Cristian Roncada

Specific instruments to assess quality of life in children and adolescents with asthma

OBJECTIVE To identify and describe specific instruments to assess health-related quality of life (HRQoL) in children and adolescents with asthma. DATA SOURCE Searches were performed in the PubMed, Ovid, and LILACS databases using different combinations of key words (MeSH terms), selecting original articles on the development of specific HRQoL questionnaires, published in English, Portuguese, or Spanish, between 1990 and 2012. DATA SYNTHESIS A total of 15 instruments that met the inclusion criteria were identified. Most studies assessed reliability through internal consistency, reproducibility, and/or sensitivity to changes. Validity was assessed by comparison with healthy controls (discordant validity) or factorial analysis. CONCLUSIONS Of the 15 instruments, three are the most frequently used: Pediatric Asthma Quality of Life Questionnaire (PAQLQ), Pediatric Quality of Life Inventory 4.0 (PedsQL-Asthma), and Disability Kids (DISABKIDS). In general, these three tools have adequate psychometric characteristics and are practical to implement, but only PAQLQ has been culturally adapted to Brazil.

Burden of asthma among inner-city children from Southern Brazil

Abstract Objective: To assess the impact of asthma in a population of inner-city Brazilian children. Methods: In a cross-sectional study, we selected children with asthma and healthy controls from public schools (8–16 years) from a capital city of Southern Brazil. Divided into three phases, questionnaires were administered, assessing lung function, body mass index and allergic sensitization. Results: From 2500 children initially included in the study (48.4% males; mean age of 11.42 ± 2.32 years), asthma prevalence was detected in 28.6% (715/2500). The disease was not controlled in 42.7% (305/715) of the children, with 7.6% of hospitalization rate. School absenteeism (at least one day of missing school because of asthma) and sedentary behavior were high (57.1 and 67.2%, respectively), with 47.9% of subjects requiring oral steroids in the previous year, and physical well-being significantly lower than controls, directly interfering with quality of life, and therefore in the daily activities of these students. Moreover, 38% of the parents admitted to being non-adherent to treatment with their children and 31.1 and 53.6%, respectively, believed that rescue medication and exercise might be harmful. Conclusions: The burden of asthma in Brazilian children seems to be substantial. New international guidelines with a special focus in developing countries settings, with more pragmatic approaches, should be a priority for discussion and implementation actions.

Asthma treatment in children and adolescents in an urban area in southern Brazil: popular myths and features.

Objective: To describe the frequency of popular myths about and features of asthma treatment in children and adolescents in an urban area in southern Brazil. Methods: The parents or legal guardians of public school students (8-16 years of age) completed a specific questionnaire regarding their understanding of asthma, asthma control, and treatment characteristics. The sample included parents or legal guardians of students with asthma (n = 127) and healthy controls (n = 124). Results: The study involved 251 parents or legal guardians, of whom 127 (68.5%) were the mothers and 130 (51.8%) were White. The mean age of these participants was 38.47 ± 12.07 years. Of the participants in the asthma and control groups, 37 (29.1%) and 26 (21.0%), respectively, reported being afraid of using asthma medications, whereas 61 (48%) and 56 (45.2%), respectively, believed that using a metered dose inhaler can lead to drug dependence. However, only 17 (13.4%) and 17 (13.7%) of the participants in the asthma and control groups, respectively, reported being afraid of using oral corticosteroids. In the asthma group, 55 students (43.3%) were diagnosed with uncontrolled asthma, only 41 (32.3%) had a prescription or written treatment plan, and 38 (29.9%) used asthma medications regularly. Conclusions: Popular myths about asthma treatment were common in our sample, as were uncontrolled asthma and inappropriate asthma management. Further studies in this field should be conducted in other developing countries, as should evaluations of pediatric asthma treatment programs in public health systems.

Clinical characteristics of children and adolescents with severe therapy-resistant asthma in Brazil.

