Prevalence and factors linked to atopic eczema in 10- and 11-year-old schoolchildren. Isaac 2 in Almeria, Spain.

BACKGROUND: Atopic eczema affects 5-10% of the Spanish paediatric population, and has increased in frequency over the last few decades, probably due to changes in the environment and lifestyle. Phase II of the ISAAC (International Study of Asthma and Allergies in Childhood) uses a standardised methodology to establish the prevalence of allergic disorders and factors linked to them in each centre. OBJECTIVES: To assess the prevalence and severity of atopic eczema, and to establish factors linked to atopic eczema in 10-11 year-old school children in the city of Almeria (South-East coast of Spain). MATERIAL AND METHODS: An ecological study was carried out as part of ISAAC II, using homologated questionnaires and allergic tests in 1143 schoolchildren. Statistic association was assessed by means of chi(2) test, and then logistic regression analysis was performed with the most significant variables from the univariant analysis. RESULTS: The prevalence of atopic eczema was 11.4%. The risk factors found in the multiple logistic regression analysis were: personal antecedents of severe asthma (OR 19 CI 95% 1.35-266) and severe rhinitis (OR 7.7 CI 95% 1.79-33), fungi in bedroom during the first year of life (OR 4.2 CI 95% 1.17-15.1) and atopic eczema in one parent (OR 5.2 CI 95% 2.69-10.1). CONCLUSIONS: The prevalence of atopic eczema is similar to that found in other studies within ISAAC Phase I. The most important risk factors for atopic eczema are family and personal history of other atopic diseases and the presence of fungi in the home.

[Utility of the Pediatric Appropriateness Evaluation Protocol (pAEP) to detect deficiencies in the healthcare circuit]. / Utilidad del Pediatric Appropriateness Evaluation Protocol para detectar deficiencias de circuitos asistenciales hospitalarios.

OBJECTIVES: To quantify the number of inappropriate pediatric hospital admissions using the Pediatric Appropriateness Evaluation Protocol (pAEP), the causes of inappropriate admissions, and the clinical utility of the paep, as well as to detect deficiencies in the healthcare circuit in hospitalized pediatric patients. MATERIAL AND METHODS: A prospective, descriptive study was carried out in a sample of 236 pediatric admissions. We analyzed several items such as age, pAEP, factors associated with inappropriate admission, main and secondary diagnoses, the diagnostic tests motivating admission, and day of the week and month of admission. RESULTS: A total of 13.6 % (CI: 9.5 %-18 %) of pediatric admissions were inappropriate. The most frequent reasons for inappropriate admissions were diagnostic tests (2.5 %) and treatment (11 %) that could have been performed on an outpatient basis. Most (90.6 %) of the admissions deemed inappropriate by the pAEP were also considered inappropriate when evaluated by experienced pediatricians. CONCLUSIONS: Improvement of healthcare circuits could decrease inappropriate admissions (better coordination between primary care and hospitals and improved access from the emergency unit to the specialized pediatric outpatient service). The pAEP allows identification of inappropriate admissions and their causes, as well as detection of deficiencies in the healthcare circuit.

Prevalence and factors linked to atopic eczema in 10- and 11-year-old schoolchildren. Isaac 2 in Almeria, Spain

Background: Atopic eczema affects 5-10% of the Spanish paediatric population, and has increased in frequency over the last few decades, probably due to changes in the environment and lifestyle. Phase II of the ISAAC (International Study of Asthma and Allergies in Childhood) uses a standardised methodology to establish the prevalence of allergic disorders and factors linked to them in each centre. Objectives: To assess the prevalence and severity of atopic eczema, and to establish factors linked to atopic eczema in 10–11 year-old school children in the city of Almeria (South-East coast of Spain). Material and methods: An ecological study was carried out as part of ISAAC II, using homologated questionnaires and allergic tests in 1143 schoolchildren. Statistic association was assessed by means of ÷2 test, and then logistic regression analysis was performed with the most significant variables from the univariant analysis. Results: The prevalence of atopic eczema was 11.4%. The risk factors found in the multiple logistic regression analysis were: personal antecedents of severe asthma (OR 19 CI 95% 1.35–266) and severe rhinitis (OR 7.7 CI 95% 1.79–33), fungi in bedroom during the first year of life (OR 4.2 CI 95% 1.17–15.1) and atopic eczema in one parent (OR 5.2 CI 95% 2.69–10.1). Conclusions: The prevalence of atopic eczema is similar to that found in other studies within ISAAC Phase I. The most important risk factors for atopic eczema are family and personal history of other atopic diseases and the presence of fungi in the home

