ICS-formoterol reliever therapy stepwise treatment algorithm for adult asthma

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Acetaminophen use and risk of asthma, rhinoconjunctivitis and eczema in adolescents : ISAAC Phase Three

Rationale: There is epidemiological evidence that the use of acetaminophen may increase the risk of developing asthma. Objectives: To investigate the risk of asthma and other allergic disorders associated with the current use of acetaminophen in 13- to 14-year-old children in different populations worldwide. Methods: As part of the International Study of Asthma and Allergies in Childhood (ISAAC) Phase Three, 13- to 14-year-old children completed written and video questionnaires obtaining data on current symptoms of asthma, rhinoconjunctivitis, and eczema, and a written environmental questionnaire obtaining data on putative risk factors, including acetaminophen use in the past 12 months. Measurements and Main Results: The primary outcome measure was the odds ratio (OR) of current asthma symptoms associated with acetaminophen use calculated by logistic regression. A total of 322,959 adolescent children from 113 centers in 50 countries participated. In the multivariate analyses the recent use of acetaminophen was associated with an exposure-dependent increased risk of current asthma symptoms (OR, 1.43 [95% confidence interval, 1.33–1.53] and 2.51 [95% confidence interval, 2.33–2.70] for medium and high versus no use, respectively). Acetaminophen use was also associated with an exposure-dependent increased risk of current symptoms of rhinoconjunctivitis and eczema. Conclusions: Acetaminophen use may represent an important risk factor for the development and/or maintenance of asthma, rhinoconjunctivitis, and eczema in adolescent children.peer-reviewe

Global variation in the prevalence and severity of asthma symptoms : phase three of the International Study of Asthma and Allergies in Childhood (ISAAC)

Background: Phase Three of the International Study of Asthma and Allergies in Childhood (ISAAC) measured the global prevalence and severity of asthma symptoms in children. Methods: A cross-sectional questionnaire survey of 798 685 children aged 13–14 years from 233 centres in 97 countries, and 388 811 children aged 6–7 years from 144 centres in 61 countries, was conducted between 2000 and 2003 in .90% of the centres. Results: The prevalence of wheeze in the past 12 months (current wheeze) ranged from 0.8% in Tibet (China) to 32.6% in Wellington (New Zealand) in the 13–14 year olds, and from 2.4% in Jodhpur (India) to 37.6% in Costa Rica in the 6–7 year olds. The prevalence of symptoms of severe asthma, defined as >4 attacks of wheeze or >1 night per week sleep disturbance from wheeze or wheeze affecting speech in the past 12 months, ranged from 0.1% in Pune (India) to 16% in Costa Rica in the 13–14 year olds and from 0% to 20.3% in the same two centres, respectively, in the 6–7 year olds. Ecological economic analyses revealed a significant trend towards a higher prevalence of current wheeze in centres in higher income countries in both age groups, but this trend was reversed for the prevalence of severe symptoms among current wheezers, especially in the older age group. Conclusion: Wide variations exist in the symptom prevalence of childhood asthma worldwide. Although asthma symptoms tend to be more prevalent in more affluent countries, they appear to be more severe in less affluent countries.peer-reviewe

Maternal post-natal tobacco use and current parental tobacco use is associated with higher body mass index in children and adolescents: an international cross-sectional study

Background: We investigated whether maternal smoking in the first year of life or any current parental smoking is associated with childhood or adolescent body mass index (BMI). Methods: Secondary analysis of data from a multi-centre, multi-country, cross-sectional study (ISAAC Phase Three). Parents/guardians of children aged 6-7 years completed questionnaires about their children's current height and weight, whether their mother smoked in the first year of the child's life and current smoking habits of both parents. Adolescents aged 13-14 years completed questionnaires about their height, weight and current parental smoking habits. A general linear mixed model was used to determine the association between BMI and parental smoking. Results: 77,192 children (18 countries) and 194 727 adolescents (35 countries) were included. The BMI of children exposed to maternal smoking during their first year of life was 0.11 kg/m2 greater than those who were not (P = 0.0033). The BMI of children of currently smoking parents was greater than those with non-smoking parents(maternal smoking: +0.08 kg/m2 (P = 0.0131), paternal smoking: +0.10 kg/m2 (P < 0.0001)). The BMI of female adolescents exposed to maternal or paternal smoking was 0.23 kg/m2 and 0.09 kg/m2 greater respectively than those who were not exposed (P < 0.0001). The BMI of male adolescents was greater with maternal smoking exposure, but not paternal smoking (0.19 kg/m2, P < 0.0001 and 0.03 kg/m2, P = 0.14 respectively). Conclusion: Parental smoking is associated with higher BMI values in children and adolescents. Whether this is due to a direct effect of parental smoking or to confounding cannot be established from this observational study

