Factors associated with medication adherence in school-aged children with asthma

Adherence to preventive asthma treatment is poor, particularly in children, yet the factors associated with adherence in this age group are not well understood. Adherence was monitored electronically over 6 months in school-aged children who attended a regional emergency department in New Zealand for an asthma exacerbation and were prescribed twice-daily inhaled corticosteroids. Participants completed questionnaires including assessment of family demographics, asthma responsibility and learning style. Multivariable analysis of factors associated with adherence was conducted. 101 children (mean (range) age 8.9 (6-15) years, 51% male) participated. Median (interquartile range) preventer adherence was 30% (17-48%) of prescribed. Four explanatory factors were identified: female sex (+12% adherence), Asian ethnicity (+19% adherence), living in a smaller household (-3.0% adherence per person in the household), and younger age at diagnosis (+2.7% for every younger year of diagnosis) (all p<0.02). In school-aged children attending the emergency department for asthma, males and non-Asian ethnic groups were at high risk for poor inhaled corticosteroid adherence and may benefit most from intervention. Four factors explained a small proportion of adherence behaviour indicating the difficulty in identifying adherence barriers. Further research is recommended in other similar populations

Diagnosis and Decision-Making in Telemedicine

This article provides an analysis of the skills that health professionals and patients employ in reaching diagnosis and decision-making in telemedicine consultations. As governmental priorities continue to emphasize patient involvement in the management of their disease, there is an increasing need to accurately capture the provider–patient interactions in clinical encounters. Drawing on conversation analysis of 10 video-mediated consultations in 3 National Health Service settings in England, this study examines the interaction between patients, General Practitioner (GPs), nurses, and consultants during diagnosis and decision-making, with the aim to identify the range of skills that participants use in the process and capture the interprofessional communication and patient involvement in the diagnosis and decision-making phases of telemedicine consultations. The analysis shows that teleconsultations enhance collaborative working among professionals and enable GPs and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation. However, interprofessional interaction may result in limited patient involvement in decisionmaking. The findings of this study can be used to inform training programs in telemedicine that focus on the development of effective skills for professionals and the provision of information to patients

The effects of attachment style on coping with visible skin conditions and responsiveness to a compassion based self-help intervention

No abstract available

Which population level environmental factors are associated with asthma, rhinoconjunctivitis and eczema? Review of the ecological analyses of ISAAC Phase One.

The International Study of Asthma and Allergies in Childhood (ISAAC) Phase One showed large worldwide variations in the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema, up to 10 to 20 fold between countries. Ecological analyses were undertaken with ISAAC Phase One data to explore factors that may have contributed to these variations, and are summarised and reviewed here.In ISAAC Phase One the prevalence of symptoms in the past 12 months of asthma, rhinoconjunctivitis and eczema were estimated from studies in 463,801 children aged 13 - 14 years in 155 centres in 56 countries, and in 257,800 children aged 6-7 years in 91 centres in 38 countries. Ecological analyses were undertaken between symptom prevalence and the following: Gross National Product per capita (GNP), food intake, immunisation rates, tuberculosis notifications, climatic factors, tobacco consumption, pollen, antibiotic sales, paracetamol sales, and outdoor air pollution.Symptom prevalence of all three conditions was positively associated with GNP, trans fatty acids, paracetamol, and women smoking, and inversely associated with food of plant origin, pollen, immunisations, tuberculosis notifications, air pollution, and men smoking. The magnitude of these associations was small, but consistent in direction between conditions. There were mixed associations of climate and antibiotic sales with symptom prevalence.The potential causality of these associations warrant further investigation. Factors which prevent the development of these conditions, or where there is an absence of a positive correlation at a population level may be as important from the policy viewpoint as a focus on the positive risk factors. Interventions based on small associations may have the potential for a large public health benefit

Electronic adherence monitoring device performance and patient acceptability: a randomized control trial

