El estudio de las desigualdades sociales en la salud infantil y adolescente en España

Health inequalities and their relationship with socioeconomic indicators in the Maresme region (Catalonia): A cross-sectional ecological study

OBJECTIVE

Health inequalities are universal, but their magnitude and determinants vary according to geographic areas, and understanding variations is essential to designing and implementing preventive and corrective policies. Our objective was to evaluate health inequalities in the Maresme region (Catalonia, Spain) and the relationship with socioeconomic indicators.

DESIGN

Cross-sectional ecological study (2017). SITE: Maresme region.

PARTICIPANTS

Population assigned to any of the Maresme's 21 basic health areas (BHAs).

MEASURES

Sociodemographic, socioeconomic, health, and health resource use indicators published by the Catalan Health Service's Information and Knowledge Unit.

RESULTS

Differences observed between BHAs were 49% in mortality, 266% in diabetes incidence, 348% in stroke incidence, and 89% in hospitalizations. In the most compared to the least disadvantaged BHAs, socioeconomic deprivation, as measured by the socioeconomic index (SEI), was 4.6 times greater and the percentage population with low educational attainment (EA) was 3.7 times higher. Greater deprivation was associated with greater prevalence of diabetes, chronic obstructive pulmonary disease, and high blood pressure, and greater incidence of diabetes, ischemic heart disease, and cancer. Likewise, a greater percentage population with low EA was associated with higher premature mortality and avoidable hospitalizations.

CONCLUSION

Great variation exists in socioeconomic, health, and health resource use between the different Maresme BHAs. Socioeconomic deprivation is strongly correlated with the prevalence and incidence of certain chronic diseases, and low EA is correlated with premature mortality and avoidable hospitalizations. Our findings point to the urgency of taking health inequalities into account in designing and implementing healthcare strategies, programs, and policies.

Professional Perspectives on Children's Health Assets: A Delphi Study

This study aims to describe a local community expert's perspective on the identification of and access to children's health assets and to gather proposals to promote children's health and well-being within their community. The health asset approach is essential for health promotion, and there is evidence of its benefits to individuals' or communities' health when this approach is observed. Children's health assets are gaining increasing interest, but the literature that captures the perception of professionals working with children is scarce. Qualitative research designed with Delphi methodology was carried out with the participation of 25 professionals working in a neighbourhood with children and families. The participants stated that this neighbourhood was a good environment for the healthy and happy growth of children but pointed out that there were inequities. They emphasised the importance of economic and physical security and feeling loved. The absolute best aspects of the neighbourhood according to these experts were its support networks, mutual help, educational and health services, and green spaces, and the most deficient aspects were the possibility of a hopeful future and emotional support within the family unit. Poverty and/or the scarcity of economic resources were identified as the main barriers to accessing health assets. Special difficulties in access to health for migrant and Roma children were also identified. The panel of experts made concrete action proposals. It was recommended to support resources and services that already exist in their community. The experts prioritised work with families, education, working in conjunction with vulnerable groups, community participation, and networking.

[Social networks use and risk factors for the development of eating disorders: A systematic review]

OBJECTIVE

Review the available scientific literature on the relationship between the use of social networks and risk factors for the development of eating disorders, such as low self-esteem, body dissatisfaction and/or idealization of thinness, in the Spanish population.

DESIGN

A systematic review of scientific literature published between 2010 and 2022 was carried out.

DATA SOURCES

PubMed, Scopus and Web of Science.

SELECTION OF STUDIES

Only original articles were included, published in Spanish or English, that measured at least one variable of use of social networks and at least one risk factor for eating disorders in the Spanish population.

DATA EXTRACTION

The PRISMA 2009 statement was used as a guide. The quality of selected articles was assessed using the Joanna Briggs Institute Critical Appraisal Checklist.

RESULTS

Twelve cross-sectional studies that met the inclusion criteria were identified. Evidence suggests that the use and frequency of use of social networks is significantly associated with body dissatisfaction (p≤0,01), drive for thinness (p≤0,001), and low self-esteem (p≤0,05) in adolescents and young adults in the Spanish population.

CONCLUSIONS

Users of social networks, mainly those based on images, are exposed to factors that could increase their risk of developing an eating disorder.

