RESUMEN
BACKGROUND: Fractional exhaled nitric oxide (FeNO) testing is a simple, noninvasive approach to assessing airway inflammation with minimal discomfort that provides results within a few minutes. For policy makers, the economic impact of this technology is the main concern, especially in developing countries. We evaluated the budget impact of asthma management using FeNO monitoring in patients aged between 4 and 18 years in Colombia. METHODS: A budget impact analysis was performed to evaluate the potential cost of FeNO monitoring. The analysis was based on a 5-year time horizon and performed from the perspective of the Colombian National Health System. The incremental budget impact was calculated by subtracting the cost of the new treatment, in which FeNO is reimbursed, from the cost of conventional treatment without FeNO (management based on clinical symptoms [with or without spirometry/peak flow] or asthma guidelines [or both] for asthma-related cases). Univariate 1-way sensitivity analyses were performed. RESULTS: In the base case analysis the 5-year costs associated with FeNO and non-FeNO were estimated to be 469 904 130 and 480 485 149, respectively, indicating savings for the Colombian National Health System of 10 581 019 if FeNO is adopted for the routine management of patients with persistent asthma. This result proved to be robust in the univariate 1-way sensitivity analysis. CONCLUSION: FeNO monitoring generated cost savings in emergency settings for infants with persistent asthma. This evidence can be used by decision makers in Colombia to improve clinical practice guidelines and should be replicated to validate the results in other middle-income countries.
Asunto(s)
Asma , Espiración , Adolescente , Asma/tratamiento farmacológico , Asma/terapia , Pruebas Respiratorias/métodos , Niño , Preescolar , Colombia , Prueba de Óxido Nítrico Exhalado Fraccionado , Humanos , Lactante , Óxido NítricoRESUMEN
Background: Fractional exhaled nitric oxide (FeNO) testing is a simple, noninvasive approach to assessing airway inflammation withminimal discomfort that provides results within a few minutes. For policy makers, the economic impact of this technology is the mainconcern, especially in developing countries. We evaluated the budget impact of asthma management using FeNO monitoring in patientsaged between 4 and 18 years in Colombia.Methods: A budget impact analysis was performed to evaluate the potential cost of FeNO monitoring. The analysis was based on a5-year time horizon and performed from the perspective of the Colombian National Health System. The incremental budget impact wascalculated by subtracting the cost of the new treatment, in which FeNO is reimbursed, from the cost of conventional treatment withoutFeNO (management based on clinical symptoms [with or without spirometry/peak flow] or asthma guidelines [or both] for asthma-relatedcases). Univariate 1-way sensitivity analyses were performed.Results: In the base case analysis the 5-year costs associated with FeNO and non-FeNO were estimated to be 469 904 130 and480 485 149, respectively, indicating savings for the Colombian National Health System of 10 581 019 if FeNO is adopted for theroutine management of patients with persistent asthma. This result proved to be robust in the univariate 1-way sensitivity analysis.Conclusion: FeNO monitoring generated cost savings in emergency settings for infants with persistent asthma. This evidence can be used bydecision makers in Colombia to improve clinical practice guidelines and should be replicated to validate the results in other middle-income countries (AU)
