Global assessment of the knowledge and confidence in managing allergic disorders among primary care pediatricians across Europe: An EAACI task force report

BACKGROUND

Pediatricians are often the first point of contact for children in Primary Care (PC), but still perceive gaps in their allergy knowledge. We investigated self-perceived knowledge gaps and educational needs in pediatricians across healthcare systems in Europe so that future educational initiatives may better support the delivery of allergy services in PC.

METHOD

A multinational survey was circulated to pediatricians who care for children and adolescents with allergy problems in PC by the EAACI Allergy Educational Needs in Primary Care Pediatricians Task Force from February to March 2023. A 5-point Likert scale was used to assess the level of agreement with questionnaire statements. Thirty surveys per country were the cut-off for inclusion and statistical analysis.

RESULTS

In this study, 1991 respondents were obtained from 56 countries across Europe and 210 responses were from countries with a cut-off below 30 participants per country. Primary care pediatricians (PCPs) comprised 74.4% of the respondents. The majority (65.3%) were contracted to state or district health services. 61.7% had awareness of guidelines for onward allergy referral in their countries but only 22.3% were aware of the EAACI competencies document for allied health professionals for allergy. Total sample respondents versus PCPs showed 52% and 47% of them have access to allergy investigations in their PC facility (mainly specific IgE and skin prick tests); 67.6% and 58.9% have access to immunotherapy, respectively. The main barrier to referral to a specialist was a consideration that the patient's condition could be diagnosed and treated in this PC facility, (57.8% and 63.6% respectively). The main reasons for referral were the need for hospital assessment, and partial response to first-line treatment (55.4% and 59.2%, 47% and 50.7%, respectively). Learning and assessment methods preference was fairly equally divided between Traditional methods (45.7% and 50.1% respectively) and e-learning 45.5% and 44.9%, respectively. Generalist physicians (GPs) have the poorest access to allergy investigations (32.7%, p = .000). The majority of the total sample (91.9%) assess patients with allergic pathology. 868 (43.6%) and 1117 (46.1%), received allergy training as undergraduates and postgraduates respectively [these proportions in PCPs were higher (45% and 59%), respectively]. PCPs with a special interest in allergology experienced greater exposure to allergy teaching as postgraduates. GPs received the largest amount of allergy teaching as undergraduates. Identifying allergic disease based on clinical presentation, respondents felt most confident in the management of eczema/atopic dermatitis (87.4%) and rhinitis/asthma (86.2%), and least confident in allergen immunotherapy (36.9%) and latex allergy (30.8%).

CONCLUSION

This study exploring the confidence of PCPs to diagnose, manage, and refer patients with allergies, demonstrated knowledge gaps and educational needs for allergy clinical practice. It detects areas in need of urgent improvement especially in latex and allergen immunotherapy. It is important to ensure the dissemination of allergy guidelines and supporting EAACI documents since the majority of PCPs lack awareness of them. This survey has enabled us to identify what the educational priorities of PCPs are and how they would like to have them met.

Repercussions of the COVID-19 pandemic on child and adolescent mental health: A matter of concern-A joint statement from EAP and ECPCP

COVID-19 pandemic and the consequent rigid social distancing measures implemented, including school closures, have heavily impacted children's and adolescents' psychosocial wellbeing, and their mental health problems significantly increased. However, child and adolescent mental health were already a serious problem before the Pandemic all over the world. COVID-19 is not just a pandemic, it is a syndemic and mentally or socially disadvantaged children and adolescents are the most affected. Non-Communicable Diseases (NCDs) and previous mental health issues are an additional worsening condition. Even though many countries have responded with decisive efforts to scale-up mental health services, a more integrated and community-based approach to mental health is required. EAP and ECPCP makes recommendations to all the stakeholders to take action to promote, protect and care for the mental health of a generation.

Prevalence of Italian children living in food insecure households and their health status

Background

Food insecurity poses a major threat to population’s health status. Children, if affected, are particularly vulnerable to the possible sequels of food insecurity. Considering that, we aimed to assess the prevalence of children (born in Italy, from Italian parents) living in food insecure households and the association with their health and socio-economic conditions.

Methods

The study was conducted from January 2017 to December 2018 in pediatric offices. Parents answered to the 18-items of the Household Food Security Index, 8 of which specifically concern children. Households were classified in 4 categories: very low, low, marginal and high food security, creating then a dichotomized variable (food secure and insecure). Pediatricians answered a dedicated questionnaire on children’s health status. We used logistic regression to assess the socio-economic variables predicting food insecurity and chi2 test to evaluate the association between food insecurity and children’s health status.

Results

Based on parents’ answers, among 573 households with children, 15.4% were food insecure. Food insecurity was associated to lower parent’s education and employment, worse household’s economic condition, higher number of children within a family and geographic location (living in south Italy rather than north). There was a significant association between food insecurity and the presence of visual, relational, psychomotor, dental and physical impairments in children.

Conclusions

Almost 1 Italian child in 7 lives in food insecure households. Children living in food insecure households have higher probability of having physical, mental and social health problems. Considering the impact on children’s health, food insecurity emerges as a public health issue and should be addressed through the appropriate measures.

Key messages

Food insecurity among children represents a public health issue even in a developed country such as Italy, affecting children’s present and future health. Policy makers should consider screening children for food insecurity and taking appropriate actions, especially for the at-risk population.

