A Danish population-based cohort study of newly diagnosed asthmatic children's care pathway – adherence to guidelines

<p>Abstract</p> <p>Background</p> <p>Asthma is the most common chronic disease in childhood. Large variations exist concerning the number of children being treated by general practitioners and by specialists. Consequently, health related costs due to this disease vary as care by specialists is more expensive compared with care by general practitioners. Little is known of the consequences of these variations concerning the quality of care. The aim of the study was to analyse associations between care providers and adherence to guidelines concerning frequency of contacts with the health service due to asthma.</p> <p>Methods</p> <p>A cohort study was performed of 36,940 incident asthmatic children's (aged 6–14) contacts with the health service using the unique personal registration number to link data from five national registries. The prevalence ratios were calculated for associations between provider (general practitioner, primary care specialist, hospital specialist or both GP and specialist) and adherence with guidelines concerning three indicators of quality of care pathway: 1) diagnostic examination of lung function at start of medical treatment 2) follow-up the first six months and 3) follow-up the next six months. The associations were adjusted for sex, age, socioeconomic status, county, and severity of disease.</p> <p>Results</p> <p>Most children (70.3%) had only been seen by their GP. About 80% of the children were treated with inhaled steroids, 70% were treated with inhaled steroids as well as inhaled beta2agonists and 13% were treated with inhaled beta2agonists only. A total of 12,650 children (34.2%) had no registered asthma-related contacts with the health service except when redeeming prescriptions. Care was in accordance with guidelines in all three indicators of quality in 7% of the cases (GPs only: 3%, primary care specialists only: 16%, hospital specialists: 28%, and both GP and specialists: 13%). Primary care specialists had a 5.01, hospital specialists a 8.81 and both GP and specialists a 4.32 times higher propensity to provide a clinical pathway according to guidelines compared to GPs alone.</p> <p>Conclusion</p> <p>The majority of the children were seen in general practice. Hospital specialists provided care in accordance with guidelines nine times more often compared with GPs, but still only one quarter of these children had pathways in accordance with guidelines. It is relevant to study further if these lacks of adherence to guidelines have implications for the asthmatic children or if guidelines are too demanding concerning frequency of follow-up or if asthmatic children should be stratified to different care pathways.</p

Color Gradients and Surface Brightness Profiles of Galaxies in the Hubble Deep Field-North

We fit elliptical isophotes to the Hubble Deep Field-North WFPC-2 and NICMOS data to study the rest-frame UV_{218}-U_{300} color profiles and rest-frame B surface brightness profiles of 33 intermediate redshift galaxies (0.5 <= z <= 1.2) with I_{814} < 25 and 50 high redshift galaxies (2.0 <= z <= 3.5) with H_{160}< 27. From the weighted least-squares fit to the color profiles we find that, at intermediate redshifts, the galaxies possess negative color gradients indicating a reddening towards the center of the profile similar to local samples whereas, at high redshifts, the galaxies possess positive color gradients. This indicates that star formation is more centrally concentrated in the distant galaxy sample which differs from the prevalent mode of extended disk star formation that we observe in the local universe. Additionally, we find that it is critical to correct for PSF effects when evaluating the surface brightness profiles since at small scale lengths and faint magnitudes, an r^{1/4} profile can be smoothed out substantially to become consistent with an exponential profile. After correcting for PSF effects, we find that at higher look-back time, the fraction of galaxies possessing exponential profiles have slightly decreased while the fraction of galaxies possessing r^{1/4} profiles have slightly increased. Our results also suggest a statistically insignificant increase in the fraction of peculiar/irregular type galaxies. We compare our results with recent semi-analytical models which treat galaxy formation and evolution following the cold dark matter hierarchical framework.Comment: 31 pages, 10 JPEG figures. To be published in AJ Vol. 124, October 200

Norbornadiene photoswitches anchored to well-defined oxide surfaces: From ultrahigh vacuum into the liquid and the electrochemical environment

Employing molecular photoswitches, we can combine solar energy conversion, storage, and release in an extremely simple single molecule system. In order to release the stored energy as electricity, the photoswitch has to interact with a semiconducting electrode surface. In this work, we explore a solar-energy-storing model system, consisting of a molecular photoswitch anchored to an atomically defined oxide surface in a liquid electrolyte and under potential control. Previously, this model system has been proven to be operational under ultrahigh vacuum (UHV) conditions. We used the tailor-made norbornadiene derivative 2-cyano-3-(4-carboxyphenyl)norbornadiene (CNBD) and characterized its photochemical and electrochemical properties in an organic electrolyte. Next, we assembled a monolayer of CNBD on a well-ordered Co3O4(111) surface by physical vapor deposition in UHV. This model interface was then transferred into the liquid electrolyte and investigated by photoelectrochemical infrared reflection absorption spectroscopy experiments. We demonstrate that the anchored monolayer of CNBD can be converted photochemically to its energy-rich counterpart 2-cyano-3-(4-carboxyphenyl)quadricyclane (CQC) under potential control. However, the reconversion potential of anchored CQC overlaps with the oxidation and decomposition potential of CNBD, which limits the electrochemically triggered reconversion

