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Pouwelse ML, Van der Meer V, Van den Boogaard M, Hugen C, Merkus P, Van den Bemt L. Astma bij kinderen: hoe zeker is de diagnose? Huisarts Wet 2015;58(8):402-5. Bij kinderen van 6-16 jaar die met een chronische aandoening bij de huisarts komen, is ‘astma’ de diagnose die het meest wordt gesteld. Doel van ons onderzoek was, vast te stellen hoe betrouwbaar die diagnose is. In zeven huisartsenpraktijken bepaalden we de puntprevalentie van de geregistreerde diagnose ‘astma’ bij kinderen van 6-16 jaar. De validiteit van de diagnose onderzochten wij aan de hand van in de status geregistreerde kenmerken, zoals luchtwegsymptomen, vastgestelde allergieen, gebruik van luchtwegmedicatie en aangetoonde reversibiliteit. Wij analyseerden 2458 patientendossiers van kinderen van 6-16 jaar. In 222 (9%) van deze dossiers stond de diagnose ‘astma’ geregistreerd; 218 daarvan konden wij gebruiken voor statusonderzoek. In 92 dossiers (42%) maakten de diagnostische gegevens de diagnose ‘astma’ waarschijnlijk, in 28 dossiers (13%) maakten zij astma onwaarschijnlijk en 98 dossiers (45%) bevatten onvoldoende diagnostische gegevens om een uitspraak te kunnen doen over de validiteit van de diagnose. In de meeste gevallen konden wij de diagnose ‘astma’ van de huisarts niet verifieren op basis van het medisch dossier. Een aantal kinderen lijkt ten onrechte in het dossier de registratie ‘astma’ te hebben gekregen. De diagnostiek en registratie van astma in de huisartsenpraktijk, met name bij kinderen jonger dan 6 jaar, verdient meer aandacht. Hetzelfde geldt voor de follow-up van die diagnose na de zesde verjaardag.

Introduction Although several eHealth interventions have been shown to be effective, little is known about the actual use of these interventions among patients in real life. Aim of the study The aim were to describe and analyse website-use among children with asthma receiving online care through the virtual asthma clinic (VAC) and to develop recommendations for further use of the VAC in paediatric asthma care. Methods Observational study conducted alongside a randomized controlled trial on the efficacy of the VAC. Website log-data of the participants were analysed in retrospect: activity (page views of information pages and treatment plan), communication with the medical team (frequency and content of messages) and login (frequency and duration) were compared between different age groups (6-11 years and 12-16 years). Results 105 children (mean age 11.2 years (± SD 2.9 years; 61% male) were included. Younger participants or parents accessed the (general) information pages significantly more often than teenagers (median page views 10 versus 4, P =.003). The median number of messages was also significantly higher (median 4 versus 2, P =.04) in the younger group. No significant difference in login frequency was found between the two age groups, but the login-frequency decreased significantly within both groups during the 16-month study period. Conclusions The VAC was used significantly different by teenagers and younger children and/or their parents regarding the need of information and communication with the medical team. Younger children used the information and communication modules more often in comparison to teenagers. These differences should be taken into account while designing an eHealth intervention for children.

Item does not contain fulltext BACKGROUND: Many adolescents have poor asthma control and are at high risk for psychosocial problems. However, structured assessment of asthma control or psychosocial problems is still not implemented in routine asthma care. Pediatricians typically rely on their clinical view and physiological measurements. To date, it is unknown whether clinical and patient reported outcomes are interrelated. Furthermore, there is no consensus on who should be the informant; the adolescent or his caregiver. STUDY AIM(S): This study aimed to assess the relationship between patient and caregiver reported outcomes [Asthma Control Questionnaire and Strengths and Difficulties Questionnaire (SDQ)] and physiological parameters (FEV1 and Fractional exhaled Nitric Oxide) in adolescents (aged 11-16) with asthma. METHODS: A multicenter observational study was performed in four Dutch pediatric outpatient departments. Association between asthma control, physiological parameters, and results of psychosocial questionnaires completed by both adolescent and caregiver was analyzed. RESULTS: Forty-eight adolescents and their caregivers participated in this study. Asthma was uncontrolled in about 30%. Asthma control was not associated with age, gender, FEV1, FeNO, or psychosocial problems. Agreement between adolescents and caregivers about how well asthma was controlled was moderate (kappa = 0.577, P < 0.01). DISCUSSION: Asthma control, physiological parameters, and psychosocial problems are different domains of health status. It could be suggested to use validated patient and caregiver reported outcomes in routine adolescent asthma care. CONCLUSION: Patient and caregiver reported outcomes on asthma control and the presence of psychosocial problems add valuable, unique information to physiological parameters in adolescent asthma management.

Contains fulltext : 88110.pdf (Publisher’s version ) (Closed access) Evidence shows that psychosocial problems among children and adolescents with asthma interfere with adherence to treatment and therefore need attention in asthma care. It is unknown whether the already frequently implemented asthma-related quality of life (QoL) instruments reflect psychosocial problems in children with asthma. The aim of this study was to assess the relationship between asthma-related QoL and psychosocial problems and to determine whether an asthma-related QoL instrument is able to identify those children and adolescents with asthma with major psychosocial problems. In a multicenter study psychosocial problems (Strengths and Difficulties Questionnaire) and asthma-related QoL (Pediatric Asthma (Caregivers) Quality of Life Questionnaire) were obtained in children and adolescents with asthma aged 6-16 years and their caregivers. A total of 339 children and adolescents (response rate 95%) from four pediatric outpatient clinics in the Netherlands with doctor-diagnosed asthma participated. Of the caregivers, 43% reported major or minor psychosocial problems of their child or adolescent which is two times more than in the reference group, whereas the percentage of adolescents reporting psychosocial problems was comparable to a reference population. Adolescents and caregivers reported few impairments in asthma-related QoL (median score between 6.2 and 7.0). However, an optimal asthma-related QoL did not rule out major psychosocial problems: 10% of the adolescents with an optimal asthma-related QoL score reported major psychosocial problems. And in one out of seven children with an optimal caregiver's asthma-related QoL score, major psychosocial problems were reported. The prevalence of psychosocial problems in children and adolescents with asthma is considerable. Assessment of asthma-related QoL alone is insufficient to identify those children with major psychosocial problems. We recommend the implementation of psychosocial screening, besides assessment of asthma-related QoL, in routine pediatric asthma care, to improve asthma management. 01 december 2010