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The article investigates the diagnostic capabilities and prevalence of chronic obstructive pulmonary disease (COPD) in primary care settings in northern Brazil. It highlights that COPD is often underdiagnosed and undertreated in resource-limited regions. The study involved 34 general practitioners a
...
nd used spirometry to evaluate their diagnostic accuracy compared to clinical assessments. Findings revealed significant discrepancies between GP diagnoses and spirometry results, with many false positives and negatives. The study underscores the need for better training and the use of spirometry to improve COPD diagnosis and case-finding in primary care, emphasizing the importance of targeted strategies to enhance healthcare outcomes in developing countries.
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The article outlines the prioritized research agenda for the prevention and control of chronic respiratory diseases (CRDs) as part of the World Health Organization's (WHO) action plan on noncommunicable diseases (NCDs) from 2008 to 2013. It highlights the significant global impact of CRDs, including
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asthma, chronic obstructive pulmonary disease (COPD), and other related conditions, particularly in low- and middle-income countries (LMICs). The document stresses the need for effective prevention strategies and better surveillance, as well as enhanced healthcare infrastructure and resources in LMICs. It calls for research into CRD risk factors, effective interventions, and integrated care approaches that align with broader NCD prevention programs. The article emphasizes the importance of public health initiatives and cross-sector collaborations to reduce the disease burden and improve patient outcomes.
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The article from the European Respiratory Journal discusses the natural history of chronic obstructive pulmonary disease (COPD), emphasizing its increasing global impact on morbidity and mortality. It highlights that while cigarette smoking is a pri
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mary risk factor, other influences such as environmental exposures and genetics also play significant roles. The article notes that lung function, measured by FEV1 (forced expiratory volume in one second), is a critical indicator of both diagnosis and prognosis. It further explores the impact of exacerbations, comorbidities, and systemic inflammation on disease progression and outcomes. The need for comprehensive patient management, which considers various comorbid conditions and inflammatory factors, is emphasized to improve clinical outcomes and reduce healthcare costs.
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The article discusses the significant impact of chronic obstructive pulmonary disease (COPD) as a global health issue, with cigarette smoking as the main risk factor. However, in developing countries, the causes of COPD are often multifactorial, involving environmental tobacco smoke, biomass fuel sm
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oke, dust, fumes, childhood illnesses, and tuberculosis (TB). Up to half of COPD patients in these regions are non-smokers. The article emphasizes that while smoking is crucial, other risk factors contribute significantly to COPD, particularly in low- and middle-income countries. It highlights the need for targeted research and public health strategies to address these diverse contributors to COPD, especially in Africa.
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BACKGROUND. Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The burden of asthma in children is increasing in low- and middle-income countries and remains under-recognised and poorly managed.
OBJE
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CTIVES. To quantify the burden of asthma in the South African (SA) population and identify the risk factors associated with disease severity in the local context.
METHODS. The SA Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The epidemiology task group reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system.
CONCLUSIONS. Asthma in children remains a common condition, which has shown an increasing prevalence in urban and rural populations of SA. Of concern is that almost half of children in urban communities experience severe asthma symptoms, and many asthmatics lack a formal diagnosis and thus access to treatment. Exposure to tobacco smoke and living in highly polluted areas increase the severity of wheezing in young children.
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The epidemiology of wheeze in children, when assessed by questionnaires, is dependent on parents' understanding of the term “wheeze”.
In a questionnaire survey of a random population sample of 4,236 children aged 6–10 yrs, parents' definition of wheeze was assessed. Predictors of a correct
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definition were determined and the potential impact of incorrect answers on prevalence estimates from the survey was assessed.
Current wheeze was reported by 13.2% of children. Overall, 83.5% of parents correctly identified “whistling or squeaking” as the definition of wheeze; the proportion was higher for parents reporting wheezy children (90.4%). Frequent attacks of reported wheeze (adjusted odds ratio (OR) 3.0), maternal history of asthma (OR 1.5) and maternal education (OR 1.5) were significantly associated with a correct answer, while the converse was found for South Asian ethnicity (OR 0.6), first language not English (OR 0.6) and living in a deprived neighbourhood (OR 0.6).
