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.

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.

Diet and prevalence of atopic eczema in 6 to 7-year-old schoolchildren in Spain: ISAAC phase III.

BACKGROUND: The prevalence of atopic dermatitis (AD), a chronic skin disease, has increased substantially in recent decades, and different factors have been implicated in its etiology. Although dietary habits are being investigated, few conclusive findings have been reported. Nevertheless, increased consumption of polyunsaturated fatty acids (PUFA) and a diet poor in antioxidants have been related to AD. OBJECTIVES: The objectives of this study were to investigate the association between AD, the intake of different foods, and the effect of a Mediterranean diet among Spanish schoolchildren aged 6 to 7. METHODS: We performed a cross-sectional study with 20 106 schoolchildren aged 6-7 years from 10 different areas of Spain. The participation rate was 76.50%. The prevalence of AD was assessed using the International Study of Asthma and Allergies in Childhood questionnaire and the criteria of the Spanish Academy of Dermatology. To calculate the Mediterranean diet score, we classified food into 2 groups: Mediterranean food, including fruit, seafood, vegetables, pulses, cereals, pasta, rice, and potatoes; and non-Mediterranean food, including meat, milk, and fast food. RESULTS: Milk was negatively associated with AD. Butter and nuts also were negatively associated, although statistical significance was only reached when these foods were consumed 3 or more times a week. CONCLUSIONS: We found no association between the Mediterranean diet score and AD and a positive association between AD and obesity.

[What do pediatricians and pediatric residents think of the rotation into Primary Health Care]. / ¿Qué opinan pediatras y residentes de Pediatría sobre la rotación por Atención Primaria?

INTRODUCTION: Since 2007, on a mandatory, pediatric residents (PR) have been obliged to rotate into primary health care centers for 3 months. On disagreeing with the type of rotation proposed, the teaching group of the Spanish Primary Care Pediatrics Association (AEPap) was raised to find out the views of Hospital Pediatricians (PH), Pediatrics Health Care (PHC) and PR in terms of need, length, year in which it should take place and rotation expectations. METHODOLOGY: Cross-sectional study using a 13 question validated questionnaire, which was distributed to the various AEPap associations, and completed via the website. The data was processed with SPSS 12.0 and analysed using the Chi(2) test. RESULTS: A total of 323 surveys from 13 Autonomous Regions were analysed, of which 56% were answered by PHC, 38.7% by PR and 5.3% by PH, 67.5% of which were women, with two age groups; one under 30 years old and the other between 41-50 years. Of the participants, 99% believed it was necessary to rotate, with a duration of 6 months proposed by the PHC (73.3%) while PR considered 1 or 2 months (56.9%), (P<0001), preferably performed in two periods (65.1% of PHC). Of the PHC, 75.5% believed that the PR who were going to work in Primary Care should work 6 months more in their last year of residency (P<0001). Of the PR, 63,9% hoped to improve their training in the rotation into Primary Health Care. CONCLUSIONS: The need to rotate into Primary Health Care was almost unanimous and three months are insufficient for the majority of respondents and PHC believe it should be 6 months. There appears to be two preferences for rotation: in a period in any year of residence or in two periods. Those PR who are thinking of working in a Primary Health Care should rotate 6 months during the fourth year of residency. The PR expect rotation to improve their training.

[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.

[Time trends and geographical variations in the prevalence of symptoms of allergic rhinitis in 6-7-year-old children from eight areas of Spain according to the ISAAC]. / Tendencia temporal y variaciones geográficas de la prevalencia de síntomas de rinitis alérgica en escolares de 6-7 años de ocho áreas españolas, según el ISAAC.

