, Ô ÙÚ·˘ÏÈÛÌfi˜ Î·È Ô ıËÏ·ÛÌfi˜ Ù˘ ÁÏÒÛÛ·˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÔÌÈÏ›·˜. 5. ∏ ‰ËÌÈÔ˘ÚÁ›· Ù‡ÏˆÓ ÛÙ· ‰¿ÎÙ˘Ï· Ô˘ ıËÏ¿˙ÂÈ ÙÔ ·È‰›, ηıÒ˜ Î·È ·ÚˆÓ˘¯›·˜, ÂÚËÙÈ΋˜ ·ÚˆÓ˘¯›·˜ Î.Ï.
¶·Ú¿Ù·ÛË ÙˆÓ ÛÙÔÌ·ÙÈÎÒÓ Û˘ÓËıÂÈÒÓ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜ Î·È ÙÚfiÔÈ ‰È·ÎÔ‹˜ ÙÔ˘˜ ¶ÔÏÏ¿ „˘¯ÔÏÔÁÈο ·›ÙÈ· ¤¯Ô˘Ó, ηٿ ηÈÚÔ‡˜, ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ·Ú¿Ù·ÛË ÙÔ˘ ıËÏ·ÛÌÔ‡ țϷ˜ ‹ ‰·ÎÙ‡ÏÔ˘. ∆· ‚·ÛÈÎfiÙÂÚ· ›ӷÈ: ™˘Ó·ÈÛıËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÛÙÔÓ „˘¯ÈÎfi ÎfiÛÌÔ ÙÔ˘ ·È‰ÈÔ‡ ·fi ÂÓÙ¿ÛÂȘ Î·È ÚÔ‚Ï‹Ì·Ù· ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, ·‰È¿ÊÔÚË ‹ ˘ÂÚÚÔÛٷ٢ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ·ÈÛı‹Ì·Ù· ˙‹ÏÈ·˜ Î·È ·Ó·ÛÊ¿ÏÂÈ·˜ ·fi ÙË Á¤ÓÓËÛË ÂÓfi˜ Ó¤Ô˘ ̈ÚÔ‡ ‹ Î·È ·fi ‰È¿ıÂÛË ÁÈ· Ì›ÌËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ ÂÓfi˜ ÌÈÎÚfiÙÂÚÔ˘ ·‰ÂÏÊÔ‡, Ô˘ Ê·›ÓÂÙ·È Ó· ÌÔÓԈϛ ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ ÌÂÁ¿ÏˆÓ. ∫ÔÈÓˆÓÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ Ë ˘ÂÚ··Û¯fiÏËÛË Ù˘ ÌËÙ¤Ú·˜, Ë ÌÔÓ·ÍÈ¿ ÙˆÓ ·È‰ÈÒÓ ÛÙ· ‰È·ÌÂÚ›ÛÌ·Ù· ÙˆÓ fiψÓ, Ë ¤ÏÏÂÈ„Ë ·È¯ÓȉÈÔ‡ Ì ¿ÏÏ· ·È‰È¿ Î·È Ë ·ÔÌfiÓˆÛË ÌÚÔÛÙ¿ ÛÙËÓ ÙËÏÂfiÚ·ÛË. ∏ ·Ú·ÙÂٷ̤ÓË ¯Ú‹ÛË È›Ï·˜, fiˆ˜ ¿ÏψÛÙÂ Î·È Ë ·Ú¿Ù·ÛË Ï‹„˘ ÙÔ˘ Á¿Ï·ÎÙÔ˜ Ì ÊÈ¿ÏË Î·È Ë ‰È·Ù‹ÚËÛË Ù˘ ·ÓÙ›ÛÙÔȯ˘ ıËÏ‹˜ ÛÙÔ ÛÙfiÌ· ÁÈ· ÔÏϤ˜ ÒÚ˜, Î·È Î˘Ú›ˆ˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡ÎÙ·˜, ¤¯Ô˘Ó ÙȘ ›‰È˜ ÂÈÙÒÛÂȘ ÛÙË Û‡ÁÎÏÂÈÛË ÙˆÓ ‰ÔÓÙÈÒÓ Ì ·˘Ù¤˜ Ô˘ ÚÔηÏÔ‡ÓÙ·È ·fi ÙËÓ ·Ú·ÙÂٷ̤ÓË ¤ÍË ıËÏ·ÛÌÔ‡ ÙÔ˘ ‰·ÎÙ‡ÏÔ˘, ·Ó Î·È ¤¯ÂÈ ˘ÔÛÙËÚȯı› fiÙÈ Ì ÙËÓ È›Ï· ÚÔηÏÔ‡ÓÙ·È ÂÚÈÛÛfiÙÂÚÔ ÚfiÛıȘ ¯·ÛÌÔ‰ÔÓٛ˜, ÂÓÒ Ì ÙÔÓ ıËÏ·ÛÌfi ‰·ÎÙ‡ÏÔ˘ ·˘Í¿ÓÂÙ·È Ë ÔÚÈ˙fiÓÙÈ· ÚfiÙ·ÍË ÙˆÓ ÚÔÛı›ˆÓ Ô‰fiÓÙˆÓ. ™ËÌ·ÓÙÈ΋ Â›Ó·È Ë Û˘Ì‚ÔÏ‹ ÙÔ˘ ·È‰È¿ÙÚÔ˘ ·ÏÏ¿ Î·È ÙÔ˘ ·È‰Ô‰ÔÓÙÈ¿ÙÚÔ˘ ÛÙËÓ ·ÔÊ˘Á‹ Ù˘ ·Ú¿Ù·Û˘ Ù˘ ‚Ï·‚ÂÚ‹˜ Û˘Ó‹ıÂÈ·˜ ÂÓfi˜ “ÌË ‰È·ÙÚÔÊÈÎÔ‡ ıËÏ·ÛÌÔ‡”, Ì ÙÔ Ó· ÂÓËÌÂÚÒÓÂÈ Î·È Ó· Û˘Ì‚Ô˘Ï‡ÂÈ ÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ÙËÓ ¤ÁηÈÚË Î·È ÛÙ·‰È·Î‹ ‰È·ÎÔ‹ ÙˆÓ Û¯ÂÙÈÎÒÓ Ù¿ÛÂˆÓ Ô˘ ÌÔÚ› Ó· ·Ú·ÙËÚÔ‡ÓÙ·È Î·Ù¿ ÙÔ˘˜ ÚÒÙÔ˘˜ Ì‹Ó˜ Ù˘ ˙ˆ‹˜ ÙÔ˘ ·È‰ÈÔ‡, ¯ˆÚ›˜ fï˜ Ó· ·ÛÎÂ›Ù·È ÛÙÔ ·È‰› ¤ÓÙÔÓË ›ÂÛË, ‰ÈfiÙÈ Ë ÚÔÛ¿ıÂÈ· ‚›·È˘ ‰È·ÎÔ‹˜ Ù˘ ¤Í˘, fi¯È ÌfiÓÔ Ôχ Û˘¯Ó¿ ·ÔÙ˘Á¯¿ÓÂÈ, ·ÏÏ¿ Û˘Óԉ‡ÂÙ·È ÂÓ›ÔÙÂ Î·È ·fi ¿ÏÏ· ÚÔ‚Ï‹Ì·Ù·, ΢ڛˆ˜ „˘¯ÔÏÔÁÈο (5,6). ŸÙ·Ó Ë Û˘Ó‹ıÂÈ· ¤¯ÂÈ ‹‰Ë ·Ú·Ù·ı›,
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·485
485
™ÙÔÌ·ÙÈΤ˜ ¤ÍÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜
ȉ›ˆ˜ ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 4-5 ÂÙÒÓ, Ë ‰È·ÎÔ‹ Ù˘ ‰ÂÓ Â›Ó·È Â‡ÎÔÏË. ∏ ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â¿Ó ÚfiÎÂÈÙ·È ÁÈ· ıËÏ·ÛÌfi țϷ˜ ‹ ‰·ÎÙ‡ÏÔ˘, ηıÒ˜ Î·È ·fi ÙËÓ ËÏÈΛ· ÙÔ˘ ·È‰ÈÔ‡. ¶Ú¤ÂÈ, fï˜, ¿ÓÙÔÙ ӷ ‚·Û›˙ÂÙ·È ÛÙËÓ Î·Ï‹ Û˘ÓÂÚÁ·Û›· Ì ÙÔ ·È‰› Î·È ÛÙËÓ ÂÓË̤ڈۋ ÙÔ˘ ÁÈ· Ù· ‰˘Û¿ÚÂÛÙ· ·ÔÙÂϤÛÌ·Ù· Ô˘ ÌÔÚ› Ó· ¤¯ÂÈ ·˘Ù‹ Ë Û˘Ó‹ıÂÈ· ÛÙ· ‰fiÓÙÈ· ÙÔ˘, ÛÙÔ ¯·ÌfiÁÂÏfi ÙÔ˘, ·ÎfiÌË Î·È ÛÙ· ‰¿ÎÙ˘Ï¿ ÙÔ˘. ∂›Ó·È, ›Û˘, ÌÂÁ¿ÏË Ë ·Í›· ÙÔ˘ ·›ÓÔ˘ Î·È Ù˘ ËıÈ΋˜ ·ÓÙ·ÌÔÈ‚‹˜ ÁÈ· ÙËÓ ÚÔÛ¿ıÂÈ· ‰È·ÎÔ‹˜ Ù˘ ¤Í˘. ™Â ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, Ë ¤ÁηÈÚË ‰È·ÎÔ‹ Ù˘ Û˘Ó‹ıÂÈ·˜ ÌÔÚ› Ó· ·ÎÔÏÔ˘ıËı› ·fi ·˘ÙfiÌ·ÙË ‚ÂÏÙ›ˆÛË Ù˘ ı¤Û˘ Î·È Ù˘ Û¯¤Û˘ ÙˆÓ ‰ÔÓÙÈÒÓ, ¯ˆÚ›˜ η̛· ¿ÏÏË ıÂڷ›·. ªÂÚÈο ·fi Ù· ̤۷ Ô˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙË ‰È·ÎÔ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ›ӷÈ: °È· ÙË Ó‡ÎÙ·: Á¿ÓÙÈ· ‹ ›‰ÂÛÌÔ˜ ÛÙÔ Â›Ì·¯Ô ‰¿ÎÙ˘ÏÔ ‹ Ì·ÎÚ‡ Ì·Ó›ÎÈ ÈÙ˙¿Ì·˜, Ú·Ì̤ÓÔ ÛÙËÓ ¿ÎÚË, ÁÈ· Ó· ÌËÓ ¤¯ÂÈ ÚfiÛ‚·ÛË ÙÔ ‰¿ÎÙ˘ÏÔ ÛÙÔ ÛÙfiÌ·. °È· ÙËÓ Ë̤ڷ: “‰·ÎÙ˘ÏÔÎÔ˘ÎÏ›ÙÛ˜” ηٷÛ΢·Ṳ̂Ó˜ Ì ‰È¿ÊÔÚ· ̤۷ ‹ ˙ˆÁÚ·ÊÈṲ̂Ó˜ ¿Óˆ ÛÙÔ ›‰ÈÔ ÙÔ ‰¿ÎÙ˘ÏÔ Î·È ··Û¯fiÏËÛË ÙˆÓ ¯ÂÚÈÒÓ ÙÔ˘ ·È‰ÈÔ‡ Ì ϷÛÙÂÏ›ÓË. ∂›Û˘ Ë Â¿ÏÂÈ„Ë ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ Ì ÈÎÚ‹ Ô˘Û›·, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÌÂȈı› Ë Â˘¯·Ú›ÛÙËÛË ·fi ÙËÓ ·›ÛıËÛË Ô˘ Û˘Óԉ‡ÂÈ ÙÔÓ ıËÏ·ÛÌfi. ™ÙËÓ ÂÚ›ÙˆÛË, fï˜, ηٿ ÙËÓ ÔÔ›· Ë ·Ú·¿Óˆ ‰È·‰Èηۛ· ‰ÂÓ ·Ô‰ÒÛÂÈ, ÙÔ ·È‰› ÌÔÚ› Ó· ‚ÔËıËı› Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË ·ÏÒÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ, ÁÈ· ˘fiÌÓËÛË Î·È ÂÍÔ˘‰ÂÙ¤ÚˆÛË Ù˘ ¢¯·Ú›ÛÙËÛ˘, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÂÓfi˜ ·ÏÔ‡ ÎÈÓËÙÔ‡ Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ‹ ÌÈ·˜ ÚÔÛÙÔÌȷ΋˜ Ͽη˜, Ô˘ ı· ¯ÚËÛÈÌÔÔÈ› ÙÔ ·È‰› ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡ÎÙ·˜.
™˘ÌÂÚ¿ÛÌ·Ù· 1. √È ÛÙÔÌ·ÙÈΤ˜ Û˘Ó‹ıÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜, fiˆ˜ Ô ıËÏ·ÛÌfi˜ țϷ˜ Î·È ‰·ÎÙ‡ÏÔ˘ ‹ ‰·ÎهψÓ, ıˆÚÔ‡ÓÙ·È ˆ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· Ù· ‚Ú¤ÊË Î·È Ù· ÌÈÎÚ¿ Ó‹È·.
2. ∏ Û˘Û¯¤ÙÈÛ‹ ÙÔ˘˜ Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÔÚıÔ‰ÔÓÙÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ Â›Ó·È ‰Â‰Ô̤ÓË. ∞˘Ù¿, fï˜, Â›Ó·È Î·Ù¿ ηÓfiÓ· ·˘ÙÔ·Ó·ÛÙÚ¤„ÈÌ· ÛÙ· ·È‰È¿ Ù· ÔÔ›· ··ÏÏ¿ÛÛÔÓÙ·È ÙˆÓ ¤ÍÂÒÓ ÙÔ˘˜ ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3-4 ÂÙÒÓ. ¶Úfi‚ÏËÌ·, Û˘ÓÂÒ˜, ·ÔÙÂÏ› Ë ·Ú¿Ù·Û‹ ÙÔ˘˜ ¤Ú·Ó Ù˘ ËÏÈΛ·˜ Ë ÔÔ›· ·ÓÙÈÛÙÔȯ› ÛÙËÓ ÂÚ›Ô‰Ô Ù˘ ÌfiÓÈÌ˘ Ô‰ÔÓÙÔÊ˘˝·˜. ™ÙËÓ ÙÂÏÂ˘Ù·›· ·˘Ù‹ ÂÚ›ÙˆÛË, ÔÈ ·ÓˆÌ·Ï›Â˜ ÛÙË Û‡ÁÎÏÂÈÛË Â›Ó·È ‚·Ú‡ÙÂÚ˜ Î·È ı· ··ÈÙËı›, Èı·Ófiٷٷ, ÔÚıÔ‰ÔÓÙÈ΋ ıÂڷ›· ÁÈ· ÙËÓ ·ÔηٿÛÙ·Û‹ ÙÔ˘˜. 3. √ ıËÏ·ÛÌfi˜ țϷ˜ ˘ÂÚÙÂÚ› ¤Ó·ÓÙÈ ÙÔ˘ ıËÏ·ÛÌÔ‡ ‰·ÎÙ‡ÏÔ˘, ΢ڛˆ˜ ÂÂȉ‹ ÙÔ ·È‰› ··ÏÏ¿ÛÛÂÙ·È ·fi ·˘Ù‹Ó ¢ÎÔÏfiÙÂÚ·. ÀÔÓÔ̇ÂÈ, fï˜, ÙÔÓ ÂÈÙ˘¯‹ ÌËÙÚÈÎfi ıËÏ·ÛÌfi Â¿Ó ¯ÚËÛÈÌÔÔÈËı› ÛÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ˙ˆ‹˜, ÂÓÒ ·˘Í¿ÓÂÈ Î·È ÙË Û˘¯ÓfiÙËÙ· ÂÂÈÛÔ‰›ˆÓ ̤Û˘ ˆÙ›Ùȉ·˜, ÚÔ‚Ï‹Ì·Ù· ÁÈ· Ù· ÔÔ›· ‰ÂÓ Ê·›ÓÂÙ·È Ó· ¢ı‡ÓÂÙ·È Ô ıËÏ·ÛÌfi˜ ‰·ÎÙ‡ÏÔ˘ ‹ ‰·ÎهψÓ. 4. ∆¤ÏÔ˜, Ë ‰È·ÎÔ‹ ÙˆÓ Û˘ÓËıÂÈÒÓ ·˘ÙÒÓ Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ì ÙË Û˘Ó·›ÓÂÛË Î·È Û˘ÓÂÚÁ·Û›· ÙÔ˘ ·È‰ÈÔ‡ Î·È Ì Û‚·ÛÌfi ÚÔ˜ ÙËÓ ÚÔÛˆÈÎfiÙËÙ¿ ÙÔ˘ Î·È ÙȘ Û˘Ó·ÈÛıËÌ·ÙÈΤ˜ ÙÔ˘ ·Ó¿ÁΘ. ∏ ‚›·ÈË ‰È·ÎÔ‹ ÙÔ˘˜ ·ÓÙÂӉ›ÎÓ˘Ù·È Î·ÙËÁÔÚËÌ·ÙÈο, ÁÈ·Ù› fi¯È ÌfiÓÔ ‰ÂÓ Ï‡ÓÂÈ ÙÔ Úfi‚ÏËÌ·, ·ÏÏ¿ ÚÔÛı¤ÙÂÈ ¿ÏÏ·. ∞˘Ùfi Ô˘ ¯ÚÂÈ¿˙ÂÙ·È Â›Ó·È Ë Û˘Ì·Ú¿ÛÙ·ÛË Î·È Ë Ú·ÁÌ·ÙÈ΋ ‰È¿ıÂÛË ÁÈ· ÂÈÎÔÈÓˆÓ›· Ì ÙÔ ·È‰›, ÒÛÙ ӷ ıÂڷ¢ı› ÙÔ “·›ÙÈÔ” Î·È fi¯È ÙÔ “Û‡Ìو̷” Ô˘ Â›Ó·È ÙÔ È›ÏÈÛÌ·.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Davidson L. Thumb and finger sucking. Pediatr Rev 2008;29:207-208. 2. Nowak AJ, Warren JJ. Infant oral health and oral habits. Pediatr Clin North Am 2000;47:1043-1066. 3. Adair SM. Pacifier use in children: a review of recent literature. Pediatr Dent 2003;25:449-458. 4. Bishara SE, Warren JJ, Broffitt B, Levy SM. Changes in the prevalence of non-nutritive sucking patterns in the first 8 years of life. Am J Orthod Dentofacial Orthop 2006;130:31-36. 5. Bishara S, Larsson E. Finger habits: Their effects and their treatments - part 1. Dent Assist 2007; 76:14-16, 18. 6. Bishara S, Larsson E. Finger habits: Their effects and their treatments - part 2. Dent Assist 2007:76:16-18, 20, 22.
¶·È‰È·ÙÚÈ΋ 2008;71:482-485
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∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏
CASE REPORT
M·ÛÙÔ΢ÙÙ¿ÚˆÛË ÛÙ· ·È‰È¿: ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ 1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌ›Ô, ∏Ú¿ÎÏÂÈÔ, ∫Ú‹ÙË 2 ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: µ·ÛÈÏÈ΋ ∞ÁÁÂÏ¿ÎÔ˘ vaagge3@yahoo.gr °Ô‡ÚÓ˜ ∆Â̤ÓÔ˘˜ 71500, ∏Ú¿ÎÏÂÈÔ, ∫Ú‹ÙË
µ. ∞ÁÁÂÏ¿ÎÔ˘1, ª. ∫Ô˘ÙÏ‹2, ¡. ¶··‰fiÔ˘ÏÔ˜2, ∂. ª·ÓÔ˘Û¿Î˘2, ¶. •Â··‰¿ÎË2, π. ÷ڈӛÙË1, º. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘2 ¶ÂÚ›ÏË„Ë: ∏ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Â›Ó·È ÌÈ· ·Û˘Ó‹ıÈÛÙË ÓfiÛÔ˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ÙËÓ ¿ıÚÔÈÛË ÌÂÁ¿ÏÔ˘ ·ÚÈıÌÔ‡ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ Û ‰È¿ÊÔÚÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∏ ÎÏÈÓÈ΋ ÂÈÎfiÓ· ÂÍ·ÚÙ¿Ù·È ·fi ÙË ‰È·ÛÔÚ¿ ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ ÛÂ Û˘ÁÎÂÎÚÈ̤ӷ fiÚÁ·Ó· Î·È ÙËÓ ¤ÎÎÚÈÛË ÌÂÛÔÏ·‚ËÙÒÓ ·fi Ù· Ì·ÛÙÔ·ÙÙ·Ú·. ∆Ô ‰¤ÚÌ· Â›Ó·È Ô ÈÛÙfi˜ Ô˘ ÚÔÛ‚¿ÏÏÂÙ·È Û˘¯ÓfiÙÂÚ· ÛÙ· ·È‰È¿ Î·È ÌÔÚ› Ó· Â›Ó·È Ë ÌfiÓË ÂΉ‹ÏˆÛË Ù˘ ÓfiÛÔ˘. √È ÂÓ‹ÏÈΘ Û˘Ó‹ıˆ˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó Û˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Î·È ¤¯Ô˘Ó ‚·Ú‡ÙÂÚË ¤ÎÊÚ·ÛË Ù˘ ÓfiÛÔ˘. ¶ÂÚÈÁÚ¿ÊÔÓÙ·È ‰‡Ô ·ÁfiÚÈ·, ËÏÈΛ·˜ 7 ÌËÓÒÓ Î·È 13 ÂÙÒÓ, Ì ‰È·ÊÔÚÂÙÈΤ˜ ÌÔÚʤ˜ ‰ÂÚÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘. ∆Ô ‚Ú¤ÊÔ˜ ·ÚÔ˘Û›·Û ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3 ÌËÓÒÓ Î·ÊÂÙȤ˜ ÎËÏȉԂϷÙȉ҉ÂȘ ‚Ï¿‚˜ ÛÙÔ ‰¤ÚÌ·, ¯ˆÚ›˜ ¿ÏÏ· ÎÏÈÓÈο ÛËÌ›· ÂÎÙfi˜ ·fi ·ÓËÛ˘¯›· Î·È ÎÓËÛÌfi. ∏ ÙÚÈ‚‹ ÙˆÓ ‚Ï·‚ÒÓ ‰ËÌÈÔ˘ÚÁÔ‡Û ÂÚ˘ıÚfiÙËÙ· Î·È ÔÌÊfi (ıÂÙÈÎfi ÛËÌÂ›Ô Darier). ∏ ‚ÈÔ„›· ‰ÂÚÌ·ÙÈ΋˜ ‚Ï¿‚˘ ¤‰ÂÈÍ ÌÂÁ¿Ï˜ ·ıÚÔ›ÛÂȘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ ÂÚÈ·ÁÁÂȷο, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ÎËÏȉԂϷÙÈ‰Ò‰Ë ÌÔÚÊ‹ ‰ÂÚÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘. ∆Ô 13 ÂÙÒÓ ·ÁfiÚÈ ÚÈÓ ·fi 6 Ì‹Ó˜ ›¯Â ·Ú¯›ÛÂÈ Ó· ·ÚÔ˘ÛÈ¿˙ÂÈ ÂÂÈÛfi‰È· Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÂÎÓ¢ÛÙÈÎfi Û˘ÚÈÁÌfi, ÂÈÁ·ÛÙÚ·ÏÁ›·, ÂÚ˘ıÚfiÙËÙ· ÎÔÚÌÔ‡, ·ÁÁÂÈÔÔ›‰ËÌ· ÚÔÛÒÔ˘, ÎÓËÛÌfi Î·È ÙÒÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘. ¢ÂÓ ˘‹Ú¯·Ó ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜. ∏ ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ ¤‰ÂÈÍ ¿ıÚÔÈÛË Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ ÂÚÈ·ÁÁÂȷο, ÂÓÒ Ô ¤ÏÂÁ¯Ô˜ ÁÈ· Û˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ‹Ù·Ó ·ÚÓËÙÈÎfi˜. ™ÙÔ ·ÁfiÚÈ Ù¤ıËΠ‰È¿ÁÓˆÛË ‰È¿¯˘Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘.
