array:24 [
  "pii" => "S0365059621003056"
  "issn" => "03650596"
  "doi" => "10.1016/j.abd.2021.03.010"
  "estado" => "S300"
  "fechaPublicacion" => "2022-03-01"
  "aid" => "496"
  "copyright" => "Sociedade Brasileira de Dermatologia"
  "copyrightAnyo" => "2021"
  "documento" => "article"
  "crossmark" => 1
  "licencia" => "http://creativecommons.org/licenses/by/4.0/"
  "subdocumento" => "fla"
  "abierto" => array:3 [
    "ES" => true
    "ES2" => true
    "LATM" => true
  ]
  "gratuito" => true
  "lecturas" => array:1 [
    "total" => 0
  ]
  "Traduccion" => array:1 [
    "pt" => array:19 [
      "pii" => "S2666275221003118"
      "issn" => "26662752"
      "doi" => "10.1016/j.abdp.2021.12.009"
      "estado" => "S300"
      "fechaPublicacion" => "2022-03-01"
      "aid" => "496"
      "copyright" => "Sociedade Brasileira de Dermatologia"
      "documento" => "article"
      "crossmark" => 1
      "licencia" => "http://creativecommons.org/licenses/by/4.0/"
      "subdocumento" => "fla"
      "abierto" => array:3 [
        "ES" => true
        "ES2" => true
        "LATM" => true
      ]
      "gratuito" => true
      "lecturas" => array:1 [
        "total" => 0
      ]
      "pt" => array:12 [
        "idiomaDefecto" => true
        "cabecera" => "<span class="elsevierStyleTextfn">Artigo original</span>"
        "titulo" => "Valida&#231;&#227;o e reprodutibilidade do question&#225;rio escrito <span class="elsevierStyleItalic">International Study of Asthma and Allergies in Childhood</span> &#40;ISAAC&#41; m&#243;dulo eczema at&#243;pico para inqu&#233;rito telef&#244;nico em crian&#231;as entre&#160;6&#8208;7&#160;anos"
        "tienePdf" => "pt"
        "tieneTextoCompleto" => "pt"
        "tieneResumen" => "pt"
        "paginas" => array:1 [
          0 => array:2 [
            "paginaInicial" => "173"
            "paginaFinal" => "178"
          ]
        ]
        "contieneResumen" => array:1 [
          "pt" => true
        ]
        "contieneTextoCompleto" => array:1 [
          "pt" => true
        ]
        "contienePdf" => array:1 [
          "pt" => true
        ]
        "resumenGrafico" => array:2 [
          "original" => 0
          "multimedia" => array:7 [
            "identificador" => "fig0005"
            "etiqueta" => "Figura 1"
            "tipo" => "MULTIMEDIAFIGURA"
            "mostrarFloat" => true
            "mostrarDisplay" => false
            "figura" => array:1 [
              0 => array:4 [
                "imagen" => "gr1.jpeg"
                "Alto" => 2246
                "Ancho" => 2508
                "Tamanyo" => 516178
              ]
            ]
            "descripcion" => array:1 [
              "pt" => "<p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Question&#225;rio ISAAC escrito m&#243;dulo Eczema At&#243;pico &#40;QEEA&#41; para crian&#231;as entre&#160;6&#160;e&#160;7&#160;anos de idade&#46;</p>"
            ]
          ]
        ]
        "autores" => array:1 [
          0 => array:2 [
            "autoresLista" => "Elisa Fontenelle de Oliveira, Camila Penedo, Solange Oliveira Rodrigues Valle, F&#225;bio Chigres Kuschnir"
            "autores" => array:4 [
              0 => array:2 [
                "nombre" => "Elisa Fontenelle de"
                "apellidos" => "Oliveira"
              ]
              1 => array:2 [
                "nombre" => "Camila"
                "apellidos" => "Penedo"
              ]
              2 => array:2 [
                "nombre" => "Solange Oliveira Rodrigues"
                "apellidos" => "Valle"
              ]
              3 => array:2 [
                "nombre" => "F&#225;bio Chigres"
                "apellidos" => "Kuschnir"
              ]
            ]
          ]
        ]
      ]
      "idiomaDefecto" => "pt"
      "Traduccion" => array:1 [
        "en" => array:9 [
          "pii" => "S0365059621003056"
          "doi" => "10.1016/j.abd.2021.03.010"
          "estado" => "S300"
          "subdocumento" => ""
          "abierto" => array:3 [
            "ES" => true
            "ES2" => true
            "LATM" => true
          ]
          "gratuito" => true
          "lecturas" => array:1 [
            "total" => 0
          ]
          "idiomaDefecto" => "en"
          "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621003056?idApp=UINPBA00008Z"
        ]
      ]
      "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221003118?idApp=UINPBA00008Z"
      "url" => "/26662752/0000009700000002/v1_202204130559/S2666275221003118/v1_202204130559/pt/main.assets"
    ]
  ]
  "itemSiguiente" => array:19 [
    "pii" => "S0365059621002993"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2020.09.014"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "490"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "simple-article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "crp"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Case Report</span>"
      "titulo" => "Primary cutaneous B-cell lymphoma leg type&#58; good response with the RADHAP 21 protocol"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "179"
          "paginaFinal" => "183"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 1873
              "Ancho" => 2507
              "Tamanyo" => 670783
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large cell non-Hodgkin lymphoma infiltrating the inguinal lymph node&#44; extending to the adipose tissue around the lymph node &#40;Hematoxylin &#38; eosin&#44; &#215;200&#41;&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Camila Gon&#231;alves Pinheiro, Lafayette Cavalcanti Bezerra Dias Cruz, Alexandre Rolim da Paz, Luciana Cavalcante Trindade"
          "autores" => array:4 [
            0 => array:2 [
              "nombre" => "Camila Gon&#231;alves"
              "apellidos" => "Pinheiro"
            ]
            1 => array:2 [
              "nombre" => "Lafayette Cavalcanti Bezerra Dias"
              "apellidos" => "Cruz"
            ]
            2 => array:2 [
              "nombre" => "Alexandre Rolim da"
              "apellidos" => "Paz"
            ]
            3 => array:2 [
              "nombre" => "Luciana Cavalcante"
              "apellidos" => "Trindade"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275221003052"
        "doi" => "10.1016/j.abdp.2020.09.028"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221003052?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621002993?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009700000002/v2_202204021027/S0365059621002993/v2_202204021027/en/main.assets"
  ]
  "itemAnterior" => array:19 [
    "pii" => "S0365059621003081"
    "issn" => "03650596"
    "doi" => "10.1016/j.abd.2021.06.006"
    "estado" => "S300"
    "fechaPublicacion" => "2022-03-01"
    "aid" => "499"
    "copyright" => "Sociedade Brasileira de Dermatologia"
    "documento" => "article"
    "crossmark" => 1
    "licencia" => "http://creativecommons.org/licenses/by/4.0/"
    "subdocumento" => "fla"
    "abierto" => array:3 [
      "ES" => true
      "ES2" => true
      "LATM" => true
    ]
    "gratuito" => true
    "lecturas" => array:1 [
      "total" => 0
    ]
    "en" => array:12 [
      "idiomaDefecto" => true
      "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
      "titulo" => "Pediatric androgenetic alopecia&#58; a retrospective review of clinical characteristics&#44; hormonal assays and metabolic syndrome risk factors in 23 patients"
      "tienePdf" => "en"
      "tieneTextoCompleto" => "en"
      "tieneResumen" => "en"
      "paginas" => array:1 [
        0 => array:2 [
          "paginaInicial" => "166"
          "paginaFinal" => "172"
        ]
      ]
      "contieneResumen" => array:1 [
        "en" => true
      ]
      "contieneTextoCompleto" => array:1 [
        "en" => true
      ]
      "contienePdf" => array:1 [
        "en" => true
      ]
      "resumenGrafico" => array:2 [
        "original" => 0
        "multimedia" => array:8 [
          "identificador" => "fig0005"
          "etiqueta" => "Figure 1"
          "tipo" => "MULTIMEDIAFIGURA"
          "mostrarFloat" => true
          "mostrarDisplay" => false
          "figura" => array:1 [
            0 => array:4 [
              "imagen" => "gr1.jpeg"
              "Alto" => 453
              "Ancho" => 1250
              "Tamanyo" => 69418
            ]
          ]
          "detalles" => array:1 [
            0 => array:3 [
              "identificador" => "at0005"
              "detalle" => "Figure "
              "rol" => "short"
            ]
          ]
          "descripcion" => array:1 [
            "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Hair loss patterns observed in pediatric androgenetic alopecia&#46; &#40;A&#41;&#44; Diffuse thinning at the crown with preservation of the frontal hairline in a female with adolescent androgenetic alopecia&#46; &#40;B&#41;&#44; Preservation of the frontal hairline in a male with adolescent androgenetic alopecia who has diffuse thinning at the crown&#46;</p>"
          ]
        ]
      ]
      "autores" => array:1 [
        0 => array:2 [
          "autoresLista" => "Deren &#214;zcan"
          "autores" => array:1 [
            0 => array:2 [
              "nombre" => "Deren"
              "apellidos" => "&#214;zcan"
            ]
          ]
        ]
      ]
    ]
    "idiomaDefecto" => "en"
    "Traduccion" => array:1 [
      "pt" => array:9 [
        "pii" => "S2666275221003143"
        "doi" => "10.1016/j.abdp.2021.12.012"
        "estado" => "S300"
        "subdocumento" => ""
        "abierto" => array:3 [
          "ES" => true
          "ES2" => true
          "LATM" => true
        ]
        "gratuito" => true
        "lecturas" => array:1 [
          "total" => 0
        ]
        "idiomaDefecto" => "pt"
        "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2666275221003143?idApp=UINPBA00008Z"
      ]
    ]
    "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621003081?idApp=UINPBA00008Z"
    "url" => "/03650596/0000009700000002/v2_202204021027/S0365059621003081/v2_202204021027/en/main.assets"
  ]
  "en" => array:19 [
    "idiomaDefecto" => true
    "cabecera" => "<span class="elsevierStyleTextfn">Original Article</span>"
    "titulo" => "Validation and reproducibility of the International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41; Written Atopic Eczema Questionnaire for telephone survey in children aged 6&#8211;7 years"
    "tieneTextoCompleto" => true
    "paginas" => array:1 [
      0 => array:2 [
        "paginaInicial" => "173"
        "paginaFinal" => "178"
      ]
    ]
    "autores" => array:1 [
      0 => array:4 [
        "autoresLista" => "Elisa Fontenelle de Oliveira, Camila Penedo, Solange Oliveira Rodrigues Valle, F&#225;bio Chigres Kuschnir"
        "autores" => array:4 [
          0 => array:4 [
            "nombre" => "Elisa Fontenelle de"
            "apellidos" => "Oliveira"
            "email" => array:1 [
              0 => "elisafontenelle@yahoo.com.br"
            ]
            "referencia" => array:3 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
              1 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">b</span>"
                "identificador" => "aff0010"
              ]
              2 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">&#42;</span>"
                "identificador" => "cor0005"
              ]
            ]
          ]
          1 => array:3 [
            "nombre" => "Camila"
            "apellidos" => "Penedo"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">a</span>"
                "identificador" => "aff0005"
              ]
            ]
          ]
          2 => array:3 [
            "nombre" => "Solange Oliveira Rodrigues"
            "apellidos" => "Valle"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">c</span>"
                "identificador" => "aff0015"
              ]
            ]
          ]
          3 => array:3 [
            "nombre" => "F&#225;bio Chigres"
            "apellidos" => "Kuschnir"
            "referencia" => array:1 [
              0 => array:2 [
                "etiqueta" => "<span class="elsevierStyleSup">d</span>"
                "identificador" => "aff0020"
              ]
            ]
          ]
        ]
        "afiliaciones" => array:4 [
          0 => array:3 [
            "entidad" => "Department of Pediatrics&#44; Instituto Nacional de Sa&#250;de da Mulher&#44; da Crian&#231;a e do Adolescente Fernandes Figueira&#44; Funda&#231;&#227;o Oswaldo Cruz&#44; Rio de Janeiro&#44; RJ&#44; Brazil"
            "etiqueta" => "a"
            "identificador" => "aff0005"
          ]
          1 => array:3 [
            "entidad" => "Programa de P&#243;s-Gradua&#231;&#227;o em Ci&#234;ncias M&#233;dicas&#44; Universidade do Estado do Rio de Janeiro&#44; Rio de Janeiro&#44; RJ&#44; Brazil"
            "etiqueta" => "b"
            "identificador" => "aff0010"
          ]
          2 => array:3 [
            "entidad" => "Department of Immunology&#44; Universidade Federal do Rio de Janeiro&#58; Programa de Sa&#250;de da Crian&#231;a da Secretaria Municipal de Sa&#250;de e Defesa Civil do Rio de Janeiro&#44; Rio de Janeiro&#44; RJ&#44; Brazil"
            "etiqueta" => "c"
            "identificador" => "aff0015"
          ]
          3 => array:3 [
            "entidad" => "Department of Pediatrics&#44; Faculdade de Ci&#234;ncias M&#233;dicas&#44; Universidade do Estado do Rio de Janeiro&#44; Rio de Janeiro&#44; RJ&#44; Brazil"
            "etiqueta" => "d"
            "identificador" => "aff0020"
          ]
        ]
        "correspondencia" => array:1 [
          0 => array:3 [
            "identificador" => "cor0005"
            "etiqueta" => "&#8270;"
            "correspondencia" => "Corresponding author&#46;"
          ]
        ]
      ]
    ]
    "resumenGrafico" => array:2 [
      "original" => 0
      "multimedia" => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2241
            "Ancho" => 2507
            "Tamanyo" => 391291
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ISAAC Written Atopic Eczema questionnaire &#40;WAEQ&#41; for children between 6 and 7 years of age&#46;</p>"
        ]
      ]
    ]
    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0045">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Atopic eczema &#40;AE&#41; is a common chronic inflammatory dermatosis that mainly affects children&#46; It is often associated with a personal and&#47;or family history of atopy&#46; Pruritus is the most important symptom&#44; which can progress to complications such as excoriation&#44; infections&#44; and sleep disturbances&#46;<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1&#44;2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">The prevalence and severity of AE is unknown in many countries&#46; The International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41; constitutes an epidemiological landmark in the study of asthma and other allergic diseases&#44; such as AE and allergic rhinitis&#44; allowing international and regional comparisons of prevalence and risk factors associated with these conditions&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> However&#44; the administration of the ISAAC Written Atopic Eczema Questionnaire &#40;WAEQ&#41; for children between 6 and 7 years of age depended on the responses of their guardians in the household&#44; which may have impacted the final results with a low response rate&#46; Data from different centers participating in the phase 3 ISAAC in Brazil provided an AE prevalence of 8&#46;2&#37; in children in this age group&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">In 2006&#44; due to the importance of Chronic Non-Communicable Diseases &#40;NCDs&#41; in the Brazilian population&#44; the Ministry of Health implemented the VIGITEL system&#46; This system interviews probabilistic samples of individuals aged 18 years and older who have a telephone in their homes&#44; using questionnaires that address risk or protective factors for NCDs&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;6</span></a> Computer-assisted telephone interviews are conducted annually&#59; however&#44; it does not include data on AE&#46;<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> This tool was shown to be faster&#44; less expensive and more practical than the traditional methods&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In a study carried out in the city of Rio de Janeiro&#44; Valle et al&#46; validated the written ISAAC asthma questionnaire for children aged 6 to 7 years by telephone interviews&#44; showing good agreement and reproducibility of this method when compared to the original one&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The aim of this study was to validate and evaluate the reproducibility of the WAEQ in children aged between 6 and 7 years administered to guardians through telephone interviews&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0050">Methods</span><p id="par0030" class="elsevierStylePara elsevierViewall">This was an observational study carried out in Rio de Janeiro&#44; Brazil&#44; in a health unit aimed at education&#44; research&#44; assistance&#44; technological development&#44; and training in womens&#44; children and adolescents health&#46; This tertiary hospital receives patients from different neighborhoods and cities&#46; Approximately 60&#37; of the assisted families are low-income&#44; and this same percentage of mothers have only elementary school education&#46;<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> The city of Rio de Janeiro&#44; with 6&#44;718&#44;903 inhabitants &#40;97&#46;3&#37; with telephone coverage&#41; and a population density of 5265&#46;82 inhabitants&#47;km<span class="elsevierStyleSup">2</span>&#44; is located in the southeastern region of Brazil&#46;<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">This was a convenience sample&#46; A search of medical records was carried out&#44; and a total of 100 children aged between 6 and 7 years&#44; divided into two groups&#44; who had fixed or mobile telephone lines at home&#44; were recruited to participate in the study&#46; They ought to be undergoing follow-up for at least six months and be scheduled for consultation at the clinics in advance&#44; sequentially&#44; on every day of the week&#46; Patients who were diagnosed with AE according to the UK diagnostic criteria established by specialists in the Dermatology and Allergy and Immunology clinics comprised the &#8220;AE&#8221; group&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The &#8220;control group&#8221; consisted