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Eastwood MC, Busby J, Jackson DJ, Pavord ID, Hanratty CE, Djukanovic R, Woodcock A, Walker S, Hardman TC, Arron JR, Choy DF, Bradding P, Brightling CE, Chaudhuri R, Cowan D, Mansur AH, Fowler SJ, Howarth P, Lordan J, Menzies-Gow A, Harrison T, Robinson DS, Holweg CTJ, Matthews JG, Heaney LG. A randomised trial of a T2-composite-biomarker strategy adjusting corticosteroidtreatment in severe asthma, a post- hoc analysis by sex. J Allergy Clin Immunol Pract 2023; 11:1233-1242.e5. [PMID: 36621603 DOI: 10.1016/j.jaip.2022.12.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND Approximately 5-10% of patients with asthma have severe disease with a consistent preponderance in females. Current asthma guidelines recommend stepwise treatment to achieve symptom control with no differential treatment considerations for either sex. OBJECTIVES To examine whether patient sex affects outcomes when using a composite T2-biomarker score to adjust corticosteroid treatment in patients with severe asthma compared to standard care. METHODS Post-hoc analysis stratifying patient outcomes by sex of a 48-week, multicentre, randomised controlled clinical trial comparing a biomarker-defined treatment algorithm with standard care. The primary outcome was the proportion of patients with a reduction in corticosteroid treatment (inhaled (ICS) and oral (OCS) corticosteroids). Secondary outcomes included exacerbation rates, hospital admissions and lung function. RESULTS Of 301 patients randomised; 194 (64.5%) were females and 107 (35.5%) were males. The biomarker algorithm led to a greater proportion of females being on a lower corticosteroid dose vs standard care which was not seen in males (effects estimate females: 3.57, 95% CI: 1.14, 11.18 vs. males 0.54, 95% CI: 0.16, 1.80). In T2-biomarker low females, reducing corticosteroid dose was not associated with increased exacerbations. Females scored higher in all ACQ-7 domains, but with no difference when adjusted for BMI/ anxiety and/or depression. Dissociation between symptoms and T2-biomarkers were noted in both sexes, with a higher proportion of females being symptom high/T2-biomarker low (22.8% vs. 15.6%; p=0.0002), whereas males were symptom low/T2-biomarker high (11.4% vs. 22.3%; p<0.0001). CONCLUSION This exploratory post-hoc analysis identified females achieved a greater benefit from biomarker-directed corticosteroid optimisation versus symptom-directed treatment.
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Affiliation(s)
- M C Eastwood
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.
| | - J Busby
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.
| | | | - I D Pavord
- Oxford Respiratory, NIHR BRC, Nuffield Department of Medicine, The University of Oxford, Oxford, UK.
| | - C E Hanratty
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.
| | - R Djukanovic
- University of Southampton, NIHR Southampton Biomedical Research Centre, Southampton, UK.
| | - A Woodcock
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
| | - S Walker
- Asthma UK 18 Mansell Street, London, UK.
| | - T C Hardman
- Niche Science & Technology Unit 26, Falstaff House, Bardolph Road, Richmond TW9 2LH.
| | - J R Arron
- Genentech Inc., South San Francisco, California, USA.
| | - D F Choy
- Genentech Inc., South San Francisco, California, USA.
| | - P Bradding
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, UK.
| | - C E Brightling
- Department of Infection, Immunity and Inflammation, Institute for Lung Health, University of Leicester, Leicester, UK.
| | - R Chaudhuri
- NHS Greater Glasgow and Clyde Health Board, Gartnavel Hospital, Glasgow, UK NHS Greater Glasgow and Clyde, Stobhill Hospital, Glasgow, UK.
| | - D Cowan
- NHS Greater Glasgow and Clyde, Stobhill Hospital, Glasgow, UK.
| | - A H Mansur
- University of Birmingham and Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.
| | - S J Fowler
- Division of Infection, Immunity and Respiratory Medicine, University of Manchester, Manchester, UK.
| | - P Howarth
- School of Clinical and Experimental Sciences, University of Southampton, NIHR, Southampton Biomedical Research Centre, Southampton, UK.
| | - J Lordan
- The Newcastle upon Tyne NHS Foundation Trust, Newcastle upon Tyne.
| | - A Menzies-Gow
- Royal Brompton & Harefield NHS Foundation Trust, London, UK.
| | - T Harrison
- UK Nottingham Respiratory NIHR Biomedical Research Centre ,University of Nottingham, Nottingham, UK School of Clinical and Experimental Sciences.
| | - D S Robinson
- University College Hospitals NHS Foundation Trust, London, UK.
| | - C T J Holweg
- Genentech Inc., South San Francisco, California, USA.
| | - J G Matthews
- Peter Gorer Department of Immunobiology, Kings College, London; 23andMe, Sunnyvale, California, USA.
| | - L G Heaney
- Centre for Experimental Medicine, School of Medicine, Dentistry and Biomedical Sciences, Queen's University, Belfast, UK.
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Bakerly N, Woodcock A, Collier S, Leather D, New J, Crawford J, Vestbo J, Saïl L. Efficacité clinique du fuorate de fluticasone/vilanterol (FF/VI) : impact sur les exacerbations dans les sous groupes de patients atteints de BPCO issus de l’étude Salford Lung Study (SLS BPCO). Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Hayat JO, Gabieta-Somnez S, Yazaki E, Kang JY, Woodcock A, Dettmar P, Mabary J, Knowles CH, Sifrim D. Pepsin in saliva for the diagnosis of gastro-oesophageal reflux disease. Gut 2015; 64:373-80. [PMID: 24812000 DOI: 10.1136/gutjnl-2014-307049] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Current diagnostic methods for gastro-oesophageal reflux disease (GORD) have moderate sensitivity/specificity and can be invasive and expensive. Pepsin detection in saliva has been proposed as an 'office-based' method for GORD diagnosis. The aims of this study were to establish normal values of salivary pepsin in healthy asymptomatic subjects and to determine its value to discriminate patients with reflux-related symptoms (GORD, hypersensitive oesophagus (HO)) from functional heartburn (FH). DESIGN 100 asymptomatic controls and 111 patients with heartburn underwent MII-pH monitoring and simultaneous salivary pepsin determination on waking, after lunch and dinner. Cut-off value for pepsin positivity was 16 ng/mL. Patients were divided into GORD (increased acid exposure time (AET), n=58); HO (normal AET and + Symptom Association Probability (SAP), n=26) and FH (normal AET and-SAP, n=27). RESULTS 1/3 of asymptomatic subjects had pepsin in saliva at low concentration (0(0-59)ng/mL). Patients with GORD and HO had higher prevalence and pepsin concentration than controls (HO, 237(52-311)ng/mL and GORD, 121(29-252)ng/mL)(p<0.05). Patients with FH had low prevalence and concentration of pepsin in saliva (0(0-40) ng/mL). A positive test had 78.6% sensitivity and 64.9% specificity for diagnosis of GORD+HO (likelihood ratio: 2.23). However, one positive sample with >210 ng/mL pepsin suggested presence of GORD+HO with 98.2% specificity (likelihood ratio: 25.1). Only 18/84 (21.4%) of GORD+HO patients had 3 negative samples. CONCLUSION In patients with symptoms suggestive of GORD, salivary pepsin testing may complement questionnaires to assist office-based diagnosis. This may lessen the use of unnecessary antireflux therapy and the need for further invasive and expensive diagnostic methods.
