[Satisfaction with primary care nursing: use of measurement tools and explanatory factors]. / Satisfacción con la enfermera en atención primaria: herramientas de medida y factores explicativos.

OBJECTIVES: This study aims to assess the psychometric properties of two measurement tools for patient satisfaction with nursing care in Primary Care, the satisfaction level, and the personal and consultation characteristics associated with its variability. METHODS: Subjects randomly selected in 23 Health Care centres in the Community of Madrid were included. Satisfaction was measured by means of the AMABLE and Baker questionnaires, in which the psychometric properties were evaluated. Sociodemographic characteristics of the consultations, variables related to health status, and other related to the consultation process were collected. An explanatory model using Generalized Estimating Equations was constructed. RESULTS: The 662 subjects expressed a mean satisfaction of 4.95/5 (SD .25) with AMABLE, and 4.83/5 (SD .42) with the Baker questionnaire. AMABLE had a single dimension (Cronbach's alpha .85), and Baker three: professional care (mean 4.76, SD .48 Cronbach's alpha .74), depth of relationship (mean 3.76, SD 1.18, Cronbach's alpha .73), and perceived time (mean 4.42, SD .86, Cronbach's alpha .47). Ageing, a better perception of health status, and appointments arranged by nurses were associated with higher expressed satisfaction. Home care, hospital admissions, delayed consultation, extended family, or high family income were associated with lower satisfaction. CONCLUSIONS: Satisfaction with nurse consultations in Primary Care was very high, and varied depending on personal characteristics and on the type of consultation. The assessed tools allowed this outcome to be measured properly.

[Cardiac abnormalities in children with neuromuscular diseases]. / Alteraciones cardiológicas en niños con enfermedad neuromuscular.

BACKGROUND: To evaluate cardiac abnormalities in children with different neuromuscular diseases (NMD) PATIENTS AND METHOD: In 40 patients with NMD, cardiac abnormalities were evaluated by cardiac auscultation, chest X-ray, electrocardiography (ECG), ambulatory Holter ECG and Doppler echography. RESULTS: Sinus tachycardia, high R/S complex, deep Q waves, repolarization disorders, electrical conduction abnormalities, auricular and ventricular extrasystoles, Wolff-Parkinson-White syndrome, mitral valve prolapse and dilated cardiomyopathy were found. CONCLUSIONS: The association of cardiac abnormalities in children with NMD is frequent. Conventional ECG monitorization, Holter ECG and echocardiography allow their diagnosis and follow-up.

[Secular increase of adipose tissue in adolescents from Zaragoza from 1980 to 1995]. / Incremento secular del tejido adiposo en adolescentes zaragozanos desde 1980 hasta 1995.

BACKGROUND: To quantify the differences between anthropometric measurements obtained nowadays in male and female adolescents and those obtained 15 years ago in a sample of similar characteristics. SUBJECTS AND METHODS: We have studied 658 healthy individuals, 329 males and 329 females from 10.0 to 15.0 years of age, from different socioeconomic levels. Weight, height, arm circumference and left skinfold thickness (biceps, triceps, subscapular and suprailiac) have been measured. We have calculated the body mass index (BMI), density, total body fat, percentage of body fat and the body adipose muscular index (BAMI), which is the ratio between body fat (kg) and non fat mass (kg). The values obtained have been compared with those obtained fifteen years ago, in another sample of 1,465 children with similar characteristics. The research team and the material used were the same in both studies. Mean differences were compared using the unpaired t-test. RESULTS: Weight has increased significantly (p < 0.05), except for males at 12 years and females at 13 and at 14 years. Height has increased significantly at all ages and in males and females (p < 0.05). BMI has only increased significantly at 10 and at 11 years in males, and at 10 years in females. Skinfold thicknesses have also increased significantly, except for biceps in males between ages of 12 and 14 years and biceps and subscapular in females at 14 years. Body fat mass and percentage of body fat have also increased significantly and, in consequence, the density has decreased and BAMI has increased both significantly (p < 0.05). CONCLUSIONS: Secular increase in weight and height during fifteen years has occurred. In general, BMI has not increased but skinfold thicknesses and body fat have increased significantly, this fact demonstrates that there has been increase in the body fat compartment.

