The use of respirators and its impact on the COVID-19 pandemic in Europe between 1 June and 14 October 2020

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Children with wheat allergy usually tolerate oats

Non peer reviewe

Bronchial hyperresponsiveness and asthma during oral immunotherapy for egg or peanut allergy in children

Background Bronchial hyperresponsiveness (BHR) and asthma are frequently present in children with food allergy. We assessed BHR in children receiving oral immunotherapy (OIT) for persistent egg or peanut allergy and examined whether OIT affects asthma control. Methods Methacholine challenge testing was performed in 89 children with persistent egg or peanut allergy diagnosed by double-blind, placebo-controlled food challenge and 80 control children without food allergy. Of the 89 food-allergic children, 50 started OIT for egg allergy and 39 for peanut allergy. Sensitization to aeroallergens was evaluated by skin prick testing. Forty of the 89 children with regular controller treatment for asthma underwent methacholine challenge testing and 34 measurement of exhaled nitric oxide (FeNO) at baseline and after 6-12 months of OIT. Results Methacholine challenge testing revealed significant BHR in 29/50 children (58%) with egg allergy, 15/39 children (38%) with peanut allergy, and 6/80 controls (7.5%). The mean cumulative dose of methacholine causing a 20% fall in FEV1 differed significantly between the egg and peanut-allergic versus the control children (1009 mu g, 1104 mu g, and 2068 mu g, respectively, p < 0.001). Egg or peanut OIT did not affect lung function, the degree of BHR or FeNO levels in children with asthma and had no adverse effect on asthma control. Lung function or BHR did not associate with the OIT outcome. Conclusion BHR was significantly more frequent in children with persistent egg or peanut allergy than in children without food allergy. Oral immunotherapy did not increase BHR and was safe for children on regular asthma medication.Peer reviewe

Observational study of inhaled corticosteroid treatment for improved expiratory variability index in steroid-naive asthmatic children

Non peer reviewe

Cut-off values to evaluate exercise-induced asthma in eucapnic voluntary hyperventilation test for children

Background and Aim The eucapnic voluntary hyperventilation (EVH) testing is a diagnostic tool for diagnostics of exercise-induced bronchoconstriction; while the testing has become more common among children, data on the test's feasibility among children remain limited. Our aim was to investigate EVH testing feasibility among children, diagnostic testing cut-off values, and which factors affect testing outcomes. Methods We recruited 134 patients aged 10-16 years with a history of exercise-induced dyspnoea and 100 healthy control children to undergo 6-min EVH testing. Testing feasibility was assessed by the children's ability to achieve >= 70% of the target minute ventilation of 30 times forced expiratory volume in 1 s (FEV1). Bronchoconstriction was assessed as a minimum of 8%, 10%, 12%, 15% or 20% fall in FEV1. Patient characteristics were correlated with EVH outcomes. Results Overall, 98% of the children reached >= 70%, 88% reached >= 80%, 79% reached >= 90% and 62% reached >= 100% of target ventilation in EVH testing; of children with a history of exercise-induced dyspnoea, the decline percentages were as follows: 24% (>= 8% fall), 17% (>= 10% fall), 10% (>= 12% fall), 6% (>= 15% fall) and 5% (>= 20% fall) in FEV1, compared to 11%, 4%, 3%, 1% and 0% among the healthy controls, respectively. Healthy controls and boys performed testing at higher ventilation rates (p <.05). Conclusion Eucapnic voluntary hyperventilation testing is feasible among children aged 10-16 years and has diagnostic value in evaluating exercise-induced dyspnoea among children. A minimum 10% fall in FEV1 is a good diagnostic cut-off value. Disease status appears to be important covariates.Peer reviewe

Obesity and smoking are factors associated with poor prognosis in patients with bacteraemia