BACKGROUND: Phase III of the International Study of Asthma and other Allergies in Childhood (ISAAC) was carried out in schoolchildren aged 6-7 years from eight areas of Spain to estimate time trends and geographic variations in the prevalence of symptoms of allergic rhinitis (AR). MATERIAL AND METHOD: A standard and validated questionnaire was used following ISAAC methodology and was completed by the schoolchildren's parents. The prevalence of symptoms of AR in Phase I (1993-1994) and Phase III (2001-2002) was compared. Eight centers participated: Asturias, Barcelona, Bilbao, Cartagena, Castellón, Madrid, Pamplona and Valencia. Poisson regression was used in the analysis. RESULTS: A total of 25,113 schoolchildren were studied with a median participation of 81.7 %. In all centers, AR symptoms tended to increase, with a prevalence ratio of rhinoconjunctivitis in the previous year of 1.61 (95 % confidence interval: 1.48-1.76) when both phases, adjusted by gender, center, and seasonal variation, were compared. The prevalence of AR symptoms was higher in boys than in girls. Wide variations in the prevalence of AR were observed across centers with a higher prevalence in Asturias, Madrid, Cartagena and Bilbao. Lower prevalences were reported in Barcelona, Castellón and Pamplona. CONCLUSIONS: There seems to have been a general increase in AR symptoms. Substantial variations between centers suggested that there may be local differences in risk factors. Intense research will be required for satisfactory preventive actions.

[Infectious diseases and use of health care resources in children less than 2 years-old who attend kindergarten]. / Enfermedad infecciosa y consumo de recursos sanitarios en menores de 2 años que acuden a guarderías.

INTRODUCTION AND OBJECTIVES: Parents often ask paediatricians for advice about the best way to care for their children. There are discrepancies in the literature on this subject. The objective of this study is to evaluate the influence of attending kindergartens on the risk of acute infections and the use of health care resources in children less than 24 months. POPULATION AND METHODS: A prospective longitudinal study was conducted on two cohorts of children 0-24 months (born between 1 January and 30 September 2010), who were grouped according to whether they attended kindergarten or not, and were usually seen in 33 pediatric clinics of the Principality of Asturias Public Health Service. RESULTS AND CONCLUSIONS: A total of 975 children were studied, of whom 43.7% attended a kindergarten at 24 months. Attending kindergarten increases the risk of pneumonia by 131%, recurrent wheezing by 69%, bronchitis by 57%, and otitis media by 64%. Early exposure to kindergarten increases the risk of pneumonia from 2.31 to 2.81, and the mean emergency room visits from 1 to 2.3. The mean antibiotic cycle is 1.7 in children who do not go to kindergarten, 3.4 if started within the first 6 months, and 2 if they start at 18 months. Day-care attendance is a risk factor of infectious diseases that increases if attending kindergartens from an early age.

Seguimiento en las consultas de Pediatría de Atención Primaria de los grandes prematuros: nacidos con menos de 32 semanas de gestación o menos de 1500 gramos / Follow-up in Primary Care Pediatric consultations of very premature babies: born at less than 32 weeks' gestation or weighing less than 1500 grams

Introducción: casi un 20% de los grandes prematuros abandona el seguimiento en los hospitales y tienen peor evolución que los que continúan el programa. Obtener datos sobre la implicación de los pediatras de Atención Primaria (PAP) en el seguimiento del prematuro de menos de 32 semanas o con peso < 1500 g es necesario para plantear estrategias de mejora. Material y métodos: estudio observacional, transversal, descriptivo, en el ámbito de las 17 comunidades autónomas españolas, a través PAPenRED (304 PAP). Se recogieron datos mediante encuestas cumplimentadas online acerca del número de grandes prematuros por pediatra, el tipo de seguimiento y las dificultades en su atención. Se describen las distribuciones de frecuencias, en porcentajes, de las variables cualitativas. Resultados: se incluyeron 870 grandes prematuros con una media por pediatra de 3,8. El 68,84% de los PAP no tienen programa común de seguimiento para el hospital y Atención Primaria (AP), y al 99% les gustaría tenerlo. El 84,27% manifiesta que estos niños tienen problemas más complejos y las patologías que presentan con mayor frecuencia en comparación con los nacidos a término son: la ansiedad familiar, la patología respiratoria y los problemas relacionados con el crecimiento, la alimentación, el desarrollo motor y los cognitivos y del comportamiento. Conclusiones: los PAP creen necesarios los programas conjuntos hospital-AP para el seguimiento de los grandes prematuros (AU)

