Spanish Child Population Research Articles

Eating Behaviours, Oral Hygiene, and Caries in a Population of Spanish Children with Divorced Parents: A Cross-Sectional Study.

Dental caries are a public health problem that is influenced by dietary habits. This cross-sectional study aimed to investigate the feeding and hygiene habits that divorced parents exercise over their children compared to non-divorced parents, and how this may influence the rate of caries in their children. The data of participants (n = 174) with an average age of 12.17 ± 2.04 years were examined to assess the mean decayed/missing/filled teeth (DMFT) index, and they were asked questions about their oral hygiene habits. At the same time, their parents answered the parental feeding style questionnaire. A moderation analysis was conducted with family control of oral hygiene habit levels as an independent variable, decayed teeth as a dependent variable, and feeding control as a moderating variable. Results showed that divorced parents were found to have more problems in controlling their children's hygiene and dietary habits, have less control over their children's feeding, and make more use of instrumental feeding, which led to children of divorced parents having more caries. Despite the limitations linked to the cross-sectional design of the study and considering both the convenience sample and the impossibility of controlling for all aetiological factors linked to the development of caries, it can be concluded that children of divorced parents have an increased risk of tooth decay. However, parental controlled feeding interferes with the effect of family controlled oral hygiene habits on the decayed tooth, decreasing the rate of caries.

The effects of obesity on longitudinal ventricular and atrial strain in a rural population of Spanish children and adolescents, evaluated by a new strain software.

Research on the relationship between body mass index (BMI) and strain values in children and adolescents is limited. Our aim was to analyse the relationship between BMI and strain values of both ventricles and left atrium in children and adolescents. Both ventricles and left atrial strain values were compared among different BMI categories in children and adolescents from a town in the South of Spain. Of the 198 subjects, aged 6-17 years, 53% were of normal weight, 26% were overweight and 21% had obesity. Lower absolute values of left ventricular global longitudinal strain (25.9 ± 2.0% vs. 26.9 ± 2.2%, p = 0.002) and right ventricular free wall longitudinal strain (29.5 ± 4.2% vs. 30.8 ± 4.5%, p = 0.04) were found in subjects with obesity and overweight versus subjects with normal weight. A lower right ventricular four-chamber longitudinal strain was also observed in males with obesity and overweight (24.8 ± 3.3% vs. 26.4 ± 3.6%, p = 0.03). Statistically significant negative correlations of BMI were found for all ventricular, but not atrial, strain values in univariate analysis. This association turned non-significant for right ventricular four-chamber longitudinal strain in multivariate analysis. Utilizing this new strain software, children and adolescents with high BMI were associated with significantly lower values for left and right ventricular free wall longitudinal strain, without impact in left atrial strain.

Serum levels of the novel adipokine isthmin-1 are associated with obesity in pubertal boys

ObjectivesTo evaluate whether there is an association between the serum levels of the novel insulin-like adipokine isthmin-1 (ISM1) and obesity-related phenotypes in a population of Spanish children and to investigate the plausible molecular alterations behind the alteration of the serum levels of this protein in children with obesity.MethodsThe study population is a sub-cohort of the PUBMEP research project, consisting of a cross-sectional population of 119 pubertal children with overweight (17 boys, 19 girls), obesity (20 boys, 25 girls), and normal weight (17 boys, 21 girls). All subjects were classified into experimental groups according to their sex, obesity, and insulin resistance (IR) status. They were counted anthropometry, glucose and lipid metabolism, inflammation and cardiovascular biomarkers as well as isthmin-1 (ISM1) serum levels. This population was intended as a discovery population to elucidate the relationship between obesity and ISM1 levels in children. Furthermore, the study population had blood whole-genome DNA methylation examined, allowing deepening into the obesity–ISM1 molecular relationship.ResultsHigher serum ISM1 levels were observed in boys with obesity than in normal weight (P = 0.004) and overweight (P = 0.007) boys. ISM1 serum levels were positively associated with body mass index (BMI) Z-score (P = 0.005) and fat mass (P = 0.058) and negatively associated with myeloperoxidase (MPO) (P = 0.043) in boys. Although we did not find associations between ISM1 serum levels and metabolic outcomes in girls, which may indicate a putative sexual dimorphism, fat mass was positively associated in all children, including boys and girls (P = 0.011). DNA methylation levels in two-enhancer-related CpG sites of ISM1 (cg03304641 and cg14269097) were associated with serum levels of ISM1 in children.ConclusionsISM1 is associated with obesity in boys at the pubertal stage, elucidating how this protein might be of special relevance as a new biomarker of obesity in children. Further studies including a longitudinal design during puberty are needed.

