Laura Maria de Lima Belizário Facury Lasmar

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.

Fatores de risco para hospitalização de crianças e adolescentes asmáticos

OBJECTIVE To assess the prevalence rate and risk factors for hospital admissions among asthma children and to evaluate care delivered to these patients. METHODS Three-hundred and twenty-five asthmatic children attending a public outpatient reference clinic were studied. Of them, 202 were hospitalized. Care was evaluated using a questionnaire covering general aspects of hospital stay and biological, demographics, socioeconomic and asthma-related factors. Univariate and multivariate analyses were performed to measure the association between hospital admissions and selected independent variables. RESULTS Of the total, 62.2% had already been hospitalized due to asthma, 64.9% developed asthma episodes, and 60.9% were hospitalized in their first year of life. Most (76.0%) had moderate to severe asthma. Despite that, 94.2% were not on anti-inflammatory drugs and were treated only during isolated acute episodes. None of these were regularly seen in primary health care centers for a periodic control of their steroid inhalants. Most parents (97.8%) referred not to know how to take care of asthma children. Symptoms onset is normally seen before the age of 12 months (OR=3.20; 95%CI 1.55-6,61) or between 12 and 24 months (OR=3.89; 95%CI 1.62-9.36). Mothers have attended school for less than 7 years (OR=3.06; 95%CI 1.62-5.76). Disease severity (OR=2.32; 95%CI 1.24-3.88), 2 or more monthly visits to emergency wards (OR=2.19; 95%CI 1.24-3.88), and referred recurrent pneumonia (OR=2.00; 95%IC 1.06-3.80) were the main risk factors for hospital admissions. CONCLUSIONS Organizing health care services is crucial to reduce hospital admissions and provide adequate care for asthma children and adolescents, especially those less than 2 years old.

Prevalence of allergic rhinitis and its impact on the use of emergency care services in a group of children and adolescents with moderate to severe persistent asthma

OBJECTIVE To assess the prevalence of allergic rhinitis and the factors associated with the use of emergency care services by children and adolescents with acute asthma submitted to inhaled corticosteroid therapy. METHODS A cross-sectional study was conducted with 126 patients treated with beclomethasone dipropionate for 3 years. The factors associated with emergency care services in the third year of beclomethasone dipropionate treatment were assessed using logistic regression models. RESULTS The prevalence of allergic rhinitis amounted to 74.6% (95%CI 65.9-81.7). The presence of allergic rhinitis (OR = 2.98, 95%CI 1.10-8.06) and asthma severity (OR = 2.09, 95%CI 1.05-4.44) were independent factors for emergency care services. CONCLUSION The prevalence of allergic rhinitis was high and that, combined with asthma severity, constituted the major risk factor for the necessity of emergency care services. Health professionals should attempt to make an early diagnosis of allergic rhinitis in asthmatic patients.

Fatores de risco para readmissão hospitalar de crianças e adolescentes asmáticos

OBJECTIVE To determine the influence that hospital admission of suckling infants with asthma has on their risk for future admissions for the same cause. METHODS A retrospective study was conducted, in which the charts of 202 patients, all less than fifteen years of age, were evaluated. All of the patients had been treated as outpatients in a pediatric pulmonology clinic and had been admitted to the hospital on one or more occasions. A multivariate analysis was conducted in order to evaluate the risk factors associated with multiple hospitalizations. RESULTS Virtually all of the patients evaluated were hospitalized a second time within 18 months of the first hospitalization. Among the patients first hospitalized at = 12 months of age, the second admission occurred sooner than did that recorded for those first hospitalized at > 12 months of age (p = 0.001). The risk factors found to be associated with multiple hospital admissions were as follows: age at first admission = 12 months (odds ratio: 2.55; 95% confidence interval: 1.18-5.48); age at first admission between 13 and 24 months (odds ratio: 3.54; 95% confidence interval: 1.31-9.63); and severity of asthma symptoms (odds ratio: 3.86; 95% confidence interval: 2.02-7.40). CONCLUSION After the first hospitalization, children with asthma should be closely monitored, since the risk of subsequent admissions is elevated in the first months following discharge, especially among those of less than two years of age. Health care facilities should be organized to confront this problem appropriately and should dispense prophylactic medication more freely.

Early diagnosis of streptococcal pharyngotonsillitis: assessment by latex particle agglutination test

OBJECTIVES Acute pharyngitis is one of the most common diseases in pediatric practice, and the most common bacterial etiology is group A beta-hemolytic streptococcus (GABHS). Correct diagnosis and treatment are primarily of importance to the prevention of non-suppurative sequelae. Rapid tests for detecting the antigen of group A streptococcus are a useful tool for the diagnosis of streptococcal pharyngotonsillitis, due to the speed of results, accuracy and low cost; however, in our country they are little used and have been little studied. The objective of this study was to evaluate the accuracy of a GABHS rapid antigen detection test kit, in comparison with oropharynx swab culture. METHODS Children aged 1 to 18 years with clinical diagnoses of acute pharyngitis were chosen at public emergency and private clinical services in Belo Horizonte, Minas Gerais, Brazil, with children being excluded if they had taken antibiotics within 30 days of their consultation. The final sample consisted of 229 patients, each of whom had two oropharynx swabs taken, one for rapid GABHS testing and the other to be sent for culture. RESULTS We observed sensitivity of 90.7%, specificity of 89.1%, a positive predictive value of 72.1%, a negative predictive value of 96.9% and a positive likelihood ratio of 9.0 for the rapid test used here, compared with culture. CONCLUSIONS The rapid test studied exhibited a good correlation with culture and is, therefore, of great use in clinical practice for detection of GABHS.

