Lactancia materna y caries dental infantil: ¿tienen alguna relación? / Breastfeeding and early childhood caries: are they associated?

Introducción: existe controversia sobre si la lactancia materna (LM) prolongada puede ser un factor de riesgo de caries. La LM se recomienda hasta al menos los dos años y tiene demostrados beneficios sobre la salud, incluida la bucodental. Repasamos la evidencia científica y presentamos los resultados de nuestra cohorte. Métodos: cohorte prospectiva, abierta y multipropósito de niños de 4-5 años, cuyos padres responden a cuestionarios autorreferidos acerca de hábitos nutricionales y estilo de vida. Análisis retrospectivo de prevalencia de caries según duración de LM. Ajustamos por edad, sexo, raza, conocimientos nutricionales y actitudes dietéticas de los padres, adhesión a la dieta mediterránea, ingesta energética total y de azúcar. Resultados: se alcanzó un tamaño muestral de 370 participantes, 50 de los cuales había tenido, al menos una caries. La LM hasta los 12 meses se asociaba con un menor riesgo de caries, pero la LM de más de 12 meses se asociaba con un riesgo mayor (odds ratio [OR]: 2,75; intervalo de confianza del 95% [IC 95]: 1,397 a 5,44; p = 0,003). La ingesta energética total o la de azúcar no resultaron ser confusores importantes para la asociación estudiada. La adhesión a dieta mediterránea puede tener un efecto protector, hace falta más investigación al respecto. Conclusiones: existe una asociación directa estadísticamente significativa entre la LM de más de 12 meses y el riesgo de caries. Sin embargo, la LM hasta los 12 meses es un factor protector. Los resultados obtenidos son consistentes con la literatura médica existente (AU)

Introduction and objectives: there is debate whether prolonged breastfeeding is a risk factor for caries. Breastfeeding, recommended for at least two years, has been associated with several benefits, including in oral health. We reviewed the literature on the subject, and present the results observed in the cohort under study.Methods: study conducted in a prospective, open-enrolment and multipurpose cohort of children aged 4-5 years, whose parents completed a self-administered questionnaire regarding diet and lifestyle habits. We performed a retrospective analysis of the prevalence of caries based on the duration of breastfeeding. We adjusted the analysis by age, sex, race, parental knowledge and attitudes, total energy and sugar intake and adherence to the Mediterranean diet.Results: the sample included 370 children, of who 50 had developed caries. Breastfeeding up to 12 months was associated with a lower risk of caries, but breastfeeding longer than 12 months was associated with an increased risk (OR 2.75; 95 IC: 1.397 - 5.44; p = 0.003). The total energy and sugar intakes were not significant confounders in the association under study. Adherence to the Mediterranean diet may have a protective effect, but more research is needed to confirm it.Conclusions: we found a significant direct association between breastfeeding for more than 12 months and the prevalence of caries. However, breastfeeding for less than 12 months had a protective effect. Our findings were consistent with the previous litera ture. (AU)

Hiperfrecuentadores en urgencias. ¿Quiénes son? ¿Por qué consultan? / Frequent users in paediatric emergency departments. Who are they? Why do they consult?

OBJETIVO: Determinar la prevalencia de hiperfrecuentadores en urgencias y analizar sus características, comparando secundariamente las primeras consultas y las reconsultas. MÉTODO: Estudio multicéntrico de cohorte retrospectivo. Se cuantifican las visitas a urgencias de pediatría de 5 hospitales públicos entre el 1 de enero y 31 de diciembre de 2013 y se seleccionan los pacientes con 10 o más visitas realizadas. Se recogen variables demográficas y clínicas y se analiza cada visita en función de si se trata de una primera consulta o una reconsulta. RESULTADOS: Los pacientes hiperfrecuentadores constituyeron el 0,60% (IC 95%: 0,56-0,64%) de los usuarios de urgencias y generaron el 3,93% (IC 95%: 3,47-4,39%) de las consultas. Los menores de 2años fueron el grupo de edad más numeroso (66,6%). Distribuyeron sus consultas durante los 4 trimestres (62,3%; p < 0,001) y no presentaron patología de base relacionada con el motivo de consulta (86,4%; p < 0,001). La mayoría se clasificaron como poco urgentes (3.186 vs. 1.812; p < 0,001) y habitualmente no precisaron intervenciones en forma de pruebas complementarias (79,4%) u observación/tratamiento (60%). La tasa de ingreso fue similar a la de la población general pediátrica (5,3%). Las reconsultas representaron el 27% de las visitas de estos pacientes, el 13,82% de ellos consultó en atención primaria antes de las siguientes visitas y fueron justificadas preferentemente por persistencia de los síntomas (56,34%). CONCLUSIONES: El hiperfrecuentador pediátrico consulta en urgencias como primera opción por procesos generalmente poco urgentes que no requieren intervenciones diagnóstico-terapéuticas de forma sistemática. Las reconsultas constituyen un número importante de visitas, se caracterizan por precisar más intervenciones y se indican más ingresos hospitalarios

