Knowledge about asthma among Danish primary school teachers. Results of a questionnaire study

An anonymous questionnaire inquiry performed among 324 school teachers in the Randers area with the purpose of elucidating teachers' knowledge about asthma is presented. To a series of statements about asthma, the teachers should answer yes, no or don't know. A limited knowledge about asthma in children was found. The knowledge about medicamental treatment was particularly limited. Only 57 per cent knew that wheezing after physical exertion is a strong indicator of asthma. Only five per cent had received proper instruction. This latter group had a significantly better knowledge of medical treatment (p < 0.0001-0.05). It is recommended that instruction in children's diseases, especially asthma should be reintroduced in teachers' training colleges.     

Unnecessary medical interventions. A questionnaire study among physicians and laymen

The aim of the study was to survey attitudes among medical doctors and lay people to unsolicited medical intervention. The design of the study was an anonymous questionnaire study including three scenarios implying ethical considerations. A total of 445 medical doctors working within different areas received the questionnaire, as did 75 medical students and 600 lay people. The results showed a response rate of 67%, highest among medical doctors and students. The lay people had significantly higher expectations concerning the medical intervention in two out of three scenarios compared to medical doctors and students. The participants were offered the opportunity to comment on the questionnaire. The conclusion of the Danish survey is that there is a significantly different approach to unsolicited medical intervention among lay people compared to medical doctors and students. Medical doctors are less disposed to perform unsolicited intervention compared with the wishes/expectations of the lay people. More open attitudes and information as well as better communication is recommended.     

Occupational skin and respiratory diseases among hairdressers

OBJECTIVES: The occurrence and causes of hairdressers' occupational skin and respiratory diseases were studied. METHODS: Of a random sample of 500 female hairdressers aged 15-54 years, 355 were available for study. Of the 189 reporting work-related skin and respiratory symptoms in a computer-aided telephone interview on exposure and health, 130 underwent a physical examination, lung function tests, prick and patch testing, and nasal and lung provocation tests. An occupational disease was diagnosed when the causality between exposure and disease was probable and the clinical tests supported the diagnosis. RESULTS: The telephone interview revealed a life-time prevalence of 16.9% for hand dermatoses, 16.9% for allergic rhinitis, and 4.5% for asthma among the hairdressers. In the clinical investigations, the prevalence was 2.8% for occupational dermatoses, 1.7% for occupational rhinitis, and 0.8% for occupational asthma. Ammonium persulfate caused 90% of the respiratory diseases and 27% of the hand dermatoses. Paraphenylenediamine, natural rubber latex, and skin irritation were also causes of hand dermatitis. Allergy to human dandruff (8.6%) and Pityrosporum ovale (12.1%) was common. Previously diagnosed atopic diseases increased the risk for occupational skin or respiratory disease 3-fold (odds ratio 2.9, 95% confidence interval 1.1-7.9). Of the cases, 37.5% (6 of 16 persons) had to change occupations during a 3-year follow-up. CONCLUSIONS: Work-related skin and respiratory symptoms are common among hairdressers. Often a specific cause (eg, ammonium persulfate) can be found if occupational diseases are suspected and diagnosed. Hairdressers with atopic diseases are at risk of developing occupational skin and respiratory diseases.     

Self reported respiratory symptoms and diseases among hairdressers

This paper presents some aspects of Polish legislation against chemical dependency. The legal regulations and rules related to enforcement and prevention of drug addiction are listed. Also included is the special insight of the Rule for Prevention of Drug Addiction of January 31, 1985.     

Knowledge of good clinical practice among Danish physicians. A questionnaire study among hospital-employed physicians in the Copenhagen area

Differences in cord serum low density lipoprotein (LDL) composition between male and female neonates with normal or high (> or = 100 mg/dl or > or = 2.59 mmol/l) serum cholesterol levels were studied in 548 full-term newborn infants of the Toledo Study (Spain), where the absence of known perinatal factors that would alter lipid levels in cord blood was confirmed. The percentage of females with a high serum total cholesterol (TC) level was higher (p < 0.02) than that of males. ANOVA two-way analysis shows significant interaction of gender and cholesterol level upon LDL-cholesterol, triglycerides and LDL-cholesterol/Apoprotein (Apo) B ratio. However, Apo B was higher in those neonates, both male and female, with high cholesterol levels. The LDL fraction carried about 55% of TC in females with high TC levels (HF), whereas it transported just 40% in males with high TC levels (HM). LDL appeared more enriched in cholesterol than in Apo B in HF than in HM (p < 0.01). An increased level of small LDL particles should be associated with the higher triglyceride level found amongst HM. Results in LDL composition suggest that metabolic gender-related differences in infants with normal or high TC are presented at birth.     