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Affiliation(s)
- Jamal O Hayat
- Centre for Digestive Diseases, Barts and the London School of Medicine and Dentistry, London, UK Department of Gastroenterology, St.George's, University of London, UK
| | - Shirley Gabieta-Somnez
- Centre for Digestive Diseases, Barts and the London School of Medicine and Dentistry, London, UK
| | - Etsuro Yazaki
- Centre for Digestive Diseases, Barts and the London School of Medicine and Dentistry, London, UK
| | - Jin-Yong Kang
- Department of Gastroenterology, St.George's, University of London, UK
| | | | | | | | - Charles H Knowles
- Centre for Digestive Diseases, Barts and the London School of Medicine and Dentistry, London, UK
| | - Daniel Sifrim
- Centre for Digestive Diseases, Barts and the London School of Medicine and Dentistry, London, UK
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Satia I, Holt K, Hilton E, Woodcock A, Smith J. P10 The Effect Of Naltrexone, An Opioid Receptor Antagonist, On Capsaicin Evoked Cough, In Healthy Male Subjects. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Busse WW, Bateman ED, O'Byrne PM, Lötvall J, Woodcock A, Medley H, Forth R, Jacques L. Once-daily fluticasone furoate 50 mcg in mild-to-moderate asthma: a 24-week placebo-controlled randomized trial. Allergy 2014; 69:1522-30. [PMID: 25040613 PMCID: PMC4329337 DOI: 10.1111/all.12480] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/04/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Inhaled glucocorticosteroids (ICS) are the mainstay of treatment in asthma. Fluticasone furoate (FF) is a novel, once-daily ICS asthma therapy. This study investigated the efficacy and safety of FF 50 mcg in patients with mild-to-moderate persistent asthma. METHODS A 24-week, multicenter, randomized, placebo-controlled and active-controlled, double-blind, double-dummy, parallel-group phase III study. Three hundred and fifty-one patients (aged ≥12 years; uncontrolled by non-ICS therapy) were randomized to treatment (1 : 1 : 1) with once-daily FF 50 mcg dosed in the evening, twice-daily fluticasone propionate (FP) 100 mcg or placebo. The primary endpoint was change from baseline in evening trough forced expiratory volume in 1 s (FEV1 ) at Week 24. Secondary endpoints were change from baseline in the percentage of rescue-free 24-h periods (powered endpoint), change from baseline in evening and morning peak expiratory flow, change from baseline in the percentage of symptom-free 24-h periods and number of withdrawals due to lack of efficacy. RESULTS Evening trough FEV1 at Week 24 was not statistically significantly increased with FF 50 mcg once-daily (37 ml [95% CI: -55, 128]; P = 0.430), but was with FP 100 mcg twice daily (102 ml [10, 194]; P = 0.030), vs placebo. No consistent trends were observed across other endpoints, including the powered secondary endpoint. No safety concerns were raised for either active treatment. CONCLUSIONS FP 100 mcg twice daily improved evening trough FEV1 in patients with mild-to-moderate persistent asthma, but FF 50 mcg once daily did not demonstrate a significant effect. Secondary endpoints showed variable results. No safety concerns were identified for FF or FP.
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Affiliation(s)
- W W Busse
- Department of Medicine, University of WisconsinMadison, WI, USA
| | - E D Bateman
- Department of Medicine, University of Cape TownCape Town, South Africa
| | - P M O'Byrne
- Michael G DeGroote School of MedicineHamilton, ON, Canada
| | - J Lötvall
- Krefting Research Centre, University of GothenburgGothenburg, Sweden
| | - A Woodcock
- Institute of Inflammation and Repair, University of ManchesterManchester, UK
| | - H Medley
- Respiratory Medicines Development Centre, GlaxoSmithKlineLondon, UK
| | - R Forth
- Quantitative Sciences Division, GlaxoSmithKlineResearch Triangle Park, NC, USA
| | - L Jacques
- Respiratory Medicines Development Centre, GlaxoSmithKlineLondon, UK
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Harris T, Kerry S, Victor C, Ekelund U, Woodcock A, Iliffe S, Whincup P, Beighton C, Ussher M, Limb E, David L, Brewin D, Adams F, Rogers A, Cook D. OP03 Does a complex intervention by primary care nurses increase walking in 60–75 year olds? Outcomes at three and twelve months from the PACE-Lift (Pedometer Accelerometer Consultation Evaluation – Lift) cluster randomised controlled trial. Br J Soc Med 2014. [DOI: 10.1136/jech-2014-204726.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Speight J, Sinclair AJ, Browne JL, Woodcock A, Bradley C. Assessing the impact of diabetes on the quality of life of older adults living in a care home: validation of the ADDQoL Senior. Diabet Med 2013; 30:74-80. [PMID: 22804615 DOI: 10.1111/j.1464-5491.2012.03748.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIMS Around a quarter of UK care-home residents have diabetes. Diabetes is known to impact quality of life but existing diabetes-specific quality of life measures are unsuitable for elderly care-home residents. We aimed to develop and evaluate a new measure for use with older adults, to be particularly suitable for use with care-home residents: the Audit of Diabetes-Dependent Quality of Life (ADDQoL) Senior*. METHODS Content and format changes were made to the 19-domain ADDQoL, informed by related measures for people with visual impairments (12 domain-specific items were retained, four items were revised/added and three items were removed). This revision was modified further following cognitive debriefing interviews with three older adults living in a care home. Psychometric evaluation of the newly developed 17-domain ADDQoL Senior was conducted using data from 90 care-home residents with diabetes who took part in a broader intervention study. RESULTS The life domains most impacted by diabetes were 'independence' and 'freedom to eat as I wish'. The ADDQoL Senior demonstrated good factor structure and internal consistency (Cronbach's alpha = 0.924). Domain scores were, as expected, significantly intercorrelated. CONCLUSIONS The ADDQoL Senior measures the perceived impact of diabetes on quality of life in older adults, and has been found to be suitable for those living in care homes if administered by interview. The scale has demonstrated acceptability and excellent psychometric properties. It is anticipated that the number of items may be reduced in the future if our current findings can be replicated.
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Affiliation(s)
- J Speight
- The Australian Centre for Behavioural Research in Diabetes, Melbourne Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, Vic, Australia.
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Smith JA, Murdoch RD, Newlands A, Smart K, Khalid S, Kelsall A, Holt K, Dockry R, Woodcock A. P152 The Impact of a Selective oral TRPV1 Antagonist in Patients with Chronic Cough. Thorax 2012. [DOI: 10.1136/thoraxjnl-2012-202678.213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Basanta M, Ibrahim B, Douce D, Morris M, Woodcock A, Fowler SJ. Methodology validation, intra-subject reproducibility and stability of exhaled volatile organic compounds. J Breath Res 2012; 6:026002. [PMID: 22549110 DOI: 10.1088/1752-7155/6/2/026002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Khalid S, Dockry R, Holt K, Sumner H, Valdramidou D, Birrell MA, Belvisi MG, Woodcock A, Smith JA. S139 Cough responses to tussive agents in health and disease. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054b.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dockry RJ, Sunger K, Marsden P, Kelsall A, Decalmer S, Powley W, Murdoch R, Woodcock A, Smith JA. S142 Investigating patterns in 24 hours of coughing. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054b.142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Gore C, Custovic A, Tannock GW, Munro K, Kerry G, Johnson K, Peterson C, Morris J, Chaloner C, Murray CS, Woodcock A. Treatment and secondary prevention effects of the probiotics Lactobacillus paracasei or Bifidobacterium lactis on early infant eczema: randomized controlled trial with follow-up until age 3 years. Clin Exp Allergy 2011; 42:112-22. [PMID: 22092692 DOI: 10.1111/j.1365-2222.2011.03885.x] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 07/25/2011] [Accepted: 08/12/2011] [Indexed: 11/28/2022]
Abstract
BACKGROUND Allergic disease has been associated with altered intestinal microbiota. Therefore, probiotics have been suggested as a potential treatment for eczema. OBJECTIVE We investigated whether dietary supplementation of infants with eczema at age 3-6 months with Lactobacillus paracasei CNCM I-2116 or Bifidobacterium lactis CNCM I-3446 had a treatment effect or altered allergic disease progression. METHODS Primary outcome included eczema severity (SCORing Atopic Dermatitis, SCORAD) 3 months post-randomization. Secondary: SCORAD (other visits); infant dermatitis quality of life (IDQoL); gastrointestinal permeability; urinary eosinophilic protein X; allergen-sensitization; allergic symptoms (age 12, 18, 36 months). A total of 208 infants aged 3-6 months with physician-diagnosed eczema were recruited; 137/208 (SCORAD ≥ 10, consuming ≥ 200 mL standard formula/day) were randomized to daily supplements containing L. paracasei or B. lactis or placebo for a 3-month period, while receiving extensively hydrolysed whey-formula (dairy-free diet). There were two open observational groups, one group exclusively breastfed (n = 22) and the other, standard formula-fed (n = 49). TRIAL NUMBER ISRCTN41490500. RESULTS Eczema severity decreased significantly over time in all groups. No significant difference was observed between randomized groups after 12-week treatment-period (SCORAD-score pre-/post-intervention: B. lactis 25.9 [95% CI: 22.8-29.2] to 12.8 [9.4-16.6]; L. paracasei 25.4 [22.1-29] to 12.5 [9.2-16.4]; placebo 26.9 [23.4-30.6] to 11.8 [9.6-14.3]; P = 0.7). Results were similar when analysis was controlled for allergen-sensitization, or when only sensitized infants were analysed. No differences were found for secondary outcomes. No difference was observed in SCORAD-score between randomized and observational groups. CONCLUSION AND CLINICAL RELEVANCE We found no benefit from supplementation with B. lactis or L. paracasei in the treatment of eczema, when given as an adjunct to basic topical treatment, and no effect on the progression of allergic disease from age 1 to 3 years.
