Association between asthma and sleep hours in Brazilian adolescents: ERICA

ObjectiveTo investigate the association between asthma and sleep duration in participants of the Study of Cardiovascular Risks in Adolescents.Materials and methodsCross-sectional, national, school-based study, involving adolescents aged 12–17 years. In the period between 2013?14, data from 59,442 participants were analyzed. Bivariate analysis between current asthma and short sleep duration, defined as < 7 h/night, was performed separately with the other variables analyzed: sex, age group, type of school, weight categories, and common mental disorders. Then, different generalized linear models with Poisson family and logarithmic link functions were used to assess the independence of potential confounding covariates associated with both asthma and short sleep duration in the previous analysis. Crude and adjusted prevalence ratios and respective 95% confidence intervals were calculated, and a value of p < 0.05 was considered significant for all analyses performed.ResultsPrevalence of current asthma was 13.4%, being significantly higher among students with short sleep duration (PR: 1.17; 95% CI: 1.01–1.35; p = 0.034). This remained significant even after adjusting for the other study covariates.ConclusionThere was a positive association between the prevalence of current asthma and short sleep duration among Brazilian adolescents. Considering the high prevalence and morbidity of the disease in this age group, the promotion of sleep hygiene should be considered as a possible health strategy aimed at contributing to better control of asthma in this population.     

Prevalence of and factors associated with current asthma symptoms in school children aged 6–7 and 13–14 yr old in Bogotá, Colombia

This cross‐sectional study of children aged 6–7 years and adolescents aged 13–14 years in Bogotá, Colombia, assessed the prevalence of asthma symptoms and their associations with dietary, health, and behavioral habits. This study is part of the International Study of Asthma and Allergies in Childhood (ISAAC)‐phase III. Asthma prevalence among the children was assessed using a parental self‐administered written questionnaire (WQ), and among adolescents using a WQ together with a video questionnaire (VQ). Associations were estimated with bivariate and multivariate analysis. The study found that the 6–7 year age‐group were more likely to report current asthma symptoms than the 13–14 year age‐group (10.4% [WQ] vs. 8.6% [WQ] and 8.0% [VQ], respectively). Factors associated with current asthma symptoms among the 6–7 year age‐group included higher maternal education (OR = 1.7, [95% CI 1.2–2.6], p = 0.007), a cat in the home during the last year (OR = 1.5, [95% CI 1.0–2.3], p = 0.036), watching TV 1–2 hours/day (OR = 2.1, [95% CI 1.2–3.9], p = 0.013), and medication with acetaminophen in the first and most recent year of life (OR = 1.8, [95% CI 1.3–2.4], p < 0.001; OR = 2.2, [95% CI 1.7–2.8], p < 0.001, respectively) or antibiotics in the first year of life (OR = 1.9, [95% CI 1.4–2.5], p < 0.001). Among the 13–14 year age‐group, factors associated with current asthma symptoms included medication with acetaminophen during the last year (OR = 1.8, [95% CI 1.4–2.3], p < 0.001); cereal, milk, and fruit consumption 3 or more times weekly (OR = 1.5, [95% CI 1.1–1.9], p = 0.010; OR = 0.8, [95% CI 0.6–1.0], p = 0.046; OR = 0.6, [95% CI 0.4–1.0], p = 0.031, respectively). Overall, compared with that in other Latin American centers, asthma prevalence in Bogotá is close the lower estimates. However, associations with dietary, health, and behavioral habits need further study to assess their complex relationship with asthma.     

Association of food allergy with asthma severity and atopic diseases in Jewish and Arab adolescents

Aim: To investigate the prevalence of reported food allergy and its association with atopic diseases and asthma severity among Jewish and Arab adolescents. Subjects and methods: The self‐report questionnaire of the International Study of Asthma and Allergies in Childhood (ISAAC) was administered to adolescents aged 13–14 years from randomly selected junior high schools in Israel. Questions regarding food allergy were added. Results: A total of 11 171 questionnaires were available for analysis. Food allergy was reported by 3.6% of participants: 1.9% milk, 0.6% egg, 0.6% peanut and 0.4% sesame. On multivariate analysis, food allergy was strongly associated with current asthma (OR, 2.5; 95% CI, 1.8–3.3), atopic eczema (OR, 3.2; 95% CI, 2.4–4.3) and allergic rhinitis (OR, 2.4; 95% CI, 1.8–3.1). Arabs were significantly more allergic to peanut (OR, 2.5; 95% CI, 1.5–4.1), egg (OR, 3.5; 95% CI, 2.1–5.9) and sesame (OR, 2.3; 95% CI, 1.2–4.5) than Jews, and less allergic to milk (OR, 0.6; 95% CI, 0.4–0.9). Asthmatic subjects with food allergy had significantly more parameters of severe asthma than those without food allergy (p < 0.001). Conclusions: The prevalence of allergy to specific foods differs between Jews and Arabs. Asthmatic adolescents with food allergy report more severe asthma than those without food allergy.     

