Παιδιατρική | Τόμος 71 • Τεύχος 6 • Νοέμβριος - Δεκέμβριος 2008

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¢ÈÌËÓÈ·›· ¤Î‰ÔÛË Ù˘ EÏÏËÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ EÙ·ÈÚ›·˜ ¶Úfi‰ÚÔ˜ ∞. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ ™˘ÓÙ·ÎÙÈ΋ EÈÙÚÔ‹ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫. ™ÙÂÊ·Ó›‰Ë˜ M¤ÏË ™. ∞Ó‰ÚÔÓ›ÎÔ˘ ª. ∞ÓıÚ·ÎfiÔ˘ÏÔ˜ ¶. ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡ÏÔ˘ °. µ·ÚÏ¿Ì˘ ∂. °·Ï·Ó¿Î˘ §. £ˆÌ·˝‰Ô˘ ª. ∫·Ó¿ÚÈÔ˘ A. K·ÙÙ¿Ì˘ ™. K›ÙÛÈÔ˘-∆˙¤ÏË ∞. ¶··‰ÔÔ‡ÏÔ˘ µ. ¶··Â˘·ÁÁ¤ÏÔ˘ ∞. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∂. ÷ÚÌ·Ó‰¿ÚË ÀÔ‚ÔÏ‹ ∂ÚÁ·ÛÈÒÓ e-mail: hps@ath.forthnet.gr

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417 ¶ÈÛÙÔÔÈËÙÈο ˘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 ∏ Â›‰Ú·ÛË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ ∞. ¶Ú·ÛÔ‡ÏË, ∞. ∞ÙÙÈÏ¿ÎÔ˜, π. ∞ÓÙˆÓÈ¿‰Ô˘ 434 ∂ıÈÛÌfi˜ ÛÙÔ ‰È·‰›ÎÙ˘Ô ÛÙËÓ ÂÊË‚È΋ ËÏÈΛ· ∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯·

∂¡¢π∞º∂ƒ√À™∞ ¶∂ƒπ¶∆ø™∏ 486 M·ÛÙÔ΢ÙÙ¿ÚˆÛË ÛÙ· ·È‰È¿: ÂÚÈÁÚ·Ê‹ ‰‡Ô ÂÚÈÙÒÛÂˆÓ µ. ∞ÁÁÂÏ¿ÎÔ˘, ª. ∫Ô˘ÙÏ‹, ¡. ¶··‰fiÔ˘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΋ EÈ̤ÏÂÈ· ∂È̤ÏÂÈ· ÂÏÏËÓÈÎÒÓ ÎÂÈÌ¤ÓˆÓ ∫. ¶··¯Ú‹ÛÙÔ˘ EÈ̤ÏÂÈ· ·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·ÎÔÔ‡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˘ ∂ÔÙ›·˜ 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¿˜, ∞. ºÈÏÈÔÔ‡ÏÔ˘, ¢. ∆Ô˘ÓÈÛÛ›‰Ô˘, ∞. ºÚ¤ÛÎÔ˘, £. ™ËÏÈÔÔ‡ÏÔ˘, ∞. §Ô˘›˙Ô˘, A. ∫ˆÓÛÙ·ÓÙfiÔ˘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·˜ ∞. ¶··‰ÔÔ‡ÏÔ˘, °. ª›¯·˜, º. ª›¯·˜, ∞. ∑ÂÚ‚Ô˘‰¿ÎË, ∫. ∆ÛÔ˘Ì¿Î·˜, ¶. °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯·

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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. ¢ËÌÔÔ‡ÏÔ˘, ∞. ª¿ÚÁ·ÚË, π. ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘ 475¢ÈÂÚ‡ÓËÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÓÔÌÔıÂÛ›·˜ ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÎÔÈÓÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÈÏÂÁ̤ӷ ÂÏÏËÓÈο ÙÚfiÊÈÌ· ∞. µ·ÛÈÏÔÔ‡ÏÔ˘, ∂. ™ÙÚÔ˘Ì‹, ¡.°. ¶··‰fiÔ˘ÏÔ˜, µ. ∫·Ú·ı¿ÓÔ˜

496 πÛÙÔÛÂÏ›‰Â˜ ÁÂÓÂÙÈ΋˜ ∂. °È·ÓÓ¿ÙÔ˘, ™. ∫›ÙÛÈÔ˘-∆˙¤ÏË 501 ∂Àƒ∂∆∏ƒπ√ ∫ƒπ∆ø¡ ∆√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·ÎfiÔ˘ÏÔ˜, ¶Ó¢ÌÔÓÔÏÔÁ›·, ¶¿ÙÚ·

Michael Anthracopoulos, Pneumonology, Patras

¶ÂÚÛÂÊfiÓË ∞˘ÁÔ˘ÛÙ›‰Ô˘-™·‚‚ÔÔ‡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· ¶··‰ÔÔ‡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·ÌÔÔ‡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 ÂÈÙ˘¯›· ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡. ∂›Ì·È Û›ÁÔ˘ÚÔ˜ fiÙÈ Ì ÙË ‰È΋ Û·˜ Û˘Ì‚ÔÏ‹ Î·È Ô ÂfiÌÂÓÔ˜ ¯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

¶ÈÛÙÔÔÈËÙÈο ˘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 ÈÛÙÔÔ›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 ÈÛÙÔÔ›ËÛË ˙ËÙÂ›Ù·È ·fi ÔÚÁ·ÓˆÌ¤ÓÔ˘˜ ·ıÏËÙÈÎÔ‡˜ Û˘ÏÏfiÁÔ˘˜. ™ÙËÓ ·ÚÔ‡Û· ·Ó·ÛÎfiËÛË ·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˜ ÌÔÚ› Ó· Á›ÓÂÈ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚÔ˜, Ì ÙËÓ ÚÔÛı‹ÎË ÂÚ·ÈÙ¤Úˆ ÏËÚÔÊÔÚÈÒÓ ÙÔ˘ ·ÙÔÌÈÎÔ‡ ηÈ, ȉ›ˆ˜, ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡, ÙË Û˘Ó˘¢ı˘ÓfiÙËÙ· ÙˆÓ ÎˉÂÌfiÓˆÓ ÛÙËÓ ÂÁ΢ÚfiÙËÙ· ÙˆÓ ÏËÚÔÊÔÚÈÒÓ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡, ÙËÓ ÚÔÙ˘ÔÔÈË̤ÓË ÎÏÈÓÈ΋ ÂͤٷÛË Î·È, Èı·ÓÒ˜, ÙËÓ ÂÈÙ¤ÏÂÛË ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ Û ÂÚÈÙÒÛÂȘ Û˘ÌÌÂÙÔ¯‹˜ Û ÔÚÁ·ÓˆÌ¤ÓË ·ÓÙ·ÁˆÓÈÛÙÈ΋ ¿ıÏËÛË. ∫·ıÒ˜, fï˜, ηӤӷ Û‡ÛÙËÌ· ÂϤÁ¯Ô˘ ‰ÂÓ ÌÔÚ› Ó· ÂÍ·ÛÊ·Ï›ÛÂÈ Ìˉ·ÌÈÓfi ΛӉ˘ÓÔ Î·Ù¿ ÙË Û˘ÌÌÂÙÔ¯‹ Û ·ÓÙ·ÁˆÓÈÛÙÈο ·ıÏ‹Ì·Ù· ˘„ËÏ‹˜ ¤ÓÙ·Û˘, Ë ÏÂÙÔÌÂÚ‹˜ 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·ÙÔÔÈÂ›Ù·È ·ÔÎÏÂÈÛÙÈο Î·È ÌfiÓÔ ·fi ηϿ ÂÎ·È‰Â˘Ì¤ÓÔ ÁÂÓÈÎfi ·È‰›·ÙÚÔ.

1 π·ÙÚÈ΋ ™¯ÔÏ‹, ¶·ÓÂÈÛÙ‹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 ¶·ÓÂÈÛÙ‹ÌÈÔ £ÂÛÛ·ÏÔӛ΢ AÏÏËÏÔÁÚ·Ê›·: πˆ¿ÓÓ˘ °ÂÚÌ·Ó¿Î˘ germjohn@med.uoc.gr ¶·È‰ÔηډÈÔÏÔÁÈ΋ ªÔÓ¿‰·, ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙËÌÈ·Îfi °.¡. ∏Ú·ÎÏ›Ԣ µÔ‡Ù˜, ∏Ú¿ÎÏÂÈÔ ∫Ú‹Ù˘

§¤ÍÂȘ ÎÏÂȉȿ: ∞ıÏËÙÈÛÌfi˜, ·È‰›, ÈÛÙÔÔ›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‡, fiÔ˘ ÂÈ‚Ú·‚‡ÂÙ·È Ë ÚÔÛ¿ıÂÈ· Î·È Ë Û˘ÌÌÂÙÔ¯‹ (1). ¢˘ÛÙ˘¯Ò˜ Ô Û‡Á¯ÚÔÓÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜ ¤¯ÂÈ ÛÙÂÚ‹ÛÂÈ ÛËÌ·ÓÙÈο ÙË ‰˘Ó·ÙfiÙËÙ· ÂχıÂÚ˘ „˘¯·ÁˆÁÈ΋˜ ¿ıÏËÛ˘ (recreational-leisure activities) Û 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 Ôԛ˜ ·ÔÎÏ›ÓÔ˘Ó ·fi ÙË ÊÈÏÔÛÔÊ›· ÙÔ˘ „˘¯·ÁˆÁÈÎÔ‡ ·ÈÁÓȉÈÔ‡, ··ÈÙÒÓÙ·˜ Û˘ÛÙËÌ·ÙÈ΋ ÚÔfiÓËÛË Î·È ·ÓÙ·ÁˆÓÈÛÙÈÎfi Ó‡̷, Ì ÛÙfi¯Ô ÙËÓ ¿ÚÈÛÙË ·ıÏËÙÈ΋ Â›‰ÔÛË (competitive sports) (1-5). ŒÙÛÈ, Ô ÚÔ-·ÁˆÓÈÛÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Î·È Ë ÈÛÙÔÔ›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

418

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·ÛÎfiËÛË ·ÔÛÎÔ› ÛÙËÓ ·ÚÔ˘Û›·ÛË ÙÔ˘ ıÂÛÌÈÎÔ‡ Ï·ÈÛ›Ô˘ Î·È ÙÔ˘ Û˘Ó‹ıÔ˘˜ ÙÚfiÔ˘ 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 ÂȂ‚ÏË̤ÓË, Ì ÎÔÈÓ‹ ·fiÊ·ÛË ÙˆÓ ÀÔ˘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 ÙÚfiÔ˘ ÂÓË̤ڈÛ˘ ÙÔ˘ ∞ÙÔÌÈÎÔ‡ ¢ÂÏÙ›Ô˘ ÀÁ›·˜ (∞.¢.À.)”]. ∏ Û˘ÌÏ‹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˘ÌÏ‹ÚˆÛ‹˜ ÙÔ˘ ηٿ ÙËÓ ÂÁÁÚ·Ê‹ ·) ÛÙÔ ÓËÈ·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˘ÌÏËÚÒÓÔÓÙ·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 ·) ÏÈÔı˘Ì›·, ‚) ÚÔοډÈÔ ¿ÏÁÔ˜ Î·È Á) ‡ÎÔÏË ÎfiˆÛË - ∞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‹˜ ÌÔÚ› 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˘ÌÏËÚÒÓÂÙ·È Ë ª·ıËÙÈ΋-∞ıÏËÙÈ΋ ∆·˘ÙfiÙËÙ·, ÛÙËÓ ÔÔ›· ·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˘ÔÔÈË̤ÓË È·ÙÚÈ΋ ÁÓˆÌÔ‰fiÙËÛË: “O ·Ú·¿Óˆ ·ıÏËÙ‹˜-Ì·ıËÙ‹˜ ÌÔÚ› 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˜ ‹ ÔÌÔÛÔÓ‰›· ¯ÔÚËÁ› Î·È ‰È·ÊÔÚÂÙÈÎfi ¤ÓÙ˘Ô È·ÙÚÈ΋˜ ÁÓˆÌÔ‰fiÙËÛ˘, ÛÙÔ ÔÔ›Ô Û˘Ó‹ıˆ˜ ˙ËÙÂ›Ù·È ÂÓ˘fiÁÚ·ÊË ÈÛÙÔÔ›ËÛË ·fi ÙÔÓ È·ÙÚfi fiÙÈ Ô ·ıÏËÙ‹˜ ÌÔÚ› 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·ÙÔÔ›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΋ ÚÔfiÓËÛË 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΋˜ ÚÔfiÓËÛ˘, Ì¿ÏÏÔÓ ÂÓ·Û¯fiÏËÛË „˘¯·ÁˆÁÈÎÔ‡ ¯·Ú·ÎÙ‹Ú·, Ì ·Ô˘Û›· ÎÈÓ‹ÙÚÔ˘ ¿ÚÈÛÙˆÓ ÂȉfiÛÂˆÓ (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 ÌÔÚ› 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, fiˆ˜ ˘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 ÂÈÙÚ¤ÂÙ·È Ì ÂÚÈÔÚÈÛÌÔ‡˜ ·Ó ˘¿Ú¯ÂÈ ˘ÔΛÌÂÓË ÛÔ‚·Ú‹

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·419

419

¶ÈÛÙÔÔ›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 ÂÈÙÚ¤ÂÙ·È ·ÎfiÌ· Î·È Û ·ÛıÂÓ›˜ Ì ÁÂÓÂÙÈο ηډȷÁÁÂȷο ÓÔÛ‹Ì·Ù·, Ô˘ ÌÔÚÔ‡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· ÂÈÙÚ¤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˘ÌÂÚÈÏ·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˘ÔÔÈË̤ÓÔ˘ ·ÙÔÌÈÎÔ‡ Î·È ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Î·È ÛÙË ÏÂÙÔÌÂÚ‹ 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¿ ÌÔÚÔ‡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 ÚÔÛˆÈÎfi (¯ÂÈÚÔÚ·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· ÂÈÙ¢¯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 ÂÈÙ¤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 ÂȂ‚·›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 ÎfiˆÛË 2. ∞ÓÂÍ‹ÁËÙË Û˘ÁÎÔ‹ - ·Ú’ ÔÏ›ÁÔÓ Û˘ÁÎÔ‹** 3. ∂‡ÎÔÏË ÎfiˆÛË / ‰‡ÛÓÔÈ· 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) * ÂȂ‚·›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 ÂÈÙ¤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 ÎfiˆÛË 2. ∞ÓÂÍ‹ÁËÙË Û˘ÁÎÔ‹ - ·Ú’ ÔÏ›ÁÔÓ Û˘ÁÎÔ‹ 3. ∂‡ÎÔÏË ÎfiˆÛË / ‰‡ÛÓÔÈ· ηٿ ÙËÓ ¿ÛÎËÛË 4. πÛÙÔÚÈÎfi ¿ÚÚ˘ıÌ˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ‹ ·ÏÌÒÓ √π∫√°∂¡∂π∞∫√ π™∆√ƒπ∫√ (5-6) 5. ¶ÚÒÈÌÔ Î·Ú‰È·Îfi ÂÂÈÛfi‰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˘‡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· ÂÌÂÈÚ›· Ù˘ πÙ·Ï›·˜, ÛÙËÓ ÔÔ›· ¤¯ÂÈ ÂÈ‚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 ˘‡ı˘ÓÔÈ ÁÈ· ÙÔÓ ¤ÏÂÁ¯Ô ÙˆÓ ·ıÏËÙÒÓ. ∏ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ·Ó›¯Ó¢Û˘ ·ԉ›¯ıËΠ̠ÙË Ì›ˆÛË Î·Ù¿ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·ÈÊÓ›‰ÈÔ˘ ηډȷÎÔ‡ ı·Ó¿ÙÔ˘ Û ·ıÏËÙ¤˜ 12-35 ÂÙÒÓ, ΢ڛˆ˜ ¯¿ÚË ÛÙËÓ ·Ó›¯Ó¢ÛË ÙˆÓ ÂÚÈÙÒÛÂˆÓ ˘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 ÂÈÌÂϤÛÙÂÚË ÎÏÈÓÈ΋ ·ÍÈÔÏfiÁËÛË, fiˆ˜ ·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˘ÌÂÚÈÏ·Ì‚·ÓÔ̤ÓÔ˘ ÙÔ˘ ÈÛÙÔÚÈÎÔ‡ ÓfiÛËÛ˘ ·fi ÓfiÛÔ Kawasaki ‹ ÚÂ˘Ì·ÙÈÎfi ˘ÚÂÙfi), ÂÈÙ¤ÏÂÛË ·ÏÔÔÈË̤ÓÔ˘ ∏∫°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·¤ÌÔÓÙ·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 ÌÂÛÔÎÔÏÈ΋ ÂÈÎÔÈÓˆÓ›· (0,02%) (24). ¶ÈÏÔÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÚÔÁÚ¿ÌÌ·ÙÔ˜ ηډÈÔÏÔÁÈÎÔ‡ ÂϤÁ¯Ô˘ ·È‰ÈÒÓ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ì ¯Ú‹ÛË ÚÔÙ˘ÔÔÈË̤ÓÔ˘ ÈÛÙÔÚÈÎÔ‡, ËÏÂÎÙÚÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜ Î·È „ËÊÈ·ÎÔ‡ ʈÓÔηډÈÔÁÚ·Ê‹Ì·ÙÔ˜, Ì ÙËÓ ¤ÁÎÚÈÛË ÙÔ˘ ¶·È‰·ÁˆÁÈÎÔ‡ πÓÛÙÈÙÔ‡ÙÔ˘ Î·È ÙÔ˘ ÀÔ˘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˘ÔÔÈË̤ÓÔ˘ ¤ÓÙ˘Ô˘ ∞.¢.À. - ¶ÚÔÙ¿ÛÂȘ ‚ÂÏÙ›ˆÛ˘ ∏ ıÂÛÌÔıÂÙË̤ÓË Î·È ˘Ô¯ÚˆÙÈ΋ ·ÍÈÔÏfiÁËÛË

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·421

421

¶ÈÛÙÔÔ›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 ÏÈÔı˘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‡ ÂÂÈÛÔ‰›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˘ÔÔÈË̤ÓÔ˘ 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˘ÔÔÈË̤ӷ ‰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 ÏÂÙÔÌÂÚ‹˜, 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 ÙÚÔÔÔÈ‹ÛÂȘ Î·È ÚÔÛı‹Î˜, Èı·ÓÒ˜ Î·È Ù· ‰›· Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÙËÓ ·ÍÈÔÏfiÁËÛË ÙˆÓ ˘fiÏÔÈˆÓ Û˘ÛÙËÌ¿ÙˆÓ (6). ∏ ÂȂ‚ÏË̤ÓË ÚÔÛı‹ÎË ÏËÚÔÊÔÚÈÒÓ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ ÌÔÚ› 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 ÚÔÛˆÈ΋ Ì·˜ ÂÌÂÈÚ›·, ˘¿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 ÂÈʇϷÍË ÁÈ· ÙËÓ ·ÛÊ¿ÏÂÈ· ÙÔ˘ È·ÙÚÈÎÔ‡ ·ÔÚÚ‹ÙÔ˘, ÌÂ Û˘Ó·ÎfiÏÔ˘ıË ÛÎfiÈÌË ·fiÎÚ˘„Ë ÏËÚÔÊÔÚÈÒÓ. ∏ ·ÎÚÈ‚‹˜ Û˘ÌÏ‹ÚˆÛË ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ÈÛÙÔÚÈÎÔ‡ Èı·ÓfiÓ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙÂÚË Î·È ·ÛʷϤÛÙÂÚË Â¿Ó Û˘ÌÏËÚÒÓÂÙ·È ˘fi ÙËÓ Î·ıÔ‰‹ÁËÛË-Â›‚ÏÂ„Ë ÙÔ˘ ÔÈÎÔÁÂÓÂÈ·ÎÔ‡ ·È‰È¿ÙÚÔ˘, Ô ÔÔ›Ô˜ ı· Ú¤ÂÈ Ó· Â›Ó·È Î·È Ô ÌfiÓÔ˜ ˘‡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 ÂÈÙ˘¯›· οıÂ Û˘ÛÙ‹Ì·ÙÔ˜ Ì·˙ÈÎÔ‡ ÚÔÏËÙÈÎÔ‡ ÂϤÁ¯Ô˘ Â›Ó·È Ë ¶·È‰È·ÙÚÈ΋ 2008;71:417-425

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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˘ÌÏËÚÒÓÂÙ·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 ÎfiˆÛË 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·˜ ÏÈÔı˘Ì‹ÛÂÈ, ¯¿ÛÂÈ ÙȘ ·ÈÛı‹ÛÂȘ ÙÔ˘ ‹ ÂÌÊ·Ó›ÛÂÈ ÂÂÈÛfi‰ÈÔ Û·ÛÌÒÓ; ¡∞π √Ãπ 3. ∂‡ÎÔÏË ÎfiˆÛË / ‰‡ÛÓÔÈ· 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· ‰‡ÛÓÔÈ· 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 ‹ οÔÈÔ 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 ÂÂÈÛfi‰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‡ ÂÂÈÛÔ‰›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·˜, fiˆ˜ ˘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 οÔÈÔ ·fi Ù· ·Ú·¿Óˆ ÓÔÛ‹Ì·Ù·; ¡∞π √Ãπ ¢ËÏÒÓˆ ˘‡ı˘Ó· fiÙÈ ÔÈ ·ÓˆÙ¤Úˆ ÏËÚÔÊÔڛ˜ Â›Ó·È ·ÏËı›˜. √ ÎˉÂÌfiÓ·˜ ∏ÌÂÚÔÌËÓ›·: √ÓÔÌ·ÙÂÒÓ˘ÌÔ - ÀÔÁÚ·Ê‹ ∆ËϤʈÓÔ ÂÈÎÔÈÓˆÓ›·˜ ÁÔÓ¤ˆÓ:

‰˘Ó·ÙfiÙËÙ· ¯ÚËÌ·ÙÔ‰fiÙËÛ˘, Ô Û·Ê‹˜ ηıÔÚÈÛÌfi˜ ÙˆÓ ·ÓȯÓ¢ÙÈÎÒÓ ÌÂıfi‰ˆÓ Ô˘ ı· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó, Ë ‰È·ıÂÛÈÌfiÙËÙ· ÁÈ· ÙÔÓ ÛÎÔfi ·˘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΋ ÂÈ‚¿Ú˘ÓÛË) ÙÔ˘ ÂϤÁ¯Ô˘ ¤¯Ô˘Ó ˆ˜ ÙÒÚ· ÔÈ ÁÔÓ›˜, ÂÓÒ Û ÂÚÈÙÒÛÂȘ ·Ó·ÛÊ¿ÏÈÛÙˆÓ, ·ÏÏÔ‰·ÒÓ Î·È ·fiÚˆÓ, ÚԂϤÂÙ·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 ÂÈÙ¤ÏÂÛË ÙÔ˘ Ì·˙ÈÎÔ‡ ÂϤÁ¯Ô˘ ÙˆÓ

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·423

423

¶ÈÛÙÔÔ›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˘ÌÏËÚÒÓÂÙ·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 ÂÈÙ¤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, ·ÓÙÈÏËÙfi ÛÙËÓ Î·ÙÒÙÂÚË ·ÚÈÛÙÂÚ‹ ·Ú·ÛÙÂÚÓÈ΋ ¯ÒÚ·, ¯ˆÚ›˜ ¿ÏÏ· Û˘ÓÔ‰¿ ·ıÔÏÔÁÈο ·ÎÚÔ·ÛÙÈο Â˘Ú‹Ì·Ù·, ÎÏÈÓÈο ÛËÌ›· ‹ Û˘ÌÙÒÌ·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· ·ÓÙÂÂͤÏıÔ˘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 ˘‡ı˘ÓÔ˜ ÁÈ· ÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô ÙÔ˘ ηډȷÁÁÂÈ·ÎÔ‡ Û˘ÛÙ‹Ì·ÙÔ˜ ÙˆÓ Ì·ıËÙÒÓ; ∏ ÈÛÙÔÔ›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˘ÌÏ‹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·ÎÔÒÓ) ÌÔÚ› Ó· Û˘Ì‚¿ÏÂÈ ÛÙËÓ ÂÈÌÂÏ‹ ·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 ÌÔÚ› Ó· Â›Ó·È È‰È·›ÙÂÚ· ÛËÌ·ÓÙÈ΋ Î·È ·fiÏ˘Ù· ÂȂ‚ÏË̤ÓË, ηÌÈ¿ ¿ÏÏË È·ÙÚÈ΋ ÂȉÈÎfiÙËÙ· ‰ÂÓ ı· Ú¤ÂÈ Ó· Û˘ÌÌÂÙ¿Û¯ÂÈ ÛÙËÓ ·Ú¯È΋ ÈÛÙÔÔ›ËÛË Ù˘ ˘Á›·˜ ÙˆÓ ·È‰ÈÒÓ. µ) ¶ÔÈ· Â›Ó·È Ë ÂÏ¿¯ÈÛÙË ··ÈÙÔ‡ÌÂÓË ÂÎ·›‰Â˘ÛË; H Â·Ú΋˜ ÂÎ·›‰Â˘ÛË ÛÙËÓ ·Ó·ÁÓÒÚÈÛË ÙˆÓ

Û˘Ó‹ıˆÓ ηٷÛÙ¿ÛÂˆÓ ·ÈÊÓ›‰ÈÔ˘ ı·Ó¿ÙÔ˘ Û ·ıÏËÙ¤˜, ηıÒ˜ Î·È Ë ÎÏÈÓÈ΋ Â¿ÚÎÂÈ· ÛÙËÓ ·È‰È·ÙÚÈ΋ ηډȷ΋ ·ÎÚfi·ÛË Î·È ÛËÌÂÈÔÏÔÁ›· Â›Ó·È ··Ú·›ÙËÙË ÚÔ¸fiıÂÛË ÂÈÙ˘¯›·˜ 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‹˜ ÂÎ·›‰Â˘ÛË ÌÔÚ› 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·ÙÔÔÈÂ›Ù·È ·ÔÎÏÂÈÛÙÈο ·fi ·È‰›·ÙÚÔ˘˜ ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙÔ ÁÓˆÛÙÈÎfi ·ÓÙÈΛÌÂÓÔ Ù˘ ·È‰ÔηډÈÔÏÔÁ›·˜ Î·È ÈÛÙÔÔÈË̤ÓË Â¿ÚÎÂÈ· Û ۯÂÙÈΤ˜ ‰È·ÁÓˆÛÙÈΤ˜ Ù¯ÓÈΤ˜. ™ÙË ¯ÒÚ· Ì·˜, fiÔ˘ Ë ·È‰ÔηډÈÔÏÔÁ›· ‰ÂÓ Â›Ó·È ÂÈۋ̈˜ ·Ó·ÁÓˆÚÈṲ̂ÓË ÂÍÂȉ›Î¢ÛË Ù˘ ·È‰È·ÙÚÈ΋˜, Ô ÂÚ·ÈÙ¤Úˆ ¤ÏÂÁ¯Ô˜ ÂÈÙÂÏÂ›Ù·È Ôχ Û˘¯Ó¿ Î·È ·fi ÌË ÂÍÂȉÈÎÂ˘Ì¤ÓÔ˘˜ ÛÙËÓ ·È‰ÔηډÈÔÏÔÁ›· ηډÈÔÏfiÁÔ˘˜ ÂÓËϛΈÓ. ∂›Ó·È ÂÈÙ·ÎÙÈ΋ Ë ·Ó¿ÁÎË ÈÛÙÔÔ›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΋ ÂÈÙÚÔ‹ Ô˘ ·ÔÊ·Û›˙ÂÈ ÁÈ· ÙËÓ ··ÏÏ·Á‹ Ì·ıËÙÒÓ ·fi ÙÔ Ì¿ıËÌ· Ù˘ Á˘ÌÓ·ÛÙÈ΋˜ ÎÚ›ÓÂÙ·È ÂȂ‚ÏË̤ÓË (1) (ηıÒ˜ ÚԂϤÂÙ·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˘ ÂÚÈıˆÚÈÔÔ›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 ÌÂÙÂÎ·›‰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

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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 ÚÔÔÙÈΤ˜ 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˘, ·ÔÛÎÔÒÓÙ·˜ ΢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 ÂÈÙ¤ÏÂÛ˘ Î·È ∏∫°Ì·ÙÔ˜ ÛÙÔÓ ·Ú¯ÈÎfi ¤ÏÂÁ¯Ô Ê·›ÓÂÙ·È ÂȂ‚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 ÂÈÙ˘¯›· ÙÔ˘ Û˘ÛÙ‹Ì·ÙÔ˜ ÂϤÁ¯Ô˘. ™˘ÌÂÚ¿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˘ ÂÎ·›‰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›·˜ ÌÔÚÔ‡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 ÌÔÚÔ‡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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∏ Â›‰Ú·ÛË Ù˘ ·È‰È΋˜ ÂÈÏË„›·˜ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿ ¢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: ∏ ÂÈÏË„›· Â›Ó·È Ì›· ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ Ó¢ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∆· ·È‰È¿ Ì ÂÈÏË„›· ‚Ú›ÛÎÔÓÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó ÁÓˆÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Î·È ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, 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˘ÌÂÚÈÊÔÚ¿˜ ÌÔÚ› Ó· ÚÔËÁËıÔ‡Ó Ù˘ ‰È¿ÁÓˆÛË Ù˘ ÂÈÏË„›·˜, 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˘ÌÂÚÈÊÔÚÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ Û ÂÈÏËÙÈο ·È‰È¿, Ì ·ÓÙÈÎÚÔ˘fiÌÂÓ· fï˜ ·ÔÙÂϤÛÌ·Ù·. ∞˘Ùfi Û˘Ì‚·›ÓÂÈ ÂÂȉ‹ Ë ¤Ú¢ӷ Û¯ÂÙÈο Ì ÙËÓ ·ÎÚÈ‚‹ Û˘Û¯¤ÙÈÛË ÌÂٷ͇ ÂÈÏË„›·˜ Î·È ÁÓˆÛÙÈ΋˜/Û˘ÌÂÚÈÊÔÚÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÂËÚ¿˙ÂÙ·È ·fi ÔÏϤ˜ ÌÂÙ·‚ÏËÙ¤˜, fiˆ˜ Ë ‡·ÚÍË Û·ÛÌÒÓ ‰È·ÊfiÚˆÓ Ù‡ˆÓ, ÙÔ ·ıÔÊ˘ÛÈÔÏÔÁÈÎfi ˘fiÛÙڈ̷ Ù˘ ÂÈÏË„›·˜, Ë ˘ÔΛÌÂÓË ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, Ë ÂÌÊ¿ÓÈÛË ˘ÔÎÏÈÓÈÎÒÓ ÂÈÏËÙÈÎÒÓ ÂÎÊÔÚÙ›ÛˆÓ, Ë Â›‰Ú·ÛË ÙˆÓ ·ÓÙÈÂÈÏËÙÈÎÒÓ Ê·ÚÌ¿ÎˆÓ Î·È ·Ú¿ÁÔÓÙ˜ Û¯ÂÙÈ˙fiÌÂÓÔÈ Ì ÙËÓ ÔÈÎÔÁ¤ÓÂÈ·. √ Ù‡Ô˜ Ù˘ ÂÈÏË„›·˜, Ë ËÏÈΛ· ¤Ó·Ú͢, Ë Û˘¯ÓfiÙËÙ· ÙˆÓ Û·ÛÌÒÓ Î·È ÔÈ ˘ÔÎÏÈÓÈΤ˜ ÂÈÏËÙÈΤ˜ ÂÎÊÔÚÙ›ÛÂȘ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ÙËÓ ÂÌÊ¿ÓÈÛË ÁÓˆÛÙÈÎÒÓ ‰È·Ù·Ú·¯ÒÓ, ÂÓÒ Ù· ÂÈÚfiÛıÂÙ· Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù·, Ë ·ÓıÂÎÙÈ΋ ÛÙ· Ê¿Ú̷η ÂÈÏË„›· 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˘ÌÂÚÈÊÔÚ¿˜ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›·. ™Â οı ÂÚ›ÙˆÛË, Ë Ó¢ÚÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛı› Ë Î·Ù¿ÏÏËÏË ·Ú¤Ì‚·ÛË, fiÔ˘ ·˘Ù‹ ¯ÚÂÈ¿˙ÂÙ·È. §¤ÍÂȘ ÎÏÂȉȿ: ¶·È‰È΋ ÂÈÏË„›·, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, Û˘ÌÂÚÈÊÔÚ¿.

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.

™˘ÓÙÔÌÔÁڷʛ˜ ∏∂° ∞∂º ™∂¶À

Paediatriki 2008;71:426-433

ËÏÂÎÙÚÔÂÁÎÂÊ·ÏÔÁÚ¿ÊËÌ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η Û‡Ó‰ÚÔÌÔ ÂÏÏÂÈÌ·ÙÈ΋˜ ÚÔÛÔ¯‹˜ Ì ˘ÂÚÎÈÓËÙÈÎfiÙËÙ·

∂ÈÛ·ÁˆÁ‹ ∏ ÂÈÏË„›· Â›Ó·È Ì›· ·fi ÙȘ ÈÔ Û˘¯Ó¤˜ ¯ÚfiÓȘ Ó¢ÚÔÏÔÁÈΤ˜ ·ı‹ÛÂȘ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ 4 ¤ˆ˜ 6 ÛÙ· 1000 ·È‰È¿ Û¯ÔÏÈ΋˜ ËÏÈΛ·˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ÂÈÏË„›· (1).

Pediatri Nov-Dec 08 new

19-12-08

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427

∂ÈÏË„›·, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È Û˘ÌÂÚÈÊÔÚ¿

™ÙËÓ ÙÚ¤¯Ô˘Û· ‚È‚ÏÈÔÁÚ·Ê›· ˘¿Ú¯ÂÈ ¤Ó· ÔÏ˘‰È¿ÛÙ·ÙÔ ‰›Ô ¤Ú¢ӷ˜ Û¯ÂÙÈο Ì ÙȘ ÁÓˆÛÙÈΤ˜ ‰˘Ó·ÙfiÙËÙ˜ Î·È Ù· Ó¢ÚÔ„˘¯ÔÏÔÁÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›·. ∆· ·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 ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ‰È·ÊÔÚÂÙÈΤ˜ „˘¯ÔÌÂÙÚÈΤ˜ ‰ÔÎÈ̷ۛ˜. ∂›Ó·È, ¿ÓÙˆ˜, ·Ô‰ÂÎÙfi fiÙÈ Ù· ·È‰È¿ Ì ÂÈÏË„›· ‚Ú›ÛÎÔÓÙ·È Û ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ Ó· ÂÌÊ·Ó›ÛÔ˘Ó ‰È·Ù·Ú·¯¤˜ Ì¿ıËÛ˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ (2-5). ∏ ·ÈÙÈÔÏÔÁ›· ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ì¿ıËÛ˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· Â›Ó·È ÔÏ˘·Ú·ÁÔÓÙÈ΋ (2-4). ¶·Ú¿ÌÂÙÚÔÈ Ô˘ ÌÔÚ› 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 ÂÈÏËÙÈο ·È‰È¿. ∂ÈÚfiÛıÂÙ·, Ë Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· Ù˘ ÂÈÏË„›·˜ Âȉڿ ÛËÌ·ÓÙÈο ÛÙËÓ ·Ó¿Ù˘ÍË ÙˆÓ ·Ú·¿Óˆ ‰È·Ù·Ú·¯ÒÓ, ηıÒ˜ Ù· ÂÚÈÛÛfiÙÂÚ· ‰È·ı¤ÛÈÌ· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ·ÚÂÌ‚·›ÓÔ˘Ó ÛÙË ÏÂÈÙÔ˘ÚÁ›· ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘, ÂËÚ¿˙ÔÓÙ·˜ ÙËÓ ÂÁÚ‹ÁÔÚÛË, ÙȘ ÓÂ˘Ì·ÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿. ∆·˘Ùfi¯ÚÔÓ·, fï˜, Ê·›ÓÂÙ·È fiÙÈ Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η (∞∂º) ÌÔÚÔ‡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˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿ Ì ÂÈÏË„›· ™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). ∏ ˘ÔÙÚÔÈ¿˙Ô˘Û· ÂÈÏËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ‰È·Ù·Ú·¯¤˜ ÂÁÎÂÊ·ÏÈÎÒÓ ·Ó·Ù˘ÍÈ·ÎÒÓ ‰È·‰ÈηÛÈÒÓ Â˘Ú¤Ô˜ Ê¿ÛÌ·ÙÔ˜. ¢È·‰Èηۛ˜ fiˆ˜ 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 ÂÈÏÔÁ‹/·Ê·›ÚÂÛË ÙˆÓ Û˘Ó‰¤ÛÂˆÓ ÌÔÚ› Ó· ‰È·ÎÔÔ‡Ó, Ó· ÂÈ‚Ú·‰˘ÓıÔ‡Ó ‹ Ó· ÂÈÙ·¯˘ÓıÔ‡Ó, ÚÔηÏÒÓÙ·˜ ‰È·Ù·Ú·¯‹ ‹/Î·È ÌfiÓÈÌË ‚Ï¿‚Ë ÛÙÔ ÂÌÏÂÎfiÌÂÓÔ ÂÁÎÂÊ·ÏÈÎfi ÓÂ˘ÚˆÓÈÎfi ·Îψ̷ (8,9). ∏ ›‰È· Ë ÂÈÏË„›·, Ë ˘ÔΛÌÂÓË ÂÁÎÂÊ·ÏÈ΋ ·ıÔÏÔÁ›·, ÔÈ „˘¯ÔÏÔÁÈΤ˜ Û˘Ó¤ÂȘ Ù˘ ÓfiÛÔ˘ Î·È Ù· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ¤¯Ô˘Ó ÚÔÙ·ı› ÁÈ· ÙËÓ ÂÚÌËÓ›· fiÏˆÓ ‹ ̤ÚÔ˘˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ Î·È Û˘ÌÂÚÈ-

ÊÔÚÈÎÒÓ ÚÔ‚ÏËÌ¿ÙˆÓ ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· (24). ∫·ı¤Ó·˜ ·fi ÙÔ˘˜ ·Ú·¿Óˆ ·Ú¿ÁÔÓÙ˜ ÌÔÚ› Ó· ‰È·ÈÚÂı› Û ÔÏÏ¿ ÂÈ̤ÚÔ˘˜ ÛÙÔȯ›·. ∂›Ó·È ÌÂıÔ‰ÔÏÔÁÈο ‰‡ÛÎÔÏÔ, ·Ó fi¯È ·Ó¤ÊÈÎÙÔ, Ó· ·ÔÌÔÓÒÛÔ˘Ì ̛· ·fi ÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ù˘ ÂÈÏË„›·˜ ˆ˜ ÙËÓ Î‡ÚÈ· Î·È ÌÔÓ·‰È΋ ·ÈÙ›· ÁÈ· Ù· ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ Î·È Ì¿ıËÛ˘ ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›·.