Introduction: almost 20% of premature babies abandons the follow-up in hospitals and they have worse outcomes than those who continue the program. Obtaining data on the involvement of Primary Care pediatricians (PAPs) in monitoring premature babies born at less than 32 weeks or weighing less than 1500 g is necessary to propose strategies for improvement. Methods: it is an observational, transversal, descriptive study, in the area of ​​the 17 Spanish autonomous communities, through PAPenRED network (304 PAPs). Data were collected by questionnaires filled out online about the number of premature babies by pediatrician, the type of monitoring and the difficulties found in their attention. Frequency distributions, percentages, qualitative variables are described. Results: 870 very premature infants were included with an average of 3.8 per pediatrician. 68.84% of PAPs do not share a common monitoring program between hospitals and Primary Care centers, despite the fact that 99% of the pediatricians would like to have it. 84.27% say that these children have more complex problems. The diseases that occur more frequently compared to those born at term are family anxiety, respiratory disease and problems in relation to growth, feeding, motor development and cognitive and behavioral issues. Conclusions: PAPs believe necessary commmon programs between hospitals and Primary Care centers for monitoring the very premature babies (AU)

Influencia de la asistencia a guarderías en la frecuentación en Urgencias y Atención Primaria / Influence of nursery attendance in Emergency and Primary Care frequentation

Introducción: las guarderías surgen para atender una necesidad social, pero no están exentas de influir sobre la salud infantil. Pacientes y métodos: estudio longitudinal prospectivo de dos cohortes de niños entre 0 y 24 meses (se diferencian en asistencia o no a guardería) que acuden a las consultas de 33 pediatras del Servicio Público de Salud del Principado de Asturias. Los datos se obtuvieron de la historia clínica informatizada y entrevistas programadas (6, 12, 18 y 24 meses). Se compararon: número medio de visitas a Servicios de Urgencias y Pediatría e influencia de diferentes variables recogidas. Se analizaron: la morbilidad registrada (infecciones agudas y sibilancias recurrentes) entre hiperfrecuentadores (HF) y no HF. Resultados: el número medio de visitas a las consultas pediátricas es significativamente mayor para los niños que acuden a guardería en todos los tramos de edad estudiados. Hay mayor porcentaje de HF entre los que acuden a guardería: los niños de entre 0 y 6 meses que acuden tienen un riesgo relativo de ser HF a Servicios de Urgencias de hasta seis veces mayor que los que no acuden y cuatro veces mayor de ser HF en las consultas de Pediatría. Conclusiones: 1) la asistencia a guardería se asocia con mayor probabilidad de ser HF en Urgencias y en la consulta de Pediatría de Atención Primaria (AP); 2) los niños HF padecen más enfermedades respiratorias e infecciosas, que no son explicadas por su asistencia a guardería, y 3) lo anterior conlleva un mayor consumo de fármacos (AU)

Introduction: nurseries arise to attend a social need, but are not without influence on children’s health. Patients and methods: prospective longitudinal study of two cohorts of children aged 0-24 months (they differ in nursery assistance or not) who come to the consultations of 33 pediatricians at the Public Health Service of Asturias. The data were obtained from the clinical history and interviews scheduled (6, 12, 18 and 24 months). They were compared: average number of visits to Emergency and Paediatrics Services, and influence of different variables collected. We analyzed: the registered morbidity (acute infections and recurrent wheezing) between frequent attenders (HF) and not HF. Results: the average number of visits to pediatric visits is significantly higher for children attending kindergarten in all age groups studied. There is a higher percentage of HF among those attending nursery: children between 0 and 6 months that have a relative risk of HF to Emergency Services up to 6 times higher than those not attending and four times higher of being HF in consultations of a Primary Care center. Conclusions: 1) attendance at kindergarten is associated with increased probability of being HF in Emergency departments and Paediatrics Primary Care services; 2) the HF children suffer more respiratory and infectious diseases, which are not explained by their attendance at a nursery, y 3) the above carries a higher drug consumption (AU)

Estado nutricional de la población infantil en Asturias (Estudio ESNUPI-AS): delgadez, sobrepeso, obesidad y talla baja / Nutritional status of children population in Asturias (SNUPI-AS study): thinness, overweight, obesity and stunting

