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Teoh L, Chatfield MD, Acworth JP, McCallum GB, Chang AB. How Does the Canadian Acute Respiratory Illness and Flu Scale Relate to Other Scales in Pediatric Asthma Exacerbations? J Asthma 2021; 59:1590-1596. [PMID: 34156320 DOI: 10.1080/02770903.2021.1946823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objectives: In children with asthma exacerbations, we evaluated the relationship between Canadian Acute Respiratory Illness and Flu Scale (CARIFS) scores and (a) Asthma Diary Scale (ADS) scores for 14 days; (b) Pediatric Asthma Caregiver's Quality of Life (QoL) Questionnaire (PACQLQ) scores on days 1, 7 and 14; (c) viral detection. We hypothesized that in children with acute asthma, CARIFS scores correlate with ADS and PACQLQ scores over time and that viruses have little impact on CARIFS scores.Methods: In children aged 2-16 years who presented with acute asthma to the Emergency Departments of 2 hospitals, we documented the clinical history, examination, asthma severity at baseline and on presentation. Eighteen respiratory pathogens were determined by PCR on nasopharyngeal aspirate (NPA) collected on recruitment. The parent(s) recorded their child's daily CARIFS and ADS and weekly PACQLQ for 14 days. We used Spearman's correlation to relate the scores of 108 children.Results: CARIFS scores correlated well with ADS scores throughout 14 days (rs ranged 0.30-0.67). CARIFS and PACQLQ scores correlated -0.28, -0.14 and -0.44 on days 1, 7 and 14 respectively. There was no significant difference in CARIFS scores between children whose NPAs were PCR virus-positive or -negative over 14 days.Conclusions: CARIFS and ADS scores correlated well as a disease severity measure during the recovery period in children with acute asthma and this was not influenced by the virus state. The ADS may be used as an alternative in selected situations. The CARIFS reflects different aspects to acute asthma severity and QoL.
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Affiliation(s)
- Laurel Teoh
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark D Chatfield
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Jason P Acworth
- Emergency Medicine Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Gabrielle B McCallum
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Anne B Chang
- Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.,Department of Respiratory and Sleep Medicine, Queensland Children's Hospital and Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia
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Gjengstø Hunderi JO, Lødrup Carlsen KC, Rolfsjord LB, Carlsen K, Mowinckel P, Skjerven HO. Parental severity assessment predicts supportive care in infant bronchiolitis. Acta Paediatr 2019; 108:131-137. [PMID: 29889987 DOI: 10.1111/apa.14443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 05/14/2018] [Accepted: 06/07/2018] [Indexed: 11/25/2022]
Abstract
AIM In infants with acute bronchiolitis, the precision of parental disease severity assessment is unclear. We aimed to determine if parental assessment at the time of hospitalisation predicted the use of supportive care, and subsequently determine the likelihood that the infant with acute bronchiolitis would receive supportive care. METHODS From the Bronchiolitis ALL south-east Norway study, we included all 267, 0-12 month old, infants with acute bronchiolitis whose parents at the time of hospitalisation completed a three-item visual analogue scale (VAS) concerning Activity, Feeding and Illness. Respiratory rate, oxygen saturation (SpO2 ) and use of supportive care were recorded daily. By multivariate logistic regression analyses we included significant predictors available at hospital admission to predict the use of supportive care. RESULTS The parental Activity, Feeding and Illness VAS scores significantly predicted supportive care with odds ratios of 1.23, 1.26 and 1.36, respectively. The prediction algorithm included parental Feeding and Illness scores, SpO2 , gender and age, with an area under the curve of 0.76 (95% CI 0.69, 0.81). A positive likelihood ratio of 2.1 gave the highest combined sensitivity of 81% and specificity of 61%. CONCLUSION Parental assessment at hospital admission moderately predicted supportive care treatment in infants with acute bronchiolitis.
