40,434 research outputs found

    Comparison of physical fitness between healthy and mild‐to‐moderate asthmatic children with exercise symptoms: A cross‐sectional study

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    .Objective Asthma is a chronic disease that may affect physical fitness, although its primary effects on exercise capacity, muscle strength, functionality and lifestyle, in children and adolescents, are still poorly understood. This study aimed to evaluate the differences in cardiorespiratory fitness, muscle strength, lifestyle, lung function, and functionality between asthmatics with exercise symptoms and healthy children. In addition, we have analyzed the association between clinical history and the presence of asthma. Study Design Cross-sectional study including 71 patients with a diagnosis of asthma and 71 healthy children and adolescents (7–17 years of age). Anthropometric data, clinical history, disease control, lifestyle (KIDMED and physical activity questionnaires), lung function (spirometry), exercise-induced bronchoconstriction test, aerobic fitness (cardiopulmonary exercise test), muscle strength and functionality (timed up and go; timed up and down stairs) were evaluated. Results Seventy-one patients with asthma (mean age 11.5 ± 2.7) and 71 healthy subjects (mean age 10.7 ± 2.5) were included. All asthmatic children had mild to moderate and stable asthma. EIB occurred in 56.3% of asthmatic children. Lung function was significantly (p < .05) lower in the asthmatic group when compared to healthy peers, as well as the cardiorespiratory fitness, muscle strength, lifestyle and functionality. Moreover, asthmatic children were more likely to have atopic dermatitis, allergic reactions, food allergies, and a family history of asthma when compared to healthy children. Conclusions Children with mild-to-moderate asthma presenting exercise symptoms show a reduction in cardiorespiratory fitness, muscle strength, lung function, functionality, and lifestyle when compared to healthy peers. The study provides data for pediatricians to support exercise practice aiming to improve prognosis and quality of life in asthmatic children.S

    Understanding the lived experience of people in Malaysia with asthma and limited health literacy and developing an intervention to support them with asthma self-management

