Patrones de sueño de los niños sanos a los cuatro años: factores sociales y estilos de crianza / Sleep patterns of healthy children at age four: social factors and parenting styles

INTRODUCCIÓN: estudio descriptivo transversal mediante un cuestionario en las consultas de Pediatría de Atención Primaria en centros de salud, cuyo objetivo es describir el patrón de sueño en los niños de cuatro años, nacidos a término, en dos zonas urbanas de la Comunidad de Madrid, y estudiar posibles asociaciones con diversas variables: antecedentes de crianza y hábitos del sueño, factores socioeconómicos y familiares. MATERIAL Y MÉTODOS: se ha estudiado a 193 niños, de los cuales 111 (57,8%) presentaron un test de cribado alterado. Un 94,9% duerme nueve o más horas nocturnas. Dentro de los antecedentes de crianza, un 89,6% ha recibido lactancia materna y el 51,8% la ha mantenido más de seis meses. El 28,5% de los padres realizó colecho. En el momento actual, el 51% comparte habitación con hermanos, mientras que el 9,9% duerme con los padres. El 57,8% utiliza aparatos electrónicos como inductores del sueño. RESULTADOS: se ha encontrado un mayor porcentaje de posibles alteraciones del sueño en niños que son hijos únicos, no asistieron a guardería, duermen con los padres en el momento actual, realizan colecho reactivo y utilizan aparatos electrónicos después de cenar. CONCLUSIONES: se concluye que la prevalencia de signos de alarma de un trastorno del sueño es alta, y dadas las implicaciones a largo plazo de estos problemas, es importante tener un protocolo de cribado adecuado para identificar a los niños con posibles alteraciones. Conocer las asociaciones estudiadas podría permitir al pediatra realizar una labor educativa con las familias susceptibles, para prevenir o solucionar estas alteraciones

INTRODUCTION: we conducted a cross-sectional and descriptive study by means of a questionnaire in the paediatrics clinics of the Paseo Imperial and Pozuelo Estación primary care centres in Madrid with the aim of describing the sleep patterns of children born at term currently aged 4 years in 2 urban areas of the Community of Madrid and of analysing potential associations with various variables: parenting history and sleep habits and socioeconomic and family-related factors. MATERIAL AND METHODS: the study included 193 children, of who 111 (57.8%) had abnormal screening results; 94.9% slept 9 or more hours per night. When it came to the parenting history, 89.6% had been breastfed, 51.8% for more than 6 months, and 28.5% had coslept with parents. At the time of the study, 51% shared a room with siblings, while 9.9% slept with parents. Also, 57.8% use electronic devices for sleep induction. RESULTS: we found higher percentages of possible sleep disturbances in only children, children not attending a childcare centre, currently sleeping with parents, that engaged in reactive cosleeping or used electronic devices after dinner. CONCLUSIONS: the prevalence of warning signs of sleep disorders was high, and given the long-term repercussions of these problems, it is important to have in place an adequate screening protocol to identify children with potential disturbances. Adequate awareness of identified associations would allow paediatricians to deliver educational interventions to susceptible families in order to prevent or resolve sleep abnormalities

MULTICAGE CAD-4: Psychometric characteristics for the screening of addictive behaviors / MULTICAGE CAD-4 para la detección de adicciones conductuales: validez estructural después de la inclusión de una escala en el abuso de teléfonos inteligentes

Addictive behaviors are not limited to drugs use, but also include certain daily behaviors that can cause gratification. Their progression to more severe pathological patterns entails grave consequences for the individual, including multiple psychopathological manifestations. The early detection of this type of behavior is of concern to primary health care. Therefore, in order to detect risk at early stages, reliable and valid tools for daily practice are essential. The MULTICAGE CAD-4 questionnaire is a screening tool for simultaneously detecting addictive behaviors. This study includes a new scale for the detection of smartphone abuse. The objective is to evaluate the adequacy of its psychometric properties. A sample of 2,074 subjects that were recruited from primary care centers ofMadrid(Spain) completed the MULTICAGE CAD-4 questionnaire. A confirmatory factor analysis, using unweighted least squares method, was performed. The test showed good internal consistency both at item and scale levels. The questionnaire structure was consistent with theoretical expectations. The MULTICAGE CAD-4, including the new smartphone scale, is a robust, reliable tool with a valid structure for assessing the presence of dysfunctional or potentially addictive behaviors, and especially useful in primary health care services