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Affiliation(s)
- Jon Olav Gjengstø Hunderi
- Department of Pediatrics and Adolescent Medicine Østfold Hospital Trust Sarpsborg Norway
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Karin C. Lødrup Carlsen
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Leif Bjarte Rolfsjord
- Institute of Clinical Medicine University of Oslo Oslo Norway
- Department of Pediatrics Innlandet Hospital Trust Elverum Norway
| | - Kai‐Håkon Carlsen
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Petter Mowinckel
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
| | - Håvard Ove Skjerven
- Division of Pediatric and Adolescent Medicine Oslo University Hospital Oslo Norway
- Institute of Clinical Medicine University of Oslo Oslo Norway
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Su G, Chen X, Liu Z, Yang L, Zhang L, Stålsby Lundborg C, Wen Z, Guo X, Qin X, Liang J, Liu X. Oral Astragalus (Huang qi) for preventing frequent episodes of acute respiratory tract infection in children. Cochrane Database Syst Rev 2016; 12:CD011958. [PMID: 27905672 PMCID: PMC6463872 DOI: 10.1002/14651858.cd011958.pub2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Acute respiratory tract infections (ARTIs) are common in children and can involve both upper and lower airways. Many children experience frequent ARTI episodes or recurrent respiratory tract infections (RRTIs) in early life, which creates challenges for paediatricians, primary care physicians, parents and carers of children.In China, Astragalus (Huang qi), alone or in combination with other herbs, is used by Traditional Chinese Medicine (TCM) practitioners in the form of a water extract, to reduce the risk of ARTIs; it is believed to stimulate the immune system. Better understanding of the therapeutic mechanisms of Astragalus may provide insights into ARTI prevention, and consequently reduced antibiotic use. OBJECTIVES To assess the effectiveness and safety of oral Astragalus for preventing frequent episodes of acute respiratory tract infections (ARTIs) in children in community settings. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Issue 12, 2015), MEDLINE (Ovid) (1946 to 31 December 2015), Embase (Elsevier) (1974 to 31 December 2015), AMED (Ovid) (1985 to 31 December 2015), Chinese National Knowledge Infrastructure (CNKI) (1979 to 31 December 2015) and Chinese Scientific Journals full text database (CQVIP) (1989 to 31 December 2015), China Biology Medicine disc (CBM 1976 to 31 December 2015) and Wanfang Data Knowledge Service Platform (WanFang) (1998 to 31 December 2015). SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing oral Astragalus as a sole Chinese herbal preparation with placebo to prevent frequent episodes of ARTIs in children. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures for this review. We assessed search results to identify relevant studies. We planned to extract data using standardised forms. Disagreements were to be resolved through discussion. Risk of bias was to be assessed using the Cochrane 'Risk of bias' tool. We planned to use mean difference (MD) or standardised mean difference (SMD) for continuous data and risk ratio (RR) or odds ratio (OR) to analyse dichotomous data, both with 95% confidence intervals (CIs). MAIN RESULTS We identified 6080 records: 3352 from English language databases, 2724 from Chinese databases, and four from other sources. Following initial screening and deduplication, we obtained 120 full-text papers for assessment. Of these, 21 were not RCTs; 55 did not meet the inclusion criteria because: participants were aged over 14 years; definition was not included for recurrent or frequent episodes;Astragalus preparation was not an intervention; Astragalus preparation was in the formula but was not the sole agent; the Astragalus preparation was not administered orally; or Astragalus was used for treatment rather than prevention of ARTI. A further 44 studies were excluded because they were not placebo-controlled, although other inclusion criteria were fulfilled.No RCTs met our inclusion criteria. AUTHORS' CONCLUSIONS We found insufficient evidence to enable assessment of the effectiveness and safety of oral Astragalus as a sole intervention to prevent frequent ARTIs in children aged up to 14 years.
