A Aldasoro Ruiz

University Hospital Donostia, San Sebastián, Basque Country, Spain

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Publications (13)5.2 Total impact

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    ABSTRACT: Objective Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management.Material and methodBefore and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied.ResultsA total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1 ± 3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3 ± 4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0 ± 4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4 ± 3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001).Conclusions An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.
    Anales de Pediatría. 10/2012; 77(4):236–246.
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    ABSTRACT: Our objective was to measure the impact of an educational intervention program on teacher's knowledge about asthma and its management. Before and after quasi-experimental study, with control group, of an educational intervention, which had as its aim to improve the teacher's knowledge of asthma and its management, was conducted in some schools of San Sebastian (Gipuzkoa), Spain. The Newcastle Asthma knowledge Questionnaire (NAKQ) was used as a measuring tool, and an adaptation of the asthma, sport and health program was used as an educational intervention. The Wilcoxon signed rank test was used to compare the total score of the questionnaire before and after the intervention, and the McNemar test was performed to compare the percentages of correct answers to each item. The Mann-Whitney U test was also performed to compare the baseline score and the score at three months between the intervention group and control group. The size of the effect and the standardised mean response were studied. A total of 138 teachers from 6 schools, which were chosen at random (study group), and 43 teachers in the control group participated in the study. In the study group, the mean score of the NAKQ before the educational intervention was 16.1±3.4 points, with a median of 16 (range 7 to 23). After the intervention the mean score increased to 22.3±4.1, with a median of 23 (range, 6 to 29). The mean difference in the overall score of the NAKQ was 7.0±4.2 points, with a median of 8 (range, -2 to17). Furthermore, the size of the effect was 2.0 (> 0.8) and the standardised mean response was 1.7. After 3 months of the intervention the mean score of the NAKQ was 21.4±3.0 points, with a median of 22 (range, 12 to 29) which was significantly higher than the score obtained before the intervention (P<.001) and slightly lower than the score obtained immediately after the intervention, assuming a size of the effect of 1.6 and a standardised mean response of 1.2. In the control group, the level of knowledge did not change modified and was lower than the level of the intervention group (P<.001). An educational intervention program conducted among teachers significantly increases their knowledge of asthma. Moreover, the increase reduces slightly but maintains its higher level for at least 3 months. In spite of the fact that some aspects of knowledge improved with the educational intervention, they were not optimal.
    Anales de Pediatría 04/2012; 77(4):236-46. · 0.87 Impact Factor
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    ABSTRACT: To validate the measurement of fractional exhaled nitric oxide concentration (FE(NO)) using a 6-sec exhalation time in patients aged between 5 and 17 years with a stationary chemiluminescence analyser (NIOX, Aerocrine) and a portable electrochemical analyser (NIOX-MINO, Aerocrine). FE(NO) was assessed in 60 patients randomised into two groups. In Group 1 (n = 30, NIOX analyser), three valid FE(NO) measurements were obtained for two exhalation times (10 sec and 6 sec); the mean of the three measurements was recorded. In Group 2 (n = 30, NIOX-MINO), a single valid measurement of FE(NO) was obtained for each exhalation time. We analysed age, gender, weight, height, diagnosis, treatment, FE(NO) and the number of attempts with both exhalation times in each analyser. Agreement between FE(NO) assessed using 10-sec and 6-sec exhalations was assessed by Bland-Altman analysis and Cohen's kappa. The mean (SD) age in Group 1 was 10.1 (3.07) years. The mean age in Group 2 was 10.43 (2.94) years. Bland-Altman analysis demonstrated good agreement between FE(NO) values obtained with both exhalation times and with both devices. Cohen's kappa, also demonstrated good agreement (NIOX, kappa = 1; NIOX-MINO, kappa = 0.93). A 6-sec exhalation time is valid for measuring FE(NO) with both analysers in children aged over 5 years.