In summary, the present study showed that misunderstanding could lead to an important bias in assessing the prevalence of wheeze, resulting in an underestimation in children from South Asian and deprived family backgrounds. Prevalence estimates for the most severe categories of wheeze might be less affected by this bias and questionnaire surveys on wheeze should incorporate measures of parents' understanding of the term wheeze.
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he aetiology of asthma and allergic disease remains poorly understood, despite considerable research. The International Study of Asthma and Allergies in Childhood (ISAAC), was founded to maximize the value of epidemiological research into asthma and allergic disease, by establishing a standardized m
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ethodology and facilitating international collaboration. Its specific aims are: 1) to describe the prevalence and severity of asthma, rhinitis and eczema in children living in different centres, and to make comparisons within and between countries; 2) to obtain baseline measures for assessment of future trends in the prevalence and severity of these diseases; and 3) to provide a framework for further aetiological research into genetic, lifestyle, environmental, and medical care factors affecting these diseases. The ISAAC design comprises three phases. Phase 1 uses core questionnaires designed to assess the prevalence and severity of asthma and allergic disease in defined populations. Phase 2 will investigate possible aetiological factors, particularly those suggested by the findings of Phase 1. Phase 3 will be a repetition of Phase 1 to assess trends in prevalence.
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The goal of asthma treatment is to obtain clinical control and reduce future risks to the patient. To reach this goal in children with asthma, ongoing monitoring is essential. While all components of asthma, such as symptoms, lung function, bronchial hyperresponsiveness and inflammation, may exist i
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n various combinations in different individuals, to date there is limited evidence on how to integrate these for optimal monitoring of children with asthma. The aims of this ERS Task Force were to describe the current practise and give an overview of the best available evidence on how to monitor children with asthma.
22 clinical and research experts reviewed the literature. A modified Delphi method and four Task Force meetings were used to reach a consensus.
This statement summarises the literature on monitoring children with asthma. Available tools for monitoring children with asthma, such as clinical tools, lung function, bronchial responsiveness and inflammatory markers, are described as are the ways in which they may be used in children with asthma. Management-related issues, comorbidities and environmental factors are summarised.
Despite considerable interest in monitoring asthma in children, for many aspects of monitoring asthma in children there is a substantial lack of evidence.
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Respiratory Effects of Exposure to Diesel Traffic in Persons with Asthma
McCreanor, J.; Cullinan, P.; Nieuwenhuijsen, M.J.; et al.
The New England Journal of Medecine
(2007)
CC2
Air pollution from road traffic is a serious health hazard, and people with preexisting respiratory disease may be at increased risk. We investigated the effects of short-term exposure to diesel traffic in people with asthma in an urban, roadside environment.
The National Asthma Education Programme (NAEP) is a registered non-profit organisation whose mission is to provide asthma education to healthcare professionals, patients and the lay public. It was founded in 1994 by Dr Mike Greenblatt and Profs Dave Luyt and Robin Green. This year NAEP celebrates it
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s 25th anniversary and remains driven by the need to improve the daily lives of numerous asthmatics in South Africa (SA) and Africa.
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, with airway reversibility. Management of chronic inflammation with anti-asthma medication improves asthma control and quality of life. The aim of this
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journal is to provide an evidence-based approach for chronic asthma management in young children and adolescents and provide guidance on the use of new asthma drugs in children.
For that, the South African Childhood Asthma Working Group (SACAWG) convened in January 2017. The asthma treatment task group reviewed the available scientific literature and international asthma treatment guidelines. The evidence was then graded according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system and recommendations were made based on scientific evidence and local context. Asthma management recommendations were made for children ˂6 years of age and older children and adolescents, as well as for stepping up and stepping down of therapy. This review does not include biologics or novel asthma drugs, which are covered in another CME article in this edition of SAMJ.