BACKGROUND: Bacteraemia is still a major cause of case fatality in all age groups. Our aim was to identify the major underlying conditions constituting risk factors for case fatality in bacteraemia patients. METHODS: The study involved 149 patients (79 male and 70 female) with bacteraemia caused by Staphylococcus aureus (S. aureus) (41 patients), Streptococcus pneumoniae (Str. pneumoniae) (42 patients), β-hemolytic streptococcae (β-hml str.) (23 patients) and Eschericia coli (E. coli) (43 patients). Underlying diseases, alcohol and tobacco consumption and body mass index (BMI) were registered. Laboratory findings and clinical data were registered on admission and 6 consecutive days and on day 10–14. Case fatality was studied within 30 days after positive blood culture. Associations between underlying conditions and case fatality were studied in univariate analysis and in a multivariate model. RESULTS: Nineteen patients (12.8%) died of bacteraemia. We found obesity (p = 0.002, RR 9.8; 95% CI 2.3 to 41.3), smoking (p < 0.001, RR 16.9; 95% CI 2.1 to 133.5), alcohol abuse (p = 0.008, RR 3.9; 95% CI 1.3 to 11.28), COPD (p = 0.01, RR 8.4; 95% CI 1.9 to 37.1) and rheumatoid arthritis (p = 0.045, RR 5.9; 95% CI 1.2 to 28.8) to be significantly associated with case fatality in bacteraemia in univariate model. The median BMI was significantly higher among those who died compared to survivors (33 vs. 26, p = 0.003). Obesity and smoking also remained independent risk factors for case fatality when their effect was studied together in a multivariate model adjusted with the effect of alcohol abuse, age (continuos variable), sex and causative organism. CONCLUSION: Our results indicate that obesity and smoking are prominent risk factors for case fatality in bacteraemic patients. Identification of risk factors underlying fatal outcome in bacteraemia may allow targeting of preventive efforts to individuals likely to derive greatest potential benefit

Kunnan talouden yhteys peruskoulun säästötoimenpiteisiin

Aiheen ajankohtaisuus ja oma mielenkiintomme taloudellsia kysymyksiä kohtaan herättivät mielenkiintomme kyseisen tutkimuksen tekoon. Tämän johdosta päädyimme tutkimaan kuntien talouden yhteyttä peruskoulun säästöihin. Pääongelmana tutkimuksessamme oli, millainen yhteys kunnan taloudella on peruskoulussa tehtyihin säästötoimenpiteisiin. Lisäksi halusimme selvittää koulujen koon ja kuntien talouden yhteyttä säästöjen määrään, kuntien peruskoulujen yleisimpiä säästötoimenpiteitä sekä eri opettajaryhmien vaikutusmahdollisuuksia koulua koskeviin säästöpäätöksiin.Tutkimukseen valitsimme kuusi kuntaa, jotka erosivat toisistaan taloudelliselta taustaltaan. Luokittelimme kunnat kolmeen eri luokkaan: hyviin, keskinkertaisiin ja huonoihin. Valitut kunnat olivat Hämeenkyrö, Valkeakoski, Lammi, Orivesi, Viiala ja Toijala. Otostutkimuksen suuntasimme koulujen johtajille ja opettajille. Otoksen koko oli 160 ja katoprosentti 23. Paremman kokonaiskuvan saamiseksi kunnassa tehdyistä säästötoimenpiteistä haastattelimme myös koulutoimenjohtajia.Valtion taloudellisen tilanteen voimakas heikkeneminen aiheutti säästöpaineita myös kunnissa. Valtion säästötoimet vaikuttivat kunnille jaettavan rahan määrään. Valtionosuuksia leikattiin, jolloin kunnat joutuivat miettimään omia säästökohteitaan. Useimmat kunnat ottivat linjakseen ns. juustohöyläperiaatteen, jolla leikattiin kaikkien hallintosektoreiden menoja tasapuolisesti. Valtion tehdessä uusia kuntia koskevia säästöpäätöksiä, juustohöyläperiaatetta kiristettiin. Tämän tilanteen johdosta ovat koulut joutuneet entistä voimakkaampien säästötoimenpiteiden käsiin. Kaikissa tutkimukseen osallistuneissa kunnissa oli jouduttu suorittamaan peruskoulua koskevia säästöjä. Valtionosuusjärjestelmän muutos ei ollut vaikuttanut peruskouluille tulevan rahan jakoperusteisiin. Koulutoimenjohtajien mielestä kunnat suhtautuivat koulutoimeen edelleen hyvin asiallisesti. Peruskoulujen saama rahamäärä ei pienentynyt suhteessa muihin kunnan menoluokkiin nähden, markkamääräisesti vähennystä luonnollisesti tapahtui.Vastaus pääongelmaan oli selvä. Kunnan taloudellisella tilanteella on selvä yhteys kunnassa tehtyjen säästötoimien määrään. Peruskoulua koskevien säästötoimien määrä kasvaa tilastollisesti merkitsevästi kunnan talouden heikentyessä. Kunnan talouden ollessa huono on vaarana, että oppilaat joutuvat eriarvoiseen asemaan kuntien välillä.Koulujen koolla on merkitystä säästöjen määrään. Pienet koulut joutuvat lisäämään erilaisia säästötoimia selvästi kunnan talouden tilan huonontuessa. Suurilla kouluilla kunnan taloudellinen tilanne ei ole vaikuttanut tehtyihin säästöpäätöksiin. Suuret koulut eivät ole joutuneet lisäämään säästötoimien määrää kunnan talouden heikentyessä.Kaikissa tutkimukseen osallistuneissa kunnissa oli tuntikehystä leikattu. Muut yleisimmät säästötoimenpiteet koskivat opetusmateriaalia, opettajien lomarahoja, lyhyiden sijaisuuksien täyttämättä jättämistä, luokkakoon suurentamista, tukiopetus- ja kerhotuntien vähentämistä.Vertailtaessa vaikutusmahdollisuuksia koulun säästöpäätöksiin, koulunjohtajat pystyivät luonnollisesti vaikuttamaan tehtyihin toimenpiteisiin muita opettajaryhmiä enemmän. Lehtoreita ja luokanopettajia vertailtaessa huomattiin, että luokanopettajat kokivat omat vaikutusmahdollisuutensa huomattavasti pienemmiksi kuin lehtorit.Ainoa tilastollisesti merkitsevä selittäjä kunnan peruskoulun säästötoimenpiteiden voimakkuuteen ja määrään oli kunnan taloudellinen tilanne. Tutkittaessa vastaajien taustoja (ikä, sukupuoli, työkokemus ja työsuhde) emme havainneet näillä muuttujilla olevan vaikutusta saatuun tulokseen.Asiasanat: kunnallistalous, peruskoulu - talous, säästäminen - koulu

