Desigualdades sociales en la salud mental infantil en Cataluña / Socio-economic inequalities in children's mental health in Catalonia

Objetivos: Analizar los factores socioeconómicos y de salud asociados a la salud mental infantil en una muestra representativa de población de 4–14 años de edad de Cataluña. Métodos: Los datos provienen de la submuestra infantil de la Encuesta de Salud de Cataluña 2006 (n=1.821). La madre, el padre o la persona encargada del menor respondió el cuestionario de salud mental infantil Strengths and Difficulties Questionnaire (SDQ). Se analizaron las puntuaciones de cada dimensión del SDQ y las dificultades totales según los factores socioeconómicos y de salud del niño/a. Se ajustaron modelos de regresión lineal múltiple. Resultados: En general, pertenecer a una familia de clase social desfavorecida, monoparental, con nivel de estudios de la madre menor que universitario y declarar problemas de salud fueron los factores asociados a una peor salud mental infantil en la mayoría de las dimensiones del SDQ. Los factores asociados a las dificultades totales fueron ser chica (coeficiente β: −1,6), pertenecer a las clases sociales menos favorecidas (grupo IV-V: 1,6), con menor nivel de estudios materno (nivel de estudios primario o menos: 1,2), pertenecer a una familia monoparental (1,5) y declarar más problemas de salud (3 o más problemas: 3,9). Conclusiones: Los niños y las niñas de familias con nivel socioeconómico menos favorecido y de familias monoparentales se encuentran a riesgo de presentar peor salud mental. El estudio aporta información útil para la monitorización y el abordaje de los problemas de salud mental infantil (AU)

Objectives: To analyse socio-economic and health status factors associated with poor mental health in a representative sample of children 4 to 14 years old in Catalonia. Methods: The data comes from a subsample of the Catalan Health Interview Survey 2006 (CHIS) (n=1821). Proxy-respondents, mainly mothers, answered the Strengths and Difficulties Questionnaire (SDQ). The SDQ dimension scores and the Total difficulties score were analysed by socio-demographics and health status factors. Multivariate linear regression models were fitted to analyse the influence of socio-economic and health status factors on mental health. Results: In general, being in a disadvantaged family, single-parent families, a family whose mother had lower level of education, and those children reporting physical health problems, have been factors associated with worse child mental health in most of SDQ dimension scores. Factors associated with Total difficulties were, being a girl (beta coefficient: −1.6), from disadvantaged social classes (group IV–V: 1.6), at lower level of maternal education (mother's educational primary level or less: 1.2), being in a single-parent family (1.5), and reporting health problems (3 or more health problems: 3.9). Conclusions: Children from disadvantaged families, and single-parent families are at higher risk of worse mental health than their counterparts in the advantaged groups. The study contributes to collecting information for monitoring and approaching mental health in children (AU)

[Socio-economic inequalities in children's mental health in Catalonia]. / Desigualdades sociales en la salud mental infantil en Cataluña.

OBJECTIVES: To analyse socio-economic and health status factors associated with poor mental health in a representative sample of children 4 to 14 years old in Catalonia. METHODS: The data comes from a subsample of the Catalan Health Interview Survey 2006 (CHIS) (n=1821). Proxy-respondents, mainly mothers, answered the Strengths and Difficulties Questionnaire (SDQ). The SDQ dimension scores and the Total difficulties score were analysed by socio-demographics and health status factors. Multivariate linear regression models were fitted to analyse the influence of socio-economic and health status factors on mental health. RESULTS: In general, being in a disadvantaged family, single-parent families, a family whose mother had lower level of education, and those children reporting physical health problems, have been factors associated with worse child mental health in most of SDQ dimension scores. Factors associated with Total difficulties were, being a girl (beta coefficient: -1.6), from disadvantaged social classes (group IV-V: 1.6), at lower level of maternal education (mother's educational primary level or less: 1.2), being in a single-parent family (1.5), and reporting health problems (3 or more health problems: 3.9). CONCLUSIONS: Children from disadvantaged families, and single-parent families are at higher risk of worse mental health than their counterparts in the advantaged groups. The study contributes to collecting information for monitoring and approaching mental health in children.