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    INTRODUCTION: People living with asthma need the knowledge and ability to respond to the demands of managing their variable symptoms. Supported self-management (including the use of written asthma action plans) improves health outcomes and reduces attacks. However, limited health literacy makes self-management difficult, which is especially challenging in low-to-middle-income countries (LMICs), where limited health literacy is prevalent. Tailored interventions, potentially including the use of mobile applications (apps), are needed to enable people with limited health literacy to realise the benefits of supported asthma self-management. AIMS AND OBJECTIVES: I aimed to 1). Systematically search for and synthesise evidence of clinical effectiveness of asthma self-management interventions targeted at people with limited health literacy and to identify strategies associated with effective programmes. 2). Explore experiences of living with asthma among people with limited health literacy in Malaysia, to understand the role of health literacy in influencing self-management decisions, the barriers to using evidence-based action plans, and how self-management can be supported. 3). Identify how to design an intervention underpinned by a theory of change. 4). Develop and refine a prototype asthma self-management app tailored to the needs of people with limited health literacy, optimising user experiences. METHODS: Using the Six essential Steps in Quality Intervention Development (6SQuID) model, the programme of work consisted of the following: 1). Following Cochrane methodology, I systematically searched ten databases using a Population, Intervention, Comparison, Outcome and Setting (PICOS) search strategy. Selection of papers, extraction of data and quality assessment (using the Cochrane Risk of Bias tool) were duplicated. The primary outcomes were clinical (asthma control) and implementation (adoption/adherence to intervention). Analysis was narrative, due to the heterogeneity of studies. 2). I adapted an arts-based qualitative methodology, Photovoice. The study was conducted in four stages: 1: Initial in-depth interviews, 2: Photo-training and photo-taking activity, 3: Photo-interviews, 4: A photo-exhibition. I purposively sampled adults with asthma and limited health literacy from four primary healthcare clinics in a district of central Malaysia. Interviews were audio-recorded, transcribed verbatim, translated and analysed using two approaches: i) Narrative exploration of the experience of living with asthma among people with limited health literacy in Malaysia; and ii) Framework analysis informed by Sørensen’s health literacy framework. Findings were interpreted in discussion within a multidisciplinary group. 3). With reference to the 6SQuID model, I used the study findings to design an intervention. 4). I adapted the Design Sprint method to an online format that took place over five days. Stakeholders provided insights on self-management issues (Stage 1), which informed the development of the prototype (Stages 2 to 4). Participants with asthma and limited health literacy tested the prototype and provided qualitative feedback, including a ‘thinking-aloud’ process triangulated with screen recordings of app browsing activities (Stage 5). Interviews were audio-recorded, translated and analysed thematically to identify utility and usability issues. RESULTS: 1). I screened 4,318 titles and abstracts, reviewed 52 full-text studies, and included five studies. The risk of bias was low in one and high in the other four studies. Clinical outcomes were reported in two studies, both at high risk of bias. None reported uptake or adherence as an outcome of the intervention. Behavioural change strategies typically focused on improving an individual’s psychological and physical capacity to enact behaviour (e.g., targeting asthma-related knowledge or comprehension). Less than half of the interventions used specific self-management strategies (e.g., written asthma action plans) tailored to limited health literacy status. A range of innovative approaches was used to provide education. 2). Twenty-six participants provided interviews; eight also completed the Photovoice activities. i) The concept of autonomy was the primary lens that pulled the data together. Through the lens of autonomy, three themes were identified: asthma as a life story, reclaiming identity in the network of everyday relationships, and redefining interactions with the health system and environment. ii) Health literacy was identified as a process of negotiating medical narratives and social practice. Participants with limited health literacy used various sources (e.g., social media) to access information about asthma and self-management but typically lacked appraisal skills. Doctor–patient communication had a pivotal role in helping patients understand asthma, though written action plans were rarely provided. Self-management decisions were influenced by socio-cultural norms, experiential knowledge and available social support. Specific challenges and recommendations in the use of action plans were identified. 3). Building on the previous literature, the systematic review and the qualitative study, I used Steps 1 to 4 of the 6SQuID model to define my intervention development. 4). Stakeholder discussions identified multi-level challenges. Five participants tested the prototype and described how the app influenced or could support self-management (utility): offering information, providing access to an asthma action plan, supporting medication adherence, and behaviour change. Specific usability issues addressed navigation, comprehension and layout. CONCLUSION: People with asthma experience challenges in coping with the variable symptoms of acute asthma. In the context of people with limited health literacy, understanding asthma and making decisions about self-management were heavily influenced by societal norms; therefore, interventions require a whole-system approach. Mobile technology may be an appropriate medium for delivering tailored self-management support at an individual level. Future studies are needed to test the feasibility of the prototype intervention in clinical practice

    Metabolic and nutritional triggers associated with increased risk of liver complications in SARS-CoV-2

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    Obesity, diabetes, cardiovascular and respiratory diseases, cancer and smoking are risk factors for negative outcomes in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which can quickly induce severe respiratory failure in 5% of cases. Coronavirus disease-associated liver injury may occur during progression of SARS-CoV-2 in patients with or without pre-existing liver disease, and damage to the liver parenchyma can be caused by infection of hepatocytes. Cirrhosis patients may be particularly vulnerable to SARS-CoV-2 if suffering with cirrhosis-associated immune dysfunction. Furthermore, pharmacotherapies including macrolide or quinolone antibiotics and steroids can also induce liver damage. In this review we addressed nutritional status and nutritional interventions in severe SARS-CoV-2 liver patients. As guidelines for SARS-CoV-2 in intensive care (IC) specifically are not yet available, strategies for management of sepsis and SARS are suggested in SARS-CoV-2. Early enteral nutrition (EN) should be started soon after IC admission, preferably employing iso-osmolar polymeric formula with initial protein content at 0.8 g/kg per day progressively increasing up to 1.3 g/kg per day and enriched with fish oil at 0.1 g/kg per day to 0.2 g/kg per day. Monitoring is necessary to identify signs of intolerance, hemodynamic instability and metabolic disorders, and transition to parenteral nutrition should not be delayed when energy and protein targets cannot be met via EN. Nutrients including vitamins A, C, D, E, B6, B12, folic acid, zinc, selenium and ω-3 fatty acids have in isolation or in combination shown beneficial effects upon immune function and inflammation modulation. Cautious and monitored supplementation up to upper limits may be beneficial in management strategies for SARS-CoV-2 liver patients

    An investigation of the relationship between perioperative characteristics and perioperative anaesthesia on the postoperative systemic inflammatory response and clinical outcome in patients undergoing surgery for colorectal cancer