Objetivos: valorar el estado de nutrición de los niños menores de quince años del Principado de Asturias, identificando los que tienen parámetros alterados, por exceso o defecto, y devolver la información obtenida a pediatras y gestores. Métodos: estudio descriptivo transversal retrospectivo. Población diana: menores de 15 años de Asturias nacidos entre 1995 y 2012. Fuente de datos: historia clínica informatizada de Atención Primaria. Variables: último peso y talla registrados, fecha de medida y de nacimiento, sexo, y códigos de área, zona básica y pediatra del niño. Indicadores calculados: peso/edad; talla/edad; índice de masa corporal (IMC)/edad y peso/longitud (< cinco años). Patrones de comparación utilizados: estándares de la Organización Mundial de la Salud (OMS) y se han utilizado los software ANTHRO y ANTHROPLUS. Se calcularon para cada niño la desviación estándar (DE) según edad y sexo para el IMC/edad, talla/edad y peso/edad; (Z-standard) y las prevalencias de cada variable ajustadas por edad y sexo. Resultados y conclusiones: se obtuvo una base neta con 89 989 registros: el 50,98% niños y el 49,02% niñas. Presentaron baja talla el 1,8%, normopeso el 66,56%, sobrepeso el 22,5%, obesidad el 10,9%, obesidad grave el 1,9% y delgadez el 1,1%.Por sexos, la tasa de obesidades mayor en niños (12,4) que en niñas (9,2). Por edades, la tasa de exceso de peso fue mayor en los niños de entre 10 y 14 años (41,9). Los niños de entre cinco y nueve años presentaron las mayores tasas de obesidad (15,1) y obesidad grave (3,7). Las diferencias de prevalencia de exceso de peso entre las68 zonas básicas estudiadas llegan hasta 20 puntos; su conocimiento permitirá establecer las zonas prioritarias de intervención (AU)

Objectives: to assess the nutritional status of children under fifteen years old of the Principality of Asturias, identifying those parameters altered by excess or defect and to return the information obtained to pediatricians and managers. Methods: retrospective cross-sectional descriptive study. Target population: children under 15 years old of Asturias born between 1995 and 2012. Data source: computerized records at primary care clinic. Variables: last recorded weight and size, extent and date of birth, gender, and codes: area, base area and pediatrician. Indicators calculated: weight/age; size/age; body mass index (BMI)/age and weight/length (

Enfermedad infecciosa y consumo de recursos sanitarios en menores de 2 años que acuden a guarderías / Infectious diseases and use of health care resources in children less than 2 years-old who attend kindergarten

INTRODUCCIÓN Y OBJETIVOS: Los padres con frecuencia solicitan a los pediatras consejo acerca del mejor sistema para el cuidado de sus hijos. En la literatura existen discrepancias al respecto. El objetivo de este estudio es evaluar la influencia de la asistencia a la guardería sobre el riesgo de infecciones agudas y la utilización de recursos sanitarios en los niños menores de 24 meses. Población y métodos: Estudio longitudinal prospectivo de 2 cohortes de niños de 0-24 meses que se diferencian por la asistencia o no a la guardería, nacidos entre el 1 de enero y el 30 de septiembre de 2010 y que acuden habitualmente a las consultas de 33 pediatras del Servicio Público de Salud del Principado de Asturias. RESULTADOS Y CONCLUSIONES: Se estudiaron 975 niños. A los 24 meses acuden a la guardería el 43,7%. Asistir a guardería incrementa el riesgo de padecer neumonía en un 131%, el de sibilancias recurrentes en un 69%, el de bronquitis un 57% y el de otitis media en un 64%. La exposición temprana a la guardería incrementa el riesgo de neumonías de 2,31 a 2,81 y la media de visitas a urgencias desde 1 a 2,3. La media de ciclos de antibióticos es de 1,7 para los que no van a la guardería, de 3,4 si la inician en los 6 primeros meses y de 2 si comienzan a partir de los 18 meses. La asistencia a guarderías es un factor de riesgo de padecer enfermedades infecciosas que aumenta si asisten desde edades tempranas

INTRODUCTION AND OBJECTIVES: Parents often ask paediatricians for advice about the best way to care for their children. There are discrepancies in the literature on this subject. The objective of this study is to evaluate the influence of attending kindergartens on the risk of acute infections and the use of health care resources in children less than 24 months. Population and methods: A prospective longitudinal study was conducted on two cohorts of children 0-24 months (born between 1 January and 30 September 2010), who were grouped according to whether they attended kindergarten or not, and were usually seen in 33 pediatric clinics of the Principality of Asturias Public Health Service. RESULTS AND CONCLUSIONS: A total of 975 children were studied, of whom 43.7% attended a kindergarten at 24 months. Attending kindergarten increases the risk of pneumonia by 131%, recurrent wheezing by 69%, bronchitis by 57%, and otitis media by 64%. Early exposure to kindergarten increases the risk of pneumonia from 2.31 to 2.81, and the mean emergency room visits from 1 to 2.3. The mean antibiotic cycle is 1.7 in children who do not go to kindergarten, 3.4 if started within the first 6 months, and 2 if they start at 18 months. Day-care attendance is a risk factor of infectious diseases that increases if attending kindergartens from an early age

