Birch allergen challenges in allergic conjunctivitis using standard conjunctival allergen challenge and environmental exposure chamber

BackgroundEnvironmental exposure chambers (EECs) have been used extensively to study allergic rhinoconjunctivitis. Few studies have been published using EECs in conjunctivitis only, and none have used conjunctival allergen challenge as a selection criterion. The present study validated ALYATEC EEC in allergic conjunctivitis to birch pollen.MethodsSixteen patients with a positive conjunctival allergen challenge (CAC) were exposed to 60 ng/m³ of Bet v 1 in an EEC on two consecutive days for a maximum of 4 h to validate EEC exposure to birch. Reproducibility was tested among seven of the patients. A conjunctival positive scoring during the CAC and the EEC exposure was defined as a Total Ocular Symptom Score (TOSS) ≥ 5.ResultsFifty percent of patients had a conjunctival positive scoring during first exposure and 75% during second exposure. The mean time to a conjunctival response was 81.2 ± 33.9 min and 101.6 ± 57 (P > 0.05) during first and second exposure, respectively. No difference in TOSS occurred between the two exposures. The time necessary to obtain a positive response during the CAC was significantly shorter than with the EEC. The estimated quantity of Bet v 1 inducing a positive response was 0.07 ± 0.03 ng (exposure 1), 0.07 ± 0.07 ng (exposure 2), 980 ± 784 ng (CAC). Conjunctival positive scoring and quantity of Bet v 1 was reproducible in all six EEC exposures.ConclusionsEarly conjunctival responses induced by birch allergen exposures in EEC were different than from those identified with direct instillation during CAC. EEC appears to be closer to natural exposure than CAC.     

Barriers to and facilitators of self-management adherence in Korean older adults with type 2 diabetes

song m., lee m. & shim b. (2009) Barriers to and facilitators of self-management adherence in Korean older adults with type 2 diabetes. International Journal of Older People Nursing 5 , 211–218
doi: 10.1111/j.1748-3743.2009.00189.x Aim. The aim of this study was to identify the barriers to and facilitators of self-management adherence in Korean older adults with type 2 diabetes. Design and methods. Qualitative data collected from 24 participants in three focus groups who had previously taken part in a diabetes self-management education programme in a community setting were analyzed using an interpretive method. Results. The barriers to adherence to self-management included ageing-related physical and psychological changes, restrictions related to specific cultural factors, lack of self-discipline and poor understanding of self-management. Facilitators of self-management were knowing the benefits of and having a system to reinforce self-management, being the master of oneself by reshaping historical life habits and family support. The perceived barriers and facilitators differed with gender as a result of the characteristics of Korean culture. Conclusions. This study identified the major barriers to and facilitators of self-management adherence specific to Korean older adults with diabetes, which can be used to develop better diabetes self-management education programmes for this population. Relevance to clinical practice. Korean nurses working with Korean older adults with diabetes can utilize the findings of this study to structure better tailored and culturally appropriate self-management programmes specific to older adults.     

Influence of self-efficacy and other factors on dietary behaviours in Japanese haemodialysis patients

In Japan, haemodialysis patients are required to adhere to a fairly rigid dietary regimen. Guided by Bandura's theory of self-efficacy, this study tested a prediction model of dietary behaviour. A total of 325 individuals completed a self-administered survey containing nine scales, which were used to measure the six constructs in the model. Using multiple regression analysis, 24% of the variance on the Dietary Behaviour Scale could be accounted for by three predictor scales, Dietary Management Self-efficacy, Support from Family, and Self-Repressive Behaviour Patterns. Multiple regression analysis identified that four scales, Character Image of Dialysis Staff, Support from Family, Dialysis Acceptance, and Somatic Symptoms, contributed to 13% of the variance of the Dietary Management Self-efficacy Scale. These results might provide direction to those who are involved in the support and care of haemodialysis patients, some of whom require life-long treatment, as is common in Japan.     

Improving medication adherence: moving from intention and motivation to a personal systems approach

Medication nonadherence is a challenging and prevalent problem in older adults. Effective medication management involves successfully completing a complex group of behaviors. Meta-analyses and narrative review findings support limited benefits to medication adherence with interventions preoccupied with personal characteristics, intention, and motivation. Evidence supports a paradigm shift toward changing personal systems in which the person lives to improve and maintain medication adherence behavior. Personal-systems change systematically improves individual systems through collaboratively shaping routines, involving supportive-others in routines, and using medication self-monitoring to improve and maintain behavior. Other advances that support personal systems change are also presented.     