    Anales de Pediatría 10/2008; 69(3):221-6. · 0.87 Impact Factor
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    ABSTRACT: Objective To validate the measurement of fractional exhaled nitric oxide concentration (FENO) using a 6-sec exhalation time in patients aged between 5 and 17 years with a stationary chemiluminescence analyser (NIOX®, Aerocrine) and a portable electrochemical analyser (NIOX-MINO®, Aerocrine). Material and methods FENO was assessed in 60 patients randomised into two groups. In Group 1 (n = 30, NIOX® analyser), three valid FENO measurements were obtained for two exhalation times (10 sec and 6 sec); the mean of the three measurements was recorded. In Group 2 (n = 30, NIOX-MINO®), a single valid measurement of FENO was obtained for each exhalation time. We analysed age, gender, weight, height, diagnosis, treatment, FENO and the number of attempts with both exhalation times in each analyser. Agreement between FENO assessed using 10-sec and 6-sec exhalations was assessed by Bland-Altman analysis and Cohen’s kappa. Results The mean (SD) age in Group 1 was 10.1 (3.07) years. The mean age in Group 2 was 10.43 (2.94) years. Bland-Altman analysis demonstrated good agreement between FENO values obtained with both exhalation times and with both de-vices. Cohen’s kappa, also demonstrated good agreement (NIOX®, K = 1; NIOX-MINO®, K = 0.93). Conclusions A 6-sec exhalation time is valid for measuring FENO with both analysers in children aged over 5 years.
    Anales De Pediatria - AN PEDIATR. 01/2008; 69(3):221-226.
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    ABSTRACT: Measurement of fractional exhaled nitric oxide (FENO) is a non-invasive marker of eosinophilic airway inflammation that can be useful in asthma diagnosis and control, as well as in treatment monitoring. We studied the correlation between two techniques for measuring FENO: the chemiluminescence-based analyzer (NIOX, Aerocrine, Sweden) and a new portable electrochemical sensor-based analyzer (NIOX-MINO, Aerocrine). FENO was measured by the single breath on-line method. In all children, three consecutives measurements were obtained with NIOX, with a maximum of six attempts, and the arithmetic mean was calculated. Next, using NIOX-MINO, a single measurement was made successively in each of the children. The variables analyzed were sex, age, height, weight, diagnosis, treatment, NIOX-MINO value, mean of three values obtained with NIOX and the NO elimination rate (nL/min). For the statistical analysis, the Bland-Altman plot was used to compare the means and the differences between measurements of FENO from NIOX and NIOX-MINO. The agreement between the two analyzers was estimated by Cohen's Kappa statistic. Thirty children were included, 14 (46.67%) boys and 16 (53.33%) girls. The mean age was 11.3+/-3.09 years. All of the children successfully performed the measurements with two analyzers. The relationship between the means and the differences in the values obtained with NIOX-MINO and NIOX were statistically significant (p<0.005). In addition, Cohen's Kappa statistic (0.78) suggested a high degree of agreement between the results obtained with the two devices. The two analyzers, NIOX-MINO and NIOX, were not equivalent. There was good agreement between the FENO values measured with the two devices. Measurement of FENO with the portable electrochemical sensor-based analyzer (NIOX-MINO) is valid and feasible in children older than 5 years.
    Anales de Pediatría 12/2007; 67(6):572-7. · 0.87 Impact Factor
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    ABSTRACT: Background Measurement of fractional exhaled nitric oxide (FENO) is a non-invasive marker of eosinophilic airway inflammation that can be useful in asthma diagnosis and control, as well as in treatment monitoring. Objective We studied the correlation between two techniques for measuring FENO: the chemiluminescence-based analyzer (NIOX®, Aerocrine, Sweden) and a new portable electrochemical sensor-based analyzer (NIOX-MINO®, Aerocrine). Material and methods FENO was measured by the single breath on-line method. In all children, three consecutives measurements were obtained with NIOX®, with a maximum of six attempts, and the arithmetic mean was calculated. Next, using NIOX-MINO®, a single measurement was made successively in each of the children. The variables analyzed were sex, age, height, weight, diagnosis, treatment, NIOX-MINO® value, mean of three values obtained with NIOX® and the NO elimination rate (nL/min). For the statistical analysis, the Bland-Altman plot was used to compare the means and the differences between measurements of FENO from NIOX® and NIOX-MINO®. The agreement between the two analyzers was estimated by Cohen's Kappa statistic. Results Thirty children were included, 14 (46.67 %) boys and 16 (53.33 %) girls. The mean age was 11.3 ± 3.09 years. All of the children successfully performed the measurements with two analyzers. The relationship between the means and the differences in the values obtained with NIOX-MINO® and NIOX® were statistically significant (p < 0.005). In addition, Cohen's Kappa statistic (0.78) suggested a high degree of agreement between the results obtained with the two devices. Conclusions The two analyzers, NIOX-MINO® and NIOX®, were not equivalent. There was good agreement between the FENO values measured with the two devices. Measurement of FENO with the portable electrochemical sensor-based analyzer (NIOX-MINO®) is valid and feasible in children older than 5 years.