OBJECTIVE: To determine the prevalence of frequent Paediatric Emergency Departments users and to analyse their characteristics, comparing initial consultations and re-consultations. METHODS: This is a multicentre retrospective cohort study of all patients who made 10 or more visits to the Paediatric Emergency Departments of 5 public hospitals between 1 January 2013 and 31 December 2013. An analysis was performed on the patient demographics and clinical data of the first consultation and consecutive re-consultations. RESULTS: Frequent users represented 0.60% (95% CI: 0.56-0.64%) of Emergency Department users, and accounted for 3.93% (95% CI: 3.47-4.39%) of all visits. The most numerous age group consisted of children under 2 years old (66.6%). Frequent users distributed their visits throughout the year (62.3%; P<.001), and did not have a chronic condition associated with their chief complaint (86.4%; P<.001). They were usually classified as non-urgent or less urgent in triage (3,186 vs. 1,812; P<.001), and often did not require any intervention, such as complementary tests (79.4%) or observation/treatment (60%). Admission rate was similar to the general paediatric population (5.3%). Re-consultations represented 27% of these patient visits, mostly related to persistence of symptoms (56.3%), with 13.8% of them consulting their Primary Care physician before seeking successive medical attention in the Paediatric Emergency Department. CONCLUSIONS: Paediatric frequent users often ask for medical care in the Emergency Department before consulting their Primary Care physician. They present with less urgent processes and do not systematically need diagnostic or therapeutic interventions. Re-consultations make up a significant number of visits, in which more interventions are done and more children are admitted

[Frequent users in paediatric emergency departments. Who are they? Why do they consult?] / Hiperfrecuentadores en urgencias. ¿Quiénes son? ¿Por qué consultan?

OBJECTIVE: To determine the prevalence of frequent Paediatric Emergency Departments users and to analyse their characteristics, comparing initial consultations and re-consultations. METHODS: This is a multicentre retrospective cohort study of all patients who made 10 or more visits to the Paediatric Emergency Departments of 5 public hospitals between 1 January 2013 and 31 December 2013. An analysis was performed on the patient demographics and clinical data of the first consultation and consecutive re-consultations. RESULTS: Frequent users represented 0.60% (95% CI: 0.56-0.64%) of Emergency Department users, and accounted for 3.93% (95% CI: 3.47-4.39%) of all visits. The most numerous age group consisted of children under 2 years old (66.6%). Frequent users distributed their visits throughout the year (62.3%; P<.001), and did not have a chronic condition associated with their chief complaint (86.4%; P<.001). They were usually classified as non-urgent or less urgent in triage (3,186 vs. 1,812; P<.001), and often did not require any intervention, such as complementary tests (79.4%) or observation/treatment (60%). Admission rate was similar to the general paediatric population (5.3%). Re-consultations represented 27% of these patient visits, mostly related to persistence of symptoms (56.3%), with 13.8% of them consulting their Primary Care physician before seeking successive medical attention in the Paediatric Emergency Department. CONCLUSIONS: Paediatric frequent users often ask for medical care in the Emergency Department before consulting their Primary Care physician. They present with less urgent processes and do not systematically need diagnostic or therapeutic interventions. Re-consultations make up a significant number of visits, in which more interventions are done and more children are admitted.