Análisis de la prescripción pediátrica de antiasmáticos en Castilla y León, 2005-2010

Se analizaron las prescripciones de antiasmáticos (subgrupo terapéutico R03) y de los principios activos: mepiramina y ketotifeno, realizadas a menores de 14 años en el sistema público de salud de Castilla y León entre 2005-2010. Los resultados se presentan en dosis diarias prescritas por mil habitantes/día (PDHD), calculadas para cada principio activo, crudas y ajustadas por edad. Se realizaron 462.354 prescripciones a una población expuesta de 1.580.229 personas-año. Los antiasmáticos más prescritos fueron los broncodilatadores (36% de PDHD), antileucotrienos (23% de PDHD), corticoides inhalados monofármaco (22% de PDHD), ß2 adrenérgicos de acción larga asociados a corticoides inhalados (10%) y mepiramina (8%). Este patrón de uso no se adecua a las recomendaciones de tratamiento actual, ni con la gravedad del asma comunicada en Castilla y León y en España. Los menores de 4 años, fueron los más consumidores. Un 9% de los envases de la terapia de mantenimiento se utilizaron “off-labelDepartamento de Pediatría e Inmunología, Obstericia y Ginecología, Nutrición y Bromatología, Psiquiatría e Historia de la Cienci

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

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

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