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Affiliation(s)
- C Gore
- School of Translational Medicine, University of Manchester, NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK.
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Stevens W, Addo-Yobo E, Roper J, Woodcock A, James H, Platts-Mills T, Custovic A. Differences in both prevalence and titre of specific immunoglobulin E among children with asthma in affluent and poor communities within a large town in Ghana. Clin Exp Allergy 2011; 41:1587-94. [PMID: 21810123 PMCID: PMC3505371 DOI: 10.1111/j.1365-2222.2011.03832.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Reports from several African countries have noted an increasing prevalence of asthma in areas of extensive urbanization. OBJECTIVE To investigate the relevance of allergen-specific sensitization and body mass index (BMI) to asthma/wheezing and exercise-induced bronchospasm (EIB) among children from affluent and poorer communities within a large town in Ghana. METHODS Children with physician-diagnosed asthma and/or current wheezing aged 9-16 years (n=99; cases) from three schools with differing socio-economic backgrounds [urban affluent (UA), urban poor (UP) or suburban/rural (SR)] were recruited from a cross-sectional study (n=1848) in Kumasi, Ghana, and matched according to age, sex and area of residence with non-asthmatic/non-wheezy controls. We assayed sera for IgE antibodies to mite, cat, dog, cockroach, Ascaris and galactose-α-1,3-galactose. RESULTS Children from the UA school had the lowest total serum IgE. However, cases from the UA school had a higher prevalence and mean titre of sIgE to mite (71.4%, 21.2 IU/mL) when compared with controls (14.3%, 0.8 IU/mL) or cases from UP (30%, 0.8 IU/mL) and SR community (47.8%, 1.6 IU/mL). While similar findings were observed with EIB in the whole population, among cases there was no difference in IgE antibody prevalence or titre between children with or without EIB. BMI was higher among UA children with and without asthma; in UP and SR communities, children with EIB (n=14) had a significantly higher BMI compared with children with asthma/wheezing without EIB (n=38) (18.2 vs. 16.4, respectively, P<0.01). CONCLUSIONS AND CLINICAL RELEVANCE In the relatively affluent school, asthma/wheezing and EIB were associated with high titre IgE antibodies to mite, decreased total IgE, and increased BMI. This contrasted with children in the urban poor school and suggests that changes relevant to a Western model of childhood asthma can occur within a short geographical distance within a large city in Africa.
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Affiliation(s)
- W Stevens
- University of Virginia Asthma and Allergic Diseases Center, Charlottesville, VA, USA
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Rybynok VO, Kyriacou PA, Binnersley J, Woodcock A. Development of a personal electronic health record card in the United Kingdom. Annu Int Conf IEEE Eng Med Biol Soc 2011; 2010:4431-5. [PMID: 21095764 DOI: 10.1109/iembs.2010.5626004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In most emergency situations, health professionals rely on patients to provide information about their medical history. However, in some cases patients might not be able to communicate this information, and in most countries, including the UK an on-line integrated patient record system has not been adopted. Therefore, in order to address this issue the ongoing project MyCare Card (MyC(2), www.myc2.org) has been established. The aim of this project is to design, implement and evaluate a prototype patient held electronic health record card. One of the tasks involved in the project was to develop a Graphical User Interface (GUI) software, which provides access to the data stored on the card. The requirements for this software had to be established via questionnaire surveys and end user evaluations, conducted simultaneously with the software development. This paper is addressing development of the MyCare Card GUI software. It also overviews the hardware and open-source software solutions selected for the MyCare Card implementation.
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Affiliation(s)
- V O Rybynok
- School of Engineering and Mathematical Sciences, City University London, UK
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Khalid S, Woodcock A, Haumann B, Ventresca P, Langley SJ, Smith JA. S114 A double blind, placebo controlled, randomised, study to assess the effects of placebo, codeine and Talnetant, on citric acid cough threshold in healthy subjects. Thorax 2010. [DOI: 10.1136/thx.2010.150946.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rybynok VO, Kyriacou PA, Binnersley J, Woodcock A. MyCare Card Development: portable GUI framework for the personal electronic health record device. ACTA ACUST UNITED AC 2010; 15:66-73. [PMID: 21062683 DOI: 10.1109/titb.2010.2091143] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
In most emergency situations, health professionals rely on patients to provide information about their medical history. However, in some cases patients might not be able to communicate this information, and in most countries an online integrated patient record system has not been adopted yet. Therefore, in order to address this issue the ongoing project MyCare Card (MyC², www.myc2.org) has been established. The aim of this project is to design, implement, and evaluate a prototype patient held electronic health record device. Due to the wide range of user requirements, the device, its communication interface, and its software have to be compatible with many common platforms and operating systems. Thus, this paper is addressing one of the software compatibility matters-the cross-platform GUI implementation. It introduces a portable object-oriented GUI framework, suitable for a declarative layout definition, components customization, and fine model-view code separation. It also rationalizes the hardware and software solutions selected for this project implementation.
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Affiliation(s)
- V O Rybynok
- School of Engineering and Mathematical Sciences, City University London, London, UK. ;
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Murray CS, Canoy D, Buchan I, Woodcock A, Simpson A, Custovic A. Body mass index in young children and allergic disease: gender differences in a longitudinal study. Clin Exp Allergy 2010; 41:78-85. [DOI: 10.1111/j.1365-2222.2010.03598.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Caress AL, Duxbury P, Woodcock A, Luker KA, Ward D, Campbell M, Austin L. Exploring the needs, concerns and behaviours of people with existing respiratory conditions in relation to the H1N1 ‘swine influenza’ pandemic: a multicentre survey and qualitative study. Health Technol Assess 2010; 14:1-108. [DOI: 10.3310/hta14340-01] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- A-L Caress
- School of Nursing, Midwifery and Social Work, University of Manchester, UK
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Al Ali W, Custovic A, Simpson A, Khoury A, Woodcock A. Household characteristics and allergen and endotoxin levels in Aleppo, Syrian Arab Republic. East Mediterr Health J 2010; 16:717-724. [PMID: 20799527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Few data are available from Eastern Mediterranean countries about levels of domestic allergens and endotoxins. Dust samples were collected from mattresses and floors of 457 homes in the Syrian city of Aleppo and analysed for antigens and endotoxins. The most important predictors for detectable levels of house-dust mite allergen Der p 1 were Arabic-style houses (OR 3.21) and newer houses (OR 1.56). In homes without cats, rubber mattresses were associated with detectable cat allergen Fel d 1 in mattress dust (OR 1.6). Cockroach allergen Bla g 2 was significantly more likely to be detected in houses over 20 years old than newer houses. Endotoxin levels were significantly higher in wool/cotton mattresses and older houses.