[Anthropometric and nutritional study in young adults. Evaluation of submandibular skinfold thickness]. / Estudio antropométrico y nutricional en adultos jóvenes. Valoración del pliegue cutáneo submandibular.

OBJECTIVE: To describe the main anthropometric characteristics of a young adult population, to compare some measurements obtained with different formulas, and to compare these results with a reference population. MATERIAL AND METHODS: We have studied 72 healthy female university students aged 19.0 to 20.9 years (mean age 19.63). We have measured weight, height, body mass index (BMI), cervical and arm circumferences, and biceps, triceps, and submandibular skinfolds. We have calculated total arm area, fat arm area and muscular arm area using traditional formulas and others recently published. Means were compared using Student's t test and we also calculated Pearson correlations. RESULTS: Concerning anthropometric measurements, they were similar to those of the reference population. Arm areas were different when calculated with different formulas (p < 0.000). All the anthropometric characteristics measured correlated with each other, except with height. Submandibular skinfold correlated with biceps skinfold (0.467), triceps skinfold (0.513), BMI (0.503), weight (0.476), cervical circumference (0.511) and arm circumference (0.505). Submandibular skinfold also showed a significant correlation with arm measurements, especially fat area (0.519, p < 0.001). CONCLUSIONS: Fat and muscular arm areas were different depending on the different formulas used to be calculated. Submandibular skinfold is easy to obtain and is related with the other indexes of body fat. This measure could be included in nutritional surveys.

[Nutrition and Metabolism Group of the Spanish Neonatology Society: recommendations and evidence for dietary supplementation with probiotics in very low birth weight infants]. / Grupo de Nutrición y Metabolismo Neonatal, Sociedad Española de Neonatología: recomendaciones y evidencias para la suplementación dietética con probióticos en recién nacidos de muy bajo peso al nacer.

Clinical practice guidelines are an important tool for improving healthcare. In recent years there has been accumulating evidence on the impact of nutritional supplementation with probiotics in the very low birth weight infants. With no uniformity in microorganisms and strains used. The Spanish Neonatology Society (SENeo), through its Nutrition and Metabolism Group has undertaken to develop recommendations that will be useful as a guide for the neonatologist in this field.

[Immigration and factors associated with breastfeeding. CALINA study]. / Inmigración y factores asociados con la lactancia materna. Estudio CALINA.

OBJECTIVE: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin. MATERIAL AND METHODS: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452). RESULTS: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=.002), have higher academic level (P=.001), greater parity (P=.003), and a higher probability of vaginal delivery (P=.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=.001). CONCLUSIONS: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin.

[Breastfeeding prevalence during the first year of life in Aragon. CALINA study]. / Prevalencia de la lactancia materna durante el primer año de vida en Aragón. Estudio CALINA.

OBJECTIVES: To study the current prevalence of breastfeeding (BF) in Aragon (Spain) during the first 12 months of life, and analyse its demographic, perinatal and social influential factors. MATERIAL AND METHODS: Obstetric, perinatal and feeding aspects were evaluated in a longitudinal and observational study, in a representative cohort of infant population from Aragon born between March 2009 to March 2010, controlled until 12 months of age (N=1.602). RESULTS: Exclusive or predominant BF was more frequent than the rest of feeding modalities during the first 4 months of life. Maintenance prevalence of any BF modality was 82.5% at 1(st) month of age, 71.8% at 3(rd), 54.3% at 6(th), and 27.8% at 12 months of age. Maternal variables that were significantly associated with BF maintenance both at 1 and 6 months of age were: delivery modality (higher probability in case of vaginal delivery), academic level (higher probability if university studies), origin (higher probability in mothers from Africa), adiposity (higher probability of normal weight or overweight mothers compared with obese ones), and not to smoke during gestation. CONCLUSIONS: BF prevalence in Aragon (Spain) during the first 12 months of age is high and has increased compared with previous data. BF continues in more than half of infants at six months and in a quarter of infants at 12 months of age. Maternal factors that significantly influence BF initiation and maintenance are, delivery modality, academic level, origin (immigration), adiposity and smoking habit.

[Perinatal aspects, growth and feeding of infants born small for gestational age]. / Aspectos perinatales, crecimiento y tipo de lactancia de los nacidos pequeños para su edad gestacional.

