pediatric epidemiological surveillance and research

SPRING MEETING 2018 TOLEDO, SPAIN

APRIL 20TH-22ND 2018

Pediatric Epidemiological Surveillance

and Research Network of AEPap

(Spanish Primary Care Association)



The Epidemiological Surveillance and Research Network in

Primary Care Pediatrics (PAPenRED) aims to establish the

monitoring of specific health problems in Primary Care.



OBJECTIVES:

- Increase knowledge of the morbidity of diseases and the study

of risk factors and epidemiological trends.

- Understand the microbiological data in collaboration with the

reference laboratories of the public network.

- Evaluate the approach of chronic pathologies.

- Serve as an alert system in low prevalence processes.

- Contribute to the evaluation of diagnostic, therapeutic and

intervention measures.



OBJECTIVES:

- Promote the participation of Primary Care in epidemiological

research.

- Evaluate the preventive and health promotion activities of the

Children's Health Program.

- Study the attitudes of the population in regard to socio-sanitary

transformations, changes in life habits and behaviours.

- Promote the search for indicators that allow interregional and

international comparison.

- Potential application of research results into clinical practice.



NATIONAL COORDINATORS

César García Vera (Zaragoza) Guadalupe del Castillo Aguas (Málaga)

Begoña Domínguez Aurrecoechea (Oviedo) Alfredo Cano Garcinuño (Palencia)

Ana Lorente García-Mauriño (Madrid) José María Mengual Gil (Zaragoza)

Webmaster/online forms: Rubén García Pérez (Bilbao)



Ana Gallego Iborra y G.del Castillo (Andalucía) José Mengual Gil (Aragón) María Ángeles Ordoñez Alonso (Asturias) Icíar Miranda Berrioategortua (Baleares) Elena Sánchez Almeida (Canarias) Alberto Bercedo Sanz (Cantabria) Alicia Bonet Garrosa (Castilla La Mancha) Mª Dolores Sánchez Díaz (Castilla y León) Cristina Cayuela Guerrero (Cataluña) Nuria Menéndez González (Extremadura) Marta Carballal Mariño (Galicia) José Vicente Bernad Usoz (La Rioja) Ana Lorente García-Mauriño (Madrid) Manuel Alcaraz Quiñonero (Murcia) Manuela Sánchez Echenique (Navarra) Tatiana Menéndez Bada (País Vasco) Ramona Mínguez Verdejo (Valencia)

REGIONAL COORDINATORS



PARTICIPATING PRIMARY

CARE PEDIATRICIAN

Currently: 340 Collaborating

Researchers/ Scheduled

number 304

Collaborating Researchers number/Scheduled number



SURVEY METHODOLOGY

● Surveys of projects are made with Google Docs, and are carried

out through an online questionnaire

● Patient records are kept and recorded in a database



SUMMARY OF RESEARCH PROJECTS (FROM 2013 TO 2018)

- Already finished (6):

1. Unintentional injuries in the Spanish children.

2. Bacterial gastroenteritis in the Pediatric population.

3. Follow up in the Primary Care Pediatrics of the very preterm infants.

4. Study of the first visit of the newborn in Primary Care and its implications for child health and

breastfeeding.

5. Descriptive study of previous infections by Varicela-Zoster virus

6. Prescription of antibiotics and performance of complementary tests based on frequency and loyalty

with the pediatrician.

- In progress (2):

7. Breastfeeding and child development (LAYDI STUDY)

8. Methicillin-Resistant Staphylococcus Aureus (MRSA) colonization (COSACO STUDY)



I. “UNINTENTIONAL INJURIES IN THE SPANISH CHILDREN” Abstract Eurosafe Conference 2017. “Prevention of Accidents Decalog

Amsterdam AEPap

● Never leave children home alone

● Know the number phone of emergencies

● Protection the furniture

● Make parents aware that:

- An accident is not fate

- Need more protectives measures at home

- Need more supervision for children who

take medication or have risky behaviour



I."BACTERIAL GASTROENTERITIS IN THE PEDIATRIC POPULATION. ETIOLOGY / EPIDEMIOLOGY"

1 Communication, 1 Poster (prize for the best poster)

1 Scientific publication Percentage of bacterial isolation

[729 surveys]



III."FOLLOW UP IN PRIMARY CARE PEDIATRICS

OF THE VERY PRETERM INFANTS” 1 Communication; 1 Publication; 1 Round Table "The great prematurity in Spain: The

development of the newborn with less than 1500 grams" in the "Summer Courses of

the Complutense University”of Madrid, 2015

- Number of surveys: 261 that cover a population of approximately

234,900 children between 0 and 14 years old

- Total 870 very preterm babies with an average of 3.8 per

pediatrician.

