Influencia de los cambios demográficos en la frecuentación de urgencias hospitalarias: 13 años de experiencia / Influence of demographic changes on the number of visits to hospital emergency departments: 13 years experience

Objetivo: Este estudio evalúa la influencia del crecimiento de la población en la utilización del Servicio de Urgencias Pediátricas de un hospital universitario de Cantabria (España) entre enero de 2001 y diciembre de 2013. Material y métodos: Se realizó un estudio retrospectivo de todas las urgencias ocurridas durante 13 años. Se emplean modelos de regresión lineal simple y polinómica para analizar la relación entre la población y la frecuentación en 2 grupos de edad (0-2 y 3-14 años). Resultados: De 2001 a 2013, las urgencias aumentaron un 14,1% y la población pediátrica un 26,3%. Las tasas de presentación por persona fueron mayores en los menores de 3 años, 1,48 (IC 95% 1,40 a 1,56) frente a 0,46 (IC 95% 0,44 a 0,48) (p < 0,01). El modelo de regresión lineal simple muestra que el crecimiento de la población produce un aumento continuo de las urgencias en los menores de 3 años (R2 = 0,50, F(1, 11) = 11,2, p < 0,05). En pacientes de 3 a 14 años la frecuentación se ajusta a un modelo de regresión cuadrática (R2 = 0,48, F(2, 10) = 4.6, p < 05) y el incremento de la población aumenta las urgencias hasta alcanzar un punto de inflexión a partir del cual disminuyen. Conclusiones: El grupo de edad de 0 a 2 años presentó un aumento constante en las urgencias relacionado con el crecimiento de la población, mientras que el grupo de 3 a 14 años experimentó una «saturación de la demanda» y una reducción de las visitas

Objective: The aim of the present study is to describe the trend in volume and age-specific rates in visits to the Paediatric Emergency Department of a university teaching hospital in Cantabria (Spain) from January 2001 to December 2013, and evaluate the influence of population growth on Emergency Department use. Material and methods: A retrospective study was conducted in which an analysis was made on all Emergency Department visits over a 13 year period. Simple and polynomial linear regressions were used to assess the relationship between population size and Emergency Department attendance rates across 2 age groups (0-2 and 3-14 years). Results: From 2001 to 2013, attendance in the Emergency Department increased by 14.1%, whereas the paediatric population rose by 26.3%. Rates of presentation per head of population were greatest among those aged < 3 years: 1.48 (95% CI 1.40-1.56) vs. 0.46 (95% CI 0.44-0.48) for the older age group (P < .01). A significant regression equation was found (F(1, 11) = 11.2, P < .05) with an R2 = 0.50, showing that population growth produces a continuous rise in the Emergency Department visits for those aged < 3 years. However, ED presentations of patients aged 3-14 years fit a quadratic regression model (R2 = 0.48, F(2, 10) = 4.6, P < .05) so increases in population increase ED presentations until an inflection point, after which increases in population will decrease ED visits. Conclusions: Those aged 0-2 years presented a steady increase in ED visits related to population growth, whereas children aged 3-14 years experienced a "saturation of the demand" and a reduction in ED presentations

[Influence of demographic changes on the number of visits to hospital emergency departments: 13 years experience]. / Influencia de los cambios demográficos en la frecuentación de urgencias hospitalarias: 13 años de experiencia.

OBJECTIVE: The aim of the present study is to describe the trend in volume and age-specific rates in visits to the Paediatric Emergency Department of a university teaching hospital in Cantabria (Spain) from January 2001 to December 2013, and evaluate the influence of population growth on Emergency Department use. MATERIAL AND METHODS: A retrospective study was conducted in which an analysis was made on all Emergency Department visits over a 13 year period. Simple and polynomial linear regressions were used to assess the relationship between population size and Emergency Department attendance rates across 2 age groups (0-2 and 3-14 years). RESULTS: From 2001 to 2013, attendance in the Emergency Department increased by 14.1%, whereas the paediatric population rose by 26.3%. Rates of presentation per head of population were greatest among those aged<3 years: 1.48 (95% CI 1.40-1.56) vs. 0.46 (95% CI 0.44-0.48) for the older age group (P<.01). A significant regression equation was found (F[1, 11]=11.2, P<.05) with an R2=0.50, showing that population growth produces a continuous rise in the Emergency Department visits for those aged<3 years. However, ED presentations of patients aged 3-14 years fit a quadratic regression model (R2=0.48, F[2, 10]=4.6, P<.05) so increases in population increase ED presentations until an inflection point, after which increases in population will decrease ED visits. CONCLUSIONS: Those aged 0-2 years presented a steady increase in ED visits related to population growth, whereas children aged 3-14 years experienced a "saturation of the demand" and a reduction in ED presentations.