[Social inequalities in under-five mortality: a systematic review]

OBJECTIVE

To identify the characteristics of the published studies on social inequalities in under-five mortality, their theoretical perspectives, axes of inequality, methods and results.

METHOD

We carried out a systematic literature review. We consulted four electronic databases and Google Scholar, for studies published between 2010 and 2018.

RESULTS

We analyzed 126 articles. In 62.7%, territory was studied as the axis of inequality, followed by socioeconomic determinants (27.8%). Neonatal, infant and under-five mortality was analyzed as an output in health in 19.0%, 49.2% and 32.3%, respectively. It predominated ecological (62.7%) and longitudinal (50.0%) studies. Significant reductions in mortality rates were found, however, the decline was not homogeneous among subpopulations.

CONCLUSIONS

The literature reports a marked decrease in under-five mortality; however, the gaps between different axes of inequality continue and in some cases they have increased. Gaps varied according to time, place, axis of inequality and type of mortality analyzed.

Social Inequalities in Breakfast Consumption among Adolescents in Spain: The DESKcohort Project

Breakfast has a critical role in energy balance and dietary regulation. Consequently, it is considered an important component of a healthy diet, especially in adolescence, when there are great opportunities to consolidate habits and establish future patterns of healthiness in adulthood. Socioeconomic position (SEP) causes inequalities that are reflected in health behaviors, physical activity, mental health, and diet. Therefore, we conducted a cross-sectional study using data from the 2019-2020 DESKcohort project (Spain) to explore the relationships between breakfast and sociodemographic characteristics, health-related behaviors, and school performance of 7319 adolescents. Our findings showed that the prevalence of skipping breakfast every day was 19.4% in girls and 13.7% in boys and was related to students' SEP. The risk of skipping breakfast was 30% higher in girls from the most disadvantaged SEP, in comparison to those in the most advanced SEP (prevalence ratio (PR) = 1.30; 95% confidence interval (CI) = 1.11-1.54). Also, boys from the most disadvantaged SEP showed 28% higher risk of skipping breakfast than those in the most advanced SEP (PR = 1.28; 95% CI = 1.04-1.59). In conclusion, future public policies should be adapted considering a SEP and gender perspective to avoid increasing nutritional and health inequalities.

Social Inequalities in Health Determinants in Spanish Children during the COVID-19 Lockdown

The COVID-19 lockdown was imposed in a context of notable inequalities in the distribution of the social determinants of health. It is possible that the housing conditions in which children and their families experienced the confinement, and the adoption of healthy behaviors, may have followed unequal patterns. The aim was to describe social inequalities in housing conditions and in health-related behaviors among children during the lockdown in Spain. This cross-sectional study was based on data from an online survey collecting information on the child population (3-12 years) living in Spain (n = 10,765). The outcome variables used were several housing conditions and health-related behaviors. The socioeconomic variables used were financial difficulties and parents' educational level. Crude prevalence and prevalence ratios estimated using Poisson models were calculated. During lockdown, children from families with low educational levels and financial difficulties not only tended to live in poor housing conditions, but were also exposed to negative health determinants such as noise and tobacco smoke; they took less physical exercise, had a poorer diet, spent more time in front of screens and had less social contact. A notable social gradient was found in most of the variables analyzed. The results point to the need to incorporate the perspective of equity in the adoption of policies in order to avoid the increase of pre-existing social inequalities in the context of a pandemic.

Children's visual impairment and visual care related to socioeconomic status in Catalonia (Spain)

BACKGROUND

The objective of this study is to assess the prevalence of visual impairment and visual care practices and its association with socioeconomic conditions in the infant population in Catalonia.

METHODS

The Catalan Institute of Statistics provided a random sample of 0 to 14-year-old non-institutionalized children whose parents were interviewed in a continuous health survey from 2011 to 2015 in Catalonia. A multistage stratified and random sampling procedure considering age, sex, county and town was followed. All results have been weighted according to the sample design and are presented as the proportion of the condition with its 95% confidence limits. Chi-square tests were performed to evaluate the association between categorical variables. To study the association of visual care with independent variables, a multiple logistic regression model was used.