Solar energy storage at an atomically defined organic-oxide hybrid interface

Molecular photoswitches provide an extremely simple solution for solar energy conversion and storage. To convert stored energy to electricity, however, the photoswitch has to be coupled to a semiconducting electrode. In this work, we report on the assembly of an operational solar-energy-storing organic-oxide hybrid interface, which consists of a tailor-made molecular photoswitch and an atomically-defined semiconducting oxide film. The synthesized norbornadiene derivative 2-cyano-3-(4-carboxyphenyl)norbornadiene (CNBD) was anchored to a well-ordered Co3O4(111) surface by physical vapor deposition in ultrahigh vacuum. Using a photochemical infrared reflection absorption spectroscopy experiment, we demonstrate that the anchored CNBD monolayer remains operational, i.e., can be photo-converted to its energy-rich counterpart 2-cyano-3-(4-carboxyphenyl)quadricyclane (CQC). We show that the activation barrier for energy release remains unaffected by the anchoring reaction and the anchored photoswitch can be charged and discharged with high reversibility. Our atomically-defined solar-energy-storing model interface enables detailed studies of energy conversion processes at organic/oxide hybrid interfaces

Anti-asthma medication prescribing to children in the Lombardy Region of Italy: chronic versus new users

<p>Abstract</p> <p>Background</p> <p>Although anti-asthma medications are amongst those most frequently under or over prescribed it is generally accepted that prescriptions for such agents can be used as a proxy for disease prevalence. The aims of this study were to estimate prevalence and incidence of childhood asthma in a representative Italian area by analysing three years of anti-asthmatic prescriptions and hospitalizations of subjects with chronic or first time treatment, and to underline appropriateness of therapeutic choices.</p> <p>Methods</p> <p>The analysis involved prescriptions given to 6-17 year olds between 2003 and 2005 in Italy's Lombardy Region. The youths were classified as potential asthmatics, based on the different degree of drug utilization: occasional, low or high users, and grouped as 'new onset' or 'chronic' cases based on the duration of therapy dispensed. The analysis of prescriptions and hospitalization rate of these groups provided an estimate of the 2005 asthma prevalence and incidence and allowed an estimation of the level of appropriateness of treatments.</p> <p>Results</p> <p>During 2005, the estimated incidence of potential asthmatics was 0.8% and the estimated prevalence was 3.5%. When viewed retrospectively for two years, records showed that 47% of potential asthmatics received prescriptions also during 2004 and 30% also during 2003. During the three years considered, 7.5%, 2.8%, and 1.5% of high, low, and occasional users, respectively, were hospitalized for asthma. The most important inappropriateness found was the prescription of long acting beta adrenergics as first time treatment.</p> <p>Conclusions</p> <p>This study allowed a proxy of asthma incidence, prevalence, and severity. The analyses highlighted a low compliance with the guidelines, suggesting that educational interventions are needed to obtain a more rational management of childhood asthma, especially in subjects starting therapy.</p

The Uptake of Integrated Perinatal Prevention of Mother-to-Child HIV Transmission Programs in Low- and Middle-Income Countries: A Systematic Review

BACKGROUND: The objective of this review was to assess the uptake of WHO recommended integrated perinatal prevention of mother-to-child transmission (PMTCT) of HIV interventions in low- and middle-income countries. METHODS AND FINDINGS: We searched 21 databases for observational studies presenting uptake of integrated PMTCT programs in low- and middle-income countries. Forty-one studies on programs implemented between 1997 and 2006, met inclusion criteria. The proportion of women attending antenatal care who were counseled and who were tested was high; 96% (range 30-100%) and 81% (range 26-100%), respectively. However, the overall median proportion of HIV positive women provided with antiretroviral prophylaxis in antenatal care and attending labor ward was 55% (range 22-99%) and 60% (range 19-100%), respectively. The proportion of women with unknown HIV status, tested for HIV at labor ward was 70%. Overall, 79% (range 44-100%) of infants were tested for HIV and 11% (range 3-18%) of them were HIV positive. We designed two PMTCT cascades using studies with outcomes for all perinatal PMTCT interventions which showed that an estimated 22% of all HIV positive women attending antenatal care and 11% of all HIV positive women delivering at labor ward were not notified about their HIV status and did not participate in PMTCT program. Only 17% of HIV positive antenatal care attendees and their infants are known to have taken antiretroviral prophylaxis. CONCLUSION: The existing evidence provides information only about the initial PMTCT programs which were based on the old WHO PMTCT guidelines. The uptake of counseling and HIV testing among pregnant women attending antenatal care was high, but their retention in PMTCT programs was low. The majority of women in the included studies did not receive ARV prophylaxis in antenatal care; nor did they attend labor ward. More studies evaluating the uptake in current PMTCT programs are urgently needed