of children without dermatoses followed at the General Pediatrics outpatient clinic&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">The study was carried out in 3 phases&#44; in both groups&#58;<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005"><span class="elsevierStyleLabel">1</span><p id="par0045" class="elsevierStylePara elsevierViewall">The first phase consisted in applying the WAEQ &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; previously validated for the Portuguese language&#44; to the guardians of the children selected through telephone interviews&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> The main indicators assessed by this tool are the presence of current AE symptoms &#40;&#34;Recurrent pruritic lesions&#34; and &#34;Lesions in the last 12 months&#34; - Questions 1 and 2&#41; and typical locations of involvement &#40;&#34;Lesions in typical locations&#34; - Question 3&#41;&#59; &#8220;Age at onset&#8221; &#40;under 2 years old&#44; between 2 and 4 years old&#44; or aged 5 and over &#8211; Question 4&#41;&#59; severity of symptoms &#40;&#8220;Complete improvement in the last 12 months&#8221; and &#8220;Sleep disturbances in the last 12 months&#8221; &#8211; Questions 5 and 6&#41; and AE diagnosed by a physician &#40;&#8220;Presence of eczema&#8221; &#8211; Question 7&#41;&#46; According to the ISAAC protocol&#44; the first question differentiates &#8220;typical&#8221; AE from other inflammatory dermatoses&#59; the second focuses only on recent cases to minimize memory biases&#44; such as incomplete data or selective memory&#59; the third&#44; which considers flexural involvement&#44; associated with the fourth &#40;&#8220;Age at onset&#8221;&#41; substantially improved the specificity of the study&#59; the fifth and sixth questions measure the dermatitis severity &#40;chronicity and morbidity&#44; respectively&#41;&#59; and finally&#44; the seventh may indicate a prior medical diagnosis&#46;<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The questions were read slowly by one of the previously trained researchers&#44; and the answers were recorded directly and immediately on a form and on an electronic record&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia></li><li class="elsevierStyleListItem" id="lsti0010"><span class="elsevierStyleLabel">2</span><p id="par0050" class="elsevierStylePara elsevierViewall">The second phase was carried out after two weeks&#44; coinciding with the appointment date&#44; so that the child&#8217;s guardian could fill in the WAEQ in person under the supervision of the main researcher and a physical examination could be performed to ascertain the absence of signs and symptoms of AE in the control group&#46; On this occasion&#44; the children from the AE group were submitted to the Scoring Atopic Dermatitis &#40;SCORAD&#41; analysis by one of the researchers&#46; According to the score&#44; the AE severity was considered mild up to 25&#44; moderate between 25 and 50&#44; and severe above 50 points&#46;<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a></p></li><li class="elsevierStyleListItem" id="lsti0015"><span class="elsevierStyleLabel">3</span><p id="par0055" class="elsevierStylePara elsevierViewall">The third phase took place 15 days after the previous one when a researcher other than the first one conducted the second telephone interview using the WAEQ&#46;</p></li></ul></p><p id="par0060" class="elsevierStylePara elsevierViewall">Only the data provided by the same guardians in all three stages of the study were considered for analysis of reproducibility and validation&#46;</p><p id="par0065" class="elsevierStylePara elsevierViewall">The reproducibility of questionnaires administered by telephone was calculated using the Kappa coefficient &#40;&#954;&#41;&#46; The results were classified as follows&#58; above 0&#46;81&#44; almost perfect agreement&#59; between 0&#46;61 and 0&#46;8&#44; substantial agreement&#59; between 0&#46;41 and 0&#46;6&#44; moderate agreement&#59; between 0&#46;21 and 0&#46;4&#44; poor agreement&#59; below 0&#46;2&#44; slight agreement&#46;<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">The validation was calculated by comparing the responses obtained during the first telephone interview with the UK clinical diagnostic criteria for AE used as the standard in our study&#46;<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> The specificity and sensitivity for each indicator and their respective accuracy were evaluated&#46;</p><p id="par0075" class="elsevierStylePara elsevierViewall">Subsequently&#44; to assess the degree of agreement between the answers to the WAEQ filled out by the guardians on the day of the consultation with those obtained at the first telephone interview&#44; the Kappa coefficient was used&#44; with the same previously mentioned classification&#46;</p><p id="par0080" class="elsevierStylePara elsevierViewall">The data were stored in an Excel database&#44; and statistical analysis was performed using SPSS software&#44; version 23&#46;</p><p id="par0085" class="elsevierStylePara elsevierViewall">This study was approved by the Ethics Committee of the IFF&#46; Written consent was replaced by verbal consent obtained prior to the interview&#44; based on article N&#46; 5 of Resolution N&#46; 510&#44; of April 7&#44; 2016&#46;</p></span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0055">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall">Between August 2019 and January 2020&#44; 88 children were included in the study&#44; 32 &#40;36&#46;4&#37;&#41; in the AE group and 56 &#40;63&#46;3&#37;&#41; in the control group&#46; Fifty-two patients &#40;59&#46;1&#37;&#41; were male &#40;64&#46;3&#37; in the control group and 50&#37; in the AE group&#59; p&#8239;&#61;&#8239;0&#46;27&#41;&#46; In the AE group&#44; mothers accounted for 86&#46;4&#37; of respondents and fathers and grandparents&#44; 6&#46;25&#37; each&#46; In the control group&#44; mothers&#44; fathers and grandmothers were the respondents in 85&#37;&#44; 7&#46;22&#37;&#44; and 7&#46;22&#37; respectively&#46; There was no statistically significant difference regarding the percentage of this proportion between the two groups&#46;</p><p id="par0095" class="elsevierStylePara elsevierViewall">Due to the presence of more than one respondent for the same child in the different phases of the research or because the last interview was not carried out due to the new coronavirus pandemic&#44; 4 patients &#40;1 from the AE group and 3 from the control group&#41; were excluded from the reproducibility assessment&#44; and another 4 &#40;1 from the control group and 3 from the AE group&#41; were excluded from the agreement assessment process between the first telephone and the in-person interview&#46; The average duration of each telephone interview was 5&#8239;minutes&#46;</p><p id="par0100" class="elsevierStylePara elsevierViewall">The distribution of severity according to SCORAD was 65&#46;6&#37;&#44; 25&#37; and 9&#46;4&#37; for mild&#44; moderate&#44; and severe AE&#44; respectively&#46; Patients in the control group were not submitted to this analysis because they did not have signs or symptoms of AE&#46;</p><p id="par0105" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> shows the reproducibility of the WAEQ data obtained in the two telephone interviews&#46; Almost perfect agreement was observed in the questions &#8220;Recurrent pruritic lesions&#8221; and &#8220;Lesions in typical locations&#8221;&#44; while a substantial agreement was observed for all the other indicators&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0110" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a> shows the results of the validation of the WAEQ obtained through the first telephone interview with the guardians when compared with the clinical diagnosis given by a specialist based on the UK criteria&#46; The first four questions &#40;&#8220;Recurrent pruritic lesions&#8221;&#44; &#8220;Lesions in the last 12 months&#8221;&#44; &#8220;Lesions in typical locations&#8221; and &#8220;Age at onset&#8221;&#41; and the sixth question &#40;&#8220;Sleep disturbance in the last 12 months&#8221;&#41; showed high sensitivity &#40; &#8805;87&#46;5&#37;&#41; and specificity &#40;&#8805;80&#46;4&#37;&#41;&#46; On the other hand&#44; the fifth &#40;&#8220;Complete improvement in the last 12 months&#8221;&#41; and seventh &#40;&#8220;Presence of eczema&#8221;&#41; items showed low sensitivity &#40;34&#46;4&#37; and 40&#46;6&#37;&#44; respectively&#41;&#44; but high specificity &#40;91&#46;1&#37; and 98&#46;2&#37;&#44; respectively&#41;&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0115" class="elsevierStylePara elsevierViewall">When the two methods of administration &#40;by phone and in-person&#41; of the WAEQ were compared&#44; discriminating the agreement of responses between them&#44; there was an almost perfect agreement &#40;&#954; ranging from 0&#46;81 to 0&#46;85&#41; in the first three questions &#40;&#8220;Recurrent pruritic lesions&#8221;&#44; &#8220;Lesions in the last 12 months&#8221;&#44; &#8220;Lesions in typical locations&#8221;&#41;&#44; and substantial agreement &#40;&#954; ranging from 0&#46;71 to 0&#46;76&#41; in the last 4 indicators &#40;<a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a>&#41;&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0060">Discussion</span><p id="par0120" class="elsevierStylePara elsevierViewall">The WAEQ applied by telephone interview showed good reproducibility in our study&#46; The reproducibility analyzes the extent of inter- and intra-observer variability&#44; which is often the main research question&#46; The inter-observer variability describes the lack of reproducibility between two or more observers&#46;<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">15</span></a> Telephone interviews carried out with guardians of children aged between 6 and 7 years&#44; by two different researchers&#44; using the WAEQ demonstrated almost perfect or substantial agreement for all indicators of eczema&#44; indicating that respondents understood the questionnaire&#44; providing consistent responses to two observers&#44; with a high level of standardization&#46; A nearly perfect agreement was observed for &#34;Lesions in typical locations&#34;&#44; which is highlighted in the diagnostic criteria for AE&#44; such as the Hanifin-Rajka and the United Kingdom criteria&#46;<a class="elsevierStyleCrossRefs" href="#bib0055"><span class="elsevierStyleSup">11&#44;16</span></a></p><p id="par0125" class="elsevierStylePara elsevierViewall">The ISAAC questionnaire aimed at adolescents aged between 13 and 14 years old&#44; filled out directly by them at school&#44; had a return rate higher than 95&#37;&#59; on the other hand&#44; the return rate of the written questionnaire aimed at children between 6 and 7 years of age&#44; which should be completed at home by their guardians&#44; had only approximately 60&#37; of return rate&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> In order to improve data quality and minimize losses in epidemiological studies&#44; written questionnaires can sometimes be replaced by telephone interview&#44; which is faster&#44; less expensive&#44; and more practical than the traditional methods&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a></p><p id="par0130" class="elsevierStylePara elsevierViewall">Studies using computer-assisted interviews have shown this technique to be useful in epidemiological surveys for chronic NCDs&#44; such as cardiovascular diseases&#44; in metropolitan areas of Brazilian states in the Southeast&#44; South and Midwest regions&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Additionally&#44; such interviews have been successfully employed in these regions in studies focused on physical activity habits and sedentary lifestyles&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a></p><p id="par0135" class="elsevierStylePara elsevierViewall">In 2018&#44; a study by the National Household Sample Survey &#40;PNAD&#41; carried out by the Brazilian Institute of Geography and Statistics &#40;IBGE&#44; <span class="elsevierStyleItalic">Instituto Brasileiro de Geografia e Estat&#237;stica</span>&#41; found that 9 of 10 Brazilian households had a mobile phone&#44; 77&#46;1&#37; of people over 10 years old had mobile phones in 2016&#44; being more than 80&#37; in regions such as the Southern&#44; Southeastern and Midwestern regions&#46;<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">19</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">Another significant sociodemographic aspect of our research is that&#44; according to the Institute for Applied Economic Research &#40;IPEA&#44; <span class="elsevierStyleItalic">Instituto de Pesquisa Econ&#244;mica Aplicada</span>&#41;&#44; in 2015&#44; around 45&#37; of the families were supported by women&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> In addition&#44; a study conducted in southeastern Brazil found that mothers of children in public schools are responsible for the feeding and hygiene of their children&#44; being better able to answer questions about the health of their offspring&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> In our sample&#44; more than 80&#37; of respondents in both groups were mothers&#44; suggesting that the information obtained about the presence or absence of eczema symptoms in their children was reliable&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">Questionnaire validation was estimated by comparing the obtained responses with the clinical criteria used for the diagnosis of AE&#44; showing the extent to which the correct answer was provided&#46; The question &#8220;Lesions in typical locations&#8221; evaluated together with &#8220;Age at onset&#8221; are considered to have high sensitivity &#40;proportion of subjects with AE whose answers were correct - true positives&#41; and specificity &#40;proportion of patients without AE who provided correct answers - true negatives&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;22</span></a> High sensitivity and specificity were obtained for the first four questions&#44; which contribute to the clinical diagnosis of recent AE&#46; Moreover&#44; the indicator &#8220;Lesions in typical locations&#8221; showed the best accuracy&#46; The worst indicator&#44; however&#44; with an accuracy of 70&#37;&#44; was &#8220;Complete improvement in the last 12 months&#8221;&#44; which indicates the chronicity of the disease&#46;</p><p id="par0150" class="elsevierStylePara elsevierViewall">The question &#8220;Presence of eczema&#8221; showed low sensitivity but high specificity&#46; Probably because the term &#8220;eczema&#8221; &#40;and not &#8220;dermatitis&#8221;&#41; has limited use in our culture&#46;<a class="elsevierStyleCrossRef" href="#bib0115"><span class="elsevierStyleSup">23</span></a></p><p id="par0155" class="elsevierStylePara elsevierViewall">The agreement between the first telephone interview and the in-person interview was almost perfect or substantial&#44; indicating that these two different WAEQ methods had similar responses&#46;</p><p id="par0160" class="elsevierStylePara elsevierViewall">The present study has some limitations that can make it difficult to generalize its results&#44; such as the non-random selection&#44; absence of sample size calculation&#44; restriction of the age group between 6 and 7 years&#44; which may not be representative of other age groups&#44; and exclusive participation of patients from a tertiary hospital&#46; However&#44; according to the SCORAD assessment&#44; only 9&#46;5&#37; of the participants had severe AE&#44; a percentage not very far from the mean prevalence of 6&#46;0&#37; of severe AE in Brazilian schoolchildren aged 6&#8211;7 years obtained by the phase 3 ISAAC&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0165" class="elsevierStylePara elsevierViewall">On the other hand&#44; the clinical diagnosis of AE carried out by a specialist&#44; the presence of only one respondent at all phases of the research and prior training of the researchers ensure good quality of data&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0065">Conclusion</span><p id="par0170" class="elsevierStylePara elsevierViewall">Our results show that the WAEQ obtained through telephone interviews has good reproducibility and high agreement with the clinical diagnosis of AE made by a specialist&#44; being able to discriminate children with and without the disease&#46; Thus&#44; it can be an appropriate alternative tool for epidemiological studies in AE&#44; especially during a pandemic&#44; such as the COVID-19&#44; when social isolation is extremely important and in-person questionnaires become impossible to obtain&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a></p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0070">Financial support</span><p id="par0175" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0075">Authors&#8217; contributions</span><p id="par0180" class="elsevierStylePara elsevierViewall">Elisa Fontenelle de Oliveira&#58; Design and planning of the study&#44; collection&#44; analysis&#44; and interpretation of data&#59; drafting and editing of the manuscript&#46;</p><p id="par0185" class="elsevierStylePara elsevierViewall">Camila Penedo&#58; Design of the study and collection of data&#46;</p><p id="par0190" class="elsevierStylePara elsevierViewall">Solange Oliveira Rodrigues Valle&#58; Design of the study and collection of data&#46;</p><p id="par0195" class="elsevierStylePara elsevierViewall">F&#225;bio Chigres Kuschnir&#58; Design of the study&#59; analysis and interpretation of data&#59; critical review of the manuscript&#46;</p></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0080">Conflicts of interest</span><p id="par0200" class="elsevierStylePara elsevierViewall">None declared&#46;</p></span></span>"
    "textoCompletoSecciones" => array:1 [
      "secciones" => array:11 [
        0 => array:3 [
          "identificador" => "xres1688454"
          "titulo" => "Abstract"
          "secciones" => array:6 [
            0 => array:2 [
              "identificador" => "abst0005"
              "titulo" => "Background"
            ]
            1 => array:2 [
              "identificador" => "abst0010"
              "titulo" => "Objective"
            ]
            2 => array:2 [
              "identificador" => "abst0015"
              "titulo" => "Methods"
            ]
            3 => array:2 [
              "identificador" => "abst0020"
              "titulo" => "Results"
            ]