Antecedentes: El óxido nítrico en aire exhalado es una medición simple y no invasiva de la inflamación de las vías respiratorias cuyosresultados están disponibles en pocos minutos. Para los responsables de la formulación de políticas sanitarias, la principal preocupaciónes el impacto económico que implica la adaptación de esta tecnología, muy especialmente en los países en desarrollo. Este estudiotiene como objetivo evaluar el impacto presupuestario, en el sistema Nacional de Salud de Colombia, del manejo del asma mediante lamonitorización de óxido nítrico exhalado en pacientes entre 4 y 18 años.Métodos: Se realizó un análisis de impacto presupuestario para evaluar el posible impacto financiero derivado de la implementación de lamonitorización óxido nítrico exhalado fraccionado en el asma. El análisis consideró un horizonte temporal de 5 años y la perspectiva delSistema Nacional de Salud de Colombia. El impacto presupuestario incremental se calculó restando el coste del nuevo tratamiento, en elque se reembolsa el FeNO, del coste del tratamiento convencional sin FeNO (manejo basado en síntomas clínicos (con o sin espirometría /flujo máximo) o guías de asma (o ambos), para los relacionados con el asma). Se realizaron análisis de sensibilidad univariantes de una vía.Resultados: En el análisis del caso base, los costos a 5 años asociados a FeNO y no FeNO se estimaron en 469.904.130 y 480.485.149 respectivamente, lo que indica un ahorro para la Salud Nacional de Colombia de 10.581.019 si se adopta la monitorización de FeNOen el manejo rutinario de pacientes con asma persistente. La solidez de este resultado fue confirmada en el análisis de sensibilidadunivariante, unidireccional.Conclusión: El óxido nítrico exhalado fraccionado ahorró costos en los entornos de emergencia en población pediátrica con asma persistente.Esta evidencia puede ser utilizada por los tomadores de decisiones en nuestro país para mejorar las guías de práctica clínic
Asunto(s)
Humanos , Masculino , Femenino , Preescolar , Niño , Adolescente , Análisis de Impacto Presupuestario de Avances Terapéuticos , Pruebas Respiratorias/métodos , Óxido Nítrico/análisis , Asma/diagnóstico , Asma/economía , ColombiaRESUMEN
INTRODUCTION AND OBJECTIVES: Despite the recommendation against routine use of inhaled bronchodilators in infants with viral bronchiolitis given in the main clinical practice guidelines (CPGs) on viral bronchiolitis, albuterol is widely prescribed to patients with this disease. The aim of this study was to identify predictors of prescription of albuterol in a population of infants hospitalized for viral bronchiolitis. MATERIAL AND METHODS: An analytical cross-sectional study performed during the period from March 2014 to August 2015, in a random sample of patients <2 years old hospitalized in the Fundacion Hospital La Misericordia, a hospital located in Bogota, Colombia. After reviewing the electronic medical records, we collected demographic, clinical, and disease-related information, including prescription of albuterol at any time during the course of hospitalization as the outcome variable. RESULTS: For a total of 1365 study participants, 1042 (76.3%) were prescribed with albuterol therapy. After controlling for potential confounders, it was found that age (OR 1.11; CI 95% 1.08-1.15; p<0.001), and a prolonged length of stay (LOS) (OR 1.93; CI 95% 1.44-2.60; p<0.001) were independent predictors of prescription of albuterol in our sample of patients. By contrast, albuterol prescription was less likely in the post-guideline assessment period (OR 0.41; CI 95% 0.31-0.54; p<0.001), and in infants with RSV isolation (OR 0.71; CI 95% 0.52-0.97; p=0.035). CONCLUSIONS: Albuterol was highly prescribed in our population of inpatients with the disease. The independent predictors of prescription of albuterol in our sample of patients were age, implementation of a CPG on viral bronchiolitis, RSV isolation, and LOS.