RESULTS

In 0 to 14-year-old children, a 12.9% (95% confidence interval [CI] [11.8-13.9]) prevalence of correctable visual impairment was observed. The prevalence of non-correctable visual impairment was 0.9% (95% CI [0.6-1.2]). Non-correctable visual impairment was more prevalent in families with lower education levels, manual professions or unemployed. Of children without visual impairment, 13,5% (95% CI:12.3-14.6) visited a visual care professional in the last 12 months while this proportion was 67.4% (95% CI [63.3-71.5]) among those with correctable visual impairment. When parents have a university degree or non-manual professions, a higher level of visual care was observed. In children with correctable visual impairment, visual reviews were more frequent when parents are employed in a non-manual profession.

CONCLUSIONS

For the first time, indicators related to visual impairment in children in Catalonia have been recorded. There is an association between lower socioeconomic status and having non-correctable visual impairment, and conversely, having correctable visual impairment was significantly associated with employed parents. More visual care is associated with higher socioeconomic status.

[Differences in use of health care time between Spanish-born and immigrant child population in two regions of the Basque Country]

INTRODUCTION

The aim of the study was to analyse the frequency and time of consultation in Primary Care and in paediatric hospital emergencies, between the native (Spanish-Born) paediatric population and children of immigrant origin, as well as its relationship with socioeconomic variables.

PATIENTS AND METHODS

The retrospective observational cohort study was conducted on 301 children in two regions of the Basque Country (Gipuzkoa). The immigrant population was represented following the proportion of nationalities distribution in 2011. The native population had the same age distribution as the immigrant origin population. The sample was selected by simple randomisation. Frequency and consultation time data were obtained through the administrative databases. An ad hoc face-to-face survey, addressed to the guardians of the study subjects, was carried out in order to obtain socio-economic data.

RESULTS

No differences were observed in frequency or mean duration of the consultation visits. The profile of the significantly more frequent child in Primary Care responded to children from 0 to 6 years old, with maximum one sibling. This profile was repeated when attending hospital emergencies. On the other hand, as regards outpatient consultation time, the relationship between mothers with a high education level or university degree and longer duration of Primary Care visits was highlighted.

CONCLUSIONS

Age, the number of siblings, and mother's education level were the variables that have best explained the variability in terms of frequency and time of consultation, affecting both groups of children equally and in the same direction.

Preparing children for climate-related disasters

Climate-related disasters affect different dimensions of children's health and well-being both directly and indirectly. Reducing children's vulnerability and exposure to climate-related disasters is crucial to protect them against risks. Children as climate-change agents and future leaders at local, national and international level can obviously contribute to reduce vulnerabilities in families and communities and transfer knowledge to them. Moreover, children can advocate for climate change mitigation. In the long term, participation of children in the climate change mitigation programmes may lead to fewer disasters and, consequently, less risk to their health. As government policies have failed to fully address and respond to the drivers of climate-related disasters, disasters preparedness and education for children should be considered an essential activity to protect children from disaster's risks. Main factors in shaping children's behaviour and response to disaster are increasing the risk perception and knowledge of the children. When a child perceived likelihood, susceptibility and severity of a disaster (such as earthquake), then they would be able and willing to learn how to prepare for that. So far, disaster education programmes for children have mostly relied on offline school-based training. Different innovative approaches can be applied to continue education within online and digital formats including virtual reality, digital games and online platforms. However, an advocacy support by influential entities such as companies engaged in entertainment industry is required to raise the awareness of public and particularly the children about disaster preparedness.

Oral Health Problems and Utilization of Dental Services Among Spanish and Immigrant Children and Adolescents

Spanish and immigrant children and adolescents vary widely in their frequency of dental visits and occurrence of dental problems. The aims of this study were to discover the prevalence of dental problems and utilization of dental services in the Spanish and immigrant child population, identify the type of treatment received, and analyze the socioeconomic and demographic variables which are associated with dental problems and non-regular utilization of dental services, based on data from the 2017 National Health Survey in Spain. The sample consisted of 4568 children aged between 3 and 14 years old. Utilization of dental services and dental problems were assessed against socioeconomic and demographic characteristics using logistic regression models. The prevalence of caries in Spanish children was 9.29% compared with 18.58% (p < 0.001) in their immigrant counterparts. The most common reason for dental visits was a check-up (Spanish: 65.05%; immigrants: 54.94%). In both groups, from the age of 7, there was a lower probability of non-regular utilization of dental services, although this increased when the social class was lower. The probability of presenting dental problems was lower in Spanish children living in towns with over 10,000 inhabitants and was higher, in both groups, over the age of 7 and in lower social classes.

