A survey on clinical presentation and nutritional status of infants with suspected cow' milk allergy

<p>Abstract</p> <p>Background</p> <p>Cow's milk is the most common food allergen in infants and the diagnosis of cow's milk allergy is difficult, even with the use of several diagnostic tests. Therefore, elimination diets and challenge tests are essential for the diagnosis and treatment of this disorder. The aim of this study is to report the clinical presentation and nutritional status of children evaluated by pediatric gastroenterologists for the assessment of symptoms suggestive of cow's milk allergy.</p> <p>Methods</p> <p>An observational cross-sectional study was performed among 9,478 patients evaluated by 30 pediatric gastroenterologists for 40 days in 5 different geographical regions in Brazil. Clinical data were collected from patients with symptoms suggestive of cow's milk allergy. The nutritional status of infants (age ≤ 24 months) seen for the first time was evaluated according to z-scores for weight-for-age, weight-for-height, and height-for-age. Epi-Info (CDC-NCHS, 2000) software was used to calculate z-scores.</p> <p>Results</p> <p>The prevalence of suspected cow's milk allergy in the study population was 5.4% (513/9,478), and the incidence was 2.2% (211/9,478). Among 159 infants seen at first evaluation, 15.1% presented with a low weight-for-age z score (< -2.0 standard deviation - SD), 8.7% with a low weight-for-height z score (< -2.0 SD), and 23.9% with a low height-for-age z score (< -2.0 SD).</p> <p>Conclusion</p> <p>The high prevalence of nutritional deficits among infants with symptoms suggestive of cow's milk allergy indicates that effective elimination diets should be prescribed to control allergy symptoms and to prevent or treat malnutrition.</p

The economic impact of severe asthma to low-income families.

BACKGROUND: To estimate the direct and indirect costs of severe asthma and the economic impact of its management to low-income families in Salvador, Brazil. METHODS: One hundred and ninety-seven patients with severe asthma and referred to a state-funded asthma center providing free treatment were evaluated. At registration, they were asked about family cost-events in the previous year and had a baseline assessment of lung function, symptoms and quality of life. During the subsequent year, they were reassessed prospectively. RESULTS: One hundred-eighty patients concluded a 12-month follow-up. Eighty-four percent were female patients, and the median family income was US$2955/year. Forty-seven percent of family members had lost their jobs because of asthma. Total cost of asthma management took 29$ 711/year, as their members went back to work. The total cost of asthma to the families was reduced by a median US$789/family/year. Consequently, an annual surplus of US$ 1500/family became available. CONCLUSIONS: Family costs of severe asthma consumed over one-fourth of the family income of the underprivileged population in a middle-income country. Adequate management brings major economic benefit to individuals and families

Evaluation of the feasibility of a school-based asthma management programme in Taiwan

[[abstract]]Aims and objectives. To investigate the feasibility of a school-based asthma management programme for middle school children. Background. Asthma rates are increasing among school-aged children. Successful asthma treatment in children depends in part on clear communication and effective education. Design. This feasibility study employed a one-group only longitudinal design with four time points over 18 months. Methods. Nineteen female and twelve male ( n = 31) seventh-grade children with asthma (13 SD 0·71 years) were identified using a six-stage asthma case-finding approach. Teachers and school staff were trained in the principles and methods of the proposed school-based asthma management programme. An individualised guided asthma self-management programme was developed for each child by a clinical team at a major academic medical centre. We assisted teachers in implementing the school programme; building a support network and monitoring children’s activities. Outcome measures included lung function tests (at 0, six, 12 and 18 months), disease-related symptoms, psychosocial status and impact of asthma on learning (at 0 and 18 months). School provided data on academic achievement and school absences at 0, six, 12 and 18 months. Results. Significant improvements were noted at six, 12 and 18 months on forced vital capacity (FVC)% of predicted ( p = 0·001, 0·015, 0·015, respectively), forced expiratory volume in one second (FEV1)% of predicted ( p = 0·001, 0·006, 0·088, respectively) and FEV1/FVC% of predicted ( p = 0·001, 0·015, 0·099, respectively). There was a trend towards improved asthma symptoms ( p = 0·050) and a significant decrease in positive perception of curriculum ( p = 0·017) at 18 months after adjustment for covariates. Conclusions. This programme was associated with respiratory benefits on physiological asthma markers commonly, with a trend for symptom control. Academic and psychosocial outcomes are subject of further inquiry. Relevance to clinical practice. School-based asthma management holds promise as a feasible clinical option for middle school children with asthma in the Taiwanese school system.[[journaltype]]國外[[incitationindex]]SCI[[booktype]]紙本[[countrycodes]]GB