INTRODUCTION: Being born small for gestational age (SGA) has short and long term risks. The aim of this study was to describe perinatal and socio-cultural characteristics, and the pattern of growth and diet of SGA infants during their first 6 months of life. MATERIALS AND METHODS: Anthropometry and diet were evaluated during six months in a representative sample of 1596 newborns the population of Aragon (Spain). RESULTS: Mothers of SGA (N=94) infants gained less weight during pregnancy (10.5±5.8 vs 12.0±5.07 kg, P=.012), gestational age at birth was lower (37.84±1.7 vs 39.06±1.6 weeks, P<.001), and the probability of cesarean delivery was higher (37.2% vs 20.5%, P=.001). The height of the mother was lower in the SGA group (1.61±0.58 vs 1.63±0.06 metres, P=.004), but their body mass index was similar. No differences were found between groups in social or cultural aspects. Mothers of SGA infants smoked more during pregnancy (32.3% vs 18.5%, P=.003) (RR = 1.92; 95% CI; 1.31 to 3.02). Infants born SGA remained smaller during the first 6 months of life, and the monthly weight gain was similar to the rest. In the SGA group, the prevalence of breastfeeding was lower at 4 months of age (54.9% vs 68.2%, RR = 0.58, 95% CI; 0.38 to 0.89). CONCLUSIONS: Infants born SGA are more likely to converge a number of characteristics that must be considered together because they may lead to health risks. SGA do not show a rapid recovery pattern of postnatal growth, and their smaller size persists at six months.

Histamine is required during neural stem cell proliferation to increase neuron differentiation.

Histamine in the adult central nervous system (CNS) acts as a neurotransmitter. This amine is one of the first neurotransmitters to appear during development reaching its maximum concentration simultaneously with neuron differentiation peak. This suggests that HA plays an important role in neurogenesis. We have previously shown that HA is able to increase neuronal differentiation of neural stem cells (NSCs) in vitro, by activating the histamine type 1 receptor. However the mechanism(s) by which HA has a neurogenic effect on NSCs has not been explored. Here we explore how HA is able to increase neuron phenotype. Cortex neuroepithelium progenitors were cultured and at passage two treatments with 100 µM HA were given during cell proliferation and differentiation or only during differentiation. Immunocytochemistry was performed on differentiated cultures to detect mature neurons. To explore the expression of certain important transcriptional factors involved on asymmetric cell division and commitment, RT-PCR and qRT-PCR were performed. Results indicate that HA is required during cell proliferation in order to increase neuron differentiation and suggest that this amine increases neuron commitment during the proliferative phase probably by rising prospero1 and neurogenin1 expression.

[Socio-cultural, obstetric and anthropometric characteristics of newborn children of mothers who smoke in Spain]. / Características socioculturales, obstétricas y antropométricas de los recién nacidos hijos de madre fumadora.

INTRODUCTION: One in every four women smoke at the beginning of the pregnancy in Spain; of these, 25-50% give up smoking during gestation and most of them smoke again after childbirth. Maternal smoking has harmful effects on babies, such as low birth-weight with its resulting morbidity. The objective of this study is to compare the anthropometric and socio-cultural characteristics between newborns from smoking mothers and those from non- smoking ones. MATERIALS AND METHODS: Smoking habits and the socio-cultural characteristics were assessed from a sample of 1499 pregnant women, as well as their newborn anthropometric variables of their newborn babies during 2009 in the Aragon region of Spain. RESULTS: In the sample of 1499 pregnant women the prevalence of smoking during pregnancy was 19.6%; among the Spanish women, 23% of them smoked during the gestation compared with only 11% in women from other countries. The smoker mothers were younger and they had a lower educational level than the non smoker ones; however, there were no statistical differences between their anthropometric characteristics. Newborns from smoker women in Aragon had a lower weigh at delivery (3155 vs. 3295 grams: p<.001) and a relative risk of low weight at birth for their gestational age of 2.1 (95% CI: 1.35 - 2.97). The length and the rest of newborn anthropometric variables were also affected. CONCLUSION: The prevalence of smoking during gestation is high in Aragon. The mothers who smoke are younger and have different socio-cultural characteristics compared with non-smoker mothers. Maternal smoking habits have a harmful effect on newborn nutritional status, representing an avoidable risk of low weight at birth.