Asunto(s)
Albuterol/administración & dosificación , Bronquiolitis Viral/tratamiento farmacológico , Broncodilatadores/administración & dosificación , Prescripciones de Medicamentos/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Administración por Inhalación , Factores de Edad , Albuterol/normas , Bronquiolitis Viral/diagnóstico , Bronquiolitis Viral/inmunología , Bronquiolitis Viral/virología , Broncodilatadores/normas , Colombia , Estudios Transversales , Prescripciones de Medicamentos/normas , Registros Electrónicos de Salud/estadística & datos numéricos , Femenino , Adhesión a Directriz/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Tiempo de Internación/estadística & datos numéricos , Masculino , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Virus Sincitiales Respiratorios/aislamiento & purificación , Medición de Riesgo/estadística & datos numéricos , Factores de RiesgoRESUMEN
INTRODUCTION AND OBJECTIVES: With the aim of making informed decisions on resource allocation, there is a critical need for studies that provide accurate information on hospital costs for treating pediatric asthma exacerbations, mainly in middle-income countries (MICs). The aim of the present study was to evaluate the direct medical costs associated with pediatric asthma exacerbations requiring hospital attendance in Bogota, Colombia. PATIENTS AND METHODS: We reviewed the available electronic medical records (EMRs) for all pediatric patients who were admitted to the Fundacion Hospital de La Misericordia with a discharge principal diagnosis pediatric asthma exacerbation over a 24-month period from January 2016 to December 2017. Direct medical costs of pediatric asthma exacerbations were retrospectively collected by dividing the patients into four groups: those admitted to the emergency department (ED) only; those admitted to the pediatric ward (PW); those admitted to the pediatric intermediate care unit (PIMC); and those admitted to the pediatric intensive care unit (PICU). RESULTS: A total of 252 patients with a median (IQR) age of 5.0 (3.0-7.0) years were analyzed, of whom 142 (56.3%) were males. Overall, the median (IQR) cost of patients treated in the ED, PW, PIMC, and PICU was US$38.8 (21.1-64.1) vs. US$260.5 (113.7-567.4) vs. 1212.4 (717.6-1609.6) vs. 2501.8 (1771.6-3405.0), respectively: this difference was statistically significant (p<0.001). CONCLUSIONS: The present study helps to further our understanding of the economic burden of pediatric asthma exacerbations requiring hospital attendance among pediatric patients in a MIC.
Asunto(s)
Asma/economía , Costos de la Atención en Salud , Hospitalización/economía , Adolescente , Niño , Preescolar , Colombia , Servicio de Urgencia en Hospital/economía , Femenino , Humanos , Unidades de Cuidado Intensivo Pediátrico/economía , Tiempo de Internación/economía , Masculino , Brote de los SíntomasRESUMEN
INTRODUCTION AND OBJECTIVES: With the objective of making informed decisions on resource allocation, there is a critical need for studies that provide accurate information on hospital costs for treating respiratory syncytial virus (RSV)-related bronchiolitis, mainly in middle-income countries (MICs). The aim of the present study was to evaluate the direct medical costs associated with bronchiolitis hospitalizations caused by infection with RSV in Bogota, Colombia. MATERIAL AND METHODS: We reviewed the available electronic medical records (EMRs) for all infants younger than two years of age who were admitted to the Fundacion Hospital de La Misericordia with a discharge principal diagnosis of RSV-related bronchiolitis over a 24-month period from January 2016 to December 2017. Direct medical costs of RSV-related bronchiolitis were retrospectively collected by dividing the infants into three groups: those requiring admission to the pediatric ward (PW) only, those requiring admission to the pediatric intermediate care unit (PIMC), and those requiring to the pediatric intensive care unit (PICU). RESULTS: A total of 89 patients with a median (IQR) age of 7.1 (3.1-12.2) months were analyzed of whom 20 (56.2%) were males. Overall, the median (IQR) cost of infants treated in the PW, in the PIMC, and in the PICU was US$518.0 (217.0-768.9) vs. 1305.2 (1051.4-1492.2) vs. 2749.7 (1372.7-4159.9), respectively, with this difference being statistically significant (p<0.001). CONCLUSIONS: The present study helps to further our understanding of the economic burden of RSV-related bronchiolitis hospitalizations among infants of under two years of age in a middle-income tropical country.