Cross-cultural adaptation to Spanish and content validity of three nutritional risk scales

IntroductionThere are various scales designed to determine the risk of malnutrition at hospital admission in children. However, most of these instruments are developed and published in English. Their cross-cultural adaptation and validation being mandatory in order to be used in our country. ObjectivesCross-culturally adapt three scales designed to determine the risk of malnutrition linked to the disease and determine the validity of their content. Material and methodsCross-cultural adaptation using the translation-back-translation method in accordance with the recommendations of the International Test Commission Guidelines for Translating and Adapting Tests. Content validity was measured by a panel of experts (under seven basic selection criteria adapted from the Fehring model) who evaluated each item of the scales by measuring 4 criteria: ambiguity, simplicity, clarity and relevance. With the extracted score, Aiken’s V statistic was obtained for each item and for the complete scales. ResultsStarting from three independent translations per scale, 3 definitive versions in Spanish of the PNRS, STRONGkids and STAMP scales were obtained semantically equivalent to their original versions. The PNRS and STRONGkids scales presented an Aiken’s V greater than 0.75 in all their items, while the STAMP scale presented a value less than 0.75 for the item “weight and height”. ConclusionThis study provides the transculturally adapted Spanish versions of the PNRS, STRONGkids and STAMP scales. The PNRS and STRONGkids scales present valid content to be applied in the state hospital context. STAMP requires the adaptation of its item “weight and height” to consider its use in a Spanish child population adequate.

Prevalence of convergence insufficiency among Spanish school children aged 6 to 14 years

Clinical relevanceConvergence insufficiency (CI) at an early age can lead to learning difficulties affecting school performance. The aim of this study was to examine the prevalence of CI in a non-clinical population of Spanish children using well defined clinical criteria and to determine whether sex is a risk factor. MethodsVisual acuity and binocular vision tests were performed in 628 children aged 6–14 years (mean age 9.6 ± 1.3 years) at three schools in the Madrid Community, Spain. To assess CI prevalence we used CITT (Convergence Insufficiency Treatment Trial) criteria. The three signs considered were: i) exophoria at least 4∆ greater at near than at far; ii) near break point of convergence (NPC) ≥ 6 cm; and iii) reduced positive fusional vergence (PFV) at near (≤ 15∆ base-out break or failed Sheard's criterion). ResultsThe CI prevalence detected was 5.30% (33 children). Proportions of children with one or two signs of CI were 23.76% (148 children) and 12.20% (76 children), respectively. No differences in these CI rates by sex were detected. ConclusionThe clinically significant CI prevalence observed here suggests the need for more binocular vision screening programmes in school settings.

Adaptación transcultural al español y validez de contenido de 3 escalas de riesgo nutricional

IntroductionThere are various scales designed to determine the risk of malnutrition at hospital admission in children. However, most of these instruments are developed and published in English. Their cross-cultural adaptation and validation being mandatory in order to be used in our country. ObjectivesCross-culturally adapt three scales designed to determine the risk of malnutrition linked to the disease and determine the validity of their content. Material and methodsCross-cultural adaptation using the translation-back-translation method in accordance with the recommendations of the International Test Commission Guidelines for Translating and Adapting Tests. Content validity was measured by a panel of experts (under seven basic selection criteria adapted from the Fehring model) who evaluated each item of the scales by measuring 4 criteria: ambiguity, simplicity, clarity and relevance. With the extracted score, Aiken's V statistic was obtained for each item and for the complete scales. ResultsStarting from three independent translations per scale, 3 definitive versions in Spanish of the PNRS, STRONGkids and STAMP scales were obtained semantically equivalent to their original versions. The PNRS and STRONGkids scales presented an Aiken's V greater than 0.75 in all their items, while the STAMP scale presented a value less than 0.75 for the item “weight and height”. ConclusionThis study provides the transculturally adapted Spanish versions of the PNRS, STRONGkids and STAMP scales. The PNRS and STRONGkids scales present valid content to be applied in the state hospital context. STAMP requires the adaptation of its item “weight and height” to consider its use in a Spanish child population adequate.

