Multilevel analysis of the use of oral health services by the pediatric population.

[ES] Objetivos:Analizar variables asociadas al uso de los servicios de salud bucodental en el último año por parte de la población de 6 a 15 años de edad residente en España. Analizar si hay variabilidad en el uso deestos servicios entre comunidades autónomas y si ésta podría explicarse por variables relacionadas conel modelo asistencial. Métodos:Estudio transversal de la Encuesta Nacional de Salud (2006). Variables independientes de índole individual (sociodemográficas, enfermedad, hábitos y socioeconómicas) y contextual (modelo asistencial y prevalencia de paro en la comunidad autónoma). Estimación de la asociación mediante regresión logística multinivel. Resultados:La varianza en el uso entre comunidades autónomas es de 0,16 (EE: 0,07) y el 4,8% de lavariabilidad total es atribuible a la comunidad autónoma. Las variables incluidas en el modelo explican el 83,11% de la varianza existente entre comunidades autónomas. Las variables individuales asociadas a unamayor probabilidad de uso fueron la presencia de enfermedad y la frecuencia de cepillado de los dientes;las asociadas a una menor probabilidad fueron la edad, la procedencia, la ingesta de refrescos azucaradosy el nivel socioeconómico. Entre las variables contextuales, estar cubierto por un modelo asistencial tipoPlan de Asistencia Dental Infantil (PADI), implantado desde hace más de 10 años, duplica la probabilidad de acudir al dentista frente a los que carecen de él (odds ratio= 2,47; intervalo de confianza del 95%:2,04-2,99). Conclusiones:El uso en el último año de los servicios de salud bucodental por la población infanto-juvenil residente en España se aleja de las recomendaciones. Se identifican variables individuales (sociodemográficas, de enfermedad, de hábitos y socioeconómicas) y contextuales (modelo asistencial) asociadas adicho uso. [EN] Objectives To analyze the variables associated with the use of oral health services in the last year by the population aged 6 to 15 years living in Spain and to determine whether there is variability in the use of these services among autonomous regions and, if so, whether this variability could be explained by variables related to the care model of the distinct autonomous regions. Methods A cross-sectional study of the Spanish National Health Survey (2006) was carried out. Independent variables were individual (sociodemographic, dental disease, habits and socioeconomic) and contextual (type of dental care model and prevalence of unemployment in the autonomous region). Association was estimated by multilevel logistic regression. Results Variance in the use of oral health services among autonomous regions was 0.16 (SE: 0.07), and 4.8% of the total variability was attributable to the autonomous region. The variables included in the model explained 83.11% of the variance. Individual variables associated with an increased likelihood of using dental services were the presence of disease and the frequency of brushing. Individual variables associated with a lower likelihood were age, origin, intake of sugary soft drinks and socioeconomic status. The contextual variables of being covered by a dental care model (of the type Childhood Dental Care Plan) older than 10 years doubled the likelihood of using oral health services compared with those without such coverage (OR = 2.47, CI = 2.04-2.99). Conclusions The use of oral health services during the last year by the pediatric population in Spain is lower than recommended. This use is associated with individual variables (demographic, dental health, habits and socioeconomic factors) and contextual variables (dental care model).Este trabajo fue financiado por el Fondo de Investigaciones Sanitarias (FIS)-ref-PI 080306.S

Socioeconomic position and childhood-adolescent weight status in rich countries: a systematic review, 1990–2013

Incluye material complementarioBackground: Childhood obesity is a major problem in rich countries due to its high prevalence and its harmful health consequences. An exploratory analysis conducted in the PubMed database highlighted that the number of papers published on the relationship between socioeconomic position (SEP) and childhood-adolescent weight status had risen substantially with respect to an earlier review which had covered the period 1990–2005. Methods: To describe the findings on the relationship between SEP and childhood-adolescent weight status in papers published in rich countries from 1990 through 2013, studies were identified in the following databases: PubMed; Web of Knowledge (WOK); PsycINFO; Global Health; and Embase. We included observational studies from the 27 richest OECD countries, which covered study populations aged 0 to 21 years, and used parental education, income and/or occupation as family SEP indicators. A total of 158 papers met the inclusion criteria and reported 134 bivariable and 90 multivariable analyses. Results: Examination of the results yielded by the bivariable analyses showed that 60.4 % of studies found an inverse relationship, 18.7 % of studies did not found relationship, and 20.9 % of studies found a relationship that varied depending on another variable, such as age, sex or ethnic group; the corresponding percentages in the multivariable analyses were 51.1, 20.0 and 27.8 %, respectively. Furthermore, 1.1 % found a positive relationship. Conclusion: The relationship between SEP and childhood-adolescent weight status in rich countries is predominantly inverse and the positive relationship almost has disappeared. The SEP indicator that yields the highest proportion of inverse relationships is parents’ education. The proportion of inverse relationships is higher when the weight status is reported by parents instead using objective measurements.This study was conducted thanks to support from the Research Project PI11/00784 “Socioeconomic context of residence area and overweight and obesity childhood” financed by the Ministry of Science and Innovation

Variables associated with the use of dental services among preschool population in Spain: a national health survey analysis.

