Spirometry and respiratory oscillometry: Feasibility and concordance in schoolchildren with asthma

Producción CientíficaObjective: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.Junta de Castilla y León (Gerencia Regional de Salud - Grant/Award Number: 2191/A/2020

Self-care support for children and adolescents with long-term conditions : the REfOCUS evidence synthesis

Background: Self-care support (e.g. education, training, peer/professional support) is intended to enhance the self-care capacities of children and young people, while simultaneously reducing the financial burden facing health-care systems. Objectives: To determine which models of self-care support for long-term conditions (LTCs) are associated with significant reductions in health utilisation and costs without compromising outcomes for children and young people. Design: Systematic review with meta-analysis. Population: Children and young people aged 0–18 years with a long-term physical or mental health condition (e.g. asthma, depression). Intervention: Self-care support in health, social care, educational or community settings. Comparator: Usual care. Outcomes: Generic/health-related quality of life (QoL)/subjective health symptoms and health service utilisation/costs. Design: Randomised/non-randomised trials, controlled before-and-after studies, and interrupted time series designs. Data sources: MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, ISI Web of Science, NHS Economic Evaluation Database, The Cochrane Library, Health Technology Assessment database, Paediatric Economic Database Evaluation, IDEAS, reference scanning, targeted author searches and forward citation searching. All databases were searched from inception to March 2015. Methods: We conducted meta-analyses, simultaneously plotting QoL and health utilisation effects. We conducted subgroup analyses for evidence quality, age, LTC and intervention (setting, target, delivery format, intensity). Results: Ninety-seven studies reporting 114 interventions were included. Thirty-seven studies reported adequate allocation concealment. Fourteen were UK studies. The vast majority of included studies recruited children and young people with asthma (n = 66, 68%). Four per cent of studies evaluated ‘pure’ self-care support (delivered through health technology without additional contact), 23% evaluated facilitated self-care support (≤ 2 hours’/four sessions’ contact), 65% were intensively facilitated (≥ 2 hours’/four sessions’ contact) and 8% were case management (≥ 2 hours’ support with multidisciplinary input). Self-care support was associated with statistically significant, minimal benefits for QoL [effect size (ES) –0.17, 95% confidence interval (CI) –0.23 to –0.11], but lacked clear benefit for hospital admissions (ES –0.05, 95% CI –0.12 to 0.03). This finding endured across intervention intensities and LTCs. Statistically significant, minimal reductions in emergency use were observed (ES –0.11, 95% CI –0.17 to –0.04). The total cost analysis was limited by the small number of data. Subgroup analyses revealed statistically significant, minimal reductions in emergency use for children aged ≤ 13 years (ES –0.10, 95% CI –0.17 to –0.04), children and young people with asthma (ES –0.12, 95% CI –0.18 to –0.06) and children and young people receiving ≥ 2 hours per four sessions of support (ES –0.10, 95% CI –0.17 to –0.03). Preliminary evidence suggested that interventions that include the child or young person, and deliver some content individually, may optimise QoL effects. Face-to-face delivery may help to maximise emergency department effects. Caution is required in interpreting these findings. Limitations: Identification of optimal models of self-care support is challenged by the size and nature of evidence available. The emphasis on meta-analysis meant that a minority of studies with incomplete but potentially relevant data were excluded. Conclusions: Self-care support is associated with positive but minimal effects on children and young people’s QoL, and minimal, but potentially important, reductions in emergency use. On current evidence, we cannot reliably conclude that self-care support significantly reduces health-care costs. Future work: Research is needed to explore the short- and longer-term effects of self-care support across a wider range of LTCs. Study registration: This study is registered as PROSPERO CRD42014015452. Funding: The National Institute for Health Research Health Services and Delivery Research programme

Análisis de la comunicación en redes sociales de la campaña de la vacuna de gripe en España

