Adherence rate to inhaled corticosteroids and their impact on asthma control

BACKGROUND

Poor asthma control is associated to high morbidity. The objective of this study was to assess the association between adherence rates to beclomethasone dipropionate (BDP) and the degree of asthma control.

METHODS

A cohort concurrent study was carried out for 12 months with 122 asthmatic patients, aged 3-12 years, randomly selected in a pediatric pulmonology outpatient clinic, who received BDP free of charge. Adherence rates were verified by pharmacy records. Clinical control was assessed through a scoring system comprised four variables (nocturnal and morning symptoms, limitation of physical activities and exacerbations). Total score was 16 points. Patients whose score was below or equal to two were considered controlled (group 1), and patients whose score was above or equal to three were considered uncontrolled (group 2). For patients able to perform spirometry, we considered as controlled the patients with forced expiratory volume in 1 s (FEV(1)) equal to or above 80% of the predicted value, and as uncontrolled the patients with FEV(1) below 80%.

RESULTS

Fewer than half (40.3% maximum) of the 122 patients maintained asthma control. Median adherence rate of groups 1 and 2 were 85.5% and 33.8%, (P < 0.001) in the 4th month, 90.0% and 48.0% (P < 0.001) in the 8th month and 84.4% and 47.0% in the 12th month (P < 0.001), respectively.

CONCLUSION

In all periods, there were statistically significant differences in adherence rates for maintaining or not maintaining the asthma control. Optimal asthma control entailed adherence rate higher than 80%. Strategies for reducing asthma morbidity should include a regular monitoring of adherence to inhaled steroids.

Qualidade do preenchimento da Caderneta de Saúde da Criança e fatores associados

A Caderneta de Saúde da Criança (CSC) é um documento imprescindível para a promoção da saúde infantil. Foi realizado um estudo transversal com amostra aleatória simples de crianças acompanhadas no Sistema Único de Saúde (SUS), visando analisar os fatores associados à qualidade do preenchimento da CSC. Foram realizadas entrevistas e verificação direta das cadernetas de 365 crianças das nove regionais de saúde de Belo Horizonte, Minas Gerais, Brasil. Foi criado um sistema de escore para classificar as CSC quanto à qualidade do seu preenchimento e relacioná-la às variáveis explicativas. O odds ratio foi calculado por regressão logística. O preenchimento dos vinte itens do escore variou de 3,1% (uso de ferruginoso) a 99,7% (data de nascimento). Os fatores associados aos piores escores foram: crianças > 12 meses de idade (OR = 1,77), mães < 6 anos de estudo (OR = 1,97), crianças não acompanhadas por médicos generalistas (OR = 3,18) e mães que não receberam explicações sobre a CSC na maternidade (OR = 1,77). Os resultados apontam a precária utilização da CSC, reforçando a necessidade de investimentos em capacitação dos profissionais e organização dos serviços para que ela cumpra seu papel na promoção da saúde infantil.

Quality of life in asthmatic adolescents: an overall evaluation of disease control

OBJECTIVE

to evaluate the relative impact of reported symptoms, school absenteeism, hospital admission, medical visits, and the presence of emotional and behavioral disorders on the health-related quality of life (HRQL) of low income asthmatic adolescents.

METHODS

Asthmatic adolescents were randomly selected among public schools in Belo Horizonte/MG, Brazil. Asthma severity was rated according to the Global Initiative for Asthma (GINA) classification. Emotional and behavior disorders (EBDs) were evaluated through the Strengths and Difficulties Questionnaire. HRQL was assessed through the Pediatric Asthma Quality of Life Questionnaire (PAQLQ). PAQLQ score was analyzed for each intervening variable. Multivariate regression analysis was conducted.