§¤ÍÂȘ ÎÏÂȉȿ: ª·ÛÙÔ΢ÙÙ¿ÚˆÛË, ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË, ‰È¿¯˘ÙË ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË, ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË, ·È‰È¿.
Mastocytosis in children: a report of two cases 1 1st Department of Paediatrics, “Venizelio” General Hospital, Heraklion, Crete 2 Allergology Clinic, 2nd Department of Paediatrics, “P. & A. Kyriakou” Childrens’ Hospital, University of Athens, Athens Correspondence: Vassiliki Aggelakou vaagge3@yahoo.gr Gournes Temenous 71500, Heraklion, Crete
V. Aggelakou1, M. Koutli2, N. Papadopoulos2, E. Manoussakis2, P. Xepapadaki2, I. Charoniti1, F. Saxoni-Papageorgiou2 Abstract: Mastocytosis is an uncommon disease in infants and children. It is characterized by aggregates of large numbers of mast cells in several body tissues. The clinical manifestations depend on the dispersion of mast cells in specific organs and the secretion of mast cell mediators. Skin is the tissue usually affected in children and dermal manifestations may be the only presenting feature of the disease. Adults usually present with systemic mastocytosis and are more often affected by the more severe forms of the disease. Two cases of cutaneous mastocytosis in childhood of different types are presented. A 7 month-old male infant had first presented at the age of three months, with brownish maculopapular cutaneous lesions. There were no other clinical signs, apart from jitteriness and pruritus. The Darier sign was positive. Biopsy of the lesion revealed large perivascular aggregates of mast cells, which were compatible with maculopapular cutaneous mastocytosis. A 13 year-old boy presented with episodes of respiratory distress, expiratory wheezing, epigastric pain, flushing, facial angioedema, pruritus and lowered blood pressure. No apparent cutaneous lesions were reported and the Darier sign was negative. Skin biopsy revealed perivascular mast cell aggregates, while examination for systemic mastocytosis was negative. The diagnosis was made of diffuse cutaneous mastocytosis.
Key words: Mastocytosis, cutaneous mastocytosis, diffuse cutaneous mastocytosis, urticaria pigmentosa, children.
∂ÈÛ·ÁˆÁ‹ √ fiÚÔ˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ÂÚÈÁÚ¿ÊÂÈ ÌÈ· ·ÓÔÌÔÈÔÁÂÓ‹ ÔÌ¿‰· ÎÏÈÓÈÎÒÓ Û˘Ó‰ÚfiÌˆÓ Ô˘ ÎÔÈÓfi ÙÔ˘˜ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Â›Ó·È Ë ·ÓÒÌ·ÏË ·‡ÍËÛË Î·È ¿ıÚÔÈÛË Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ Û ¤Ó·Ó ‹ ÂÚÈÛÛfiÙÂÚÔ˘˜ ÈÛÙÔ‡˜ ÙÔ˘ ÛÒÌ·ÙÔ˜. ∆Ô 2000, ÔÈ Valent Î·È Û˘Ó. ÚfiÙÂÈÓ·Ó Ù·ÍÈÓfiÌËÛË Ù˘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘ ‚¿ÛÂÈ Ó¤ˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÎÚÈÙËÚ›ˆÓ, Ë ÔÔ›· ¤ÁÈÓ ·Ô‰ÂÎÙ‹ ·fi ÙÔÓ Paediatriki 2008;71:486-492
¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈÛÌfi ÀÁ›·˜ (¶›Ó·Î˜ 1 Î·È 2) (1,2). ∆· Ì·ÛÙÔ·ÙÙ·Ú· ·ıÚÔ›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙÔÓ Û˘Ó‰ÂÙÈÎfi ÈÛÙfi, Á‡Úˆ ·fi Ù· ÂÚÈÊÂÚÈο Ó‡ڷ Î·È Ù· ·ÈÌÔÊfiÚ· Î·È ÏÂÌÊÈο ·ÁÁ›·, ˘fi ÙËÓ Â›‰Ú·ÛË Î˘ÙÙ·ÚÔÎÈÓÒÓ (ÈÓÙÂÚÏ¢ΛÓ˜ 1,4,5,6,9,10,15) Î·È ÙÔ˘ ·Ú¿ÁÔÓÙ· ÙˆÓ ·Ú¯¤ÁÔÓˆÓ Î˘ÙÙ¿ÚˆÓ SCF (stem cell factor), Ô˘ Â›Ó·È Ô Î‡ÚÈÔ˜ ·˘ÍËÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜ ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ. √ SCF ‰È·ÊÔÚÔÔÈ›
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ª·ÛÙÔ΢ÙÙ¿ÚˆÛË ÛÙ· ·È‰È¿
¶›Ó·Î·˜ 1. ∆·ÍÈÓfiÌËÛË Ù˘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘ ·fi ÙÔÓ ¶·ÁÎfiÛÌÈÔ √ÚÁ·ÓÈÛÌfi ÀÁ›·˜ (¶√À)
¶›Ó·Î·˜ 2. ∫ÚÈÙ‹ÚÈ· ÙÔ˘ ¶√À ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘
¢ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË 1. ∫ËÏȉԂϷÙȉ҉˘ ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ‹ ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË (urticaria pigmentosa) (70-90%) 2. ¢È¿¯˘ÙË ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË (1-3%) 3. ªÔÓ‹Ú˜ Ì·ÛÙÔ·Ùو̷ (10-30%) 4. ∂Í·ÓıËÌ·ÙÈ΋ ÎËÏȉ҉˘ ÙËÏ·ÁÁÂÈÂÎÙ·Û›· (Ôχ Û¿ÓÈ·)
ªÂ›˙ÔÓ·*
∫·ÏÔ‹ı˘ Û˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË 1. ™˘ÛÙËÌ·ÙÈ΋, ‚Ú·‰Â›·˜ ÂͤÏÈ͢, Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË 2. ª·ÛÙÔ΢ÙÙ¿ÚˆÛË ·ÔÎÏÂÈÛÙÈο ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ™˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË, ÌÂ Û˘ÓÔ‰fi ·ÈÌ·ÙÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹ Ô˘ ‰ÂÓ Û¯ÂÙ›˙ÂÙ·È Ì ٷ Ì·ÛÙÔ·ÙÙ·Ú· 1. ™˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Ì ÔÍ›· Ì˘ÂÏÔÁÂÓ‹ Ï¢¯·ÈÌ›· 2. ™˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ÌÂ Ì˘ÂÏÔ¸ÂÚÏ·ÛÈÎfi Û‡Ó‰ÚÔÌÔ 3. ™˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ÌÂ Ì˘ÂÏÔ‰˘ÛÏ·ÛÙÈÎfi Û‡Ó‰ÚÔÌÔ 4. ™˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Ì ¯ÚfiÓÈ· Ì˘ÂÏÔÌÔÓÔ΢ÙÙ·ÚÈ΋ Ï¢¯·ÈÌ›· 5. ™˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Ì ÌË-Hodgkin ϤÌʈ̷ 6. ™˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Ì ˘ÂÚˈÛÈÓÔÊÈÏÈÎfi Û‡Ó‰ÚÔÌÔ ∫·ÎÔ‹ı˘ Û˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË §Â˘¯·ÈÌ›· ·fi Ì·ÛÙÔ·ÙÙ·Ú· ™¿ÚΈ̷ ·fi Ì·ÛÙÔ·ÙÙ·Ú· ∂͈‰ÂÚÌ·ÙÈÎfi Ì·ÛÙÔ·Ùو̷
Ù· Ì·ÛÙÔ·ÙÙ·Ú· ·fi Ù· ÔÏ˘‰‡Ó·Ì· CD34+ ·Ú¯¤ÁÔÓ· ·ÙÙ·Ú·, Ù· ÔÔ›· ÂÎÊÚ¿˙Ô˘Ó ÙÔÓ ˘Ô‰Ô¯¤· ÙÔ˘ SCF, c-KIT (3). ªÂϤÙ˜ ÙˆÓ ÙÂÏÂ˘Ù·›ˆÓ ¯ÚfiÓˆÓ ¤‰ÂÈÍ·Ó fiÙÈ ÙÔ˘Ï¿¯ÈÛÙÔÓ ÔÚÈṲ̂Ó˜ ÌÔÚʤ˜ Û˘ÛÙËÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘, Ì ¤Ó·ÚÍË Î˘Ú›ˆ˜ ÌÂÙ¿ Ù· 20 ¯ÚfiÓÈ· ˙ˆ‹˜, ÔÊ›ÏÔÓÙ·È Û ‰ÈÂÁÂÚÙÈΤ˜ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔÓ ˘Ô‰Ô¯¤· c-KIT, Ì ·ÚÈ· ÌÂÙ¿ÏÏ·ÍË ÙËÓ D816V (2,3). ∆Ô ÎÏÈÓÈÎfi Ê¿ÛÌ· Ù˘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘ ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ Ï‹ÚË ·Ô˘Û›· Û˘ÌÙˆÌ¿ÙˆÓ Ì¤¯ÚÈ ÙËÓ ·ÚÔ˘Û›· ÛÔ‚·ÚÒÓ ÂΉËÏÒÛˆÓ. ∫‡ÚÈÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi Ù˘ ÓfiÛÔ˘ Â›Ó·È Ë ¤ÎÎÚÈÛË ÌÂÛÔÏ·‚ËÙÒÓ ·fi Ù· Ì·ÛÙÔ·ÙÙ·Ú·, ˘fi ÙËÓ Â›‰Ú·ÛË ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ, Ô˘ Ô‰ËÁ› Û ÔÈΛϘ ÂΉËÏÒÛÂȘ (¶›Ó·Î˜ 3 Î·È 4). ∆· ·È‰È¿ Û˘Ó‹ıˆ˜ ÂÌÊ·Ó›˙Ô˘Ó ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Î·È Î˘Ú›ˆ˜ ÙËÓ ÎËÏȉԂϷÙÈ‰Ò‰Ë ÌÔÚÊ‹, Ô˘ ÎÏ·ÛÈο ÔÓÔÌ¿˙ÂÙ·È ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË. ÷ڷÎÙËÚÈÛÙÈÎfi Î·È ‰È·ÁÓˆÛÙÈÎfi ÛËÌÂ›Ô Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘ Â›Ó·È ÙÔ ÛËÌÂ›Ô Darier, ÙÔ ÔÔ›Ô Û˘Ó›ÛÙ·Ù·È ÛÙË ‰ËÌÈÔ˘ÚÁ›· ÂÚ˘ıÚfiÙËÙ·˜ Î·È ÔÌÊÔ‡ ÛÙ· fiÚÈ· Ù˘ ‰ÂÚÌ·ÙÈ΋˜ ·ÏÏÔ›ˆÛ˘, ÌÂÙ¿ ·fi Ì˯·ÓÈ΋ ÙÚÈ‚‹ Ù˘ (5). √È ÂÓ‹ÏÈΘ Û˘¯Ó¿ ¿Û¯Ô˘Ó ·fi Û˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË.
¶ÔÏ˘ÂÛÙȷΤ˜ ‰ÈËı‹ÛÂȘ ·fi Ì·ÛÙÔ·ÙÙ·Ú· ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ ‹ Û ¿ÏÏÔ fiÚÁ·ÓÔ ÂÎÙfi˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ (>15 ‰ÈËı‹ÛÂȘ) ∂Ï¿ÛÛÔÓ·* 1. ª·ÛÙÔ·ÙÙ·Ú· Ì ·ÓÒÌ·ÏË ÌÔÚÊÔÏÔÁ›· ÛÙÔÓ Ì˘ÂÏfi ‹ ¿ÏÏÔ fiÚÁ·ÓÔ ÂÎÙfi˜ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ (>25%) 2. ªÂÙ¿ÏÏ·ÍË D816V ÛÙÔ Îˆ‰ÈÎfiÓÈÔ 816 ÙÔ˘ c-KIT Û fiÚÁ·ÓÔ ÂÎÙfi˜ ·fi ÙÔ ‰¤ÚÌ·† 3. ª·ÛÙÔ·ÙÙ·Ú· Ì ¤ÎÊÚ·ÛË CD2, CD25 ‹ Î·È Ù· ‰‡Ô ÛÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ 4. ∆Ú˘Ù¿ÛË ÔÚÔ‡ >20 ng/mL (‰ÂÓ ıˆÚÂ›Ù·È ÎÚÈÙ‹ÚÈÔ Û ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙٿوÛË ÌÂ Û˘ÓÔ‰fi ·ÈÌ·ÙÔÏÔÁÈ΋ ‰È·Ù·Ú·¯‹) * ¢È¿ÁÓˆÛË Û˘ÛÙËÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘ Ù›ıÂÙ·È Ì ÙÔ˘Ï¿¯ÈÛÙÔÓ ¤Ó· Ì›˙ÔÓ Î·È ¤Ó· ¤Ï·ÛÛÔÓ ÎÚÈÙ‹ÚÈÔ ‹ ÙÚ›· ÂÏ¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ· † ∫·È ¿ÏϘ ÌÂÙ·ÏÏ¿ÍÂȘ ÛÙÔ Îˆ‰ÈÎfiÓÈÔ 816 ÛÙÔ c-KIT ıˆÚÔ‡ÓÙ·È Â›Û˘ ¤Ï·ÛÛÔÓ ÎÚÈÙ‹ÚÈÔ
1Ë ÂÚ›ÙˆÛË µÚ¤ÊÔ˜ ·ÁfiÚÈ 7,5 ÌËÓÒÓ ÚÔÛ‹Ïı ÛÙÔ Â͈ÙÂÚÈÎfi ·È‰È·ÙÚÈÎfi È·ÙÚÂ›Ô ÏfiÁˆ ÂÌÊ¿ÓÈÛ˘ ηÊÂÙÈÒÓ ÎËÏȉԂϷÙȉˆ‰ÒÓ ‚Ï·‚ÒÓ ·fi 4Ì‹ÓÔ˘, ÛÙ·‰È·Î¿ ·˘Í·ÓfiÌÂÓˆÓ Û ̤ÁÂıÔ˜ Î·È ·ÚÈıÌfi, ÌÂ Û˘ÓÔ‰fi ·ÓËÛ˘¯›· Î·È ÎÓËÛÌfi. ∆Ô ‚Ú¤ÊÔ˜ ›¯Â Ï¿‚ÂÈ ÙÔÈ΋ ·ÁˆÁ‹ Ì ÊÏÔ˘ÙÈη˙fiÓË Î·È ÂÓ˘‰¿ÙˆÛË. ∂›Ó·È ÙÔ ÌÔÓ·‰ÈÎfi ·È‰› Ê·ÈÓÔÙ˘Èο ˘ÁÈÒÓ ÁÔÓ¤ˆÓ, Ì ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ÂχıÂÚÔ. ∏ ۈ̷ÙÈ΋ ·‡ÍËÛË Î·È Ë „˘¯ÔÎÈÓËÙÈ΋ ÙÔ˘ ·Ó¿Ù˘ÍË ‹Ù·Ó Û˘Ì‚·Ù¤˜ Ì ÙËÓ ËÏÈΛ· ÙÔ˘. ∞fi ÙË Ê˘ÛÈ΋ ÂͤٷÛË ‰È·ÈÛÙÒıËÎ·Ó ÎËÏȉԂϷÙȉ҉ÂȘ ηÊÂÙȤ˜ ‚Ï¿‚˜ ‰¤ÚÌ·ÙÔ˜, ÛÙËÓ ÂÚÈÔ¯‹ ÙÔ˘ ·˘¯¤Ó·, ÛÙÔÓ ÎÔÚÌfi ηÈ, ÏÈÁfiÙÂÚÔ, ÛÙ· ¿ÎÚ·, ÌÂÁ¤ıÔ˘˜ 2-10 ÂηÙÔÛÙÒÓ Î·È ˆÔÂȉԇ˜ Û¯‹Ì·ÙÔ˜, Ì ıÂÙÈÎfi ÛËÌÂ›Ô Darier (∂ÈÎfiÓ˜ 1 Î·È 2). ∏ ÂͤٷÛË ÙˆÓ ˘fiÏÔȈÓ
∂ÈÎfiÓ· 1. ªÂÏ·Á¯ÚˆÌ·ÙÈ΋ ‚Ï·Ù›‰·-Ͽη ÛÙÔ ‚Ú¤ÊÔ˜ Ì ÙË ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË. ¶·È‰È·ÙÚÈ΋ 2008;71:486-492
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µ. ∞ÁÁÂÏ¿ÎÔ˘ Î·È Û˘Ó.
∂ÈÎfiÓ· 2. ™ËÌÂ›Ô Darier ÛÙÔ ›‰ÈÔ ‚Ú¤ÊÔ˜
Û˘ÛÙËÌ¿ÙˆÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈ΋. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜ ¤‰ÂÈÍÂ: °ÂÓÈ΋ ·›Ì·ÙÔ˜: §Â˘Î¿ ·ÈÌÔÛÊ·›ÚÈ·=15.000 Î.Î.¯. (¶=25%, §=64%, ª=7%, ∏=4%), ·ÈÌÔÛÊ·ÈÚ›ÓË=10,6 g/dl, ·ÈÌ·ÙÔÎÚ›Ù˘=32,4%, ·ÈÌÔÂÙ¿ÏÈ·=574000 K/ÌL, ¢∂∫=1,5%, ∆∫∂=9 mm (1Ë ÒÚ·). √ ‚ÈÔ¯ËÌÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜, Ë ÙÚ˘Ù¿ÛË ÔÚÔ‡ 12 ng/ml (Ê.Ù. <14 ng/ml) Î·È ÙÔ ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Ê˘ÛÈÔÏÔÁÈÎfi. ™ÙË ‚ÈÔ„›· ‰ÂÚÌ·ÙÈ΋˜ ‚Ï¿‚˘ ·Ú·ÙËÚ‹ıËÎ·Ó ˘ÎÓ¤˜ ‰ÈËı‹ÛÂȘ ·fi ·ÙÙ·Ú· Ì ÈÛÙÔ¯ËÌÈÎÔ‡˜ Î·È ÈÛÙÔÏÔÁÈÎÔ‡˜ ¯·Ú·ÎÙ‹Ú˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ¯fiÚÈÔ, ÂÈÎfiÓ· Û˘Ì‚·Ù‹ Ì ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË (∂ÈÎfiÓ· 3). ∆Ô ‚Ú¤ÊÔ˜ Ù¤ıËΠ۠·ÁˆÁ‹ Ì ÎÂÙÔÙÈÊ·›ÓÈÔ, Ì ̤ÙÚÈ· ·ÓÙ·fiÎÚÈÛË, Î·È ÛÙË Û˘Ó¤¯ÂÈ· Ì ÛÂÙÈÚÈ˙›ÓË, Ì ηϿ ·ÔÙÂϤÛÌ·Ù· fiÛÔÓ ·ÊÔÚ¿ ÙËÓ ·ÓËÛ˘¯›· Î·È ÙÔÓ ÎÓËÛÌfi. ∞ÎfiÌË, ‰fiıËÎ·Ó Ô‰ËÁ›Â˜ ÛÙÔ˘˜ ÁÔÓ›˜ ÁÈ· ·ÔÊ˘Á‹ ÂÎÏ˘ÙÈÎÒÓ ·Ú·ÁfiÓÙˆÓ ·ÔÎÔÎΛˆÛ˘ ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ.
2Ë ÂÚ›ÙˆÛË ∞ÁfiÚÈ ËÏÈΛ·˜ 13 ÂÙÒÓ ·ÚÔ˘Û›·˙ ·fi 6Ì‹ÓÔ˘ ÂÂÈÛfi‰È· Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÂÈÁ·ÛÙÚÈÎfi ¿ÏÁÔ˜, ÎÓËÛÌfi, ‰È¿¯˘ÙË ÂÚ˘ıÚfiÙËÙ· (flushing) Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ·ÁÁÂÈÔÔ›‰ËÌ· ÚÔÛÒÔ˘. ∆· Û˘ÌÙÒÌ·Ù· ·Ú¯Èο ‹Ù·Ó ‹È· Î·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓ·, ÂÓÒ ÛÙ·‰È·Î¿ ·˘Í‹ıËÎ·Ó ÛÂ Û˘¯ÓfiÙËÙ· Î·È ‚·Ú‡ÙËÙ·. ∆· ÂÂÈÛfi‰È· ‰ÂÓ Â›¯·Ó ÂÚÈÔ‰ÈÎfiÙËÙ·, ‰ÂÓ Û¯ÂÙ›˙ÔÓÙ·Ó Ì ÙË Ï‹„Ë ÙÚÔÊ‹˜ ‹ ÙËÓ ¿ÛÎËÛË Î·È ·ÎÔÏÔ˘ıÔ‡ÓÙ·Ó ·fi ÎfiˆÛË Î·È ˘ÓËÏ›·. ™Â ¤Ó· ÂÂÈÛfi‰ÈÔ Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËΠ۠∫¤ÓÙÚÔ ÀÁ›·˜ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘, ‰È·ÈÛÙÒıËÎ·Ó ÙÒÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÂÎÓ¢ÛÙÈÎfi˜ Û˘ÚÈÁÌfi˜, ÂÚ˘ıÚfiÙËÙ· ‰¤ÚÌ·ÙÔ˜ Î·È ·ÁÁÂÈÔÔ›‰ËÌ· ÚÔÛÒÔ˘ Î·È ¯ÔÚËÁ‹ıËÎ·Ó ·‰ÚÂÓ·Ï›ÓË ˘Ô‰fiÚÈ· Î·È ÎÔÚÙÈÎÔÂȉ‹ ÂÓ‰ÔÌ˘˚ο. §fiÁˆ Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ÙˆÓ Û˘Ìو̿وÓ, Ô ·ÛıÂÓ‹˜ ·Ú·¤ÌÊıËΠÁÈ· ÏËÚ¤ÛÙÂÚÔ ¤ÏÂÁ¯Ô. ∆Ô Paediatriki 2008;71:486-492
∂ÈÎfiÓ· 3. µÈÔ„›· ‰¤ÚÌ·ÙÔ˜ ÙÔ˘ ‚Ú¤ÊÔ˘˜ Ì ÙË ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË.
