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.

[Therapeutic education in asthma management]. / La educación terapéutica en el asma.

All guidelines, protocols and recommendations underline the importance of therapeutic education as a key element in asthma management and control. Considerable evidence supports the efficacy and effectiveness of this measure. Health personnel, as well as patients and their parents, can and should be educated with two main objectives: to achieve the best possible quality of life and to allow self control of the disease. These goals can be attained through an educational process that should be individually tailored, continuous, progressive, dynamic, and sequential. The process poses more than a few difficulties involving patients, health professionals, and the health systems. Knowledge of the various psychological factors that can be present in asthmatic patients, as well as the factors related to the highly prevalent phenomenon of non-adherence, is essential. Awareness of the factors influencing physician-patient-family communication is also highly important to achieve the objectives set in therapeutic education. The educational process helps knowledge and abilities to be acquired and allows attitudes and beliefs to be modified. Patients and caregivers should be provided with an individual written action plan based on symptoms and/or forced expiratory volume in 1 second. Periodic follow-up visits are also required.

[Knowledge and attitudes of teachers on children with asthma]. / Conocimientos y actitudes del profesor ante el asma del alumno.

INTRODUCTION: The right management of asthma in the school background is an important issue in order for the disease to make good progress. AIMS: To find out the situation in schools in Tenerife, to identify the information teachers have about asthma in children, the origin of the information, experience, attitudes and the existence of working protocols in school centres, and educational needs. INDIVIDUALS AND METHODS: 284 teachers of 35 public, private and state financed schools. A survey with 11 questions was performed. RESULTS: A total of 84% of the teachers were informed about the asthmatic pupils in class, of which. 27% attended to an asthma crisis during school hours. 64% admitted they did not know the main steps to control a seizure, and a 10% of this group had to attend to at least one (p<0.001). There were 58% who could help the child to administer the aerosol, but did not know the first steps on how to control a seizure, versus a 42%, who could not help and did not know those steps (p<0.001). Almost all (95%) expressed their intention to get such information. CONCLUSIONS: The information and knowledge teachers have is limited and not recorded. The design of a program on educational intervention, as well as individualized information to teachers is needed, and must be suitable for those needs. The symptoms, first steps to stop a seizure and aerosol therapy technique should be considered as fundamental training.

Conocimientos y actitudes del profesor ante el asma del alumno / Knowledge and attitudes of teachers on children with asthma

Introducción: El correcto tratamiento del asma en la escuela es un aspecto importante para lograr una buena evolución de la enfermedad. Objetivos: Investigar la situación en colegios de Tenerife y observar la información que posee el profesorado, el origen de esta información, la experiencia y las actitudes ante la enfermedad, la existencia de protocolos de actuación en el centro escolar y las necesidades educativas. Sujetos y método: Doscientos ochenta y cuatro profesores de 35 centros públicos, privados y concertados. Listado de preguntas autocumplimentado. Resultados: El 84% de los profesores es informado sobre los alumnos asmáticos en clase. El 27% asiste crisis de asma en el horario escolar. El 64% admite no conocer los primeros pasos ante una crisis y un 10,4% de este grupo atendió al menos una crisis (p<0,001). El 58% que puede ayudar al niño a administrarse el aerosol no conoce los primeros pasos en la actuación ante una crisis, frente a un 41,7% que no puede ayudarle y no conocen los primeros pasos (p<0,001). El 95% de los profesores manifiesta deseos y preferencias de obtener información. Conclusiones: La información del profesorado es escasa y no protocolizada, y es necesario diseñar programas de intervención educativa y de información al profesorado, individualizados y adecuados a las necesidades observadas. Los síntomas, los primeros pasos ante una crisis y la técnica de aerosolterapia son los puntos clave del entrenamiento (AU)

Introduction: The right management of asthma in the school background is an important issue in order for the disease to make good progress. Aims: To find out the situation in schools in Tenerife, to identify the information teachers have about asthma in children, the origin of the information, experience, attitudes and the existence of working protocols in school centres, and educational needs. Individuals and methods: 284 teachers of 35 public, private and state financed schools. A survey with 11 questions was performed. Results: A total of 84% of the teachers were informed about the asthmatic pupils in class, of which. 27% attended to an asthma crisis during school hours. 64% admitted they did not know the main steps to control a seizure, and a 10% of this group had to attend to at least one (p<0.001). There were 58% who could help the child to administer the aerosol, but did not know the first steps on how to control a seizure, versus a 42%, who could not help and did not know those steps (p<0.001). Almost all (95%) expressed their intention to get such information. Conclusions: The information and knowledge teachers have is limited and not recorded. The design of a program on educational intervention, as well as individualized information to teachers is needed, and must be suitable for those needs. The symptoms, first steps to stop a seizure and aerosol therapy technique should be considered as fundamental training (AU)

