Resources to handle childhood asthma in Spain: The role of plans and guides and the participation of nurses.

BACKGROUND: Describe the assistance provided to asthmatic patients by Primary Care Paediatricians (PCP) in Spain and the material and human resources available for diagnosis and follow-up. METHODS: A cross-sectional descriptive study using an on-line survey, sent to PCP regarding the availability of diagnostic resources, carrying out programmed and educational activities, collaboration of nursing staff and their relationship with existing institutional plans to care for children with asthma. A latent class model (LCM) was used to describe the differences among paediatricians based on the variables studied. RESULTS: Of the 708 answers, 675 were considered valid; 76% of the paediatricians had a spirometer, 75% specific IgE, 17% prick-test, 95% had placebo inhalers and 97% inhalation chambers. 57% performed programmed activities with their patients, while 56% shared their care of asthmatic patients with their nursing staff, but only 25% of the nurses were involved in the follow-up and 12% in education. LCM identified four patterns. The two groups with greater access to diagnostic resources counted on institutional plans/guidelines. However, the only variable differentiating the groups with more programmed and educational activities was the participation of nurses. CONCLUSIONS: The availability of asthma plans/guidelines and resources for diagnosis and follow-up is not sufficient to improve important aspects of primary care for children with asthma. Organisational changes are necessary to include programmed asthma-related visits and paediatric teams with greater involvement of the nurses when caring for these patients.

Quality of life in caregivers of children with asthma: Validity and reliability of the IFABI-R questionnaire.

BACKGROUND: Parents'/caregivers' quality of life is an important aspect to consider when handling paediatric asthma, but there is a paucity of valid and reliable instruments to measure it. The Family Impact of Childhood Bronchial Asthma (IFABI-R) is a recently developed questionnaire to facilitate the assessment of asthma-related parents'/caregivers' quality of life. This study researches the psychometric properties of IFABI-R. METHODS: Parents/main caregivers of 462 children between 4 and 14 years of age with active asthma were included in the sample. IFABI-R was administered on two different occasions and a number of other variables related to the parents'/caregivers' quality of life were measured: child's asthma control, family functioning, and parents'/caregivers' perception of asthma symptoms in the child. IFABI-R evaluative and discriminative properties were analysed, and the minimal important change in the IFABI-R score was identified. RESULTS: IFABI-R showed high internal consistency (Cronbach's alpha=0.941), cross-sectional construct validity (correlation with the degree of child's asthma control, family functioning and parent/caregiver perception of the child's asthma symptoms), longitudinal construct validity (correlation of changes in the IFABI-R with changes in asthma control and changes in the perception of symptoms), sensitivity to change and test-retest reliability. An absolute change of 0.3 units in IFABI-R related to a minimal significant change in the parents'/caregivers' quality of life. CONCLUSIONS: IFABI-R is a reliable and valid instrument to study the quality of life of parents/caregivers of children with asthma.

Anti-asthmatic prescription variability in children according to age.

INTRODUCTION: There is little research in the Spanish paediatric population about the consumption of anti-asthmatic agents. The aim of this study was to describe the current pattern of anti-asthmatic drug prescription in the paediatric population from a region of Spain, using the prescribed daily dose as a unit of measurement. METHODS: We analysed the requirements of R03 therapeutic subgroup (anti-asthmatic agents) in children less than 14 years of age in the Public Health System of Castilla y León from 2005 to 2010. Consumption data are presented in prescribed daily doses per thousand inhabitants per day (PDHD) and compared with defined daily doses per thousand inhabitants per day (DHD). RESULTS: 394 876 prescriptions of anti-asthmatics were given to a population of 1 580 229 persons/year. Bronchodilators, leukotriene receptor antagonists, single inhaled corticosteroids (ICS) and long-acting ß2-adrenergics associated with inhaled corticosteroids were the most commonly prescribed drugs: 7.5, 5.2, 4.9 and 2.2 PDHD, respectively. The maximum prescription of bronchodilators (15.9 PDHD/9.8 DHD) occurred in children under 12 months, with montelukast (8.9 PDHD/3.6 DHD) and single inhaled corticosteroids (7.9 PDHD/2.9 DHD) at one year of age. CONCLUSIONS: Between 2005 and 2010, children under four years received a high prescription of anti-asthmatic drugs. The use of maintenance therapy was poorly aligned with the recommendations of asthma guidelines. The PDHD was more accurate for measuring consumption than DHD, especially in younger children.

[Starting of a new pediatric palliative care program in a general hospital: characteristics of the population and use of resources].