Pediatric Asthma Is Associated With Poorer 3-Year Academic Achievement in Urban Elementary and Middle-School Students

ObjectiveAsthma has been associated with worse academic performance in a single school year, yet this association may be magnified over time as students with asthma continue to fall behind. This study examined the relationship between asthma and standardized test performance aggregated across 3 school years, including whether performance varied by likelihood of having significant asthma.MethodsData were from students in grades K-8 at 2 urban public schools in the Northeastern United States (2015–2018). Asthma was based on parent- and self-report and school health center records. Standardized test performance was assessed using Measures of Academic Progress (MAP) and Partnership for Assessment of Readiness for College and Careers (PARCC). Mixed effects linear and logistic regression models were used to evaluate the relationship between asthma and performance during 3 school years.ResultsAny asthma was associated with worse MAP performance across the 3 academic years. Students with the most significant asthma demonstrated worse performance on MAP and PARCC. Aggregating across 3 school years, students scored 3.17 points worse on MAP reading (95% confidence interval [CI]: 0.7–5.63; P = .012) and 3.56 points worse on MAP mathematics (95% CI: 0.52–6.6; P = .022); they had 48.8% (95% CI: 1.9%–73.2%; P = .044) and 58.0% (95% CI: 21%–78%; P = .007) lower odds of proficiency on PARCC English/Language Arts and Mathematics, respectively compared to those without asthma.ConclusionsThe relationship between asthma and poorer academic achievement in 1 school year may be magnified over multiple years, particularly among those with more significant asthma. School-based asthma interventions may support academic growth and more equitable health outcomes.     

Health self-perception and its association with physical activity and nutritional status in adolescents

ObjectiveTo evaluate the association between total physical activities, physical activity in free time and nutritional status with self-perceived health in adolescents of both genders.MethodsThis is a quantitative study that integrates the school-based, cross-sectional epidemiological survey with statewide coverage, whose sample consisted of 6261 adolescents (14–19 years old) selected by random conglomerate sampling. Data were collected using the Global School-based Student Health Survey. The chi-squared test (χ²) and the Poisson regression model with robust variance were used in the data analyses.ResultsIt was observed that 27.3% of the adolescents had a negative health self-perception, which was higher among girls (33.0% vs. 19.0%, p < 0.001). After adjusting for potential confounding factors, it was observed that boys who did not practice physical activity during free time (PR = 1.44, 95% CI: 1.15–1.81) and were classified as insufficiently active (PR = 1.27, 95% CI: 1.04–1.56), as well as girls who did not practice physical activity during free time (PR = 1.15, 95% CI: 1.02–1.29) and were classified as overweight (PR = 1.27, 95% CI: 1.01–1.29) had a greater chance of negative health self-perception.ConclusionBehavioral issues may have different effects on health self-perception when comparing boys with girls. Negative health self-perception was associated with nutritional status in girls and a lower level of physical activity in boys, and the practice of physical activity in the free time was considered a protective factor against a negative health self-perception for adolescents of both genders.     

Prevalence of and factors associated with current asthma symptoms in school children aged 6-7 and 13-14 yr old in Bogotá, Colombia.