·ÁfiÚÈ ‹Ù·Ó Û ηϋ ÁÂÓÈ΋ ηٿÛÙ·ÛË, ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ·‡ÍËÛË Î·È ·Ó¿Ù˘ÍË Î·È ¯ˆÚ›˜ ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù· ·fi ÙËÓ Î·Ù¿ Û˘ÛÙ‹Ì·Ù· ÂͤٷÛË. ™ÙÔ ·ÙÔÌÈÎfi ·Ó·ÌÓËÛÙÈÎfi ·Ó·Ê¤ÚÂÙ·È ÔÈÛıÔÛÙÂÚÓÈÎfi ¿ÏÁÔ˜ Ì η‡ÛÔ˜, ÂÚ˘Á¤˜ Î·È ‰˘ÛηٷÔÛ›· ÚÔ ¤ÙÔ˘˜. ™ÙËÓ ÂÓ‰ÔÛÎfiËÛË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡, ‰È·ÈÛÙÒıËΠ‹È· Á·ÛÙÚ›Ùȉ· Î·È ¯ÔÚËÁ‹ıËΠıÂڷ›· Ì ·Ó·ÛÙÔÏ›˜ Ù˘ ·ÓÙÏ›·˜ ÚˆÙÔÓ›ˆÓ ÁÈ· 3 Ì‹Ó˜. ∞fi ÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi ·Ó·Ê¤ÚÂÙ·È Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË ÛÙÔÓ ·Ù¤Ú· Î·È ÙÔ˘˜ ÁÔÓ›˜ ÙÔ˘ Î·È ˘Ôı˘ÚÂÔÂȉÈÛÌfi˜, ÎÓ›‰ˆÛË ÌÂÙ¿ ·fi Ï‹„Ë Ê·ÚÌ¿ÎˆÓ Î·È ÂÚÈÔ‰Èο ·ÁÁÂÈÔÔ›‰ËÌ· ÛÙË ÌËÙ¤Ú·. ∆· ·‰¤ÚÊÈ· ÙÔ˘, 18 Î·È 5 ÂÙÒÓ, Â›Ó·È Ê·ÈÓÔÙ˘Èο ˘ÁÈ‹. √ ÂÚÁ·ÛÙËÚÈ·Îfi˜ Î·È ·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜, Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÁÂÓÈ΋ ·›Ì·ÙÔ˜, ∆∫∂, ‚·ÛÈÎÔ‡˜ ‚ÈÔ¯ËÌÈÎÔ‡˜ ‰Â›ÎÙ˜, ı˘ÚÂÔÂȉÈΤ˜ ÔÚÌfiÓ˜, ·˘ÙÔ·ÓÙÈÛÒÌ·Ù· (·ÓÙÈı˘ÚÂÔÂȉÈο, ·ÓÙÈ˘ÚËÓÈο, ·ÓÙÈ-DNA), ·ÓÙÈÛÒÌ·Ù· ÁÈ· EBV, CMV
∂ÈÎfiÓ· 4. µÈÔ„›· ‰¤ÚÌ·ÙÔ˜ ÙÔ˘ ·ÛıÂÓÔ‡˜ Ì ÙË ‰È¿¯˘ÙË Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË.
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ª·ÛÙÔ΢ÙÙ¿ÚˆÛË ÛÙ· ·È‰È¿
¶›Ó·Î·˜ 3. ªÂÛÔÏ·‚ËÙ¤˜ ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ Î·È Ë ÎÏÈÓÈ΋ ÙÔ˘˜ ÛËÌ·Û›· ªÂÛÔÏ·‚ËÙ¤˜
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∞ÁÁÂÈԉȷÛÙÔÏ‹, ÂÚ‡ıËÌ·, Ô›‰ËÌ·, ÎÓËÛÌfi˜, ÎÓ›‰ˆÛË, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, ·˘ÍË̤ÓÔ Á·ÛÙÚÈÎfi Ô͇, ÂÓÂÚÁÔÔ›ËÛË Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ∏·Ú›ÓË √ÛÙÂÔfiÚˆÛË, ·Ó·ÛÙÔÏ‹ ‰ËÌÈÔ˘ÚÁ›·˜ ıÚfiÌ‚Ô˘, ·Ú¿Ù·ÛË PTT ∆Ú˘Ù¿ÛË ¢È¿Û·ÛË ÈÓˆ‰ÔÁfiÓÔ˘ Î·È ÂÓÂÚÁÔÔ›ËÛË ÎÔÏÏ·ÁÂÓ¿Û˘ Ô˘ Ô‰ËÁ› Û ηٷÛÙÚÔÊ‹ ÈÛÙÒÓ, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, ÔÛÙÂÔfiÚˆÛË Ã˘Ì¿ÛË ∆ÔÈ΋ ·Ó·ÛÙÔÏ‹ ‹Í˘, ÂÓÂÚÁÔÔ›ËÛË Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ, ‰ËÌÈÔ˘ÚÁ›· Ê˘ÛÛ·Ï›‰ˆÓ (;) ∫·ı„›ÓË G Î·È ∫·Ú‚Ô͢ÂÙȉ¿ÛË ∞ ¶·Ú·ÁˆÁ‹ ÎÈÓ›Ó˘, Ë·ÙÈ΋ ›ÓˆÛË (;) ŸÍÈÓ˜ ˘‰ÚÔÏ¿Û˜ µÏ¿‚˜ ÔÛÙÒÓ, ÔÛÙÂÔfiÚˆÛË ¶·Ú·ÙÂٷ̤ÓÔ˜ ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, ·˘ÍË̤ÓË ·Ú·ÁˆÁ‹ ‚ϤÓÓ˘, ·˘ÍË̤ÓË ‰È·ÂÚ·§Â˘ÎÔÙÚȤÓÈ· C4, D4, E4 ÙfiÙËÙ· Î·È Û˘Û·ÛÙÈÎfiÙËÙ· ·ÁÁ›ˆÓ ¶ÚÔÛÙ·ÁÏ·Ó‰›ÓË D2 ∞ÁÁÂÈԉȷÛÙÔÏ‹, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, ¯ËÌÂÈÔÙ·Í›· Ô˘‰ÂÙÂÚÔÊ›ÏˆÓ ¶·Ú¿ÁÔÓÙ·˜ ÂÓÂÚÁÔÔ›ËÛ˘ ∞˘ÍË̤ÓË ‰È·ÂÚ·ÙfiÙËÙ· ·ÁÁ›ˆÓ, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, ¯ËÌÂÈÔÙ·Í›· Î·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂÙ·Ï›ˆÓ (PAF) Ï¢ÎÔ΢ÙÙ¿ÚˆÓ TNF ¢ËÌÈÔ˘ÚÁ›· ÊÏÂÁÌÔÓ‹˜ IL-3 ¶ÔÏÏ·Ï·ÛÈ·ÛÌfi˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ IL-4, IL-13 ¶·Ú·ÁˆÁ‹ IgE, ·Ú·ÁˆÁ‹ ‚ϤÓÓ˘ IL-5 ¶·Ú·ÁˆÁ‹ Î·È ÂÓÂÚÁÔÔ›ËÛË ËˆÛÈÓÔʛψÓ
Î·È ÈÔ‡˜ Ë·Ù›Ùȉ·˜, Ï‹ÚË ¤ÏÂÁ¯Ô Û˘ÌÏËÚÒÌ·ÙÔ˜, ‰ÔÎÈÌ·Û›· ·˘ÙfiÏÔÁÔ˘ ÔÚÔ‡, ·ÓÔÛÔÛÊ·ÈÚ›Ó˜, ·ÎÙÈÓÔÁÚ·Ê›· ıÒڷη, ˘ÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜ Î·È ÔÈÛÔÊ·ÁÔÁÚ¿ÊËÌ·, ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ∏ ÙÚ˘Ù¿ÛË ÔÚÔ‡ ‹Ù·Ó 4 ng/ml. ∏ pHÌÂÙÚ›· ÔÈÛÔÊ¿ÁÔ˘ ¤‰ÂÈÍ ÌÂÙÚ›Ô˘ ‚·ıÌÔ‡ Á·ÛÙÚÔÔÈÛÔÊ·ÁÈ΋ ·ÏÈÓ‰ÚfiÌËÛË, ÂÓÒ ÛÙËÓ ÂÓ‰ÔÛÎfiËÛË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡ ‰È·ÈÛÙÒıËΠ‰È¿‚ÚˆÛË ÛÙËÓ Î·Ú‰ÈÔÔÈÛÔÊ·ÁÈ΋ Û˘Ì‚ÔÏ‹, ηıÒ˜ Î·È ‹ÈÔ Ô›‰ËÌ· Î·È ÂÚ˘ıÚfiÙËÙ· ÛÙÔ ÛÒÌ· Î·È ÙÔ ¿ÓÙÚÔ ÙÔ˘ ÛÙÔÌ¿¯Ô˘. √È ‚ÈÔ„›Â˜ Ô˘ ÂÏ‹ÊıËÛ·Ó ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈΤ˜. ŒÁÈÓ ‚ÈÔ„›· ˘ÁÈÔ‡˜ ‰¤ÚÌ·ÙÔ˜, ÛÙËÓ ÔÔ›· ‚Ú¤ıËΠ‰È¿Ù·ÛË ·ÁÁ›ˆÓ, Ì ‰ÈfiÁΈÛË ÙˆÓ ÂÓ‰ÔıËÏÈ·ÎÒÓ Î˘ÙÙ¿ÚˆÓ Î·È ·‡ÍËÛË ÙÔ˘ ·ÚÈıÌÔ‡ ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ ÂÚÈ·ÁÁÂȷο (∂ÈÎfiÓ· 4). ∆Ô ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi. ∏ ÂͤٷÛË ÙÔ˘ Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ ¤‰ÂÈÍ ·˘ÍË̤ÓË Î˘ÙÙ·ÚÔ‚Ú›ıÂÈ·, ÌÂ Ê˘ÛÈÔÏÔÁÈΤ˜ fiϘ ÙȘ ΢ÙÙ·ÚÈΤ˜ ÛÂÈÚ¤˜ Î·È ¯ˆÚ›˜ ·ÚÔ˘Û›· Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ. ™ÙÔÓ Ì˘ÂÏfi ‰ÂÓ ·ÓȯÓ‡ıËΠÌÂÙ¿ÏÏ·ÍË ÛÙÔ ÂÍfiÓÈÔ 17 ÙÔ˘ ÁÔÓȉ›Ô˘ c-KIT. ªÂ Ù· ·ÓˆÙ¤Úˆ ‰Â‰Ô̤ӷ, Ù¤ıËÎÂ Ë ‰È¿ÁÓˆÛË Ù˘ ‰È¿¯˘Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘. √ ·ÛıÂÓ‹˜ ¤Ï·‚ ‰È¿ÁÓˆÛË ‰È¿¯˘Ù˘ ‰ÂÚÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘, ηıfiÛÔÓ ‰ÂÓ ÏËÚÔ‡Û ٷ ÎÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË Ù˘ Û˘ÛÙËÌ·ÙÈ΋˜ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘ (¶›Ó·Î·˜ 2). ∆¤ıËΠ۠ıÂڷ›· Ì Ï‚ÔÛÂÙÈÚÈ˙›ÓË Î·È Ú·ÓÈÙȉ›ÓË, ÂÊԉȿÛıËΠ̠·‰ÚÂÓ·Ï›ÓË ·˘ÙfiÌ·Ù˘ ¤Á¯˘Û˘ Î·È ‰ÂÓ ·ÚÔ˘Û›·ÛÂ Ó¤Ô ÂÂÈÛfi‰ÈÔ Ù· ÂfiÌÂÓ· 2 ¯ÚfiÓÈ·.
™˘˙‹ÙËÛË ∏ Û˘¯ÓfiÙËÙ· Ù˘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘ ˘ÔÏÔÁ›˙ÂÙ·È Û ¤Ó· ÂÚÈÛÙ·ÙÈÎfi ·Ó¿ 1000-8000 ÂÈÛΤ„ÂȘ Û Â͈ÙÂÚÈÎfi ‰ÂÚÌ·ÙÔÏÔÁÈÎfi È·ÙÚÂ›Ô ‹ ‰‡Ô ÂÚÈÙÒ-
ÛÂȘ ÙÔ ¯ÚfiÓÔ Û ¤Ó·Ó ÏËı˘ÛÌfi 300.000, Ô˘ ·ÓÙÈÛÙÔȯ› ÛÂ Û˘¯ÓfiÙËÙ· 0,000667% (6,7). ∏ ÓfiÛÔ˜ ÚÔÛ‚¿ÏÏÂÈ Ù· ‰‡Ô ʇϷ Û ›ÛË Û˘¯ÓfiÙËÙ· Î·È ¤¯ÂÈ ÌÈ· ‰ÈÎfiÚ˘ÊË ËÏÈÎȷ΋ ηٷÓÔÌ‹: ÛÙËÓ ÚÒÈÌË ·È‰È΋ ËÏÈΛ· Î·È ÛÙËÓ ÙÚ›ÙË Ì ٤ٷÚÙË ‰ÂηÂÙ›· Ù˘ ˙ˆ‹˜. ¶ÂÚ›Ô˘ Ù· 2/3 ÙˆÓ ·ÛıÂÓÒÓ Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛË Â›Ó·È ·È‰È¿. ∏ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ‰ÂÓ Â›Ó·È ÎÏËÚÔÓÔÌÈ΋ ÓfiÛÔ˜ Î·È Ë Û˘¯ÓfiÙËÙ· ÔÈÎÔÁÂÓÔ‡˜ ηٷÓÔÌ‹˜ Â›Ó·È ÂÚ›Ô˘ 11% (8). ∏ ¤Ó·ÚÍË ÛÙËÓ ·È‰È΋ ËÏÈΛ· ‹ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ ‰È·Ê¤ÚÂÈ ˆ˜ ÚÔ˜ ÙËÓ ÎÏÈÓÈ΋ ¤ÎÊÚ·ÛË, ÙËÓ ÔÚ›·, ÙËÓ ·Ó‡ÚÂÛË ÌÂÙ·ÏÏ¿ÍÂˆÓ ÛÙÔÓ ˘Ô‰Ô¯¤· c-Kit Î·È ÙËÓ ÚfiÁÓˆÛË. ∆Ô 80% ÙˆÓ ·ÛıÂÓÒÓ Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛË ¤¯ÂÈ ÚÔÛ‚ÔÏ‹ ÙÔ˘ ‰¤ÚÌ·ÙÔ˜ Î·È ÌfiÓÔ ÙÔ 20% ÙˆÓ ·ÛıÂÓÒÓ ÌÂ Û˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ‰ÂÓ ¤¯ÂÈ ‰ÂÚÌ·ÙÈΤ˜ ÂΉËÏÒÛÂȘ (7). ∏ ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË (¢ª) Â›Ó·È Ë ÌfiÓË ÂΉ‹ÏˆÛË Û¯Â‰fiÓ ÛÙÔ Û‡ÓÔÏÔ ÙˆÓ ·Û¯fiÓÙˆÓ ·È‰ÈÒÓ. ∏ Û˘¯ÓfiÙÂÚË ÌÔÚÊ‹ ¢ª Â›Ó·È Ë ÎËÏȉԂϷÙȉ҉˘ ÌÔÚÊ‹, Ô˘ ÎÏ·ÛÈο ÔÓÔÌ¿˙ÂÙ·È ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË (ª∫) Î·È ·ÊÔÚ¿ ÙÔ 70-90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ¢ª (8-10). √È ‚Ï¿‚˜ ÛÙ· ·È‰È¿, Û ۯ¤ÛË Ì ÙÔ˘˜ ÂÓ‹ÏÈΘ, Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ÌÂÏ·Á¯ÚˆÌ·ÙÈΤ˜ Î·È ÏÈÁfiÙÂÚÔ ÂÚ˘ıÚ¤˜ ÎËÏ›‰Â˜, ‚Ï·Ù›‰Â˜, ϿΘ ‹ fi˙ÔÈ ÔÈΛÏÔ˘ ÌÂÁ¤ıÔ˘˜ (̤ÛË ‰È¿ÌÂÙÚÔ˜ 5 mm Î·È Ì¤ÁÈÛÙË 15 mm) Î·È Ì ÂÓÙfiÈÛË Î˘Ú›ˆ˜ ÛÙÔÓ ÎÔÚÌfi Î·È Û¿ÓÈ· ¤ˆ˜ ηıfiÏÔ˘ ÛÙȘ ·Ï¿Ì˜, Ù· ¤ÏÌ·Ù·, ÙÔ ÚfiÛˆÔ Î·È ÙÔ ÙÚȯˆÙfi Ù˘ ÎÂÊ·Ï‹˜ (7-10). ∆Ô ÛËÌÂ›Ô Darier Â›Ó·È ıÂÙÈÎfi ÛÙÔ Û‡ÓÔÏÔ Û¯Â‰fiÓ ÙˆÓ ·ÛıÂÓÒÓ Ì ¢ª. √ ÎÓËÛÌfi˜ Â›Ó·È ÙÔ ÈÔ Û˘¯Ófi Û‡Ìو̷ Ù˘ ª∫ Î·È ÔÈΛÏÏÂÈ Û ¯ÚÔÓÈfiÙËÙ· Î·È ¤ÓÙ·ÛË (8-10). ∆Ô flushing ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ·fi ˙ÂÛÙfi ‹ ÎÚ‡Ô Ì¿ÓÈÔ, ÙÚÈ‚‹ ÙˆÓ ‚Ï·‚ÒÓ Î·È ¿ÛÎËÛË. ∏ ‰ËÌÈÔ˘ÚÁ›· Ê˘Û·Ï›‰ˆÓ ¿ӈ ÛÙȘ ‚Ï¿‚˜ Â›Ó·È ¶·È‰È·ÙÚÈ΋ 2008;71:486-492
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·490
490
µ. ∞ÁÁÂÏ¿ÎÔ˘ Î·È Û˘Ó.
¶›Ó·Î·˜ 4. ¶·Ú¿ÁÔÓÙ˜ Ô˘ ÚÔηÏÔ‡Ó ·ÔÎÔÎΛˆÛË ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ 1. º¿Ú̷η Î·È ¿ÏÏÔÈ ·Ú¿ÁÔÓÙ˜ Ì ÌÂÁ¿ÏË Èı·ÓfiÙËÙ· ÁÈ· ·ÔÎÔÎΛˆÛË# ñ √Ùȉ‹ÔÙ ÛÙÔ ÔÔ›Ô Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ ¿ÙÔÌÔ Â›Ó·È ·ÏÏÂÚÁÈÎfi ñ ¢ËÏËÙ‹ÚÈ· (ÊȉÈÒÓ, ˘ÌÂÓÔÙ¤ÚˆÓ) ñ µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È ·fi ·Ú¿ÛÈÙ· ÂÓÙ¤ÚÔ˘, ·ʋ Ì ̤‰Ô˘Û· Î·È ‚ÚÒÛË Î·Ú·‚›‰·˜ Î·È ·ÛÙ·ÎÔ‡ ñ ¢ÂÍÙÚ¿Ó˜ (Û ÔÚÈṲ̂ӷ ÂÓ‰ÔÊϤ‚È· ‰È·Ï‡Ì·Ù· Î·È ÔÊı·ÏÌÈΤ˜ ÛÙ·ÁfiÓ˜) ñ πˆ‰ÈÔ‡¯· ÛÎÈ·ÁÚ·ÊÈο ñ ∞ÛÈÚ›ÓË Î·È ¿ÏÏ· ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ñ ¡·ÚΈÙÈο (Έ‰Â˝ÓË, ÌÔÚÊ›ÓË, ÌÂÂÚȉ›ÓË, Âıȉ›ÓË) ñ ¶·Ú¿ÁÔÓÙ˜ Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ (d-ÙÔ˘ÌÔÎÔ˘Ú·Ú›ÓË, ‰ÂηÌÂıfiÓÈÔ, ÁηÏÏ·Ì›ÓË, ÌÂÙÔÎÔ˘ÚfiÓÈÔ, ·ÓÎÔ˘ÚfiÓÈÔ) ñ ™˘Ì·ıÔÌÈÌËÙÈο (ÈÛÔÚÔÙÂÚÂÓfiÏË, ·ÌÊÂÙ·Ì›ÓË, ÂʉڛÓË, Ê·ÈÓ˘ÏÂÊÚ›ÓË) ñ ÕÏÏ· (ÛÎÔÔÏ·Ì›ÓË, ··‚ÂÚ›ÓË, ‰È˘Úȉ·ÌfiÏË, ıÂÈ·Ì›ÓË, ÙÚÈÌÂıÔÚÊ¿ÓË) 2. º˘ÛÈο ÂÚÂı›ÛÌ·Ù· Î·È Ê¿Ú̷η Ô˘ ·ÔÎÔÎÎÈÒÓÔ˘Ó Ù· Ì·ÛÙÔ·ÙÙ·Ú· ÛÙÔ˘˜ ÂÚÈÛÛfiÙÂÚÔ˘˜ ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛË* ñ ™ˆÌ·ÙÈ΋ ¿ÛÎËÛË, ˙¤ÛÙË, ÎÚ‡Ô, ÙÚÈ‚‹, ¤ÎıÂÛË ÛÙÔÓ ‹ÏÈÔ ñ º¿Ú̷η - ∞ÏÎÔfiÏË, ÔÏ˘Ì˘Í›ÓË µ, ·ÌÊÔÙÂÚÈΛÓË µ, ÎÈÓ›ÓË, ‰ÂÍÙÚÔÌÂıÔÚÊ¿ÓË, ÙÔÈο ·Ó·ÈÛıËÙÈο (ÏȉÔη˝ÓË, ÙÂÙڷη˝ÓË, ÚÔη˝ÓË, ÌÂı˘Ï··Ì¤Ó Û˘ÓÙËÚËÙÈÎfi) 3. ∆ÚÔʤ˜ Î·È ÚfiÛıÂÙ· Ô˘ ÌÔÚ› Ó· ·ÔÎÔÎÎÈÒÛÔ˘Ó Ù· Ì·ÛÙÔ·ÙÙ·Ú· Û ÔÚÈṲ̂ӷ ¿ÙÔÌ· Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛ˨ ñ ∑ÂÛÙ¤˜ ÙÚÔʤ˜ ñ ∆ÚÔʤ˜ Ì ηڢ·̷ٷ ñ ¶ÚfiÛıÂÙ· ÙÚÔÊ›ÌˆÓ 4. ÕÏÏÔÈ ·Ú¿ÁÔÓÙ˜ ñ æ˘¯ÔÏÔÁÈÎfi stress ñ ªÂÚÈΤ˜ ÈÔÁÂÓ›˜ Î·È ‚·ÎÙËÚȷΤ˜ ÏÔÈÌÒÍÂȘ #
¶Ï‹Ú˘ ·ÔÊ˘Á‹. ∂¿Ó Â›Ó·È ·Ó·Áη›Ô, ¯ÔÚËÁÔ‡ÓÙ·È Î¿Ùˆ ·fi ›‚ÏÂ„Ë Î·È Ì ‰˘Ó·ÙfiÙËÙ· ›ÁÔ˘Û·˜ ·ÓÙÈÌÂÙÒÈÛ˘. * ¶Ú¤ÂÈ Ó· ÚÔÛÂÁÁ›˙ÔÓÙ·È ÚÔÛÂÎÙÈο, οو ·fi ¿ÌÂÛË Â›‚ÏÂ„Ë ·ÙfiÌÔ˘ Ô˘ ¤¯ÂÈ ÂÎ·È‰Â˘Ù› È·ÙÚÈο Ó· ¯ÔÚËÁ‹ÛÂÈ Â›ÁÔ˘Û· ıÂڷ›·. ¨ ¶Ú¤ÂÈ Ó· ÚÔÛÂÁÁ›˙ÔÓÙ·È ÚÔÛÂÎÙÈο, ·Ú¯Èο Û ÌÈÎÚ¤˜ ÔÛfiÙËÙ˜ Î·È Î¿Ùˆ ·fi ÙËÓ Â›‚ÏÂ„Ë ·ÙfiÌÔ˘ Ô˘ Â›Ó·È ¤ÙÔÈÌÔ Ó· ¯ÔÚËÁ‹ÛÂÈ Â›ÁÔ˘Û· ıÂڷ›·.
