[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.

[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.

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.