Post-infectious bronchiolitis obliterans in children

OBJECTIVE To review publications about the main features of post-infectious bronchiolitis obliterans and its history, etiology, epidemiology, risk factors, pathogenesis, histological findings, clinical presentation, complementary tests, diagnostic criteria, differential diagnosis, treatment and prognosis. SOURCES Non-systematic review of MEDLINE and LILACS databases and selection of 66 most relevant studies. SUMMARY OF THE FINDINGS In the post-infectious bronchiolitis obliterans there is an insult to respiratory epithelial cells, and its clinical severity is associated with the degree of lesion and inflammation. Diagnosis is made according to clinical signs and symptoms, by exclusion of main differential diagnoses and with the aid of complementary tests. High resolution CT, particularly images obtained during inspiration and expiration, provide information for the evaluation of the small airways. Pulmonary function tests show fixed airway obstructions and marked decrease of FEF25-75%. Treatment has not been definitely established, and corticoids have been administered as pulse therapy or by inhalation of high doses of steroids. However, data about its efficacy are scarce in the literature. Long-term prognosis is variable, and there might be either clinical improvement or deterioration into respiratory insufficiency and death. CONCLUSION Post-infectious bronchiolitis obliterans is a disease with a high morbidity rate; it should be treated by a multidisciplinary team, and patients should be followed up for a long period of time.

Factors Related to Lower Adherence Rates to Inhaled Corticosteroids in Children and Adolescents : A Prospective Randomized Cohort Study

UNLABELLED Asthma morbidity is high, partly due to low adherence to inhaled corticosteroids (ICS). This study aims to assess rates and factors related to low adherence to ICS over time in asthmatic children and adolescents. METHODS A concurrent cohort study was carried out for 24 months in 168 randomly selected patients suffering from persistent moderate asthma. All of them were given beclomethasone dipropionate (BDP) free of charge. Adherence rates were verified by pharmacy records (doses filled/doses prescribed). A multivariate analysis evaluated factors related with low adherence rates. RESULTS Overall adherence rates were 72.5, 58.6 and 61.1% in the 4th, 12th and 24th months of follow-up, respectively. Factors associated to adherence rates <70% were: mothers schooling level (p = 0.03), replacement of the caregiver (p = 0.03), prescription greater than two puffs/day (p = 0.005), absence of rhinosinusitis (p = 0.002) and age under 7 years (p = 0.04). Only the number of consultations lower than two in a 4-month period was associated to a lower adherence rate in all study periods (p = 0.02). CONCLUSIONS Adherence rates decreased over time, even in patients who had received the medication free of charge, and factors related to lower adherence changed during the follow-up. Results have shown that adherence had a dynamic pattern and its determinants should be re-evaluated continuously. Only the number of consultations was associated to a lower adherence rate in all periods, pointing out that health programs must recognize and facilitate the access of patients needing special care, which can contribute for better adherence and reducing asthma morbidity.

Gastroesophageal reflux and asthma in childhood: a study on their relationship using esophageal PH monitoring

OBJECTIVES This study aims at verifying the prevalence of gastroesophageal reflux in asthmatic children, and at determining the sensitivity and specificity of the reflux index for the diagnosis of gastroesophageal reflux disease. METHODS Sixty-nine children, aged 1-5 years, with asthma, were studied by 24-hour pH monitoring. The patients were randomly selected. RESULTS Ages varied from 12.4 to 63.1 months, mean age = 30.79 months, and 62.3% were males. Gastroesophageal reflux was observed in 68.1% of the children. The patients were divided into two groups, moderate and severe asthma, and gastroesophageal reflux was diagnosed in 58.5 and 82.1% of the cases, respectively. Occult gastroesophageal reflux occurred in 31.8% of the cases. The reflux index showed an sensitivity of 89.4%, specificity of 95.5%, positive predictive value of 97.7% and negative predictive value of 80.8%. CONCLUSIONS The results of this study indicate a relationship between gastroesophageal reflux and asthma, and suggest that the reflux index as a single parameter of pH monitoring has good sensitivity and specificity for the diagnosis of gastroesophageal reflux disease.

Bronquiolite obliterante pós-infecciosa em crianças

OBJECTIVES: To review publications about the main features of post-infectious bronchiolitis obliterans and its history, etiology, epidemiology, risk factors, pathogenesis, histological findings, clinical presentation, complementary tests, diagnostic criteria, differential diagnosis, treatment and prognosis. SOURCES: Non-systematic review of MEDLINE and LILACS databases and selection of 66 most relevant studies. SUMMARY OF THE FINDINGS: In the post-infectious bronchiolitis obliterans there is an insult to respiratory epithelial cells, and its clinical severity is associated with the degree of lesion and inflammation. Diagnosis is made according to clinical signs and symptoms, by exclusion of main differential diagnoses and with the aid of complementary tests. High resolution CT, particularly images obtained during inspiration and expiration, provide information for the evaluation of the small airways. Pulmonary function tests show fixed airway obstructions and marked decrease of FEF25-75%. Treatment has not been definitely established, and corticoids have been administered as pulse therapy or by inhalation of high doses of steroids. However, data about its efficacy are scarce in the literature. Long-term prognosis is variable, and there might be either clinical improvement or deterioration into respiratory insufficiency and death. CONCLUSION: Post-infectious bronchiolitis obliterans is a disease with a high morbidity rate; it should be treated by a multidisciplinary team, and patients should be followed up for a long period of time.