Parental perceptions and beliefs about childhood asthma: a cross-sectional study

Aim To assess parental perceptions and beliefs about asthma in children. Methods We invited 6000 children aged 3 to 15 years from different schools in Lebanon to participate in the study from September 2007 to May 2008. In the first phase, in order to determine the prevalence of asthma in children, parents of all participating children filled out a small questionnaire. In the second phase, only parents of children with asthma filled out a detailed questionnaire about their perceptions of asthma. Results Phase I included parents of 4051 children, 574 (14%) of whom had asthma and were recruited to phase II. Out of these, 389 parents entered the final data analysis. Around 54% of parents believed that asthma was hereditary and 7% believed it was contagious. When asked about triggering factors, 51% stated virus infection, 75% dust, and 17% food. Sixty percent of children with asthma lived with someone who smoked. Sixty-seven percent of parents believed that herbs had a role in asthma treatment and only 49% received asthma education. There was a significant difference in education level (P = 0.01) between the parents who denied the label of asthma (79%) and those who accepted it (21%). Sixty-seven percent of parents preferred oral over inhaler treatment, 48% believed inhalers were addictive, 56% worried about inhalers’ side effects, and 76% worried about using inhaled corticosteroids. Significantly more parents from rural (53%) than from urban areas (38%) believed that inhalers were addictive (P = 0.004). Conclusion Parents of children with asthma had considerable misperceptions about the use of inhalers and the safety of inhaled corticosteroids. To improve asthma care in children, it is necessary to provide adequate education to parent

The role of statins in prevention and treatment of community acquired pneumonia: a systematic review and meta-analysis.

BACKGROUND: Emerging epidemiological evidence suggests that statins may reduce the risk of community-acquired pneumonia (CAP) and its complications. PURPOSE: Performed a systematic review to address the role of statins in the prevention or treatment of CAP. DATA SOURCE: Ovid MEDLINE, Cochrane, EMBASE, ISI Web of Science, and Scopus from inception through December 2011 were searched for randomized clinical trials, cohort and case-control studies. STUDY SELECTION: Two authors independently reviewed studies that examined the role of statins in CAP. DATA EXTRACTION: Data about study characteristics, adjusted effect-estimates and quality characteristics was extracted. DATA SYNTHESIS: Eighteen studies corresponding to 21 effect-estimates (eight and 13 of which addressed the preventive and therapeutic roles of statins, respectively) were included. All studies were of good methodological quality. Random-effects meta-analyses of adjusted effect-estimates were used. Statins were associated with a lower risk of CAP, 0.84 (95% CI, 0.74-0.95), I(2) = 90.5% and a lower short-term mortality in patients with CAP, 0.68 (95% CI, 0.59-0.78), I(2) = 75.7%. Meta-regression did not identify sources of heterogeneity. A funnel plot suggested publication bias in the treatment group, which was adjusted by a novel regression method with a resultant effect-estimate of 0.85 (95% CI, 0.77-0.93). Sensitivity analyses using the rule-out approach showed that it is unlikely that the results were due to an unmeasured confounder. CONCLUSIONS: Our meta-analysis reveals a beneficial role of statins for the risk of development and mortality associated with CAP. However, the results constitute very low quality evidence as per the GRADE framework due to observational study design, heterogeneity and publication bias

Association between proton pump inhibitor therapy and clostridium difficile infection: a contemporary systematic review and meta-analysis.

Abstract Introduction Emerging epidemiological evidence suggests that proton pump inhibitor (PPI) acid-suppression therapy is associated with an increased risk of Clostridium difficile infection (CDI). Methods Ovid MEDLINE, EMBASE, ISI Web of Science, and Scopus were searched from 1990 to January 2012 for analytical studies that reported an adjusted effect estimate of the association between PPI use and CDI. We performed random-effect meta-analyses. We used the GRADE framework to interpret the findings. Results We identified 47 eligible citations (37 case-control and 14 cohort studies) with corresponding 51 effect estimates. The pooled OR was 1.65, 95% CI (1.47, 1.85), I2 = 89.9%, with evidence of publication bias suggested by a contour funnel plot. A novel regression based method was used to adjust for publication bias and resulted in an adjusted pooled OR of 1.51 (95% CI, 1.26–1.83). In a speculative analysis that assumes that this association is based on causality, and based on published baseline CDI incidence, the risk of CDI would be very low in the general population taking PPIs with an estimated NNH of 3925 at 1 year. Conclusions In this rigorously conducted systemic review and meta-analysis, we found very low quality evidence (GRADE class) for an association between PPI use and CDI that does not support a cause-effect relationship

Non prescribed sale of antibiotics in Riyadh, Saudi Arabia: A Cross Sectional Study

