Association of rhinitis with asthma prevalence and severity.

Asthma and rhinitis often co-exist in the same patient. Although some authors observed a higher prevalence and/or greater severity of asthma in patients with rhinitis, this view is not homogeneous and the debate continues. The aim of our study is to describe the prevalence of rhinitis in children and adolescents and to analyse their relationship with the prevalence of asthma. A multicentre study was conducted using the methodology of the International Study of Asthma and Allergies in Childhood (ISAAC). The target population of the study was all those school children aged 6-7 and 13-14 years from 6 of the main health catchment areas of Galicia (1.9 million inhabitants). The schools required were randomly selected, and all children in the targeted age ranges were included. Multiple logistic regression was used to obtain adjusted prevalence odds ratios (OR) between asthma symptoms of the schoolchildren and rhinitis prevalence. The results were adjusted for parental smoking habits, maternal education level, cat and dog exposure, and obesity. A total of 21,420 valid questionnaires were finally obtained. Rhinitis was associated with a significant increase in the prevalence of asthma in both age groups. The highest OR were 11.375 for exercise induced asthma (EIA) for children with recent rhinoconjunctivitis and 9.807 for children with recent rhinitis in 6-7 years old group. The prevalence OR's are higher in EIA and severe asthmatics. Rhinitis in children and adolescents is associated with a higher prevalence and severity of asthma.

Comedores preescolares y escolares. Guías, recomendaciones y normativa en España / School lunch menus in Spain. A review on recommendations and policy

Introducción: Una dieta apropiada en la infancia es fundamental para un crecimiento y desarrollo adecuados, pero también para la prevención del desarrollo de enfermedades no transmisibles. La etapa escolar es transcendental. Una proporción importante de alumnos hacen uso del comedor escolar. Se revisa la situación actual de los comedores escolares, así como la normativa y las guías para los comedores en España y en sus diferentes Comunidades Autónomas.Material y métodos: Se recoge en esta revisión la normativa estatal así como la de cada Comunidad Autónoma referidas a las características de los menús escolares, dejando de lado las relativas a los aspectos que tienen que ver con las instalaciones o las garantías higiénico-sanitarias.Resultados: Existe una normativa estatal sobre los comedores escolares relativamente reciente, aunque al ser una competencia transferida es desarrollada por cada Comunidad Autónoma. Dentro de una cierta heterogeneidad, hacen referencia a la distribución de la dieta y a los alimentos a restringir. Suelen dar pautas, ejemplos de menús diarios y representaciones gráficas. En general, se constata una tendencia hacia la mejoría en la adecuación nutricional, pero todavía con bastante por acordar: modelo de gestión, tipo de supervisión, sostenibilidad y consumo de proximidad, así como los horarios.Conclusiones: Los aportes nutricionales realizados en el comedor escolar son importantes cualitativa y cuantitativamente. Además, el comedor debe cumplir funciones educativas y de equidad social. Aunque en todas las Comunidades Autónomas estas preocupaciones guían el desarrollo de la normativa espcífica, existe gran heterogeneidad en su concreción práctica. (AU)

Introduction: An appropriate diet in childhood is essential for suitable growth and development, but it is also essential for preventing the development of non-communicable diseases in later stages. The School stage is fundamental. A significant proportion of students in Spain make use of the school lunch. We review the current situation in Spain, as well as public policy on school lunch and a nationwide review of specific legislation on each Autonomous Community.Material and methods: National public policy and specific considerations in every Autonomous Community were reviewed. Only considerations on the composition of the school menu were considered.Results: There are relatively recent state regulations but on school lunch menus also specific to each Autonomous Community. In general, and within a certain heterogeneity, they refer to the distribution of the diet and foods to be restricted. They usually provide guidelines, examples of daily menus, and graphic representations. Regarding school menus, there is a trend towards improvement in nutritional adequacy, but there is still room to improve. There are certain aspects related to the best solutions yet to be elucidated: management model, type of supervision, sustainability and local consumption, as well as school lunch schedules.Conclusions: The nutritional contributions made in the school canteens are qualitatively and quantitatively important. In addition, it must fulfill educational and social equity functions. Although these concerns address specific recommendation in every Autonomous Community, there is huge heterogeneity on practical implementations. (AU)

Study on the nutritional status and feeding habits in school-children in Madrid City (Spain) during the economic crisis.

