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To determine if solar-powered battery systems could be successfully used for electricity-dependent medical devices by families during a power outage.
We assessed the use of and satisfaction with solar-powered battery systems distributed to 15 families following Hurricane Maria in rural Puerto Rico. Interviews were conducted in July 2018, 3 mo following distribution of the systems.
The solar-powered battery systems powered refrigeration for medications and prescribed diets, asthma therapy, inflatable mattresses to prevent bedsores, and continuous positive airway pressure machines for sleep apnea. Despite some system problems, such as inadequate power, defective cables, and blown fuses, families successfully dealt with these issues with some outside help. Almost all families were pleased with the systems and a majority would recommend solar-powered battery systems to a neighbor.
Families accepted and successfully used solar-powered battery systems to power medical devices. Solar-powered battery systems should be considered as alternatives to generators for power outages after hurricanes and other disasters. Additional research and analysis are needed to inform policy on increasing access to such systems.
Children with asthma face serious mental health risk, but the pathways remain unclear. This study aimed to examine bullying victimisation and perpetration in children with asthma and a comparison sample without a chronic health condition, and the role of bullying in moderating psychosocial adjustment outcomes for those with asthma. A sample of children with (n = 24) and without asthma (n = 39), and their parents, were recruited from hospital clinics. Parents rated children’s psychosocial adjustment; children provided self-report of bullying victimisation and perpetration; from which co-occurring bully/victim status was derived. No differences in mean perpetration or victimisation were found, but children with asthma were more likely to be bully/victims (involved both as target and perpetrator), compared to those without asthma. Children with asthma who were victims of bullying had greater peer problems and overall adjustment problems; bully/victims did not show this pattern. Children with asthma may be more likely to be bully/victims, and those who are victims of bullying may be at elevated risk for psychosocial adjustment problems and require particular support in this area from school counsellors and psychologists.
Helminth infections such as ascariasis elicit a type 2 immune response resembling that involved in allergic inflammation, but differing to allergy, they are also accompanied with strong immunomodulation. This has stimulated an increasing number of investigations, not only to better understand the mechanisms of allergy and helminth immunity but to find parasite-derived anti-inflammatory products that could improve the current treatments of chronic non-communicable inflammatory diseases such as asthma. A great number of helminth-derived immunomodulators have been discovered and some of them extensively analysed, showing their potential use as anti-inflammatory drugs in clinical settings. Since Ascaris lumbricoides is one of the most successful parasites, several groups have focused on the immunomodulatory properties of this helminth. As a result, several excretory/secretory components and purified molecules have been analysed, revealing interesting anti-inflammatory activities potentially useful as therapeutic tools. One of these molecules is A. lumbricoides cystatin, whose genomic, cellular, molecular, and immunomodulatory properties are described in this review.
Following hurricanes, there can be increases in exacerbations of chronic diseases, such as asthma. Asthma is common among children, and many asthma exacerbations can be prevented. This systematic literature review assessed literature describing the impact of hurricanes on children with asthma in the United States. Medline, Embase, Global Health, PubMed, and Scopus databases were searched for peer-reviewed, English-language articles published January 1990 to June 2019 that described the effect of a hurricane on children with asthma. This search identified 212 articles; 8 met inclusion criteria. All 8 were related to Hurricane Katrina, but research questions and study design varied. Articles included information on asthma after hurricanes from cross-sectional surveys, retrospective chart review, and objective clinical testing. Four articles described discontinuity in health insurance, asthma-related health care, or asthma medication use; and 3 articles examined the relationship between mold exposure and asthma symptoms and reported varying results. The eighth study quantified the burden of asthma among people visiting mobile medical units but did not describe factors associated with asthma symptoms. These results highlight opportunities for future research (eg, on more recent hurricanes) and disaster preparedness planning (eg, strategies to prevent health-care discontinuity among children with asthma).
