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Leru PM, Anton VF, Chovancova Z, Baros J, Socha K, Petkova V, Kurowski M. Evaluation of respiratory allergies burden and management in primary care and comparative analysis of health care data from Romania, Poland, Czech Republic and Bulgaria - preliminary study. ROMANIAN JOURNAL OF INTERNAL MEDICINE = REVUE ROUMAINE DE MEDECINE INTERNE 2024; 0:rjim-2024-0018. [PMID: 38656830 DOI: 10.2478/rjim-2024-0018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Respiratory allergies mostly allergic rhinitis and asthma represent an important and increasing public health problem and one of the priorities for the European health systems. There is an increasing public concern regarding the persistence and severity of allergic diseases and many difficulties of health systems in providing prompt specialized medical assistance. Our study aims to highlight the main results of the Alliance 4Life project focused on the evaluation of the burden and management of respiratory allergies in primary care from Romania and comparative health-related data from four Central and Eastern European countries. METHOD We developed a questionnaire focused on patients with allergic rhinitis and asthma directly addressed to general practitioner (GP) specialists from Romania who attended the annual national conference in Bucharest. RESULTS The main results showed that patients with respiratory allergies are frequently encountered in primary care practice, only a few patients are evaluated by allergists and there is a clear need for education in this field. CONCLUSIONS This preliminary study confirms that respiratory allergies represent a considerable burden in primary care and the questionnaire may be a useful tool in further studies considering the experience of other healthcare systems. More advanced studies integrating epidemiology with data on air pollution and environmental conditions should be envisaged.
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Affiliation(s)
- Polliana Mihaela Leru
- 1Clinical Department 5, Carol Davila University of Medicine and Pharmacy, 050474, Bucharest, Romania
- 2Allergology Department, Colentina Clinical Hospital, 020125, Bucharest, Romania
| | - Vlad Florin Anton
- 2Allergology Department, Colentina Clinical Hospital, 020125, Bucharest, Romania
| | - Zita Chovancova
- 3Department of Immunology and Allergy, St. Anne's University Hospital in Brno, Pekarska 53, 65691, Brno, Czechia
- 4Medical Faculty of Masaryk University, Kamenice 5, 62500, Brno, Czechia
| | - Jan Baros
- 3Department of Immunology and Allergy, St. Anne's University Hospital in Brno, Pekarska 53, 65691, Brno, Czechia
- 4Medical Faculty of Masaryk University, Kamenice 5, 62500, Brno, Czechia
| | - Konrad Socha
- 5Healthcare Systems Development Department, Medical University of Lodz, 90-419 Lodz, Poland
| | - Valentina Petkova
- 6Department of Organisation and Economics of Pharmacy, Medical University Sofia, 1431 Sofia, Bulgaria
| | - Marcin Kurowski
- 7Department of Immunology and Allergy, Medical University of Lodz, 90-419 Lodz, Poland
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Campo G, Tonet E. Should Cardiologists Be Concerned About Malnutrition in ACS Patients? JACC. ADVANCES 2023; 2:100633. [PMID: 38938359 PMCID: PMC11198555 DOI: 10.1016/j.jacadv.2023.100633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/29/2024]
Affiliation(s)
- Gianluca Campo
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, Cona, Ferrara, Italy
| | - Elisabetta Tonet
- Cardiology Unit, Azienda Ospedaliero Universitaria of Ferrara, Cona, Ferrara, Italy
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3
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Almousa H, Alsaad SM, Ismail D, Mahjoub S, Bin Obaid S, Alsaleh S. Allergic rhinitis guidelines knowledge, attitudes, and practices among primary health care physicians: A national multicentre cross-sectional study. J Family Med Prim Care 2023; 12:1202-1208. [PMID: 37636198 PMCID: PMC10451594 DOI: 10.4103/jfmpc.jfmpc_85_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/02/2023] [Accepted: 03/06/2023] [Indexed: 08/29/2023] Open
Abstract
Background Allergic rhinitis (AR) is considered one of the most common reasons for patients visiting primary health care clinics. Physicians' adherence to management guidelines for AR results in better patient outcomes. Therefore, the present study aimed to assess the knowledge, attitudes, and practices of primary health care practitioners (PHCPs) towards allergic rhinitis guidelines in Saudi Arabia. Methods This observational cross-sectional study conducted from August 2021 to November 2021 included 282 primary care physicians across all regions of Saudi Arabia. We used a two-part, validated, self-administered Perception Attitude and Practice of Primary Care Practitioners questionnaire. The first part was demographics, and the second part comprised three domains (perception, attitude, and practice) including 48 items. Statistical Package for the Social Sciences (SPSS), version 21 was used to analyze the data. Results Most of the 282 physicians were Saudis (79%). Allergic rhinitis and its impact on asthma (ARIA) guidelines were recognized by 71% of the physicians. Second-generation oral antihistamines were considered the safest drug by the majority (82%), followed by intranasal corticosteroids (75.2%). Most physicians diagnosed AR based on clinical history (95%), while (43%) utilized allergy testing. Intranasal corticosteroids were the most preferred treatment option (70%) followed by second-generation and first-generation oral antihistamines (66% and 55%, respectively). Conclusion Our study demonstrates the importance of education and awareness for PHCPs managing AR. ARIA guidelines should be implemented as a standard of care for AR, as PHCPs are the first ones to encounter patients with AR, to improve outcomes and avoid undertreatment and complications.
