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OBJECTIVE: The purpose of this study was to describe the feasibility of respiratory oscillometry (RO) in schoolchildren with asthma, and the concordance of its results with those of spirometry, to determine its clinical usefulness. METHODS: RO and spirometry were performed in 154 children (6 to 14-year-old) with asthma, following strict quality criteria for the tests. Their feasibility (probability of valid test, time of execution, number of maneuvers needed to achieve a valid test, and perceived difficulty) was compared. The factors that influence feasibility were analyzed with multivariate methods. FEV1, FEV1/FVC, FVC and FEF25-75 for spirometry, and R5, AX and R5-19 for RO, were converted into z-scores and their concordance was investigated through intraclass correlation coefficients (ICC) and kappa indices for normal/abnormal values. RESULTS: There were no differences in the probability of obtaining a valid RO or spirometry (83.1% vs. 81.8%, p = 0.868). RO required a lower number of maneuvers [mean (SD) 4.2 (1.8) versus 6.0 (1.6), p < 0.001] and less execution time [5.1 (2.7) versus 7.6 (2.4) minutes, p < 0.001], and patients considered it less difficult. Age increased the probability of obtaining valid RO and spirometry. The concordance of results between RO and spirometry was low, and only between zFEV1 and zAX could it be considered moderate (ICC = 0.412, kappa = 0.427). CONCLUSION: RO and spirometry are feasible in children with asthma. RO has some practical advantages, but the concordance of its results with spirometry is low.

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Introducción: La calidad de vida relacionada con la salud (CVRS) es un marcador relevante para valorar los efectos de una intervención terapéutica. El objetivo del estudio es analizar la CVRS comparando casos con trastorno por déficit de atención con hiperactividad (TDAH) tratados farmacológicamente con metilfenidato (TDAH-T), casos no tratados (TDAH-N) y controles. Material y métodos: Muestra de 228 participantes entre 8 y 14 años (114 controles, 57 TDAH-T y 57 TDAH-N). Muestreo consecutivo de TDAH según DSM-IV (ADHD Rating Scales IV) y muestreo aleatorio de controles emparejados por sexo y edad. Evaluación de CVRS mediante KIDSCREEN-52 versión padres. Resultados: La intensidad de síntomas de TDAH es significativamente menor en TDAH-T que en TDAH-N y se observa correlación significativa moderada entre mayor intensidad de síntomas de TDAH y peor CVRS. Los casos de TDAH tienen significativamente peor CVRS que los controles en bienestar psíquico, estado de ánimo, relación con padres, relación con amigos, entorno escolar y aceptación social. Los casos de TDAH-T presentan significativamente mejor CVRS que TDAH-N en la dimensión escolar, pero no se diferencian significativamente en otras dimensiones del KIDSCREEN-52. Conclusiones: Sería recomendable que el tratamiento del TDAH integrase modelos terapéuticos multidimensionales que mejoren los síntomas básicos del trastorno y la CVRS

Introduction: The health-related quality of life (HRQoL) questionnaire is important in order to assess the effects of therapeutic intervention. The aim of this study is to analyse HRQoL, comparing cases of attention deficit hyperactivity disorder (ADHD) treated with methylphenidate (ADHD-T), untreated cases (ADHD-N), and controls. Material and methods: The study included a sample of 228 participants between 8 and 14 years old (114 controls, 57 ADHD-T, and 57 ADHD-N). Consecutive sampling was used in ADHD according to DSM-IV criteria (ADHD Rating Scales IV), and random sampling of controls matched by gender and age. The evaluation of HRQoL was made by using KIDSCREEN-52 parent version. Results: The intensity of ADHD symptoms is significantly lower in ADHD-T than in ADHD-N. There is a moderate significant correlation between greater intensity of ADHD symptoms and worse HRQoL. ADHD cases have significantly worse HRQoL than controls on psychic well-being, mood, relationship with parents and friends, school environment, and social acceptance. The cases of ADHD-T have significantly better HRQoL than ADHD-N in the school dimension, but do not differ significantly in other dimensions of KIDSCREEN-52. Conclusions: It would be advisable that the treatment of ADHD integrates multi-dimensional therapeutic models that improve the basic symptoms of the disorder, as well as the HRQoL