Û˘¯Ó‹ ÛÙ· ÚÒÙ· ¯ÚfiÓÈ· ˙ˆ‹˜, Ì ˘Ô¯ÒÚËÛË ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 3 ¯ÚfiÓˆÓ (8-10). √È Ê˘Û·Ï›‰Â˜ Â›Ó·È Û˘¯Ó¿ ·ÈÌÔÚÚ·ÁÈΤ˜ Î·È ˘Ô¯ˆÚÔ‡Ó ¯ˆÚ›˜ Ó· ‰ËÌÈÔ˘ÚÁ‹ÛÔ˘Ó Ô˘Ï¤˜. √È ‚Ï¿‚˜ Ù˘ ª∫ ‚ÂÏÙÈÒÓÔÓÙ·È (~80%) ‹ ˘Ô¯ˆÚÔ‡Ó Ï‹Úˆ˜ (~50% ) ̤¯ÚÈ ÙËÓ ÂÊ˂›·, fiÙ·Ó ‰ÂÓ ˘¿Ú¯ÂÈ Û˘ÛÙËÌ·ÙÈ΋ ÓfiÛÔ˜ (8). Paediatriki 2008;71:486-492
∆· Ì·ÛÙÔ΢ÙÙÒÌ·Ù· ÂÌÊ·Ó›˙ÔÓÙ·È Î˘Ú›ˆ˜ ÛÙ· ·È‰È¿ Î·È Û¿ÓÈ· ÛÙÔ˘˜ ÂÓ‹ÏÈΘ Î·È ·ÔÙÂÏÔ‡Ó ÙÔ 10-30% Ù˘ ¢ª (8-12). ™˘¯Ó¿ ˘¿Ú¯Ô˘Ó ÛÙË Á¤ÓÓËÛË ‹ ÂΉËÏÒÓÔÓÙ·È Ì¤Û· ÛÙÔ˘˜ ÚÒÙÔ˘˜ 3 Ì‹Ó˜ Ù˘ ˙ˆ‹˜. ∂›Ó·È Û˘Ó‹ıˆ˜ ÌÔÓ‹ÚÂȘ, Û˘Ì·Á›˜, ηÊÂÙÈÔ›, ›‰ÔÈ ‹ ÂÏ·ÊÚ¿ ÂËṲ́ÓÔÈ fi˙ÔÈ ‹ ϿΘ ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ (3-4 cm), Ì ÂÓÙfiÈÛË Î˘Ú›ˆ˜ ÛÙ· ¿ÎÚ· (·ÎfiÌ· Î·È ÛÙ· ¤ÏÌ·Ù·). ∏ ÂÌÊ¿ÓÈÛË Î·È ¿ÏÏÔ˘ Ì·ÛÙÔ΢ÙÙÒÌ·ÙÔ˜ ¤Ú·Ó ÙˆÓ ‰‡Ô ÌËÓÒÓ ·fi ÙËÓ ÂÌÊ¿ÓÈÛË Ù˘ ÚÒÙ˘ ‚Ï¿‚˘ Â›Ó·È Û¿ÓÈ·. ∆Ô ÛËÌÂ›Ô Darier Â›Ó·È ıÂÙÈÎfi. ªÔÚ› Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó Ê˘Û·Ï›‰Â˜ ¿Óˆ ÛÙË ‚Ï¿‚Ë. ™¿ÓÈ·, ÔÈ ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙÙÒÌ·Ù· ÂÌÊ·Ó›˙Ô˘Ó Û˘ÌÙÒÌ·Ù·, fiˆ˜ flushing ‹ ·Ó·Ê˘Ï·ÎÙÈΤ˜ ·ÓÙȉڿÛÂȘ (11,12). ∏ ÚfiÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ Ì ̷ÛÙÔ·Ùو̷ Â›Ó·È Î·Ï‹, Ì ϋÚË ‹ ÌÂÚÈ΋ ˘Ô¯ÒÚËÛË ÙˆÓ ‚Ï·‚ÒÓ ÛÙÔ 92% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (8-10). ∏ ‰È¿¯˘ÙË ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË (¢¢ª) Â›Ó·È Û¿ÓÈ· ÌÔÚÊ‹ ¢ª (~1-3%) Î·È ÂÌÊ·Ó›˙ÂÙ·È Û ·È‰È¿ ËÏÈΛ·˜ <3 ¯ÚfiÓˆÓ (9). ∆Ô ‰¤ÚÌ· ÌÔÚ› Ó· Â›Ó·È Ê˘ÛÈÔÏÔÁÈÎfi ηٿ ÙË Á¤ÓÓËÛË, ·ÏÏ¿ Û‡ÓÙÔÌ· ÂÌÊ·Ó›˙ÂÈ ÁÂÓÈÎÂ˘Ì¤ÓË ¿¯˘ÓÛË, Ì ÂÈÎfiÓ· ÊÏÔÈÔ‡ ÔÚÙÔηÏÈÔ‡. ∏ ‰ËÌÈÔ˘ÚÁ›· Ê˘Û·Ï›‰ˆÓ Î·È Ë ÂÌÊ¿ÓÈÛË ÛÔ‚·ÚÒÓ Û˘ÛÙËÌ·ÙÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ (flushing, ˘fiÙ·ÛË, shock Î·È Á·ÛÙÚÂÓÙÂÚÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ ‰È¿ÚÚÔÈ· ‹ ·ÈÌÔÚÚ·Á›·) ··ÓÙÒÓÙ·È Û˘¯Ó¿ (9). √È ·ÛıÂÓ›˜ Ì ¢¢ª ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÌÂٿوÛË ÛÂ Û˘ÛÙËÌ·ÙÈ΋ ÌÔÚÊ‹ Î·È Ù¿ÛË ÁÈ· ·Ú·ÌÔÓ‹ ÙˆÓ ‚Ï·‚ÒÓ ÛÙËÓ ÂÓ‹ÏÈÎÔ ˙ˆ‹ (7,9). ∏ Û˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË (™ª) Â›Ó·È Ë ÛÔ‚·ÚfiÙÂÚË ÌÔÚÊ‹ Ù˘ ÓfiÛÔ˘, ηٿ ÙËÓ ÔÔ›· Ù· Ì·ÛÙÔ·ÙÙ·Ú· ‰ÈËıÔ‡Ó ÙÔ ‰¤ÚÌ· ‹ Î·È ¿ÏÏ· fiÚÁ·Ó· Î·È Î˘Ú›ˆ˜ ÙÔÓ Ì˘ÂÏfi ÙˆÓ ÔÛÙÒÓ. °È· ÙË ‰È¿ÁÓˆÛË ¯ÚÂÈ¿˙ÂÙ·È Ó· ˘¿Ú¯Ô˘Ó 1 Ì›˙ÔÓ Î·È 1 ¤Ï·ÛÛÔÓ ÎÚÈÙ‹ÚÈÔ ‹ 3 ÂÏ¿ÛÛÔÓ· ÎÚÈÙ‹ÚÈ· (¶›Ó·Î·˜ 2) (1,2). ∂›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ· Û ·È‰È¿ <5 ¯ÚfiÓˆÓ, ÂÓÒ Ë Èı·ÓfiÙËÙ· Ù˘ ‰È¿ÁÓˆÛ˘ ·˘Í¿ÓÂÙ·È Î·Ù¿ ÙËÓ ÂÊ˂›· Î·È ÌÂÙ¿ ·fi ·˘Ù‹Ó (13). ∆· Û˘ÌÙÒÌ·Ù· Ù˘ ÂÎÙÂٷ̤Ó˘ ¢ª Î·È Ù˘ ™ª Â›Ó·È ÁÓˆÛÙ¿ ˆ˜ “Û‡Ó‰ÚÔÌÔ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘” Î·È ÔÊ›ÏÔÓÙ·È ÛÙËÓ ·ÔÎÔÎΛˆÛË ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ Î·È ÙËÓ ¤ÎÎÚÈÛË ÌÂÛÔÏ·‚ËÙÒÓ ˘fi ÙËÓ Â›‰Ú·ÛË ‰È·ÊfiÚˆÓ ·Ú·ÁfiÓÙˆÓ (¶›Ó·Î˜ 3 Î·È 4). ∏ ÛÔ‚·ÚfiÙÂÚË ÂΉ‹ÏˆÛË ÙÔ˘ “Û˘Ó‰ÚfiÌÔ˘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘” Â›Ó·È Ë ·Ó·Ê˘Ï·Í›·. ™Â ÚfiÛÊ·ÙË ÌÂϤÙË Ô˘ ·ÊÔÚÔ‡Û ÙËÓ ·Ó·Ê˘Ï·Í›· Û ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛË, Ë Û˘¯ÓfiÙËÙ· Ù˘ ·Ó·Ê˘Ï·Í›·˜ ÛÙ· ·È‰È¿ Ù˘ ÌÂϤÙ˘ Ô˘ ›¯·Ó ·ÔÎÏÂÈÛÙÈο ¢ª ‹Ù·Ó 9%, ÂÓÒ ÛÙÔ˘˜ ÂÓ‹ÏÈΘ ‹Ù·Ó 49% Î·È ·ÊÔÚÔ‡Û ·ÛıÂÓ›˜ ۯ‰fiÓ ·ÔÎÏÂÈÛÙÈο Ì ™ª (14). ∆Ô ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ÛÙ· ·È‰È¿ ‹Ù·Ó οÔÈ· ÙÚÔÊ‹ ‹ ·ʋ Ì ÎÚ‡Ô ÓÂÚfi ‹ ·‰È¢ÎÚ›ÓÈÛÙÔ. ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ‹Ù·Ó ÙÔ ‰‹ÁÌ· ˘ÌÂÓÔÙ¤ÚˆÓ,
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·491
491
ª·ÛÙÔ΢ÙÙ¿ÚˆÛË ÛÙ· ·È‰È¿
Û·ÓÈfiÙÂÚ· οÔÈ· ÙÚÔÊ‹ ‹ Ê¿ÚÌ·ÎÔ, ÂÓÒ Û ÌÂÁ¿ÏÔ ÔÛÔÛÙfi ·Ú¤ÌÂÈÓ ·‰È¢ÎÚ›ÓÈÛÙÔ (14). ∏ Û˘¯ÓfiÙËÙ· Ù˘ ·ÙÔ›·˜ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛË Â›Ó·È ›‰È· Ì ÙÔ˘ ÁÂÓÈÎÔ‡ ÏËı˘ÛÌÔ‡, ÂÓÒ Ë Û˘¯ÓfiÙËÙ· Ù˘ ·Ó·Ê˘Ï·Í›·˜ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚË ÛÙË Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË. °ÂÓÈο, ÔÈ ·ÛıÂÓ›˜ Ì ·ÙÔ›· Î·È Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Î¿ÓÔ˘Ó ÛÔ‚·ÚfiÙÂÚ˜ ·ÓÙȉڿÛÂȘ, Û ۯ¤ÛË Ì ·˘ÙÔ‡˜ Ô˘ ¿Û¯Ô˘Ó ÌfiÓÔ ·fi Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË (15). ∏ ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ Â›Ó·È ÈÔ Â‡ÎÔÏË fiÙ·Ó ˘¿Ú¯Ô˘Ó ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ Î·È ıÂÙÈÎfi ÛËÌÂ›Ô Darier, ÂÓÒ ··ÈÙÂ›Ù·È ÌÂÁ¿ÏÔ˜ ‚·ıÌfi˜ ˘Ô„›·˜ Ù˘ ‰È¿ÁÓˆÛ˘ ·fi ÙÔÓ ÎÏÈÓÈÎfi ÁÈ·ÙÚfi fiÙ·Ó ·˘Ù¿ ·Ô˘ÛÈ¿˙Ô˘Ó. ™Ù· ·È‰È¿ Ì ¢ª ¯ˆÚ›˜ ¿ÏÏ· ÎÏÈÓÈο Â˘Ú‹Ì·Ù·, Ë ‰È¿ÁÓˆÛË Ù›ıÂÙ·È Ì ÙË ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜ Î·È ‰ÂÓ ··ÈÙÂ›Ù·È ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜. ŸÌˆ˜, fiÙ·Ó ˘¿Ú¯Ô˘Ó ÎÏÈÓÈο ÛËÌ›·, fiˆ˜ ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË ‹ ÛÏËÓÔÌÂÁ·Ï›·, Û˘ÛÙËÌ·ÙÈο Û˘ÌÙÒÌ·Ù· Î·È Ë ÓfiÛÔ˜ ÂÌÊ·Ó›˙ÂÙ·È ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 5 ÂÙÒÓ, Ú¤ÂÈ Ó· Á›ÓÂÙ·È Ï‹Ú˘ ¤ÏÂÁ¯Ô˜ ÁÈ· ÙÔÓ ·ÔÎÏÂÈÛÌfi ™ª. √ ¤ÏÂÁ¯Ô˜ ÂÚÈÏ·Ì‚¿ÓÂÈ Ì¤ÙÚËÛË Ù˘ ÙÚ˘Ù¿Û˘ ÔÚÔ‡, ‚ÈÔ„›· Ì˘ÂÏÔ‡ ÙˆÓ ÔÛÙÒÓ, ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ Î·È ·Ó›¯Ó¢ÛË Ù˘ ÌÂÙ¿ÏÏ·Í˘ D816V ÛÙÔÓ c-Kit (13). ÕÏϘ ÂÚÁ·ÛÙËÚȷΤ˜ ‹ ÂÓ‰ÔÛÎÔÈΤ˜ ÂÍÂÙ¿ÛÂȘ ··ÈÙÔ‡ÓÙ·È Î·Ù¿ ÂÚ›ÙˆÛË. ∏ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Ú¤ÂÈ Ó· ·ÔÎÏ›ÂÙ·È Û ·ÛıÂÓ›˜ Ì ·ӷϷ̂·ÓfiÌÂÓ· ÂÂÈÛfi‰È· ȉÈÔ·ıÔ‡˜ ·Ó·Ê˘Ï·Í›·˜ (14,15). ∏ ıÂڷ›· Â›Ó·È Û˘Ìو̷ÙÈ΋, Ì ʿÚ̷η ÂÎÏÔÁ‹˜ Ù· H1 ·ÓÙÈÈÛÙ·ÌÈÓÈο, fiˆ˜ Ë ˘‰ÚÔ͢˙›ÓË, ·ÏÏ¿ Î·È Ù· ÓÂfiÙÂÚ·, fiˆ˜ Ë ÛÂÙÈÚÈ˙›ÓË, Ë Ï‚ÔÛÂÙÈÚÈ˙›ÓË, Ë ÏÔÚ·Ù·‰›ÓË ‹ Ë ‰ÂÛÏÔÚ·Ù·‰›ÓË. ∆Ô ÎÂÙÔÙÈÊ·›ÓÈÔ Ê·›ÓÂÙ·È Ó· ˘ÔÏ›ÂÙ·È ÙˆÓ ·ÓÙÈÈÛÙ·ÌÈÓÈÎÒÓ ÛÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ (16). ∏ ÚÔÛı‹ÎË ∏2 ·ÓÙÈÈÛÙ·ÌÈÓÈÎÒÓ, fiˆ˜ Ë Ú·ÓÈÙȉ›ÓË ‹ Ë ÛÈÌÂÙȉ›ÓË, Â›Ó·È ¯Ú‹ÛÈÌË fiÙ·Ó ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù· ·fi ˘ÂÚ¤ÎÎÚÈÛË Á·ÛÙÚÈÎÔ‡ ÔͤԘ. ∆Ô ¯ÚˆÌÔÁÏ˘ÎÈÎfi Ó¿ÙÚÈÔ ·fi ÙÔ ÛÙfiÌ· ¤¯ÂÈ ¯ÔÚËÁËı› Ì ηϿ ·ÔÙÂϤÛÌ·Ù· Û ·ÛıÂÓ›˜ Ì ‰È·ÚÚÔ˚Τ˜ ÎÂÓÒÛÂȘ, ΈÏÈÎÔÂȉ‹ ÎÔÈÏȷο ¿ÏÁË, Ì˘ÔÛÎÂÏÂÙÈο ¿ÏÁË ‹ ÎÂÊ·Ï·ÏÁ›· (16). ™Â ·ÛıÂÓ›˜ Ì ª∫ ‹ Ì·ÛÙÔ΢ÙÙÒÌ·Ù· ¤¯Ô˘Ó ¯ÔÚËÁËı› ÙÔÈο ÛÙÂÚÔÂȉ‹, Ì ηϿ ·ÔÙÂϤÛÌ·Ù· (16,17). √È ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛË Î·È ÈÛÙÔÚÈÎfi ·Ó·Ê˘Ï·Í›·˜ Ú¤ÂÈ ÔˆÛ‰‹ÔÙ ӷ Â›Ó·È ÂÊԉȷṲ̂ÓÔÈ Ì ·‰ÚÂÓ·Ï›ÓË ·˘ÙfiÌ·Ù˘ ¤Á¯˘Û˘, ÎÔÚÙÈÎÔÂȉ‹ Î·È ·ÓÙÈÈÛÙ·ÌÈÓÈο ÁÈ· Ó· ·ÓÙÈÌÂÙˆ›˙Ô˘Ó ¤ÁηÈÚ· Ù˘¯fiÓ ÂÂÈÛfi‰ÈÔ. √È ·ÛıÂÓ›˜ ÌÂ Û˘Ìو̷ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Ú¤ÂÈ Ó· ·ÔʇÁÔ˘Ó ÁÓˆÛÙÔ‡˜ ÂÎÏ˘ÙÈÎÔ‡˜ ·Ú¿ÁÔÓÙ˜ ·ÔÎÔÎΛˆÛ˘ ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ (¶›Ó·Î·˜ 3). π‰È·›ÙÂÚË ·Ó·ÊÔÚ¿ Ú¤ÂÈ Ó· Á›ÓÂÈ ÛÙÔÓ Î›Ó‰˘ÓÔ ·fi ÙË ¯ÔÚ‹ÁËÛË ÛÎÈ·ÁÚ·ÊÈÎÒÓ Ô˘ÛÈÒÓ ÁÈ·
·ÎÙÈÓÔÏÔÁÈÎfi ¤ÏÂÁ¯Ô Î·È ·fi ÙË ¯ÔÚ‹ÁËÛË ·Ó·ÈÛıËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ ÛÙË ‰È¿ÚÎÂÈ· ¯ÂÈÚÔ˘ÚÁÈ΋˜ ¤̂·Û˘ ‹ ÂÓ‰ÔÛÎfiËÛ˘, Û ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛË. ∫¿ÔÈÔÈ Û˘ÁÁÚ·Ê›˜ ÚÔÙ›ÓÔ˘Ó ÙËÓ ÂÓ‰Ô‰ÂÚÌÈ΋ ‰ÔÎÈÌ·Û›· Ì ÙÔ Ê¿ÚÌ·ÎÔ Ô˘ ÚfiÎÂÈÙ·È Ó· ¯ÔÚËÁËı› ÚÈÓ ·fi ÙË ¯ÂÈÚÔ˘ÚÁÈ΋ ¤̂·ÛË (7). ∏ ¤Ó·ÚÍË ıÂڷ›·˜ Ì ·ÓÙÈÈÛÙ·ÌÈÓÈο ÚÈÓ ·fi ÙËÓ Â¤Ì‚·ÛË Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ (7). ™˘ÌÂÚ·ÛÌ·ÙÈο, Ë Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Â›Ó·È Û¿ÓÈ·, ·È‰È·ÙÚÈ΋ ΢ڛˆ˜, ÓfiÛÔ˜ Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ¿ıÚÔÈÛË ÙˆÓ Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ ÛÙÔ ‰¤ÚÌ·. ™˘¯ÓfiÙÂÚË Â›Ó·È Ë ÎËÏȉԂϷÙȉ҉˘ ÌÔÚÊ‹ ‹ Ë ÌÂÏ·Á¯ÚˆÌ·ÙÈ΋ ÎÓ›‰ˆÛË. ∏ ‰È¿¯˘ÙË ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË, ȉȷ›ÙÂÚ· ¯ˆÚ›˜ ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜, Â›Ó·È ÂÍ·ÈÚÂÙÈο Û¿ÓÈ·. √È ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ ·È‰È·ÙÚÈ΋˜ ¢ª Â›Ó·È ÌË Û˘Ìو̷ÙÈΤ˜, Ì ·˘ÙfiÌ·ÙË ˘Ô¯ÒÚËÛË ÙˆÓ ‚Ï·‚ÒÓ ÚÈÓ ÙËÓ ÂÊ˂›·. °È· ÙË ‰È¿ÁÓˆÛË Ù˘ ÓfiÛÔ˘ ÛÙ· ÌÈÎÚ¿ ·È‰È¿ Ì ‰ÂÚÌ·ÙÈΤ˜ ‚Ï¿‚˜ ·ÚΛ Ë ‚ÈÔ„›· ‰¤ÚÌ·ÙÔ˜. ™Â ÂÚÈÙÒÛÂȘ ÌÂ Û˘ÛÙËÌ·ÙÈ΋ ÚÔÛ‚ÔÏ‹ ‹ ÂÌÊ¿ÓÈÛË ‰ÂÚÌ·ÙÈÎÒÓ ‚Ï·‚ÒÓ ÌÂÙ¿ Ù· 5 ¤ÙË, ··ÈÙÂ›Ù·È ÂÎÙÂÓ¤ÛÙÂÚÔ˜ ¤ÏÂÁ¯Ô˜ ÁÈ· ·ÔÎÏÂÈÛÌfi Ù˘ ™ª.