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Affiliation(s)
- W Al Ali
- North West Lung Research Centre, Wythenshawe Hospital, Manchester, United Kingdom.
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Al Ali W, Custovic A, Simpson A, Khoury A, Woodcock A. Household characteristics and allergen and endotoxin levels in Aleppo, Syrian Arab Republic. East Mediterr Health J 2010. [DOI: 10.26719/2010.16.7.717] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
BACKGROUND National Health Service immunization statistics for England indicate that uptake of the first plus second dose of measles, mumps and rubella (MMR) vaccine, and pre-school booster against diphtheria, tetanus, polio and pertussis, is lower than for the primary course alone. This qualitative study aimed to explore parents' views about pre-school immunization and to identify possible reasons for lower pre-school uptake compared with the primary course. METHODS Semi-structured interviews were conducted with 21 parents of children aged 2-5 years from 19 family units. The parents were recruited from nine playgroups and pre-schools in three locations in southern England. Data collection and analysis were guided by a modified Grounded Theory approach. RESULTS Although most parents believed pre-school immunization to be important and most intended to immunise, a minority questioned whether it was necessary based on their understanding of the duration of protection provided by the primary course. Compared with primary immunization, parents typically received no information about pre-school doses prior to their invitation to attend and had little or no contact with healthcare professionals. Other barriers included minor illness, apprehension about taking an older child for vaccinations and work or childcare commitments. CONCLUSIONS Parents reported uncertainties, anxieties and time constraints, all of which may contribute to poor attendance for pre-school immunization. These findings have important implications for providing parents with timely information about boosters and the two-dose MMR programme. They indicate the potential value of playgroup or pre-school involvement and the need for improved communication with children about immunization.
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Affiliation(s)
- Sarah Tickner
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey, UK.
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Abstract
BACKGROUND Allergic diseases have risen in prevalence over recent decades. The aetiology remains unclear but is likely to be a result of changing lifestyle and/or environment. A reduction in antioxidant intake, consequent to reduced intake of fresh fruits and vegetables, has been suggested as a possible cause. OBJECTIVE To investigate whether dietary antioxidant intake at age 5 was related to atopy at 5 and 8 years of age amongst children in an unselected birth cohort. METHODS Children were followed from birth. Parents completed a validated respiratory questionnaire and children were skin prick tested at 5 and 8 years of age. Serum IgE levels were measured at age 5. At age 5, antioxidant intake was assessed using a semi-quantitative food frequency questionnaire (FFQ). A nutrient analysis program computed nutrient intake, and frequency counts of foods high in the antioxidant vitamins A, C and E were assessed. RESULTS Eight hundred and sixty-one children completed both the respiratory and FFQ. Beta-carotene intake was associated with reduced risk of allergic sensitization at age 5 [0.80 (0.68-0.93)] and 8 [0.81 (0.70-0.94)]. In addition, beta-carotene intake was negatively associated with total IgE levels (P = 0.002). Vitamin E intake was associated with an increased risk of allergic sensitization [1.19 (1.02-1.39)], only at age 5. There was no association between antioxidant intakes and wheeze or eczema. CONCLUSION Increased beta-carotene intake was associated with a reduced risk of allergic sensitization and lower IgE levels, in 5- and 8-year-old children. Dietary antioxidants may play a role in the development of allergic sensitization.
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Affiliation(s)
- S Patel
- School of Translational Medicine, University of Manchester and NIHR Translational Research Facility in Respiratory Medicine, University Hospital of South Manchester NHS Foundation Trust, Manchester, UK
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Young EC, Brammer C, Owen E, Brown N, Lowe J, Johnson C, Calam R, Jones S, Woodcock A, Smith JA. The effect of mindfulness meditation on cough reflex sensitivity. Thorax 2009; 64:993-8. [DOI: 10.1136/thx.2009.116723] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
BACKGROUND Women are consistently over-represented in specialist cough clinics and known to have a more sensitive cough reflex than men. Whether female sex and other patient characteristics are associated with higher cough rates is not known. A study was conducted to determine the predictors of objective cough frequency in patients presenting to a tertiary referral clinic with chronic cough. METHODS 100 subjects (65 women) of mean (SD) age 55.8 (11.0) years and median cough duration 4 years (IQR 2.0-10.0) with unexplained chronic cough completed flow-volume loops (mean (SD) forced expiratory volume in 1 s 103 (15.2)% predicted; forced expiratory flow (FEF(50)) 68.8 (24.1)% predicted), methacholine challenge (42% positive), citric acid cough reflex sensitivity (C5; 0.12 M (IQR 0.06-0.50)) and the Leicester Cough Questionnaire. 24-h ambulatory cough monitoring was performed in 86 subjects; manually counted coughs were quantified as the number of explosive cough sounds per hour. RESULTS Women coughed significantly more than men (geometric mean 16.6 coughs/h (95% CI 13.1 to 21.0) vs 9.4 coughs/h (95% CI 6.4 to 13.9), p = 0.01)). The cough reflex was also more sensitive in women than in men (median logC5 -0.9 M vs -0.6 M, p = 0.002), but cough-related quality of life was similar in women and men (12.0 (3.6) and 12.2 (3.2), respectively, p = 0.76). Linear regression analysis showed that 38.6% of the variation in cough rate was predicted by sex (p = 0.01), logC5 (p<0.001) and age (p = 0.002) but not lung function or bronchial hyper-reactivity. CONCLUSIONS Ambulatory objective cough monitoring provides novel insights into factors modulating chronic cough. These findings suggest that effects of sex and age must be taken into account in the study of cough and when designing clinical trials testing novel antitussive agents.
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Affiliation(s)
- A Kelsall
- Education and Research Centre, Wythenshawe Hospital, Manchester, UK
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McGuinness K, Morice A, Woodcock A, Smith J. The Leicester Cough Monitor: a semi-automated, semi-validated cough detection system? Eur Respir J 2008; 32:529-30; author reply 530-1. [PMID: 18669799 DOI: 10.1183/09031936.00052008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Lidyard AM, Woodcock A, Noone P. Economic considerations from the exhaust application of reactive dyes under ultra‐low liquor ratio conditions*. ACTA ACUST UNITED AC 2008. [DOI: 10.1111/j.1478-4408.1992.tb01398.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- A M Lidyard
- ICI Colours, Hexagon House, Blackley, Manchester M3 9DA, UK
| | - A Woodcock
- ICI Colours, Hexagon House, Blackley, Manchester M3 9DA, UK
| | - P Noone
- ICI Colours, Hexagon House, Blackley, Manchester M3 9DA, UK
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Henderson J, Granell R, Heron J, Sherriff A, Simpson A, Woodcock A, Strachan DP, Shaheen SO, Sterne JAC. Associations of wheezing phenotypes in the first 6 years of life with atopy, lung function and airway responsiveness in mid-childhood. Thorax 2008; 63:974-80. [PMID: 18678704 PMCID: PMC2582336 DOI: 10.1136/thx.2007.093187] [Citation(s) in RCA: 352] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background: Patterns of wheezing during early childhood may indicate differences in aetiology and prognosis of respiratory illnesses. Improved characterisation of wheezing phenotypes could lead to the identification of environmental influences on the development of asthma and airway diseases in predisposed individuals. Methods: Data collected on wheezing at seven time points from birth to 7 years from 6265 children in a longitudinal birth cohort (the ALSPAC study) were analysed. Latent class analysis was used to assign phenotypes based on patterns of wheezing. Measures of atopy, airway function (forced expiratory volume in 1 s (FEV1), mid forced expiratory flow (FEF25-75)) and bronchial responsiveness were made at 7–9 years of age. Results: Six phenotypes were identified. The strongest associations with atopy and airway responsiveness were found for intermediate onset (18 months) wheezing (OR for atopy 8.36, 95% CI 5.2 to 13.4; mean difference in dose response to methacholine 1.76, 95% CI 1.41 to 2.12 %FEV1 per μmol, compared with infrequent/never wheeze phenotype). Late onset wheezing (after 42 months) was also associated with atopy (OR 6.6, 95% CI 4.7 to 9.4) and airway responsiveness (mean difference 1.61, 95% CI 1.37 to 1.85 %FEV1 per μmol). Transient and prolonged early wheeze were not associated with atopy but were weakly associated with increased airway responsiveness and persistent wheeze had intermediate associations with these outcomes. Conclusions: The wheezing phenotypes most strongly associated with atopy and airway responsiveness were characterised by onset after age 18 months. This has potential implications for the timing of environmental influences on the initiation of atopic wheezing in early childhood.
