Physiological changes in urinary and salivary electrolytes due to physical activity in warm environments

Changes in heart rate; oral temperature; mean skin temperature; urinary pH, volume, sodium, potassium, chloride, urea and creatinine; salivary pH, sodium, potassium and urea; expired air and oxygen consumption have been monitored in young men doing ( 1) exercise on an ergometer for 4 min at 10C, 20C, 30C and 40C dry bulb 50% rh at 120-320 W;· (2) 20 min at 30C dry bulb at 50% rh, 60% rh, and 85% rh at 120W, 145W and 170W; and (3) 60 min at 20C, 30C and 40C dry bulb and 50% rh at 170w. Changes in work rate, environmental temperature, relative humidity and exposure time were found to correlate well with the urinary and salivary changes and in most cases changes in both work rate and ambient temperature produced simple summation effects. The increase in salivary components correlated well with the decrease in urinary components. Salivary sodium, potassium and Na+/K+ ratio increased significantly when work intensity, exposure time and environmental temperature were increased. Salivary urea correlates significantly with increased exposure time. The elevated values for salivary components may be explained on the basis of volatilization caused by forced ventilation during exercise; increased penetration of plasma components into saliva; increased water reabsorption, decreased sodium reabsorption, and increased potassium secretion in the ductile system of the salivary glands due to increased sympathetic activity. The results show that changes in saliva give a valid indication of the body's response to work and environmental stress and suggest that saliva could be used to study the combined effects of work and heat in places where it is impracticable to obtain samples of blood or urine

Monitoring histological changes in oral mucosa using AgNORs as biomarkers for oxygenic stress in smokers and COPD patients

Background: It is well known that tobacco smoke causes cellular proliferation and chronic obstructive pulmonary disease (COPD), but changes in buccal mucosa cells in smokers and COPD patients remains unknown. Aims: The aim of this study is twofold: (i) to assess the effect of smoking on cellular proliferative activity of buccal mucosa in healthy smokers and in smoking COPD patients (ii) to detect early cellular proliferative activity in buccal mucosa. Our hypothesis is that tobacco smoking induces changes in buccal mucosa cells that we can detect using AgNOR analysis. Methods: 879 male subjects; non-smokers (controls), smokers and COPD patients were studied. Cytogenic damage was defined using the argyrophilic nucleolar organiser regions (AgNOR). Buccal mucosa cells were obtained from swabs and brushing. The respiratory symptoms were assessed by St. George’s questionnaire and lung function tests were measured by Vitalograph spirometer. Statistical analysis using ANOVA and discriminant analysis (classification)was used to determine differences between the three groups, regression models were built on the lung function data. Results: The AgNOR count, nuclear area, nuclear volume, and percentage of cells with 5 or more AgNORs, were significantly higher in smokers than non–smokers (5.20 vs 3.27, 74.66 vs 55.65, 462.67 vs 304.01, 73.93% vs 14.75%, respectively). For COPD patients, the values were 6.77, 110.42, 813.26, 96.97%, respectively.Respiratory symptoms were higher in smokers and COPD patients than non- smokers. There was significant relationship between respiratory symptoms and AgNORs count (P≤ 0.001). There was positive association between cigarette smoking and enhanced cellular activity in oral mucosa. Pack years of smoking is significantly associated with cellular abnormality in smokers and COPD patients. Conclusions: Strong correlations were found between AgNORs parameters and respiratory symptoms, pulmonary function tests and pack years. Keywords: COPD, buccal mucosa, AgNOR staining, discriminant analysis

Effects of Traffic Air Pollution on Respiratory Health and Allergies in Schoolchildren

The objective of the study is to investigate gender differences in the respiratory effects of air pollution in schoolchildren. We studied 1397 schoolchildren from two locations in Egypt; Cairo city with high level of air pollution and Shbeen Al Koom in the Delta with low level of air pollution. Lung function testing was done by the Vitalograph spirometer. The Arabic version of ISAAC questionnaire was used (the International Study of Asthma and Allergies in Childhood). Air pollution measurements were collected from the Government sites in both locations. Boys in Shbeen Al Koom had significantly (p< 0.05) higher lung function tests than boys in Cairo. There was no significant differences in lung function tests between girls in both locations. Children in Cairo had significantly (p< 0.01) higher prevalence rates of asthma, rhinitis and eczema than children in Shbeen Al Koom. The prevalence rates of ever rhinitis were 6% and 3% higher in boys and girls in Cairo compared with Shbeen Al Koom, respectively. Children who developed rash less than 2 years of age were 2% and 5% higher in boys and girls in Cairo compared with Shbeen Al Koom, respectively. The prevalence of other allergic symptoms were 2-3% and 3-5% higher in boys and girls in Cairo compared with Shbeen Al Koom, respectively. The present study shows the adverse respiratory effects of exposure to traffic air pollution on schoolchildren showing gender difference. The study will help to implement strategic health intervention programmes to improve the respiratory health of children