∂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 ÂÈÏË„›· ·Ó·Ê¤ÚÔÓÙ·È ÛÙȘ ÂÈÙÒÛÂȘ Ù˘ ÓfiÛÔ˘ ÛÙË ÓÔËÌÔÛ‡ÓË, ÙË Ì·ıËÛȷ΋ ÈηÓfiÙËÙ· Î·È ÙË Û¯ÔÏÈ΋ ÙÔ˘˜ Â›‰ÔÛË (10-16). ∫¿ÔȘ ÌÂϤÙ˜ ˘ÔÛÙËÚ›˙Ô˘Ó fiÙÈ ÔÈ ÓÔËÙÈΤ˜ ÂȉfiÛÂȘ ÙˆÓ ÂÈÏËÙÈÎÒÓ ·È‰ÈÒÓ, ·ÎfiÌ· Î·È ·˘ÙÒÓ Ì ȉÈÔ·ı‹ ÂÈÏË„›·, ˘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‹ ÂÈÏË„›· (2,14). √ ΛӉ˘ÓÔ˜ ÁÈ· Û¯ÔÏÈ΋ ·ÔÙ˘¯›· Ê·›ÓÂÙ·È fiÙÈ Â›Ó·È ÌÂÁ·Ï‡ÙÂÚÔ˜ ÛÙ· ·È‰È¿ ÌÂ Û˘Ìو̷ÙÈ΋ ‹ ÎÚ˘ÙÔÁÂÓ‹ ÂÈÏË„›· (2,13), ÂÓÒ ·ÚÎÂÙ¤˜ ÌÂϤÙ˜ ·Ó·Ê¤ÚÔ˘Ó Ê˘ÛÈÔÏÔÁÈ΋ Â›‰ÔÛË ÛÙ· ·È‰È¿ Ì ÌÈÎÚfiÙÂÚ˘ ÎÏÈÓÈ΋˜ ÛÔ‚·ÚfiÙËÙ·˜ ÂÈÏË„›· (2,3). ∂ÓÙÔ‡ÙÔȘ, Û ÌÈ· ÚÔÔÙÈ΋ ÌÂϤÙË ·È‰ÈÒÓ Ì ȉÈÔ·ı‹ ÂÈÏË„›· Î·È Ê˘ÛÈÔÏÔÁÈ΋ ÓÔËÌÔÛ‡ÓË (12) ‚Ú¤ıËΠÌÂÁ·Ï‡ÙÂÚÔ ·fi ÙÔ ·Ó·ÌÂÓfiÌÂÓÔ ÔÛÔÛÙfi Â·Ó¿Ï˄˘ Ù˘ Û¯ÔÏÈ΋˜ Ù¿Í˘ (34%) Î·È ÂȉÈ΋˜ ÂÎ·›‰Â˘Û˘ (19%) ÛÙ· ·È‰È¿ ·˘Ù¿, fiÙ·Ó Û˘ÁÎÚ›ıËÎ·Ó Ì ٷ ·‰¤ÚÊÈ· ÙÔ˘˜, Ô˘ ¯ÚËÛÈÌÔÔÈ‹ıËÎ·Ó ˆ˜ Ì¿ÚÙ˘Ú˜. ∂ÈϤÔÓ, Ù· ·È‰È¿ Ì ȉÈÔ·ı‹ ÂÈÏË„›· ›¯·Ó ¯·ÌËÏfiÙÂÚË Â›‰ÔÛË ÛÙȘ ÂÈ̤ÚÔ˘˜ 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‹ ÂÈÏË„›· Î·È ÂȉÈÎfiÙÂÚ· Ì ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›·, Ë ÔÔ›· Â›Ó·È Ë Î·ÏÔËı¤ÛÙÂÚ˘ ÚfiÁÓˆÛ˘ ÂÈÏË„›·, ¤¯Ô˘Ó ηٿ ̤ÛÔÓ fiÚÔ Ê˘ÛÈÔÏÔÁÈÎfi ‰Â›ÎÙË ÓÔËÌÔÛ‡Ó˘ (17). ŸÌˆ˜, ·ÎfiÌ· Î·È ÛÙË ƒÔÏ¿Ó‰ÂÈÔ ÂÈÏË„›· ¤¯Ô˘Ó ·Ó·ÊÂÚı› ‰˘ÛÎÔϛ˜ ÛÙË Û˘ÁΤÓÙÚˆÛË Î·È ÛÙË Ì¿ıËÛË (18). º·›ÓÂÙ·È, ÏÔÈfiÓ, fiÙÈ ·ÎfiÌË Î·È Ù· ·È‰È¿ Ì ȉÈÔ·ı‹ ÂÈÏË„›· ‚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 ÂÈÏËÙÈο 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

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∞. ¶Ú·ÛÔ‡ÏË Î·È Û˘Ó.

‰È·Ù·Ú·¯¤˜, fiˆ˜ ÙÔ Û‡Ó‰ÚÔÌÔ Landau-Kleffner, fiÔ˘ Ë ÚfiÁÓˆÛË Ù˘ ÁÓˆÛÙÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Â›Ó·È ÊÙˆ¯‹, ·ÎfiÌË Î·È Û ÂÈÙ˘¯‹ ıÂÚ·›·, Ì ·‡ÛË ÙˆÓ ÂÈÏËÙÈÎÒÓ ÎÚ›ÛÂˆÓ Î·È Â·Ó·ÊÔÚ¿ ÙÔ˘ ∏∂° ÛÂ Ê˘ÛÈÔÏÔÁÈο Â›‰· (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 ÂÈÏË„›·. ŒÙÛÈ, ·Ó·Ê¤ÚÂÙ·È fiÙÈ Ù· ÂÈÏËÙÈο ·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· ÂÂÍÂÚÁ·Û›·˜ ÏËÚÔÊÔÚÈÒÓ Î·È ÛÙÔÓ ÔÙÈÎÔ-ÎÈÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi (21-23). ∏ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÂÈÏËÙÈ΋˜ 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 ÂÈÏËÙÈο ·È‰È¿ ÙˆÓ ÔÔ›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 ÂÈÏËÙÈÎÒÓ 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˜ ÂÈÏË„›Â˜, ÂÓÒ ÌÂÁ·Ï‡ÙÂÚÔ˜ Ê·›ÓÂÙ·È Ó· Â›Ó·È Ô Î›Ó‰˘ÓÔ˜ ÛÙËÓ ÂÈÏËÙÈ΋ 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˘ Â›‰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˜ ÂÈÏËÙÈΤ˜ ÎÚ›ÛÂȘ (25). ∂›Û˘, ·ÛıÂÓ›˜ Ì ÁÂÓÈÎÂ˘Ì¤Ó˜ ÂÈÏËÙÈΤ˜ 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 ÂÈÏËÙÔÁfiÓÔ ÂÛÙ›· ÛÙÔ ·ÚÈÛÙÂÚfi ËÌÈÛÊ·›ÚÈÔ ÂÌÊ·Ó›˙Ô˘Ó Û˘¯Ó¿ ‰˘ÛÎÔÏ›· ÛÙËÓ ·ÔÌÓËÌfiÓ¢ÛË ÏÂÎÙÈÎÒÓ ÏËÚÔÊÔÚÈÒÓ, ÂÓÒ ·È‰È¿ Ì ÂÈÏËÙÔÁfiÓÔ ÂÛÙ›· ÛÙÔ ‰ÂÍÈfi ËÌÈÛÊ·›ÚÈÔ ¤¯Ô˘Ó ‰˘ÛÎÔϛ˜ ÛÙË ¯ˆÚÔ-ÔÙÈ΋ ÌÓ‹ÌË (27). ∆¤ÏÔ˜, ÔÈ ˘ÔÙÚÔÈ¿˙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˘ ÂÈÏËÙÈ΋˜ ÓfiÛÔ˘, fiÛÔÓ ·ÊÔÚ¿ ÛÙËÓ ÂÌÊ¿ÓÈÛË Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›·, ‰ÂÓ ¤¯ÂÈ ·ÎfiÌ· Ï‹Úˆ˜ ‰È¢ÎÚÈÓÈÛÙ› (2,3). ∏ Û˘Û¯¤ÙÈÛË ÙˆÓ ˘ÔÎÏÈÓÈÎÒÓ ÂÈÏËÙÈÎÒÓ 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 ÂÈÏËÙÈ΋˜ ‰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 Ôԛ˜ ÂËÚ¿˙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˜ ÂÓÙfiÈÛ˘, Ô˘ Û˘Û¯ÂÙ›˙ÔÓÙ·È Ì ·ÚÔ‰ÈΤ˜ ÁÓˆÛÙÈΤ˜ ‰˘ÛÎÔϛ˜ ˆ˜ ÙÔ ÌfiÓÔ ÎÏÈÓÈÎfi Û‡Ìو̷. ∏ Â›‰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 ÌÔÚ› 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 ÂÈÏË„›·, ÔÈ Ì·ıËÛȷΤ˜ ‰˘ÛÎÔϛ˜ ηÈ/‹ ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ ÚÔËÁÔ‡ÓÙ·È ¯ÚÔÓÈο Ù˘ ÂÌÊ¿ÓÈÛ˘ ÙˆÓ Û·ÛÌÒÓ (31-33). ∏ ÎÏÈÓÈ΋ ÂÌÂÈÚ›· ¤¯ÂÈ ‰Â›ÍÂÈ fiÙÈ Ù· ÚÔ‚Ï‹Ì·Ù· ·˘Ù¿ ÌÂÚÈΤ˜ ÊÔÚ¤˜ ‚ÂÏÙÈÒÓÔÓÙ·È ‹ ÂÍ·Ê·Ó›˙ÔÓÙ·È Ì ÙËÓ ·ÓÙÈÂÈÏËÙÈ΋ ıÂÚ·›·. ∞˘Ù¤˜ ÔÈ ÂÚÈÙÒÛÂȘ ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ˘fiıÂÛË fiÙÈ Û ÌÂÚÈÎÔ‡˜ ·ÛıÂÓ›˜ Ë ÂÈÏË„›· Â›Ó·È ÌÈ· ÁÂÓÈÎfiÙÂÚË Î·Ù¿ÛÙ·ÛË Ô˘ Û˘ÌÂÚÈÏ·Ì‚¿ÓÂÈ ÙfiÛÔ Û·ÛÌÔ‡˜ fiÛÔ Î·È Ì·ıËÛȷο-Û˘ÌÂÚÈÊÔÚÈο ÚÔ‚Ï‹Ì·Ù· (33). ™ÙË ÌÂϤÙË ÙˆÓ Schouten Î·È Û˘Ó. (31), 69 ·È‰È¿ Ì ÚfiÛÊ·ÙË ‰È¿ÁÓˆÛË ÂÈÏË„›·˜ ÂÎÙÈÌ‹ıËÎ·Ó Û˘ÁÎÚÈÙÈο Ì ÌÈ· ÔÌ¿‰· ÂϤÁ¯Ô˘. ¶ÚÈÓ ÙË ‰È¿ÁÓˆÛË, 22% ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· ›¯·Ó Â·Ó·Ï¿‚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 ÂÈÏË„›· ‰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 ¤ÎÙˆÛË Ù˘ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘ ÌÔÚ› Ó· Â›Ó·È ÙÔ ÚÒÙÔ Û‡Ìو̷ Ù˘ ¤Ó·Ú͢ Ù˘ ÂÈÏËÙÈ΋˜ ÓfiÛÔ˘. ∆¤ÏÔ˜, Û ÂÈÏËÙÈÎÔ‡˜ ·ÛıÂÓ›˜ Ì ÔÚÁ·ÓÈ΋ ÂÁÎÂÊ·ÏÈ΋ ‚Ï¿‚Ë, ·Ú·ÙËÚ›ٷÈ, Û˘Ó‹ıˆ˜, ÓÔËÙÈ΋ ˘ÛÙ¤ÚËÛË ·Ó¿ÏÔÁ· Ì ÙËÓ ÂÓÙfiÈÛË Î·È ÙÔ Ì¤ÁÂıÔ˜ Ù˘ ‚Ï¿‚˘ (35). ŒÙÛÈ, ·ÛıÂÓ›˜ Ì ‰ÔÌÈΤ˜ ‹

Pediatri Nov-Dec 08 new

19-12-08

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429

∂ÈÏË„›·, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È Û˘ÌÂÚÈÊÔÚ¿

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˘ÌÂÚÈÊÔÚ¿ ¶·È‰È¿ Î·È ¤ÊË‚ÔÈ Ì ÂÈÏË„›· ‚Ú›ÛÎÔÓÙ·È Û ÌÂÁ·Ï‡ÙÂÚÔ Î›Ó‰˘ÓÔ Ó· ÂΉËÏÒÛÔ˘Ó ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜ ·fi fi,ÙÈ ·È‰È¿ Ì ¿ÏϘ ¯ÚfiÓȘ ·ı‹ÛÂȘ ÛÙ· ÔÔ›· ¯ÔÚËÁÂ›Ù·È Ì·ÎÚÔ¯ÚfiÓÈ· Ê·Ú̷΢ÙÈ΋ ·ÁˆÁ‹, fiˆ˜ ÙÔ ¿ÛıÌ· Î·È Ô ‰È·‚‹Ù˘ (4,37). ™Â Û˘Ó‰˘·ÛÌfi Ì ÙËÓ ÂÈÏËÙÈ΋ ÓfiÛÔ, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ÂÈıÂÙÈÎfiÙËÙ· (ۈ̷ÙÈ΋ Î·È ÏÂÎÙÈ΋), Û˘Ó·ÈÛıËÌ·ÙÈ΋ ·ÛÙ¿ıÂÈ·, Ó¢ÚÈÎfiÙËÙ·, ·ÚÔÚÌËÙÈÎfiÙËÙ·, ˘ÂÚÎÈÓËÙÈÎfiÙËÙ· Î·È ·˘ÙÔÙÚ·˘Ì·ÙÈΤ˜ Û˘ÌÂÚÈÊÔÚ¤˜ (3,4,32,33). ∂ÈϤÔÓ, ÔÈ Û·ÛÌÔ› Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÌÔÚ› 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˘ÌÂÚÈÊÔÚ¿˜ (38). ∏ ‰ÈÂÈÛ‰˘ÙÈ΋ Î·È Û˘Ó¯‹˜ Â›‰Ú·ÛË Ù˘ ÂÈÏË„›·˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÙÔÓ›˙ÂÙ·È ÂÚÈÛÛfiÙÂÚÔ ÛÙȘ ÌÂϤÙ˜ ÙˆÓ Austin Î·È Û˘Ó. (39), fiˆ˜ Î·È Dunn Î·È Û˘Ó. (40), fiÔ˘ Ë ·Ó‡ÚÂÛË ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿ 6 Ì‹Ó˜ ÚÈÓ ÙÔ ÚÒÙÔ ÂÂÈÛfi‰ÈÔ Û·ÛÌÒÓ ‰Â›¯ÓÂÈ fiÙÈ Ë „˘¯Ô·ıÔÏÔÁ›· Î·È Ë ÂÈÏË„›· Û˘Ó‰¤ÔÓÙ·È ·Ó·fiÛ·ÛÙ·. ŒÙÛÈ, Ë ÂÈÏË„›· ÌÔÚ› 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 ÂÈÏË„›· (¤ˆ˜ 80%), Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ˘Ô‰ËÏÒÓÔ˘Ó fiÙÈ ÔÈ ‰˘ÛÎÔϛ˜ Û˘ÌÂÚÈÊÔÚ¿˜ ÌÔÚ› Ó· ·Ó·Ù˘¯ıÔ‡Ó ÛÙËÓ ÚÒÈÌË ·È‰È΋ ËÏÈΛ· Î·È Ó· ÂÈÌ›ÓÔ˘Ó ÛÙËÓ ÂÓ‹ÏÈÎË ˙ˆ‹ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì ÂÈÏË„›· (5,41). ∂ȉÈο ÚÔ‚Ï‹Ì·Ù· Û˘ÌÂÚÈÊÔÚ¿˜, fiˆ˜ ‰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 ÂÈÏË„›·˜ 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 ÂÈÏË„›·, 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΋˜ ÂÈÏË„›·˜ ˘ÔÛÙËÚ›˙ÂÈ ÙËÓ ˘fiıÂÛË fiÙÈ Ë Â›‰Ú·ÛË Ù˘ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ÙÔ˘ ∫¡™ Î·È Ù˘ ÂÈÏË„›·˜ 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˘ÌÂÚÈÊÔÚÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ì ÙË ÌÔÚÊ‹ ÙÔ˘ ™∂¶À (44). º·›ÓÂÙ·È, Â›Û˘, Ó· ˘¿Ú¯ÂÈ Û¯¤ÛË ÌÂٷ͇ ÂÈÏË„›·˜ 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΋ ÂÈÏË„›· 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›, Â›Û˘, ÌÂٷ͇ ηٿıÏȄ˘ Î·È ÂÈÏË„›·˜, ·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· ÂÈÏËÙÈÎÒÓ ÂÊ‹‚ˆÓ ›¯Â Û˘ÌÙÒÌ·Ù· ηٿıÏȄ˘, ÂÓÒ ÔÈ Oguz Î·È Û˘Ó. (48) ‚Ú‹Î·Ó ÂÚÈÛÛfiÙÂÚ· Û˘ÌÙÒÌ·Ù· ηٿıÏȄ˘ Û ÂÊ‹‚Ô˘˜ Ì ÂÈÏË„›· 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). ∏ Â›ÙˆÛË Ù˘ ·Á¯Ò‰Ô˘˜ ‰È·Ù·Ú·¯‹˜ ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· ‰ÂÓ Â›Ó·È ÁÓˆÛÙ‹, ·ÏÏ¿ Ë Ê‡ÛË ÙˆÓ Û·ÛÌÒÓ, Ì ÙÔÓ ·Úfi‚ÏÂÙÔ ¯·Ú·ÎÙ‹Ú· ÙˆÓ ÂÂÈÛÔ‰›ˆÓ Î·È ÙËÓ ·ÒÏÂÈ· ÂϤÁ¯Ô˘ Ô˘ ÚÔηÏ›, ÌÔÚ› 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 ÌÔÚ› Ó· Û¯ÂÙ›˙ÔÓÙ·È Ì Êfi‚Ô ‹ ¿Á¯Ô˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙÔ˘ ÂÂÈÛÔ‰›Ô˘, Ô˘ Ì ÙË ÛÂÈÚ¿ ÙÔ˘˜ Ô‰ËÁÔ‡Ó Û ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (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˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿ Ì ÂÈÏË„›· ·Ó·Ê¤ÚÔÓÙ·È Î˘Ú›ˆ˜ Ù· ÂÈÚfiÛıÂÙ· 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 ÂÈÏË„›· ¤¯Ô˘Ó ÂÈÚfiÛıÂÙ· Ó¢ÚÔÏÔÁÈο ÂÏÏ›ÌÌ·Ù·, fiˆ˜ 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˘ ‰ÈÏ¿ÛÈÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜, Û ۯ¤ÛË Ì ٷ ·È‰È¿ Ô˘ ¿Û¯Ô˘Ó ·fi ÌË ÂÈÏÂÁ̤ÓË ÂÈÏË„›· (53). ™˘Û¯¤ÙÈÛË ÌÂٷ͇ ÌË Î·Ï¿ ÂÏÂÁ¯fiÌÂÓˆÓ Û·ÛÌÒÓ Î·È ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜ ¤¯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˘ÌÂÚÈÊÔÚ¿˜ Û ·È‰È¿ Ì ÂÈÏË„›· 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˘ ÂÈÏË„›·˜, 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 ÂÈÏË„›·. ŒÙÛÈ, ·˘ÍË̤ÓÔ˜ ΛӉ˘ÓÔ˜ Û˘ÌÂÚÈÊÔÚÈÎÒÓ ‰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 ÂÈÏË„›· ÛÙËÓ ÂÌÊ¿ÓÈÛË ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ (4,41,55,56). ∞Ó·ÊÔÚÈο Ì ÙÔÓ ÚfiÏÔ ÙˆÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Ù˘ ÂÈÏË„›·˜ (Ù‡Ô˜ Û·ÛÌÒÓ, ËÏÈΛ· ¤Ó·Ú͢, ‰È¿ÚÎÂÈ· ÂÈÏË„›·˜, ¤ÏÂÁ¯Ô˜ Û·ÛÌÒÓ Î.Ï..) ÛÙËÓ ÂÌÊ¿ÓÈÛË ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜, 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 ÂÈıÂÙÈο, 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˘ÌÂÚÈÊÔÚ¿˜ (4,58). ™Â ÚfiÛÊ·ÙË ÌÂϤÙË ÛÙËÓ ∂ÏÏ¿‰·, ‚Ú¤ıËΠfiÙÈ ·ÎfiÌ· Î·È ·È‰È¿ Ì ȉÈÔ·ı‹ ÂÈÏË„›· Î·È Î·Ï¿ ÂÏÂÁ¯fiÌÂÓÔ˘˜ Û·ÛÌÔ‡˜ ·ÚÔ˘ÛÈ¿˙Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ‰È·Ù·Ú·¯ÒÓ Û˘ÌÂÚÈÊÔÚ¿˜ (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 ÂÈÏË„›· ·ÔÙÂÏÔ‡Ó ¤Ó·Ó Â›Û˘ ÛËÌ·ÓÙÈÎfi ·Ú¿ÁÔÓÙ· Û˘Û¯ÂÙÈ˙fiÌÂÓÔ Ì ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ (4,22,33). ŒÙÛÈ, ·fi ÙË Ì›· ÏÂ˘Ú¿ ÔÈ ‰È·Ù·Ú·¯¤˜ Û˘ÌÂÚÈÊÔÚ¿˜ ‹ ‰È¿ıÂÛ˘ Û ·È‰È¿ Ì ÂÈÏË„›· ÌÔÚ› Ó· Â›Ó·È ÂΉ‹ÏˆÛË Ù˘ ÁÓˆÛÙÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜, ÂÓÒ, ·fi ÙËÓ ¿ÏÏË, ÌÔÚ› Ó· ·ÔÙÂÏÔ‡Ó ÙËÓ ·ÈÙ›· Ù˘ ÌÂȈ̤Ó˘ ÈηÓfiÙËÙ·˜ Ì¿ıËÛ˘. ¶·Ú¿ÏÏËÏ· Ì ٷ ·Ú·¿Óˆ, ÛÙÔ ÂÈÏËÙÈÎfi ·È‰› ÂÌÊ·Ó›˙ÔÓÙ·È ·ÓÙȉڷÛÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ ÔÈ Ôԛ˜ ÔÊ›ÏÔÓÙ·È ÛÙË ¯ÚÔÓÈfiÙËÙ· Ù˘ ÓfiÛÔ˘ Î·È Ù˘ ıÂÚ·¢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 ÌÔÚ› 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˘. ∂ÈϤÔÓ, Ô Êfi‚Ô˜ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ ÂÈÏËÙÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘, Ô˘ ·˘Ùfi ηı·˘Ùfi ÌÔÚ› ·Ó¿ ¿Û· ÛÙÈÁÌ‹ ·Úfi‚ÏÂÙ· Ó· ÂΉËψı› ÛÙÔ ÛÙÂÓfi ‹ ¢ڇÙÂÚÔ ÂÚÈ‚¿ÏÏÔÓ, ÛÙÈÁÌ·Ù›˙ÂÈ ÙÔ ·È‰› ÎÔÈÓˆÓÈο, ÌÂÈÒÓÂÈ ÙËÓ ·˘ÙÔÂÎÙ›ÌËÛ‹ ÙÔ˘ Î·È ÚÔηÏ› ÂÈÚfiÛıÂÙË „˘¯È΋ ÂÈ‚¿Ú˘ÓÛË (60). ∞ÚÁfiÙÂÚ·, ÛÙËÓ ÂÚ›Ô‰Ô Ù˘ ÂÊ˂›·˜, ÔÈ „˘¯ÔÏÔÁÈΤ˜ Î·È ÎÔÈÓˆÓÈΤ˜ ÚÔÂÎÙ¿ÛÂȘ Ù˘ ÂÈÏË„›·˜ ÌÂÙ·ÙÚ¤Ô˘Ó ÙËÓ ÂÈÏË„›· Û ÌÈ· ‰˘Û‚¿ÛÙ·ÎÙË Î·Ù¿ÛÙ·ÛË ÁÈ· ÙÔ ÓÂPaediatriki 2008;71:426-433

·Úfi ¿ÙÔÌÔ (60,61). °È’ ·˘Ùfi, ÙÔ ÂÈÏËÙÈÎfi ·È‰› Ú¤ÂÈ Ó· ÙÔ ‚ϤÔ˘Ì ÛÙÔ Û‡ÓÔÏfi ÙÔ˘.

∞ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η ∆· ·ÓÙÈÂÈÏËÙÈο Ê¿Ú̷η (∞∂º) ‰ÚÔ˘Ó ÌÂÈÒÓÔÓÙ·˜ ÙË ÌÂÌ‚Ú·ÓÈ΋ ‰ÈÂÁÂÚÛÈÌfiÙËÙ·, ·˘Í¿ÓÔÓÙ·˜ ÙË ÌÂÙ·Û˘Ó·ÙÈ΋ ·Ó·ÛÙÔÏ‹ ‹ ÙÚÔÔÔÈÒÓÙ·˜ 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 ÂȉڿÛÂÒÓ ÙÔ˘˜ ÛÙËÓ ·Ó¿Ù˘ÍË ÙÔ˘ ÂÁÎÂÊ¿ÏÔ˘ (7,62). MÂϤÙ˜ Û ıËÏ·ÛÙÈο ¤¯Ô˘Ó ‰Â›ÍÂÈ ‰˘ÛÌÂÓ›˜ ÂȉڿÛÂȘ 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΋˜ ·fiÙˆÛ˘ (8,9,63). °ÂÓÈο, ÔÈ ÂȉڿÛÂȘ ÙˆÓ ∞∂º ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÛÙË Û˘ÌÂÚÈÊÔÚ¿ ÂÍ·ÙÔÌÈ·ÔÓÙ·È. ªÔÚ› Ó· ·ÚÔ˘ÛÈ·ÛÙÔ‡Ó ÙfiÛÔ ıÂÙÈΤ˜ fiÛÔ Î·È ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ. ∆· ∞∂º (ÎÏ·ÛÈο Î·È ÓÂfiÙÂÚ·) ÌÔÚÔ‡Ó ¿ÌÂÛ· Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙË ÁÓˆÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›·, ÂÊfiÛÔÓ Ë ÂÛÙȷ΋ ÂÈÏËÙÈ΋ ‰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 ÌÔÚ› Ó· ¤¯Ô˘Ó Î·È ·ÓÙÈηٷıÏÈÙÈ΋ ‹ ·Á¯ÔÏ˘ÙÈ΋ ‰Ú¿ÛË (6,64). ∆· ·È‰È¿ Ì ÂÈÏË„›·, fiˆ˜ ·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·¯¤˜ ÌÔÚ› Ó· ÂËÚ·ÛÙÔ‡Ó ıÂÙÈο ·fi Ù· ∞∂º, Ì Â·ÎfiÏÔ˘ıË ıÂÙÈ΋ Â›‰Ú·ÛË ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È ÙË Û˘ÌÂÚÈÊÔÚ¿. ŒÙÛÈ, fiÙ·Ó Ë ÂÈÏË„›· ¤¯ÂÈ ÛËÌ·ÓÙÈΤ˜ ÁÓˆÛÙÈΤ˜ ‹ Û˘ÌÂÚÈÊÔÚÈΤ˜ ÂȉڿÛÂȘ Î·È Ë ·ÓÙÈÂÈÏËÙÈ΋ ·ÁˆÁ‹ Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋, ÙfiÙ ٷ ÔʤÏË ÌÔÚ› Ó· ÍÂÂÚ¿ÛÔ˘Ó ÙȘ Ù˘¯fiÓ ·ÚÂÓ¤ÚÁÂȘ ÙˆÓ ∞∂º. ∞ÓÙ›ıÂÙ·, Û’ ¤Ó· ˘„ËÏ¿ ÏÂÈÙÔ˘ÚÁÈÎfi ·È‰› ÛÙÔ ÔÔ›Ô Ë ÂÈÏË„›· ‰ÂÓ ¤¯ÂÈ Â›‰Ú·ÛË, ·ÎfiÌ· Î·È ‹Ș ·ÚÂÓ¤ÚÁÂȘ ·fi Ù· ∞∂º ı· Á›ÓÔ˘Ó ·ÓÙÈÏËÙ¤˜ (6,7,64). √È ·ÚÓËÙÈΤ˜ ÂȉڿÛÂȘ ÙˆÓ ∞∂º ÛÙË ÁÓˆÛÙÈ΋ ÏÂÈÙÔ˘ÚÁ›· Â›Ó·È ›Ûˆ˜ ÔÈ ÈÔ ÁÓˆÛÙ¤˜ Î·È ÈÔ Û˘˙ËÙË̤Ó˜, ȉȷ›ÙÂÚ· ÔÈ ÂȉڿÛÂȘ ÙÔ˘˜ ÛÙËÓ ÂÁÚ‹ÁÔÚÛË, ÙËÓ ÚÔÛÔ¯‹, ÙË ÌÓ‹ÌË Î·È ÙËÓ Ù·¯‡ÙËÙ· ÂÂÍÂÚÁ·Û›·˜ (7,64). ¢˘ÛÌÂÓ›˜ ÁÓˆÛÙÈΤ˜ ÂȉڿÛÂȘ ·Ó·Ê¤ÚÔÓÙ·È Û˘¯ÓfiÙÂÚ· Ì ʿÚ̷η fiˆ˜ Ë Ê·ÈÓÔ‚·Ú‚ÈÙ¿ÏË Î·È ÔÈ ‚ÂÓ˙ԉȷ˙Â›Ó˜, Ô˘ ‰ÂÓ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ıÂÚ·¢ÙÈο Û‹ÌÂÚ· ÛÙËÓ Î·ıËÌÂÚÈÓ‹ È·ÙÚÈ΋ Ú¿ÍË (7,64). OÈ Û¯ÂÙÈΤ˜ ÌÂϤÙ˜ Ô˘ ·ÊÔÚÔ‡Ó ÙËÓ Î·Ú‚·Ì·˙Â›ÓË Â›Ó·È ·ÓÙÈÎÚÔ˘fiÌÂÓ˜, Ë

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·431

431

∂ÈÏË„›·, ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜ Î·È Û˘ÌÂÚÈÊÔÚ¿

ÔÍηڂ·Ì·˙Â›ÓË Ê·›ÓÂÙ·È ˆ˜ ‰ÂÓ ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜, ÂÓÒ ÁÈ· ÙÔ ‚·ÏÚÔ˚Îfi Ó¿ÙÚÈÔ ÔÈ ÂȉڿÛÂȘ ‰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΋ Â›‰Ú·ÛË Ù˘ Ï·ÌÔÙÚÈÁ›Ó˘ ÛÙȘ ÁÓˆÛÙÈΤ˜ ÏÂÈÙÔ˘ÚÁ›Â˜. ∆¤ÏÔ˜, Ë ÔÏ˘ıÂÚ·›· Ê·›ÓÂÙ·È ˆ˜ Â›Ó·È ·Ú¿ÁÔÓÙ·˜ ÎÈÓ‰‡ÓÔ˘, ÂÓÒ Ë ÌÔÓÔıÂÚ·›· Û ̤ÙÚȘ ‰fiÛÂȘ ‰ÂÓ Ê·›ÓÂÙ·È Ó· ÂËÚ¿˙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˜ ÂȉڿÛÂȘ ÙˆÓ ∞∂º ÛÙ· ·È‰È¿ Ì ÂÈÏË„›· 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˘, fiˆ˜ Ë ÚÔÛÔ¯‹ Î·È Ë ÓÔËÙÈ΋ ÎfiˆÛË. ∏ ‰˘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·ÛÎfiËÛ·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˜ ÂȉڿÛÂȘ ÛÙȘ Û˘Ó‹ıÂȘ ıÂÚ·¢ÙÈΤ˜ ‰fiÛÂȘ. ∆¤ÏÔ˜, Ù· ∞∂º ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛÙ› Ì ¤Ó· ÌÂÁ¿ÏÔ Â‡ÚÔ˜ ÚÔ‚ÏËÌ¿ÙˆÓ Û˘ÌÂÚÈÊÔÚ¿˜. ∫·Ù¿ıÏÈ„Ë, Ì·Ó›·, „‡¯ˆÛË, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÂÈıÂÙÈÎfiÙËÙ·, ˘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˘ıÂÚ·›·, 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 ÂÈÏË„›· ·ÚÔ˘ÛÈ¿˙Ô˘Ó ‰È·Ù·Ú·¯¤˜ ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ 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 ·ÓÙÈÂÈÏËÙÈÎÒÓ 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 ÌÔÚÔ‡Ó Ó· ¤¯Ô˘Ó Û·Ê‹ ÚÔÁÓˆÛÙÈ΋ ·Í›· ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË ÙˆÓ ‰È·Ù·Ú·¯ÒÓ Ì¿ıËÛ˘ Î·È Û˘ÌÂÚÈÊÔ-

Ú¿˜ Û fiÏ· Ù· ·È‰È¿ Ì ÂÈÏË„›·. °È’ ·˘Ùfi Î·È Ë Û˘ÛÙËÌ·ÙÈ΋ Ó¢ÚÔÏÔÁÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙˆÓ ·È‰ÈÒÓ Ì ÂÈÏË„›· ı· Ú¤ÂÈ Ó· ÂÚÈÏ·Ì‚¿ÓÂÈ ÙËÓ ÂÎÙ›ÌËÛË ÙˆÓ ÁÓˆÛÙÈÎÒÓ ÏÂÈÙÔ˘ÚÁÈÒÓ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·ÛÊ·ÏÈÛı› Ë Î·Ù¿ÏÏËÏË ·Ú¤Ì‚·ÛË, fiÔ˘ Î·È fiÔÙ ·˘Ù‹ ¯ÚÂÈ¿˙ÂÙ·È.

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∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯·

AÏÏËÏÔÁÚ·Ê›·: ∞ıËÓ¿ ¶··‰ÔÔ‡ÏÔ˘ athinapap@yahoo.com ¶·È‰È·ÙÚÈÎfi ∆Ì‹Ì·, °ÂÓÈÎfi ¡ÔÛÔÎÔÌÂ›Ô ∫∞∆, ∞ı‹Ó·

¶ÂÚ›ÏË„Ë: √ ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜, ÓfiÛËÌ· ÂÍ¿ÚÙËÛ˘ Ù˘ ÙÂÏÂ˘Ù·›·˜ ‰ÂηÂÙ›·˜, ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Û ÛËÌ·ÓÙÈÎfi ·ÚÈıÌfi ÂÊ‹‚ˆÓ ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜. ÷ڷÎÙËÚ›˙ÂÙ·È ·fi ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË Î·È ÂÍ·ÚÙÒÌÂÓË Û˘ÌÂÚÈÊÔÚ¿, Ë ÔÔ›· ÂËÚ¿˙ÂÈ ·ÚÓËÙÈο ÙË ÛˆÌ·ÙÈ΋, ·Î·‰ËÌ·˚΋, ÎÔÈÓˆÓÈ΋, ÔÈÎÔÓÔÌÈ΋ Î·È Â·ÁÁÂÏÌ·ÙÈ΋ ˙ˆ‹ ÙÔ˘ ¯Ú‹ÛÙË. √ ÂÚÈÔÚÈÛÌfi˜ Ù˘ ¯Ú‹Û˘ ÚÔηÏ› Û˘ÌÙÒÌ·Ù· ÛÙ¤ÚËÛ˘, fiˆ˜ ·ÓËÛ˘¯›·, ¢ÂÚÂıÈÛÙfiÙËÙ·, ÙÚfiÌÔ, ¿Á¯Ô˜, Ê·ÓÙ·ÛÈÒÛÂȘ Î·È ÂÈıÂÙÈÎfiÙËÙ·, Ù· ÔÔ›· ˘Ô¯ˆÚÔ‡Ó ÌÂÙ¿ ·fi Ó¤· ¯Ú‹ÛË. √Ê›ÏÂÙ·È ÛÂ Û˘Ó‰˘·ÛÌfi ÎÔÈÓˆÓÈÎÒÓ ·Ú·ÁfiÓÙˆÓ Î·È ÚÔÛˆÈÎÒÓ ¯·Ú·ÎÙËÚÈÛÙÈÎÒÓ Î·È Û˘¯Ó¿ Û˘Ó‰˘¿˙ÂÙ·È Ì ηٿıÏÈ„Ë. ∏ Â›ÙˆÛË 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 ÛÎÔfi ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ ÙÚfiÔ˘ ˙ˆ‹˜ ÙˆÓ ·Û¯fiÓÙˆÓ Î·È ÙËÓ ·Ó¿Ù˘ÍË ¿ÏÏˆÓ ‰Ú·ÛÙËÚÈÔًوÓ, ÂËÚ¿˙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 ÙÚfiÔ Ì ÙÔÓ ÔÔ›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 ÛÎÔfi Î·È ÁÈ· Û˘ÁÎÂÎÚÈ̤ÓÔ ¯ÚfiÓÔ, Ì ÂÈÙ‹ÚËÛË, ÂÓÒ fiÏÔÈ ÔÈ ·ÚÌfi‰ÈÔÈ ÊÔÚ›˜ ÔÈ ÔÔ›ÔÈ ÂÌϤÎÔÓÙ·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˘ÌÙˆÌ¿ÙˆÓ Î·È ÂÈÚÚÂÒÓ ÂÚÈÙÒÛˆÓ.