Chronic diseases and preexisting conditions shape daily life for many archaeologists both in and out of the field. Chronic issues, however, can be overlooked in safety planning, which more often focuses on emergency situations because they are considered mundane, or they are imperceptible to project directors and crews until a serious problem arises. This article focuses on asthma, diabetes, and depression as common medical conditions that impact otherwise healthy archaeologists during fieldwork, with the goal of raising awareness of these conditions in particular, and the need to be more attentive to chronic diseases in general. Archaeological fieldwork presents novel situations that put those with chronic diseases and preexisting conditions at risk: environmental hazards, remoteness from medical and social resources and networks, lack of group awareness, and varying cultural norms. As a result, if chronic diseases are not attended to properly in the field, they can lead to life-threatening situations. Managing the risk presented by these conditions requires a group culture where team members are aware of issues, as appropriate, and collaborate to mitigate them during fieldwork. Descriptions of how chronic diseases affect archaeologists in the field are followed by “best practice” recommendations for self-management and for group leaders.
Background: Growing evidence from observational studies indicates a high prevalence of anxiety in asthma. However, prevalence rates of coexisting anxiety symptoms and comorbid anxiety disorders vary widely across studies. We aimed to evaluate the associations between anxiety and asthma and provide more precise comorbidity estimates.
We systematically reviewed the literature from case-controlled studies and conducted a meta-analysis to evaluate the pooled prevalence estimates and risks of anxiety symptoms and anxiety disorders in asthma individuals. Screening, data extraction, and quality assessment were undertaken following PRISMA guidelines for preferred reporting of systematic reviews and meta-analysis. A random-effects model was used to calculate pooled prevalence rates. Meta-analysis was conducted using Review Manager 5.3. Multiple databases including PubMed, ScienceDirect, PsychINFO, and PsycARTICLES were searched for publications before 1 December 2019. The review protocol was registered on PROSPERO (ref: CRD42020176028).
In total, 19 studies involving 106813 participants were included. The pooled prevalence of anxiety symptoms and anxiety disorders in individuals with asthma was 0.32 (95% CI 0.22–0.43) and 0.24 (95% CI 0.13–0.41), respectively. The risks of coexisting anxiety symptoms and comorbid anxiety disorders were significantly higher in asthma patients than in non-asthma controls indicated by OR 1.89 (95% CI 1.42–2.52; Z = 4.37; p < 0.001) and OR 2.08 (95% CI 1.70–2.56; Z = 6.97; p < 0.001), respectively. Anxiety symptoms and anxiety disorders occur at increased frequency among patients with asthma.
Our findings highlight the need for appropriate assessments for these comorbid conditions, which may help to identify a subgroup of patients who might benefit from interventions designed to reduce anxiety and enhance the quality of life.
Asthma is increasing in prevalence in school-aged children. Causes for it include psychological triggers such as anxiety, stress, and depression. Interventions that are derived from education and psychology appear promising for symptom reduction. These treatments include written emotional expression, relaxation and guided imagery, gratitude exercises, mindfulness, and yoga, amongst others. This chapter reviews the myriad causes and treatments for childhood asthma.
To investigate the effect of the time spent on quarantine on distress, anxiety, depression, and somatization of chronic disease patients during the COVID-19 quarantine in Greece and the differences in these parameters between healthy individuals and chronic disease patients.
The sample consisted of 943 healthy individuals and 163 patients (respiratory, autoimmune, cardiovascular, endocrine, patients with other diseases, and patients with more than one disease) completing sociodemographic assessments as well as the 4-Dimensional Symptom Questionnaire (4DSQ) during March 30, 2020 to May 3, 2020. Pearson's correlation was used to search for the association between time spent on quarantine and the 4DSQ subscales (distress, anxiety, depression, and somatization). Independent sample T-test and Glass's Δ were used for differences between healthy individuals and chronic disease patients in these subscales, an analysis also carried out between healthy individuals and all patient subgroups.
