Astma sergancio vaiko gyvenimo kokybe: kieno gyvenimo kokybe ir kaip matuojame?

Copyright © 2000 Lithuanian Paediatric Respiratory SocietyPaediatricians increasingly recognize the importance of health-related quality of life (HRQL). Childhood asthma is common and for many years the reduction and monitoring of symptoms were the main goals of treatment. However, many additional treatment goals have been added including reduction of hospitalization, reduction of chronic inflammation, and normal psychological development. HRQL is a multidimensional construct which is likely to be influenced by a range of factors in children’s family and social environment. To understand the magnitude of any treatment or intervention benefit requires the perspective of the sufferer as well. In article authors described factors, that could influence quality of life, and measures to assess those factors.Rima Staugas and Michael Sawye

Vitamin E, peroxidative and non-peroxidative free radical damage markers, and sample collection timing in children and adolescents with cystic fibrosis

Neil R. Badcock, David Parsons, Rima E. Staugas, Jacqui J.E. Aldis and Richard T.L. Coupe

A risk screening questionnaire for adult asthmatics to predict attendance at hospital emergency departments

Study objectives: To develop a practical screening tool that could identify adult patients highly likely to attend a hospital emergency department (ED) in a 1-year period. Design: Retrospective case-control study of patients who did and did not attend a hospital ED for asthma in the past year. Setting: Adelaide, South Australia. Participants: One hundred sixty- five adults attending an ED for asthma were compared with 260 adults with asthma from a community survey who had not attended an ED in the previous year. Measurements and results: The following variables were independently related to ED attendance: having been woken from sleep by asthma in past month; having been admitted to hospital because of asthma in the past year; having seen more than one general practitioner for asthma in the last 12 months; a moderate or severe self-rating of asthma in the last month; and having taken oral steroid medication for asthma in past month. A risk screening questionnaire using the weighted responses to these five variables with a cutoff score of 30/100 demonstrated a sensitivity of 90% and specificity of 88%. Conclusions: These findings agree with those of previous studies that markers of asthma severity and discontinuity of care are risk factors for adverse asthma outcomes. Validation of the risk screening questionnaire is required in a prospective study.Wakefield, M ; Ruffin, R ; Campbell, D ; Staugas, R ; Beilby, J ; Mccaul,

Trends in hospital readmission for asthma: has the Australian National Asthma Campaign had an effect?

ObjectivesTo describe patterns of hospital readmission for asthma in South Australia from 1989 to 1996, in relation to implementation of the National Asthma Campaign.Design and settingA comparison of hospital admissions in South Australia of patients aged between one year and 49 years for three conditions: asthma (or respiratory failure with asthma as an underlying condition) and two control conditions--diabetes and epilepsy. Individuals were identified by Medicare number and date of birth.Outcome measuresHospital readmission within 28 days and within one year.ResultsOverall, by 1996, there was a statistically significant decline in the risk of readmission for asthma within 28 days of 18% and within one year of 17% compared with 1989 readmission rates. There were no reductions in the risk of readmission for diabetes or epilepsy, suggesting that the decline in risk of readmission for asthma was greater than the underlying effects of general changes in hospital casemix.ConclusionsThe decline in risk of readmission may reflect changes in asthma severity or improved management practices. However, hospital readmission rates still remain high, and to further reduce readmissions for asthma there is a need to identify factors related to presentation for asthma at accident and emergency departments.Mccaul, Kieran A. ; Wakefield, Melanie A. ; Roder, David M. ; Ruffin, Richard E. ; Heard, Adrian R. ; Alpers, John H. ; Staugas, Rima E.http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&uid=10738474&cmd=showdetailview&indexed=googl

Association between parental perception of children's vulnerability to illness and management of children's asthma

This study examined the relationship between asthma management strategies used by parents and parental perception of children's vulnerability to illness. Home interviews were conducted with 101 parents of children previously hospitalized with asthma. The child vulnerability scale (CVS) was employed to assess parents' perception of their children's vulnerability to illness. The asthma severity index (ASI) was used to measure the frequency and intensity of asthma symptoms experienced by children in the preceding 12 months. Five markers of parental asthma management were assessed: (i) school absences; (ii) visits to the general practitioner (GP); (iii) visits to the emergency room (ER); (iv) hospitalizations; and (v) whether children are using a regular preventer. After controlling for the frequency and intensity of children's asthma symptoms, parents who perceived that their children were more vulnerable to medical illness were significantly more likely to keep their children home from school (P = 0.01), were more likely to take their children to the GP for acute asthma care (P = 0.02), and were more likely to be giving their children regular preventer medication (P = 0.02). In contrast, the use of tertiary pediatric care services was not significantly associated with parental perceptions of their children's vulnerability. The results suggest that parental attitudes and beliefs about the vulnerability of their children to illness were associated with greater use of GP services by parents and more frequent school absences for children. The use of hospital services by parents appeared to be more strongly associated with the actual level of children's asthma symptoms than their vulnerability to illness