This article sets out to describe the characteristics of patients at a second-level hospital who are likely to receive pedi-atric palliative care (PPC), the frequency of visits to the emergency room, admissions and technological devices used. A retrospective study was carried out of the patients who received care from the start of the PPC program (January 2017 to January 2020) at a secondary-level hospital. Twenty-nine patients were included, 58.6% male with mean age at entry into the study of 2.3 years (SD: 2.4); 44.8% of them were from rural areas. The prevalence of multimorbidity was 41%, with a higher frequency of neurological patholo-gy. Respiratory infection was the most frequent cause of emergency care (n = 360) and hospitalization (n=145). Half of patients (51.7%) depended on medical devices. Better knowledge of the resources used by this population can lead to more effective distribution/management that in turn can enable PPC to be offered regardless of the place of residence.

Clinical correlates and determinants of airway inflammation in pediatric asthma.

BACKGROUND: Airway inflammation is a key component in the pathophysiology of asthma. However, neither its role in the clinical features of asthma nor the factors affecting the degree of inflammation have been fully defined. METHODS: We determined the fractional exhaled nitric oxide concentration (FE(NO)) using a portable device (NIOX-MINO, Aerocrine, Solna, Sweden) in a consecutive sample of 149 asthmatic children aged 6 to 14 years. In order to establish an association with FE(NO), we analyzed symptoms, spirometric parameters before and after a bronchodilator test, and the impact of asthma on quality of life during the previous 4 weeks. We also investigated how clinical variables that regulate inflammation affected FE(NO). RESULTS: In patients not treated with inhaled corticosteroids (ICs), FE(NO) was higher when specific symptoms (wheeze and cough) had been present during the previous 4 weeks; however, we were unable to establish a relationship with symptom frequency, bronchodilator use, asthma crises, hospital admissions, limitation of daily activities, or spirometry results. In patients treated with ICs, FE(NO) was not related to the clinical expression of asthma, except for a reduced ratio of forced expiratory volume in 1 second to forced vital capacity, both before and after bronchodilation. The main determinant of FE level in untreated patients was sensitization to house dust mite. In patients treated with ICs, FE(NO) was only associated with adherence to therapy. CONCLUSION: Airway inflammation, as determined by FE(NO), is only weakly associated with the clinical expression of asthma and spirometry results. Adherence to treatment is the main determinant of the degree of inflammation in patients taking ICs.

[Feasibility of FeNO measurement in asthmatic children in the primary care setting. CANON Study]. / Factibilidad de la medición en atención primaria de la fracción exhalada de óxido nítrico en niños con asma. Estudio CANON.

AIM: Asses the feasibility of exhaled nitric oxide (FeNO) measurement in asthmatic children using a hand-held device in the primary care setting. METHODS: Multicentre study performed in the paediatric clinics in seven Spanish primary health care centres. Each centre consecutively included 6-14 year-old children with doctor-diagnosed asthma. Children were asked to obtain two valid measurements of FeNO with the hand-held device NIOX MINO (Aerocrine AB, Solna, Sweden). Feasibility analysis included: (a) percentage of children able to perform the manoeuvre, (b) time required to obtain a successful determination, (c) number of attempts needed, and (d) acceptability of the technical procedure by clinical personnel involved in their guidance. RESULTS: The Study enrolled 151 children. A total of 149 (98.7%) were able to perform the FeNO manoeuvre. The majority (55%) of children had previous experience of using the hand-held device. The Overall median (and Interquartile Range, IQR) of attempts needed to reach a first valid measurement was 2 (1-3) and median (IQR) of time taken was 4 min (3-5). Nurses considered the overall procedure was very easy or easy in 87.8% (teaching) and 86.5% (performing) of children. Children with previous experience performed the manoeuvre in less attempts, less time and more easily than children without experience. CONCLUSIONS: Measurement of FeNO using NIOX MINO device is technically feasible and acceptable for children and staff in the clinical context of asthma management in primary health care. Previous experience had a positive, learning effect, in teaching and performing the FeNO manoeuvre.

Group education on asthma for children and caregivers: a randomized, controlled trial addressing effects on morbidity and quality of life.