Background: After arising of anti-vaccine groups and their dissemination, it is necessary to carry out communication campaigns on the benefits of vaccination aimed at citizens, and social networks are a good way to reach a large population. The objective of this article is to determine the communication on Twitter social network during the influenza vaccine campaign in 2018 in Spain. Methods: Big data methods were used to collect all tweets about the influenza vaccine during October 23 to December 15. They were determined by cluster analysis, eigenvector and pagerank calculations to determinate who were the most important influencers during the campaign. Results: A total of 9,147 tweets were collected, of which 71.94% were retweets (RT). Ten groups generated 69.92% of the message traffic on vaccines. The main emotion expressed in the messages about vaccines is the fear of consequences if people do not get vaccinated. Conclusions: It was determined that the information on the campaign is favorable to vaccination but is mainly directed by (supposedly) doctors, nurses or anonymous patients who tweet and are followed by many users. The official and institutional campaigns, some of which are re-disseminated in a possibly organized way, are very neglected in the monitoring of society in the networks.Fundamentos: Tras la aparición y difusión de los grupos anti-vacunas, se hace necesario realizar campañas de comunicación orientadas a la ciudadanía sobre los beneficios de la vacunación, y las redes sociales son una buena vía para alcanzar a una gran cantidad de población. Este artículo tuvo como objetivo analizar la comunicación en la red social Twitter durante la campaña de la vacuna de la gripe en el año 2018. Métodos: Se emplearon métodos de big data para recoger la totalidad de tuits sobre la vacuna de la gripe del 23 de octubre al 15 de diciembre de 2018. Se determinaron por análisis de cluster y los cálculos del eigenvector y pagerank quiénes fueron los usuarios o influencers más importantes durante la campaña. Resultados: Se recogieron un total de 9.147 tuits, de los cuales el 71,94% fueron retuits (RT) o reenvíos de lo que escriben otros usuarios. Diez grupos generaron el 69,92% del tráfico de los mensajes sobre vacunas. La emoción principal vertida en los mensajes sobre vacunas fue el miedo a las consecuencias si la gente no se vacunara. Conclusiones: Se determina que la información sobre la campaña es favorable a la vacunación pero está dirigida principalmente por (supuestamente) médicos, enfermeras o enfermos anónimos que tuitean y son muy seguidos por multitud de usuarios. Las campañas oficiales e institucionales, siendo algunas de ellas redifundidas de forma posiblemente organizada, quedan muy relegadas del seguimiento de la sociedad en las redes

Analysis of communication in social networks of the influenza vaccine campaign in Spain

OBJECTIVE: After arising of anti-vaccine groups and their dissemination, it is necessary to carry out communication campaigns on the benefits of vaccination aimed at citizens, and social networks are a good way to reach a large population. The objective of this article is to determine the communication on Twitter social network during the influenza vaccine campaign in 2018 in Spain. METHODS: Big data methods were used to collect all tweets about the influenza vaccine during October 23 to December 15. They were determined by cluster analysis, eigenvector and pagerank calculations to determinate who were the most important influencers during the campaign. RESULTS: A total of 9,147 tweets were collected, of which 71.94% were retweets (RT). Ten groups generated 69.92% of the message traffic on vaccines. The main emotion expressed in the messages about vaccines is the fear of consequences if people do not get vaccinated. CONCLUSIONS: It was determined that the information on the campaign is favorable to vaccination but is mainly directed by (supposedly) doctors, nurses or anonymous patients who tweet and are followed by many users. The official and institutional campaigns, some of which are re-disseminated in a possibly organized way, are very neglected in the monitoring of society in the networks.Fundamentos: Tras la aparición y difusión de los grupos anti-vacunas, se hace necesario realizar campañas de comunicación orientadas a la ciudadanía sobre los beneficios de la vacunación, y las redes sociales son una buena vía para alcanzar a una gran cantidad de población. Este artículo tuvo como objetivo analizar la comunicación en la red social Twitter durante la campaña de la vacuna de la gripe en el año 2018. Métodos: Se emplearon métodos de big data para recoger la totalidad de tuits sobre la vacuna de la gripe del 23 de octubre al 15 de diciembre de 2018. Se determinaron por análisis de cluster y los cálculos del eigenvector y pagerank quiénes fueron los usuarios o influencers más importantes durante la campaña. Resultados: Se recogieron un total de 9.147 tuits, de los cuales el 71,94% fueron retuits (RT) o reenvíos de lo que escriben otros usuarios. Diez grupos generaron el 69,92% del tráfico de los mensajes sobre vacunas. La emoción principal vertida en los mensajes sobre vacunas fue el miedo a las consecuencias si la gente no se vacunara. Conclusiones: Se determina que la información sobre la campaña es favorable a la vacunación pero está dirigida principalmente por (supuestamente) médicos, enfermeras o enfermos anónimos que tuitean y son muy seguidos por multitud de usuarios. Las campañas oficiales e institucionales, siendo algunas de ellas redifundidas de forma posiblemente organizada, quedan muy relegadas del seguimiento de la sociedad en las redes