Child health and the possibilities for childcare in a context of poverty and food insecurity: The narratives of parents attending a self-managed foodbank in Spain

Food insecurity would influence children's health and development through its effects on nutrition and household stress in the context of broader poverty-related problems. This study contributes to research regarding the characterisation of food-insecure households with children under the age of 18. In particular, it highlights the social and institutional aspects which influence and interact with parents' attempts to protect their children from hunger and destitution. In this study, we document some aspects of the harsh realities faced by mothers and fathers with children under the age of 18 living in poverty who attended a self-organised foodbank in the city of Madrid in 2015. We used a qualitative methodology consisting of 7 months of participant observation and the conduction of 15 in-depth interviews. This study shows how the possibilities for the meaningful protection of children in food-insecure households can be influenced by parental coping strategies, community resources and availability and accessibility to public help. Foodbanks can help reduce both household hunger (although not meeting all nutritional requirements) and parental psychosocial distress, which might support parents to better protect their children. In particular, self-managed foodbanks appear to help parents cope with emotional distress by reducing feelings of powerlessness and self-blame through their active involvement, and thanks to the collective caring that occurs between members. Public services are of special relevance, since their absence or an active institutional discrimination has been shown to further damage impoverished households with children. We suggest that public policies in Spain are revised and reinforced to enable a more genuine protection of children and their families living under severe deprivation, and to prevent life-long damage. Public institutions could assume that people attending a foodbank are living in severe poverty and need access to adequate and supportive public resources to address it.

Direct and Indirect Influences of Objective Socioeconomic Position on Adolescent Health: The Mediating Roles of Subjective Socioeconomic Status and Lifestyles

The use of composite indices and subjective measures to evaluate socioeconomic position, taking into account the effect of inequalities on adolescent health-related behaviors, can contribute to understanding the effect of inequalities on health during adolescence. The aim of this study was to examine the direct and indirect contribution of objective and subjective socioeconomic factors in a broad range of health and lifestyles outcomes. The data come from a representative sample of adolescents (N = 15,340; M age = 13.69) of the Health Behavior in School-aged Children study in Spain. Structural equation modeling was used for data analysis. A global index for evaluating objective socioeconomic position predicted both health and healthy lifestyles. Subjective socioeconomic status mediated the relationship between objective socioeconomic position and health but did not have a significant effect on healthy lifestyles when objective indicators were considered. Lastly, fit indices of the multiple-mediator model—including the direct effect of objective socioeconomic position on health and its indirect effects through the subjective perception of wealth and lifestyles—explained 28.7% of global health variance. Interventions aimed at reducing the impact of health inequalities should address, in addition to material deprivation, the psychological and behavioral consequences of feeling poor.

Análisis de las diferencias en la atención a la salud mental del niño y adolescente en España a través de los Planes Estratégicos de Salud Mental Autonómicos

Introduccion: La Psiquiatría Infantil es una especialidad relativamente reciente. Es un área importante de trabajo ya que los datos reflejan que la tasa de prevalencia de trastornos mentales en niños y adolescentes se sitúa entre el 15 y el 20 % de la población infanto-juvenil a nivel mundial, o que el 80 % de los trastornos mentales de los adultos tuvieron comienzo antes de los 18 años. En toda España se puede ofrecer asistencia a niños y adolescentes, aunque ésta no se encuentra homogeneizada en todas las Comunidades Autónomas (CCAA). Adicionalmente, España es uno de los dos únicos países de la Unión Europea que no dispone de la especialidad de Psiquiatría del Niño y Adolescente. Al no existir a día de hoy una especialidad propia, el carácter de la atención ofrecida dependerá de la formación particular de cada profesional. Objetivo: Analizar la situación de la atención a la Salud Mental del Niño y Adolescente en España a través de los Planes Estratégicos de Salud Mental Autonómicos. Método: Se analizaron mediante lectura exhaustiva las líneas estratégicas de los 17 Planes Estratégicos de Salud Mental de todas las CCAA. Resultados: Se han encontrado desigualdades tanto en la vigencia y actualización de dichos planes, como en la estructura y oferta de recursos asistenciales y formativos. Conclusión: Hoy en día la especificidad en la atención a la Salud Mental del niño y adolescente se distribuye de forma desigual en España, dependerá de la CCAA en la que resida el niño o adolescente.