OBJECTIVE: To establish the efficacy in terms of morbidity and quality of life of a group education program on asthma aimed at children and caregivers. METHODS: An open, randomized, controlled trial was undertaken in 13 primary health care centers in Spain, Cuba, and Uruguay and involved 245 children with active asthma aged 9 to 13 years and their caregivers. The intervention consisted of 3 educational sessions lasting 45 to 60 minutes each and was performed with 3 intervention groups: children alone, caregivers alone, and both children and caregivers. The outcome measures were difference between intervention and control groups in the rate of asthma attacks and hospital admission, as well as the quality of life of children and caregivers in the 6 months following the intervention. RESULTS: The rate of asthma attacks per patient-year decreased when the intervention was given only to children (mean difference, -1.61; 95% confidence interval [CI], -2.87 to -0.34) or to both children and caregivers (-1.60; 95% CI, -2.88 to -0.31). Hospital admissions per patient-year decreased in the intervention groups children alone (-0.28; 95% CI, -0.51 to -0.05) and both children and caregivers (-0.25; 95% CI, -0.49 to -0.02). Education provided to caregivers alone was not associated with any changes in morbidity. No differences were observed in terms of quality of life between controls and any of the intervention groups. CONCLUSIONS: Group education on asthma reduces morbidity but does not improve quality of life. The benefits are apparent when education is aimed at children but no additional benefit is obtained if the intervention is also aimed at their caregivers. Finally, group education for adult caregivers alone is not effective.

Inicio de un nuevo programa de cuidados paliativos pediátricos en un hospital general: características de la población y uso de recursos / Starting of a new pediatric palliative care program in a general hospital: characteristics of the population and use of resources

Se describen las características de los pacientes susceptibles de cuidados paliativos pediátricos (CPP) de un hospital de segundo nivel, así como la frecuencia de visitas a urgencias, de ingresos y de dispositivos tecnológicos empleados. Estudio retrospectivo de los pacientes atendidos desde el inicio del programa de CPP (enero 2017 a enero 2020) en un hospital de nivel secundario. Se incluyeron 29 niños, 58,6% varones y edad media a la entrada en el estudio de 2,3 años (DE: 2,4); el 44,8% procedían del ámbito rural. El 41% presentaron multimorbilidad, con mayor frecuencia de patología neurológica. La causa más frecuente de atención en urgencias (n = 360) y hospitalización (n = 145) fue la infeccioso-respiratoria. El 51,7% de los pacientes eran dependientes de dispositivos médicos. Conocer el uso de recursos de esta población puede ayudar a un mejor reparto de los mismos para poder ofrecer CPP con independencia del lugar de residencia.(AU)

This article sets out to describe the characteristics of patients at a second-level hospital who are likely to receive pediatric palliative care (PPC), the frequency of visits to the emergency room, admissions and technological devices used. A retrospective study was carried out of the patients who received care from the start of the PPC program (January 2017 to January 2020) at a secondary-level hospital. Twenty-nine patients were included, 58.6% male with mean age at entry into the study of 2.3 years (SD: 2.4); 44.8% of them were from rural areas. The prevalence of multimorbidity was 41%, with a higher frequency of neurological pathology. Respiratory infection was the most frequent cause of emergency care (n = 360) and hospitalization (n=145). Half of patients (51.7%) depended on medical devices. Better knowledge of the resources used by this population can lead to more effective distribution/management that in turn can enable PPC to be offered regardless of the place of residence.(AU)

[Paediatric prescribing of anti-asthmatics in primary care in Castilla-León. Geographical variability]. / Prescripción pediátrica de fármacos antiasmáticos en atención primaria en Castilla y León. Variabilidad geográfica.

INTRODUCTION AND OBJECTIVES: Asthma is one of the most prevalent chronic diseases with effective treatment in paediatrics. The aim of this study is to describe the paediatric prescribing of anti-asthmatics in Castilla-León, analyzing its geographic variability and temporal evolution. MATERIAL AND METHODS: An analysis was made of prescriptions dispensed in pharmacies of R03 therapeutic subgroup (anti-asthmatic agents), and the active ingredients mepyramine and ketotifen, prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 in Primary Care. Data is presented in prescribed daily doses per thousand inhabitants per day (PDHD) for each active ingredient being calculated raw rates and age-adjusted to the variables health area, type of health zone and year of study. RESULTS: A total of 462,354 prescriptions of anti-asthmatic agents were dispensed to a population of 1,580,229 persons/year. There was wide variation between areas in the type and intensity of anti-asthmatic agents used, partly explained by differences in the prevalence of asthma. Montelukast predominated as controller drug in most of them (PDHD 3.1 to 7.7), being similar the consumption intensity in the three types of health zones (PDHD 4.7 to 4.8). The annual variability was low. CONCLUSIONS: The study describes the paediatric prescribing pattern of anti-asthmatic agents in Castilla-León between 2005-2010. It shows wide geographical variation, as well as inadequacies regarding current recommendations of asthma treatment.