Abstract Objective: To describe the clinical characteristics, lung function, radiological findings, and the inflammatory cell profile in induced sputum in children and adolescents with severe therapy-resistant asthma (STRA) treated at a referral center in southern Brazil. Methods: We retrospectively analyzed children and adolescents (3-18 years of age) with uncontrolled STRA treated with high-dose inhaled corticosteroids and long-acting ß2 agonists. We prospectively collected data on disease control, lung function, skin test reactivity to allergens, the inflammatory cell profile in induced sputum, chest CT findings, and esophageal pH monitoring results. Results: We analyzed 21 patients (mean age, 9.2 ± 2.98 years). Of those, 18 (86%) were atopic. Most had uncontrolled asthma and near-normal baseline lung function. In 4 and 7, induced sputum was found to be eosinophilic and neutrophilic, respectively; the inflammatory cell profile in induced sputum having changed in 67% of those in whom induced sputum analysis was repeated. Of the 8 patients receiving treatment with omalizumab (an anti-IgE antibody), 7 (87.5%) showed significant improvement in quality of life, as well as significant reductions in the numbers of exacerbations and hospitalizations. Conclusions: Children with STRA present with near-normal lung function and a variable airway inflammatory pattern during clinical follow-up, showing a significant clinical response to omalizumab. In children, STRA differs from that seen in adults, further studies being required in order to gain a better understanding of the disease mechanisms.

The impact of asthma in Brazil: a longitudinal analysis of data from a Brazilian national database system

Objetivo: Apresentar dados longitudinais oficiais sobre o impacto da asma no Brasil entre 2008 e 2013. Métodos: Estudo descritivo de dados extraídos de um banco de dados do governo brasileiro entre 2008 e 2013, no qual foram analisados as hospitalizações e óbitos por asma, bem como o custo das hospitalizações. Foi também realizada uma subanálise geográfica. Resultados: Em 2013, 2.047 pessoas morreram de asma no Brasil (5 óbitos/dia), com mais de 120.000 hospitalizações por asma. Durante o período de estudo, o número absoluto de óbitos e hospitalizações por asma diminuiu 10% e 36%, respectivamente. No entanto, a taxa de mortalidade hospitalar aumentou aproximadamente 25%. A subanálise geográfica mostrou que as regiões Norte/Nordeste e Sudeste apresentaram as maiores taxas de hospitalização e mortalidade hospitalar por asma, respectivamente. A análise dos estados representativos de cada região mostrou discrepâncias entre as hospitalizações por asma e as taxas de mortalidade hospitalar por asma. Durante o período de estudo, as hospitalizações por asma custaram US

Prevalência de câncer colorretal associado ao papilomavírus humano: uma revisão sistemática com metanálise

170 milhões ao sistema público de saúde. Conclusões: Embora os óbitos e hospitalizações por asma no Brasil estejam diminuindo desde 2009, os números absolutos ainda são altos, com elevados custos diretos e indiretos para a sociedade, o que mostra a relevância do impacto da asma em países de renda média.

Validation of the Brazilian version of the childhood asthma control test (c-ACT).