Desarrollo infantil y condición socioeconómica. Artículo de revisión

Introducción. El desarrollo infantil parte de factores endógenos y exógenos; entre estos últimos se encuentra la condición socioeconómica, la cual puede influir en la salud y las oportunidades en la vida adulta.Objetivos. Conocer y analizar la influencia de las condiciones socioeconómicas en el desarrollo infantil.Materiales y métodos. Se realizó una revisión bibliográfica en 10 bases de datos mediante una búsqueda de artículos publicados entre 2012 y 2017. Se seleccionaron los artículos con base en las palabras clave y la relación entre el desarrollo infantil y la condición socioeconómica.Resultados. Se seleccionaron 10 artículos. Las variables más utilizadas para valorar condición socioeconómica fueron ingresos familiares y educación parental y para desarrollo infantil, áreas de cognición, motricidad fina y gruesa. Se encontró una relación significativa entre desarrollo infantil y nivel socioeconómico, escolaridad, ocupación de los padres, estado civil de la madre y condiciones de la vivienda, que suponen una desventaja y la probabilidad de alteración en el desarrollo infantil.Conclusión. El desarrollo infantil está influenciado por condiciones socioeconómicas determinadas por aspectos histórico-culturales, abordadas en su mayoría desde la sociología funcionalista como factores aislados. Se propone un enfoque metodológico holístico e integrador que dé lugar a la historicidad como elemento nodal.

Socioeconomic Status in Adolescents: A Study of Its Relationship with Overweight and Obesity and Influence on Social Network Configuration

Socioeconomic status (SES) influences all the determinants of health, conditioning health throughout life. The aim of the present study was to explore the relationship between socioeconomic status and obesity in adolescence through an analysis of the patterns of contact between peers as a function of this parameter. A cross-sectional study was performed, analyzing a sample of 235 students aged 14 to 18 and 11 class networks. Social network analysis was used to analyze structural variables of centrality from a sociocentric perspective. We found that adolescents with a medium-low SES presented a two-fold higher probability of being overweight, but we did not detect any differences in the configuration of their social networks when compared with those of normal-weight adolescents. However, we did find significant differences in the formation of networks according to SES in the overall sample and disaggregated by gender, whereby adolescents with a high SES in general presented a higher capacity to form wider social networks. Elucidating the relationship between SES and overweight and its influence on social network formation can contribute to the design of preventative strategies against overweight and obesity in adolescents, since their social environment can provide them with several resources to combat excess weight.

Desigualdades sociodemográficas na prática de atividade física de lazer e deslocamento ativo para a escola em adolescentes: Pesquisa Nacional de Saúde do Escolar (PeNSE 2009, 2012 e 2015)

