To integrate new evidence into the Canadian Asthma Management Continuum diagram, encompassing both pediatric and adult asthma.
The Canadian Thoracic Society Asthma Committee members, comprised of experts in pediatric and adult respirology, allergy and immunology, emergency medicine, general pediatrics, family medicine, pharmacoepidemiology and evidence-based medicine, updated the continuum diagram, based primarily on the 2008 Global Initiative for Asthma guidelines, and performed a focused review of literature pertaining to key aspects of asthma diagnosis and management in children six years of age and over, and adults.
In patients six years of age and over, management of asthma begins with establishing an accurate diagnosis, typically by supplementing medical history with objective measures of lung function. All patients and caregivers should receive self-management education, including a written action plan. Inhaled corticosteroids (ICS) remain the first-line controller therapy for all ages. When asthma is not controlled with a low dose of ICS, the literature supports the addition of long-acting beta2-agonists in adults, while the preferred approach in children is to increase the dose of ICS. Leukotriene receptor antagonists are acceptable as second-line monotherapy and as an alternative add-on therapy in both age groups. Antiimmunoglobulin E therapy may be of benefit in adults, and in children 12 years of age and over with difficult to control allergic asthma, despite high-dose ICS and at least one other controller.
The foundation of asthma management is establishing an accurate diagnosis based on objective measures (eg, spirometry) in individuals six years of age and over. Emphasis is placed on the similarities and differences between pediatric and adult asthma management approaches to achieve asthma control.
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Allergic sensitization, an important risk factor for allergic diseases such as asthma and rhinitis, has increased worldwide. Almost half of the young adult population is sensitized to common airborne allergens. Parallel, the prevalence of asthma and clinical allergy also increased all over the world. Allergic diseases are the most common diseases among children, adolescents and young adults in Sweden. Among adults, 8-10% have asthma, 30% rhinitis and 11% eczema. Among children and adolescents around 5-8% report food allergy. Part of the increase in asthma prevalence is related to changes in diagnostic criteria and increased awareness in the population. The increase may have levelled off in some areas.
The study explores the long-term trends in socioeconomic differences in height among young adult men. We linked information from conscript inspections to a longitudinal demographic database of five parishes in Southern Sweden. Detailed information on the occupation and landholding was used to investigate the differences in height. Even if there is indication of a reduction in the magnitude of the differences in height over time the reduction is neither dramatic nor uniform. The most systematic and consistent difference is that sons of fathers with white collar occupations were taller than others. They were 4cm taller than the sons of low-skilled manual workers in the first half of the 19th century, and almost 2cm taller in the mid-20th century. This difference is much smaller than those found between elite and destitute groups historically, in for example Britain, but comparable to that found in other studies on 19th century populations using information on family background. Most of the reduction in the socioeconomic differences in height was a result of reduced height penalty and premium for small disadvantaged and privileged groups. Changes in the distribution of income and the economic structure are plausible explanations for the changes in socioeconomic differences in height.
Paediatric reference intervals based on samples from healthy children are difficult to establish and consequently data are often from hospitalized children. Furthermore, biases may present in published data due to differences in the analytical methods employed. Blood samples from 1429 healthy Danish children were collected for establishing reference intervals for 21 common biochemical properties (Alanine transaminase, Albumin, Alkaline phosphatase, Aspartate transaminase, Bilirubin, Calcium, Cholesterol, Creatinine, Creatine kinase, HDL-Cholesterol, Iron, Lactate dehydrogenase, LDL- Cholesterol, Magnesium, Phosphate, Potassium, Protein, Sodium, Transferrin, Triglycerides and Urate). Samples were analyzed on a Roche-Modular-P/ISE-system. The NORIP reference material (NFKK Reference Serum X) was included in all the analytical runs. Reference values were recalculated according to the target values of X for the properties and statistical calculations carried out as performed in the NORIP study. Thus commutable (regarding analytical method) reference intervals for 20 properties were established and for LDL-Cholesterol reference intervals were reported for the specific analytical method employed. The data were compared to previous studies and to those obtained from the youngest age group in the NORIP study. Marked age differences were observed for most of the properties. Several properties also showed gender-related differences, mainly at the onset of puberty. Data are presented as suggested intervals for combined age groups, but can be accessed via the NORIP home page if more detailed division according to age or gender is desired.
Drawing on identity development theory, the connection between engagement in sport and identity status was examined. First-year undergraduates (n = 116 sport-involved youth; 67% women; mean age = 18.58 yrs) completed measures of interpersonal and ideological identity status (achievement, moratorium, diffusion, foreclosure), along with behavioral (breadth, intensity) and psychological (e.g., enjoyment, competence) indicators of sport engagement. Using structural equation modeling, we examined the relation between latent sport engagement and identity status in interpersonal and ideological domains. As hypothesized, latent sport engagement predicted greater interpersonal (but not ideological) identity achievement. Consistent with identity development theory, an additional specific relation was observed between lower breadth of sport involvement and higher interpersonal identity achievement. Results demonstrate the value of examining behavioral and psychological indicators of sport engagement jointly, and support a growing body of research linking sport and positive youth development.
In the Dena'ina Athabascan language Yagheli Ch'tsizlan means
"we are getting healthier," and in many important ways this is true.
Although we face many challenges, the Alaska Native community has made great strides in health over the years. In this booklet we are highlighting some key Alaska Native health concerns. Addressing these concerns is an important step on the path towards getting healthier.
Websites and discussion forums have become an important and sometimes controversial source of information on suicide. Using a case report, our aim was to examine the responses, attitudes and beliefs that were communicated on a forum before, during and after a suicide act. We undertook two related analyses: a qualitative investigation of the messages that were posted before the suicide and a combined qualitative-quantitative analysis of the messages posted during and after the suicide. Nearly half the posted messages before the suicide encouraged the victim to complete the suicidal act, and a surprising number of posts after the suicide expressed excitement, although around half of the posts considered the suicide to be tragic. It is of great importance to increase awareness of suicide signals and understanding about how to respond to individuals who communicate suicide intentions on different forums on the internet.
The study determined the effect of seasons and meteorological variables on ovarian-menstrual function.
Women (N=129) living in Novosibirsk (55°N), Russia, provided data on normal menstrual cycles for over 1 year between 1999 and 2008. Of these, 18 together with 20 other healthy women were investigated once in winter and once in summer in 2006-2009. The investigated variables included serum levels of follicle-stimulating hormone (FSH), luteinising hormone (LH) and prolactin on day ~ 7 of the menstrual cycle, ovary follicle size (by ultrasound) on day ~ 12 and ovulation occurrence on subsequent days.
In summer vs. winter, there was a trend towards increased FSH secretion, significantly larger ovarian follicle size, higher frequency of ovulation (97% vs. 71%) and a shorter menstrual cycle (by 0.9 days). LH and prolactin levels did not change. In all seasons combined, increased sunshine (data derived from local meteorological records) 2-3 days before the presumed ovulation day (calculated from the mean menstrual cycle) led to a shorter cycle length. Air/perceived temperature, atmospheric pressure, moon phase/light were not significant predictors.
Ovarian activity is greater in summer vs. winter in women living in a continental climate at temperate latitudes; sunshine is a factor that influences menstrual cycle.