Motivos de abandono y no práctica de actividad físicodeportiva en adolescentes españoles: estudio Avena / Motives of Doprout and Non Practice Physical Activity and Sport in Spanish Adolescents: The Avena Study

A pesar de los reconocidos beneficios físicos, psíquicos y sociales que la práctica de actividad físico-deportiva produce en la salud de los jóvenes,la prevalencia de abandono y falta de este tipo de actividades está mostrando un importante aumento a nivel mundial, particularmente en los países desarrollados. Se precisan actuaciones educativas inmediatas para frenar esta situación. El objetivo del estudio es analizar la expresión de interés hacia la actividad físico-deportiva atendiendo al nivel de participación de ésta, y conocerlos motivos de abandono y no práctica en una muestra representativa de adolescentes españoles. Se efectuó un estudio descriptivo de corte transversal y se empleó la encuesta sobre comportamientos, actitudes y valores sobreactividad físico-deportiva del estudio AVENA (Alimentación y Valoración del Estado Nutricional en Adolescentes). La muestra fue de 2.859 adolescentes españoles (1.357 hombres, 1.502 mujeres; rango de edad: 13-18,5 años)y elegida de entre los escolares de Enseñanza Secundaria, procedentes tanto de centros públicos como privados de cinco ciudades españolas: Granada, Madrid, Murcia, Santander y Zaragoza. Los principales resultados verifican una elevada expresión de interés hacia la práctica físico-deportiva aunque casi la mitad de los adolescentes indican un nivel de participación insuficiente respecto a lo que realmente querrían practicar. La exigencia del estudio y la pereza y desgana suponen los principales motivos de abandono de la misma. Respecto a los motivos de no práctica, la falta de tiempo, seguido muy de lejo (..) (AU)

Despite the recognized physical, psychological and social benefits of physical and sport practice in the health of young people, prevalence of doprout and lack of such activities is increasing in developed countries. Interventions of different society institutions are required, being particularly relevant educational institutions. The aim of the study is to analyze the interest physical activity and sport regarding the level of participation in this practice and to know the reasons for abandoning and non practicing in a representative sample of Spanish adolescents. A descriptive cross-sectional study was implemented and the survey about behaviours, attitudes and values related to physical activity and sport practice, which was developed in the AVENA (Feeding and assessment of nutritional status of spanish adolescents) study. The sample size was 2859Spanish adolescents (1.357 men, 1.502 women; age range: 13-18.5 years) and (..) (AU)

Apesar dos reconhecidos benefícios físicos, psíquicos e sociais que produz a pratica de atividade fisico-esportivo em jovens, a prevalência de abandono e a falta dessa atividade esta crescendo a nível mundial especialmente em países desenvolvidos. Necessitam atuações educativas imediatas para desaceleraressa situação. O objetivo desse estudo é (..)(AU)

[Therapeutic potential of the endocannabinoid system in perinatal asphyxia]. / Potencial terapéutico del sistema endocannabinoide en la asfixia perinatal.

INTRODUCTION: Perinatal asphyxia is the most frequent cause of neonatal brain injury and, despite advances in neonatology, it has not been possible to reduce its incidence. This is due to the difficulty to diagnose with precision the presence and onset of hypoxia and also to the existence of a limited period of time in which rescue strategies are effective. Thus, it is necessary to find out new and more effective therapeutic strategies, appearing the use of cannabinoids as a promising one. DEVELOPMENT: The endocannabinoid system modulates a wide range of physiological processes in mammals, being its participation in the retrograde system of signaling one of the most important, so it has been considered as an endogenous neuroprotective system. In experimental models of perinatal asphyxia, modulation of the endocannabinoid system through the administration of synthetic cannabinoids and endocannabinoids has demonstrated neuroprotective effects both in vitro and in vivo, by inhibition the intracellular calcium influx, decreasing the release of glutamate and cytokines, diminishing the inflammatory response and leading hypothermia. Moreover, it seems to play an important role in the development of the central nervous system, as it appears in the fetal period since the beginning. CONCLUSION: Modulation of the endocannabinoid system appears as a novel therapeutic strategy against neonatal hypoxic-ischemic brain injury.

