The influence of parental education on child mental health in Spain.

PURPOSE: To analyze the association between parental education and offspring's mental health in a nationally representative Spanish sample, and assess the contribution of other socioeconomic factors to the association. METHODS: We conducted a secondary analysis of data on 4- to 15-year-olds participating in the 2006 Spanish National Health Survey. Mental health was assessed using the parent-reported Strengths & Difficulties Questionnaire. Parents' respective educational levels were summarized in a single variable. Univariate and multivariate analyses, controlling for family-, child- and parent-related characteristics, were used to study the association. RESULTS: The final sample comprised 5,635 children. A strong association between parental education and parent-reported child mental health was observed among 4- to 11-year-olds, with odds ratios (ORs) increasing as parental educational level decreased. Where both parents had a sub-university level, maternal education showed a stronger association than did paternal education. Following adjustment for covariates, parental education continued to be the strongest risk factor for parent-reported child mental health problems, OR = 3.7 (95% CI 2.4-5.8) for the lowest educational level, but no association was found among 12- to 15-year-olds. Male sex, immigrant status, activity limitation, parent's poor mental health, low social support, poor family function, single-parent families, low family income and social class were associated with parent-reported child mental health problems in both age groups. CONCLUSIONS: Our results show that there is a strong association between parental education and parent-reported child mental health, and that this is indeed stronger than that for income and social class. Among adolescents, however, the effect of parental education would appear to be outweighed by other factors.

Risk of stroke in prescription and other amphetamine-type stimulants use: A systematic review.

INTRODUCTION AND AIMS: Amphetamine-type stimulants (ATS) are a putative cause of stroke with high abuse potential. We aim to systematically review the association between use of ATS and stroke. DESIGN AND METHODS: To assure a sensitive search strategy, a broad definition of ATS was used. Cochrane Plus, EMBASE, IBECS/Lilacs, ISI WOK, Medline and Scopus were searched through 2016. Three researchers independently reviewed studies (Meta-analysis of Observational Studies in Epidemiology and Preferred Reporting Items for Systematic Reviews and Meta-analyses). Validity and bias were appraised. RESULTS: Of 3998 articles, four cohort studies and eight case-control studies (CCS) were selected; 11 focused on prescribed or over-the-counter ATS. Current ATS users showed a higher ischaemic stroke risk than non-users in two cohort studies {adjusted rate ratio = 1.6 [95% confidence interval (CI) = 1.1, 2.4] and 3.4 [95% CI = 1.1, 10.6]}. One study observed increased risk of haemorrhagic stroke in former users versus non-users [adjusted rate ratio = 2.3 (95% CI = 1.3, 4.1)]. Higher haemorrhagic stroke risk was seen in two CCS among women using ATS [adjusted odds ratio (aOR) = 16.6 (95% CI = 1.5, 182.2) and 3.9 (95% CI = 1.1, 13.1)]. All-stroke was negatively associated with ATS in another CCS [aOR = 0.4 (95% CI = 0.2, 0.8)] and positively associated in the only study on non-medical ATS [aOR = 3.8 (95% CI = 1.2, 12.6)]. Selection bias and uncontrolled confounding were common. DISCUSSION AND CONCLUSIONS: This is the first systematic review on ATS and stroke. Limited epidemiological evidence suggests that ATS use increases stroke risk. Possible disparities in ATS effect across stroke type and higher effect in women deserve further clarification. Studies on non-medical ATS use should be a priority. [Indave BI, Sordo L, Bravo MJ, Sarasa-Renedo A, Fernández-Balbuena S, De la Fuente L, Sonego M, Barrio G. Risk of stroke in prescription and other amphetamine-type stimulants use: A systematic review. Drug Alcohol Rev 2018;37:56-69].

Dietary patterns and nutritional status of HIV-infected children and adolescents in El Salvador: A cross-sectional study.