O objetivo foi identificar desigualdades na prática de atividade física de lazer e deslocamento ativo para escola em adolescentes brasileiros, bem como suas tendências de acordo com o sexo, tipo de escola, escolaridade materna e regiões geográficas de 2009 a 2015. Estudo descritivo baseado em dados da Pesquisa Nacional de Saúde do Escolar (PeNSE) de 2009, 2012 e 2015. Foram considerados ativos no lazer aqueles que acumularam, no mínimo, 60 minutos por dia, em cinco ou mais dias da semana anteriores à entrevista. Para deslocamento ativo para escola, foi avaliado o transporte a pé ou de bicicleta para a escola na semana anterior à entrevista. Os desfechos foram estratificados pelo sexo, tipo de escola, escolaridade materna e regiões geográficas. As desigualdades foram avaliadas por meio de diferenças e razões entre as estimativas, bem como por índices sumários de desigualdade. Foram incluídos na PeNSE 2009, 2012 e 2015, 61.301, 61.145 e 51.192 escolares, respectivamente. A prevalência de atividade física de lazer foi 13,8% em 2009, 15,9% em 2012 e 14,7% em 2015; já para o deslocamento ativo para escola, foi 70,6%, 61,7%, 66,7%, respectivamente. Meninos apresentaram uma prevalência de 10 pontos percentuais (p.p.) maior de atividade física de lazer e cerca de 5p.p. no deslocamento ativo para escola do que as meninas. Escolares filhos de mães com maior escolaridade apresentaram, em média, uma prevalência de atividade física de lazer 10p.p. maior do que seu grupo extremo de comparação e cerca de 30p.p. menor com relação ao deslocamento ativo para escola. As desigualdades observadas permaneceram constantes ao longo do período avaliado. Foram identificadas desigualdades socioeconômicas e entre os sexos, que se mantiveram constantes ao longo do período analisado e que foram específicas para cada domínio de atividade física.

Socioeconomic position and occupational social class and their association with risky alcohol consumption among adolescents

OBJECTIVES

To compare different measures of socioeconomic position (SEP) and occupational social class (OSC) and to evaluate their association with risky alcohol consumption among adolescents attending the last mandatory secondary school (ages 15-17 years).

METHODS

This was a cross-sectional study. 1268 adolescents in Catalonia (Spain) participated in the study. Family affluence scale (FAS), parents' OSC, parents' level of education and monthly familiar income were used to compare socioeconomic indicators. Logistic regression analyses were conducted to evaluate socioeconomic variables and missing associated factors, and to observe the relation between each SEP variable and OSC adjusting by sociodemographic variables.

RESULTS

Familiar income had more than 30% of missing values. OSC had the fewest missing values associated factors. Being immigrant was associated with all SEP missing values. All SEP measures were positively associated with risky alcohol consumption, yet the strength of these associations diminished after adjustment for sociodemographic variables. Weekly available money was the variable with the strongest association with risky alcohol consumption.

CONCLUSIONS

OSC seems to be as good as the other indicators to assess adolescents' SEP. Adolescents with high SEP and those belonging to upper social classes reported higher levels of risky alcohol consumption.

[Health and determinants of health in second generations of international immigrants: Social inequalities in health since childhood?]

OBJECTIVE

To analyse the social inequalities in health between children and youth population of an immigrant origin from low-income countries and those of native origin in the Basque Country.

METHOD

Cross-sectional descriptive study using data from the Basque Country Health Survey 2013. Variables of health, behaviours and life conditions were used as the outcome variables. Prevalence ratios were calculated using robust Poisson models.

RESULTS

The children with immigrant parents had poorer self-rated health, a higher prevalence of obesity, spent more hours in sedentary activities and lived in households with greater economic difficulties. The differences persisted even after adjusting for social class and educational level of parents.

CONCLUSIONS

A migrant background is a highly relevant axis of health inequalities and has an influence beyond a generation. Given this reality, it is necessary to implement effective and suitable measures to ensure life with good health conditions and to reduce social inequalities in health, not only in childhood but through the entire life cycle.

Mental Health and Quality of Life Among Spanish-born and Immigrant Children in Years 2006 and 2012

BACKGROUND

One of every five children and adolescents in the European Union suffers from behavioural, and emotional disturbances.

OBJECTIVES

To compare factors associated with the quality of life and mental health of immigrant and Spanish children aged 4-14years both during the years 2006 and 2012 and to evaluate changes over this time period.

DESIGN AND METHODS

An epidemiologic age and sex matched case-control study (1:2) was conducted. The study group were 677 immigrant children and 1354 matched Spanish children (controls). This study was conducted using data obtained from the Spanish National Health Surveys done in 2006 and 2012. We used the Strengths and Difficulties Questionnaire to obtain the score for variables derived from mental health and the Kidscreen-10 questionnaire to score the Health-Related Quality of Life.