Potencial terapéutico del sistema endocannabinoide en la asfixia perinatal / Therapeutic potential of the endocannabinoid system in perinatal asphyxia

Introducción. La asfixia perinatal es la causa más frecuente de lesión cerebral en el neonato y, pese a los avances de la neonatología, no se ha conseguido reducir su incidencia. Esto se debe, en gran parte, a la dificultad de diagnosticar con precisión la presencia y el inicio de un cuadro hipóxico, y a la existencia de un período limitado para la aplicación de las estrategias de rescate. Por todo ello, se hace necesaria la búsqueda de nuevas y más efectivas estrategias terapéuticas, entre las que el empleo de cannabinoides aparece como muy prometedor. Desarrollo. El sistema endocannabinoide actúa en un amplio rango de procesos fisiológicos en mamíferos, siendo su participación en el sistema retrógrado de señalización neuronal uno de los más importantes, por lo que se empieza a considerar como un sistema neuroprotector endógeno de gran relevancia. En modelos experimentales de asfixia perinatal,la modulación del sistema endocannabinoide mediante la administración de cannabinoides sintéticos y endocannabinoides ha demostrado generar un elevado efecto neuroprotector tanto en estudios in vivo como in vitro, mediante su capacidad para inhibir la entrada masiva de calcio, reducir la liberación de glutamato y de citocinas, disminuir la respuesta inflamatoria e inducir hipotermia. Además, aparece desde las primeras etapas del período fetal, apuntando a que desempeña un papel relevante en el desarrollo del sistema nervioso central. Conclusiones. La modulación del sistema endocannabinoide se postula como una prometedora vía de actuación en la búsqueda de nuevas estrategias terapéuticas frente al daño hipóxico-isquémico neonatal (AU)

Introduction. Perinatal asphyxia is the most frequent cause of neonatal brain injury and, despite advances in neonatology, it has not been possible to reduce its incidence. This is due to the difficulty to diagnose with precision the presence and onset of hypoxia and also to the existence of a limited period of time in which rescue strategies are effective. Thus, it is necessary to find out new and more effective therapeutic strategies, appearing the use of cannabinoids as a promising one. Development. The endocannabinoid system modulates a wide range of physiological processes in mammals, being its participation in the retrograde system of signaling one of the most important, so it has been considered as an endogenous neuroprotective system. In experimental models of perinatal asphyxia, modulation of the endocannabinoid system through the administration of synthetic cannabinoids and endocannabinoids has demonstrated neuroprotective effects both in vitro and in vivo, by inhibition the intracellular calcium influx, decreasing the release of glutamate and cytokines, diminishing the inflammatory response and leading hypothermia. Moreover, it seems to play an important role in the development of the central nervous system, as it appears in the fetal period since the beginning. Conclusion. Modulation of the endocannabinoid system appears as a novel therapeutic strategy against neonatal hypoxicischemic brain injury (AU)

Breast-feeding and risk of hospitalization for all causes and fever of unknown origin.

BACKGROUND: Breast-feeding has shown to give a reduction in the risk of hospitalization due to respiratory tract infections and gastrointestinal conditions during the first two years of life. The association of breast-feeding with all admission causes and with fever of unknown origin (FUO) was analysed. METHODS: A case-reference study in Cantabria (northern Spain) was carried out. Cases (n=336) were hospitalized children aged less than 24 months at University of Cantabria Hospital; the reference was a 1:1 matched (by time from delivery to admission) sample of children from mothers delivering at the same hospital. Information on breast-feeding, socioeconomic variables and employment were obtained. Odds ratios (ORs), their 95% confidence intervals (CIs), and mean length of breast-feeding were estimated after adjusment for confounding variables. RESULTS: In the reference population, shorter duration of breast-feeding was associated with smoking, lower educational level, and less privileged social strata. The frequency of breast-feeding was higher in the reference than in the cases, 82.3% vs 75.6% (p=0.023). Significant negative trends were noted in univariate analyses between the length of breast-feeding and both all admission causes and FUO, although the statistical significance was lost after adjusting for confounding variables (educational level, social class, smoking, and use of incubator after delivery). The adjusted mean length of breast-feeding was shorter in hospitalized children < or = 6 months old for both all admission causes (40.6 +/- 5.4 vs 99.5 +/- 5.4, p < 0.001) and FUO (40.8 +/- 12.4 vs 91.7 +/- 12.4, p=0.006). CONCLUSION: Breast-feeding time is shorter in hospitalized children for both all admission causes and FUO.