    Anales De Pediatria - AN PEDIATR. 01/2007; 67(6):572-577.
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    ABSTRACT: Sleep apnea-hypopnea syndrome (SAHS) is relatively frequent in children. The gold standard for diagnosis is polysomnography. However, because of technical difficulties and the cost of this method, new alternatives have become available, such as respiratory polygraphy (RP) performed at home or in hospital, which have provided satisfactory results in children with clinical suspicion of SAHS. The aim of this study was to analyze the diagnostic utility of in-home RP in the diagnosis of SAHS in a sample of boys and girls referred to the pediatric respiratory care department for suspected sleep apnea, snoring, or both. In all patients, a history and physical examination were performed; X-ray of the chest and cavum and RP were carried out. The following qualitative variables were analyzed: place where RP was performed, the result, sex, the reason for consulting, place of residence, results of otorhinolaryngological examination, and treatment. The quantitative variables analyzed were age, total number of apneas, total number of hypopneas, apnea index/hour, hypopnea index/hour, mean and minimum SpxO2, number of snores per hour and the snore index/hour. Statistical analysis was performed using Pearson's chi-square test and Student's t-test. A total of 132 patients were studied, 44 (33.3 %) through in-home RP (group 1) and 88 (66.6 %) through in-hospital RP (group 2). In group 1, two recordings (4.5 %) were considered nonvalid. The mean age of the patients was 8.3 years (SD 3.02). The results [means (standard deviation)] of in-home RP were as follows: apnea-hypopnea index (AHI)/h: 3.4 (4.3); mean SpxO2: 97.3 (1.8); minimum SpxO2: 87.7 (10.3). In group 2, four recordings (4.5 %) were nonvalid. The mean age of the patients was 7.4 years (SD 3). The results of in-hospital RP were as follows: AHI/h: 4.45 (5.4); mean SpxO2: 96.8 (1.8); minimum SpxO2: 87 (11). No significant differences were found between the validity of in-home and in-hospital RP. Likewise, no significant differences were found between AHI/h, SpxO2 and in-home and in-hospital RP. In conclusion, in our sample, the diagnostic utility of in-home RP was equal to that of in-hospital RP. In-home RP allows the possibility of performing a more physiological sleep study and, by eliminating the cost of hospitalization, is more cost-efficient. Therefore, in-home RP is a valid and reliable technique for the diagnosis of childhood SAHS.
    Anales de Pediatría 11/2006; 65(4):310-5. · 0.87 Impact Factor
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    ABSTRACT: Introduction Sleep apnea-hypopnea syndrome (SAHS) is relatively frequent in children. The gold standard for diagnosis is polysomnography. However, because of technical difficulties and the cost of this method, new alternatives have become available, such as respiratory polygraphy (RP) performed at home or in hospital, which have provided satisfactory results in children with clinical suspicion of SAHS. Objective The aim of this study was to analyze the diagnostic utility of in-home RP in the diagnosis of SAHS in a sample of boys and girls referred to the pediatric respiratory care department for suspected sleep apnea, snoring, or both. Material and methods In all patients, a history and physical examination were performed; X-ray of the chest and cavum and RP were carried out. The following qualitative variables were analyzed: place where RP was performed, the result, sex, the reason for consulting, place of residence, results of otorhinolaryngological examination, and treatment. The quantitative variables analyzed were age, total number of apneas, total number of hypopneas, apnea index/hour, hypopnea index/hour, mean and minimum SpxO2, number of snores per hour and the snore index/hour. Statistical analysis was performed using Pearson's chi-square test and Student's t-test. Results A total of 132 patients were studied, 44 (33.3 %) through in-home RP (group 1) and 88 (66.6 %) through in-hospital RP (group 2). In group 1, two recordings (4.5 %) were considered nonvalid. The mean age of the patients was 8.3 years (SD 3.02). The results [means (standard deviation)] of in-home RP were as follows: apnea-hypopnea index (AHI)/h: 3.4 (4.3); mean SpxO2: 97.3 (1.8); minimum SpxO2: 87.7 (10.3). In group 2, four recordings (4.5 %) were nonvalid. The mean age of the patients was 7.4 years (SD 3). The results of in-hospital RP were as follows: AHI/h: 4.45 (5.4); mean SpxO2: 96.8 (1.8); minimum SpxO2: 87 (11). No significant differences were found between the validity of in-home and in-hospital RP. Likewise, no significant differences were found between AHI/h, SpxO2 and in-home and in-hospital RP. Conclusion In conclusion, in our sample, the diagnostic utility of in-home RP was equal to that of in-hospital RP. In-home RP allows the possibility of performing a more physiological sleep study and, by eliminating the cost of hospitalization, is more cost-efficient. Therefore, in-home RP is a valid and reliable technique for the diagnosis of childhood SAHS.