Nutritional Study in Spanish Pediatric Population (EsNuPI): updated findings and initial conclusions

Introduction: eating habits and lifestyles during early childhood are important due to their association with chronic diseases in adulthood. Objectives: to evaluate energy and nutrient intake, main food sources, and dietary patterns in the EsNuPI study participants. Methods: a sociodemographic questionnaire, food frequency questionnaire, two 24 h recalls, and a physical activity questionnaire were used in two cohorts of Spanish children aged 1 to < 10 years, who were non-vegans living in municipalities > 50,000 inhabitants - one representative cohort of consumers of all types of milks (SRS = 707) and one other cohort consuming adapted milks (AMS = 741). Results: 84.7 % in SRS and 83.5 % in AMS showed a plausible, adequate energy (EI) (1503 and 1404 kcal/day, respectively). The percentage of children with protein intake > 20 % of EI was 12 % for SRS, and 6 % for AMS. Both cohorts exceeded the recommendations for total fat (36.5 % in SRS, 35.9 % in AMS) and saturated fat (13.1 % vs 12.1 %, respectively); DHA intake was significantly lower in SRS (20 mg vs 90 mg). Vitamin D intake was significantly lower in SRS, although both cohorts did not meet the recommendation. When analyzing dietary patterns, one of palatable energy-dense foods and two of Mediterranean type were highlighted. Conclusions: it is recommended that consumption of saturated fatty acids and protein be reduced, but calcium, vitamin D, and magnesium intakes should be increased, especially in children > 4 years. These findings are important for designing interventions in the Spanish child population. The findings of the EsNuPI study provide useful information for the design and promotion of appropriate interventions for Spanish children.

Breakfast Habits of a Representative Sample of the Spanish Child and Adolescent Population (The ENALIA Study): Association with Diet Quality.

The association between breakfast quality and total diet quality of children and adolescents ((1–17.9 years (n = 1570)) from the National Dietary Survey on the Child and Adolescent Population in Spain (ENALIA) was analyzed. Dietary information was collected using two non–consecutive one–day food diaries (1–10 years old) or two 24 h dietary recalls (>10 years). Breakfast quality index (BQI) and a variant of Nutrient Rich Foods index (NRF9.3) were calculated to assess the total diet quality. Children and adolescents who had breakfast on at least one day (n = 1561) were divided into two groups according to BQI: Worse Quality Breakfast (WQB) (BQI < 4 points (P66), n = 781) and Good Quality Breakfast (GQB) (BQI ≥ 4, n = 780). Younger children and those whose parents have university education presented higher BQI. GQB group had significantly higher intakes of micronutrients (vitamins A, D, C, B1, B2, B6, niacin, folate, calcium, potassium, magnesium). Fewer GQB children exceeded the Acceptable Macronutrient Distribution Range for fat and had folate and calcium intakes below their estimated average requirement. Daily NRF9.3 was 496.2 ± 54.0, being higher in GQB (503.8 ± 50.6 vs. 488.6 ± 56.2, p < 0.001). Increasing the quality of breakfast increased the possibility of having a NRF9.3 higher than P50 (OR: 1.893, CI: 1.549–2.315, p < 0.0001). Breakfasts have room for quality improvement in a high percentage of children. A higher quality breakfast is associated with a benefit in the quality of the total diet.

Dietary Exposure Estimation to Chemicals Transferred from Milk and Dairy Products Packaging Materials in Spanish Child and Adolescent Population.

Packaging materials are subject to risk assessment since they can transfer their components to the food, and they may constitute a risk for the consumers’ health. Therefore, estimating the exposure to chemicals migrating from packaging is required. In this study, a novel approach based on a total diet study (TDS)-like investigation to evaluate the exposure to chemicals transferred from the packaging was presented. The proposed methodology involved a non-targeted gas chromatography coupled to mass spectrometry (GC-MS) method to identify potential migrants and the determination of the migrants in composite food samples. The method was applied to evaluate the dietary exposure to chemicals from food packaging materials used for milk and dairy products in the Spanish child and adolescent populations. Several migrants identified in packaging materials were selected to determine their concentration in composite food samples. These chemicals included diethyl phthalate (DEP), diisobutyl phthalate (DIBP), dibutyl phthalate (DBP), bis(2ethylhexyl) phthalate (DEHP), benzophenone (BP), 1,3-diphenylpropane (1,3-DPP), and bis(2-ethylhexyl) terephthalate (DEHT). The method exhibited a good sensitivity (limit of detection, LOD ≤ 0.05 µg/g) and a satisfactory recovery (78.4-124%). Finally, the exposure was estimated using the Spanish national dietary survey ENALIA. Phthalates DBP and DEHP showed the highest mean exposure, ranging from 2.42 (10–17 years)–4.40 (12–35 months) and 1.35 (10–17 years)–4.07 (12–35 months) µg/kg bw/day for DBP and DEHP, respectively.