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Affiliation(s)
- Hisham Almousa
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saad M. Alsaad
- Family and Community Medicine Department, College of Medicine, King Saud University, Saudi Arabia
| | - Dawood Ismail
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saleh Mahjoub
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Saad Alsaleh
- Otolaryngology-Head and Neck Surgery Department, College of Medicine, King Saud University, Saudi Arabia
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4
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Gnasso R, Iommazzo I, Corbi G, Celi F, Iannicelli AM, Ferrara N, Ruosi C. Italian long-term care facilities during COVID-19 era: a review. JOURNAL OF GERONTOLOGY AND GERIATRICS 2022. [DOI: 10.36150/2499-6564-n365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Infections Are a Very Dangerous Affair: Enterobiasis and Death. Healthcare (Basel) 2021; 9:healthcare9121641. [PMID: 34946367 PMCID: PMC8701381 DOI: 10.3390/healthcare9121641] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 11/24/2021] [Accepted: 11/25/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Enterobiasis or oxyuriasis from Enterobius vermicularis is an infection usually localized in the large bowel and cecum. Generally, the symptoms are characterized by anal itching, and intestinal or nervous disorders. Rarely, it is responsible for death. METHODS A forensic autopsy of a 52-year-old white male inmate who died 5 days after hospitalization was performed. Histological and toxicological analyses were also performed. RESULTS The death occurred by localization of Enterobius vermicularis in the duodenum and in the proximal ileum, with intestinal haemorrhage, inflammation, and peritonitis documented by histological examination. CONCLUSION This is a common infectious disease, and can rarely occur with a fatal outcome, even in advanced populations. The lack of knowledge related to the rarity of death from enterobiasis disease can determine a dangerous concern.
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Mathioudakis AG, Tsilochristou O, Adcock IM, Bikov A, Bjermer L, Clini E, Flood B, Herth F, Horvath I, Kalayci O, Papadopoulos NG, Ryan D, Sanchez Garcia S, Correia-de-Sousa J, Tonia T, Pinnock H, Agache I, Janson C. ERS/EAACI statement on adherence to international adult asthma guidelines. Eur Respir Rev 2021; 30:30/161/210132. [PMID: 34526316 DOI: 10.1183/16000617.0132-2021] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Accepted: 06/26/2021] [Indexed: 12/20/2022] Open
Abstract
Guidelines aim to standardise and optimise asthma diagnosis and management. Nevertheless, adherence to guidelines is suboptimal and may vary across different healthcare professional (HCP) groups.Further to these concerns, this European Respiratory Society (ERS)/European Academy of Allergy and Clinical Immunology (EAACI) statement aims to: 1) evaluate the understanding of and adherence to international asthma guidelines by HCPs of different specialties via an international online survey; and 2) assess strategies focused at improving implementation of guideline-recommended interventions, and compare process and clinical outcomes in patients managed by HCPs of different specialties via systematic reviews.The online survey identified discrepancies between HCPs of different specialties which may be due to poor dissemination or lack of knowledge of the guidelines but also a reflection of the adaptations made in different clinical settings, based on available resources. The systematic reviews demonstrated that multifaceted quality improvement initiatives addressing multiple challenges to guidelines adherence are most effective in improving guidelines adherence. Differences in outcomes between patients managed by generalists or specialists should be further evaluated.Guidelines need to consider the heterogeneity of real-life settings for asthma management and tailor their recommendations accordingly. Continuous, multifaceted quality improvement processes are required to optimise and maintain guidelines adherence. Validated referral pathways for uncontrolled asthma or uncertain diagnosis are needed.
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Affiliation(s)
- Alexander G Mathioudakis
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK .,North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.,These authors were Task Force Co-chairs and are equal authors
| | - Olympia Tsilochristou
- Dept of Allergy, Guy's and St Thomas' Foundation Trust, London, UK.,Peter Gorer Dept of Immunobiology, King's College London, London, UK.,These authors were Task Force Co-chairs and are equal authors
| | - Ian M Adcock
- National Heart and Lung Institute, Imperial College London and the NIHR Imperial Biomedical Research Centre, London, UK
| | - Andras Bikov
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK.,North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Dept of Clinical Sciences, Lund University, Lund, Sweden
| | - Enrico Clini
- Dept of Medical Specialities, University Hospital of Modena, University of Modena-Reggio Emilia, Modena, Italy
| | - Breda Flood
- European Federation of Allergy and Airways Diseases Patients Association (EFA), Dublin, Ireland
| | - Felix Herth
- Dept of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg, University of Heidelberg, Heidelberg, Germany
| | - Ildiko Horvath
- National Koranyi Institute for Pulmonology, Budapest, Hungary.,Institute of Public Health, Semmelweis University, Budapest, Hungary
| | - Omer Kalayci
- Hacettepe University School of Medicine, Ankara, Turkey
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, University of Manchester, Manchester, UK.,Allergy Dept, Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece
| | - Dermot Ryan
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | | | - Jaime Correia-de-Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal.,ICVS/3B's - PT Government Associate Laboratory, Guimarães, Portugal
| | - Thomy Tonia
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hillary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Ioana Agache
- Allergy & Clinical Immunology, Transylvania University, Brasov, Romania.,These authors were Task Force Co-chairs and are equal authors
| | - Christer Janson