[ES] Fundamentos: la salud bucodental es parte fundamental de la salud desde la erupción del primer diente. Para conseguirla, se precisa instaurar precozmente hábitos saludables como la revisión dental periódica. En nuestro medio, la caries es la enfermedad crónica pediátrica más prevalente y podría estar aumentando en los preescolares. Objetivos: a) describir la prevalencia del uso de los servicios de salud bucodental por los preescolares españoles, b) cuantificar y analizar la variabilidad entre comunidades autónomas y c) identificar las variables asociadas a dicho uso. Métodos: estudio transversal basado en la Encuesta Nacional de Salud (2006). Muestra: 2.172 niños de 2 a 5 años (ambos inclusive). Variable dependiente: haber acudido a los servicios dentales alguna vez en la vida. Variables independientes: sociodemográficas, de salud bucodental autoreferida, de hábitos y de nivel socioeconómico familiar. Análisis mediante regresión logística multivariante. Resultados: el 20,8% de los preescolares españoles refirió haber acudido a los servicios dentales. La probabilidad de uso aumentó con la edad (OR: 1,88; IC: 1,53-2,31), la frecuencia de cepillado dental diario (3 o más veces frente a menos de una vez al día: OR: 2,94; IC: 1,47-5,87) y la presencia de caries (OR: 2,60; IC: 1,22-5,51). Hay un gradiente socioeconómico en la probabilidad de uso: aumentó con el nivel socioeconómico familiar, medido a través de la clase social (baja frente a a: OR: 0,41; IC: 0,19-0,86) y del nivel de estudios maternos (OR: 1,62; IC: 1,13-2,32). No existió variabilidad en el uso atribuible a la comunidad autónoma de residencia. Conclusiones: los preescolares españoles utilizan menos de lo deseable los servicios dentales. La promoción de su uso debería intensificarse en los niños procedentes de familias desfavorecidas. [EN] oral health is integral to health from the eruption of the first tooth. To achieving, it is necessary an early establishment of healthy oral habits as regular dental checkups. In developed countries, caries is the most prevalent chronic pediatric disease and it may be increasing in preschool age. a) assessing prevalence of oral health services use among Spanish preschool population, b) quantifying and analyzing the existence of variability among autonomous community and c) identifying variables associated with such use. cross-sectional study about Spanish National health Survey (2006). 2,172 children aged between 2 and 5 years (both inclusive). have gone to dental services at least once during life. sociodemographic, self-referred dental health, habits and family socioeconomic status variables. Multivariate logistic regression analysis. 20.8% of Spanish preschoolers reported had attended dental services. Probability of use increased with age (OR: 1,88; IC:1,53-2,31), frequency of daily tooth brushing (three or more times per day vrs less than once: OR: 2,94; IC: 1,47-5,87) and presence of caries (OR: 2,60; IC: 1,22-5,51). There is a socioeconomic gradient about probability of use: it increased with family socioeconomic status measured by social class (low vrs high: OR: 0,41; IC: 0,19-0,86) and maternal educational level (OR: 1,62; IC: 1,13-2,32). There was not variability in the oral health services use attributable to the autonomous community. the use of dental health services among Spanish preschool population is lower than desirable. The promotion of its use should be intensified in children from disadvantaged families.S

Variables asociadas al uso de los servicios de salud bucodental por la población preescolar en España: un análisis de la Encuesta Nacional de Salud