RESULTS

One hundred and forty-six adolescents participated in the present study, 45% being male and age ranging from 14 to 16 years old. Mean PAQLQ score was 5.7 +/- 1.3 SD, with no significant difference regarding sociodemographic characteristics, except for gender (p = 0.001). The regression equation of the final model for the multivariate analysis was as follows: Mean PAQLQ score = 1.88 (Constant) - 0.42 gender + 1.14 nighttime symptoms + 0.69 medical visits in the past 12 months + 0.95 EBDs. Therefore, if the other variables remained constant, PAQLQ score: reduced in 0.42 points for females (p = 0.01); increased in 1.14 when there were no nighttime symptoms (p < 0.01); increased in 0.69 when there was no medical visit for respiratory problems within the past 12 months (p < 0.01); and increased in 0.95 when no EBDs were present (p < 0.01). This model was able to explain approximately half of the variation found in PAQLQ score (R-Sq = 49.4%).

CONCLUSIONS

HRQL of asthmatic adolescents is influenced by the complex interaction among several factors: the severity of clinical symptoms, morbidity, gender, and the psychological resources available so as to deal with such difficulties. A careful evaluation of HRQL is essential in order to capture feelings and subjective perceptions, which are not investigated by the conventional evaluation of asthma control.

Epidemiological trends of allergic diseases in adolescents

Objective:

To assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in adolescents in the city of Belo Horizonte, Brazil, in 2012 by administering the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire, as well as to compare the observed prevalences with those found in studies performed 10 years earlier and employing the same methodology used here.

Methods:

This was a cross-sectional study conducted between May and December of 2012 and involving adolescents in the 13- to 14-year age bracket. Participants were randomly selected from among adolescents studying at public schools in Belo Horizonte and completed the ISAAC questionnaire. Proportions were calculated in order to assess the prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in the sample as a whole, and the chi-square goodness-of-fit test was used in order to compare the prevalences observed in 2012 with those found in 2002.

Results:

The prevalences of symptoms of asthma, allergic rhinitis, and allergic rhinoconjunctivitis in 2012 were 19.8%, 35.3%, and 16.3%, respectively, being significantly higher than those found in 2002 (asthma, p = 0.006; allergic rhinitis, p < 0.01; and allergic rhinoconjunctivitis, p = 0.002).

Conclusions:

The prevalences of asthma, allergic rhinitis, and allergic rhinoconjunctivitis among adolescents in 2012 were found to be high, having increased in comparison with those found 10 years earlier, despite efforts in prevention, diagnosis, and treatment.

Oral and inhaled corticoid treatment for wheezing in the first year of life

OBJECTIVE

To evaluate the prevalence of corticoid utilization for the treatment of wheezing in infants less than 12 months old and to analyze factors associated with this practice.

METHODS

This was a cross-sectional study that administered the validated questionnaire from the International Study on the Prevalence of Wheezing in Infants to 1,261 infants aged 12 to 15 months in Belo Horizonte, Brazil. Proportions and 95% confidence intervals were calculated and the chi-square test was used to detect associations between variables.

RESULTS

Six hundred and fifty-six (52%) infants, 53% male and 48.2% white, exhibited wheezing during the first year of life. Mean age at first episode was 5.11±2.89 months. There was a high rate of morbidity, with many emergency visits (71%) and hospitalizations (27.8%). Also common were a family history of asthma and atopic disease (32.2 to 71%) and exposure to passive smoking (41.5%) and to mould (47.3%). The prevalence rates for corticoid use, whether via oral route (48.7%) or inhaled (51.3%), were elevated and were higher in the group that suffered three or more episodes. Children suffering greater morbidity were more likely to be prescribed a corticoid (p < 0.05).

CONCLUSION

The high frequency of corticoid use highlights the need to establish specific criteria for the treatment of wheezing in the first years of life in order to avoid extrapolation of asthma treatments to other conditions that are transitory and self-limiting and in which using corticoids could involve more risk than benefit.

Asthma and allergic rhinitis co-morbidity: a cross-sectional questionnaire study on adolescents aged 13-14 years

AIMS

There is scarce epidemiological population-based data on the prevalence of asthma and allergic rhinitis (AR) co-morbidity in adolescents. The aim was to verify asthma and AR prevalence rates in order to emphasise asthma/AR co-morbidity.

METHODS

Cross-sectional study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire in adolescents aged 13-14 years, chosen randomly from public schools in Belo Horizonte, Brazil.