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Bronquiolitis Viral/economía , Hospitalización/economía , Infecciones por Virus Sincitial Respiratorio/economía , Colombia/epidemiología , Costo de Enfermedad , Femenino , Humanos , Lactante , Masculino , Estudios RetrospectivosRESUMEN
BACKGROUND: Among the preventive strategies for lowering the incidence of upper respiratory tract infections (URTI) and acute diarrhoea episodes, two of the most common diseases in children, zinc supplementation has received special interest. However, there is a need for additional studies that determine the preventive effects of different doses of zinc on URTI and diarrhoeal disease episodes in children. METHODS: In a randomised, triple-blind clinical trial, we evaluated the efficacy of 12 months of daily zinc supplementation in the incidence of URTI and acute diarrhoea in a population of healthy children aged between 6 and 12 months living in Bogota, Colombia. The outcomes analysed were incidence of URTI, acute diarrhoeal disease episodes, and side effects of the interventions. RESULTS: Between 2010 and 2013, a total of 355 children underwent randomisation, with 174 assigned to the zinc supplementation group and 181 to the control group. In the multivariate analyses, having been randomised to the non-supplemented control group (IRR 1.73, 95% CI 1.52-1.97, p<0.001), and nursery attendance (IRR 1.41, 95% CI 1.07-1.87, p=0.016) were independently linked to the number of URTI. Likewise, having been randomised to the non-supplemented group (IRR 1.43, 95% CI 1.20-1.71, p<0.001), and lower socioeconomic status (IRR 1.86, 95% CI 1.11-3.13, p=0.018) were independently associated to the number of diarrhoeal disease episodes. CONCLUSIONS: Daily supplementation of 5mg of zinc during 12 months significantly decreased the incidence of URTI and diarrhoeal disease episodes in a healthy population of children aged between 6 and 12 months.
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Diarrea Infantil/prevención & control , Suplementos Dietéticos , Infecciones del Sistema Respiratorio/prevención & control , Oligoelementos/uso terapéutico , Zinc/uso terapéutico , Colombia/epidemiología , Diarrea Infantil/epidemiología , Femenino , Humanos , Incidencia , Lactante , Masculino , Pruebas de Función Respiratoria , Infecciones del Sistema Respiratorio/epidemiología , Oligoelementos/administración & dosificación , Resultado del Tratamiento , Zinc/administración & dosificaciónRESUMEN
Although viral acute lower respiratory infections (ALRIs) are a major public health problem in tropical low- and middle-income countries (LMICs), and there is growing evidence showing their relationship with meteorological parameters, studies performed in these countries are scarce. In an analytical cross-sectional study, we determined which of the main meteorological parameters (temperature, absolute humidity, rainfall, wind speed, and solar radiation) predicted respiratory syncytial virus (RSV) activity in a population of hospitalized children with ALRI during a 5-year period, from January 2009 to December 2013. Out of a total of 4559 children included in the study (mean age 9·2 ± 8·5 months), 2953 (64·8%) presented RSV infection during the 3-month period from March to May. In the multivariate analysis, after controlling for absolute humidity, wind speed, and solar radiation, temperature [incidence rate ratio (IRR) 2·25, 95% confidence interval (CI) 1·11-4·53, P = 0·024], and rainfall (IRR 1·01, 95% CI 1·00-1·02, P = 0·044) were independently associated with the monthly number of RSV infections. In conclusion, in Bogota, the capital of a tropical LMIC lying slightly above the equator, RSV activity peaks in the 3-month period from March to May, the main rainy period of the year in the city. In addition, rainfall and temperature are the two most important meteorological parameters that are independently associated with RSV activity in hospitalized children with ALRI in the city.
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Epidemias , Lluvia , Infecciones por Virus Sincitial Respiratorio/epidemiología , Virus Sincitial Respiratorio Humano/fisiología , Temperatura , Colombia/epidemiología , Estudios Transversales , Humanos , Lactante , Infecciones por Virus Sincitial Respiratorio/virologíaRESUMEN
This study aimed to determine which meteorological conditions are associated with respiratory syncytial virus (RSV) isolates in a population of children hospitalized with acute lower respiratory infection (ALRI) in Bogota, Colombia. In an analytical cross-sectional study, links were examined between the number of monthly RSV infections and monthly average climatic variation (temperature, relative humidity, rainfall, wind speed, solar radiation) between 1 January 2010 and 30 April 2011 in a population of hospitalized children aged <3 years with ALRI caused by RSV. Out of a total of 1548 children included in the study (mean age 9·2 ± 8·5 months), 1194 (77·1%) presented RSV infection during the 3-month period from March to May. In the multivariate analysis, after controlling for wind speed, relative humidity, and solar radiation, monthly average temperature [incident rate ratio (IRR) 3·14, 95% confidence interval (CI) 1·56-6·30, P = 0·001] and rainfall (IRR 1·008, 95% CI 1·00-1·01, P = 0·048) were independently associated with the monthly number of RSV infections. In conclusion, in Bogota, a tropical Latin American city, average temperature and rainfall are the meteorological variables most strongly associated with RSV isolation in children hospitalized with ALRI in the city.