Epidemiology of chronic bronchitis

In this short paper, the definition of chronic bronchitis, as it is now widely accepted by epidemiologists, is given and a comparison is made with the disease as usually referred to by general practitioners. Risk factors which are related to the development of the disease are then briefly discussed and the importance of internal parameters is underlined. At last, the methodological difficulties which arise in the assessment of the relationship between air pollution and respiratory symptoms are emphasized.     

A comparative assessment of the clinical efficacy of standard and low-volume plasmapheresis in treating patients with bronchial asthma and chronic bronchitis

21 patients with bronchial asthma and chronic obstructive bronchitis resistant to standard therapy have been exposed to discrete plasmapheresis. Changes in the bronchial tree inflammation measured by fibre bronchoscopy and activity of neuron-specific enolase (NSE) in bronchial wash-offs made it clear that low-volume plasmapheresis is not inferior in efficacy to the standard method. The trend in the fall of NSE activity as a marker of diffuse neuroendocrine system objectively reflects attenuating inflammation in bronchial mucosa in response to treatment of chronic obstructive diseases of the lungs using different techniques of plasmapheresis.     

Body-image and eating disturbances predict onset of depression among female adolescents: A longitudinal study.

This study examined data from a 4-year school-based longitudinal study (n?=?1,124), to test whether the increase in major depression that occurs among girls during adolescence may be partially explained by the body-image and eating disturbances that emerge after puberty. Elevated body dissatisfaction, dietary restraint, and bulimic symptoms at study entry predicted onset of subsequent depression among initially nondepressed youth in bivariate analyses controlling for initial depressive symptoms. Although the unique effect for body dissatisfaction was not significant in the multivariate model, this set of risk factors was able to fairly accurately foretell which girls would go on to develop major depression. Results were consistent with the assertion that the body-image- and eating-related risk factors that emerge after puberty might contribute to the elevated rates of depression for adolescent girls. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Medical research and the ethics committee. A questionnaire study among project leaders in the health region 4

All 159 principal investigators whose projects had been assessed by the biomedical research ethics committee in Health Region 4 (Central Norway) during 1986-92 were asked to complete a questionnaire about medical research ethics and the work of the ethics committee. Their answers about scientific fraud and misconduct have been published previously. This paper reports how the 119 respondents (70% of those addressed) regard the role and work of the ethics committees and how they perceived the committee's assessment of their own project. A majority agreed that medical ethics committees are an important part of the scientific community (90%), that scientific quality is an important ethical element of any project (85%), and that researchers put more effort into their study protocol as they knew it would be assessed by an ethics committee (85%). More than 70% agreed that the committee's comments were useful and relevant, but a majority of these agreed only partly. The results are discussed in relation to the characteristics of the investigators.     

Patient assessment in ambulatory surgery. A questionnaire study

In our department, from the beginning of December 1994 to the end of February 1995, we operated upon a selected group of 199 patients, hospitalized as day surgery patients. Each patient was given a questionnaire to fill in after discharge. We asked them to evaluate day surgery from the consumer's point of view. We did not record any data which could identify the single patient. We received 158 questionnaires (79%) of which 151 were accepted. One hundred and seven patients (71%) found day surgery acceptable and a good alternative to conventional hospitalization, 82% preferred having the same doctor and primary nursing during the treatment. One hundred and sixteen patients were discharged as planned (77%). There were no serious complications. Provided that patients are carefully selected, we find day surgery a highly satisfactory method of management which is safe and efficient.     

Acute exacerbations of chronic bronchitis

Not every patient with bronchitis needs to be treated with an antibiotic. When treatment is indicated, however, the regimen should be selected carefully. A simple four-part disease classification scheme serves as a practical aid for initial assessment of the patient and as a guideline for choosing therapy.     

Diagnosis and treatment of thyrotoxicosis in childhood. A European questionnaire study

A covering letter and a questionnaire covering the diagnosis and treatment of thyrotoxicosis in childhood was circulated between October 1992 and February 1993 amongst 672 European members of the European Thyroid Association (ETA) and members of the European Society for Pediatric Endocrinology (ESPE). Almost 50% replied to the letter and 99 individuals or groups from 22 countries completed the questionnaire. A consensus was reached on the use of total thyroxine (T4) and/or free T4 and thyrotropin as routine diagnostic tools. Two-thirds included total triiodothyronine (T3) and/or free T3 and 32% used a thyrotropin-releasing hormone test. Surprisingly, thyroglobulin autoantibodies were used as a routine test by 78%; 63% included thyrotropin receptor antibodies and 60% microsomal antibodies, whereas only 50% measured thyroperoxidase antibodies. For thyroid imaging, 40% performed a thyroid scintigram and 56% measured the size of the thyroid gland by ultrasound. Antithyroid drugs (ATD) were the basic initial treatment of choice given by 99% of the respondents for children with uncomplicated Graves' disease. Carbimazole, methimazole and thiamazole were the most frequently used drugs, with a median initial dose of 0.8 mg.kg-1.day-1. Two-thirds added beta-blockers and a few used sedatives. The ATD dose was adjusted for each patient by 39%, whereas 56% combined ATD with T4 for long-term treatment; 84% gave treatment for a fixed period (44% for 1-2 years). Surgery was considered the treatment of choice in children with an adenoma (83%), with a nodular (53%) or large goiter (16%) and recurrence after ATD (14%).(ABSTRACT TRUNCATED AT 250 WORDS)     