This cross-sectional study of children aged 6-7 years and adolescents aged 13-14 years in Bogotá, Colombia, assessed the prevalence of asthma symptoms and their associations with dietary, health, and behavioral habits. This study is part of the International Study of Asthma and Allergies in Childhood (ISAAC)-phase III. Asthma prevalence among the children was assessed using a parental self-administered written questionnaire (WQ), and among adolescents using a WQ together with a video questionnaire (VQ). Associations were estimated with bivariate and multivariate analysis. The study found that the 6-7 year age-group were more likely to report current asthma symptoms than the 13-14 year age-group (10.4% [WQ] vs. 8.6% [WQ] and 8.0% [VQ], respectively). Factors associated with current asthma symptoms among the 6-7 year age-group included higher maternal education (OR = 1.7, [95% CI 1.2-2.6], p = 0.007), a cat in the home during the last year (OR = 1.5, [95% CI 1.0-2.3], p = 0.036), watching TV 1-2 hours/day (OR = 2.1, [95% CI 1.2-3.9], p = 0.013), and medication with acetaminophen in the first and most recent year of life (OR = 1.8, [95% CI 1.3-2.4], p < 0.001; OR = 2.2, [95% CI 1.7-2.8], p < 0.001, respectively) or antibiotics in the first year of life (OR = 1.9, [95% CI 1.4-2.5], p < 0.001). Among the 13-14 year age-group, factors associated with current asthma symptoms included medication with acetaminophen during the last year (OR = 1.8, [95% CI 1.4-2.3], p < 0.001); cereal, milk, and fruit consumption 3 or more times weekly (OR = 1.5, [95% CI 1.1-1.9], p = 0.010; OR = 0.8, [95% CI 0.6-1.0], p = 0.046; OR = 0.6, [95% CI 0.4-1.0], p = 0.031, respectively). Overall, compared with that in other Latin American centers, asthma prevalence in Bogotá is close the lower estimates. However, associations with dietary, health, and behavioral habits need further study to assess their complex relationship with asthma.     

Idiopathic musculoskeletal pain,musculoskeletal pain syndromes,and use of electronic devices in adolescents with asthma

ObjectiveTo evaluate idiopathic musculoskeletal pain, musculoskeletal pain syndromes, and use of electronic devices in adolescents with asthma and healthy controls.MethodsCross-sectional study was conducted on 150 asthmatic adolescents and 300 controls. Adolescents completed a self-administered questionnaire regarding painful symptoms, use of electronic devices, and physical activity. Seven musculoskeletal pain syndromes were evaluated, and Asthma Control Test (ACT) was assessed.ResultsMusculoskeletal pain (42% vs. 61%, p = 0.0002) and musculoskeletal pain syndromes (2.7% vs. 15.7%, p = 0.0006) were significantly lower in asthmatic adolescents than in controls. The frequency of pain in the hands and wrists was reduced in asthmatic than in controls (12.6% vs. 31.1%, p = 0.004), in addition to cell phone use (80% vs. 93%, p < 0.0001), simultaneous use of at least two electronic media (47% vs. 91%, p < 0.0001), myofascial syndrome (0% vs. 7.1%, p = 0.043), and tendinitis (0% vs. 9.2%, p = 0.008). Logistic regression analysis, including asthma with musculoskeletal pain as the dependent variable, and female sex, ACT > 20, simultaneous use of at least two electronic devices, cell phone use, and weekends and weekdays of cell phone use, as independent variables, showed that female sex (odds ratio [OR], 2.06; 95% confidence interval [CI], 1.929–6.316; p = 0.0009) and ACT ≥ 20 (OR, 0.194; 95% CI, 0.039–0.967; p = 0.045) were associated with asthma and musculoskeletal pain (Nagelkerke R² = 0.206).ConclusionsMusculoskeletal pain and musculoskeletal pain syndromes were lower in adolescents with asthma. Female sex was associated with musculoskeletal pain in asthmatic, whereas patients with asthma symptoms and well-controlled disease reported a lower prevalence of musculoskeletal pain.     