RESULTS

A total of 3262 students were identified, 3083 (47.3% males) of whom completed the questionnaire (response rate 94.7%). The prevalence of symptoms related to asthma and AR co-morbidity was 8.4% (95% CI, 8.09-10.25). Among asthmatic adolescents, symptoms of AR were reported in 46.5% (95% CI, 42.60-52.08%).

CONCLUSIONS

There is a high prevalence of adolescent asthma and AR co-morbidity in this area of Brazil. This co-morbidity is an important health issue that requires strategic application of primary health care facilities to achieve adequate control of both asthma and allergic rhinitis.

Correlation between Bhalla score and spirometry in children and adolescents with Cystic Fibrosis

Objective: to correlate the findings of high resolution computed tomography of the chest based on the Bhalla score with the clinical data and spirometry in children and adolescents with cystic fibrosis, and to study the concordance between two radiologists for the Bhalla score and its categories. Methods: we evaluated the medical records of 23 patients from the outpatient clinic. The items evaluated included age, weight, height, height/age Z-score, weight/age Z-score, body mass index (BMI), O2 saturation, spirometry and Bhalla score. Results: the patients had a mean age of 17.4 years ± 5.7 years, with fifteen females and eight males. There was good correlation between Bhalla score and spirometry (FVC-r =0.718, p<0.001; FEV1-r=0.830, p<0.001; FEF25-75%-r =0.786, p<0.001; FEV1/FVC-r=0.714, p<0.001). It was also noted that some patients with FEF25-75%> 70% already had changes in their final Bhalla score. In the analysis of the concordance between the examiners a Kappa coefficient of 0.81 (p <0.001) was found, and an intraclass correlation coefficient of 0.98. Conclusion: a good correlation between Bhalla scores with spirometry confirmed its usefulness in evaluating and monitoring patients with cystic fibrosis, given it can be used both in patients who are unable to perform spirometry as well as for a pooled analysis of the two examinations since the HRCT scans show early changes in patients with normal function tests.

["Children cannot wait": why mothers seek urgency and emergency care services for their children in non-urgent situations]

The scope of this article is to seek to understand the reasons why mothers seek urgency and emergency attention for children in non-urgent situations in a public hospital of the Unified Health System in Belo Horizonte in the state of Minas Gerais. It is a study involving a qualitative approach with semi-structured interviews as the data collection tool. Twenty-seven mothers of children with complaints classified as minor and non-urgent were interviewed. Fever and respiratory problems were found to be the main complaints. Even when the situation is non-urgent, mothers take their children to the emergency service because of the swift resolution, quality and specific pediatric medical care advantages, ease of access, previous experiences and recommendations from others, among other reasons. The statements revealed the mismatch between these mothers' feelings and the rationale of the organization of the service. This work raises questions that can provide input for reflection on the organization of the services centered on the users, who are in the final analysis the subject and scope of the care-giving process.

Prevalence of emotional and behavioral disorders in adolescents with asthma

OBJECTIVE

To determine the prevalence of emotional and behavioral disorders in adolescents with asthma and to compare it with that of adolescents without asthma.

METHODS

A transversal study using the Strengths and Difficulties Questionnaire, administered to adolescents with or without asthma, ranging from 14 to 16 years of age and randomly selected from schools in the city of Belo Horizonte, Brazil.

RESULTS

The prevalence of emotional and behavioral disorders in adolescents with and without asthma was 20.4% (95% CI: 14.5-27.8%) and 9.0% (95% CI: 6.1-12.8%), respectively. Among adolescents with asthma, 56.6% (95% CI: 48.3-64.5%) presented normal scores, and 23.0% (95% CI 16.8-30.7%) presented borderline scores. Among adolescents without asthma, 75.0% (95% CI: 69.7-79.6%) presented normal scores, and 16.0% (95% CI: 12.2-20.7%) presented borderline scores. The median total score on the questionnaire was 14 and 12 among subjects with and without asthma, respectively (p < 0.01). In the final logistic regression model, adjusted for socioeconomic variables, the association between emotional/behavioral disorders and the following variables remained significant: being female (OR = 1.98; 95% CI: 1.10-3.56; p = 0.02) and having asthma (OR = 2.66; 95% CI: 1.52-4.64; p = 0.001).

