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.

[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.

¿Qué profesional médico es el más adecuado para impartir cuidados en salud a niños en Atención Primaria en países desarrollados? Revisión sistemática / What medical professional is the most adequate to provide health care to children in primary care in developed countries? Systematic review

Introducción: existe controversia sobre el tipo de profesional más adecuado –pediatras (PED) o médicos de familia/generales (MF/MG)– para prestar atención sanitaria a niños y adolescentes en Atención Primaria (AP). No existen revisiones sistemáticas previas que hayan estudiado este aspecto. El objetivo de este estudio es comparar la atención sanitaria proporcionada por PED y MF/MG en los siguientes aspectos de la práctica clínica: la prescripción de antibióticos (ATB), la indicación de pruebas diagnósticas, el manejo de la otitis media (OMA), del asma, del síndrome febril y de diversas alteraciones psicopatológicas, así como la realización de actividades preventivas. Material y métodos: diseño de estudio: revisión sistemática. Fuente de los datos: hasta diciembre de 2008 se revisaron las bases de datos MEDLINE y CENTRAL, el metabuscador TRIP Database y el buscador Google Académico para recuperar artículos originales y revisiones sistemáticas que compararan la práctica clínica de ambos tipos de profesionales. No se efectuó restricción por idioma. Selección de estudios: se incluyeron estudios de cualquier tipo de diseño (transversal, cohortes, casos y controles, experimentales) que compararan la práctica clínica del PED y el MF/MG. Se excluyeron todas las referencias que no contuvieran investigación original (cartas al director o editoriales). Asimismo, se evaluó la calidad metodológica de cada estudio con el instrumento “OSTEBA; Fichas de lectura crítica”. Dicha calidad era valorada de forma independiente por dos revisores, que llegaban a un consenso en caso de discrepancia. La extracción de datos fue realizada por siete parejas de revisores de forma independiente. Las discrepancias se resolvieron mediante consenso. Resultados: como promedio, los MF/MG prescribieron más ATB que los PED en infecciones del tracto respiratorio superior de probable etiología vírica –odds ratio (OR): 1,4; intervalo de confianza del 95% (IC 95%): 1,1-1,8–. Los PED tuvieron más probabilidades de adherirse a las recomendaciones de guías de práctica clínica sobre el manejo del síndrome febril (OR: 9; IC 95%: 3-25) y del trastorno por déficit de atención con/sin hiperactividad (OR: 5; IC 95%: 3-11), y una mayor capacidad de resolución para otras enfermedades de elevada prevalencia durante la infancia y la adolescencia (como asma y OMA). Los PED presentaban porcentajes de vacunación superiores a los de los MF/MG en todos los estudios que evaluaron este resultado. Conclusión: en vista de los resultados expuestos, parece recomendable mantener la figura del PED en los equipos de AP y reforzar su función específica como primer punto de contacto del niño con el sistema sanitario (AU)

Introduction: There is controversy about which health professional is the most adequate –pediatricians (PED) or family practitioners/general physicians (FP/GP)– to provide health care services to children and adolescents in Primary Care (PC). There are not previous systematic reviews approaching this subject in the previously published literature. The objective of this study is to compare health care provided between PED and FP/GP in the following aspects of the clinical practice: antibiotic (ATB) prescription; diagnostic test indication; acute otitis media (AOM), asthma, febrile syndrome and several psychopathological conditions’ management; and preventive measures accomplishment. Material and methods: study design: systematic review. Data sources: MEDLINE and CENTRAL databases, TRIP Database and Google Scholar, were searched until December 2008 to retrieve original papers and systematic reviews comparing the clinical practice of both kinds of health professionals. No language restriction was made. Studies’ selection: studies of any kind of design were included (cross-sectional, cohorts, case-controls and experimental) comparing the clinical practice of PED and FP/GP. The references without original research were excluded (letters to the editor, editorials). The methodological quality of each study was assessed with the tool “OSTEBA; Critical Appraisal Cards”. Two reviewers assessed the quality of the studies independently, achieving consensus in case of discrepancy. Seven pairs of reviewers made the data extraction independently. Discrepancies were achieved by consensus. Results: On average, FP/GP prescribed more ATB than PED in upper respiratory tract infections of probable viral etiology –odds ratio (OR): 1.4; 95% confidence interval (95% CI): 1.1-1.8–; PED were more likely to adhere to clinical guidelines recommendations on febrile syndrome management (OR: 9; 95% CI: 3-25) and on attention deficit disorder with/without hyperactivity (OR: 5; 95% CI: 3-11), and showed more resolution capacity on other highly prevalent conditions in children and adolescents (such as asthma and AOM). PED showed higher vaccination coverage than FP/GP in all the studies assessing this result. Conclusion: based on the presented results, it seems reasonable to recommend maintaining the PED figure in PC health centers and reinforcing its specific task as the first point of contact of the child with the health care system (AU)

Intervención del pediatra de Atención Primaria en la prevención del consumo de sustancias de abuso / No disponible

El aumento del consumo de sustancias de abuso, el policonsumo, la baja percepcióndel riesgo por parte de los jóvenes y la consideración de estos consumos en el contexto deuna cultura de ocio y diversión constituyen serios problemas para la salud actual y futurade nuestros adolescentes.El pediatra de Atención Primaria (AP) goza de una posición privilegiada por los frecuentescontactos con el niño en crecimiento y su familia.La prevención del consumo de sustancias de abuso debe realizarse de una forma integrale inespecífica, como prevención de conductas de riesgo, durante la infancia y adolescencia.En este trabajo se plantean distintas posibilidades de intervención en la prevención delconsumo de sustancias de abuso desde la AP

The increase of substance abuse consumption, polyconsumption, the low perception ofrisk by young people and the consideration of these consumptions in the context of a leisureculture and fun, constitute a serious problem for the present and future health of ouradolescents.Primary Care Paediatrician (AP) enjoys an exceptional position because of his/her frequentcontacts with the growing child and his/her family.Prevention of substance abuse consumption must be carried out in a comprehensiveand unspecific way, as risk behaviour’s prevention, during childhood and adolescence.In this work, different possibilities of intervention on substance abuse prevention areconsidered from Primary Care Health