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Affiliation(s)
- Guobin Su
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
- Karolinska InstitutetGlobal Health ‐ Health Systems and Policy: Medicines, focusing antibiotics, Department of Public Health SciencesTomtebodavägen 18a, Widerströmska HusetStockholmStockholmSweden171 77
| | - Xiankun Chen
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineKey Unit of Methodology in Clinical ResearchGuangzhouGuangdongChina
| | - Zhuangzhu Liu
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
- Guangdong Provincial Hospital of Chinese MedicineEmergency DepartmentNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Lihong Yang
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineEvidence‐Based Medicine and Clinical Research Service GroupNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - La Zhang
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
| | - Cecilia Stålsby Lundborg
- Karolinska InstitutetGlobal Health ‐ Health Systems and Policy: Medicines, focusing antibiotics, Department of Public Health SciencesTomtebodavägen 18a, Widerströmska HusetStockholmStockholmSweden171 77
| | - Zehuai Wen
- Guangdong Provincial Hospital of Chinese MedicineKey Unit of Methodology in Clinical ResearchNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Xinfeng Guo
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineEvidence‐Based Medicine and Clinical Research Service GroupNo 111 Dade RoadGuangzhouGuangdongChina510120
| | - Xindong Qin
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
| | - Jueyao Liang
- Guangzhou University of Chinese MedicineThe Second Clinical CollegeNo 12 Jichang RoadGuangzhouGuangdongChina510120
| | - Xusheng Liu
- Guangdong Provincial Hospital of Chinese Medicine, the Second Affiliated Hospital, Guangzhou University of Chinese MedicineDepartment of NephrologyNo 111 Dade RoadYue Xiu DistrictGuangzhouGuangdong ProvinceChina510120
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Zoch B, Karch A, Dreesman J, Monazahian M, Baillot A, Mikolajczyk RT. Feasibility of a birth cohort study dedicated to assessing acute infections using symptom diaries and parental collection of biomaterials. BMC Infect Dis 2015; 15:436. [PMID: 26493700 PMCID: PMC4618955 DOI: 10.1186/s12879-015-1189-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 10/07/2015] [Indexed: 11/23/2022] Open
Abstract
Background A birth cohort dedicated to studying infections in early childhood may be assisted by parental recording of symptoms on a daily basis and a collection of biomaterials. We aimed at testing the feasibility of this approach for use in a long-term study focusing on infections in children in Germany. Methods Parents of 1- to 3-year-old children (n = 75) were recruited in nursery schools. They were asked to complete a symptom diary on a daily basis and to take monthly and symptom-triggered nasal swabs and stool samples from their child over the study period of three months. Feasibility was measured by means of the return proportions of symptom diaries and bio samples; acceptance was assessed by a questionnaire delivered to participants at the end of the study. Results The majority of the participants filled in the symptom diary during the three months study for 75 or more days (77.3 %), and provided the monthly nasal swabs (62.7 %) and stool samples (65.3 %). The time needed for the tasks was acceptable for most participants (symptom diary: 92.3 %, nasal swabs: 98.5 %, stool samples: 100.0 %). In 64.3 % of the symptom-triggered nasal swabs, respiratory viruses were found compared to 55.5 % in throat swabs taken by health-care professionals within the “ARE surveillance Lower Saxony”, a special project by the Governmental Institute of Public Health of Lower Saxony to investigate causal pathogens for acute respiratory infections in children. Conclusions The parental assessment of symptoms and collection of biomaterials in a birth cohort dedicated to studying infections appears feasible in a middle class German population. The success of the study will depend on the ability to maintain these activities over a long time period. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1189-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Beate Zoch
- ESME - Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,PhD Programme "Epidemiology", Braunschweig-Hannover, Braunschweig, Germany.
| | - André Karch
- ESME - Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,PhD Programme "Epidemiology", Braunschweig-Hannover, Braunschweig, Germany. .,German Centre for Infection Research (DZIF), Hannover-Braunschweig site, Braunschweig, Germany.
| | - Johannes Dreesman
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany.
| | - Masyar Monazahian
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany.
| | - Armin Baillot
- Governmental Institute of Public Health of Lower Saxony, Hannover, Germany.
| | - Rafael T Mikolajczyk
- ESME - Research Group Epidemiological and Statistical Methods, Helmholtz Centre for Infection Research, Inhoffenstr. 7, 38124, Braunschweig, Germany. .,German Centre for Infection Research (DZIF), Hannover-Braunschweig site, Braunschweig, Germany. .,Hannover Medical School (MHH), Hannover, Germany.