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Lluvia , Infecciones por Virus Sincitial Respiratorio/epidemiología , Temperatura , Clima Tropical , Preescolar , Colombia/epidemiología , Estudios Transversales , Humanos , Humedad , Lactante , Luz Solar , Factores de Tiempo , VientoAsunto(s)
Disnea/diagnóstico , Neoplasias Renales/diagnóstico , Pulmón/diagnóstico por imagen , Linfangioleiomiomatosis/diagnóstico , Neumotórax/diagnóstico , Adolescente , Disnea/etiología , Disnea/terapia , Servicios Médicos de Urgencia , Femenino , Humanos , Neoplasias Renales/complicaciones , Neoplasias Renales/terapia , Linfangioleiomiomatosis/complicaciones , Linfangioleiomiomatosis/terapia , Nefrectomía , Neumotórax/etiología , Neumotórax/terapia , Radiografía , Recurrencia , ToracostomíaRESUMEN
BACKGROUND: Allergic rhinitis is one of the most frequent chronic diseases among children. The objective of the study was to assess the prevalence of and the factors associated with self-reported allergic rhinitis symptoms in schoolchildren from Bogota, Colombia. METHODOLOGY/PRINCIPAL: We followed the International Study of Asthma and Allergies in Childhood (ISAAC) methodology. Our sample included 3,256 children aged 6 - 7 and 3,830 adolescents aged 13 - 14 years. RESULTS: The prevalence of self-reported allergic rhinitis symptoms was 30.8% among children and 36.6% among adolescents. Factors associated with self-reported allergic rhinitis among children included current asthma and atopic dermatitis symptoms; use of acetaminophen in the first year of life and in the last 12 months; antibiotic use in the first year of life; high- school and university maternal education; smokers at home; and caesarean delivery. Among adolescents, associated factors included current asthma and atopic dermatitis symptoms; current acetaminophen use once per month; frequent fast-food consumption; cat exposure at home; and smoking. CONCLUSION: Further exploration of factors associated with allergic rhinitis symptoms is needed.
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Rinitis Alérgica Perenne/epidemiología , Adolescente , Niño , Colombia/epidemiología , Femenino , Humanos , Masculino , Prevalencia , Factores de Riesgo , Población Urbana/estadística & datos numéricosRESUMEN
Selective screening media for the detection and identification of Aeromonas strains are needed to guide primary isolation procedures in the clinical laboratory. This study compared the selective CromoCen® AGN chromogenic agar medium for the detection and identification of Aeromonas strains that were isolated from various samples against the conventional selective agar media that are commonly used for the isolation of this organism in food, environmental and clinical samples. The Miles and Misra and ecometric methods were used to evaluate the microbiological performance of CromoCen® AGN chromogenic agar medium, which was shown to be satisfactory. A total of 14 reference Aeromonas strains, 44 wild strains and 106 clinical stool specimens were examined using both non-chromogenic selective agars that are commonly used for Aeromonas isolation and CromoCen® AGN agar. The latter exhibited 94.73% sensitivity and 100% specificity for the various samples. On CromoCen® AGN agar medium, Aeromonas formed colonies with light green, greenish and salmon pigments with or without a surrounding wide transparent zone (halo) of 2-3mm in diameter around the entire border. This medium is recommended for the isolation and potential identification of the Aeromonas genus.