    Anales de Pediatría. 10/2006; 65(4).
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    ABSTRACT: To determine the current prevalence of asthma in children aged 6-12 years old in San Sebastian (Guipuzcoa, Spain). An observational, cross sectional study was performed in 6-12-year-old children in schools. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was employed. Bronchial hyperresponsiveness was investigated using the free running test, with peak expiratory flow (PEF) measured with a peak flow meter as the main measurement. The ISAAC questionnaire (n = 919) was distributed to 460 boys (50.1%) and 459 girls (49.9%) with a mean age of 8 years (SD 1.87). The response rate to the questionnaire was 93 % (n = 855). Participation in the free running test was 90.8% (n = 835). A total of 89.88% of the children (n = 826) completed both tests. The questionnaire of symptoms and signs compatible with asthma revealed a current prevalence of asthma of 25.56% (n = 216) and a cumulative prevalence of 25.44% (n = 85). Nocturnal asthma was found in 29.37% (n = 47) and severe asthma in 9.27% (n = 14). Bronchial hyperresponsiveness was found in 23% of the participants. An epidemiological diagnosis of asthma (asthma-related symptoms plus bronchial hyperresponsiveness) was made in 6.54%. The current prevalence of asthma in 6-12-year-old schoolchildren in San Sebastian, determined through symptoms and signs compatible with asthma in the previous year and a positive free running test, is similar to that reported in other national studies.
    Anales de Pediatría 04/2006; 64(3):224-8. · 0.87 Impact Factor
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    ABSTRACT: We analyzed a cohort of 400 patients referred from the otorhinolaryngology department (40.05 %), primary care (PC) (36.52 %), and the pediatric pulmonary unit (17.63 %). The children were referred for clinical suspicion of apneas in 191 (47.87 %), snoring and apneas in 101 (25 %), and snoring in 87 (21.80 %). Adenotonsillar hypertrophy was found in 211 patients (52.75 %), tonsillar hypertrophy in 87 (21.75 %), and adenoid hypertrophy in 73 (18.25 %). All patients underwent respiratory polygraphy (RP) during sleep. Obstructive sleep apnea-hypopnea syndrome (OSAHS) was diagnosed in 298 patients (74.5 %). OSAHS was mild in 96 patients (24 %), moderate in 148 (37 %), and severe in 54 (13.5 %). The results of RP expressed in means plus standard deviation were as follows: number of apneas 21.38 (24.47), number of hypopneas 19.81 (20.74), apnea-hypopnea index per hour (AHI/h) 5.29 (7.10), mean oxygen saturation 94.60 (11.80), minimal saturation 83.14 (13.45), number of snores 98.27 (254.55), and snoring index per hour 5.68 (6.5). Significant differences were found between oxygen saturation and AHI/h per hour. No differences were found among age, mean oxygen saturation, area of residence, reason for consulting, and AHI/h. Adenotonsillectomy was performed in 289 patients (72.25 %) of the initial cohort. In conclusion, OSAHS in childhood is frequent. RP during sleep aids diagnosis. The main cause of OSAHS in children is adenotonsillar hypertrophy.