µÈ‚ÏÈÔÁÚ·Ê›· 1. Valent P, Sperr W, Schwartz L, Horny HP. Diagnosis and classification of mast cell proliferative disorders: delineation from immunologic diseases and non-mast cell hematopoietic neoplasms. J Allergy Clin Immunol 2004; 114:3-11. 2. Valent P. Diagnostic evaluation and classification of mastocytosis. Immunol Allergy Clin N Am 2006;26:515-534. 3. Carter MC, Metcalfe DD. Pediatric mastocytosis. Arch Dis Child 2002;86:315-319. 4. Alto W, Clarcq L. Cutaneous and systemic manifestations of mastocytosis. Am Fam Physician 1999;59:3047-3054, 3059-3060. 5. Surjushe A, Jindal S, Gote P, Saple DG. Darier’s sign. Indian J Dermatol Venereol Leprol 2007;73:363-364. 6. Hartmann K, Bruns BS, Henz MB. Mastocytosis: Review of clinical and experimental aspects. J Investig Dermatol Symp Proc 2001;6:143-147. 7. Brockow K. Urticaria pigmentosa. Immunol Allergy Clin N Am 2004;24:287-316. 8. Ben-Amitai D, Matzker A, Cohen HA. Paediatric cutaneous mastocytosis: A review of 180 patients. Isr Med Assoc J 2005;7:320-322. 9. Kiszewski AE, Duraãn-Mckinster C, Orozco-Covarrubias L, Gutiérrez-Castrellfin P, Ruiz-Maldonado R. Cutaneous mastocytosis in children: a clinical analysis of 71 cases. J Eur Acad Dermatol Venereol 2004;18:285-290. 10. Akoglu G, Erkin G, Cakir B, Boztepe G, Sahin S, Karaduman A, et al. Cutaneous mastocytosis: demographic aspects and clinical features of 55 patients. J Eur Acad Dermatol Venereol 2006;20:969-973. 11. Roy J, Metry DW, Hicks J, Morgan AJ, Heptulla R. An unusual presentation of mastocytosis: Unilateral swelling of the vulva. Pediatr Dermatol 2005;22:554-557. 12. Conrad H, Gausche-Hill M, Burbulys D. A 6-month old ¶·È‰È·ÙÚÈ΋ 2008;71:486-492
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µ. ∞ÁÁÂÏ¿ÎÔ˘ Î·È Û˘Ó.
with total body flushing and a macular-papular lesion. Pediatr Emerg Care 2007;23:321-323. 13. Shaffer HC, Parsons DJ, Peden DB, Morrell D. Recurrent syncope and anaphylaxis as presentation of systemic mastocytosis in a pediatric patient: case report and literature review. J Am Acad Dermatol 2006;54(5 Suppl):S210-213. 14. Brockow K, Jofer C, Behrendt H, Ring J. Anaphylaxis in patients with mastocytosis: a study on history, clinical features and risk factors in 120 patients. Allergy 2008;63: 226-232.
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15. Greenhawt M, Akin C. Mastocytosis and allergy. Curr Opin Allergy Clin Immunol 2007;7:387-392. 16. Heide R, Tank B, Oranje A. Mastocytosis in childhood. Pediatr Dermatol 2002;19:375-381. 17. Valent P, Akin C, Escribano L, Födinger M, Hartmann K, Brockow K, et al. Standards and standardization in mastocytosis: consensus statements on diagnostics, treatment recommendations and response criteria. Eur J Clin Invest 2007;37:435-453.
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∫§π¡π∫√ ∫√Àπ∑
CLINICAL QUIZ
∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
ª. ∫·ÏÏÈÒÚ·, ª. ª·˘Ú›ÎÔ˘ ª. Kalliora, ª. Mavrikou ∞ÁfiÚÈ ËÏÈΛ·˜ 3,5 ÂÙÒÓ ÂÈÛ‹¯ıË ÏfiÁˆ ˘„ËÏÔ‡ ˘ÚÂÙÔ‡ ·fi 24ÒÚÔ˘, ¯ˆÚ›˜ Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù·, Î·È ‰È·ÈÛو̤Ó˘ ·‡ÍËÛ˘ Ù˘ ·ÏηÏÈ΋˜ ʈÛÊ·Ù¿Û˘ (ALP): 3621U/L Û ÂÚÁ·ÛÙËÚÈ·Îfi ¤ÏÂÁ¯Ô. ¶ÚÔ ‰‡Ô ‚‰ÔÌ¿‰ˆÓ ·Ó·Ê¤ÚÂÙ·È Â̇ÚÂÙÔ ‰È¿ÚÎÂÈ·˜ 7 ËÌÂÚÒÓ ÌÂ Û˘ÌÙÒÌ·Ù· ·fi ÙÔ ·ÓÒÙÂÚÔ ·Ó·Ó¢ÛÙÈÎfi. ∂χıÂÚÔ ·ÙÔÌÈÎfi Î·È ÔÈÎÔÁÂÓÂÈ·Îfi ÈÛÙÔÚÈÎfi. ∫·Ù¿ ÙËÓ ÎÏÈÓÈ΋ ÂͤٷÛË, ÏËÓ ˆÙ›Ùȉ·˜ Î·È Ë·ÙÔÛÏËÓÔÌÂÁ·Ï›·˜ ~2 cm, ‰ÂÓ ‰È·ÈÛÙÒıËÎ·Ó ¿ÏÏ· ·ıÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ∂ÚÁ·ÛÙËÚÈ·Îfi˜ ¤ÏÂÁ¯Ô˜: ALP (3381U/L). πÛÔ¤Ó˙˘Ì· ALP: Ë·ÙÈÎfi: L1 = 61,6%, L2 = (-), ÂÓÙÂÚÈÎfi = (-), ÔÛÙÈÎfi = 11,5, µ2 = 26,9%, (Ë ÈÛÔÌÔÚÊ‹ µ2 Â›Ó·È ÔÛÙÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È Â›Ó·È Û˘¯Ófi ‡ÚËÌ· Û ·È‰È¿ Ì ‚·ÚÈ¿ ›ˆÛË). °ÂÓÈ΋ ·›Ì·ÙÔ˜, µ/à ¤ÏÂÁ¯Ô˜, °ÂÓÈ΋ Ô‡ÚˆÓ: Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜.
493
Abs M. pneumoniae (-), Abs CMV (-), Abs Toxoplasma (-), ÂÚËÙÔ˚Ô› (-), ·‰ÂÓÔ˚Ô› (-). Abs (EBV-VCA) IgG (+), (EBV-VCA) IgM (+). ¶·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜: ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜: ª¤ÁÂıÔ˜ ÛÏ‹Ó· ·˘ÍË̤ÓÔ Î·Ù¿ 1,5 cm ÂÚ›Ô˘ (ÂÈÌ‹Î˘ ¿ÍÔÓ·˜ ·˘ÙÔ‡ 10,94 cm). ªÂÚÈÎÔ› ÌÂÛÂÓÙ¤ÚÈÔÈ ÏÂÌÊ·‰¤Ó˜ ~1 cm ÛÙË ‰ÂÍÈ¿ ÎÔÈÏ›·. ¶ÔÚ›·-ŒÎ‚·ÛË: ÃÔÚËÁ‹ıËΠ·ÌÔ͢ÎÈÏÏ›ÓË ÏfiÁˆ ˆÙ›Ùȉ·˜. ∞˘Ú¤ÙËÛ ÙÔ ‰Â‡ÙÂÚo 24ˆÚÔ. ™Ù·‰È·Î¿ ÌÂÈÒıËÎ·Ó ÔÈ ÙÈ̤˜ Ù˘ ALP, ÌÂ Ê˘ÛÈÔÏÔÁÈ΋ ÙÈÌ‹ (220 U/L) Û 2 Ì‹Ó˜.
AÏÏËÏÔÁÚ·Ê›·: ª·Ú›· ∫·ÏÏÈÒÚ· kagoris@in.gr ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ °ÂÓÈÎÔ‡ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·
1st Department of Paediatrics, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece Correspondence: Maria Kalliora kagoris@in.gr 1st Department of Paediatrics, “P. & A. Kyriakou” Children’s Hospital, Athens, Greece
¶Èı·Ó¤˜ ‰È·ÁÓÒÛÂȘ: 1. ∫·ÏÔ‹ı˘ ·ÚÔ‰È΋ ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· 2. ∏·Ù›Ùȉ· 3. ƒ·¯›Ùȉ·
∏ ·¿ÓÙËÛË ÛÙË ÛÂÏ›‰· 500 ¶·È‰È·ÙÚÈ΋ 2008;71:493,500
Ë ÌÂ-
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¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ ∞ÏÏËÏÔÁÚ·Ê›·: ∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘ emmgalan@med.uoc.gr ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘
Department of Paediatrics, University of Crete Correspondence: Emmanouil Galanakis emmgalan@med.uoc.gr Department of Paediatrics, University of Crete
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K·Ù¢ı˘ÓÙ‹ÚȘ ÁÚ·Ì̤˜ 2008 ∂. °·Ï·Ó¿Î˘
Guidelines 2008 E. Galanakis
√‰ËÁ›Â˜ ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÌÂÙ¿‰ÔÛ˘ Ù˘ Ïԛ̈͢ HIV ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ·È‰›. ™ÙÔ Pediatrics ÙÔ˘ ¡ÔÂÌ‚Ú›Ô˘ (2008:122:112734) ·Ú·Ù›ıÂÓÙ·È ÔÈ Ô‰ËÁ›Â˜ (ˆ˜ Policy Statement) Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ (American Academy of Pediatrics, AAP) ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ ÌÂÙ¿‰ÔÛ˘ ÙÔ˘ ÈÔ‡ Ù˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·Ó¿ÚÎÂÈ·˜ ·fi ÙË ÌËÙ¤Ú· ÛÙÔ ·È‰› (ÂÚÈÁÂÓÓËÙÈ΋ ÌÂÙ¿‰ÔÛË ‹ οıÂÙË ÌÂÙ¿‰ÔÛË). √È Ô‰ËÁ›Â˜ Û˘ÓÔ„›˙ÔÓÙ·È ÛÙÔÓ Î·ıÔÏÈÎfi ¤ÏÂÁ¯Ô ÙˆÓ ÂÁ·ˆÓ, ÌÂÙ¿ ·fi ÂÓË̤ڈÛË, Ì›· ‹ Î·È ‰˘Ô ÊÔÚ¤˜ ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ·ËÛ˘, ·ÏÏÈÒ˜ ηٿ ÙÔÓ ÙÔÎÂÙfi ÛÙË ÌËÙ¤Ú· ‹/Î·È ÛÙÔ ÓÂÔÁÓfi (Ì ÌÂıfi‰Ô˘˜ Ù·¯Â›·˜ ·Ó›¯Ó¢Û˘, ·ÔÙÂϤÛÌ·Ù· Û 20-60 min). ÀÂÓı˘Ì›˙ÂÙ·È fiÙÈ Ë ÚÔÏËÙÈ΋ ·ÁˆÁ‹ Ì ·ÓÙÈ-ÚÂÙÚÔ˚ο Û¯‹Ì·Ù· ÚÈÓ, ηٿ Î·È ÌÂÙ¿ ÙÔÓ ÙÔÎÂÙfi Â›Ó·È ÂÍ·ÈÚÂÙÈο ·ÔÙÂÏÂÛÌ·ÙÈ΋ Î·È ¤¯ÂÈ ·ÏÏ¿ÍÂÈ ‰Ú·ÛÙÈο ÙË Ê˘ÛÈ΋ ÔÚ›· Ù˘ οıÂÙ˘ ÌÂÙ¿‰ÔÛ˘. √ÌÔ›ˆ˜ ˘ÂÓı˘Ì›˙ÂÙ·È fiÙÈ Ë Ïԛ̈ÍË Ù˘ ÌËÙ¤Ú·˜ ·fi HIV ·ÔÙÂÏ› ·ÓÙ¤Ó‰ÂÈÍË ıËÏ·ÛÌÔ‡. √È ¤ÁÎ˘Â˜ Î·È Ï¯ˆ›‰Â˜ ‰È·ÙËÚÔ‡Ó ‚¤‚·È· ÙÔ ‰Èη›ˆÌ· Ù˘ ÂÓËÌÂڈ̤Ó˘ ¿ÚÓËÛ˘ ÛÙÔÓ ¤ÏÂÁ¯Ô HIV, ˆÛÙfiÛÔ Ê·›ÓÂÙ·È Ó· ·Ú·ÌÂÚ›˙ÂÙ·È ÛÙ·‰È·Î¿ Ë ‰˘ÛΛÓËÙË ÚÔ¸fiıÂÛË Ù˘ ÂÓËÌÂڈ̤Ó˘ ¤ÁÁÚ·Ê˘ Û˘Ó·›ÓÂÛ˘. ™Â ¿ÏÏË Û‡ÛÙ·ÛË (Statement) ÙÔ˘ ∞ÌÂÚÈηÓÈÎÔ‡ ∫ÔÏÂÁ›Ô˘ π·ÙÚÒÓ (American College of Physicians, ACP), ÚÔ‰ËÌÔÛÈÂ˘Ì¤ÓË ÛÙÔ Annals of Internal Medicine (30 ¡ÔÂÌ‚Ú›Ô˘ 2008), ÚÔÙ›ÓÂÙ·È Ì¿ÏÈÛÙ· ¤ÏÂÁ¯Ô˜ ÚÔ˘Ù›Ó·˜ Û fiÏÔ˘˜ ÙÔ˘˜ ·ÛıÂÓ›˜ 13-64 ÂÙÒÓ (¿Ú· Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜) Ô˘ οÓÔ˘Ó È·ÙÚÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· ¿ÏÏÔ ÏfiÁÔ.
√‰ËÁ›Â˜ ÁÈ· ÙË ¯ÔÚ‹ÁËÛË ‚ÈÙ·Ì›Ó˘ D Û ‚Ú¤ÊË, ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ™ÙÔ ›‰ÈÔ Ù‡¯Ô˜ ÙÔ˘ Pediatrics (¡Ô¤Ì‚ÚÈÔ˜ 2008:122:1142-52), ·Ú·Ù›ıÂÓÙ·È ÔÈ Ô‰ËÁ›Â˜ (ˆ˜ Clinical Report) Ù˘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ (American Academy of Pediatrics, AAP) ÁÈ· ÙËÓ ÚfiÏË„Ë Ù˘ Ú·¯›Ùȉ·˜. ™‡Ìʈӷ Ì ÙȘ Ô‰ËÁ›Â˜ ·˘Ù¤˜, Û ÂÚÈÙÒÛÂȘ ·Ó·ÚÎÔ‡˜ Ï‹„˘ ‚ÈÙ·Ì›Ó˘ D Ì ÙËÓ ÙÚÔÊ‹ Î·È ÌÂȈ̤Ó˘ ¤ÎıÂÛ˘ ÛÙÔ ËÏÈ·Îfi ʈ˜, Ú¤ÂÈ Ó· ÂÍ·ÛÊ·Ï›˙ÂÙ·È Ë ÂÏ¿¯ÈÛÙË ÔÛfiÙËÙ· ÙˆÓ 400 IU ‚ÈÙ·Ì›Ó˘ D ËÌÂÚËÛ›ˆ˜ Û fiÏ· Ù· ‚Ú¤ÊË, ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. π‰È·›ÙÂÚË ¤ÌÊ·ÛË ‰›‰ÂÙ·È ÛÙ· ıËÏ¿˙ÔÓÙ· ‚Ú¤ÊË ‹‰Ë ·fi ÙȘ ÚÒÙ˜ Ë̤Ú˜ Ù˘ ˙ˆ‹˜ Î·È ÛÙÔ˘˜ ÂÊ‹‚Ô˘˜ Ô˘ ‰ÂÓ ÙÚ¤ÊÔÓÙ·È ÛˆÛÙ¿. ∏ ÙÚ¤¯Ô˘Û· Û‡ÛÙ·ÛË ·˘Í¿ÓÂÈ ÙËÓ ÂÏ¿¯ÈÛÙË ËÌÂÚ‹ÛÈ· ÚfiÛÏË„Ë ·fi 200 IU Û 400 IU. √È Ô‰ËÁ›Â˜ ˘ÂÓı˘Ì›˙Ô˘Ó fiÙÈ ÔÏϤ˜ ÚfiÛÊ·Ù˜ ÌÂϤÙ˜ ˘Ô‰ÂÈÎÓ‡Ô˘Ó Â˘ÂÚÁÂÙÈ΋ ‰Ú¿ÛË Ù˘ ‚ÈÙ·Ì›Ó˘ D ÛÙËÓ ·ÔÙÂÏÂÛÌ·ÙÈ΋ ÂÁÁÂÓ‹ ·ÓÔÛ›·, ηıÒ˜ Î·È Î·Ù¿ ÙÔ˘ ‰È·‚‹ÙË Î·È ÙÔ˘ ηÚΛÓÔ˘. ∆Ô Pediatrics ›¯Â ÊÈÏÔÍÂÓ‹ÛÂÈ Ôχ ÚfiÛÊ·Ù· Î·È Û˘ÛÙ¿ÛÂȘ ÁÈ· ÙËÓ ·Ó¿ÚÎÂÈ· Ù˘ ‚ÈÙ·Ì›Ó˘ D Û ·È‰È¿ ·fi ÙË Drug and Therapeutics Committee of the Lawson Wilkins Pediatric Endocrine Society, ∏¶∞ (Pediatrics 2008;122:398-417). √‰ËÁ›Â˜ ÁÈ· ÙË Ê˘ÛÈ΋ ¿ÛÎËÛË ÙˆÓ ·È‰ÈÒÓ Û ËÏÂÎÙÚÔÓÈ΋ ‰ËÌÔÛ›Â˘ÛË ÛÙÔÓ ‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ Department of Health and Human Services ÙˆÓ ∏¶∞ (http://www.health.gov/ paguidelines/default.aspx, 8 √ÎÙˆ‚Ú›Ô˘ 2008). √È Ô‰ËÁ›Â˜ Â›Ó·È ÏÂÙÔÌÂÚ›˜ Î·È ·ÊÔÚÔ‡Ó
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PAEDIATRIC NEWS IN BRIEF fiϘ ÙȘ ËÏÈ˘ ¿Óˆ ÙˆÓ 6 ÂÙÒÓ Î·È ·Â˘ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ Û ·ÁÁÂÏ̷ٛ˜ ˘Á›·˜, ·ÏÏ¿ Î·È ÛÙÔ Â˘Ú‡ ÎÔÈÓfi. °È· Ù· ·È‰È¿ Î·È ÙÔ˘˜ ÂÊ‹‚Ô˘˜, ÔÈ Ô‰ËÁ›Â˜ Û˘ÓÔ„›˙ÔÓÙ·È Û ÙÔ˘Ï¿¯ÈÛÙÔÓ 1 ÒÚ· ۈ̷ÙÈ΋˜ ¿ÛÎËÛ˘ ËÌÂÚËÛ›ˆ˜ (Ë ¿ÛÎËÛË Ó· Â›Ó·È Î·Ù¿ÏÏËÏË ÁÈ· ÙËÓ ËÏÈΛ·, ¢¯¿ÚÈÛÙË Î·È Ó· ¤¯ÂÈ ÔÈÎÈÏ›·), Ì ¤ÌÊ·ÛË ÛÙËÓ ·ÂÚfi‚È· ¿ÛÎËÛË Î·È Û ÙÔ˘Ï¿¯ÈÛÙÔÓ ÙÚȘ ‚‰ÔÌ·‰È·›ˆ˜ ÈÔ ¤ÓÙÔÓË ¿ÛÎËÛË ÁÈ· ÙËÓ ÂÓ‰˘Ó¿ÌˆÛË ÙÔ˘ Ì˘ÔÛÎÂÏÂÙÈÎÔ‡. ∏ ‚ÚÂÊÈ΋ ıÓËÛÈÌfiÙËÙ· ÛÙËÓ ∂ÏÏ¿‰· Î·È ·ÏÏ·¯Ô‡. ∂ӉȷʤÚÔÓÙ· Û˘ÁÎÚÈÙÈο ÛÙÔȯ›· ÁÈ· ÙË ‚ÚÂÊÈ΋ ıÓËÛÈÌfiÙËÙ· Û ÔÏϤ˜ ¯ÒÚ˜ ·ÁÎÔÛÌ›ˆ˜ ·ÚÔ˘ÛÈ¿ÛıËÎ·Ó ÚfiÛÊ·Ù· ·fi ÙÔ CDC (Centers for Disease Control and Prevention) ÙˆÓ ∏¶∞ (ÈÛÙÔÛÂÏ›‰· http://www.cdc.gov/nchs/data/ databriefs/db09.htm, ‚Ï Î·È http//www.medscape. com/viewarticle/582117). ¶ÚÒÙ˜ ÛÙËÓ Ù·ÍÈÓfi-
495
ÌËÛË ¤Ú¯ÔÓÙ·È Ë ™ÈÁηԇÚË, ÙÔ ÃÔÓÁÎ-∫ÔÓÁÎ Î·È Ë π·ˆÓ›· (2,0-2,8 ı¿Ó·ÙÔÈ ‚ÚÂÊÒÓ ·Ó¿ 1000 ˙ÒÓÙ· ÓÂÔÁÓ¿). ∏ ∂ÏÏ¿‰·, Ì 4,1 ı·Ó¿ÙÔ˘˜ ‚ÚÂÊÒÓ ·Ó¿ 1000 ˙ÒÓÙ· ÓÂÔÁÓ¿, ʤÚÂÙ·È ÈÔ Î¿Ùˆ ·fi ¯ÒÚ˜ Ì ·Ú·‰ÔÛȷο ¯·ÌËÏ‹ ıÓËÛÈÌfiÙËÙ·, fiˆ˜ ÔÈ ÛηӉÈÓ·‚ÈΤ˜ (™Ô˘Ë‰›· 3,1, ¡ÔÚ‚ËÁ›· 3,2, ºÈÓÏ·Ó‰›· 3,3), ·ÏÏ¿ ÈÛÔ‚·ıÌ› Ì ÙË °ÂÚÌ·Ó›·, ÙËÓ πÙ·Ï›· Î·È ÙËÓ √ÏÏ·Ó‰›· Î·È ÚÔËÁÂ›Ù·È Ù˘ ∞˘ÛÙÚ·Ï›·˜ Î·È ÙÔ˘ πÛÚ·‹Ï (4,5), Ù˘ ∞ÁÁÏ›·˜ Î·È √˘·Ï›·˜ (5,0) ÙÔ˘ ∫·Ó·‰¿ (5,3) Î·È ÙˆÓ ∏¶∞ (6,9). ∆· ÛÙÔȯ›· ·˘Ù¿ ‚·Û›˙ÔÓÙ·È Û ‰Â‰Ô̤ӷ ÙÔ˘ 2004 Î·È ÙÔÓ›˙ÂÙ·È fiÙÈ ·ÏÏ·Á¤˜ ·Ú·ÙËÚÔ‡ÓÙ·È ¯ÚfiÓÔ Ì ÙÔ ¯ÚfiÓÔ. ¶ÂÚÈÛÛfiÙÂÚ· Û˘ÁÎÚÈÙÈο Î·È ‰È·¯ÚÔÓÈο ‰Â‰Ô̤ӷ ·Ú¤¯ÔÓÙ·È ·fi Ù· ∏ӈ̤ӷ ŒıÓË Û ÂΉfiÛÂȘ fiˆ˜ Ë ËÏÂÎÙÚÔÓÈ΋ http://www.un.org/esa/population/ publications/wpp2006/WPP2006_Highlights_ rev.pdf.