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Affiliation(s)
- J Henderson
- Department of Community Based Medicine, University of Bristol, Bristol, UK.
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Patel S, Murray C, Kerry G, Woodcock A, Custovic A. Dietary antioxidant intake, wheeze and atopic status in 5-year-old children. J Hum Nutr Diet 2008. [DOI: 10.1111/j.1365-277x.2008.00865_8.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Kelsall A, Decalmer S, Webster D, Brown N, McGuinness K, Woodcock A, Smith J. How to quantify coughing: correlations with quality of life in chronic cough. Eur Respir J 2008; 32:175-9. [PMID: 18287128 DOI: 10.1183/09031936.00101307] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Different methods are used for quantifying coughing in sound recordings, but as yet no method has been shown to be more valid than any other. In the present study, the relationships between three different units of cough were examined and their ability to predict subjective ratings of cough and cough-related quality of life were evaluated. In total, 70 subjects (mean+/-SD age 55+/-11.7 yrs, 51 (73%) females) with chronic unexplained cough (median duration 4.8 yrs, interquartile range 2.5-10.1 yrs) performed fully ambulatory 24-h sound recordings, which were manually counted by trained observers and quantified by 1) explosive phases, 2) cough seconds and 3) cough epochs. Subjects also completed cough visual analogue scales (VAS) and the Leicester Cough Questionnaire (LCQ). All units of cough were strongly correlated; explosive phases and cough seconds correlated slightly more strongly than cough seconds with cough epochs or explosive phases with cough epochs. LCQ scores correlated moderately with explosive phases and seconds; epochs correlated slightly less well. Cough VAS scores showed a similar pattern. Explosive phases and seconds are interchangeable units of cough, moderately related to subjective measures and cough-related quality of life; epochs are a less satisfactory alternative.
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Affiliation(s)
- A Kelsall
- Respiratory Research Group, University of Manchester, Manchester, UK.
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Partridge MR, Caress AL, Brown C, Hennings J, Luker K, Woodcock A, Campbell M. Can lay people deliver asthma self-management education as effectively as primary care based practice nurses? Thorax 2008; 63:778-83. [PMID: 18281394 DOI: 10.1136/thx.2007.084251] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine whether well trained lay people could deliver asthma self-management education with comparable outcomes to that achieved by primary care based practice nurses. DESIGN Randomised equivalence trial. SETTING 39 general practices in West London and North West England. PARTICIPANTS 567 patients with asthma who were on regular maintenance therapy. 15 lay educators were recruited and trained to deliver asthma self-management education. INTERVENTION An initial consultation of up to 45 min offered either by a lay educator or a practice based primary care nurse, followed by a second shorter face to face consultation and telephone follow-up for 1 year. MAIN OUTCOME MEASURES Unscheduled need for healthcare. SECONDARY OUTCOME MEASURES Patient satisfaction and need for courses of oral steroids. RESULTS 567 patients were randomised to care by a nurse (n = 287) or a lay educator (n = 280) and 146 and 171, respectively, attended the first face to face educational session. During the first two consultations, management changes were made in 35/146 patients seen by a practice nurse (24.0%) and in 56/171 patients (32.7%) seen by a lay educator. For 418/567 patients (73.7%), we have 1 year data on use of unscheduled healthcare. Under an intention to treat approach, 61/205 patients (29.8%) in the nurse led group required unscheduled care compared with 65/213 (30.5%) in the lay led group (90% CI for difference -8.1% to 6.6%; 95% CI for difference -9.5% to 8.0%). The 90% CI contained the predetermined equivalence region (-5% to +5%) giving an inconclusive result regarding the equivalence of the two approaches. Despite the fact that all patients had been prescribed regular maintenance therapy, 122/418 patients (29.2%) required courses of steroid tablets during the course of 1 year. Patient satisfaction following the initial face to face consultation was similar in both groups. CONCLUSIONS It is possible to recruit and train lay educators to deliver a discrete area of respiratory care, with comparable outcomes to those seen by nurses.
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Affiliation(s)
- M R Partridge
- Imperial College London, NHLI Division, Charing Cross Hospital, St Dunstan's Road, London W6 8RP, UK.
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Woodcock A. Asthma exacerbations. Thorax 2008; 63:88; author reply 88. [PMID: 18156580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
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Marinho S, Simpson A, Söderström L, Woodcock A, Ahlstedt S, Custovic A. Quantification of atopy and the probability of rhinitis in preschool children: a population-based birth cohort study. Allergy 2007; 62:1379-86. [PMID: 17822449 DOI: 10.1111/j.1398-9995.2007.01502.x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Atopy quantification using IgE levels/skin test diameter (SPT-MWD) may better predict the expression of rhinitis than using atopy as a dichotomous variable. OBJECTIVE To investigate the association between the presence, temporal pattern and severity of rhinitis in preschool children and specific IgE levels/SPT-MWDs. METHODS Children were followed prospectively to age 5 years in a whole-population birth cohort study. We administered questionnaires (n = 815), skin prick tested children (n = 717) and measured specific serum IgE (n = 478) to inhalant and food allergens. Main outcomes were current rhinitis (CR) and current rhinoconjunctivitis (CRC). RESULTS The prevalence of CR and CRC was 26.1% and 12.1%, respectively. The risk of CR and CRC increased significantly with increasing IgE to grass, mite and cat; CRC was also associated with increasing IgE to dog and peanut. Similarly, increasing SPT-MWDs to inhalant allergens were significantly associated with CR and CRC. This association was also shown for grass within the group of atopic children. Perennial and seasonal rhinitis were associated with increasing IgE/SPT-MWD to mite and grass, respectively. Moderate/severe rhinitis was associated with increasing IgE/SPT-MWD to grass. In a multivariate analysis, increasing levels of IgE/SPT-MWD to grass were the strongest independent predictors of both CR (for IgE: OR 1.42, 95% CI 1.23-1.64, P < 0.001) and CRC (for IgE: 1.51, 1.30-1.76, P < 0.001). CONCLUSION The probability of CR/CRC increases with increasing specific IgE levels or SPT-MWD. With respect to allergic rhinitis, the absolute levels of specific IgE antibody or the size of SPT wheal offer more information than just the presence/absence of sensitization.
