Educación en el niño y adolescente con asma (1.ª parte). Introducción. Diagnóstico educativo / Education in children and adolescents with asthma (part 1). Introduction. Eduactional diagnosis

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Educación en el niño y adolescente con asma (2ª parte) / Education in children and adolescents with asthma (part 2)

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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

No disponible

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.

Tratamiento de las sibilancias recurrentes/asma en el niño menor de 3 años de edad / No disponible

Las guías y consensos actuales enfatizan la importancia del control del asma para disminuirla morbilidad y mejorar la calidad de vida de estos pacientes. En niños menores de 3años, conseguir un adecuado control resulta más difícil que a otras edades debido a la heterogeneidadde fenotipos de sibilantes recurrentes, patrón inflamatorio predominante y factoresdesencadenantes, probablemente distintos y evolución y respuesta al tratamiento variables.Identificar el fenotipo sibilante podría ayudar a tomar decisiones terapéuticas,aunque en ocasiones se solapan en un mismo paciente características de distintos fenotiposy el tratamiento debería individualizarse en función de la respuesta.Se revisan los tres pilares básicos del tratamiento: educación, medidas preventivas y tratamientofarmacológico tanto del episodio agudo como de mantenimiento. Los fármacos recomendadospara el tratamiento de mantenimiento en menores de 3 años son los corticoides inhalados(CI) y los inhibidores de leucotrienos. Los CI son de elección en el asma y la respuestaes más satisfactoria ante niños con sibilancias y atopia. No existen evidencias para recomendardosis bajas de CI en la prevención de episodios de sibilancias desencadenadas exclusivamentepor virus a esta edad; los inhibidores de los leucotrienos estarían más indicados en estos casos.También constituyen una alternativa a los CI en el asma leve y podrían asociarse a ellos paradisminuir las exacerbaciones inducidas por virus. No obstante, algunos niños no responden aninguno de estos fármacos. Se recomienda revisar periódicamente el tratamiento y suspenderloo considerar un diagnóstico o tratamiento alternativo si no se observan beneficios(AU)

Today’s guides and consensus emphasize the importance of asthma control in diminishingmorbidity and improving these patients’ quality of life. This control is not easy in childrenunder 3 years of age due to: recurrent wheezing phenotype heterogeneity, triggeringfactors and predominant inflammatory pattern (probably different), and variable evolutionand treatment response. Identifying the wheezing phenotype could help making therapeutic decisions. However,characteristics from different phenotypes can sometimes overlap in a patient, so thetreatment should be adjusted according to the patient’s response.We review the 3 basic pillars of treatment: education, preventive measures and drugtreatment. We do this for the acute episode and for the treatment maintenance.The recommended drugs on children under 3 are inhaled corticoids (IC) and leukotrieneinhibitors. IC are the treatment of choice for asthma and there is a better response on childrenwith wheezing plus atopy. There is no evidence in the recommendation of low IC doses in theprevention of wheezing episodes exclusively triggered by virus on children of this age. Leukotrieneinhibitors are more appropriate in these cases. They are an alternative to IC on childrenwith mild asthma and they could be used to decrease exacerbations induced by virus.Some children, however, do not respond to any of these drugs. It is recommended toreview the treatment periodically and suspend it or consider an alternative treatment ordiagnosis if benefits are not observed(AU)

Neumonía adquirida en la comunidad. Puesta al día / No disponible

Se presenta un protocolo de neumonía adquirida en la comunidad (NAC) en niños y adolescentes para facilitar el diagnóstico y tratamiento de esta entidad clínica en el ámbito de Atención Primaria. En él se exponen los conocimientos actuales disponibles para optimizar el rendimiento de las pruebas diagnósticas, las recomendaciones terapéuticas para el uso racional de los antibióticos, las medidas preventivas, el seguimiento del paciente y la evaluación de los criterios de derivación hospitalaria. Este protocolo se ha elaborado recientemente tras la revisión de la literatura y en sus recomendaciones se aplican criterios de medicina basada en la evidencia o pruebas. Forma parte de los protocolos realizados y actualizados por el Grupo de Vías Respiratorias (GVR) de la Asociación Española de Pediatría de Atención Primaria (AEPap), cuyos contenidos pueden descargarse desde las direcciones: www.aepap.org/gvr/, www.respirar.org/ Presentamos en este documento únicamente una guía rápida de actuación ante la NAC en las consultas de Pediatría de Atención Primaria, considerando los puntos clave a tener en cuenta en cada uno de los apartados (AU)

We present a protocol for community-acquired pneumonia (CAP) in children and adolescents in order to facilitate the diagnosis and treatment of this clinical entity in the field of Primary Health Care. It presents the current knowledge available to optimize the diagnostic tests’ performance, therapeutic recommendations for the rational use of antibiotics, preventive measures, patient monitoring and the evaluation of hospital referral criteria. This protocol has been developed recently after reviewing the literature. Evidence-based medicine criteria are applied. It is part of the protocols made and updated by the Primary Care Spanish Paediatrics Association’s (AEPap) Airway Group (Grupo de Vías Respiratorias). Its contents can be downloaded from the following addresses: www.aepap.org/gvr/, www.respi rar.org/. This document should only be considered as a quick and short action guide for CAP on Primary Health Care paediatric consultation, considering the key points in each section (AU)