[Validation of a nutritional screening tool for hospitalized pediatric patients]. / Validación de una herramienta de cribado nutricional para pacientes pediátricos hospitalizados.

BACKGROUND: Malnutrition among hospitalized patients has clinical implications, and interest has arisen to find screening tools able to identify subjects under risk. At present, there is no consensus about the most suitable nutrition screening tool for pediatric patients. AIM: To validate STAMP (Screening Tool for the Assessment of Malnutrition in Pediatrics) pediatric screening tool in Spain. METHODS: Descriptive cross-sectional study of patients admitted to a 3rd level children's hospital with both medical and surgical specialities. During the first 24 hours of admission, STAMP screening tool was applied. For its validation, results were compared with those obtained from a nutritional assessment performed by specialist staff, which included clinical, anthropometric and body composition data. RESULTS: A sample of 250 children was studied. Nutritional assessment identified 64 patients (25.6%) under risk, 40 of whom were malnourished (16%). STAMP classified 48.4% of the patients as being under nutritional risk. This tool showed 75% sensitivity and 60.8% specificity when identifying patients under risk according to nutritional assessment. It showed 90% sensitivity and 59.5% specificity when identifying malnourished patients. COMMENTS: Malnutrition was less frequent than that reported in other European countries, although diagnosis technique was different. STAMP is a simple and useful tool for nutritional screening, avoiding the need to assess all patients on admission in order to identify those under nutritional risk.

[To born small for gestational age may depend on the growth curve used]. / Nacer pequeño para la edad gestacional puede depender de la curva de crecimiento utilizada.

INTRODUCTION AND OBJECTIVE: Population standards of intrauterine growth are necessary to evaluate if the newborn has grown well, if their nutritional conditions are appropriate and to identify groups at risk as those small for gestational age (SGA). Differences in the number of SGA newborns identified, depending on the standard applied, have been analyzed in this study. MATERIAL AND METHODS: Cross-sectional study conducted in 4,486 Caucasian newborns (2,361 boys and 2,125 girls), born between 35 and 41 weeks. Weight and length valuation was performed following the standard methodology. Percentage of children under the 10(th) percentile for weight and length was calculated depending on the standard used (Olsen et al. 2010, Lubchenco et al. 1966, Delgado et al. 1996, Carrascosa et al. 2008), being diagnosed of SGA. RESULTS: Weight and length were significantly higher in boys than in girls at all ages. 10(th) percentile values defined for every gestational age are globally similar among the different standards and our population, with the clear exception of Lubchenco curves whose 10(th) percentile values are even 300 g. lower for the newborns at the highest gestational ages. Lubchenco charts do not fit the pattern of intrauterine growth of our population and identify a smaller number of SGA. The percentage of SGA of our sample ranged between 1.7% and 14% in depending on the standard, sex and gestational age considered. CONCLUSION: The number of children classified as SGA is different according to each standard used. Lubchenco charts identify a smaller number of SGA than the others. The rest of curves show similar values and seem to be well adapted for our population. The correct identification of SGA will allow a better assessment of short and long-term risks of these newborns.

[Nutritional characteristics of newborns of overweight and obese mothers]. / Características nutricionales de los recién nacidos de madres con sobrepeso y obesidad.

INTRODUCTION: Maternal nutritional status is an important factor of adequate intrauterine growth and neonatal weight. The aim of this study is to evaluate the relationship between pre-gestational BMI (Body Mass Index) and breastfeeding duration, as well as infant anthropometric measurements during their first six months of life. MATERIALS AND METHODS: Anthropometric measurements and the type of feeding were evaluated in a representative sample of 1,547 newborns from our population during 2009, according to their maternal BMI, and also in a sub-cohort of 759 infants followed up to 6 months of life. RESULTS: A total of 72.9% of women had a normal weight, 18.7% were overweight and 8.4% obese. Women with a BMI ≥ 25 kg/m(2) had lower weight gain during pregnancy (P < .001), lower socioeconomic and cultural level (P < .001), and their infants had higher weight at delivery (P=.003) and at 6 months of life, with no differences in body length. Newborn weight increased in relation to maternal BMI, but over 35 kg/m(2) it decreased progressively (P < .001). Breastfeeding prevalence in obese women was 58.5% at hospital postpartum discharge, and 8.6% at six months of life; as opposed to 70.8% and 13.9%, respectively in women with normal BMI. CONCLUSIONS: In our sample, maternal obesity is associated with a low socioeconomic and cultural level, higher infant weight at delivery and at 6 months of life, and less prevalence of exclusive breastfeeding; all of them nutritional risk factors in the short and long term.