Condiciones de trabajo de los pediatras de Atención Primaria / Working conditions of primary care pediatricians

Introducción: en el sistema público de salud, la población debería ser el centro del sistema y el profesional sanitario su principal activo; garantizar que el encuentro asistencial se realice bajo unas condiciones de calidad es fundamental en la organización y diseño de los sistemas sanitarios. Conocer la realidad de los Equipos de Atención Primaria (EAP) y las condiciones de trabajo de los pediatras de Atención Primaria (PAP) resulta imprescindible para poder ofrecer una mejor asistencia a nuestros pacientes. El objetivo es conocer las condiciones del lugar de trabajo y los medios y recursos disponibles, las cargas de trabajo, la autonomía de gestión y la conciliación de la vida familiar y laboral. Material y métodos: estudio observacional descriptivo mediante encuesta realizada on-line a PAP en España a través de la lista de distribución PEDIAP y de la lista de correo de la Asociación Española de Pediatría de Atención Primaria (AEPap) en diciembre de 2012. Resultados: recogidas 809 respuestas de todas las comunidades autónomas (CC. AA.) de un total de 6258 plazas de PAP. Un 40,6% opina que las condiciones de la consulta no permiten una correcta realización de su trabajo. El 50% no tiene acceso a las pruebas complementarias que considera necesarias. Ocho de cada diez dedican más del 75% de su jornada a labores exclusivamente asistenciales. Hasta un tercio de los pediatras tiene que asumir la consulta completa del compañero durante periodos prolongados por falta de cobertura con suplentes. Casi el 80% considera que existen condiciones que facilitan la conciliación de la vida familiar y laboral. Solo el 28% de los equipos tiene capacidad para autogestionar el presupuesto asignado a suplencias. Existen diferencias importantes para todos los ítems estudiados entre las distintas CC. AA. Conclusiones: las condiciones laborales de los PAP distan de cumplir unos requisitos que aseguren una correcta atención clínica. La escasa capacidad de participación en la gestión sitúa las posibilidades de mejora fuera de los PAP e incluso de los propios EAP (AU)

Introduction: in the Public Health System, the population should be the focus and its main asset; ensuring that the patient-doctor encounter takes place under quality conditions is fundamental in the organization and design of health systems. To know the reality of primary care teams (AP) and the working conditions of Primary Care Pediatricians (PAP) is essential in order to provide better care to our patients. The objectives are: to know the conditions of the workplace and the means, resources, workloads, management autonomy and work-life balance. Methods: descriptive observational study by online survey to PAP in Spain through a distribution list (PEDIAP) and the mailing list of the Spanish Association of Primary Care Pediatrics (AEPap) in December 2012. Results: 809 responses from all the regions of a total of 6258 PAP posts. Some 40.6% believe that the conditions of the office does not allow the proper development of their work, 50% have no access to any additional tests deemed necessary, eight in ten spend more than 75% of their time working exclusively in care tasks. Up to a third of the pediatricians have to take care of the full work of a colleague for extended periods due to lack of a substitute doctor. Nearly 80% believe that there are conditions that facilitate work-life balance. Only 28% of health care teams have the ability to self-manage the budget for substitutions. There are significant differences for all items studied among the various autonomous regions. Conclusions:PAP working conditions are far from fulfilling the requirements that ensure proper clinical care. The limited ability to participate in managing the potential for improvement lies outside the PAP and even the AP's team (AU)

Crecemos en Europa / We grow in Europe

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Diagnóstico y manejo de la sinusitis: actitudes de los pediatras / Diagnosis and management of sinusitis: attitudes of the pediatricians