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Nathan AM, Zaki R, Rozario R, Dhania N, Mohd Hamirudin SNS, Eg KP, Kee SY, Teh C, Jabar KA, Westerhout C, Thavagnanam S, de Bruyne J. Cross cultural translation, adaptation and reliability of the Malay version of the Canadian Acute Respiratory Illness and Flu Scale (CARIFS). Health Qual Life Outcomes 2015; 13:139. [PMID: 26338016 PMCID: PMC4559942 DOI: 10.1186/s12955-015-0336-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 08/26/2015] [Indexed: 05/28/2023] Open
Abstract
Background The Canadian Acute Respiratory Illness and Flu Scale (CARIFS) is a parent-proxy questionnaire that assesses severity of acute respiratory infections in children. The aim was to (a) perform a cross-cultural adaptation and (b) prove that the Malay CARIFS is a reliable tool. Findings The CARIFS underwent forward and backward translations as recommended by international guidelines. A pilot study was performed on the harmonised version and the final version of the Malay version of CARIFS was produced. A test-retest, 1 h apart, was then performed on parents with children less than 13 years old, admitted with a respiratory tract infection. Parents of children with asthma and who were not eloquent in Malay, were excluded. The data was analysed for consistency (Cronbach’s alpha) and reliability (test-retest co-efficient). Thirty-three parents were recruited. Children were aged median (IQR) 6 (2.8, 13.3) months with a male: female ratio of 22:11 and 88 % were Malays. Parents were interviewed at median (IQR) 6 (3, 11.5) days of admission. The Cronbach’s α coefficient was 0.70 for all items. The test–retest reliability analysis had a minimum and maximum intraclass correlation coefficient of 0.63 and 0.97 respectively. Clinically, the longer patients were admitted, the lower the severity score (r = −0.35, p < 0.05), indicating that they were getting better. Conclusion The Malay version of CARIFS is a valid and reliable tool to determine severity of respiratory illness in children. Parent-centred questionnaires are useful and should be an adjunct to other methods, in monitoring response to treatment. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0336-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna Marie Nathan
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia. .,University Malaya Paediatric and Child Health Research Group, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rafdzah Zaki
- Department of Social & Preventive Medicine, Faculty of Medicine, Julius Centre University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Rachael Rozario
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Nurul Dhania
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | | | - Kah Peng Eg
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia. .,University Malaya Paediatric and Child Health Research Group, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Sze Ying Kee
- Department of Paediatrics, University Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
| | - Cindy Teh
- Department of Microbiology, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Kartini Abdul Jabar
- Department of Microbiology, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Caroline Westerhout
- Department of Biomedical Imaging, University Malaya Medical Centre, 50603, Kuala Lumpur, Malaysia.
| | - Surendran Thavagnanam
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia. .,University Malaya Paediatric and Child Health Research Group, University Malaya, 50603, Kuala Lumpur, Malaysia.
| | - Jessie de Bruyne
- Department of Paediatrics, University Malaya, 50603, Kuala Lumpur, Malaysia. .,University Malaya Paediatric and Child Health Research Group, University Malaya, 50603, Kuala Lumpur, Malaysia.