[Tobacco, infant feeding, and wheezing in the first three years of life]. / Tabaco, lactancia y sibilantes en los primeros tres años.

BACKGROUND: Wheezing lower respiratory tract diseases are frequent and troublesome in young children. However, the only avoidable risk factors for them are tobacco smoke exposure and feeding practices. OBJECTIVE: To measure the influence of these avoidable factors on the risk of wheeze in the first 3 years of life. METHODS: We performed a population study including all the children born between January 1998 and November 2002 who were attended in the same primary health center in Palencia (Spain) from birth. Information on family history, pregnancy, delivery, and smoking was obtained soon after birth. Feeding practices were recorded on monthly visits. Wheezing episodes in the first 3 years of life were identified by a pediatrician. RESULTS: Two hundred thirty-four children were included and 43 had at least one episode of wheezing. The results were adjusted by sex, prematurity, a family history of allergy, having older siblings, maternal age, and month of birth. No association was found between wheezing and exclusive breast feeding for 3 months (hazard ratio [HR] 5 0.83, 95 % CI: 0.42-1.64), or with postnatal exposure to tobacco smoke (HR 5 1.2, 95 % CI: 0.45-2.34). Tobacco smoke exposure during pregnancy was associated with a higher risk of wheezing: HR 5 2.54 (95 % CI: 1.18-5.48). CONCLUSIONS: Prenatal exposure to tobacco smoke is the main modifiable risk factor for wheezing diseases in the first 3 years of life.

[Prescription of systemic cold and cough drugs to children 0-13 years old. An unresolved problem]. / Prescripción de fármacos anticatarrales de uso sistémico a niños de 0-13 años. Un problema no resuelto.

INTRODUCTION AND OBJECTIVES: Upper respiratory tract infections are the most common cause of paediatric consultation, generating a high volume of prescriptions of drugs with unfavourable risk-benefit ratio. The aim of this study is to describe the prescription of systemic cough and cold medicines to children under 14 years of age in Castilla y León and analyse its variability. POPULATION AND METHODS: A count was made of the prescriptions for the R05 therapeutic subgroup (antitussives and mucolytics) and the R01B pharmacological therapeutic subgroup (nasal decongestants for systemic use), prescribed for children under the age of 14 in the Public Health System between 2005-2010. The number of prescriptions was analysed as crude and age-adjusted rates, as well as a a multivariate analysis (Poisson regression) of the variability associated with health area, the urban/rural environment, age, and year of prescription. RESULTS: There were 806,785 prescriptions for systemic cough and cold drugs given to an exposed population of 1,580,229 person-years. Prescription rates (per 100 person-years) were 20.7 (antitussives), 7.0 (sympathomimetic) and 23.4 (mucolytics). These drugs were employed more often in children <4 years. The prescription of mucolytics and sympathomimetics was highest at age of 1 year (rates=41.9 and 18.7, respectively) and of antitussives at 3 years (35.7). Multivariate analysis showed that in rural areas the prescription was higher than in urban areas, and that there were also significant differences between health areas. CONCLUSIONS: Between 2005 and 2010 there was a high prescription of systemic cough and cold medicines, especially in children under 2 years old, and often outside the recommended conditions of use, and there was a high geographic variabilty.

[Determining factors of physical activity level in school children and adolescents: the OPACA study]. / Determinantes del nivel de actividad física en escolares y adolescentes: estudio OPACA.

INTRODUCTION: Physical activity is a key factor for human health. This study attempts to measure the level of physical activity in children and to find out what are the factors that determine it. METHOD: In a sample of the 11 and 14 year-old population of the centre-south area of Palencia, physical activity was measured using a three day diary, and anthropometric and socioeconomic variables were collected. Three variables were analysed: fat-free mass adjusted activity energy expenditure (AEE/FFM), physical activity level (PAL), and categorical physical activity (active/inactive). RESULTS: A total of 179 children were included, of whom 71.5% were active or very active. Males were more active than females, and activity was also higher in summer. Physical activity declined between 11 and 14 years, and was lower during the weekends than in working days. There were no differences related to obesity, overweight or percent body fat. More active children had lower blood pressure. Physical activity was directly related to weekly hours spent in sport activities, and inversely related to time spent on sedentary activities. Multivariate analysis showed that children from families with low educational levels had a higher activity level not related to sport activities. CONCLUSIONS: The level of physical activity in this population is acceptable, although there are sex differences and there is a declining trend through the adolescence.