Late presentation of upper airway obstruction in Pierre Robin sequence

A retrospective review was carried out of 11 consecutive patients with the Pierre Robin sequence referred to a tertiary paediatric referral centre over a five year period from 1993 to 1998. Ten patients were diagnosed with significant upper airway obstruction; seven of these presented late at between 24 and 51 days of age. Failure to thrive occured in six of these seven infants at the time of presentation, and was a strong indicator of the severity of upper airway obstruction. Growth normalised on treatment of the upper airway obstruction with nasopharyngeal tube placement. All children had been reviewed by either an experienced general paediatrician or a neonatologist in the first week of life, suggesting that clinical signs alone are insufficent to alert the physician to the degree of upper airway obstruction or that obstruction developed gradually after discharge home. The use of polysomnography greatly improved the diagnostic accuracy in assesssing the severity of upper airway obstruction and monitoring the response to treatment. This report highlights the prevalence of late presentation of upper airway obstruction in the Pierre Robin sequence and emphasises the need for close prospective respiratory monitoring in this condition. Objective measures such as polysomnography should be used, as clinical signs alone may be an inadequate guide to the degree of upper airway obstruction.


Effects of birthweight and oxygen supplementation on lung function in late childhood in children of very low birth weight

The definitive version may be found at www.wiley.comImpaired respiratory function has been found frequently in ex-premature children, but it is unclear which specific factors influence this impairment the most. The aim of this study was to determine the importance of the contributions of birth weight, gestational age, neonatal respiratory disease, and its treatment on subsequent childhood lung function at age 11 years in a cohort of children of very low birth weight (VLBW; 2,000 g) of similar age. VLBW children were shorter and lighter than controls (P < 0.0001) at 11 years of age, and had reduced expiratory flows (P < 0.00001) and forced vital capacities (P < 0.001). The residual volume to total lung capacity ratio (RV/TLC ratio) was increased (P < 0.00001), while total lung capacity (TLC) remained unchanged. Those with bronchopulmonary dysplasia (BPD) had the lowest mean expiratory flows. Males had lower expiratory flows than females. On univariate analysis, gestational age by itself accounted for 8.8% of the explained variance in FEV(1) at 11 years of age, but birth weight accounted for 16% on its own; both together accounted for a further 0.2% (16.2%), suggesting that the latter was the dominant factor. On multivariate analysis, the contribution of birth weight and gestational age was small, and the best predictors at 11 years of age, which together explained 43.4% of the total variance in FEV(1), were log days of supplemental oxygen (9.6%) and a reported history of asthma (10.8%). For FEF(25-75), these predictors explained 7.2% and 13.4%, respectively, of the total explained variance of 40.6%. The relation between neonatal oxygen supplementation and childhood FEV(1) was such that up to 20 days of supplemental oxygen had little effect on subsequent FEV(1) at 11 years of age, but each additional week of supplemental oxygen after that time was associated with a progressive reduction in FEV(1) of 3%. These data confirm the significant role of supplemental oxygen in the neonatal period and a history of asthma on the subsequent reduction of expiratory flows in VLBW children. Birth weight was a more important prenatal factor than gestational age, but both were of lesser predictive significance than either supplemental oxygen or a reported history of asthma.J. Declan Kennedy, Lisa J. Edward, David J. Bates, A. James Martin, Silvia Nobbs, Ross R. Haslam, Andrew J. McPhee, Rima E. Staugas, Peter Baghurs

Health-service use by children with asthma over a 6-month period

The definitive version is available at www.blackwell-synergy.comOBJECTIVES: The present study aims to describe the use of health services by children with asthma, and examine disease-specific, parental and sociodemographic variables associated with different levels of health-service utilization. METHODS: Parents of 135 children attending an emergency room (ER) completed questionnaires measuring the children's asthma symptoms, and sociodemographic and psychological variables. Parents were contacted monthly for 6 months to document the number of planned and unplanned visits to hospital and community health-care services for asthma. RESULTS: At least one further unplanned visit to the ER was made by 37% of children, while 62% made at least one unplanned visit to a general practitioner (GP). Fifty-five per cent made planned review visits to a GP, 30% to paediatricians and 5% to hospital clinics. After controlling for the level of asthma symptoms, parental anxiety and parental perceptions of children's vulnerability were associated with unplanned GP visits (P = 0.05 and P = 0.01, respectively); a planned review visit and the child being admitted to hospital for the index attack were associated with unplanned ER visits (P = 0.05 and P = 0.004, respectively). CONCLUSIONS: Children with asthma more frequently attend GP services than hospital services for both planned and unplanned asthma management. Different variables predict the unplanned use of GP and ER services. Understanding these differences is imperative if children and families are to make the most effective use of health services.N.J. Spurrier, R. Staugas, M.G. Sawyer, M.A. Wakefield, R.E. Ruffin, J. Jureidini, F. Arney and P. Baghurs