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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√
NEWS FROM THE INTERNET
πÛÙÔÛÂÏ›‰Â˜ ÁÂÓÂÙÈ΋˜ ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, ∞ı‹Ó·
∂. °È·ÓÓ¿ÙÔ˘, ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË
AÏÏËÏÔÁÚ·Ê›·: ™ÔÊ›· ∫›ÙÛÈÔ˘-∆˙¤ÏË skitsiou@med.uoa.gr ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”, £Ë‚ÒÓ Î·È §Â‚·‰Â›·˜, 11527 ∞ı‹Ó·
E. Giannatou, S. Kitsiou-Tzeli
Department of Medical Genetics, Medical School, University of Athens, “Aghia Sofia” Children’s Hospital, Athens, Greece Correspondence: Sophia Kitsiou-Tzeli skitsiou@med.uoa.gr Department of Medical Genetics, Medical School, University of Athens, “Aghia Sofia” Children’s Hospital, Thivon & Levadias St., 11257 Athens, Greece
Paediatriki 2008;71:496-499
Genetics Sites
∏ ÈÛÙÔÛÂÏ›‰· Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ∞ÓıÚÒÔ˘ - http://www.eshg.org ∏ ÈÛÙÔÛÂÏ›‰· www.eshg.org ·ÔÙÂÏ› ÙÔÓ Â›ÛËÌÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ∞ÓıÚÒÔ˘. π‰Ú‡ıËΠÙÔ 1967 Î·È ¤¯ÂÈ ¤‰Ú· ÙÔ µ¤ÏÁÈÔ. ™Ùfi¯Ô˜ Ù˘ ∂Ù·ÈÚ›·˜ Â›Ó·È Ë ÚÔÒıËÛË Ù˘ ‚·ÛÈ΋˜ Î·È ÎÏÈÓÈ΋˜ ¤Ú¢ӷ˜ ÛÙÔ Â‰›Ô Ù˘ È·ÙÚÈ΋˜ ÁÂÓÂÙÈ΋˜ Î·È Ë ‰È¢ÎfiÏ˘ÓÛË Ù˘ ÂÈÎÔÈÓˆÓ›·˜ ÌÂٷ͇ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ. ∏ ∂Ù·ÈÚ›· ‰›ÓÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ÂÓı¿ÚÚ˘ÓÛË Ó¤ˆÓ ÂÈÛÙËÌfiÓˆÓ Î·È ÛÙË ÌÂÙ¿‰ÔÛË Ù˘ Ù¯ÓÔÁÓˆÛ›·˜ Û ı¤Ì·Ù· ·ÚÔ¯‹˜ ÁÂÓÂÙÈÎÒÓ È·ÙÚÈÎÒÓ ˘ËÚÂÛÈÒÓ ÛÙȘ ·Ó·Ù˘ÛÛfiÌÂÓ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜. ™ÙȘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Ù˘ ∂Ù·ÈÚ›·˜ ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È Ë ÔÚÁ¿ÓˆÛË ÙÔ˘ ÂÙ‹ÛÈÔ˘ European Human Genetics Conference Î·È Ë ¤Î‰ÔÛË ÙÔ˘ ·Ó·ÁÓˆÚÈṲ̂ÓÔ˘ ·ÚÔ˘˜ ÂÚÈÔ‰ÈÎÔ‡ European Journal of Human Genetics. ™ÙËÓ Î·ÙËÁÔÚ›· “ª·ı‹Ì·Ù·” (ESHG Courses) ·Ú¤¯ÔÓÙ·È ÂÈϤÔÓ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÂÎ·È‰Â˘ÙÈο ÛÂÌÈÓ¿ÚÈ· Ô˘ ‰ÈÔÚÁ·ÓÒÓÂÈ Ë ∂Ù·ÈÚ›· Û ‰È¿ÊÔÚ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ Î·È ·ÊÔÚÔ‡Ó ÛÙË ªÔÚȷ΋ °ÂÓÂÙÈ΋, ∫ÏÈÓÈ΋ °ÂÓÂÙÈ΋, °ÂÓÂÙÈ΋ ÙÔ˘ ∫·ÚΛÓÔ˘, ∫˘ÙÙ·ÚÔÁÂÓÂÙÈ΋, °ÂÓÂÙÈ΋ ™˘Ì‚Ô˘Ï¢ÙÈ΋, ¢˘ÛÌÔÚÊÔÏÔÁ›·, µÈÔÏËÚÔÊÔÚÈ΋ Î·È ™Ù·ÙÈÛÙÈ΋ °ÂÓÂÙÈ΋. ™ÙËÓ Î·ÙËÁÔÚ›· “™˘Ó¤‰ÚÈ·” Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙÔ ÂÙ‹ÛÈÔ Û˘Ó¤‰ÚÈÔ Ù˘ ∂Ù·ÈÚ›·˜, Ì ÂÚÈÏ‹„ÂȘ ÙˆÓ ·Ó·ÎÔÈÓÒÛˆÓ-‰È·Ï¤ÍˆÓ, fiˆ˜ Î·È ÛÂ Û˘Ó¤‰ÚÈ· ÚÔËÁÔ‡ÌÂÓˆÓ ÂÙÒÓ. ™ÙËÓ Î·ÙËÁÔÚ›· “¶ÏËÚÔÊÔڛ˜ ÁÈ· ∞ÛıÂÓ›˜” (Patient Information) ÌÔÚ› ηÓ›˜ Ó· ‚ÚÂÈ ÂÓËÌÂÚˆÙÈο Ê˘ÏÏ¿‰È· ¯Ú‹ÛÈÌ· ÁÈ· ·ÛıÂÓ›˜, ÔÈÎÔÁ¤ÓÂȘ, ·ÏÏ¿ Î·È ÁÈ·ÙÚÔ‡˜, Ô˘ ‰›ÓÔ˘Ó ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ٷ ÁÂÓÂÙÈο ÙÂÛÙ, ÙËÓ ·ÌÓÈԷڷΤÓÙËÛË, ÙË Ï‹„Ë ÙÚÔÊÔ‚Ï¿ÛÙ˘, ÙÔ˘˜ ÙÚfiÔ˘˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î.¿. √È ÏËÚÔÊÔڛ˜ ·˘Ù¤˜ ¤¯Ô˘Ó ÛÙfi¯Ô Ó· ·Ó·‰Â›ÍÔ˘Ó ÙȘ ÂÈÛÙËÌÔÓÈΤ˜, ·ÏÏ¿ Î·È ÙȘ ÎÔÈÓˆÓÈΤ˜ Î·È „˘¯ÔÏÔÁÈΤ˜ ‰È·ÛÙ¿ÛÂȘ Ù˘ ÁÂÓÂÙÈ΋˜ Î·È ÙˆÓ ÁÂÓÂÙÈÎÒÓ ·Ó·Ï‡ÛˆÓ. ∆· Ê˘ÏÏ¿‰È· Ì ÙȘ ·Ú·¿Óˆ ÏËÚÔÊÔڛ˜ Â›Ó·È ‰È·ı¤ÛÈÌ· ̤ۈ ÙÔ˘ www.eurogentest.org/patients, Û ÌÔÚÊ‹ Ô˘ ÌÔÚÔ‡Ó Ó· ÂÎÙ˘ˆıÔ‡Ó Î·È Ó· ‰ÔıÔ‡Ó ÛÙÔ˘˜ ·ÛıÂÓ›˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Î·ÙËÁÔÚ›· “∞Ó·ÎÔÈÓÒÛÂȘ ∆‡Ô˘” (Press Releases), fiÔ˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÂÈÏÂÁ̤ӷ ı¤Ì·Ù· °ÂÓÂÙÈ΋˜, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ·, ·fi ÙÔ ÊÂÙÈÓfi ÂÙ‹ÛÈÔ Û˘Ó¤‰ÚÈÔ Ù˘ ∂Ù·ÈÚ›·˜, ÙÔ ı¤Ì·: “√È ÚÔÁÂÓÓËÙÈÎÔ› ‚ÈÔ¯ËÌÈÎÔ› ‰Â›ÎÙ˜ ÂÓÙÔ›˙Ô˘Ó ÙȘ ÌÈÛ¤˜ ÌfiÓÔ ·fi ÙȘ ¯ÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜, ÁÂÁÔÓfi˜ Ô˘ ı· Ú¤ÂÈ Ó· ÏËÚÔÊÔÚÔ‡ÓÙ·È ÔÈ Á˘Ó·›Î˜ ÚÈÓ ˘Ô‚ÏËıÔ‡Ó Û’ ·˘ÙÔ‡˜”, Î.¿. ™ÙËÓ Î·ÙËÁÔÚ›· “¶›Ó·Î·˜ ∞Ó·ÎÔÈÓÒÛˆӔ (Notice µoard) ·Ú¤¯ÔÓÙ·È ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ Û¯ÂÙÈο Ì ÌÂÙ·Ù˘¯È·Î¿ ÚÔÁÚ¿ÌÌ·Ù· Î·È ˘ÔÙÚÔʛ˜ Û ‰È¿ÊÔÚ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ ÁÈ· Ó¤Ô˘˜ ÂÈÛÙ‹ÌÔÓ˜.
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∏ πÛÙÔÛÂÏ›‰· ÙÔ˘ ∞ÌÂÚÈηÓÈÎÔ‡ ∫ÔÏÂÁ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ - http://www.acmg.net ∏ ÈÛÙÔÛÂÏ›‰· www.acmg.net ·ÔÙÂÏ› ÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ ∞ÌÂÚÈηÓÈÎÔ‡ ∫ÔÏÂÁ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜. ∆Ô ∫ÔϤÁÈÔ È‰Ú‡ıËΠÙÔ 1991 Î·È ÛÙfi¯Ô ÙÔ˘ ¤¯ÂÈ ÙË ‰È¿ÁÓˆÛË, ·ÓÙÈÌÂÙÒÈÛË Î·È ÚfiÏË„Ë ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ, ÚÔˆıÒÓÙ·˜ ÙËÓ ·Ó¿Ù˘ÍË Î·È ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ˘ËÚÂÛÈÒÓ Ù˘ ÁÂÓÂÙÈ΋˜. ™ÙËÓ ÚÔÛ¿ıÂÈ¿ ÙÔ˘ ·˘Ù‹, ̤ÏË ÙÔ˘ ∫ÔÏÂÁ›Ô˘ -ÎÏÈÓÈÎÔ› Î·È ÌÔÚÈ·ÎÔ› ÁÂÓÂÙÈÛÙ¤˜, ΢ÙÙ·ÚÔÁÂÓÂÙÈÛÙ¤˜, ÁÂÓÂÙÈÎÔ› Û‡Ì‚Ô˘ÏÔÈ Î·È ‚ÈÔ¯ËÌÈÎÔ›- ·Ú¤¯Ô˘Ó ˘ËÚÂۛ˜ ÂÈÛÙËÌÔÓÈ΋˜ ÂÓË̤ڈÛ˘ Î·È ÚÔÙ¿ÛÂȘ Âη›‰Â˘Û˘ ÁÈ· fiÛÔ˘˜ È·ÙÚÔ‡˜ ¿ÏÏÔ˘˜ ÂȉÈÎÔÙ‹ÙˆÓ ‹ ¿ÏÏÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ ÂÈı˘ÌÔ‡Ó Ó· ·Û¯ÔÏËıÔ‡Ó Ì ÙË ÁÂÓÂÙÈ΋. ™ÙËÓ ÎÂÓÙÚÈ΋ ÛÂÏ›‰· Î·È ÛÙË ÛÙ‹ÏË “∞Ó·ÎÔÈÓÒÛÂȘ” (Spotlight), ÁÈ· ÙÔ ¤ÙÔ˜ 2008 ˘¿Ú¯Ô˘Ó Û‡ÓÙÔ̘ Î·È Û·Ê›˜ Ô‰ËÁ›Â˜ ÁÈ· ÙÔÓ ÙÚfiÔ ‰È·¯Â›ÚÈÛ˘ ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÂÍÂÙ¿ÛˆÓ, Ì ‚¿ÛË ÙȘ ÚÔ¸Ôı¤ÛÂȘ Ô˘ ıˆÚÔ‡ÓÙ·È ·fi ÙÔ ∫ÔϤÁÈÔ ˆ˜ ÂÏ¿¯ÈÛÙ˜ ÚÔ··ÈÙÔ‡ÌÂÓ˜ ÁÈ· ÔÔÈÔ‰‹ÔÙ ڈÙfiÎÔÏÏÔ ÁÂÓÂÙÈÎÔ‡ ÂϤÁ¯Ô˘. ™ÙËÓ Î·ÙËÁÔÚ›· “¢ËÌÔÛȇÛÂȘ” ÌÔÚ› ηÓ›˜ Ó· ‚ÚÂÈ ¤Ó·Ó Ú·ÎÙÈÎfi Ô‰ËÁfi Û¯ÂÙÈο Ì ÙȘ ÁÂÓÂÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· Ù· Û˘¯ÓfiÙÂÚ· ÁÂÓÂÙÈο ÓÔÛ‹Ì·Ù·, fiˆ˜ Â›Ó·È ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ‡ıÚ·˘ÛÙÔ˘ Ã-¯ÚˆÌÔÛÒÌ·ÙÔ˜ Î·È Ë ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, ·ÏÏ¿ Î·È Ô‰ËÁ›Â˜ ÁÈ· ÓÔÛ‹Ì·Ù· Ô˘ ¯ÚÂÈ¿˙ÔÓÙ·È ÁÂÓÂÙÈ΋ ÂÎÙ›ÌËÛË ‹ Û˘Ì‚Ô˘Ï¢ÙÈ΋. ∂›Û˘, ÛÙËÓ ›‰È· ηÙËÁÔÚ›· ‚Ú›ÛÎÂÙ·È Î·È ÙÔ Â›ÛËÌÔ ÂÚÈÔ‰ÈÎfi ÙÔ˘ ∫ÔÏÂÁ›Ô˘, ÙÔ Genetics in Medicine. ™Ùfi¯Ô˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ Â›Ó·È Ë ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÂÈÙ¢ÁÌ¿ÙˆÓ Ù˘ ÁÂÓÂÙÈ΋˜ ÛÙËÓ È·ÙÚÈ΋ Ú·ÎÙÈ΋.
∏ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ March of Dimes - http://www.marchofdimes.com ∏ ÈÛÙÔÛÂÏ›‰· www.marchofdimes.com ·ÔÙÂÏ› ÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ ÔÚÁ·ÓÈÛÌÔ‡ March of Dimes, Ô˘ ȉڇıËΠÙÔ 1938. ∞ÔÛÙÔÏ‹ ÙÔ˘ ÔÚÁ·ÓÈÛÌÔ‡ Â›Ó·È Ë ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙˆÓ ‚ÚÂÊÒÓ Ì ÙËÓ ÚfiÏË„Ë ÙˆÓ Û˘ÁÁÂÓÒÓ ·ÓˆÌ·ÏÈÒÓ, Ù˘ ÚÔˆÚfiÙËÙ·˜ Î·È Ù˘ ÂÚÈÁÂÓÓËÙÈ΋˜ ıÓËÛÈÌfiÙËÙ·˜, ̤ۈ Ù˘ ¤Ú¢ӷ˜, Ù˘ ÚÔÒıËÛ˘ Ù˘ ÔÚÁ¿ÓˆÛ˘ ÎÔÈÓˆÓÈÎÒÓ ˘ËÚÂÛÈÒÓ Î·È Ù˘ Âη›‰Â˘Û˘. ™ÙËÓ Î·ÙËÁÔÚ›· “∂Á΢ÌÔÛ‡ÓË Î·È ¡ÂÔÁÓfi” (Pregnancy & Newborn) Î·È ÛÙËÓ ˘ÔηÙËÁÔÚ›· “°ÂÓÂÙÈ΋ Î·È Û˘ÁÁÂÓ›˜ ·ÓˆÌ·Ï›Â˜” ·Ú¤¯ÔÓÙ·È ¯Ú‹ÛÈ̘ ÏËÚÔÊÔڛ˜ ÁÈ· ·ÛıÂÓ›˜, ÔÈÎÔÁ¤ÓÂȘ, ·ÏÏ¿ Î·È ÁÈ·ÙÚÔ‡˜, ÁÈ· Ù· Û˘¯ÓfiÙÂÚ· ÁÂÓÂÙÈο ÓÔÛ‹Ì·Ù· Î·È Û‡Ó‰ÚÔÌ·. ™ÙËÓ ›‰È· ÛÂÏ›‰· Î·È ÛÙËÓ ˘ÔηÙËÁÔÚ›· “°ÂÓÂÙÈ΋ ™˘Ì‚Ô˘Ï¢ÙÈ΋” ·Ó·Ï‡ÂÙ·È Ë ÛËÌ·Û›· Ù˘ ÂÍÂȉÈÎÂ˘Ì¤Ó˘ °ÂÓÂÙÈ΋˜ ™˘Ì‚Ô˘Ï¢ÙÈ΋˜ ·fi ÂȉÈÎfi ÁÂÓÂÙÈÛÙ‹, ηıÒ˜ Î·È Ë ‰È·‰Èηۛ· Ù˘ ÌÂıfi‰Ô˘. ¶ÂÚÈÁÚ¿ÊÂÙ·È Ô ÚfiÏÔ˜ Ù˘ °ÂÓÂÙÈ΋˜ ™˘Ì‚Ô˘Ï¢ÙÈ΋˜ ÁÈ· ÙËÓ ÂÓË̤ڈÛË ·ÙfiÌˆÓ Î·È ÔÈÎÔÁÂÓÂÈÒÓ, ηıÒ˜ Î·È ÁÈ· ÙË ‰È¢ÎfiÏ˘ÓÛË ÛÙË Ï‹„Ë ÙˆÓ ÚÔÛˆÈÎÒÓ ÙÔ˘˜ ·ÔÊ¿ÛÂˆÓ ˆ˜ ÚÔ˜ ÙËÓ ÂÁ΢ÌÔÛ‡ÓË, ÙË ÊÚÔÓÙ›‰· ·È‰ÈÒÓ Î·È ÙË ‰˘Ó·ÙfiÙËÙ· ¶·È‰È·ÙÚÈ΋ 2008;71:496-499
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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ ÁÂÓÂÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∆¤ÏÔ˜, ··ÓÙÒÓÙ·È ÂÚˆÙ‹Ì·Ù· fiˆ˜ “Û ÔÈÔ˘˜ ·Â˘ı‡ÓÂÙ·È Ë °ÂÓÂÙÈ΋ ™˘Ì‚Ô˘Ï¢ÙÈ΋», «ÙÈ ı· ·ÍÈÔÏÔÁËı› ηٿ ÙË ‰È¿ÚÎÂÈ· Ù˘ ÂͤٷÛ˘ ·fi ÙÔÓ ÎÏÈÓÈÎfi ÁÂÓÂÙÈÛÙ‹”, Î.¿.
∏ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ ∂˘Úˆ·˚ÎÔ‡ ∫·Ù·ÏfiÁÔ˘ ÙˆÓ DNA-¢È·ÁÓˆÛÙÈÎÒÓ ∂ÚÁ·ÛÙËÚ›ˆÓ http://www.eddnal.com ∏ ÈÛÙÔÛÂÏ›‰· www.eddnal.com ·ÔÙÂÏ› ÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ ∂˘Úˆ·˚ÎÔ‡ ∫·Ù·ÏfiÁÔ˘ ÙˆÓ DNA-¢È·ÁÓˆÛÙÈÎÒÓ ∂ÚÁ·ÛÙËÚ›ˆÓ (European Directory of DNA Diagnostic Laboratories, EDDNAL). O EDDNAL ·ÔÙÂÏ› ÌË ÎÂÚ‰ÔÛÎÔÈÎfi ÔÚÁ·ÓÈÛÌfi, ¯ÚËÌ·ÙÔ‰ÔÙÔ‡ÌÂÓÔ ·fi ÙËÓ ∂˘Úˆ·˚΋ ∂ÈÙÚÔ‹. ø˜ ·ÔÛÙÔÏ‹ ¤¯ÂÈ ÙË ‰È¿‰ÔÛË ÏËÚÔÊÔÚÈÒÓ ÌÂٷ͇ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ Ô˘ ·Û¯ÔÏÔ‡ÓÙ·È Ì ÙËÓ È·ÙÚÈ΋ ÁÂÓÂÙÈ΋, Û¯ÂÙÈο Ì ÙË ‰È·ıÂÛÈÌfiÙËÙ· ÙˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ·Ó·Ï‡ÛÂˆÓ Ô˘ ‚·Û›˙ÔÓÙ·È ÛÙÔ DNA ÁÈ· Û¿ÓÈ· ÁÂÓÂÙÈο ÓÔÛ‹Ì·Ù· ÛÙËÓ ∂˘ÚÒË. ¶ÚÔÛ¿ıÂÈ· ÙÔ˘ EDDNAL Â›Ó·È Ë ÚÔÒıËÛË ÁÂÓÂÙÈÎÒÓ ÙÂÛÙ ˘„ËÏÒÓ ÚԉȷÁÚ·ÊÒÓ, ηıÒ˜ Î·È Ë ‰È¢ÎfiÏ˘ÓÛË ÙˆÓ ÂÚ¢ÓËÙÒÓ ÛÙËÓ ·Ó¿Ù˘ÍË Ó¤ˆÓ ‰È·ÁÓˆÛÙÈÎÒÓ ÌÂıfi‰ˆÓ. ¶·Ú¤¯ÔÓÙ·È ÏËÚÔÊÔڛ˜ ÁÈ· ÂÚÁ·ÛÙ‹ÚÈ· ‰È·ÁÓˆÛÙÈÎÒÓ ‹/Î·È ÂÚ¢ÓËÙÈÎÒÓ ˘ËÚÂÛÈÒÓ Ô˘ ‚Ú›ÛÎÔÓÙ·È Û ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘. ª¤Û· ·fi ÙȘ ˘ÔηÙËÁÔڛ˜ Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ·Ú¤¯ÔÓÙ·È ÂȉÈΤ˜ ÏËÚÔÊÔڛ˜ ÁÈ· Ù· ΤÓÙÚ· (˘Â‡ı˘ÓÔ˜ ΤÓÙÚÔ˘ Û οı ¯ÒÚ·, Ì ÛÙÔȯ›· ÂÈÎÔÈÓˆÓ›·˜), ·ÏÏ¿ Î·È Û˘Ó‰¤ÛÂȘ Ì ÈÛÙÔÛÂÏ›‰Â˜ ¿ÏÏˆÓ ‰È·‰ÈÎÙ˘·ÎÒÓ ÙfiˆÓ, Û¯ÂÙÈΤ˜ Ì DNA ‰È·ÁÓˆÛÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ. ∏ ÛËÌ·Û›· Ù˘ ÈÛÙÔÛÂÏ›‰·˜ ÁÈ· ÙÔÓ ·ÛÎÔ‡ÓÙ· ·È‰›·ÙÚÔ Â›Ó·È Ôχ ÛËÌ·ÓÙÈ΋, ηıÒ˜ ÔÈ ÌÔÚȷΤ˜ ÂÍÂÙ¿ÛÂȘ ¤¯Ô˘Ó ÂÈÛ·¯ı› ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú·ÎÙÈ΋. ∂›Ó·È ‚·ÛÈÎfi ÁÈ· ÙÔÓ ·È‰›·ÙÚÔ Ó· ¤¯ÂÈ Û¯ËÌ·Ù›ÛÂÈ ÌÈ· ·Ú¯È΋ ÚÔÛˆÈ΋ ÁÓÒÛË ÚÈÓ ·Â˘ı˘Óı› ÛÙÔÓ ÂȉÈÎfi ÁÂÓÂÙÈÛÙ‹, Ô ÔÔ›Ô˜ ı· ÙÔÓ Î·Ù¢ı‡ÓÂÈ ·ÛʷϤÛÙÂÚ·.