Prescripción pediátrica de fármacos antiasmáticos en atención primaria en Castilla y León. Variabilidad geográfica / Paediatric prescribing of anti-asthmatics in primary care in Castilla-León. Geographical variability

INTRODUCCIÓN Y OBJETIVOS: El asma es una de las enfermedades crónicas con tratamiento eficaz más prevalentes en pediatría. El objetivo de este trabajo es describir la prescripción pediátrica de antiasmáticos en Castilla y León, analizando su variabilidad geográfica y su evolución temporal. MATERIAL Y MÉTODOS: Se estudiaron las prescripciones dispensadas en farmacias del subgrupo terapéutico R03 (medicamentos antiasmáticos) y de los principios activos mepiramina y ketotifeno, realizadas a menores de 14 años en atención primaria en el Sistema Nacional de Salud entre 2005 y 2010. Los datos se presentan en dosis diarias prescritas por 1.000 habitantes/día (PDHD) para cada principio activo, calculándose tasas crudas y ajustadas por edad para las variables área sanitaria, tipo de zona de salud y año del estudio. RESULTADOS: Se realizaron 462.354 prescripciones de antiasmáticos a una población expuesta de 1.580.229 personas-año. Hubo amplia variabilidad entre las áreas en el tipo e intensidad de los antiasmáticos utilizados, en parte explicada por diferencias en su prevalencia de asma. Montelukast predominó como fármaco controlador en la mayoría de ellas (3,1-7,7 PDHD), siendo su intensidad de consumo similar en los 3 tipos de zonas de salud (4,7-4,8 PDHD). La variabilidad anual fue escasa. CONCLUSIONES: El estudio describe el patrón pediátrico de prescripción de antiasmáticos en Castilla y León entre 2005 y 2010. Muestra gran variabilidad geográfica, así como inadecuaciones respecto a las recomendaciones actuales de tratamiento del asma

INTRODUCTION AND OBJECTIVES: Asthma is one of the most prevalent chronic diseases with effective treatment in paediatrics. The aim of this study is to describe the paediatric prescribing of anti-asthmatics in Castilla-León, analyzing its geographic variability and temporal evolution. MATERIAL AND METHODS: An analysis was made of prescriptions dispensed in pharmacies of R03 therapeutic subgroup (anti-asthmatic agents), and the active ingredients mepyramine and ketotifen, prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 in Primary Care. Data is presented in prescribed daily doses per thousand inhabitants per day (PDHD) for each active ingredient being calculated raw rates and age-adjusted to the variables health area, type of health zone and year of study. RESULTS: A total of 462,354 prescriptions of anti-asthmatic agents were dispensed to a population of 1,580,229 persons/year. There was wide variation between areas in the type and intensity of anti-asthmatic agents used, partly explained by differences in the prevalence of asthma. Montelukast predominated as controller drug in most of them (PDHD 3.1 to 7.7), being similar the consumption intensity in the three types of health zones (PDHD 4.7 to 4.8). The annual variability was low. CONCLUSIONS: The study describes the paediatric prescribing pattern of anti-asthmatic agents in Castilla-León between 2005-2010. It shows wide geographical variation, as well as inadequacies regarding current recommendations of asthma treatment

Prescripción off-label de antiasmáticos en Atención Primaria / Off-label prescription of anti-asthmatic agents in Primary Care

Introducción y objetivos: se denomina prescripción off-label a la realizada fuera de las condiciones autorizadas en la ficha técnica de un medicamento. En Atención Primaria se publican cifras globales de prescripción off-label en diferentes países del 3-67%. El objetivo del estudio ha sido conocer la intensidad de este tipo de prescripción en el caso de los antiasmáticos en un periodo reciente, en Castilla-León (España). Métodos: se analizaron las prescripciones correspondientes al subgrupo terapéutico R03 (medicamentos para enfermedades obstructivas respiratorias) realizadas a menores de 14 años entre 2005-2010 en el sistema público de salud autonómico. La información sobre el uso off-label se presenta en número de prescripciones consumidas de antiasmáticos a dosis y/o edades no recomendadas en su ficha técnica. Resultados: se realizaron 394876 prescripciones de antiasmáticos a una población expuesta de 1 580229 personas/año. Los menores de cuatro años fueron los que más antiasmáticos recibieron. La máxima prescripción de broncodilatadores ocurrió en menores de dos años, la de montelukast y corticoides inhalados monofármaco al año de edad. El 46% de las prescripciones de salbutamol sistémico y el 15,9% de las de la terapia de mantenimiento se prescribieron off-label. Conclusiones: el estudio muestra un uso importante de antiasmáticos a edades muy tempranas en las que es difícil hacer el diagnóstico de asma y un consumo notable de fármacos controladores a dosis y/o edades no autorizadas. La prescripción off-label no presupone una prescripción inadecuada, pero debería tener un beneficio real para el paciente y estar apoyada por avales científicos que justifiquen su uso (AU)