Introduction: Colorectal cancer is one of the most prevalent types of tumors worldwide. Deaths caused by these malignant tumors remain high and have stayed practically at the same level for the last few decades. Among the established risk factors for the development of cancer are infections due to pathogens or viruses. Among the viruses, the human papillomavirus (HPV) is the most prevalent, with over 180 strains, 40 of which are directly related to anogenital infections. Objective: Systematically assess the main studies which link HPV to colorectal cancer with meta-analysis. Methods: The search strategy adopted was the logic based on specific descriptors (English language), in combination with the Boolean operators (AND/OR). The search was conducted in the following databases: PubMed, ScienceDirect, and Scientific Electronic Library Online (SciELO), between April and May 2015. Results: 1,549 samples were assessed, with 956 (61.7%) being males. Six hundred thirty out of 1,358 cases of colorectal cancer due to HPV were diagnosed (51.9%). From these, 408 of 767 (51.9%) were male and 404 of 598 (67.5%) were linked to HPV 16 and 18, with tumor prevalence in the area of the cervix (253 of 411; 61.3%). From the total of 598 samples for the prevalence estimate of HPV 16 and 18, the number of cases with similar numbers was 204 (31.7%) and 200 (35.8%), respectively. Relatively significant numbers were found in the area of the cervix, 253 (61.3%), and the area of the rectum, 158 (38.7%). Conclusion: After conducting the present study, the link between HPV and colorectal cancer was made evident, without a distinction between the sexes, with similar values between HPV 16 and HPV 18.Introduction: Colorectal cancer is one of the most prevalent types of tumors worldwide. Deaths caused by these malignant tumors remain high and have stayed practically at the same level for the last few decades. Among the established risk factors for the development of cancer are infections due to pathogens or viruses. Among the viruses, the human papillomavirus (HPV) is the most prevalent, with over 180 strains, 40 of which are directly related to anogenital infections. Objective: Systematically assess the main studies which link HPV to colorectal cancer with meta-analysis. Methods: The search strategy adopted was the logic based on specific descriptors (English language), in combination with the Boolean operators (AND/OR). The search was conducted in the following databases: PubMed, ScienceDirect, and Scientific Electronic Library Online (SciELO), between April and May 2015. Results: 1,549 samples were assessed, with 956 (61.7%) being males. Six hundred thirty out of 1,358 cases of colorectal cancer due to HPV were diagnosed (51.9%). From these, 408 of 767 (51.9%) were male and 404 of 598 (67.5%) were linked to HPV 16 and 18, with tumor prevalence in the area of the cervix (253 of 411; 61.3%). From the total of 598 samples for the prevalence estimate of HPV 16 and 18, the number of cases with similar numbers was 204 (31.7%) and 200 (35.8%), respectively. Relatively significant numbers were found in the area of the cervix, 253 (61.3%), and the area of the rectum, 158 (38.7%). Conclusion: After conducting the present study, the link between HPV and colorectal cancer was made evident, without a distinction between the sexes, with similar values between HPV 16 and HPV 18.

Valor do emprego do questionário WHOQOL-BREF na avaliação da qualidade de vida de pais de crianças com asma

Childrens perception of their symptoms has proved reliable and relevant to disease management and should be considered when assessing their asthma control. The aim of the study is to validate the Brazilian Portuguese version of the Childhood Asthma Control Test (c‐ACT) in children aged 4–11 years.

Impact of omalizumab in children from a middle-income country with severe therapy-resistant asthma: A real-life study

Objective:: To evaluate the quality of life (QOL) of parents of children with asthma and to analyze the internal consistency of the generic QOL tool World Health Organization Quality of Life, abbreviated version (WHOQOL-BREF). Methods:: We evaluated the QOL of parents of asthmatic and healthy children aged between 8 and 16, using the generic WHOQOL-BREF questionnaire. We also evaluated the internal consistency using Cronbachs alpha (αC), in order to determine whether the tool had good validity for the target audience. Results:: The study included 162 individuals with a mean age of 43.8±13.6 years, of which 104 were female (64.2%) and 128 were married (79.0%). When assessing the QOL, the group of parents of healthy children had higher scores than the group of parents of asthmatic children in the four areas evaluated by the questionnaire (Physical, Psychological Health, Social Relationships and Environment), indicating a better quality of life. Regarding the internal consistency of the WHOQOL-BREF, values of ˛C were 0.86 points for the group of parents of asthmatic children, and 0.88 for the group of parents of healthy children. Conclusions:: Parents of children with asthma have impaired quality of life due to their childrens disease. Furthermore, the WHOQOL-BREF, even as a generic tool, showed to be practical and efficient to evaluate the quality of life of parents of asthmatic children.

Comparação da força e capacidade funcional entre idosos praticantes de musculação, hidroginástica e não praticantes de exercícios físicos

Severe asthma in children is a global health problem. Severe therapy‐resistant asthma (STRA) in children is a major clinical challenge due to persistent symptoms despite high doses of corticosteroids and results in high public health costs. Omalizumab (anti‐IgE monoclonal antibody) has been described as an effective add‐on therapy in these patients. The characteristics of children with STRA from low‐ and middle‐income countries have scarcely been reported, and no real‐life study has been published on the effects of omalizumab in this group of patients. The aim of our study is to report the first clinical real‐life experiences with omalizumab in Brazilian children with STRA.