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    In UK, colorectal cancer (CRC) is the fourth most common cancer and the second most common cause of cancer death. Until now, surgical resection remains the cornerstone for the management of CRC in all stages, however, stress response elicit from surgery may cause different changes through multiple systems in human body including neural, endocrine, metabolic, inflammatory, and immunological changes. In addition, other perioperative factors such as volatile anaesthetic and opioids may induce the immunosuppression. There is a proportional correlation between the stress response and the magnitude of the inflammatory immune response, invasiveness, and duration of surgery. The pre-operative and post-operative status of patients are important when considering the prognosis. The systemic inflammatory response (SIR) has been recognised to correlate with tumour progression and the prognosis of CRC. An exaggerated postoperative SIR is associated with postoperative infective complications and poor survival. Several predictive markers of the SIR have been used, such as the neutrophil to lymphocyte ratio (NLR), serum C-reactive protein (CRP) level, and Glasgow prognostic score (GPS). Some evidence reported that general anaesthesia (GA) combined with regional anaesthesia (RA) are better than the single use of general anaesthesia in reducing the post-operative immuno-suppression in some degrees. Furthermore, the peri-operative inflammatory process may be affected by the choice of anaesthetic technique, with propofol reported to have anti-inflammatory effect by targeting neutrophil activity. Up to now, there is insufficient evidence to recommend any specific anaesthetic or analgesic technique for patients undergoing surgery for tumour resection based on inflammatory response, recurrence, and metastasis. The work presented in this thesis further examines the relationship between the perioperative characteristics, perioperative anaesthesia, and the postoperative systemic inflammatory response following surgery for colorectal cancer. Several preoperative medications along with anaesthesia might influence the postoperative systemic inflammatory response but the question is whether the post-operative systemic inflammatory response affected by the administration of different types of anaesthesia or not following surgery for colorectal cancer. Chapter 1 discusses the epidemiology, aetiology, carcinogenesis, risk factors of colorectal cancer, pro-carcinogenic factors, anti-carcinogenic agents, inflammation and cancer, the post-operative systemic inflammatory response, tumour staging, screening, and diagnosis of colorectal cancer. Chapter 2 discusses the treatment of colorectal cancer. Chapter 3 discusses different anaesthetic techniques and agents. Chapter 4 provides summary and aims of the thesis. Chapter 5 represents findings from a systematic review and meta-analysis about the effect of anaesthesia on the postoperative systemic inflammatory response in patients undergoing surgery. The results conclude that there was some evidence that anaesthetic regimens may reduce the magnitude of the post-operative SIR. However, the studies identified in this systematic review were heterogeneous and generally of low quality. Chapter 6 represents a retrospective cohort study about the relationship between anaesthetic technique, clinicopathological characteristics and the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colon cancer. The results show that the type of anaesthesia varied over time and appears to influence the magnitude of the postoperative SIR on post-operative day 2 for those patients who underwent for open surgery but not laparoscopic surgery. Chapter 7 represents a prospective cohort study about the effect of anaesthesia on the magnitude of the postoperative systemic inflammatory response in patients undergoing elective surgery for colorectal cancer in the context of an enhanced recovery pathway. The results show that there was a modest but an independent association between regional anaesthesia (RA) and a lower magnitude of the postoperative SIR. Chapter 8 represents the relationship between pre-operative medications, the type of anaesthesia and post-operative sequelae in patients undergoing surgery for colorectal cancer. The results show that there was no association between the preoperative administration of aspirin, statins and ACE inhibitors and anaesthesia. Chapter 9 represents the relationship between nutritional status, anaesthetic approach, and peri-operative characteristics of patients undergoing surgery for colorectal cancer. The results show that there was no significant association between measures of nutritional status and anaesthetic approach. Chapter 10 represents the relationship between opioid administration, type of anaesthesia and clinicopathological characteristics in patients undergoing surgery for colorectal cancer. The results show that opioid administration was independently associated with both anaesthetic and operative factors. Chapter 11 represents the main findings of the thesis and some recommendation for a future work

    Seasonal variations in air concentrations of 27 organochlorine pesticides (OCPs) and 25 current-use pesticides (CUPs) across three agricultural areas of South Africa