Impact of pharmaceutical care on health outcomes in patients with COPD

Background Chronic obstructive pulmonary disease (COPD) treatment goals are often not achieved despite the availability of many effective treatments. Furthermore, clinical pharmacist interventions to improve clinical and humanistic outcomes in COPD patients have not yet been explored and few randomized controlled trials have been reported to evaluate the impact of pharmaceutical care on health outcomes in patients with COPD. Objective The aimof the present studywas to evaluate the impact of pharmaceutical care intervention,with a strong focus on self-management, on a range of clinical and humanistic outcomes in patients with COPD. Setting Outpatient COPD Clinic at the Royal Medical Services Hospital. Method In a randomised, controlled, prospective clinical trial, a total of 133 COPD patients were randomly assigned to intervention or control group. A structured education about COPD and management of its symptoms was delivered by the clinical pharmacist for patients in the intervention group. Patientswere followed up at 6 months during a scheduled visit. Effectiveness of the intervention was assessed in terms of improvement in health-related quality of life,medication adherence, disease knowledge and healthcare utilization. Data collected at baseline and at the 6 month assessment was coded and entered into SPSS software version 17 for statistical analysis. A P value of\0.05 was considered statistically significant. Main outcome measure The primary outcome measure was health-related quality of life improvement. All other data collected including healthcare utilization, COPD knowledge and medication adherence formed secondary outcome measures. Results A total of 66 patients were randomized to the intervention group and 67 patients were randomized to the control group. Although the current study failed to illustrate significant improvement in health-related quality of life parameters, the results indicated significant improvements in COPD knowledge (P\0.001), medication adherence (P\0.05), medication beliefs (P\ 0.01) and significant reduction in hospital admission rates (P\0.05) in intervention patients when compared with control group patients at the end of the study. Conclusion The enhanced patient outcomes as a result of the pharmaceutical care programme in the present study demonstrate the value of an enhanced clinical pharmacy service in achieving the desired health outcomes for patients with COPD

Childhood body mass index and wheezing disorders: a systematic review and meta-analysis

BACKGROUND: It has been claimed that overweight/obesity are associated with childhood asthma and wheezing disorders, although the results of observational studies have remained inconsistent. We conducted a systematic review and meta-analysis to investigate this. METHODS: An online search of published papers linking childhood asthma and wheezing with overweight/obesity up to May 2014 using EMBASE and Medline medical research databases was carried out. Summary odds ratios (OR) were estimated using random-effects models. Sub-group meta-analyses were performed to assess the robustness of risk associations and between-study heterogeneity. RESULTS: A total of 38 studies comprising 1,411,335 participants were included in our meta-analysis. The summary ORs of underweight (85th to <95th percentile), and obesity (≥95th percentile) were 0.85 (95% CI: 0.75 to 0.97; P=0.02), 1.23 (95% CI: 1.17 to 1.29; p<0.001), and 1.46, (95% CI: 1.36 to 1.57, P<0.001) respectively. Heterogeneity was significant and substantial in all three weight categories, and not accounted for by predefined study characteristics. CONCLUSION: Our results suggest that underweight is associated with a reduced risk of childhood asthma, and overweight and obesity are associated with an increased risk of childhood asthma. Although our findings assert that overweight/obesity and childhood asthma are associated, the causal pathway and temporal aspects of this relationship remain unanswered and deserve further epidemiological investigation

Socioeconomic questionnaire and clinical assessment in the HELENA Cross-sectional Study: methodology