Satisfacción con la enfermera en atención primaria: herramientas de medida y factores explicativos / Satisfaction with primary care nursing: Use of measurement tools and explanatory factors

Objetivos: Analizar las propiedades psicométricas de 2 herramientas de medida de la satisfacción con la atención recibida de la enfermera en atención primaria y estimar los valores de esta satisfacción y las características del paciente y el servicio asociadas con su variabilidad. Métodos: Los sujetos fueron elegidos aleatoriamente en 23 centros de salud de la Comunidad de Madrid. Se midió la satisfacción con los cuestionarios AMABLE y de Baker, cuyas propiedades psicométricas fueron evaluadas. Se recogieron variables sociodemográficas y otras relativas al estado de salud, o al proceso de atención. Se construyó un modelo explicativo mediante Generalized Estimating Equations. Resultados: Los 662 sujetos expresaron una satisfacción media de 4,95/5 (DE 0,25) con AMABLE y 4,83/5 (DE 0,42) con el cuestionario Baker. AMABLE se explicaba en una única dimensión (alfa Cronbach 0,85), y Baker en 3: cuidados profesionales (media 4,76 [DE 0,48], alfa Cronbach 0,74), profundidad de la relación (media 3,76 [DE 1,18], alfa Cronbach 0,73) y tiempo dedicado (media 4,42 [DE 0,86], alfa Cronbach 0,47). La edad, una mejor percepción del estado de salud y la consulta concertada por la enfermera se asociaban con una mayor satisfacción expresada. La atención en el domicilio, los ingresos hospitalarios, el retraso en la consulta, la familia más extensa o la renta familiar elevada se asociaban con una menor satisfacción. Conclusiones: La satisfacción con la consulta de la enfermera en atención primaria era muy alta y se asociaba con características personales y de la propia consulta. Las herramientas evaluadas eran adecuadas para medir este resultado (AU)

Objectives: This study aims to assess the psychometric properties of two measurement tools for patient satisfaction with nursing care in Primary Care, the satisfaction level, and the personal and consultation characteristics associated with its variability. Methods: Subjects randomly selected in 23 Health Care centres in the Community of Madrid were included. Satisfaction was measured by means of the AMABLE and Baker questionnaires, in which the psychometric properties were evaluated. Sociodemographic characteristics of the consultations, variables related to health status, and other related to the consultation process were collected. An explanatory model using Generalized Estimating Equations was constructed. Results: The 662 subjects expressed a mean satisfaction of 4.95/5 (SD .25) with AMABLE, and 4.83/5 (SD .42) with the Baker questionnaire. AMABLE had a single dimension (Cronbach's alpha .85), and Baker three: professional care (mean 4.76, SD .48 Cronbach's alpha .74), depth of relationship (mean 3.76, SD 1.18, Cronbach's alpha .73), and perceived time (mean 4.42, SD .86, Cronbach's alpha .47). Ageing, a better perception of health status, and appointments arranged by nurses were associated with higher expressed satisfaction. Home care, hospital admissions, delayed consultation, extended family, or high family income were associated with lower satisfaction. Conclusions: Satisfaction with nurse consultations in Primary Care was very high, and varied depending on personal characteristics and on the type of consultation. The assessed tools allowed this outcome to be measured properly (AU)

[Differences between reference charts of weight in children up to the age of 18 months]. / Diferencias entre los estándares de referencia para el peso en niños de hasta 18 meses de edad.