Pubertad y melatonina / Puberty and melatonin

Antecedentes: La melatonina, principal producto hormonal de la glándula pineal tiene una producción nocturna máxima. Aun cuando no todos los investigadores están de acuerdo, numerosos datos sugieren que los niveles elevados prepuberales mantienen el eje hipotálamo-hipófiso-gonadal en reposo, ejerciéndose de este modo un efecto inhibidor del desarrollo puberal. Como consecuencia, el descenso de los valores séricos de melatonina con la edad activa la secreción pulsátil de hormona liberadora de gonadotropina (GnRH) y de esta forma el eje reproductor, y en consecuencia se produce el comienzo de la pubertad. Objetivo. Estudiar el patrón de excreción urinaria de melatonina en niños de distintas edades, las características de su eliminación rítmica y analizar si la pubertad se asocia a una disminución significativa de su producción. Material y métodos: Se estudiaron 32 niños (17 varones y 15 mujeres), realizándose determinaciones urinarias (mediante radioinmunoanálisis [RIA]) de melatonina en orina diurna (recogida entre las 9:00 y 21:00 h) y nocturna (recogida entre las 21:00 y 9:00 h del día siguiente) y determinaciones sanguíneas de hormona luteinizante (LH), foliculoestimulante (FSH), testosterona, estradiol y sulfato de deshidroepiandrosterona (DHEAS). Se estudia el patrón circadiano y la secreción de melatonina en los distintos estadios de Tanner de desarrollo puberal (análisis de varianza [ANOVA]). Resultados: No hay diferencias significativas entre la secreción diurna y nocturna de melatonina entre varones (1,38 0,52 pg/ ml melatonina diurna y 6,92 2,06 pg/ml melatonina nocturna) y mujeres (1,15 0,43 pg/ml melatonina diurna y 11,41 4,32 pg/ml melatonina nocturna). Hay diferencias altamente significativas (p < 0,001) entre las tasas diurnas y nocturnas de secreción de melatonina en ambos sexos. Hay diferencias altamente significativas (p < 0,001) en la secreción diurna, nocturna y total entre los distintos estadios de Tanner de desarrollo puberal, encontrándose en las comparaciones entre grupos que entre los estadios I y II, tanto en varones como en mujeres se observa un significativo descenso de estas tasas de secreción. Hay una significativa disminución de la secreción de melatonina con la edad en ambos sexos (relación lineal), con mayor descenso nocturno. No hay relación entre la secreción de melatonina y la de estradiol, testosterona, LH, FSH y DHEAS. Conclusiones: La secreción de melatonina sigue un patrón circadiano, con mayor secreción nocturna, siendo la amplitud de este ritmo significativamente superior en niñas, por mayor secreción nocturna. Se observa un descenso significativo de la secreción entre los estadios I y II de desarrollo puberal, con descenso mantenido posterior en los siguientes estadios. (AU)

[Puberty and melatonin]. / Pubertad y melatonina.

BACKGROUND: Melatonin is the main hormone secreted by the pineal gland and secretion is maximal at night. Although researchers disagree, numerous data suggest that elevated melatonin levels during the prepubertal age maintain the hypothalamic-pituitary-gonadal axis in quiescence, thus exerting an inhibitory effect on pubertal development. The decrease in serum melatonin with advancing age activates hypothalamic pulsatile secretion of gonadotropin-releasing hormone and consequently the reproductive axis, which results in the onset of puberty. OBJECTIVE: To evaluate urinary melatonin levels in children of different ages and the characteristics of its rhythmic excretion and to determine whether puberty is associated with a significant reduction in urinary melatonin levels. MATERIAL AND METHODS: Thirty-two children were studied (17 boys and 15 girls). Concentrations of 24-h urinary melatonin were quantified by radioimmunoassay in daytime samples (collected between 9.00 and 21.00) and nighttime samples (collected between 21.00 and 9.00 on the following day). Blood levels of luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol, testosterone and dehydroepiandrosterone sulfate (DHEAS) were calculated. Circadian rhythms and melatonin secretion in the various Tanner stages were assessed (ANOVA). RESULTS: No significant differences were found between day- and nighttime secretion of melatonin among boys (daytime melatonin: 1.38 0.52 pg/ml; nighttime melatonin: 6.92 2.06 pg/ml) and girls (daytime melatonin: 1.15 0.43 pg/ml; nighttime melatonin: 11.41 4.32 pg/ml). Highly significant differences were found (p < 0.001) between the day and night rates of melatonin secretion in both genders. Highly significant differences (p < 0.001) were also found in day-, nighttime and total secretion among the different Tanner stages. Comparison among groups revealed a significant decrease in secretion rates in stages I and II in both boys and girls. Melatonin significantly decreased with age in both sexes (lineal relationship). This decrease was greater at night. No relationship was found between the secretion of melatonin and estradiol, testosterone, LH, FSH and DHEAS. CONCLUSIONS: Melatonin secretion follows a circadian pattern, with greater secretion at night. The change in this rhythm was significantly greater in girls, due to greater nighttime secretion. Secretion significantly decreases in Tanner stages I and II with subsequent decreases in the later stages.