Introduction and objectives: off-label prescribing is when performed outside of the official information of the product. Overall figures of off-label prescribing in primary care in different countries are 3-67%. The aim of the study was to determine the intensity of this type of prescription in anti-asthmatic agents in a recent period of time, in Castilla y León. Methods: the requirements for the therapeutic subgroup R03 (anti-asthmatic agents) prescribed in children less than 14 years of age in the Castilla-León health service from 2005 to 2010 were analyzed. Information on off-label prescribing is shown in number of anti-asthmatic prescriptions consumed at doses and/or at ages not recommended in its technical specifications. Results: a total of 394 876 prescriptions for anti-asthmatic agents were performed to an exposed population of 1 580 229 person-years. Children under four years received the highest levels of anti-asthmatic agents. The maximum prescription of bronchodilators occurred in children under 2 years, and of montelukast and single inhaled corticosteroids at one year of age. 46% of prescriptions of systemic salbutamol and 15.9% of maintenance therapy prescriptions were made in an off-label manner. Conclusions: the study shows an important and very early use of anti-asthmatic agents at ages where it is difficult to make a diagnosis of asthma and also a remarkable consumption of controller therapy at not authorized dose and/or ages. Off-label prescription do not presuppose inappropriate prescription but it should have a real benefit to the patient and be supported by scientific guarantees to justify its use (AU)

Opiniones y expectativas de los padres respecto a las infecciones respiratorias agudas de lactantes y pre-escolares. Influencia en la disposición a consultar / Opinions and expectations of the parents regarding acute respiratory infections of infants and pre-school children. Influence on the facility to consult

Objetivos: Describir las opiniones y expectativas de los padres relacionadas con la disposición a consultar por infecciones respiratorias agudas de lactantes y pre-escolares. Métodos: Estudio transversal con muestra oportunista de padres de niños menores de cinco años. Se diseñó un cuestionario que exploraba las opiniones acerca de la frecuencia, sintomatología, gravedad y tratamiento de las infecciones respiratorias agudas, así como las expectativas respecto a la atención médica por esas enfermedades, y la disposición de los padres a consultar con el médico en distintas situaciones. Se realizó un análisis multivariante exploratorio para identificar las variables más relacionadas con la disposición a consultar. Resultados: Se recogieron 317 encuestas. El 54,6% de los niños del estudio eran varones, la edad mediana (amplitud intercuartil) era de 2,0 (0,6-3,3 años) y un 5,7% había estado alguna vez hospitalizado por enfermedades respiratorias. El modelo multivariante encontró siete variables asociadas a la disposición a consultar, agrupables en tres dominios: 1) percepción de vulnerabilidad del niño (menor edad y antecedentes de hospitalización); 2) percepción de una amenaza (creencia en la gravedad de las infecciones respiratorias y expectativa de que el médico le indique si es grave); y 3) percepción de eficacia del tratamiento farmacológico (creer en la eficacia de medicinas para tos y mocos, creer en la eficacia de antibióticos, y esperar una prescripción en la consulta). Conclusiones: La disposición a consultar por las infecciones respiratorias agudas de lactantes y pre-escolares se asocia a un conjunto definido de opiniones y expectativas de los padres

Aim: Describe the parents' beliefs and expectations related to the willingness to consult for acute respiratory infections in infants and preschool children. Methods: Cross-sectional study of an opportunistic sample of parents of children of less than five years. A questionnaire was designed to explore beliefs about frequency, symptoms, severity and treatment of acute respiratory infections, expectations on health care from doctors, and willingness to consult in certain circumstances. In an exploratory multivariate analysis, the main variables related to willingness to consult were identified. Results:. There were 317 questionnaires collected; 54.6 percent of children were male, their median age (interquartile range) was 2.0 years (0.6-3.3 years), and 5.7% had been hospitalized because respiratory diseases. The multivariate model found seven variables related to the willingness to consult, that could be clustered in three domains: 1) perception of vulnerability in children (lower age and previous hospitalization); 2) perception of threat (beliefs about severity of respiratory diseases and expectations that the doctor says whether the disease is severe); and 3) perception of efficacy of drugs (beliefs about efficacy of symptomatic drugs and of antibiotics, and expectations of being prescribed a drug). Conclusions:. The willingness to consult for acute respiratory infections in infants and preschool children is related to a definite set parents' beliefs and expectations

[Allergic sensitization profile in 0-5 year old children with wheezing and/or atopic dermatitis]. / Perfil de sensibilización alérgica en niños de 0 a 5 años con sibilancias o dermatitis atópica.