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Fase de remisión en niños con diabetes tipo 1 / Remission phase in children with type 1 diabetes

Objetivos. l. Relacionar la aparición de la fase de remisión (FR) en diabéticos tipo 1 menores de 14 años con variables conocidas en el momento del diagnóstico y con la pauta de tratamiento insulínico instaurada al debut. 2. Valorar si la existencia de esta fase influye en el requerimiento insulínico y en el control metabólico en los cinco primeros años de evolución de la diabetes. Pacientes y métodos. Estudio retrospectivo de los niños con diabetes tipo 1 con debut antes de los 14 años de edad. Se definió FR como aquella en la que el requerimiento insulínico era menor de 0,5 U/kg/día. Resultados. Se incluyeron en el estudio 121 pacientes (71 varones) de edades comprendidas entre 1,0 y 13,7 años en el momento del diagnóstico. 78 pacientes (64,5 por ciento) presentaron FR. En los varones 53/71 presentaron FR, frente a 25/50 en mujeres (p<0,01). En los menores de 5 años la proporción de FR fue de 20/46, menor que en los otros segmentos de edad (p<0,001). En los tratados con insulinoterapia intensiva la proporción de FR fue de 35/48 frente a 43/73 en los tratados de forma convencional (No significación). La dosis de insulina al alta hospitalaria fue menor en el grupo con FR (0,56 U/kg/d frente a 0,78) (p<0,001). La duración de la FR fue de 10,6 (7,2) meses, rango l-30. E1 requerimiento insulínico y los valores de hemoglobina glicada media solo fueron menores en el grupo con FR en el primer año de evolución. Conclusiones. l. Los diabéticos tipo 1 menores de 14 años que presentan FR son con mayor frecuencia los varones, los mayores de 5 años y los que reciben menor dosis de insulina al debut. La insulinoterapia intensiva no aumenta la prevalencia de FR. 2. No existen diferencias en el requerimiento insulínico ni en el control metabólico entre los dos y cinco años de diabetes entre los niños que presentan FR y los que no. (AU)

Utilidad del Pediatric Appropriateness Evaluation Protocol para detectar deficiencias de circuitos asistenciales hospitalarios / Utility of the pediatric appropriateness evaluation protocol (pAEP) to detect deficiencies in the healthcre circuit

Objetivos Cuantificar el porcentaje de ingresos inadecuados según el Pediatric Appropriateness Evaluation Protocol (pAEP), sus causas, la utilidad clínica del pAEP y detectar deficiencias en los circuitos asistenciales en los pacientes pediátricos hospitalizados.Material y métodos Estudio descriptivo, prospectivo de 236 pacientes hospitalizados en el Servicio de Pediatría. Entre las variables analizadas destacan: edad del paciente, protocolo pAEP, causas de ingresos inadecuados, diagnóstico principal y secundario al ingreso del paciente, prueba diagnóstica motivo del ingreso, día de la semana y mes del ingreso.Resultados El 13,6 por ciento (IC 95 por ciento, 9,5-18 por ciento) de las hospitalizaciones pediátricas son inadecuadas según el protocolo pAEP. Las causas de ingresos inadecuados son: pruebas diagnósticas (2,5 por ciento de los ingresos pediátricos) y tratamientos (11 por ciento de los ingresos pediátricos) que podrían haberse realizado como paciente externo. El 90,6 por ciento de los ingresos inadecuados según el pAEP también son considerados inadecuados cuando son evaluados por pediatras expertos.Conclusiones Observamos deficiencias en los circuitos asistenciales cuya mejora podría disminuir el porcentaje de ingresos inadecuados (mayor coordinación atención primaria y hospitalizada y mejor accesibilidad desde urgencias a consultas externas especializadas pediátricas). Para mejorar la calidad en la asistencia pediátrica, el pAEP nos permite identificar ingresos inapropiados y sus causas, así como detectar deficiencias en los circuitos asistenciales (AU)