Desgaste profesional y entorno laboral de los pediatras de Atención Primaria / Professional burn-out and work setting of Primary Health Care pediatricians

Objetivo: Identificar la posible asociación entre el grado de desgaste profesional y percepción de problemas laborales, en el ejercicio asistencial de los pediatras de Atención Primaria de Tenerife. Material y Método: Estudio transversal mediante cuestionario Maslach Burnout Inventory (MBI) para valorar el desgaste profesional o Burnout (BO), y preguntas relativas a la percepción de los problemas profesionales. Encuesta anónima a los 102 pediatras de Atención Primaria (AP) de Tenerife. Se describen las distribuciones conjuntas de las dimensiones del MBI, sexo, edad, integración en Equipo, demanda asistencial, confianza en la dirección del Centro y Gerencia. Las comparaciones se realizan mediante la prueba U de Mann-Whitney para variables ordinales o la Chi (2) de Pearson para categóricas a un nivel p¡Ü0,05. Resultados: Tasa de > participación: 66%. Presentaron alto nivel de agotamiento emocional 55%, alto nivel de despersonalización 33% y baja realización personal 47%. El 8% presentan un desgaste profesional total. No se encontró diferencia significativa en el BO por sexo, ni edad. Los pediatras integrados en Equipos presentaban mayor despersonalización (p=0.03).A mayor duración del ejercicio profesional, mayor porcentaje con nivel medio-alto de agotamiento (p=0.04). La elevada demanda asistencial se asocia de forma negativa con el estado de ánimo, arrojando un nivel medio-alto de agotamiento (p=0.006). Encontramos niveles medio-altos de despersonalización entre quienes no se consideran apoyados por la Administración de su Centro (p=0,005), no confían en la Dirección de su Centro (p=0,04) y no confían en la Gerencia para solucionar los problemas de trabajo (p=0,02). Conclusiones: Los pediatras de Atención Primaria de Tenerife, presentan niveles altos de Síndrome de Burnout asociados a una percepción negativa hacia la Administración (AU)

Objetives: To identify possible association among level of Burnout Syndrome and perception of job problems, on the service of providing care in Paediatricians Primary Care. Methods: Cross-sectional study though Maslach Burnout Inventory (MBI) questionnaire to estimate (BO) Burnout Syndrome and questions about perception of work problems. Anonymous questionnaire to on hundred and two Primary Care Paediatricians in Tenerife. MBI dimension are described in relation with sex, age, outfit integration, assistance demand, director confidence, and management. Comparisons are performed with U Mann-Whiyney or ordinal variables or Chi (2) Pearson for categorical variable (p¡Ü0.05). Result: Participation rate was 66%, high level of emotional exhaustion: 55%, high level of depersonalization: 33%, low personal achievements: 47%. Presents total BO: 8%. There was not found significantly differences between sex or age in BO. Paediatrics inside out fits showed higher depersonalization (p=0.03). For long time of professional care service, higher percentage of quite severe emotional exhaustion (p=0,04). The high assistance demand was found to be related with wood, as negative bringing out in moderate-severe level of emotional exhaustion (p=0.006). We founded moderate-severe levels of depersonalization among people who do not feel support from administration centre (p=0.005), do not have confidence on director ship (p=0,04) and do not have confidence on management to settle work problems (p=0,02).Conclusions: Tenerife´s Primary Care Paediatrics show high level on BO related with negative perception of Administration (AU)