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Fischer JB, Prasad PA, Coffin SE, Alpern ER, Mistry RD. Canadian Acute Respiratory Illness and Flu Scale (CARIFS) for clinical detection of influenza in children. Clin Pediatr (Phila) 2014; 53:1174-80. [PMID: 25009116 DOI: 10.1177/0009922814542608] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Validated clinical scales, such as the Canadian Acute Respiratory Illness and Flu Scale (CARIFS), have not been used to differentiate influenza (FLU) from other respiratory viruses. METHODS Secondary analysis of a prospective cohort presenting to the emergency department (ED) with an influenza-like infection from 2008 to 2010. Subjects were children aged 0 to 19 years who had a venipuncture and respiratory virus polymerase chain reaction. Demographics and CARIFS items were assessed during the ED visit; comparisons were made between FLU and non-FLU subjects. RESULTS The 203 subjects had median age 30.5 months; 61.6% were male. Comorbid conditions (51.2%) were common. FLU was identified in 26.6%, and were older than non-FLU patients (69.7 vs 47.9 months, P = .02). Demographic, household factors, and mean CARIFS score did not differ between FLU (33.7), and non-FLU (32.0) (mean difference 1.6, 95% CI: -2.0 to 5.2) groups. CONCLUSIONS CARIFS cannot discriminate between FLU and non-FLU infection in ED children with influenza-like infection.
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Affiliation(s)
| | - Priya A Prasad
- Department of Epidemiology at University of California, San Francisco, CA, USA
| | - Susan E Coffin
- Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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Longmier E, Barrett B, Brown R. Can patients or clinicians predict the severity or duration of an acute upper respiratory infection? Fam Pract 2013; 30:379-85. [PMID: 23515376 PMCID: PMC3722504 DOI: 10.1093/fampra/cmt006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Acute upper respiratory infections (URI) are the second most common diagnosis in primary care offices. As treatments have limited effectiveness, patient counseling regarding expectations for the course of the URI is an important aspect of care. It is unknown how accurate patients, clinicians or questionnaires such as the Wisconsin Upper Respiratory Symptom Survey (WURSS) instrument are at predicting URI severity and duration, and whether these predictions should be used to counsel patients. METHODS Seven hundred and nineteen individuals with recent onset cold in community clinic settings participated. Participants and clinicians predicted the severity and duration of the URI and participants completed the WURSS instrument at initial visit. Subsequent URI global severity was calculated as area under the curve using an average of twice-daily WURSS-21 self-reports as the y-axis and illness duration as the x-axis. URI duration was determined by self-report of beginning and end of illness. Linear regression analysis was used to correlate baseline predictions with subsequent outcomes. Analyses by gender, age and income were also performed. RESULTS There was no significant association between participant and clinician predictions of severity or duration. Initial WURSS values explained 0.119 (95% CI: 0.074-0.163) of the variance in subsequent severity outcomes. There were no significant differences in associations by age, gender or income. CONCLUSIONS Clinicians should not use their predictive assessments or their patients' predictions when advising patients on the expected course of a URI. This study also suggests that the WURSS instrument could give some predictive information, but whether this is clinically useful is uncertain.
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Affiliation(s)
- E Longmier
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, Alumni Hall, 1100 Delaplaine ct, Madison, WI 53715, USA.