Continuity of Care in Primary Care for Young Children With Chronic Conditions

Objectives1) To assess continuity of care (CoC) within primary-care practices for children with asthma and autism spectrum disorder (ASD) compared to children without chronic conditions, and 2) to determine patient and clinical-care factors associated with CoC.MethodsRetrospective cohort study of electronic health records from office visits of children <9 years, seen ≥4 times between 2015 and 2019 in 10 practices of a community-based primary health care network in California. Three cohorts were constructed: 1) Asthma: ≥2 visits with asthma visit diagnoses; 2) ASD: same method; 3) Controls: no chronic conditions. CoC, using Usual Provider of Care measure (range > 0–1), was calculated for 1) all visits (overall) and 2) well-care visits. Fractional regression models examined CoC adjusting for patient age, medical insurance, practice affiliation, and number of visits.ResultsOf 30,678 children, 1875 (6.1%) were classified with Asthma, 294 (1.0%) with ASD, and 15,465 (50.4%) as Controls. Overall CoC was lower for Asthma (Mean = 0.58, SD 0.21) and ASD (M = 0.57, SD = 0.20) than Controls (M = 0.66, SD = 0.21); differences in well-care CoC were minimal. In regression models, lower overall CoC was found for Asthma (aOR = 0.90, 95% CI, 0.85–0.94). Lower overall and well-care CoC were associated with public insurance (aOR = 0.77, CI, 0.74–0.81; aOR = 0.64, CI, 0.59–0.69).ConclusionAfter accounting for patient and clinical-care factors, children with asthma, but not with ASD, in this primary-care network had significantly lower CoC compared to children without chronic conditions. Public insurance was the most prominent patient factor associated with low CoC, emphasizing the need to address disparities in CoC.     

Indoor environment,atopy and the risk of asthma in children in New Zealand

The objective of this study was to examine the relationship between the indoor environment, atopy and asthma in 7–9-year-old children. Cases and controls were randomly selected from children who participated in the International Study of Asthma and Allergies in Childhood (ISAAC) in Wellington, New Zealand. Cases were children with a previous diagnosis of asthma and current medication use (n = 233) and controls were children with no history of wheezing and no diagnosis of asthma (n = 241). Information was recorded about the indoor environment during the first year of life and currently. Dust was sampled from floors and beds and Der p 1 and Fel d 1 measured using enzyme-linked immunosorbent assays. Skin-prick tests were performed with eight common allergens. Sensitization to Dermatophagoides farinae (OR = 3.19; 95% CI 1.74–5.84), Dermatophagoides pteronyssinus (OR = 2.06; 95% CI 1.16–3.65) and cat (OR = 3.89; 95% CI 1.06–14.30) were independently associated with current asthma. The use of a sheepskin in the first year of life (OR = 1.91; 95% CI 1.11–3.33) was also independently associated with current asthma but current Der p 1 levels showed no association with current asthma. Exposures in early life may be more important than current exposures in determining asthma at age 7–9 years. Prospective studies are needed in New Zealand to determine the relative importance of early life exposures to Der p 1 and other risk factors for asthma.     

Adiposity,inflammation and fat-soluble vitamins in adolescents

ObjectiveEvaluate the association between inflammatory process, adiposity, and vitamins A, D, and E in adolescents, according to gender.MethodsCross-sectional study with adolescents aged 12–19 years old of both genders attending public schools in Recife. A questionnaire was used to collect data on socioeconomic level, lifestyle, and food intake of adolescents. Then, an anthropometric evaluation and a blood sampling were performed to analyze serum concentrations of α-1-acid glycoprotein, retinol, β-carotene, α-tocopherol, and 25-hydroxy-vitamin D.ResultsThe levels of α-1-acid glycoprotein were higher for abdominal obesity in both genders. Male adolescents with insufficient serum α-tocopherol levels had low levels of α-1-acid glycoprotein (p = 0.03) and an increased risk of 25-hydroxy-vitamin D and β-carotene deficiency in relation to total and abdominal fat; female adolescents had an increased risk of insufficient β-carotene with abdominal obesity (PR: 1.33; 95% CI: 1.2–1.5).ConclusionAbdominal adiposity implies a higher risk of inflammation and causes different changes to the levels of fat-soluble vitamins according to gender.     

Impact of parental smoking on childhood asthma

ObjetiveTo evaluate the exposure to environmental tobacco smoke (ETS) of the childhood population in this community and its relationship with asthma symptoms.MethodsA cross-sectional study was conducted using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire on children and adolescents in this community. The symptoms “wheezing ever”, “current asthma”, “severe asthma”, and “exercise-induced asthma” were defined by this questionnaire. Parental smoking was classified into four mutually exclusive categories: 1) no parent smokes; 2) only the mother smokes; 3) only the father smokes; and 4) both parents smoke. The odds ratio of the prevalence of asthma symptoms according to ETS exposure was calculated using logistic regression.ResultsA total of 10,314 children and 10,453 adolescents were included. Over 51% of the children and adolescents were exposed to ETS at home. ETS is associated with a higher prevalence of asthma symptoms, particularly if the mother or both parents smoke.ConclusionThe prevalence of ETS is still high in this community, although there has been a decreasing tendency in the last 15 years. ETS is associated with higher prevalence of asthma.     

