Qualidade de Vida em Mães de Crianças com Alergia Alimentar.
Arquivos
Data
2018-07-25
Autores
Sauretti, Priscila Nalin
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Estadual Paulista (Unesp)
Resumo
Introdução. A alergia alimentar (AA) é um problema crescente de saúde pública, com estimativa de prevalência atual na faixa de 4% a 8%. O tratamento essencialmente nutricional, com a exclusão dos alérgenos alimentares implicados. Assim, para as crianças afetadas e seus pais ou cuidadores, tanto a morbidade que precede o diagnóstico e tratamento, quanto às restrições alimentares indicadas após o diagnóstico podem resultar em sobrecarga emocional, acrescentando ansiedade e estresse às tarefas diárias e afetar a Qualidade de Vida (QV). O WHOQOL-BREF, validado para a língua portuguesa, é um instrumento genérico para aplicação em adultos. Considerando ser importante avaliar a QV em mães de crianças com alergia alimentar, os objetivos deste estudo são: avaliar a QV de mães de crianças com alergia alimentar em dois momentos: ao diagnóstico da alergia alimentar da criança (alergia alimentar não tratada), e em segundo momento quando a criança estiver com o tratamento estável e assintomática e correlacionar os escores dos diferentes domínios do WHOQOL-BREF com o escore total do CoMiSS. Métodos. Estudo observacional, transversal, em uma amostra de mães de crianças com AA diagnosticadas antes dos três anos de idade. Critérios de inclusão: As mães respondedoras do instrumento de avaliação de Qualidade de Vida deveriam ser adultas (idade acima de 18 anos); serem capazes de compreender as instruções e de responder as questões formuladas no WHOQOL-BREF; ter conhecimento da condição clínica do paciente e residir no mesmo domicílio do paciente. Critérios de inclusão para as crianças: idade menor que 36 meses ao diagnóstico da AA; diagnóstico da AA baseado em dados clínicos, laboratoriais, provocação oral aberta e prick teste; seguimento clínico para acompanhamento por pelo menos seis meses. Critérios de exclusão para as crianças: crianças com diagnóstico duvidoso de alergia alimentar; crianças com co-morbidades crônicas, tais como doenças genéticas, neurológicas, cardiológicas, endocrinológicas e nefrológicas. Foram colhidos dados clínicos mediante entrevista com as mães segundo protocolo desenvolvido para o estudo. O instrumento genérico impresso, auto administrado, foi aplicado a mães de crianças com alergia alimentar. O escore CoMiSS foi aplicado no mesmo dia da avaliação da QV. Resultados. O WHOQOL-BREF foi administrado a 86 mães, sendo grande proporção com ensino médio e superior completos. No estudo, o questionário foi auto administrado em 91% e a mediana do tempo de preenchimento do questionário foi de 5 minutos. Entretanto, 48% estavam desempregadas. O índice de aglomeração denotou que as famílias são pequenas e vivem em moradias com poucos cômodos. A maioria das crianças nasceu de cesariana, sendo primogênitas em metade dos casos. As crianças apresentaram o início dos sintomas e a primeira consulta antes dos seis meses de vida, com introdução precoce do leite de vaca e predomínio de manifestações gastrointestinais e pouco comprometimento do estado nutricional tanto ao nascimento quanto no momento do diagnóstico. Observou-se antecedente alérgico positivo em pais ou irmãos em 45,3% e maior ocorrência de antecedente positivo na mãe, em alergia respiratória. Observou-se que não houve diferença estatisticamente significativa entre os quatro Domínios avaliados e Correlação positiva, de moderada a forte intensidade, e altamente significativa entre os valores obtidos nos Domínios. As quatro facetas com piores avaliações foram: recreação e lazer; recursos financeiros; sono e repouso; sentimentos negativos em ordem crescente de valores. Observou-se Correlação negativa, ou seja, quanto maiores os valores do CoMiSS, menores os valores dos Domínios Psicológico, Relações Sociais e Meio Ambiente. Não houve diferença estatisticamente significativa para os quatro Domínios na comparação entre antes e após o tratamento. Para as 34 mães que responderam os dois questionários (mediana e o intervalo interquartil) do tempo em meses entre os dois questionários foi de 9 (6-15), as quatro facetas com piores avaliações no momento do diagnóstico foram: recreação-lazer; recursos financeiros; sono-repouso; sentimentos negativos em ordem crescente de valores. A evolução destas facetas mostrou: nenhuma melhoria para recursos financeiros; pequena melhora para recreação-lazer e sono-repouso e moderada melhora para sentimentos negativos. Conclusões. Este estudo de pesquisa transversal observou alto índice de participação no estudo, facilidade da auto-aplicação do questionário, baixo número de perdas de respostas às facetas, o que apóia a aplicabilidade clínica da escala WHOQOL-BREF como medida de qualidade de vida de mães de crianças com alergia alimentar. A aplicação do questionário em mães de crianças com alergia alimentar na faixa etária das crianças avaliadas, denota a mãe como o principal membro da família com maior preocupação com a saúde da criança. Isto implica em melhor definição em quem educar para o problema. As mães identificaram a necessidade de sono e repouso associado à recreação e lazer como facetas comprometidas durante todo o processo de diagnóstico e tratamento da alergia alimentar de seus filhos. As preocupações com o tratamento da alergia alimentar se perpetuam mesmo após o diagnóstico inicial. A escala genérica de QV não foi capaz de detectar mudanças após o tratamento. Este achado denota duas situações: que realmente não há mudança na QV das mães após o diagnóstico ou a necessidade do uso de questionários específicos para estudos de alergia alimentar, que necessitam a avaliação de desfechos. Este estudo contribui para a literatura de alergia alimentar e chama a atenção para a necessidade de considerar a avaliação continua da mãe, mesmo após o diagnóstico inicial. O aumento no número de crianças diagnosticadas com alergias alimentares ressalta a importância de intervenções para abordar preocupações psicossociais, como estresse e ansiedade nos pais.