Fundamentos: la salud bucodental es parte fundamental de la salud desde la erupción del primer diente. Para conseguirla, se precisa instaurar precozmente hábitos saludables como la revisión dental periódica. En nuestro medio, la caries es la enfermedad crónica pediátrica más prevalente y podría estar aumentando en los preescolares. Objetivos: a) describir la prevalencia del uso de los servicios de salud bucodental por los preescolares españoles, b) cuantificar y analizar la variabilidad entre comunidades autónomas y c) identificar las variables asociadas a dicho uso. Métodos: estudio transversal basado en la Encuesta Nacional de Salud (2006). Muestra: 2.172 niños de 2 a 5 años (ambos inclusive). Variable dependiente: haber acudido a los servicios dentales alguna vez en la vida. Variables independientes: sociodemográficas, de salud bucodental autoreferida, de hábitos y de nivel socioeconómico familiar. Análisis mediante regresión logística multivariante. Resultados: el 20,8% de los preescolares españoles refirió haber acudido a los servicios dentales. La probabilidad de uso aumentó con la edad (OR: 1,88; IC: 1,53-2,31), la frecuencia de cepillado dental diario (3 o más veces frente a menos de una vez al día: OR: 2,94; IC: 1,47-5,87) y la presencia de caries (OR: 2,60; IC: 1,22-5,51). Hay un gradiente socioeconómico en la probabilidad de uso: aumentó con el nivel socioeconómico familiar, medido a través de la clase social (baja frente a alta: OR: 0,41; IC: 0,19-0,86) y del nivel de estudios maternos (OR: 1,62; IC: 1,13-2,32). No existió variabilidad en el uso atribuible a la comunidad autónoma de residencia. Conclusiones: los preescolares españoles utilizan menos de lo deseable los servicios dentales. La promoción de su uso debería intensificarse en los niños procedentes de familias desfavorecidas

Variables asociadas al uso de los servicios de salud bucodental por la población preescolar en España: un análisis de la Encuesta Nacional de Salud

Background: oral health is integral to health from the eruption of the first tooth. To achieving, it is necessary an early establishment of healthy oral habits as regular dental checkups. In developed countries, caries is the most prevalent chronic pediatric disease and it may be increasing in preschool age. Objectives: a) assessing prevalence of oral health services use among Spanish preschool population, b) quantifying and analyzing the existence of variability among autonomous community and c) identifying variables associated with such use. Methods: cross-sectional study about Spanish National health Survey (2006). Sample: 2,172 children aged between 2 and 5 years (both inclusive). Dependent variable: have gone to dental services at least once during life. Independent variables: sociodemographic, self-referred dental health, habits and family socioeconomic status variables. Multivariate logistic regression analysis. Results: 20.8% of Spanish preschoolers reported had attended dental services. Probability of use increased with age (OR: 1,88; IC:1,53-2,31), frequency of daily tooth brushing (three or more times per day vrs less than once: OR: 2,94; IC: 1,47-5,87) and presence of caries (OR: 2,60; IC: 1,22-5,51). There is a socioeconomic gradient about probability of use: it increased with family socioeconomic status measured by social class (low vrs high: OR: 0,41; IC: 0,19-0,86) and maternal educational level (OR: 1,62; IC: 1,13-2,32). There was not variability in the oral health services use attributable to the autonomous community. Conclusions: the use of dental health services among Spanish preschool population is lower than desirable. The promotion of its use should be intensified in children from disadvantaged families.Fundamentos: la salud bucodental es parte fundamental de la salud desde la erupción del primer diente. Para conseguirla, se precisa instaurar precozmente hábitos saludables como la revisión dental periódica. En nuestro medio, la caries es la enfermedad crónica pediátrica más prevalente y podría estar aumentando en los preescolares. Objetivos: a) describir la prevalencia del uso de los servicios de salud bucodental por los preescolares españoles, b) cuantificar y analizar la variabilidad entre comunidades autónomas y c) identificar las variables asociadas a dicho uso. Métodos: estudio transversal basado en la Encuesta Nacional de Salud (2006). Muestra: 2.172 niños de 2 a 5 años (ambos inclusive). Variable dependiente: haber acudido a los servicios dentales alguna vez en la vida. Variables independientes: sociodemográficas, de salud bucodental autoreferida, de hábitos y de nivel socioeconómico familiar. Análisis mediante regresión logística multivariante. Resultados: el 20,8% de los preescolares españoles refirió haber acudido a los servicios dentales. La probabilidad de uso aumentó con la edad (OR: 1,88; IC: 1,53-2,31), la frecuencia de cepillado dental diario (3 o más veces frente a menos de una vez al día: OR: 2,94; IC: 1,47-5,87) y la presencia de caries (OR: 2,60; IC: 1,22-5,51). Hay un gradiente socioeconómico en la probabilidad de uso: aumentó con el nivel socioeconómico familiar, medido a través de la clase social (baja frente a a: OR: 0,41; IC: 0,19-0,86) y del nivel de estudios maternos (OR: 1,62; IC: 1,13-2,32). No existió variabilidad en el uso atribuible a la comunidad autónoma de residencia. Conclusiones: los preescolares españoles utilizan menos de lo deseable los servicios dentales. La promoción de su uso debería intensificarse en los niños procedentes de familias desfavorecidas

Total effective xenoestrogen burden in serum samples and risk for breast cancer in a population-based multicase-control study in Spain.