INTRODUCTION: the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families. MATERIAL AND METHODS: cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables. RESULTS: 1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% werebetween six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations. CONCLUSIONS: children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families.

Study on the nutritional status and feeding habits in school-children in madrid city (Spain) during the economic crisis / Impacto de la crisis económica en el estado nutricional y en los hábitos alimentarios de escolares de Madrid (España)

Introduction: the recent economic and financial crisis has affected most Western countries, especially families of low socioeconomic classes. We speculate that worsening of socioeconomic condition associated with the crisis would increase obesity, mainly in disadvantaged families. Material and methods: cross-sectional study of the 290,111 children aged three to 12 years old attending public school during the term 2014-2015 in Madrid City, by means of a stratified weighted sample randomly chosen, taking into account age (grade), city district and schools. The questionnaire included weight and height (auto-reported), dietary report (weekly frequency of intake), as well as socioeconomic variables. Results: 1,208 questionnaires were evaluated from 64 classes. Half of participants were boys; 42% were younger than five years old, 35% were between six and eight years old, and 23% older than eight. Undernutrition was present in 5.0%, and excess of weight (overweight + obesity) in 36.7%. Undernutrition was higher in children under the age of six (9.1%). No relationship was found between undernutrition and the characteristics of the families but was slightly higher in families where both parents were unemployed. Excess of weight was higher in children of non-Spaniard parents (44% vs 32%, p < 0.0001), as well as in those families with economic problems (41% vs 31%, p = 0.0005). Only for meat, grains and dairy, the weekly intake was close to the recommendations. Conclusions: children from lower income households were at a higher risk of being overweight compared with their peers. Participation in a school-based food aid program may reduce food insecurity for children and their families

Introducción: la reciente crisis económica y financiera que ha afectado a los países occidentales ha sido especialmente más intensa en las familias con menos recursos económicos. Nos preguntamos si el empeoramiento de la situación económica se ha asociado a un aumento en la tasa de obesidad infantil. Material y métodos: estudio transversal de una muestra ponderada que representase a los 290.111 niños de tres a 12 años matriculados en las escuelas públicas de Madrid en el curso 2014-2015. Se utilizó un cuestionario que incluía peso y talla (autorreportados), ingesta dietética (frecuencia semanal de consumo) y variables socioeconómicas. Resultados: se evaluaron 1.208 cuestionarios de 64 clases, repartidos por igual entre niños y niñas. El 42% eran menores de cinco años, el 35% tenía entre seis y ocho años, y el 23% eran mayores de ocho años. Se presentó desnutrición en el 5,0% de la muestra, mientras que se halló exceso de peso (sobrepeso + obesidad) en el 36,7%. El bajo peso fue mayor en los niños < 6 años (9,1%), sin diferencias entre sexos. No se pudo encontrar ninguna correlación entre la desnutrición y las características de las familias, aunque fue ligeramente superior cuando ambos padres estaban en el paro. El exceso de peso fue mayor en hijos de padres no españoles (42% vs. 32%, p < 0,0001), así como en las familias con dificultades económicas (41% vs. 31%, p = 0,0005). La ingesta media semanal correcta solo se encontró en carne, cereales y lácteos. Conclusiones: los niños de familias con un nivel socioeconómico bajo tienen mayor riesgo de padecer un exceso de peso. La participación en comedores escolares podría disminuir la inseguridad alimentaria, especialmente en tiempos de dificultades económicas

Impacto do tabagismo parental sobre a asma infantil / Impact of parental smoking on childhood asthma

