Culture-specific programs for children and adults from minority groups who have asthma (Review)

Background People with asthma who come from minority groups have poorer asthma outcomes and more asthma related visits to Emergency Departments (ED). Various programmes are used to educate and empower people with asthma and these have previously been shown to improve certain asthma outcomes. Models of care for chronic diseases in minority groups usually include a focus of the cultural context of the individual and not just the symptoms of the disease. Therefore, questions about whether culturally specific asthma education programmes for people from minority groups are effective at improving asthma outcomes, are feasible and are cost-effective need to be answered. Objectives To determine whether culture-specific asthma programmes, in comparison to generic asthma education programmes or usual care, improve asthma related outcomes in children and adults with asthma who belong to minority groups. Search strategy We searched the Cochrane Register of Controlled Trials (CENTRAL), the Cochrane Airways Group Specialised Register, MEDLINE, EMBASE, review articles and reference lists of relevant articles. The latest search was performed in May 2008. Selection criteria All randomised controlled trials (RCTs) comparing the use of culture-specific asthma education programmes with generic asthma education programmes, or usual care, in adults or children from minority groups who suffer from asthma. Data collection and analysis Two review authors independently selected, extracted and assessed the data for inclusion. We contacted authors for further information if required. Main results Four studies were eligible for inclusion in the review. A total of 617 patients, aged from 5 to 59 years were included in the meta-analysis of data. Use of a culture-specific programme was superior to generic programmes or usual care, in improving asthma quality of life scores in adults, pooled WMD 0.25 (95% CI 0.09 to 0.41), asthma knowledge scores in children, WMD 3.30 (95% CI 1.07 to 5.53), and in a single study, reducing asthma exacerbation in children (risk ratio for hospitalisations 0.32, 95% CI 0.15, 0.70). Authors' conclusions Current limited data show that culture-specific programmes for adults and children from minority groups with asthma, are more effective than generic programmes in improving most (quality of life, asthma knowledge, asthma exacerbations, asthma control) but not all asthma outcomes. This evidence is limited by the small number of included studies and the lack of reported outcomes. Further trials are required to answer this question conclusively

Can we use the approaches of ecological inference to learn about the potential for dependence bias in dualsystem estimation? An application to cancer registration data

The dual-system estimator, or estimators with a similar underlying set of assumptions and structure, is a widely used approach to estimate the unknown size of a population. Within official statistics its use is linked with population census, while in health applications it is often used to estimate true levels of incidence from imperfect reporting systems; the classic example being work by Sekar and Deming exploring the estimation of births in India in the 1940s. Critical to the implementation of dual-system estimation are the assumptions that the probability of being counted in a source is homogeneous and that the event of being counted in each source is independent. When either of these assumptions fails, the two by two table will have an odds ratio different to one and the dual-system estimator will be biased. Inferential frameworks such as the aggregate association index (AAI) have been developed to allow the researcher to assess the plausibility of independence between two variables in a two by two table, when only the margins are observed. Given any appropriate measure of relationship, this strategy relies on determining the AAI, which provides an indication of the likely association structure between the variables given only the marginal information. Further advances of the AAI have also been established including its link with the odds ratio and its relationship with the size of the study being undertaken. Determining the population size from a two by two table given limited information is an alternative variation of the framework on which the AAI is built. Therefore the underlying theoretical properties of the two by two table are identical in both scenarios – it is only the nature of the unknown information that differs. In this paper we make the first steps to exploring the use of an AAI type framework (and its relatives) to assess the plausibility of an independence assumption in applications of population size estimation. We use alternative data set-ups based on real data relating to historical cancer registration (with three sources of registration) to demonstrate that the chi-square statistic behaves differently over a range of values for the missing data for differing true relationships between the two variables. We then apply the approach to the cancer registration from two of the registration systems to show that we can see evidence of potential dependence from the observed but incomplete data. The first results in this paper demonstrate the possibility of exploring the independence assumption when estimating the unknown population size from two lists. As with the AAI framework, the aim is not to directly estimate the level of the association but rather alert the analyst to the potential for an association and its direction allowing them to assess the likelihood of a biased estimate for the population size. This has important implications within a health setting where it is potentially useful to understand if the true population size, of say cancer patients, is likely to be higher or lower than the estimate constructed assuming independence. Within the official statistics setting, it can alert us to situations where it is advantageous to explore whether external data exist that would allow an adjustment for dependence in our two lists

Environmental Attitudes and Behaviors among Secondary Students in Hong Kong

Although researchers have identified correlations between specific attitudes and particular behaviors in the pro-environmental domain, the general relationship between young people’s development of environmental knowledge, attitudes, and behaviors is not well understood. Past research indicates that geographic context can play a role, while social factors such as age and gender can have a more significant impact on predicting attitudes and behaviors than formal education. Few studies have systematically examined the relationships between education and environmental attitudes and behaviors among youth in Hong Kong. The purpose of this paper is to report the findings of a study comparing secondary school students’ environmental attitudes and behaviors with age and related factors in two international schools and two government schools in Hong Kong. Students’ attitudes and behaviors were compared based on school type (curriculum), while the authors additionally compared the significance of social factors and attitudes on students’ behaviors. Design/methodology/approach – Attitudes were measured using the New Ecological Paradigm (NEP) and the NEP for Children (NEPC), the most commonly used, internationally standardized tools for investigating environmental attitudes and values of adults and young people for comparative purposes. The authors compared NEP/NEPC scores and student self-reported environmental behaviors using a short questionnaire. Findings – No significant differences were found in attitudes or behaviors based on school type. However the authors did observe a significant effect of gender and age on students’ attitudes, and a significant correlation of student attitudes in the NEP with students’ self-reports regarding air conditioning consumption. Originality/value – This study builds a foundation for cross-national studies and for evaluating the impact of curricula over time.postprin

Bone marrow transplantation corrects haemolytic anaemia in a novel ENU mutagenesis mouse model of TPI deficiency.

In this study, we performed a genome-wide N-ethyl-N-nitrosourea (ENU) mutagenesis screen in mice to identify novel genes or alleles that regulate erythropoiesis. Here, we describe a recessive mouse strain, called RBC19, harbouring a point mutation within the housekeeping gene, Tpi1, which encodes the glycolysis enzyme, triosephosphate isomerase (TPI). A serine in place of a phenylalanine at amino acid 57 severely diminishes enzyme activity in red blood cells and other tissues, resulting in a macrocytic haemolytic phenotype in homozygous mice, which closely resembles human TPI deficiency. A rescue study was performed using bone marrow transplantation of wild-type donor cells, which restored all haematological parameters and increased red blood cell enzyme function to wild-type levels after 7 weeks. This is the first study performed in a mammalian model of TPI deficiency, demonstrating that the haematological phenotype can be rescued