CONCLUSIONS

The prevalence of emotional and behavioral disorders is higher in adolescents with asthma than in those without asthma, underscoring the need for a holistic, interdisciplinary approach.

Does BCG revaccination protect against the development of asthma?

Single BCG vaccination has been considered as a protective factor against asthma. However the effect of a second dose of BCG on the prevalence rate of asthma and asthma-allergic rhinitis-eczema comorbidity has not been studied exclusively among adolescents. In this ISAAC protocol-based cross sectional study we assessed the association between one single versus two doses of BCG among 2213 individuals aged 13-14 years old. We found no association between BCG revaccination and asthma, associated (OR = 0.68, 95% CI, 0.37-1.25) or not to allergic rhinitis and/or atopic eczema (OR = 1.07, 95% CI, 0.84-1.36).

Lung function in severe pediatric asthma: a longitudinal study in children and adolescents in Brazil

Background

In severe asthma, high doses of inhaled corticosteroids (ICS) are used in order to achieve clinical and functional control. This study aimed to evaluate lung function in outpatients (children and adolescents) with severe asthma in Brazil, all of whom were treated with high doses of ICS. We evaluated all spirometry tests together and by ICS dose: 800 and > 800 µg/day.

Methods

This was a 3-year longitudinal study in which we analyzed 384 spirometry tests in 65 severe asthma patients (6–18 years of age), divided into two groups by the dose of ICS (budesonide or equivalent): 800 and > 800 µg/day.

Results

At baseline, the forced expiratory volume in one second (FEV₁) and the FEV₁/forced vital capacity (FVC) ratio were both < 80% of the predicted values in 50.8% of the patients. The median age of the patients was 10.4 years (interquartile range 7.8–13.6 years). In the sample as a whole, there were significant increases in FEV₁% and in the FEV₁/FVC% ratio (p = 0.01 and p < 0.001, respectively) over the course of the study. In the > 800 µg/day group, there were no statistical increases or decreases in FEV₁, the FEV₁/FVC ratio, or forced expiratory flow between 25 and 75% of the FVC (FEF_25–75%), when calculated as percentages of the predicted values. However, the z-score for FEF_25–75% showed a statistically significant reduction, in the sample as a whole and in the > 800 µg/day group. Also in the > 800 µg/day group, there was a significant reduction in the post-bronchodilator FEV₁% (p = 0.004).

Conclusions

The fact that the spirometric parameters (as percentages of the predicted values) remained constant in the > 800 µg/day group, whereas there was a gain in lung function in the sample as a whole, suggests an early plateau phase in the > 800 µg/day group. However, there was some loss of lung function in the > 800 µg/day group, as evidenced by a decrease in the z-score for FEF_25–75%, suggesting irreversible small airway impairment, and by a reduction in the post-bronchodilator FEV₁%, suggesting reduced reversibility of airway obstruction. Among children and adolescents with severe asthma, the use of ICS doses higher than those recommended for age does not appear to improve lung function.

Pulmonary function in children and adolescents with sickle cell disease: have we paid proper attention to this problem?

Objective:

To evaluate pulmonary function and functional capacity in children and adolescents with sickle cell disease.

Methods:

This was a cross-sectional study involving 70 children and adolescents (8-15 years of age) with sickle cell disease who underwent pulmonary function tests (spirometry) and functional capacity testing (six-minute walk test). The results of the pulmonary function tests were compared with variables related to the severity of sickle cell disease and history of asthma and of acute chest syndrome.

Results:

Of the 64 patients who underwent spirometry, 15 (23.4%) showed abnormal results: restrictive lung disease, in 8 (12.5%); and obstructive lung disease, in 7 (10.9%). Of the 69 patients who underwent the six-minute walk test, 18 (26.1%) showed abnormal results regarding the six-minute walk distance as a percentage of the predicted value for age, and there was a ≥ 3% decrease in SpO₂ in 36 patients (52.2%). Abnormal pulmonary function was not significantly associated with any of the other variables studied, except for hypoxemia and restrictive lung disease.