Clustering of Dietary Patterns and Lifestyles Among Spanish Children in the EsNuPI Study †.

Dietary patterns (DPs) are known to be tied to lifestyle behaviors. Understanding DPs and their relationships with lifestyle factors can help to prevent children from engaging in unhealthy dietary practices. We aimed to describe DPs in Spanish children aged 1 to <10 years and to examine their associations with sociodemographic and lifestyle variables. The consumption of toddler and young children milk formulas, enriched and fortified milk within the Spanish pediatric population is increasing, and there is a lack of evidence whether the consumption of this type of milk is causing an impact on nutrient intakes and if they are helping to reach the nutrient recommendations. Within the Nutritional Study in the Spanish Pediatric Population (EsNuPI), we considered two study cohorts and three different age groups in three year-intervals in each of them. The study cohort included 740 children in a representative sample of the urban non-vegan Spanish population and 772 children in a convenience cohort of adapted milk consumers (AMS) (including follow-on formula, toddler’s milk, growing up milk, and fortified and enriched milks) who provided information about sociodemographics, lifestyle, and dietary habits; a food frequency questionnaire was used for the latter. Principal component analysis was performed to identify DPs from 18 food groups. Food groups and sociodemographic/lifestyle variables were combined through a hierarchical cluster algorithm. Three DPs predominated in every age group and study sample: a palatable energy-dense food dietary pattern, and two Mediterranean-like DPs. However, children from the AMS showed a predominant dietary pattern markedly related to the Mediterranean diet, with high consumption of cereals, fruits and vegetables, as well as milk and dairy products. The age of children and certain lifestyle factors, namely level of physical activity, parental education, and household income, correlated closely with the dietary clusters. Thus, the findings provide insight into designing lifestyle interventions that could reverse the appearance of unhealthy DPs in the Spanish child population.

Buss and Perry Aggression Questionnaire-Short Form in Spanish Children

As aggressive behaviors emerge at early ages, is necessary to analyze this construct and its relationship with emotional variables as soon as possible to plan more effective interventions. This work has three main goals. First, to validate the scores of the Aggression Questionnaire Short Form (AQ-SF) in a random sample of 1202 Spanish children (M = 10.09, SD = 1.31, 51% girls), considering its factorial invariance across sex and age and possible differences as a function of these variables. Second, to identify aggression profiles based on the AQ-SF and, finally, to analyze possible differences in school anxiety based on these profiles. Confirmatory factor analysis supported the four-dimensional structure of the AQ-SF scores. Factorial invariance analysis of this model across sex and age confirmed that the model maintains the same structure in boys and girls and different age groups. Latent mean analysis identified significant sex and age differences. Five aggression profiles (High, Moderate High, High Physical, Moderate Low, and Low) were identified using latent profile analysis, and differential functioning of those profiles was found across the dimensions of school anxiety. Results show the adequacy of the AQ-SF scores in Spanish child population and provide relevant data to plan psychoeducational interventions.

Generalized Partially Linear Models on Riemannian Manifolds

SummaryWe introduce generalized partially linear models with covariates on Riemannian manifolds. These models, like ordinary generalized linear models, are a generalization of partially linear models on Riemannian manifolds that allow for scalar response variables with error distribution models other than a normal distribution. Partially linear models are particularly useful when some of the covariates of the model are elements of a Riemannian manifold, because the curvature of these spaces makes it difficult to define parametric models. The model was developed to address an interesting application: the prediction of children's garment fit based on three-dimensional scanning of their bodies. For this reason, we focus on logistic and ordinal models and on the important and difficult case where the Riemannian manifold is the three-dimensional case of Kendall's shape space. An experimental study with a well-known three-dimensional database is carried out to check the goodness of the procedure. Finally, it is applied to a three-dimensional database obtained from an anthropometric survey of the Spanish child population. A comparative study with related techniques is carried out.

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.