Respiratory drive during carbachol challenge in allergic sheep

Diaphragmatic activity is the standard assessment of respiratory neural output but is difficult to measure and cannot be used for long‐term clinical monitoring. The tidal breathing minute ventilation ( ) and mean inspiratory flow (V_T/t_I) reflect respiratory drive and can be monitored non‐invasively using respiratory inductive plethysmography (RIP). Recent findings indicate that peak inspiratory acceleration (PIA) correlates to diaphragmatic activity during CO₂ rebreathing in piglets. The aim of the present study was to assess whether tidal breathing peak inspiratory acceleration reflects respiratory drive during carbachol challenge. Aerosolized carbachol was administered to 15 allergic sheep until pulmonary resistance increased by at least 400%. After threshold dose, slight increases in
and V_T/t_I were seen (8 and 5%, respectively; P=NS), while PIA increased by 30% (P<0·05). The change in PIA was closely correlated to changes in
and V_T/t_I (r=0·73, P<0·01 and r=0·88, P<0·001, respectively). In conclusion, peak inspiratory acceleration reflected respiratory drive during bronchoprovocation. Further, this new measure of drive has the potential to accurately estimate drive in chronic obstructive lung disease where intrinsic positive end expiratory pressure prevents accurate selection of beginning inspiration necessary for computation of, e.g. V_T/t_I.     

Effect of nitric oxide inhibition on nasal airway resistance after nasal allergen challenge in allergic rhinitis

BACKGROUND: Nitric oxide has been detected by chemiluminescence in the lumen of nasal airway, which is increased in nasal breathing in patients with seasonal rhinitis during a chronic exposure. The purpose of this study was to determinate the effect of a NO-synthase inhibitor NGL-arginine methyl ester (L-NAME) on nasal airway resistance (NAR) in patients with seasonal allergic rhinitis after an acute challenge to the allergen. METHODS: Nitric oxide levels in the nose were measured by the chemiluminescence method in nine non-atopic volunteers and in seven patients with seasonal rhinitis at rest and after an acute challenge with the allergen. NAR were measured by active anterior rhinomanometry. RESULTS: Basal nasal NO concentration in allergic rhinitis was 496.5 +/- 151.4 parts per billion (ppb). (n = 7) and it was not significantly different from levels found in the control group: 458.4 +/- 105.9 ppb (n = 9). The topical administration of L-NAME in allergic rhinitis reduced the NO concentration (338.6 +/- 99.3 ppb, P < 0.001; n = 7). In the rhinitic patients the challenge with the allergen did not modify the nasal NO levels (504.5 +/- 138.5 ppb). The application of the allergen after the pretreatment with placebo caused a significant increase in NAR (from 0.32 +/- 0.11 Pa s cm-3 to 1.01 +/- 0.12 Pa s cm-3, P < 0.001; n = 7). Pre-treatment with L-NAME did not prevent the increase in NAR induced by allergen challenge (from 0.36 +/- 0.15 Pa s cm-3 to 1.06 +/- 0.26 Pa s cm-3). CONCLUSIONS: The results indicate that nasal administration of a NOS inhibitor L-NAME, at doses capable of decreasing nasal NO levels, has no effect on NAR and it does not prevent the NAR increase induced by an acute challenge with allergen in subjects with seasonal rhinitis.     

Understanding adherence to assistive devices among older adults: a conceptual review

Abstract

Purpose: The aim of this study was to identify and examine how existing literature has conceptualized adherence to assistive devices (ADs) among older adults.

Methods: English articles were searched in MEDLINE, PubMed, and CINAHL (January 1990 to October 2017) for the key words “acceptance”, “adherence”, “assistive devices”, “compliance”, “concept,” and relevant synonyms. Bibliographies of selected articles were also examined. Articles were analyzed if the following conditions were met conjointly: (1) attempted to define or conceptualize adherence to some degree; (2) were concerned with any AD for older adults; (3) were concerned with adults aged 65 years or older.

Results: Sixteen of the 484 articles were included. Adherence to ADs among older adults seemed to be conceptualized under three core themes: psychological, contextual, and functional factors; each with their own unique considerations related to adherence that are analyzed in this study.

Conclusion: This review identified a large gap in knowledge about adherence to ADs. Adherence is multi-factorial and highly specific to the individual’s circumstances and their relationship with their health care practitioner. Further empirical research should focus on how the three core themes of adherence interact with and influence each other.

• Implications for rehabilitation

• Health care professionals who assess for, and recommend ADs should foster a shared decision-making relationship with their clients

• This review identifies some of the key themes that practitioners should consider when developing and implementing AD regimens with older adults

• Conceptualizing AD adherence among older adults will help improve monitoring of and quality of care for AD users

     

广州地区引起食物过敏性疾病的变应原谱分析?