Introduction. Food allergy (FA) is a problem with an estimate of current prevalence in the range of 4% to 8%. The treatment essentially nutritional, excluding the food involved. Thus, for affected children and their parents or caregivers, both the morbidity preceding diagnosis and treatment and dietary restrictions indicated after diagnosis can result in emotional overload, adding anxiety and stress to daily tasks, and affecting Quality of Life (QV). The WHOQOL-BREF, validated for the Portuguese language, is a generic instrument for application in adults. Considering that it is essential to evaluate the QoL in mothers of children with food allergy, the objectives of this study are: to evaluate the QoL of mothers of children with food allergy in two moments: the diagnosis of food allergy of the child (untreated food allergy) and second time when the child has stable and asymptomatic treatment and correlate the scores of the different WHOQOL-BREF domains with the total CoMiSS score. Methods. Observational, cross-sectional study in a sample of mothers of children with FA diagnosed before the age of three years. Inclusion criteria: mothers responding instrument should be adults (age above 18 years); be able to understand the instructions and to answer the questions in the WHOQOL-BREF; be aware of the patient's clinical condition and reside in the same household as the patient. Inclusion criteria for children: age less than 36 months at diagnosis of FA; diagnosis of FA based on clinical data, laboratory, open oral challenge and prick test; follow-up for at least six months. Exclusion criteria for children: chronic comorbidities, such as genetic, neurological, cardiologic, endocrinological and nephrological diseases. Clinical data were collected through interviews with the mothers according to the protocol developed for the study. The printed, selfadministered generic instrument was applied to mothers. The CoMiSS score was applied on the same day as the QOL. Results. The WHOQOLBREF was administered to 86 mothers, being large proportion with complete high school and higher education. In the study, the questionnaire was self-administered in 91% and the median time for completing the questionnaire was 5 minutes. However, 48% were unemployed. The agglomeration index denoted that the families are small and live in houses with few rooms. Most of the children were born cesarean, being first born in half of the cases. The children presented the onset of symptoms and the first consultation before six months of life, with early introduction of cow's milk and a predominance of gastrointestinal manifestations and little impairment of nutritional status both at birth and at the time of diagnosis. A positive allergic history in parents or siblings was observed in 45.3% and a higher occurrence of a real antecedent in the mother, in respiratory allergy. It was observed that there was no statistically significant difference between the four domains evaluated and positive correlation, highly significant among the values obtained in the Domains. The four facets with the worst evaluations were: recreation and leisure; financial resources; sleep and rest; negative feelings in increasing order of values. A negative correlation was observed, that is, the higher the CoMiSS values, the lower the values of the Psychological, Social Relations and the Environment Domains. There was no statistically significant difference for the four domains in the comparison between before and after treatment. For the 34 mothers who answered the two questionnaires (median and the interquartile range of time in months between the two questionnaires was 9 (6-15), the four facets with the worst evaluations at the time of diagnosis were recreation-leisure, financial resources , sleep-rest, negative feelings in ascending order of values The evolution of these facets showed: no improvement for financial resources, small improvement for recreationleisure and sleep-rest and moderate improvement for negative feelings. Conclusions. This cross-sectional research study found that the high index of participation in the study and the ease of self-application of the questionnaire, the low number of facet response losses, support the clinical applicability of the WHOQOL-BREF scale as a measure of the quality of life of mothers of children with food allergy. The application of the questionnaire in mothers of children with food allergy in the age range of the children evaluated denotes the mother as the principal member of the family with greater concern about the health of the child. This implies a better definition of who educate for the problem. The mothers identified the need for sleep and rest associated with recreation and leisure as facets compromised throughout the process of diagnosis and treatment of food allergy of their children. Concerns about the treatment of food allergy continue even after the initial diagnosis. The generic scale of QOL was not able to detect changes after treatment. This finding denotes two situations: that there is no change in the QoL of the mothers after diagnosis or the need to use specific questionnaires for food allergy studies, which require the evaluation of outcomes. This study contributes to the literature on food allergy and draws attention to the need to consider a continuous assessment of the mother, even after the initial diagnosis. The increase in the number of children diagnosed with food allergies underscores the importance of interventions to address psychosocial concerns such as stress and anxiety in parents.
