Resources to handle childhood asthma in Spain: The role of plans and guides and the participation of nurses.

BACKGROUND: Describe the assistance provided to asthmatic patients by Primary Care Paediatricians (PCP) in Spain and the material and human resources available for diagnosis and follow-up. METHODS: A cross-sectional descriptive study using an on-line survey, sent to PCP regarding the availability of diagnostic resources, carrying out programmed and educational activities, collaboration of nursing staff and their relationship with existing institutional plans to care for children with asthma. A latent class model (LCM) was used to describe the differences among paediatricians based on the variables studied. RESULTS: Of the 708 answers, 675 were considered valid; 76% of the paediatricians had a spirometer, 75% specific IgE, 17% prick-test, 95% had placebo inhalers and 97% inhalation chambers. 57% performed programmed activities with their patients, while 56% shared their care of asthmatic patients with their nursing staff, but only 25% of the nurses were involved in the follow-up and 12% in education. LCM identified four patterns. The two groups with greater access to diagnostic resources counted on institutional plans/guidelines. However, the only variable differentiating the groups with more programmed and educational activities was the participation of nurses. CONCLUSIONS: The availability of asthma plans/guidelines and resources for diagnosis and follow-up is not sufficient to improve important aspects of primary care for children with asthma. Organisational changes are necessary to include programmed asthma-related visits and paediatric teams with greater involvement of the nurses when caring for these patients.

Dietary acrylamide: What happens during digestion.

Acrylamide is a well-known potentially carcinogen compound formed during thermal processing as an intermediate of Maillard reactions. Three objectives were addressed: the impact of gastric digestion on acrylamide content of French Fries, chips, chicken nuggets, onions rings, breakfast cereals, biscuits, crackers, instant coffee and coffee substitute; the acrylamide content evolution during gastrointestinal digestion of French fries and chips; and the effectiveness of blanching and air-frying on acrylamide mitigation after gastrointestinal digestion. A significant increase (p-value <0.05) in acrylamide content was observed for most of the products after gastric digestion (maximum registered for sweet biscuits, from 30±8 to 150±48µg/kg). However, at the end of the intestinal stage, acrylamide values were statistically similar (p-value=0.132) for French fries and lower than the initial values (before digestion) in potato chips (p-value=0.027). Finally, the low acrylamide content found in blanched and air-fried samples, remained still lower than for deep fried samples even after gastrointestinal digestion.

Effect of pretreatments and air-frying, a novel technology, on acrylamide generation in fried potatoes.

This paper investigated the effect of air-frying technology, in combination with a pretreatment based of soaking the samples in different chemical agent solutions (citric acid, glycine, calcium lactate, sodium chloride, or nicotinic acid [vitamin B3]), on the generation of acrylamide in fried potatoes. The influence of reducing sugars on the development of surface's color was also analyzed. The experiments were conducted at 180 °C by means of air-frying and deep-oil-frying, as a reference technology. Based on the evolution of color crust with frying time, it could be concluded that the rate of Maillard reaction decreased as the initial reducing sugars content increased in the raw material, and was also lower for deep-oil-frying than for air-frying regardless of pretreatments applied. Air-frying reduced acrylamide content by about 90% compared with conventional deep-oil-frying without being necessary the application of a pretreatment. However, deep-oil fried potatoes pretreated with solutions of nicotinic acid, citric acid, glycine at 1%, and NaCl at 2% presented much lower acrylamide levels (up to 80% to 90% reduction) than nonpretreated samples.

A randomized, multicenter, open-label clinical trial to assess the immunogenicity of a meningococcal C vaccine booster dose administered to children aged 14 to 18 months.