Mediterranean diet and asthma in Spanish schoolchildren

Gonzalez Barcala FJ, Pertega S, Bamonde L, Garnelo L, Perez Castro T, Sampedro M, Sanchez Lastres J, San Jose Gonzalez MA, Lopez Silvarrey A. Mediterranean diet and asthma in Spanish schoolchildren.
Pediatr Allergy Immunol 2010: 21: 1021–1027.
© 2010 John Wiley & Sons A/S There is still debate on the effect of dietetic factors on the prevalence or severity of asthma, as well as the interaction with other factors. We have analysed the prevalence and severity of asthma according to adherence to the Mediterranean diet (MD), its association with obesity and family life style. We performed a cross‐sectional study on 14,700 children and adolescents in six health areas in our region. We used the International Study of Asthma and Allergies in Childhood questionnaire to collect asthma symptoms, dietary habits, anthropometric parameters, parental smoking habits and maternal education level. The diet pattern was analysed using a Mediterranean Diet Score. In the logistic regression we analysed the influence of adhering to the MD on the prevalence and severity of asthma, adjusted for the other parameters included. Greater adherence to the MD is associated with a higher risk of severe asthma (odds ratios = 2.26, 95% CI: 1.21–4.22) in girls of 6–7 yr. There was no significant relationship for the other asthma categories in the population studied. The results of our study do not support a protective effect of the MD on the prevalence or severity of asthma.     

Asthma control in the quality of life levels of asthmatic patients’ caregivers: a systematic review with meta-analysis and meta-regression

ObjectiveTo perform a systematic review with meta-analysis and meta-regression to correlate the total scores of asthma control with the increase in the total scores of health-related quality of life levels of parents of asthmatic children.SourcesThe search was carried out in the following databases: PubMed (MEDLINE); Embase and ScienceDirect (Elsevier); SciELO and LILACs (Bireme) in June 2017. The included studies assessed asthma control through the Asthma Control Questionnaire (ACQ), Asthma Control Test (C-ACT/ACT), and Global Initiative for Asthma (GINA) questionnaires, whereas the Pediatric Asthma Caregiver's Quality of Life Questionnaire (PACQLQ) was applied to assess the HRQoL of parents and family members.Summary of the findings294 articles were evaluated in the selected databases, of which (n = 38) were excluded for duplicity; (n = 239) after the reading of the titles and abstracts and (n = 5) after reading the studies in full, totaling 12 studies eligible for the meta-analysis. Of the 12 eligible articles, 11 (92%) were published in the last five years, and evaluated children and adolescents aged 1–20 years, totaling 2804 samples. In the evaluation of the correlation between the disease control scores by ACQ and C-ACT/ACT, the results were satisfactory for both ACQ analyses [R²: ?0.88; p < 0.001], and for C-ACT/ACT [R²: 0.82; p < 0.001].ConclusionsThe results show that asthma control levels can influence the total HRQoL scores of parents or relatives of children and adolescents with asthma.     

Changes in the prevalence of asthma and allergic diseases among Brazilian schoolchildren (13-14 years old): comparison between ISAAC Phases One and Three

The present study is aimed to describe the changes in the prevalence of symptoms of asthma, rhinitis and eczema among Brazilian adolescents (AD, 13-14 years old) between Phases 1 and 3 of the International Study of Asthma and Allergies in Childhood (ISAAC). The prevalence of self-reported symptoms of asthma, rhinitis and eczema in AD from five Brazilian cities (Curitiba, Porto Alegre, Recife, Salvador and S?o Paulo), obtained during ISAAC Phase 1 (n = 15 419) and Phase 3 (n = 15 684), was compared to determine the trend of prevalence in a 7-year interval. There was a trend to reduction in the current prevalence of wheezing and increasing of nocturnal cough when averaging figures from the five cities. The prevalence of wheezing in the last 12 months was 27.7 vs. 19.9% (p < 0.01); asthma ever 14.9 vs. 14.7% (p > 0.05); severe episode of wheezing 5.2 vs. 5.2%; nocturnal cough 32.6 vs. 34.9% (p < 0.01); exercise wheezing 23.6 vs. 23.0% (p > 0.05) and awake with wheezing 11.8 vs. 11.2% (p > 0.05). Similar things were observed with the prevalence of current symptoms of rhinitis and eczema. In Brazil, there was a small but significant mean decrease in the prevalence of two asthma-related symptoms, wheezing and nocturnal cough, though this trend was not consistent in the surveyed cities. The prevalence of asthma symptoms in Brazil, despite its mean trend to a decrease, is still one of the highest in Latin America.     