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Aeromonas/aislamiento & purificación , Técnicas Bacteriológicas/métodos , Medios de Cultivo/química , Heces/microbiología , Infecciones por Bacterias Gramnegativas/diagnóstico , Infecciones por Bacterias Gramnegativas/microbiología , Aeromonas/crecimiento & desarrollo , Aeromonas/metabolismo , Agar , Niño , Compuestos Cromogénicos/metabolismo , Humanos , Tamizaje Masivo/métodos , Selección Genética , Sensibilidad y EspecificidadRESUMEN
INTRODUCTION: Recurrent emergency department (ED) visits for asthma exacerbations produce anxiety as well as high costs to the health system and the family. OBJECTIVE: To identify factors associated with recurrent ED visits for asthma exacerbations in children in Bogotá, Colombia. METHODS: Data obtained from a survey of parents of 223 patients with asthma (mean +/- SD: 4.8+/-3.5 years of age) attending an asthma clinic were analysed. Demographic data and a broad asthma knowledge and attitudes questionnaire were completed by the parents. RESULTS: Of the 223 asthmatic patients enrolled, 60 (26.9 %) had 3 or more visits to the ED for asthma in the last 6 months ("recurrent ED visits"). After controlling by age, educational level of the father, and severity of the disease; parents of children with "recurrent ED visits" were more prone to report that they attended ED because the asthma exacerbations were severe enough to go to the primary care physician (OR, 2.45; CI 95 %, 1.13-5.30; p=0.02); that asthma medications should be administered only when the children are symptomatic (OR, 3.26; CI 95 %, 1.45-7.36; p=0.004), and conversely they were less prone to have knowledge that asthma exacerbations can be avoided if medications are administered in the asymptomatic periods (OR, 0.31; CI 95 %, 0.14-0.68; p=0.003). CONCLUSIONS: An educational programme intended to reduce the recurrent ED visits for asthma exacerbations should consider the inclusion of an explanation about the chronic nature of the disease and the importance of long-term therapy.
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Asma/epidemiología , Servicio de Urgencia en Hospital , Padres/educación , Educación del Paciente como Asunto , Estado Asmático/epidemiología , Asma/psicología , Niño , Preescolar , Colombia , Femenino , Humanos , Lactante , Masculino , Padres/psicología , Prevención Secundaria , Índice de Severidad de la Enfermedad , Estado Asmático/psicología , Encuestas y CuestionariosRESUMEN
OBJECTIVE: Interventions to increase asthma knowledge enable children and/or their parents to acquire skills needed for the prevention and/or appropriate management of crises. Periods of illness caused by the disease can thereby be reduced. However, no validated instrument for quantifying knowledge of asthma is available in Spanish. The aim of the present study was to develop and validate an asthma knowledge questionnaire that could be self-administered by parents and/or persons charged with caring for asthmatic children. MATERIAL AND METHODS: The 17 items that make up the questionnaire were obtained on the basis of a review of the literature, focus group discussions, the professional experience of the researchers, and pilot studies. We evaluated the instrument's face, content, and concurrent validity and analyzed its factorial structure. The test-retest reliability of the questionnaire and its sensitivity to change were also assessed. RESULTS: A total of 120 pediatric patients with a mean (SD) age of 4.5 (3.7) years participated. Factor analysis demonstrated a probable structure of 3 factors that together explained 85% of the total variance in results. The opinion of an interdisciplinary group of experts on asthma confirmed the face validity of the instrument. The questionnaire's ability to distinguish between parents with high and low asthma knowledge demonstrated its concurrent validity. Test-retest reliability was demonstrated, as was sensitivity to change between 2 different testing moments. CONCLUSIONS: The asthma knowledge questionnaire developed is useful and reliable for quantifying the baseline level of asthma knowledge of parents of asthmatic children as well as to assess the efficacy of an educational intervention aiming to increase knowledge and understanding of the disease.
