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      Características clínicas de los niños asmáticos hospitalizados en un Servicio de Pediatría Translated title: Clinical characteristics of asthmatic children hospitalized in a pediatric unit

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          Abstract

          Introducción:El asma es una enfermedad heterogénea con prevalencia descrita en aumento. En Chile, existen escasos estudios en que se describa las características clínicas de los pacientes pediátricos hospitalizados. Objetivos: Describir las características clínicas de los niños hospitalizados por episodios de crisis asmáticas. Pacientes y Método: Estudio descriptivo, restrospectivo en niños con asma entre 6 y 15 años, hospitalizados en el Servicio de Pediatría del Hospital Clínico de la Pontificia Universidad Católica de Chile, entre los años 1998 y 2004. Resultados: De un total de 317 fichas clínicas que correspondían a pacientes asmáticos hospitalizados, se pudo acceder sólo a 188, de las cuales 113 cumplían con los criterios de inclusión. Sesenta y ocho fichas correspondían a niños (61%), setenta y cinco niños iniciaron cuadros obstructivos antes de los 3 años (66%), el desencadenante más frecuente fueron los virus respiratorios en 53 casos (47%), el 93% (105 casos) requirió FiO2 < 0,5%, y 60 pacientes (53%) tenían antecedentes de atopía. Conclusión: La mayoría de los pacientes hospitalizados presentó crisis leves o moderadas, sin requerir ingreso a la unidad de paciente crítico. La atopía fue un antecedente frecuente. Es importante realizar un estudio prospectivo que evalúe el tipo y adherencia a tratamiento en relación a la evolución clínica del asma en niños

          Translated abstract

          Background: Asthma is a heterogeneous disease with arising prevalence. There are few studies in Chile that describe clinical characteristics of pediatric hospitalized patients. Objective: To describe clinical characteristics of patients hospitalized due to asthma attacks. Method: Descriptive-retrospective study in asthmatic children between 6 and 15 years-old, hospitalized in the Pediatric Service at the Clinical Hospital of Pontificia Universidad Católica of Chile between 1998 and 2004. Results: From a total of 317 asthmatic clinical charts, we reviewed 188 (61%), from which 113 met inclusion criteria. Sixty eight patients were male (61%), 75 cases (66%) presented acute exacerbations before 3 years-old, the most frequent trigger was respiratory virus infections in 53 cases (47%), 93% (105 patients) required FiO2 < 50% and atopy was present in 60 patients (53%). Conclusion: The majority of hospitalized patients presented mild or moderate crisis and did not need management on intensive critical units. Atopy was a frequent finding. It is important to develop a prospective study that evaluates type and adherence to asthma treatment, in order to achieve clinical influence in asthma evolution

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          Siblings, day-care attendance, and the risk of asthma and wheezing during childhood.

          Young children with older siblings and those who attend day care are at increased risk for infections, which in turn may protect against the development of allergic diseases, including asthma. However, the results of studies examining the relation between exposure to other children and the subsequent development of asthma have been conflicting. In a study involving 1035 children followed since birth as part of the Tucson Children's Respiratory Study, we determined the incidence of asthma (defined as at least one episode of asthma diagnosed by a physician when the child was 6 to 13 years old) and the prevalence of frequent wheezing (more than three wheezing episodes during the preceding year) in relation to the number of siblings at home and in relation to attendance at day care during infancy. The presence of one or more older siblings at home protected against the development of asthma (adjusted relative risk for each additional older sibling, 0.8; 95 percent confidence interval, 0.7 to 1.0; P=0.04), as did attendance at day care during the first six months of life (adjusted relative risk, 0.4; 95 percent confidence interval, 0.2 to 1.0; P=0.04). Children with more exposure to other children at home or at day care were more likely to have frequent wheezing at the age of 2 years than children with little or no exposure (adjusted relative risk, 1.4; 95 percent confidence interval, 1.1 to 1.8; P=0.01) but were less likely to have frequent wheezing from the age of 6 (adjusted relative risk, 0.8; 95 percent confidence interval, 0.6 to 1.0; P=0.03) through the age of 13 (adjusted relative risk, 0.3; 95 percent confidence interval, 0.2 to 0.5; P<0.001). Exposure of young children to older children at home or to other children at day care protects against the development of asthma and frequent wheezing later in childhood.
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            Trends in childhood asthma: prevalence, health care utilization, and mortality.