- Dept of Medical Science, Respiratory, Allergy and Sleep Research, Uppsala University and University Hospital, Uppsala, Sweden.,These authors were Task Force Co-chairs and are equal authors
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7
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Beridze V, Bakhtadze T, Beridze S, Phagava K, Chkhaidze I, Brożek GM, Zejda JE. Coexistence of asthmatic and non-respiratory allergic symptoms in children of Batumi Region, Georgia: occurrence and association with known diagnosis of asthma. Cent Eur J Public Health 2021; 29:23-27. [PMID: 33831283 DOI: 10.21101/cejph.a6143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 01/04/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Our recent studies showed that in children in the Batumi region, Georgia, underdiagnosis of asthma is 65%, and that not all children with known asthma had a history of allergic disorders. So, we decided to assess the association of known diagnosis of paediatric asthma with asthma-like symptoms and non-respiratory allergic symptoms and diseases using questionnaire-derived data provided by respiratory health survey. METHODS Subjects of the cross-sectional population-based study were 3,239 urban and 2,113 rural children aged 5-17 years whose respiratory status was assessed using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. For children with a known diagnosis of asthma, the occurrence of respiratory symptoms suggestive of asthmatic tendency and of allergic symptoms and diseases was measured and statistical association of known asthma with the respiratory and allergic symptoms was expressed as odds ratios (OR) and their 95% confidence intervals (95% CI). RESULTS Respiratory and all allergic symptoms and diseases, except for eczema, were statistically significantly (p < 0.05) more prevalent in children with asthma than in children without asthma. Based on the distribution of asthma vis-à-vis asthmatic tendency without or with allergic symptoms and allergic diseases the following odds ratios expressing likelihood of asthma were obtained: for asthmatic tendency: OR = 18.09 (95% CI: 11.82-27.68), for any allergic symptom: OR = 6.85 (95% CI: 4.69-10.02), for any allergic disease: OR = 10.75 (95% CI: 7.36-15.70), for asthmatic tendency with coexisting any allergic symptom: OR = 18.94 (95% CI: 12.96-27.68), for asthmatic tendency with coexisting any allergic disease: OR = 25.65 (95% CI: 17.47-37.67), and for asthmatic tendency with coexisting any allergic symptom and allergic disease: OR = 27.02 (95% CI: 18.18-40.15). CONCLUSIONS The findings support the view that in epidemiological setting questionnaire-based studies on asthma seems to more readily identify cases in children with more severe clinical presentation of the disease and with coexisting allergic disorders, perhaps reflecting diagnostic practices of consulting paediatricians.
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Affiliation(s)
- Vakhtang Beridze
- M. Iashvili Batumi Maternity and Child Central Hospital, Shota Rustaveli State University, Batumi, Georgia
| | - Tamar Bakhtadze
- M. Iashvili Batumi Maternity and Child Central Hospital, Shota Rustaveli State University, Batumi, Georgia
| | - Sophio Beridze
- M. Iashvili Batumi Maternity and Child Central Hospital, Shota Rustaveli State University, Batumi, Georgia
| | - Karaman Phagava
- Department of Paediatrics, Tbilisi State Medical University, Tbilisi, Georgia
| | | | - Grzegorz Marek Brożek
- Department of Epidemiology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Katowice, Poland
| | - Jan Eugeniusz Zejda
- Department of Epidemiology, Faculty of Medical Sciences, Medical University of Silesia in Katowice, Katowice, Poland
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8
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Abdullah B, Kandiah R, Hassan NFHN, Ismail AF, Mohammad ZW, Wang DY. Assessment of perception, attitude, and practice of primary care practitioners towards allergic rhinitis practice guidelines: Development and validation of a new questionnaire. World Allergy Organ J 2020; 13:100482. [PMID: 33294114 PMCID: PMC7689322 DOI: 10.1016/j.waojou.2020.100482] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 10/06/2020] [Accepted: 10/21/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Primary care practitioners (PCPs), being the front liners, play an important role in treating allergic rhinitis (AR). As there is no proper tool to assess their perception, attitude, and practice in utilizing the guidelines, we aimed to develop and validate a new questionnaire for such purpose. METHODS The development phase consists of both literature and expert panel review. The validation phase consists of content validity, face validity, and construct validity. Cronbach's alpha was used to verify internal consistency. The development phase produced a questionnaire with 3 domains: perception, attitude, and practice consisting of 60 items (PAP-PCP questionnaire). Item response theory analysis for perception demonstrated the difficulty and discrimination values were acceptable except for 3 items. Exploratory factor analysis for attitude and practice domains showed the psychometric properties were good except for 3 items in practice domain. Experts judgement was used to decide on the final selection of questionnaire which consists of 59 items. RESULTS The final validated questionnaire has 3 domains with 59 items. All domains had Cronbach's alpha above 0.65 which was reliable. 302 physicians completed the questionnaire. 98% PCPs diagnosed AR based on clinical history. Although, majority agree AR guidelines is useful (67%), they had difficulty in using it to classify AR (54.9%) and determine AR severity (73.9%). Oral anti-histamines (first and second generation) were the most prescribed (>75%) followed by intranasal corticosteroids (59%) and combined intranasal corticosteroid and oral anti-histamine (51%). Majority agreed that treatment efficacy (81.8%), adverse effects (83.8%), fear of adverse effects (73.5%), route of administration (69.4%), dosing frequency (72.5%), taste (64.6%) and cost (73.5%) affect treatment compliance. CONCLUSIONS The newly developed and validated questionnaire is a promising instrument in understanding the treatment gap in AR. Although further testing and refinement are needed, it provides an initial means for evaluating knowledge and understanding of PCPs in treating AR.