Los comportamientos adictivos no se limitan al uso de drogas, sino que también incluyen ciertos comportamientos diarios que pueden causar gratificación. Su progresión a patrones patológicos más severos conlleva graves consecuencias para el individuo, incluidas múltiples manifestaciones psicopatológicas. La detección temprana de este tipo de comportamiento es de interés para la atención primaria de salud. Por lo tanto, para detectar riesgos en etapas tempranas, las herramientas confiables y válidas para la práctica diaria son esenciales. El cuestionario MULTICAGE CAD-4 es una herramienta de detección para detectar simultáneamente conductas adictivas. Este estudio incluye una nueva escala para la detección del abuso de teléfonos inteligentes. El objetivo es evaluar la adecuación de sus propiedades psicométricas. Una muestra de 2.074 sujetos reclutados en centros de atención primaria de Madrid (España) completó el cuestionario MULTICAGE CAD-4. Se realizó un análisis factorial confirmatorio, utilizando el método de mínimos cuadrados no ponderados. La prueba mostró una buena consistencia interna tanto a nivel del ítem como de las escalas. La estructura del cuestionario fue consistente con las expectativas teóricas. El MULTICAGE CAD-4, incluida la nueva escala para teléfonos inteligentes, es una herramienta robusta y confiable con una estructura válida para evaluar la presencia de comportamientos disfuncionales o potencialmente adictivos, y especialmente útil en servicios de atención primaria de salud

Prevalencia de la lactancia materna y factores asociados con el inicio y la duración de la lactancia materna exclusiva en la Comunidad de Madrid entre los participantes en el estudio ELOIN / Prevalence of breastfeeding and factors associated with the start and duration of exclusive breastfeeding in the Community of Madrid among participants in the ELOIN

INTRODUCCIÓN: La lactancia materna tiene importantes beneficios para la salud poblacional. Los objetivos de este estudio son: a) conocer la prevalencia y duración de la lactancia materna y lactancia materna exclusiva; b) analizar las razones de no inicio y de abandono de la lactancia materna, y c) describir los factores asociados a la lactancia materna exclusiva y con su mantenimiento durante 6meses. MATERIAL Y MÉTODOS: Estudio transversal a partir de datos basales de la cohorte ELOIN, obtenidos por cuestionario epidemiológico. Se estudió una muestra de 2.627 niños de 4años nacidos en 2008-2009 de la Comunidad de Madrid. Se utilizaron modelos de regresión logística. RESULTADOS: La prevalencia de lactancia materna exclusiva y lactancia materna fue del 77,6 y del 88%, respectivamente; la lactancia materna exclusiva a los 6 meses fue del 25,4%, y la lactancia materna a los 2 años, del 7,7%. Las razones principales de finalización de la lactancia fueron la producción insuficiente de leche (36%) y la incorporación al trabajo (25,9%). Las variables asociadas con el inicio o mantenimiento de la lactancia materna exclusiva fueron: madre de más de 35años, estatus económico medio-alto, extranjera con menos de 10 años de residencia en España y haber participado en taller de lactancia tras el parto. CONCLUSIONES: La prevalencia de lactancia materna en la Comunidad de Madrid no alcanzó en 2008-2009 las recomendaciones internacionales. Es necesario intensificar estrategias de promoción, protección y apoyo a la lactancia materna, incluyendo su monitorización periódica

INTRODUCTION: Breastfeeding has important benefits for population health. The aims of this study are: (I) to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (II) analyse the reasons for not starting or abandoning of breastfeeding, and (III) describe the factors associated with the initiation and duration of exclusive breastfeeding. MATERIAL AND METHODS: Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2,627 children born in 2008-2009 from the Community of Madrid was studied. Logistic regression models were used. RESULTS: Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6 months 25.4%, and prevalence of breastfeeding at 2 years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35 years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. CONCLUSIONS: Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008-2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring

[Prevalence of breastfeeding and factors associated with the start and duration of exclusive breastfeeding in the Community of Madrid among participants in the ELOIN]. / Prevalencia de la lactancia materna y factores asociados con el inicio y la duración de la lactancia materna exclusiva en la Comunidad de Madrid entre los participantes en el estudio ELOIN.

