Abordaje del trastorno por déficit de atención con/sin hiperactividad desde la visión del pediatra de cabecera / Attention Deficit Hyperactivity Disorder’s approach, the primary care pediatrician’s view

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[The Spanish version of the Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ). Transcultural adaptation and reliability analysis]. / Versión española del NAKQ. Adaptación transcultural y análisis de fiabilidad y validez.

INTRODUCTION: The Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ) has proven to be a valid instrument for asthma knowledge assessment of patients and their parents. The widespread use of the SRS-22 in non-English-speaking countries requires its transcultural adaptation. Our objective was to obtain a version of the NAKQ questionnaire adapted to Spanish and to analyze its validity and reliability. MATERIAL AND METHODS: The Spanish version was obtained by using the forward/back-translation method with expert, bilingual translators. The questionnaire was administered to 157 parents with high knowledge (n = 78) and low knowledge (n = 79) of asthma. The differences in the number of answers between both groups were analyzed with the chi(2) test. Internal consistency was determined with Cronbach's alpha coefficient and test-retest reliability with the tau-b of Kendall correlation coefficient, and kappa statistics. RESULTS: At the end of the process, 23 of the 31 items were classified as of total equivalence and eight ase of moderate equivalence. The mean score of parents high knowledge was 23 +/- 2.94 and the mean score of parents low knowledge was 16.84 +/- 2.56. The difference between the two groups was statistically significant (p < 0.001). The overall Cronbach's alpha coefficient of the questionnaire was 0.72, the Kendall's tau-b 0,8573 was significant (p = 0.01) and the kappa index showed good or very good consistency in more than half of the items. CONCLUSIONS: The Spanish version of the NAKQ has proven to be acceptable and culturally equivalent to the original version and it has a good degree of consistency, validity and reliability.

Versión española del NAKQ. Adaptación transcultural y análisis de fiabilidad y validez / The Spanish version of the Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ). Transcultural adaptation and reliability analysis

Introducción: el Newcastle Asthma Knowledge Questionnaire (NAKQ) ha probado ser un instrumento válido para evaluar los conocimientos sobre asma en pacientes y sus padres. El empleo extendido del NAKQ en países de habla no inglesa requiere su adaptación transcultural. Nuestro objetivo fue obtener una versión adaptada del cuestionario NAKQ al castellano y analizar su fiabilidad y validez.Material y métodos: para obtener la versión en español se ha seguido la metodología de traducción directa e inversa con traductores expertos bilingües. El cuestionario se administró a 157 padres/madres con gran conocimiento (n=78) y escaso conocimiento (n=79) de asma. Las diferencias en el número de respuestas entre ambos grupos se analizaron con la prueba de la χ2. La consistencia interna del cuestionario se determinó con el coeficiente alfa de Cronbach y la reproducibilidad test-retest, con el coeficiente de correlación tau-b de Kendall y el índice kappa.Resultados: al final del proceso, 23 de los 31 ítems fueron clasificados como de equivalencia total y 8, de equivalencia moderada. La puntuación media de los padres con gran conocimiento fue 23±2,94 y de los de escaso conocimiento fue 16,84±2,56. La diferencia entre los dos grupos fue significativa (p<0,001). El coeficiente global de Cronbach del cuestionario fue 0,72, la tau-b de Kendall fue 0,8573, con significación (p=0,01) y el índice kappa mostró en más de la mitad de los ítems buena o muy buena reproducibilidad.Conclusiones: la versión española del NAKQ es aceptable y equivalente culturalmente a la versión original y tiene un buen grado de fiabilidad, validez y reproducibilidad(AU)

Introduction: The Newcastle Asthma Knowledge Questionnaire for parents of children with asthma (NAKQ) has proven to be a valid instrument for asthma knowledge assessment of patients and their parents. The widespread use of the SRS-22 in non-English-speaking countries requires its transcultural adaptation. Our objective was to obtain a version of the NAKQ questionnaire adapted to Spanish and to analyze its validity and reliability. Material and methods: The Spanish version was obtained by using the forward/back-translation method with expert, bilingual translators. The questionnaire was administered to 157 parents with high knowledge (n=78) and low knowledge (n=79) of asthma. The differences in the number of answers between both groups were analyzed with the χ2 test. Internal consistency was determined with Cronbach’s alpha coefficient and test–retest reliability with the tau-b of Kendall correlation coefficient, and kappa statistics. Results: At the end of the process, 23 of the 31 items were classified as of total equivalence and eight ase of moderate equivalence. The mean score of parents high knowledge was 23±2.94 and the mean score of parents low knowledge was 16.84±2.56. The difference between the two groups was statistically significant (p<0.001). The overall Cronbach’s alpha coefficient of the questionnaire was 0.72, the Kendall’s tau-b 0,8573 was significant (p=0.01) and the kappa index showed good or very good consistency in more than half of the items. Conclusions: The Spanish version of the NAKQ has proven to be acceptable and culturally equivalent to the original version and it has a good degree of consistency, validity and reliability (AU)