§¤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 ·ÓÂÙ˘ÁÌ¤ÓˆÓ ÎÔÈÓˆÓÈÒÓ, Ô „˘¯›·ÙÚÔ˜ Goldberg I. ·Ú·Ù‹ÚËÛ ÂÚÈÙÒÛÂȘ Ì ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË Î·È ÂÍ·ÚÙÒÌÂÓË Û˘ÌÂÚÈÊÔÚ¿ Î·È ‰È·Ù‡ˆÛ ÙÔÓ fiÚÔ ‰È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ (1). √ fiÚÔ˜, ·Ú¯Èο, ·ÓÙÈÌÂÙˆ›ÛÙËΠ·fi Ù· ̤۷ ÂÓË̤ڈÛ˘ Î·È ÙËÓ ÂÈÛÙËÌÔÓÈ΋ 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 ÚÔÛˆÈ΋ 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˘ÌÙÒÌ·Ù· ÛÙ¤ÚËÛ˘

Pediatri Nov-Dec 08 new

19-12-08

16:31

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435

¢È·‰ÈÎÙ˘·Îfi˜ ÂıÈÛÌfi˜ ÛÙËÓ ÂÊ˂›·

¶›Ó·Î·˜ 1. ÀÔηÙËÁÔڛ˜ ‰È·‰ÈÎÙ˘·ÎÔ‡ ÂıÈÛÌÔ‡ ¢È·‰ÈÎÙ˘·Îfi˜ ÛÂÍÔ˘·ÏÈÎfi˜ ÂıÈÛÌfi˜

¢È·‰ÈÎÙ˘·Î¤˜ Û¯¤ÛÂȘ ÂıÈÛÌÔ‡

¢È·‰ÈÎÙ˘·Îfi˜ „˘¯·Ó·ÁηÛÌfi˜

ÀÂÚÊfiÚÙˆÛË ÏËÚÔÊÔÚÈÒÓ

ÀÂÚ‚ÔÏÈ΋ ÂÓ·Û¯fiÏËÛË Ì ÙËÓ ÚÔ‚ÔÏ‹, ÙË Ï‹„Ë Î·È ÂÌÔÚ›· ÔÚÓÔÁÚ·ÊÈÎÔ‡ ˘ÏÈÎÔ‡ ÛÙÔ ‰È·‰›ÎÙ˘Ô ‹ ÂÌÏÔ΋ Û ÛÂÍÔ˘·ÏÈΤ˜ Ê·ÓÙ·ÛÈÒÛÂȘ Î·È ·›ÍÈÌÔ ÚfiÏˆÓ ÛÙ· chat rooms. ÀÂÚ‚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, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ˘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˘ÌÂÚÈÊÔÚ¿˜ 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 ÂfiÌÂÓË ¤Î‰ÔÛË ÙÔ˘ DSM-V (Diagnostic and Statistic Manual of Mental Disorders) (4). ∆ËÓ ›‰È· ÂÚ›Ô‰Ô, ·Ú’ fiϘ ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ·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 ÌÔÚ› Ó· ÂËÚ¿ÛÂÈ ·ÚÓËÙÈο ÙËÓ ·Î·‰ËÌ·˚΋, ÎÔÈÓˆÓÈ΋, ÔÈÎÔÓÔÌÈ΋ Î·È Â·ÁÁÂÏÌ·ÙÈ΋ ˙ˆ‹ ÂÓfi˜ ·ÓıÚÒÔ˘, ηٿ ÙÔÓ ›‰ÈÔ ÙÚfiÔ Ô˘ ÂËÚ¿˙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˜, fiˆ˜ 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 ‚ÈÓÙÂÔ·È¯Ó›‰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·, fiˆ˜ ·˘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· ÂÈÙ¢¯ı› Ë ›‰È· ÈηÓÔÔ›ËÛË ‹ ÌÂȈ̤ÓË ÈηÓÔÔ›ËÛË ÌÂÙ¿ ·fi ÙÔÓ ›‰ÈÔ ¯ÚfiÓÔ Û‡Ó‰ÂÛ˘, ‚) ·Ó¿Ù˘ÍË ÂÓfi˜ ‹ ÂÚÈÛÛfiÙÂÚˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙ¤ÚËÛ˘ ÌÂÙ¿ ·fi ‰È·ÎÔ‹ ‹ Ì›ˆÛË ¯Ú‹Û˘ ̤۷ Û ‰È¿ÛÙËÌ· ÂÓfi˜ ÌËÓfi˜, Û˘ÌÙÒÌ·Ù· Ô˘ ÚÔηÏÔ‡Ó Î·Ù·fiÓËÛË ‹ ‰È·Ù·Ú·¯‹ Ù˘ ÎÔÈÓˆÓÈ΋˜, ÚÔÛˆÈ΋˜ 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˘ÌÙˆÌ¿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) ÂÈÏÔÁ‹ ÔÏÏÒÓ ‰Ú·ÛÙËÚÈÔÙ‹ÙˆÓ Ì¤Ûˆ ‰È·‰ÈÎÙ‡Ô˘ (·ÁÔÚ¿, ÂÈÎÔÈÓˆÓ›·, ·È¯Ó›‰È·) Î·È ÛÙ) ‰È·ÎÔ‹ ‹ ÛËÌ·ÓÙÈ΋ Ì›ˆÛË Ù˘ ÎÔÈÓˆÓÈ΋˜, ÚÔÛˆÈ΋˜, ‰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 ÔÔ›Ô ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ·Ó›¯Ó¢Û˘ ·ÙfiÌˆÓ Ì ÛÔ‚·Ú‹ ÂÍ¿ÚÙËÛË Î·È ·ÓÙÈÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿. §›ÁÔ ·ÚÁfiÙÂÚ·, Ô Ko ‰ËÌÔÛ›Â˘Û ÙÚÔÔÔÈ‹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· ¢·ÈÛıËÙÔÔ›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‹ ÂÈÎÔÈÓˆÓ›· 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˘ÌÂÚÈÊÔÚ¿. ™˘¯Ó¿, ‰ÂÓ ÂÚÈÔÚ›˙ÂÙ·È ÌfiÓÔ Û ‰È·‰ÈÎÙ˘·Î¤˜ Û¯¤ÛÂȘ, ·ÏÏ¿ ÂÂÎÙ›ÓÂÈ ÙË ‰Ú·ÛÙËÚÈfiÙËÙ¿ ÙÔ˘ Û on line gaming, on line Ù˘¯ÂÚ¿ ·È¯Ó›‰È· Î·È ·ÁÔÚ¤˜/eBay, ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¶·È‰È·ÙÚÈ΋ 2008;71:434-440

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·436

436

∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. °ÂˆÚÁÈÔÔ‡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˘ÌÂÚÈÊÔÚ¿. ¶Úfi‰ÚÔÌ· ÛËÌ›·, fiˆ˜ ˘ÂÚ‚ÔÏÈÎfi˜ ¯ÚfiÓÔ˜ ÂÓ·Û¯fiÏËÛ˘, Ì›ˆÛË ÙÔ˘ ¯ÚfiÓÔ˘ ÂÈÎÔÈÓˆÓ›·˜ Ì ʛÏÔ˘˜ Î·È ¿ÏϘ ÎÔÈÓˆÓÈΤ˜ Û˘Ó·Ó·ÛÙÚÔʤ˜, ·Ú·Ì¤ÏËÛË ˘Ô¯ÚÂÒÛˆÓ, ÛËÌ·ÓÙÈ΋ ÙÒÛË Ù˘ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘, ÌÂÙ·‚ÔϤ˜ ÛÙË Û˘ÌÂÚÈÊÔÚ¿ 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· ·ÓÙÈÌÂÙÒÈÛ˘ 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˜ ÚÔÛˆÈÎfiÙËÙ·˜ ∏ 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 ÂÈÚÚÂ‹ ÛÙËÓ ·Ó¿Ù˘ÍË ÂıÈÛÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜. ™˘ÓÔ„›˙ÔÓÙ·˜, Û‡Ìʈӷ Ì ÙË ıˆڛ· ·˘Ù‹, ÂıÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 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˜ ·ÓıÚÒˆÓ Â›Ó·È ÈÔ ÂÈÚÚÂ›˜ Û οÔȘ 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 ÂÈÚÚÂ‹˜ ÛÙË ¯Ú‹ÛË ·Ú·ÈÛıËÛÈÔÁfiÓˆÓ, ·ÏÏ¿ ÏÈÁfiÙÂÚÔ ÂÈÚÚÂ‹˜ ÛÙË ¯Ú‹ÛË ËÚˆ›Ó˘, Û ۯ¤ÛË Ì ÙË Ì·‡ÚË Ê˘Ï‹ Î·È ÙÔ˘˜ §·ÙÈÓÔ·ÌÂÚÈηÓÔ‡˜. °) £ÂˆÚ›· Û˘ÌÂÚÈÊÔÚ¿˜ ∫¿ı ¿ÙÔÌÔ ·Ì›‚ÂÙ·È ‹ ÙÈ̈ÚÂ›Ù·È ÁÈ· οıÂ Û˘ÌÂÚÈÊÔÚ¿ Ô˘ ÂΉËÏÒÓÂÈ. ŒÓ· ÓÙÚÔ·Ïfi ·È‰› Ô˘ ÊÔ‚¿Ù·È ÙË Û˘Û¯¤ÙÈÛË Ì ӤԢ˜ ·ÓıÚÒÔ˘˜ ·ÔÌÔPaediatriki 2008;71:434-440

ÓÒÓÂÙ·È, Ì ÛÎÔfi 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˘ ÂÈÛÚ¿ÙÙÂÈ Î·È Ë ÔÔ›· ÂÓÈÛ¯‡ÂÈ ·ÚfiÌÔȘ Û˘ÌÂÚÈÊÔÚ¤˜. ∆· Ó·ÚΈÙÈο, ÙÔ ·ÏÎÔfiÏ, Ù· Ù˘¯ÂÚ¿ ·È¯Ó›‰È·, ÙÔ ‰È·‰›ÎÙ˘Ô ÚÔÛʤÚÔ˘Ó ·ÌÔÈ‚‹-ÂÈ‚Ú¿‚¢ÛË, Ì ÙË ÌÔÚÊ‹ ËÚÂÌ›·˜, ·Á¿˘, ‰˘Ó·ÌÈÛÌÔ‡, Ê˘ÛÈ΋˜ Î·È Û˘Ó·ÈÛıËÌ·ÙÈ΋˜ Î¿Ï˘„˘ ηÈ, ΢ڛˆ˜, ÙÔÓ ÙÚfiÔ ·ÔÊ˘Á‹˜ Ù˘ Ú·ÁÌ·ÙÈÎfiÙËÙ·˜. ŒÙÛÈ, Ù· ¿ÙÔÌ· ÂÈ˙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˘ÌÂÚÈÊÔÚ¤˜ ¤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 ÛÎÔfi 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 ÌÈÎÚÔÚˆÙ½Ó˜ ·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˘ÌÂÚÈÊÔÚ¿˜ ∏ ·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˘ÌÂÚÈÊÔÚ¿ Â›Ó·È ·ÔÙ¤ÏÂÛÌ· Û˘Ó‰˘·ÛÌÔ‡ ÎÔÈÓˆÓÈÎÒÓ ·ÈÙÈÒÓ Î·È ÚÔÛˆÈÎÒÓ ¯·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 ÂÈÚÚÂ‹ 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· ÂÈÙ˘Á¯¿ÓÔ˘Ó Ó· ˘Ô‰‡ÔÓÙ·È ÚfiÏÔ˘˜ Ô˘ ‰ÂÓ ¤¯Ô˘Ó ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ·, ·ÏÏ¿ ÙÔ˘˜ ÔÔ›Ô˘˜ ÂÈı˘ÌÔ‡Ó (16,17). ∆· ·È‰È¿ Ì ÎÔÈÓˆÓÈΤ˜ ·Ó·ÛÊ¿ÏÂȘ ÂȉÈÒÎÔ˘Ó ÙË ¯Ú‹ÛË, ÈÛÙ‡ÔÓÙ·˜ fiÙÈ ¤ÙÛÈ ı· ÍÂÂÚ¿ÛÔ˘Ó ÙË ¯·ÌËÏ‹ ·˘ÙÔÂÎÙ›ÌËÛË Ô˘ ‰È·ı¤ÙÔ˘Ó Î·È ı· ·Ó·Ù‡ÍÔ˘Ó ÙÚfiÔ˘˜ ÂÈÎÔÈÓˆÓ›·˜ 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

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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 ÚÔÛˆÈÎfiÙËÙ· ÀÂÚÎÈÓËÙÈÎfiÙËÙ· ¢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΋ ÚÔÛˆÈÎfiÙËÙ·

¢È·Ù·Ú·¯‹ ÛÙËÓ ÔÈÎÔÁÂÓÂȷ΋ Û˘ÓÔ¯‹ ªÔÓÔÁÔÓÂ˚΋ ÔÈÎÔÁ¤ÓÂÈ· ∂ÏÏÈ‹˜ ÔÈÎÔÁÂÓÂȷ΋ ÛÙ‹ÚÈÍË ∂ÏÏÈ‹˜ ÂÔÙ›· ∂χıÂÚË ¯Ú‹ÛË, ¯ˆÚ›˜ ¯ÚÔÓÈÎÔ‡˜ Î·È ÔÈÔÙÈÎÔ‡˜ ÂÚÈÔÚÈÛÌÔ‡˜ ÀÂÚÚÔÛٷ٢ÙÈÎfi ‹ ·˘ÛÙËÚfi ÂÚÈ‚¿ÏÏÔÓ ¶·ÚÔ˘Û›· ËÏÂÎÙÚÔÓÈÎÔ‡ ˘ÔÏÔÁÈÛÙ‹ ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙÔ˘ ·È‰ÈÔ‡ ªÂȈ̤Ó˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÂÎÙfi˜ ÛÈÙÈÔ‡ ™˘¯Ó¤˜ ÂÈÛΤ„ÂȘ Û internet café

·˘Í¿ÓÂÈ ÙËÓ ·ÔÌfiÓˆÛË (19). ¶ÔÏϤ˜ ¤Ú¢Ó˜ ¤‰ÂÈÍ·Ó fiÙÈ ·È‰È¿ Ì „˘¯È·ÙÚÈΤ˜ ‰È·Ù·Ú·¯¤˜, fiˆ˜ ηٿıÏÈ„Ë, „˘¯·Ó·ÁηÛÙÈÎfiÙËÙ·-ηٷӷÁηÛÙÈÎfiÙËÙ·, ÊÔ‚›Â˜, ·Ó·Ù‡ÛÛÔ˘Ó Â˘ÎÔÏfiÙÂÚ· ÂıÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 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‹ ÙÚfiÔ ··Û¯fiÏËÛ˘ Î·È „˘¯·ÁˆÁ›·˜ ÛÙÔ Û›ÙÈ, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÔÈ ÂÎÙfi˜ ÛÈÙÈÔ‡ ‰Ú·ÛÙËÚÈfiÙËÙ˜, fi¯È ÌfiÓÔ Â›Ó·È ÂÈΛӉ˘Ó˜, ·ÏÏ¿ ··ÈÙÔ‡Ó Î·È ÙËÓ ·ÚÔ˘Û›· ÙˆÓ ÁÔÓ¤ˆÓ Ô˘, ÏfiÁˆ ÔχˆÚ˘ Â·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. ∂ÈϤÔÓ, 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 ÂÈ‚·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›˜ ÂÔÙ›· Î·È ¯ˆÚ›˜ ¯ÚÔÓÈο fiÚÈ·. √ ¯ÚfiÓÔ˜ Î·È Ë ÔÈfiÙËÙ· Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ·ԉ›¯ıËÎ·Ó ÛËÌ·ÓÙÈΤ˜ ÂÈÚfiÛıÂÙ˜ ·Ú¿ÌÂÙÚÔÈ. ∆· on line ·È¯Ó›‰È· Î·È Ù· chat rooms ·ÔÙÂÏÔ‡Ó ÙÚfiÔ Â‡ÎÔÏ˘ Û˘Ó¿ÓÙËÛ˘ ÙˆÓ ÂÊ‹‚ˆÓ Î·È ÂÏ΢ÛÙÈÎfi ̤ÛÔ ÂÈÎÔÈÓˆÓ›·˜ Î·È ·ÓÙ·ÁˆÓÈÛÙÈÎfiÙËÙ·˜, Ù· ÔÔ›· ÁÚ‹ÁÔÚ· Ô‰ËÁÔ‡Ó Û ·ÏfiÁÈÛÙË Î·È ÔχˆÚË ¯Ú‹ÛË,

Û ·Ú·Ì¤ÏËÛË Î·ıËÎfiÓÙˆÓ Î·È Û ÂÍ·ÚÙË̤ÓË Û˘ÌÂÚÈÊÔÚ¿ (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˘ Â›ÙˆÛ˘. √È ÂÚÈÛÛfiÙÂÚ˜ ·ÊÔÚÔ‡Ó ÙȘ ÂÚÈÔ¯¤˜ ηٷÛ΢‹˜ Ù˘ ËÏÂÎÙÚÔÓÈ΋˜ Ù¯ÓÔÏÔÁ›·˜, fiˆ˜ 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‰¤˜ ÂÈÏÔΤ˜ ∏ ‰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¤˜ ÂÈÏÔΤ˜ ÔÈ Ôԛ˜ ÚÔηÏÔ‡Ó ·ÓËÛ˘¯›· ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ, fiˆ˜ ·ÓÙÈÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ·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˜ ÂÈÛΤ„ÂȘ Û ›ÓÙÂÚÓÂ٠ηʤ, ÎÏÔ‹ ÚÔ˜ ÂÍ·ÛÊ¿ÏÈÛË ÙˆÓ ··Ú·›ÙËÙˆÓ ¯ÚËÌ¿ÙˆÓ, ÂÏÏÈ‹ ÍÂÎÔ‡Ú·ÛË Î·È ‰È·ÙÚÔÊ‹ Î·È ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 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¿ ÂÌϤÎÔÓÙ·È Û ÛÂÍÔ˘·ÏÈΤ˜ ÚÔÛÎÏ‹ÛÂȘ Î·È ·˘ÙÔÎÙÔÓ›· (40-44). ™Â ÌÈ· ·Ó·ÛÎfiËÛ‹ 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

16:31

™ÂÏ›‰·438

438

∞. ¶··‰ÔÔ‡ÏÔ˘, ¶. °ÂˆÚÁÈÔÔ‡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 ÂÚÈÙÒÛÂȘ ‰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˘ ηÚÈ·›Ô˘ ۈϋӷ ›Ûˆ˜ Â›Ó·È Ë ÈÔ ·Ï‹ ÂÈÏÔ΋, Ô˘ ‡ÎÔÏ· ·Ôηı›ÛٷٷÈ.

£ÂÚ·›· £ÂÚ·¢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). ∏ ıÂÚ·›· ·ÚÔ˘ÛÈ¿˙ÂÈ È‰È·ÈÙÂÚfiÙËÙ˜, Û ۯ¤ÛË Ì ¿ÏÏ· ›‰Ë ÂıÈÛÌÔ‡. µ·ÛÈ΋ ‰È·ÊÔÚ¿ ·ÔÙÂÏ› ÙÔ ÁÂÁÔÓfi˜ fiÙÈ ‰ÂÓ ÂÓÔ¯ÔÔÈÂ›Ù·È Î¿ÔÈ· ÙÔÍÈ΋ Ô˘Û›· ·ÏÏ¿ οÔÈÔ˜ ÙÚfiÔ˜ ˙ˆ‹˜ Î·È Ë ·Ú¤Ì‚·ÛË ı· Ú¤ÂÈ Ó· ÂÛÙÈ¿˙ÂÙ·È ÛÙËÓ ·ÏÏ·Á‹ Ù˘ ηıËÌÂÚÈÓfiÙËÙ·˜ ÙÔ˘ ¿Û¯ÔÓÙÔ˜. √È ‹Ș ÂÚÈÙÒÛÂȘ ·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· ÔÔ›· ÂÊ·ÚÌfi˙ÂÙ·È Ë ÁÓˆÛȷ΋ Û˘ÌÂÚÈÊÔÚÈ΋ ıÂÚ·›· (47). ∆Ô ÚÒÙÔ Î¤ÓÙÚÔ Ô˘ ‰ÈÔÚÁ·ÓÒıËΠ̠ÙË ÌÔÚÊ‹ ηٷÛ΋ӈÛ˘ ÁÈ· ÂÊ‹‚Ô˘˜ Â›Ó·È ÛÙËÓ ·Ú·Ïȷ΋ ΈÌfiÔÏË Boltenhagen ÛÙËÓ ÂÚÈÔ¯‹ Mecklenburg ÛÙË ¢˘ÙÈ΋ Pomerania (°ÂÚÌ·Ó›·), ÙÔ ÔÔ›Ô ÂȉÈÒÎÂÈ Ó· ‚ÔËı‹ÛÂÈ Ù· ·È‰È¿ Ó· ‚ÂÏÙÈÒÛÔ˘Ó ÙȘ Û¯¤ÛÂȘ Ì ʛÏÔ˘˜, Ó· ÂÈϤÁÔ˘Ó ‰È·ÊÔÚÂÙÈΤ˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ Î·È ‰È·ÊÔÚÂÙÈ΋ ηٷÓÔÌ‹ ÙˆÓ ˆÚÒÓ ÙÔ˘ 24ÒÚÔ˘. ∆Ô Î¤ÓÙÚÔ ÂȉÈÒÎÂÈ ÂÈϤÔÓ ÙËÓ ·Ú¤Ì‚·ÛË ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ ÙÔ˘ ·È‰ÈÔ‡, Ô˘ ÔÏϤ˜ ÊÔÚ¤˜ ıˆÚÂ›Ù·È ˘‡ı˘ÓÔ. ™Â ÌÂÚÈΤ˜ ÂÚÈÙÒÛÂȘ, Â›Ó·È ··Ú·›ÙËÙË Ë ¯Ú‹ÛË ·ÓÙÈηٷıÏÈÙÈÎÒÓ Û΢·ÛÌ¿ÙˆÓ.

KÚÈÙÈ΋ À¿Ú¯ÂÈ ·ÚÎÂÙfi˜ ÛÎÂÙÈÎÈÛÌfi˜ 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˘˜ ·ÓıÚÒÔ˘˜ ·ÔÙÂÏ› ¤Ó· ·Î›Ó‰˘ÓÔ ÊÈÏÈÎfi ÂÚÁ·Ï›Ô, ÙÔ ÔÔ›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 ÙÚfiÔ, ÂıÈÛÌfi˜ ı· ÌÔÚÔ‡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˘ÌÂÚÈÊÔÚ¤˜ ηٿ ÙȘ Ôԛ˜ Ù· ¿ÙÔÌ· ·ÔÔÈÔ‡ÓÙ·È ÔÈÎÔÁÂÓÂȷΤ˜ ·Ó¿ÁΘ, Ê›ÏÔ˘˜ ‹ ÎÔÈÓˆÓÈΤ˜ ÂΉËÏÒÛÂȘ (50). ∏ ¢¯·Ú›ÛÙËÛË ·fi ÙË ¯Ú‹ÛË ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ‰ÂÓ ÌÔÚ› Ó· Û˘ÁÎÚÈı› Ô‡Ù ÛÙÔ ÂÏ¿¯ÈÛÙÔ Ì ÙË ¯Ú‹ÛË ÎÔη˝Ó˘ ‹ ËÚˆ›Ó˘. √‡Ù ÌÔÚ› Ó· Û˘ÁÎÚÈı› Ì ÙËÓ ·ıÔÏÔÁÈ΋ ÂÍ¿ÚÙËÛË ·fi Ù˘¯ÂÚ¿ ·È¯Ó›‰È·, Ë ÔÔ›· ·ÔÙÂÏ› ÌÂÌÔӈ̤ÓË ·ÓÙÈÎÔÈÓˆÓÈ΋ Û˘ÌÂÚÈÊÔÚ¿. ∞ÓÙ›ıÂÙ·, ÙÔ ‰È·‰›ÎÙ˘Ô ¤¯ÂÈ Ì¤ÁÈÛÙÔ ·ÙÔÌÈÎfi Î·È ÎÔÈÓˆÓÈÎfi fiÊÂÏÔ˜. ∞ÔÙÂÏ› ÙÔ ··Ú·›ÙËÙÔ Ì¤ÛÔ ÏÂÈÙÔ˘ÚÁ›·˜ ÔÏÏÒÓ ÂȯÂÈÚ‹ÛÂˆÓ Î·È ¿ÌÂÛ˘ ÚfiÛ‚·Û˘ Û Ï›ÛÙ· ˘ÏÈο ·Á·ı¿, ÚÔÛʤÚÂÈ ÙÔÓ ÙÚfiÔ Â‡ÎÔÏ˘ Â·ÁÁÂÏÌ·ÙÈ΋˜ ‹ ÚÔÛˆÈ΋˜ ÂÈÎÔÈÓˆÓ›·˜ 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 ˘‡ı˘ÓË ÁÈ· ÙËÓ ÂÁηٿÛÙ·ÛË ÂıÈÛÌÔ‡, ·ÏÏ¿ ¿ÙÔÌ· ÌÂ Û˘ÁÎÂÎÚÈ̤Ó˜ Û˘ÌÂÚÈÊÔÚ¤˜ ÌÔÚÔ‡Ó Ó· ÂÚÈ¤ÛÔ˘Ó Û ˘ÂÚ‚ÔÏÈ΋ ¯Ú‹ÛË (50). ∆Ô ÂÚÒÙËÌ· Ô˘ Ù›ıÂÙ·È Â›Ó·È ÙÈ ÚÔηÏ› ·ÏÏ·Á¤˜ ÛÙËÓ ÈÛÔÚÚÔ›· Ù˘ ·ÓıÚÒÈÓ˘ „˘¯ÔÛ‡ÓıÂÛ˘. ∂›Ó·È ÁÂÁÔÓfi˜ fiÙÈ ÔÈ ÎÔÈÓˆÓÈΤ˜ Î·È Â·ÁÁÂÏÌ·ÙÈΤ˜ ··ÈÙ‹ÛÂȘ ‰ËÌÈÔ˘ÚÁÔ‡Ó ÚÔÛˆÈÎfiÙËÙ˜ ÌÔÓ·¯ÈΤ˜, ÊÔ‚ÈṲ̂Ó˜, ·Ó·ÛÊ·Ï›˜, ηٷıÏÈÙÈΤ˜, ¯ˆÚ›˜ ηÏÏȤÚÁÂÈ· Î·È ÛÙ·ıÂÚfiÙËÙ·, Ì ·ÔÙ¤ÏÂÛÌ· ÙÔ ‰È·‰›ÎÙ˘Ô Ó· Â›Ó·È Ô ÙÚfiÔ˜ ‡ÎÔÏ˘ ‰È·Ê˘Á‹˜. ÿÛˆ˜ ÙÂÏÈο Ó· Â›Ó·È ÙÔ Ì¤ÛÔ ÙÔ ÔÔ›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˘˜ ·ÓıÚÒÔ˘˜, ÔÈ ÔÔ›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¤˜ Â·ÁÁÂÏÌ·ÙÈΤ˜ ··ÈÙ‹ÛÂȘ ·Ó¿ÏÔÁ· Ì ÙȘ ÈηÓfiÙËÙ˜ Î·È ÙËÓ ÚÔÛˆÈÎfiÙËÙ¿ ÙÔ˘˜ Î·È ·˘ÍË̤Ó˜ ‰Ú·ÛÙËÚÈfiÙËÙ˜ ÂÎÙfi˜ ÛÈÙÈÔ‡. ¶ÈÛÙ‡ԢÌ fiÙÈ ÔÈ ·ÏËıÈÓ¤˜ Û¯¤ÛÂȘ-ÊÈϛ˜ Î·È Ë Â·Ó-Â·Ê‹ ÙˆÓ ÂÊ‹‚ˆÓ Ì ÙË Ê‡ÛË Î·È ÙË ¢ËÌÈÔ˘ÚÁ›· ı· ·ÔÙÚ¤„Ô˘Ó ÂıÈÛÙÈΤ˜ Û˘ÌÂÚÈÊÔÚ¤˜ Î·È ı· Ô‰ËÁ‹ÛÔ˘Ó Û ÈÛÔÚÚÔË̤Ó˜ Û¯¤ÛÂȘ Ì ÙÔ˘˜ Á‡Úˆ Û˘Ó·ÓıÚÒÔ˘˜ 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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ORIGINAL ARTICLE

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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, ∞. ºÈÏÈÔÔ‡ÏÔ˘1, ¢. ∆Ô˘ÓÈÛÛ›‰Ô˘1, ∞. ºÚ¤ÛÎÔ˘1, £. ™ËÏÈÔÔ‡ÏÔ˘1, ∞. §Ô˘›˙Ô˘1, A. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜1, ¢. ∫·ÊÂÙ˙‹˜2 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∆Ô ‰È·‰›ÎÙ˘Ô ·ÔÙÂÏ› ϤÔÓ ·Ó·Áη›Ô ÂÚÁ·ÏÂ›Ô ÂÓË̤ڈÛ˘, ÎÔÈÓˆÓÈ΋˜ Â·Ê‹˜ 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˘ÌÂÚÈÊÔÚÒÓ 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·. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ·ÓÒÓ˘Ì· ÂÚˆÙËÌ·ÙÔÏfiÁÈ·, Ù· ÔÔ›· ·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 ÎÔÈÓˆÓÈÎÔÔ›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›ÛÙËΠ̠ÔχˆÚË ¯Ú‹ÛË (11-20 ÒÚ˜/‚‰ÔÌ¿‰·). ™‡Ìʈӷ Ì ÙÔ YIAS, 1% ÙˆÓ ÂÊ‹‚ˆÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ›¯Â Û˘ÌÂÚÈÊÔÚ¿ ÂıÈÛÌÔ‡, ÂÓÒ 12,8% ·ÚÔ˘Û›·˙ ÔÚȷ΋ ¯Ú‹ÛË (ÚÔ‚Ï‹Ì·Ù· Ô˘ ‰˘ÓËÙÈο ı· ÌÔÚÔ‡Û·Ó Ó· Ô‰ËÁ‹ÛÔ˘Ó Û ÂıÈÛÌfi). ™˘ÌÂÚ¿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΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›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΋ ¶·ÓÂÈÛÙËÌ›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˘, ÂÈÎÔÈÓˆÓ›·˜ 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 ÔÔ›Ô ·ÔÙÂÏ› ÊıËÓfi Î·È Â‡ÎÔÏ· ÚÔÛ‚¿ÛÈÌÔ ‰›Ô ÎÔÈÓˆÓÈÎÔÔ›ËÛ˘ (2) Î·È ÂÓ·Û¯fiÏËÛ˘ Ì ÔÈΛϘ ‰Ú·ÛÙËÚÈfiÙËÙ˜ (3). √È ıÂÙÈΤ˜ ÂȉڿÛÂȘ Ù˘ ¯Ú‹Û˘ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ÛÙËÓ „˘¯ÔÎÔÈÓˆÓÈ΋ ·Ó¿Ù˘ÍË Î·È Û˘ÌÂÚÈÊÔÚ¿ ÙˆÓ ÂÊ‹‚ˆÓ ·ÊÔÚÔ‡Ó ÛÙËÓ ÎÔÈÓˆÓÈÎÔÔ›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 ÂÌÂÚȤ¯ÂÈ ÙËÓ Èı·ÓfiÙËÙ· ÂÌÊ¿ÓÈÛ˘ ·ÚÓËÙÈÎÒÓ ÂȉڿÛÂˆÓ (1,6,7), ÔÈ Ôԛ˜ 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˘ÌÂÚÈÊÔÚ¤˜ 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· ‹ ÂÈÎÔÈÓˆÓ›· ̤ۈ e-mails Î·È chat rooms (12). ™ËÌ·ÓÙÈΤ˜ ÂÈÙÒÛÂȘ Â›Ó·È Ë Û¯ÔÏÈ΋ ·ÔÙ˘¯›· (13), ηıÒ˜ Î·È ÔÈ ‰˘ÛÏÂÈÙÔ˘ÚÁÈΤ˜ ‰È·ÚÔÛˆÈΤ˜ 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˘ Â›ÙˆÛ˘ 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·ÙÔÔÈ‹ıËΠηٿ ÙË ‰È¿ÚÎÂÈ· ÂÓfi˜ ¤ÙÔ˘˜ (π·ÓÔ˘¿ÚÈÔ˜ 2007 - π·ÓÔ˘¿ÚÈÔ˜ 2008), ηÙfiÈÓ ¤ÁÎÚÈÛ˘ ÙÔ˘ π·ÙÚÔ·È‰·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 ˘fiÏÔÈÔ 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˘ ÂÈÛΤÙÔÓÙ·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 ÂÎ·›‰Â˘ÛË, (7) ·Ó·˙‹ÙËÛË ÏËÚÔÊÔÚÈÒÓ Û¯ÂÙÈο Ì ÛÂÍÔ˘·ÏÈ΋ ‰È··È‰·ÁÒÁËÛË, (8) ·ÁÔÚ¤˜ ÚÔ˚fiÓÙˆÓ. ∆Ô YIAS ÂÊ·ÚÌfiÛÙËΠ̠ÛÎÔfi Ó· ÂÎÙÈÌËı› Ë Â›ÙˆÛË Ù˘ ÔÚȷ΋˜ Î·È ÂıÈÛÙÈ΋˜ ¯Ú‹Û˘ ÙÔ˘ ›ÓÙÂÚÓÂÙ, fiˆ˜ ·˘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 ÌÔÚ› 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·ÙÔÔÈ‹ıËÎ·Ó Ì ÙËÓ ÂÊ·ÚÌÔÁ‹ ÙÔ˘ SAS, ¤Î‰ÔÛË 9.0 ( SAS Inc., USA). ∏ ÔÌ¿‰· ÂϤÁ¯Ô˘ ¯ÚËÛÈÌÔÔÈ‹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· ·ÍÈÔÈÛÙ›·˜ 95% (Confidence Intervals, 95% CI). ÀÔÏÔÁ›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. ∂ÈϤÔÓ, 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 ÂÈÏÂÁÌ¤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 ÈÛÙfiÙÔÔ˘˜ 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 ÛÎÔfi 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›· ‹ ÂÎ·›‰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˘. ∂ÈϤÔÓ, 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 ÂȂ‚·›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 ÂÈÚÔÛı¤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

Pediatri Nov-Dec 08 new

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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˜ ÙfiÔ˜ 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) ÀËÚÂۛ˜ 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) ÂÎ·›‰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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16:31

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445

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˜ ÙfiÔ˜ 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 ÀËÚÂۛ˜ 575 0,04495 0,2819 ∂ÚÁ·Û›· & ÂÎ·›‰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 Â›Û˘ ÈÛ¯˘Úfi˜ ÚÔÁÓˆÛÙÈÎfi˜ ·Ú¿ÁÔÓÙ·˜. ÀÂÚ‚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). ∂ÈϤÔÓ, 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). ™ÎÔfi˜ 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˘. ∂ÈϤÔÓ, 55,5% (n=5) ÙˆÓ ÂÚÈÙÒÛÂˆÓ 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 ÛÎÔfi 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 ÛÎÔfi 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·˜, fiˆ˜ 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 ÙÔÔıÂÙË̤ÓÔ˜ Û ÚÔÛˆÈÎfi ¯ÒÚÔ (‰ˆÌ¿ÙÈÔ), Ô/Ë ¤ÊË‚Ô˜ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ·ÔÌÔÓÒÓÂÙ·È, Ó· ¯·Ï·ÚÒÓÂÈ, Ó· ÂÈÎÔÈÓˆÓ› Î·È ÁÂÓÈο Ó· ‚ÈÒÓÂÈ ÂÌÂÈڛ˜ ¯ˆÚ›˜ ¤ÏÂÁ¯Ô ‹ ÂÈÛÙ·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˜ ÙfiÔ˜ 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›· & ÂÎ·›‰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· ∞ÍÈÔÈÛÙ›·˜, NE: ∏ ÌÂÙ·‚ÏËÙ‹ ‰ÂÓ Â›Ó·È ÛÙ·ÙÈÛÙÈο ÛËÌ·ÓÙÈ΋ (p-value < 0,0500) Î·È ‰ÂÓ Û˘ÌÂÚÈÏ‹ÊıËΠÛÙÔ ÌÔÓÙ¤ÏÔ ·ÏÈÓ‰ÚfiÌËÛ˘, NS: ∏ ÌÂÙ·‚ÏËÙ‹ Û˘ÌÂÚÈÏ‹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 ÔÔÈ·‰‹ÔÙ ·fi ÙȘ ηÙËÁÔڛ˜ ·ıÔÏÔÁÈ΋˜ ¯Ú‹Û˘ ÙÔ˘ ›ÓÙÂÚÓÂÙ (¶›Ó·Î·˜ 4). ∆Ô ÁÂÁÔÓfi˜ ·˘Ùfi ÌÔÚ› Ó· ÔÊ›ÏÂÙ·È ÛÙÔÓ Û¯ÂÙÈÎfi ÂÚÈÔÚÈÛÌfi ÙˆÓ ÂÈÙÚÂfiÌÂÓˆÓ ÈÛÙÔÙfiˆÓ ‹ Î·È ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÌÂÚÈο ·fi Ù· ·È‰È¿ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡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˘ ÂÈÛΤÙÔÓÙ·È ÔÈ ¤ÊË‚ÔÈ, ÔÈ ÈÛÙfiÙÔÔÈ Ô˘ Û¯ÂÙ›˙ÔÓÙ·È Ì ÂÈÎÔÈÓˆÓ›· (.¯. 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΋ Â·Ê‹. 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˘ÌÂÚÈÊÔÚ¿˜ (21,22). ∆¤ÙÔÈ· Û˘ÌÂÚÈÊÔÚ¿ ÌÔÚ› Ó· ÂÈÙÂÏÂ›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), fiˆ˜ ¿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˘ ÂÂÚ¯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 ÔÔ›· ·˘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‹ıËΠÂÚ›ÙˆÛË ÂıÈÛÌÔ‡ ÛÙËÓ ÔÌ¿‰· 3 (˘„ËÏ‹˜ ¯Ú‹Û˘). ∞˘Ùfi ÂÓ‰¤¯ÂÙ·È Ó· ÔÊ›ÏÂÙ·È ÛÙÔ fiÙÈ Ë ÂıÈÛÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ ‰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 (.¯. οÔÈÔ˜ ¤ÊË‚Ô˜ Ì ÂıÈÛÌfi ÌÔÚ› 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). ∏ Â›ÙˆÛË 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˘ ¶·ÓÂÈÛÙËÌ›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 ˘fiÏÔÈ˜ Â˘Úˆ·˚Τ˜ ¯ÒÚ˜ Î·È ‚¤‚·È· ÙȘ ·ÛÈ·ÙÈΤ˜ (34). ∆Ô Â›‰Ô˜ ÙˆÓ ÂÈÛÎÂÙfiÌÂÓˆÓ 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˘ÌÂÚÈÊÔÚÒÓ ¯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˘¯·ÈÔÔ›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˜ ÂÈÏÔÁ‹˜ Î·È ·Ó·ÊÔÚ¿˜ ÂÏ·¯ÈÛÙÔÔÈ‹ıËηÓ. √È ÂÚÈÔÚÈÛÌÔ› Ù˘ ÌÂϤÙ˘ Â›Ó·È ÔÈ ·Ú·Î¿Ùˆ: ·) §fiÁˆ ÙÔ˘ ÂȉËÌÈÔÏÔÁÈÎÔ‡ 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·ÙÔÔÈËı› ·Ó¿ÏÔÁË ÌÂϤÙË Û ÂıÓÈÎfi Â›‰Ô, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÍ·¯ıÔ‡Ó Ù· ·Ó¿ÏÔÁ· Û˘ÌÂÚ¿ÛÌ·Ù·.

