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- Hederos, Carl-Axel, et al.
(författare)
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Comparison of clinically diagnosed asthma with parental assessment of children's asthma in a questionnaire
- 2007
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Ingår i: Pediatric Allergy and Immunology. - : Wiley. - 0905-6157 .- 1399-3038. ; 18:2, s. 135-141
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Tidskriftsartikel (refereegranskat)abstract
- Epidemiological evaluations of the prevalence of asthma are usually based on written questionnaires (WQs) in combination with validation by clinical investigation. In the present investigation, we compared parental assessment of asthma among their preschool children in response to a WQ with the corresponding medical records in the same region. An International Study of Asthma and Allergies in Childhood (ISAAC)-based WQ was answered by 75% of the parents of 6295 children aged 1–6 yr. Clinically diagnosed asthma, recorded in connection with admissions to the hospital or a visit to any of the outpatient clinics in the same region, were analysed in parallel. Finally, a complementary WQ was sent to the parents of children identified as asthmatic by either or both of this approaches. In response to the WQ 5.9% were claimed to suffer from asthma diagnosed by a doctor. According to the medical records, the prevalence of clinically diagnosed asthma was 4.9%. The estimated prevalence among children requiring treatment for their asthma was 4.4%. The sensitivity of the WQ was 77%, the specificity 97.5%. In the 1–2 yr age group the sensitivity was only 22%. This WQ was able to identify 54% of the children with a medical record of asthma. Forty percent of the children claimed by their parents to be asthmatic had no medical record of asthma. An ISAAC-based parentally completed WQ provided an acceptable estimation of the prevalence of asthma in children 2–6 yr of age, although only half of the individual patients identified in this manner are the same as those identified clinically.
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| 3. |
- Hederos, Carl-Axel
(författare)
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Asthma in young children : epidemiology, burden of asthma and effects of a parental information program
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: The prevalence of asthma is usually estimated on the basis of the results of questionnaires. A comparison with prevalence according to medical records has not been reported before. Adherence to medical advice and prescriptions are generally poor in chronic diseases like asthma. There is a lack of intervention studies to improve adherence. Aims: 1: To perform an epidemiological analysis of the asthma prevalence and the use of the healthcare system in a Swedish region. 2: To compare the parental assessment of children s asthma according to a questionnaire with physicians diagnosed asthma. 3: To perform an intervention with additional information and support to parents of preschool children with newly diagnosed asthma in order to improve adherence. 4: To evaluate the effects on quality of life and separately analyze the answers of the mothers and the fathers. 5: To analyze any remaining intervention effects after 6 years. Methods: Firstly, all outpatient clinics had computerised patient records and thus these visits could be studied as well as admissions to hospital for asthma. In 1999 a questionnaire was answered by 75% of the parents of 6 295 children 1-6 years of age. Secondly, a controlled, prospective intervention study where the parents of 60 children were randomised to either a control group (CG) or to an intervention group (IG) which had group meetings in close connection to the diagnosis. Outcome was measured by questionnaires and by classification of the children according to clinical examination, blood tests, symptoms and medication. Adherence rate was calculated with the help of diaries and weighing the inhalers used. Fathers and mothers answered separately the Paediatric Caregiver s Quality of Life Questionnaire. Children were followed up after 6 years and objective measurements of lung function were added to the other parameters. Results: The burden of asthma was mainly handled by the outpatient clinics. According to the parental questionnaire 5.9 % had asthma in 1999, according to the medical records 4.9%. With register diagnosis as gold standard the sensitivity of the questionnaire was 77%. The questionnaire identified half of the children with a medical record of asthma. Forty percent of the children claimed by their parents to be asthmatic had no medical record of asthma. One third of the children with newly diagnosed asthma had risk of developing persistent asthma. The intervention resulted in an improvement of the parents view on adherence issues and on adherence per se. The children in the IG had less exacerbation days despite having lower inhaled steroid doses. There were no major gender differences in indices of quality of life, but according to individual questions mothers were more affected by their children s asthma. After 6 months the mothers in the IG showed improvements in all indices. At the 6 year follow-up 71% still had asthma. The IG had fewer contacts with nurses than the CG and they had lower inhaled corticosteroid (ICS) doses. The IG parents still had a more positive view on adherence questions and their quality of life was better. The children who were older than 2 years of age at inclusion had a higher risk of developing persistent asthma. Intermittent ICS was used by 81%. The lung function was preserved. The burden on the health care system was low. Hospital admittances due to asthma in the region are the lowest in the country. Conclusions: A parentally completed questionnaire provided an acceptable estimation of the prevalence of asthma in children 2-6 years of age compared to asthma registered in medical records although in half of the cases the individual child was not identified. Straightforward and timely information to parents of children with asthma has long-term positive effects which can be mediated through equalization of the parent s roles in handling their child s asthma. The hospital admissions due to asthma are very few, possibly as a result of the intervention and improved medical care in the paediatric outpatient clinics. Asthma diagnosed before age 2 has a better prognosis. Most children with a high risk of persistent asthma can be successfully treated with intermittent ICS.
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| 4. |
- Wikholm, Emma, et al.
(författare)
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Iron Deficiency Is Common During Remission in Children With Inflammatory Bowel Disease
- 2016
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Ingår i: Global pediatric health. - : Sage Publications. - 2333-794X. ; 3
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to study prevalence of iron deficiency in children with inflammatory bowel disease (IBD) during remission. In addition, there was an observational evaluation of hematological response to oral iron. A population-based retrospective study including 90 Swedish children (median 13 years) with IBD was performed. Patient records covered in median 25 months. Iron deficiency was present in 70/77 children (91%) in which iron status could be assessed. In clinical and biochemical remission, iron deficiency was found in 57/67 (85%) of children, and 23 (34%) of them had iron deficiency anemia. Thirty-six iron-deficient children were prescribed oral iron supplementation and 32 (89%) improved hemoglobin levels over 6 months. In conclusion, iron deficiency is common during clinical remission in children with IBD, even in cohorts with low prevalence of anemia. Therefore, regular biochemical screening for iron deficiency is warranted during all stages of disease, irrespective of symptoms and inflammatory blood markers.
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