Introducción: la sinusitis es una patología frecuente de la que desconocemos su abordaje en la práctica pediátrica diaria. Material y métodos: se realiza un estudio trasversal, de ámbito nacional mediante una encuesta distribuida on-line a los socios de dos sociedades pediátricas en marzo de 2013. Resultados: se obtuvieron 994 respuestas (78% de Atención Primaria). La mayoría de profesionales estima una frecuencia de sinusitis de alrededor del 1% de las visitas, el 76,6% refiere diagnosticarla exclusivamente con criterios clínicos, y el 92% considera una asociación de síntomas que incluyen rinorrea persistente/purulenta (89%), dolor facial/cefalea (84%), tos prolongada o nocturna y fiebre en el contexto de infección respiratoria de vías altas (IRA) 54%. El 19,7% de los profesionales de primaria y el 33,4% de los de especializada solicitarían un estudio radiológico. Un 90% refiere utilizar antibióticos con o sin otros tratamientos: amoxicilina-clavulánico (52%), seguido de amoxicilina 46% (relación que se invierte en especializada). Un 81% de los pediatras refiere diagnosticar IRA en más del 30% de las visitas, y en el 85% de los casos no prescriben tratamiento farmacológico. Ante una sintomatología catarral prolongada más de 14 días, un 70% decidiría tratar. Los tratamientos más utilizados serían antiinflamatorios/analgésicos en el 54,5% de los casos, y antibióticos en el 51,4%. Conclusiones: las respuestas de los pediatras sobre conocimientos y práctica clínica en IRA y sinusitis indican un alto nivel de adecuación a las Guías más recientes, destacando la escasa utilización de antibióticos en las IRA, el diagnóstico eminentemente clínico de la sinusitis y la elección empírica de antibióticos en la misma (AU)

Introduction: sinusitis is a common condition whose approach in daily pediatric practice is not well known. Methods: performing a national level cross-sectional study through a survey distributed "on line" to members of 2 pediatric societies, in March 2013. Results: 994 responses were obtained (78% of Primary Care). Most professionals estimated the frequency of sinusitis being about 1% of the visits. 76.6% reported exclusively diagnosis with clinical criteria, considering (92%) an association of symptoms including persistent / purulent rhinorrhea (89%), facial pain / headache (84%), prolonged or nocturnal cough and fever in the context of upper respiratory infection (URI) (54%). Between 19.7 and 33.4% of professionals (primary / specialist) would request radiographs. 90% reported using antibiotics with or without other adjunctive treatments, being amoxicillin-clavulanate (52%) the chosen antibiotic, followed by amoxicillin 46%. 81% of pediatricians diagnose URI in more than 30% of visits and in 85% of cases do not prescribe drug treatment. When the URI lasts more than 14 days, 70% of them decide to treat. The most widely used treatments are anti-inflammatory / analgesics (54.5%) and antibiotics (51.4%). Conclusions: pediatricians' knowledge and clinical practice in URI and sinusitis indicate a high level of compliance with the most recent clinical practice guidelines, highlighting the limited use of antibiotics in the URI, the clinical diagnosis of sinusitis and the empirical choice of antibiotic (AU)

Parents' smoking habit and prevalence of atopic eczema in 6-7 and 13-14 year-old schoolchildren in Spain. ISAAC phase III.

BACKGROUND AND AIMS: Atopic eczema (AE) is the most frequent inflammatory skin disease in childhood in the western world. Several studies have reported a significant increase of prevalence in recent decades and the environmental factors implicated in its aetiology, including environmental tobacco smoke. This study aims to investigate the possible association of AE prevalence in Spanish schoolchildren aged 6-7 and 13-14 years in relation to their parents' smoking habits. METHODS: We conducted a cross-sectional population-based study with 6-7 year-old (n = 27805) and 13-14 year-old (n = 31235) schoolchildren from 10 Spanish centres. AE prevalence was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, and the Spanish Academy of Dermatology criteria, used in Spain to diagnose AE. RESULTS: An association was found in school-children aged 6-7 (adjusted for gender, presence of asthma, presence of rhinitis, siblings and mother's level of education) between AE being clinically diagnosed with the mother's smoking habit (RPRa 1.40, 1.10-1.78) and there being more than 2 smokers at home (RPRa 1.34, 1.01-1.78). Regarding the presence of itchy rash, an association was observed with fathers who smoke (RPRa 1.40, 1.13-1.72). Among the 13-14 year-olds, no association was observed in relation to either clinically diagnosed AE or the appearance of itchy rash with parents' smoking habit. CONCLUSIONS: Our results indicate the risk for children of being exposed to environmental tobacco smoke in terms of AE, especially when they are younger.