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ORIGINAL ARTICLE

449

∏ ¯Ú‹ÛË ÙˆÓ ËÏÂÎÙÚÔÓÈÎÒÓ ˘ÔÏÔÁÈÛÙÒÓ Î·È ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘ ·fi ·È‰È¿-ÂÊ‹‚Ô˘˜ ÛÙËÓ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ ∞. ¶··‰ÔÔ‡ÏÔ˘, °. ª›¯·˜, º. ª›¯·˜, ∞. ∑ÂÚ‚Ô˘‰¿ÎË, ∫. ∆ÛÔ˘Ì¿Î·˜, ¶. °ÂˆÚÁÈÔÔ‡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 Â·Ê‹ Ì ÙÔ˘˜ ËÏÂÎÙÚÔÓÈÎÔ‡˜ ˘ÔÏÔÁÈÛÙ¤˜ (∏À) Î·È Ì ÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ·˘ÙÔ› ÂÁ΢ÌÔÓÔ‡Ó. ™ÎÔfi˜ 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˘ÌÏ‹ÚˆÛ·Ó ÂȉÈÎfi ·ÓÒÓ˘ÌÔ ÂÚˆÙËÌ·ÙÔÏfiÁÈÔ, ηٿ ÙË ¯ÚÔÓÈ΋ ÂÚ›Ô‰Ô ™Â٤̂ÚÈÔ˜ - ¢ÂΤ̂ÚÈÔ˜ 2007. ∞ÔÙÂϤÛÌ·Ù·: ∞fi ÙÔ Û‡ÓÔÏÔ ÙˆÓ ·È‰ÈÒÓ, 90,1% ¯ÚËÛÈÌÔÔÈÔ‡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·. √ ÛÎÔfi˜ Ù˘ ¯Ú‹Û˘ ‹Ù·Ó Ë ‰È·ÛΤ‰·ÛË Û ÔÛÔÛÙfi 70% Î·È Ë ÂÎ·›‰Â˘ÛË Û ÔÛÔÛÙfi 29%. ªfiÓÔ ÛÙÔ 51,6% ÙˆÓ ·È‰ÈÒÓ ÔÈ ÁÔÓ›˜ Â¤‚ÏÂ·Ó ÙË ¯Ú‹ÛË. 32,3% ÙˆÓ ·È‰ÈÒÓ ÂÈÛΤÙÔÓÙ·Ó Û˘¯Ó¿ ›ÓÙÂÚÓÂ٠ηʤ (̤ÛË ËÏÈΛ· 13 ÂÙÒÓ) Î·È 37,8% ÔÚÓÔÁÚ·ÊÈÎÔ‡˜ ‰È·‰ÈÎÙ˘·ÎÔ‡˜ ÙfiÔ˘˜ (̤ÛË ËÏÈΛ· 12,5 ÂÙÒÓ). ∂ÈϤÔÓ, 43 ·È‰È¿ (22,3%) ·Ó¤ÊÂÚ·Ó ÚÔ‚Ï‹Ì·Ù· ˘Á›·˜ ÌÂÙ¿ ·fi ÔχˆÚË ¯Ú‹ÛË. ™˘ÌÂÚ¿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˜ Â·Ú΋ ÂÈÙ‹ÚËÛË, Î·È Ù· ·È‰È¿ ‹Ù·Ó ÂÎÙÂıÂÈ̤ӷ ÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ ÙÔ˘ ‰È·‰ÈÎÙ‡Ô˘.

AÏÏËÏÔÁÚ·Ê›·: ∞ıËÓ¿ ¶··‰ÔÔ‡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

∞. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.

∂ÈÛ·ÁˆÁ‹ √ ËÏÂÎÙÚÔÓÈÎfi˜ ˘ÔÏÔÁÈÛÙ‹˜ (∏À) Â›Ó·È Ë Û˘Û΢‹ Ô˘, ÂÚÈÛÛfiÙÂÚÔ ·fi ÔÔÈ·‰‹ÔÙ ¿ÏÏË, ¯·Ú·ÎÙËÚ›˙ÂÈ ÙËÓ ÂÔ¯‹ 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›˜ ÂÈ˙ËÙÔ‡Ó ÙËÓ ÂÍÔÈΛˆÛË ÙˆÓ ·È‰ÈÒÓ ÙÔ˘˜ Ì ÙËÓ Î·ÈÓÔ‡ÚÁÈ· Ù¯ÓÔÏÔÁ›·, ̤۷ ·fi ÙËÓ ÔÔ›· ÌÔÚÔ‡Ó Ó· ·ÔÎÙ‹ÛÔ˘Ó ÁÓÒÛÂȘ. ∂ÈϤÔÓ, Ë ·Ó·ÛÊ·Ï‹˜ Î·È ··ÈÙËÙÈ΋ Û‡Á¯ÚÔÓË ÎÔÈÓˆÓ›·, Ë ÔÔ›· 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˘ ÛÈÙÈÔ‡, ¤‰ˆÛ ÂÚÈÛÛfiÙÂÚË ¤ÌÊ·ÛË ÛÙÔ˘˜ ∏À ˆ˜ ÙÚfiÔ ··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 ÙfiÔ (internet). ∆· ·È‰È¿ Î·È ÔÈ ¤ÊË‚ÔÈ ÙÔ ¯ÚËÛÈÌÔÔÈÔ‡Ó ˆ˜ ̤ÛÔ ÂÈÎÔÈÓˆÓ›·˜, ·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 ÙÚfiÔ Ì ÙÔÓ ÔÔ›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΋ Â›‰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, ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 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˜ ÙÚfiÔ˜ ÂÎ·›‰Â˘Û‹˜ ÙÔ˘˜ Â›Ó·È Ì¤Û· ·fi ÙËÓ ·Ú·Ù‹ÚËÛË Î·È ÙË Ì›ÌËÛË. ŒÙÛÈ, ÙÂÏÈο, Ë Û˘Ó¯‹˜ Â·Ê‹ Ì ÛÎËÓ¤˜ ‚›·˜ ÛÙ¤ÏÓÂÈ ÛÙ· ·È‰È¿ ÙÔ Ì‹Ó˘Ì· fiÙÈ Ë ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ Â›Ó·È ÎÔÈÓˆÓÈο ·Ô‰ÂÎÙ‹ Î·È Ù· ·¢·ÈÛıËÙÔÔÈ› Paediatriki 2008;71:449-457

ÛÂ Û˘ÌÂÚÈÊÔÚ¤˜ Ô˘ Ô ÔÏÈÙÈÛÌfi˜ Î·È Ô ·ÓıÚˆÈÛÌfi˜ ηٷ‰Èο˙Ô˘Ó (3). ∂ÈÚfiÛıÂÙ·, Â›Ó·È ·ÓËÛ˘¯ËÙÈ΋ Ë ·˘ÍË̤ÓË ‰˘Ó·ÙfiÙËÙ· ÚfiÛ‚·Û˘ Û ÔÚÓÔÁÚ·ÊÈÎÔ‡˜, ÚÔÛ‚ÏËÙÈÎÔ‡˜ Î·È ·Î·Ù¿ÏÏËÏÔ˘˜ ‰È·‰ÈÎÙ˘·ÎÔ‡˜ ÙfiÔ˘˜ 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. ÀÔÏÔÁ›˙ÂÙ·È fiÙÈ ˘¿Ú¯Ô˘Ó 14 ÂηÙÔÌ̇ÚÈ· ‰È·‰ÈÎÙ˘·ÎÔ› ÙfiÔÈ ÔÈ ÔÔ›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 Â·Ê‹ 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 ÔÔ›Ô˜ ·Ó·Ù‡ÛÛÂÙ·È ÌÂÙ¿ ·fi ÔχˆÚË Î·ıËÌÂÚÈÓ‹ ¯Ú‹ÛË. √ fiÚÔ˜ ˘ÈÔıÂÙ‹ıËΠÚÒÙ· ·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˘·ÈÛıËÙÔÔ›ËÛË ÙˆÓ ¯ÚËÛÙÒÓ (7). ∏ ÍËÚÔÊı·ÏÌ›·, ÙÔ Û‡Ó‰ÚÔÌÔ ÙÔ˘ ηÚÈ·›Ô˘ ۈϋӷ Î·È ÔÈ ÙÚ·˘Ì·ÙÈÛÌÔ› ÙˆÓ ‰·ÎÙ‡ÏˆÓ ·fi ÙȘ ÌÔÓfiÙÔÓ˜ ÎÈÓ‹ÛÂȘ Â›Ó·È Û˘¯Ó¿ Û˘ÓÔ‰¿ Û˘ÌÙÒÌ·Ù·, ÂÓÒ Ô ÂıÈṲ̂ÓÔ˜ ·ÚÔ˘ÛÈ¿˙ÂÈ ÁÂÓÈ΋ ·Ì¤ÏÂÈ· ÁÈ· ÙËÓ ˘Á›· ÙÔ˘ Î·È Ù· Û˘ÌÙÒÌ·Ù¿ ÙÔ˘ Î·È ¿ÚÓËÛË ÁÈ· ‡ÓÔ Î·È ÎÔÈÓˆÓÈΤ˜ Â·Ê¤˜. °È· ÙÔ˘˜ ÏfiÁÔ˘˜ ·˘ÙÔ‡˜, Â›Ó·È ÂȂ‚ÏË̤ÓÔ Î¿ı ¯ÒÚ· Ó· ηٷÁÚ¿„ÂÈ ÙËÓ Â›ÙˆÛË Ù˘ ¯Ú‹Û˘ Î·È Ó· ηıÔÚ›ÛÂÈ ÙËÓ ¤ÎÙ·ÛË ÙˆÓ ·ÚÓËÙÈÎÒÓ ÂȉڿÛˆÓ, ÒÛÙ ӷ ÏËÊıÔ‡Ó ÚÔÏËÙÈο ̤ÙÚ·. ™ÙËÓ ∂ÏÏ¿‰· Ù· ‰Â‰Ô̤ӷ Â›Ó·È ÂÏÏÈ‹. °È’ ·˘Ùfi, Ë ·ÚÔ‡Û· ÌÂϤÙË Â›¯Â ˆ˜ ÛÎÔfi 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˘ ÂËÚ¿˙Ô˘Ó ÙË ¯Ú‹ÛË.

ÀÏÈÎfi Î·È ª¤ıÔ‰ÔÈ ∏ Û˘ÏÏÔÁ‹ ÛÙÔȯ›ˆÓ ¤ÁÈÓ ·fi ‰ËÌfiÛÈ· Û¯ÔÏ›· Ô˘ ÂÈϤ¯ıËÎ·Ó ÌÂÙ¿ ·fi Ù˘¯·ÈÔÔ›ËÛË Ì ‚¿ÛË ÙË ¯ˆÚÔı¤ÙËÛË. ∏ ÂÚÈÔ¯‹ Ù˘ ∞ı‹Ó·˜ ¯ˆÚ›ÛÙËΠ۠ÎÂÓÙÚÈÎfi, ‚fiÚÂÈÔ Î·È ÓfiÙÈÔ ÚÔ·ÛÙÈ·Îfi ÙÌ‹Ì· Î·È ÂÈϤ¯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 ™Â٤̂ÚÈÔ˜-¢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) ∆ÔÔıÂÛ›· 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˜ - ÂÈÛÙ‹ÌÔÓ·˜ - ÂȯÂÈÚËÌ·Ù›·˜ ∂¿ÁÁÂÏÌ· ·Ù¤Ú· - ÂÚÁ¿Ù˘ - ˘¿ÏÏËÏÔ˜ - ÂÈÛÙ‹ÌÔÓ·˜ - ÂȯÂÈÚËÌ·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˜ ÂȯÂÈÚË̷ٛ˜

··ÓÙË̤ӷ ÂÚˆÙËÌ·ÙÔÏfiÁÈ· (46% ·ÁfiÚÈ·, ̤ÛË ËÏÈΛ· 12,3 ÂÙÒÓ), Ù· ÔÔ›· ηٷ¯ˆÚ‹ıËÎ·Ó Î·È ·Ó·Ï‡ıËÎ·Ó Ì ÙË ‚Ô‹ıÂÈ· ÙÔ˘ ÛÙ·ÙÈÛÙÈÎÔ‡ ÚÔÁÚ¿ÌÌ·ÙÔ˜ SPSS 12.0. ÃÚËÛÈÌÔÔÈ‹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·ÁÔÓÙÔÔ›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˘ ÂÎ·›‰Â˘Û˘ Î·È ÎÔÈÓˆÓÈÎÔÔÈÎÔÓÔÌÈÎÔ‡ ÂÈ¤‰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 ÂȯÂÈÚËÌ·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 ¯ÚËÛÈÌÔÔÈ› ∏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

∞. ¶··‰ÔÔ‡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˜ - ÂÈÛÙ‹ÌÔÓ·˜ - ÂȯÂÈÚËÌ·Ù›·˜ ∂¿ÁÁÂÏÌ· ·Ù¤Ú· - ÂÚÁ¿Ù˘ - ˘¿ÏÏËÏÔ˜ - ÂÈÛÙ‹ÌÔÓ·˜ - ÂȯÂÈÚËÌ·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 ¯ÚËÛÈÌÔÔÈ› ∏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 ¯ÚËÛÈÌÔÔÈÔ‡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 ÂÈÙÂÏÔ‡Û ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÎ·›‰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‹ıËΠ۠ÔÛÔÛÙfi 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 ÙÔÔıÂÙË̤ÓÔÈ Û ÔÛÔÛÙfi 21,6% ÛÙÔ Û·ÏfiÓÈ ÙÔ˘ ÛÈÙÈÔ‡, 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 ÔÔ›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· Â›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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™ÂÏ›‰·454

454

∞. ¶··‰ÔÔ‡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· Â›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˘, fiˆ˜ Î·È Ô ·ÚÈıÌfi˜ ÙˆÓ Û¯ÔÏ›ˆÓ, Â›Ó·È ÌÈÎÚfi˜ Î·È ‰ÂÓ Â›Ó·È ·ÓÙÈÚÔÛˆ¢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 ÂÈϤÔÓ ÂÈÛËÌ·›ÓÂÙ·È Ë ·˘ÍË̤ÓË ¯Ú‹ÛË Û ·È‰È¿ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜: Ù· 3/4 Î·È ÙÔ 1/4 ¯ÚËÛÈÌÔÔÈÔ‡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·ÈÛÙÒıËΠÔχ 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›·˜. ∂ÈϤÔÓ, ‚¿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 ÂÈÛΤÙÂÙ·È Ù· ›ÓÙÂÚÓÂ٠ηʤ (̤ÛË ËÏÈΛ· 13 ÂÙÒÓ), ÂÎ ÙˆÓ ÔÔ›ˆÓ Ù· ÌÈÛ¿ (56,3%) ÙÔ˘Ï¿¯ÈÛÙÔÓ 1-2 ÊÔÚ¤˜/ ‚‰ÔÌ¿‰·. ¢ÂÓ ·Ú·ÙËÚ‹ıËΠ‰È·ÊÔÚ¿ ÛÙË Û˘¯ÓfiÙËÙ· ÂÈÛΤ„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 ¯ÚËÛÈÌÔÔÈ‹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‡˜ ÙfiÔ˘˜ 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 ÂÎ·›‰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 ÂÎ·›‰Â˘ÛË ÂÚȤÚÁÂÈ· ÂÈÎÔÈÓˆÓ›· 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·.

Pediatri Nov-Dec 08 new

19-12-08

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™ÂÏ›‰·455

455

∏ÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ ÛÙ· ·È‰È¿

¶›Ó·Î·˜ 7. ÃÚ‹ÛË ÔÚÓÔÁÚ·ÊÈÎÒÓ sites Î·È ·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ - ÔÏÏ·Ï‹ ·Ú·ÁÔÓÙÔÔ›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˘ÌÂÚÈÏ‹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 ÂȯÂÈÚËÌ·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· Â·ÁÁÂÏÌ·ÙÈÎÔ‡˜ ›Ù ÁÈ· ÚÔÛˆÈÎÔ‡˜ ÏfiÁÔ˘˜ (60% ÂÚ›Ô˘ ÙˆÓ ÓÔÈÎÔ΢ÚÒÓ ¯ÚËÛÈÌÔÔÈÔ‡Û·Ó ∏À), ÂËÚ¤·Û ÙËÓ ËÏÈΛ· ¤Ó·Ú͢ Ù˘ ÂÎÌ¿ıËÛ˘, Û ·ÓÙ›ıÂÛË Ì ÙËÓ ·ÚÔ˘Û›· ÌÂÁ·Ï‡ÙÂÚˆÓ ·‰ÂÏÊÒÓ, Ô˘ ‰ÂÓ Ê¿ÓËΠӷ Âȉڿ 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‹ıËΠÂ·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· ÂÎ·È‰Â‡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 ÂÈÙ‹ÚËÛË ÙˆÓ ÁÔÓ¤ˆÓ ‹Ù·Ó ·ÓÂ·Ú΋˜. ∆· ÌÈÛ¿ ·È-

‰È¿ ÌÂÙ¿ ÙËÓ ÂÎ·›‰Â˘Û‹ ÙÔ˘˜ ÂÁηٷÏ›ÊÙËÎ·Ó ÛÙËÓ ¤ÏÍË Ù˘ Ó¤·˜ Ù¯ÓÔÏÔÁ›·˜ Î·È ÛÙÔ˘˜ ÎÈÓ‰‡ÓÔ˘˜ Ô˘ ·˘Ù‹ ÂÁ΢ÌÔÓ›. ™ÙÔ ‹ÌÈÛ˘ ÙˆÓ ÂÚÈÙÒÛˆÓ, Ô ∏À ‹Ù·Ó ÙÔÔıÂÙË̤ÓÔ˜ ÛÙÔ ‰ˆÌ¿ÙÈÔ ÙˆÓ ·È‰ÈÒÓ, Ù· ÔÔ›· ÙÔÓ ¯ÚËÛÈÌÔÔÈÔ‡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 ÂÈÛÎÂÊı› ‰È·‰ÈÎÙ˘·ÎÔ‡˜ ÙfiÔ˘˜ 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˜ ÂÈÛΤ„ÂȘ Û ›ÓÙÂÚÓÂ٠ηʤ, ‚·ÛÈÎfi˜ ·ÓÂÍ¿ÚÙËÙÔ˜ ˘‡ı˘ÓÔ˜ ·Ú¿ÁÔÓÙ·˜ Ù˘ ¯Ú‹Û˘ ÔÚÓÔÁÚ·ÊÈÎÒÓ ÛÂÏ›‰ˆÓ, Ë ÔÔ›· 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· ¯ÚËÛÈÌÔÔÈÔ‡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˘ ÂÈΛӉ˘Ó· Â›Ó·È Ù· chat rooms (ÈÛÙÔ·›ıÔ˘Û˜ Û˘˙ËÙ‹ÛˆÓ), ÛËÌ›· ‰ËÌÈÔ˘ÚÁ›·˜ Î·È Û˘ÌÌÂÙÔ¯‹˜ Û ËÏÂÎÙÚÔÓÈΤ˜ ÎÔÈӈӛ˜, fiÔ˘ ÔÌ¿‰Â˜ ·ÓıÚÒˆÓ ·ÓÙ·ÏÏ¿ÛÛÔ˘Ó ·fi„ÂȘ ÁÈ· οÔÈÔ ˙‹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˜ ÌÔÚ› Ó· ˘Ô‰‡ÂÙ·È fiÔÈÔ Ù‡Ô ·ÓıÚÒÔ˘ ı¤ÏÂÈ Î·È fiÔÈ· ËÏÈΛ· ÚÔÙÈÌ¿. ŒÙÛÈ, ÂÓÒ ÌÔÈ¿˙ÂÈ Û˘˙‹ÙËÛË ÌÂٷ͇ ÂÊ‹‚ˆÓ, ÛÙËÓ Ú·ÁÌ·ÙÈÎfiÙËÙ· ÌÔÚ› Ó· Â›Ó·È Û˘˙‹ÙËÛË ÌÂٷ͇ ÂÊ‹‚Ô˘ Î·È ÂÓ‹ÏÈη. ∏ Î·Ï˘Ì̤ÓË Ê‡ÛË ÙˆÓ chat rooms ÂÈÙÚ¤ÂÈ Û ÂÈΛӉ˘ÓÔ˘˜ Ù‡Ô˘˜ Ó· ‚Ú›ÛÎÔ˘Ó Ï›· ·È‰È¿ Î·È ÂÊ‹‚Ô˘˜. ÀÔÏÔÁ›˙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 ÂÈÛÙÔϤ˜ 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‹ Â·Ê‹ ÙˆÓ ÁÔÓ¤ˆÓ Ì ٷ ·È‰È¿ ÙÔ˘˜ Î·È ÙËÓ ·Ó·ÁηÈfiÙËÙ· ηχÙÂÚ˘ ÂÓË̤ڈÛ˘ Î·È ÂÈÙ‹ÚËÛ˘ (10). ÃÚ‹ÛË ÁÈ· ÏfiÁÔ˘˜ ÂÎ·›‰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›· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÌfiÓÔ ÁÈ· ÙÔ Û˘ÁÎÂÎÚÈ̤ÓÔ Ì¿ıËÌ·, ÂÓÒ ‰ÂÓ ÂÈÙÚ¤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

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∞. ¶··‰ÔÔ‡ÏÔ˘ Î·È Û˘Ó.

¯ÒÚÔ ÙÔ˘ Û¯ÔÏ›Ԣ. ∂ÓÒ ÙÔ ›ÓÙÂÚÓÂÙ ·ÔÙÂÏ› ·Ú¿ı˘ÚÔ ÛÙË ÁÓÒÛË Î·È ÛÙËÓ ÂÎ·›‰Â˘ÛË Î·È ¤¯ÂÈ ÙË ‰˘Ó·ÌÈ΋ Ó· ÙÂÏÂÈÔÔÈ‹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 ¯ÚËÛÈÌÔÔÈ› 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 ÂÈıÂÙÈÎfiÙËÙ·, ·¢·ÈÛıËÙÔÔÈÔ‡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΋ Â›‰Ú·ÛË. ÕÌÂÛË Â›Ó·È Ë ÂÈıÂÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿ 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 ÂÈıÂÙÈÎfiÙËÙ· 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 ÂÈÚÚÂ‹ ÛÙÔ Ó· ·ÓÙÈÁÚ¿„Ô˘Ó Û˘ÌÂÚÈÊÔÚ¤˜ (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˘ ÔÔ›Ô˘ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛÙ› Î·È ·ÓËÛ˘¯‹ÛÂÈ ÔÏϤ˜ ¯ÒÚ˜. ¶Úfi‰ÚÔÌ· Û˘ÌÙÒÌ·Ù· ·ÔÙÂÏÔ‡Ó Ô ˘ÂÚ‚ÔÏÈÎfi˜ ¯ÚfiÓÔ˜ ÂÓ·Û¯fiÏËÛ˘, Ë ·Ú·Ì¤ÏËÛË ˘Ô¯ÚÂÒÛˆÓ, Ë ·fiÙÔÌË ÙÒÛË Ù˘ Û¯ÔÏÈ΋˜ Â›‰ÔÛ˘, Ë ·ÔÌfiÓˆÛË Î·È Ë ¿ÚÓËÛË Û˘Ó¿ÓÙËÛ˘ Ì ʛÏÔ˘˜, Ë ÂÈıÂÙÈÎfiÙËÙ·, Ë ·ÏÏ·Á‹ ÛÙË Û˘ÌÂÚÈÊÔÚ¿, 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˘ÌÙÒÌ·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˘ ¶·ÓÂÈÛÙËÌȷ΋˜ ¶·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 ‹ ηٷıÏÈÙÈο ·È‰È¿, Û ÂÚ›ÙˆÛË ÂÏÏÈÔ‡˜ Â›‚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 ·ÓÙÈÏËÙÈ΋ ÈηÓfiÙËÙ· ÙˆÓ ·È‰ÈÒÓ, ÙÔÓ Û˘ÓÙÔÓÈÛÌfi ÙˆÓ ÎÈÓ‹ÛÂˆÓ Î·È ÙÔÓ Ù·˘Ùfi¯ÚÔÓÔ ¯ÂÈÚÈÛÌfi ÔÏÏÒÓ ÂÈÎfiÓˆÓ, fï˜ ÂÈÚfiÛıÂÙ· ÚÔηÏÔ‡Ó ·›ÛıËÌ· ÌÔÓ·ÍÈ¿˜ Î·È ÌÂÏ·Á¯ÔÏ›·˜ (11,25). ∂›Ó·È ¤Ó· ÌÔÓ·¯ÈÎfi “¿ıÏËÌ·”. ∞ÎfiÌ· Î·È Ë ÂÈÎÔÈÓˆÓ›· Ì ʛÏÔ˘˜ ̤ۈ ›ÓÙÂÚÓÂÙ ·Ó·ÈÚ› ÙËÓ ÚÔÛˆÈ΋ Î·È ÔÙÈ΋ Â·Ê‹, ÙË ÛˆÌ·ÙÈ΋ Î·È ·ÈÛıËÙÈ΋ Û˘Û¯¤ÙÈÛË, ÂÓÒ Û˘¯Ó¿ ‰ËÌÈÔ˘ÚÁ› „‡ÙÈÎË ÂÈÎfiÓ· ÙÔ˘ ÂÈÎÔÈÓˆÓÔ‡ÓÙÔ˜. º·›ÓÂÙ·È fiÙÈ ·˘Ùfi Á›ÓÂÙ·È ·ÓÙÈÏËÙfi ·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 ·ÓÙÈÚÔÛˆ¢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 ·ÓÂÙ˘ÁÌ¤ÓˆÓ ¯ˆÚÒÓ. √È ÁÔÓ›˜ ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ ÛÙËÓ ÂÎ·›‰Â˘ÛË ÙˆÓ ·È‰ÈÒÓ, ·ÏÏ¿ ˘ÛÙÂÚÔ‡Ó ÛÙËÓ ÂÈÙ‹ÚËÛË Ù˘ ¯Ú‹Û˘ Î·È Ù· ·È‰È¿ Â›Ó·È ÂÎÙÂıÂÈ̤ӷ Î·È ÂÈÚÚÂ‹ Û ÎÈÓ‰‡ÓÔ˘˜, fiˆ˜ Ë ·Ó¿Ù˘ÍË ÂÈıÂÙÈ΋˜ Û˘ÌÂÚÈÊÔÚ¿˜, 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˘ ·ÓÙÈÌÂÙÒÈÛ˘.

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¶·È‰È·ÙÚÈ΋ 2008;71:449-457

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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 ™ÎÔfi˜: ∏ ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Û‡ÓÙÔÌÔ˘, ¢¤ÏÈÎÙÔ˘ Î·È ·ÍÈfiÈÛÙÔ˘ ÂÚÁ·Ï›Ԣ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÚÒÈÌˆÓ ‰ÂÈÎÙÒÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ. ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ: ªÂÏÂÙ‹ıËÎ·Ó ‰‡Ô ·ÓÙÈÚÔÛˆ¢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 ÂÈÏÔÁ‹ ÙˆÓ ÂÈ̤ÚÔ˘˜ ÎÏÈÌ¿ÎˆÓ Ù˘ ‰ÔÎÈÌ·Û›·˜ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ‰ÔÎÈÌ¿ÛıËÎ·Ó ÔÏÏ¿ ‰È·ÁÓˆÛÙÈο ÂÚÁ·Ï›· ·Ó·Ù˘Íȷ΋˜ ÂÎÙ›ÌËÛ˘, fiˆ˜ ‰ÔÎÈ̷ۛ˜ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡, ÔÙÈ΋˜ ·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˘ ÂÂϤÁËÛ·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· Â›‰· ·ÍÈÔÏfiÁËÛ˘ ÙˆÓ ÈηÓÔÙ‹ÙˆÓ ÙˆÓ ·È‰ÈÒÓ (∂Í·ÈÚÂÙÈ΋ Â›‰ÔÛË ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘, º˘ÛÈÔÏÔÁÈ΋ Â›‰ÔÛË, √Úȷ΋ Â›‰ÔÛË Î·È Ã·ÌËÏ‹ Â›‰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. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ·ÍÈÔÈÛÙ›· Ù˘ ‰ÔÎÈÌ·Û›·˜ ∞’ ∆∂™∆ ‚Ú¤ıËΠfiÙÈ Â›Ó·È 99,8% Î·È Ë ÂÁ΢ÚfiÙËÙ· 97%. ∆Ô ∞’ ∆∂™∆ ·ÓȯÓ‡ÂÈ ·ÍÈfiÈÛÙ· 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·˜, fiˆ˜ ÙË ¯·Ú·ÎÙËÚ›˙ÂÈ Ë ∞ÌÂÚÈηÓÈ΋ ∞η‰ËÌ›· ¶·È‰È·ÙÚÈ΋˜, Ô˘ ÔÊ›ÏÂÙ·È ÛÙË ÌÂÙ·‚·ÏÏfiÌÂÓË ÂȉËÌÈÔÏÔÁ›· ÙˆÓ ÓÔÛËÌ¿ÙˆÓ Ù˘ ÂÔ¯‹˜ Ì·˜. ŒÙÛÈ Ô ·È‰›·ÙÚÔ˜, ¤Ú·Ó Ù˘ ·Ú·‰ÔÛȷ΋˜ ÂÓ·Û¯fiÏËÛ‹˜ ÙÔ˘ Ì ٷ ÂÌ‡ÚÂÙ· 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· fiˆ˜ ÔÈ ·Ó·Ù˘ÍȷΤ˜ ‰È·Ù·Ú·¯¤˜ ÙÔ˘ ÏfiÁÔ˘, Ù˘ ÔÌÈÏ›·˜ Î·È Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜, 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 ÂȉfiÛÂȘ 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 ÂÈÙ˘¯›· 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˜ ·ÔηχÙÂÈ 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˘ÌÏËÚÒÓÔ˘Ó ÙÔ 7Ô ¤ÙÔ˜ Ù˘ ËÏÈΛ·˜ ÙÔ˘˜ (3). ™ÙȘ ∏.¶.∞., fiÔ˘ ¤¯Ô˘Ó Á›ÓÂÈ ÌÂÁ¿Ï˜ ÏËı˘ÛÌȷΤ˜ Î·È ‰È·¯ÚÔÓÈΤ˜ ÌÂϤÙ˜, ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ¤Ó· ÛÙ· ÙÚ›· ·È‰È¿ ÙÔ˘ ÓËÈ·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˜ ÂȉËÌÈÔÏÔÁÈΤ˜ ÌÂϤÙ˜, Ô‡Ù ‰È·ı¤ÙÔ˘Ì οÔÈÔ ÂȉÈÎfi Î·È ¤Á΢ÚÔ ÙÂÛÙ ·Ó›¯Ó¢Û˘ Ù˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜. ∏ Â›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˜ ÂÈÙÒÛÂȘ Ô˘ ·˘Ù‹ Û˘ÓÂ¿ÁÂÙ·È (5). ∏ ÌÂÙ¿‚·ÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Û¯ÔÏÂ›Ô Î·È Ë ÂÈÙ˘¯‹˜ Û¯ÔÏÈ΋ ÙÔ˘ ÊÔ›ÙËÛË Î·ıÔÚ›˙ÂÙ·È ·fi ÔÏÏÔ‡˜ ·Ú¿ÁÔÓÙ˜, fiˆ˜ 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· ÌÔÚԇ̠ӷ ÂϤÁ¯Ô˘Ì Ì ·ÓÙÈÎÂÈÌÂÓÈÎfi Î·È ·ÛÊ·Ï‹ ÙÚfiÔ 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). ™ÎÔfi˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ë ‰ËÌÈÔ˘ÚÁ›· ÂÓfi˜ Û‡ÓÙÔÌÔ˘, ¢¤ÏÈÎÙÔ˘ Î·È ·ÍÈfiÈÛÙÔ˘ ÂÚÁ·Ï›Ԣ ÁÈ· ÙÔÓ ÂÓÙÔÈÛÌfi ÚÒÈÌˆÓ ‰ÂÈÎÙÒÓ Ì·ıËÛÈ·ÎÒÓ ‰˘ÛÎÔÏÈÒÓ Ô˘ Ó· ‰›ÓÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· ÛÙÔÓ ·È‰›·ÙÚÔ Ó· ÂϤÁ¯ÂÈ ÚÔÏËÙÈο, Ì ·ÓÙÈÎÂÈÌÂÓÈÎfi Î·È ·ÛÊ·Ï‹ ÙÚfiÔ, ÙË Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· Ê˘ÛÈÔÏÔÁÈÎÒÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜.

ÀÏÈÎfi Î·È Ì¤ıÔ‰ÔÈ °È· ÙËÓ ÂÈÏÔÁ‹ ÙˆÓ ÂÈ̤ÚÔ˘˜ ÎÏÈÌ¿ÎˆÓ Ù˘ ‰ÔÎÈÌ·Û›·˜ ÌÂÏÂÙ‹ıËÎ·Ó Î·È ‰ÔÎÈÌ¿ÛıËÎ·Ó ÔÏÏ¿ ‰È·ÁÓˆÛÙÈο ÂÚÁ·Ï›· ·Ó·Ù˘Íȷ΋˜ ÂÎÙ›ÌËÛ˘, fiˆ˜ ‰ÔÎÈ̷ۛ˜ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡, ÔÙÈ΋˜ ·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‹ıËΠ۠ÏËı˘ÛÌÈ·Îfi ‰Â›ÁÌ· 322 ·È‰ÈÒÓ ËÏÈΛ·˜ 4 ¤ˆ˜ 7 ¯ÚÔÓÒÓ, Ù· ÔÔ›· ÊÔÈÙÔ‡Û·Ó Û ۯÔÏ›· (ÓËÈ·ÁˆÁ›· Î·È ‰ËÌÔÙÈο) ÙˆÓ ∞ıËÓÒÓ. ∆Ô Â‡ÚÔ˜ ÙˆÓ ËÏÈÎÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÂÂÎÙ¿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‹ Â›‰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·˜ ÂÎ·›‰Â˘Û˘ Û ·ÛÙÈΤ˜ ÂÚÈÔ¯¤˜ Ù˘ ∞ÙÙÈ΋˜. ∏ ÂÈÏÔÁ‹ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ¤ÁÈÓ ÌÂ Ù˘¯·›Ô ÙÚfiÔ ·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· ÂÂϤÁË ›ÛÔ˜ ·ÚÈıÌfi˜ ·ÁÔÚÈÒÓ-ÎÔÚÈÙÛÈÒÓ ÌÂ Ù˘¯·›Ô ÙÚfiÔ. ™ÙÔ ‰Â›ÁÌ· Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÌfiÓÔ ·È‰È¿ Ì ÂÏÏËÓÈ΋ ˘ËÎÔfiÙËÙ·. √È ÁÔÓ›˜ ÂÓËÌÂÚÒıËÎ·Ó ÁÈ· ÙÔ Â›‰Ô˜ Î·È ÙÔÓ ÛÎÔfi 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 ÂÈÏÔÁ‹ ÙˆÓ ÎÏÈÌ¿ÎˆÓ Ô˘ ı· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó. µ. ∆ËÓ ÂÈÏÔÁ‹ 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

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°. ∆ÔÓ ÂÓÙÔÈÛÌfi ÂÓ‰ÂÈÎÙÈÎÒÓ ··ÓÙ‹ÛÂˆÓ ÁÈ· ÙË ‚·ıÌÔÏfiÁËÛË ÙˆÓ ÏÂÎÙÈÎÒÓ ÎÏÈÌ¿ÎˆÓ Î·È ÙÔÓ ÔÚÈÛÌfi ÎÚÈÙËÚ›ˆÓ ·ÓÙÈÎÂÈÌÂÓÈ΋˜ ·ÍÈÔÏfiÁËÛ˘ ÁÈ· ÙȘ ··ÓÙ‹ÛÂȘ ÙÔ˘ ÔÙÈÎÔÎÈÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡. ¢. ∆ËÓ ÈÏÔÙÈ΋ ÂÊ·ÚÌÔÁ‹ ÙˆÓ ÂÈ̤ÚÔ˘˜ ÎÏÈÌ¿ÎˆÓ Ù˘ ‰ÔÎÈÌ·Û›·˜, ÚÔÎÂÈ̤ÓÔ˘ Ó· ÂÓÙÔÈÛÙÔ‡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· ÔÔ›· ‚·Û›ÛÙËÎÂ Ë ÂÈÏÔÁ‹ 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˘ÌÂÚÈÏËÊı› ÛÙËÓ Îϛ̷η ı· ¤ÚÂ ӷ ¤¯ÂÈ ÙË ‰˘Ó·ÙfiÙËÙ· Ó· ‰È·ÎÚ›ÓÂÈ ‰È·ÊÔÚÂÙÈΤ˜ ËÏÈ˘, ‰ËÏ·‰‹ ÙÔ ÔÛÔÛÙfi ÙˆÓ ÂÈÙ˘¯ËÌ¤ÓˆÓ ··ÓÙ‹ÛÂˆÓ ÛÙËÓ ÂÚÒÙËÛË ·˘Ù‹ Ó· ·˘Í¿ÓÂÙ·È Ì ÙËÓ ËÏÈΛ·. ÃÚËÛÈÌÔÔÈ‹ıËÎ·Ó ÂÚˆÙ‹ÛÂȘ Ì ÙË ÌÂÁ·Ï‡ÙÂÚË ‰˘Ó·Ù‹ ÈηÓfiÙËÙ· ·Ó·Ù˘Íȷ΋˜ ‰È¿ÎÚÈÛ˘. ∏ ËÏÈÎȷ΋ ÔÌ¿‰· ÁÈ· ÙËÓ ÔÔ›· ıˆڋıËΠηٿÏÏËÏË ÌÈ· ÂÚÒÙËÛË Î·ıÔÚ›ÛÙËΠ̠‚¿ÛË ÙË ¯ÚÔÓÔÏÔÁÈ΋ ËÏÈΛ· ÛÙËÓ ÔÔ›· Ë Û˘ÁÎÂÎÚÈ̤ÓË ÂÚÒÙËÛË ··ÓÙ‹ıËΠÂÈÙ˘¯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 ÂÈÙ˘¯›·˜ 50%. ªÂ ÙËÓ ÈÛÔÌÂÚ‹ ·˘Ù‹ ηٷÓÔÌ‹ ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ ÛÙȘ ‰È¿ÊÔÚ˜ ËÏÈÎȷΤ˜ ÔÌ¿‰Â˜ ÂȉÈÒÍ·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˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÔÈ ‰‡ÛÎÔϘ ÂÚˆÙ‹ÛÂȘ Ì ˘„ËÏ‹ Û˘Ó¿ÊÂÈ·, ‰ËÏ·‰‹ ÂÚˆÙ‹ÛÂȘ ÛÙȘ Ôԛ˜ 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 ÂÈÏÔÁ‹ ÙˆÓ ÂÓ‰ÂÈÎÙÈÎÒÓ ÛˆÛÙÒÓ ··ÓÙ‹ÛÂˆÓ Ì ‚¿ÛË ÙȘ Ôԛ˜ ·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 Ôԛ˜ ¯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΋ Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ. ™˘ÌÏËÚˆÓfiÙ·Ó ÙÔ ÌÔÚʈÙÈÎfi Â›Â‰Ô ÙˆÓ ÁÔÓÈÒÓ Î·È ÙÔ Â¿ÁÁÂÏÌ¿ ÙÔ˘˜. ∞fi ÙÔÓ ÓËÈ·ÁˆÁfi ‹ ‰¿ÛηÏÔ Ù˘ Ù¿Í˘ ˙ËÙ‹ıËΠӷ ‚·ıÌÔÏÔÁ‹ÛÂÈ ÙË ÁÂÓÈ΋ Â›‰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 ∏ ÂfiÌÂÓË Î·È ÙÂÏÈ΋ Ê¿ÛË Ù˘ ÛÙ¿ıÌÈÛ˘ ÙÔ˘ ∞ã ∆∂™∆ ›¯Â ˆ˜ ÛÙfi¯Ô ·ÊÂÓfi˜ ÌÂÓ ÙËÓ ÂȂ‚·›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 ·ÍÈÔÈÛÙ›·˜ Î·È ÂÁ΢ÚfiÙËÙ·˜ ÙˆÓ ÎÏÈ̿ΈÓ. ªÂÙ¿ ÙË ÛÙ·ÙÈÛÙÈ΋ ·Ó¿Ï˘ÛË, Ë ÙÂÏÈ΋ Û‡ÓıÂÛË ÙˆÓ ÂÚˆÙ‹ÛÂˆÓ Ô˘ ÂÂϤÁËÛ·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· ÂÂÍÂÚÁ·Ûı› Î·È Ó· Û˘ÁÎÚ›ÓÂÈ Û‡ÓıÂÙ˜ ¤ÓÓÔȘ ÚÔÎÂÈ̤ÓÔ˘ Ó· ηٷϋÍÂÈ Û ÏÔÁÈο Û˘ÌÂÚ¿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· ·ÓÙÈÚÔÛˆ‡ÂÈ ‰È·ÊÔÚÂÙÈÎfi ·Ó·Ù˘ÍÈ·Îfi Â›‰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: ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È 10 οÚÙ˜ Ì ۯ‹Ì·Ù· ÔÙÈ΋˜ ·ÓÙ›Ï˄˘, ÎÏÈÌ·ÎÔ‡ÌÂÓ˘ ÔÙÈ΋˜ 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· ÔÙÈ΋ ‰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 ÙÔÔı¤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· ÔÔ›· 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