BACKGROUND: A booster meningococcal C (MenC) vaccine dose is recommended after the first year of life. The objective of this study was to assess its immunogenicity and factors that modify the immunoresponse. METHODS: An open label study in which 389 children 14 to 18 months of age, previously primed with 3 doses of a MenC vaccine conjugated with CRM197 (MenC-CRM) or with 2 doses of a MenC vaccine conjugated with tetanus toxoid (MenC-TT), were randomized to be boosted with either of these vaccines and a DTaP-IPV-Hib vaccine at the same time. Immunogenicity against MenC and Haemophilus influenzae type b was assessed before and 1 month after the booster dose. RESULTS: Before the second year booster, 44.9% of the studied children had MenC bactericidal (SBA) seroprotection rate of > or =1:8, with no differences related to the vaccine used for priming, whereas the anti Hib antibody concentration was higher in children primed with the MenC-TT (0.59; 95% CI: 0.49-0.71 vs. 0.39; 95% CI: 0.32-0.48).One month after the MenC vaccine booster 99.5% of the children had SBA > or =1:128. Children primed with MenC-TT reached higher SBA titers: 6520 (95% CI: 5359-7932) than those primed with MenC-CRM: 1903 (95% CI: 1600-2262). Children primed with MenC-CRM had SBA titers of 2061 (95% CI: 1599-2627) when boosted with MenC-TT and 1746 (95% CI: 1378-2213) when boosted with MenC-CRM. Children primed with MenC-TT had SBA titers of 6786 (95% CI: 5023-9167) and 6278 (95% CI: 4841-8144) when boosted with MenC-TT or MenC-CRM. There was no difference in the PRP antibody concentration after boosting. CONCLUSIONS: A booster MenC dose induces high SBA and anti Hib response with over 99% of children seroprotected. Children primed with a MenC-TT vaccine reached SBA titers 3.5 times higher no matter which vaccine was used for boosting.

[Validation of the tympanic thermometer in primary care]. / Validación del termómetro timpánico en atención primaria.

OBJECTIVE: The aim of the study is to validate a tympanic thermometer (TT) use in primary care. PATIENTS AND METHODS: Validation study phase IV of the tympanic thermometer ThermoScan Pro LT. Measurements are compared to axillary temperature (AT) measured with a glass mercury thermometer. 412 subjects 6 months to 15 years old attended in primary care clinics were studied. Exclusion criteria were middle ear conditions, intense crying or sweating. The highest of the three measurements in each ear was used to calculate sensitivity and specificity of the TT and to analyse the concordance with AT. The impact of ambient temperature, age, gender, cerumen, presence of a febrile condition and the examiner on the results was assessed. RESULTS: Sensitivity of TT to detect fever (AT > 38 degrees C) was 89.7% (95% IC: 81.8-97.5) and specificity 90.7% (95% IC: 87.7-93.7). As a mean TT measures 0.5 degree C higher than AT but there was a high dispersion of the data (-1.59-0.6 degrees C). Accuracy of TT was influenced by the sex of the patient (p = 0.029), examiner (p < 0.01), presence of a febrile condition (p < 0.01) and positioning of the patient (p = 0.026). Repeatability coefficient was 0.34 degree C for the right ear and 0.42 degree C for the left. CONCLUSION: The sensitivity of the TT to detect fever was adequate, though there was a poor concordance with AT and had an important variation among repeated measurements in the same ear.

Inhibition of serum bactericidal reaction by lipopolysaccharide.

An Rc-mutant of Escherichia coli that lacks UDPgalactose 4-epimerase grows normally without galactose but makes lipopolysaccharide lacking most of its carbohydrate. Exogenous galactose overrides the mutation and results in the formation of a complete lipopolysaccharide, thereby producing a smooth phenocopy. The smooth phenocopy was much more resistant to the bactericidal activity of normal human serum than was the rough phenotype. More complement was utilized by the rough mutant in the bactericidal process than by the smooth phenocopy. An antiserum was prepared in rabbits to a specific outer membrane protein in the mutant bacterium, the lambda receptor, whose expression could be suppressed by the addition of 10 mM maltose. The effect of the O-antigen in the lipopolysaccharide produced by the smooth phenocopy on the binding of antibody to the lambda receptor was determined. The smooth phenocopy exhibited significantly less binding of antibody than did the rough phenocopy. In addition, expression of the lambda receptor had little effect on the binding of antibody to the lambda receptor in the smooth phenocopy but caused significantly increased binding in the rough mutant. The results suggest that the increased resistance to the lethal action of normal human serum shown by the smooth phenocopy may be due to the blocking of antibody binding sites by the O-antigen of lipopolysaccharide, thereby preventing activation of the classical pathway of complement.