Asunto(s)
Asma/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Padres/psicología , Encuestas y Cuestionarios , Adulto , Asma/psicología , Preescolar , Femenino , Humanos , Lactante , MasculinoRESUMEN
Objetivo: Una intervención educativa destinada a aumentar el conocimiento acerca del asma permite a los niños y/o sus padres adquirir habilidades que les permitan prevenir y/o manejar adecuadamente las crisis asmáticas, disminuyendo la morbilidad producida por la enfermedad. Sin embargo, en nuestro medio no contamos con un instrumento validado que nos permita cuantificar el nivel de conocimiento de asma. El objetivo del presente estudio ha sido desarrollar y validar un cuestionario de conocimientos acerca del asma para ser cumplimentado por los padres y/o personas encargadas del cuidado de pacientes pediátricos asmáticos. Material y métodos: Los 17 ítems que conforman el cuestionario se obtuvieron de la revisión de la bibliografía, la realización de grupos focales, la experiencia profesional de los investigadores y la realización de pruebas piloto. Se evaluó la validez de apariencia, de contenido y de criterio concurrente del instrumento; asimismo se determinaron la estructura factorial, la fiabilidad test-retest y la sensibilidad al cambio del cuestionario. Resultados: Se incluyó a 120 pacientes pediátricos con una edad promedio (± desviación estándar) de 4,5 ± 3,7 años. El análisis factorial demostró una estructura probable de 3 factores, que en conjunto explican el 85% de la varianza total de los resultados. La validez de apariencia y de contenido se basó en el concepto de un grupo multidisciplinario de expertos en el tema. La validez de criterio concurrente se demostró mediante la habilidad del cuestionario para distinguir a los padres con alto y con bajo conocimiento acerca del asma. Se demostraron además una adecuada fiabilidad test-retest y una adecuada sensibilidad al cambio al comparar la puntuación del cuestionario administrado en 2 ocasiones distintas. Conclusiones: El cuestionario de conocimientos de asma desarrollado en el estudio es una herramienta útil y fiable para cuantificar el nivel basal de conocimiento acerca del asma en padres de niños asmáticos, así como para determinar la eficacia de una intervención educativa destinada a aumentar el conocimiento y la comprensión de la enfermedad
Objective: Interventions to increase asthma knowledge enable children and/or their parents to acquire skills needed for the prevention and/or appropriate management of crises. Periods of illness caused by the disease can thereby be reduced. However, no validated instrument for quantifying knowledge of asthma is available in Spanish. The aim of the present study was to develop and validate an asthma knowledge questionnaire that could be self-administered by parents and/or persons charged with caring for asthmatic children. Material and methods: The 17 items that make up the questionnaire were obtained on the basis of a review of the literature, focus group discussions, the professional experience of the researchers, and pilot studies. We evaluated the instrument's face, content, and concurrent validity and analyzed its factorial structure. The test-retest reliability of the questionnaire and its sensitivity to change were also assessed. Results: A total of 120 pediatric patients with a mean (SD) age of 4.5 (3.7) years participated. Factor analysis demonstrated a probable structure of 3 factors that together explained 85% of the total variance in results. The opinion of an interdisciplinary group of experts on asthma confirmed the face validity of the instrument. The questionnaire's ability to distinguish between parents with high and low asthma knowledge demonstrated its concurrent validity. Test-retest reliability was demonstrated, as was sensitivity to change between 2 different testing moments. Conclusions: The asthma knowledge questionnaire developed is useful and reliable for quantifying the baseline level of asthma knowledge of parents of asthmatic children as well as to assess the efficacy of an educational intervention aiming to increase knowledge and understanding of the disease
Asunto(s)
Humanos , Asma/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Padres/psicología , Encuestas y Cuestionarios , Asma/psicologíaRESUMEN
BACKGROUND: Although the role of flexible bronchoscopy as an important diagnostic and therapeutic tool in pediatric medicine has been demonstrated, the procedure can cause complications which should be foreseen by the bronchoscopist. However, no precise information is available about the factors associated with the presence of such complications. OBJECTIVE: To determine the incidence of complications caused by bronchoscopy in pediatric patients and the factors associated with their presence. MATERIAL AND METHOD: This was a retrospective cohort study which reviewed the records of patients aged between 1 month and 18 years who had undergone bronchoscopy between January 1 and December 31, 2002. The presence or absence of several variables considered predictive of postbronchoscopy complications was recorded in each patient. RESULTS: After adjustment for the method used to access the airway, age less than or equal to 3 months was the only independent factor associated with the presence of complications (odds ratio = 8.19; 95% confidence interval, 1.61-41.55; P=.01). CONCLUSIONS: We conclude that patients 3 months old or younger are at greater risk of presenting complications after bronchoscopies performed under general anesthesia. Consequently a risk-benefit analysis should be carried out for patients in this age group, and the possibility of performing the procedure under sedation should be considered.