OBJETIVO: Avaliar a exposição da população infantil à FCA em nossa comunidade e sua relação com os sintomas de asma. MÉTODOS: Foi realizado um estudo transversal usando o questionário de estudo ISAAC em crianças e adolescentes da nossa comunidade. Pelo questionário, fez-se a definição por "já ocorreu sibilância", "asma atual", "asma grave" e "asma induzida pelo exercício". O tabagismo parental foi classificado em quatro categorias mutuamente excludentes: 1) nenhum dos pais fuma; 2) somente a mãe fuma; 3) somente o pai fuma; e 4) ambos os pais fumam. Calculou-se a odds ratio da prevalência de sintomas de asma, de acordo com a exposição à FCA, usando regressão logística. RESULTADOS: Foram incluídas, no total, 10.314 crianças e 10.453 adolescentes. Mais de 51% das crianças e adolescentes foram expostos à FCA em casa. A FCA se associa a uma prevalência mais alta de sintomas de asma, particularmente se a mãe ou ambos os pais fumam. CONCLUSÕES: A prevalência da FCA continua a ser alta em nossa comunidade, embora com uma tendência para diminuição nos últimos 15 anos. A FCA se associa a uma prevalência mais alta de asma.

OBJETIVE: To evaluate the exposure to environmental tobacco smoke (ETS) of the childhood population in this community and its relationship with asthma symptoms. METHODS: A cross-sectional study was conducted using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire on children and adolescents in this community. The symptoms "wheezing ever", "current asthma", "severe asthma", and "exercise-induced asthma" were defined by this questionnaire. Parental smoking was classified into four mutually exclusive categories: 1) no parent smokes; 2) only the mother smokes; 3) only the father smokes; and 4) both parents smoke. The odds ratio of the prevalence of asthma symptoms according to ETS exposure was calculated using logistic regression. RESULTS: A total of 10,314 children and 10,453 adolescents were included. Over 51% of the children and adolescents were exposed to ETS at home. ETS is associated with a higher prevalence of asthma symptoms, particularly if the mother or both parents smoke. CONCLUSION: The prevalence of ETS is still high in this community, although there has been a decreasing tendency in the last 15 years. ETS is associated with higher prevalence of asthma.

Exposure to paracetamol and asthma symptoms.

BACKGROUND: Paracetamol is one of the factors that have been associated with the observed increase in asthma prevalence in the last few years. The influence of environmental or genetic factors in this disease may be different in some countries than in others. The purpose of this study was to analyse the relationship between the paracetamol consumption and asthma prevalence in our community. METHODS: A cross-sectional study was conducted on more than 20,000 children and adolescents in Galicia, Spain. The International Study of Asthma and Allergies in Childhood methodology was used to collect the information on asthma symptoms in children, paracetamol consumption, body mass index (BMI), pets in the home, education level of the mother and parental asthma and smoking habits. The influence of paracetamol consumption on the prevalence of asthma symptoms was calculated using logistic regression, adjusted for the other parameters included in the study. RESULTS: After adjusting for gender, BMI, having a cat or dog, maternal education, parental asthma and smoking, in 6- to 7-year-old children, the consumption of paracetamol during the first year of life is associated with asthma [odds ratio (OR) 2.04 (1.79-2.31) for wheezing at some time]. Paracetamol consumption in the previous year leads to a significant increase in the probability of wheezing at some time [OR 3.32 (2.51-4.41)] in young children and adolescents [OR 2.12 (1.68-2.67)]. CONCLUSIONS: Paracetamol consumption is associated with a significant increase in asthma symptoms. The effect is greater the more often the drug is taken.

Prevalencia de síntomas de asma en los niños y adolescentes de la Comunidad Autónoma de Galicia (España) y sus variaciones geográficas / Prevalence and Geographic Variations in Asthma Symptoms in Children and Adolescents in Galicia (Spain)

Objetivos: Determinar la prevalencia y variaciones geográficas de síntomas relacionados con asma enniños y adolescentes gallegos.Población y métodos: Estudio transversal según la metodología ISAAC (Internacional Study of Asthmaand Allergies in Childhood) mediante cuestionario escrito distribuido en el medio escolar. Se incluyeron10.371 niños de 6-7 años y 10.372 adolescentes de 13-14 años de todas las Áreas Sanitarias de Galicia. Seanalizaron las variaciones geográficas mediante un modelo de regresión logística.Resultados: Las sibilancias en los últimos 12 meses oscilaron en los pequeños, del 11,4 (Santiago) al 15,7%(Vigo) y en los adolescentes del 8,8 (Ourense) al 18,8% (Vigo). Según el género se observó una mayorfrecuencia en varones de 6-7 años (p < 0,001) y con tendencia a la significación estadística en las chicasde 13-14 años (p = 0,08). El riesgo (Odds ratio [OR]) de sibilancias en los últimos 12 meses, en el área demayor prevalencia con respecto a la de menor, fue 1,45 (intervalo de confianza [IC] del 95%: 1,12-1,88)en niños y 2,39 (IC 95%: 1,82-3,13) en adolescentes. La prevalencia de asma estimada para Galicia fue de13,6% en niños y 12,2% en adolescentes.Conclusiones: La prevalencia de sibilancias en los últimos 12 meses en las diferentes áreas gallegas essensiblemente superior al resto de ciudades españolas participantes en el ISAAC en los pequeños, siendomuy similar en los adolescentes, salvo en Vigo donde es sensiblemente superior. Encontramos un patróngeográficomuydefinido en los adolescentes, siendo mayores las prevalencias en la costa que en el interior(AU)