- 99% of pediatricians would like to have a common program

Hospital- Primary Care follow-up of the very preterm infants.



IV. "STUDY OF THE FIRST VISIT OF THE NEWBORN

IN PRIMARY CARE AND ITS IMPLICATIONS FOR CHILD HEALTH AND

BREASTFEEDING" 1 IHAN Research Accessit Award 2015; 2 Communications AEPap Meeting (1 prize for

best oral communication); 2 Papers; 1 Poster (prize for the best poster)

Conclusions:

• We can highlight tan less than half of the newborns go for the first

time, in the first week of life to the primary care centre. Exclusive

breastfeeding would improve if the newborn comes early to the care

consultation primary.

• The data from this study indicate the need to protocolize the early

visit of newborns in primary care

• The pediatrician- sentinels networks are an effective way of knowing

health problems that allow to obtain broad samples with little effort



V. "DESCRIPTIVE STUDY OF EARLY INFECTIONS BY

VARICELLA-ZOSTER VIRUS: VARICELLA IN INFANTS (UNDER

13 MONTHS) AND HERPES ZOSTER IN CHILDHOOD" 2 Communications AEPap Meeting 2017 (1 award) 2 publication under development

Conclusions:

Varicella-Zoster is shown in this series as a disease generally

mild in pediatrics.

• Most have had chickenpox at early ages.

• The source of infection can be deduced in a few cases.

• Complications, including postherpetic neuralgy, are rare.

• Surprisingly, there was a high number of zoster cases

treated in primary care with topical or systemic antivirals.



VI."PRESCRIPTION OF ANTIBIOTICS AND PERFORMANCE OF COMPLEMENTARY

TESTS BASED ON FREQUENCY AND LOYALTY WITH THE PEDIATRICIAN 2 Communications AEPap Meeting 2017 (1 award for best oral communication).

1 Recent Publication

A total of 212 pediatricians took part and reviewed

2,726 patients’ records. Conclusions:

• Antibiotics prescription and complementary

tests were significantly related to medical

overuse.

• They were also related to loyalty, but less

significantly.



VII. “BREASTFEEDING AND CHILD DEVELOPMENT”. Influence of cultural and individual socioeconomic factors in the beginning

And duration of the breastfeeding. LAYDI STUDY (Collaborative study)

Prospective study: Follow up of a cohort of infants, from 0 to 24 months of age. 8

scheduled visits

Objectives:

• The aim of this study is to contribute to the knowledge of our population breastfeeding

characteristics:

- Factors associated with its beginning and duration.

- Identify mothers' perceptions about their self-efficacy in breastfeeding.

Design strategies for community and intersectoral participation in order to provide

resources that facilitate breastfeeding.

• To describe the development and morbidity of infants during the first two years of life,

taking into consideration food and biological, socioeconomic and cultural variables.



“BREASTFEEDING AND CHILD DEVELOPMENT”.(LAYDI STUDY)

COHORT OF CHILDREN INCLUDED WITHIN TWO

MONTHS OF THE CAPTATION PERIOD 1660 children (570 already made the fifth visit)

210 researchers collecting data

Preliminaries: • National children (80%) , immigrant parents (20%) • 22% did not received information during pregnancy

about the importance of the breastfeeding for the health of the mother and the baby.

• 49% did not receive practical explanations. • Public hospital (86%), unassisted vaginal births (69%) • Cesareans (17%) • Newborns separated from their mother after delivery

(23%).

• Percentage of mothers who decided to

breastfeed: ( 90,4%)

• Type of feeding: - Exclusive breastfeeding (65.14%)

- Predominant breastfeeding (1,29%)

- Mixed breastfeeding (22,9%)

- Artificial feeding after cessation of

breastfeeding (1,80%)

- Artificial feeding from the birth (9,58%)

• When do women decide on the type of

food?