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Akmatov MK, Krebs S, Preusse M, Gatzemeier A, Frischmann U, Schughart K, Pessler F. E-mail-based symptomatic surveillance combined with self-collection of nasal swabs: a new tool for acute respiratory infection epidemiology. Int J Infect Dis 2011; 15:e799-803. [PMID: 21852171 PMCID: PMC7110865 DOI: 10.1016/j.ijid.2011.07.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Revised: 07/13/2011] [Accepted: 07/19/2011] [Indexed: 12/04/2022] Open
Abstract
Objective We examined the feasibility of combining communication by e-mail and self-collection of nasal swabs for the prospective detection of acute respiratory infections in a non-medical setting. Methods The study was conducted among a convenience sample of employees (n = 53) at a research institution (December 2009–April 2010). Real-time data on the occurrence of acute respiratory symptoms and a nasal self-swab were collected prospectively, with automated weekly e-mails as a reminder mechanism. Reverse transcription polymerase chain reaction (RT-PCR) was used to detect respiratory viral pathogens in the swabs. Results Fifty-one out of 53 participants completed the study. The study design was well accepted. Thirty (∼57%) participants reported at least one episode of acute respiratory infection and returned the nasal swab during the study period (eight participants reported two episodes). The majority had no difficulties taking the self-swab and preferred this to swabbing by study personnel. Most participants obtained and returned the swabs within the recommended time. Viral respiratory pathogens were detected in 19 of 38 swabs (50%), with coronaviruses 229E/NL63 and OC43 and rhinoviruses A and B constituting 17 positive swabs (89%). Conclusions Combining e-mail-based symptomatic surveillance with nasal self-swabbing promises to be a powerful tool for the real-time identification of incident cases of acute respiratory infections and the associated pathogens in population-based studies.
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Affiliation(s)
- Manas K Akmatov
- Department of Infection Genetics, Helmholtz Centre for Infection Research, Inhoffenstrasse 7, 38124 Braunschweig, Germany.
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Osborne RH, Norquist JM, Elsworth GR, Busija L, Mehta V, Herring T, Gupta SB. Development and validation of the Influenza Intensity and Impact Questionnaire (FluiiQ™). VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2011; 14:687-699. [PMID: 21839407 DOI: 10.1016/j.jval.2010.12.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/25/2010] [Accepted: 12/16/2010] [Indexed: 05/31/2023]
Abstract
OBJECTIVE Clinical trials of new agents to reduce the severity and impact of influenza require accurate assessment of the effect of influenza infection. Because there are limited high-quality adult influenza Patient Reported Outcomes (PRO) measures, the aim was to develop and validate a simple but comprehensive questionnaire for epidemiological research and clinical trials. METHODS Construct and item generation was guided by the literature, concept mapping, focus groups, and interviews with individuals with laboratory-confirmed influenza and expert physicians. Items were administered to 311 people with influenza-like illness (ILI) across 25 US sites. Analyses included classic psychometrics, structural equation modeling (SEM), and Rasch analyses. RESULTS Concept mapping generated 149 concepts covering the influenza experience and clustered into symptoms and impact on daily activities, emotions, and others. Items were drafted using simplicity and brevity criteria. Eleven symptoms from the literature underwent review by physicians and patients, and two were removed and one added. The symptoms domain factored into systemic and respiratory symptoms, whereas the impact domains were unidimensional. All domains displayed good internal consistency (Cronbach α ≥ 0.8) except the three-item respiratory domain (α = 0.48). A five-factor SEM indicated excellent fit where systemic, respiratory, and daily activities domains differentiated patients with ILI or confirmed influenza. All scales were responsive over time. CONCLUSIONS Patient and clinician consultations resulted in an influenza PRO measure with high validity and good overall evidence of reliability and responsiveness. The Influenza Intensity and Impact Questionnaire (FluiiQ™) will improve the evaluation of existing and future agents designed to prevent or control influenza infection by increasing the breadth and depth of measurement in this field.
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Affiliation(s)
- Richard H Osborne
- Public Health Innovation, Population Health Strategic Research Centre, Faculty of Health, Deakin University, Melbourne, Victoria, Australia.