INTRODUCTION: Growth is a complex phenomenon that has in pediatric age special relevancy because it constitutes a fundamental indicator of nutritional status. OBJECTIVE: To evaluate differences about weight analysis of infants aged 0-18 months depending on the population reference used. METHODS: This is a longitudinal weight and length study in a representative sample of 383 infants from Aragon since birth until 18 months of age. A descriptive analysis was realized and "z-scores" were calculated from five growth curves. Finally there was calculated the percentage of children who were staying above or under 2DS for weight depending on the standard used. RESULTS: 50.1% were males and 49.9% women. Weight and length of the children were higher in girls than in boys in all the ages (p<0.01). Major differences between weight z-score averages from standards were at 6 months and later. The percentage of children on a weight<2 DS ranged between 0.5 and one 3.3% at 18 months of age depending on the standard. CONCLUSION: Global differences exist when weight is evaluated in the same sample of infants up to 18 months of age depending on different population standards, as well as in the number of children who stay out of the limits of the normality with each of them.

Grupo de Nutrición y Metabolismo Neonatal, Sociedad Española de Neonatología: recomendaciones y evidencias para la suplementación dietética con probióticos en recién nacidos de muy bajo peso al nacer / Nutrition and Metabolism Group of the Spanish Neonatology Society: Recommendations and evidence for dietary supplementation with probiotics in very low birth weight infants

Las guías de práctica clínica son una importante herramienta para la mejora de la atención sanitaria. En los últimos años, se han ido acumulando evidencias sobre el impacto de la suplementación nutricional con probióticos en el recién nacido de muy bajo peso, sin que exista uniformidad en los microorganismos y las cepas utilizadas. Desde la Sociedad Espa˜nola de Neonatología, a través de su Grupo de Nutrición y Metabolismo de SENeo, se ha acometido la elaboración de unas recomendaciones que sean útiles para orientar al neonatólogo en este campo

Clinical practice guidelines are an important tool for improving healthcare. In recent years there has been accumulating evidence on the impact of nutritional supplementation with probiotics in the very low birth weight infants. With no uniformity in microorganisms and strains Clinical practice guidelines are an important tool for improving healthcare. In recent years there has been accumulating evidence on the impact of nutritional supplementation with probiotics in the very low birth weight infants. With no uniformity in microorganisms and strains

Inmigración y factores asociados con la lactancia materna. Estudio CALINA / Immigration and factors associated with breastfeeding. CALINA study

OBJETIVO: Identificar las características socioculturales, obstétricas y perinatales asociadas con la lactancia materna completa (LMC) durante 4 meses, en dependencia del origen materno. MATERIAL Y MÉTODOS: Estudio de una cohorte representativa de la población de lactantes aragoneses (n = 1.452). Se han evaluado las variables socioculturales, obstétricas y perinatológicas asociadas a la modalidad de lactancia materna, en dependencia del origen de la madre. RESULTADOS: La prevalencia de LMC en nuestro medio es más alta en las madres inmigrantes que en las de origen español. El 37,2% de las de origen español mantienen la LMC a los 4 meses frente al 43% de las inmigrantes (p = 0,039) (RR españolas/inmigrantes=0,76; IC del 95%, 0,58-0,99); a los 6 meses, esto ocurre en un 13,9% vs. 23,8%, respectivamente (p < 0,001) (RR españolas/inmigrantes=0,52; IC del 95%, 0,37-0,72). Los factores que se asocian a la LMC a los 4 meses son diferentes entre ambos grupos. Las madres de origen español tienen más edad (p = 0,002), nivel educativo (p = 0,001), paridad (p = 0,003) y mayor probabilidad de parto vaginal (p = 0,005), y sus hijos presentan mayores valores antropométricos al nacimiento. Sin embargo, en las madres inmigrantes, el mantenimiento de LMC se asocia a un mayor índice de masa corporal materno y a no trabajar fuera del domicilio. En ambos grupos, la LMC se mantiene con más frecuencia en aquellas madres que no fuman (p = 0,001). CONCLUSIONES: La prevalencia de LMC durante los primeros meses de edad es más alta en las madres inmigrantes que en las madres de origen español y los factores socioculturales, obstétricos y perinatales que se asocian a la misma son distintos en función del origen materno