目的：分析食物过敏患者血清中13种相同食物变应原特异性 IgG(sIgG)和特异性 IgE(sIgE)在不同年龄和性别间的分布特征,探讨两者在食物过敏性疾病中的关系。方法以2009~2012年门诊314例患者为研究对象,并根据年龄分为未成年组(163例)与成年组(151例);通过酶联免疫吸附试验检测患者血清中13种食物变应原 sIgG,同时通过免疫捕获法检测患者血清中的 sIgE。结果80.25%的患者 sIgG 呈阳性反应,阳性率无明显性别差异,但未成年组(94.48%)高于成年组(64.90%),差异有统计学意义(P <0.05);34.39%的患者 sIgE 呈阳性反应,男性阳性率(40.68%)高于女性(26.28%),未成年组(55.21%)高于成年组(11.92%),差异均有统计学意义(P <0.05)。结论相同食物变应原的 sIgG 和 sIgE 总阳性率差异较大,两者的阳性分布特征也有不同,食物过敏性疾病与年龄、性别、食物种类和个体特异性相关。     

Asthma patients with low perceived burden of illness: a challenge for guideline adherence

RATIONALE AND AIMS: The reason why many patients seem to tolerate suffering from sub-optimal treated asthma remains unclear. The aim was to evaluate the guideline adherence combined with quality of life of patients with moderate to severe asthma. METHODS: 256 asthma patients from 43 primary care practices in Saxony-Anhalt filled in a questionnaire including the Asthma Quality of Life Questionnaire (AQLQ), the Patient Health Questionnaire (PHQ-D) and questions evaluating the asthma severity, medication and self-management. RESULTS: 43.4% suffered from moderate to severe asthma. Drug treatment accorded with guidelines in 36.9%, drug dosage of inhaled steroids was too low in 34.3%, and 21.5% were not treated according to guidelines. A total of 7.3% of the patients received end-of-dose therapy. AQLQ declined and depression rose with asthma severity and guideline non-adherence (P < 0.001). Only 29.1% received asthma education. However, 64.5% of the patients without education did not want to receive education. They had a higher quality of life, lower depression (P < 0.001) and lower use of steroids (P = 0.016). Higher depression scores where related with hospital admission (OR 3.29; 95% CI 1.57-6.87 for each quartile of PHQ-D) and unscheduled home visits or ambulatory care (OR 1.58; 1.07-2.33). CONCLUSION: There is a large variation of asthma severity which can partly be explained by the guideline adherence of medication and deficits of patients' management. The perceived burden of illness plays a more important role for education and self-management than the real severity of disease. Therefore, target-oriented interventions are needed to identify and motivate patients at risk.     

Treatment adherence of youth and young adults with and without a chronic illness

The present study was undertaken to explore the psychosocial functioning of young people with chronic illness, their beliefs about treatment adherence, difficulties with adherence and concerns about living with their illness. A small correlational study was undertaken to compare the psychosocial functioning of young people, with and without chronic illness, aged between 12 and 24 years. Subjects were recruited from a metropolitan teaching hospital. Group 1 included 44 young people with chronic illness; Group 2 included 41 young people without chronic illness. Both groups were divided on the basis of age: younger (12-18 years, n = 24); older (19-24 years, n = 61) and sex (female = 43; male = 42). Subjects completed the Achenbach self-report questionnaire as a measure of psychosocial functioning, and a second questionnaire constructed for this study to explore treatment adherence. Psychosocial functioning scores were found to be similar on the majority of subscales. Young women with chronic illness were, however, found to have significantly higher internalizing scores than young women without chronic illness. A significant negative relationship was found for the chronic illness group between internalizing scores and treatment adherence. The findings highlight potential areas of difficulty in psychosocial functioning of some young people with chronic illness. They also suggest the existence of a subgroup of young people with chronic illness who experience more problems than their peers. More research is needed to generate evidence about this possible subgroup to determine predictors of psychosocial functioning and test the timing and efficacy of psychosocial interventions.     

Food incentives improve adherence to tuberculosis drug treatment among homeless patients in Russia

Scand J Caring Sci; 2013; 27; 117–122 Food incentives improve adherence to tuberculosis drug treatment among homeless patients in Russia The aim of the study was to evaluate the impact of food incentives on adherence to tuberculosis (TB) drug treatment among homeless patients with TB. Food packages were thus given as a part of directly observed therapy to 142 homeless patients with TB at a dispensary in Saint Petersburg, Russian Federation. In addition, a social worker provided the patients with information and legal assistance, for example help with internal passports. Among the 142 patients, 66 were included in the study at the dispensary during their entire treatment period, while 76 patients were included in the study during shorter periods mainly because of transfer to inpatient care. In the first group, 59% of the patients continued the TB drug treatment without interruption in contrast to 31% in a control group. In the second group, that is those studied during shorter periods, 95% continued the TB drug treatment without interruption while attached to the dispensary. Food was introduced in the TB programme of the City of St. Petersburg as a consequence of this study. In conclusion, it can be stated that the food incentive had a strong positive impact on the adherence to TB drug treatment among these socially marginalized patients. The social support contributed in all probability also to the positive results.     