Obesidad infantil: opiniones y actitudes de los pediatras Childhood obesity: pediatricians' attitudes and opinions

Objetivos: Identificar las actitudes y opiniones de los pediatras respecto al tratamiento, la prevención y la organización asistencial de la obesidad, identificar las barreras que encuentran en el tratamiento de la obesidad y las herramientas que creen más útiles para prestar una atención más efectiva. Métodos: Encuesta postal a los pediatras de atención primaria de Castilla y León, explorando la necesidad de acción frente a la obesidad, la utilidad de medidas terapéuticas y estrategias preventivas, las barreras que obstaculizan el tratamiento, las herramientas útiles para el pediatra, la eficacia propia en el tratamiento de la obesidad y la utilidad de incorporar la obesidad a la cartera de servicios. Resultados: Se consideró la obesidad como un problema de salud importante que necesita una actuación por parte de los pediatras. Esta disposición a la acción era menor entre quienes manifestaron más barreras personales. Las barreras más frecuentes procedían del medio social: disponibilidad y publicidad de determinados alimentos y bebidas, dificultades en involucrar a los padres en el tratamiento, ausencia de percepción del problema por el niño y los padres. La herramienta mejor considerada fue la formación del personal sanitario. Los pediatras se consideraban algo o poco eficaces en el tratamiento de la obesidad. La efectividad de un servicio de atención a la obesidad en atención primaria pareció ligeramente superada por la carga de trabajo que requeriría. Conclusiones: Pese a su alta disposición a la acción frente a la obesidad, los pediatras se sienten limitados debido a las barreras que encuentran, sobre todo de tipo social o cultural, y demandan más formación como una herramienta frente a la epidemia de obesidad infantil.<br>Objectives: To identify the Spanish pediatricians' opinions and attitudes towards obesity, in relation with its treatment, prevention, and care organization, barriers they find in its treatment, and to know the tools they consider more useful to have for the management of obese children. Methods: Mail survey posted to the primary care pediatricians of Castilla-León (Spain) exploring: willingness to act against obesity, utility of therapies and preventive strategies, barriers found in treating obese patients, most needed tools for treating obesity, autoefficacy, and support to an obese children management programme in primary care. Results: There was a broad consensus in seeing obesity as an important health problem that demands action from pediatricians. This willingness to action decreased when bigger personal barriers were found. The most frequently encountered barriers came from the social milieu: easy access and advertisement of certain foods and beverages, lack of implication of parents, lack of perception of a weight problem in children and parents. Training was the most trusted tool. Pediatricians considered themselves as some or low efficacious in treating obesity. The effectiveness of an obese children management program in primary care was surpassed by the work it would need. Conclusions: In spite of their high willingness to act against obesity, pediatricians feel themselves limited because they find barriers mainly from the social and cultural milieus. They ask for training to fight pediatric obesity