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INTRODUCTION: The health-related quality of life (HRQoL) questionnaire is important in order to assess the effects of therapeutic intervention. The aim of this study is to analyse HRQoL, comparing cases of attention deficit hyperactivity disorder (ADHD) treated with methylphenidate (ADHD-T), untreated cases (ADHD-N), and controls. MATERIAL AND METHODS: The study included a sample of 228 participants between 8 and 14 years old (114 controls, 57 ADHD-T, and 57 ADHD-N). Consecutive sampling was used in ADHD according to DSM-IV criteria (ADHD Rating Scales IV), and random sampling of controls matched by gender and age. The evaluation of HRQoL was made by using KIDSCREEN-52 parent version. RESULTS: The intensity of ADHD symptoms is significantly lower in ADHD-T than in ADHD-N. There is a moderate significant correlation between greater intensity of ADHD symptoms and worse HRQoL. ADHD cases have significantly worse HRQoL than controls on psychic well-being, mood, relationship with parents and friends, school environment, and social acceptance. The cases of ADHD-T have significantly better HRQoL than ADHD-N in the school dimension, but do not differ significantly in other dimensions of KIDSCREEN-52. CONCLUSIONS: It would be advisable that the treatment of ADHD integrates multi-dimensional therapeutic models that improve the basic symptoms of the disorder, as well as the HRQoL.

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BACKGROUND: The aim of this research is to analyze Attention Deficit Hyperactivity Disorder Rating Scales IV (ADHD RS-IV) criteria validity and its clinical usefulness for the assessment of Attention Deficit Hyperactivity Disorder (ADHD) as a function of assessment method and age. METHODOLOGY: A sample was obtained from an epidemiological study (n = 1095, 6-16 years). Clinical cases of ADHD (ADHD-CL) were selected by dimensional ADHD RS-IV and later by clinical interview (DSM-IV). ADHD-CL cases were compared with four categorical results of ADHD RS-IV provided by parents (CATPA), teachers (CATPR), either parents or teachers (CATPAOPR) and both parents and teachers (CATPA&PR). Criterion validity and clinical usefulness of the answer modalities to ADHD RS-IV were studied. RESULTS: ADHD-CL rate was 6.9% in childhood, 6.2% in preadolescence and 6.9% in adolescence. Alternative methods to the clinical interview led to increased numbers of ADHD cases in all age groups analyzed, in the following sequence: CATPAOPR> CATPRO> CATPA> CATPA&PR> ADHD-CL. CATPA&PR was the procedure with the greatest validity, specificity and clinical usefulness in all three age groups, particularly in the childhood. CONCLUSIONS: Isolated use of ADHD RS-IV leads to an increase in ADHD cases compared to clinical interview, and varies depending on the procedure used

ANTECEDENTES: se estudia la validez de criterio y utilidad clínica del Attention Deficit Hiperactivity Disorder Rating Scales IV (ADHD RS-IV) en el Trastorno por Déficit de Atención con Hiperactividad (TDAH) en función del método y edad. MÉTODO: muestra extraída de un estudio epidemiológico (n = 1095, 6-16 años). Los casos de TDAH clínico (TDAH-CL) fueron seleccionados mediante ADHD RS-IV dimensional y entrevista clínica (DSM-IV) y fueron comparados con cuatro modalidades categoriales de respuesta al ADHD RS-IV implementado por padres (CATPA), profesores (CATPR), padres o profesores indistintamente (CATPAOPR) y/o conjuntamente (CATPAYPR). Se estudió la validez de criterio y utilidad clínica de las modalidades de respuesta. RESULTADOS: la tasa de TDAHCL es 6,9% en infancia, 6,2% en preadolescencia y 6,9% en adolescencia. Los procedimientos alternativos a la entrevista clínica aumentan los casos de TDAH en los tres grupos de edad, siguiendo la sucesión CATPAOPR > CATPRO > CATPA > CATPAYPR > TDAH-CL. El procedimiento con mayor índice de validez, especifidad, utilidad clínica y capacidad predictiva de TDAH fue CATPAYPR. CONCLUSIONES: la utilización de una versión categorial del ADHD RS-IV produce un incremento de casos de TDAH respecto a la entrevista clínica que varía en función del método utilizado