∏ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ http://iatriki-genetiki.med.uoa.gr ∏ ÈÛÙÔÛÂÏ›‰· http://iatriki-genetiki.med.uoa.gr ·ÔÙÂÏ› ÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, Ô˘ ¤¯ÂÈ ¤‰Ú· ÙÔ ÃˆÚ¤ÌÂÈÔ ∂Ú¢ÓËÙÈÎfi ∂ÚÁ·ÛÙ‹ÚÈÔ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “∞Á›· ™ÔÊ›·”. §ÂÈÙÔ˘ÚÁ› ·fi ÙÔ 1999 ˆ˜ ·ÓÂÍ¿ÚÙËÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. ∞ÔÙÂÏ› ΤÓÙÚÔ ·Ó·ÊÔÚ¿˜ ÁÈ· fiÏÔ ÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ, ÁÈ· ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË, ·ÓÙÈÌÂÙÒÈÛË Î·È ÚfiÏË„Ë ÙˆÓ ÁÂÓÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ™ÙËÓ Î·ÙËÁÔÚ›· “∂Ú¢ÓËÙÈΤ˜ ¢Ú·ÛÙËÚÈfiÙËÙ˜” Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙËÓ ÂÙ‹ÛÈ· ËÌÂÚ›‰· Ô˘ ‰ÈÔÚÁ·ÓÒÓÂÙ·È ·fi ÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜, ˘fi ÙËÓ ·ÈÁ›‰· Ù˘ π·ÙÚÈ΋˜ ™¯ÔÏ‹˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. ™ÙËÓ ›‰È· ηÙËÁÔÚ›· ÌÔÚ› οı ÂӉȷÊÂÚfiÌÂÓÔ˜ Ó· ‚ÚÂÈ ÙȘ ÂÚÈÏ‹„ÂȘ Ù˘ ËÌÂÚ›‰·˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Î·ÙËÁÔÚ›· “ÀËÚÂۛ˜”, fiÔ˘ Ô ÂÈÛΤÙ˘ ÌÔÚ› Ó· ‚ÚÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔ˘˜ ÂȉÈÎÔ‡˜ ÁÂÓÂÙÈÎÔ‡˜ ÂϤÁ¯Ô˘˜ Ô˘ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ, fiˆ˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜, ÌÔÚÈ·Îfi˜ ΢ÙÙ·ÚÔÁÂÓÂÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È ÌÔÚȷ΋ ·Ó¿Ï˘ÛË ÌÔÓÔÁÔÓȉȷÎÒÓ ÓÔÛËÌ¿ÙˆÓ (ÌÂÛÔÁÂȷ΋ ·Ó·ÈÌ›·, ÈÓÔ΢ÛÙÈ΋ ÓfiÛÔ˜, ÓfiÛÔ˜ Wilson, Ì˘˚Τ˜ ‰˘ÛÙÚÔʛ˜, Paediatriki 2008;71:496-499
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Ì˘˚΋ ‰˘ÛÙÚÔÊ›· Duchenne / Becker, ÚÔÛˆÔˆÌÔ‚Ú·¯ÈfiÓÈÔ˜ Ì˘˚΋ ‰˘ÛÙÚÔÊ›·, ÓˆÙÈ·›· Ì˘˚΋ ·ÙÚÔÊ›·, Û‡Ó‰ÚÔÌ· Prader Willi & Angelman, Û‡Ó‰ÚÔÌÔ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ ‡ıÚ·˘ÛÙÔ˘ Ã, ¤ÏÂÁ¯Ô˜ ÌÈÎÚÔÂÏÏÂÈÌÌ¿ÙˆÓ ¯ÚˆÌÔÛÒÌ·ÙÔ˜ À), ηıÒ˜ Î·È Û·Ê‹ ÂÚÈÁÚ·Ê‹ ÙˆÓ Û¯ÂÙÈÎÒÓ ÁÂÓÂÙÈÎÒÓ ÓÔÛËÌ¿ÙˆÓ. ™ÙËÓ ›‰È· ηÙËÁÔÚ›· Î·È ÛÙËÓ ˘ÔηÙËÁÔÚ›· “∂͈ÙÂÚÈο π·ÙÚ›·” Á›ÓÂÙ·È ·Ó·ÊÔÚ¿ ÛÙ· ÂÍÂȉÈÎÂ˘Ì¤Ó· π·ÙÚ›· °ÂÓÂÙÈ΋˜ Ô˘ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÛÙÔÓ ¯ÒÚÔ ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘, fiˆ˜ Â›Ó·È Ù· π·ÙÚ›· °ÂÓÂÙÈ΋˜ ™˘Ì‚Ô˘Ï¢ÙÈ΋˜, ∫ÏÈÓÈ΋˜ °ÂÓÂÙÈ΋˜ Î·È ™˘Ì‚Ô˘Ï¢ÙÈ΋˜ ∫‡ËÛ˘, ‰›ÓÔÓÙ·˜ ¯Ú‹ÛÈ̘ ηÙ¢ı‡ÓÛÂȘ Û ÂӉȷÊÂÚfiÌÂÓÔ˘˜ ÁÈ·ÙÚÔ‡˜, ·ÏÏ¿ Î·È Û ·ÛıÂÓ›˜ ‹ ÔÈÎÔÁ¤ÓÂȘ Ì ÁÂÓÂÙÈÎfi ÓfiÛËÌ·. ™ÙËÓ Î·ÙËÁÔÚ›· “¢ËÌÔÛȇÛÂȘ” Ô ·È‰›·ÙÚÔ˜ ÌÔÚ› Ó· ÂÓËÌÂÚˆı› ÂÚÈÛÛfiÙÂÚÔ ÁÈ· ÓÔÛ‹Ì·Ù· Ô˘ ¤¯Ô˘Ó ÌÂÏÂÙËı› ȉȷ›ÙÂÚ· Î·È ¤¯Ô˘Ó ‰ËÌÔÛÈ¢ı› Û ¤ÁÎÚÈÙ· È·ÙÚÈο ÂÚÈÔ‰Èο. ∏ ÈÛÙÔÛÂÏ›‰· ·˘Ù‹ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙȘ ‰˘Ó·ÙfiÙËÙ˜ ÂÊ·ÚÌÔÁ‹˜ ÛÙËÓ Î·ıËÌÂÚÈÓ‹ Ú¿ÍË ÙˆÓ ÂÍÂÏ›ÍÂˆÓ ÛÙË ÁÂÓÂÙÈ΋ ÛÙË ¯ÒÚ· Ì·˜ Î·È ·ÔÙÂÏ› ¯Ú‹ÛÈÌÔ ÂÚÁ·ÏÂ›Ô ÛÙËÓ ÂÓË̤ڈÛË ÙÔ˘ ·È‰È¿ÙÚÔ˘ ÁÈ· ÙËÓ Î·Ï‡ÙÂÚË Â͢ËÚ¤ÙËÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜.
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∫§π¡π∫√ ∫√Àπ∑ ∞¶∞¡∆∏™∏ ¢È¿ÁÓˆÛË: ∫·ÏÔ‹ı˘ ·ÚÔ‰È΋ ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›·
∏ ALP Â›Ó·È ¤Ó·˜ ¢·›ÛıËÙÔ˜ ‰Â›ÎÙ˘ Ë·ÙÈ΋˜ ‹ ÔÛÙÈ΋˜ ‚Ï¿‚˘ ÛÙ· ·È‰È¿ Î·È ÙÔ˘˜ ÂÓ‹ÏÈΘ. ™Ù· ·È‰È¿ ¤¯ÂÈ ·Ó·ÊÂÚı› ÌÈ· ηٿÛÙ·ÛË Ô˘ ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÚÔ‰È΋ ·ÏÏ¿ ÛËÌ·ÓÙÈ΋ ·‡ÍËÛË Ù˘ ALP, Ì ·Ô˘Û›· ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Î·È ÎÏÈÓÈÎÒÓ Â˘ÚËÌ¿ÙˆÓ Ë·ÙÈ΋˜ ‹ ÔÛÙÈ΋˜ ÓfiÛÔ˘. ∏ ηٿÛÙ·ÛË ·˘Ù‹ ÂÚÈÁÚ¿ÊÂÙ·È ˆ˜ ηÏÔ‹ı˘ ·ÚÔ‰È΋ ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· Ù˘ ‚ÚÂÊÈ΋˜ Î·È ·È‰È΋˜ ËÏÈΛ·˜. ∆· ÎÚÈÙ‹ÚÈ· ‰È¿ÁÓˆÛ˘, Û‡Ìʈӷ Ì ÙÔ˘˜ Kraut et al., (1985) ›ӷÈ: 1. ∏ÏÈΛ· ÌÈÎÚfiÙÂÚË ÙˆÓ 5 ÂÙÒÓ 2. ¶ÔÈÎÈÏ›· ÎÏÈÓÈÎÒÓ Û˘ÌÙˆÌ¿ÙˆÓ 3. ∞Ô˘Û›· ÎÏÈÓÈÎÒÓ Î·È ÂÚÁ·ÛÙËÚÈ·ÎÒÓ Â˘ÚËÌ¿ÙˆÓ ÔÛÙÈ΋˜ ‹ Ë·ÙÈ΋˜ ÓfiÛÔ˘ 4. ∞‡ÍËÛË ·ÌÊÔÙ¤ÚˆÓ ÙˆÓ ÈÛÔÂÓ˙‡ÌˆÓ (Ë·ÙÈÎfi Î·È ÔÛÙÈÎfi) ALP 5. º˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ALP ÂÓÙfi˜ 4 ÌËÓÒÓ (1,2). √ ·ÛıÂÓ‹˜ Ì·˜ ‰ÂÓ Â›¯Â ÎÏÈÓÈο Î·È ÂÚÁ·ÛÙËÚȷο Â˘Ú‹Ì·Ù· Ë·ÙÈ΋˜ ‹ ÔÛÙÈ΋˜ ‚Ï¿‚˘. √ Ë·ÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ ‹Ù·Ó Ê˘ÛÈÔÏÔÁÈÎfi˜. ¶·Ú·ıÔÚÌfiÓË, ‚ÈÙ·Ì›ÓË D, ·ÎÙÈÓÔÁÚ·Ê›· Ì·ÎÚÒÓ ÔÛÙÒÓ: Ê˘ÛÈÔÏÔÁÈο Â˘Ú‹Ì·Ù·. ¶ÚÔËÁ‹ıËΠÏԛ̈ÍË ·fi Èfi Epstein Barr Î·È Â›¯Â Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ ALP Û 2 Ì‹Ó˜ (3). ∏ ·ÈÙÈÔÏÔÁ›· Ù˘ ηÏÔ‹ıÔ˘˜ ·ÚÔ‰È΋˜ ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›·˜ ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙË. £ÂˆÚÂ›Ù·È fiÙÈ ÔÈ ÈÔ›, fiˆ˜ ·‰ÂÓÔ˚Ô›, Áڛ˘, ÚÔÙ·˚Ô›, ÂÚËÙÔ˚Ô›, ÂÚ˘ıÚ¿˜, ÈÏ·Ú¿˜, Epstein Barr Î·È echo ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ. ∂›Û˘, ¿ÏϘ ÏÔÈÌÒÍÂȘ, fiˆ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ Î·È ·Ó·Ó¢ÛÙÈÎÔ‡, Èı·ÓfiÓ Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ Î·Ù¿ÛÙ·ÛË ·˘Ù‹ (2,3,4). ∏ ·ıÔÁ¤ÓÂÈ· Ù˘ ηÏÔ‹ıÔ˘˜ ·ÚÔ‰È΋˜ ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›·˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋. ¢È¿ÊÔÚÔÈ Ì˯·ÓÈÛÌÔ› ¤¯Ô˘Ó ÂÓÔ¯ÔÔÈËı›, fiˆ˜ ·‡ÍËÛË Ù˘ ALP ÏfiÁˆ Ù˘
Paediatriki 2008;71:493,500
Û˘ÛÛÒÚ¢Û˘ ÙˆÓ ÌÂÙ·‚ÔÏÈÙÒÓ Ù˘ ‚ÈÙ·Ì›Ó˘ D (25-OH D3), ÌÂȈ̤ÓË Î¿ı·ÚÛË Ù˘ ALP ·fi ÙÔ Ï¿ÛÌ·, Èı·ÓfiÓ ÏfiÁˆ ÈÔÁÂÓÔ‡˜ Ïԛ̈͢ ‹ ˘ÂÚ‚ÔÏÈ΋˜ Û˘ÛÛÒÚ¢Û˘ ÛÈ·ÏÈÎÒÓ ÔͤˆÓ ÙÔ˘ Ë·ÙÈÎÔ‡ ÈÛÔÂÓ˙‡ÌÔ˘ (3,5). ∏ ηÏÔ‹ı˘ ·ÚÔ‰È΋ ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· Ù›ÓÂÈ Ó· ¤¯ÂÈ ÌÈ· Âԯȷ΋ ηٷÓÔÌ‹, ΢ڛˆ˜ ÙÔ ÊıÈÓfiˆÚÔ Î·È ÙÔÓ ¯ÂÈÌÒÓ·, ÂÔ¯¤˜ ηٿ ÙȘ Ôԛ˜ ÔÈ ÈÒÛÂȘ Â›Ó·È ÈÔ Û˘¯Ó¤˜ (6). ∏ ηÏÔ‹ı˘ ·ÚÔ‰È΋ ˘ÂÚʈÛÊ·Ù·Û·ÈÌ›· ı· Ú¤ÂÈ Ó· Ï·Ì‚¿ÓÂÙ·È ˘’ fi„Ë ·Ú¯Èο ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË Ù˘ ·‡ÍËÛ˘ ALP ¯ˆÚ›˜ ÂÌÊ·Ó‹ ·ÈÙ›· Û ·È‰È¿ <5 ÂÙÒÓ, ÒÛÙ ӷ ·ÔʇÁÂÙ·È Ô ÂÎÙÂٷ̤ÓÔ˜ ¤ÏÂÁ¯Ô˜, Î·È Ó· ÂȂ‚·ÈÒÓÂÙ·È ·ÚÁfiÙÂÚ· Ì ÙȘ Ê˘ÛÈÔÏÔÁÈΤ˜ ÙÈ̤˜ Ù˘ ALP Û 2-4 Ì‹Ó˜ (1).
µÈ‚ÏÈÔÁÚ·Ê›· 1. Carroll, AJ, Coakley JC. Transient hyperphosphatasaemia: an important condition to recognize. J Paediatr Child Health 2001;37:359-362. 2. Stein P, Rosalki SB, Foo AY, Hjelm M. Transient hyperphosphatasemia of infancy and early childhood: clinical and biochemical features of 21 cases and literature review. Clin Chem 1987;33:313-318. 3. Eboriadou M, Skouli G, Panagopoulou P, Haidopoulou K, Makedou A, Varlamis G. Acute laryngotracheobronchitis and associated transient hyperphosphatasemia: a new case of transient hyperphosphatasemia in early childhood. J Paediatr Child Health 2006;42:149-150. 4. Suzuki M, Okazaki T, Nagai T, Töro~ K, Sétonyi P. Viral infection of infants and children with benign transient hyperphosphatasemia. FEMS Immunol Med Microbiol 2002;33:215-218. 5. Crofton PM. What is the cause of benign transient hyperphosphatasemia? A study of 35 cases. Clin Chem 1988;34:335-340. 6. Behúlovaã D, Bzdúch V, Holesovaã D, Vasilenkovaã A, Ponec J. Transient hyperphosphatasemia of infancy and childhood: study of 194 cases. Clin Chem 2000;46:1868-1869.
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∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÛÙÔÓ ÙfiÌÔ 71 ÙÔ˘ ¤ÙÔ˘˜ 2008 ∞ı·Ó·Û¤Ï˘ ™ˆÙ‹Ú˘ ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡ÏÔ˘ º·Ó‹ ∞Ó‰Ú¤Ô˘ ∞ϤͷӉÚÔ˜ ∞Ó‰ÚÔÓ›ÎÔ˘ ™Ù˘ÏÈ·Ó‹ ∞ÙÙÈÏ¿ÎÔ˜ ∞¯ÈÏϤ·˜ µ·˙·›Ô˘ ∞Ó‰ÚÈ·Ó‹ µ¿Ô˜ °ÂÒÚÁÈÔ˜ µ·Ú‚·Ú‹ÁÔ˘-ºÚ›Ì· ∞Ó·ÛÙ·Û›· µÏ·¯Ô··‰ÔÔ‡ÏÔ˘ ∂Ï›‰· µÔ‡‰Ú˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ °·Ï·Ó¿Î˘ ∂ÌÌ·ÓÔ˘‹Ï °·ÚÔ‡ÊË-∫Ô‡ÙÛ· ∞Ó·ÛÙ·Û›· °ÂˆÚÁ·ÎfiÔ˘ÏÔ˜ ¢ËÌ‹ÙÚÈÔ˜ °ÂˆÚÁÔ‡ÏË ∂ϤÓË °È·ÓÓ·ÎÔ‡ÏÈ· ª·›ÚË ¢ÂÏËÁÂÒÚÔÁÏÔ˘ ∂˘ı‡ÌÈÔ˜ ¢È·Ì·ÓÙ‹ ∂ÏÈÛ¿‚ÂÙ ¢ÚfiÛÔ˘-∞Á·Î›‰Ô˘ µ·ÛÈÏÈ΋ ∑·ÊÂÈÚ›Ô˘ ¢ËÌ‹ÙÚÈÔ˜ £ˆÌ·˚‰Ô˘ ¢¿ÊÓË-§ˆÚ¤Ù· ∫·Ó·Î¿-Gantenbein ÃÚÈÛÙ›Ó· ∫·Ó¿ÚÈÔ˘ ª·Ú›· ∫·ÛÛÈÔ‡-¶ÚÔ‡ÓÙ˙Ô˘ ∫˘Úȷ΋ ∫·Ù˙ËÏ¿Î˘ ¡ÈÎfiÏ·Ô˜ ∫·ÙÛ·ÚÔ‡-¶ÂÎÙ·Û›‰Ë ∂˘ÛÙ·ı›· ∫·ÙÙ¿Ì˘ ∞ÓÙÒÓ˘ ∫·Ê¿ÙÔ˜ ∞ÓÙÒÓ˘ ∫·ÊÚ›ÙÛ· ¶·Ó·ÁÈÒÙ· ∫›ÙÛÈÔ˘-∆˙¤ÏË ™ÔÊ›· ∫ÔÏ·˚Ù˘ °ÂÚ¿ÛÈÌÔ˜ ∫ÔÏÏÈfi˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ∫fiÛÛ˘‚· §˘‰›· ∫ÚÈÙÛ¤ÏË ∂ϤÓË ∫ÒÛÙ·ÏÔ˜ ÃÚ‹ÛÙÔ˜ ∫ˆÛÙ·Ú›‰Ô˘ ™Ù·˘ÚԇϷ ª·Ï·Ì›ÙÛË-¶Ô‡¯ÓÂÚ ∞ÚÈ¿‰ÓË ª·ÓÙ·‰¿Î˘ ∂ÏȉÔÊfiÚÔ˜ ª·ÛÙÚÔÁÈ¿ÓÓË ƒ›Ù· ªÔÛ¯fi‚Ë ª·Ú›· ª¿Î· ª·ÚÁ·Ú›Ù· ªÈÙÛÒÚË ª·Ú›· ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘ ¡ÈÎfiÏ·Ô˜
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∂˘ÚÂÙ‹ÚÈÔ Û˘ÁÁڷʤˆÓ ÙÔ˘ ∆fiÌÔ˘ 71 Akbulut T. Antoniadou I. Attilakos A. Augoustides-Savvopoulou P. Baka M. Bouhoutsou D. Castellsagué X. Del Torso S. Diamante E. Doganis D. Douladiris N. Drossou-Agakidou V. EDIG consortium Florakis D. Fuentes-Lugo D. Hadjipanyidis A. Ioannou H.P. Kallergi C. Katsarou E. Kosmidis S. Kotsis V. Lang H. Mastroyianni S. Nadalin S. Nicholson A.J. Nunez D.A. Park F. Ponce-Rivera M. Pourtsidis A. Prassouli A. Radtke A. Sarafidou J. Saxoni-Papageorgiou F. Skardoutsou A. Sotiropoulos G.C. Stabouli S. Synodinou M. Trimis G. Tsampoura Z. Van Esso D. Varvoutsi M. Vasilatou-Kosmidis H. Voudris K. ∞ÁÁÂÏ¿ÎÔ˘ µ. ∞ÁÁÂÏÔÔ‡ÏÔ˘ ƒ. ∞˚‚¿˙Ë ¢. ∞˚‚¿˙˘ µ. ∞ÏÂÍ·Ó‰Ú¿ÙÔ˜ Ã. ∞Ó·ÁÓˆÛÙ¿ÙÔ˘ ¡. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ª.µ. ∞ÓÙ¿ÚË µ. Paediatriki 2008;71:502-504
177 210 210 291 296 296 345 92 291 296 296 291 383 345 96 92 291 296 210 296 186 87 210 87 92 162 177 96 296 210 87 210 296 210 87 186 296 345 291 92 296 296 210 49, 54, 317, 486 271 219 219 301 403 231 135
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∂Àƒ∂∆∏ƒπ√ ™À°°ƒ∞º∂ø¡ ∫·ÏÌ·ÓÙ‹ ª. ∫·Ó·‚¿Î˘ ∂. ∫¿ÓÙ˙ÈÔ˘ ∫. ∫·Ú·ÁÈ¿ÓÓË ¶. ∫·Ú·ı¿ÓÔ˜ µ. ∫·Ú·Ì·ÍfiÁÏÔ˘ ¢. ∫·Ú·Ó¿ÛÈÔ˘ ∫. ∫·Úfi΢ ∞. ∫·ÙÛ·Ú¿Î˘ π. ∫·Ê¿ÙÔ˜ ∞. ∫·ÊÂÙ˙‹˜ ¢. ∫›ÙÛÈÔ˜ ∫. ∫›ÙÛÈÔ˘-∆˙¤ÏË ™. ∫Ï·‰›ÙÔ˘ ª. ∫Ô˚Ó¿ÎË ™. ∫fiÎÔÚË ∂. ∫ÔÏ·˝Ù˘ °. ∫ÔÏȷϤÍË ∞. ∫ÔÓÙÔÁÈ¿ÓÓË ª. ∫ÔÓÙfiÔ˘ÏÔ˜ ∂. ∫ÔڷοÎË ∂. ∫ÔÚÌ¿˜ °. ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿Î˘ °. ∫Ô‡ÚÙ˘ ∞. ∫Ô‡ÛÙ· ∂. ∫Ô˘ÙÏ‹ ª. ∫Ô˘ÙÛ·˘Ù›ÎË Ã. ∫ÚÈÙÛ¤ÏË ∂. ∫˘ÚÈfiÔ˘ÏÔ˜ °. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ A. ∫ˆÓÛÙ·ÓÙÔ˘Ï¿ÎË ∂. ∫ÒÛÙ· ∫. ∫ˆÛÙ¿ÎÔ˘ ∫. ∫ÒÛÙ·ÏÔ˜ Ã. §·‚Ú¿ÓÔ˜ °. §¿ÁÁ·ÚË µ. §Â‚ÂÓÙfiÔ˘ÏÔ˜ °. §ÈÓ·Ú‰¿Î˘ ª. §Ô˘›˙Ô˘ ∞. ª·ÁηӿÚË º. ª·Î¤‰Ô˘ ∫. ª¿Î˘ ∞. ª·Ï·ıÚ¿ÎË ª. ª·ÓÔ˘Ú¿ ∞. ª·ÓÔ˘Û¿Î˘ ∂. ª¿ÓÙ˙ÈÔ˘ ∂. ª·ÓÙÔ‡‰Ë˜ ™. ª·ÓÒÏ· ∞. ª¿ÚÁ·ÚË ∞. ª·ÚÁ¿ÚË ª.∫. ª·ÚΤ·˜ ¡. ª·ÛÙÚÔÁÈ¿ÓÓË ™. ª·˘Ú›Î· ¶. ª·˘Ú›ÎÔ˘ ª.
