Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study

Background: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. Methods: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. Results: The mean age of participants was 24.9 ± 0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR) =2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR = 4.05; 95% CI 1.7-9.6), bronchitis (RR = 2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR = 0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. Conclusions: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found (AU)

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Incidence of asthma in young adults from Castellon, Spain: A prospective cohort study.

BACKGROUND: The objective was to estimate the incidence of asthma in young adults from 13-15 years old to 23-25 years old, and associated factors. METHODS: In 2012, a population-based prospective cohort study was carried out in Castellon from the cohort who had participated in the International Study of Asthma and Allergy in Childhood in 1994 and 2002. A telephone survey was undertaken using the same questionnaires. A new case of asthma was defined as a participant free of the disease in 2002 who suffered asthma, was diagnosed with asthma, or took medications against asthma based on self-report from 2002 to 2012. RESULTS: The mean age of participants was 24.9±0.6 with a follow-up of 79.1%. Asthma cumulative incidence was 3.4%: 44 new cases occurred among 1280 participants. The incidence was higher in females than males with relative risk (RR)=2.02 (95% confidence interval [CI] 1.1-3.8). A significant decrease of asthma incidence density was observed (8.2 cases to 3.5 cases per 1000 person/year). Factors associated with the incidence of asthma were allergic rhinitis (RR=4.05; 95% CI 1.7-9.6), bronchitis (RR=2.13; 95% CI 1.0-4.5), mother's age at time of birth (RR=0.87; 95% CI 0.8-0.9) and a pet other than a dog or cat (RR=0.42; 95% CI 0.2-0.9). For gender, some variations in the risk factors were observed. CONCLUSIONS: A significant decrease in the incidence of asthma was observed. Several risk and protective factors were found.

Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain)

BACKGROUND: The objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors. METHODS: A population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002-2012. RESULTS: Of the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23-25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person-years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15-1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16-2.68), atopic dermatitis (RR=1.51; 95% CI 1.11-2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12-3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor. CONCLUSIONS: An increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender

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Incidence of allergic rhinitis in a cohort of young adults from 13-15 years old to 23-25 years old in Castellon (Spain).

BACKGROUND: The objective of this study was to estimate the incidence of Allergic Rhinitis (AR) in young adults and its risk or protective factors. METHODS: A population-based prospective cohort study was carried out in 2012. The cohort participated in the International Study of Asthma and Allergy in Childhood in Castellon in 1994 and 2002. A telephone survey was conducted using the same questionnaires. A new case of AR was defined as the participants free of the disease in 2002, who self-reported suffering from AR or taking medications for AR in the period 2002-2012. RESULTS: Of the 1805 schoolchildren in the cohort in 2002, 1435 young adults (23-25 years old) participated (follow-up 79.1%) in 2012; 743 were female and 692 male; their mean age was 24.9±0.6 years. Two hundred new cases of AR occurred in 1259 participants free of the disease with an incidence of 17.3 per 1000 person-years, and the incidence increased from 2002 (RR=1.42; 95% CI 1.15-1.75). The risk factors of AR adjusted by age and gender were sinusitis (RR=1.77; 95% CI 1.16-2.68), atopic dermatitis (RR=1.51; 95% CI 1.11-2.06) and constant exposure to truck traffic (RR=1.88; 95% CI 1.12-3.17). For male participants, the risk factors were asthma, sinusitis and atopic dermatitis, and for females bronchitis was a risk factor and presence of older siblings a protective factor. CONCLUSIONS: An increase in AR incidence was observed. Sinusitis, atopic dermatitis and constant exposure to truck traffic were the risk factors of the AR with some differences by gender.

Ventilación mecánica domiciliaria en niños: estudio multicéntrico español / Domiciliary mechanical ventilation in children: a spanish multicentre study

Introducción: La ventilación mecánica domiciliaria (VMD) es una técnica cada vez más frecuente en el niño. Existen pocos estudios que hayan analizado las características y necesidades de los niños sometidos a esta técnica. Material y métodos: Estudio descriptivo observacional transversal multicéntrico de pacientes entre un mes y 16 años dependientes de ventilación mecánica domiciliaria. Resultados: Se estudiaron 163 pacientes de 17 hospitales españoles con una edad media de 7,6 años. La causa más frecuente de VMD fueron los trastornos neuromusculares. El inicio de la VMD fue a una edad media de 4,6 años. Un 71,3% recibieron ventilación no invasiva. Los pacientes con ventilación invasiva tenían menor edad, menor edad de inicio de la VMD y mayor tiempo de uso diario. El 80,9% precisaban VM solo durante el sueño, y un 11,7% durante todo el día. Únicamente un 3,4% de los pacientes tiene asistencia sanitaria externa como ayuda a la familia. Un 48,2% es controlado en consultas específicas de VMD o consultas multidisciplinares. Un 72,1% de los pacientes está escolarizado (recibiendo enseñanza adaptada un 42,3%). Solo un 47,8% de los pacientes escolarizados cuentan con cuidadores específicos en su centro escolar. Conclusiones: La VMD en niños se utiliza en un grupo muy heterogéneo de pacientes iniciándose en un importante porcentaje en los primeros 3 años de vida. A pesar de que un significativo porcentaje de pacientes tiene una gran dependencia de la VMD pocas familias cuentan con ayudas específicas tanto a nivel escolar como en el domicilio, y el seguimiento sanitario es heterogéneo y poco coordinado(AU)