INTRODUCTION: The present study aimed to assess the nutritional status, the dietary patterns and its associated factors in the HIV-infected population of children and adolescents on antiretroviral treatment at the El Salvador reference center for pediatric HIV care (CENID). METHODS: A cross-sectional survey was carried out between December 2010 and December 2011. Socio-demographic and clinical characteristics were collected from 307 children and adolescents aged 2-18 years and receiving antiretroviral therapy. Nutritional status was assessed by height-for-age, weight-for-height and body mass index-for-age. Dietary data was collected through a 24 hour recall, and through a weekly food frequency questionnaire. Dietary patterns were identified by principal component analysis. Bivariate and multivariable statistical methods were used to assess the factors associated with "high adherence" to the "healthy diet" pattern. RESULTS: More than a third of the study group (33.2%) were stunted, 3.3% were identified as being wasted, and 10% were overweight or obese. Their diets were predominantly based on a high consumption of cereals, beans, eggs and processed foods and a low consumption of fruits, vegetables and dairy products. Three dietary patterns were identified: "healthy diet", "high fat/sugar diet" and "low diversity diet". Being female (OR: 1.63; 95%CI: 0.97-2.75), younger (OR: 2.37; 95%CI: 1.28-4.36) and institutionalized (OR: 14.5; 95%CI: 5.35-39.50) increased the odds to adhere to the "healthy diet" pattern. CONCLUSION: Our findings reveal a high prevalence of stunting and overweight in HIV-infected children in El Salvador. Institutionalized children were more likely to adhere to a healthy dietary pattern whereas children in poverty were more likely to have less varied and healthy diets. These results highlight the need to assess the dietary patterns of HIV-infected children and adolescents in order to guide public policies to design healthy life style interventions for this population at risk.

Indirect methods to estimate hidden population. / Métodos indirectos para la estimación de poblaciones ocultas.

Estimating the prevalence of the so-called "hidden populations" can be challenging, because the identification of its members is difficult due to their socially sanctionable or illegal behaviours. This article provides a critical review of the most widely used methods for estimating the size of a hard-to-reach population. All are indirect methods, based on incomplete data sources. Depending on the available data, one method can be more appropriate than another. Besides, each method must fulfil a number of requirements, and each one may be subject to specific risk of bias. To choose the most suitable method, an accurate evaluation of the available data is necessary, and. if possible several methods should be used simultaneously to be able to compare the results and to critically evaluate if these results fit with the reality.

En determinadas situaciones podemos encontrar dificultades a la hora de calcular prevalencias en algunas poblaciones. Es el caso de personas que tienen comportamientos que son difíciles de identificar debido a que pueden estar sancionados socialmente o ser ilegales. Es lo que llamamos poblaciones ocultas. Este artículo proporciona una revisión crítica de los métodos más utilizados para calcular el tamaño de una población de difícil acceso. Se trata de métodos indirectos, que estiman la prevalencia de una población oculta basándose en fuentes de datos incompletas. Se exponen diferentes métodos, cada uno de ellos tiene diferentes indicaciones para ser utilizado, dependiendo de los datos de los que dispongamos. Además, precisan de una serie de requisitos para poder ser aplicados y cada uno está expuesto a diferentes tipos de sesgos. Por estos motivos, hay que valorar correctamente los datos disponibles para aplicar el método más preciso, y si fuese posible, utilizar simultáneamente varios métodos para poder comparar los resultados obtenidos, además de valorar críticamente los resultados y comprobar si se ajustan a la realidad.

[Indirect methods to estimate hidden population]. / Métodos indirectos para la estimación de poblaciones ocultas.

Estimating the prevalence of the so-called "hidden populations" can be challenging, because the identification of its members is difficult due to their socially sanctionable or illegal behaviors. This article provides a critical review of the most widely used methods for estimating the size of a hard-to-reach population. All are indirect methods, based on incomplete data sources. Depending on the available data, one method can be more appropriate than another. Besides, each method must fulfill a number of requirements, and each one may be subject to specific risk of bias. To choose the most suitable method, an accurate evaluation of the available data is necessary, and. if possible several methods should be used simultaneously to be able to compare the results and to critically evaluate if these results fit with the reality.