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Ertmann RK, Siersma V, Reventlow S, Söderström M. Infants' symptoms of illness assessed by parents: impact and implications. Scand J Prim Health Care 2011; 29:67-74. [PMID: 21591836 PMCID: PMC3347950 DOI: 10.3109/02813432.2011.576863] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES. Some parents with a sick infant contact a doctor, while others do not. The reasons underlying such parental decisions have not been thoroughly studied. The purpose of this study was to explore how the actual symptoms in the infant were associated with parent-rated illness, illness severity, and the probability of the parents contacting a doctor. DESIGN. A retrospective questionnaire and a prospective diary study covering 14 months of the participating infants' lives. SETTING AND SUBJECTS. The 194 participating infants were followed for three months prospectively from the age of 11 to 14 months using diary cards, and retrospectively from birth until the age of 11 months by a questionnaire. RESULTS. During the three months of the diary card prospective follow-up, the infants had symptoms on average every second day, and the vast majority (92%) had 10 or more days with at least one symptom; 38% of the infants were reported to have had five or more symptoms for more than five days. Fever, earache, and vomiting were the symptoms most likely to cause parents to rate their infant as ill. Earache was the symptom that triggered doctor contact most immediately. The parent-rated illness severity was strongly related to the tendency to contact a doctor. However, this association was markedly weaker when adjustment was made for the infant not eating normally, having a cough, or running a fever. CONCLUSION. Specific symptoms such as fever, earache, and vomiting were strongly associated with the probability of parents rating the infant as ill. An earache would cause the parents to contact a doctor. Fever and vomiting were other symptoms triggering doctor contacts. First, these symptoms could cause the parents to want a doctor's expert evaluation of the infant's illness; second, the parents could expect medication to be necessary; or third, it could just be difficult for the parents to handle the ill infant.
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Affiliation(s)
- Ruth K Ertmann
- Department of General Practice and the Research Unit for General Practice in Copenhagen, University of Copenhagen, Denmark
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Petsky HL, Acworth JP, Clark R, Thearle DM, Masters IB, Chang AB. Asthma and protracted bronchitis: who fares better during an acute respiratory infection? J Paediatr Child Health 2009; 45:42-7. [PMID: 19208065 DOI: 10.1111/j.1440-1754.2008.01433.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM Acute respiratory infections (ARI) are common in children, and symptoms range from days to weeks. The aim of this study was to determine if children with asthma have more severe ARI episodes compared with children with protracted bronchitis and controls. METHODS Parents prospectively scored their child's next ARI using the Canadian acute respiratory illness and flu scale (CARIFS) and a validated cough diary (on days 1-7, 10 and 14 of illness). Children were age- and season-matched. RESULTS On days 10 and 14 of illness, children with protracted bronchitis had significantly higher median CARIFS when compared with children with asthma and healthy controls. On day 14, the median CARIFS were: asthma = 4.1 (interquartile range (IQR) 4.0), protracted bronchitis = 19.6 (IQR 25.8) and controls = 4.1 (IQR 5.25). The median cough score was significantly different between groups on days 1, 7, 10 and 14 (P < 0.001). A significantly higher proportion of children with protracted bronchitis (63%) were still coughing at day 14 in comparison with children with asthma (24%) and healthy controls (26%). CONCLUSION Children with protracted bronchitis had the most severe ARI symptoms and higher percentage of respiratory morbidity at day 14 in comparison with children with asthma and healthy controls.
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Affiliation(s)
- Helen L Petsky
- Department of Respiratory Medicine, Royal Children's Hospital, Queensland, Australia.