- Before pregnancy (69.5%)

- During pregnancy (25,3%)

- After the birth of the baby (5,1%).



“BREASTFEEDING AND CHILD DEVELOPMENT”. (LAYDI STUDY)

Exclusive breastfeeding

First Visit

Artificial feeding

from the birth

Relative Risk

(Confidence interval 95%)

n % n %

Previous experiences 395 39,0% 60 40,3% 0,97 (IC 95: 0,78 a 1,19; p=0,819)

Couple 342 33,8% 26 17,5% 1,93 (IC 95: 1,35 a 2,77; p=0,001)

Midwives/nurses 315 31,1% 10 6,7% 5,26 (IC 95: 2,86 a 9,65; p<0,001)

Family 259 25,6% 8 5,4% 4,76 (IC 95: 2,41 a 9,42; p<0,001)

Doctors 167 13,5% 19 12,8% 1,47 (IC 95: 0,94 a 2,29; p=0,153)

Friends 86 8,5% 5 3,4% 2,53 (IC 95: 1,04 a 6,13; p=0,046)

Books 114 11,2% 0 0%

My own decision 67 6,6% 26 17,4% 0,38 (IC 95: 0,25 a 0,58; p<0,001)

Internet 74 7,3% 1 0,7% 10,88(IC 95: 1,52 a 77,71; p<0,001)

Other mothers 107 10,5% 4 2,7% 3,93 (IC 95: 1,47 a 10,52; p=0,006)

TV 15 1,4% 0 0%

Total surveys 1013 149

Who or what has influenced

the decision of the type of

breastfeeding for your baby

the most?

(Comparison of “Exclusive Breastfeeding Group” with “Artificial Feeding from the Birth Group”)



“BREASTFEEDING AND CHILD DEVELOPMENT”. (LAYDI STUDY)

SOCIAL AND CULTURAL CHARACTERISTICS OF MOTHERS: - RR of exclusive breastfeeding is higher in university mothers than in non-university mothers

(75% vs. 58%; RR 1,30, CI 95: 1,20 a 1,41)

- RR of artificial feeding start is higher in non-university mothers (15% vs. 4%; RR=3,38; CI 95: 2,25 a 5,07)

- RR of exclusive breastfeeding is higher es greater en of 30-34 years than in mothers of 25-29

(72% vs. 61%; RR=1,18; CI 95: 1,03 a 1,34)

- Mothers who received breastfeeding themselves as children have higher RR of giving breastfeeding

(69% vs. 57%; RR=1,21; CI 95%: 1,09 a 1,34)

- Mothers with previous pregnancies choose to give artificial feeding more often from the beginning

(12% vs. 8%; RR=1,58; CI 95: 1,12 a 2,22)

- Satisfaction is greater in mothers with exclusive breastfeeding compared to those of mixed breastfeeding

(94% y 77% classification as satisfied or very satisfied, 61,25 vs. 53,95 on the BSES-SF Scale)

[RR = Relative Risk; CI = Confidence Interval)



VIII: METHICILLIN-RESISTANT STAPHYLOCOCCUS AUREUS (MRSA) COLONIZATION IN HEALTHY CHILDREN IN

THE COMMUNITY (“COSACO STUDY”). MULTICENTRIC SPANISH NATIONAL PROJECT. Study in collaboration

with SEIP and Hospital La Paz, Madrid

Description:

Observational, prospective and multicentric Study. Collaborative Study coordinated by the Spanish Society of Pediatric

Infectology (SEIP), University Hospital La Paz and PAPenRED (belonging to the AEPap). Seventy three pediatrician offices,

Collaborating Researchers of PAPenRED, from all over Spain have been selected.

Main objective

- Determine the prevalence of colonization by Staphylococcus Aureus Resitent to Methicillin (MRSA) in healthy Spanish

children. In addition, the strains are genotypically analyzed.

Secondary objectives:

- Determine the prevalence of colonization by MRSA in the community in the Spanish pediatric population by regions

and in relation to the rural and urban areas.

- Establish colonization risk factor in the pediatric population.

- Analyze the resistances of the MRSA in order to establish recommendations for the empirical treatment of these

infections acquired in the community.

- Establish recommendations on the community approach of the infection detecting the possible reservoirs.

pediatric epidemiological surveillance and research

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