No statistically significant correlations were noted between the 4DSQ subscales and the quarantine duration, both for the patient and the healthy individuals’ group. Chronic disease patients had significantly higher levels of distress (p = 0.001, Δ = 0.28) and somatization (p = 0.000, Δ = 0.47), but not there were no significant differences in anxiety (p = 0.098, Δ = 0.14) and depression (p = 0.052, Δ = 0.19). Concerning head-to-head comparisons between the healthy individuals’ group and each patient group, significantly higher scores in distress were found only for patients with respiratory diseases (p = 0.028, Δ = 0.42). Regarding somatization, significantly higher scores were noted for the healthy individuals’ group compared with patients with autoimmune diseases (p = 0.010, Δ = 0.62), respiratory diseases (p = 0.027, Δ = 0.42), other diseases (p = 0.003, Δ = 0.55), and more than one disease (p = 0.012, Δ = 0.60). No statistically significant differences were found in anxiety and depression.
Significance of results
The results of this study indicate that interventional programs for chronic disease patients during quarantine should focus on distress and somatization, not on anxiety and depression. Respiratory patients might have more supportive care needs compared with patients with other diseases.
First do no harm’ is a fine principle; however, most medicines worth using have side effects, so it’s important that the prescriber can assess the risk/benefit ratio. This chapter provides examples of good advice (e.g. not to use NSAIDs in renal or liver impairment), overly cautious advice that may be flouted (e.g. cephalosporins in pencillin allergic patients) and advice that may appear overly cautious but should still be followed as there is a safer alternative (e.g.metformin in renal failure).
Respiratory emergencies normally manifest as bronchoconstriction and/or hypoxia and/or hypercapnia. Primary management goals are explained, and the pharmacological management of all three manifestations are described.
Introduction: Despite improvements in the recognition of asthma among the pediatric population and the use of preventative therapies, rates of emergency department (ED) visits and hospitalizations remain high, leading one to question how these acute health care visits for asthma can be further avoided. In this study, we aimed to identify predictors of future repeat acute care visits among children and adolescents who had already received ‘best practice’ discharge treatments and instructions during their first asthma ED visit. Methods: We performed a retrospective single center cohort study of all children ages 1-17 years presenting to the ED at the Children's Hospital of Eastern Ontario in Ottawa, Canada for an acute asthma exacerbation during a 1-year time frame between September 1, 2014 – August 31, 2015. Only children with no prior ED asthma visit and documentation of receipt of a prescription for inhaled corticosteroids and/or a written asthma action plan were included. Multivariable logistic regression was performed to identify predictors of repeat future asthma ED visit or hospitalization in the year following the first ED visit. Results: We identified 909 children with an eligible ED visit during the study period, of whom 24% had a repeat asthma ED visit or hospitalization within the subsequent 1 year. Predictors of repeat acute asthma visits included having a nut allergy (OR 1.76, 95% CI: 1.15, 2.70), higher severity symptoms at triage (OR 2.04, 95% CI: 1.23, 3.39), a primary care physician (OR 2.23, 95% CI: 1.26, 3.93), or a prior history of asthma (OR 1.53, 95% CI: 1.03, 2.28). Conclusion: In children and adolescents with repeat asthma ED visits and hospitalizations despite having received ‘best practice’ asthma discharge management at their first ED visit, factors such as having an allergy to nuts, higher severity symptoms at presentation, a prior history of asthma, and having a primary care provider may be used to identify these more high-risk children and adolescents. Such parameters can be used practically to target and apply more intensive preventative interventions to those most in need at the first ED visit, in order to prevent future return visits.