BACKGROUND: Although allergic diseases are frequent in childhood, few studies have characterised the IgE sensitization profile among young children with allergic-like symptoms. OBJECTIVE: To determine the prevalence and the type of allergic sensitization, as well as the demographic and environmental factors related to both characteristics, among 0-5 year old children presenting with wheezing and/or atopic dermatitis. METHODS: Collaborative cross-over study developed in the paediatric setting of 20 Spanish Primary Health Care Centres. An allergology evaluation including blood determination of specific IgE antibodies to common inhalant and food allergens was performed on 468 children who presented with wheezing and/or atopic dermatitis. RESULTS: Allergic sensitization was detected in 32.4% of the children with wheezing (95% confidence interval, 95%CI, 26.3-38.6%), in 54.8% of the children who had atopic dermatitis (95%CI, 42.1-67.6%) and in 39.2% of the children with both processes (95%CI, 32.0-46.4%). The risk of allergic sensitization was sex related (male versus female adjusted odds ratio, OR(A), 1.91, 95%CI, 1.24-2.95), and also related to the age (3-5 versus 0-2 year old OR(A) 1.96, 95%CI, 1.27-3.0), type of early feeding (maternal milk versus infant formula OR(A) 0.51, 95%CI, 0.31-0.84) and geoclimatic area (OR(A) Continental versus Atlantic 2.26, 95%CI, 1.30-3.93). Compared to the Atlantic area, the Continental area the sensitization was lower to mites (OR(A) 0.16, 95%CI, 0.07-0.36) and higher to grass (OR(A) 4.65, 95%CI 1.99-10.86), cow milk (OR(A) 5.17, 95%CI, 1.71-15.62) and egg (OR(A) 5.26, 95%CI, 2.04-13.62), whereas in the Mediterranean area the sensitization was lower to mites (OR(A) 0.29, 95%CI, 0.13-0.64) and higher to cow milk (OR(A) 3.81, 95%CI, 1.20-12.14) and egg (OR(A) 5.24, 95%CI, 1.94-14.20). CONCLUSION: A significant proportion of small children treated at the paediatric primary health care centres due to wheezing and/or atopic dermatitis had allergic sensitization. There appears to be a geoclimatic variation in the prevalence of sensitization to inhalant and food allergens among young children with allergic like symptoms who live in Spain.

Resources to handle childhood asthma in Spain: The role of plans and guides and the participation of nurses

BACKGROUND: Describe the assistance provided to asthmatic patients by Primary Care Paediatricians (PCP) in Spain and the material and human resources available for diagnosis and follow-up. METHODS: A cross-sectional descriptive study using an on-line survey, sent to PCP regarding the availability of diagnostic resources, carrying out programmed and educational activities, collaboration of nursing staff and their relationship with existing institutional plans to care for children with asthma. A latent class model (LCM) was used to describe the differences among paediatricians based on the variables studied. RESULTS: Of the 708 answers, 675 were considered valid; 76% of the paediatricians had a spirometer, 75% specific IgE, 17% prick-test, 95% had placebo inhalers and 97% inhalation chambers. 57% performed programmed activities with their patients, while 56% shared their care of asthmatic patients with their nursing staff, but only 25% of the nurses were involved in the follow-up and 12% in education. LCM identified four patterns. The two groups with greater access to diagnostic resources counted on institutional plans/guidelines. However, the only variable differentiating the groups with more programmed and educational activities was the participation of nurses. CONCLUSIONS: The availability of asthma plans/guidelines and resources for diagnosis and follow-up is not sufficient to improve important aspects of primary care for children with asthma. Organisational changes are necessary to include programmed asthma-related visits and paediatric teams with greater involvement of the nurses when caring for these patients

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Quality of life in caregivers of children with asthma: Validity and reliability of the IFABI-R questionnaire