INTRODUCTION: Breastfeeding has important benefits for population health. The aims of this study are: (i)to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (ii)analyse the reasons for not starting or abandoning of breastfeeding, and (iii)describe the factors associated with the initiation and duration of exclusive breastfeeding. MATERIAL AND METHODS: Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2,627 children born in 2008-2009 from the Community of Madrid was studied. Logistic regression models were used. RESULTS: Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6months 25.4%, and prevalence of breastfeeding at 2years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. CONCLUSIONS: Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008-2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring.

Breastfeeding promotion plan in Madrid, Spain.

BACKGROUND: Promotion and protection of breastfeeding is a public health objective. In April 2009, health authorities in the Madrid region in central Spain signed a collaboration agreement with The United Nations Children's Fund and created a breastfeeding committee. OBJECTIVE: To report the creation and implementation of a plan to promote and improve the quality of breastfeeding care in public hospitals in the region of Madrid, according to the Baby-Friendly Hospital Initiative (BFHI) standards. METHODS: The action plan included institutional commitment; creation of a breastfeeding committee in each hospital; outcome analyses, staff training, creation of educational materials; and dissemination of activities. The plan was adopted by the 19 non-BFHI-designated public maternity units in the Madrid region. Each hospital completed a modified version of the World Health Organization self-assessment questionnaire in 2009 (pre-intervention) and again in 2011. RESULTS: Thirteen maternity units (68.4%) established a breastfeeding committee, and 32 months after implementation of the plan, the other 6 hospitals have created one. Nine training courses have been carried out to train professional experts on breastfeeding as trainers. The 271 trainers provided 18-hour breastfeeding courses for 1423 professionals. In 2009, there was only 1 BFHI-accredited hospital. Currently, 52.6% of the other 19 hospitals have some level of accreditation, and 2 are fully accredited. CONCLUSIONS: An intervention to improve the quality of breastfeeding care based on an organized regional approach to the BFHI was useful for BFHI implementation.

Effectiveness of an implementation strategy for a breastfeeding guideline in Primary Care: cluster randomised trial.

BACKGROUND: The protection and promotion of breastfeeding is considered a priority in Europe where only 22% of infants less than 6 months old are exclusively breastfed. In Spain this percentage reaches 24.8% but in our city it falls to 18.26%. Various studies emphasise that the improvement of these results should be based upon the training of health professionals. Following the recommendations of a breastfeeding guide can modify the practice of health professionals and improve results with respect to exclusively or predominatly breastfed children at 6 months of age. METHOD/DESIGN: This study involves a community based cluster randomized trial in primary healthcare centres in Leganés (Madrid, Spain). The project aims to determine whether the use of an implementation strategy (including training session, information distribution, opinion leader) of a breastfeeding guideline in primary care is more effective than usual diffusion. The number of patients required will be 240 (120 in each arm). It will be included all the mothers of infants born during the study period (6 months) who come to the health centre on the first visit of the child care programme and who give their consent to participate. The main outcome variable is the exclusive o predominant breastfeeding at 6 moths of age..Main effectiveness will be analyzed by comparing the percentage of infants with exclusive or predominant breastfeeding at 6 months between the intervention group and the control group. All statistical tests will be performed with intention to treat. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis. DISCUSSION: Strategies need to be found which facilitate the giving of effective advice on breastfeeding by professionals and which provide support to women during the breastfeeding period. By applying the guide's recommendations, clinical variability can be reduced and the care received by patients can be improved. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov, number NCT01474096.