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Objetivo: Buscar un modelo reducido de síntomas del Trastorno por Déficit de Atención con Hiperactividad Combinado (TDAH-C), que presente adecuada validez de criterio para el diagnóstico del trastorno. Metodología: Contexto de estudio epidemiológico. Muestra de 1095 casos entre 6 y 16 años [4.38 % TDAH-C]. Selección de casos con primera fase psicométrica de sospecha TDAH-C que requiere que ADHD RS-IV, implementado por padres (PA) y profesores (PR), supere el PC 90. Segunda fase: Los casos seleccionados se evalúan mediante entrevista clínica modelo DISC-IV (DSM-IV) para confirmar TDAH-C. Se implementa regresión logística para buscar modelo parsimonioso de ítems que permita predecir TDAH-C. Resultados: El modelo de ítems que permite predecir TDAH-C contiene 8 de 36 ítems del ADHD RS-IV contestados por PA y PR. Considerando odss ratio del modelo de regresión logística, los ítems del ADHD RS-IV presentan un ranking de 15PR > 1PA > 16PR > 12PA > 17PA > 10PA > 14PA > 4PR. El modelo presenta validez de criterio para TDAH-C clínico (sensibilidad: 97.9 %. Especifidad: 93.8%. Razón de verosimilitud: 16.02). Conclusiones: Es posible reducir la lista de síntomas de TDAH-C con buena validez de criterio, manteniendo los que proporcionan mayor discriminación entre TDAH-C y población general

Main Objective: To look for a reduced model of symptoms of the attention deficit hyperactivity disorder combined type (ADHD-C), that shows suitable levels of criterion validity for the diagnostic of the disease. Methods: Epidemiological study. Sample of 1095 children between 6 and 16 years. First stage: psicometric study using ADHD RS-IV answered by parents (P) and teachers (T). ADHD is suspected when both questionnaires are over 90th percentile. Second stage: Clinical interview DISC-IV (DSM-IV) only in those selected cases to confirm ADHD-C. Logistic regression is implemented to find the most parsimonious model to predict ADHD-C. Results: The model that predicts clinical ADHD-C consists of 8 of the 36 items of the ADHD RS-IV answered by P and T. If we consider the Odds Ratio obtained by regression, the items present a ranking of: 15 T> 1 P> 16 T> 12 P> 17 P> 10 P> 14 P> 4 T. The model has criterion validity for symptomatic ADHD-C (sensitivity: 97.9%. Specificity: 93.8%. Likelihood ratio: 16.02). Conclusions: It is possible to reduce the list of symptoms of ADHD-C with good criterion validity, removing redundant items and keeping those that provide greater discrimination between ADHD-C and the general population

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Introducción: El trastorno negativista desafiante (TND) se caracteriza por un patrón de comportamiento negativista, desafiante, desobediente y hostil, dirigido a las figuras de autoridad. El TND es uno de los motivos más frecuentes de consulta clínica en salud mental durante la infancia y adolescencia. Presenta gran morbilidad y disfuncionalidad, mostrando repercusiones futuras si no es tratado de forma temprana. Objetivo: Determinar la tasa de prevalencia de TND en escolares de 6-16 años de Castilla y León (España). Material y métodos: Estudio epidemiológico poblacional, con diseño muestral polietápico estratificado, proporcional y por conglomerados. Muestra analizada: 1.049 sujetos. Casos definidos según criterios DSM-IV. Resultados: La prevalencia de TND es 5,6% (IC 95%: 4,2-7%). Prevalencia género masculino = 6,8%; femenino = 4,3%. Prevalencia educación secundaria = 6,2%; educación primaria = 5,3%. No existen diferencias significativas en función del sexo, edad, tipo de centro, ni por zona sociodemográfica. La prevalencia de TND sin considerar deterioro funcional aumentaría al 7,4%. Los casos de TND presentan significativamente peores resultados académicos (resultados académicos globales, lectura, matemáticas y expresión escrita) y peor conducta en clase (relación con compañeros, respeto a las normas, destrezas de organización, realización de tareas académicas e interrupción de la clase). Conclusiones: Castilla y León presenta una tasa de prevalencia de TND levemente superior a la observada en publicaciones internacionales. En función de su distribución por edad, morbilidad y repercusión clínica disfuncional, parece necesaria una planificación sanitaria que incida en un diagnóstico temprano e intervención preventiva (AU)

