Relationship between subjective social status and measures of health in older Taiwanese persons

OBJECTIVES: To compare the association between subjective ladder ranking and health measures with the association between objective indices and health measures in older Taiwanese men and women. DESIGN: Cross-sectional study. SETTING: A population-representative sample of elderly and nearly elderly men and women in Taiwan. PARTICIPANTS: The study included 991 participants from the Social Environment and Biomarkers of Aging Study in Taiwan. MEASUREMENTS: The information collected included demographic characteristics; subjective ladder score of SES; objective measures of SES, including education, income, and occupation; health behaviors; health-related variables such as self-rated health, basic activity of daily living difficulties, instrumental activity of daily living (IADL) difficulties, and physical activity difficulties; and depression score. RESULTS: Low ladder score was associated with poorer self-rated health and more reported IADL and physical activity difficulties, even after adjustment for objective measures of SES and other covariates. The multiply adjusted odds ratio for a one-quartile difference in ladder score and worse self-rated health was 1.19 (95% confidence interval=1.06-1.33). The associations between subjective ladder ranking and health status were generally stronger in those who had 6 years or less of education than in those who received more education. CONCLUSION: A simple subjective assessment of one's ranking on the social hierarchy was associated with self-rated health and physical functional status in an older ethnic Chinese population. The associations were independent of the effects of traditional objective measures of SES, such as education, income, and occupation.     

小儿哮喘病与卡介苗疤痕的相关性研究

目的研究卡介苗疤痕（卡疤）与哮喘的相关性。方法观察200例儿童,年龄6—12岁,其中哮喘患儿100例,正常对照100例,测量卡疤纵横直径,取平均值。结果哮喘患儿中卡疤直径大于5mm者有52例,占52％。正常对照组卡疤直径大于5mm者有72例,占72％,两组相比较,差别有显著性。两组儿童在年龄分布和性别构成上差异无显著性。结论卡疤直径可能是哮喘发作的一个有价值的预报因子。     

现实中哮喘治疗现状的前瞻性、多中心研究

目的 过去对支气管哮喘(简称哮喘)现状的研究多采用横断面的回顾性调查,结果有局限性.本研究采用前瞻性的方法对重庆地区哮喘防治的现状进行研究,为改进目前哮喘的防治提供依据.方法 利用统一的调查问卷,采用前瞻性、多中心、非干预性的研究方法,对重庆地区9家教学医院、市区级医院就诊的184例哮喘患者进行6个月的前瞻性调查研究,调查患者的哮喘控制水平、用药和经济负担等情况.结果 入选患者以重度(62.0％)居多,哮喘控制不佳的患者比例较高,哮喘控制评分(ACT)＜20分占82.6％,采用吸入激素为主治疗方法的患者仅占29.6％.6个月后失访率为34.8％.研究结束时与基线数据比较,哮喘控制水平明显改善(P＜0.001),哮喘加重显著减少(P＜0.001),而且平均医疗费用减低33.9％.结论 地区哮喘控制现状不佳,规范化治疗的患者比例很低.但经规范治疗和管理后,哮喘控制水平显著改善,急性加重率和治疗费用均显著降低.但仍有约1/3的患者不能接受医师的随访,改善哮喘的管理还需要更多的努力.     

儿童百日咳与支气管哮喘关系的研究进展

支气管哮喘(哮喘)是一种多因素异质性疾病,严重影响儿童的身心健康。对于其发病原因及机制的研究一直是学者们关注的重点。近年来,呼吸道合胞病毒、鼻病毒、肺炎支原体等病原体感染与哮喘的关系逐渐明确,但是百日咳与哮喘之间的关系尚不明确。有研究认为百日咳杆菌感染后可诱导IgE的产生、激活Th2细胞并诱导Th17免疫应答,加强中性...     

