Lung function decline in relation to diagnostic criteria for airflow obstruction in respiratory symptomatic subjects

Contains fulltext : 108583.pdf (publisher's version ) (Open Access)BACKGROUND: Current COPD guidelines advocate a fixed < 0.70 FEV1/FVC cutpoint to define airflow obstruction. We compared rate of lung function decline in respiratory symptomatic 40+ subjects who were 'obstructive' or 'non-obstructive' according to the fixed and/or age and gender specific lower limit of normal (LLN) FEV1/FVC cutpoints. METHODS: We studied 3,324 respiratory symptomatic subjects referred to primary care diagnostic centres for spirometry. The cohort was subdivided into four categories based on presence or absence of obstruction according to the fixed and LLN FEV1/FVC cutpoints. Postbronchodilator FEV1 decline served as primary outcome to compare subjects between the respective categories. RESULTS: 918 subjects were obstructive according to the fixed FEV1/FVC cutpoint; 389 (42%) of them were non-obstructive according to the LLN cutpoint. In smokers, postbronchodilator FEV1 decline was 21 (SE 3) ml/year in those non-obstructive according to both cutpoints, 21 (7) ml/year in those obstructive according to the fixed but not according to the LLN cutpoint, and 50 (5) ml/year in those obstructive according to both cutpoints (p = 0.004). CONCLUSION: This study showed that respiratory symptomatic 40+ smokers and non-smokers who show FEV1/FVC values below the fixed 0.70 cutpoint but above their age/gender specific LLN value did not show accelerated FEV1 decline, in contrast with those showing FEV1/FVC values below their LLN cutpoint

Asthma control, quality of life, and the role of patient enablement: a cross-sectional observational study

BACKGROUND: Self-assessment of asthma and a stronger doctor-patient relationship can improve asthma outcomes. Evidence for the influence of patient enablement on quality of life and the control of asthma is lacking. AIMS: To assess asthma severity, medication use, asthma control, and patient enablement in patients with asthma treated in primary care and to study the relationship between these variables and quality of life. METHODS: A cross-sectional study was conducted in an urban clinic in northern Portugal. Data were collected from both clinical records and questionnaires from a random sample of asthma patients. The modified Patient Enablement Instrument, the Asthma Quality of Life Questionnaire, and the Asthma Control Questionnaire were used. Peak expiratory flow and forced expiratory volume in one second (FEV1) were measured. Receiver operating characteristic curve analysis was performed to establish cut-off values for the quality of life measurements. The associations between enablement, asthma control, and quality of life were tested using logistic regression models. RESULTS: The study sample included 180 patients. There was a strong correlation between asthma control and quality of life (r=0.81, p<0.001). A weak association between patient enablement and asthma control and quality of life was found in the logistic regression models. Poor control of asthma was associated with female gender, concomitant co-morbidities, reduced FEV1, and increased severity of asthma. CONCLUSIONS: The weak correlation between enablement and asthma control requires further study to determine if improved enablement can improve asthma outcomes independent of gender, severity, and concomitant co-morbidities. This study confirms the strong correlation between asthma control and quality of life.No conflicts of interests are reported for this study. JCS was an unpaid member of the scientific board of AstraZeneca (AZ) Foundation Portugal from June 2009 until August 2011. His department has received research funding from AZ in 2008. He has received sponsorships from or delivered consultancy services to AZ, Nycomed, GSK, MSD, and Novartis. He is a member of the editorial Board of PCRJ

Predictors of changes in sick leave in workers with asthma: a follow-up study.

Contains fulltext : 49216.pdf (publisher's version ) (Closed access)OBJECTIVE: The aim of this prospective study was to investigate predictors of 1-year changes in sick leave in workers with asthma. METHODS: The initial cohort consisted of 111 workers with asthma. One-hundred and one participants completed the follow-up after 1 year. Self-reported sick leave over the past 12 months was reported at baseline and at follow-up. At the start of this study, all participants completed questionnaires on adaptation to functional limitations, psychosocial variables, working conditions, lung function characteristics, disease history characteristics, health complaints and functional limitations, and person characteristics ('potential predictors'). Three multivariate logistic regression models were calculated, with an increase in sick leave, a decrease in sick leave, and stable high sick leave as dependent (outcome) variables, and the potential predictors as independent (explanatory) variables. RESULTS: An increase in sick leave was predicted by a lower level of education and perceiving more functional limitations in activities of daily life. A decrease in sick leave was predicted by spending all energy at work less often and perceiving fewer health complaints in social activities (adaptation criteria 4 and 5). Stable high sick leave was predicted by less job satisfaction, perceiving more support from the employer and perceiving more health complaints in social activities (adaptation criterion 5). Lung function characteristics, or disease history characteristics were not predictive for changes in sick leave in any of the groups. CONCLUSION: We conclude that adaptation to functional limitations played a major role in changes in sick leave in workers with asthma. Lung function characteristics hardly played a role

The effect of mathematical games on on-task behaviours in the primary classroom

A challenge for primary classroom teachers is to maintain students&rsquo; engagement with learning tasks while catering for their diverse needs, capabilities and interests. Multiple pedagogical approaches are employed to promote on-task behaviours in the mathematics classroom. There is a general assumption by educators that games ignite children&rsquo;s on-task behaviours, but there is little systemically researched empirical data to support this claim. This paper compares students&rsquo; on-task behaviours during non-digital game-playing lessons compared with non-game-playing lessons. Six randomly selected grade 5 and 6 students (9&ndash;12 year olds) were observed during ten mathematics lessons. A total of 2,100 observations were recorded via an observational schedule and analysed by comparing the percentage of exhibited behaviours. The study found the children spent 93 % of the class-time exhibiting on-task engagement during the game-playing lessons compared with 72 % during the non-game-playing lessons. The game-playing lessons also promoted greater incidents of student talk related to the mathematical task (34 %) compared with the non-game playing lessons (11 %). These results support the argument that games serve to increase students&rsquo; time-on-task in mathematics lessons. Therefore, it is contended that use of games explicitly addressing the mathematical content being taught in a classroom is one way to increase engagement and, in turn, potential for learning