Impulse oscillometry and free-running tests for diagnosing asthma and monitoring lung function in young children

Background: Separating individuals with viral-induced wheezing from those with asthma is challenging, and there are no guidelines for children under 6 years of age. Impulse oscillometry, however, is feasible in 4-year-old children. Objective: To explore the use of impulse oscillometry in diagnosing and monitoring asthma in young children and evaluating treatment response to inhaled corticosteroid (ICS). Methods: A total of 42 children (median age 5.3 years, range 4.0-7.9 years) with physician-diagnosed asthma and lability in oscillometry were followed for 6 months after initiation of ICS treatment. All children performed the 6-minute free-running test and impulse oscillometry at 3 time points. After the baseline, they attended a second visit when they had achieved good asthma control and a third visit approximately 60 days after the second visit. A positive ICS response was defined as having greater than 19 points in asthma control test and no hyperreactivity on the third visit. Results: In total, 38 of 42 children responded to ICS treatment. Exercise-induced increases of resistance at 5 Hz decreased after ICS treatment (61% vs 18% vs 13.5%, P < .001), and running distance during the 6-minute test was lengthened (800 m vs 850 m vs 850 m, P = .001). Significant improvements in childhood asthma control scores occurred between the baseline and subsequent visits (21 vs 24 vs 24, P < .001) and acute physicians' visits for respiratory symptoms (1, (0-6) vs 0, (0-2), P = .001). Similar profiles were observed in children without aeroallergen sensitization and among those under 5 years of age. Conclusion: Impulse oscillometry is a useful tool in diagnosing asthma and monitoring lung function in young children. (C) 2021 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc.Peer reviewe

Eucapnic voluntary hyperventilation test decreases exhaled nitric oxide level in children

Background Exhaled nitric oxide (FeNO) measurements and eucapnic voluntary hyperventilation (EVH) tests have been used as diagnostic tools for asthma. Data on the impact of hyperventilation on the level of FeNO are limited. Aim We aimed to evaluate whether EVH tests affect the level of FeNO in children aged 10-16 years. Methods A total of 234 children aged 10-16 years had a 6-min EVH test performed. In total, FeNO values for 153 of 234 children were measured before the test and within 15 min after the test. According to a baseline FeNO level of 20 ppb, children were divided into two groups: those with low values (FeNO = 20 ppb). Results The median age of the children was 13.4 years (interquartile range 12.3-15.3 years); 58% were boys and 42% were girls. Of these children, 51% were sensitized to aeroallergens. In 101 of 153 children (66%), the FeNO values decreased after the EVH test. In children with low and high baseline levels, the median level of FeNO decreased after the EVH test: 10.5 ppb before versus 9.5 ppb after (p .011), and 31.0 ppb before versus 28.0 ppb after (p .011), respectively. The decrease in FeNO after EVH test was not associated with induced bronchoconstriction expressed as a change in FEV1 (R-s = .19). Conclusions The EVH test decreases FeNO levels. Therefore, FeNO should be measured before an EVH test is performed.Peer reviewe