Question 2:What are the effects of inhaled corticosteroids on growth in children?

This review summarizes the current evidence regarding the effects of inhaled corticosteroids (ICS) on growth in children with asthma. The evidence from randomized trials showed a mean reduction of -0.48 cm/year (95% CI -0.65 to -0.30) in linear growth velocity and of -0.61 cm (95% CI -0.83 to -0.38) in height during a one-year treatment with ICS. Some first-generation drugs had a slightly larger suppressive effect on growth than newer drugs, with a mean reduction in linear growth velocity of -0.91, -0.59, -0.08 and -0.39 cm/year for beclomethasone, budesonide, ciclesonide and fluticasone, respectively. There was evidence of a dose-response relationship, with medium doses (HFA-beclomethasone or equivalent, 100-200 mu g/day) producing a greater reduction than low doses (50-100 mu g/day), in height, but not in linear growth velocity. ICS-induced growth suppression was less pronounced during subsequent years of treatment. Most "real life" observational studies did not show significant suppressive effects of ICS on long-term growth or adult height, and some studies found an initial growth reduction related to ICS which did not persist in subsequent years. It remains unclear to what extent long-term ICS use in childhood has an effect on final adult height. It appears that the deleterious effects of ICS on adult height, if any, are small (max 1.2 cm). In conclusion, use of ICS in prepubertal children with asthma is associated with a small but dose dependent depression in growth in the first year of treatment, but no clinically relevant effect on adult height. (C) 2018 Elsevier Ltd. All rights reserved

'A Divided Soul'? the Cold War odyssey of O. John Rogge

In 1948 O. John Rogge, a prominent American liberal, was a contender for the Progressive Party's vice-presidential nomination. He was then a man of the Left: an activist in the international peace movement, a champion of radical causes and a defender of organizations deemed subversive by the Department of Justice. In 1951 he persuaded his\ud client to turn government witness in the Rosenberg espionage trial and was converted into 'Rogge the Rat' by his former allies. In tracing this transformation, this paper will argue that Rogge was neither a typical Cold War apostate nor a typical anti-Stalinist intellectual. Instead, his political trajectory was the outcome of a failed attempt to steer global politics away from Cold War dichotomies. The paper will therefore throw new light\ud both on the movement to find a 'third way' between East and West, and on the phenomenon of non-communist Left activism during the early Cold War

A patient-preference cohort study of office versus inpatient uterine polyp treatment for abnormal uterine bleeding.

Uterine polyps can cause abnormal bleeding in women. Conventional practise is to remove them under general anaesthesia but advances in technology have made it possible to perform polypectomy in the office setting. We conducted a patient-preference study to explore women's preferences for treatment setting and to evaluate the effectiveness and treatment experience of women undergoing uterine polypectomy. Three hundred ninety-nine women with abnormal uterine bleeding who were found to have uterine polyps at diagnostic hysteroscopy were recruited. Office polypectomies were performed in office hysteroscopy clinics, and inpatient procedures were undertaken in operating theatres. Three hundred twenty-four of 399 (81 %) expressed a preference for office treatment. There was no difference found between office treatment and inpatient treatment in terms of alleviating abnormal uterine bleeding as assessed by patients and in improving disease-specific quality of life. Acceptability was lower and patient pain scores were significantly higher in the office group. When offered a choice of treatment setting for uterine polypectomy, patients have a preference for office over inpatient treatment. Ambulatory gynaecology services should be available within healthcare systems to meet patient demand