Randomised clinical trial: The beneficial effects of VSL#3 in obese children with non-alcoholic steatohepatitis

BACKGROUND

Gut microbiota modifiers may have beneficial effects of non-alcoholic fatty liver disease (NAFLD) but randomised controlled trials (RCT) are lacking in children.

AIM

To perform a double-blind RCT of VSL#3 vs. placebo in obese children with biopsy-proven NAFLD.

METHODS

Of 48 randomised children, 44 (22 VSL#3 and 22 placebo) completed the study. The main outcome was the change in fatty liver severity at 4 months as detected by ultrasonography. Secondary outcomes were the changes in triglycerides, insulin resistance as detected by the homoeostasis model assessment (HOMA), alanine transaminase (ALT), body mass index (BMI), glucagon-like peptide 1 (GLP-1) and activated GLP-1 (aGLP-1). Ordinal and linear models with cluster confidence intervals were used to evaluate the efficacy of VSL#3 vs. placebo at 4 months.

RESULTS

At baseline, moderate and severe NAFLD were present in 64% and 36% of PLA children and in 55% and 45% of VSL#3 children. The probability that children supplemented with VSL#3 had none, light, moderate or severe FL at the end of the study was 21%, 70%, 9% and 0% respectively with corresponding values of 0%, 7%, 76% and 17% for the placebo group (P < 0.001). No between-group differences were detected in triglycerides, HOMA and ALT while BMI decreased and GLP-1 and aGLP1 increased in the VSL#3 group (P < 0.001 for all comparisons).

CONCLUSIONS

A 4-month supplement of VSL#3 significantly improves NAFLD in children. The VSL#3-dependent GLP-1 increase could be responsible for these beneficial effects. Trial identifier: NCT01650025 (www.clinicaltrial.gov).

Antiandrogen withdrawal in the treatment of hormone-relapsed prostate cancer: single institutional experience

OBJECTIVES

Locally advanced and metastatic prostate cancer eventually progresses in spite of complete androgen blockade. Second-line therapy is usually disappointing, and further progression is the rule. Laboratory and clinical data have indicated that antiandrogen withdrawal may be a valuable strategy in the treatment of these patients. However, after antiandrogen withdrawal, controversial clinical results have been reported. Therefore every contribution to this therapeutic strategy is useful.

METHODS

Herein we present our experience with antiandrogen discontinuation in a series of 44 patients with locally advanced or metastatic prostate cancer treated with complete androgen blockade (CAB).

RESULTS

Prostate-specific antigen (PSA) decline was observed in 13 of 44 (29%) and in 11 of these patients the reduction was greater than 50%. No response or further progression after antiandrogen withdrawal was observed in 31 of the 44 patients (71%). Among these patients 14 died due to prostate cancer after a mean period of 5.6 months. No patient in the responding group has died.

CONCLUSIONS

Our data indicate that approximately 30% of patients with advanced prostate cancer treated with CAB respond to antiandrogen withdrawal with a reduction in serum PSA levels. Even though it is not clear whether this PSA reduction produces a benefit in terms of survival, we feel that antiandrogen withdrawal must be the first therapeutic maneuver in patients with advanced prostate cancer who progress after CAB. If there is no PSA response within 4 months, second-line treatment is necessary.

Electromagnetic interference by GSM cellular phones and UHF radios with intensive-care and operating-room ventilators

The aim of this study was to evaluate the risks deriving from the interference by radio handsets (GSM cellular phones and UHF radios) with intensive-care and operating-room ventilators. Tests were conducted in three hospitals in Rome on 22 lung ventilators in accordance with the recommended practice ANSI C63.18-1997. When electromagnetic interference (EMI) effects occurred, the authors determined maximum interference distances. They also evaluated the distances at which the use of a given handset would result in a 5% and a 95% probability of interference. The degree of risk posed by each observed event was estimated, and safe distances are suggested. EMI events of varying degrees and natures were observed even with transmitters placed at a considerable distance. All observed effects were temporary. Only three ventilators of a certain model stopped working altogether and had to be reset.

Recombinant alpha interferon in metastatic renal cell carcinoma. A cooperative phase II study

A total of 61 evaluable patients with advanced renal cell carcinoma have been treated with 3 x 10(6) IU per square meter of body surface with recombinant alpha 2b interferon three times a week within a Cooperative Phase II Study. Toxic death for terminal renal failure occurred in 1 patient (1.63%), and toxicities greater than WHO grade 2 were present in 10 cases (16%). The overall response rate after six months of treatment was 13.1% (partial response 4, minor response 4). Two complete responses were obtained at nine and fifteen months (3.3%). Long-lasting stabilization of disease was 13.1 percent.

[Congenital dysplasia of the hip. Preliminary results of a longitudinal study in the first 6 months of life]

The authors report their experience of a serial follow-up for congenital dysplasia of the hip (CDH). 699 babies born during a three-months period were examined on their first day of life, on the forth and at the age of 1 and 6 months. 2 dislocated hips, 222 clicking hips were discovered in the neonatal period. At the first month 1 dislocated hip and only 6 clicking hips were detected. At the sixth month all babies were normal with the exception of two clicking hips. X-ray examination confirmed clinical dislocation diagnosis and showed pathological signs (subluxation and acetabular dysplasia) also in normal and clicking hips. According to their results the authors suggest that clinical examination during the first 6 months of life and X-ray can decrease the incidence of late diagnosis of CDH.