The relationship between inflammation and symptoms in asthma

In asthma, symptoms are the main reason for recourse to healthcare and are a fundamental parameter for the evaluation of asthma control. Currently, asthma is defined as a chronic inflammatory disease. Uncontrolled asthmatics have an increased number of eosinophils in induced sputum and an increased production of exhaled NO. Control by anti-inflammatory treatment is accompanied by a reduction in bronchial eosinophilia and exhaled NO. Asthma symptoms are the result of complex mechanisms and many factors modify their perception. Experimental data suggests that there is a relationship between the perception of symptoms and eosinophilic inflammation, and that inhaled corticoid therapy improves this perception. Although they are still not applicable in routine practice, follow-up strategies based on the evaluation of inflammation are thought to be more effective in reducing exacerbations than those usually recommended based on retrospective evaluation of symptoms and sequential analysis of respiratory function. Inhaled corticosteroid therapy is the reference maintenance therapy for persistent asthma and adjustment of anti-inflammatory treatment based on symptoms is an effective strategy to prevent exacerbations and reduce the total dose of inhaled corticosteroids. A French expert group has undertaken a study of the association between inflammation and asthma symptoms by carrying out a critical review of the international literature.     

Medication use,sleep, and caregiver smoking status among urban children with asthma

Objective: Children living in urban settings from low-income, minority families are at a high risk for experiencing asthma morbidity. Environmental tobacco smoke (ETS, i.e., secondhand) exposure, typically from caregiver smoking, has been associated with increased quick-relief medication use and child nocturnal awakenings due to increased asthma symptoms as well as worse sleep quality in children with asthma. This study investigated the moderating role of caregiver smoking status on the association between quick-relief medication use and child's sleep quality in urban children with persistent asthma. Methods: Fifty-four urban children with persistent asthma and their primary caregivers completed a baseline research session. Caregivers then completed ecological momentary assessment surveys via smartphones twice daily for two weeks in which smoking behaviors, child quick-relief medication use, and child's sleep quality were assessed. Results: Twenty caregivers (37%) reported smoking at least one day across the two-week period. The caregiver smoking status significantly moderated the association between quick-relief medication use and child's sleep quality after controlling for child age and monthly household income. The caregiver smoking status exacerbated the association between quick-relief medication use and child's sleep quality, such that more medication usage was associated with worse sleep quality. Conclusions: Findings suggest that in urban families with a caregiver who smokes, more daily quick-relief medication use may put children at an increased risk for worse sleep quality. The effects of ETS exposure on child's sleep quality in addition to child asthma symptoms should be an integral part of discussions between pediatric healthcare providers and families of children with asthma.     

Level of asthma control and its relationship with medication use in asthma patients in Brazil

OBJECTIVE:

To assess asthma patients in Brazil in terms of the level of asthma control, compliance with maintenance treatment, and the use of rescue medication.

METHODS:

We used data from a Latin American survey of a total of 400 asthma patients in four Brazilian state capitals, all of whom completed a questionnaire regarding asthma control and treatment.

RESULTS:

In that sample, the prevalence of asthma was 8.8%. Among the 400 patients studied, asthma was classified, in accordance with the Global Initiative for Asthma criteria, as controlled, partially controlled, and uncontrolled in 37 (9.3%), 226 (56.5%), and 137 (34.3%), respectively. In those three groups, the proportion of patients on maintenance therapy in the past four weeks was 5.4%, 19.9%, and 41.6%, respectively. The use of rescue medication was significantly more common in the uncontrolled asthma group (86.9%; p < 0.001).

CONCLUSIONS:

Our findings suggest that, in accordance with the established international criteria, asthma is uncontrolled in the vast majority of asthma patients in Brazil. Maintenance medications are still underutilized in Brazil, and patients with partially controlled or uncontrolled asthma are more likely to use rescue medications and oral corticosteroids.     