Conclusions:

In this sample of children and adolescents with sickle cell disease, there was a significant prevalence of abnormal pulmonary function. The high prevalence of respiratory disorders suggests the need for a closer look at the lung function of this population, in childhood and thereafter.

From lip to lab: salty tasting skin is the main clue that raises clinical suspicion of cystic fibrosis in young infants

AIM

This study developed a clinical decision rule (CDR) to rule in or rule out cystic fibrosis (CF) in the first weeks of life.

METHODS

We combined a two-step nonconcurrent birth cohort and a cross-sectional controlled study in which observers and mothers were blinded to confirmatory sweat test results. Neonates from uncomplicated pregnancies and deliveries, with two subsequent tests for immunoreactive trypsinogen (IRT) higher than 70 ng/mL, were eligible to take part.

RESULTS

We included 49 CF-affected and 177 CF-unaffected infants with an average age of 34 days. CF-affected infants demonstrated statistically significant differences in weight gain, stool frequency and salty tasting skin from birth. Multivariate analysis showed that the main predictors of CF were salty tasting skin (odds ratio 17.2) and weight gain of <10.5 g per day (odds ratio 4.6). Depending on the CDR score, we obtained the following results: sensitivity (42.9-61.2%), specificity (89.6-96.5%), positive (62.5-77.8%) and negative (85.6-89.1%) predictive value and positive (5.8-12.3) and negative (0.4-0.6) likelihood ratio.

CONCLUSION

The CDR could provide a reliable index of clinical suspicion and timely referral for sweat testing in settings without newborn screening programmes and may also be applied to false-negative individuals where such programmes already exist.

Parapneumonic pleural effusion: early versus late thoracoscopy

Objective:

To evaluate the best time to perform thoracoscopy for the treatment of complicated parapneumonic pleural effusion in the fibrinopurulent phase in patients ≤ 14 years of age, regarding the postoperative evolution and occurrence of complications.

Methods:

This was a retrospective comparative study involving patients with parapneumonic pleural effusion presenting with septations or loculations on chest ultrasound who underwent thoracoscopy between January of 2000 and January of 2013. The patients were divided into two groups: early thoracoscopy (ET), performed by day 5 of hospitalization; and late thoracoscopy (LT), performed after day 5 of hospitalization.

Results:

We included 60 patients, 30 in each group. The mean age was 3.4 years; 28 patients (46.7%) were male; and 47 (78.3%) underwent primary thoracoscopy (no previous simple drainage). The two groups were similar regarding gender, age, weight, and type of thoracoscopy (p > 0.05 for all). There was a significant difference between the ET and the LT groups regarding the length of the hospital stay (14.5 days vs. 21.7 days; p < 0.001). There were also significant differences between the groups regarding the duration of fever in days; the total number of days from admission to the initiation of drainage; and the total number of days with the drain in place. Eight patients (13.6%) had at least one post-thoracoscopy complication, there being no difference between the groups. There were no deaths.

Conclusions:

Performing ET by day 5 of hospitalization was associated with shorter hospital stays, shorter duration of drainage, and shorter duration of fever, although not with a higher frequency of complications, requiring ICU admission, or requiring blood transfusion.

Correlation between peak nasal inspiratory flow and peak expiratory flow in children and adolescents

BACKGROUND

PEAK nasal inspiratory flow (PNIF) has been proposed as a simple method to evaluate nasal patency. Asthma and allergic rhinitis are commonly associated, and lower airway assessment can provide information concerning an objective interpretation of nasal function.

AIMS

TO determine whether the PNIF is correlated with peak expiratory flow (PEF) in children and adolescents.

METHODS AND RESULTS

Cross-sectional study carried out in healthy students randomly chosen in 14 public schools of the city of Belo Horizonte. PNIF and PEF were assessed for each subject as the following characteristics: gender, height, weight and age. We created a linear regression model to explain the PNIF, in which we included all the variables with a p value ≤ 0.25 in a univariate analysis, and to calculate the relationship between the maximum PNIF and maximum PEF by the Spearman correlation coefficient. In total, 297 healthy subjects, aged between six and eighteen years were evaluated. A positive and significant correlation between PNIF and PEF was found.