            4 => array:2 [
              "identificador" => "abst0025"
              "titulo" => "Study limitations"
            ]
            5 => array:2 [
              "identificador" => "abst0030"
              "titulo" => "Conclusions"
            ]
          ]
        ]
        1 => array:2 [
          "identificador" => "xpalclavsec1497312"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
        ]
        3 => array:2 [
          "identificador" => "sec0010"
          "titulo" => "Methods"
        ]
        4 => array:2 [
          "identificador" => "sec0015"
          "titulo" => "Results"
        ]
        5 => array:2 [
          "identificador" => "sec0020"
          "titulo" => "Discussion"
        ]
        6 => array:2 [
          "identificador" => "sec0025"
          "titulo" => "Conclusion"
        ]
        7 => array:2 [
          "identificador" => "sec0030"
          "titulo" => "Financial support"
        ]
        8 => array:2 [
          "identificador" => "sec0035"
          "titulo" => "Authors&#8217; contributions"
        ]
        9 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Conflicts of interest"
        ]
        10 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2021-02-10"
    "fechaAceptado" => "2021-03-27"
    "PalabrasClave" => array:1 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec1497312"
          "palabras" => array:4 [
            0 => "Atopic eczema"
            1 => "Epidemiology"
            2 => "Pediatrics"
            3 => "Validation study"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:1 [
      "en" => array:3 [
        "titulo" => "Abstract"
        "resumen" => "<span id="abst0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0010">Background</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">The prevalence of atopic eczema is unknown in many countries&#46; The International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41; is an epidemiological landmark in the study of allergic diseases&#46;</p></span> <span id="abst0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0015">Objective</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">To validate and assess the reproducibility of the ISAAC Written Atopic Eczema Questionnaire &#40;WAEQ&#41; for children aged between 6 and 7 years by telephone contact&#46;</p></span> <span id="abst0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0020">Methods</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Observational study through interviews with guardians of children aged 6 to 7 years using the ISAAC atopic eczema module questionnaire in three different phases separated by 2 weeks&#58; telephone interviews in the first and third contacts and in-person interviews under supervision in the second contact&#46; Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients&#46;</p></span> <span id="abst0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0025">Results</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Data from 88 children &#40;32 from the atopic eczema group&#41; were analyzed&#46; Reproducibility showed almost perfect agreement for the questions &#8220;Recurrent pruritic lesions&#8221; and &#8220;Lesions in typical locations&#8221; &#40;Kappa between 0&#46;81&#8211;0&#46;82&#41;&#44; while a substantial agreement was observed for all other indicators &#40;Kappa variation between 0&#46;66 and 0&#46;78&#41;&#46; The validation showed high specificity &#40;&#8805; 80&#46;4&#37;&#41; and sensitivity &#40;&#8805; 87&#46;5&#37;&#41; for all questions&#44; except those related to chronicity and medical diagnosis &#40;34&#46;4&#37; and 40&#46;6&#37;&#44; respectively&#41;&#46;</p></span> <span id="abst0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0030">Study limitations</span><p id="spar0055" class="elsevierStyleSimplePara elsevierViewall">Non-random selection&#44; no sample size calculation&#44; participants from a tertiary hospital and study period coincident with the Coronavirus pandemic&#46;</p></span> <span id="abst0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0035">Conclusions</span><p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">Our results showed that the ISAAC atopic eczema module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of atopic eczema&#46; It may be an appropriate alternative tool in epidemiological studies of childhood atopic eczema&#44; especially in periods of social isolation&#46;</p></span>"
        "secciones" => array:6 [
          0 => array:2 [
            "identificador" => "abst0005"
            "titulo" => "Background"
          ]
          1 => array:2 [
            "identificador" => "abst0010"
            "titulo" => "Objective"
          ]
          2 => array:2 [
            "identificador" => "abst0015"
            "titulo" => "Methods"
          ]
          3 => array:2 [
            "identificador" => "abst0020"
            "titulo" => "Results"
          ]
          4 => array:2 [
            "identificador" => "abst0025"
            "titulo" => "Study limitations"
          ]
          5 => array:2 [
            "identificador" => "abst0030"
            "titulo" => "Conclusions"
          ]
        ]
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara" id="npar0015">Study conducted at the Department of Pediatrics&#44; Instituto Nacional de Sa&#250;de da Mulher&#44; da Crian&#231;a e do Adolescente Fernandes Figueira&#44; Funda&#231;&#227;o Oswaldo Cruz&#44; Rio de Janeiro&#44; RJ&#44; Brazil&#46;</p>"
      ]
    ]
    "multimedia" => array:4 [
      0 => array:8 [
        "identificador" => "fig0005"
        "etiqueta" => "Figure 1"
        "tipo" => "MULTIMEDIAFIGURA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "figura" => array:1 [
          0 => array:4 [
            "imagen" => "gr1.jpeg"
            "Alto" => 2241
            "Ancho" => 2507
            "Tamanyo" => 391291
          ]
        ]
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0005"
            "detalle" => "Figure "
            "rol" => "short"
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">ISAAC Written Atopic Eczema questionnaire &#40;WAEQ&#41; for children between 6 and 7 years of age&#46;</p>"
        ]
      ]
      1 => array:8 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0010"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">95&#37; CI&#44; 95&#37; Confidence Interval&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indicator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Agreement n &#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0005"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Kappa Coefficient &#40;&#954;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrent pruritic lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;90&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;82&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;71&#8211;0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lesions in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">74 &#40;87&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;78&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;67&#8211;0&#46;90&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lesions in typical locations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">76 &#40;90&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69&#8211;0&#46;93&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70 &#40;83&#46;4&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;58&#8211;0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complete improvement in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">68 &#40;81&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;66&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52&#8211;0&#46;79&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep disturbance in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;85&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;74&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;62&#8211;0&#46;87&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presence of eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;91&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;70&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;52&#8211;0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2872322.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0005"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Total number and percentage of concordant responses between the 2 telephone interviews&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Reproducibility of atopic eczema indicators of the ISAAC written atopic eczema questionnaire &#40;WAEQ&#41; for children aged 6&#8211;7 years applied through telephone interviews with their caregivers &#40;n&#8239;&#61;&#8239;84&#41; Rio de Janeiro&#44; 2020&#46;</p>"
        ]
      ]
      2 => array:8 [
        "identificador" => "tbl0010"
        "etiqueta" => "Table 2"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0015"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:1 [
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indicator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Sensitivity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Specificity &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Accuracy &#40;&#37;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrent pruritic lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;8&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">80&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">85&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lesions in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lesions in typical locations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">96&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">93&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complete improvement in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">34&#46;4&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">70&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep disturbance in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">87&#46;5&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">91&#46;1&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">89&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presence of eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">40&#46;6&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">98&#46;2&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77&#46;0&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2872320.png"
              ]
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">Validation of Written Atopic Eczema Questionnaire &#40;WAEQ&#41; eczema indicators for children aged 6&#8211;7 years obtained through telephone interviews with the guardians compared to the clinical diagnosis of atopic eczema &#40;n&#8239;&#61;&#8239;88&#41;&#46; Rio de Janeiro&#44; 2020&#46;</p>"
        ]
      ]
      3 => array:8 [
        "identificador" => "tbl0015"
        "etiqueta" => "Table 3"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "detalles" => array:1 [
          0 => array:3 [
            "identificador" => "at0020"
            "detalle" => "Table "
            "rol" => "short"
          ]
        ]
        "tabla" => array:3 [
          "leyenda" => "<p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">95&#37; CI&#44; 95&#37; Confidence Interval&#46;</p>"
          "tablatextoimagen" => array:1 [
            0 => array:2 [
              "tabla" => array:1 [
                0 => """
                  <table border="0" frame="\n
                  \t\t\t\t\tvoid\n
                  \t\t\t\t" class=""><thead title="thead"><tr title="table-row"><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Indicator&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Agreement n&#40;&#37;&#41;<a class="elsevierStyleCrossRef" href="#tblfn0010"><span class="elsevierStyleSup">a</span></a>&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">Kappa Coefficient &#40;&#954;&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">95&#37; CI&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th><th class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t" scope="col" style="border-bottom: 2px solid black">p-value&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t\t\t</th></tr></thead><tbody title="tbody"><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Recurrent pruritic lesions&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">78 &#40;92&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;85&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;73&#8211;0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lesions in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">75 &#40;89&#46;3&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;81&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;69&#8211;0&#46;92&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Lesions in typical locations&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">77 &#40;91&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;83&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;70&#8211;0&#46;95&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Age at onset&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">73 &#40;86&#46;9&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;63&#8211;0&#46;88&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Complete improvement in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">71 &#40;84&#46;5&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;71&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;57&#8211;0&#46;84&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Sleep disturbance in the last 12 months&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">72 &#40;85&#46;7&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;73&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;59&#8211;0&#46;86&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr><tr title="table-row"><td class="td-with-role" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t ; entry_with_role_rowhead " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">Presence of eczema&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">79 &#40;94&#46;0&#41;&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;76&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">0&#46;56&#8211;0&#46;96&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-entry\n
                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">&#60;0&#46;001&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td></tr></tbody></table>
                  """
              ]
              "imagenFichero" => array:1 [
                0 => "xTab2872321.png"
              ]
            ]
          ]
          "notaPie" => array:1 [
            0 => array:3 [
              "identificador" => "tblfn0010"
              "etiqueta" => "a"
              "nota" => "<p class="elsevierStyleNotepara" id="npar0010">Total number and percentage of concordant responses between the 1<span class="elsevierStyleSup">st</span> telephone interview and the in-person interview&#46;</p>"
            ]
          ]
        ]
        "descripcion" => array:1 [
          "en" => "<p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">Agreement between the in-person responses to the Written Atopic Eczema Questionnaire &#40;WAEQ&#41; provided by caregivers of children aged 6&#8211;7 years and the responses obtained at the 1<span class="elsevierStyleSup">st</span> telephone interview &#40;n&#8239;&#61;&#8239;84&#41;&#46; Rio de Janeiro&#44; 2020&#46;</p>"
        ]
      ]
    ]
    "bibliografia" => array:2 [
      "titulo" => "References"
      "seccion" => array:1 [
        0 => array:2 [
          "identificador" => "bibs0005"
          "bibliografiaReferencia" => array:24 [
            0 => array:3 [
              "identificador" => "bib0005"
              "etiqueta" => "1"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Hanifin&#8217;s and Rajka&#8217;s minor criteria for atopic dermatitis&#58; which do 2-year-olds exhibit&#63;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "M&#46; B&#246;hme"
                            1 => "A&#46; Svensson"
                            2 => "I&#46; Kull"
                            3 => "C&#46;F&#46; Wahlgren"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1067/mjd.2000.110070"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2000"
                        "volumen" => "43"
                        "paginaInicial" => "785"
                        "paginaFinal" => "792"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/11050581"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            1 => array:3 [
              "identificador" => "bib0010"
              "etiqueta" => "2"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Guidelines of care for the management of atopic dermatitis&#58; section 1&#46; Diagnosis and assessment of atopic dermatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "L&#46;F&#46; Eichenfield"
                            1 => "W&#46;L&#46; Tom"
                            2 => "S&#46;L&#46; Chamlin"
                            3 => "S&#46;R&#46; Feldman"
                            4 => "J&#46;M&#46; Hanifin"
                            5 => "E&#46;L&#46; Simpson"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1016/j.jaad.2013.10.010"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Am Acad Dermatol"
                        "fecha" => "2014"
                        "volumen" => "70"
                        "paginaInicial" => "338"
                        "paginaFinal" => "351"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/24290431"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            2 => array:3 [
              "identificador" => "bib0015"
              "etiqueta" => "3"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International study of asthma and allergies in childhood &#40;ISAAC&#41;&#58; rationale and methods"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "M&#46;I&#46; Asher"
                            1 => "U&#46; Keil"
                            2 => "H&#46;R&#46; Anderson"
                            3 => "R&#46; Beasley"
                            4 => "J&#46; Crane"
                            5 => "F&#46; Martinez"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1183/09031936.95.08030483"
                      "Revista" => array:6 [
                        "tituloSerie" => "Eur Respir J"
