Undiagnosed asthma in older people: an underestimated problem

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.WHAT WE NEED TO KNOW: Are older people with respiratory symptoms aware this could be asthma? Which explanations for undiagnosed asthma apply most commonly in older Australians with asthma? Can we improve awareness of asthma in older people with undiagnosed asthma? Is the possibility of asthma in older people firmly established on the general practitioners’ radar screen? What reasons most often determine whether GPs perform spirometry in their practice? WHAT WE NEED TO DO: Conduct a representative population study to assess whether older Australians recognise respiratory symptoms as being asthma and are reporting these symptoms. Conduct and evaluate a pilot asthma health promotion program for older people. Conduct a controlled therapeutic trial of people with undiagnosed asthma to assess treatment benefits and produce treatment recommendations. Identify whether the prominence of asthma in older people can be brought to the attention of GPs. Analyse more carefully the issues associated with innovation of office spirometry.David H Wilson, Sarah L Appleton, Robert J Adams and Richard E Ruffi

An algorithmic approach to diagnosing asthma in older patients in general practice

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.WHAT WE NEED TO KNOW: How effective would an algorithm be in helping general practitioners diagnose asthma? What proportion of older people with undiagnosed asthma fail to recognise symptoms? What proportion of the population believe asthma does not occur in the older population? What systems or supports do GPs need to diagnose asthma more effectively? WHAT WE NEED TO DO: Work on developing a gold standard for asthma diagnosis. Develop prototype algorithms for general practice discussion. Conduct a general practice study to assess the effectiveness of an algorithm. In conjunction with GPs, develop a pilot program to increase awareness of the current asthma problem. Conduct focus-group research to identify why some people do not believe they can develop asthma for the first time in adult life. Conduct focus-group research to identify why some adults do not attribute asthma symptoms to asthma. Conduct focus groups with GPs to identify what support is needed to diagnose asthma more effectively. Consult with all stakeholders before an intervention is used. Evaluate any interventions used.Richard E Ruffin, David H Wilson, Sarah L Appleton and Robert J Adam

Second-order modelling of variable density turbulent jets : evaluation in the near field region

International audienceThis paper is concerned with a complete second-order model of variable density turbulent Jets. Emphasis is given here on the near-fleld region of the flow where it is found that the influence of the density variations is quite important resulting in a complex behaviour of both the mean and turbulent velocity fields. Particular attention has been paid to the mesh grid and the initial conditions so that quantitative comparison with the experimental data obtained in the study developed in parallel to that one at I.M.S.T. can be made. Results relative to the velocity field only will be reported herein since quite few studies have been focusing so far on the near-field region where the model shows shoncomings which may not be visible when looking at results obtained in the far-field where pseudo-similarity is attained

Seminar on race did little to help Jackson tensions

Editorial columns by David R. Bowen, U.S. Representative from Mississippi (D)\u27 1973-1983.https://scholarsjunction.msstate.edu/db-columns/1018/thumbnail.jp

Gene expression profile of cervical tissue compared to exfoliated cells: Impact on biomarker discovery

BACKGROUND: Exfoliated cervical cells are used in cytology-based cancer screening and may also be a source for molecular biomarkers indicative of neoplastic changes in the underlying tissue. However, because of keratinization and terminal differentiation it is not clear that these cells have an mRNA profile representative of cervical tissue, and that the profile can distinguish the lesions targeted for early detection. RESULTS: We used whole genome microarrays (25,353 unique genes) to compare the transcription profiles from seven samples of normal exfoliated cells and one cervical tissue. We detected 10,158 genes in exfoliated cells, 14,544 in the tissue and 7320 genes in both samples. For both sample types the genes grouped into the same major gene ontology (GO) categories in the same order, with exfoliated cells, having on average 20% fewer genes in each category. We also compared microarray results of samples from women with cervical intraepithelial neoplasia grade 3 (CIN3, n = 15) to those from age and race matched women without significant abnormalities (CIN1, CIN0; n = 15). We used three microarray-adapted statistical packages to identify differential gene expression. The six genes identified in common were two to four fold upregulated in CIN3 samples. One of these genes, the ubiquitin-conjugating enzyme E2 variant 1, participates in the degradation of p53 through interaction with the oncogenic HPV E6 protein. CONCLUSION: The findings encourage further exploration of gene expression using exfoliated cells to identify and validate applicable biomarkers. We conclude that the gene expression profile of exfoliated cervical cells partially represents that of tissue and is complex enough to provide potential differentiation between disease and non-disease

Prevalence of asthma and asthma action plans in South Australia: population surveys from 1990 to 2001

