A soft systems approach of asthma management in children based on therapeutic education and e-learning.

One of the most common respiratory chronic diseases is asthma, with 5-16 % of world prevalence. In chronic disease, prevention, diagnosis, management, and palliation are the strategies for a care model; the patient-self management is fundamental with the so-called therapeutic education (TE) to train the patient in the necessary skills. The challenge of TE grows when the patient is a child or a person with special needs, even more in public health care in low- and middle-income countries. This is a problematic human situation, that needs soft system thinking. In this research, the analytic hierarchy process was used to determine the perceived importance of the factors that affect children's asthma health care in a public health institution in Mexico. The soft systems methodology (SSM) was applied to learn about the disease self-management, in order to obtain activities models and an action plan. According to AHP, human resources and education were percived as the most important among the factors that affect children health care within the institution. The perceived importance of two main subfactors (human resources training and TE) was around 34 %, which emphasizes the need to generate strategies for the improvement of the education of patients and health care providers. In MSS, the rich vision, the CATWOE, the root definition, and an activities model were proposed, including the application of an instructional design methodology (ADDIE) for the development of learning objects of asthma for children. Desirable and feasible actions and recommendations include the update of the national clinical practice guides, the use of control measures such as the Asthma Control Test, and a daily asthma diary to register the daily status of the breathing capacity, the drug administration, and the potential trigger events. The proposed model can be used as part of a systemic patient-and-family centered approach for chronic care model (CCM), particularly in diseases unsuitable for prevention interventions.

Therapeutic Patient Education with Learning Objects Improves Asthma Control in Mexican Children.

One of the most common chronic diseases that causes missed school days and workdays is pediatric asthma, producing education, health and economic delays in low and middle-income countries. A patient-centered remarkable therapeutic strategy in the prevention and treatment of chronic diseases is the Therapeutic Patient Education (TPE) which denotes an outstanding difference in the outcomes, from the awareness, to the personal treatment adaption to prevent crises. In this paper, an intervention of TPE with learning objects (LOs) of a pediatric asthma course, designed to train the uncontrolled patient and the caregiver as a team on the specific knowledge to self-control the disease, was carried out at a health facility in Mexico. The Asthma Control Test (ACT) was used and the learning performance was evaluated with formative quizzes. A randomized controlled trial was designed, with pairs of children patients and caregivers during 60 days; the control group was trained with the usual approach, receiving general information about the disease. ACT measures showed statistical significance for the TPE group after the use of the LOs, achieving a controlled state, while the control group did not show difference. Also, the intervention group obtained a higher score in learning performance assessment. The users learned how to avoid risks, the personal triggers of the patient, how to correctly use the different treatments and accessories, consequently, they learned how to self-manage the disease. Our study also confirmed that control of asthma is not only a matter of knowledge, but financial issues to afford the treatment.

Comparison of the def index with Nyvad's caries diagnostic criteria in 3- and 4-year-old Colombian children.

PURPOSE: The aims of this research were to determine the epidemiological profile of dental caries in 3- and 4-year-old preschool children living in Bogotá, Colombia, and to compare two different caries indices--the standard def and Nyvad's new caries diagnostic criteria. METHODS: The children were screened by two calibrated examiners who first brushed the children's teeth and air dried them for 5 seconds before they were examined. The diagnostic criteria used were the standard def-t and def-s and the def-t and def-s of the new caries diagnostic system proposed by Nyvad. The chi-square test2 was used with a significance level of 5%. RESULTS: Prevalence of caries was 70% using the standard def-t criteria and 97% with the criteria proposed by Nyvad. The standard def-t and def-s were 3.3 and 5.7, respectively, and the def-t and def-s with the Nyvad citeria were 8.7 and 14.3, respectively. CONCLUSIONS: Prevalence of caries was high, indicating that the population studied had a high disease rate. The results obtained with the more detailed Nyvad new caries diagnostic criteria were higher than the ones obtained with the standard def-t index, both for teeth and surfaces.

Plasma concentrations of beta-endorphin and adrenocorticotropic hormone in women with and without childbirth preparation.

We studied plasma concentrations of beta-endorphin (beta-EP) and adrenocorticotropic hormone (ACTH) during dilation, expulsion and immediate puerperium in 47 primiparous women with an uneventful pregnancy and spontaneous vaginal delivery. Twenty-five women had received childbirth preparation with the Lamaze method, and 22 had received no preparation. Mean concentrations of beta-EP from the beginning of labor until puerperium were higher in women who had received preparation, but there was no significant difference between the two groups. When behavior during labor was evaluated regardless of which group the patient was assigned to, women whose behavior was unsatisfactory has significantly higher concentrations of ACTH at all times during childbirth. We discuss the role of childbirth preparation as a way to enhance beta-EP secretion. Levels of ACTH, on the other hand, appear to be more closely related with behavior during labor, regardless of whether the mother received preparation.

Plasma levels of beta-endorphin and ACTH during labor and immediate puerperium.

We measured concentrations of beta-endorphin (beta-EP) and adrenocorticotropic hormone (ACTH) in maternal peripheral plasma during dilation, the expulsive period and immediate puerperium, and in the umbilical vein. Plasma levels of both peptides increased markedly and were directly correlated during labor, and decreased 24 h after birth; they were no longer correlated during immediate puerperium. In the umbilical vein, beta-EP and ACTH were also directly correlated. Moreover, the concentration of each of the two peptides in maternal plasma during the expulsive period was correlated with the corresponding concentration in umbilical vein. We discuss the importance of placental corticotropin-releasing factor in the regulation of maternal and fetal stress.