    Anales de Pediatría 03/2006; 64(2):120-5. · 0.87 Impact Factor
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    ABSTRACT: We analyzed a cohort of 400 patients referred from the otorhinolaryngology department (40.05%), primary care (PC) (36.52%), and the pediatric pulmonary unit (17.63%). The children were referred for clinical suspicion of apneas in 191 (47.87%), snoring and apneas in 101 (25%), and snoring in 87 (21.80%). Adenotonsillar hypertrophy was found in 211 patients (52.75%), tonsillar hypertrophy in 87 (21.75%), and adenoid hypertrophy in 73 (18.25%). All patients underwent respiratory polygraphy (RP) during sleep. Obstructive sleep apnea-hypopnea syndrome (OSAHS) was diagnosed in 298 patients (74.5%). OSAHS was mild in 96 patients (24%), moderate in 148 (37%), and severe in 54 (13.5%). The results of RP expressed in means plus standard deviation were as follows: number of apneas 21.38 (24.47), number of hypopneas 19.81 (20.74), apnea-hypopnea index per hour (AHI/h) 5.29 (7.10), mean oxygen saturation 94.60 (11.80), minimal saturation 83.14 (13.45), number of snores 98.27 (254.55), and snoring index per hour 5.68 (6.5). Significant differences were found between oxygen saturation and AHI/h per hour. No differences were found among age, mean oxygen saturation, area of residence, reason for consulting, and AHI/h. Adenotonsillectomy was performed in 289 patients (72.25%) of the initial cohort. In conclusion, OSAHS in childhood is frequent. RP during sleep aids diagnosis. The main cause of OSAHS in children is adenotonsillar hypertrophy.
    Anales De Pediatria - AN PEDIATR. 01/2006; 64(2):120-125.
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    ABSTRACT: Objective To determine the current prevalence of asthma in children aged 6-12 years old in San Sebastian (Guipuzcoa, Spain). Patients and methods An observational, cross sectional study was performed in 6-12-year-old children in schools. The International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire was employed. Bronchial hyperresponsiveness was investigated using the free running test, with peak expiratory flow (PEF) measured with a peak flow meter as the main measurement. The ISAAC questionnaire (n = 919) was distributed to 460 boys (50.1 %) and 459 girls (49.9%) with a mean age of 8 years (SD 1.87). The response rate to the questionnaire was 93 % (n = 855). Participation in the free running test was 90.8 % (n = 835). A total of 89.88% of the children (n = 826) completed both tests. Results The questionnaire of symptoms and signs compatible with asthma revealed a current prevalence of asthma of 25.56 % (n = 216) and a cumulative prevalence of 25.44% (n = 85). Nocturnal asthma was found in 29.37% (n 47) and severe asthma in 9.27 % (n = 14). Bronchial hyperresponsiveness was found in 23% of the participants. An epidemiological diagnosis of asthma (asthma-related symptoms plus bronchial hyperresponsiveness) was made in 6.54%. Conclusions The current prevalence of asthma in 6-12-year-old schoolchildren in San Sebastian, determined through symptoms and signs compatible with asthma in the previous year and a positive free running test, is similar to that reported in other national studies.
    Anales De Pediatria - AN PEDIATR. 01/2006; 64(3):224-228.
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    ABSTRACT: PC wheezing (PCw) is defined as the concentration of methacholine at which wheeze is detected on auscultation of the trachea. PCw has been suggested as a measure of bronchial hyperresponsiveness in methacholine challenge testing (MCT). The aim of this study was to determine the agreement between the concentration of methacholine that produces a 20 % decrease in forced expiratory volume in 1 second (FEV1) (PC20) and PCw in MCT in asthmatic children. Eighteen asthmatic children with a mean age of 11.5 years (range: 6-16 years) were studied. Fifteen of the children were under treatment with inhaled glucocorticoids. MCT was performed according to the guidelines of the American Thoracic Society (1999) using a Hudson nebulizer calibrated to obtain a mean output of 0.14 ml/min. After each nebulization, two independent observers registered FEV1 and tracheal auscultation. FEV1 was determined by forced spirometry 30 and 90 seconds after the end of nebulization and PC20 was registered (exponential model). Respiratory rate and transcutaneous oxygen saturation were continuously monitored. Tracheal auscultation was performed at 0, 60 and 120 seconds after the end of nebulization. The end point was defined as the appearance of wheezing over the trachea. The values of PC20 and PCw, as well as the concentration of methacholine corresponding to a decrease in FEV1 equal to or higher than 20 %, were compared using Student's matched pairs-test and Wilcoxon's test. The degree of agreement between variables was compared by using Bland-Altman's test. MCT was positive in 17 of 18 patients. No differences were found between PC20 and PCw (p 0.15). Both variables showed agreement in 12 of 17. A clear association was found between both measures (log PCw, log PC20): R: 0.92; p < 0.001. The mean decrease in FEV1 on reaching PCw was 24.8 % (range: 10-41). No adverse effects were observed. The agreement between PC20 and PCw in MCT in asthmatic children is excellent. PCw could be helpful in determining bronchial hyperresponsiveness in young asthmatic children in whom spirometry is not feasible.
    Anales espanoles de pediatria 04/2002; 56(4):304-9.