Introduction: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. Materials and methods: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. Results: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. Conclusions: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated(AU)

[Domiciliary mechanical ventilation in children: a Spanish multicentre study]. / Ventilación mecánica domiciliaria en niños: estudio multicéntrico español.

INTRODUCTION: Domiciliary mechanical ventilation (DMV) use is increasing in children. Few studies have analysed the characteristics of patients using this technique. MATERIALS AND METHODS: An observational, descriptive, transversal, multicentre study was conducted on patients between 1 month and 16 years of age dependent on domiciliary mechanical ventilation. RESULTS: A total of 163 patients with a median age of 7.6 years from 17 Spanish hospitals were studied. The main reasons for DMV were neuromuscular disorders. The median age at beginning of DMV was 4.6 years. Almost three-quarters (71.3%) received non-invasive ventilation. Patients depending on invasive ventilation were younger, started DMV at an earlier age, and had more hours of mechanical ventilation per day. The large majority (80.9%) used DMV during sleep time only, and 11.7% during the whole day. Only 3.4% of patients had external health assistance. Just under half (48.2%) were being followed up in specific DMV or multidisciplinary clinics. Almost three-quarters (72.1%) of patients attended school (42.3% with adapted schooling). Only 47.8% of school patients had specific caregivers in their schools. CONCLUSIONS: DMV in children is used in a very heterogeneous group of patients, and in an important number of patients it is started before the third year of life. Despite there being a significant proportion of patients with a high dependency on DMV, few families receive specific support at home or at school, and health care surveillance is variable and poorly coordinated.

[Design and validation of a dosing algorithm for vancomycin in premature neonates]. / Diseño y validación de un esquema de dosificación de vancomicina en neonatos prematuros.

INTRODUCTION: Inappropriate use of vancomycin contributes to the development of resistant bacteria and jeopardizes the safety and effectiveness of treatment. The aim of this article was to design and validate an empirical dosing algorithm for vancomycin in premature neonates according to their population-based pharmacokinetic characteristics. PATIENTS AND METHODS: We performed a retrospective analysis of 129 serum samples from a cohort of 53 neonates. Homogeneous population groups were identified both from their individual pharmacokinetic parameters and from their biometric characteristics. The design of the dosing algorithm was based on simulation of the serum vancomycin concentration that would be reached with several different doses. The algorithm was validated in another cohort of 30 neonates and 108 serum samples. RESULTS: Introduction of the algorithm significantly increased the percentage initial values obtained with correct minimum and maximum concentrations in the first monitoring round (p<0.05). The mean number of serum samples obtained per patient for treatment monitoring was significantly reduced (3.6+/-2 vs. 4.9+/-3). CONCLUSIONS: The implantation of the dosing algorithm for vancomycin in premature neonates increased the efficiency of treatment, reduced monitoring requirements, and optimized serum vancomycin concentrations from the start of treatment.

Diseño y validación de un esquema de dosificación de vancomicina en neonatos prematuros / Design and validation of a dosing algorithm for vancomycin in premature neonates

Introducción: La utilización inadecuada de la vancomicina favorece la aparición de gérmenes resistentes y compromete la efectividad y la seguridad de los tratamientos. El objetivo del presente trabajo es el diseño y la validación de una pauta empírica inicial de dosificación de vancomicina en neonatos prematuros de acuerdo con sus características farmacocinéticas poblacionales. Pacientes y métodos: Análisis retrospectivo de 129 muestras séricas procedentes de una cohorte de 53 neonatos en la que se identificaron grupos poblacionales homogéneos a partir de los parámetros farmacocinéticos individuales y de las características biométricas. El diseño del esquema de dosificación se realizó mediante simulación de las concentraciones plasmáticas de vancomicina que se alcanzarían a partir de diferentes pautas. La validación se hizo en otra cohorte de 30 neonatos y 108 muestras séricas. Resultados: La implantación del algoritmo aumentó significativamente (p < 0,05) el porcentaje de concentraciones iniciales obtenidas con valores de concentración mínima y concentración máxima correctos en la primera monitorización. El número medio de muestras séricas obtenidas por paciente para la monitorización del tratamiento disminuyó significativamente (3,6 ± 2 respecto a 4,9 ± 3). Conclusiones: La implantación del algoritmo de dosificación de la vancomicina para neonatos prematuros mejora la eficiencia del tratamiento, reduce la necesidad de monitorización y optimiza las concentraciones séricas de la vancomicina desde su inicio (AU)