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Key Words
- 2-PL IRT, Two-parameter logistic item response theory
- ARIA, Allergic Rhinitis and its Impact on Asthma
- Allergic rhinitis guidelines
- Attitude
- CVI, Content Validity Index
- EAR, Allergic rhinitis
- EFA, exploratory factor analysis
- FVI, Face Validity Index
- GINA, Global Initiative for Asthma
- IgE, immunoglobulin
- KMO, Kaiser-Meyer-Olkin test
- ORL, Otorhinolaryngologist
- PCPs, Primary care practitioners
- Perception
- Practice
- Primary care practitioners
- S-CVI/Ave, Scale-level CVI of averaging calculation method
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Affiliation(s)
- Baharudin Abdullah
- Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Ramaprabah Kandiah
- Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Nik Fariza Husna Nik Hassan
- Department of Otorhinolaryngology- Head & Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Ahmad Filza Ismail
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - Zahiruddin Wan Mohammad
- Department of Community Medicine, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, 119228, Singapore
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Mollica M, Aronne L, Paoli G, Flora M, Mazzeo G, Tartaglione S, Polito R, Tranfa C, Ceparano M, Komici K, Mazzarella G, Iadevaia C. Elderly with COPD: comoborbitidies and systemic consequences. JOURNAL OF GERONTOLOGY AND GERIATRICS 2020. [DOI: 10.36150/2499-6564-434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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10
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Zejda JE, Beridze V, Bakhtadze T, Beridze S, Abuladze L, Partenadze N, Lawson J. Prevalence of and factors associated with underdiagnosis of pediatric asthma in Batumi, Georgia. Allergol Immunopathol (Madr) 2020; 48:73-77. [PMID: 31477393 DOI: 10.1016/j.aller.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 05/12/2019] [Accepted: 05/22/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE A recent survey in Batumi, Georgia showed a low prevalence of asthma in children (1.8%). A potential explanation is underdiagnosis of asthma. To investigate this, we conducted a follow up to the survey with the objective of estimating the level of childhood asthma underdiagnosis and to describe factors related to it. METHODS Subjects included 437 survey participants who had a history of asthma-like symptoms and no diagnosis of asthma. All children underwent clinical examination (spirometry, skin prick tests, FeNO measurement) to identify new cases of asthma. The distribution of host and environmental factors was compared between the group with newly identified asthma and a group of 59 children with previously known asthma (diagnosed asthma). RESULTS Clinical investigation identified 107 cases of undiagnosed asthma. The corrected asthma prevalence estimate was 5.1% (95%CI: 4.4%-5.9%) suggesting that 65% of asthma cases were undiagnosed. Compared to children with diagnosed asthma, children with undiagnosed asthma were younger (8.2±1.6 vs. 9.3±2.1; p=0.0005), had less frequent history of allergic disorders (38.3% vs. 64.4%; p=0.001), and a lower prevalence of parental asthma (1.8% vs. 8.4%; p=0.04). The groups did not differ in terms of environmental characteristics except for more exposure to passive smoking in the undiagnosed asthma group (p=0.01). Multivariate analysis confirmed results of simple analyses. CONCLUSION In Batumi, 65% of children with asthma remain undiagnosed. Older age of a child, coexisting allergic disorders, and parental asthma seem to facilitate diagnosis. Implementation of current diagnostic guidelines should improve diagnostic accuracy of pediatric asthma in Batumi.
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Affiliation(s)
- J E Zejda
- Department of Epidemiology, School of Medicine, Medical University of Silesia, Katowice, Poland.
| | - V Beridze
- Faculty of Natural Sciences and Health Care, Shota Rustaveli State University, Batumi, Georgia
| | - T Bakhtadze
- Faculty of Natural Sciences and Health Care, Shota Rustaveli State University, Batumi, Georgia
| | - S Beridze
- Faculty of Natural Sciences and Health Care, Shota Rustaveli State University, Batumi, Georgia
| | - L Abuladze
- Maternity and Child Health Center, Batumi, Georgia
| | - N Partenadze
- Maternity and Child Health Center, Batumi, Georgia
| | - J Lawson
- Canadian Centre for Health and Safety in Agriculture, College of Medicine, University of Saskatchewan, Saskatoon, Canada
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Impact of Malnutrition on Long-Term Mortality in Elderly Patients with Acute Myocardial Infarction. Nutrients 2019; 11:nu11020224. [PMID: 30678180 PMCID: PMC6412515 DOI: 10.3390/nu11020224] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/08/2019] [Accepted: 01/15/2019] [Indexed: 11/18/2022] Open
Abstract
Background: Malnutrition is a frequent condition in the elderly, and is associated with prolonged hospitalization and increased mortality. However, the impacts of malnutrition among elderly patients with acute myocardial infarction have not been clarified yet. Methods and Results: We enrolled 174 patients aged 65 years and over, admitted with the diagnosis of acute myocardial infarction (AMI), who underwent evaluation of nutritional status by Mini Nutritional Assessment (MNA) and evaluation of mortality risk by GRACE Score 2.0. All-cause mortality was the outcome considered for this study. Over a mean follow-up of 24.5 ± 18.2 months, 43 deaths have been registered (24.3%). Non-survivors were more likely to be older, with worse glomerular filtration rate, lower systolic blood pressure, lower albumin and MNA score, higher prevalence of Killip classification III-IV grade, and higher Troponin I levels. Multivariate Cox proportional analysis revealed that GRACE Score and MNA showed a significant and independent impact on mortality, (HR = 1.76, 95%, CI = 1.34–2.32, and HR = 0.56, 95% CI = 0.42–0.73, respectively). Moreover, the clinical decision curve revealed a higher clinical net benefit when the MNA was included, compared to the partial models without MNA. Conclusion: Nutritional status is an independent predictor of long-term mortality among elderly patients with AMI. MNA score in elderly patients with AMI may help prognostic stratification and identification of patients with, or at risk of, malnutrition in order to apply interventions to improve nutritional status, and maybe survival in this population.