BACKGROUND: To investigate the performance and patient acceptability of an inhaler electronic monitoring device in a real-world childhood asthma population. METHODS: Children 6 to 15 years presenting with asthma to the hospital emergency department and prescribed inhaled corticosteroids were included. Participants were randomized to receive a device with reminder features enabled or disabled for use with their preventer. Device quality control tests were conducted. Questionnaires on device acceptability, utility and ergonomics were completed at six months. RESULTS: A total of 1306 quality control tests were conducted; 84% passed pre-issue and 87% return testing. The most common failure reason was actuation under-recording. Acceptability scores were high, with higher scores in the reminder than non-reminder group (median, 5th-95th percentile: 4.1, 3.1–5.0 versus 3.7, 2.3–4.8; p 90%) rated the device easy to use. Feedback was positive across five themes: device acceptability, ringtone acceptability, suggestions for improvement, effect on medication use, and effect on asthma control. CONCLUSIONS: This study investigates electronic monitoring device performance and acceptability in children using quantitative and qualitative measures. Results indicate satisfactory reliability, although failure rates of 13–16% indicate the importance of quality control. Favorable acceptability ratings support the use of these devices in children

Molecular aspects of eye development and regeneration in the Australian redclaw crayfish, Cherax quadricarinatus

The compound eye evolved over 500 million years ago and enables mosaic vision in most arthropod species. The molecular regulation of the development of the compound eye has been primarily studied in the fruit fly Drosophila melanogaster. However, due to the nature of holometabolous insects halting growth after their terminal metamorphosis into the adult form, they lack the capacity to regenerate. Crustaceans, unlike holometabolous insects, continue to grow during adulthood, achieved through regular shedding of their exoskeleton, in a cyclic process known as molting. This therefore offers crustaceans as a highly suitable model to study ocular regeneration in the adult arthropod eye. We have assessed the regenerative capacity of the retinal section of the Cherax quadricarinatus (red-claw crayfish) eye, following ablation and successive post-metamorphic molts. This work then provides a transcriptomic description of the outer, pigmented retinal tissue (the ommatidia and lamina ganglionaris) and the basal, non-pigmented neuroendocrine ocular tissue (the X-organ Sinus Gland complex, hemiellipsoid body and optic nerve). Using comparative analysis, we identified all the transcripts in the C. quadricarinatus ocular transcriptome that are known to function in compound eye development in D. melanogaster. Differentially and uniquely transcribed genes of the retina are described, suggesting proposed mechanisms that may regulate ocular regeneration in decapod Crustacea. This research exemplifies the application C. quadricarinatus holds as an optimal model to study the regulation of ocular regeneration. Further in-depth transcriptomic analyses are now required, sampled throughout the regeneration process to better define the regulatory mechanism

Dose dependency of iatrogenic glucocorticoid excess and adrenal insufficiency and mortality: a cohort study in England

Context: Adrenal insufficiency and Cushing’s syndrome are known adverse events of glucocorticoids. However, no population estimates of dose-related risks are available. Objective: To investigate dose-related risks of adrenal dysfunction and death in adults with six chronic inflammatory diseases treated with oral glucocorticoids. Design and setting: Retrospective record-linkage open-cohort study spanning primary and hospital care in England. Patients: 70,638 people oral glucocorticoid-users and 41,166 non-users aged ≥18 years registered in 389 practices in 1998-2017. Main outcome measures: Incidence rates and hazard ratios (HRs) of diagnosed adrenal dysfunction and death. Results: During a median follow-up of 5.5 years, 183 patients had glucocorticoid-induced adrenal insufficiency and 248 glucocorticoid-induced Cushing’s syndrome. A total of 22,317 (31.6%) and 7,544 (18.3%) deaths occurred amongst glucocorticoid users and non-users, respectively. Incidence of all outcomes increased with higher current daily and cumulative doses. For adrenal insufficiency, the increases in HRs were of 1.07 (95% CI 1.04-1.09) for every increase of 5mg per day and of 2.25 (95% CI 2.15-2.35) per 1000mg of cumulative prednisolone-equivalent dose over the past year. The respective increases in HRs for Cushing’s syndrome were of 1.09 (95% CI 1.08-1.11) and 2.31 (95% CI 2.23-2.40) and for mortality of 1.26 (95% CI 2.24-1.28) and 2.05 (95% CI 2.04-2.06). Conclusion: We report a high glucocorticoid dose-dependent increased risk of adrenal adverse events and death. The low observed absolute risk of adrenal insufficiency highlights a potential lack of awareness, and a need for increased physician and patient education about the risks of adrenal dysfunction induced by glucocorticoids