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24

4 16 3 2

17 7

78 9

167

108

150 28

47

24 24 87

6 33 28

10

17

61

16 24

901 60 52 32 57 209 38 15 96 55 23 47 48 24 24 321 2002

21

47

19

11 15 31

23 47 24

24 24

155

210

24 24 64

24 182

ÌËÓÒÓ (̤ÛË ËÏÈΛ·: 5 ¯ÚfiÓÈ· Î·È 8 Ì‹Ó˜). ∆· ·È‰È¿ ÊÔÈÙÔ‡Û·Ó Û ÓËÈ·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. Ÿˆ˜ 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% ‹Ș ‰˘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% ‹Ș ‰˘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

OÙÈÎÔÎÈÓËÙÈÎfi˜ 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

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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 ‹Ș ‰˘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% ‹Ș ‰˘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˜ ÂȉfiÛÂȘ ·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˜ ÂȉfiÛÂȘ ·fi ÙȘ ·Ó·ÌÂÓfiÌÂÓ˜ ÁÈ· ÙËÓ ËÏÈΛ· ÙÔ˘˜. ªÂ ÛÎÔfi ÙË Û‡ÁÎÚÈÛË ÙˆÓ ·ÔÙÂÏÂÛÌ¿ÙˆÓ, ·Ú¿ÏÏËÏ· Ì ÙË ¯ÔÚ‹ÁËÛË ÙÔ˘ ∞ã ∆∂™∆ ¯ÔÚËÁ‹ıËÎ·Ó ÛÙ· ·È‰È¿ Î·È ‰‡Ô ÂÈÚfiÛıÂÙ˜ 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 ∆∂™∆, ηÙËÁÔÚÈÔÔÈ‹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 ηÙËÁÔÚÈÔÔÈ‹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 ηÙËÁÔÚÈÔÔ›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 ÂȉfiÛÂȘ ÌÂٷ͇ ·ÁÔÚÈÒÓ/ÎÔÚÈÙÛÈÒÓ ÛÙËÓ √ÙÈ΋ ∞ÓÙ›ÏË„Ë, ¯ÚËÛÈÌÔÔÈ‹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 ∆∂™∆. Ÿˆ˜ 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, ηÙËÁÔÚÈÔÔÈ‹Û·Ì ÙȘ ÙÈ̤˜ Ù˘, fiˆ˜ Î·È ÚÈÓ, ÒÛÙ ӷ ÌÔÚ¤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 ÔÙÈ΋ ·ÓÙ›ÏË„Ë, ¯ÚËÛÈÌÔÔÈ‹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 ∆∂™∆. Ÿˆ˜ ·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 ∆∂™∆. ™˘ÌÂÚ·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¿ ηÙËÁÔÚÈÔÔÈ‹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. ∂ÈϤÔÓ, ·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 ÌÔÚԇ̠ӷ ·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 ∆∂™∆. ∞ÍÈÔÈÛÙ›· 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 ϤÔÓ ÛÙË µã ‰ËÌÔÙÈÎÔ‡. ∞fi ·˘Ù¿ ÌÔÚ¤Û·Ì ӷ ¤ÚıÔ˘Ì ÙÂÏÈο Û Â·Ê‹ 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. Ÿˆ˜ ·Ú·ÙËÚԇ̠ÛÙËÓ ∂ÈÎfiÓ· 2 Î·È ÛÙÔÓ ¶›Ó·Î· 9, ÙÔ ÔÛÔÛÙfi ÙˆÓ ·È‰ÈÒÓ Ô˘ ÂÌÊ·Ó›˙Ô˘Ó ¯·ÌËÏfiÙÂÚ˜ ÈηÓfiÙËÙ˜ ÛÙÔ˘˜ ÂÈ̤ÚÔ˘˜ 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 Â·Ê‹ Ì ÙÔÓ ‰¿ÛηÏÔ ÙˆÓ ·È‰ÈÒÓ ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ (¡=201) Î·È ÙÔ˘ ˙ËÙ‹Û·Ì ӷ Û˘ÌÏËÚÒÛÂÈ 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˘ÌÏ‹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΋ Â›‰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· ¤ÚÂ ӷ ¤¯Ô˘Ó ·Ó·Ù‡ÍÂÈ Û‡Ìʈӷ Ì ÙËÓ ËÏÈΛ· ÙÔ˘˜. ™ÙÔÓ ›Ó·Î· 10 ·Ú·ÙËÚԇ̠ˆ˜ 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˘ ÔÔ›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 οÔȘ ‰˘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. ™˘ÓÂÒ˜, ÚÔ·ÙÂÈ ÙÔ Û˘Ì¤Ú·ÛÌ· fiÙÈ Ë ÎÏÈÓÈ΋ ÂÎÙ›ÌËÛË, Ë ÔÔ›·, fiˆ˜ ¤¯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΋ Â›‰ÔÛË ÙˆÓ ·È‰ÈÒÓ.

™˘˙‹ÙËÛË ∏ ÌÂÙ¿‚·ÛË ÙÔ˘ ·È‰ÈÔ‡ ÛÙÔ Û¯ÔÏÂ›Ô ·ÔÙÂÏ› Ì›˙ÔÓ· ·ÏÏ·Á‹ ÛÙË ˙ˆ‹ ÙÔ˘. ¶Ú¤ÂÈ ÏÔÈfiÓ 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 ÌÔÚ› 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 ÂÈ̤ÚÔ˘˜ ÂÙÔÈÌfiÙËÙ˜ fiˆ˜: °ÓˆÛÙÈ΋, °ÏˆÛÛÈ΋, ∫ÈÓËÙÈ΋, ™˘Ó·ÈÛıËÌ·ÙÈ΋ Î·È °Ú·ÊÈ΋. ∂ÈϤÔÓ, 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 ϤÔÓ ·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˜, fiÔ˘ ΢Úȷگ› Ô ¤ÓÙ˘Ô˜ ÏfiÁÔ˜, Ì ÙÔÓ ÔÔ›Ô ÂÍÔÈÎÂÈÒÓÔÓÙ·È ·fi ÌÈÎÚ‹ ËÏÈΛ· Î·È ÙÔÓ ÔÔ›Ô ÛÙ·‰È·Î¿ ÚÔÛ·ıÔ‡Ó Ó· ·ÔΈ‰ÈÎÔÔÈ‹ÛÔ˘Ó. ™¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ÏÔÈfiÓ 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· ÂÎ·È‰Â‡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›· Â·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˘˜ ÂÈ̤ÚÔ˘˜ 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

OÙÈÎÔÎÈÓËÙÈÎfi˜ 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˘¯›·. ÃÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÈ· ÚÔÏËÙÈÎfi ÏËı˘ÛÌÈ·Îfi ¤ÏÂÁ¯Ô fiÏˆÓ ÙˆÓ ·È‰ÈÒÓ ÚÔÛ¯ÔÏÈ΋˜ ËÏÈΛ·˜ Ô˘ ·Ú·ÎÔÏÔ˘ıÔ‡Ó ÓËÈ·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 ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ÂÈÏÂÁ̤Ó˜ ÂÚÈÙÒÛÂȘ 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 ÚÔÏËÙÈÎfi˜ ¤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˘ÌÂÚÈÊÔÚ¿˜. ∂¿Ó ·˘Ù¿ Ù· Û˘ÌÙÒÌ·Ù· ‰ÂÓ ·ÓÙÈÌÂÙˆÈÛıÔ‡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˘ÌÂÚÈÊÔÚ¤˜, Ó· Ô‰ËÁËıÔ‡Ó Û ¯Ú‹ÛË ÂıÈÛÙÈÎÒÓ Ô˘ÛÈÒÓ Î·È Û ÂÊË‚È΋ ÂÁ΢ÌÔÛ‡ÓË (15,7,16). ∏ Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ·, fiˆ˜ Î·È fiÏ· Ù· ·Ó·Ù˘Íȷο ÌÂÁ¤ıË, ÌÂÙÚÒÓÙ·È Ì ÚfiÙ˘˜ 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 ·Ϥ˜ ‰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

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∞ÓȯÓ¢ÙÈ΋ ‰ÔÎÈÌ·Û›· Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜

Á›ÓÂÙ·È ÚÔÏËÙÈÎfi˜ ¤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 ÚÔÏËÙÈÎfi˜ ¤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˘ ÂÈϤÁÔ˘Ó Ù· ȉȈÙÈο ÓËÈ·ÁˆÁ›·. ∆· ·ÓȯÓ¢ÙÈο ÙÂÛÙ Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È Û ·˘Ù¤˜ ÙȘ ÂÚÈÙÒÛÂȘ, ·ÚfiÙÈ ‰ÂÓ Â›Ó·È ÛÙ·ıÌÈṲ̂ӷ, Â›Ó·È ¯Ú‹ÛÈÌ· ˘fi ÙËÓ ¤ÓÓÔÈ· fiÙÈ ÌÔÚ› οÔȘ 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 ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËı› 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 ÓËÈ·ÁˆÁ›·, ΢ڛˆ˜ Ù˘ ∞ÙÙÈ΋˜). ™Ùfi¯Ô˜ Ì·˜ Â›Ó·È Ó· ÂÂÎÙ›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 ·ÓÙÈÚÔÛˆ¢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 ÙÚfiÔ ÛÙÔ ÂÚÒÙËÌ· “∂›Ó·È ÙÔ ·È‰› ¤ÙÔÈÌÔ Ó· ÊÔÈÙ‹ÛÂÈ ÛÙÔ ™¯ÔÏ›Ô;”, “¡∞π ‹ √Ãπ”. ∆Ô È‰È·›ÙÂÚÔ ¯·Ú·ÎÙËÚÈÛÙÈÎfi ÙÔ˘, ÙÔ ÔÔ›Ô ÂÈ‚¿ÏÏÂÙ·È Ó· ÛËÌÂȈı›, Â›Ó·È Ë ÈηÓfiÙËÙ¿ ÙÔ˘ Ó· ÂϤÁ¯ÂÈ ÔÏ˘Â›‰· ÙË Ì·ıËÛȷ΋ ÈηÓfiÙËÙ·. ¶ÂÚÈÏ·Ì‚¿ÓÂÈ 4 Ú·ÎÙÈΤ˜ Î·È 4 ÏÂÎÙÈΤ˜ ÈηÓfiÙËÙ˜. ŒÙÛÈ, ÂϤÁ¯ÔÓÙ·È Ë ÔÙÈ΋ ·ÓÙ›ÏË„Ë Î·È Ô ÔÙÈÎÔÎÈÓËÙÈÎfi˜ Û˘ÓÙÔÓÈÛÌfi˜, Ë ÌÓ‹ÌË Î·È Ë ·‰Ú‹ ÎÈÓËÙÈÎfiÙËÙ·, ηıÒ˜ Â›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˘ÌÏËڈ̷ÙÈΤ˜ 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˘ÌÂÚÈÊÔÚ¿ ÙÔ˘ ·È‰ÈÔ‡ ηٿ ÙË ¯ÔÚ‹ÁËÛË Ù˘ ‰ÔÎÈÌ·Û›·˜, ·Ú¤¯ÔÓÙ¿˜ Ì·˜ ÙË ‰˘Ó·ÙfiÙËÙ· ÂÓÙÔÈÛÌÔ‡ ·Ú·ÁfiÓÙˆÓ Ô˘ ÂËÚ¿˙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 ÍÂÂÚÓ¿ Ù· 15 ÏÂÙ¿. ŒÙÛÈ, ÌÔÚ› Ó· ÂÊ·ÚÌfi˙ÂÙ·È ÁÚ‹ÁÔÚ· Î·È ÛÂ

ÔÏÏ¿ ·È‰È¿ ÛÙÔÓ ¯ÒÚÔ ÙÔ˘ ÓËÈ·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 ÙÚfiÔ ÙË Û¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ÛÙȘ ·Ú·Ì¤ÙÚÔ˘˜ Ô˘ ·Ó·Ê¤ÚıËηÓ. ¶ÚÔÏËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ Ù˘ Û¯ÔÏÈ΋˜ ÂÙÔÈÌfiÙËÙ·˜ ÂÊ·ÚÌfi˙ÂÙ·È ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ·ÓÂÙ˘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 ÂÎ·›‰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.

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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.

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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΢fiÔ˘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

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¶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. ¢ËÌÔÔ‡ÏÔ˘1, ∞. ª¿ÚÁ·ÚË2, π. ∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘1 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: √ ÚfiÏÔ˜ Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ Û Â›Â‰Ô ÎÔÈÓfiÙËÙ·˜ ¤¯ÂÈ ·Ó·ÁÓˆÚÈÛı› ˆ˜ ȉȷ›ÙÂÚ· ÛËÌ·ÓÙÈÎfi˜ ÁÈ· ÙË ‚ÂÏÙ›ˆÛË Ù˘ ˘Á›·˜ ÙÔ˘ ÏËı˘ÛÌÔ‡. ∏ ÂÓÂÚÁÔÔ›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˘ ÂÔÙ‡ÂÙ·È ÂÈÛÙËÌÔÓÈο ·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˘ÓÂȉËÙÔÔÈ‹ÛÔ˘Ó fiÙÈ Ë ÊÚÔÓÙ›‰· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ¤¯ÂÈ ˆ˜ ¿ÌÂÛÔ Î·È Ì·ÎÚÔÚfiıÂÛÌÔ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜, Î·È ‚) Ë ÚÔÙ˘ÔÔ›ËÛË ÙÔ˘ ۯ‰ȷÛÌÔ‡ Î·È Ë ·Ú·ÁˆÁ‹ ÂÔÙÈÎÔ‡ ˘ÏÈÎÔ‡, ÒÛÙ ÙÔ ÚfiÁÚ·ÌÌ· Ó· ÌÔÚ› 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 ÓËÈ·ÁˆÁ›ˆÓ, ‰ËÌÔÙÈÎÒÓ Î·È Á˘ÌÓ·Û›ˆÓ Ù˘ ÂÚÈÔ¯‹˜. √ ۯ‰ȷÛÌfi˜ ÂÚÈÂÏ¿Ì‚·ÓÂ: ·) ÎÔÈÓÔÙÈ΋ Û˘ÌÌÂÙÔ¯‹, ‚) ‰Ú¿ÛÂȘ ¢·ÈÛıËÙÔÔ›ËÛ˘-ÂÎ·›‰Â˘Û˘ Â·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·ÙfiÈÛË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÙˆÓ Ì·ıËÙÒÓ (p<0,01) ÚÔ˜ ÙËÓ Î·ÙËÁÔÚ›· Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ ¿ÚÈÛÙË Â›‰ÔÛË Û 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·. √ ÙÚfiÔ˜ ·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˜. ™˘ÌÂÚ¿ÛÌ·Ù·: ∏ ÂÓÂÚÁÔÔ›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

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·470

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∞. •ÂηϿÎË Î·È Û˘Ó.

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‹ ÂÈÎÔÈÓˆÓ›·˜ 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 ÙÚÔÔÔ›ËÛË ÌÈ·˜ Û˘ÌÂÚÈÊÔÚ¿˜ ‹ ÙËÓ ·ÏÏ·Á‹ ÙÔ˘ ¢ڇÙÂÚÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜. ∏ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Â›Ó·È Â˘Ú‡ÙÂÚË Î·È ÂÌÂÚȤ¯ÂÈ ÙÔÌ›˜ fiˆ˜ 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˘ ÂÔ¯‹˜ 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). ∏ ÚÔÛˆÈ΋ ‰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‡˜ ·ÓıÚÒÔ˘˜ ‹ ÔÌ¿‰Â˜ Î·È ÔˆÛ‰‹ÔÙ ÛËÌ·ÙÔ‰ÔÙ› ÌÈ· ‰˘Ó·ÌÈ΋ ·ÏÏËÏÂ›‰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˘ÌÂÚȤϷ‚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· ÂÈϤÍÂÈ ÙËÓ ÂÚÈÛÛfiÙÂÚÔ "˘ÁÈ‹" Û˘ÌÂÚÈÊÔÚ¿ ("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 ÔÔ›Ô È‰Ú‡ıËÎÂ Î·È ÂÔÙ‡ÂÙ·È ÂÈÛÙËÌÔÓÈο ·fi ÙË ¢È‡ı˘ÓÛË ∫ÔÈÓˆÓÈ΋˜ ¶·È‰È·ÙÚÈ΋˜ ÙÔ˘ πÓÛÙÈÙÔ‡ÙÔ˘ ÀÁ›·˜ ÙÔ˘ ¶·È‰ÈÔ‡, ¤¯ÂÈ Ì·ÎÚ¿ ÂÌÂÈÚ›· 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 ÂÓÂÚÁÔÔ›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˘ÔÔ›ËÛË ÙˆÓ ÚÔÁÚ·ÌÌ¿ÙˆÓ, ÒÛÙ ӷ ÌÔÚÔ‡Ó Ó· ·Ó··Ú·¯ıÔ‡Ó. √ ÛÎÔfi˜ 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˜ ÌÔÚ› 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, fiˆ˜ Î·È ÔÈ ÂÓ‹ÏÈΘ, Û ڇÔ˘˜ Ô˘ ‚Ú›ÛÎÔÓÙ·È ÛÙÔÓ ·¤Ú·, ÙÔ ¤‰·ÊÔ˜ ‹ ÙÔ ÓÂÚfi, Ô˘ ÙÔ˘˜ ¤ÙÔ˘Ó, ÙÔ˘˜ ÂÈÛÓ¤Ô˘Ó ‹ ÙÔ˘˜ ·ÔÚÚÔÊÔ‡Ó ·fi ÙÔ ‰¤ÚÌ· ÙÔ˘˜. √È ·Ó·Ù˘ÛÛfiÌÂÓÔÈ,

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·471

471

∞ÁˆÁ‹ Î·È ÚÔ·ÁˆÁ‹ ˘Á›·˜

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 ·ÓÔÛÔÔÈËÙÈÎfi 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˜ ÂȉڿÛÂȘ.

3. ¶¤ÙÔ˘Ó, ÂÈÛÓ¤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¿, ÂÂȉ‹ ·›˙Ô˘Ó Û Â͈ÙÂÚÈÎÔ‡˜ ¯ÒÚÔ˘˜, ‰ÂÓ ϤÓÔ˘Ó Û˘¯Ó¿ Ù· ¯¤ÚÈ· ÙÔ˘˜, Ù· ÔÔ›· ‚¿˙Ô˘Ó ÛÙÔ ÛÙfiÌ· ÙÔ˘˜, ÂÓÒ ÌÂÚÈΤ˜ ÊÔÚ¤˜ “ÙÚÒÓ” Â›Ùˉ˜ ¯ÒÌ·.

5. ∆· ·È‰È¿ ¤¯Ô˘Ó ÌÂÁ·Ï‡ÙÂÚÔ ÚÔÛ‰fiÎÈÌÔ ÂÈ‚›ˆÛ˘ ·fi ÙÔ˘˜ ÂÓ‹ÏÈΘ. ∆Ô ÌÂÁ·Ï‡ÙÂÚÔ ‰È¿ÛÙËÌ· Ù˘ ˙ˆ‹˜ ÙÔ˘˜ Â›Ó·È ÌÚÔÛÙ¿ 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˘ ·ÓıÚÒÔ˘ 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˘ÓÂȉËÙÔÔÈ‹ÛÔ˘Ó fiÙÈ Ë ÊÚÔÓÙ›‰· ÙÔ˘ ÂÚÈ‚¿ÏÏÔÓÙÔ˜ ¤¯ÂÈ ˆ˜ ¿ÌÂÛÔ Î·È Ì·ÎÚÔÚfiıÂÛÌÔ ·ÔÙ¤ÏÂÛÌ· ÙËÓ ÚÔÛÙ·Û›· Ù˘ ˘Á›·˜ Î·È ‚) Ë ÚÔÙ˘ÔÔ›ËÛË ÙÔ˘ ۯ‰ȷÛÌÔ‡ Î·È Ë ·Ú·ÁˆÁ‹ ÂÔÙÈÎÔ‡ ˘ÏÈÎÔ‡, ÒÛÙ ÙÔ ÚfiÁÚ·ÌÌ· Ó· ÌÔÚ› 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 ÓËÈ·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˘·ÈÛıËÙÔÔ›ËÛË Î·È ÛÙËÓ ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ Û˘ÌÌÂÙ¯fiÓÙˆÓ, ÒÛÙ ӷ ‰È·ÌÔÚʈı› ÎÔÈÓ‹ ÛÙ¿ÛË Î·È ‰˘Ó·ÙfiÙËÙ· ÂÓÂÚÁÔ‡ ÂÌÏÔ΋˜. ™ÙÔ Ï·›ÛÈÔ ·˘Ùfi, Ú·ÁÌ·ÙÔÔÈ‹ıËÎ·Ó Û˘Ó·ÓÙ‹ÛÂȘ ÌÂ: ·) ÙÔÈÎÔ‡˜ ÊÔÚ›˜, fiˆ˜ ÔÈ ‰ËÌÔÙÈΤ˜ ·Ú¯¤˜ Ù˘ fiÏ˘, ÙÔ √ÈÎÔÏÔÁÈÎfi ∂ÚÁ·ÛÙ‹ÚÈ ÙÔ˘ ‰‹ÌÔ˘ Î·È ÔÈ ÚfiÛÎÔÔÈ. ∞Ô-

Ù¤ÏÂÛÌ· ÙˆÓ Û˘Ó·ÓÙ‹ÛÂˆÓ ‹Ù·Ó Ë ÂÓÂÚÁfi˜ Û˘ÌÌÂÙÔ¯‹ ÙÔ˘ √ÈÎÔÏoÁÈÎÔ‡ EÚÁ·ÛÙËÚ›Ô˘, ‰Ú¿ÛË Ë ÔÔ›· ¯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, ÓËÈ·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˘·ÈÛıËÙÔÔ›ËÛ‹ ÙÔ˘˜ Î·È ÙËÓ ˘ÈÔı¤ÙËÛË ˘ÁÈÒÓ Ú·ÎÙÈÎÒÓ ÛÙÔ ÔÈÎÔÁÂÓÂÈ·Îfi ÂÚÈ‚¿ÏÏÔÓ.

2. ¢Ú¿ÛÂȘ ¢·ÈÛıËÙÔÔ›ËÛ˘-ÂÎ·›‰Â˘Û˘ Â·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˘ ·¢ı˘ÓfiÙ·Ó Û fiÏÔ˘˜ ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ÚˆÙÔ‚¿ıÌÈ·˜ Î·È ‰Â˘ÙÂÚÔ‚¿ıÌÈ·˜ ÂÎ·›‰Â˘Û˘, Ì ÙË Û˘ÓÂÚÁ·Û›· ÙˆÓ ·ÓÙ›ÛÙÔȯˆÓ °Ú·Ê›ˆÓ ∂Î·›‰Â˘Û˘. ∆Ô ÛÂÌÈÓ¿ÚÈÔ ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ Â›¯Â ÛÙfi¯Ô ·ÊÂÓfi˜ ÙËÓ ÂÓË̤ڈÛË Î·È ÙËÓ Â˘·ÈÛıËÙÔÔ›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˜ ÔÙÈΤ˜-ÂÈÛÙËÌÔÓÈΤ˜ 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˘ÓÂ¿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·, ·ÍÈÔÔÈÂ›Ù·È ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ˙ˆ‹ (14). £· Ú¤ÂÈ Ó· ÛËÌÂȈı› fiÙÈ Ë ÂÚÈ‚·ÏÏÔÓÙÈ΋ ÂÎ·›‰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 ÂÎ·›‰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˜ ÂÈÙÒÛÂȘ 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 ÂÎ·›‰Â˘Û‹ ÙÔ˘˜ ÛÙÔÓ ÙÚfiÔ ·ÚÔ˘Û›·Û˘, ÏfiÁˆ ÙˆÓ È‰È·ÈÙÂÚÔÙ‹ÙˆÓ Ù˘ ·È‰È΋˜ ËÏÈΛ·˜. ∆ÔÓ›ÛıËηÓ, ÏÔÈfiÓ, 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”. ∏ ÂÈÏÔÁ‹ 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‡ ÂÈ¤‰Ô˘ ·È‰ÈÒÓ ∂ã Î·È ™∆ã ‰ËÌÔÙÈÎÔ‡ ÌÂÙ¿ ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ.

10-12 13-15 ∞ÚÈıÌfi˜ ÛˆÛÙÒÓ ··ÓÙ‹ÛˆÓ

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 ÂÔÙÈÎfi ˘ÏÈÎfi ‰fiıËΠ۠ËÏÂÎÙÚÔÓÈ΋ ÌÔÚÊ‹ ÛÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ fiÏˆÓ ÙˆÓ Û¯ÔÏ›ˆÓ. ‚) ¶·È‰ÈÎÔ› ÛÙ·ıÌÔ› Î·È ÓËÈ·ÁˆÁ›·: ™Ù· ·È‰È¿ ÙˆÓ ·È‰ÈÎÒÓ ÛÙ·ıÌÒÓ Î·È ÙˆÓ ÓËÈ·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·ÙÔÔ›ËÛ·Ó Ì¤ÏË ÙÔ˘ √ÈÎÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘, Ì ÙËÓ ˘ÔÛÙ‹ÚÈÍË Î·È ÙËÓ ÂÔÙ›· ÙˆÓ ÂÈÛÙËÌfiÓˆÓ 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˘·ÈÛıËÙÔÔ›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 ÙÚfiÔ˘˜: ·) ∫·Ù·Û΢¿ÛıËΠÂÚˆÙËÌ·ÙÔÏfiÁÈÔ ÁÓÒÛˆÓ, ÙÔ ÔÔ›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 ‰fiıËΠÂ›Û˘ ÛÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜ ηٿ ÙË ‰È¿ÚÎÂÈ· ÙˆÓ ·ÚÔ˘ÛÈ¿ÛˆÓ, Ì ÛÙfi¯Ô Ó· ·ÍÈÔÏÔÁËı› ÙÔ ÂÚȯfiÌÂÓÔ Ù˘ ÔÌÈÏ›·˜, Ô ÙÚfiÔ˜ 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·ÙÔÔÈ‹ıËÎ·Ó Û˘Ó·ÓÙ‹ÛÂȘ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ ÙÔ˘ ∫.À.¶.∫. Ì ٷ ̤ÏË ÙÔ˘ √ÈÎÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘ Î·È ÂÎÚÔÛÒÔ˘˜ ÙˆÓ ÊÔÚ¤ˆÓ, Ì ÛÙfi¯Ô ÙËÓ ÂÎÙ›ÌËÛË Ù˘ Û˘ÓÔÏÈ΋˜ ÂÌÂÈÚ›·˜.

∞ÔÙÂϤÛÌ·Ù· ¶Ú·ÁÌ·ÙÔÔÈ‹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 ÙÚfiÔ˘˜: 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 ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË ÙÔ˘ ÁÓˆÛÙÈÎÔ‡ ÙÔ˘˜ ÂÈ¤‰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‡ ÂÈ¤‰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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Paediatriki 2008;71:469-474

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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% -

-

-

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·473

473

∞ÁˆÁ‹ Î·È ÚÔ·ÁˆÁ‹ ˘Á›·˜

¶›Ó·Î·˜ 2. ∞ÍÈÔÏfiÁËÛË ÙÔ˘ ÙÚfiÔ˘ ·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% -

-

ÌÂÙ¿ Î·È ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ (ÚÔ¸¿Ú¯Ô˘Û˜ Î·È Ó¤Â˜ ÁÓÒÛÂȘ) ‚Ú›ÛÎÂÙ·È Û Â›Â‰Ô ÈηÓÔÔÈËÙÈÎfi ¤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 ÔÔ›Ô ı· ÌÔÚÔ‡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 ÛÎÔfi ÙËÓ ÂÎÙ›ÌËÛË Ù˘ ¿ÌÂÛ˘ ·ÔÙÂÏÂÛÌ·ÙÈÎfiÙËÙ·˜ ÙˆÓ ·ÚÔ˘ÛÈ¿ÛˆÓ, ‰ÈÂÚ¢ӋıËÎÂ Ë ÌÂÙ·ÙfiÈÛË ÁÓÒÛˆÓ, Ì ¯ÔÚ‹ÁËÛË ·Ó¿ÏÔÁˆÓ ÂÚˆÙËÌ·ÙÔÏÔÁ›ˆÓ Û ·ÓÙÈÚÔÛˆ¢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. Ÿˆ˜ Ê·›ÓÂÙ·È ÛÙËÓ ∂ÈÎfiÓ· 2, ·Ú·ÙËÚÂ›Ù·È ÌÂÙ·ÙfiÈÛË ÙÔ˘ ‰Â›ÁÌ·ÙÔ˜ ÚÔ˜ ÙËÓ Î·ÙËÁÔÚ›· ÙˆÓ 1617 ÛˆÛÙÒÓ ··ÓÙ‹ÛˆÓ, Ô˘ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙËÓ ¿ÚÈÛÙË Â›‰ÔÛË. ∏ ÌÂÙ·ÙfiÈÛË ·˘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˘ÓÙÚÈÙÈ΋ ÏÂÈÔ„ËÊ›· ÙˆÓ ÂÎ·È‰Â˘ÙÈÎÒÓ (¶›Ó·Î·˜ 1).

II. √ ÙÚfiÔ˜ ·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˘ÌÂÚÈÊÔÚ¿˜ Ù˘ Ù¿Í˘ ÂÎÙÈÌ‹ıËΠ̠‚¿ÛË ÙÔÓ ‚·ıÌfi ÚÔÛÔ¯‹˜ Î·È Û˘ÌÌÂ-

ÙÔ¯‹˜, Ô˘ ıˆڋıËÎ·Ó ·ÚÎÂÙ¿ ¤ˆ˜ Ôχ ÈηÓÔÔÈËÙÈΤ˜ ·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 ÌÔÚ› Ó· ·Ô‰Ôı› ÛÙËÓ ¤ÏÏÂÈ„Ë ÚÔÛÔ¯‹˜ ‹ ÂӉȷʤÚÔÓÙÔ˜, ·ÏÏ¿ ı· ÌÔÚÔ‡Û ›Ûˆ˜ Ó· ÂÚÌËÓ¢Ù› ·fi Ù· ‰È·ÊÔÚÂÙÈο ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ οı ËÏÈÎȷ΋˜ ÔÌ¿‰·˜.

™˘˙‹ÙËÛË ∏ ÂÓÂÚÁÔÔ›ËÛË Ù˘ ÎÔÈÓfiÙËÙ·˜ ·ÔÙÂÏ› ÚÔ¸fiıÂÛË ÛÙ· Û‡Á¯ÚÔÓ· ÌÔÓ٤Ϸ ÚÔ·ÁˆÁ‹˜ Ù˘ ˘Á›·˜ (16), ÂÓÒ Ô ÚfiÏÔ˜ Ù˘ ÚˆÙÔ‚¿ıÌÈ·˜ ÊÚÔÓÙ›‰·˜ ˘Á›·˜ Û 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 ÂÎ·›‰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 ÂÌÈÛÙÔÛ‡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 ÌÔÚ¤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 ÂÎ·›‰Â˘ÛË Û¯ÂÙÈ΋ Ì ÙËÓ ÚÔ·ÁˆÁ‹ Ù˘ ˘Á›·˜ Î·È ‰ÂÓ ÌÔÚÔ‡Ó Â‡ÎÔÏ· Ó· ·ÔÛÙ·ÛÈÔÔÈËıÔ‡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 ÂÈÏÔÁ‹, Â›Ó·È ÂÚÈÛÛfiÙÂÚÔ ·ıËÙÈÎÔ› ‰¤ÎÙ˜ ·ÔÊ¿ÛÂˆÓ Î·È ÏËÚÔÊÔÚÈÒÓ ÁÈ· ÙËÓ ˘Á›·. ŒÙÛÈ, Ë ÂÌÂÈÚ›· Ù˘ ÔÌ¿‰·˜ Ì·˜ Ì ÙÔ˘˜ ÊÔÈÙËÙ¤˜-̤ÏË ÙÔ˘ √ÈÎÔÏÔÁÈÎÔ‡ ∂ÚÁ·ÛÙËÚ›Ô˘

¶›Ó·Î·˜ 3. ∞ÍÈÔÏfiÁËÛË Ù˘ Û˘ÌÂÚÈÊÔÚ¿˜ Ù˘ Ù¿Í˘ ηٿ ÙȘ ·ÚÔ˘ÛÈ¿ÛÂȘ ÛÙ· ‰ËÌÔÙÈο Î·È ÛÙ· Á˘ÌÓ¿ÛÈ·

¢ËÌÔÙÈο °˘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%

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Pediatri Nov-Dec 08 new

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∞. •ÂηϿÎË Î·È Û˘Ó.

‹Ù·Ó ÌÈ· ÚfiÎÏËÛË Î·È ÌÈ· ¤ÎÏËÍË Û ÔÏÏ¿ Â›‰·, Ô˘ ÎÚ›ıËΠ·fi fiÏÔ˘˜ ˆ˜ ıÂÙÈ΋. ªÂ ‚¿ÛË Ù· ·ÔÙÂϤÛÌ·Ù· ·fi ÙËÓ ·ÍÈÔÏfiÁËÛË ÙÔ˘ ÚÔÁÚ¿ÌÌ·ÙÔ˜, ÌÔÚ› ηÓ›˜ Ì ۯÂÙÈ΋ ·ÛÊ¿ÏÂÈ· Ó· Û˘ÌÂÚ¿ÓÂÈ fiÙÈ ÙÔ ı¤Ì· Î·È Ô ÙÚfiÔ˜ ÚÔÛ¤ÁÁÈÛ˘ ‹Ù·Ó ·Ô‰ÂÎÙ¿ ·fi ÙÔ˘˜ ÂÎ·È‰Â˘ÙÈÎÔ‡˜, ÔÈ ÔÔ›ÔÈ ÂÈÚfiÛıÂÙ· ·ÍÈÔÏfiÁËÛ·Ó ¤ÌÌÂÛ· Î·È ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ Ì·ıËÙÒÓ, Ô˘ Û ÛËÌ·ÓÙÈÎfi ÔÛÔÛÙfi ‹Ù·Ó ÚÔÛÂÎÙÈÎÔ› Î·È Ì ÈηÓÔÔÈËÙÈ΋ Û˘ÌÌÂÙÔ¯‹. ∂›Ó·È Â›Û˘ ÛÎfiÈÌÔ 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 ÈηÓÔÔÈËÙÈ΋. ∏ ÏËÚÔÊÔÚ›·, fï˜, Ú¤ÂÈ Ó· Â·Ó·Ï·Ì‚¿ÓÂÙ·È Î·È Ó· Û˘ÌÏËÚÒÓÂÙ·È, ÒÛÙ ÙÂÏÈο Ó· ÂÌ‰ˆı› ·fi Ù· ·È‰È¿. ∞˘Ùfi ÌÔÚ› Ó· ÂÈÙ¢¯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· ÈηÓÔÔÈËÙÈ΋ ·ÏÏ·Á‹ ÛÙ¿Û˘ Î·È Û˘ÌÂÚÈÊÔÚ¿˜, ‰ÈfiÙÈ ·˘Ù¿ ‰È·ÌÔÚÊÒÓÔÓÙ·È ·fi ÙËÓ Â›‰Ú·ÛË ÔÏÏÒÓ ·Ú·Ì¤ÙÚˆÓ. ∏ ·ÚÔ¯‹ Ù˘ ÏËÚÔÊÔÚ›·˜ Î·È Ë Â˘·ÈÛıËÙÔÔ›ËÛË Â›Ó·È ÛËÌ·ÓÙÈΤ˜, ·ÏÏ¿ ÂÍ›ÛÔ˘ ÛËÌ·ÓÙÈΤ˜ Â›Ó·È ÔÈ ÂÔÈı‹ÛÂȘ Î·È ÔÈ ‰˘Ó·ÙfiÙËÙ˜ ÙÔ˘ ·ÙfiÌÔ˘, ¤ÙÛÈ fiˆ˜ ‰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· ÂÈϤÍÂÈ ÙËÓ ÂÚÈÛÛfiÙÂÚÔ “˘ÁÈ‹” Û˘ÌÂÚÈÊÔÚ¿ (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 ÂfiÌÂÓÔ 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›·˜. ∞ÛÎÏËÈÂ›Ô ¶¿ÚÎÔ ∞ıËÓÒÓ, π·ÙÚÈ΋ ™¯ÔÏ‹ ¶·ÓÂÈÛÙËÌ›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.

Paediatriki 2008;71:469-474

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·˚΋ ÂÌÂÈÚ›· Î·È Ú·ÎÙÈ΋. ¶·È‰·ÁˆÁÈÎfi πÓÛÙÈÙÔ‡ÙÔ, ∂ÈıÂÒÚËÛË ∂Î·È‰Â˘ÙÈÎÒÓ £ÂÌ¿ÙˆÓ 2002;7:52-65.