Generalized linear models for geometrical current predictors: An application to predict garment fit

The aim of this article is to model an ordinal response variable in terms of vector-valued functional data included on a vector-valued reproducing kernel Hilbert space (RKHS). In particular, we focus on the vector-valued RKHS obtained when a geometrical object (body) is characterized by a current and on the ordinal regression model. A common way to solve this problem in functional data analysis is to express the data in the orthonormal basis given by decomposition of the covariance operator. But our data present very important differences with respect to the usual functional data setting. On the one hand, they are vector-valued functions, and on the other, they are functions in an RKHS with a previously defined norm. We propose to use three different bases: the orthonormal basis given by the kernel that defines the RKHS, a basis obtained from decomposition of the integral operator defined using the covariance function and a third basis that combines the previous two. The three approaches are compared and applied to an interesting problem: building a model to predict the fit of children's garment sizes, based on a 3D database of the Spanish child population. Our proposal has been compared with alternative methods that explore the performance of other classifiers (Support Vector Machine and [Formula: see text]-NN), and with the result of applying the classification method proposed in this work, from different characterizations of the objects (landmarks and multivariate anthropometric measurements instead of currents), obtaining in all these cases worst results.

The relationship of obesity with lifestyle and dietary exposure to endocrine-disrupting chemicals

Phytoestrogens are natural components of plants, including numerous foods that form part of the habitual diet of humans and animals. They have similar estrogenic effects to those of synthetic endocrine disrupters such as monomers of plastic materials, e.g., polycarbonates and epoxy resins. The most frequently used monomer is bisphenol A (BPA), which has been found to migrate from drink and food packaging, plastic baby bottles, and the coating of cans. Numerous studies have associated exposure to endocrine disrupters with obesity, classifying them as obesogens. The objectives of this study were to estimate the dietary exposure to phytoestrogens and BPA in a group of Spanish schoolchildren and to estimate their potential obesogenic effects. The diet of this population of healthy Spanish children was estimated to have a mean total estrogenic capacity of 5.10−12 M eq.E2 (5 pmol/day). The effects of this additional estrogenic burden are highly controversial, and no definitive conclusion has been reached. Thus, some authors consider exposure to these substances with estrogenic activity to be positive at certain stages of life, whereas others regard it as posing a risk at any age. In the present population of children, the likelihood of normal weight versus obesity was significantly related to the total proliferative effect (OR = 0.51, p = 0.026) as well as to the energy expenditure on physical activity, with lesser activity implying a greater risk of obesity (OR = 13.54, p = 0.001). Further research is warranted on the obesogenic effects of exposure to endocrine disruptors present in foods.

Spanish Validation of the Child and Adolescent Perfectionism Scale: Factorial Invariance and Latent Means Differences across Sex and Age.

The present study analyzed the psychometric properties of a Spanish translation of the child–adolescent perfectionism scale (CAPS-S), as well as its factorial invariance and latent means differences across sex and age. A sample of 1809 Spanish students of Primary Education, aged between 8 and 11 (Mage = 9.53, SD = 1.11), was used. Confirmatory factor analyses and multigroup confirmatory factor analyses were applied to examine the factor structure of the CAPS-S. The results revealed that a model made up of 13 items structured in 3 factors—Self-Oriented Perfectionism-Striving (SOP-Striving), Self-Oriented Perfectionism-Critical (SOP-Critical), and Socially Prescribed Perfectionism (SPP)—showed a better fit than any of the previously tested models, and it was invariant across sex and age. SOP-Striving did not significantly correlate with school anxiety and aggression, whereas significant and positive correlations were found in the case of SOP-Critical and SPP. The levels of reliability and stability of the scale were ω = 0.91, 0.74, 0.73, and 0.80, and rxx = 0.73, 0.62, 0.73, and 0.74, for the total CAPS-S and for the SOP-Striving, SOP-Critical, and SPP dimensions, respectively. Analysis of latent means differences revealed that boys scored significantly higher than girls in SOP-Critical. The 9-year-olds scored significantly lower in SPP than their 8-year-old peers. Conversely, 11-year-olds scored higher in SOP-Critical than 8-year-olds. In addition, 10- and 11-year-olds scored higher than their 9-year-old peers. The CAPS-S presented in this research is a reliable and valid instrument to assess perfectionism in Spanish child population.

Prevalence of FLG loss-of-function mutations R501X, 2282del4, and R2447X in Spanish children with atopic dermatitis.