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MESH Headings
- Allergens/immunology
- Animals
- Cats
- Child, Preschool
- Cohort Studies
- Conjunctivitis, Allergic/diagnosis
- Conjunctivitis, Allergic/epidemiology
- Conjunctivitis, Allergic/immunology
- Dogs
- Female
- Humans
- Hypersensitivity, Immediate/diagnosis
- Hypersensitivity, Immediate/epidemiology
- Hypersensitivity, Immediate/immunology
- Immunoglobulin E/blood
- Male
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/epidemiology
- Rhinitis, Allergic, Perennial/immunology
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/epidemiology
- Rhinitis, Allergic, Seasonal/immunology
- Risk Factors
- Skin Tests/methods
- Surveys and Questionnaires
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Affiliation(s)
- S Marinho
- Academic Division of Medicine and Surgery, University of Manchester, Manchester, UK
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Woodcock A, Bain S, Charlton M, Bradley C. Extent of satisfaction with tablets and food-timing in sulphonylurea-treated diabetes. Diabetes Res Clin Pract 2007; 78:324-33. [PMID: 17517445 DOI: 10.1016/j.diabres.2005.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2005] [Revised: 04/21/2005] [Accepted: 07/01/2005] [Indexed: 10/23/2022]
Abstract
This study measured patient views about following tablet-taking and food-timing recommendations in Type 2 diabetes. Two new questionnaires were validated. Outpatients with Type 2 diabetes treated with sulphonylurea agents (n=131) completed the seven-item Diabetes Tablet Treatment Questionnaire (DTTQ) and nine-item Diabetes Food Timing Questionnaire (DFTQ). Mean glycosylated haemoglobin (HbA1c) was 7.8% (S.D. 1.8%). At least 74% had optimal DTTQ item scores for tablet-taking as recommended, difficulty taking tablets, side effects, perceived hypoglycaemia and willingness to continue current tablets, but 71% scored sub-optimally regarding recent hyperglycaemia. Under half scored optimally on DFTQ items concerning eating at recommended times, difficulty with food-timing, denying oneself food and guilt about eating. Principal components and reliability analyses identified a two-item tablet problem scale within the DTTQ (alpha 0.72) and a seven-item food-timing problem scale in the DFTQ (alpha 0.77). Satisfaction and adherence were not closely related to glycaemic control. Only scores for perceived hyperglycaemia (r=0.38), perceived hypoglycaemia (r=-0.24) and satisfaction to continue current tablets (r=-0.20) correlated significantly with HbA1c. Clinicians found that the DTTQ helped to raise tablet-taking issues otherwise missed in consultations. Both questionnaires can be used to guide the need for focussed discussion, educational intervention and/or treatment change and to evaluate their impact.
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Affiliation(s)
- A Woodcock
- Department of Psychology, Royal Holloway, University of London, Egham, Surrey TW20 0EX, England, UK.
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Decalmer S, Woodcock A, Greaves M, Howe M, Smith J. Airway abnormalities at flexible bronchoscopy in patients with chronic cough. Eur Respir J 2007; 30:1138-42. [PMID: 17928312 DOI: 10.1183/09031936.00034807] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The algorithms utilised in the diagnosis of chronic cough advocate sequential investigations and treatment trials for asthma-like syndromes, post-nasal drip and gastro-oesophageal reflux disease; however, the role of bronchoscopy is unclear. In the present authors' specialist clinic (North West Lung Centre Cough Clinic, Manchester, UK), flexible bronchoscopy is included in the diagnostic work-up of patients with chronic unexplained cough. In a retrospective review, the authors report on their experiences. Over an 18-month period, patients followed a diagnostic algorithm that included: chest radiography; pulmonary function; methacholine challenge; ear, nose and throat examination; and empirical reflux treatment. Where diagnosis remained elusive, bronchoscopy was performed. A total of 82 bronchoscopies were carried out for the sole indication of chronic cough. Patient age (mean+/-SD) was 54.9+/-11.22 yrs, with a median (range) cough duration of 5 (0.5-30) yrs. In nine (11%) subjects, a diagnosis was made on inspection or biopsy. These included seven cases of tracheobronchopathia osteochondroplastica (TPO), one case of elongated uvula and one case of endobronchial amyloidosis. All TPO patients had early changes, with a typical nodular appearance to the tracheal cartilage, without significant airway obstruction. These subtle changes could not have been predicted from less invasive procedures and would have been missed without bronchoscopy. Flexible bronchoscopy is indicated in persistent unexplained cough and may reveal contributing pathology.
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Affiliation(s)
- S Decalmer
- University of Manchester, North West Lung Research Centre, South Manchester University Hospitals Trust, Southmoor Rd, Wythenshawe, Manchester M23 9LT, UK
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Abstract
Educational ergonomics - the teaching of ergonomics and the design of environments where ergonomics teaching and learning might occur - has received little attention from ergonomists. This paper first describes the roots of the author's interest and research in educational ergonomics; second it provides a personal view of the opportunities and challenges posed by the two streams of educational ergonomics; and lastly it considers the implications of teaching ergonomics to children in terms of their personal development, the design of schools and the impact such initiatives might have on wider societal problems.
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Affiliation(s)
- A Woodcock
- The Design and Ergonomics Applied Research Group, Coventry School of Art and Design, Coventry, UK.
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Simpson A, Hankinson J, Borg-Bartolo S, Lowe L, John S, Woodcock A, Ollier W, Custovic A. Haplotype Tagging SNPs in the Beta Adrenergic Receptor (ADRB2) Gene are Associated with Pre and Post-bronchodilator Lung Function in Preschool Children. J Allergy Clin Immunol 2007. [DOI: 10.1016/j.jaci.2006.11.541] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Murray CS, Tannock GW, Simon MA, Harmsen HJM, Welling GW, Custovic A, Woodcock A. Fecal microbiota in sensitized wheezy and non-sensitized non-wheezy children: a nested case-control study. Clin Exp Allergy 2006; 35:741-5. [PMID: 15969664 DOI: 10.1111/j.1365-2222.2005.02259.x] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND It has been suggested that intestinal microbiota of allergic and non-allergic children differs in composition, and that microbiota-immune system interactions may predispose children to develop sensitization. Previous studies have examined fecal microbiota of allergic children with atopic dermatitis, but little is known about that of atopic wheezy children. OBJECTIVE To investigate the composition of the fecal microbiota of young sensitized wheezy and non-sensitized non-wheezy children, using molecular methods. METHODS Within the context of a prospective birth cohort, we carried out a nested case-control study of sensitized wheezy children (cases) and non-sensitized non-wheezy controls. Cases and controls were matched for age, sex, parental atopy, allergen exposure, and pet ownership. We evaluated the composition of fecal microbiota by nucleic acid-based methods (PCR combined with denaturing gradient gel electrophoresis and quantification of bifidobacteria by fluorescent in situ hybridization). RESULTS Thirty-three case-control pairs (mean age 4.4 years) provided stool samples. Comparison of total bacterial community profiles showed that each child had a unique fecal microbiota (mean Dice's similarity coefficient 22%, range 3.3-60.8%). There was no difference between the groups in prevalence of Lactic Acid bacteria (12/33 vs. 11/33, P=0.8) or bifidobacteria (30/33 vs. 31/33, P=1.00, cases vs. controls). The bifidobacterial species detected were similar in both groups. The percentage of bifidobacteria in total fecal microflora was no different between cases (median 1.7%, range 0-20.8%) and controls (1.9%, 0-18.2%, P=0.7). However, cases with eczema had significantly fewer bifidobacteria (median 1.6%, range 0-4.8%) than their controls (4.0%, 1.9-18.2%, P=0.05). CONCLUSION We found no differences in fecal microbiota composition between sensitized wheezy and non-sensitized, non-wheezy children aged 3-5 years using nucleic acid-based methods. Differences appear to be isolated to those allergic children with eczema.
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Affiliation(s)
- C S Murray
- North West Lung Centre, Wythenshawe Hospital, Manchester, UK.
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Wolffsohn JS, Anderson SJ, Mitchell J, Woodcock A, Rubinstein M, Ffytche T, Browning A, Willbond K, Amoaku WM, Bradley C. Effect of age related macular degeneration on the Eger macular stressometer photostress recovery time. Br J Ophthalmol 2006; 90:432-4. [PMID: 16547321 PMCID: PMC1856983 DOI: 10.1136/bjo.2005.085787] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
AIM To assess the repeatability of Eger macular stressometer (EMS) measures of photostress recovery and determine their association with other measures of visual function. METHODS EMS photostress recovery time was measured in 90 patients with bilateral exudative age related macular degeneration (AMD), 19 with bilateral atrophic AMD and 47 with both forms of the condition (mean age 79 (SD 13) years). Measurements were made on two occasions separated by 1 year. Intrasession repeatability was assessed by repeating the measures after a 10 minute recovery period at the first visit. Distance visual acuity was measured with a logMAR chart, near visual acuity with a MNRead chart at 25 cm, contrast sensitivity with a Pelli-Robson chart, and the presence of central visual disturbance assessed with an Amsler grid. A questionnaire was used to assess self reported difficulties with glare recovery. RESULTS The average EMS recovery time was 11.0 (SD 8.9) seconds, decreasing by 1.6 (5.2) seconds on repeated measurement (p<0.05). EMS photostress recovery was not correlated with visual function measures or subjective difficulties with lights (p>0.05). EMS photostress recovery time did not predict those whose vision decreased over the following year compared with those among whom it remained stable. CONCLUSIONS The EMS test is not a useful tool in determining the severity or progression of AMD.
