Cristina Gonçalves Alvim

Adherence rate to inhaled corticosteroids and their impact on asthma control

Background:  Poor asthma control is associated to high morbidity. The objective of this study was to assess the association between adherence rates to beclomethasone dipropionate (BDP) and the degree of asthma control.

Qualidade do preenchimento da Caderneta de Saúde da Criança e fatores associados

The Child Health Record (CHR) is an essential document for childrens health care activities. A cross-sectional study was performed with simple random sampling, aimed at analyzing factors related to quality of data completion on the CHR. Interviews and direct verification of 365 CHRs from 9 health districts in Belo Horizonte, Minas Gerais State, Brazil, were performed. A scoring system was created to classify the CHRs in terms of quality of data completion and to relate them to explanatory variables. Odds ratios were calculated by logistic regression. Completion of the 20 scoring items varied from 3.1% (use of iron supplements) to 99.7% (date of birth). Factors associated with worse scores were: children > 12 months old (OR = 1.77), mothers with < or = 6 years of schooling (OR = 1.97), children not treated by general practitioners (OR = 3.18), and mothers who had not received explanations on the CHR while in the maternity ward (OR = 1.77). The results show poor use of the CHR and emphasize the need for on-going efforts to train health professionals and prepare health services for their important role in the promotion of childrens health.

Quality of Life in Asthmatic Adolescents: An Overall Evaluation of Disease Control

Objective. to evaluate the relative impact of reported symptoms, school absenteeism, hospital admission, medical visits, and the presence of emotional and behavioral disorders on the health-related quality of life (HRQL) of low income asthmatic adolescents. Methods. Asthmatic adolescents were randomly selected among public schools in Belo Horizonte/MG, Brazil. Asthma severity was rated according to the Global Initiative for Asthma (GINA) classification. Emotional and behavior disorders (EBDs) were evaluated through the Strengths and Difficulties Questionnaire. HRQL was assessed through the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). PAQLQ score was analyzed for each intervening variable. Multivariate regression analysis was conducted. Results. One hundred and forty-six adolescents participated in the present study, 45% being male and age ranging from 14 to 16 years old. Mean PAQLQ score was 5.7 ± 1.3 SD, with no significant difference regarding sociodemographic characteristics, except for gender (p = 0.001). The regression equation of the final model for the multivariate analysis was as follows: Mean PAQLQ score = 1.88 (Constant) − 0.42 gender + 1.14 nighttime symptoms + 0.69 medical visits in the past 12 months + 0.95 EBDs. Therefore, if the other variables remained constant, PAQLQ score: reduced in 0.42 points for females (p = 0.01); increased in 1.14 when there were no nighttime symptoms (p < 0.01); increased in 0.69 when there was no medical visit for respiratory problems within the past 12 months (p < 0.01); and increased in 0.95 when no EBDs were present (p < 0.01). This model was able to explain approximately half of the variation found in PAQLQ score (R-Sq = 49.4%). Conclusions. HRQL of asthmatic adolescents is influenced by the complex interaction among several factors: the severity of clinical symptoms, morbidity, gender, and the psychological resources available so as to deal with such difficulties. A careful evaluation of HRQL is essential in order to capture feelings and subjective perceptions, which are not investigated by the conventional evaluation of asthma control.

Asthma and allergic rhinitis co-morbidity: a cross-sectional questionnaire study on adolescents aged 13-14 years

AIMS There is scarce epidemiological population-based data on the prevalence of asthma and allergic rhinitis (AR) co-morbidity in adolescents. The aim was to verify asthma and AR prevalence rates in order to emphasise asthma/AR co-morbidity. METHODS Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in adolescents aged 13-14 years, chosen randomly from public schools in Belo Horizonte, Brazil. RESULTS A total of 3262 students were identified, 3083 (47.3% males) of whom completed the questionnaire (response rate 94.7%). The prevalence of symptoms related to asthma and AR co-morbidity was 8.4% (95% CI, 8.09-10.25). Among asthmatic adolescents, symptoms of AR were reported in 46.5% (95% CI, 42.60-52.08%). CONCLUSIONS There is a high prevalence of adolescent asthma and AR co-morbidity in this area of Brazil. This co-morbidity is an important health issue that requires strategic application of primary health care facilities to achieve adequate control of both asthma and allergic rhinitis.

Compliance with inhaled corticosteroid treatment: rates reported by guardians and measured by the pharmacy

A morbidade associada a asma e elevada,principalmente nos paises em desenvolvimento, e as falhas naadesaoaousodecorticoideinalatoriocontribuemparaestaelevacao.Este estudo objetiva comparar as taxas de adesao ao uso debeclometasonarelatadaspelosresponsaveiseasmensuradaspelosregistros de dispensacao farmaceutica do medicamento.