OBJECTIVE: To identify socio-cultural, obstetric and perinatal characteristics associated with complete breastfeeding (CBF) during the first 4 months of age, depending on maternal origin. MATERIAL AND METHODS: Socio-cultural, obstetric and perinatal aspects associated with breastfeeding depending on maternal origin were evaluated in a longitudinal study in a representative infant population from Aragon (n = 1452). RESULTS: The prevalence of CBF was higher in immigrant mothers than in those from Spain. CBF was maintained in 37.2% of mothers from Spain at 4 months, compared with 43% of immigrants (P=0.039) (RR Spanish/immigrants=0.76; 95% CI: 0.58-0.99); at 6 months this occurred in 13.9% vs. 23.8%, respectively (P<0.001) (RR Spanish/immigrants=0.52; 95% CI: 0.37-0.72). The factors associated with CBF at 4 months are different between both groups. Mothers born in Spain are older (P=0.002), have higher academic level (P=0.001), greater parity (P=0.003), and a higher probability of vaginal delivery (P=0.005); and their children have the highest anthropometric values at birth. However, in immigrant mothers, the maintenance of CBF was associated with a higher maternal body mass index and with working at home. In both groups, CBF remains more frequently in those mothers who do not smoke (P=0.001). CONCLUSIONS: The prevalence of CBF during the first months of life is higher in immigrant mothers than in those from Spain, and socio-cultural, obstetric and perinatal factors are different, depending on maternal origin

Uso de sellantes de fosas y fisuras para la prevención de caries en población infanto-juvenil: revisión metodológica de ensayos clínicos / Use of pit and fissure sealants for preventing caries in child population: Methodological review of clinical trials

La caries dental es uno de los problemas más relevantes dentro del ámbito odontológico y de la Salud Pública. En Chile existe una alta prevalencia de caries en la población infanto-juvenil, siendo esta una de las prioridades de salud del país. Se constata la necesidad de utilizar métodos complementarios para su control. Los sellantes de fosas y fisuras representan una de las intervenciones preventivas más efectivas en odontología, siendo considerados como un aporte a la Salud Pública. Sin embargo, no existen evidencias consistentes acerca de su verdadera efectividad e impacto en la prevención de caries. Las inconsistencias encontradas podrían deberse a la presencia de sesgos o a la heterogeneidad de los estudios disponibles en la literatura. Así, se propone realizar una revisión sistemática con el fin de evaluar la calidad metodológica de los ensayos clínicos controlados que utilizan sellantes de fosas y fisuras. Se condujo una búsqueda de ensayos realizados entre 1990 y 2007, encontrándose trece que cumplieron con los criterios de inclusión y exclusión. Los estudios incluidos fueron obtenidos y evaluados por un único revisor. Se concluye que la evidencia que avala la utilización de esta intervención es metodológicamente muy pobre. Estos hallazgos debieran estimular a los profesionales a esclarecer la verdad referente a la efectividad de los sellantes, antes de aplicarlos indiscriminadamente. Se recomienda la realización de nuevos ensayos clínicos ejecutados con un adecuado diseño metodológico y de análisis estadístico, cuyos resultados sirvan como evidencia confiable para la toma de decisiones que guíen las políticas de Salud Pública.

Dental decay is one of the most important problems within the Public Oral Health. Chile has a high prevalence of decay among children and adolescents, being this issue one of the priorities of public health in the country. Taking into account this context, there is a necessity of using complementary methods for its control. Pit and fissures sealants represent one of the most effective preventive interventions in dentistry, being considered as a contribution to the public health interventions. Nevertheless, there are no consistent evidences about their true effectiveness and impact in the prevention of caries. These inconsistencies could be due to the presence of bias or the heterogeneity of the studies available in literature. Thus, we propose to make a review with the aim to evaluate the methodological quality of clinical trials using pit and fissure sealants. A search of studies between 1990 and 2012 was conducted and 18 clinical trials that fulfilled the inclusion and exclusion criteria were found. The studies included were obtained and evaluated by a single reviewer. This review concludes that the evidence that guarantees the use of this intervention is methodologically poor. These findings may stimulate the professionals to clarify the truth referring to the effectiveness of sealants, before applying it indiscriminately. The accomplishment of new clinical trials executed with an appropriate methodological design and statistical analysis is recommended, generating reliable results for the decision making that guides the Public Health Policies.