Uso racional del medicamento en el asma infantil / No disponible

Más del 50% de los pacientes con asma tienen un tratamiento no consistente con las guías de práctica clínica (GPC). El pediatra no recibe información periódica de su prescripción para conocer y reflexionar sobre su adecuación o no a los criterios de las GPC. Objetivo: conseguir y mantener el mejor control posible del asma infantil, promoviendo el uso racional de los fármacos antiasmáticos. Método: partiendo de un caso clínico, analizaremos interactivamente las opciones terapéuticas posibles y daremos argumentos para elegir la mejor. Análisis de la prescripción en Extremadura. Conclusiones: el tratamiento de elección en la mayor parte de los niños con asma es un corticoide inhalado (CI) a dosis bajas-medias en monoterapia. Las indicaciones de antileukotrienos en monoterapia son las de su ficha técnica: familia sin capacidad para emplear inhaladores y no existencia reciente de crisis asmáticas que hayan precisado corticoides orales. Los beta-agonistas de acción larga (BAAL) asociados al CI deben restringirse a los escalones de mayor gravedad del asma en niños mayores de 4 años si no existiera buen control con el CI. Actualmente no puede recomendarse el uso de la asociación BAAL/CI como tratamiento de rescate en menores de 18 años. Salbutamol y terbutalina son los medicamentos de elección para el asma inducida por ejercicio. En las crisis el B2 agonista de acción rápida es el medicamento de elección. El bromuro de ipratropio sólo en crisis graves, junto al B2. En las crisis moderadas-graves asociar tandas cortas de corticoides orales

More than 50% of patients with asthma are treated in a way that is not consistent with the Clinical Practice Guidelines (GPC). Paediatricians do not receive regular information on their prescriptions to be able know and reflect on their appropriateness to the criteria of the CPG. Objetive: to obtain and to maintain the best control possible of children’s asthma, promoting the rational use of antiasthmatic drugs. Methods: based on one clinical case, we will analyze the possible therapeutic options interactively and we will give arguments to choose the best. Analysis of the prescription in Extremadura. Conclusions: the treatment recommended for most children with asthma is an inhaled corticosteroid (CI) at low-medium doses as monotherapy. The indications of monotherapy with montelukast are those of the data sheet: family without desire/ability to use inhalers and lack of recent asthma attacks. Steroid and long-acting ‚ agonist (BAAL) associated should be restricted to the most serious grades of asthma in children older than 4 years unless good control with CI. The association BAAL / CI cannot be recommended currently as maintenance and rescue therapy in patients less than 18 year of age. Salbutamol and Terbutaline are drugs recommended for the exercise induced asthma. In attacks: a quick action B2 agonist is the drug of choice. Ipratropium bromide only in serious attacks, with Beta-2. In moderate-severe crises can be associated short oral corticosteroids rounds

El tratamiento del niño y adolescente con TDAH en Atención Primaria desde el punto de vista de la evidencia / No disponible

El pediatra de Atención Primaria es el profesional sanitario que valora en primer lugaral niño con sospecha de trastorno por déficit de atención con/sin hiperactividad (TDAH); esresponsable, una vez establecido el diagnóstico, de instaurar y/o seguir un tratamiento óptimo,de eficacia probada por la comunidad científica, personalizado para minimizar losriesgos, coste-efectivo y que respete las opiniones de los pacientes informados.Método: se presenta una revisión bibliográfica actualizada y resumida de los últimosdiez años sobre las evidencias científicas disponibles en relación con la eficacia, la seguridad,la eficiencia y otros aspectos del manejo del tratamiento del TDAH con el objetivo defacilitar la toma de decisiones en el ámbito de la Atención Primaria.Resultados: el niño con TDAH presenta una morbilidad importante y debe ser tratado.Los pilares del tratamiento son: plan de acción, educación, tratamiento farmacológico, nofarmacológico y revisiones periódicas.En el niño con TDAH puro el tratamiento de elección es el metilfenidato por su eficacia,seguridad y coste-efectividad.Las intervenciones psicosociales se recomiendan para el tratamiento de los problemasde conducta comórbidos y en familias disfuncionales.Los trastornos de aprendizaje deben ser evaluados y tratados en su centro escolar.Las revisiones periódicas son necesarias para monitorizar los resultados del tratamientoe identificar barreras para su adherencia.El paciente será derivado a Atención Especializada si el tratamiento correctamente establecidono cumple los objetivos o requiere recursos no disponibles en Atención Primaria