Optimizar la rotación MIR de Pediatría en Atención Primaria (en el centro de salud) / Making efficient the Primary Care training of Pediatrics’ residents (in the health centre)

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Influencia de la asistencia a guarderías sobre la morbilidad en niños menores de 12 meses de edad / Influence of day care attendance on morbidity in children under 12 months of age

Introducción: la estructura actual de la sociedad española favorece la asistencia de los niños a guarderías infantiles a edades cada vez más tempranas. Esto es un factor de riesgo por sí solo para el padecimiento de infecciones del tracto respiratorio superior e inferior, otitis media aguda, infecciones gastrointestinales y otras infecciones. Objetivo: evaluar la influencia de la asistencia a la guardería sobre el riesgo de padecer infecciones en los niños menores de 12 meses de edad. Población y métodos: estudio longitudinal prospectivo. Se incluyeron en el estudio los niños nacidos entre el 1 de enero y el 30 de septiembre de 2010 que acuden a consulta de Pediatría de Atención Primaria. Se excluyeron los niños que presentaban patología respiratoria o cardiaca grave o inmunodeficiencias graves. Los datos se obtuvieron de la historia clínica informatizada y de las entrevistas en visitas programadas a los padres a los 6 y a los 12 meses. Para el análisis estadístico de los datos se utilizó el programa estadístico R® (R Development Core Team, 2011). Resultados: los niños que acuden a la guardería presentan más episodios infecciosos que los que no lo hacen, siendo estadísticamente significativas (p-valor <0,05) las diferencias respecto a bronquiolitis, bronquitis, conjuntivitis, faringoamigdalitis, gastroenteritis aguda, laringitis, neumonía, otitis media aguda, resfriado común, sibilancias, sinusitis y para el total de patologías. Los niños que asisten a guarderías tienen un riesgo dos o más veces mayor de padecer bronquiolitis, bronquitis, faringoamigdalitis y otitis media, que los que no acuden. Conclusión: teniendo en cuenta estos resultados, parece aconsejable intentar otras fórmulas diferentes para el cuidado de los niños en edades tempranas (AU)

Introduction: the current structure of Spanish society favors the attendance of children at day care to increasingly early ages. This is a risk factor in itself to the condition of infection of the upper and lower respiratory tract, as well as acute otitis media, gastrointestinal infections and other infections. Objective: to evaluate the influence of day care attendance on the risk of infections in children under 12 months of age. Population and methods: prospective longitudinal study. Children born between 1 January and 30 September 2010, attending primary care pediatrics’ offices, were included. We excluded children who had severe respiratory or cardiac disease or severe immune deficiency. The data were obtained from computerized medical records and interviews with parents in scheduled visits at 6 and 12 months. In the statistical analysis of the data the statistical software R© (R Development Core Team, 2011) was used. Results: children who attend day care have one or more infectious episodes in higher percentages with statistically significant (p-value <0.05) differences for bronchiolitis, bronchitis, conjunctivitis, tonsillopharyngitis, acute gastroenteritis, laryngitis, pneumonia, acute otitis media, common cold, wheezing, sinusitis and for total pathologies. Attendance at nursery could be responsible for between 35% and 50% of the acute otitis, gastroenteritis, bronchiolitis and bronchitis. Conclusion: taking into account these results, it seems advisable to try other different ways for the care of children in early ages (AU)

Radiografía de la Pediatría de Atención Primaria española: nuestro espacio en el Sistema Nacional de Salud / Radiogram of Primary Care Pediatrics in Spain: our place in the National Health System

En la presente ponencia se abordan las actividades asistenciales de la Pediatría de Atención Primaria (PAP). Se expone el marco legal en el que se desarrolla, las actividades asistenciales, de promoción y prevención, los recursos del sistema público de salud, y las fortalezas y debilidades de la PAP. Se evalúan las actividades a partir de los datos del Sistema de Información Sanitaria (SIS), destacando la gran disparidad existente en las diferentes comunidades autónomas (CCAA). Se presenta de manera somera el estado de salud de la población infantil. No se abordan los aspectos organizativos ni de formación que han sido planteados en anteriores foros profesionales. Finalmente, se exponen las conclusiones y los nuevos retos (AU)

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Diez años de AEPap. Parte IV. Un proyecto de futuro / No disponible

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