Introduction: Oppositional defiant disorder (ODD) is characterized by a pattern of negative, defiant, disobedient and hostile behavior toward authority figures. ODD is one of the most frequent reasons for clinical consultation on mental health during childhood and adolescence. ODD has a high morbidity and dysfunction, and has important implications for the future if not treated early. Objective: To determine the prevalence of ODD in schoolchildren aged 6-16 years in Castile and Leon (Spain). Material and methods: Population study with a stratified multistage sample, and a proportional cluster design. Sample analyzed: 1,049. Cases were defined according to DSM-IV criteria. Results: An overall prevalence rate of 5.6% was found (95% CI: 4.2%---7%). Male gender prevalence = 6.8%; female = 4.3%. Prevalence in secondary education = 6.2%; primary education = 5.3%. No significant differences by gender, age, grade, type of school, or demographic area were found. ODD prevalence without considering functional impairment, such as is performed in some research, would increase the prevalence to 7.4%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, maths and writing), and worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks, and disruption of the class). Conclusions: Castile and Leon has a prevalence rate of ODD slightly higher to that observed in international publications. Depending on the distribution by age, morbidity and clinical dysfunctional impact, an early diagnosis and a preventive intervention are required for health planning (AU)

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INTRODUCTION: Oppositional defiant disorder (ODD) is characterized by a pattern of negative, defiant, disobedient and hostile behavior toward authority figures. ODD is one of the most frequent reasons for clinical consultation on mental health during childhood and adolescence. ODD has a high morbidity and dysfunction, and has important implications for the future if not treated early. OBJECTIVE: To determine the prevalence of ODD in schoolchildren aged 6-16 years in Castile and Leon (Spain). MATERIAL AND METHODS: Population study with a stratified multistage sample, and a proportional cluster design. Sample analyzed: 1,049. Cases were defined according to DSM-IV criteria. RESULTS: An overall prevalence rate of 5.6% was found (95% CI: 4.2%-7%). Male gender prevalence=6.8%; female=4.3%. Prevalence in secondary education=6.2%; primary education=5.3%. No significant differences by gender, age, grade, type of school, or demographic area were found. ODD prevalence without considering functional impairment, such as is performed in some research, would increase the prevalence to 7.4%. ODD cases have significantly worse academic outcomes (overall academic performance, reading, maths and writing), and worse classroom behavior (relationship with peers, respect for rules, organizational skills, academic tasks, and disruption of the class). CONCLUSIONS: Castile and Leon has a prevalence rate of ODD slightly higher to that observed in international publications. Depending on the distribution by age, morbidity and clinical dysfunctional impact, an early diagnosis and a preventive intervention are required for health planning.

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Introducción. Objetivos: Estudiar la validez para el diagnóstico del trastorno por déficit de atención con hiperactividad (TDAH), de cada uno de los ítems DSM-IV y buscar un modelo reducido de ítems que ayude a detectar casos de niños con TDAH. Sujetos y método. Se utilizan los datos de un estudio epidemiológico sobre TDAH con una muestra de 1095 casos. El 6.6% son TDAH. Casos de TDAH definidos según ADHD RS-IV y criterios clínicos DSM-IV. Controles definidos por exclusión. Resultados. El modelo de regresión logística que mejor predice el fenotipo inatento está compuesto por los ítems del ADHD RS-IV (versión padres) 1, 3, 9, 15 y 17 (Se: 96.7%, Es: 81.5%); el fenotipo hiperactivo/impulsivo por los ítems 2, 4, 10, 12, 14 y 16 (Se: 96.6%, Es: 81%) y el fenotipo combinado por los ítems 9, 10, 12, 14 y 15 (Se: 100 %, Es: 82.6%). Existe una reducción del 66% de los ítems en el fenotipo combinado. Conclusiones. Es posible reducir la lista de síntomas de TDAH con unos niveles de validez adecuados y determinados ítems parecen tener mayor capacidad para determinar decisiones diagnósticas (AU)