Objectives: To determine the prevalence and geographic variations of the symptoms associated withasthma in Galician children and adolescents.Population and methods: A cross-sectional epidemiological study following ISAAC (International Studyof Asthma and Allergies in Childhood) methodology, and using a written questionnaire distributed inschools. The study sample included 10,371 6-7 year-old children and 10,372 13-14 year-old adolescents,all of them from Galician Health Areas. A logistic regression model was used to analyse geographic variations. Results: In the 6-7 year-old group, wheezing in the last 12 months varied from 11.4% (Santiago) to 15.7%(Vigo) and in the adolescents varied from 8.8% (Ourense) to 18.8% (Vigo). The distribution by gender showeda predominant significance in 6-7 year-old males (P < .001), and near to be statistically significant in 13-14year-old females (P = .08). The risk (odds ratio [OR]) of wheezing in the last 12 months in the area withhighest prevalence in comparison with the area of lowest prevalence was 1.45 (95% Confidence Interval[CI], 1.12-1.88) for children and 2.39 (95% CI, 1.82-3.13) for adolescents. The estimated prevalence of asthmain the Autonomous Community of Galicia was 13.6% in younger children and 12.2% in adolescents.Conclusions: The prevalence of wheezing in the last 12 months in the different areas of Galicia is considerablyhigher than the rest of Spanish ISAAC cities in the 6-7 years group and very similar in the 13-14 yearsgroup, except in Vigo where it is considerably higher. We found a clearly defined geographic pattern inthe adolescent group, with higher prevalences in coastal areas than in the interior(AU)

Prevalence and geographic variations in asthma symptoms in children and adolescents in Galicia (Spain).

OBJECTIVES: To determine the prevalence and geographic variations of the symptoms associated with asthma in Galician children and adolescents. POPULATION AND METHODS: A cross-sectional epidemiological study following ISAAC (International Study of Asthma and Allergies in Childhood) methodology, and using a written questionnaire distributed in schools. The study sample included 10,371 6-7 year-old children and 10,372 13-14 year-old adolescents, all of them from Galician Health Areas. A logistic regression model was used to analyse geographic variations. RESULTS: In the 6-7 year-old group, wheezing in the last 12 months varied from 11.4% (Santiago) to 15.7% (Vigo) and in the adolescents varied from 8.8% (Ourense) to 18.8% (Vigo). The distribution by gender showed a predominant significance in 6-7 year-old males (P<.001), and near to be statistically significant in 13-14 year-old females (P=.08). The risk (odds ratio [OR]) of wheezing in the last 12 months in the area with highest prevalence in comparison with the area of lowest prevalence was 1.45 (95% Confidence Interval [CI], 1.12-1.88) for children and 2.39 (95% CI, 1.82-3.13) for adolescents. The estimated prevalence of asthma in the Autonomous Community of Galicia was 13.6% in younger children and 12.2% in adolescents. CONCLUSIONS: The prevalence of wheezing in the last 12 months in the different areas of Galicia is considerably higher than the rest of Spanish ISAAC cities in the 6-7 years group and very similar in the 13-14 years group, except in Vigo where it is considerably higher. We found a clearly defined geographic pattern in the adolescent group, with higher prevalences in coastal areas than in the interior.

Consultas de una población pediátrica rural, en un centro de salud, durante el horario de mañana / Consultations during the morning at a health centre of a rural paediatric population

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