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12
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Baiardini I, Novakova S, Mihaicuta S, Oguzulgen IK, Canonica GW. Adherence to treatment in allergic respiratory diseases. Expert Rev Respir Med 2018; 13:53-62. [PMID: 30518277 DOI: 10.1080/17476348.2019.1554438] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Introduction: Asthma and allergic rhinitis (AR) are chronic conditions in which management needs adherence to prescribed drugs. Despite the benefits of regular maintenance of asthma and AR therapy, low adherence is a frequent issue in clinical practice. Areas covered: The aim of this review is to provide a targeted analysis of the more recent literature on adherence in asthma and AR, focused on the following areas: adherence extent, barriers and consequences, effects of educational interventions and use of new technologies to improve the level of adherence. Expert commentary: Despite the extent, reasons and effects of this problem being well known, non-adherence in asthma and allergic AR remains worryingly high. Poor adherence leads to unsatisfactory health outcomes, with a negative impact on patients and society. Recent literature suggests that successful programs to improve adherence should include a combination of strategies. The new technologies represent a promising tool to improve adherence.
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Affiliation(s)
- Ilaria Baiardini
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy
| | - Silviya Novakova
- b Allergy Unit of Internal Consulting Department , University Hospital "St. George" , Plovdiv , Bulgaria
| | - Stefan Mihaicuta
- c Pulmonology Department, CardioPrevent Foundation , University of Medicine and Pharmacy "Dr Victor Babes" , Timisoara , Romania
| | | | - Giorgio Walter Canonica
- a Department of Biomedical Sciences , Humanitas University , Milano , Italy.,e Personalized Medicine, Asthma and Allergy Clinic , Humanitas Research Hospital, Milano, Italy
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13
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Spinozzi F, Murgia N, Baldacci S, Maio S, Pala AP, Casciari C, dell'Omo M, Viegi G. Characteristics and predictors of allergic rhinitis undertreatment in primary care. Int J Immunopathol Pharmacol 2015; 29:129-36. [PMID: 26680255 DOI: 10.1177/0394632015595779] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 06/17/2015] [Indexed: 01/11/2023] Open
Abstract
Although allergic rhinitis is considered a raising medical problem in many countries it is often undertreated. The reasons for this phenomenon are not completely clear.The aim of this study is to evaluate factors associated with allergic rhinitis under-/no treatment.A sample of 518 allergic rhinitis patients recruited by their primary care physicians, as a part of the ARGA study, were invited to fill in a specific questionnaire regarding rhinitis symptoms, treatment, and rhinitis-related work/social disability. Chi-square test and logistic regression were performed to assess risk factors for allergic rhinitis under-/no treatment.Over one out of four patients had no treatment despite the symptoms and 13.5% were inadequately treated. Participants with asthma (OR 0.47, 95% CI 0.30-0.75) and conjunctivitis (0.44, 95% CI 0.27-0.71) were at lower risk of allergic rhinitis under-/no treatment: in asthmatics this reduction was related mainly to the concomitant asthma treatment (OR 0.19, 95% CI 0.10-0.37).Asthmatics with under-/not treated rhinitis had the highest prevalence of rhinitis-related quality of life impairment.Under-/no treatment for allergic rhinitis is still rather frequent despite the relevance of this disease. The simultaneous presence of asthma and an anti-asthmatic therapy are able to influence positively the treatment. Targeted interventions toward a better characterization and a tight follow-up of rhinitis patient without asthma are needed.
