Early identification of dyslexia: Understanding the issues

Purpose: The purpose of this tutorial is to provide an overview of the benefits and challenges associated with the early identification of dyslexia. Method: The literature on the early identification of dyslexia is reviewed. Theoretical arguments and research evidence are summarized. An overview of response to intervention as a method of early identification is provided, and the benefits and challenges associated with it are discussed. Finally, the role of speech-language pathologists in the early identification process is addressed. Conclusions: Early identification of dyslexia is crucial to ensure that children are able to maximize their educational potential, and speech-language pathologists are well placed to play a role in this process. However, early identification alone is not sufficient—difficulties with reading may persist or become apparent later in schooling. Therefore, continuing progress monitoring and access to suitable intervention programs are essential

Physical activity and pulmonary rehabilitation in difficult-to-treat asthma associated with elevated body mass index

This thesis studies physical activity levels, pulmonary rehabilitation and their effects in participants with difficult-to-treat asthma associated with elevated body mass index (BMI). The three results chapters present the original research which I conducted during my period of study. All three chapters are presented as contracted papers, two of which have been peer-reviewed and published in scientific journals. This thesis has been approved for submission as an ‘alternative format’ thesis by the Higher Degrees Committee of the University of Glasgow. The focus of the thesis is exercise in participants with difficult-to-treat asthma associated with elevated body mass index. There are two research questions addressed by the thesis, do asthma severity or body mass index affect physical activity levels in asthma? The first results chapter concludes that they both do. Secondly, does pulmonary rehabilitation improve asthma control in this group of participants? The results of the work suggest that it may lead to some improvements in asthma control, but not to a clinically significant degree. “Physical activity levels in asthma: relationship with disease severity, body mass index and novel accelerometer-derived metrics” was published in the Journal of Asthma, online version published 2nd August 2022. This paper reports physical activity (PA) levels in participants with varying degrees of asthma severity and body mass index (BMI). It incorporates the use of two novel accelerometerbased metrics and how they correlate with asthma control. This paper provides an introduction into how difficult-to-treat asthma and elevated BMI affect physical activity and leads onto the main work in pulmonary rehabilitation. “A pragmatic randomised controlled trial of tailored pulmonary rehabilitation in participants with difficult-to-control asthma and elevated body mass index” was published in BMC Pulmonary Medicine, online version published 24th September 2022. This paper presents the initial outcomes at completion of an eight-week asthma-tailored pulmonary rehabilitation programme, comparing participants who completed PR with a control group who had usual care. The final results chapter, “Immediate and longer-term effects of an asthma tailored pulmonary rehabilitation programme in overweight and obese participants with difficult-to-treat asthma” has been submitted to Respiratory Medicine, to be considered for publication. This paper presents wider results of the above trial in a prospective observational format, as everyone who was randomised to usual care was invited to participate in PR after completion of the initial 8-week observation period. Here we consider the immediate and longerterm outcomes of a larger group of participants undergoing PR, and look at possible predictors of response

Immediate and one-year outcomes of an asthma-tailored pulmonary rehabilitation programme in overweight and obese people with difficult-to-treat asthma

Introduction Management of difficult-to-treat asthma is particularly challenging in people with elevated body mass index (BMI). Our randomised controlled trial of pulmonary rehabilitation (PR) showed improved outcomes at 8 weeks. Here we assess immediate and one-year effects of asthma-tailored PR in participants with difficult-to-treat asthma and BMI ≥25 kg/m2, and identify response predictors.Methods A prospective observational study of PR, tailored to asthma, comparing outcomes at baseline (V1), immediately after 8 weeks of PR (V2), and at 1 year (V3). Baseline characteristics were compared in responders/non-responders defined by achievement of minimum clinically important difference (MCID) for asthma control questionnaire (ACQ6) (0.5) at 8 weeks and 1 year.ResultsOf 92 participants, 56 attended V2 and 45 attended V3. Mean age was 60 (SD 13) years, 60% were female, and median (IQR) BMI was 33.8 (29.5–38.7) kg/m2. At V1, V2, and V3, respectively, there were significant differences in ACQ6 (mean (95% CI): 2.5 (2.1–2.9), 2.2 (1.8–2.5), and 2.3 (1.9–2.7), p<0.003), Borg breathlessness score post-6-minute walk test (median (IQR): 2 (0.5–3), 1 (0–2), and 1 (0.5–2), p<0.035), and annualised exacerbations requiring prednisolone (median (IQR): 3 (2–5), 0 (0–4.7), and 1.5 (0–4.2), p<0.003). A total of 27/56 (48%) had improvements >MCID for ACQ6 at V2 and 16 (33%) at V3. Participants with higher ACQ6 scores at baseline (suggesting poorer asthma control) were more likely to achieve MCID. Baseline BMI, within the range studied, was not predictive.Conclusion Pulmonary rehabilitation induced improvements in asthma-related outcomes including perception of breathlessness, asthma control, and exacerbation frequency at 1 year. Those with poorer baseline asthma control were more likely to benefit