Paediatricians in Primary Care are the first professionals who assess the child with apossible attention deficit hyperactivity disorder (ADHD). Once the diagnosis is established,their responsibility is to initiate and/or follow-up an optimal treatment, with demonstratedefficacy by the scientific community, individualized to each case in order to minimize risks;cost-effective and taking into account the opinion of informed patients. Methods: an updated bibliographic review is presented in this paper with the evidencesavailable through the last ten years concerning the efficacy, safety, efficiency and other featuresrelated to the ADHD treatment, with the purpose of facilitating the decision-makingprocess in Primary Health Care.Results: the child with ADHD has an important morbidity and should be treated. Thekey elements of this treatment are: an action plan, education, pharmacological treatment,non-pharmacological treatment and periodical follow-up.Due to its efficacy, safety and cost-effectiveness, the recommended treatment ismethylphenidate. For comorbidities related to behaviour disorders and dysfunctional families,psychosocial interventions are indicated.Learning disorders must be assessed and treated in the school environment.Periodical follow-up is needed for monitoring the outcomes of the treatment and foridentifying barriers to treatment adherence.If the indicated treatment doesn’t reach the objectives or additional resources non-availableat the Primary Care level are needed, the patient must be referred to specialized care

Adherencia al tratamiento del asma en el paciente pediátrico y sus cuidadores / No disponible

El tratamiento del asma exige al paciente y/o cuidadores tomar decisiones complejas. La adherencia al tratamiento no es una prioridad para la mayoría de los pacientes. La adherencia al tratamiento es un factor primordial en el éxito del manejo del asma. El profesional sanitario es mal perceptor de la falta de adherencia. La comunicación efectiva entre profesional sanitario y paciente y la elaboración de un plan terapéutico escrito, acordado entre ambos, son piezas clave en la adherencia

Asthma treatment requires to patient and/or attendants to make complex decisions. Adherence to asthma therapy is not a priority for the majority of the patients. Adherence to therapy is a basic issue in the successfull management of asthma.The sanitary professional is badly perceptor of the lack of adhesion. The effective communication between patient and sanitary professional and the elaboration of a therapeutic written plan, agreed among both, are key pieces in the adhesion

[Care of children and adolescents with asthma by primary care physicians: current situation and proposals for improvement]. / Asistencia al niño y adolescentes con asma en atención primaria. Situación actual y propuestas de mejora.

INTRODUCTION: To provide good asthma care to children and adolescents the following conditions are required: well-trained health professionals with the structure and resources necessary to perform their work efficiently, and client satisfaction as a measure of compliance and self-management. The aims of this study were to determine the current situation of asthma management by primary care pediatricians and to promote improvement of the healthcare and quality of life of these children and their families. MATERIAL AND METHODS: We performed a descriptive study. A questionnaire was completed by primary care pediatricians attending asthma courses given by the Respiratory Team of the Spanish Association of Primary Care Pediatrics in 2001. RESULTS: Three hundred twenty-three questionnaires were completed. The mean age of the pediatricians was 42 years and 70.6 % were women. A total of 7.4 % referred all patients to the pediatric pneumologist and 21.3 % referred all patients to the pediatric allergy clinic; 61.9 % referred only patients with moderate-severe persistent asthma. Concerning items registered in medical records, 32.5 % recorded a codified asthma diagnosis and 61 % included severity classification. Spirometers were available to 48.6 % and peak flow meters to 45.5 %. With regard to lung function measurement, 17.3 % performed spirometry and 33.2 % performed peak expiratory flow. Concerning asthma educational issues, 90.4 % had received education on environmental factors, 81.7 % had received training in the proper use of medication inhalers and 41.2 % had received training in written self-management plans. CONCLUSIONS: This is the first study to present results on the current situation of asthma management by primary care pediatricians in Spain. The results show the need to improve record-keeping, facilitate the resources required for diagnosis and follow-up and prioritize education in order to achieve an optimal level of self-management by patients and their families.

Asistencia al niño y adolescente con asma en atención primaria. Situación actual y propuestas de mejora / Care of children and adolescents with asthma by primary care physicians: current situation and proposals for improvement