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Affiliation(s)
- F Spinozzi
- Laboratory of Experimental Immunology and Allergy, Department of Medicine, University of Perugia, Piazzale Gambuli, 06100 Perugia, Italy
| | - N Murgia
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100 Perugia, Italy
| | - S Baldacci
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy
| | - S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy
| | - A P Pala
- Technosciences Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy
| | - C Casciari
- Laboratory of Experimental Immunology and Allergy, Department of Medicine, University of Perugia, Piazzale Gambuli, 06100 Perugia, Italy
| | - M dell'Omo
- Section of Occupational Medicine, Respiratory Diseases and Toxicology, University of Perugia, Piazzale Gambuli, 06100 Perugia, Italy
| | - G Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Via Trieste 41, 56126 Pisa, Italy CNR Institute of Biomedicine and Molecular Immunology "A. Monroy", Via Ugo La Malfa 153, 90146 Palermo, Italy
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Navarro-Locsin CG, Romualdez JA. Attitudes, practices on allergic rhinitis of generalists and specialists in Philippine National Capital Region. Asia Pac Allergy 2015; 5:203-9. [PMID: 26539402 PMCID: PMC4630458 DOI: 10.5415/apallergy.2015.5.4.203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2015] [Accepted: 10/11/2015] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Treatment of allergic rhinitis (AR) consistent with consensus guidelines is reported to result in better patient outcomes. However, physicians may manage patients independently of guidelines. Asian data on physician perspectives regarding AR diagnosis and management is limited. OBJECTIVE The study objective is to assess attitudes and practices on AR of Filipino specialists and generalists. METHODS A cross sectional survey of 100 specialists and 100 generalists was conducted from November 2014 to January 2015. A previously validated and pilot tested questionnaire was administered via structured face to face interviews. RESULTS Specialists reported greater adequate knowledge of AR (specialists, 58%; generalists, 39%) and adherence to guidelines (specialists, 84%; generalists, 54%). Diagnostic tests were not routinely used (specialists, 81%; generalists, 92%). Monotherapy, specifically antihistamines, was preferred for mild AR. For moderate-severe AR, preference for monotherapy versus combination therapy (specialists, 49% vs. 51%; generalists, 44% vs. 56%) was similar. Both groups preferred intranasal corticosteroid spray (INCS) for monotherapy and antileukotrienes, antihistamines, INCS for combination therapy. For adjuvant therapy, specialists (82%) preferred nasal irrigation/douche. Primary consideration for choice of therapy was efficacy. Cost was the perceived reason for patients' noncompliance with treatment. CONCLUSION Despite differences in awareness of and adherence to guidelines, prescribing patterns on management of mild and moderate-severe AR are similar among Filipino specialists and generalists. This can be attributed to a shared perception of efficacy and cost as drivers for therapeutic choices.
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Affiliation(s)
| | - Joel A Romualdez
- Department of Otolaryngology-Head & Neck Surgery, St. Luke's Medical Center, Quezon City 1112, Philippines
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15
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Combination treatment in asthma: Reviewing old and new options. Pulm Pharmacol Ther 2015; 34:72-4. [PMID: 26365488 DOI: 10.1016/j.pupt.2015.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 08/28/2015] [Accepted: 08/29/2015] [Indexed: 11/24/2022]
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16
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Sirtuin 1 and aging theory for chronic obstructive pulmonary disease. Anal Cell Pathol (Amst) 2015; 2015:897327. [PMID: 26236580 PMCID: PMC4506835 DOI: 10.1155/2015/897327] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Revised: 06/15/2015] [Accepted: 06/17/2015] [Indexed: 02/07/2023] Open
Abstract
Chronic Obstructive Pulmonary disease (COPD) is an inflammatory syndrome that represents an increasing health problem, especially in the elderly population. Drug therapies are symptomatic and inadequate to contrast disease progression and mortality. Thus, there is an urgent need to clarify the molecular mechanisms responsible for this condition in order to identify new biomarkers and therapeutic targets. Processes including oxidant/antioxidant, protease/antiprotease, and proliferative/antiproliferative balance and control of inflammatory response become dysfunctional during aging as well as in COPD. Recently it was suggested that Sirtuin 1 (SIRT1), an antiaging molecule involved in the response to oxidative stress and chronic inflammation, is implicated in both development and progression of COPD. The present review focuses on the involvement of SIRT1 in the regulation of redox state, inflammation, and premature senescence, all crucial characteristics of COPD phenotypes. Recent evidence corroborating the statement of the “aging theory for COPD” was also discussed.
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17
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Leru PM. Drug allergies in primary care practice in Romania: a questionnaire - based survey. Allergy Asthma Clin Immunol 2014; 10:16. [PMID: 24690448 PMCID: PMC4021609 DOI: 10.1186/1710-1492-10-16] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2013] [Accepted: 03/10/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Recent data from literature have shown many difficulties in managing allergic diseases in primary care in most countries and a consequently clear need for standardized educational programmes. Drug allergies represent an important medical issue for general practitioners (GPs) in Romania, though no national data about incidence, severity and management exist.The aim of our study was to evaluate epidemiological aspects of drug allergies in primary care practice in Bucharest, especially the diagnostic and therapeutic attitudes of family doctors and their need for education and training in this field of pathology. FINDINGS A questionnaire with 21specific questions was addressed to 800 family doctors from Bucharest, either directly or via internet, with a response rate of 31,87%.The answers showed a significant interest of GPs in drug allergies, which are considered an increasing pathology. Almost half of the responders had never attended any form of education in allergology and 96% expressed a clear interest to participate in specialized educational programmes. We have noticed an underestimation of the severity of drug allergy, a surprisingly high percentage of allergy skin tests or blood tests recommended by GPs without specialist advice, and persistant confidence in alternative medicine. CONCLUSIONS We concluded that the attitude towards and the competence regarding drug allergies of GPs in this study, as well as their collaboration with allergists, are not standardized and updated according to current guidelines. Further educational programs for GPs in drug allergies, based on standardized guidelines and national epidemiological studies for evaluation of drug allergy-related morbidity and mortality are needed.