Atopic dermatitis (AD) is the most prevalent inflammatory skin disorder, and is often associated with a personal or family history of atopic disease. The presence of loss-of-function mutations in the filaggrin gene (FLG) is the main predisposing factor for AD FLG mutations show ethnic and geographical variations, even between European populations. We sought to determine the frequency of the 3 most common FLG null mutations in a population of Spanish children consisting of healthy controls and AD patients. We also investigated the association between these 3 FLG mutations and AD. A total of 214 participants (111 AD patients and 103 healthy controls) were enrolled in this study. Genotyping for 3 FLG null mutations (R501X, 2282del4, and R2447X) was performed by conventional Sanger sequencing. The combined mutation frequency was 1.9% in the control group and 12.6% in the AD group. The most common FLG mutation in AD patients was R501X (9.9%), followed by R2447X (2.7%) and 2282del4 (1.8%). These findings further our understanding of the prevalence of FLG null mutations in the Spanish population, and suggest that the frequency of FLG mutations in AD patients in Spain is slightly higher than that of other Mediterranean countries.

Supervised classification of geometrical objects by integrating currents and functional data analysis

This paper focuses on the application of supervised classification techniques to a set of geometrical objects (bodies) characterized by currents, in particular, discriminant analysis and some nonparametric methods. A current is a relevant mathematical object to model geometrical data, like hypersurfaces, through integration of vector fields over them. As a consequence of the choice of a vector-valued reproducing kernel Hilbert space (RKHS) as a test space to integrate over hypersurfaces, it is possible to consider that hypersurfaces are embedded in this Hilbert space. This embedding enables us to consider classification algorithms of geometrical objects. We present a method to apply supervised classification techniques in the obtained vector-valued RKHS. This method is based on the eigenfunction decomposition of the kernel. The novelty of this paper is therefore the reformulation of a size and shape supervised classification problem in functional data analysis terms using the theory of currents and vector-valued RKHSs. This approach is applied to a 3D database obtained from an anthropometric survey of the Spanish child population with a potential application to online sales of children’s wear.

A Kernel Regression Procedure in the 3D Shape Space with an Application to Online Sales of Children’s Wear

This paper is focused on kernel regression when the response variable is the shape of a 3D object represented by a configuration matrix of landmarks. Regression methods on this shape space are not trivial because this space has a complex finite-dimensional Riemannian manifold structure (non-Euclidean). Papers about it are scarce in the literature, the majority of them are restricted to the case of a single explanatory variable, and many of them are based on the approximated tangent space. In this paper, there are several methodological innovations. The first one is the adaptation of the general method for kernel regression analysis in manifold-valued data to the three-dimensional case of Kendall’s shape space. The second one is its generalization to the multivariate case and the addressing of the curse-of-dimensionality problem. Finally, we propose bootstrap confidence intervals for prediction. A simulation study is carried out to check the goodness of the procedure, and a comparison with a current approach is performed. Then, it is applied to a 3D database obtained from an anthropometric survey of the Spanish child population with a potential application to online sales of children’s wear.

Child hospital admissions associated with influenza virus infection in 6 Spanish cities (2014–2016)

IntroductionThere are only a limited number of studies on the impact of influenza in the Spanish child population. The present work intends to increase this knowledge by studying some key aspects, such as the incidence of hospital admissions, clinic variables, comorbidities, and the vaccination status in the hospitalised children. MethodsA retrospective, observational study was conducted by reviewing the medical records of children under 15 years and hospitalised due to community acquired influenza confirmed microbiologically, during 2́flu seasons (2014–2015 and 2015–2016). The study was carried out in 10 hospitals of 6 cities, which represent approximately 12% of the Spanish child population. ResultsA total of 907 children were admitted to hospital with main diagnosis of influenza infection (447 <2 years), estimating an average annual rate of hospitalization incidence of 0.51 cases/1000 children (95% CI, 0.48–0.55). Just under half (45%) of the cases had an underlying disease considered a risk factor for severe influenza, and most (74%) had not been vaccinated. The percentage of children with underlying diseases increased with age, from 26% in children <6 months to 74% in children >10 years. Admission to the PICU was required in 10% (92) of the cases, mainly due to acute respiratory failure. ConclusionInfluenza continues to be an important cause of hospitalization in the Spanish child population. Children <6 months of age and children with underlying diseases make up the majority (>50%) of the cases. Many of the severe forms of childhood influenza that occur today could be avoided if current vaccination guidelines were met.