Prevalência de transtornos emocionais e comportamentais em adolescentes com asma

OBJECTIVE To determine the prevalence of emotional and behavioral disorders in adolescents with asthma and to compare it with that of adolescents without asthma. METHODS A transversal study using the Strengths and Difficulties Questionnaire, administered to adolescents with or without asthma, ranging from 14 to 16 years of age and randomly selected from schools in the city of Belo Horizonte, Brazil. RESULTS The prevalence of emotional and behavioral disorders in adolescents with and without asthma was 20.4% (95% CI: 14.5-27.8%) and 9.0% (95% CI: 6.1-12.8%), respectively. Among adolescents with asthma, 56.6% (95% CI: 48.3-64.5%) presented normal scores, and 23.0% (95% CI 16.8-30.7%) presented borderline scores. Among adolescents without asthma, 75.0% (95% CI: 69.7-79.6%) presented normal scores, and 16.0% (95% CI: 12.2-20.7%) presented borderline scores. The median total score on the questionnaire was 14 and 12 among subjects with and without asthma, respectively (p < 0.01). In the final logistic regression model, adjusted for socioeconomic variables, the association between emotional/behavioral disorders and the following variables remained significant: being female (OR = 1.98; 95% CI: 1.10-3.56; p = 0.02) and having asthma (OR = 2.66; 95% CI: 1.52-4.64; p = 0.001). CONCLUSIONS The prevalence of emotional and behavioral disorders is higher in adolescents with asthma than in those without asthma, underscoring the need for a holistic, interdisciplinary approach.

Corticoide oral e inalatório para tratamento de sibilância no primeiro ano de vida

OBJECTIVE To evaluate the prevalence of corticoid utilization for the treatment of wheezing in infants less than 12 months old and to analyze factors associated with this practice. METHODS This was a cross-sectional study that administered the validated questionnaire from the International Study on the Prevalence of Wheezing in Infants to 1,261 infants aged 12 to 15 months in Belo Horizonte, Brazil. Proportions and 95% confidence intervals were calculated and the chi-square test was used to detect associations between variables. RESULTS Six hundred and fifty-six (52%) infants, 53% male and 48.2% white, exhibited wheezing during the first year of life. Mean age at first episode was 5.11±2.89 months. There was a high rate of morbidity, with many emergency visits (71%) and hospitalizations (27.8%). Also common were a family history of asthma and atopic disease (32.2 to 71%) and exposure to passive smoking (41.5%) and to mould (47.3%). The prevalence rates for corticoid use, whether via oral route (48.7%) or inhaled (51.3%), were elevated and were higher in the group that suffered three or more episodes. Children suffering greater morbidity were more likely to be prescribed a corticoid (p < 0.05). CONCLUSION The high frequency of corticoid use highlights the need to establish specific criteria for the treatment of wheezing in the first years of life in order to avoid extrapolation of asthma treatments to other conditions that are transitory and self-limiting and in which using corticoids could involve more risk than benefit.

Correlation between Bhalla score and spirometry in children and adolescents with Cystic Fibrosis

OBJECTIVE To correlate the findings of high resolution computed tomography of the chest based on the Bhalla score with the clinical data and spirometry in children and adolescents with cystic fibrosis, and to study the concordance between two radiologists for the Bhalla score and its categories. METHODS We evaluated the medical records of 23 patients from the outpatient clinic. The items evaluated included age, weight, height, height/age Z-score, weight/age Z-score, body mass index (BMI), O2 saturation, spirometry and Bhalla score. RESULTS The patients had a mean age of 17.4 years ± 5.7 years, with fifteen females and eight males. There was good correlation between Bhalla score and spirometry (FVC-r =0.718, p<0.001; FEV1-r=0.830, p<0.001; FEF25-75%-r =0.786, p<0.001; FEV1/FVC-r=0.714, p<0.001). It was also noted that some patients with FEF25-75%> 70% already had changes in their final Bhalla score. In the analysis of the concordance between the examiners a Kappa coefficient of 0.81 (p <0.001) was found, and an intraclass correlation coefficient of 0.98. CONCLUSION A good correlation between Bhalla scores with spirometry confirmed its usefulness in evaluating and monitoring patients with cystic fibrosis, given it can be used both in patients who are unable to perform spirometry as well as for a pooled analysis of the two examinations since the HRCT scans show early changes in patients with normal function tests.

From lip to lab: salty tasting skin is the main clue that raises clinical suspicion of cystic fibrosis in young infants

This study developed a clinical decision rule (CDR) to rule in or rule out cystic fibrosis (CF) in the first weeks of life.

Matriz de competências essenciais para a formação e avaliação de desempenho de estudantes de medicina

OBJETIVO: O artigo propoe uma matriz de competencias essenciais para valorizacao e intencionalidade dos percursos academicos e como referencia de processos avaliativos dos estudantes. METODOLOGIA: O estudo apresenta delineamento quanti-qualitativo. Apos revisao integrativa da literatura e pesquisa documental, foi elaborada e consolidada a versao inicial. O teste piloto com 12 professores, membros do Colegiado de Graduacao do curso medico da UFMG, contribuiu para ajustes do documento. A validacao da matriz foi orientada pela metodologia Delphi, com avaliacao docente individual, por via eletronica e utilizacao da ferramenta Googledocs. RESULTADOS: Houve consenso entre os 112 professores avaliadores para aprovacao da matriz, composta por seis grandes dominios - profissionalismo; relacionamentos interpessoais e comunicacao; atencao integral a saude da pessoa; organizacao de sistemas de saude e atencao em saude publica; gestao do conhecimento; conhecimento medico -, 28 subdominios e 204 descritores dos conhecimentos, habilidades e atitudes essenciais na formacao do medico, durante sua graduacao. CONCLUSOES: Considera-se que a matriz contribuira na qualificacao da formacao medica e na certificacao das competencias para o atendimento adequado as demandas de saude, dentro de padroes de excelencia tecnica e responsabilidade social.