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Affiliation(s)
- J S Wolffsohn
- School of Life and Health Sciences, Aston University, Birmingham B4 7ET, UK.
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Murray CS, Simpson B, Kerry G, Woodcock A, Custovic A. Dietary intake in sensitized children with recurrent wheeze and healthy controls: a nested case-control study. Allergy 2006; 61:438-42. [PMID: 16512805 DOI: 10.1111/j.1398-9995.2005.00927.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rising prevalence of asthma and allergic disease remains unexplained. Several risk factors have been implicated including diet, in particular poly-unsaturated fats and antioxidant intake. METHODS A nested case-control study comparing the dietary intake of sensitized children with recurrent wheeze (age 3-5 years) and nonsensitized children who had never wheezed was carried out within an unselected population-based cohort. Cases and controls were matched for age, sex, parental atopy, indoor allergen exposure and pet ownership. Dietary intake was assessed using a validated semi-quantitative food frequency questionnaire and nutrient analysis program. RESULTS Thirty-seven case-control pairs (23 male, mean age 4.4 years) participated. Daily total polyunsaturated fat intake was significantly higher in sensitized wheezers (g/day, geometric mean, 95% confidence intervals: 7.1, 6.4-7.9) compared with nonsensitized nonwheezy children (5.6, 5.0-6.3, P = 0.003). Daily omega-3 and omega-6 fat intakes were not significantly different between the two groups. No significant differences were found in intake of any antioxidant or antioxidant cofactors between the groups. CONCLUSIONS Young sensitized wheezy children had a significantly higher total polyunsaturated fat intake compared with nonsensitized nonwheezy children. However, we were unable to distinguish a significant difference in specific poly-unsaturated fat intakes. Otherwise the children in both groups had a very similar nutritional intake.
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Affiliation(s)
- C S Murray
- North West Lung Centre, Wythenshawe Hospital, Manchester, UK
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Peterson C, Hansson T, Hadley E, Chaloner C, Woodcock A, Custovic A, Gore C. Faecal Eosinophilic Protein X (f-EPX), Atopic Dermatitis, Sensitisation and Gastrointestinal Permeability in Infants Aged 3-6 Months. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.1182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Gore C, Hadley E, Chaloner E, Kerry G, Johnson K, Woodcock A, Custovic A. Gastrointestinal Permeability is Abnormal in Young Infants with Atopic Dermatitis but Not Associated with Disease Severity or Sensitisation. J Allergy Clin Immunol 2006. [DOI: 10.1016/j.jaci.2005.12.1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Abstract
BACKGROUND Little is known about cough frequency in adults with cystic fibrosis (CF). This study aimed to determine (1) daytime and overnight cough rates in patients with CF at the beginning and end of a course of antibiotics for treatment of an exacerbation; (2) the relationship between cough frequencies and standard clinical measures of disease; and (3) the relationship between objective cough rates and the subjective assessment of cough. METHODS Nineteen adult patients admitted with a pulmonary exacerbation performed daytime and overnight sound recordings on admission; 13 had repeat recordings prior to discharge. Coughs were manually quantified in cough seconds (time spent coughing). Patients subjectively scored their cough using a visual analogue scale (VAS) and numerical score. Lung function, C-reactive protein (CRP) levels, and sputum weights were recorded. RESULTS Cough rates fell substantially with treatment; median fall in cough rate was 51.3% (IQR 32.3-77.5) (p<0.001) for daytime and 72.2% (28.6-90.1) (p = 0.049) for overnight. Multivariate regression analyses showed that forced expiratory volume in 1 second and CRP levels predicted overnight cough rates on admission. On discharge, sputum volume predicted daytime cough rates. Only the change in overnight VAS correlated with the change in objective cough rates. CONCLUSIONS The cough rate significantly decreases with treatment of a pulmonary exacerbation in adults with CF. Lung function, sputum volume, and CRP influences the cough rate, with the effects differing from day to night and between admission and discharge. Subjective reporting of a nocturnal cough may indicate a pulmonary exacerbation of CF in adults.
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Affiliation(s)
- J A Smith
- North West Lung Centre, South Manchester University Hospitals Trust, UK.
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Abstract
BACKGROUND High-efficiency particulate-arrest-filter vacuum cleaners are recommended to allergy sufferers although their use increases personal cat allergen exposure. We aimed to measure personal mite allergen exposure during vacuum cleaning by nasal air sampling and to compare exposures while vacuuming and emptying the vacuum cleaner bag. METHODS Five brand new high-efficiency vacuum cleaners were selected. An old, previously used vacuum cleaner with its original microfilter in situ was used as a control. Nasal air samples were taken prior to and during vacuum cleaning in 10 homes. Samples were processed by HALOgen assay. Personal mite and cat allergen exposure was measured as the dust compartments were emptied. RESULTS There was an increase in personal mite allergen exposure with vacuum cleaning, which approached significance (P = 0.058). There was no difference between the high-efficiency vacuum cleaners and the control vacuum cleaner (P = 0.141). When the dust compartments were emptied, personal mite and cat allergen exposure increased (P < 0.02). CONCLUSIONS. The increase in personal mite allergen exposure while vacuum cleaning in an area with mild to moderate mite allergen exposure is small. High-efficiency vacuum cleaners confer no benefit and cannot currently be recommended to allergy sufferers as a means of reducing personal mite allergen exposure.
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Affiliation(s)
- R B Gore
- North West Lung Centre, Wythenshawe Hospital, Manchester, UK
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Murray CS, Poletti G, Kebadze T, Morris J, Woodcock A, Johnston SL, Custovic A. Study of modifiable risk factors for asthma exacerbations: virus infection and allergen exposure increase the risk of asthma hospital admissions in children. Thorax 2005; 61:376-82. [PMID: 16384881 PMCID: PMC2111190 DOI: 10.1136/thx.2005.042523] [Citation(s) in RCA: 327] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Asthma exacerbation is the most common cause of hospital admission in children. A study was undertaken to investigate the importance of allergen exposure in sensitised individuals in combination with viral infections and other potentially modifiable risk factors precipitating asthma hospital admission in children. METHODS Eighty four children aged 3-17 years admitted to hospital over a 1 year period with an acute asthma exacerbation (AA) were matched for age and sex with two control groups: stable asthmatics (SA) and children admitted to hospital with non-respiratory conditions (IC). Risk factors were assessed by questionnaires and determination of allergen sensitisation, home allergen exposure, pollen exposure, and respiratory virus infection. RESULTS Several non-modifiable factors (atopy, duration of asthma) were associated with increased risk. Among the modifiable factors, pet ownership, housing characteristics, and parental smoking did not differ between the groups. Regular inhaled corticosteroid treatment was significantly less common in the AA group than in the SA group (OR 0.2, 95% CI 0.1 to 0.6; p = 0.002). A significantly higher proportion of the AA group were virus infected (44%) and sensitised and highly exposed to sensitising allergen (76%) compared with the SA (18% and 48%) and IC groups (17% and 28%; both p<0.001). In a multiple conditional logistic regression (AA v SA), allergen sensitisation and exposure or virus detection alone were no longer independently associated with hospital admission. However, the combination of virus detection and sensitisation with high allergen exposure substantially increased the risk of admission to hospital (OR 19.4, 95% CI 3.7 to 101.5, p<0.001). CONCLUSIONS Natural virus infection and real life allergen exposure in allergic asthmatic children increase the risk of hospital admission. Strategies for preventing exacerbations will need to address these factors.