En determinadas situaciones podemos encontrar dificultades a la hora de calcular prevalencias en algunas poblaciones. Es el caso de personas que tienen comportamientos que son difíciles de identificar debido a que pueden estar sancionados socialmente o ser ilegales. Es lo que llamamos poblaciones ocultas. Este artículo proporciona una revisión crítica de los métodos más utilizados para calcular el tamaño de una población de difícil acceso. Se trata de métodos indirectos, que estiman la prevalencia de una población oculta basándose en fuentes de datos incompletas. Se exponen diferentes métodos, cada uno de ellos tiene diferentes indicaciones para ser utilizado, dependiendo de los datos de los que dispongamos. Además, precisan de una serie de requisitos para poder ser aplicados y cada uno está expuesto a diferentes tipos de sesgos. Por estos motivos, hay que valorar correctamente los datos disponibles para aplicar el método más preciso, y si fuese posible, utilizar simultáneamente varios métodos para poder comparar los resultados obtenidos, además de valorar críticamente los resultados y comprobar si se ajustan a la realidad.

Dyslipidemia, Diet and Physical Exercise in Children on Treatment With Antiretroviral Medication in El Salvador: A Cross-sectional Study.

BACKGROUND: Dyslipidemias are common in HIV-infected children, especially if treated with protease inhibitors, but there are few data on how to treat dyslipidemias in this population. We estimated the dyslipidemia prevalence and its association with treatment, diet and physical exercise in children on antiretroviral treatment at the El Salvador reference center for pediatric HIV care (CENID). METHODS: Information was gathered regarding socio-demographic characteristics, treatment, diet and physical activity of 173 children aged 5-18 years and receiving antiretroviral therapy. Triglycerides, total cholesterol, low-density lipoprotein (LDL-C), high-density lipoprotein (HDL-C), viral load and CD4 T-lymphocytes were measured. Abnormal concentrations were defined as triglycerides ≥130 mg/dL in 10- to 18-year olds and ≥100 mg/dL in <10-year olds; total cholesterol ≥200 mg/dL; LDL-C ≥130 mg/dL and HDL-C ≤35 mg/dL. We adjusted 4 different multivariate models to assess the independent association of each type of dyslipidemia with protease inhibitors, diet and physical exercise. RESULTS: Of the 173 children, 83 (48%) had hypertriglyceridemia and 25 (14.5%) hypercholesterolemia. High LDL-C concentrations were observed in 17 children (9.8%) and low HDL-C in 38 (22%). Treatment with protease inhibitors was significantly associated with hypertriglyceridemia [prevalence ratio (PR) 2.8; 95% confidence interval (CI): 2.0-3.8] and hypercholesterolemia (PR 9.0; 95% CI: 3.6-22.2). Higher adherence to a "high fat/sugar diet" was associated with hypercholesterolemia (PR 1.6; 95% CI: 1.1-2.3) and high LDL-C (PR 1.7; 95% CI: 1.0-2.9). Compared with those exercising <3 times/week, children exercising ≥7 times were less likely to have low HDL-C (PR = 0.4; 95% CI: 0.2-0.7). CONCLUSIONS: These results suggest that a healthy diet and exercise habits can contribute to controlling some aspects of the lipid profile in this population.

Hypoxaemia as a Mortality Risk Factor in Acute Lower Respiratory Infections in Children in Low and Middle-Income Countries: Systematic Review and Meta-Analysis.