15. ™˘ÚÔÔ‡ÏÔ˘ ¢. ∏ ÂÚÈ‚·ÏÏÔÓÙÈ΋ ÂÎ·›‰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 ÂÈÛ‹Ì·ÓÛË ÎÔÈÓÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÈÏÂÁ̤ӷ ÂÏÏËÓÈο ÙÚfiÊÈÌ· ∞. µ·ÛÈÏÔÔ‡ÏÔ˘1, ∂. ™ÙÚÔ˘Ì‹2, ¡.°. ¶··‰fiÔ˘ÏÔ˜1, µ. ∫·Ú·ı¿ÓÔ˜2 ¶ÂÚ›ÏË„Ë ∂ÈÛ·ÁˆÁ‹: ∏ ı¤ÛÈÛË ÓÔÌÔıÂÛ›·˜ ·fi ÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË Û¯ÂÙÈο Ì ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ ÛÙԯ‡ÂÈ ÛÙËÓ Â›Ù¢ÍË ÂÓfi˜ ˘„ËÏÔ‡ ÂÈ¤‰Ô˘ ÚÔÛÙ·Û›·˜ Ù˘ ˘Á›·˜ Î·È ÛÙË ‰È·ÛÊ¿ÏÈÛË ÙÔ˘ ‰ÈηÈÒÌ·ÙÔ˜ Ô˘ ¤¯Ô˘Ó Î·È ÔÈ ·ÏÏÂÚÁÈÎÔ› ηٷӷψ٤˜ ÛÙËÓ ÂÓË̤ڈÛË. ™ÎÔfi˜ ·˘Ù‹˜ Ù˘ ÌÂϤÙ˘ ‹Ù·Ó Ô ¤ÏÂÁ¯Ô˜ Î·È Ë ·ÍÈÔÏfiÁËÛË Ù˘ ÂÈÛ‹Ì·ÓÛ˘ Û˘ÁÎÂÎÚÈÌ¤ÓˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Î·È ·Ú·ÁÒÁˆÓ ÙÔ˘˜ Û 198 ÂÈÏÂÁ̤ӷ ÙÚfiÊÈÌ· (ÌÈÛÎfiÙ·, 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 ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÁÈ· ÙËÓ ·ÔÊ˘Á‹ ÂÈÌfiÏ˘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 ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ. ∞ÍÈÔÏfiÁËÛË ÙˆÓ ÂÙÈÎÂÙÒÓ ÂÈÏÂÁÌ¤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· ÂÈÌÔχÓÛÂȘ, Ì ¯Ú‹ÛË ÂÚˆÙËÌ·ÙÔÏÔÁ›Ô˘ Î·È ÚfiÙ˘˘ 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‡˜ ÙÚfiÔ˘˜ (7 ÁÈ· ÙÔ ÛÈÙ¿ÚÈ, 29 ÁÈ· ÙÔ Á¿Ï·, 6 ÁÈ· ÙÔ ·‚Áfi, 8 ÁÈ· ÙÔ˘˜ ÍËÚÔ‡˜ ηÚÔ‡˜ ‰¤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 ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘ ÁÈ· ÙË ‰‹ÏˆÛË Ù˘ Èı·Ó‹˜ ·ÚÔ˘Û›·˜ ÙÔ˘˜. √È ÂÎÚfiÛˆÔÈ ÙˆÓ ÂÙ·ÈÚÈÒÓ ·Ó¤ÊÂÚ·Ó ·‰˘Ó·Ì›· ηٷÁÚ·Ê‹˜ Û·ÊÔ‡˜ Û‡ÛÙ·Û˘ Î·È ÔÛÔÙÈÎÔÔ›ËÛ˘ ÙˆÓ Ù˘¯·›ˆÓ ÚÔÛÌ›ÍÂˆÓ Ô˘ ÚÔ·ÙÔ˘Ó Î·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹. ™˘ÌÂÚ¿ÛÌ·Ù·: √ ÌË ÂÓÈ·›Ô˜ ÙÚfiÔ˜ ηٷÁÚ·Ê‹˜ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ÚÔ˚fiÓÙ· Î·È Ë ÚÔÏËÙÈ΋ ÂÈÛ‹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’ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· 2 ∆Ì‹Ì· ¢È·ÙÚÔÊ‹˜, ÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹ÌÈÔ, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: ∞ÈÌÈÏ›· µ·ÛÈÏÔÔ‡ÏÔ˘ evassil@allergy.gr ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∂Ú¢ÓËÙÈÎfi ∫¤ÓÙÚÔ & ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, µ’ ¶·ÓÂÈÛÙËÌȷ΋ ∫ÏÈÓÈ΋ ¡ÔÛÔÎÔÌ›Ԣ ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó·

§¤ÍÂȘ ÎÏÂȉȿ: ∂ÏÏËÓÈ΋ ·ÁÔÚ¿, ÂÈÛ‹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

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·476

476

∞. µ·ÛÈÏÔÔ‡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‹ √ ÂÈÔÏ·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˘ÓÂÂÈÒÓ 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 ÚÔÏËÙÈÎfi ̤ÙÚÔ Î·È ÛÙԯ‡ÂÈ ÛÙÔÓ ·fiÏ˘ÙÔ ·ÔÎÏÂÈÛÌfi ÙˆÓ ˘‡ı˘ÓˆÓ ÁÈ· ·ÓÙȉڿÛÂȘ ÙÚÔʛ̈Ó. ∆· ·ÏÏÂÚÁÈο ¿ÙÔÌ· Î·È ÔÈ ÔÈÎÔÁ¤ÓÂȤ˜ ÙÔ˘˜ ˘Ô¯ÚÂÔ‡ÓÙ·È Ó· Â·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 ÂÈÙ˘Á¯¿ÓÂÙ·È Â‡ÎÔÏ· Î·È ‰˘Û¯ÂÚ·›ÓÂÙ·È ·ÎfiÌ· ÂÚÈÛÛfiÙÂÚÔ ·fi ÙÔ ÁÂÁÔÓfi˜ fiÙÈ Û ÔÏϤ˜ ¯ÒÚ˜ Ë ÓÔÌÔıÂÛ›· ‰ÂÓ ÂÈ‚¿ÏÏÂÈ ÙËÓ Ï‹ÚË ÂÈÛ‹Ì·ÓÛË ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ Ô˘ ÂÌÂÚȤ¯ÔÓÙ·È ÛÙ· ÂÂÍÂÚÁ·Ṳ̂ӷ ÙÚfiÊÈÌ·. ø˜ Û˘Ó¤ÂÈ·, Ë Ù˘¯·›· ηٷӿψÛË ÙÚÔÊ›ÌˆÓ Ì ÎÚ˘Ì̤ӷ ·ÏÏÂÚÁÈÔÁfiÓ· ¤¯ÂÈ ·Ԃ› ÔÏϤ˜ ÊÔÚ¤˜ ÌÔÈÚ·›· (2). °È’ ·˘ÙfiÓ ÙÔÓ ÏfiÁÔ, Â›Ó·È ÂÍ·ÈÚÂÙÈο ÛËÌ·ÓÙÈÎfi ÁÈ· ÙÔÓ ·ÏÏÂÚÁÈÎfi ηٷӷψً Ù· ÂÌÔÚÈο ÙÚfiÊÈÌ· Ó· ¤¯Ô˘Ó ·ÎÚÈ‚‹ Î·È ·Ó·ÌÊÈÛ‚‹ÙËÙË ÂÈÛ‹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› ηÚÔ›, ÛÔ˘Û·ÌfiÛÔÚÔÈ, ÛfiÁÈ·, ÛÈÙËÚ¿ Î·È ·‚Á¿), Ù· ÔÔ›· ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·›ÓÔÓÙ·È ¿Óˆ ÛÙȘ ÂÙÈΤÙ˜ ÙˆÓ ÙÚÔʛ̈Ó, ·ÓÂÍ·Úًو˜ ÔÛfiÙËÙ·˜ (3). ™ÙËÓ ∞ÌÂÚÈ΋, Û‡Ìʈӷ Ì ÙÔÓ ÓfiÌÔ ÚÔÛÙ·Û›·˜ ηٷӷψÙÒÓ (4) ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÙÚÔʛ̈Ó, Â›Ó·È ˘Ô¯ÚˆÙÈÎfi Ó· ÂÈÛËÌ·›ÓÂÙ·È Û ·Ï‹ ÁÏÒÛÛ· Ë ·ÚÔ˘Û›· ÔÔÈÔ˘‰‹ÔÙ ·fi Ù· ÔÎÙÒ ‚·ÛÈο ·ÏÏÂÚÁÈÔPaediatriki 2008;71:475-481

ÁfiÓ·, ·ÎfiÌ· Î·È fiÙ·Ó ·˘Ù¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ·ÚÒÌ·Ù·, ÚfiÛıÂÙ· Î·È ¯ÚˆÛÙÈΤ˜ (5). ∏ ·ÚÔ‡Û· ÌÂϤÙË ·ÔÛÎÔ› ÛÙÔÓ ¤ÏÂÁ¯Ô Î·È ÙËÓ ·ÍÈÔÏfiÁËÛË Ù˘ Â› ÙÔ˘ ·ÚfiÓÙÔ˜ ÂÈÛ‹Ì·ÓÛ˘ ÂÈÏÂÁÌ¤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 ÂÈÏÂÁ̤ӷ ÙÚfiÊÈÌ· (ÛÔÎÔÏ¿Ù˜ ˘Á›·˜ Î·È Á¿Ï·ÎÙÔ˜, ÌÈÛÎfiÙ·, „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 - ÚÔÏËÙÈÎÒÓ Ì¤ÙÚˆÓ ÙˆÓ ‚ÈÔÌ˯·ÓÈÒÓ, ÚÔ˜ ·ÔÊ˘Á‹ ÂÈÌfiÏ˘ÓÛ˘ ÙˆÓ ÚÔ˚fiÓÙˆÓ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁÈ΋ ‰È·‰Èηۛ· ™ÎÔfi˜ 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 ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙËÓ ÂÏÏËÓÈ΋ ·ÁÔÚ¿ ∏ ÈÛ¯‡Ô˘Û· ÓÔÌÔıÂÛ›· ÛÙËÓ ∂ÏÏ¿‰· ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙÚÔÊÈÎÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Â›Ó·È ÎÔÈÓ‹ Ì ÙËÓ Â˘Úˆ·˚΋. ™ÙÔ Ï·›ÛÈÔ Ù˘ ·ÚÔ‡Û·˜ ÌÂϤÙ˘, Ë ÓÔÌÔıÂÛ›· ‰ÈÂÚ¢ӋıËΠ̤ۈ Ù˘ Â›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 ÂÈÏÂÁ̤ӷ ÚÔ˚fiÓÙ· ∏ ·ÍÈÔÏfiÁËÛË Ù˘ ÂÊ·ÚÌÔÁ‹˜ Ù˘ ÓÔÌÔıÂÛ›·˜ Û ÚÔ˚fiÓÙ· Ù˘ ÂÏÏËÓÈ΋˜ ·ÁÔÚ¿˜ ¤ÁÈÓ ÁÈ· ÎÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ·, ˘‡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‡” . ∏ ÂÈÏÔÁ‹ ÙˆÓ ˘fi ÌÂϤÙË ÚÔ˚fiÓÙˆÓ ¤ÁÈÓ Ì ‚¿ÛË ÁÓˆÛÙ¤˜ ÚÔÙÈÌ‹ÛÂȘ ·ÙfiÌˆÓ Ó·ڋ˜ ËÏÈΛ·˜, fiˆ˜ Â›Ó·È ÔÈ ÛÔÎÔÏ¿Ù˜ ˘Á›·˜ Î·È Á¿Ï·ÎÙÔ˜, Ù· ÌÈÛÎfiÙ· Î·È Ù· Û˘Û΢·Ṳ̂ӷ „ˆÌÈ¿. ∏ ¤Ú¢ӷ ·ÁÔÚ¿˜ Ú·ÁÌ·ÙÔÔÈ‹ıËΠ۠2 ÌÂÁ¿Ï· ÔÏ˘Î·Ù·ÛÙ‹Ì·Ù· ÙÚÔʛ̈Ó, ηٿ ÙÔ ¯ÚÔÓÈÎfi ‰È¿ÛÙËÌ· √ÎÙˆ‚Ú›Ô˘-ª·˝Ô˘ 2007, fiÔ˘ ηٷÁÚ¿ÊËΠ̠ÏÂÙÔ̤ÚÂÈ· Ë Û‡ÛÙ·ÛË ÙˆÓ ÂÈÏÂÁÌ¤ÓˆÓ ÙÚÔʛ̈Ó, fiˆ˜ ·˘Ù‹ ·Ó·ÊÂÚfiÙ·Ó ÛÙËÓ ÂÙÈΤٷ ÙÔ˘˜.

Pediatri Nov-Dec 08 new

19-12-08

16:31

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477

∞ÍÈÔÏfiÁËÛË ÂÈÛ‹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#

™˘ÌÏËÚÒÛÙ ٷ ·Ú·Î¿Ùˆ ÁÈ· οı ÚÔ˚fiÓ. ∏ ÛÙ‹ÏË π ˘Ô‰ËÏÒÓÂÈ Ù· ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ÌÔÚ› Ó· ‚ÚÂıÔ‡Ó ÛÙÔ ÚÔ˚fiÓ ·fi ÚÔÛı‹ÎË ‹ ÂÈÌfiÏ˘ÓÛË (·fi ¿ÏÏ· ÚÔ˚fiÓÙ·). ∏ ÛÙ‹ÏË ππ ˘Ô‰ËÏÒÓÂÈ Ù· ·ÏÏÂÚÁÈÔÁfiÓ· Ô˘ ÌÔÚ› Ó· ˘¿Ú¯Ô˘Ó Û ¿ÏÏ· ÚÔ˚fiÓÙ· ÁÈ· Ù· ÔÔ›· ¯ÚËÛÈÌÔÔÈÂ›Ù·È Ô ›‰ÈÔ˜ ÂÍÔÏÈÛÌfi˜, Û ‰È·ÊÔÚÂÙÈ΋ ¯ÚÔÓÈ΋ ÛÙÈÁÌ‹. ∏ ÛÙ‹ÏË πππ ˘Ô‰ËÏÒÓÂÈ ·Ó ˘¿Ú¯Ô˘Ó ÔÔÈ·‰‹ÔÙ ·ÏÏÂÚÁÈÔÁfiÓ· ÛÙÔ Ï¿ÓÔ Û·˜. ™˘ÌÏËÚÒÛÙ ٷ ÎÂÏÈ¿ Ì ¤Ó· ¡∞π ‹ √Ãπ ηÈ, fiÙ·Ó Ú¤ÂÈ, Ì ÙÔ fiÓÔÌ· ÙÔ˘ Û˘ÛÙ·ÙÈÎÔ‡. ªËÓ ·Ê‹ÛÂÙ ¿‰ÂÈ· ÎÂÏÈ¿.

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¶·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˘ ∫·ÚÔ› ‰¤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˘, fiˆ˜ ·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˘ ÂÈÌfiÏ˘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 ÂÈÛ˘Ó¿„Ù ÙËÓ ÂÙÈΤٷ ÂÓfi˜ ¤ÙÔÈÌÔ˘ ÚÔ˚fiÓÙÔ˜ Û ·˘Ù‹ ÙË ÊfiÚÌ·. ∞Ó ÁÈ· ÔÔÈÔ‰‹ÔÙ ÏfiÁÔ ˘¿ÚÍÔ˘Ó ·ÏÏ·Á¤˜ ÛÙÔ ÚÔ˚fiÓ, ›ÛÙ ˘‡ı˘ÓÔÈ ÁÈ· ÙËÓ ÂÓË̤ڈÛË ÙˆÓ ‰Â‰ÔÌ¤ÓˆÓ Û·˜, ·ÏÏ¿ Î·È ÁÈ· ÙËÓ ¿ÌÂÛË ÂÓË̤ڈۋ Ì·˜. ¢È‡ı˘ÓÛË ÚÔÌËıÂ˘Ù‹: ∆ÚfiÔ˜ Â·Ê‹˜ Ì ÙÔÓ ÚÔÌËıÂ˘Ù‹: ÀÔÁÚ·Ê‹ ∏ÌÂÚÔÌËÓ›·

∞ÎÔÏÔ‡ıËÛ ÂÈÎÔÈÓˆÓ›· (Â› ÙfiÔ˘ Â›ÛÎÂ„Ë ‹ ÙËÏÂʈÓÈ΋ ÂÈÎÔÈÓˆÓ›·) Ì 3 ‚ÈÔÌ˯·Ó›Â˜ ÙÚÔʛ̈Ó, ·fi ÙȘ Ôԛ˜ 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‹ ÂÈÌfiÏ˘ÓÛ‹ ÙÔ˘˜ ·fi Ù˘¯·›· ÚfiÛÌÈÍË ÏfiÁˆ ·ÚÔ˘Û›·˜ ÛÙÔÓ ‚ÈÔÌ˯·ÓÈÎfi ¯ÒÚÔ ‹ ¯Ú‹Û˘ ÎÔÈÓ‹˜ ·Ú·ÁˆÁÈ΋˜ ÁÚ·ÌÌ‹˜, ÂÏÏÈÔ‡˜ 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, fiˆ˜ 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‡˜ ÙÚfiÔ˘˜ ηٷÁÚ·Ê‹˜ ÙÔ˘˜.

∞ÔÙÂϤÛÌ·Ù· πÛ¯‡Ô˘Û· ÓÔÌÔıÂÛ›· ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÛÙËÓ ∂˘Úˆ·˚΋ ŒÓˆÛË ™ÙȘ ¯ÒÚ˜ Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘, Ë ÓÔÌÔıÂÛ›· Û¯ÂÙÈο Ì ÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ÙÚÔÊ›ÌˆÓ ÛÙԯ‡ÂÈ ÛÙËÓ Â›Ù¢ÍË ÂÓfi˜ ˘„ËÏÔ‡ ÂÈ¤‰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

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∞. µ·ÛÈÏÔÔ‡ÏÔ˘ Î·È Û˘Ó.

¶›Ó·Î·˜ 2. ∂ÚˆÙËÌ·ÙÔÏfiÁÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈ‹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 ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ; 2. ¶·›ÚÓÂÙ οÔÈ· 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· ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ˆ˜ ÚfiÛıÂÙ· Û ‰È·Ï‡Ù˜, ·ÚÒÌ·Ù· ‹ ·ÏÎÔÔÏÔ‡¯· ÔÙ¿ ηٿ ÙËÓ ÂÂÍÂÚÁ·Û›· ÙÚÔʛ̈Ó. ∏ √‰ËÁ›· 2003/89/ EC (11) ÁÈ· ÙËÓ ÂÈÛ‹Ì·ÓÛË ÂÊ·ÚÌfiÛÙËΠÛÙ· ÎÚ¿ÙË Ì¤ÏË Ù˘ ∂˘Úˆ·˚΋˜ ŒÓˆÛ˘ ÙÔ 2004, ηٷÚÁÒÓÙ·˜ ÙÔ˘˜ ηÓfiÓ˜ ÂÈÛ‹Ì·ÓÛ˘ ÙÚÔÊ›ÌˆÓ ÙÔ˘ 1996 (9,10), fiÔ˘ ›Û¯˘Â Ô Î·ÓfiÓ·˜ ÙÔ˘ 25% (12), ηıÒ˜ Î·È ¿ÏÏÔ˘˜ ÙÚfiÔ˘˜ ηٷÁÚ·Ê‹˜. °È· ·Ú¿‰ÂÈÁÌ·, ˘‹Ú¯Â Ë ‰˘Ó·ÙfiÙËÙ· ηٷÁÚ·Ê‹˜ οÔÈˆÓ 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˜ ηÚfi˜, ı· Ú¤ÂÈ Ó· ÂÈÛËÌ·›ÓÂÙ·È Û·ÊÒ˜ Î·È Ó· ÌËÓ ·Ó·Ê¤ÚÂÙ·È Ì ÁÂÓÈÎÔ‡˜ fiÚÔ˘˜ fiˆ˜ “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· ÂÈÛËÌ·›ÓÔÓÙ·È Î·È ÛÙ· ÔÔ›· ÂÚÈÏ·Ì‚¿ÓÔÓÙ·È ÙÔ Á¿Ï·, ÙÔ ·‚Áfi, Ù· ÛÈÙËÚ¿, ÔÈ ÍËÚÔ› ηÚÔ› 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·ÙÔÔÈ‹ÛÔ˘Ó ÙȘ ··Ú·›ÙËÙ˜ ·ÏÏ·Á¤˜ ÛÙȘ ÂÙÈΤÙ˜ (11). ∆· ÚÔ˚fiÓÙ· Ô˘ ·Ú‹¯ıËÛ·Ó ÌÂÙ¿ ÙËÓ 25Ë ¡ÔÂÌ‚Ú›Ô˘ 2005 ‰ÂÓ ÂÈÙÚ¤ÂÙ·È Ó· ˆÏÔ‡ÓÙ·È ¯ˆÚ›˜ ÛˆÛÙ‹ ÂÈÛ‹Ì·ÓÛË, ÂÓÒ Ù· ÚÔ˚fiÓÙ· Ô˘ ›¯·Ó ‹‰Ë ·Ú·¯ı› ÚÈÓ ÙËÓ ·Ú·¿Óˆ ËÌÂÚÔÌËÓ›· ÌÔÚÔ‡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· ÂÈÛËÌ·›ÓÂÙ·È ÛÙËÓ ÂÙÈΤٷ Ì ۷ʋ Î·È ·ÎÚÈ‚‹ ÙÚfiÔ Î·È Ë ÂÈÛ‹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 ÙÚfiÔ ÂÈÛ‹Ì·ÓÛ˘, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ˘¿Ú¯Ô˘Ó ‰È·ÊÔÚ¤˜ ÛÙË ‰È·Ù‡ˆÛË Î·È ÛÙ· ۇ̂ÔÏ· ‹ ÙÔÓ ÙÚfiÔ Ô˘ ·Ó·ÁÚ¿ÊÔÓÙ·È ÛÙȘ ÂÙÈΤÙ˜ Ù· ·ÏÏÂÚÁÈÔÁfiÓ·. ¢È·ÊÔÚÔÔÈ‹ÛÂȘ ÛÙËÓ ÂÈÛ‹Ì·ÓÛË ÙˆÓ ˘fi ÌÂϤÙË ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û˘ÛÙ·ÙÈÎÒÓ ÛÙ· ÂÈÏÂÁ̤ӷ ÚÔ˚fiÓÙ· √ ·Î·ıfiÚÈÛÙÔ˜ ÙÚfiÔ˜ ·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 ÙÚfiÔÈ ·Ó·ÁÚ·Ê‹˜ ÙˆÓ ˘fi ÂͤٷÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ÚÔ˚fiÓÙ· Ô˘ Û˘ÌÂÚÈÂÏ‹ÊıËÛ·Ó ÛÙË ÌÂϤÙË. ™ÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛˆÓ, 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‡˜ ÙÚfiÔ˘˜, fiˆ˜ “ÁÏÔ˘Ù¤ÓË” (8 ÊÔÚ¤˜), “‚‡ÓË” (12 ÊÔÚ¤˜), “Natural Oat Bran” (3 ÊÔÚ¤˜), “ÚÔ˙‡ÌÈ” (9 ÊÔÚ¤˜).

¶›Ó·Î·˜ 3. ∆ÚfiÔÈ ‰‹ÏˆÛ˘ ÎÔÈÓÒÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ˘fi ÌÂϤÙË ÚÔ˚fiÓÙ· Ù˘ ÂÏÏËÓÈ΋˜ ·ÁÔÚ¿˜, fiˆ˜ ·˘ÙÔ› ·Ó¢ڤıËÛ·Ó ÛÙȘ ÂÙÈΤÙ˜ ÂÈÛ‹Ì·ÓÛ˘ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ∫ÔÈÓ¿ ·ÏÏÂÚÁÈÔÁfiÓ· ÙÚfiÊÈÌ·

∆ÚfiÔ˜ ·Ó·ÁÚ·Ê‹˜ ÙÔ˘˜ ÛÙȘ ÂÙÈΤÙ˜ ÙˆÓ ˘fi ÌÂϤÙË ÙÚÔʛ̈Ó

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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, ÛÂÚÌ¤ÙÈ, 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, ·ÛÚ¿‰È

•ËÚÔ› ηÚÔ›

ÍËÚÔ› ηÚÔ›, ÊÔ˘ÓÙÔ‡ÎÈ·, ·Ì‡Á‰·Ï·, ÊÔ˘ÓÙÔ˘Îfi·ÛÙ·, ‚¿ÊÏ·, ηڇ‰È·, ¿ÚˆÌ· ÊÔ˘ÓÙÔ‡ÎÈ, ÔÏÙfi˜ ÍËÚÒÓ Î·ÚÒÓ

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 ÂÈÛ‹Ì·ÓÛ˘ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÏÏËÓÈο ÙÚfiÊÈÌ·

¶›Ó·Î·˜ 4. ∞Û·Ê‹˜ ÂÈÛ‹Ì·ÓÛË Û˘ÛÙ·ÙÈÎÒÓ ÙÚÔÊ›ÌˆÓ ¿ÁÓˆÛÙ˘ ÚÔ¤Ï¢Û˘

¶›Ó·Î·˜ 5. ∆ÚfiÔÈ ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘ ÛÙ· ˘fi ÌÂϤÙË ÙÚfiÊÈÌ·

™˘ÛÙ·ÙÈο ÙÚÔÊ›ÌˆÓ ¿ÁÓˆÛÙ˘ ÚÔ¤Ï¢Û˘ ÏfiÁˆ ÂÏÏÈÔ‡˜ ÂÈÛ‹Ì·ÓÛ˘

∆‡Ô˜ ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘

∞ÚÈıÌfi˜ ÚÔ˚fiÓÙˆÓ ÛÙ· ÔÔ›· ·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 ˙·¯·ÚÔÏ·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, οÔÈÔÈ ·fi ÙÔ˘˜ ÔÔ›Ô˘˜ ·Ê‹ÓÔ˘Ó ÂÚÈıÒÚÈ· ·ÚÂÍËÁ‹ÛÂˆÓ Î·È ÌË ·Ó·ÁÓÒÚÈÛ˘ Ù˘ ·ÚÔ˘Û›·˜ ÙÔ˘, fiˆ˜ ÔÈ fiÚÔÈ Ï·ÎÙfi˙Ë, ·Û‚¤ÛÙÈÔ, ‚Ô‡Ù˘ÚÔ, ‚¿ÊÏ·, Îڤ̷ Á¿Ï·ÎÙÔ˜, ÎÂÊ›Ú, ÛÂÚÌ¤ÙÈ, 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‡˜ ÙÚfiÔ˘˜, Ì ÂÈÎÚ·Ù¤ÛÙÂÚÔ˘˜ ÙÔ˘˜ fiÚÔ˘˜ ·‚Áfi, ÛÎfiÓË ·‚ÁÔ‡, ÚˆÙ½Ó˜ ·‚ÁÔ‡, ·ÛÚ¿‰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·ÚÔ› ‰¤Ó‰ÚˆÓ ·Ó·Ê¤ÚÔÓÙ·Ó Î˘Ú›ˆ˜ Ì ÙÔÓ ÁÂÓÈÎfi fiÚÔ ÍËÚÔ› ηÚÔ› (93 ÊÔÚ¤˜) Î·È ÏÈÁfiÙÂÚÔ Ì ·Ó·ÊÔÚ¿ ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ ›‰Ô˘˜ ÙÔ˘ ÂÌÂÚȯfiÌÂÓÔ˘ ηÚÔ‡, fiˆ˜ 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 Â› ̤ÚÔ˘˜ Û‡ÓıÂÙ· ˘ÏÈο ¿ÁÓˆÛÙ˘ Û‡ÛÙ·Û˘, ¯ˆÚ›˜ ÂÚ·ÈÙ¤Úˆ ·Ó¿Ï˘ÛË (¶›Ó·Î·˜ 4), fiˆ˜: - “‚¿ÊÏ·” Û ¤Ó· ÚÔ˚fiÓ, Ù˘ ÔÔ›·˜ Ë Èı·Ó‹ Û‡ÛÙ·ÛË, fiˆ˜ ηٷÁÚ¿ÊËΠ۠¿ÏÏÔ ÚÔ˚fiÓ Ù˘ ›‰È·˜ ÂÙ·ÈÚ›·˜, ›ӷÈ: ·Ï‡ÚÈ Û›ÙÔ˘, ˙¿¯·ÚË, Á¿Ï· ¿·¯Ô, Ê˘ÙÈο ¤Ï·È·, Á·Ï·Îو̷ÙÔÔÈËÙ‹˜: ÏÂÎÈı›-

∫·Ì›· ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ∆Ô ÚÔ˚fiÓ ÌÔÚ› Ó· ÂÚȤ¯ÂÈ ›¯ÓË ·fi ¶Èı·ÓfiÓ Ó· ÂÚȤ¯ÂÈ ›¯ÓË/ ›¯ÓË ·fi ¶·Ú·Û΢¿˙ÂÙ·È/ ·Ú¿ÁÂÙ·È Û ÂÚÁÔÛÙ¿ÛÈÔ Ô˘ ¯ÚËÛÈÌÔÔÈ› ∂Ó‰¤¯ÂÙ·È Ó· ÂÚȤ¯ÔÓÙ·È ›¯ÓË ·fi ∂Ӊ¯fiÌÂÓË ·ÚÔ˘Û›·

% ¯Ú‹ÛË Û˘ÁÎÂÎÚÈ̤Ó˘ ÚÔÏËÙÈ΋˜ ÂÈÛ‹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 ÔÔ›· Èı·ÓfiÓ Â›Ó·È Ì‡ÎËÙ·˜ ·ÓÂÙ˘Á̤ÓÔ˜ Û Á¿Ï·, ÂÓÒ ÌÔÚ› Ó· ÂÚȤ¯ÂÈ ›¯ÓË ÛÈÙËÚÒÓ (‚‡Ó˘) (13) - “‚Ô‡Ù˘ÚÔ/‚Ô‡Ù˘ÚÔ ˙·¯·ÚÔÏ·ÛÙÈ΋˜/‚Ô‡Ù˘ÚÔ Û˘Ì˘Îӈ̤ÓÔ”, ÙÔ ÔÔ›Ô ÌÔÚ› Ó· Â›Ó·È ˙ˆÈ΋˜ ‹ Ê˘ÙÈ΋˜ ÚÔ¤Ï¢Û˘ Î·È Ó· ÂÚȤ¯ÂÈ ÚˆÙ½Ó˜ Á¿Ï·ÎÙÔ˜ (14) - “ÏÂÎÈı›ÓË”, Ë ÔÔ›· ÌÔÚ› 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· ÔÔ›· ·Ó‹ÎÔ˘Ó ÙÔ ÂÏ·ÈfiÏ·‰Ô, ÙÔ ÛÔÁȤϷÈÔ, ÙÔ ËÏȤϷÈÔ, ÙÔ ÛË۷̤ϷÈÔ ‹ Î·È ¿ÏÏ· ¤Ï·È· ÍËÚÒÓ Î·ÚÒÓ, fiˆ˜ ÙÔ ÊÈÛÙÈΤϷÈÔ (1). ¶ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÙÚfiÊÈÌ· Ù˘ ÂÏÏËÓÈ΋˜ ·ÁÔÚ¿˜ ™ÙÔ 65% ÙˆÓ ÚÔ˚fiÓÙˆÓ Ô˘ ÌÂÏÂÙ‹ıËÎ·Ó ˘‹Ú¯Â ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË Ù˘ ·ÚÔ˘Û›·˜ ·ÏÏÂÚÁÈÔÁfiÓˆÓ. ™¯Â‰fiÓ Û fiÏ· ·Ó·ÊÂÚfiÙ·Ó fiÙÈ ÂÚȤ¯Ô˘Ó ‹ ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó ÛÈÙËÚ¿ ‹ ÚÔ˚fiÓÙ· ÙÔ˘˜ (196), Á¿Ï· ‹ ÚÔ˚fiÓÙ· ÙÔ˘ (192) Î·È Î·ÚÔ‡˜ ‰¤Ó‰ÚˆÓ ‹ ÚÔ˚fiÓÙ· ÙÔ˘˜ (190). ¶ÂÚÈÛÛfiÙÂÚ· ·fi 2/3 ÂÚȤ¯Ô˘Ó ‹ ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó ÛfiÁÈ· ‹ ÚÔ˚fiÓÙ· Ù˘ (144) Î·È ÛÔ˘Û¿ÌÈ (126). ∆¤ÏÔ˜, ÂÚ›Ô˘ Ù· ÌÈÛ¿ ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó ·‚Á¿, ÂÓÒ 26 ÚÔ˚fiÓÙ· ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó ÊÈÛÙ›ÎÈ· ‹ ÚÔ˚fiÓÙ· ÙÔ˘˜. ∏ Èı·Ó‹ ·ÚÔ˘Û›· ·ÏÏÂÚÁÈÔÁfiÓÔ˘ ÛÙ· ÚÔ˚fiÓÙ· ‰ËÏÒıËΠ̠¤ÓÙ ‰È·ÊÔÚÂÙÈÎÔ‡˜ ÙÚfiÔ˘˜ (¶›Ó·Î·˜ 5), Û˘¯ÓfiÙÂÚ· fï˜ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·Ó Ë ÊÚ¿ÛË (49,89%) “ÙÔ ÚÔ˚fiÓ ÌÔÚ› Ó· ÂÚȤ¯ÂÈ ›¯ÓË/ ›¯ÓË ·fi”. ∫·Ù¿ ‰‹ÏˆÛË ÙˆÓ ·Ú·ÁˆÁÒÓ Ô˘ ÂÚˆÙ‹ıËÎ·Ó ÛÙ· Ï·›ÛÈ· Ù˘ ÌÂϤÙ˘, Ì ·˘ÙfiÓ ÙÔÓ ÙÚfiÔ ·ÔÛÎÔÔ‡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

480

∞. µ·ÛÈÏÔÔ‡ÏÔ˘ Î·È Û˘Ó.

ÎÏÈ̷Έً ÂÈÎfiÓ· ÙÔ˘ ÎÈÓ‰‡ÓÔ˘ (18). √È ·Ú·ÁˆÁÔ› ‰‹ÏˆÛ·Ó Â›Û˘ fiÙÈ Ù· ÚÔ˚fiÓÙ· ¯ˆÚ›˜ ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ‹Ù·Ó ·Ï·ÈÔ‡ ·Ôı¤Ì·ÙÔ˜ Î·È fiÙÈ ÛÙÔ Ì¤ÏÏÔÓ Ë ÂÈÛ‹Ì·ÓÛË ı· ÚÔÛÙÂı› ·ÎfiÌ· Î·È ÛÂ Û˘Û΢·Û›Â˜ ·fi ÙȘ Ôԛ˜ 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 ÂÈÛ‹Ì·ÓÛË ·ÏÏÂÚÁÈÔÁfiÓˆÓ Û ÂÈÏÂÁ̤ӷ 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˜ ÙÚfiÔ˜ 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 ÂÈÛÙËÌfiÓˆÓ (ÁÈ·ÙÚÔ›, ‰È·ÈÙÔÏfiÁÔÈ). ∏ ÂÎÙÂٷ̤ÓË ¯Ú‹ÛË ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘ ·fi ÙȘ ÂÙ·Èڛ˜, ÂÍ·ÈÙ›·˜ Ù˘ ‰˘ÛÎÔÏ›·˜ Ó· ‰È·ÛÊ·Ï›ÛÔ˘Ó ¯ÒÚÔ˘˜ ·Ú·ÁˆÁ‹˜ ÂχıÂÚÔ˘˜ ·ÏÏÂÚÁÈÔÁfiÓˆÓ Î·È ÂÔ̤ӈ˜ ÚÔ˚fiÓÙ· ··ÏÏ·Á̤ӷ ·fi ·ÏÏÂÚÁÈÔÁfiÓ·, ‰ËÌÈÔ˘ÚÁ› ÂÈϤÔÓ 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΋ Â·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· ÂÈÛËÌ·›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¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È fiÚÔÈ Ù¯ÓÈÎÔ› Î·È ÂÈÛÙËÌÔÓÈÎÔ› Ô˘ Â›Ó·È ·Û·Ê›˜, fiˆ˜ “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·. ∂ÈϤÔÓ, ÂÓÒ ıˆÚÂ›Ù·È ˘Ô¯ÚˆÙÈ΋ Ë ·Ó·ÁÚ·Ê‹ Ù˘ ËÁ‹˜ ÚÔ¤Ï¢Û˘ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ (11), Û˘¯Ó¿ ¯ÚËÛÈÌÔÔÈÔ‡ÓÙ·È ÁÂÓÈÎÔ› fiÚÔÈ fiˆ˜ “¿ÚˆÌ·/·ÚˆÌ·ÙÈΤ˜ ‡Ï˜”, “Ê˘ÙÈÎfi ¤Ï·ÈÔ”, “·Û‚¤ÛÙÈÔ”, “ÏÂÎÈı›ÓË”, “‚Ô‡Ù˘ÚÔ” Î·È “ÍËÚÔ› ηÚÔ›”. √ ÙÚfiÔ˜ Ô˘ Ô ·ÏÏÂÚÁÈÎfi˜ ηٷӷψً˜ ı· ·ÓÙÈÌÂÙˆ›ÛÂÈ ÙËÓ ·Û¿ÊÂÈ· ÛÙËÓ ÂÈÛ‹Ì·ÓÛË ‰È·ÊÔÚÔÔÈÂ›Ù·È Î·Ù¿ ÂÚ›ÙˆÛË, fiˆ˜ ¤¯ÂÈ Ê·Ó› Î·È ·fi ¿ÏϘ ÌÂϤÙ˜ (16-19). ¢‡Ó·Ù·È Ó· ÂÚÈÔÚ›ÛÂÈ ÛËÌ·ÓÙÈο ÙȘ ÂÈÏÔÁ¤˜ 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΋ ÂÈÛ‹Ì·ÓÛË “ÍËÚÔ› ηÚÔ›”, ÂÓÒ ¤Ó· ¿ÙÔPaediatriki 2008;71:475-481

ÌÔ Ì ·ÏÏÂÚÁ›· ÛÙÔ ·‚Áfi ·ÔÎÏ›ÂÈ ¤Ó· ÚÔ˚fiÓ Ì ÂÈÛ‹Ì·ÓÛË ÁÈ· ÏÂÎÈı›ÓË, Ù˘ ÔÔ›·˜ Ë ÚԤϢÛË ÂÓ‰¤¯ÂÙ·È Ó· Â›Ó·È Ë ÛfiÁÈ· (16). √ ·˘ÛÙËÚfi˜ ·ÔÎÏÂÈÛÌfi˜ ÙÚÔÊÒÓ ÌÔÚ› Ó· Ô‰ËÁ‹ÛÂÈ Û ÛËÌ·ÓÙÈΤ˜ ‰È·ÙÚÔÊÈΤ˜ ·ÓÂ¿ÚÎÂȘ Î·È ·ÓÈÛÔÚÚÔ›Â˜ ÛÙÔ ‰È·ÈÙÔÏfiÁÈÔ (17). ∞fi ÙËÓ ¿ÏÏË, Ô Î·Ù·Ó·ÏˆÙ‹˜, ¤¯ÔÓÙ·˜ ÂÚÈÔÚÈṲ̂Ó˜ ÂÈÏÔÁ¤˜ ÙÚÔʛ̈Ó, ‰‡Ó·Ù·È Ó· ·ÁÓÔ‹ÛÂÈ ÙËÓ ÂÈÛ‹Ì·ÓÛË, ı¤ÙÔÓÙ·˜ Û ΛӉ˘ÓÔ ÙË ˙ˆ‹ ÙÔ˘, ‰Â‰Ô̤ÓÔ˘ fiÙÈ ÌÈ· ·ÏÏÂÚÁÈ΋ ·ÓÙ›‰Ú·ÛË ÌÔÚ› Ó· ÚÔÎÏËı› ·ÎfiÌ· Î·È Ì ›¯ÓË ÙÔ˘ ˘‡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 ÂÈÙ·ÎÙÈ΋ ÙËÓ ·Ó¿ÁÎË, fi¯È ÌfiÓÔ ÏÂÙÔÌÂÚÔ‡˜ ÂÈÛ‹Ì·ÓÛ˘, ·ÏÏ¿ Î·È ÔÛÔÙÈÎÔÔ›ËÛ˘ ÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ (19). ∂ÈÚfiÛıÂÙË ·Û¿ÊÂÈ· ÚÔ·ÙÂÈ ·fi ÙËÓ ÂÎÙÂٷ̤ÓË ¯Ú‹ÛË ÚÔÏËÙÈ΋˜ ÂÈÛ‹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˘ ÌÔÚ› Ó· ÂÚȤ¯Ô˘Ó οÔÈÔ ·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). ∏ ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË ¯ÚËÛÈÌÔÔÈÂ›Ù·È ÁÈ· ÙËÓ Ù˘¯·›·, ·ÎÔ‡ÛÈ· ·˘Ù‹ ·ÚÔ˘Û›· ·‰‹ÏˆÙˆÓ ·ÏÏÂÚÁÈÔÁfiÓˆÓ ÛÙ· ÙÚfiÊÈÌ· (1). ∂ÈϤÔÓ, ‰ÂÓ ˘Ê›ÛÙ·Ù·È Û˘ÁÎÂÎÚÈ̤ÓË ÓÔÌÈ΋ ··›ÙËÛË Î·È Ô‰ËÁ›· ÁÈ· ÙÔÓ ÙÚfiÔ 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˘ ÚÔÏËÙÈ΋˜ ÂÈÛ‹Ì·ÓÛ˘, ÒÛÙÂ Ô Î·Ù·Ó·ÏˆÙ‹˜ Ó· ÌÔÚ› Ó· ÙËÓ ·ÍÈÔÏÔÁ› ÛˆÛÙ¿ (1) Î·È Ó· ÌËÓ Ô‰ËÁÂ›Ù·È Û ·ÎÚ·›Ô˘˜ ‰È·ÙÚÔÊÈÎÔ‡˜ ·ÔÎÏÂÈÛÌÔ‡˜ ‹ Û ·‰È·ÊÔÚ›· ÁÈ· ÙËÓ ÂÈÛ‹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¿ ¯ÚËÛÈÌÔÔÈ‹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