Accelerometer-derived sleep metrics in mild and difficult-to-treat asthma

Introduction: Poor sleep health is associated with increased asthma morbidity and mortality. Accelerometers have been validated to assess sleep parameters though studies using this method in patients with asthma are sparse and none have compared mild to difficult-to-treat asthma populations. Methods: We performed a retrospective analysis from two recent in-house trials comparing sleep metrics between patients with mild and difficult-to-treat asthma. Participants wore accelerometers for 24-hours/day for seven days. Results: Of 124 participants (44 mild, 80 difficult-to-treat), no between-group differences were observed in sleep-window, sleep-time, sleep efficiency or wake time. Sleep-onset time was ~ 40 min later in the difficult-to-treat group (p = 0.019). Discussion: Broadly, we observed no difference in accelerometer-derived sleep-metrics between mild and difficult-to-treat asthma. This is the largest analysis of accelerometer-derived sleep parameters in asthma and the first comparing groups by asthma severity. Sleep-onset initiation may be delayed in difficult-to-treat asthma but a dedicated study is needed to confirm

A total diet replacement weight management programme for difficult-to-treat asthma associated with obesity: a randomised controlled feasibility trial

Background: Obesity is often associated with uncontrolled, difficult-to-treat asthma and increased morbidity and mortality. Previous studies suggest that weight loss may improve asthma outcomes but with heterogenous asthma populations studied and unclear consensus on optimal method of weight management. The Counterweight-Plus weight management programme (CWP) is an evidence-based, dietitian-led, total diet replacement (TDR) programme. Research question: Can use of the CWP compared to usual care (UC) improve asthma control and quality of life in patients with difficult-to-treat asthma and obesity? Study design and methods: We conducted a 1:1 (CWP:UC) randomised, controlled single centre trial in adults with difficult-to-treat asthma and body mass index ≥30kg/m2. CWP: 12-week TDR phase (800kcal/day low-energy formula); stepwise food reintroduction and weight loss maintenance up to 1 year. Primary outcome: change in asthma control questionnaire (ACQ6) score over 16 weeks. Secondary outcome: change in asthma quality of life questionnaire (AQLQ) score. Results: 35 participants were randomised (36 screened) and 33 attended 16-week follow-up (17 CWP, 16 UC). Overall, mean (95%CI) ACQ6 at baseline was 2.8 (2.4, 3.1). Weight loss was greater in CWP than UC (mean difference -12.1kg; 95%CI -16.9, -7.4; p<0.001). ACQ6 improved more in CWP than UC (mean difference -0.69; 95%CI -1.37, -0.01; p=0.048). A larger proportion of participants achieved minimal clinically important difference in ACQ6 with CWP than UC (53% vs 19%; p=0.041; NNT 3 (95%CI 1.5, 26.9)). AQLQ improvement was greater in CWP than UC (mean difference 0.76; 95%CI 0.18, 1.34; p=0.013). Interpretation: Utilising a structured weight management programme results in clinically important improvements in asthma control and quality of life over 16 weeks compared to usual care, in adults with difficult-to-treat asthma and obesity. This generalisable programme is easy to deliver for this challenging phenotype. Longer-term outcomes continue to be studied

Can nature deliver on the sustainable development goals?

The increasing availability of data and improved analytical techniques now enable better understanding of where environmental conditions and human health are tightly linked, and where investing in nature can deliver net benefits for people—especially with respect to the most vulnerable populations in developing countries. These advances bring more opportunities for interventions that can advance multiple SDGs at once. We have harmonised a suite of global datasets to explore the essential nexus of forests, poverty, and human health, an overlap of SDG numbers 1, 2, 3, 6, and 15. Our study combined demographic and health surveys for 297 112 children in 35 developing countries with data describing the local environmental conditions for each child (appendix).4 This allowed us to estimate the effect forests might have in supporting human health, while controlling for the influence of important socio-economic differences.4 We extended this work to look at how forests affect three childhood health concerns of global significance for the world's poorest people: stunting, anaemia, and diarrhoeal disease

Managing Nystagmus in childhood

The onset of a spontaneous oscillation of the eyes can occur at any time in life but is most commonly encountered during childhood. In the UK, nystagmus in the general population has been reported to have a prevalence of 2.4 in 1000. It can occur as an isolated disorder, in association with a number of different eye conditions, or as a result of a range of neurological disorders. The onset of nystagmus in childhood is not rare and can be the cause of significant clinical and parental concern, and sometimes requires urgent investigation. There is currently no standard clinical approach to investigating nystagmus in childhood. This Clinical Practice Point provides a single point of reference for busy clinicians when managing these complex patients from differential diagnosis, through long-term management, to discharge. It also covers provision of support for patients and carers throughout and beyond clinical care pathways. This document is specific to nystagmus in children