RESULTS

Spanish girls scored higher in conduct problems (2.04±0.1) and better in problems with peers (1.21±0.08) regarding immigrant girls (1.82±0.12-1.92±0.13 respectively). Concerning total scores, immigrant children obtained significantly lower scores in quality of life (81.29±0.76) and in problems with peers (2.04±0.09) than their matched Spanish children (84.4±0.45 and 1.26±0.06) in 2006. Immigrant children had lower total scores in prosocial behaviour (8.62±0.11) compared to the matched Spanish children (8.92±0.06) in 2012. The total average scores of immigrant children in terms of quality of life, emotional symptoms, behavioural problems, hyperactivity and problems with peers were significantly better in 2012 (86.58; 1.84; 1.46; 3.77 and 1.48 respectively) than in 2006 (81.29; 2.15; 1.90; 4.58 and2.04).

CONCLUSIONS

Immigrant children had a poorer quality of life and mental health than matched Spanish children in 2006.

[Distribution of dental caries and its association with variables of social protection in children 12 years of age in the county of Avellaneda, Province of Buenos Aires]

Different international organizations have indicated the need to analyze the conditions of each population in order to identify groups and individuals at risk as an operational strategy in pursuit of greater equity, efficacy and efficiency in the health system. The aim of this study was to identify differentials in the dental caries profiles of children attending public schools in the county of Avellaneda (Province of Buenos Aires, Argentina) and their association with variables of social protection. In 2014, an observational, analytical and cross-sectional study was performed with a sample of 656 students 12 years of age from 40 public schools in the 8 county districts (out of a total universe of 3580 individuals distributed in 70 schools). The dental status of 12-year-old schoolchildren living in the localities evaluated showed an unequal distribution; sub-groups with high caries prevalence, morbidity and severity were identified, requiring the targeting of health interventions. An association between untreated disease and lack of social protection was observed.

Childhood Excess Weight in Spain From 2006 to 2012. Determinants and Parental Misperception

INTRODUCTION AND OBJECTIVES

Due to the high prevalence of childhood obesity in Spain, we analyzed changes in its prevalence from 2006 to 2007 and from 2011 to 2012, as well as diet, sleep, and sedentary habits in 5- to 14-year-olds and parental misperceptions about their children's excess weight.

METHODS

The sample was from the Spanish National Health Surveys for 2006 to 2007 (n=5590) and for 2011 to 2012 (n=3601). Data were collected by trained personnel through telephone interviews with parents/guardians. Weight and height were self-reported and the International Obesity Task Force cutpoints were used to define overweight and obesity.

RESULTS

The prevalence of childhood excess weight was 30.1% from 2006 to 2007 and 29.7% from 2011 to 2012, while that of childhood obesity was 9.6% and 9%, respectively. Parental misperception of childhood excess weight increased from 60.8% to 71.4% (P<.001). Daily consumption of vegetables increased by 7.8%, while that of soft drinks and snacks decreased. This decrease was greatest in children from families with a low socioeconomic status, who also decreased their consumption of sweets and fast food. Adherence to sleep recommendations decreased by 5%, but adherence to recommended sedentary time did not change.

CONCLUSIONS

High childhood overweight and obesity rates remained stable in Spain from 2006 to 2007 and from 2011 to 2012, but there was an increase in parental misperception of childhood excess weight. Despite reduced consumption of soft drinks and snacks, there was low adherence to dietary recommendations, hours of sleep, and sedentary habits.

[Influence of postcode on paediatric admissions in Seville]

INTRODUCTION

The postcode (where the home is situated) is an indicator of socioeconomic status and is associated with morbidity, mortality, and the use of health services. The aim of this study was to analyse its effects on paediatric admissions and to determine the rates of the most common causes of paediatric admissions in Seville.

MATHERIAL AND METHODS

An observational cross-sectional study with two analysis units: under 15 year-old "admissions" in public hospitals in Seville (n=2,660) and "city districts" of Seville (n=11). The independent variable analysed was whether the postcode of the admitted patients was within a Regional Government designated "area with social transformation needs". The analysis of the admissions was performed using X²-test, Fisher test and Student-t test, with the description of rates using the calculation of crude and specific rates, and by rate ratio.