OBJECTIVE: To evaluate the association between hypoxaemia and mortality from acute lower respiratory infections (ALRI) in children in low- and middle-income countries (LMIC). DESIGN: Systematic review and meta-analysis. STUDY SELECTION: Observational studies reporting on the association between hypoxaemia and death from ALRI in children below five years in LMIC. DATA SOURCES: Medline, Embase, Global Health Library, Lilacs, and Web of Science to February 2015. RISK OF BIAS ASSESSMENT: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. RESULTS: Out of 11,627 papers retrieved, 18 studies from 13 countries on 20,224 children met the inclusion criteria. Twelve (66.6%) studies had either low or moderate risk of bias. Hypoxaemia defined as oxygen saturation rate (SpO2) <90% associated with significantly increased odds of death from ALRI (OR 5.47, 95% CI 3.93 to 7.63) in 12 studies on 13,936 children. An Sp02 <92% associated with a similar increased risk of mortality (OR 3.66, 95% CI 1.42 to 9.47) in 3 studies on 673 children. Sensitivity analyses (excluding studies with high risk of bias and using adjusted OR) and subgroup analyses (by: altitude, definition of ALRI, country income, HIV prevalence) did not affect results. Only one study was performed on children living at high altitude. CONCLUSIONS: The results of this review support the routine evaluation of SpO2 for identifying children with ALRI at increased risk of death. Both a Sp02 value of 92% and 90% equally identify children at increased risk of mortality. More research is needed on children living at high altitude. Policy makers in LMIC should aim at improving the regular use of pulse oximetry and the availability of oxygen in order to decrease mortality from ALRI.

Risk factors for mortality from acute lower respiratory infections (ALRI) in children under five years of age in low and middle-income countries: a systematic review and meta-analysis of observational studies.

OBJECTIVE: To evaluate risk factors for death from acute lower respiratory infections (ALRI) in children in low- and middle-income countries. DESIGN: Systematic review and meta-analysis. STUDY SELECTION: Observational studies reporting on risk factors for death from ALRI in children below five years in low- and middle income countries. DATA SOURCES: Medline, Embase, Global Health Library, Lilacs, and Web of Science to January 2014. RISK OF BIAS ASSESSMENT: Quality In Prognosis Studies tool with minor adaptations to assess the risk of bias; funnel plots and Egger's test to evaluate publication bias. RESULTS: Out of 10,655 papers retrieved, 77 studies from 39 countries (198,359 children) met the inclusion criteria. Host and disease characteristics more strongly associated with ALRI mortality were: diagnosis of very severe pneumonia as per WHO definition (odds ratio 9.42, 95% confidence interval 6.37‒13.92); age below two months (5.22, 1.70‒16.03); diagnosis of Pneumocystis Carinii (4.79, 2.67‒8.61), chronic underlying diseases (4.76, 3.27‒6.93); HIV/AIDS (4.68, 3.72‒5.90); and severe malnutrition (OR 4.27, 3.47‒5.25). Socio-economic and environmental factors significantly associated with increased odds of death from ALRI were: young maternal age (1.84, 1.03‒3.31); low maternal education (1.43, 1.13‒1.82); low socio-economic status (1.62, 1.32‒2.00); second-hand smoke exposure (1.52, 1.20 to 1.93); indoor air pollution (3.02, 2.11‒4.31). Immunisation (0.46, 0.36‒0.58) and good antenatal practices (0.50, 0.31‒0.81) were associated with decreased odds of death. CONCLUSIONS: Host and disease characteristics as well as socio-economic and environmental determinants affect the risk of death from ALRI in children. Together with the prevention and treatment of chronic diseases, interventions to modify underlying risk factors such as poverty, lack of female education, and poor environmental conditions, should be considered among the strategies to reduce ALRI mortality in children in low- and middle-income countries.

[Health problems of foreign adopted children in Spain]. / Problemas de salud de los niños extranjeros adoptados en España.

BACKGROUND: We decided to assess the health problems of internationally adopted children in Spain. PATIENTS AND METHODS: Retrospective study of 135 medical records from the Hospital Niño Jesus, Madrid. The prevalence of malnutrition, anemia, parasitosis and other acquired and congenital diseases was studied. RESULTS: 18.9% of children were considered completely healthy; 37.8% children had a single disease and 43.3% had two or more. 32.3% were found to have anemia, 30.2% parasitosis and 25.2% malnutrition. CONCLUSIONS: The high morbidity figures observed in our study reinforces the need of special medical care in this group of children.