Introduction: Inappropriate use of vancomycin contributes to the development of resistant bacteria and jeopardizes the safety and effectiveness of treatment. The aim of this article was to design and validate an empirical dosing algorithm for vancomycin in premature neonates according to their population-based pharmacokinetic characteristics. Patients and methods: We performed a retrospective analysis of 129 serum samples from a cohort of 53 neonates. Homogeneous population groups were identified both from their individual pharmacokinetic parameters and from their biometric characteristics. The design of the dosing algorithm was based on simulation of the serum vancomycin concentration that would be reached with several different doses. The algorithm was validated in another cohort of 30 neonates and 108 serum samples. Results: Introduction of the algorithm significantly increased the percentage initial values obtained with correct minimum and maximum concentrations in the first monitoring round (p < 0.05). The mean number of serum samples obtained per patient for treatment monitoring was significantly reduced (3.6 ± 2 vs. 4.9 ± 3). Conclusions: The implantation of the dosing algorithm for vancomycin in premature neonates increased the efficiency of treatment, reduced monitoring requirements, and optimized serum vancomycin concentrations from the start of treatment (AU)

[Incidence of allergic rhinitis in a cohort of schoolchildren between 1994 and 2002 in Castellón (Spain), following the ISAAC study]. / Incidencia de rinitis alérgica en escolares entre 1994 y 2002 en Castellón según el estudio ISAAC.

OBJECTIVE: To estimate the incidence of allergic rhinitis in schoolchildren in Castellón by comparing phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC), carried out in 1994 and 2002, respectively. MATERIAL AND METHODS: A cohort study was performed with 3607 schoolchildren aged 6-7 years old who participated in phase I of the ISAAC study. Of these, 1805 participated in phase III (8 years later) at the age of 14-15 years, with 1627 schoolchildren without allergic rhinitis in phase I. The cumulative incidence of allergic rhinitis was estimated. Two definitions of new cases of allergic rhinitis were used: the first was based on medical diagnosis or treatment of the disease, and the second also included symptoms of allergic rhinitis in the previous 12 months. Relative risks were calculated using Poisson regression. RESULTS: Participation was 50.0 %, and 151 new cases of allergic rhinitis according to the first definition (cumulative incidence of 9.3 % and 1.2 % per year) and 339 new cases according to the second definition (cumulative incidence of 20.8 % and 2.6 % per year) were found. No differences in incidence by gender were observed with the first definition (RR = 1.00 95 % CI 0.73-1.38) but with the second definition, the incidence was greater in girls (RR = 1.46 95 % CI 1.18-1.82). CONCLUSIONS: The cumulative incidence of allergic rhinitis according to the first definition was in the range of incidence from cohort studies of adolescents.

Incidencia de rinitis alérgica en escolares entre 1994 y 2002 en Castellón según el estudio ISAAC / Incidence of allergic rhinitis in a cohort of schoolchildren between 1994 and 2002 in Castellón (Spain), following the ISAAC study

Objetivo Estimar la incidencia de rinitis alérgica en población escolar de Castellón al comparar las fases I y III del International Study of Asthma and Allergies in Childhood (ISAAC), efectuadas en 1994 y 2002, respectivamente. Material y métodos Se estudió una cohorte de 3.607 escolares que participaron en la fase I (grupo de 6 y 7 años). De ellos, 8 años más tarde, participaron en la fase III 1.805 (grupo de 14 y 15 años), con 1.627 escolares sin rinitis alérgica en la fase I. Se estimó la incidencia acumulada de rinitis alérgica. Se utilizaron dos definiciones como caso nuevo de rinitis alérgica, la primera por diagnóstico o tratamiento médico de la rinitis alérgica y la segunda incluyendo, además, síntomas en los últimos 12 meses. Se calculó el riesgo relativo mediante modelos de regresión de Poisson. Resultados La participación alcanzó el 50 % y se detectaron 151 casos nuevos de rinitis alérgica según la primera definición (incidencia acumulada 9,3 y 1,2 % anual), y 339 casos nuevos con la segunda definición (incidencia acumulada 20,8 y 2,6 % anual). No se observaron diferencias por sexo para la primera definición (riesgo relativo [RR]: 1,00; intervalo de confianza del 95 % [IC 95 %]: 0,73-1,38), pero con la segunda definición las mujeres tuvieron mayor incidencia (RR: 1,46; IC 95 %: 1,18-1,82). Conclusiones La incidencia acumulada de rinitis alérgica según la primera definición fue comparable a las estimadas en estudios de cohorte de poblaciones adolescentes