A Personal Construct Psychology based investigation into a Product Service System for renting pushchairs to consumers

This is the peer-reviewed version of the following article: Maurizio Catulli and Nick Reed, ‘A Personal Construct Psychology Based Investigation Into a Product Service System for Renting Pushchairs to Consumers’, Business Strategy and the Environment, Vol. 26(5): 656-671, February 2017, which has been published in final form at DOI: 10.1002/bse.1944. Under embargo. Embargo end date: 1 February 2019. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.This paper explores how consumers construe a Product Service System (PSS) for the supply of pushchairs. A PSS is a system of products, services, networks of actors and supporting infrastructure designed to be more sustainable than traditional business models. PSS face an implementation challenge in consumer markets and this case based research explores some reasons for this. The study applies Personal Construct Psychology (in particular, Repertory Grid Technique) which has not previously been used in relation to researching PSS. Results suggest that PSS might be difficult to implement in relation to pushchairs. Renting pre-used equipment may meet resistance because of a perceived risk that acquisition by this means might endanger infants. Participants in the study construed buying new products from specialist infant product shops as being the best way of acquiring them. Accordingly PSS providers may, for instance, have to implement certified quality assurance processes in order to reassure consumers.Peer reviewedFinal Accepted Versio

Single and two-particle energy gaps across the disorder-driven superconductor-insulator transition

The competition between superconductivity and localization raises profound questions in condensed matter physics. In spite of decades of research, the mechanism of the superconductor-insulator transition (SIT) and the nature of the insulator are not understood. We use quantum Monte Carlo simulations that treat, on an equal footing, inhomogeneous amplitude variations and phase fluctuations, a major advance over previous theories. We gain new microscopic insights and make testable predictions for local spectroscopic probes. The energy gap in the density of states survives across the transition, but coherence peaks exist only in the superconductor. A characteristic pseudogap persists above the critical disorder and critical temperature, in contrast to conventional theories. Surprisingly, the insulator has a two-particle gap scale that vanishes at the SIT, despite a robust single-particle gap.Comment: 7 pages, 5 figures (plus supplement with 4 pages, 5 figures

Comparative prebiotic activity of mixtures of cereal grain polysaccharides

The main components of the non-starch polysaccharide (NSP) fraction of wheat flour are arabinoxylan (AX) and β-glucan. These are also present in other cereal grains, but their proportions vary with AX being the major component in wheat and rye and β-glucan in barley and oats. Therefore, it was hypothesised that these NSPs could act synergistically when fermented in vitro at the ratios present in the major foods consumed, resulting in increased prebiotic activity. AX and β-glucan were therefore tested in in vitro fermentation studies to assess their prebiotic activity when used individually and/or in different ratios. Short-chain fatty-acids (SCFAs) produced from in vitro fermentation were measured using HPLC and bacterial populations were measured using flow cytometry with fluorescence in situ hybridisation (Flow-FISH). Fermentation of AX alone resulted in a significant bifidogenic activity and increased concentrations of SCFAs, mainly acetate, after 8-24 h of fermentation, however β-glucan alone did not show prebiotic activity. The greatest prebiotic activity, based on concentration of total SCFAs and increases in total bacteria as well as beneficial Bifidobacterium and Clostridium coccoides/Eubacterium groups, was observed when AX and β-glucan were combined at a 3:1 ratio, which corresponds to their ratios in wheat flour which is major source of cereal fibre in the diet. This indicates that the population of bacteria in the human GI tract may be modulated by the composition of the fibre in the diet, to maximise the prebiotic potential