Severe asthma in children: Evaluation and management

Severe asthma in children is associated with significant morbidity. Children with severe asthma are at increased risk for adverse outcomes including medication-related side effects, life-threatening exacerbations, and impaired quality of life. It is important to differentiate between severe therapy resistant asthma and difficult-to-treat asthma due to comorbidities. The most common problems that need to be excluded before a diagnosis of severe asthma can be made are poor medication adherence, poor medication technique or incorrect diagnosis of asthma. Difficult to treat asthma is a much more common reason for persistent symptoms and exacerbations and can be managed if comorbidities are clearly addressed. Children with persistent symptoms and exacerbations despite correct inhaler technique and good medical adherence to standard Step 4 asthma therapies according to the guidelines^1,2, should be referred to an asthma specialist with expertise in severe asthma.     

细胞因子和低亲合力IgE受体水平的变化与外源性哮喘的关系

目的 探讨T,S细胞异常活化在外源性哮喘免疫调节机制中的作用。方法 对30例外源性哮喘患者发作期和缓解期及30例健康成年人的外周血,采用ELISA双抗体夹心法,测定血清可溶性白介素-2受体(Soluble interleukin-2 receptor,sIL-2R)和白介素-4(Interleukin-4,IL-4)水平,用抗人CD_(23)的McAb测定CD_(23)。结果 外源性哮喘发作期血清sIL-2R,IL-4和CD_(23)水平明显升高,与缓解期和对照组有明显差异(P均<0.01),且CD_(23)水平分别与血清sIL-2R和IL-4之间有明显正相关(r=0.85,0.64,P均<0.01)。结论 T,B细胞异常活化是外源性哮喘发病的关键,通过测定细胞因子水平的变化,监测T,B细胞的活化,为今后临床干预哮喘的发生和治疗提供理论基础。     

儿童重症支气管哮喘的识别与管理

儿童重症支气管哮喘(哮喘)具有高度异质性,临床上常与难治性哮喘混淆.排除用药依从性差、吸入技术差、误诊等因素,积极处理共存疾病,正确诊断重症哮喘,选择相应的治疗,对减轻药物相关不良反应、减少危及生命的哮喘发作、改善远期预后等方面具有重要作用.     

The Program for the Prevention of Childhood Asthma: a specialized care program for children with wheezing or asthma in Brazil

Objective

: To present the Programa Infantil de Prevenção de Asma (PIPA, Program for the Prevention of Childhood Asthma) and the characteristics of the patients followed in this program.

Methods

: Implemented in the city of Uruguaiana, Brazil, PIPA has as its target population children and adolescents (< 18 years of age) with asthma or suspected asthma. Patients either enroll in PIPA spontaneously or are referred by pediatricians or primary care physicians. In this retrospective study, we use a standardized protocol to assess PIPA patients.

Results

: By the end of the study period, 646 patients were being followed. Of those, 298 (46.1%) were ≤ 3 years of age. In this group of patients, recurrent wheezing was identified in 60.7%, and the first episode of wheezing occurred in the first six months of life in 86.0%. Severe wheezing was identified in 29.5% and 45.4% in the children ≤ 3 and > 3 years of age, respectively. Physician-diagnosed asthma was reported in 26.5% and 82.2%, respectively. In the sample as a whole, the prevalence of passive smoking was high (> 36%), occurring during pregnancy in > 15%; > 40% of the patients had been born by cesarean section; and 30% had a mother who had had < 8 years of schooling.

Conclusions

: A prevention program for children with asthma is an effective strategy for controlling the disease. Knowledge of local epidemiological and environmental characteristics is essential to reducing the prevalence of the severe forms of asthma, to improving the use of health resources, and to preventing pulmonary changes that could lead to COPD in adulthood.     