                        "fecha" => "1995"
                        "volumen" => "8"
                        "paginaInicial" => "483"
                        "paginaFinal" => "491"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7789502"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            3 => array:3 [
              "identificador" => "bib0020"
              "etiqueta" => "4"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Prevalence of symptoms of asthma&#44; rhinitis&#44; and atopic eczema among brazilian children and adolescents identified by the International Study Of Asthma And Allergies In Childhood &#40;ISAAC&#41; &#8211; Phase 3"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:5 [
                            0 => "D&#46; Sol&#233;"
                            1 => "G&#46;F&#46; Wandalsen"
                            2 => "I&#46;C&#46; Camelo-Nunes"
                            3 => "C&#46;K&#46; Naspitz"
                            4 => "ISAAC - Grupo Brasileiro"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Pediatr"
                        "fecha" => "2006"
                        "volumen" => "82"
                        "paginaInicial" => "341"
                        "paginaFinal" => "346"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            4 => array:3 [
              "identificador" => "bib0025"
              "etiqueta" => "5"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Validity and reproducibility of the asthma core International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41; written questionnaire obtained by telephone survey"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "S&#46;O&#46;R&#46; Valle"
                            1 => "F&#46;C&#46; Kuschnir"
                            2 => "D&#46; Sol&#233;"
                            3 => "M&#46;A&#46;V&#46; Silva"
                            4 => "R&#46;I&#46; Silva"
                            5 => "A&#46;J&#46;L&#46;A&#46; da Cunha"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "J Asthma"
                        "fecha" => "2012"
                        "volumen" => "49"
                        "paginaInicial" => "390"
                        "paginaFinal" => "394"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            5 => array:3 [
              "identificador" => "bib0030"
              "etiqueta" => "6"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Telephone survey&#58; valid inferences in regions with low coverage rate of residential lines &#91;thesis&#93;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "R&#46;T&#46;I&#46; Bernal"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:3 [
                        "fecha" => "2011"
                        "editorial" => "Universidade de S&#227;o Paulo"
                        "editorialLocalizacion" => "S&#227;o Paulo &#40;SP&#41;"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            6 => array:3 [
              "identificador" => "bib0035"
              "etiqueta" => "7"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "gov&#46;br &#91;Internet&#93;&#46; Minist&#233;rio da Sa&#250;de divulga novos dados da Pesquisa Vigitel &#91;cited 2020 May 5&#93;&#46; Available from&#58; <a target="_blank" href="https://www.gov.br/saude/pt-br/assuntos/noticias/ministerio-da-saude-divulga-novos-dados-da-pesquisa-vigitel">https&#58;&#47;&#47;www&#46;gov&#46;br&#47;saude&#47;pt-br&#47;assuntos&#47;noticias&#47;ministerio-da-saude-divulga-novos-dados-da-pesquisa-vigitel</a>&#46;"
                ]
              ]
            ]
            7 => array:3 [
              "identificador" => "bib0040"
              "etiqueta" => "8"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "Minist&#233;rio da Sa&#250;de&#44; Secretaria de Vigil&#226;ncia em Sa&#250;de&#44; Secretaria de Gest&#227;o Estrat&#233;gica e Participativa&#46; Vigitel Brasil 2006&#58; vigil&#226;ncia de fatores de risco e prote&#231;&#227;o para doen&#231;as cr&#244;nicas por inqu&#233;rito telef&#244;nico &#91;Internet&#93;&#46; Bras&#237;lia&#58; Minist&#233;rio da Sa&#250;de&#59; 2007 &#91;cited 2020 Sep 20&#93;&#46; Available from&#58; <a target="_blank" href="https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2006.pdf">https&#58;&#47;&#47;bvsms&#46;saude&#46;gov&#46;br&#47;bvs&#47;publicacoes&#47;vigitel&#95;brasil&#95;2006&#46;pdf</a>&#46;"
                ]
              ]
            ]
            8 => array:3 [
              "identificador" => "bib0045"
              "etiqueta" => "9"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Reproductive risk and family income&#58; analysis of the profile of pregnant women"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46;B&#46; Xavier"
                            1 => "C&#46;B&#46; Jannotti"
                            2 => "K&#46;S&#46; Silva"
                            3 => "A&#46;C&#46; Martins"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1590/s1413-81232013000400029"
                      "Revista" => array:6 [
                        "tituloSerie" => "Ci&#234;ncia e Sa&#250;de Coletiva"
                        "fecha" => "2013"
                        "volumen" => "18"
                        "paginaInicial" => "1161"
                        "paginaFinal" => "1171"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/23670393"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            9 => array:3 [
              "identificador" => "bib0050"
              "etiqueta" => "10"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "cidades&#46;ibge&#46;gov &#91;Internet&#93;&#46; Conhe&#231;a cidades e estados do Brasil &#91;cited 2020 May 8&#93;&#46; Available from&#58; <a target="_blank" href="http://www.cidades.ibge.gov.br">http&#58;&#47;&#47;www&#46;cidades&#46;ibge&#46;gov&#46;br</a>&#46;"
                ]
              ]
            ]
            10 => array:3 [
              "identificador" => "bib0055"
              "etiqueta" => "11"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "The U&#46;K&#46; Working Party&#8217;s Diagnostic Criteria for Atopic Dermatitis&#46; III&#46; Independent hospital validation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "H&#46;C&#46; Williams"
                            1 => "P&#46;G&#46; Burney"
                            2 => "A&#46;C&#46; Pembroke"
                            3 => "R&#46;J&#46; Hay"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/j.1365-2133.1994.tb08532.x"
                      "Revista" => array:6 [
                        "tituloSerie" => "Br J Dermatol"
                        "fecha" => "1994"
                        "volumen" => "131"
                        "paginaInicial" => "406"
                        "paginaFinal" => "416"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7918017"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            11 => array:3 [
              "identificador" => "bib0060"
              "etiqueta" => "12"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41;&#58; validation of the written questionnaire &#40;eczema component&#41; and prevalence of atopic eczema among Brazilian children"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "E&#46; Yamada"
                            1 => "A&#46;T&#46; Vanna"
                            2 => "C&#46;K&#46; Naspitz"
                            3 => "D&#46; Sol&#233;"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "J Investig Allergol Clin Immunol"
                        "fecha" => "2002"
                        "volumen" => "12"
                        "paginaInicial" => "34"
                        "paginaFinal" => "41"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/12109530"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            12 => array:3 [
              "identificador" => "bib0065"
              "etiqueta" => "13"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Consensus-based european guidelines for treatment of atopic eczema &#40;atopic dermatitis&#41; in adults and children&#58; Part I"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => true
                          "autores" => array:6 [
                            0 => "A&#46; Wollenberg"
                            1 => "S&#46; Barbarot"
                            2 => "T&#46; Bieber"
                            3 => "S&#46; Christen-Zaech"
                            4 => "M&#46; Deleuran"
                            5 => "A&#46; Fink-Wagner"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/jdv.14891"
                      "Revista" => array:6 [
                        "tituloSerie" => "J Eur Acad Dermatol Venereol"
                        "fecha" => "2018"
                        "volumen" => "32"
                        "paginaInicial" => "657"
                        "paginaFinal" => "682"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/29676534"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            13 => array:3 [
              "identificador" => "bib0070"
              "etiqueta" => "14"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Quality assure and control"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "M&#46; Szklo"
                            1 => "F&#46;J&#46; Nieto"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:6 [
                        "editores" => "M&#46;Szklo, F&#46;J&#46;Nieto"
                        "titulo" => "Epidemiology&#58; Beyond the Basics"
                        "paginaInicial" => "313"
                        "paginaFinal" => "365"
                        "edicion" => "3th ed&#46;"
                        "serieFecha" => "2014"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            14 => array:3 [
              "identificador" => "bib0075"
              "etiqueta" => "15"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "L&#46; Gordis"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Libro" => array:4 [
                        "edicion" => "5th ed&#46;"
                        "fecha" => "2014"
                        "editorial" => "Elsevier"
                        "editorialLocalizacion" => "Philadelphia"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            15 => array:3 [
              "identificador" => "bib0080"
              "etiqueta" => "16"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Epidemiology of atopic dermatitis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "F&#46;S&#46; Larsen"
                            1 => "J&#46;M&#46; Hanifin"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Immunol Allergy Clin North Am"
                        "fecha" => "2002"
                        "volumen" => "22"
                        "paginaInicial" => "1"
                        "paginaFinal" => "24"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            16 => array:3 [
              "identificador" => "bib0085"
              "etiqueta" => "17"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Worldwide variation in prevalence of symptoms of asthma&#44; allergic rhinoconjunctivitis&#44; and atopic eczema&#58; ISAAC"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:1 [
                            0 => "The International Study of Asthma and Allergies in Childhood &#40;ISAAC&#41; Steering Committee"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:6 [
                        "tituloSerie" => "Lancet"
                        "fecha" => "1998"
                        "volumen" => "351"
                        "paginaInicial" => "1225"
                        "paginaFinal" => "1232"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/9643741"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            17 => array:3 [
              "identificador" => "bib0090"
              "etiqueta" => "18"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Home landline telephone coverage and potential bias in epidemiological surveys"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "R&#46; Bernal"
                            1 => "N&#46;N&#46; Silva"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Rev Saude P&#250;blica"
                        "fecha" => "2009"
                        "volumen" => "43"
                        "paginaInicial" => "422"
                        "paginaFinal" => "426"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            18 => array:3 [
              "identificador" => "bib0095"
              "etiqueta" => "19"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "noticias&#46;r7&#46;com &#91;Internet&#93;&#46; Economia &#91;cited 2020 Mar 8&#93;&#46; Available from&#58; <a target="_blank" href="https://noticias.r7.com/economia">https&#58;&#47;&#47;noticias&#46;r7&#46;com&#47;economia</a>&#46;"
                ]
              ]
            ]
            19 => array:3 [
              "identificador" => "bib0100"
              "etiqueta" => "20"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ipea&#46;gov &#91;Internet&#93;&#46; Retrato das desigualdades de g&#234;nero e ra&#231;a &#91;cited 2020 Aug 23&#93;&#46; Available from&#58; <a target="_blank" href="https://www.ipea.gov.br/retrato/indicadores_chefia_familia.html">https&#58;&#47;&#47;www&#46;ipea&#46;gov&#46;br&#47;retrato&#47;indicadores&#95;chefia&#95;familia&#46;html</a>&#46;"
                ]
              ]
            ]
            20 => array:3 [
              "identificador" => "bib0105"
              "etiqueta" => "21"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Parental and aloparental care received by children in public and private schools in Vit&#243;ria&#44; ES"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:2 [
                            0 => "L&#46;W&#46; Silva"
                            1 => "R&#46; Tokumaru"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "Revista" => array:5 [
                        "tituloSerie" => "Psicol Reflex Crit"
                        "fecha" => "2008"
                        "volumen" => "21"
                        "paginaInicial" => "133"
                        "paginaFinal" => "141"
                      ]
                    ]
                  ]
                ]
              ]
            ]
            21 => array:3 [
              "identificador" => "bib0110"
              "etiqueta" => "22"
              "referencia" => array:1 [
                0 => array:1 [
                  "referenciaCompleta" => "ISAAC&#46; The International Study of Asthma and Allergies in Childhood manual &#91;Internet&#93;&#46; Auckland &#40;NZ&#41;&#58; M&#252;nster&#59; 1993 &#91;cited 2020 May 08&#93;&#46; Available from&#58; <a target="_blank" href="https://www.isaac.auckland.ac.nz">https&#58;&#47;&#47;www&#46;isaac&#46;auckland&#46;ac&#46;nz</a>&#46;"
                ]
              ]
            ]
            22 => array:3 [
              "identificador" => "bib0115"
              "etiqueta" => "23"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Atopic dermatitis&#44; atopic eczema or eczema&#63; A systematic review&#44; meta-analysis and recommendation for uniform use of &#8220;atopic dermatitis&#8221;"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:4 [
                            0 => "R&#46; Kantor"
                            1 => "J&#46;P&#46; Thyssen"
                            2 => "A&#46;S&#46; Paller"
                            3 => "J&#46;I&#46; Silverberg"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:2 [
                      "doi" => "10.1111/all.12982"
                      "Revista" => array:6 [
                        "tituloSerie" => "Allergy"
                        "fecha" => "2016"
                        "volumen" => "71"
                        "paginaInicial" => "1480"
                        "paginaFinal" => "1485"
                        "link" => array:1 [
                          0 => array:2 [
                            "url" => "https://www.ncbi.nlm.nih.gov/pubmed/27392131"
                            "web" => "Medline"
                          ]
                        ]
                      ]
                    ]
                  ]
                ]
              ]
            ]
            23 => array:3 [
              "identificador" => "bib0120"
              "etiqueta" => "24"
              "referencia" => array:1 [
                0 => array:2 [
                  "contribucion" => array:1 [
                    0 => array:2 [
                      "titulo" => "Pandemics&#58; Risks&#44; Impacts&#44; and Mitigation"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:6 [
                            0 => "N&#46; Madhav"
                            1 => "B&#46; Oppenheim"
                            2 => "M&#46; Gallivan"
                            3 => "P&#46; Mulembakani"
                            4 => "E&#46; Rubin"
                            5 => "N&#46; Wolfe"
                          ]
                        ]
                      ]
                    ]
                  ]
                  "host" => array:1 [
                    0 => array:1 [
                      "LibroEditado" => array:4 [
                        "editores" => "D&#46;T&#46;Jamison, H&#46;Gelband, S&#46;Horton, P&#46;Jha, R&#46;Laxminarayan, C&#46;H&#46;Mock"
                        "titulo" => "Disease Control Priorities&#58; Improving Health and Reducing Poverty"
                        "edicion" => "3rd ed&#46;"
                        "serieFecha" => "2017"
                      ]
                    ]
                  ]
                ]
              ]
            ]
          ]
        ]
      ]
    ]
  ]
  "idiomaDefecto" => "en"
  "url" => "/03650596/0000009700000002/v2_202204021027/S0365059621003056/v2_202204021027/en/main.assets"
  "Apartado" => array:4 [
    "identificador" => "89516"
    "tipo" => "SECCION"
    "en" => array:2 [
      "titulo" => "Original Article"
      "idiomaDefecto" => true
    ]
    "idiomaDefecto" => "en"
  ]
  "PDF" => "https://static.elsevier.es/multimedia/03650596/0000009700000002/v2_202204021027/S0365059621003056/v2_202204021027/en/main.pdf?idApp=UINPBA00008Z&text.app=http://www.anaisdedermatologia.org.br/"
  "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0365059621003056?idApp=UINPBA00008Z"
]
Share
Journal Information
Vol. 97. Issue 2.
Pages 173-178 (1 March 2022)
Visits
5144
Vol. 97. Issue 2.
Pages 173-178 (1 March 2022)
Original Article
Open Access
Validation and reproducibility of the International Study of Asthma and Allergies in Childhood (ISAAC) Written Atopic Eczema Questionnaire for telephone survey in children aged 6–7 years
Visits
5144
Elisa Fontenelle de Oliveiraa,b,
Corresponding author
elisafontenelle@yahoo.com.br