Association between Frequency of Consumption of Fruit, Vegetables, Nuts and Pulses and BMI: Analyses of the International Study of Asthma and Allergies in Childhood (ISAAC).

Diets which emphasize intakes of plant-based foods are recommended to reduce disease risk and for promoting healthy weight. The aim of this study was to examine the association between fruit, vegetables, pulses and nut intake and body mass index (BMI) across countries in adolescents (13-14 years) and children (6-7 years). Data from the International Study of Asthma and Allergies in Childhood; 77,243 children's parents and 201,871 adolescents was used to examine the association between dietary intake (Food Frequency Questionnaire) and BMI using general linear models, adjusting for country gross national index. Adolescents who consumed fruit, vegetables, pulses and nuts three or more times a week had a lower BMI than the never or occasional group; eating nuts three or more times a week, was associated with a BMI value of 0.274 kg/m² lower than the never group (p < 0.001). Compared to children who never or occasionally reported eating vegetables, those reporting that they ate vegetables three or more times per week had a lower BMI of -0.079 kg/m². In this large global study, an inverse association was observed between BMI and the reported increasing intake of vegetables in 6-7 years old and fruit, vegetables, pulses and nuts in adolescents. This study supports current dietary recommendations which emphasize the consumption of vegetables, nut and pulses, although the effect sizes were small.Acknowledgments: This work was supported by Cure Kids New Zealand through a grant to E.A. Mitchell and I. Braithwaite. Cure Kids New Zealand had no role or influence in design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.Revisión por pare

Fast-food consumption and body mass index in children and adolescents: an international cross-sectional study

OBJECTIVE: To investigate whether reported fast-food consumption over the previous year is associated with higher childhood or adolescent body mass index (BMI). DESIGN: Secondary analysis from a multicentre, multicountry cross-sectional study (International Study of Asthma and Allergies in Children (ISAAC) Phase Three). SUBJECTS AND METHODS: Parents/guardians of children aged 6-7 completed questionnaires which included questions about their children's asthma and allergies, fast-food consumption, height and weight. Adolescents aged 13-14 completed the same questionnaire. The questionnaire asked 'In the past 12 months, how often on average did you (your child) eat fast-food/burgers?' The responses were infrequent (never/only occasionally), frequent (once/twice a week) or very frequent (three or more times per week). A general linear mixed model was used to determine the association between BMI and fast-food consumption, adjusting for Gross National Income per capita by country, measurement type (whether heights/weights were reported or measured), age and sex. RESULTS: 72,900 children (17 countries) and 199,135 adolescents (36 countries) provided data. Frequent and very frequent fast-food consumption was reported in 23% and 4% of children, and 39% and 13% of adolescents, respectively. Children in the frequent and very frequent groups had a BMI that was 0.15 and 0.22 kg/m(2) higher than those in the infrequent group (p<0.001). Male adolescents in the frequent and very frequent groups had a BMI that was 0.14 and 0.28 kg/m(2) lower than those in the infrequent group (p<0.001). Female adolescents in the frequent and very frequent groups had a BMI that was 0.19 kg/m(2) lower than those in the infrequent group (p<0.001). CONCLUSIONS: Reported fast-food consumption is high in childhood and increases in adolescence. Compared with infrequent fast-food consumption, frequent and very frequent consumption is associated with a higher BMI in children. Owing to residual confounding, reverse causation and likely misreporting, the reverse association observed in adolescents should be interpreted with caution