Higher hydroxyurea adherence among young adults with sickle cell disease compared to children and adolescents

BackgroundSickle cell disease (SCD) results in severe complications, such as anaemia and pain episodes. Hydroxyurea (HU) is efficacious in SCD, yet adherence remains low.ObjectiveTo assess the relationship of HU adherence to health care utilization and patients’ characteristics.MethodsThis is a 5-year retrospective chart review. Patients’ demographics and medical history were collected from the electronic medical record (EMR). HU adherence was evaluated using foetal haemoglobin “HbF%”, mean corpuscular volume “MCV”, and absolute neutrophil count “ANC”. Age groups included children (<12 years), adolescents (12–17 years), and young adults (≥18 years).ResultsA total of 113 SCD patients on HU were included (median age 14 years, IQR 10–20; 50% female; 88% HbSS). Young adults had significantly higher HU adherence compared to adolescents and children, including higher median HbF% (24.2 vs. 12.4 vs. 8.6, p = .003), MCV (fl) (106.4 vs. 96.2 vs. 95.4, p = .01) and lower ANC (10³/ml) (3.25 vs. 4.9 vs. 4.2, p = .01), respectively. Patients with chronic pain had lower HU adherence (HbF% 15.3 vs. 10.7, p = .04; ANC 3.6 vs. 6.3, p = .002; MCV 102.3 vs. 93.1, p = .1). Patients with higher HbF or MCV and lower ANC had significantly less frequent emergency room visits (r_s=–0.26, p = .01; r_s=–0.23, p = .01; r_s=0.24, p = .01) and hospitalizations (r_s=–0.27, p = .01; r_s=–0.31, p = .01; r_s=0.21, p = .02) as well as shorter length of stays (r_s=–0.27, p = .0045; r_s=–.34, p = 0.004; r_s=0.23, p = .02), respectively. Similar trends in HU adherence and health care utilization were seen in subgroup analysis of only HbSS patients. There was no significant association of HU adherence to patients’ sex, socio-economic status, distance from hospital, and HU duration.ConclusionsYoung adults with SCD had significantly higher HU adherence compared to children and adolescents. Patients with lower HU adherence and/or chronic pain had increased health care utilization. Future studies examining barriers to adherence and evaluating interventions to optimize HU adherence in SCD are warranted.

KEY MESSAGES

1. Young adults with SCD had significantly higher HU adherence, as reflected in their laboratory markers, compared to children and adolescents.
2. Patients with higher HU adherence and/or those without chronic pain had lower or less frequent health care utilization.
3. No significant association of HU adherence to patients’ sex, socio-economic status and distance from hospital.

     

Beliefs about food allergies in adolescents aged 11–19 years: A systematic review

AimsResearch suggests of people with food allergy (FA), adolescents have the highest risk of fatal allergic reactions to food, yet understanding of this population and how they manage their condition is limited. Understanding beliefs and how they affect behaviour could inform ways to reduce risk taking behaviour and fatal reactions in adolescents. This systematic review aimed to explore beliefs adolescents hold about their FA, and how these may be associated with FA management.DemographicsAdolescents aged 11–19 years with FA.MethodologyA systematic search of seven databases was conducted. Papers of any design were included that reported on the beliefs about FA in adolescents aged 11–19 years. Data was systemised by narrative thematic analysis.Findings20 studies were included. Themes included navigating FA in different environments, carriage and use of adrenaline auto‐injectors, management of the risk of anaphylaxis, behaviour and understanding of others, and food‐allergic identity.ImplicationsAdolescents with FA hold a variety of condition beliefs; some beliefs were related to behaviour that could lead to an allergic reaction, while other beliefs were related to protective behaviours. Further research into understanding adolescent beliefs in order to inform clinical management and reduce the risk of potential fatal reactions is essential.     

OVA致敏BN大鼠IL-17表达水平的变化

目的 研究卵清蛋白(OVA)致敏的Brown Norway(BN)大鼠外周血中白细胞介素(IL)-17表达水平的变化,探讨IL-17在鸡蛋所致食物过敏(FA)中的作用.方法 建立OVA致敏的大鼠模型(OVA组),并以仅给予PBS灌胃的大鼠(PBS组)作为对照,采用实时荧光定量PCR(RT-PCR)检测各组IL-17A mRNA表达水平,采用ELISA法检测各组血浆中IL-17蛋白水平.结果 OVA组IL-17A mRNA表达水平显著高于PBS组,差异有统计学意义(P<0.01),且OVA组IL-17水平也明显高于PBS组,差异有统计学意义(P<0.05).结论 OVA诱发FA动物模型中可检测到外周血IL-17表达水平上升,提示IL-17可能在FA的发病过程中起重要作用.