Corresponding author.
, Camila Penedoa, Solange Oliveira Rodrigues Vallec, Fábio Chigres Kuschnird
a Department of Pediatrics, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil
b Programa de Pós-Graduação em Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
c Department of Immunology, Universidade Federal do Rio de Janeiro: Programa de Saúde da Criança da Secretaria Municipal de Saúde e Defesa Civil do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
d Department of Pediatrics, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ, Brazil
This item has received

Under a Creative Commons license
Article information
Abstract
Full Text
Bibliography
Download PDF
Statistics
Figures (1)
Tables (3)
Table 1. Reproducibility of atopic eczema indicators of the ISAAC written atopic eczema questionnaire (WAEQ) for children aged 6–7 years applied through telephone interviews with their caregivers (n = 84) Rio de Janeiro, 2020.
Table 2. Validation of Written Atopic Eczema Questionnaire (WAEQ) eczema indicators for children aged 6–7 years obtained through telephone interviews with the guardians compared to the clinical diagnosis of atopic eczema (n = 88). Rio de Janeiro, 2020.
Table 3. Agreement between the in-person responses to the Written Atopic Eczema Questionnaire (WAEQ) provided by caregivers of children aged 6–7 years and the responses obtained at the 1st telephone interview (n = 84). Rio de Janeiro, 2020.
Show moreShow less
Abstract
Background