Rationale: Environmental factors such as dietary habits, breastfeeding, socioeconomic conditions and educational factors are strong influences on nutritional and puberty status, physical activity, food choices and their interactions. Several diseases of adulthood seem to be linked to, or to originate from, lifestyle in childhood and adolescence. Objective: The aims of this study are to describe birth parameters and socioeconomic factors and to assess clinical status in adolescents aged 13-16 years from 10 European countries participating in the Healthy Lifestyle in Europe by Nutrition in Adolescence (HELENA) Cross-Sectional Study (CSS). Methodology: A self-report questionnaire on the socioeconomic status, a parental questionnaire concerning neonatal period and also a case report form (CRF), in which clinical items during clinical examination (such as medical history, treatments, anthropometry, Tanner staging, blood pressure, heart rate) were assessed. To develop these documents, first a list of items was established, a search of existing documents was performed and the advice of local and international experts was taken. All documents (questionnaires and an operations manual) were discussed in plenary HELENA meetings; a final version of these documents was fixed, and the process of translation and back translation was performed. Results: The questionnaires and CRF were tested for validation in all 10 participant cities; 208 adolescents were enrolled during the pilot study. All items that caused problems or questions in one or more participating centers or were completed by < 85% of the adolescents were reviewed before the beginning of the HELENA-CSS. Conclusion: These final questionnaires and CRF will contribute to better understanding of the inequalities in nutrition, behavior and health in the European adolescent population. The experience and process should be useful for other multicenter studies

Clinically diagnosed childhood asthma and follow-up of symptoms in a Swedish case control study

BACKGROUND: Childhood asthma has risen dramatically not only in the western societies and now forms a major and still increasing public health problem. The aims of this study were to follow up at the age of ten the patterns of asthma symptoms and associations among children with a clinically diagnosed asthma in a sizeable urban-rural community and to in compare them with demographic controls using a standardised questionnaire. METHODS: In a defined region in Sweden with a population of about 150 000 inhabitants, all children (n = 2 104) born in 1990 were recorded. At the age of seven all primary care and hospital records of the 1 752 children still living in the community were examined, and a group of children (n = 191) was defined with a well-documented and medically confirmed asthma diagnosis. At the age of ten, 86 % of these cases (n = 158) and controls (n = 171) completed an ISAAC questionnaire concerning asthma history, symptoms and related conditions. RESULTS: Different types of asthma symptoms were highly and significantly over-represented in the cases. Reported asthma heredity was significantly higher among the cases. No significant difference in reported allergic rhinitis or eczema as a child was found between cases and controls. No significant difference concerning social factors or environmental exposure was found between case and controls. Among the control group 4.7 % of the parents reported that their child actually had asthma. These are likely to be new asthma cases between the age of seven and ten and give an estimated asthma prevalence rate at the age of ten of 15.1 % in the studied cohort. CONCLUSION: A combination of medical verified asthma diagnosis through medical records and the use of self-reported symptom through the ISAAC questionnaire seem to be valid and reliable measures to follow-up childhood asthma in the local community. The asthma prevalence at the age of ten in the studied birth cohort is considerably higher than previous reports for Sweden. Both the high prevalence figure and allowing the three-year lag phase for further settling of events in the community point at the complementary roles of both hospital and primary care in the comprehensive coverage and control of childhood asthma in the community

Investigating International Time Trends in the Incidence and Prevalence of Atopic Eczema 1990-2010: A Systematic Review of Epidemiological Studies

The prevalence of atopic eczema has been found to have increased greatly in some parts of the world. Building on a systematic review of global disease trends in asthma, our objective was to study trends in incidence and prevalence of atopic eczema. Disease trends are important for health service planning and for generating hypotheses regarding the aetiology of chronic disorders. We conducted a systematic search for high quality reports of cohort, repeated cross-sectional and routine healthcare database-based studies in seven electronic databases. Studies were required to report on at least two measures of the incidence and/or prevalence of atopic eczema between 1990 and 2010 and needed to use comparable methods at all assessment points. We retrieved 2,464 citations, from which we included 69 reports. Assessing global trends was complicated by the use of a range of outcome measures across studies and possible changes in diagnostic criteria over time. Notwithstanding these difficulties, there was evidence suggesting that the prevalence of atopic eczema was increasing in Africa, eastern Asia, western Europe and parts of northern Europe (i.e. the UK). No clear trends were identified in other regions. There was inadequate study coverage worldwide, particularly for repeated measures of atopic eczema incidence. Further epidemiological work is needed to investigate trends in what is now one of the most common long-term disorders globally. A range of relevant measures of incidence and prevalence, careful use of definitions and description of diagnostic criteria, improved study design, more comprehensive reporting and appropriate interpretation of these data are all essential to ensure that this important field of epidemiological enquiry progresses in a scientifically robust manner