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Affiliation(s)
- C S Murray
- Academic Division of Medicine and Surgery South, The University of Manchester, North West Lung Centre, South Manchester University Hospitals NHS Trust, Manchester M23 9LT, UK.
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Gore C, Johnson RJ, Caress AL, Woodcock A, Custovic A. The information needs and preferred roles in treatment decision-making of parents caring for infants with atopic dermatitis: a qualitative study. Allergy 2005; 60:938-43. [PMID: 15932385 DOI: 10.1111/j.1398-9995.2005.00776.x] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Information needs and preferences in treatment decision-making of parents caring for infants with atopic dermatitis (AD) are unknown, despite emphasis on quality information-giving and involvement of health-care users in treatment decisions. OBJECTIVE To explore information needs and decisional role-preferences of parents caring for infants with AD. METHODS Qualitative study. Purposive sample: 31 parents caring for infants with AD. Tape-recorded focussed conversation-style interviews. Interview topic-guide literature-derived. Control Preferences Scale (5 sort-card vignettes 'very active' to 'very passive' role) adapted for use with parents; used to facilitate discussion. Thematic analysis of verbatim transcripts. RESULTS Nine core information needs identified: AD-causation, role of diet, medication-use, medication-side-effects, exacerbating factors, new/alternative medication, nonpharmacological treatments, AD-prevention, AD and other atopic conditions. Parents desired verbal and written information. Many felt their baby's condition was not taken seriously, leading to delayed diagnosis and treatment. They had to be more active than they wished to obtain information/treatment. Parents preferred sharing decisions with their doctor. CONCLUSIONS Parents caring for infants with AD have clearly defined, unmet information needs, forcing them into more active roles in the treatment decision-making process than they desire. The study-findings may inform the development of written information specifically for these parents and improve partnership during consultations.
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Affiliation(s)
- C Gore
- North West Lung Research Centre, Wythenshawe Hospital, Manchester, UK
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Hadley EA, Smillie FI, Turner MA, Custovic A, Woodcock A, Arkwright PD. Effect of Mycobacterium vaccae on cytokine responses in children with atopic dermatitis. Clin Exp Immunol 2005; 140:101-8. [PMID: 15762881 PMCID: PMC1809349 DOI: 10.1111/j.1365-2249.2005.02743.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The increasing prevalence of atopic diseases over the last few decades is thought to be due to reduced exposure to environmental microbes that normally down-regulate allergic responses (hygiene hypothesis). We have shown previously that administration of the environmental microbe Mycobacterium vaccae ameliorates atopic dermatitis in school-age children at 3 months post-treatment. The present study tested the hypothesis that M. vaccae suppresses Th2-type cytokine activity and increases transforming growth factor (TGF)-beta(1) immunomodulatory activity in these children. Interleukin (IL)-4, IL-5, TGF-beta(1) and interferon (IFN)-gamma activity were assessed in resting and stimulated peripheral blood mononuclear cells (PBMC) isolated from 12 of the children who received M. vaccae in our original clinical trial. A cDNA expression array was used to examine a broader range of cytokine pathway transcripts. There were no significant changes in either Th2-type or TGF-beta(1) activity. A 5- to 10-fold increase in Th1-type activity was found at 1 month post-M. vaccae administration (P < 0.05), but it had returned to baseline by 3 months. The results do not support the hypothesis that M. vaccae reduces Th2-type or increases TGF-beta(1) activity of PBMC isolated from children with atopic dermatitis. The transient surge in IFN-gamma at 1 month is unlikely to explain any improvement in eczema score at 3 months.
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Affiliation(s)
- E A Hadley
- North West Lung Research Centre, Wythenshawe Hospital, Manchester, UK.
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Caress AL, Beaver K, Luker K, Campbell M, Woodcock A. Involvement in treatment decisions: what do adults with asthma want and what do they get? Results of a cross sectional survey. Thorax 2005; 60:199-205. [PMID: 15741435 PMCID: PMC1747348 DOI: 10.1136/thx.2004.029041] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Current healthcare policy advocates patient participation in treatment decision making. However, in asthma there is little evidence regarding patients' views on such involvement. This study explored the preferred and perceived level of involvement in treatment decisions, rationales for role preference, perceived facilitators of/barriers to involvement, and the interrelationship of role preference and demographic variables in a sample of patients with asthma. METHODS A cross sectional survey was performed of 230 adults with clinician diagnosed asthma from 10 primary care sites and one specialist respiratory centre in north-west England. Preferred role in treatment decisions was assessed using the Control Preferences Scale. RESULTS Fifty five (23.9%) preferred an active role, 82 (35.7%) a collaborative role, and 93 (40.4%) a passive role; 19 (8.2%) perceived their role as active compared with 45 (19.6%) collaborative and 166 (72.2%) passive. Only 33.5% (n = 77) of respondents attained their most preferred role; 55.2% (n = 127) were less involved than they preferred. Patient related, professional related, and organisational factors, especially quality and duration of consultations, facilitated or hampered involvement. Role preferences were not strongly associated with demographic variables or asthma severity. CONCLUSIONS This study in patients with asthma highlights the fact that there is a need for professional and patient education regarding partnership working, skilful communication, and innovative approaches to service delivery.
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Affiliation(s)
- A-L Caress
- School of Nursing, Midwifery and Social Work, University of Manchester, Oxford Road, Manchester M13 9PL, UK.
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Langley SJ, Goldthorpe S, Craven M, Woodcock A, Custovic A. Relationship between exposure to domestic allergens and bronchial hyperresponsiveness in non-sensitised, atopic asthmatic subjects. Thorax 2005; 60:17-21. [PMID: 15618577 PMCID: PMC1747172 DOI: 10.1136/thx.2004.027839] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The effect of exposure to allergens not causing sensitisation in atopic asthmatic subjects has not previously been studied. A study was undertaken to assess the degree of asthma severity (measured by spirometry, airway reactivity and exhaled nitric oxide) in atopic asthmatic patients not sensitised to the domestic allergen to which they were exposed. METHODS Dust samples were collected from the living room carpet and mattress in the homes of 248 subjects and dust mite, cat and dog allergen concentrations were measured. Spirometry, non-specific bronchial reactivity (BR), and exhaled nitric oxide (eNO) were ascertained. Patients' sensitisation status was assessed by skin prick testing. RESULTS Adult atopic asthmatics not sensitised to mite but exposed to high levels of mite allergen had significantly more severe BR than subjects not exposed to high levels of mite (PD(20), geometric mean (GM) 0.21 mg (95% CI 0.09 to 0.47) v 0.86 mg (95% CI 0.44 to 1.67), mean ratio difference 4.1 (95% CI 1.5 to 11.4), p=0.008). Subjects not sensitised but exposed to high levels of dog allergen also had significantly more severe BR than subjects not exposed (PD20 GM 0.16 v 0.52 mg, mean ratio difference 3.3 (95% CI 1.2 to 9.2), p=0.01). The differences in BR between these groups were still significant after adjusting for confounding factors. This effect of greater airway reactivity was not seen in subjects exposed but not sensitised to cat allergens. CONCLUSION Atopic asthmatic subjects who are exposed to high levels of dust mite or dog allergens but not sensitised to these allergens have evidence of increased airway reactivity.
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Affiliation(s)
- S J Langley
- Medicines Evaluation Unit, North West Lung Centre, Wythenshawe Hospital, Manchester M23 9LT, UK.
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Murray C, Simpson A, Kissen P, Simpson B, Woodcock A, Custovic A. Natural antioxidant intake and wheeze in 5-year-old children. J Allergy Clin Immunol 2005. [DOI: 10.1016/j.jaci.2004.12.706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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