19-12-08

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∞ÍÈÔÏfiÁËÛË ÂÈÛ‹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 ÚÔÏËÙÈ΋ ÂÈÛ‹Ì·ÓÛË. π‰·ÓÈ΋ ¿ÓÙˆ˜ ı· ‹Ù·Ó Ë ¯Ú‹ÛË Îˆ‰ÈÎÔÔÈËÌ¤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 ÂÈÏÂÁÌ¤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˘˜, ÔfiÙÂ Ë Î·Ù·ÁÚ·Ê‹ ÙˆÓ Û˘ÛÙ·ÙÈÎÒÓ ¤ÁÈÓ ·¢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· Â›ÛÎÂ„Ë ÛÙÔÓ ¯ÒÚÔ ·Ú·ÁˆÁ‹˜ ÙˆÓ ‚ÈÔÌ˯·ÓÈÒÓ ÙÚÔÊ›ÌˆÓ Î·È ÔÈ ·Ú·ÁˆÁÔ› Ê¿ÓËÎ·Ó È‰È·›ÙÂÚ· ÂÈÊ˘Ï·ÎÙÈÎÔ› Û οı ›‰Ô˘˜ ¤Ú¢ӷ. ŒÙÛÈ, ¯¿Û·Ì ÙËÓ Â˘Î·ÈÚ›· ÁÈ· ÏËÚ¤ÛÙÂÚË Î·È Û·Ê‹ ÂÈÙfiÈ· ·ÍÈÔÏfiÁËÛË Èı·ÓÒÓ ÚÔÛÌ›ÍÂˆÓ Î·Ù¿ ÙËÓ ·Ú·ÁˆÁ‹. ™˘ÌÂÚ·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· οÔȘ ·ÏÏ·Á¤˜ ÛÙÔÓ ÙÚfiÔ ÂÈÛ‹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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PRACTICAL ISSUE

™ÙÔÌ·ÙÈΤ˜ ¤ÍÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜: Ë Â›‰Ú·Û‹ ÙÔ˘˜ ÛÙËÓ ˘Á›· ÙÔ˘ ·È‰ÈÔ‡ µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ, ¡ÔÛÔÎÔÌÂ›Ô ¶·›‰ˆÓ “¶. & ∞. ∫˘ÚÈ·ÎÔ‡”, ∞ı‹Ó· AÏÏËÏÔÁÚ·Ê›·: °ÂÒÚÁÈÔ˜ ∆ÛfiÏ·˜ geotsol@otenet.gr µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›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·, ‹ È›Ï·˜, 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, ÔfiÙ ·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 ÂÚÈÙÒÛÂˆÓ ÔÈ Û˘Ó‹ıÂȘ ·˘Ù¤˜ ‰È·ÎfiÙÔÓÙ·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˘ ·ÓıÚÒÔ˘. √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 ›ӷ 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 ϤÔÓ 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˜ È›Ï·˜, 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 Ôԛ˜ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ 70-90% ÙˆÓ ‚ÚÂÊÒÓ, ıˆÚÔ‡ÓÙ·È ˆ˜ Ê˘ÛÈÔÏÔÁÈΤ˜ ÚÔÎÂÈ̤ÓÔ˘ ÁÈ· ·È‰È¿ ‚ÚÂÊÈ΋˜ ‹ ÓËȷ΋˜ 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 ÂȉËÌÈÔÏÔÁ›· 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·ÎfiÙÔ˘Ó Î·Ù¿ ηÓfiÓ· ÛÙËÓ ËÏÈΛ· ÙˆÓ 2-4 ÂÙÒÓ. À¿Ú¯ÂÈ, ˆÛÙfiÛÔ, ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·È‰ÈÒÓ ÌÂÁ·Ï‡ÙÂÚ˘ ËÏÈΛ·˜ Ù· ÔÔ›· 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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¶›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 ÔÔ›· Á›ÓÂÙ·È Ô ıËÏ·ÛÌfi˜ 3. ∏ ËÌÂÚ‹ÛÈ· ‰È¿ÚÎÂÈ· Î·È Ô ÙÚfiÔ˜ ÙÔÔı¤ÙËÛ˘ ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ‹ Ù˘ È›Ï·˜ ÛÙÔ ÛÙfiÌ· 4. √ ¯ÚfiÓÔ˜ ¤Ó·Ú͢ Î·È Ë ‰È¿ÚÎÂÈ· ‰È·Ù‹ÚËÛ˘ Ù˘ Û˘Ó‹ıÂÈ·˜ 5. ∏ ı¤ÛË ÙËÓ ÔÔ›· ·›ÚÓÂÈ Ë Î¿Ùˆ ÁÓ¿ıÔ˜ 6. ∏ Û˘Ó‡·ÚÍË ¿ÏÏˆÓ ·Ú·ÁfiÓÙˆÓ, fiˆ˜ Ë ÛÙ¿ÛË Ù˘ ÎÂÊ·Ï‹˜, Ô ÙÚfiÔ˜ ·Ó·ÓÔ‹˜ Î.Ï.

7. √ ÙfiÓÔ˜ ÙˆÓ ÂÚÈÛÙÔÌ·ÙÈÎÒÓ Ì˘ÒÓ , ΢ڛˆ˜ ÙÔ˘ ÛÊÈÁÎÙ‹Ú· ÙÔ˘ ÛÙfiÌ·ÙÔ˜

™¯ÂÙÈο Ì ÙȘ ÂÈÙÒÛÂȘ 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· ÔÔ›·, 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˘ ‹ È›Ï·˜ 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, ÂÙÂÚfiÏ¢ÚË ‹ ·ÌÊ›Ï¢ÚË. ∂¿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 ÈηÓÔÔÈËÙÈΤ˜ 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· ÔÔ›· ¯ÚËÛÈÌÔÔÈÔ‡Ó È›Ï· ·Ó¤Ú¯ÂÙ·È Û 75-85% ÛÙȘ ·ÓÂÙ˘Á̤Ó˜ ¯ÒÚ˜ (3). ∏ ¯Ú‹ÛË È›Ï·˜ ·Ú·ÙËÚÂ›Ù·È Û˘¯ÓfiÙÂÚ· ÛÙ· ‚Ú¤ÊË Ù· ÔÔ›· ›Ù ‰ÂÓ ı‹Ï·Û·Ó ηıfiÏÔ˘ ›Ù ‰È¤ÎÔ„·Ó ÓˆÚ›˜ ÙÔÓ ÌËÙÚÈÎfi ıËÏ·ÛÌfi. ∆· ıÂÙÈο ÛÙÔȯ›· ·fi ÙË ¯Ú‹ÛË Ù˘ È›Ï·˜ ·Ó·Ê¤ÚÔÓÙ·È ÛÙÔÓ ¶›Ó·Î· 2. √È ·ÚÓËÙÈΤ˜ Â͈ԉÔÓÙÈΤ˜ Û˘Ó¤ÂȘ Ù˘ È›Ï·˜ 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˘ ¯ÚËÛÈÌÔÔÈÔ‡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˘ È›Ï·˜ 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˘˜ ÂÎ·›‰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˘, ÂÂȉ‹ 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· ÔÔ›· ¯ÚËÛÈÌÔÔÈÔ‡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· ÏÂÙ¿ 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΋ Â› ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡ Â›‰Ú·ÛË Ù˘ È›Ï·˜, 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‹ Â›‰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›˜ È›Ï·, 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 ¯ÚËÛÈÌÔÔÈÂ›Ù·È È›Ï· ÛÙÔÓ ÚÒÙÔ Ì‹Ó· ˙ˆ‹˜ ÙˆÓ ıËÏ·˙fiÓÙˆÓ ‚ÚÂÊÒÓ, ÔfiÙÂ Î·È ÂÈÙ˘Á¯¿ÓÂÙ·È, fiˆ˜ ÚԷӷʤÚıËÎÂ, Ë Â‰Ú·›ˆÛË ÙÔ˘ ÌËÙÚÈÎÔ‡ ıËÏ·ÛÌÔ‡, ·ÏÏ¿ ¶›Ó·Î·˜ 3. ∞ÚÓËÙÈΤ˜ Â͈ԉÔÓÙÈΤ˜ Û˘Ó¤ÂȘ Ù˘ È›Ï·˜ 1. ∏ ·‡ÍËÛË Ù˘ Û˘¯ÓfiÙËÙ·˜ ÂΉ‹ÏˆÛ˘ ÂÂÈÛÔ‰›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

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484

°. ∆ÛfiÏ·˜

Ó· ¯ÔÚËÁÂ›Ù·È È›Ï· ÛÙÔ ‚Ú¤ÊÔ˜ ÌÂÙ¿ ÙËÓ ÂÁηٿÛÙ·ÛË ÂÈÙ˘¯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. ÀÔÏÔÁ›˙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·ÎfiÙÂÙ·È ‰˘ÛÎÔÏfiÙÂÚ· ÛÙ· ÎÔÚ›ÙÛÈ· Î·È Î·Ù¿ ηÓfiÓ· ÌÂÙ¿ ÙËÓ ËÏÈΛ· ÙˆÓ 2 ÂÙÒÓ (1). ÀÔÏÔÁ›˙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·˜ ÌÔÚ› 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 ÂȉȈÎfiÌÂÓÔ ·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¯ÔÔÈÂ›Ù·È ÁÈ· ÙËÓ ÂΉ‹ÏˆÛË ÔÍ›·˜ ̤Û˘ ˆÙ›Ùȉ·˜, fiˆ˜ Û˘Ì‚·›ÓÂÈ Ì ÙË ¯Ú‹ÛË È›Ï·˜. ∆· ÚÔ‚Ï‹Ì·Ù· Ù· ÔÔ›· ·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, ÔfiÙ 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˜ ÂÚÈÙÒÛÂȘ, 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· Â·Ó·ÎÙÔ‡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 ÔÈÛı›ˆÓ Ô‰fiÓÙˆÓ. ∏ ·ÓˆÌ·Ï›· ·˘Ù‹ ÌÔÚ›, ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÂÚÈÙÒÛÂȘ, 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 ·ÓÙÈÌÂÙˆÈÛÙ› Ì ÙÔÓ Î·Ù¿ÏÏËÏÔ ÙÚfiÔ 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›·˜, fiˆ˜ Ë ÌË Î·Ï‹ ÚÔÊÔÚ¿ ‰ÈÏÒÓ 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˘¯›·˜, ÂÚËÙÈ΋˜ ·ÚˆÓ˘¯›·˜ Î.Ï.

¶·Ú¿Ù·ÛË ÙˆÓ ÛÙÔÌ·ÙÈÎÒÓ Û˘ÓËıÂÈÒÓ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜ Î·È ÙÚfiÔÈ ‰È·ÎÔ‹˜ ÙÔ˘˜ ¶ÔÏÏ¿ „˘¯ÔÏÔÁÈο ·›ÙÈ· ¤¯Ô˘Ó, ηٿ ηÈÚÔ‡˜, ÂÓÔ¯ÔÔÈËı› ÁÈ· ÙËÓ ·Ú¿Ù·ÛË ÙÔ˘ ıËÏ·ÛÌÔ‡ È›Ï·˜ ‹ ‰·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 ‹ ˘ÂÚÚÔÛٷ٢ÙÈ΋ Û˘ÌÂÚÈÊÔÚ¿, ·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˘ÌÂÚÈÊÔÚ¿˜ ÂÓfi˜ ÌÈÎÚfiÙÂÚÔ˘ ·‰ÂÏÊÔ‡, Ô˘ Ê·›ÓÂÙ·È Ó· ÌÔÓÔˆÏ› ÙÔ ÂӉȷʤÚÔÓ ÙˆÓ ÌÂÁ¿ÏˆÓ. ∫ÔÈÓˆÓÈÎÔ› ·Ú¿ÁÔÓÙ˜, fiˆ˜ 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 ÌÚÔÛÙ¿ ÛÙËÓ ÙËÏÂfiÚ·ÛË. ∏ ·Ú·ÙÂٷ̤ÓË ¯Ú‹ÛË È›Ï·˜, fiˆ˜ ¿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˜ ÂÈÙÒÛÂȘ 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˘ ÌÔÚ› 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

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™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. ∏ ·ÓÙÈÌÂÙÒÈÛË ÂÍ·ÚÙ¿Ù·È ·fi ÙÔ Â¿Ó ÚfiÎÂÈÙ·È ÁÈ· ıËÏ·ÛÌfi È›Ï·˜ ‹ ‰·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˘ ÌÔÚ› Ó· ¤¯ÂÈ ·˘Ù‹ Ë Û˘Ó‹ıÂÈ· ÛÙ· ‰fiÓÙÈ· ÙÔ˘, ÛÙÔ ¯·ÌfiÁÂÏfi ÙÔ˘, ·ÎfiÌË Î·È ÛÙ· ‰¿ÎÙ˘Ï¿ ÙÔ˘. ∂›Ó·È, Â›Û˘, ÌÂÁ¿ÏË Ë ·Í›· ÙÔ˘ Â·›ÓÔ˘ Î·È Ù˘ ËıÈ΋˜ ·ÓÙ·ÌÔÈ‚‹˜ ÁÈ· ÙËÓ ÚÔÛ¿ıÂÈ· ‰È·ÎÔ‹˜ Ù˘ ¤Í˘. ™Â ÔÏϤ˜ ÂÚÈÙÒÛÂȘ, Ë ¤ÁηÈÚË ‰È·ÎÔ‹ Ù˘ Û˘Ó‹ıÂÈ·˜ ÌÔÚ› Ó· ·ÎÔÏÔ˘ıËı› ·fi ·˘ÙfiÌ·ÙË ‚ÂÏÙ›ˆÛË Ù˘ ı¤Û˘ Î·È Ù˘ Û¯¤Û˘ ÙˆÓ ‰ÔÓÙÈÒÓ, ¯ˆÚ›˜ η̛· ¿ÏÏË ıÂÚ·›·. ªÂÚÈο ·fi Ù· ̤۷ Ô˘ ÌÔÚ› Ó· ¯ÚËÛÈÌÔÔÈËıÔ‡Ó ÁÈ· ÙË ‰È·ÎÔ‹ ÙÔ˘ ıËÏ·ÛÌÔ‡ ÙÔ˘ ‰·ÎÙ‡ÏÔ˘ ›ӷÈ: °È· ÙË Ó‡ÎÙ·: Á¿ÓÙÈ· ‹ Â›‰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 Ï·ÛÙÂÏ›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 ÔÔ›· Ë ·Ú·¿Óˆ ‰È·‰Èηۛ· ‰ÂÓ ·Ô‰ÒÛÂÈ, ÙÔ ·È‰› ÌÔÚ› Ó· ‚ÔËıËı› Ì ÙË ¯ÚËÛÈÌÔÔ›ËÛË ·ÏÒÓ ÔÚıÔ‰ÔÓÙÈÎÒÓ Ì˯·ÓËÌ¿ÙˆÓ, ÁÈ· ˘fiÌÓËÛË Î·È ÂÍÔ˘‰ÂÙ¤ÚˆÛË Ù˘ ¢¯·Ú›ÛÙËÛ˘, fiˆ˜ ÁÈ· ·Ú¿‰ÂÈÁÌ· ÂÓfi˜ ·ÏÔ‡ ÎÈÓËÙÔ‡ Ì˯·Ó‹Ì·ÙÔ˜ Ù˘ ¿Óˆ ÁÓ¿ıÔ˘ ‹ ÌÈ·˜ ÚÔÛÙÔÌȷ΋˜ Ͽη˜, Ô˘ ı· ¯ÚËÛÈÌÔÔÈ› ÙÔ ·È‰› ÌfiÓÔ Î·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ó‡ÎÙ·˜.

™˘ÌÂÚ¿ÛÌ·Ù· 1. √È ÛÙÔÌ·ÙÈΤ˜ Û˘Ó‹ıÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜, fiˆ˜ Ô ıËÏ·ÛÌfi˜ È›Ï·˜ 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· ÔÔ›· ··ÏÏ¿ÛÛÔÓÙ·È ÙˆÓ ¤ÍÂÒÓ ÙÔ˘˜ ÚÈÓ ·fi ÙËÓ ËÏÈΛ· ÙˆÓ 3-4 ÂÙÒÓ. ¶Úfi‚ÏËÌ·, Û˘ÓÂÒ˜, ·ÔÙÂÏ› Ë ·Ú¿Ù·Û‹ ÙÔ˘˜ ¤Ú·Ó Ù˘ ËÏÈΛ·˜ Ë ÔÔ›· ·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΋ ıÂÚ·›· ÁÈ· ÙËÓ ·ÔηٿÛÙ·Û‹ ÙÔ˘˜.

3. √ ıËÏ·ÛÌfi˜ È›Ï·˜ ˘ÂÚÙÂÚ› ¤Ó·ÓÙÈ ÙÔ˘ ıËÏ·ÛÌÔ‡ ‰·ÎÙ‡ÏÔ˘, ΢ڛˆ˜ ÂÂȉ‹ ÙÔ ·È‰› ··ÏÏ¿ÛÛÂÙ·È ·fi ·˘Ù‹Ó ¢ÎÔÏfiÙÂÚ·. ÀÔÓÔ̇ÂÈ, fï˜, ÙÔÓ ÂÈÙ˘¯‹ ÌËÙÚÈÎfi ıËÏ·ÛÌfi Â¿Ó ¯ÚËÛÈÌÔÔÈËı› ÛÙÔÓ ÚÒÙÔ Ì‹Ó· Ù˘ ˙ˆ‹˜, ÂÓÒ ·˘Í¿ÓÂÈ Î·È ÙË Û˘¯ÓfiÙËÙ· ÂÂÈÛÔ‰›ˆÓ ̤Û˘ ˆÙ›Ùȉ·˜, ÚÔ‚Ï‹Ì·Ù· ÁÈ· Ù· ÔÔ›· ‰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 ÚÔÛˆÈÎfiÙËÙ¿ 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· ÂÈÎÔÈÓˆÓ›· Ì ÙÔ ·È‰›, ÒÛÙ ӷ ıÂÚ·¢ı› ÙÔ “·›ÙÈÔ” Î·È fi¯È ÙÔ “Û‡Ìو̷” 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 ÂÚÈÙÒÛÂˆÓ 1 ∞’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, µÂÓÈ˙¤ÏÂÈÔ °ÂÓÈÎfi ¡ÔÛÔÎÔÌ›Ô, ∏Ú¿ÎÏÂÈÔ, ∫Ú‹ÙË 2 ∞ÏÏÂÚÁÈÔÏÔÁÈÎfi ∆Ì‹Ì·, µ’ ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›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, ¡. ¶··‰fiÔ˘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·ÛÔÚ¿ 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 ÌÔÚ› 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 ÂÂÈÛfi‰È· Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÂÎÓ¢ÛÙÈÎfi Û˘ÚÈÁÌfi, ÂÈÁ·ÛÙÚ·ÏÁ›·, ÂÚ˘ıÚfiÙËÙ· ÎÔÚÌÔ‡, ·ÁÁÂÈÔÔ›‰ËÌ· ÚÔÛÒÔ˘, 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 ÔÔ›· ¤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·ÊÔÚÔÔÈ›

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487

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¸ÂÚÏ·ÛÈÎfi Û‡Ó‰ÚÔÌÔ 3. ™˘ÛÙËÌ·ÙÈ΋ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË ÌÂ Ì˘ÂÏÔ‰˘ÛÏ·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· ÔÔ›· 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˘ÌÙˆÌ¿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 ÔÔ›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 ÙÔÈ΋ ·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 ˘fiÏÔÈˆÓ

∂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

Pediatri Nov-Dec 08 new

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488

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%, ·ÈÌÔÂÙ¿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˘ ÂÂÈÛfi‰È· Ì ·Ó·Ó¢ÛÙÈ΋ ‰˘Û¯¤ÚÂÈ·, ÂÈÁ·ÛÙÚÈÎfi ¿ÏÁÔ˜, ÎÓËÛÌfi, ‰È¿¯˘ÙË ÂÚ˘ıÚfiÙËÙ· (flushing) Î·È ÌÂÚÈΤ˜ ÊÔÚ¤˜ ·ÁÁÂÈÔÔ›‰ËÌ· ÚÔÛÒÔ˘. ∆· Û˘ÌÙÒÌ·Ù· ·Ú¯Èο ‹Ù·Ó ‹È· Î·È ·˘ÙÔÂÚÈÔÚÈ˙fiÌÂÓ·, ÂÓÒ ÛÙ·‰È·Î¿ ·˘Í‹ıËÎ·Ó ÛÂ Û˘¯ÓfiÙËÙ· Î·È ‚·Ú‡ÙËÙ·. ∆· ÂÂÈÛfi‰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 ÎfiˆÛË Î·È ˘ÓËÏ›·. ™Â ¤Ó· ÂÂÈÛfi‰ÈÔ Ô˘ ·ÓÙÈÌÂÙˆ›ÛıËΠ۠∫¤ÓÙÚÔ ÀÁ›·˜ Ù˘ ÂÚÈÔ¯‹˜ ÙÔ˘, ‰È·ÈÛÙÒıËÎ·Ó ÙÒÛË Ù˘ ·ÚÙËÚȷ΋˜ ›ÂÛ˘, ÂÎÓ¢ÛÙÈÎfi˜ Û˘ÚÈÁÌfi˜, ÂÚ˘ıÚfiÙËÙ· ‰¤ÚÌ·ÙÔ˜ Î·È ·ÁÁÂÈÔÔ›‰ËÌ· ÚÔÛÒÔ˘ Î·È ¯ÔÚËÁ‹ıËÎ·Ó ·‰ÚÂÓ·Ï›ÓË ˘Ô‰fiÚÈ· Î·È ÎÔÚÙÈÎÔÂȉ‹ ÂÓ‰ÔÌ˘˚ο. §fiÁˆ Ù˘ ÛÔ‚·ÚfiÙËÙ·˜ ÙˆÓ Û˘Ìو̿وÓ, 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 ÔÈÛıÔÛÙÂÚÓÈÎfi ¿ÏÁÔ˜ Ì η‡ÛÔ˜, ÂÚ˘Á¤˜ Î·È ‰˘ÛηٷÔÛ›· ÚÔ ¤ÙÔ˘˜. ™ÙËÓ ÂÓ‰ÔÛÎfiËÛË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡, ‰È·ÈÛÙÒıËΠ‹È· Á·ÛÙÚ›Ùȉ· Î·È ¯ÔÚËÁ‹ıËΠıÂÚ·›· 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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™ÂÏ›‰·489

489

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, ÂÓÂÚÁÔÔ›ËÛË Ï¢ÎÔ΢ÙÙ¿ÚˆÓ ∏·Ú›ÓË √ÛÙÂÔfiÚˆÛË, ·Ó·ÛÙÔÏ‹ ‰ËÌÈÔ˘ÚÁ›·˜ ıÚfiÌ‚Ô˘, ·Ú¿Ù·ÛË PTT ∆Ú˘Ù¿ÛË ¢È¿Û·ÛË ÈÓˆ‰ÔÁfiÓÔ˘ Î·È ÂÓÂÚÁÔÔ›ËÛË ÎÔÏÏ·ÁÂÓ¿Û˘ Ô˘ Ô‰ËÁ› Û ηٷÛÙÚÔÊ‹ ÈÛÙÒÓ, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, ÔÛÙÂÔfiÚˆÛË Ã˘Ì¿ÛË ∆ÔÈ΋ ·Ó·ÛÙÔÏ‹ ‹Í˘, ÂÓÂÚÁÔÔ›ËÛË Ì·ÛÙÔ΢ÙÙ¿ÚˆÓ, ‰ËÌÈÔ˘ÚÁ›· Ê˘ÛÛ·Ï›‰ˆÓ (;) ∫·ı„›ÓË G Î·È ∫·Ú‚Ô͢ÂÙȉ¿ÛË ∞ ¶·Ú·ÁˆÁ‹ ÎÈÓ›Ó˘, Ë·ÙÈ΋ ›ÓˆÛË (;) ŸÍÈÓ˜ ˘‰ÚÔÏ¿Û˜ µÏ¿‚˜ ÔÛÙÒÓ, ÔÛÙÂÔfiÚˆÛË ¶·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·˜ ÂÓÂÚÁÔÔ›ËÛ˘ ∞˘ÍË̤ÓË ‰È·ÂÚ·ÙfiÙËÙ· ·ÁÁ›ˆÓ, ‚ÚÔÁ¯fiÛ·ÛÌÔ˜, ¯ËÌÂÈÔÙ·Í›· Î·È ÂÓÂÚÁÔÔ›ËÛË ÙˆÓ ·ÈÌÔÂÙ·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 ÂÓÂÚÁÔÔ›ËÛË ËˆÛÈÓÔʛψÓ

Î·È ÈÔ‡˜ Ë·Ù›Ùȉ·˜, Ï‹ÚË ¤ÏÂÁ¯Ô Û˘ÌÏËÚÒÌ·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‰ÔÛÎfiËÛË ÙÔ˘ ·ÓÒÙÂÚÔ˘ ÂÙÈÎÔ‡ ‰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 ÔÔ›· ‚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 ÛÈÓıËÚÔÁÚ¿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). ∆¤ıËΠ۠ıÂÚ·›· 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 ÂÂÈÛfi‰ÈÔ Ù· ÂfiÌÂÓ· 2 ¯ÚfiÓÈ·.

™˘˙‹ÙËÛË ∏ Û˘¯ÓfiÙËÙ· Ù˘ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛ˘ ˘ÔÏÔÁ›˙ÂÙ·È Û ¤Ó· ÂÚÈÛÙ·ÙÈÎfi ·Ó¿ 1000-8000 ÂÈÛΤ„ÂȘ Û Â͈ÙÂÚÈÎfi ‰ÂÚÌ·ÙÔÏÔÁÈÎfi È·ÙÚÂ›Ô ‹ ‰‡Ô ÂÚÈÙÒ-

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 ÂÚÈÙÒÛÂˆÓ ¢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 ÂÓÙfiÈÛË Î˘Ú›ˆ˜ ÛÙÔÓ ÎÔÚÌfi Î·È Û¿ÓÈ· ¤ˆ˜ ηıfiÏÔ˘ ÛÙȘ ·Ï¿Ì˜, Ù· ¤ÏÌ·Ù·, ÙÔ ÚfiÛˆÔ 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‡Ìو̷ 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 Â¿Óˆ 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 ÔÔ›Ô Â›Ó·È ÁÓˆÛÙfi fiÙÈ ÙÔ ¿ÙÔÌÔ Â›Ó·È ·ÏÏÂÚÁÈÎfi ñ ¢ËÏËÙ‹ÚÈ· (ÊȉÈÒÓ, ˘ÌÂÓÔÙ¤ÚˆÓ) ñ µÈÔÏÔÁÈÎÔ› ·Ú¿ÁÔÓÙ˜ Ô˘ ÂÎÎÚ›ÓÔÓÙ·È ·fi ·Ú¿ÛÈÙ· ÂÓÙ¤ÚÔ˘, Â·Ê‹ 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 ∞ÛÈÚ›ÓË Î·È ¿ÏÏ· ÌË ÛÙÂÚÔÂȉ‹ ·ÓÙÈÊÏÂÁÌÔÓÒ‰Ë ñ ¡·ÚΈÙÈο (Έ‰Â˝ÓË, ÌÔÚÊ›ÓË, ÌÂÂÚȉ›ÓË, Âıȉ›ÓË) ñ ¶·Ú¿ÁÔÓÙ˜ Ó¢ÚÔÌ˘˚ÎÔ‡ ·ÔÎÏÂÈÛÌÔ‡ (d-ÙÔ˘ÌÔÎÔ˘Ú·Ú›ÓË, ‰ÂηÌÂıfiÓÈÔ, ÁηÏÏ·Ì›ÓË, ÌÂÙÔÎÔ˘ÚfiÓÈÔ, ·ÓÎÔ˘ÚfiÓÈÔ) ñ ™˘Ì·ıÔÌÈÌËÙÈο (ÈÛÔÚÔÙÂÚÂÓfiÏË, ·ÌÊÂÙ·Ì›ÓË, ÂʉڛÓË, Ê·ÈÓ˘ÏÂÊÚ›ÓË) ñ ÕÏÏ· (ÛÎÔÔÏ·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, ÙÔÈο ·Ó·ÈÛıËÙÈο (ÏȉÔη˝ÓË, ÙÂÙڷη˝ÓË, ÚÔη˝ÓË, ÌÂı˘Ï··Ì¤Ó Û˘ÓÙËÚËÙÈÎfi) 3. ∆ÚÔʤ˜ Î·È ÚfiÛıÂÙ· Ô˘ ÌÔÚ› 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 Â›‚ÏÂ„Ë Î·È Ì ‰˘Ó·ÙfiÙËÙ· Â›ÁÔ˘Û·˜ ·ÓÙÈÌÂÙÒÈÛ˘. * ¶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· ıÂÚ·›·. ¨ ¶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· ıÂÚ·›·.

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›, Â›‰ÔÈ ‹ ÂÏ·ÊÚ¿ ÂËṲ́ÓÔÈ fi˙ÔÈ ‹ ϿΘ ÌÂÁ¿ÏÔ˘ ÌÂÁ¤ıÔ˘˜ (3-4 cm), Ì ÂÓÙfiÈÛË 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. ªÔÚ› Ó· ‰ËÌÈÔ˘ÚÁËıÔ‡Ó Ê˘Û·Ï›‰Â˜ ¿Óˆ ÛÙË ‚Ï¿‚Ë. ™¿ÓÈ·, ÔÈ ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙÙÒÌ·Ù· ÂÌÊ·Ó›˙Ô˘Ó Û˘ÌÙÒÌ·Ù·, fiˆ˜ flushing ‹ ·Ó·Ê˘Ï·ÎÙÈΤ˜ ·ÓÙȉڿÛÂȘ (11,12). ∏ ÚfiÁÓˆÛË ÙˆÓ ·È‰ÈÒÓ Ì ̷ÛÙÔ·Ùو̷ Â›Ó·È Î·Ï‹, Ì Ï‹ÚË ‹ ÌÂÚÈ΋ ˘Ô¯ÒÚËÛË ÙˆÓ ‚Ï·‚ÒÓ ÛÙÔ 92% ÙˆÓ ÂÚÈÙÒÛÂˆÓ (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· ÌÔÚ› 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˘ÌÙˆÌ¿ÙˆÓ (flushing, ˘fiÙ·ÛË, shock Î·È Á·ÛÙÚÂÓÙÂÚÈο Û˘ÌÙÒÌ·Ù·, fiˆ˜ ‰È¿ÚÚÔÈ· ‹ ·ÈÌÔÚÚ·Á›·) ··ÓÙÒÓÙ·È Û˘¯Ó¿ (9). √È ·ÛıÂÓ›˜ Ì ¢¢ª ¤¯Ô˘Ó ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÁÈ· ÌÂÙ¿ÙˆÛË 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 ÔÔ›· 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˘ÌÙÒÌ·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 οÔÈ· ÙÚÔÊ‹ ‹ Â·Ê‹ Ì ÎÚ‡Ô ÓÂÚfi ‹ ·‰È¢ÎÚ›ÓÈÛÙÔ. ™ÙÔ˘˜ ÂÓ‹ÏÈΘ, ÙÔ Î‡ÚÈÔ ·›ÙÈÔ ‹Ù·Ó ÙÔ ‰‹ÁÌ· ˘ÌÂÓÔÙ¤ÚˆÓ,

Pediatri Nov-Dec 08 new

19-12-08

16:31

™ÂÏ›‰·491

491

ª·ÛÙÔ΢ÙÙ¿ÚˆÛË ÛÙ· ·È‰È¿

Û·ÓÈfiÙÂÚ· οÔÈ· 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›·, fiˆ˜ ÏÂÌÊ·‰ÂÓÈ΋ ‰ÈfiÁΈÛË ‹ ÛÏËÓÔÌÂÁ·Ï›·, Û˘ÛÙËÌ·ÙÈο Û˘ÌÙÒÌ·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, ÛÈÓıËÚÔÁÚ¿ÊËÌ· ÔÛÙÒÓ Î·È ·Ó›¯Ó¢ÛË Ù˘ ÌÂÙ¿ÏÏ·Í˘ D816V ÛÙÔÓ c-Kit (13). ÕÏϘ ÂÚÁ·ÛÙËÚȷΤ˜ ‹ ÂÓ‰ÔÛÎÔÈΤ˜ ÂÍÂÙ¿ÛÂȘ ··ÈÙÔ‡ÓÙ·È Î·Ù¿ ÂÚ›ÙˆÛË. ∏ Ì·ÛÙÔ΢ÙÙ¿ÚˆÛË Ú¤ÂÈ Ó· ·ÔÎÏ›ÂÙ·È Û ·ÛıÂÓ›˜ Ì Â·Ó·Ï·Ì‚·ÓfiÌÂÓ· ÂÂÈÛfi‰È· ȉÈÔ·ıÔ‡˜ ·Ó·Ê˘Ï·Í›·˜ (14,15). ∏ ıÂÚ·›· Â›Ó·È Û˘Ìو̷ÙÈ΋, Ì ʿÚ̷η ÂÎÏÔÁ‹˜ Ù· H1 ·ÓÙÈÈÛÙ·ÌÈÓÈο, fiˆ˜ Ë ˘‰ÚÔ͢˙›ÓË, ·ÏÏ¿ Î·È Ù· ÓÂfiÙÂÚ·, fiˆ˜ 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˘ÌÙˆÌ¿ÙˆÓ (16). ∏ ÚÔÛı‹ÎË ∏2 ·ÓÙÈÈÛÙ·ÌÈÓÈÎÒÓ, fiˆ˜ Ë Ú·ÓÈÙȉ›ÓË ‹ Ë ÛÈÌÂÙȉ›ÓË, Â›Ó·È ¯Ú‹ÛÈÌË fiÙ·Ó ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·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› ÙÔÈο ÛÙÂÚÔÂȉ‹, Ì ηϿ ·ÔÙÂϤÛÌ·Ù· (16,17). √È ·ÛıÂÓ›˜ Ì ̷ÛÙÔ΢ÙÙ¿ÚˆÛË Î·È ÈÛÙÔÚÈÎfi ·Ó·Ê˘Ï·Í›·˜ Ú¤ÂÈ ÔˆÛ‰‹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 ÂÂÈÛfi‰ÈÔ. √È ·ÛıÂÓ›˜ ÌÂ Û˘Ìو̷ÙÈ΋ 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΋˜ Â¤Ì‚·Û˘ ‹ ÂÓ‰ÔÛÎfiËÛ˘, 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΋ Â¤Ì‚·ÛË (7). ∏ ¤Ó·ÚÍË ıÂÚ·›·˜ Ì ·ÓÙÈÈÛÙ·ÌÈÓÈο ÚÈÓ ·fi ÙËÓ Â¤Ì‚·ÛË Â›Ó·È ·ÔÙÂÏÂÛÌ·ÙÈ΋ (7). ™˘ÌÂÚ·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˜ ÂÚÈÙÒÛÂȘ ·È‰È·ÙÚÈ΋˜ ¢ª Â›Ó·È ÌË Û˘Ìو̷ÙÈΤ˜, 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 ÂÚÈÙÒÛÂȘ 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.

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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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492

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.

Paediatriki 2008;71:486-492

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˘ÌÙÒÌ·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 ÂÌ‡ÚÂÙÔ ‰È¿ÚÎÂÈ·˜ 7 ËÌÂÚÒÓ ÌÂ Û˘ÌÙÒÌ·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 (-), ÂÚËÙÔ˚Ô› (-), ·‰ÂÓÔ˚Ô› (-).

Abs (EBV-VCA) IgG (+), (EBV-VCA) IgM (+). ¶·Ú·ÎÏÈÓÈÎfi˜ ¤ÏÂÁ¯Ô˜: ÀÂÚ˯ÔÁÚ¿ÊËÌ· ÎÔÈÏ›·˜: ª¤ÁÂıÔ˜ ÛÏ‹Ó· ·˘ÍË̤ÓÔ Î·Ù¿ 1,5 cm ÂÚ›Ô˘ (ÂÈÌ‹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-

Pediatri Nov-Dec 08 new

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¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋, ¶·ÓÂÈÛÙ‹ÌÈÔ ∫Ú‹Ù˘ ∞ÏÏËÏÔÁÚ·Ê›·: ∂ÌÌ·ÓÔ˘‹Ï °·Ï·Ó¿Î˘ emmgalan@med.uoc.gr ¶·È‰È·ÙÚÈ΋ ∫ÏÈÓÈ΋ ¶·ÓÂÈÛÙËÌ›Ô˘ ∫Ú‹Ù˘

Department of Paediatrics, University of Crete Correspondence: Emmanouil Galanakis emmgalan@med.uoc.gr Department of Paediatrics, University of Crete

ÙÂ-

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416

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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˘ ·ÓıÚÒÈÓ˘ ·ÓÔÛÔ·ÓÂ¿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). ÀÂÓı˘Ì›˙ÂÙ·È fiÙÈ Ë ÚÔÏËÙÈ΋ ·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 ÂÚÈÙÒÛÂȘ ·ÓÂ·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 ·ÓÂ¿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 ÙfiÔ 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 ÏÂÙÔÌÂÚ›˜ Î·È ·ÊÔÚÔ‡Ó

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PAEDIATRIC NEWS IN BRIEF fiϘ ÙȘ ËÏÈ˘ ¿Óˆ ÙˆÓ 6 ÂÙÒÓ Î·È ·¢ı‡ÓÔÓÙ·È Î˘Ú›ˆ˜ Û Â·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 ™ÈÁηÔ‡ÚË, 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·, fiˆ˜ 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 fiˆ˜ Ë ËÏÂÎÙÚÔÓÈ΋ http://www.un.org/esa/population/ publications/wpp2006/WPP2006_Highlights_ rev.pdf.