Risk factors associated with wheezing in infants

Objectiveto identify possible risk factors associated with wheezing in infants (12-15 months-old) in the state of Mato Grosso, Brazil.Methodsthis was a cross-sectional study performed by applying a standardized written questionnaire from the international study on wheezing in infants (Estudio Internacional de Sibilancia en Lactantes - EISL), phase 3. Parents and/or guardians of infants were interviewed at primary health care clinics or at home from August of 2009 to November of 2010. Factors associated to wheezing were studied using bivariate and multivariate analysis (using the Statistical Package for Social Sciences [SPSS] v.18.0), and expressed as odds ratios (OR) and 95% confidence intervals (95% CI).Resultsthe written questionnaire was answered by 1,060 parents and/or guardians. The risk factors for wheezing were: history of asthma in the family [mother (OR = 1.62; 95% CI = 1.07-2.43); father (OR = 1.98; 95% CI = 1.22-3.23); siblings (OR = 2.13; 95% CI = 1.18-3.87)]; history of previous pneumonia (OR = 10.80; 95% CI = 4.52-25.77); having had more than six upper respiratory tract infections (URTIs) (OR = 2.95; 95% CI = 2.11-4.14); having had first URTI before the third month of life (OR = 1.50; 95% CI = 1.04-2.17); living in a moderately polluted area (OR = 1.59; 95% CI = 1.08-2.33); paracetamol use for URTI (OR = 2.13; 95% CI = 1.54-2.95); and antibiotic use for skin infection (OR = 2.29; 95% CI = 1.18-4.46).Conclusionsthe study of risk factors for wheezing in the first year of life is important to help physicians identify young children at high risk of developing asthma and to improve public health prevention strategies in order to reduce the morbidity of wheezing in childhood.     

Social Epidemiology of Early Adolescent Cyberbullying in the United States

ObjectiveTo determine the prevalence and sociodemographic correlates of cyberbullying victimization and perpetration among a racially, ethnically and socioeconomically diverse population-based sample of 11–12-year-old early adolescents.MethodsWe analyzed cross-sectional data from the Adolescent Brain Cognitive Development (ABCD) Study (Year 2; N = 9429). Multiple logistic regression analyses were used to estimate associations between sociodemographic factors (sex, race/ethnicity, sexual orientation, country of birth, household income, parental education) and adolescent-reported cyberbullying victimization and perpetration.ResultsIn the overall sample, lifetime prevalence of cyberbullying victimization was 9.6%, with 65.8% occurring in the past 12 months, while lifetime prevalence of cyberbullying perpetration was 1.1%, with 59.8% occurring in the past 12 months. Boys reported higher odds of cyberbullying perpetration (AOR 1.71, 95% CI 1.01–2.92) but lower odds of cyberbullying victimization (AOR 0.80, 95% CI 0.68–0.94) than girls. Sexual minorities reported 2.83 higher odds of cyberbullying victimization (95% CI 1.69–4.75) than nonsexual minorities. Lower household income was associated with 1.64 (95% CI 1.34–2.00) higher odds of cyberbullying victimization than higher household income, however household income was not associated with cyberbullying perpetration. Total screen time, particularly on the internet and social media, was associated with both cyberbullying victimization and perpetration.ConclusionsNearly one in 10 early adolescents reported cyberbullying victimization. Pediatricians, parents, teachers, and online platforms can provide education to support victims and prevent perpetration for early adolescents at the highest risk of cyberbullying.     