CONCLUSIONS

PEF is predictive of PNIF. However, these measures evaluate two distinct segments of the airways and should be both obtained for a more precise assessment of airflow limitation.

Sweat conductivity for diagnosing cystic fibrosis after positive newborn screening: prospective, diagnostic test accuracy study

OBJECTIVE

To assess the accuracy of sweat conductivity among newborns and very young infants.

DESIGN

Prospective, population-based, diagnostic test accuracy study.

SETTING

Public Statewide Newborn Screening Programme where the incidence rate of cystic fibrosis (CF) is ≈1:11 000.

PATIENTS

Newborns and very young infants with positive two-tiered immunoreactive trypsinogen.

INTERVENTIONS

Sweat conductivity and sweat chloride were performed simultaneously, on the same day and facility by independent technicians, with the cut-off values of 80 mmol/L and 60 mmol/L, respectively.

MAIN OUTCOME MEASURES

Sensitivity, specificity, positive and negative predictive values (PPV and NPV), overall accuracy, positive and negative likelihood ratios (+LR, -LR) and post (sweat conductivity (SC)) test probability were calculated to assess SC performance.

RESULTS

1193 participants were included, 68 with and 1108 without CF, and 17 with intermediate values. The mean (SD) age was 48 (19.2) days, ranging from 15 to 90 days. SC yielded sensitivity of 98.5% (95% CI 95.7 to 100), specificity of 99.9% (95% CI 99.7 to 100), PPV of 98.5% (95% CI 95.7 to 100) and NPV of 99.9% (95% CI 99.7 to 100), overall accuracy of 99.8% (95% CI 99.6 to 100), +LR of 1091.7 (95% CI 153.8 to 7744.9) and -LR of 0.01 (95% CI 0.00 to 0.10). After a positive and negative sweat conductivity result, the patient's probability of CF increases around 350 times and drops to virtually zero, respectively.

CONCLUSION

Sweat conductivity had excellent accuracy in ruling in or ruling out CF after positive two-tiered immunoreactive trypsinogen among newborns and very young infants.

Sweat conductivity diagnostic accuracy for cystic fibrosis: a systematic review and meta-analysis

OBJECTIVE

We conducted a systematic review and meta-analysis of diagnostic test accuracy studies to summarise the properties of sweat conductivity (SC) to rule in/out cystic fibrosis (CF).

DATA SOURCE

We searched PubMed, Embase, Web of Science, Google Scholar, SciELO and LILACS up to 13 March 2023.

STUDY SELECTION

We selected prospective and retrospective diagnostic test accuracy studies which compared SC, measured through two well-established and commercially available devices, that is, Nanoduct or Sweat-Chek Analyser, to quantitative measurement of sweat chloride.

MAIN OUTCOME MEASURES

Pooled sensitivity, specificity, positive likelihood ratio (+LR) and negative likelihood ratio (-LR), and their corresponding 95% CIs.

DATA EXTRACTION AND SYNTHESIS

The Preferred Reporting Items for a Systematic Review and Meta-analysis of Diagnostic Test Accuracy Studies guidelines were followed. Data were extracted by one reviewer and checked by another. The hierarchical summary receiver operating characteristics model was used to estimate diagnostic test accuracy.

RESULTS

Ten studies involving 8286 participants were included. The pooled estimates of sensitivity, specificity, +LR and -LR were 0.97 (95% CI 0.94 to 0.98), 0.99 (95% CI 0.98 to 0.99), 171 (95% CI 58 to 500) and 0.02 (95% CI 0.01 to 0.05), respectively. Sensitivity analyses did not reveal a substantial impact of study-level factors on the results, such as study quality, cut-off values for a positive test, study sample size and participant age group. The quality of evidence was considered moderate.

CONCLUSION

SC demonstrated excellent diagnostic performance. In addition, its accuracy parameters suggest its role as an alternative to the sweat test for CF diagnosis.