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Broncoscopía/efectos adversos , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Estudios Retrospectivos , Factores de RiesgoRESUMEN
INTRODUCCIÓN: A pesar de que se ha demostrado el papel de la broncoscopia flexible en pediatría como una importante herramienta diagnóstica y terapéutica, el procedimiento puede ocasionar complicaciones que el broncoscopista debe prever antes de su realización; sin embargo, no se conocen con precisión los factores que se asocian a la presencia de estas complicaciones. OBJETIVO: Determinar la incidencia y los factores que se asocian a la presencia de complicaciones debidas a la realización de broncoscopias en pacientes pediátricos. MATERIAL Y MÉTODO: Se realizó un estudio de cohorte retrospectivo, en el que se revisaron los registros de los pacientes de entre 1 mes y 18 años de edad a los que se les realizó broncoscopia entre el 1 de enero y el 31 de diciembre de 2002. Se registró para cada paciente la presencia o no de varias variables predictoras y de complicaciones posbroncoscopia. RESULTADOS: Después de ajustar por el tipo de acceso a la vía aérea, la edad menor o igual a 3 meses fue el único factor independiente que se asoció a la presencia de alguna complicación (odds ratio = 8,19; intervalo de confianza del 95 por ciento, 1,61-41,55; p = 0,01).CONCLUSIONES: Concluimos que los pacientes con una edad menor o igual a 3 meses tienen mayor riesgo de presentar complicaciones tras la realización de broncoscopias con anestesia general, por lo que debe establecerse un balance riesgo-beneficio en pacientes de esta edad y considerar la realización del procedimiento bajo sedación (AU)
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Persona de Mediana Edad , Preescolar , Niño , Adolescente , Adulto , Masculino , Femenino , Humanos , Factores de Riesgo , Estudios de Cohortes , Incidencia , Complicaciones Posoperatorias , Estudios Retrospectivos , BroncoscopíaRESUMEN
In the last few years, the use of chromogenic and fluorogenic reactions for the identification of the most important pathogens in human urinary tract infections has became a powerful tool in clinic diagnostic. The study was carry out in two hospitals in Havana City, comparing the performance of experimental medium with the traditional one: C.L.E.D. Medium produced by Centro Nacional de Biopreparados (BIOCEN). Additional biochemical test were applied (indole, motility, citrate, H2S glucose and lactose) for the more accurate identification of different strains. During the test 119 positive samples were evaluated with 82 identified as E. coli (68.9%). As coliforms 18 samples (15.1%) were identify without any biochemical test. The diagnostic sensitivity was 100% and diagnostic specificity of new medium was of 97.4% for all assayed samples.
Asunto(s)
Técnicas Bacteriológicas , Compuestos Cromogénicos , Medios de Cultivo , Infecciones por Escherichia coli/microbiología , Escherichia coli/aislamiento & purificación , Colorantes Fluorescentes , Infecciones Urinarias/microbiología , Metabolismo de los Hidratos de Carbono , Niño , Ácido Cítrico/metabolismo , Diagnóstico Diferencial , Enterobacteriaceae/aislamiento & purificación , Enterobacteriaceae/metabolismo , Infecciones por Enterobacteriaceae/diagnóstico , Infecciones por Enterobacteriaceae/microbiología , Escherichia coli/metabolismo , Infecciones por Escherichia coli/diagnóstico , Fermentación , Humanos , Sulfuro de Hidrógeno/análisis , Sensibilidad y Especificidad , Urea/metabolismoRESUMEN
Study of some parameters of the process of hydrolysis in addition to other experiments has made it possible to develop a method for obtaining a nutrient base for the cultivation of microorganisms with the use of cattle whole blood as protein substrate and papain as a hydrolyzing agent. The product thus obtained is characterized by high levels of amino and total nitrogen (4% and 14% respectively). Biological studies with the use of this product in different culture media and observations on the growth and characteristics of many microbial strains have shown the possibility of its use for the diagnosis of infectious diseases, for the control of the quality of foodstuffs and water.