BACKGROUND: Parents'/caregivers' quality of life is an important aspect to consider when handling paediatric asthma, but there is a paucity of valid and reliable instruments to measure it. The Family Impact of Childhood Bronchial Asthma (IFABI-R) is a recently developed questionnaire to facilitate the assessment of asthma-related parents'/caregivers' quality of life. This study researches the psychometric properties of IFABI-R. METHODS: Parents/main caregivers of 462 children between 4 and 14 years of age with active asthma were included in the sample. IFABI-R was administered on two different occasions and a number of other variables related to the parents'/caregivers' quality of life were measured: child's asthma control, family functioning, and parents'/caregivers' perception of asthma symptoms in the child. IFABI-R evaluative and discriminative properties were analysed, and the minimal important change in the IFABI-R score was identified. RESULTS: IFABI-R showed high internal consistency (Cronbach's alpha = 0.941), cross-sectional construct validity (correlation with the degree of child's asthma control, family functioning and parent/caregiver perception of the child's asthma symptoms), longitudinal construct validity (correlation of changes in the IFABI-R with changes in asthma control and changes in the perception of symptoms), sensitivity to change and test-retest reliability. An absolute change of 0.3 units in IFABI-R related to a minimal significant change in the parents'/caregivers' quality of life. CONCLUSIONS: IFABI-R is a reliable and valid instrument to study the quality of life of parents/caregivers of children with asthma

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Anti-asthmatic prescription variability in children according to age

INTRODUCTION: There is little research in the Spanish paediatric population about the consumption of anti-asthmatic agents. The aim of this study was to describe the current pattern of anti-asthmatic drug prescription in the paediatric population from a region of Spain, using the prescribed daily dose as a unit of measurement. METHODS: We analysed the requirements of R03 therapeutic subgroup (anti-asthmatic agents) in children less than 14 years of age in the Public Health System of Castilla y León from 2005 to 2010. Consumption data are presented in prescribed daily doses per thousand inhabitants per day (PDHD) and compared with defined daily doses per thousand inhabitants per day (DHD). RESULTS: 394 876 prescriptions of anti-asthmatics were given to a population of 1 580 229 persons/year. Bronchodilators, leukotriene receptor antagonists, single inhaled corticosteroids (ICS) and long-acting β2-adrenergics associated with inhaled corticosteroids were the most commonly prescribed drugs: 7.5, 5.2, 4.9 and 2.2 PDHD, respectively. The maximum prescription of bronchodilators (15.9 PDHD/9.8 DHD) occurred in children under 12 months, with montelukast (8.9 PDHD/3.6 DHD) and single inhaled corticosteroids (7.9 PDHD/2.9 DHD) at one year of age. CONCLUSIONS: Between 2005 and 2010, children under four years received a high prescription of anti-asthmatic drugs. The use of maintenance therapy was poorly aligned with the recommendations of asthma guidelines. The PDHD was more accurate for measuring consumption than DHD, especially in younger children

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Mochilas escolares y dolor de espalda en la población infantil / School backpacks and back pain in child population

Introducción: el peso de las mochilas preocupa por el esfuerzo físico que realizan los niños y su relación con problemas de espalda. El objetivo es conocer los hábitos del uso de mochilas y su relación con el dolor de espalda en población escolar. Material y métodos: estudio observacional en 4 consultas pediátricas. Se analizan variables demográficas, antropométricas y se administra un cuestionario. Resultados: son 159 niños, 80 varones y 79 mujeres, de 11 y 14 años, que cursan 5º de Educación Primaria (EP) y 2º de Educación Secundaria (ESO). El 69% acude al colegio andando, el 80% lleva la mochila en ambos hombros, el 59% se cansa y el 62,3% refiere dolor de espalda. La puntuación del dolor es 5 (escala 0-10). La mochila pesa 6,3 ± 2 kg. El peso relativo (porcentaje de peso en relación al peso del niño) es 13,4% ± 5,5 y no difiere entre sexos, medio urbano o rural, pero sí entre grupos de edad (15,5% en EP, 11,6% en ESO, p < 0,001) y centro (público: 14,3%; concertado: 12,3%; p = 0,02). No encontramos diferencias en el peso con o sin dolor (13,8% versus 12,7%; p = 0,19) ni en la presencia de dolor por sexo o edad. No se encuentra asociación entre dolor y horas de tele/ videojuegos pero sí entre dolor y horas de deporte extraescolar (más horas, menos dolor: OR [odds ratio]: 0,23; IC [intervalo de confianza] 95%: 0,08-0,7). Existe diferencia en la puntuación de síntomas psicosomáticos, mayor en los que sufren dolor (OR 1,37; IC 95%: 1,2-1,6). Conclusiones: el peso de las mochilas es el 13,4% ± 5,5 del peso del niño. Aunque no encontramos asociación entre dolor y peso, este influye en la sensación de malestar en la infancia y debe considerarse un problema de salud(AU)