RESULTS

Children living in districts with a lower socioeconomic status were on average 7 months younger (P<.001), and they were significantly more likely to be admitted via the emergency department (P<.001). There was no statistical difference detected in either the length of hospital stay or mortality. The crude admission rate ratio was higher in districts with a lower socioeconomic status (1.8), with a higher specific rate ratio detected in admissions due to asthma, respiratory infections, inguinal hernia, and epilepsy/convulsions.

CONCLUSIONS

Paediatric hospital admission rates of the main diagnoses were higher in districts with a lower socioeconomic status. Children living in these districts were more likely to be admitted younger and via the emergency department.

[Monitoring social determinants of health]

Public health surveillance is the systematic and continuous collection, analysis, dissemination and interpretation of health-related data for planning, implementation and evaluation of public health initiatives. Apart from the health system, social determinants of health include the circumstances in which people are born, grow up, live, work and age, and they go a long way to explaining health inequalities. A surveillance system of the social determinants of health requires a comprehensive and social overview of health. This paper analyses the importance of monitoring social determinants of health and health inequalities, and describes some relevant aspects concerning the implementation of surveillance during the data collection, compilation and analysis phases, as well as dissemination of information and evaluation of the surveillance system. It is important to have indicators from sources designed for this purpose, such as continuous records or periodic surveys, explicitly describing its limitations and strengths. The results should be published periodically in a communicative format that both enhances the public's ability to understand the problems that affect them, whilst at the same time empowering the population, with the ultimate goal of guiding health-related initiatives at different levels of intervention.

Do environmental barriers affect the parent-reported quality of life of children and adolescents with cerebral palsy?

Physical, social, and attitudinal environment may affect the quality of life (QoL) of children and adolescents with cerebral palsy (CP). Participants in this study included parents of 206 children and adolescents with CP (55.8% males) aged 8-18 years (M=11.96, SD=3). Distribution according to the Gross Motor Function Classification System (GMFCS) was 24.3% level I, 18% level II, 18% level III, 12.6% level IV, and 27.2 level V. Environmental barriers were assessed with the Spanish version of the European Child Environment Questionnaire (ECEQ), and QoL was assessed with the KIDSCREEN parents' version. The results of the correlation analysis revealed that GMFCS level, IQ, and type of schooling are significantly correlated with QoL. Barriers were also associated with QoL. A series of hierarchical regression analyses indicated that, after controlling for the effect of child and parent's variables, barriers at home and at school significantly contribute to QoL. These findings underscore the importance of providing interventions to produce environmental changes that contribute to the improvement of QoL.

A systematic map of systematic reviews in pediatric dentistry--what do we really know?

OBJECTIVES

To identify, appraise and summarize existing knowledge and knowledge gaps in practice-relevant questions in pediatric dentistry.

METHODS

A systematic mapping of systematic reviews was undertaken for domains considered important in daily clinical practice. The literature search covered questions in the following domains: behavior management problems/dental anxiety; caries risk assessment and caries detection including radiographic technologies; prevention and non-operative treatment of caries in primary and young permanent teeth; operative treatment of caries in primary and young permanent teeth; prevention and treatment of periodontal disease; management of tooth developmental and mineralization disturbances; prevention and treatment of oral conditions in children with chronic diseases/developmental disturbances/obesity; diagnosis, prevention and treatment of dental erosion and tooth wear; treatment of traumatic injuries in primary and young permanent teeth and cost-effectiveness of these interventions. Abstracts and full text reviews were assessed independently by two reviewers and any differences were solved by consensus. AMSTAR was used to assess the risk of bias of each included systematic review. Reviews judged as having a low or moderate risk of bias were used to formulate existing knowledge and knowledge gaps.

RESULTS

Out of 81 systematic reviews meeting the inclusion criteria, 38 were judged to have a low or moderate risk of bias. Half of them concerned caries prevention. The quality of evidence was high for a caries-preventive effect of daily use of fluoride toothpaste and moderate for fissure sealing with resin-based materials. For the rest the quality of evidence for the effects of interventions was low or very low.

CONCLUSION

There is an urgent need for primary clinical research of good quality in most clinically-relevant domains in pediatric dentistry.