病毒感染与成人哮喘发病关系的研究

目的 探讨病毒感染与成人哮喘的关系及在其发病机制中的作用,为临床诊断和治疗提供有利的线索和依据。方法 应用间接酶联免疫吸附试验（ＥＬＩＳＡ）对１３０例成人哮喘患（哮喘组）和２０名健康体检（正常对照组）的血清进行呼吸道合胞病毒（ＲＳＶ）、腺病素（ＡＤＶ３、７）、副流感病毒（ＰＩＶⅠ、Ⅲ）和巨细胞病毒（ＣＭＶ）特异性ＩｇＧ、ＩｇＭ抗体检测;同时对１７例ＲＳＶ－ＩｇＭ阳性病例和正常对照组作ＲＳＶ－Ｉ     

Recommendations for the prevention and diagnosis of asthma in children: Evidence from international guidelines adapted for Mexico

Background

With the availability of high-quality asthma guidelines worldwide, one possible approach of developing a valid guideline, without re-working the evidence, already analysed by major guidelines, is the ADAPTE approach, as was used for the development of National Guidelines on asthma.

支气管哮喘患儿心理行为问题与家庭管理方式特征研究

目的探讨支气管哮喘（简称哮喘）患儿的心理行为问题与家庭管理方式的特征及相关性。方法采取整群随机抽样方法,抽取2012年至2013年在唐山市4家三级甲等医院内就诊的哮喘患儿的母亲或父亲150名为研究对象,采用家长用儿童行为量表和家庭管理测量量表中文版进行调查。结果哮喘患儿的心理行为问题检出率为23．7％,高于国内常模（12．97％）（x^2=12．34,P〈0．05）;男孩主要表现为社交退缩、交往不良和攻击性表现,女孩主要表现为抑郁、社交退缩和分裂样;患儿的社交退缩、交往不良等行为异常表现与患儿的日常生活状况、父母疾病管理能力和父母相互支持呈负相关（r=-0．21,-0．25,-0．29,P〈0．05）,与父母对疾病担心状况、父母疾病管理困难状况和父母疾病精力消耗状况呈正相关（r=0．26,0．24,P〈0．05）。结论哮喘患儿的心理行为问题检出率较高,家庭管理方式呈忍耐型,医护人员应积极提供家庭支持,改善患儿的家庭管理方式,促进患儿的心理行为健康。     

呼吸道细菌感染与哮喘关系的研究进展

哮喘是一种慢性气道炎症性疾病,目前认为病毒感染可以导致气道炎症的发生发展.从而引起哮喘的发生及病情的恶化.但是细菌感染与哮喘的关系尚不明确.本文通过整理近年来各国研究者的研究资料,发现细菌感染不但参与哮喘的发病,而且还会导致病情加重.其机制是促进IgE的合成、增加组胺和多种炎症因子的释放从而导致气道炎症.在有细菌感染的证据下针对性应用抗生素可以起到良好的治疗作用,但是抗生素治疗不是哮喘治疗的常规方案.因此,抗生素在细菌感染与哮喘哮喘防治中的地位需要进一步深入研究.     

Subjective social status affects smoking abstinence during acute withdrawal through affective mediators

Objectives Direct and mediated associations between subjective social status (SSS), a subjective measure of socio‐economic status, and smoking abstinence were examined during the period of acute withdrawal among a diverse sample of 421 smokers (33% Caucasian, 34% African American, 33% Latino) undergoing a quit attempt. Methods Logistic regressions examined relations between SSS and abstinence, controlling for socio‐demographic variables. Depression, stress, positive affect and negative affect on the quit day were examined as potential affective mediators of the SSS‐abstinence association, with and without adjusting for pre‐quit mediator scores. Results SSS predicted abstinence to 2 weeks post‐quit. Abstinence rates were 2.6 (postquit week 1) and 2.4 (postquit week 2) times higher in the highest versus the lowest SSS quartile. Depression and positive affect mediated the SSS–abstinence relationships, but only depression maintained significance when adjusting for the baseline mediator score. Conclusions Among a diverse sample of quitting smokers, low SSS predicted relapse during acute withdrawal after controlling for numerous covariates, an effect accounted for partially by quit day affective symptomatology. Smokers endorsing lower SSS face significant hurdles in achieving cessation, highlighting the need for targeted interventions encompassing attention to quit day mood reactivity.