Introduction. Objective: To study the validity of each of the items DSM-IV for the diagnosis of the Attention Deficit Hyperactivity Disorder (ADHD), and to look for a reduced model of items that allows predicting ADHD. Subjects and methods: We use the information of an epidemiological study on ADHD with a sample of 1095 children. 6.6 % are ADHD cases. ADHD cases are defined according to ADHD RS-IV and clinical criteria DSM-IV. Controls are defined by exclusion. Results: The model of logistic regression that better predicts the inattentive phenotype is composed by the items of the ADHD RS-IV (parents’ version) 1, 3, 9, 15 and 17 (Sensitivity: 96.7%, Specificity: 81.5%); the hyperactive / impulsive phenotype by the items 2, 4, 10, 12, 14 and 16 (Sensitivity: 96.6%, Specificity: 81%) and the combined phenotype by the items 9, 10, 12, 14 and 15 (Sensitivity: 100%, Specificity: 82.6%). A reduction of 66 % of the items in the combined phenotype is detected. Conclusions: It is possible to reduce the list of ADHD symptoms with suitable levels of validity and all the items should not have the same weight at the moment of making diagnostic decisions (AU)

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Objetivos: Estudiar la validez para el diagnóstico del trastorno por déficit de atención con hiperactividad (TDAH), de cada uno de los ítems DSM-IV y buscar un modelo reducido de ítems que permita predecir TDAH. Método: Se utilizan los datos de un estudio epidemiológico sobre TDAH con una muestra de 1095 casos. El 6.6% son TDAH. Casos de TDAH definidos según ADHD RS-IV y criterios clínicos DSM-IV. Controles definidos por exclusión. Resultados: El modelo de regresión logística que mejor predice el fenotipo inatento está compuesto por los ítems del ADHD RS-IV (versión profesores) 5, 7, 13, 15 y 17 (Sensibilidad: 88.7%, Especifidad: 84.2%); el fenotipo hiperactivo/impulsivo por los ítems 2, 4, 8 y 16 (Sensibilidad: 86.4%, Especifidad: 83.7%) y el fenotipo combinado por los ítems 2, 6, 15, 16 y 17 (Sensibilidad: 91.6 %, Especifidad: 84.4%). Existe una reducción del 72.2% de los ítems en el fenotipo combinado. Conclusiones: Es posible reducir la lista de síntomas de TDAH con unos niveles de validez adecuados y los ítems no deberían tener el mismo peso a la hora de tomar decisiones diagnósticas (AU)

Objective: To study the validity of each of the DSM-IV items for the diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), and to look for a reduced model of items that would allow prediction of ADHD. Method: We use the information from an epidemiological study of ADHD with a sample of 1095 children. Of these, 6.6 % are ADHD cases. ADHD cases are defined according to ADHD RS-IV and DSM-IV clinical criteria. Controls are defined by exclusion. Results: The model of logistic regression that best predicts the inattentive phenotype is composed of the ADHD RS-IV (teachers? version) items 5, 7, 13, 15 and 17 (Sensitivity: 88.7%, Specificity: 84.2%); the hyperactive / impulsive phenotype by the items 2, 4, 8 and 16 (Sensitivity: 86.4%, Specificity: 83.7%) and the combined phenotype by the items 2, 6, 15, 16 and 17 (Sensitivity: 91.6%, Specificity: 84.4%). A reduction of 72.2 % of the items in the combined phenotype is detected. Conclusions: It is possible to reduce the list of ADHD symptoms with satisfactory levels of validity and not all the items should have the same weight when making diagnostic decisions (AU)

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