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.OBJECTIVES: To assess trends in the prevalence of self-reported doctor-diagnosed asthma, associated asthma related morbidity, and the uptake of written asthma action plans in South Australia, 1990–2001. DESIGN, SETTING AND PARTICIPANTS: Surveys by telephone interview of the South Australian population between 1990 and 2001, and interview of participants in their own homes by trained health interviewers. MAIN OUTCOME MEASURES: Asthma prevalence, percentage of patients with written action plans, and asthma associated morbidity. RESULTS: The reported prevalence of doctor-diagnosed asthma has increased from 8% (95% CI, 6.4%–9.6%) in 1990 to 12.8% (95% CI, 11.4%–14.2%) in 2001. Morbidity, as measured by wakening at night (daily or weekly) and days lost from normal activities because of asthma, has remained constant over the decade. The percentage of patients with written asthma action plans increased to a peak of 42.3% (95% CI, 40.3%–44.3%) in 1995, but then declined to 22.2% (95% CI, 20.7%–23.7%) in 2001. CONCLUSIONS: The prevalence of asthma has increased while morbidity has remained constant, indicating that the burden of asthma has increased. The associated decline in the percentage of patients with asthma action plans in recent years is cause for concern.David H Wilson, Robert J Adams, Sarah L Appleton, Graeme Hugo, David Wilkinson, Janet Hiller, Philip Ryan, Julianne Cheek and Richard E Ruffi

Clinical Use of the Surgeon General’s “My Family Health Portrait” (MFHP) Tool: Opinions of Future Health Care Providers

This study examined medical students’ and house officers’ opinions about the Surgeon General’s “My Family Health Portrait” (MFHP) tool. Participants used the tool and were surveyed about tool mechanics, potential clinical uses, and barriers. None of the 97 participants had previously used this tool. The average time to enter a family history was 15 min (range 3 to 45 min). Participants agreed or strongly agreed that the MFHP tool is understandable (98%), easy to use (93%), and suitable for general public use (84%). Sixty‐seven percent would encourage their patients to use the tool; 39% would ensure staff assistance. Participants would use the tool to identify patients at increased risk for disease (86%), record family history in the medical chart (84%), recommend preventive health behaviors (80%), and refer to genetics services (72%). Concerns about use of the tool included patient access, information accuracy, technical challenges, and the need for physician education on interpreting family history information.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/147053/1/jgc40510.pd

The 11th National prevocational medical education forum

The document attached has been archived with permission from the editor of the Medical Journal of Australia. An external link to the publisher’s copy is included.Richard E Ruffin, Brendan J Crotty, Louis I Landau and Barry P McGrat

Pegylated Interferon Pharmacokinetics and Self-Reported Depressive Symptoms During Antiviral Treatment for Chronic Hepatitis C

Pegylated interferon-2a (PegIFN-2a) + ribavirin treatment for chronic hepatitis C is often associated with depressive symptoms. Previous studies have failed to explore whether PegIFN-2a pharmacokinetic variability plays an etiologic role in PegIFN-2a-induced mood disorders. The objective of this investigation was to evaluate the association between trough PegIFN-2a concentration at treatment week 4 (“PegIFN-2a Cmin4”) and an increase in depressive symptoms

Cellular inhibitor of apoptosis-2 is a critical regulator of apoptosis in airway epithelial cells treated with asthma-related inflammatory cytokines

Aberrant apoptosis of airway epithelial cells (AECs) is a disease contributing feature in the airways of asthmatics. The proinflammatory cytokines tumor necrosis factor α (TNFα) and interferon γ (IFNγ) are increased in asthma and have been shown to contribute to apoptosis at the airways. In the present study, we investigated the role of the inhibitor of apoptosis protein (IAP) family in primary AECs exposed to TNFα and IFNγ. IAPs are potent regulators of caspase activity elicited by the intrinsic and extrinsic apoptosis pathways. However, while caspase‐mediated apoptosis was observed in AECs exposed to doxorubicin, it was not observed after cytokine treatment. Instead, AECs exhibited proapoptotic changes evidenced by an increased Bax:Bcl2 transcript ratio and partial processing of procaspase‐3. Examination by quantitative reverse transcription polymerase chain reaction (qRT‐PCR) and Western analysis showed that proapoptotic changes were associated with a time‐ and dose‐dependent induction of cellular IAP‐2 (cIAP2), potentiated primarily by IFNγ. The abundance of the IAP antagonists X‐linked IAP‐associated factor 1 (XAF1) and second mitochondria‐derived activator of caspases did not change, although a moderate nuclear redistribution was observed for XAF1, which was also observed for cIAP2. Small interfering RNA (siRNA)‐mediated depletion of cIAP2 from AECs leads to caspase‐3 activation and poly (ADP‐ribose) polymerase cleavage, but this required extended cytokine exposure to produce a concomitant decrease in cIAP1 and Bcl2. These results indicate that AECs possess endogenous mechanisms making them highly resistant to apoptosis due to asthma‐related inflammatory cytokines, and the activity of cIAP2 plays an important role in this protection.Eugene Roscioli, Rhys Hamon, Richard E. Ruffin, Susan Lester, and Peter Zalewsk