Aspectos sobre la medición del impacto de la caries dental en la calidad de vida de las personas: artículo de revisión / Bearing impact measure of the dental caries in the quality of life: review article

Objetivo: Determinar, mediante una revisión de literatura publicada, la existencia de estudios enfocados en la relación entre historia de caries y calidad de vida relacionada a salud oral (CVRSO) utilizando instrumentos validados. Material y Método: Artículo de revisión bibliográfica de literatura publicada los últimos diez años usando la base de datos MEDLINE. Dos revisores independientes recopilaron y analizaron los artículos en dos etapas: En una primera etapa fueron seleccionados aquellos artículos en que en su resumen relacionaran historia de caries y calidad de vida utilizando un instrumento de medición validado, excluyendo todos aquellos en que los individuos tuvieran alguna patología base que por si misma afecta su calidad de vida y artículos de validación. En una segunda etapa fue analizado el texto completo de los artículos previamente seleccionados, se aceptaron estudios experimentales y observacionales, se excluyeron artículos de revisión. Los desacuerdos fueron resueltos por consenso. Resultados: De un total de 311 artículos, 12 artículos relacionaban enfermedades orales y calidad de vida relacionada a salud oral siendo "historia de caries" uno más de los parámetros medidos y 6 artículos tenían como objetivo relacionar directamente "historia de caries" y "calidad de vida", en estos últimos las dimensiones más afectadas fueron: dolor dental, comer-masticar alimentos, lavarse los dientes y sonreír.

Aim: To determine, through a review of published literature, the existence of studies focused on the relationship between history of decay and quality of life related to oral health (QOLROH), using validated instruments. Material and Method: Literature review of reports published in the last ten years using the MEDLINE database. Two reviewers independently assessed and analyzed articles in two stages: In the first stage the articles whose abstract related dental caries and quality of life using a validated measurement instrument were selected, excluding those in which individuals had a systemic pathology affecting itself their quality of life, and excluding articles of validation. In a second stage the full text of the previously selected articles was analyzed, experimental and observational studies were accepted and review articles were excluded. Disagreements were resolved by consensus. Results: Out of a total of 311 articles, 12 articles connected oral diseases and quality of life related to oral health, being "history of decay" one more of the measured parameters and only 6 articles related directly "history of decay" and "quality of life". In the latter the most affected dimensions were: Dental pain, eat-chew food, brushing your teeth and smile.

Severidad de caries y pérdida de dientes de una población pre-Hispánica del norte de Chile / Caries severity and tooth loss in an ancient pre-Columbian culture in the north of Chile

El conocer la historia natural de las patologías bucales sin intervenciones modernas, permite comparar el desarrollo de éstas con los datos actuales. Este estudio tiene como objetivo conocer la severidad de caries dental y de pérdida de dientes en una muestra de restos humanos de la cultura Atacameña (500 DC) en San Pedro de Atacama en el norte de Chile. Se estudiaron 139 restos humanos, en cada uno de ellos se realizó un examen clínico, consignado la información en una ficha individual donde se registró, el número de dientes presentes y perdidos pre y post mortem y el número de lesiones de caries. Estas variables permitieron calcular el índice CPD (Obturadas=0). El análisis estadístico incluyó una descripción de frecuencias y el cálculo de estadísticas de dispersión y tendencia central para las variables continuas. Los resultados muestran que el índice CPD mínimo, asume que las piezas perdidas post mortem estaban sanas fue 17.14 con un promedio de 3.93 lesiones de caries y 13.2 dientes perdidos en vida. Los restos humanos de la población estudiada presentan un gran daño de su salud bucal. Gran cantidad de piezas dentarias perdidas en vida y bajo número de dientes sanos.

The aim of this study was to determine the severity of dental caries and tooth loss in a sample of 139 human remains of the Atacama culture (500 AD) in San Pedro de Atacama, northern Chile. A clinical examination was performed on each remain by a calibrated examiner. The number of present and missing teeth in pre-and post-mortem stages and the number of carious lesions were recorded. The DMT index (filled = 0) was calculated. Statistical analysis included a description of frequency and calculation of statistical dispersion and central tendency for continuous variables. The results reveal a DMT of 17.14 with an average of 3.93 carious lesions and 13.2 teeth lost in life. The oral health situation of the studied population presented severe damage, high rate of tooth loss and DMT scores.