[Young people dating violence surveillance in Madrid, Spain]. / Violencia de pareja en jóvenes de 15 a 16 años de la Comunidad de Madrid.

BACKGROUND: Dating violence in young adults is an important public health issue because of its magnitude and impact on health. The goal of this study is to determine the prevalence 12 months before the survey by sex and its association with socio-demographic and health risk behavior. METHODS: Data were drawn from the Non-communicable Disease Risk-Factor Surveillance System in young people (Spanish acronym, SIVFRENT-J), on a representative sample of students of the fourth-year of secondary education (15 to 16 years) in Madrid Region. The students were asked whether they had ever suffered any physical violence (PV) and/or sexual violence (SV) dating episodes. Prevalence with 95% confidence intervals (CI95%) of the occurrence of such episodes were estimated; generalized linear models with binomial family and logarithmic link were used to estimate the association between physical and/or sexual violence (PSV) and health risk behavior through prevalence ratios (PR, CI95%). RESULTS: In 1713 dating girls and 1664 dating boys, the prevalence of PV was 2.9% (CI95%:2.0-3.9) and 4.0% (CI95%:2.9-5.0) (p>0.05), SV 5.3% (CI95%:4.1-6.5) and 2.4% (CI95%:1.6-3.2) (p< 0.001) and PSV 7.1% (CI95%:5.6-8.6) and 5.1% (CI95%:4.0-6.3) (p<0.05) in that order. In the girls explanatory model, PSV was associated with eating disorders PR:1.74 (CI95%:1.14-2.66), sexual risk behavior (SRB), PR:1.67 (CI95%:1.11-2.50), excessive alcohol consumption, PR:1.57 (CI95%:1.06-2.34) and worse perceived health, PR:1.67 (CI95%:1.08-2.57). In boys, PSV was associated with having been born in a country other than Spain, PR:2.05 (CI95%:1.32-3.18), eating disorders, PR:2.79 (CI95%:1.58-4.92), SRB, PR:2.22 (CI95%:1.34-3.66) and drug consumption, PR:2.14 (CI95%:1.39-3.28). CONCLUSION: VFS was higher in girls and was associated to others health risk factors with similar characteristics according to sex.

Unperceived intimate partner violence and women's health.

OBJECTIVE: Women who experience intimate partner violence (IPV) often do not perceive themselves as abused. This study sought to estimate the health effects of unperceived IPV (uIPV), taking violence-free women as the reference, and to compare the effects of uIPV with those of perceived IPV (pIPV). METHOD: We performed a cross-sectional population study through telephone interviews of 2835 women aged 18 to 70 years living in the region of Madrid and having an ongoing intimate partner relationship or contact with a former partner in the preceding year. Based on 26 questions from the Conflict Tactics Scale-1 and the Enquête Nacional sur les Violences envers les Femmes en France and the question "Do you feel abused by your partner?" a variable was constructed in three categories, namely, the absence of IPV, uIPV and pIPV. Using logistic regression, we analyzed the association between health problems, medication use, health-service utilization and IPV (perceived and unperceived) vis-à-vis the absence of IPV. RESULTS: There were 247 cases of uIPV and 96 of pIPV (prevalences of 8.8% and 3.4%, respectively). The multivariate analysis showed that a substantial number of the outcomes explored were associated with uIPV, pIPV, or both. The highest odds ratios (ORs) were obtained for depression (Patient Health Questionnaire-9≥10) (uIPV: OR 3.4, 95% CI 2.4-3.8; and pIPV: 4.1, 95%CI 2.5-6.8). In most problems, the ORs did not significantly differ between the two types of IPV. CONCLUSIONS: uIPV is 2.6 times more frequent than pIPV and is associated with at least as many health problems as pIPV.