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πÛÙÔÛÂÏ›‰Â˜ ÁÂÓÂÙÈ΋˜ ∂ÚÁ·ÛÙ‹ÚÈÔ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ¶·ÓÂÈÛÙËÌ›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΋˜ ¶·ÓÂÈÛÙËÌ›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˘ ∞ÓıÚÒÔ˘ - http://www.eshg.org ∏ ÈÛÙÔÛÂÏ›‰· www.eshg.org ·ÔÙÂÏ› ÙÔÓ Â›ÛËÌÔ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ Ù˘ ∂˘Úˆ·˚΋˜ ∂Ù·ÈÚ›·˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ∞ÓıÚÒÔ˘. 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 ‰›Ô Ù˘ È·ÙÚÈ΋˜ ÁÂÓÂÙÈ΋˜ Î·È Ë ‰È¢ÎfiÏ˘ÓÛË Ù˘ ÂÈÎÔÈÓˆÓ›·˜ ÌÂٷ͇ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ. ∏ ∂Ù·ÈÚ›· ‰›ÓÂÈ È‰È·›ÙÂÚË ÛËÌ·Û›· ÛÙËÓ ÂÓı¿ÚÚ˘ÓÛË Ó¤ˆÓ ÂÈÛÙËÌfiÓˆÓ 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 ÂÈϤÔÓ 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›·, µÈÔÏËÚÔÊÔÚÈ΋ 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, fiˆ˜ Î·È ÛÂ Û˘Ó¤‰ÚÈ· ÚÔËÁÔ‡ÌÂÓˆÓ ÂÙÒÓ. ™ÙËÓ Î·ÙËÁÔÚ›· “¶ÏËÚÔÊÔڛ˜ ÁÈ· ∞ÛıÂÓ›˜” (Patient Information) ÌÔÚ› 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 ·ÌÓÈÔ·Ú·Î¤ÓÙËÛË, ÙË Ï‹„Ë ÙÚÔÊÔ‚Ï¿ÛÙ˘, ÙÔ˘˜ ÙÚfiÔ˘˜ ÎÏËÚÔÓÔÌÈÎfiÙËÙ·˜ Î.¿. √È ÏËÚÔÊÔڛ˜ ·˘Ù¤˜ ¤¯Ô˘Ó ÛÙfi¯Ô Ó· ·Ó·‰Â›ÍÔ˘Ó ÙȘ ÂÈÛÙËÌÔÓÈΤ˜, ·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˘ ÌÔÚÔ‡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), fiÔ˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÂÈÏÂÁ̤ӷ ı¤Ì·Ù· °ÂÓÂÙÈ΋˜, fiˆ˜ 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˘˜ ÂÈÛÙ‹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 ÙfiÔ ÙÔ˘ ∞ÌÂÚÈηÓÈÎÔ‡ ∫ÔÏÂÁ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜. ∆Ô ∫ÔϤÁÈÔ È‰Ú‡ıËΠÙÔ 1991 Î·È ÛÙfi¯Ô ÙÔ˘ ¤¯ÂÈ ÙË ‰È¿ÁÓˆÛË, ·ÓÙÈÌÂÙÒÈÛË 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˜ ÂÈÛÙËÌÔÓÈ΋˜ ÂÓË̤ڈÛ˘ Î·È ÚÔÙ¿ÛÂȘ ÂÎ·›‰Â˘Û˘ ÁÈ· fiÛÔ˘˜ È·ÙÚÔ‡˜ ¿ÏÏÔ˘˜ ÂȉÈÎÔÙ‹ÙˆÓ ‹ ¿ÏÏÔ˘˜ ÂÈÛÙ‹ÌÔÓ˜ ÂÈı˘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 ÙÚfiÔ ‰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· ÔÔÈÔ‰‹ÔÙ ÚˆÙfiÎÔÏÏÔ ÁÂÓÂÙÈÎÔ‡ ÂϤÁ¯Ô˘. ™ÙËÓ Î·ÙËÁÔÚ›· “¢ËÌÔÛȇÛÂȘ” ÌÔÚ› ηÓ›˜ Ó· ‚ÚÂÈ ¤Ó·Ó Ú·ÎÙÈÎfi Ô‰ËÁfi Û¯ÂÙÈο Ì ÙȘ ÁÂÓÂÙÈΤ˜ ÂÍÂÙ¿ÛÂȘ ÁÈ· Ù· Û˘¯ÓfiÙÂÚ· ÁÂÓÂÙÈο ÓÔÛ‹Ì·Ù·, fiˆ˜ 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 ÂÈÙ¢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 ÙfiÔ ÙÔ˘ ÌË ÎÂÚ‰ÔÛÎÔÈÎÔ‡ 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˘ ÂÎ·›‰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 ÚÔÛˆÈÎÒÓ 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

Pediatri Nov-Dec 08 new

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¡∂∞ ∞¶√ ∆√ ¢π∞¢π∫∆À√ ÁÂÓÂÙÈÎÔ‡ ÂϤÁ¯Ô˘. ∆¤ÏÔ˜, ··ÓÙÒÓÙ·È ÂÚˆÙ‹Ì·Ù· fiˆ˜ “Û ÔÈÔ˘˜ ·¢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 ÙfiÔ ÙÔ˘ ∂˘Úˆ·˚ÎÔ‡ ∫·Ù·ÏfiÁÔ˘ ÙˆÓ DNA-¢È·ÁÓˆÛÙÈÎÒÓ ∂ÚÁ·ÛÙËÚ›ˆÓ (European Directory of DNA Diagnostic Laboratories, EDDNAL). O EDDNAL ·ÔÙÂÏ› ÌË ÎÂÚ‰ÔÛÎÔÈÎfi ÔÚÁ·ÓÈÛÌfi, ¯ÚËÌ·ÙÔ‰ÔÙÔ‡ÌÂÓÔ ·fi ÙËÓ ∂˘Úˆ·˚΋ ∂ÈÙÚÔ‹. ø˜ ·ÔÛÙÔÏ‹ ¤¯ÂÈ ÙË ‰È¿‰ÔÛË ÏËÚÔÊÔÚÈÒÓ ÌÂٷ͇ ÙˆÓ ÂÈÛÙËÌfiÓˆÓ 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 ∂˘ÚÒË. ¶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· (˘‡ı˘ÓÔ˜ ΤÓÙÚÔ˘ Û οı ¯ÒÚ·, Ì ÛÙÔȯ›· ÂÈÎÔÈÓˆÓ›·˜), ·ÏÏ¿ Î·È Û˘Ó‰¤ÛÂȘ Ì ÈÛÙÔÛÂÏ›‰Â˜ ¿ÏÏˆÓ ‰È·‰ÈÎÙ˘·ÎÒÓ ÙfiˆÓ, 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΋ ÚÔÛˆÈ΋ ÁÓÒÛË ÚÈÓ ·¢ı˘Óı› ÛÙÔÓ ÂȉÈÎfi ÁÂÓÂÙÈÛÙ‹, Ô ÔÔ›Ô˜ ı· ÙÔÓ Î·Ù¢ı‡ÓÂÈ ·ÛʷϤÛÙÂÚ·.

∏ ÈÛÙÔÛÂÏ›‰· ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ http://iatriki-genetiki.med.uoa.gr ∏ ÈÛÙÔÛÂÏ›‰· http://iatriki-genetiki.med.uoa.gr ·ÔÙÂÏ› ÙÔÓ ‰È·‰ÈÎÙ˘·Îfi ÙfiÔ ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘ π·ÙÚÈ΋˜ °ÂÓÂÙÈ΋˜ ÙÔ˘ ¶·ÓÂÈÛÙËÌ›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˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. ∞ÔÙÂÏ› ΤÓÙÚÔ ·Ó·ÊÔÚ¿˜ ÁÈ· fiÏÔ ÙÔÓ ÂÏÏ·‰ÈÎfi ¯ÒÚÔ, ÁÈ· ı¤Ì·Ù· Ô˘ ·ÊÔÚÔ‡Ó ÛÙË ‰È¿ÁÓˆÛË, ·ÓÙÈÌÂÙÒÈÛË 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˘ ¶·ÓÂÈÛÙËÌ›Ô˘ ∞ıËÓÒÓ. ™ÙËÓ ›‰È· ηÙËÁÔÚ›· ÌÔÚ› οı ÂӉȷÊÂÚfiÌÂÓÔ˜ Ó· ‚ÚÂÈ ÙȘ ÂÚÈÏ‹„ÂȘ Ù˘ ËÌÂÚ›‰·˜. π‰È·›ÙÂÚÔ ÂӉȷʤÚÔÓ ·ÚÔ˘ÛÈ¿˙ÂÈ Ë Î·ÙËÁÔÚ›· “ÀËÚÂۛ˜”, fiÔ˘ Ô ÂÈÛΤÙ˘ ÌÔÚ› Ó· ‚ÚÂÈ ÏËÚÔÊÔڛ˜ ÁÈ· ÙÔ˘˜ ÂȉÈÎÔ‡˜ ÁÂÓÂÙÈÎÔ‡˜ ÂϤÁ¯Ô˘˜ Ô˘ Ú·ÁÌ·ÙÔÔÈÔ‡ÓÙ·È ÛÙÔ ∂ÚÁ·ÛÙ‹ÚÈÔ, fiˆ˜ ΢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, ÚÔÛˆÔˆÌÔ‚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·ÙÔÔÈÔ‡ÓÙ·È ÛÙÔÓ ¯ÒÚÔ ÙÔ˘ ∂ÚÁ·ÛÙËÚ›Ô˘, fiˆ˜ 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˜ ÌÔÚ› 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 Â͢ËÚ¤ÙËÛË ÙˆÓ ·ÛıÂÓÒÓ Î·È ÙˆÓ ÔÈÎÔÁÂÓÂÈÒÓ ÙÔ˘˜.

¶·È‰È·ÙÚÈ΋ 2008;71:496-499

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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˘ÌÙˆÌ¿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›, fiˆ˜ ·‰ÂÓÔ˚Ô›, ÁÚ›˘, ÚÔÙ·˚Ô›, ÂÚËÙÔ˚Ô›, ÂÚ˘ıÚ¿˜, ÈÏ·Ú¿˜, Epstein Barr Î·È echo ·›˙Ô˘Ó ÛËÌ·ÓÙÈÎfi ÚfiÏÔ. ∂›Û˘, ¿ÏϘ ÏÔÈÌÒÍÂȘ, fiˆ˜ ÏÔÈÌÒÍÂȘ ÙÔ˘ Ô˘ÚÔÔÈËÙÈÎÔ‡ 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¯ÔÔÈËı›, fiˆ˜ ·‡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· Âԯȷ΋ ηٷÓÔÌ‹, ΢ڛˆ˜ ÙÔ ÊıÈÓfiˆÚÔ Î·È ÙÔÓ ¯ÂÈÌÒÓ·, ÂÔ¯¤˜ ηٿ ÙȘ Ôԛ˜ 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· ÂȂ‚·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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∂Àƒ∂∆∏ƒπ√ ∫ƒπ∆ø¡

501

∂˘¯·ÚÈÛٛ˜ ÚÔ˜ ÙÔ˘˜ ∫ÚÈÙ¤˜ Ù˘ “¶·È‰È·ÙÚÈ΋˜” ∏ ™˘ÓÙ·ÎÙÈ΋ ∂ÈÙÚÔ‹ ¢¯·ÚÈÛÙ› ıÂÚÌ¿ ÙÔ˘˜ ÎÚÈÙ¤˜ ÙÔ˘ ÂÚÈÔ‰ÈÎÔ‡ «¶·È‰È·ÙÚÈ΋» Ô˘ ÚÔÛ¤ÊÂÚ·Ó ÙËÓ ›ڷ Î·È ÙÔÓ ¯ÚfiÓÔ ÙÔ˘˜ ÁÈ· Ó· ÂÍ·ÛÊ·Ï›ÛÔ˘Ó ÙÂÎÌËÚȈ̤Ó˜ Î·È ·ÓÙÈÎÂÈÌÂÓÈΤ˜ ·ÍÈÔÏÔÁ‹ÛÂȘ ÁÈ· ÙȘ ÂÈÛÙËÌÔÓÈΤ˜ ÂÚÁ·Û›Â˜ Ô˘ ‰ËÌÔÛȇıËÎ·Ó Î·Ù¿ ÙÔ ¤ÙÔ˜ 2008. √ ¢È¢ı˘ÓÙ‹˜ ™‡ÓÙ·Í˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ™ÙÂÊ·Ó›‰Ë˜

∫ÚÈÙ¤˜ ÙˆÓ ÂÚÁ·ÛÈÒÓ Ô˘ ‰ËÌÔÛȇıËÎ·Ó ÛÙÔÓ ÙfiÌÔ 71 ÙÔ˘ ¤ÙÔ˘˜ 2008 ∞ı·Ó·Û¤Ï˘ ™ˆÙ‹Ú˘ ∞ı·Ó·ÛÈ¿‰Ô˘-¶ÈÂÚÔÔ‡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··‰ÔÔ‡ÏÔ˘ ∂Ï›‰· µÔ‡‰Ú˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ °·Ï·Ó¿Î˘ ∂ÌÌ·ÓÔ˘‹Ï °·ÚÔ‡ÊË-∫Ô‡ÙÛ· ∞Ó·ÛÙ·Û›· °ÂˆÚÁ·ÎfiÔ˘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˘ ∂ÏȉÔÊfiÚÔ˜ ª·ÛÙÚÔÁÈ¿ÓÓË ƒ›Ù· ªÔÛ¯fi‚Ë ª·Ú›· ª¿Î· ª·ÚÁ·Ú›Ù· ªÈÙÛÒÚË ª·Ú›· ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘ ¡ÈÎfiÏ·Ô˜

¡ÈÎÔÏ¿Ô˘-¶··Ó·ÁÈÒÙÔ˘ ∞ÏÂÍ¿Ó‰Ú· ¡ÙÔ˘ÓÙÔ˘Ó¿Î˘ ∂Ï¢ı¤ÚÈÔ˜-™Ù·‡ÚÔ˜ •Â··‰¿ÎË ¶·Ú·Û΢‹ √ÈÎÔÓfiÌÔ˘ ª·Ú›Ó· ¶··Á·ÚÔ˘Ê¿Ï˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ¶··ÁÈ¿ÓÓ˘ πˆ¿ÓÓ˘ ¶··ÁÚËÁÔÚ›Ô˘-£ÂÔ‰ˆÚ›‰Ô˘ ª·Ú›· ¶··‰fiÔ˘ÏÔ˜ ¡ÈÎfiÏ·Ô˜ ¶··‰ÔÔ‡ÏÔ˘ ∞ÏÂÍ¿Ó‰Ú· ¶··Â˘·ÁÁ¤ÏÔ˘ µ·ÛÈÏÈ΋ ¶ÂÚ‚·Ó›‰Ô˘ ¶·Ó·ÁÈÒÙ· ¶ÂÙÚ›‰Ô˘ ∂ϤÓË ¶Ô˘ÚÙÛ›‰Ë˜ ∞fiÛÙÔÏÔ˜ ¶Ú·ÛÔ‡ÏË ∞ÏÂÍ›· ¶Ú›ÊÙ˘ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ƒ¿ÌÌÔ˜ ™˘Ú›‰ˆÓ ™·Ï¿ÎÔ˜ ÃÚ‹ÛÙÔ˜ ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ ºˆÙÂÈÓ‹ ™·Ú·Ê›‰Ë˜ ∫ÔÛÌ¿˜ ™ÂÚ‚ÈÙ˙fiÁÏÔ˘ ª·Ú›Ó· ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞ÓÙÈÁfiÓË ™ÈÁ¿Ï·˜ πˆ¿ÓÓ˘ ™›‰Ë µ·ÛÈÏÈ΋ ™ÈÒÌÔ˘ ∞ÈηÙÂÚ›ÓË ™ËÏÈÔÔ‡ÏÔ˘ ÷ڿ ™ËÏÈÒÙË-°Îڤη µ·ÛÈÏÈ΋ ™Ô‡ÏÔ˘ µ¿Ó· ™Ù·ÌÔÁÈ¿ÓÓÔ˘-ª·˘ÚÔÂȉ‹ §¤Ï· ™ÙÂȷοÎË ∂˘Ù˘¯›· ™˘Ú›ÁÔ˘-¶··‚·ÛÈÏ›Ԣ ∞ÓÙÈÁfiÓË ∆˙Ô‡ÊË ªÂÚfiË ∆Û¤˙Ô˘ ∞Û·Û›· ∆Û›ÙÔ˘Ú· ™Ù¤ÏÏ· ∆Û›ÙÛÈη ÕÚÙÂÌË ∆Ûfiη-°ÂÓÓ·Ù¿ ∂ϤÓË ∆ÛÔÏÈ¿ ª·Ú›˙· ∆ÛÔ˘Ì¿Î·˜ ∫ˆÓÛÙ·ÓÙ›ÓÔ˜ ºÚ˘Û›Ú· ∂ϤÓË Ã·ÚÌ·Ó‰¿ÚË ∂˘·ÁÁÂÏ›· ÷Ù˙ËÛ‚·ÛÙÔ‡-§Ô˘Î›‰Ô˘ ÷ڛÎÏÂÈ· ÃÚ‡Û˘ ¢ÈÔÓ‡ÛÈÔ˜

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¶·È‰È·ÙÚÈ΋ 2008;71:501

Pediatri Nov-Dec 08 new

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16:31

™ÂÏ›‰·502

∂Àƒ∂∆∏ƒπ√ ™À°°ƒ∞º∂ø¡

∂˘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. ∞ÁÁÂÏÔÔ‡ÏÔ˘ ƒ. ∞˚‚¿˙Ë ¢. ∞˚‚¿˙˘ µ. ∞ÏÂÍ·Ó‰Ú¿ÙÔ˜ Ã. ∞Ó·ÁÓˆÛÙ¿ÙÔ˘ ¡. ∞ÓıÚ·ÎfiÔ˘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

∞ÓÙˆÓÈ¿‰Ô˘-∫Ô˘Ì¿ÙÔ˘ π.

426, 469 ∞ÓÙˆÓ›ÙÛË ª.

215 ∞Ó˘Ê·ÓÙ¿Î˘ ∫.

317 ∞ÚÁ˘ÚÔÔ‡ÏÔ˘-¶·Ù¿Î· ¶.

219 ∞ÛÎËÙ‹ µ.

75, 311 ∞ÙÙÈÏ¿ÎÔ˜ ∞.

426 ∞˘ÁÂÓ¿ÎË ∞.

60 µ·ÚÏ¿Ì˘ °.

135, 215, 417 µ·ÚÏ¿Ì˘ ™.

215 µ·ÛÈÏÂÈ¿‰Ë˜ Õ.

219 µ·ÛÈÏÔÔ‡ÏÔ˘ ∞.

475 µ·ÛÈÏÔÔ‡ÏÔ˘ µ.

383 µÂÏÈÛÛ·Ú›Ô˘ µ.

383 µÂÏÈÛÛ·Ú›Ô˘ π.ª.

37 µ›‰Ú· ¡.

361 µÏ·¯¿ÎË °.

192 µÏ·¯Ô··‰ÔÔ‡ÏÔ˘ ∂.

277 µÏ¿¯Ô˜ ∞.

390 µÚ¿ÓË √.

141 °·Ï·Ó¿Î˘ ∂.

171, 248, 324, 404, 494 °·ÏÏ¿-µÔ˘Ì‚Ô˘Ú¿ÎË ∞.

263 °ÂÚÌ·Ó¿Î˘ π.

238, 403, 417 °ÂˆÚÁÈÔÔ‡ÏÔ˘-ª›¯· ¶.

434, 449 °È·Ï·Ì¿ ∂.

219 °È·ÓÓ¿ÎË ª.

37 °È·ÓÓ·ÎÔÔ‡ÏÔ˘ Ã.

238 °È·ÓÓ·ÎÔ‡ÏÈ· ª.

361 °È·ÓÓ¿ÙÔ˘ ∂.

497 °Ô˘ÚÙ˙ÂÏ›‰Ë˜ ¶.

311 ¢ÂÌÂÚÙ˙›‰Ô˘ µ.

141 ¢ËÌÔÔ‡ÏÔ˘ ∞.

355 ¢ËÌÔÔ‡ÏÔ˘ ∞ÈÎ.

469 ¢ÈÔÌ‹‰Ô˘˜ ª.

251 ¢ÔÏÈ·Ó›ÙË ª.

376 ¢Ô‡‰· ∂.

368 ¢Ú·ÎˆÓ¿Î˘ °.

60 ∑·Ú‰·‚¿ °.

219 ∑ÂÚ‚Ô˘‰¿ÎË ∞.

449 ∑‹‚·-¶ÂÙÚÔÔ‡ÏÔ˘ ª.

376 ∑‹ÎÔ˜ ¢.

251 ∑ÔÏÒÙ· ∞ÈÎ.

469 ∏Ï›· ™.

49 ∏ÏÈÔ‰ÚÔÌ›ÙË ∑.

469 £ÂÔ‰ÔÛ›Ô˘ ª.

251 £ˆÌ·˝‰Ë˜ ∆.

219 £ˆÌ·˝‰Ô˘ §.

407, 458 £ˆÌ¿˜ ¢.

277 ÿÌ‚ÚÈÔ˜ °.

141 ∫·‚·ÏÈÒÙ˘ π.

301 ∫·‰fiÁÏÔ˘ ¡.

128 ∫·ÏÏÈÒÚ· ª.

493

Pediatri Nov-Dec 08 new

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™ÂÏ›‰·503

∂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. ∫ÔÓÙfiÔ˘ÏÔ˜ ∂. ∫ÔڷοÎË ∂. ∫ÔÚÌ¿˜ °. ∫Ô˘ÁÈÔ˘ÌÔ˘Ù˙¿Î˘ °. ∫Ô‡ÚÙ˘ ∞. ∫Ô‡ÛÙ· ∂. ∫Ô˘ÙÏ‹ ª. ∫Ô˘ÙÛ·˘Ù›ÎË Ã. ∫ÚÈÙÛ¤ÏË ∂. ∫˘ÚÈfiÔ˘ÏÔ˜ °. ∫ˆÓÛÙ·ÓÙfiÔ˘ÏÔ˜ A. ∫ˆÓÛÙ·ÓÙÔ˘Ï¿ÎË ∂. ∫ÒÛÙ· ∫. ∫ˆÛÙ¿ÎÔ˘ ∫. ∫ÒÛÙ·ÏÔ˜ Ã. §·‚Ú¿ÓÔ˜ °. §¿ÁÁ·ÚË µ. §Â‚ÂÓÙfiÔ˘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

ª·‡ÚÔ˘ ∞.

255 ª·˘ÚÔ˘‰‹ ∞.

141 ªÂÁÚ¤Ì˘ ™.

105 ª¤ÓÂÁ·˜ ¢.

469 ªËÙÛÈÒÓË ∞.

311 ª›¯·˜ °.

449 ª›¯·˜ º.

449 ªÔÛÎÔÊ›‰Ë˜ ª.

135 ª·˙ÔÔ‡ÏÔ˘-∫˘Úηӛ‰Ô˘ ∂.

283 ª¿ÎˆÛË ™.

49 ª·ÚÙÛfiη˜ Ã.™.

409 ªÂÏÔÁÈ¿ÓÓË ∫.

361 ªÂÚÙÛÈ¿˜ °.

24 ªfiÙÛ˘ ¢.

383 ªÔ˘ÏÔ˘Î¿ÎË π.

355 ªÔ˘ÚÏ‹ ∂.

219 ª˘ÚÈÔÎÂÊ·ÏÈÙ¿Î˘ ¡.

243, 247 ¡Â¿Ú¯Ô˘ ∞.

60 ¡›Î·˜ π.

311 ¡ÈÎÔÏ·˝‰Ë˜ ¡.

18 ¡ÈˆÙ¿Î˘ °.

49, 54, 192 ¡ÙÈÓfiÔ˘ÏÔ˜ ∞.

1 ¡ÙÈÔ‡‰Ë˜ °.

247 ¡ÙÔ˘Ì¿ ™.

128 •ÂηϿÎË ∞.

469 •Â··‰¿ÎË ¶.

486 •˘ÓÈ¿˜ π.

141 √Ì¿‰· ∫ÏÈÓÈ΋˜ ¶ÚÔÏËÙÈ΋˜ π·ÙÚÈ΋˜ Î·È ¢È·ÙÚÔÊ‹˜ 24 √ÚÁ·ÓÔ‡ ª.

54 ¶¿‚Ë ∂.

148 ¶¿Ì·ÓÔ˜ ∞.

105 ¶·ÓÙÂÏÈ¿‰Ë˜ Ã.

42 ¶·ÓÙÈΛ‰Ô˘ ª.

141 ¶··Á·ÚÔ˘Ê¿Ï˘ ∫.

165 ¶··ÁÈ¿ÓÓ˘ I. 417 ¶··ÁÈ·ÓÓÔÔ‡ÏÔ˘ √.

301 ¶··‰¿Î˘ µ.

277 ¶··‰¿ÎÔ˘-§·ÁÔÁÈ¿ÓÓË ™.

376 ¶··‰ËÌËÙÚ›Ô˘ ∞.

1 ¶··‰fiÔ˘ÏÔ˜ ¡.

37, 76, 475, 486 ¶··‰ÔÔ‡ÏÔ˘ ∞.

434, 449 ¶··‰ÔÔ‡ÏÔ˘ ª.

128 ¶··‰ÔÔ‡ÏÔ˘-∞Ï·Ù¿ÎË ∂.

135 ¶··‰ÔÔ‡ÏÔ˘-∆·¿ÎË °.

247 ¶··ı·Ó·Û›Ô˘ ∞.

123 ¶··ÓÙ˙›Ì·˜ ∫.

243 ¶··ÛÙ·‡ÚÔ˘ £.

141 ¶··¯ÈÏϤˆ˜ ¶.

317 ¶··¯Ú‹ÛÙÔ˜ π.

323 ¶·˘Ï›‰Ô˘ ∂.

42 ¶·˘Ï›ÙÔ˘-∆ÛÈfiÓÙÛË ∞.

135 ¶Ú·ÛÔ‡ÏË ∞.

426, 469 ¶Ú›ÊÙ˘ ∫.¡.

231 ¶·È‰È·ÙÚÈ΋ 2008;71:502-504

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∂Àƒ∂∆∏ƒπ√ ™À°°ƒ∞º∂ø¡ ™·‚‚›‰Ô˘ ∞. ™·˚Ù¿Î˘ ∂. ™·ÎÂÏÏ¿Ú˘ °. ™·Ï·‚Ô‡Ú· ∫. ™·ÍÒÓË-¶··ÁˆÚÁ›Ô˘ º. ™·Ú·ÓÙÔÔ‡ÏÔ˘ ∞ÈÎ. ™·Úȉ¿Î˘ π. ™·ÚÚ‹ ∫. ™ËÊÈ·ÓÔ‡ ¶. ™È·ÌÔÔ‡ÏÔ˘-ª·˘Ú›‰Ô˘ ∞. ™È¯ÏÈÌ›ÚË ¶. ™ÎÈ·‰¿˜ ∫. ™Ô˘Ì¿ÎË ∂. ™ËÏÈÔÔ‡ÏÔ˘ £. ™‡ÚÔÁÏÔ˘ ∫. ™Ù·Ì·Ù¿ÎË ∞. ™ÙÂÊ·Ó¿ÎË ™. ™ÙÂÊ·Ó›‰Ë˜ ∫. ™ÙÚ›ÓÙ˙˘ ¡. ™ÙÚÔ˘Ì‹ ∂. ™ˆÊÚÔÓ¿ ™. ∆·‚Ï·‰¿ÎË £. ∆·ÎÔ‡‰·˜ ¢. ∆·¿ÎË °. ∆·ÛÈÔÔ‡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 ∞-∂. ºÈÏÈÔÔ‡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

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™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·ÓÔÔ›ËÛË ¯ÚˆÌÔÛÒÌ·ÙÔ˜ à 271 ∞ÂÚÈÛÌfi˜ 18 ∞ıÏËÙÈÛÌfi˜ 417 ∞ÈÌÔÛÊ·ÈÚ›ÓË 192 ∞ÎÚÔÔÛı›· 355 ∞Ó¿Ù˘ÍË 157 ∞ÓÂÌ¢ÏÔÁÈ¿ 148 ∞ÓÂ¿ÚÎÂÈ· ·˘ÍËÙÈ΋˜ ÔÚÌfiÓ˘ 123 ∞ÓÂ¿ÚÎÂÈ· ‚ÈÙ·Ì›Ó˘ µ12 54 ∞ÓÔÛÔÊ·ÈÓfiÙ˘Ô˜ 135 ∞ÓÙ·ÏÏ·Á‹ ·ÂÚ›ˆÓ 18 ∞ÓÙÈÌÂÙÒÈÛË 235 ∞ÓÙÈÌÂÙÒÈÛË ·¯˘Û·ÚΛ·˜ 376 ∞ÓÙÈÚÔÛˆ¢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

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506

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Paediatriki 2008;71:505-507

441 475 148 331 355 64 475 475 434, 441 361 60

∏ ◊‚Ë ∏ıÈο ‰ÈÏ‹ÌÌ·Ù· ∏ÏÂÎÙÚÔÓÈÎÔ› ˘ÔÏÔÁÈÛÙ¤˜ ◊Ê·ÈÛÙÔ˜

128 383 449 283

£ £ÚÂÙÈο Û˘ÛÙ·ÙÈο £ÚÔÌ‚ÔÂÓÈ΋ ÔÚʇڷ

157 399

π π·ÙÚÈ΋ ÁÂÓÂÙÈ΋ πÓ҉˘ ‰˘ÛÏ·Û›· ÔÛÙÒÓ

283 317

∫ ∫·Ì‡Ï˜ ·Ó¿Ù˘Í˘ ∫¿ÓÈÛÌ· ∫·Ú‰È·ÁÁÂȷο ÓÔÛ‹Ì·Ù· ∫·Ú‰ÈÔÏÔÁÈÎfi˜ ¤ÏÂÁ¯Ô˜ ∫·ÚÓÈÙ›ÓË ∫·Ù¿¯ÚËÛË ‰È·‰ÈÎÙ‡Ô˘ ∫·Ù¢ı˘ÓÙ‹ÚȘ Ô‰ËÁ›Â˜ ∫ÏÈÓÈο ÎÚÈÙ‹ÚÈ· ∫ÏÈÓÈ΋ ÁÂÓÂÙÈ΋ ∫ÏÈÓÈ΋ ¤Î‚·ÛË ∫ÔÈÓfiÙËÙ· ∫˘Ùfi¯ÚˆÌ·-b5-·Ó·ÁˆÁ¿ÛË

70 219 215 417 116 441 417 224 271 135 469 192

§ §ÂÌÊ·‰¤Ó˜ §ÂÌÊ·‰ÂÓÔ¿ıÂÈ· §Â˘ÎÔÂÁÎÂÊ·ÏÔ¿ıÂÈ· §Èȉ·ÈÌÈÎfi ÚÔÊ›Ï §ÈÔÚˆÙ½Ó˜ §ÔÈÌÒÍÂȘ

390 243 311 215 24 301

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311 219 368 486 192 486 361 24 141 148 277 1 105 192 37 60

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243 331 64 231 311 475 243 116

√ √ÁÎÔÁÔÓ›‰È· √‰ËÁ›Â˜ ‰È·ÙÚÔÊ‹˜ √ÈÎÔÓÔÌÈ΋ ·ÍÈÔÏfiÁËÛË √§§ ·È‰È΋˜ ËÏÈΛ·˜ √Í›· ‚ÚÔÁ¯ÈÔÏ›Ùȉ· √Í›· Ï·Ú˘ÁÁÔÙÚ·¯ÂÈÔ‚ÚÔÁ¯›Ùȉ· √Í›· Ï¢¯·ÈÌ›· √͢ÁfiÓˆÛË √ÚıÔ‰ÔÓÙÈΤ˜ ·ÓˆÌ·Ï›Â˜ ŸÚ¯ÂȘ

255 376 148 255 231 231 263 18 482 277

¶ ¶·È‰› 417 ¶·È‰È¿ 37, 70, 141, 263, 301, 311, 361, 449, 486 ¶·È‰È·ÙÚÈ΋ 105 ¶·È‰È΋ ÂÈÏË„›· 426 ¶·È‰È΋ ËÏÈΛ· 201, 390

Pediatri Nov-Dec 08 new

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∂Àƒ∂∆∏ƒπ√ §∂•∂ø¡-∫§∂π¢πø¡

507

¶·È‰È΋ ·¯˘Û·ÚΛ· 368, 376 ¶·Ú¿ÁÔÓÙ˜ ÎÈÓ‰‡ÓÔ˘ 449 ¶·ÚÂÌ‚¿ÛÂȘ 376 ¶·¯˘Û·ÚΛ· 24, 70, 157 ¶ÂÚÈ‚¿ÏÏÔÓ 469 ¶ÂÚÈÙÔÌ‹ 355 ¶ÂÚÈÊÂÚÈ΋ ÚÒÈÌË ‹‚Ë 317 ¶È›Ï· 482 ¶ÈÛÙÔÔ›ËÛË ˘Á›·˜ 417 ¶Ó¢ÌÔÓÈfiÎÔÎÎÔ˜ 148 ¶ÔÏ˘·ÎfiÚÂÛÙ· ÏÈ·Ú¿ Ôͤ· 116 ¶ÔÏ˘Û˘ÛÙËÌ·ÙÈο ÓÔÛ‹Ì·Ù· 1 ¶Ú‚ÈÔÙÈο 116 ¶ÚÔ‚ÈÔÙÈο 116 ¶ÚÔÁÂÓÓËÙÈ΋ ‰È¿ÁÓˆÛË 235, 383 ¶ÚÔÁÂÓÓËÙÈÎfi˜ ¤ÏÂÁ¯Ô˜ 238 ¶ÚfiÏË„Ë 215 ¶ÚÔʇϷÍË ˘ÚÂÙÈÎÒÓ Û·ÛÌÒÓ 42 ¶ÚÒÙÔ ÂÂÈÛfi‰ÈÔ ·‡ÚÂÙˆÓ Û·ÛÌÒÓ 201 ƒ ƒÔÙ·˚fi˜ ™ ™›‰ËÚÔ˜ ™ÎÂÏÂÙÈ΋ ‰˘ÛÏ·Û›· ™·ÛÌÔ› ™ÙÔÌ·ÙÈΤ˜ ¤ÍÂȘ ÂÎÙfi˜ ‰È·ÙÚÔÊ‹˜ ™˘ÁÁÂÓ›˜ ηډÈÔ¿ıÂȘ ™˘ÁÁÂÓ‹˜ ·ÌÊÔÙÂÚfiÏ¢ÚÔ˜ Ú·È‚Ô˚ÔÔ‰›· ™˘ÌÂÚÈÊÔÚ¿ ™˘Ó·ÈÛıËÌ·ÙÈΤ˜ ·ÓÙȉڿÛÂȘ ™˘Ó‰ÚÔÌÈ΋ ·¯˘Û·ÚΛ· ™‡Ó‰ÚÔÌÔ Bardet-Biedl ™‡Ó‰ÚÔÌÔ McCune-Albright ™‡Ó‰ÚÔÌÔ Prader-Willi ™‡Ó‰ÚÔÌÔ Turner

301

116 49 311 482 238 283 426 383 224 224 317 123 123, 235

™‡Ó‰ÚÔÌÔ ·ÈÊÓ›‰ÈÔ˘ ‚ÚÂÊÈÎÔ‡ ı·Ó¿ÙÔ˘ ™‡Ó‰ÚÔÌÔ ˘ÔÏ·ÛÙÈ΋˜ ·ÚÈÛÙÂÚ‹˜ ηډȿ˜ ™˘Ó‰˘·Ṳ̂ÓË ·ÓÂ¿ÚÎÂÈ· ÔÚÌÔÓÒÓ ™˘ÛÙ¿ÛÂȘ ™˘ÛÙ¿ÛÂȘ ∞ÌÂÚÈηÓÈ΋˜ ∞η‰ËÌ›·˜ ¶·È‰È·ÙÚÈ΋˜ ™¯ÔÏÈ΋ ÂÙÔÈÌfiÙËÙ· ™ˆÌ·ÙÈ΋ ¿ÛÎËÛË

304 238 128 235 304 458 157

∆ ∆ÂÏÈÎfi ·Ó¿ÛÙËÌ· ∆ÚÔÊÈÎfi ·ÏÏÂÚÁÈÔÁfiÓÔ

128 475

À À¤ÚÙ·ÛË ÀÔıÚ„›· ÀÔ¯ÔÓ‰ÚÔÏ·Û›· À„›Û˘¯ÓÔ˜ ·ÂÚÈÛÌfi˜ Ì ٷϷÓÙÒÛÂȘ ⁄„Ô˜-ÛÙfi¯Ô˜

311 70 49 18 128

º º›ÌˆÛË º˘ÛÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· º˘ÛÈ΋ ηٿÛÙ·ÛË

355 368 368

à ÃÔÚÙÔÊ·Á›· ÃÚfiÓÈ· ‰È¿ÚÚÔÈ· ÃÚfiÓÈ· ÓÂÊÚÈ΋ ·ÓÂ¿ÚÎÂÈ· ÃÚfiÓÈ· ÓÔÛ‹Ì·Ù· ÃÚfiÓÈÔ˜ ‚‹¯·˜ ÃÚˆÌÔÛˆÌÈΤ˜ ·ÓˆÌ·Ï›Â˜ ÃÚˆÌÔÛˆÌÈΤ˜ ‰È·Ù·Ú·¯¤˜

54 64 123 157 37 255 263

æ æ˘¯ÔÏÔÁÈ΋ Á¤ÓÓËÛË

331

¶·È‰È·ÙÚÈ΋ 2008;71:505-507

Pediatri Nov-Dec 08 new

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16:32

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¶ƒ√™∂Ã∏ ™À¡∂¢ƒπ∞

xv

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΋ ¶·ÓÂÈÛÙËÌ›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 ™˘ÌÂÚÈÊÔÚÈÛÙÈÎÒÓ ¶ÚÔÛÂÁÁ›ÛÂˆÓ Û ¶·È‰È¿ Î·È ∂Ê‹‚Ô˘˜ √ÚÁ¿ÓˆÛË: ∂ÏÏËÓÈ΋ ∂Ù·ÈÚ›· ŒÚ¢ӷ˜ Ù˘ ™˘ÌÂÚÈÊÔÚ¿˜ ¶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

÷ÚÔÎfiÂÈÔ ¶·ÓÂÈÛÙ‹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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xvi

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 ∑·›Ԣ, ∞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