PROSPERO REGISTRATION NUMBER

CRD42022284504.

[Adolescence and asthma management: the perspective of adolescents receiving primary health care]

OBJECTIVE

To study the influence of adolescence characteristics on asthma management.

METHODS

This is a qualitative study conducted in the city of Divinópolis, in Minas Gerais, Southeast Brazil. The data were collected by semi-structured interviews guided by an interview guide with seven asthmatic adolescents followed in primary public health service of the city.

RESULTS

Using content analysis, three thematic categories were found in the adolescents responses: 1) Family relationships in the treatment of asthma in adolescence; 2) The asthmatic adolescent and their peers; and 3) The role of the school in the asthmatic adolescents.

CONCLUSIONS

The results showed that peers, family and school should be more valued by professionals and by health services and care for asthmatic adolescents since these social relationships are intimately connected with teenagers and have an important role for the asthma treatment. Attempts to meet the demands of adolescents contribute to improve asthma management.

Language evaluation protocol for children aged 2 months to 23 months: analysis of sensitivity and specificity

PURPOSE

To establish cutoff points for the analysis of the Behavior Observation Form (BOF) of children in the ages of 2 to 23 months and evaluate the sensitivity and specificity by age group and domains (Emission, Reception, and Cognitive Aspects of Language).

METHODS

The sample consisted of 752 children who underwent BOF. Each child was classified as having appropriate language development for the age or having possible risk of language impairment. Performance Indicators (PI) were calculated in each domain as well as the overall PI in all domains. The values for sensitivity and specificity were also calculated. The cutoff points for possible risk of language impairment for each domain and each age group were obtained using the receiver operating characteristics curve.

RESULTS

The results of the study revealed that one-third of the assessed children have a risk of language impairment in the first two years of life. The analysis of BOF showed high sensitivity (>90%) in all categories and in all age groups; however, the chance of false-positive results was higher than 20% in the majority of aspects evaluated. It was possible to establish the cutoff points for all categories and age groups with good correlation between sensitivity and specificity, except for the age group of 2 to 6 months.

CONCLUSION

This study provides important contributions to the discussion on the evaluation of the language development of children younger than 2 years.

[Continuing or discontinuing BCG revaccination in adolescents]

BCG revaccination was introduced in Brazil in the mid-90's but no study has evaluated vaccine coverage through direct assessment of the scar. BCG scars were assessed in 2,785 public school adolescents, aged 13 to 14 years, in Southeastern Brazil, between September 2001 and May 2002. The prevalence rate of revaccination was 64.3% (95% CI: 62.5-66.0). Despite the efforts to implement and sustain revaccination, continuing this practice should be reevaluated by public health authorities due to the lack of evidence on its effectiveness.

Rate and predictors of insufficient sweat volume in very young infants after pilocarpine gel iontophoresis: prospective, population-based study

OBJECTIVE

To verify the rate and predictors of 'quantity not sufficient' (QNS) among Brazilian infants younger than 3 months with positive newborn screening (NBS) for cystic fibrosis (CF).

DESIGN

Prospective, population-based study.

SETTING

Public Statewide Newborn Screening Programme where the incidence rate of CF is ≈1:11 000.

PATIENTS

Subjects with positive two-tiered immunoreactive trypsinogen.

INTERVENTIONS

Sweat induction and collection were performed in the same facility; one sweat sample was obtained per individual.

MAIN OUTCOME MEASURES

The QNS rate and its predictors; analysis corresponded to the day of sweat collection.

RESULTS

Among the 975 participants, QNS rates for 10 and 15 µL were 3.6% (95% CI 2.5% to 4.9%) and 8.3% (95% CI 6.6% to 10.2%). Infants weighing >3056 and >3845 g and with gestational age higher than 37 weeks had a greater likelihood (5.5 and 6.7, and 2.7 and 5.8 times more, respectively) of avoiding QNS than their peers.

CONCLUSION

QNS rates fulfilled the requirements, but predictors differed from those recommended by the Cystic Fibrosis Foundations guidelines.