Introduction: In Canada, acute asthma is a common cause of emergency department (ED) attendance and its treatment is affected by ED overcrowding and increasing wait times. Literature suggests that a clinical pathway (CP) for the treatment of acute asthma can increase the use of medical therapy, reduce hospital admission rates and decrease associated costs. However, only few have looked at the effect on ED length of stay (ED LOS) when such a CP is initiated by triage nurse/respiratory therapist among adults. In this optic, an asthma CP was launched on Feb. 2016 at Centre Hospitalier Universitaire de Sherbrooke (QC) and included medical directives allowing triage nurse and respiratory therapist initiation of treatment. Methods: The objectives are to determine the effect of an ED nurse/respiratory therapist-initiated asthma CP on (1) ED LOS, (2) time-to-treatment (beta-agonist, corticosteroids), time-to-MD and other secondary outcomes. This was a retrospective before-after study. Adults presenting to the ED before and after CP implementation with a final diagnosis of asthma or asthma exacerbation were eligible. The groups A (before implementation) and B (after implementation) were compared for ED LOS. Three subgroups of 50 patients were generated and compared for outcomes: A1 (before implementation), B1 (after implementation without CP) and B2 (after implementation with CP). All five groups were controlled for triage level and sex. Results: In total, 1086 patients were included; 543 before implementation (Mar. 2011 – Feb. 2016) and 543 after (Feb. 2016 – Jun. 2019), of whom 14% (N = 77) were treated by CP. The average ED LOS was similar (10.36h vs 10.65h; (p = 0,31)) in group A and in group B. In groups A1, B1 and B2, the median ED LOS were respectively 6.00, 6.84, 4.80; these differences were not statistically significant. The average time-to-treatment for beta-agonist in A1, B1 and B2 was respectively 148, 180 and 50 mins; the differences between B2 and A1 and between B2 and B1 were both statistically significant (p < 0,05). Conclusion: Although this study indicates a low compliance to the CP, it shows that time-to-treatment can be reduced. It didn't demonstrate any statistically significant decrease in ED LOS, most likely due to low number of patients and non-normal distribution, but the 1.2h shorter could be a major advantage if it proves true. Further studies are essential to understand facilitators and alleviate the barriers in anticipation of a multi-centric implementation.
The effective management of chronic asthma requires long-term adherence to both pharmacotherapy and optimal self-management practices. The use of mobile applications (apps) offer a promising and cost-effective platform to support the self-management of asthma. However, students as consumers may not always be sufficiently knowledgeable to select the best app to link with the management of their condition. If school psychologists become familiar with apps, they may be better positioned to provide guidance to students about app selection and how to identify apps that include appropriate behaviour change techniques (BCT). Accordingly, the overall aim of this study was to present a method by which school psychologists could identify quality apps for the purpose of supporting students who need to self-manage chronic asthma. A directed content analysis was used to evaluate asthma apps, based on behaviour change content and app quality. A systematic selection process yielded a total of 36 apps (26 from iTunes, 12 from Google Play) that were evaluated using two published rating measures. Overall, apps contained limited BCTs and a low level of quality health information. Conversely, apps with higher quality health information utilised a larger range of BCTs than lower quality apps. It was concluded that while apps designed to support the management of asthma appear to be a potentially valuable addition to traditional interventions, the technology is still in its infancy, and school psychologists should be aware of the limited behaviour change content, age appropriateness of apps, and whether the health information provided is evidence-based.
Interaction between a healthy microbiome and the immune system leads to body homeostasis, as dysbiosis in microbiome content and loss of diversity may result in disease development. Due to the ability of probiotics to help and modify microbiome constitution, probiotics are now widely used for the prevention and treatment of different gastrointestinal, inflammatory, and, more recently, respiratory diseases. In this regard, chronic respiratory diseases including chronic obstructive pulmonary disease (COPD), asthma and allergic rhinitis are among the most common and complicated respiratory diseases with no specific treatment until now. Accordingly, many studies have evaluated the therapeutic efficacy of probiotic administration (mostly via the oral route and much lesser nasal route) on chronic respiratory diseases. We tried to summarise and evaluate these studies to give a perspective of probiotic therapy via both the oral and nasal routes for respiratory infections (in general) and chronic respiratory diseases (specifically). We finally concluded that probiotics might be useful for allergic diseases. For asthmatic patients, probiotics can modulate serum cytokines and IgE and decrease eosinophilia, but with no significant reduction in clinical symptoms. For COPD, only limited studies were found with uncertain clinical efficacy. For intranasal administration, although some studies propose more efficiency than the oral route, more clinical evaluations are warranted.