Background Antibiotics sales without medical prescriptions are increasingly recognized as sources of antimicrobial misuse that can exacerbate the global burden of antibiotic resistance. We aimed to determine the percentage of pharmacies who sell antibiotics without medical prescriptions, examining the potential associated risks of such practice in Riyadh, Saudi Arabia, by simulation of different clinical scenarios. Methods A cross sectional study of a quasi-random sample of pharmacies stratified by the five regions of Riyadh. Each pharmacy was visited once by two investigators who simulated having a relative with a specific clinical illness (sore throat, acute bronchitis, otitis media, acute sinusitis, diarrhea, and urinary tract infection (UTI) in childbearing aged women). Results A total of 327 pharmacies were visited. Antibiotics were dispensed without a medical prescription in 244 (77.6%) of 327, of which 231 (95%) were dispensed without a patient request. Simulated cases of sore throat and diarrhea resulted in an antibiotic being dispensed in (90%) of encounters, followed by UTI (75%), acute bronchitis (73%), otitis media (51%) and acute sinusitis (40%). Metronidazole (89%) and ciprofloxacin (86%) were commonly given for diarrhea and UTI, respectively, whereas amoxicillin/clavulanate was dispensed (51%) for the other simulated cases. None of the pharmacists asked about antibiotic allergy history or provided information about drug interactions. Only 23% asked about pregnancy status when dispensing antibiotics for UTI-simulated cases. Conclusions We observed that an antibiotic could be obtained in Riyadh without a medical prescription or an evidence-based indication with associated potential clinical risks. Strict enforcement and adherence to existing regulations are warranted

The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.

Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. Purpose We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. Data source We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. Study selection Two authors independently reviewed the studies for eligibility. Data extraction Data about studies characteristics, adjusted effect estimates and quality were extracted. Data synthesis Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22–1.7), I2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15–1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). Conclusion In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics

Knowledge, Attitudes and Perceptions of Saudis towards Participating in Clinical Trials.

AIM:To assess the knowledge, attitudes, and perceptions of Saudis towards participating in clinical trials (CTs). METHODS:A cross-sectional study was conducted on 232 Saudi adult patients and their companions visiting adult outpatient clinics at King Fahad Medical City, Riyadh, Saudi Arabia. Data were collected using a self-administered questionnaire based on information obtained from the literature. The questionnaire was divided into four sections, one covering the respondents' demographics, and the other three assessing knowledge, attitudes, and perceptions towards participating in CTs. RESULTS:A total of 148 (63.8%) respondents were males, and 52 (22.4%) participants had been invited to participate in a CT previously. Of those, 39 (75%) participated. Knowledge about the essential elements of informed consent ranged from 55.7% (number of participants needed) to 85.7% (confidentiality of personal information). The majority (163, 73.8%) of respondents was willing to participate in a CT after consulting their family physician and 130 (58.0%) respondents would be motivated to participate in a CT if they were healthy. Only 36.8% of the respondents believed that patients who participated in a CT received the best care. Moreover, 110 (48.7%) respondents believed that research was conducted in a responsible and ethical manner. CONCLUSIONS:The present study assessed the current understanding of CTs among Saudi participants. Although the majority of participants had an acceptable level of knowledge about CTs, they exhibited conditional attitudes and misperceptions towards participating in a CT. Increased patient awareness may improve patients' attitudes towards ethical conduct of CTs

Transient Osteoporosis of the Hip/Bone Marrow Edema Syndrome with Soft Tissue Involvement: A Case Report

Transient osteoporosis of the hip (TOH) is a rare condition mainly affecting pregnant women in their third trimester and middle aged men. We report a case of TOH/Bone marrow edema syndrome in pregnancy with involvement of the surrounding soft tissues on magnetic resonance image, which has not been previously reported. The presence of such edema in the soft tissues may help to differentiate this condition from early avascular necrosis of the hip, and may also provide an insight into the pathogenesis of the condition. The reported patient was treated conservatively and fully recovered

Parental perceptions and beliefs about childhood asthma: a cross-sectional study

Aim To assess parental perceptions and beliefs about asthma in children. Methods We invited 6000 children aged 3 to 15 years from different schools in Lebanon to participate in the study from September 2007 to May 2008. In the first phase, in order to determine the prevalence of asthma in children, parents of all participating children filled out a small questionnaire. In the second phase, only parents of children with asthma filled out a detailed questionnaire about their perceptions of asthma. Results Phase I included parents of 4051 children, 574 (14%) of whom had asthma and were recruited to phase II. Out of these, 389 parents entered the final data analysis. Around 54% of parents believed that asthma was hereditary and 7% believed it was contagious. When asked about triggering factors, 51% stated virus infection, 75% dust, and 17% food. Sixty percent of children with asthma lived with someone who smoked. Sixty-seven percent of parents believed that herbs had a role in asthma treatment and only 49% received asthma education. There was a significant difference in education level (P = 0.01) between the parents who denied the label of asthma (79%) and those who accepted it (21%). Sixty-seven percent of parents preferred oral over inhaler treatment, 48% believed inhalers were addictive, 56% worried about inhalers’ side effects, and 76% worried about using inhaled corticosteroids. Significantly more parents from rural (53%) than from urban areas (38%) believed that inhalers were addictive (P = 0.004). Conclusion Parents of children with asthma had considerable misperceptions about the use of inhalers and the safety of inhaled corticosteroids. To improve asthma care in children, it is necessary to provide adequate education to parent