            Our objective was to use national data to produce a comprehensive description of trends in childhood asthma prevalence, health care utilization, and mortality to assess changes in the disease burden among US children. Five data sources from the National Center for Health Statistics were used to describe trends in asthma for children aged 0 to 17 years from 1980 to the most recent year for which data were available. These included the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics System. Asthma prevalence increased by an average of 4.3% per year from 1980 to 1996, from 3.6% to 6.2%. The peak prevalence was 7.5% in 1995. In 1997, asthma attack prevalence was 5.4%, but changes in the NHIS design in 1997 preclude comparison to previous estimates. Asthma attack prevalence remained level from 1997 to 2000. After a decrease between 1980 and 1989, the asthma office visit rate increased by an average of 3.8% per year from 1989 to 1999. The asthma hospitalization rate grew by 1.4% per year from 1980 to 1999. Although childhood asthma deaths are rare, the asthma death rate increased by 3.4% per year from 1980 to 1998. Children aged 0 to 4 years had the largest increase in prevalence and had greater health care use, but adolescents had the highest mortality. The asthma burden was borne disproportionately by black children throughout the period. Racial disparities were largest for asthma hospitalizations and mortality: compared with white children, in 1998-1999, black children were >3 times as likely to be hospitalized and in 1997-1998 >4 times as likely to die from asthma. Recent data suggest that the burden from childhood asthma may have recently plateaued after several years of increasing, although additional years of data collection are necessary to confirm a change in trend. Racial and ethnic disparities remain large for asthma health care utilization and mortality.
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              Epidemiologic aspects of overweight and obesity in the United States.

              National survey data from the U.S. show that the prevalence of overweight and obesity among adults remained relatively constant over the 20-year period from 1960 to 1980, began to increase around the mid-1980s and has continued to increase. Data for children and adolescents, based on different definitions, show the same pattern. It can sometimes be more useful to look at the whole distribution of body mass index, rather than on prevalence estimates based on pre-defined cutoffs. Data from several countries suggest that for both adults and children, the distribution of BMI has become more skewed over time. Although many hypotheses have been put forward about the causes of the increases, data to address these issues are sparse. Obesity is a well-known risk factor for numerous health conditions. Nonetheless, the health consequences of the increases in obesity have not been fully delineated. Increases in diabetes have been noted in conjunction with the rise in obesity. On the other hand, declines in some other cardiovascular risk factors have been seen at all BMI levels. Rising life expectancy and decreasing heart disease mortality rates seem to confound some of the expectations about the effects of increasing obesity on mortality. The effects of obesity on morbidity may be greater than its effects on mortality. The increasing prevalence of obesity poses challenges for researchers and for policy makers.
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                Author and article information

                Journal
                rcp
                Revista chilena de pediatría
                Rev. chil. pediatr.
                Sociedad Chilena de Pediatría (Santiago, , Chile )
                0370-4106
                February 2007
                : 78
                : 1
                : 29-34
                Affiliations
                [01] orgnamePontificia Universidad Católica de Chile orgdiv1Departamento de Pediatría orgdiv2Sección de Respiratorio Chile
                Article
                S0370-41062007000100004 S0370-4106(07)07800104
                10.4067/S0370-41062007000100004
                8e3c9bcc-898c-477c-a03d-175523904028

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 14 March 2006
                : 29 December 2006
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 25, Pages: 6
                Product

                SciELO Chile

                Categories
                ARTÍCULOS ORIGINALES

                asma,atopy,hospital admission,children,asthma,atopia,hospitalización,niños

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