Introducción Para ofrecer atención de calidad al niño-adolescente con asma es necesario: la capacitación de los profesionales implicados, estructura y recursos para desarrollar el trabajo eficazmente y satisfacción del usuario como medida del cumplimiento de sus expectativas. Los objetivos del trabajo son: conocer la situación actual del manejo del paciente con asma por el pediatra de atención primaria y promover la mejora en la asistencia y calidad de vida de estos niños y sus familias. Material y métodos: Estudio descriptivo: encuesta realizada a pediatras asistentes a los cursos sobre asma impartidos por el Grupo de Vías Respiratorias de la Asociación Española de Pediatría de Atención Primaria, durante 2001.Resultados Se han realizado 323 encuestas. Edad media, 42 años; mujeres, 70,6 por ciento. Derivan todos los pacientes al neumólogo, 7,4 por ciento; al alergólogo, 21,3 por ciento; sólo derivan asma moderada-grave, 61,9 por ciento. Registran en la historia clínica el diagnostico de asma codificada, 32,5 por ciento; la clasificación de gravedad, 61 por ciento. Disponen de espirómetro 48,6 por ciento; de medidor de flujo espiratorio máximo (MFEM), 45,5 por ciento. Realizan estudio de función pulmonar: espirometría, 17,3 por ciento; MFEM, 33,2 por ciento. Educación: sobre factores desencadenantes, 90,4 por ciento; técnica inhalatoria, 81,7 por ciento; plan de acción escrito, 41,2 por ciento. Conclusiones: El estudio muestra por primera vez resultados de la situación actual del tratamiento del paciente con asma por el pediatra de atención primaria en España. Los datos muestran la necesidad de: mejorar los registros, disponer y optimizar los recursos para el diagnóstico y seguimiento y priorizar la educación para conseguir el máximo nivel de automanejo por el paciente y familiares (AU)

[The development of the incidence of diabetes mellitus I in children 0 to 14 years of age in Malaga (1982-1993)]. / Evolución de la incidencia de la diabetes mellitus tipo I en niños de 0 a 14 años en Málaga (1982-1993).

OBJECTIVE: A prospective study was conducted to assess the evolution of the incidence of type 1 diabetes mellitus (insulin-dependent) in Málaga among children less than 14 years of age between 1982 and 1993. PATIENTS AND METHODS: The capture-recapture method was chosen for estimating the probability of ascertainment and two sources were used: The hospital registry and Málaga Diabetes Association members. RESULTS: We detected 437 children and the ascertainment achieved was 98.8%. The average annual incidence was 14.3/10(5) and the prevalence at the end of the period was 0.78 patients/10(3). During the last 6 years of the observation period, the incidence rose by 42%. The highest incidence was found among children between 10 and 13 years of age in both sexes. The age of onset and female/male ratio increased during the study period. There was an inverse relationship with monthly temperature. CONCLUSIONS: In comparison with other European epidemiological studies, we found a higher incidence and increased rate of growth of the incidence of type 1 diabetes mellitus during the observation period.

[Incidence of IDDM in children (age 0-14 yrs) in Málaga 1982-1988]. / Incidencia de IDDM en niños (0-14 a.) en Málaga, 1982-1988.

The annual incidence of diabetes mellitus in children 0 to 14 years of age in the province of Malaga (Spain) between 1982 and 1988 was 11.4 cases per 100,000 inhabitants (range = 9.7-13.1). There was an inverse relationship with seasonal temperature; the onset of the disease occurred more frequently during the colder months. The highest incidence was found among children between 5 and 9 years of age, with 13.88 cases per 100,000. The male/female ratio was 1.3 in children between 0 and 5 years and in children between 5 and 9 years of age and 0.97 in children between 10-14 years. The onset of the disease as ketoacidosis remained constant at 25% and was independent of age. When compared with other European epidemiological studies, we found a higher incidence of diabetes mellitus than that in Central European or Mediterranean Countries.

[Revised Denver test: prospective study in primary care nursing consultations]. / Test de Denver revisado: estudio prospectivo en consulta de enfermería de atención primaria.

UNLABELLED: OBJECTIVE MAIN: To ascertain psychometric development and periodically monitor further development, using the Revised Denver Test (DDST-R) to structure attention given in the area in which the child is deficient. SITE. "Las Lagunas" Health Centre, Mijas Costa (Málaga) in the Nursing Consultations for Mother and Child, Primary Attention. PATIENTS OR OTHERS PARTICIPANTS: All the children seen in the Nursing Consultations under the Healthy Child sub-programme. INTERVENTION: Carrying out of the DDST-R, detection of anomalies, structuring of treatment, referral to paediatrician where necessary. MAIN MEASUREMENTS AND RESULTS: 215 Tests carried out, 194 )90.23%) normal, 21 (9.76%) deviant. There were 100 females (46.51%), of whom 93 (93%) were found to be normal (93%) with 7 (7%) deviant. 18 children were affected in one area, 3 in two areas. Frequency of deviance by area: Personal-Social 6 (2.79%), Language 12 (5.58%) Fine Motor control 1 (0.46%) Gross motor control 3 (1.39%) Others 2 (0.93%). CONCLUSIONS: The DDST-R provides a useful means of screening to detect deviance in the area under study. Because it is easy to use it is suitable for Primary Attention, and should be included as a matter of routine in the examinations carried out by Nursing in the Attention to the Healthy Child sub-programme, to assist in structuring the care given in the areas noted as deficient.