Twins, data and emails. Some of the words that first come to mind when I think of Nick. Lots of twins. With lots of data. And short single-finger-typed emails. And great wine. Well, it works, there is no doubt. That’s how I ended up in Australia, working on asthma genetics.
Mobile health (mHealth) due to its popularity and accessibility can be widely applied in different health areas such as the management of chronic diseases. However, its success depends on the acceptance of their users. Therefore, the aim of this study was to survey the attitudes of patients with chronic disease toward mHealth technology and their willingness to use it.
This study was conducted within a 2-year period (2016–2018) to determine and compare the attitude and willingness of patients with asthma, diabetes, and multiple sclerosis (MS) toward using mHealth technology in a province in Iran.
In total, 222 patients participated in this study. More than 93 percent of the patients with diabetes and MS, and 65 percent of the asthmatic patients preferred using mHealth services rather than consulting a physician (p < .0001). About 98, 94, and 49 percent of the MS, diabetic, and asthmatic patients, respectively felt comfortable if their health conditions checked by physicians through mHealth technology (p < .0001).
Our results showed that the majority of the patients felt comfortable and preferred using mHealth technology rather than consulting the physicians. The attitudes of diabetic and MS patients toward mHealth technology were rather more positive compared to asthmatic patient attitude. These results may be helpful for the developers of mHealth technology, and researchers who design mHelath interventions for patients with chronic disease.
To analyse the associations between chronic respiratory diseases and intakes of total flavonoids and their major subclasses (flavanones, anthocyanins, flavan-3-ols, flavonols, flavones, polymers and proanthocyanidins).
The analysis was conducted in the frame of the Genes Environment Interaction in Respiratory Diseases (GEIRD) study. The European Prospective Investigation into Cancer and Nutrition FFQ was used to ascertain dietary intake. Multinomial regression models adjusting for age, sex, centre, BMI, smoking habit, alcohol intake, education, total energy intake, vitamin C intake and total fruit intake were used to examine the associations between dietary exposures and the relative risk ratio (RRR) of being a case.
Individuals (n 990) hierarchically defined as follows: cases with asthma (current, n 159; past, n 78), chronic bronchitis (n 47), rhinitis (allergic rhinitis, n 167; non-allergic rhinitis, n 142) and controls (n 97).
An increase of 1 sd in flavanones was associated with a reduced risk of non-allergic rhinitis (adjusted RRR = 0·68, 95 % CI 0·47, 0·97); a similar result was found comparing the highest v. lowest quartile of flavanones intake (adjusted RRR = 0·24, 95 % CI 0·10, 0·59).
Flavonoids contained in fruits and vegetables, especially flavanones, might reduce the risk of non-allergic rhinitis. No associations were found between other flavonoids and the considered outcomes.
This chapter focuses on assisting the traditionally trained mental health provider in becoming familiar with disease-specific psychological guidelines, as well as serving as a handy resource of medical information for the experienced practitioner. The reader will then be introduced to specific guidelines relevant for the mental health provider in working with children and adolescents with specific medical conditions, including cystic fibrosis, obesity, diabetes mellitus type 1, asthma, food allergies, chronic pain, and epilepsy. Relevant websites for accessing guidelines for these medical conditions are identified, as well as critical resources for clinicians, such as information about how to respond in the event of a seizure, a sample asthma action plan, recommendations for obesity treatment based on the patient’s age, and recommended depression and anxiety screeners that are commonly used in primary care.
This chapter provides an overview of pediatric asthma. The author reviews the pathophysiology, precipitating factors and clinical symptoms of asthma. The preoperative plan for patients with asthma is reviewed. A comprehensive discussion on anesthetics for the asthmatic is presented as is the management of perioperative asthma exacerbation. Each of the medications commonly used for pediatric asthma are reviewed.