Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood
Systematic literature review of modifiable risk factors for recurrent acute otitis media in childhood
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DOI：
10.1590/s0021-75572006000200003
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发表时间：
2006-04-01
影响因子：
3.3
通讯作者：
Silva, Daniela Brunelli e
中科院分区：
文献类型：
--
作者：
Lubianca Neto, José Faibes;Hemb, Lucas;Silva, Daniela Brunelli e
目的：回顾关于复发性急性中耳炎的可改变危险因素的证据。资料来源：无语言限制的Medline，1966年1月至2005年7月，使用描述符“急性中耳炎/危险因素”。共获得二百五十七篇文章。这些研究包括随机临床试验、队列、病例对照和横断面研究，这些研究以分析复发急性中耳炎的可改变危险因素为主要目标，以18岁以下的个体为样本。数据汇总：确定了9个与宿主有关的危险因素，8个与环境有关的危险因素。在第一组中，过敏、头面部异常、胃食道反流和腺样体的存在被归类为可修改的。在第二类中，包括上呼吸道感染、日托中心就诊、兄弟姐妹/家庭规模、被动吸烟、母乳喂养和使用奶嘴。然后根据证据等级对危险因素进行分类。结论：复发性急性中耳炎的危险因素是安抚奶嘴的使用和日托中心的护理。可能的危险因素是母乳缺乏、兄弟姐妹的存在、头面部畸形、被动吸烟和腺样体的存在。没有可修改的因素被归类为不太可能。其中需要进一步研究的包括过敏、胃食道反流和孕期被动吸烟。
OBJECTIVE: Review evidence about modifiable risk factors for recurrent acute otitis media.SOURCE OF DATA: MEDLINE with no language restriction, from January 1966 to July 2005, using descriptors "acute otitis media/risk factors". Two hundred and fifty-seven articles were obtained. These included randomized clinical trials, cohorts, case-control and cross-sectional studies that contained analyses of modifiable risk factors for the development of recurrent acute otitis media as the main objective and with samples of individuals up to the age of 18 years. Except when relevant, the following were excluded: non-systematic reviews, reports of cases, series of cases, and medical society guidelines.SUMMARY OF DATA: Nine risk factors linked to the host and eight linked to the environment were identified. Of the first group, allergy, craniofacial abnormalities, gastroesophageal reflux and the presence of adenoids were classified as modifiable. In the second category, upper airway infections, day care center attendance, presence of siblings/family size, passive smoking, breastfeeding and use of pacifiers were included. Afterwards, the risk factors were classified in accordance with levels of evidence.CONCLUSIONS: The risk factors established for recurrent acute otitis media and capable of being modified were the use of pacifiers and care in daycare centers. The probable risk factors were privation of mother's milk, presence of siblings, craniofacial abnormalities, passive smoking and presence of adenoids. No modifiable factor was classified as unlikely. Among those that need further study are allergy, gastroesophageal reflux and passive smoking during gestation.