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    For decades pesticides have been used in agriculture, however, the occurrence of legacy organochlorine pesticides (OCPs) and current-use pesticides (CUPs) is poorly understood in Africa. This study investigates air concentrations of OCPs and CUPs in three South African agricultural areas, their spatial/seasonal variations and mixture profiles. Between 2017 and 2018, 54 polyurethane foam-disks passive air-samplers (PUF-PAS) were positioned in three agricultural areas of the Western Cape, producing mainly apples, table grapes and wheat. Within areas, 25 CUPs were measured at two sites (farm and village), and 27 OCPs at one site (farm). Kruskal-Wallis tests investigated area differences in OCPs concentrations, and linear mixed-effect models studied differences in CUPs concentrations between areas, sites and sampling rounds

    Pharmacological, Biopesticide, and Post-Harvest Loss Management Application of Jimsonweed (<em>Datura stramonium</em>)

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    Datura stramonium is one of the most intriguing, in part because of its well-known therapeutic and psychoactive properties in the treatment of many diseases. Datura species have been found to exhibit a variety of biological activity. Insecticide, fungicide, antioxidant, antibacterial, hypoglycemic, and immune response boosting properties have been linked to the genus’ species. These effects are linked to the existence of secondary metabolites such as terpenoids, flavonoids, with anolides, tannins, phenolic compounds, and tropane alkaloids, which are the most prevalent atropine and scopolamine in the genus Datura. Ingestion of Jimson weed produces the toxidrome of anticholinergic intoxication. Understanding and recognizing the classic signs and symptoms of anticholinergic intoxication can help clinicians evaluate persons presenting with Jimson weed poisoning. Moreover, this review is to identify the most important phytochemical substances extracted from the Jimsonweed and to characterize their biological activity for health effect and biopesticide application. Biopesticides are less harmful than chemical pesticides because they do not leave harmful residues, generally target one specific pest or a small number of related pests rather than broad spectrum chemical pesticides that affect other beneficial insects, birds, mammals, or non-target species, are effective in smaller quantities, decompose quickly and do not cause environmental problems, and are often cheaper. In conclusion, Datura stramonium, beside its medicinal value, can applicable for biopesticide application and for postharvest loss control of insects such as weevil

    Patient evaluations of asthma counselling quality in primary health care:a cross-sectional survey

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    Abstract Background: Healthcare staff have a key role in counselling patients. This study describes asthma patients’ evaluations of primary care counselling quality. Methods: The research applied a cross-sectional study design, with data collected from adult asthma patients (n = 73). Data were analysed by descriptive statistics. Results: Most of participating patients were women (73%) and over 60 years old (67%). The patients were generally satisfied with the counselling. Subjection to an asthma test (p = 0.009) and smoking (p = 0.019) were found to significantly positively affect patient perceptions of counselling quality. The patients also felt that support services should be covered more (74%). Patients with comprehensive education (p = 0.039) and smokers (p = 0.015) were more likely to be satisfied with the counselling than other patients. Counselling was client-oriented (53%) and most patients reported experiencing positive interactions (92%). Most patients agreed that counselling benefitted adherence to self-care (75%) and health promotion (67%). Moreover, almost all of the patients were satisfied with the staff members’ knowledge and skills (97%). Subjection to an asthma test (p = 0.043), age (p = 0.030), smoking (p = 0.014), and duration of illness (p = 0.002) influenced satisfaction with counselling resources. Conclusion: The results indicate that counselling benefits asthma patients. Performing an asthma test, as well as considering smoking habits and educational level, can improve patient perceptions of counselling

    Posicionamento atual sobre vitamina D na prática clínica: Posicionamento da Associação Brasileira de Nutrologia (Abran)

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    Objective: To establish a position statement to standardize the recommendations of the Brazilian Association of Nutrology related to vitamin D deficiency management in the clinical practice with an emphasis on the diagnosis, treatment and prevention. Methods: We present an update on the diagnosis, prevention and treatment of vitamin D deficiency, based on the most recent scientific evidence, including an extensive data review of PubMed, Lilacs and SciELO. Results: Based on the recent information obtained in contrast to previous published Brazilian and American guidelines, the authors drafted the agreement, which was approved by the scientific board of the Brazilian Association of Nutrology. Conclusion: After a critical analysis of the most recent data, a scientific update regarding vitamin D management was presented resulting in the present institutional guide from the Brazilian Association of Nutrology about the prevention, diagnosis and treatment of this condition in Brazil
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