Protecting healing relationships in the age of electronic health records: report from an international conference

We present findings of an international conference of diverse participants exploring the influence of electronic health records (EHRs) on the patient-practitioner relationship. Attendees united around a belief in the primacy of this relationship and the importance of undistracted attention. They explored administrative, regulatory, and financial requirements that have guided United States (US) EHR design and challenged patient-care documentation, usability, user satisfaction, interconnectivity, and data sharing. The United States experience was contrasted with those of other nations, many of which have prioritized patient-care documentation rather than billing requirements and experienced high user satisfaction. Conference participants examined educational methods to teach diverse learners effective patient-centered EHR use, including alternative models of care delivery and documentation, and explored novel ways to involve patients as healthcare partners like health-data uploading, chart co-creation, shared practitioner notes, applications, and telehealth. Future best practices must preserve human relationships, while building an effective patient-practitioner (or team)-EHR triad

Localization for Yang-Mills Theory on the Fuzzy Sphere

We present a new model for Yang-Mills theory on the fuzzy sphere in which the configuration space of gauge fields is given by a coadjoint orbit. In the classical limit it reduces to ordinary Yang-Mills theory on the sphere. We find all classical solutions of the gauge theory and use nonabelian localization techniques to write the partition function entirely as a sum over local contributions from critical points of the action, which are evaluated explicitly. The partition function of ordinary Yang-Mills theory on the sphere is recovered in the classical limit as a sum over instantons. We also apply abelian localization techniques and the geometry of symmetric spaces to derive an explicit combinatorial expression for the partition function, and compare the two approaches. These extend the standard techniques for solving gauge theory on the sphere to the fuzzy case in a rigorous framework.Comment: 55 pages. V2: references added; V3: minor corrections, reference added; Final version to be published in Communications in Mathematical Physic

Effect of once-daily indacaterol maleate/mometasone furoate on exacerbation risk in adolescent and adult asthma: a double-blind randomised controlled trial

ObjectiveTo investigate the safety and efficacy of QMF149, a once-daily, fixed-dose combination of the long-acting β2-agonist (LABA) indacaterol maleate and inhaled corticosteroid (ICS) mometasone furoate (MF) for the treatment of persistent asthma. The hypothesis was that QMF149 would not increase the risk of serious asthma exacerbations.Setting174 research centres in nine countries.Participants1519 adolescents and adults with persistent asthma who were treated or qualified for treatment with combination LABA/ICS were randomised, and 1508 were included in the intention-to-treat analysis.InterventionPatients were randomised to QMF149 (indacaterol maleate 500 µg/MF 400 µg) or MF (400 µg) once daily via Twisthaler inhalation device in a double-blind, parallel-group study for 6–21 months.Primary and secondary outcome measuresThe primary end point was time to first serious asthma exacerbation (resulting in hospitalisation, intubation or death). The key secondary end point was annual rate of exacerbations requiring systemic corticosteroids.ResultsTreatment with QMF149 resulted in no significant difference in time to first serious exacerbation compared to MF (2 (0.3%) vs 6 events (0.8%); difference −0.52 percentage point; 95% CI −1.25 to 0.21, p=0.160, HR=0.31; 95% CI 0.06 to 1.54, p=0.151). QMF149 significantly reduced the annual rate of exacerbations requiring systemic corticosteroids (rate ratio=0.71; 95% CI 0.55 to 0.90, p=0.005). Proportions of patients experiencing adverse events were similar across groups (74.0% in the QMF149 group and 73.4% in the MF group). Serious adverse events occurred in 4% and 5.8% of patients in the QMF149 and MF groups, respectively.ConclusionsNo significant difference was observed in the primary outcome of time to first serious asthma exacerbation in patients treated with QMF149 compared with patients treated with MF. Long-term treatment with QMF149 once daily had a favourable safety/efficacy profile in adolescent and adult patients with persistent asthma.Trial registration numberClinicalTrials.gov; NCT00941798