Objective To estimate the incidence of allergic rhinitis in schoolchildren in Castellón by comparing phases I and III of the International Study of Asthma and Allergies in Childhood (ISAAC), carried out in 1994 and 2002, respectively. Material and methods A cohort study was performed with 3607 schoolchildren aged 6-7 years old who participated in phase I of the ISAAC study. Of these, 1805 participated in phase III (8 years later) at the age of 14-15 years, with 1627 schoolchildren without allergic rhinitis in phase I. The cumulative incidence of allergic rhinitis was estimated. Two definitions of new cases of allergic rhinitis were used: the first was based on medical diagnosis or treatment of the disease, and the second also included symptoms of allergic rhinitis in the previous 12 months. Relative risks were calculated using Poisson regression. Results Participation was 50.0 %, and 151 new cases of allergic rhinitis according to the first definition (cumulative incidence of 9.3 % and 1.2 % per year) and 339 new cases according to the second definition (cumulative incidence of 20.8 % and 2.6 % per year) were found. No differences in incidence by gender were observed with the first definition (RR = 1.00 95 % CI 0.73-1.38) but with the second definition, the incidence was greater in girls (RR = 1.46 95 % CI 1.18-1.82). Conclusions The cumulative incidence of allergic rhinitis according to the first definition was in the range of incidence from cohort studies of adolescents

[Causes of neonatal death in the community of Valencia (Spain)]. / Causas de mortalidad neonatal en la Comunidad Valenciana.

Objectives To describe the causes of neonatal mortality in the Community of Valencia (VC) and to compare two registration systems for causes of death: that of the Spanish Society of Neonatology and that of the Word Health Organization's "Statistical Bulletin of Deaths (SBD)".MethodsData related to death from the SSN's mortality form, which orders all the diagnoses according to their severity, and data from the SBD, which uses sequential criteria (basic, intermediate or immediate cause of death) were obtained. Both systems were joined in a single form. Data from 19 hospitals in the Community of Valencia (1998-99) were collected. Two features were compared: a) "single cause of death" meaning the first diagnosis of the SSN system versus the "basic cause" of the SBD; and b) "multidiagnosis", which compares all the diagnoses mentioned anywhere in either of the two systems.ResultsA total of 206 neonatal deaths were included. When using the "basic cause" criterion the most common causes of death were malformations (31 %), respiratory distress syndrome (20 %) and extreme prematurity (10 %). However, when applying the "first diagnosis" criterion, the most common causes were respiratory distress syndrome (34 %), malformations (33 %) and asphyxia (9 %). These differences were statistically significant. When the causes of death were compared using the "multidiagnosis" criterion the differences were greater.ConclusionsThe two systems differ qualitatively and quantitatively. The SSN form is useful for studying prevalent morbidity among deaths as well as other parameters, but it may fail to identify the causes of death. The SBD uses more explicit criteria for the causes of death. Thus, both systems should be complementary.

Bronquiolitis en el primer mes de vida / Bronchiolitis in the first month of life

Objetivo: Analizar la hospitalización por bronquiolitis durante el primer mes de vida y sus características clínico epidemiológicas. Método: Estudio descriptivo y analítico de los casos de bronquiolitis con edad neonatal (0-30 días), ingresados en nuestro hospital desde 1997 a 2000. Se estudiaron las características epidemiológicas y clínicas, comparándose la necesidad de unidad de cuidados intensivos neonatales (UCIN) y la mortalidad con otra población de lactantes mayores con bronquiolitis. Resultados: Se hospitalizaron 108 niños (15,5 por ciento de las 695 bronquiolitis hospitalizadas). Nacieron intrahospitalarios 93 (8,5 por mil). El 10,1 por ciento del total presentaron bajo peso al nacimiento y el 9,2 por ciento fueron pretérminos. En el 87 por ciento se analizó la presencia de virus respiratorio sincitial (VRS) en moco nasal (positivo: 63,8 por ciento). Se consideraron graves el 21,2 por ciento, moderados: 58,3 por ciento y leves: 20,3 por ciento, precisaron UCIN el 19,4 por ciento, con diferencia significativa con los lactantes de más edad (9,8 por ciento). La estancia media fue de 10 días. No hubo diferencias en la mortalidad. La tasa de infección nosocomial, en la sala de Neonatología para los VRS positivos, fue del 4 por ciento. Conclusiones: La proporción de bronquiolitis para esta edad ha sido mayor que la publicada. Precisaron UCIN en mayor proporción que los lactantes mayores, si bien no se han producido fallecimientos. Su ingreso en la sala neonatal, no ha presentado complicaciones comial) 5. Estadísticamente las variables cuantitativas se han descrito con media y desviación estándar y las variables cualitativas con proporción y se han comparado por el test de Chi2. Significación estadística < 0,05. (AU)