健康儿童专业人员对幼儿期哮喘样症状和烟草烟雾暴露进行系统评估的评价：一项随机试验。
Evaluation of systematic assessment of asthma-like symptoms and tobacco smoke exposure in early childhood by well-child professionals: a randomised trial.
作者信息
Hafkamp-de Groen Esther, van der Valk Ralf J P, Mohangoo Ashna D, van der Wouden Johannes C, Duijts Liesbeth, Jaddoe Vincent W, Hofman Albert, de Koning Harry J, de Jongste Johan C, Raat Hein
机构信息
The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
The Generation R Study Group, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Paediatrics, Division of Respiratory Medicine, Erasmus Medical Center-Sophia Children's Hospital, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
出版信息
PLoS One. 2014 Mar 13;9(3):e90982. doi: 10.1371/journal.pone.0090982. eCollection 2014.
OBJECTIVES
This study aimed to evaluate the effectiveness of systematic assessment of asthma-like symptoms and environmental tobacco smoke (ETS) exposure during regular preventive well-child visits between age 1 and 4 years by well-child professionals.
METHODS
Sixteen well-child centres in Rotterdam, the Netherlands, were randomised into 8 centres where the brief assessment form regarding asthma-like symptoms and ETS exposure was used and 8 centres that applied usual care. 3596 and 4179 children (born between April 2002 and January 2006) and their parents visited the intervention and control centres, respectively. At child's age 6 years, physician-diagnosed asthma ever, wheezing, fractional exhaled nitric oxide (FeNO), airway resistance (Rint), health-related quality of life (HRQOL) and ETS exposure at home ever were measured. Linear mixed models were applied.
RESULTS
No differences in asthma, wheezing, FeNO, Rint or HRQOL measurements between intervention and control group were found using multilevel regression in an intention-to-treat analysis (p>0.05). Children of whom the parents were interviewed by using the brief assessment form at the intervention well-child centres had a decreased risk on ETS exposure at home ever, compared to children who visited the control well-child centres, in an explorative per-protocol analysis (aOR = 0.71, 95% CI:0.59-0.87).
CONCLUSIONS
Systematic assessment and counselling of asthma-like symptoms and ETS exposure in early childhood by well-child care professionals using a brief assessment form was not effective in reducing the prevalence of physician-diagnosed asthma ever and wheezing, and did not improve FeNO, Rint or HRQOL at age 6 years. Our results hold some promise for interviewing parents and using information leaflets at well-child centres to reduce ETS exposure at home in preschool children.
TRIAL REGISTRATION
Controlled-Trials.com ISRCTN15790308.
目的
本研究旨在评估儿童健康专业人员在1至4岁儿童定期预防性健康检查期间，对哮喘样症状和环境烟草烟雾（ETS）暴露进行系统评估的有效性。
方法
荷兰鹿特丹的16个儿童健康中心被随机分为8个使用哮喘样症状和ETS暴露简短评估表的中心，以及8个采用常规护理的中心。分别有3596名和4179名儿童（2002年4月至2006年1月出生）及其父母前往干预中心和对照中心就诊。在儿童6岁时，测量医生诊断的哮喘病史、喘息、呼出一氧化氮分数（FeNO）、气道阻力（Rint）、健康相关生活质量（HRQOL）以及家中ETS暴露情况。应用线性混合模型。
结果
在意向性分析中，使用多水平回归未发现干预组和对照组在哮喘、喘息、FeNO、Rint或HRQOL测量方面存在差异（p>0.05）。在探索性的符合方案分析中，与前往对照儿童健康中心的儿童相比，在干预儿童健康中心其父母接受简短评估表访谈的儿童家中ETS暴露的风险降低（校正比值比 = 0.71，95%可信区间：0.59 - 0.87）。
结论
儿童健康护理专业人员使用简短评估表对幼儿哮喘样症状和ETS暴露进行系统评估和咨询，在降低医生诊断的哮喘病史和喘息患病率方面无效，且未改善6岁时的FeNO、Rint或HRQOL。我们的结果对于在儿童健康中心访谈父母并使用信息手册以减少学龄前儿童家中ETS暴露具有一定前景。
试验注册
Controlled-Trials.com ISRCTN15790308
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