The prevalence of atopic eczema is unknown in many countries. The International Study of Asthma and Allergies in Childhood (ISAAC) is an epidemiological landmark in the study of allergic diseases.

Objective

To validate and assess the reproducibility of the ISAAC Written Atopic Eczema Questionnaire (WAEQ) for children aged between 6 and 7 years by telephone contact.

Methods

Observational study through interviews with guardians of children aged 6 to 7 years using the ISAAC atopic eczema module questionnaire in three different phases separated by 2 weeks: telephone interviews in the first and third contacts and in-person interviews under supervision in the second contact. Reproducibility was estimated using the Kappa index and validation using the sensitivity and specificity coefficients.

Results

Data from 88 children (32 from the atopic eczema group) were analyzed. Reproducibility showed almost perfect agreement for the questions “Recurrent pruritic lesions” and “Lesions in typical locations” (Kappa between 0.81–0.82), while a substantial agreement was observed for all other indicators (Kappa variation between 0.66 and 0.78). The validation showed high specificity (≥ 80.4%) and sensitivity (≥ 87.5%) for all questions, except those related to chronicity and medical diagnosis (34.4% and 40.6%, respectively).

Study limitations

Non-random selection, no sample size calculation, participants from a tertiary hospital and study period coincident with the Coronavirus pandemic.

Conclusions

Our results showed that the ISAAC atopic eczema module questionnaire by telephone interviews has good reproducibility and high agreement with the clinical diagnosis of atopic eczema. It may be an appropriate alternative tool in epidemiological studies of childhood atopic eczema, especially in periods of social isolation.