The final conclusions are that it is important to ensure good response, treatment and adherence, type of medication, device and checking of technique are all critical. Stepping up of therapy should be done only after ensuring good adherence and technique. Once therapeutic response is achieved, medication administration has to be stepped down to improve ease of use and avoid unnecessary side-effects.
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Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. A task force supported by the European Respiratory Society has developed these evidence
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-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
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Although asthma is very common, affecting 5–10% of the population, the diagnosis of asthma in adults remains a challenge in the real world, which results in both over- and under-diagnosis. A taskforce was set up by the European Respiratory Society to systematically review the literature on the dia
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gnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendations for clinical practice.
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Asthma is a heterogeneous condition characterised by chronic inflammation and variable expiratory airflow limitation, as well as airway reversibility. The diagnosis of asthma in young children is limited by the inability to perform objective lung function testing in this group of patients and the wi
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de variety of conditions that can phenotypically present with asthma-like symptoms.
This article provides an evidence-based approach for clinicians to accurately diagnose asthma in young children and to assess the level of control to guide therapeutic decisions.
The South African Childhood Asthma Working Group (SACAWG) convened in January 2017 with task groups, each headed by a section leader, constituting the editorial committee on assessment of asthma epidemiology, diagnosis, control, treatments, novel treatments and self-management plans. The asthma diagnosis and control task groups reviewed the available scientific literature and assigned evidence according to the Grades of Recommendation Assessment, Development and Evaluation (GRADE) system, providing recommendations based on current evidence.
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Asthma is the most common chronic illness of childhood. The prevalence is rising and the mortality and morbidity from asthma are unacceptably high in South Africa. This article emphasizes the importance to make a correct diagnosis based, most importantly, on the clinical history and supported by inv
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estigations. Further, the appropriate drug and device must be chosen to achieve good asthma control. It explains that patients must be followed up regularly and their asthma control must be assessed so that the treatment can then be adjusted according to the level of control. Additionally, Asthma education and adherence are important components of management of the condition.
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The UK could regain its leadershipin the provision of development assistance for healthunder the next government. But this doesn’t seem likely if the party manifestos are any guide.
Movilidad poblacional y VIH/sida en Centroamérica y México
R. Leyva-Flores; B. Aracena-Genao; E. Serván-Mori
PAHO (Pan American Health Organization; World Health Organization); Rev Panam Salud Publica; Pan American Journal of Public Health
(2014)
C2
Investigación original / Original research
Rev Panam Salud Publica 36(3), 2014
Diabetes is not new to South-East Asia, since this condition was first described by Indian and Egyptian physicians three and a half thousand years ago. Diabetes is a serious, chronic disease characterized by chronic elevation of blood glucose and disturbance of carbohydrate, fat and protein metaboli
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sm that occurs either when the pancreas does not produce enough insulin or when the body cannot effectively use the insulin it produces. Raised blood glucose, a common effect of uncontrolled diabetes, may, over time, lead to serious damage to the heart, blood vessels, eyes, kidneys and nerves. Diabetes is therefore not only a disease in itself but also an intermediate stage for many other serious conditions.
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Disability, CBR & Inclusive Development, [S.l.], v. 24, n. 3, p. 112-122, nov. 2013. ISSN 2211-5242
Children with disabilities encounter more violence in their lives than their peers without disability. Organisations involved in Community Based Rehabilitation (CBR) come across many cases of violen
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ce against the children they work with. Many organisations have no policy on child protection since it is not within the scope of their expertise. Others work with child protection policies that are hard to apply in the realities they deal with. Through research done in Ethiopia, with a recent update, the author attempts to show that there is a need for policies in CBR, that follow a community approach rather than an individual approach to child protection.
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Parental Stress in Raising a Child with Disabilities in India
Vidya Bhushan Gupta, Priyanka Mehrotra, Naveen Mehrotra
Disability, CBR & Inclusive Development Journal (DCIDJ)
(2012)
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