403 224, 383 141 18 475 301 376 148 60 24, 70, 157 37, 441 128 224, 235, 255, 383, 497 60 361 49, 54, 192, 317 383 255 361 42 238 441 331 215 123 486 247 441 148 441 441 128 383 64, 116 271 383 224 24 441 361 215 390, 399 60 238 486 247 458 399 469 238 323 311 469 493
503
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Pediatri Nov-Dec 08 new
504
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16:31
™ÂÏ›‰·504
∂Àƒ∂∆∏ƒπ√ ™À°°ƒ∞º∂ø¡ ™·‚‚›‰Ô˘ ∞. ™·˚Ù¿Î˘ ∂. ™·ÎÂÏÏ¿Ú˘ °. ™·Ï·‚Ô‡Ú· ∫. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ º. ™·Ú·ÓÙÔÔ‡ÏÔ˘ ∞ÈÎ. ™·Úȉ¿Î˘ π. ™·ÚÚ‹ ∫. ™ËÊÈ·ÓÔ‡ ¶. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. ™È¯ÏÈÌ›ÚË ¶. ™ÎÈ·‰¿˜ ∫. ™Ô˘Ì¿ÎË ∂. ™ËÏÈÔÔ‡ÏÔ˘ £. ™‡ÚÔÁÏÔ˘ ∫. ™Ù·Ì·Ù¿ÎË ∞. ™ÙÂÊ·Ó¿ÎË ™. ™ÙÂÊ·Ó›‰Ë˜ ∫. ™ÙÚ›ÓÙ˙˘ ¡. ™ÙÚÔ˘Ì‹ ∂. ™ˆÊÚÔÓ¿ ™. ∆·‚Ï·‰¿ÎË £. ∆·ÎÔ‡‰·˜ ¢. ∆·¿ÎË °. ∆·ÛÈÔÔ‡ÏÔ˘ µ. ∆˙ËÙËÚ›‰Ô˘ ª. ∆˙›ÓË ∂. ∆˙ÈÊ‹ º. ∆˙Ô‡ÊË ª. ∆ÔÎ̷Λ‰Ë˜ ™.
Paediatriki 2008;71:502-504
238 238 355 255 37, 486 301 60 24 165 201, 399 201 165 383 441 141 317 304 75, 173, 311, 327 383 475 361 60 141 243 376 42 469 255 201 368
∆Ô˘ÓÈÛÛ›‰Ô˘ ¢. ∆Ô‡ÛÔ˘Ï˘ ¢. ∆Û·Ô‡ÛË Ã. ∆ÛÈ¿ÓÙ˘ π. ∆ÛÈ¿ÓÙÔ˘ µ. ∆ÛÈ¿ÙÛÈÔ˘ √. ∆ÛÈÏÈÌÈÁοÎË ∞. ∆ÛÈÔ‡Ú˘ π. ∆Û›ÙÛÈη ∞. ∆ÛfiÏ·˜ °. ∆ÛÔÏÈ¿ ª. ∆ÛÔ˘Ì¿Î·˜ ∫. º·ÚÌ¿ÎË ∞-∂. ºÈÏÈÔÔ‡ÏÔ˘ ∞. ºÈÏ›Ô˘ √. ºÏ¤‚· ∞. ºÔ‡ÓÙ˙ËÏ· Œ. ºÚ¤ÛÎÔ˘ ∞. ºÚ˘Û›Ú· Œ. ºˆÙ›Ô˘ ∫. ÷ÏÈ¿ÛÔ˜ ¡. ÷ڛÛ˘ °. ÷ڈӛÙË π. ÷Ù˙Ë·ı·Ó·Û›Ô˘ Ã. ÷Ù˙ˉ¿ÎË ∂. ÛÙÔÁÏÔ˘ ∞. ÃÚÈÛÙÈ·Ó¿Î˘ ∂.π. ÃÚÈÛÙÔÁÈÒÚÁÔ˜ ™. ÃÚÈÛÙfi‰Ô˘ÏÔ˜ ∞. æÒÓË ™.
441 368 399 383 148 301 304 128 441, 500 482 37 449 361 441 376 135 219 441 224 165 390, 399 355 54, 486 123, 317 238 215 243 383 368 224
Pediatri Nov-Dec 08 new
19-12-08
16:31
™ÂÏ›‰·505
∂Àƒ∂∆∏ƒπ√ §∂•∂ø¡-∫§∂π¢πø¡
505
∂˘ÚÂÙ‹ÚÈÔ Ï¤ÍˆÓ-ÎÏÂȉÈÒÓ ÙÔ˘ ∆fiÌÔ˘ 71 AIS Amino acids Behavioural problems Biliary atresia Blood pressure Cellular Childhood obesity Childhood overweight Children CIN 2/3 CMV Ïԛ̈ÍË EBV Enteral feeding tolerance Epidemiology Essential hypertension FGFR3 Gene therapy Genetic disease Genital warts Growth reference Growth standard Gs ÚˆÙ½ÓË Gs· ÌÂÙ·ÏÏ¿ÍÂȘ HPV Human papilloma virus 11 Human papilloma virus 6 Humoral Idiopathic generalized epilepsy Immunity Larynx Left ventricular mass index Liver failure Liver insufficiency Liver transplantation Living donor liver transplantation Lymphoma Management NADP-·Ó·ÁˆÁ¿ÛË Paediatric transplant programme Paediatrics Papilloma Parenteral nutrition Plasma citrulline PRES Preterm neonates Prevention Quadrivalent vaccine Recovery Small intestine Split liver Split techniques
345 291 210 87 186 296 92, 96 96 210 345 135 135 291 92 186 49 177 177 345 96 96 317 317 345 162 162 296 210 296 162 186 87 87 87 87 296 92 192 87 177 162 291 291 311 291 92 345 296 291 87 87
VaIN 2/3 VIN 2/3 Viral vectors Voice disorders Well-controlled seizures
345 345 177 162 210
A ∞ã ∆∂™∆ 458 ∞ÁˆÁ‹ ˘Á›·˜ 469 ∞‰Ú·ÓÔÔ›ËÛË ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à 271 ∞ÂÚÈÛÌfi˜ 18 ∞ıÏËÙÈÛÌfi˜ 417 ∞ÈÌÔÛÊ·ÈÚ›ÓË 192 ∞ÎÚÔÔÛı›· 355 ∞Ó¿Ù˘ÍË 157 ∞ÓÂÌ¢ÏÔÁÈ¿ 148 ∞Ó¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ 123 ∞Ó¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12 54 ∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ 135 ∞ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ 18 ∞ÓÙÈÌÂÙÒÈÛË 235 ∞ÓÙÈÌÂÙÒÈÛË ·¯˘Û·ÚΛ·˜ 376 ∞ÓÙÈÚÔÛˆÂ˘ÙÈÎfi ÂıÓÈÎfi ‰Â›ÁÌ· 70 ∞ÓÙÈÛÙ¿ıÌÈÛË ‰fiÛ˘ 271 ∞ÓÙ›¯ÂÈÚ·˜ 482 ∞ÔÎÏÂÈÛÙÈο ¯ÔÚÙÔÊ¿ÁÔÈ 54 ∞ÚÁÈÓ›ÓË 116 ∞Ú¯·›· ÈÛÙÔÚ›· Ù˘ È·ÙÚÈ΋˜ 283 ÕÙ˘Ë Ïԛ̈ÍË 37 ∞˘ÍËÙÈ΋ ÔÚÌfiÓË 49, 123, 128 B µÚ¤ÊË µÚԢΤÏψÛË ° °¿Ï·Ù· ˘„ËÏ‹˜ ‰È·ÙÚÔÊÈ΋˜ ·Í›·˜ °·ÛÙÚÂÓÙÂÚ›Ùȉ· °ÂÓÂÙÈ΋ °ÂÓÂÙÈ΋ ηıÔ‰‹ÁËÛË °ÂÓÂÙÈ΋ Û˘Ì‚Ô˘Ï¢ÙÈ΋ °ÏÔ˘Ù·Ì›ÓË °ÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ ¢ ¢¿ÎÙ˘ÏÔ ¢¿ÛηÏÔÈ ¢Â›ÎÙ˘ Ì¿˙·˜ ÛÒÌ·ÙÔ˜ ¢Â›ÎÙ˘ ˘ÁÈÂÈÓ‹˜ ‰È·ÙÚÔÊ‹˜ ¢ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ¢È·‰Èηۛ· ·fiÊ·Û˘
54, 331 399
116 301 1, 105 1 235 116 426
482 219 368 24 486 383 ¶·È‰È·ÙÚÈ΋ 2008;71:505-507
Pediatri Nov-Dec 08 new
506
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∂Àƒ∂∆∏ƒπ√ §∂•∂ø¡-∫§∂π¢πø¡ ¢È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ 434 ¢È·‰›ÎÙ˘Ô 441, 449 ¢È·˙¿ÌË 42 ¢È·ÙÚÔÊ‹ 24, 54, 361 ¢È·ÙÚÔÊ‹ ‚Ú¤ÊÔ˘˜ 116 ¢È·ÙÚÔÊ‹ ·È‰ÈÒÓ 157 ¢È¿¯˘ÙË ‰ÂÚÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË 486 ¢ÈÂÚ‡ÓËÛË 201 ¢ÈfiÁΈÛË 390 ¢ÈÛÎÔÂȉ‹˜ ·ÙÂÏÂÎÙ·Û›· 60 ¢È-˘ÔÎÂÈÌÂÓÈÎfi˜ ÓÔ˘˜ 331 ¢ª™ 376 ¢˘Û·Ó¿ÏÔÁÔ ÎÔÓÙfi ·Ó¿ÛÙËÌ· 49 ∂ “∂ıÈÛÌfi˜” ÛÙÔ ‰È·‰›ÎÙ˘Ô ∂ÏÏËÓÈ΋ ·ÁÔÚ¿ ∂Ì‚fiÏÈ· ŒÌ‚Ú˘· ∂Ó·ÏÏ·ÎÙÈΤ˜ ıÂڷ›˜ ∂ÓÙÂÚÔ¿ıÂÈ· ∂ÈÛ‹Ì·ÓÛË ∂ÙÈΤÙ˜ ∂Ê˂›· ŒÊË‚ÔÈ ŒÊË‚Ô˜
Paediatriki 2008;71:505-507
441 475 148 331 355 64 475 475 434, 441 361 60
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Pediatri Nov-Dec 08 new
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∂Àƒ∂∆∏ƒπ√ §∂•∂ø¡-∫§∂π¢πø¡
507
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301
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17 π·ÓÔ˘·Ú›Ô˘ 2009
æ˘¯È΋ ·ÓıÂÎÙÈÎfiÙËÙ· ÛÙËÓ ·È‰È΋ & ÂÊË‚È΋ ËÏÈΛ· ¶ÏËÚÔÊÔڛ˜: Era Ltd ∆ËÏ.: 210-3634944 Fax: 210-3631690 E-mail: info@era.gr
∂ıÓÈÎfi ÿ‰Ú˘Ì· ∂Ú¢ÓÒÓ, ∞ı‹Ó·
19 π·ÓÔ˘·Ú›Ô˘ 2009
19Ë ∂ÈÛÙËÌÔÓÈ΋ ∏ÌÂÚ›‰· Ì ı¤Ì·: ∂›Î·ÈÚ· £¤Ì·Ù· ÛÙËÓ ¶·È‰È·ÙÚÈ΋ √ÚÁ¿ÓˆÛË: º. ∞ı·Ó·ÛÈ¿‰Ô˘ ¶ÏËÚÔÊÔڛ˜: Global Events TËÏ.: 2310-247743, 4 Fax: 2310-247746 E-mail: info@globalevents.gr Website: www.globalevents.gr
•ÂÓÔ‰Ô¯Â›Ô “Makedonia Palace”, £ÂÛÛ·ÏÔÓ›ÎË
28-30 π·ÓÔ˘·Ú›Ô˘ 2009
35th British Paediatric Neurology Association Annual Conference National Motorcycle Museum, Solihull ¶ÏËÚÔÊÔڛ˜: BPNA Secretariat, Bridge House, Harrow Road, Bolton, BL1 4NH ∆ËÏ.: 01204 492888 Fax: 01204 493003 E-mail: info@bpna.org.uk Website: www.bpna.org.uk/2009/
Birmingham, England, UK
20-22 ª·ÚÙ›Ô˘ 2009
2Ô ∂ÓÙ·ÙÈÎfi ™ÂÌÈÓ¿ÚÈÔ ÛÙËÓ ∂ÊË‚È΋ π·ÙÚÈ΋ •ÂÓÔ‰Ô¯Â›Ô N.J.V. ATHENS PLAZA, ™‡ÓÙ·ÁÌ· √ÚÁ¿ÓˆÛË: ªÔÓ¿‰· ∂ÊË‚È΋˜ ÀÁ›·˜ (ª.∂.À.), µã ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡» ¶ÏËÚÔÊÔڛ˜: °Ú·ÌÌ·Ù›· Ù˘ ª.∂.À., ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ «¶. & ∞. ∫˘ÚÈ·ÎÔ‡», ªÂÛÔÁ›ˆÓ 24, °Ô˘‰‹, ∆.∫. 115 27 TËÏ.: 210-7710824, 213-2009806 E-mail: info@youth-health.gr Website: www.youth-health.gr
∞ı‹Ó·
3-5 ∞ÚÈÏ›Ô˘ 2009
1Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ °ÓˆÛÈ·ÎÒÓ ™˘ÌÂÚÈÊÔÚÈÛÙÈÎÒÓ ¶ÚÔÛÂÁÁ›ÛÂˆÓ Û ¶·È‰È¿ Î·È ∂Ê‹‚Ô˘˜ √ÚÁ¿ÓˆÛË: ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ŒÚ¢ӷ˜ Ù˘ ™˘ÌÂÚÈÊÔÚ¿˜ ¶ÏËÚÔÊÔڛ˜: Ibis El Greco ∞.∂., Î. ª·Ú›· §Â‚¤ÓÙË ∆ËÏ.: 2810-301711 Fax: 2810-301689, 301683 E-mail: mleventi@ibiselgreco.gr Website: www.childCBTconf2009.gr, www.ibiselgreco.com
÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ, ∞ı‹Ó·
15-17 ∞ÚÈÏ›Ô˘ 2009
European Surgical Institute: Minimally Invasive Techniques in Paediatric Surgery ¶ÏËÚÔÊÔڛ˜: European Surgical Institute ∆ËÏ.: 49-0-4-052-973-200 Fax: 49-0-4-052-973-209 E-mail: info@esi-online.de
Norderstedt, Germany
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20-24 ∞ÚÈÏ›Ô˘ 2009
Annual Course of the European Society for Pediatric Neurosurgery Corfu Chandris Hotel ¶ÏËÚÔÊÔڛ˜: Erasmus Conferences Tours & Travel S.A. ∆ËÏ.: 210.7257693 Fax: 210.7257532 E-mail: info@erasmus.gr Website: http://www.erasmus.gr/
∫¤Ú΢ڷ, ∂ÏÏ¿‰·
15-17 ª·˝Ô˘ 2009
6Ô ¶·ÓÂÏÏ‹ÓÈÔ ™˘Ó¤‰ÚÈÔ ¶·È‰Ô„˘¯È·ÙÚÈ΋˜ √ÚÁ¿ÓˆÛË: ¶·È‰Ô„˘¯È·ÙÚÈ΋ ∂Ù·ÈÚ›· ∂ÏÏ¿‰Ô˜, ŒÓˆÛË æ˘¯È¿ÙÚˆÓ ¶·È‰ÈÒÓ Î·È ∂Ê‹‚ˆÓ ¶ÏËÚÔÊÔڛ˜: ∫∂°ª ∆Ô˘ÚÈÛÙÈΤ˜ & ™˘Ó‰ÚȷΤ˜ ∂ȯÂÈÚ‹ÛÂÈ, Congress World - ª. ¶···Ó·ÁÈÒÙÔ˘ ∆ËÏ.: 210-7210052, 7210001 Fax: 210-7210051 E-mail: info@congressworld.gr Website: www.congressworld.gr
∞›ÁÏË ∑·Â›Ô˘, ∞ı‹Ó·
21-24 ª·˝Ô˘ 2009
2nd International Congress on ADHD ¶ÏËÚÔÊÔڛ˜: Congress and Exhibition Office CPOHANSER Service, Zum Ehrenhain 34, 22885 Barsbüttel, Germany ∆ËÏ.: +49-40-670 88 20 Fax: +49-40-670 32 83 E-mail: adhd2009@cpo-hanser.de Website: www.cpo-hanser.de, www.adhd-congress.org
Vienna, Austria
3-6 πÔ˘Ó›Ô˘ 2009
42nd Annual Meeting of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) ¶ÏËÚÔÊÔڛ˜: Vanda Williamson, 12, rue de la Croix-Faubin, 75557 Paris Cedex 11, France Tel: +33 (0)1 44 64 15 15, Fax: +33 (0)1 44 64 15 24 E-mail: espghan@colloquium.fr Website: www.espghan.org
Budapest, Hungary
4-6 πÔ˘Ó›Ô˘ 2009
21st Annual Meeting of the European Academy of Vilnius, Lithuania Childhood Disability ¶ÏËÚÔÊÔڛ˜: AIM Group - Conbaltas UAB, Konstitucijos av.15 / Kernavés 5, LT-09319 Vilnius, Lithuania ∆ËÏ.: + 370 5 212 0004, Fax: + 370 5 212 00 13 E-mail: info@eacd2009.com Website: www.eacd2009.com
9-13 πÔ˘Ó›Ô˘ 2009
27th Annual Meeting of the European Society for Paediatric Infectious Diseases - ESPID 2009 ¶ÏËÚÔÊÔڛ˜: Liraz Bregman ∆ËÏ.: 41-229-080-488, Fax: 41-227-322-850 E-mail: espid@kenes.com
Brussels, Belgium
11-13 πÔ˘Ó›Ô˘ 2009
3rd International Symposium on Childhood, Adolescent and Young Adult Non Hodgkin Lymphoma ¶ÏËÚÔÊÔڛ˜: Alfred Reiter, MD ∆ËÏ.: 49-641-9943420, Fax: 49-641-9943429 E-mail: alfred.reiter.@paediat.med.uni-giessen.de
Frankfurt, Germany
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17-20 πÔ˘Ó›Ô˘ 2009
20th Congress of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC) ¶ÏËÚÔÊÔڛ˜: KENES International, 1-3 Rue de Chantepoulet, PO Box 1726, CH-1211 Geneva 1 Switzerland ∆ËÏ.: + 41 22 908 0488 Fax: + 41 22 732 2850 E-mail: espnic@kenes.com Website: www.kenes.com/espnic
Verona, Italy
19-21 πÔ˘Ó›Ô˘ 2009
47Ô ¶·ÓÂÏÏ‹ÓÈÔ ¶·È‰È·ÙÚÈÎfi ™˘Ó¤‰ÚÈÔ ¶ÏËÚÔÊÔڛ˜: AC&C Professional Congress Organiser, ¶ÈÂÚ›·˜ 1∞, 144 51 ªÂÙ·ÌfiÚʈÛË ∞ÙÙÈ΋˜ ∆ËÏ.: 210 6889 130 Fax: 210 6844 777 E-mail: pedcongress@acnc.gr Website: www.acnc.gr
Minoa Palace Hotel, ÷ÓÈ¿
21-26 πÔ˘Ó›Ô˘ 2009
5th World Congress of Paediatric Cardiology and Cardiac Surgery ¶ÏËÚÔÊÔڛ˜: ICMS Pty Ltd ∆ËÏ.: 61-396-820-244 Fax: 61-396-820-288 E-mail: pccs2009@icms.com.au
Cairns, QLD, Australia
Mohammed Shuweikhat, 10 ÂÙÒÓ, ™·Ô˘‰È΋ ∞Ú·‚›· ¶·È‰› Ì ÌÂÚÈ΋ fiÚ·ÛË “∆· Ù˘ÊÏ¿ ·È‰È¿ ˙ˆÁÚ·Ê›˙Ô˘Ó”, ÕÓÓ· §·Ô˘Ù¿ÚË-°ÎÚÈÙ˙¿Ï·, ∞ı‹Ó· 2006
Mohammed Shuweikhat, 10 years old, Saudi Arabia Partially blind child “Blind children paint”, Anna Laoutari-Gritzala, Athens 2006