La educación terapéutica en el asma / Therapeutic education in asthma management

Todas las recomendaciones, guías y protocolos establecen el papel de la educación terapéutica como elemento clave en el manejo y control del asma, disponiéndose de evidencias que demuestran su eficacia y efectividad. Tanto los profesionales sanitarios como los pacientes y sus familias pueden y han de ser formados y educados, con dos objetivos fundamentales: conseguir una óptima calidad de vida y una capacidad suficiente para manejar el asma de una forma autogestionada. Ello se puede conseguir a través de un proceso educativo que ha de ser individualizado, continuo, progresivo, dinámico y secuencial. En este proceso han de superarse no pocas dificultades, relacionadas con el paciente, con los profesionales y con el propio sistema sanitario. Es preciso conocer los diferentes aspectos psicológicos que pueden relacionarse con el paciente asmático, así como aquellos que están relacionados con el fenómeno tan prevalente de la falta de adherencia. El conocimiento de los factores que inciden en la comunicación médico-paciente-familia es de enorme importancia para conseguir los objetivos que se plantean en la educación terapéutica. El proceso educativo conduce, no sólo a la adquisición de conocimientos y habilidades, sino también a un cambio de actitudes y creencias. Es necesario proveer al paciente y a sus cuidadores de un plan de acción por escrito individualizado, basado en síntomas y/o flujo espiratorio máximo (FEM), ligado siempre a revisiones periódicas

All guidelines, protocols and recommendations underline the importance of therapeutic education as a key element in asthma management and control. Considerable evidence supports the efficacy and effectiveness of this measure. Health personnel, as well as patients and their parents, can and should be educated with two main objectives: to achieve the best possible quality of life and to allow self control of the disease. These goals can be attained through an educational process that should be individually tailored, continuous, progressive, dynamic, and sequential. The process poses more than a few difficulties involving patients, health professionals, and the health systems. Knowledge of the various psychological factors that can be present in asthmatic patients, as well as the factors related to the highly prevalent phenomenon of non-adherence, is essential. Awareness of the factors influencing physician-patient-family communication is also highly important to achieve the objectives set in therapeutic education. The educational process helps knowledge and abilities to be acquired and allows attitudes and beliefs to be modified. Patients and caregivers should be provided with an individual written action plan based on symptoms and/or forced expiratory volume in 1 second. Periodic follow-up visits are also required

Percepción de los problemas profesionales en pediatras de Atención Primaria / Perception of professional problems in primary health care pediatricians

Objetivo. Determinar la percepción de los problemas profesional en pediatras de Atención Primaria (AP) de Tenerife. Material y Métodos. Estudio observacional transversal. Se enviaron dos cuestionarios a 102 pediatras. El primero, con diez preguntas sobre percepción de problemas profesionales, con valoración en escala a 1 a 10 según grado de preocupación, y el segundo, con datos generales de filiación y situación profesional. Resultados. Respondieron 64 (63•; 33% H, 67% M). Según la edad, el 42,5% (25-40) y 57,4% (41-65 años). El 81,3% están integrados en los equipos de AP. El 90,2% tienen más de cinco años de ejercicio profesional. Consideran tienen una demanda asistencial alta o muy alta, el 75,8%. El 84,4% considera como preocupación mayoritaria la presión asistencial diaria, seguido de la falta de promoción profesional (74,2%) y la falta de sensibilidad de los gestores ante sus problemas (71,6%). Otras preocupaciones fueron no trabajar en equipo con otros pediatras (65,5%), las retribuciones (53,2%), la precariedad laboral (55,7%) y la falta de sustitución del personal médico (51,7%8 y la falta de sustitución de personal médico (51,7%). El 35,4% ha pensado abandonar la profesión en el último año. Conclusión. La presión asistencial es la preocupación principal. La uniformidad de las respuestas es el aspecto más llamativo del trabajo independientemente de la edad, sexo y tiempo trabajado para el Sistema Sanitario de Salud (AU)

Objective. To set how a community of Primary Care paediatricians of Santa Cruz de Tenerife province notices their professional problems. Material and Methods. Observational transversal research. Two questionnaires were sent to paediatricians. One of them about how they notice the professional problems and also they should value each question, and the other questionnaire about professional details. Results. The 64% of paediatrician answered the questionnaires (men 33% women 67% age: 25-40 years 42,6%, age: 41-65 years 57,4%). The 81,3% of them are in AP team. The 90,2% of them have more than five years of professional practice and consider they have a high demand assistance 75,79%. We got that the 84,4% of them are very worried about high daily pressure assistance. In the second place the most important worries are the insufficient labour promotion (74,2%), and no feeling of the board about these problems (71,6%). Other worries were: no team working between the paediatricians of the same centre (62,6%), the wages (53,2%), the bad labour situation (55,7%), and the no replacement of the medical staff (51,7%). That the 35,4% of them have thought to abandon their job in the last year. Conclusion. The assistance pressure Is the main worry. On the other side the questionnaire five very similar answers and this is most surprising date, more than the age, the sex and the working time for National Health System (AU)