Keywords:
Atopic eczema
Epidemiology
Pediatrics
Validation study
Full Text
Introduction

Atopic eczema (AE) is a common chronic inflammatory dermatosis that mainly affects children. It is often associated with a personal and/or family history of atopy. Pruritus is the most important symptom, which can progress to complications such as excoriation, infections, and sleep disturbances.1,2

The prevalence and severity of AE is unknown in many countries. The International Study of Asthma and Allergies in Childhood (ISAAC) constitutes an epidemiological landmark in the study of asthma and other allergic diseases, such as AE and allergic rhinitis, allowing international and regional comparisons of prevalence and risk factors associated with these conditions.3 However, the administration of the ISAAC Written Atopic Eczema Questionnaire (WAEQ) for children between 6 and 7 years of age depended on the responses of their guardians in the household, which may have impacted the final results with a low response rate. Data from different centers participating in the phase 3 ISAAC in Brazil provided an AE prevalence of 8.2% in children in this age group.4

In 2006, due to the importance of Chronic Non-Communicable Diseases (NCDs) in the Brazilian population, the Ministry of Health implemented the VIGITEL system. This system interviews probabilistic samples of individuals aged 18 years and older who have a telephone in their homes, using questionnaires that address risk or protective factors for NCDs.5,6 Computer-assisted telephone interviews are conducted annually; however, it does not include data on AE.7 This tool was shown to be faster, less expensive and more practical than the traditional methods.8

In a study carried out in the city of Rio de Janeiro, Valle et al. validated the written ISAAC asthma questionnaire for children aged 6 to 7 years by telephone interviews, showing good agreement and reproducibility of this method when compared to the original one.5

The aim of this study was to validate and evaluate the reproducibility of the WAEQ in children aged between 6 and 7 years administered to guardians through telephone interviews.

Methods

This was an observational study carried out in Rio de Janeiro, Brazil, in a health unit aimed at education, research, assistance, technological development, and training in womens, children and adolescents health. This tertiary hospital receives patients from different neighborhoods and cities. Approximately 60% of the assisted families are low-income, and this same percentage of mothers have only elementary school education.9 The city of Rio de Janeiro, with 6,718,903 inhabitants (97.3% with telephone coverage) and a population density of 5265.82 inhabitants/km2, is located in the southeastern region of Brazil.10

This was a convenience sample. A search of medical records was carried out, and a total of 100 children aged between 6 and 7 years, divided into two groups, who had fixed or mobile telephone lines at home, were recruited to participate in the study. They ought to be undergoing follow-up for at least six months and be scheduled for consultation at the clinics in advance, sequentially, on every day of the week. Patients who were diagnosed with AE according to the UK diagnostic criteria established by specialists in the Dermatology and Allergy and Immunology clinics comprised the “AE” group.11 The “control group” consisted of children without dermatoses followed at the General Pediatrics outpatient clinic.

The study was carried out in 3 phases, in both groups:

  • 1

    The first phase consisted in applying the WAEQ (Fig. 1), previously validated for the Portuguese language, to the guardians of the children selected through telephone interviews.12 The main indicators assessed by this tool are the presence of current AE symptoms ("Recurrent pruritic lesions" and "Lesions in the last 12 months" - Questions 1 and 2) and typical locations of involvement ("Lesions in typical locations" - Question 3); “Age at onset” (under 2 years old, between 2 and 4 years old, or aged 5 and over – Question 4); severity of symptoms (“Complete improvement in the last 12 months” and “Sleep disturbances in the last 12 months” – Questions 5 and 6) and AE diagnosed by a physician (“Presence of eczema” – Question 7). According to the ISAAC protocol, the first question differentiates “typical” AE from other inflammatory dermatoses; the second focuses only on recent cases to minimize memory biases, such as incomplete data or selective memory; the third, which considers flexural involvement, associated with the fourth (“Age at onset”) substantially improved the specificity of the study; the fifth and sixth questions measure the dermatitis severity (chronicity and morbidity, respectively); and finally, the seventh may indicate a prior medical diagnosis.3 The questions were read slowly by one of the previously trained researchers, and the answers were recorded directly and immediately on a form and on an electronic record.

    Figure 1.

    ISAAC Written Atopic Eczema questionnaire (WAEQ) for children between 6 and 7 years of age.

    (0.37MB).
  • 2

    The second phase was carried out after two weeks, coinciding with the appointment date, so that the child’s guardian could fill in the WAEQ in person under the supervision of the main researcher and a physical examination could be performed to ascertain the absence of signs and symptoms of AE in the control group. On this occasion, the children from the AE group were submitted to the Scoring Atopic Dermatitis (SCORAD) analysis by one of the researchers. According to the score, the AE severity was considered mild up to 25, moderate between 25 and 50, and severe above 50 points.13

  • 3

    The third phase took place 15 days after the previous one when a researcher other than the first one conducted the second telephone interview using the WAEQ.

Only the data provided by the same guardians in all three stages of the study were considered for analysis of reproducibility and validation.

The reproducibility of questionnaires administered by telephone was calculated using the Kappa coefficient (κ). The results were classified as follows: above 0.81, almost perfect agreement; between 0.61 and 0.8, substantial agreement; between 0.41 and 0.6, moderate agreement; between 0.21 and 0.4, poor agreement; below 0.2, slight agreement.14

The validation was calculated by comparing the responses obtained during the first telephone interview with the UK clinical diagnostic criteria for AE used as the standard in our study.11 The specificity and sensitivity for each indicator and their respective accuracy were evaluated.

Subsequently, to assess the degree of agreement between the answers to the WAEQ filled out by the guardians on the day of the consultation with those obtained at the first telephone interview, the Kappa coefficient was used, with the same previously mentioned classification.

The data were stored in an Excel database, and statistical analysis was performed using SPSS software, version 23.

This study was approved by the Ethics Committee of the IFF. Written consent was replaced by verbal consent obtained prior to the interview, based on article N. 5 of Resolution N. 510, of April 7, 2016.

Results

Between August 2019 and January 2020, 88 children were included in the study, 32 (36.4%) in the AE group and 56 (63.3%) in the control group. Fifty-two patients (59.1%) were male (64.3% in the control group and 50% in the AE group; p = 0.27). In the AE group, mothers accounted for 86.4% of respondents and fathers and grandparents, 6.25% each. In the control group, mothers, fathers and grandmothers were the respondents in 85%, 7.22%, and 7.22% respectively. There was no statistically significant difference regarding the percentage of this proportion between the two groups.

Due to the presence of more than one respondent for the same child in the different phases of the research or because the last interview was not carried out due to the new coronavirus pandemic, 4 patients (1 from the AE group and 3 from the control group) were excluded from the reproducibility assessment, and another 4 (1 from the control group and 3 from the AE group) were excluded from the agreement assessment process between the first telephone and the in-person interview. The average duration of each telephone interview was 5 minutes.

The distribution of severity according to SCORAD was 65.6%, 25% and 9.4% for mild, moderate, and severe AE, respectively. Patients in the control group were not submitted to this analysis because they did not have signs or symptoms of AE.

Table 1 shows the reproducibility of the WAEQ data obtained in the two telephone interviews. Almost perfect agreement was observed in the questions “Recurrent pruritic lesions” and “Lesions in typical locations”, while a substantial agreement was observed for all the other indicators.

Table 1.

Reproducibility of atopic eczema indicators of the ISAAC written atopic eczema questionnaire (WAEQ) for children aged 6–7 years applied through telephone interviews with their caregivers (n = 84) Rio de Janeiro, 2020.

Indicator  Agreement n (%)a  Kappa Coefficient (κ)  95% CI  p-value 
Recurrent pruritic lesions  76 (90.5)  0.82  0.71–0.93  <0.001 
Lesions in the last 12 months  74 (87.9)  0.78  0.67–0.90  <0.001 
Lesions in typical locations  76 (90.5)  0.81  0.69–0.93  <0.001 
Age at onset  70 (83.4)  0.71  0.58–0.83  <0.001 
Complete improvement in the last 12 months  68 (81.0)  0.66  0.52–0.79  <0.001 
Sleep disturbance in the last 12 months  72 (85.7)  0.74  0.62–0.87  <0.001 
Presence of eczema  77 (91.0)  0.70  0.52–0.96  <0.001 

95% CI, 95% Confidence Interval.

a

Total number and percentage of concordant responses between the 2 telephone interviews.

Table 2 shows the results of the validation of the WAEQ obtained through the first telephone interview with the guardians when compared with the clinical diagnosis given by a specialist based on the UK criteria. The first four questions (“Recurrent pruritic lesions”, “Lesions in the last 12 months”, “Lesions in typical locations” and “Age at onset”) and the sixth question (“Sleep disturbance in the last 12 months”) showed high sensitivity ( ≥87.5%) and specificity (≥80.4%). On the other hand, the fifth (“Complete improvement in the last 12 months”) and seventh (“Presence of eczema”) items showed low sensitivity (34.4% and 40.6%, respectively), but high specificity (91.1% and 98.2%, respectively).

Table 2.

Validation of Written Atopic Eczema Questionnaire (WAEQ) eczema indicators for children aged 6–7 years obtained through telephone interviews with the guardians compared to the clinical diagnosis of atopic eczema (n = 88). Rio de Janeiro, 2020.

Indicator  Sensitivity (%)  Specificity (%)  Accuracy (%) 
Recurrent pruritic lesions  93.8  80.4  85.0 
Lesions in the last 12 months  87.5  91.1  89.0 
Lesions in typical locations  87.5  96.4  93.0 
Age at onset  87.5  91.1  89.0 
Complete improvement in the last 12 months  34.4  91.1  70.0 
Sleep disturbance in the last 12 months  87.5  91.1  89.0 
Presence of eczema  40.6  98.2  77.0 

When the two methods of administration (by phone and in-person) of the WAEQ were compared, discriminating the agreement of responses between them, there was an almost perfect agreement (κ ranging from 0.81 to 0.85) in the first three questions (“Recurrent pruritic lesions”, “Lesions in the last 12 months”, “Lesions in typical locations”), and substantial agreement (κ ranging from 0.71 to 0.76) in the last 4 indicators (Table 3).

Table 3.

Agreement between the in-person responses to the Written Atopic Eczema Questionnaire (WAEQ) provided by caregivers of children aged 6–7 years and the responses obtained at the 1st telephone interview (n = 84). Rio de Janeiro, 2020.

Indicator  Agreement n(%)a  Kappa Coefficient (κ)  95% CI  p-value 
Recurrent pruritic lesions  78 (92.9)  0.85  0.73–0.96  <0.001 
Lesions in the last 12 months  75 (89.3)  0.81  0.69–0.92  <0.001 
Lesions in typical locations  77 (91.7)  0.83  0.70–0.95  <0.001 
Age at onset  73 (86.9)  0.76  0.63–0.88  <0.001 
Complete improvement in the last 12 months  71 (84.5)  0.71  0.57–0.84  <0.001 
Sleep disturbance in the last 12 months  72 (85.7)  0.73  0.59–0.86  <0.001 
Presence of eczema  79 (94.0)  0.76  0.56–0.96  <0.001 

95% CI, 95% Confidence Interval.

a

Total number and percentage of concordant responses between the 1st telephone interview and the in-person interview.