BACKGROUND: Most studies on endocrine-disrupting chemicals and breast cancer have focused on single compounds and have produced inconclusive findings. OBJECTIVES: We assessed the combined estrogenic effects of mixtures of xenoestrogens in serum and their relationship to breast cancer risk. METHODS: A total of 186 incident pretreatment breast cancer cases and 196 frequency-matched controls were randomly sampled from a large population-based multicase-control study in Spain. The total effective xenoestrogen burden attributable to organohalogenated xenoestrogens (TEXB-α) and endogenous hormones and more polar xenoestrogens (TEXB-β) was determined in serum samples using high-performance liquid chromatography and E-Screen bioassay. Odds ratios for breast cancer comparing tertiles of serum TEXB-α and TEXB-β were estimated using logistic models, and smooth risk trends were obtained using spline models. RESULTS: Cases had higher geometric mean TEXB-α and TEXB-β levels (8.32 and 9.94 Eeq pM/mL, respectively) than controls (2.99 and 5.96 Eeq pM/mL, respectively). The fully adjusted odds ratios for breast cancer (95% confidence intervals) comparing the second and third tertiles of TEXB-α with the first tertile were 1.77 (0.76, 4.10) and 3.45 (1.50, 7.97), respectively, and those for TEXB-β were 2.35 (1.10, 5.03) and 4.01 (1.88, 8.56), respectively. A steady increase in risk was evident across all detected TEXB-α levels and a sigmoidal trend was observed for TEXB-β. Individual xenoestrogens showed weak and opposing associations with breast cancer risk. CONCLUSIONS: This is the first study to show a strong positive association between serum total xenoestrogen burden and breast cancer risk, highlighting the importance of evaluating xenoestrogen mixtures, rather than single compounds, when studying hormone-related cancers.This study was partially supported by Acción Transversal del Cancer, approved by the Spanish Ministry Council on 11 October 2007; Carlos III Institute of Health (grants PI08/1770, PI09/00773- Cantabria, PI11/00610, PI12/00265, PI12/00488, PI12/00715, and PI12/01270); and Fundación Marqués de Valdecilla (grant API 10/09). Biological samples were stored at biobanks supported by the Carlos III Institute of Health and the European Regional Development Fund (MAR Biobank RD09/0076/00036 and ISCIII Biobank RD09/0076/00108)

Total effective xenoestrogen burden in serum samples and risk for breast cancer in a population-based multicase-control study in Spain.

BACKGROUND: Most studies on endocrine-disrupting chemicals and breast cancer have focused on single compounds and have produced inconclusive findings. OBJECTIVES: We assessed the combined estrogenic effects of mixtures of xenoestrogens in serum and their relationship to breast cancer risk. METHODS: A total of 186 incident pretreatment breast cancer cases and 196 frequency-matched controls were randomly sampled from a large population-based multicase-control study in Spain. The total effective xenoestrogen burden attributable to organohalogenated xenoestrogens (TEXB-α) and endogenous hormones and more polar xenoestrogens (TEXB-β) was determined in serum samples using high-performance liquid chromatography and E-Screen bioassay. Odds ratios for breast cancer comparing tertiles of serum TEXB-α and TEXB-β were estimated using logistic models, and smooth risk trends were obtained using spline models. RESULTS: Cases had higher geometric mean TEXB-α and TEXB-β levels (8.32 and 9.94 Eeq pM/mL, respectively) than controls (2.99 and 5.96 Eeq pM/mL, respectively). The fully adjusted odds ratios for breast cancer (95% confidence intervals) comparing the second and third tertiles of TEXB-α with the first tertile were 1.77 (0.76, 4.10) and 3.45 (1.50, 7.97), respectively, and those for TEXB-β were 2.35 (1.10, 5.03) and 4.01 (1.88, 8.56), respectively. A steady increase in risk was evident across all detected TEXB-α levels and a sigmoidal trend was observed for TEXB-β. Individual xenoestrogens showed weak and opposing associations with breast cancer risk. CONCLUSIONS: This is the first study to show a strong positive association between serum total xenoestrogen burden and breast cancer risk, highlighting the importance of evaluating xenoestrogen mixtures, rather than single compounds, when studying hormone-related cancers.This study was partially supported by Acción Transversal del Cancer, approved by the Spanish Ministry Council on 11 October 2007; Carlos III Institute of Health (grants PI08/1770, PI09/00773- Cantabria, PI11/00610, PI12/00265, PI12/00488, PI12/00715, and PI12/01270); and Fundación Marqués de Valdecilla (grant API 10/09). Biological samples were stored at biobanks supported by the Carlos III Institute of Health and the European Regional Development Fund (MAR Biobank RD09/0076/00036 and ISCIII Biobank RD09/0076/00108)