[Mortality risk factors in critical surgical patients]. / Factores de riesgo de mortalidad de los pacientes quirúrgicos graves.

OBJECTIVE: To determine mortality risk factors for critically ill postoperative patients. PATIENTS: Two hundred eleven patients undergoing any type of surgery admitted to the intensive care unit (ICU) over a period of one year were enrolled. METHOD: We performed a cross-sectional study that was retrospective for pre- and intraoperative observations and prospective for ICU observations. A univariate analysis was performed and relative risk (95% CI) was calculated. Multivariate analysis was also performed and the adjusted odds ratio calculated (95% CI). The end point of measurement was death in the ICU. RESULTS: The independent risk factors for mortality were age 60 years (OR: 2.8; 95% CI 1.36-5.09), physical status ASA-V (OR: 9.66; 95% CI 5.62-14.31), intracranial surgery to treat severe head injury (OR: 5.33; 95% CI 3.08-9.47), hemorrhagic shock during surgery (OR: 5.20; 95% CI 4.16-8.29), arterial hypotension during surgery (OR: 4.0; 95% CI 2.78-11.65), APACHE III score upon admission to the ICU (OR: 9.29; 95% CI 3.62-21.38), multiple organ dysfunction syndrome (OR: 7.96; 95% CI 3.73-13.92), and cardiopulmonary arrest in the ICU (OR: 5.85; 95% CI 2.21-10.43). The APACHE III score demonstrated high sensitivity (87%) and positive predictive value (96%). CONCLUSIONS: Surgical patients in critical condition continue to account for a large number of admissions to and death in the ICU. The variables analyzed were sufficient to explain patient outcome, such that risk factors for mortality in surgical patients admitted to the ICU could be determined.

Factores de riesgo de mortalidad de los pacientes quirúrgicos graves / Mortality risk factors in critically ill postoperative patients

Objetivo. Determinar los factores de riesgo de la mortalidad de los pacientes quirúrgicos graves.Material y métodos. Se incluyó a los 211 pacientes operados, independientemente del tipo de intervención quirúrgica practicada, que ingresaron durante el período de tiempo de un año en la unidad de cuidados intensivos (UCI). Se realizó un estudio de corte transversal, ambispectivo (retrospectivo en cuanto a las observaciones pre e intraoperatorias y prospectivo en cuanto a las observaciones en la UCI). Se analizaron variables correspondientes a las etapas pre, intra y postoperatoria. Se realizó un análisis univariado y se calculó el riesgo relativo con un intervalo de confianza (IC) del 95 por ciento. También se realizó un análisis multivariado calculándose la odds ratio (OR) ajustada, así como los intervalos de confianza del 95 por ciento. El punto final de la medición fue la mortalidad en la UCI. Resultados. Las variables que constituyeron factores de riesgo independientes para la mortalidad fueron: edad igual o mayor de 60 años (OR: 2,8; IC del 95 por ciento: 1,36-5,09), estado físico 5, según la clasificación de la American Society of Anesthesiologists (OR: 9,66; IC del 95 por ciento: 5,62-14,31), cirugía intracraneal para tratamiento del trauma craneoencefálico grave (OR: 5,33; IC del 95 por ciento: 3,089,47), shock hemorrágico intraoperatorio (OR: 5,20; IC del 95 por ciento: 4,16-8,29), hipotensión arterial intraoperatoria (OR: 4,0; IC del 95 por ciento: 2,78-11,65), índice APACHE III en el momento del ingreso en UCI (OR: 9,29; IC del 95 por ciento: 3,6221,38), síndrome de disfunción orgánica múltiple (OR: 7,96; IC del 95 por ciento: 3,73-13,92), y paro cardiorrespiratorio en la UCI (OR: 5,85; IC del 95 por ciento: 2,21-10,43). El índice APACHE III evidenció una elevada sensibilidad (87 por ciento) y valor predictivo positivo (96 por ciento).Conclusiones. Los pacientes quirúrgicos graves continúan siendo una causa importante de ingreso y mortalidad en la UCI. Las variables consideradas en el estudio fueron suficientes para explicar el desenlace final de los pacientes, por lo que se pudieron determinar los factores de riesgo para la mortalidad de los pacientes quirúrgicos admitidos en la UCI (AU)