Discussion

The WAEQ applied by telephone interview showed good reproducibility in our study. The reproducibility analyzes the extent of inter- and intra-observer variability, which is often the main research question. The inter-observer variability describes the lack of reproducibility between two or more observers.15 Telephone interviews carried out with guardians of children aged between 6 and 7 years, by two different researchers, using the WAEQ demonstrated almost perfect or substantial agreement for all indicators of eczema, indicating that respondents understood the questionnaire, providing consistent responses to two observers, with a high level of standardization. A nearly perfect agreement was observed for "Lesions in typical locations", which is highlighted in the diagnostic criteria for AE, such as the Hanifin-Rajka and the United Kingdom criteria.11,16

The ISAAC questionnaire aimed at adolescents aged between 13 and 14 years old, filled out directly by them at school, had a return rate higher than 95%; on the other hand, the return rate of the written questionnaire aimed at children between 6 and 7 years of age, which should be completed at home by their guardians, had only approximately 60% of return rate.17 In order to improve data quality and minimize losses in epidemiological studies, written questionnaires can sometimes be replaced by telephone interview, which is faster, less expensive, and more practical than the traditional methods.6

Studies using computer-assisted interviews have shown this technique to be useful in epidemiological surveys for chronic NCDs, such as cardiovascular diseases, in metropolitan areas of Brazilian states in the Southeast, South and Midwest regions.6 Additionally, such interviews have been successfully employed in these regions in studies focused on physical activity habits and sedentary lifestyles.18

In 2018, a study by the National Household Sample Survey (PNAD) carried out by the Brazilian Institute of Geography and Statistics (IBGE, Instituto Brasileiro de Geografia e Estatística) found that 9 of 10 Brazilian households had a mobile phone, 77.1% of people over 10 years old had mobile phones in 2016, being more than 80% in regions such as the Southern, Southeastern and Midwestern regions.19

Another significant sociodemographic aspect of our research is that, according to the Institute for Applied Economic Research (IPEA, Instituto de Pesquisa Econômica Aplicada), in 2015, around 45% of the families were supported by women.20 In addition, a study conducted in southeastern Brazil found that mothers of children in public schools are responsible for the feeding and hygiene of their children, being better able to answer questions about the health of their offspring.21 In our sample, more than 80% of respondents in both groups were mothers, suggesting that the information obtained about the presence or absence of eczema symptoms in their children was reliable.

Questionnaire validation was estimated by comparing the obtained responses with the clinical criteria used for the diagnosis of AE, showing the extent to which the correct answer was provided. The question “Lesions in typical locations” evaluated together with “Age at onset” are considered to have high sensitivity (proportion of subjects with AE whose answers were correct - true positives) and specificity (proportion of patients without AE who provided correct answers - true negatives).15,22 High sensitivity and specificity were obtained for the first four questions, which contribute to the clinical diagnosis of recent AE. Moreover, the indicator “Lesions in typical locations” showed the best accuracy. The worst indicator, however, with an accuracy of 70%, was “Complete improvement in the last 12 months”, which indicates the chronicity of the disease.

The question “Presence of eczema” showed low sensitivity but high specificity. Probably because the term “eczema” (and not “dermatitis”) has limited use in our culture.23

The agreement between the first telephone interview and the in-person interview was almost perfect or substantial, indicating that these two different WAEQ methods had similar responses.

The present study has some limitations that can make it difficult to generalize its results, such as the non-random selection, absence of sample size calculation, restriction of the age group between 6 and 7 years, which may not be representative of other age groups, and exclusive participation of patients from a tertiary hospital. However, according to the SCORAD assessment, only 9.5% of the participants had severe AE, a percentage not very far from the mean prevalence of 6.0% of severe AE in Brazilian schoolchildren aged 6–7 years obtained by the phase 3 ISAAC.4

On the other hand, the clinical diagnosis of AE carried out by a specialist, the presence of only one respondent at all phases of the research and prior training of the researchers ensure good quality of data.

Conclusion

Our results show that the WAEQ obtained through telephone interviews has good reproducibility and high agreement with the clinical diagnosis of AE made by a specialist, being able to discriminate children with and without the disease. Thus, it can be an appropriate alternative tool for epidemiological studies in AE, especially during a pandemic, such as the COVID-19, when social isolation is extremely important and in-person questionnaires become impossible to obtain.24

Financial support

None declared.

Authors’ contributions

Elisa Fontenelle de Oliveira: Design and planning of the study, collection, analysis, and interpretation of data; drafting and editing of the manuscript.

Camila Penedo: Design of the study and collection of data.

Solange Oliveira Rodrigues Valle: Design of the study and collection of data.

Fábio Chigres Kuschnir: Design of the study; analysis and interpretation of data; critical review of the manuscript.

Conflicts of interest

None declared.

References
[1]
M. Böhme, A. Svensson, I. Kull, C.F. Wahlgren.
Hanifin’s and Rajka’s minor criteria for atopic dermatitis: which do 2-year-olds exhibit?.
J Am Acad Dermatol, 43 (2000), pp. 785-792
[2]
L.F. Eichenfield, W.L. Tom, S.L. Chamlin, S.R. Feldman, J.M. Hanifin, E.L. Simpson, et al.
Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis.
J Am Acad Dermatol, 70 (2014), pp. 338-351
[3]
M.I. Asher, U. Keil, H.R. Anderson, R. Beasley, J. Crane, F. Martinez, et al.
International study of asthma and allergies in childhood (ISAAC): rationale and methods.
Eur Respir J, 8 (1995), pp. 483-491
[4]
D. Solé, G.F. Wandalsen, I.C. Camelo-Nunes, C.K. Naspitz, ISAAC - Grupo Brasileiro.
Prevalence of symptoms of asthma, rhinitis, and atopic eczema among brazilian children and adolescents identified by the International Study Of Asthma And Allergies In Childhood (ISAAC) – Phase 3.
J Pediatr, 82 (2006), pp. 341-346
[5]
S.O.R. Valle, F.C. Kuschnir, D. Solé, M.A.V. Silva, R.I. Silva, A.J.L.A. da Cunha.
Validity and reproducibility of the asthma core International Study of Asthma and Allergies in Childhood (ISAAC) written questionnaire obtained by telephone survey.
J Asthma, 49 (2012), pp. 390-394
[6]
R.T.I. Bernal.
Telephone survey: valid inferences in regions with low coverage rate of residential lines [thesis].
Universidade de São Paulo, (2011),
[7]
gov.br [Internet]. Ministério da Saúde divulga novos dados da Pesquisa Vigitel [cited 2020 May 5]. Available from: https://www.gov.br/saude/pt-br/assuntos/noticias/ministerio-da-saude-divulga-novos-dados-da-pesquisa-vigitel.
[8]
Ministério da Saúde, Secretaria de Vigilância em Saúde, Secretaria de Gestão Estratégica e Participativa. Vigitel Brasil 2006: vigilância de fatores de risco e proteção para doenças crônicas por inquérito telefônico [Internet]. Brasília: Ministério da Saúde; 2007 [cited 2020 Sep 20]. Available from: https://bvsms.saude.gov.br/bvs/publicacoes/vigitel_brasil_2006.pdf.
[9]
R.B. Xavier, C.B. Jannotti, K.S. Silva, A.C. Martins.
Reproductive risk and family income: analysis of the profile of pregnant women.
Ciência e Saúde Coletiva, 18 (2013), pp. 1161-1171
[10]
cidades.ibge.gov [Internet]. Conheça cidades e estados do Brasil [cited 2020 May 8]. Available from: http://www.cidades.ibge.gov.br.
[11]
H.C. Williams, P.G. Burney, A.C. Pembroke, R.J. Hay.
The U.K. Working Party’s Diagnostic Criteria for Atopic Dermatitis. III. Independent hospital validation.
Br J Dermatol, 131 (1994), pp. 406-416
[12]
E. Yamada, A.T. Vanna, C.K. Naspitz, D. Solé.
International Study of Asthma and Allergies in Childhood (ISAAC): validation of the written questionnaire (eczema component) and prevalence of atopic eczema among Brazilian children.
J Investig Allergol Clin Immunol, 12 (2002), pp. 34-41
[13]
A. Wollenberg, S. Barbarot, T. Bieber, S. Christen-Zaech, M. Deleuran, A. Fink-Wagner, et al.
Consensus-based european guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: Part I.
J Eur Acad Dermatol Venereol, 32 (2018), pp. 657-682
[14]
M. Szklo, F.J. Nieto.
Quality assure and control.
Epidemiology: Beyond the Basics, 3th ed., pp. 313-365
[15]
L. Gordis.
Epidemiology.
5th ed., Elsevier, (2014),
[16]
F.S. Larsen, J.M. Hanifin.
Epidemiology of atopic dermatitis.
Immunol Allergy Clin North Am, 22 (2002), pp. 1-24
[17]
The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee.
Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC.
Lancet, 351 (1998), pp. 1225-1232
[18]
R. Bernal, N.N. Silva.
Home landline telephone coverage and potential bias in epidemiological surveys.
Rev Saude Pública, 43 (2009), pp. 422-426
[19]
noticias.r7.com [Internet]. Economia [cited 2020 Mar 8]. Available from: https://noticias.r7.com/economia.
[20]
ipea.gov [Internet]. Retrato das desigualdades de gênero e raça [cited 2020 Aug 23]. Available from: https://www.ipea.gov.br/retrato/indicadores_chefia_familia.html.
[21]
L.W. Silva, R. Tokumaru.
Parental and aloparental care received by children in public and private schools in Vitória, ES.
Psicol Reflex Crit, 21 (2008), pp. 133-141
[22]
ISAAC. The International Study of Asthma and Allergies in Childhood manual [Internet]. Auckland (NZ): Münster; 1993 [cited 2020 May 08]. Available from: https://www.isaac.auckland.ac.nz.
[23]
R. Kantor, J.P. Thyssen, A.S. Paller, J.I. Silverberg.
Atopic dermatitis, atopic eczema or eczema? A systematic review, meta-analysis and recommendation for uniform use of “atopic dermatitis”.
Allergy, 71 (2016), pp. 1480-1485
[24]
N. Madhav, B. Oppenheim, M. Gallivan, P. Mulembakani, E. Rubin, N. Wolfe.
Pandemics: Risks, Impacts, and Mitigation.
Disease Control Priorities: Improving Health and Reducing Poverty, 3rd ed.,

Study conducted at the Department of Pediatrics, Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, RJ, Brazil.

Copyright © 2021. Sociedade Brasileira de Dermatologia
Idiomas
Anais Brasileiros de Dermatologia
Article options
Tools
en pt
Cookies policy Política de cookies
To improve our services and products, we use "cookies" (own or third parties authorized) to show advertising related to client preferences through the analyses of navigation customer behavior. Continuing navigation will be considered as acceptance of this use. You can change the settings or obtain more information by clicking here. Utilizamos cookies próprios e de terceiros para melhorar nossos serviços e mostrar publicidade relacionada às suas preferências, analisando seus hábitos de navegação. Se continuar a navegar, consideramos que aceita o seu uso. Você pode alterar a configuração ou obter mais informações aqui.