Effect of a web-based chronic disease management system on asthma control and health-related quality of life: study protocol for a randomized controlled trial

<p>Abstract</p> <p>Background</p> <p>Asthma is a prevalent and costly disease resulting in reduced quality of life for a large proportion of individuals. Effective patient self-management is critical for improving health outcomes. However, key aspects of self-management such as self-monitoring of behaviours and symptoms, coupled with regular feedback from the health care team, are rarely addressed or integrated into ongoing care. Health information technology (HIT) provides unique opportunities to facilitate this by providing a means for two way communication and exchange of information between the patient and care team, and access to their health information, presented in personalized ways that can alert them when there is a need for action. The objective of this study is to evaluate the acceptability and efficacy of using a web-based self-management system, My Asthma Portal (MAP), linked to a case-management system on asthma control, and asthma health-related quality of life.</p> <p>Methods</p> <p>The trial is a parallel multi-centered 2-arm pilot randomized controlled trial. Participants are randomly assigned to one of two conditions: a) MAP and usual care; or b) usual care alone. Individuals will be included if they are between 18 and 70, have a confirmed asthma diagnosis, and their asthma is classified as not well controlled by their physician. Asthma control will be evaluated by calculating the amount of fast acting beta agonists recorded as dispensed in the provincial drug database, and asthma quality of life using the Mini Asthma Related Quality of Life Questionnaire. Power calculations indicated a needed total sample size of 80 subjects. Data are collected at baseline, 3, 6, and 9 months post randomization. Recruitment started in March 2010 and the inclusion of patients in the trial in June 2010.</p> <p>Discussion</p> <p>Self-management support from the care team is critical for improving chronic disease outcomes. Given the high volume of patients and time constraints during clinical visits, primary care physicians have limited time to teach and reinforce use of proven self-management strategies. HIT has the potential to provide clinicians and a large number of patients with tools to support health behaviour change.</p> <p>Trial Registration</p> <p>Current Controlled Trials <a href="http://www.controlled-trials.com/ISRCTN34326236">ISRCTN34326236</a>.</p

Review of the projected impacts of climate change on coastal fishes in southern Africa

The coastal zone represents one of the most economically and ecologically important ecosystems on the planet, none more so than in southern Africa. This manuscript examines the potential impacts of climate change on the coastal fishes in southern Africa and provides some of the first information for the Southern Hemisphere, outside of Australasia. It begins by describing the coastal zone in terms of its physical characteristics, climate, fish biodiversity and fisheries. The region is divided into seven biogeographical zones based on previous descriptions and interpretations by the authors. A global review of the impacts of climate change on coastal zones is then applied to make qualitative predictions on the likely impacts of climate change on migratory, resident, estuarine-dependent and catadromous fishes in each of these biogeographical zones. In many respects the southern African region represents a microcosm of climate change variability and of coastal habitats. Based on the broad range of climate change impacts and life history styles of coastal fishes, the predicted impacts on fishes will be diverse. If anything, this review reveals our lack of fundamental knowledge in this field, in particular in southern Africa. Several research priorities, including the need for process-based fundamental research programs are highlighted

Fluid Mechanics 1986: Annual Report of Fluid Mechanics Division

This report, presents an overview of the research and development activities of the Fluid Mechanics division during 1986. The division is mainly concerned with Investigations of complex flow fields associated with aerospace vehicles. The repamp; highlights progress in several areas of computational and experimental' fluid mechanics, including vortex dominated flows, flow visualisation, airfoil design codes, and Laser based flow measurements. Some of the work was sponsored by external agencies like ARDB and NSTL

Communiqué no.64 du CNDD-FDD du 14 mai 2003.

Document collected by the University of Texas Libraries from the web-site of the Reseau Documentaire International Sur La Region Des Grands Lacs Africains (International Documentation Network on the Great African Lakes Region). The Reseau distributes "gray literature", non-published or limited distribution government or NGO documents regarding the Great Lakes area of central Africa including Rwanda, Burundi, and the Democratic Republic of Congo.UT Librarie

Nascimento de recém-nascidos de baixo peso em instituição filantrópica terciária do Município de Piracicaba