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Ekerljung L, Bjerg A, Bossios A, Axelsson M, Torén K, Wennergren G, Lötvall J, Lundbäck B. Five-fold increase in use of inhaled corticosteroids over 18 years in the general adult population in west Sweden. Respir Med 2014; 108:685-93. [PMID: 24685491 DOI: 10.1016/j.rmed.2014.02.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 02/24/2014] [Accepted: 02/26/2014] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Asthma medication was increasingly used during the second part of the past century. There are few detailed data from population studies on use of asthma medication. The current study aimed to determine the use and determinants of asthma medication in West Sweden and to assess changes during the last two decades. METHODS From a random population sample participating in a survey on respiratory symptoms, 2000 individuals were randomly selected for clinical examinations and structured interviews, 1172 participated. All subjects reporting asthma (n = 1524) were also invited, and 834 participated. In total, 964 subjects with asthma participated. Asthma medication use was assessed in the general population and among two severity categories of asthma: multi-symptom asthma (MSA) and "other" asthma (having fewer symptoms). Current data, from 2010, was compared with data from 1992. RESULTS Asthma medication was used by 11% of the population, 4.4% used ICS with concurrent use of LABA, 3.3% used ICS without LABA, while 3.2% only used SABA. Compared with 1992, the prevalence of asthma medication use had increased with 54%, and use of ICS had increased from 1.5% to 7.7%. CONCLUSION Subjects with MSA reported using asthma medication more frequently and at higher doses, and a higher proportion used ICS.A shift in asthma medication use has occurred since 1992, with increased use of ICS and decreased use of SABA only, implying better asthma control on a population level. Multi-symptom asthma should alert the treating physician to consider under-medication and/or poor treatment adherence.
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Affiliation(s)
- Linda Ekerljung
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, SE 40530 Gothenburg, Sweden.
| | - Anders Bjerg
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, SE 40530 Gothenburg, Sweden
| | - Apostolos Bossios
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, SE 40530 Gothenburg, Sweden
| | - Malin Axelsson
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, SE 40530 Gothenburg, Sweden
| | - Kjell Torén
- Department of Environmental and Occupational Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 414, 40530 Gothenburg, Sweden
| | - Göran Wennergren
- Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Drottning Silvias Barn- och Ungdomssjukhus, 416 85 Gothenburg, Sweden
| | - Jan Lötvall
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, SE 40530 Gothenburg, Sweden
| | - Bo Lundbäck
- Krefting Research Centre, Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Box 424, SE 40530 Gothenburg, Sweden
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Cazzoletti L, Corsico AG, Albicini F, Di Vincenzo EMG, Gini E, Grosso A, Ronzoni V, Bugiani M, Pirina P, Cerveri I. The course of asthma in young adults: a population-based nine-year follow-up on asthma remission and control. PLoS One 2014; 9:e86956. [PMID: 24489813 PMCID: PMC3906087 DOI: 10.1371/journal.pone.0086956] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022] Open
Abstract
Background Only few longitudinal studies on the course of asthma among adults have been carried out. Objective The aim of the present prospective study, carried out between 2000 and 2009 in Italy, is to assess asthma remission and control in adults with asthma, as well as their determinants. Methods All the subjects with current asthma (21–47 years) identified in 2000 in the Italian Study on Asthma in Young Adults in 6 Italian centres were followed up. Asthma remission was assessed at follow-up in 2008–2009 (n = 214), asthma control at baseline and follow-up. Asthma remission and control were related to potential determinants by a binomial logistic and a multinomial logistic model. Separate models for remission were used for men and women. Results The estimate of the proportion of subjects who were in remission was 29.7% (95%CI: 14.4%;44.9%). Men who were not under control at baseline had a very low probability of being in remission at follow-up (OR = 0.06; 95%CI:0.01;0.33) when compared to women (OR = 0.40; 95%CI:0.17;0.94). The estimates of the proportion of subjects who were under control, partial control or who were not under control in our sample were 26.3% (95%CI: 21.2;31.3%), 51.6% (95%CI: 44.6;58.7%) and 22.1% (95%CI: 16.6;27.6%), respectively. Female gender, increasing age, the presence of chronic cough and phlegm and partial or absent asthma control at baseline increased the risk of uncontrolled asthma at follow-up. Conclusion Asthma remission was achieved in nearly 1/3 of the subjects with active asthma in the Italian adult population, whereas the proportion of the subjects with controlled asthma among the remaining subjects was still low.
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Affiliation(s)
- Lucia Cazzoletti
- Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy
- * E-mail:
| | | | - Federica Albicini
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Eti Maria Giulia Di Vincenzo
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Erica Gini
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Amelia Grosso
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | - Vanessa Ronzoni
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
| | | | - Pietro Pirina
- Institute of Respiratory Diseases, University of Sassari, Sassari, Italy
| | - Isa Cerveri
- Division of Respiratory Diseases, Istituto di Ricovero e Cura a Carattere Scientifico “San Matteo” Hospital Foundation, University of Pavia, Pavia, Italy
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Lee GB, Le TT. Training Pediatricians to Adhere to Asthma Guidelines. PEDIATRIC ALLERGY IMMUNOLOGY AND PULMONOLOGY 2013; 26:110-114. [DOI: 10.1089/ped.2013.0265] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Gerald B. Lee
- Section of Allergy and Immunology, Department of Pediatrics, University of Louisville School of Medicine, Louisville, Kentucky
| | - Tao T. Le
- Section of Allergy and Immunology, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky
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Agache I, Ryan D, Rodriguez MR, Yusuf O, Angier E, Jutel M. Allergy management in primary care across European countries -- actual status. Allergy 2013; 68:836-43. [PMID: 23735183 DOI: 10.1111/all.12150] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/15/2013] [Indexed: 11/29/2022]
Abstract
The standard of care for allergies within a primary care (PC) setting has a strong influence on disease prevention and control, quality of life, and patient satisfaction. The level of knowledge of allergic diseases and the accessibility to regular follow-up are essential. EAACI and IPCRG conducted a survey to evaluate the actual status of care for allergic diseases in PC. Access to allergy and asthma specialist treatment was identified as the greatest 'unmet need'. The average waiting time between a referral and being seen in a public health service is usually >6 weeks. Referring the patients to an 'organ' specialist is much easier compared with referral to an allergist. Most PCPs have access to blood tests for total and specific IgE. Skin prick testing is available in only half of the cases, while provocation tests, allergen quantification in homes, and a dietician service are even less available. 20.6% of practices do not have access to allergy tests at all. Other issues raised were low political or general public awareness, lack of understanding by the patients of their allergic disease, the need to invest in PC, and to achieve sufficient competence at the appropriate level of care.