Introduction. Food allergy (FA) is a problem with an estimate of current prevalence in the range of 4% to 8%. The treatment essentially nutritional, excluding the food involved. Thus, for affected children and their parents or caregivers, both the morbidity preceding diagnosis and treatment and dietary restrictions indicated after diagnosis can result in emotional overload, adding anxiety and stress to daily tasks, and affecting Quality of Life (QV). The WHOQOL-BREF, validated for the Portuguese language, is a generic instrument for application in adults. Considering that it is essential to evaluate the QoL in mothers of children with food allergy, the objectives of this study are: to evaluate the QoL of mothers of children with food allergy in two moments: the diagnosis of food allergy of the child (untreated food allergy) and second time when the child has stable and asymptomatic treatment and correlate the scores of the different WHOQOL-BREF domains with the total CoMiSS score. Methods. Observational, cross-sectional study in a sample of mothers of children with FA diagnosed before the age of three years. Inclusion criteria: mothers responding instrument should be adults (age above 18 years); be able to understand the instructions and to answer the questions in the WHOQOL-BREF; be aware of the patient's clinical condition and reside in the same household as the patient. Inclusion criteria for children: age less than 36 months at diagnosis of FA; diagnosis of FA based on clinical data, laboratory, open oral challenge and prick test; follow-up for at least six months. Exclusion criteria for children: chronic comorbidities, such as genetic, neurological, cardiologic, endocrinological and nephrological diseases. Clinical data were collected through interviews with the mothers according to the protocol developed for the study. The printed, selfadministered generic instrument was applied to mothers. The CoMiSS score was applied on the same day as the QOL. Results. The WHOQOLBREF was administered to 86 mothers, being large proportion with complete high school and higher education. In the study, the questionnaire was self-administered in 91% and the median time for completing the questionnaire was 5 minutes. However, 48% were unemployed. The agglomeration index denoted that the families are small and live in houses with few rooms. Most of the children were born cesarean, being first born in half of the cases. The children presented the onset of symptoms and the first consultation before six months of life, with early introduction of cow's milk and a predominance of gastrointestinal manifestations and little impairment of nutritional status both at birth and at the time of diagnosis. A positive allergic history in parents or siblings was observed in 45.3% and a higher occurrence of a real antecedent in the mother, in respiratory allergy. It was observed that there was no statistically significant difference between the four domains evaluated and positive correlation, highly significant among the values obtained in the Domains. The four facets with the worst evaluations were: recreation and leisure; financial resources; sleep and rest; negative feelings in increasing order of values. A negative correlation was observed, that is, the higher the CoMiSS values, the lower the values of the Psychological, Social Relations and the Environment Domains. There was no statistically significant difference for the four domains in the comparison between before and after treatment. For the 34 mothers who answered the two questionnaires (median and the interquartile range of time in months between the two questionnaires was 9 (6-15), the four facets with the worst evaluations at the time of diagnosis were recreation-leisure, financial resources , sleep-rest, negative feelings in ascending order of values The evolution of these facets showed: no improvement for financial resources, small improvement for recreationleisure and sleep-rest and moderate improvement for negative feelings. Conclusions. This cross-sectional research study found that the high index of participation in the study and the ease of self-application of the questionnaire, the low number of facet response losses, support the clinical applicability of the WHOQOL-BREF scale as a measure of the quality of life of mothers of children with food allergy. The application of the questionnaire in mothers of children with food allergy in the age range of the children evaluated denotes the mother as the principal member of the family with greater concern about the health of the child. This implies a better definition of who educate for the problem. The mothers identified the need for sleep and rest associated with recreation and leisure as facets compromised throughout the process of diagnosis and treatment of food allergy of their children. Concerns about the treatment of food allergy continue even after the initial diagnosis. The generic scale of QOL was not able to detect changes after treatment. This finding denotes two situations: that there is no change in the QoL of the mothers after diagnosis or the need to use specific questionnaires for food allergy studies, which require the evaluation of outcomes. This study contributes to the literature on food allergy and draws attention to the need to consider a continuous assessment of the mother, even after the initial diagnosis. The increase in the number of children diagnosed with food allergies underscores the importance of interventions to address psychosocial concerns such as stress and anxiety in parents.
Descrição
Palavras-chave
Qualidade de vida, WHOQOL-BREF, Alergia alimentar, Crianças, Whoqol-bref, Quality of Life, Children, Food allergy