Objetivo: Identificar factores de riesgo asociados al nacimiento de recién nacidos de bajo peso y comparar estos factores entre los neonatos de bajo peso y peso adecuado para la edad gestacional. Métodos: Estudio de caso control, con enfoque cuantitativo, basado en el análisis documental de tablas de recién nacidos de bajo peso del Hospital Santa Casa de Misericórdia de Piracicaba, en São Paulo. Fue realizado en el periodo de enero a diciembre de 2007. Resultados: Se incluyeron en la investigación 129 neonatos. De entre las variables analizadas tres estaban asociadas al nacimiento de bajo peso en la institución en estudio: el tabaquismo (x2 = 11,91), el número de consultas de prenatal (x2 = 36,87) y la presencia de enfermedades gestacionales (x2 = 125,24). Conclusión: Es importante realizar programas preventivos, basados en estudios epidemiológicos para disminuir el nacimiento de neonatos de bajo peso y, consecuentemente, influir en la reducción de tasas de mortalidad infantil.Objetivo: Identificar fatores de risco associados ao nascimento de recém-nascidos de baixo peso e comparar estes fatores entre os neonatos de baixo peso e peso adequado para a idade gestacional. Métodos: Trata-se por um estudo de caso-controle, com abordagem quantitativa, baseado na análise documental de prontuários de recém-nascidos de baixo peso do Hospital Santa Casa de Misericórdia de Piracicaba, em São Paulo. Foi realizado no período de janeiro a dezembro de 2007. Resultados: Foram incluídos na pesquisa 129 neonatos. Dentre as variáveis analisadas três estavam associadas ao nascimento de baixo peso na instituição em estudo: o tabagismo (x2 = 11,91), o número de consultas de pré-natal (x2 = 36,87) e a presença de doenças gestacionais (x2 = 125,24). Conclusão: É importante realizar programas preventivos, baseados em estudos epidemiológicos para diminuir o nascimento de neonatos de baixo peso e, conseqüentemente, influenciar na redução de taxas de mortalidade infantil.Objective: To identify risk factors associated with the birth of newborns with low birth weight and compare these factors among newborns with low weight and weight appropriate for gestational age. Methods: a case-control study, with quantitative approach, based on the analysis of documentary records of newborns with low birth weight, Hospital Santa Casa de Misericordia de Piracicaba, in Sao Paulo. The study was conducted from January to December 2007. Results: 129 neonates were included in the survey. Among the factors analyzed, only three are associated with low birth weight in the institution under study: smokers (x2 = 11.91), the number of pre-natal care visits (x2 = 36.87) and the presence of serious pregnancy illnesses (x2 = 125.24). Conclusion: It is important to carry out preventive programs, based on epidemiological studies to decrease the number of births of newborns with low weight and, consequently, help to reduce infant mortality rates

The effects of season and level of concentrate on the voluntary intake and digestibility of herabage by outdoor sows

The intake and the digestibility of herbage, and the effect of level of supplementary concentrate food, were measured in late spring and late summer in two studies, each with eight multiparous, pregnant sows. In the spring study sows were nose rung to prevent rooting but only four nose-rung sows were available for the summer study; the remaining four were unrung. In both cases, sows had access to a plentiful (>2·5 t organic matter (OM) per ha) ryegrass/clover sward in a paddock of 1922 m2. After a week of adaptation to the herbage in the experimental paddock, sows were offered 1·5 or 3·0 kg/day concentrate for consecutive 2-week periods in a change-over experimental design with four sows on each treatment in each period. Samples of herbage were also taken to measure the sward density, chemical composition and n-alkane content. Herbage intake and digestibility estimates were calculated using the n-alkanes technique, with the marker dosed on small food pellets. In the spring study, the herbage intake ranged from 0·9 to 1·8 kg OM per day in the first period (herbage neutral-detergent fibre(NDF) content 439 (s.e.41·6) g/kg OM) and 0·2 to 1·4 kg in the second (475 (s.e.29·3) g NDF per kg OM). The intake was affected by the level of concentrate only in the second period. The results obtained during the summer study with the rung and unrung sows showed an intake between 0·9 and 2·4 kg OM per day in the first period (524 (s.e. 16·0) g NDF per kg OM) and between 1·3 and 4·8 kg in the second (526 (s.e. 21·8) g NDF per kg OM). A high intake estimation for certain unrung individuals appeared to reflect their frenzied feeding behaviour and possible loss of some marker pellets. There were no differences between level of concentrate treatments in either period. Digestibility of the diet was affected by the intake of herbage and the level of fibre consumed (P < 0·01). These herbage intakes equated to proportionately 0·50 (s.e. 0·05) and 0·66 (s.e. 0·1) (or 0·49 (s.e. 0·07) excluding problem sows) of the maintenance energy requirement in each season. Faeces of unrung sows indicated a high ingestion of soil or stones by some individuals: one of the sows produced a bulked faeces sample containing 450 g/kg fresh weight of stones, whilst another sow had a faecal ash content of 937 g/kg DM. The results indicate that the intake of nutrients from herbage by grazing sows is highly variable between seasons and individuals.Peer reviewe