What Parents Want Doctors to Know: Responses to an Open-Ended Item on an Asthma Questionnaire

ObjectiveUnstructured parental comments could solicit important information about children's asthma, yet are rarely captured in clinical asthma questionnaires. This mixed-methods study describes parents’ written responses to an open-ended question in a validated asthma questionnaire.MethodsThe Pediatric Asthma Control and Communication Instrument (PACCI) asthma questionnaire was administered to parents of children with asthma symptoms presenting to 48 pediatric primary care offices (PPCP), 1 pediatric pulmonology office, and 1 emergency department (ED). Responses to the question, “Please write down any concern or anything else you would like your doctor to know about your child's asthma” were analyzed using a phenomenological approach until thematic saturation was achieved for each site. Logistic regressions tested whether sociodemographic and clinical characteristics were associated with responding to the open-ended question.ResultsOf 7,988 parents who completed the PACCI, 954 (12%) responded to the open-ended question—2% in PPCP, 31% in the ED, and 50% in the pulmonary setting. More severe asthma was associated with higher odds of responding (odds ratio, 2.01; 95% confidence interval, 1.42–2.84). Based on responses provided, we identified 3 communication types: 1) clarifying symptoms, 2) asking questions, and 3) communicating distress. Responses also covered 5 asthma-related themes: 1) diagnostic uncertainty, 2) understanding asthma etiology and prognosis, 3) medication management, 4) impact on child function, and 5) personal asthma characteristics.ConclusionParents of children with severe asthma provided clarifying details, asked questions, and relayed health concerns and distress. None of these topics may be easily captured by closed-ended asthma questionnaires.     

Prevalence and risk factors for insomnia among Portuguese adolescents

Epidemiologic studies have shown that insomnia is the most prevalent sleep disorder at all ages, associated with sociodemographic and environmental factors and lifestyle. The aim of this study was to quantify the prevalence of insomnia and analyze its determinants among Portuguese adolescents. In a cross-sectional study, we evaluated 6,919 students from the 7th to the 12th grade from 26 secondary schools, during 2012. Data were collected using a self-administered questionnaire. Insomnia was defined based on the Diagnostic and Statistical Manual of Mental Disorders IV criteria. Prevalences were expressed in proportions with 95 % confidence intervals (CI), and the magnitude of association between variables was detailed using odds ratio (OR). The prevalence of symptoms of insomnia was 21.4 %, and the prevalence of insomnia was 8.3 %. After adjustment for gender and age, insomnia was associated with female gender (adjusted OR?=?1.82; CI 95 %: 1.56–2.13), age ≥16 years (adjusted OR?=?1.17; CI 95 %: 1.01–1.35), coffee and alcohol consumption (adjusted OR?=?1.40; CI 95 %: 1.20–1.63 and adjusted OR?=?1.21; CI 95 %: 1.03–1.41, respectively), and depressive symptoms (adjusted OR?=?3.59; CI 95 %: 3.04–4.24). Conclusions: The high prevalence of insomnia in our sample of Portuguese adolescents confirms findings from epidemiologic studies that have shown insomnia to affect from 4.4 to 13.4 % of adolescents. The main risk factors for insomnia among these adolescents are gender (female), age (≥16 years), depression, and coffee and alcohol consumption, which is also in concordance with those in the literature.     

Environmental and socio-demographic factors associated to asthma in adolescents in Rio de Janeiro, Brazil

Although asthma is of frequent occurrence, little is known about the factors associated with this disease in Brazil. We studied the association between asthma, environmental and socio-demographic factors in adolescents in Nova lguacu, Rio de Janeiro State. Cross-sectional study using the questionnaires about asthma and environmental factors from the International Study of Asthma and Allergies in Childhood (ISAAC). We performed bivariate analyses between asthma and the factors studied using prevalence ratio (PR), confidence intervals of 95% (95% Cl) and Chi-squared test. Factors associated to asthma in a bivariate analysis were studied using logistic regression and odds ratio (OR). We included 3,033 students, aged 13-14 yrs, selected from 37 schools. The prevalence of asthma was 13.1%. Being female (OR = 1.40; 95%Cl:1.11-1.77), the presence of a mother who smokes (OR = 1.32; 95%Cl:1.04-1.66), a cat in the domicile (OR = 1.32; 95%Cl:1.04-1.69), being the firstborn (OR = 1.34; 95%Cl:1.07-1.68), frequent use of paracetamol (OR = 1.45; 95%Cl: 1.15-1.84), the presence of rhinitis (OR = 5.15; 95%:3.89-6.82) and eczema (OR = 2.35; 95%Cl:1.73-3.19) were independently associated to asthma. Environmental and socio-demographic factors were associated to asthma in adolescents in Rio de Janeiro, irrespective of the presence of others allergic diseases. Interventions acting on these factors may decrease the occurrence of asthma in this population.