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Affiliation(s)
- I. Agache
- Department of Allergy and Clinical Immunology; Faculty of Medicine; Transylvania University; Brasov; Romania
| | | | - M. R. Rodriguez
- Son Pisa Primary Care Health Centre; Palma de Mallorca; Spain
| | | | - E. Angier
- Department of Immunology and Allergy; Northern General Hospital; Sheffield; UK
| | - M. Jutel
- Department of Clinical Immunology; Wroclaw Medical University; Wroclaw; Poland
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Potential mechanisms linking atherosclerosis and increased cardiovascular risk in COPD: focus on Sirtuins. Int J Mol Sci 2013; 14:12696-713. [PMID: 23774840 PMCID: PMC3709808 DOI: 10.3390/ijms140612696] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Revised: 05/11/2013] [Accepted: 06/05/2013] [Indexed: 11/17/2022] Open
Abstract
The development of atherosclerosis is a multi-step process, at least in part controlled by the vascular endothelium function. Observations in humans and experimental models of atherosclerosis have identified monocyte recruitment as an early event in atherogenesis. Chronic inflammation is associated with ageing and its related diseases (e.g., atherosclerosis and chronic obstructive pulmonary disease). Recently it has been discovered that Sirtuins (NAD+-dependent deacetylases) represent a pivotal regulator of longevity and health. They appear to have a prominent role in vascular biology and regulate aspects of age-dependent atherosclerosis. Many studies demonstrate that SIRT1 exhibits anti-inflammatory properties in vitro (e.g., fatty acid-induced inflammation), in vivo (e.g., atherosclerosis, sustainment of normal immune function in knock-out mice) and in clinical studies (e.g., patients with chronic obstructive pulmonary disease). Because of a significant reduction of SIRT1 in rodent lungs exposed to cigarette smoke and in lungs of patients with chronic obstructive pulmonary disease (COPD), activation of SIRT1 may be a potential target for chronic obstructive pulmonary disease therapy. We review the inflammatory mechanisms involved in COPD-CVD coexistence and the potential role of SIRT1 in the regulation of these systems.
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Maio S, Simoni M, Baldacci S, Angino A, Martini F, Cerrai S, Sarno G, Silvi P, Borbotti M, Pala AP, Bresciani M, Paggiaro PL, Viegi G. The ARGA study with Italian general practitioners: prescriptions for allergic rhinitis and adherence to ARIA guidelines. Curr Med Res Opin 2012; 28:1743-51. [PMID: 22958052 DOI: 10.1185/03007995.2012.724393] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND General practitioners (GPs) are the healthcare professionals to whom patients with rhinitis firstly refer for their symptoms. OBJECTIVE In the present study, we assessed drug prescriptions for allergic rhinitis (AR) and evaluated prescriptive adherence to ARIA treatment guidelines. METHODS Data on 1379 AR patients were collected by 107 Italian GPs. Adherence to ARIA guidelines was evaluated according to AR severity classification. RESULTS AR was diagnosed by GPs as mild intermittent for 46.2% of patients, mild persistent for 26.6%, moderate-severe intermittent for 20.2%, and moderate-severe persistent for 7%; 43.7% of AR patients had concomitant asthma. The most frequently prescribed therapeutic groups were antihistamines (anti-H, 76%) and nasal corticosteroids (NCS, 46%). Anti-H were significantly used more often to treat AR alone than AR + asthma (85 vs. 68%, p < 0.001), whereas NCS were used more often to treat AR + asthma than AR alone (50 vs. 42%, p = 0.01). Among patients with only mild intermittent AR, 39% were prescribed combined therapy. Among patients with moderate-severe persistent AR, 30% of those with AR alone and 18% of those with AR + asthma were prescribed monotherapy based on anti-H. GPs were more compliant with ARIA guidelines while treating AR alone (57%) than AR + asthma (46%) patients. The adherence increased according to the severity grade and was satisfactory for moderate-severe persistent AR (89% for AR alone and 95% for AR + asthma). CONCLUSIONS Adherence to ARIA guidelines is satisfactory only for treatment of more severe patients, thus GPs often tend to treat patients independently from ARIA guidelines. Since prescription data only provide limited information to judge prescribing quality, some deviation from the gold standard are to be expected.
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Affiliation(s)
- S Maio
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy.
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Ferrante G, La Grutta S. Reasons for inadequate asthma control in children: an important contribution from the "French 6 Cities Study". Multidiscip Respir Med 2012; 7:23. [PMID: 22958876 PMCID: PMC3436680 DOI: 10.1186/2049-6958-7-23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 11/10/2022] Open
Affiliation(s)
- Giuliana Ferrante
- CNR Institute of Biomedicine and Clinical Immunology, Palermo, Italy.
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