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Powell H, Smart J, Wood LG, Grissell T, Shafren DR, Hensley MJ, Gibson PG. Validity of the common cold questionnaire (CCQ) in asthma exacerbations. PLoS One 2008; 3:e1802. [PMID: 18350141 PMCID: PMC2266793 DOI: 10.1371/journal.pone.0001802] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2007] [Accepted: 11/19/2007] [Indexed: 12/26/2022] Open
Abstract
Background The common cold questionnaire (CCQ) is used to discriminate those with and without a viral infection. Its usefulness in people with acute asthma is unknown. Our aim was to assess the ability of the CCQ to detect viral infection and to monitor recovery during a viral induced asthma exacerbation and confirmed by virological testing. Methodology/Principal Findings We studied subjects (≥7 yrs) admitted to hospital with acute asthma and diagnosed as positive (n = 63), or negative to viral infection (n = 27) according to molecular and virological testing from respiratory samples. CCQ, asthma history and asthma control questionnaires were completed and repeated 4–6 weeks later. Sensitivity, specificity, and response to change of the CCQ were assessed by receiver operator curve (ROC) analysis and effect size calculation respectively. The CCQ did not discriminate between viral and non-viral infection for subjects with asthma (sensitivity = 76.2%; specificity = 29.6%). ROC analysis could not differentiate between positive or negative virus in subjects with asthma. The CCQ had a large response to change following recovery (effect size = 1.01). 39% of subjects recovering from viral exacerbation remained positive to virological testing at follow-up despite improvement in clinical symptoms. The CCQ reflected clinical improvement in these subjects, thus providing additional information to complement virological testing. Conclusions/Significance The CCQ is a useful instrument for monitoring response to viral infection in people with asthma. Reliable differentiation between viral and non-viral asthma exacerbations was not achieved with the CCQ and requires specific virological testing. When combined with virological testing, the CCQ should be a useful outcome measure for evaluating therapies in viral-induced asthma.
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Affiliation(s)
- Heather Powell
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Joanne Smart
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia
| | - Lisa G. Wood
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia
- School of Medical Practice and Population Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Terry Grissell
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia
- School of Medical Practice and Population Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Darren R. Shafren
- School of Medical Practice and Population Health, The University of Newcastle, Callaghan, New South Wales, Australia
- Picornaviral Research Unit, Royal Newcastle Hospital, Newcastle, New South Wales, Australia
| | - Michael J. Hensley
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia
- School of Medical Practice and Population Health, The University of Newcastle, Callaghan, New South Wales, Australia
| | - Peter G. Gibson
- Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton, New South Wales, Australia
- School of Medical Practice and Population Health, The University of Newcastle, Callaghan, New South Wales, Australia
- * E-mail:
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Masters IB, Zimmerman PV, Pandeya N, Petsky HL, Wilson SB, Chang AB. Quantified Tracheobronchomalacia Disorders and Their Clinical Profiles in Children. Chest 2008; 133:461-7. [DOI: 10.1378/chest.07-2283] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Harnden A, Perera R, Brueggemann AB, Mayon-White R, Crook DW, Thomson A, Mant D. Respiratory infections for which general practitioners consider prescribing an antibiotic: a prospective study. Arch Dis Child 2007; 92:594-7. [PMID: 17369279 PMCID: PMC2083765 DOI: 10.1136/adc.2007.116665] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To determine the viral aetiology of respiratory infections in children presenting to primary care with "more than a simple cold". DESIGN Observational study in 18 Oxfordshire general practices over four winters (2000-01 to 2003-04). PATIENTS 425 children aged 6 months to 12 years with cough and fever for whom general practitioners considered prescribing an antibiotic. METHODS Nasopharyngeal aspirate obtained from 408 (96%) children was subjected to PCR for respiratory viruses. Parents completed an illness diary for the duration of illness. RESULTS A viral cause of infection was detected in most (77%) children. Clinical symptoms correctly identified the infecting virus in 45% of cases. The duration of illness was short and the time course was very similar for all infecting viruses. One third of children were prescribed an antibiotic (34%), but this made no difference to the rate of parent-assessed recovery (Kruskal-Wallis, p = 0.67). About one in five children with influenza who did not receive an antibiotic had persistent fever on day 7 compared to no children receiving antibiotics (p = 0.02); this difference remained after adjustment for severity and other factors and was not seen with other viruses. CONCLUSIONS Most children receiving antibiotics for respiratory symptoms in general practice have an identifiable viral illness. In routine clinical practice, neither the specific infecting virus nor the use of antibiotics has a significant effect on the time course of illness. Antibiotics may reduce the duration of fever in children with influenza which could reflect an increased risk of secondary bacterial infection for such children.
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Affiliation(s)
- Anthony Harnden
- Department of Primary Health Care, University of Oxford, Oxford, UK.
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