Effects of seaprose on the rheology of bronchial mucus in patients with chronic bronchitis. A double-blind study vs placebo

Approximately 2000 children aged between 0 and 14 years die annually of accidents and their sequelae in Japan. Moreover, accidents and their sequelae are the leading cause of death in the 1-4 year, 5-9 year and 10-14 year age groups. Accidental drowning and traffic accidents account for 2/3 of all such deaths. Measures for preventing injury in these age groups are clearly necessary, since the mortality rate due to accidents and their sequelae in children 0 to 4 years old is higher in Japan than in European countries. It is considered that the lives of 824 infants aged between 0 and 4 years might be saved annually in Japan if the mortality rate could be reduced to a level comparable to that in Sweden by accident prevention and control. Therefore, a systematic approach for prevention of childhood injury is a high priority in Japan.     

The diagnosis of chronic dust-induced bronchitis

In dust-induced bronchitis, alterations in the pulmonary parenchyma present themselves in the main cellular indices for bronchioalveolar lavage (BAL), thought to be of much importance to its diagnosis. A total of 53 patients with initial and manifest forms of dust bronchitis underwent BAL. There has been found the following: a decrease in the mononuclear phagocyte system cells (MPhS) reflecting the state of local cellular immunity; rise in the amounts of coniophages, suggesting phagocytic activity of alveolar macrophages (AM) and dust blockade of MPhS cells; emergence and augmentation of counts of gigantic Pirogov-Langhans' cells characteristic of tuberculous granulomas, and also decrease in the counts of lymphocytes. There is a striking decrement in the vitality of AM, with polycytosis being commonly seen. Detection of granular forms of Mycobacterium tuberculosis in BAL and Pirogov-Langhans' cells enables a major proportion of "dust-induced bronchitis" to be considered as belonging to the silicotuberculous process.     

Sputum metalloproteinase-9/tissue inhibitor of metalloproteinase-1 ratio correlates with airflow obstruction in asthma and chronic bronchitis

Asthma and chronic bronchitis are inflammatory diseases with extracellular matrix (ECM) remodeling and collagen deposition. Collagen homeostasis is controlled by metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs). We evaluated MMP and TIMP balance in induced sputum of 10 control, 31 untreated asthmatic, and 16 chronic bronchitic subjects. We first performed zymographic analysis to identify the profile of MMPs. Zymography revealed a similar MMPs profile in all populations studied and that MMP-9 was the major enzyme released. We then measured, using enzyme immunoassay, the concentrations of MMP-9 and of its inhibitor TIMP-1 and evaluated whether airflow limitation may be associated with an imbalance between these enzymes. MMP-9 and TIMP-1 concentrations were greater in sputum of patients with asthma and chronic bronchitis than in control subjects. The molar ratio between MMP-9 and TIMP-1 was lower in asthmatics and chronic bronchitics than in control subjects, and positively correlated with FEV1 values. In asthma, MMP-9 levels were significantly correlated with the number of macrophages and neutrophils. This study shows that airway inflammation in asthma and chronic bronchitis is associated with an imbalance between MMP-9 and TIMP-1 which may have a role in the pathogenesis of ECM remodeling and airflow obstruction.     

Occurrence of asthma in schoolchildren. Is the disease underdiagnosed?

A cross sectional study of 1064 unselected school children aged 6-17 years obtained the following for 851 of them (80%): complete data from a questionnaire on current asthma diagnosed by a physician, information on previous recurrent wheezing and present exposure to tobacco smoking combined with measurement of peak expiratory flow rate (PEFR) before and after six minutes running. Seventy-five (8.8%) had had previous periods of recurrent wheezing, and 535 (62.7%) were exposed to tobacco smoking at home. A correlation was found between passive smoking and previous recurrent wheezing. Thirty-four (4.0%) suffered from current asthma. Thirty-one children (3.6%) without an earlier diagnosis of asthma showed a significant exercise-induced fall in PEFR) (at least 15%). Thirty of these 31 children were followed up, and at reinvestigation, 27 (95%) were confirmed to suffer from hyperreactive airways based on significant exercise-induced fall in PEFR and/or a significantly increased variability of PEFR of at least 15% as measured by home recordings of PEFR. In conclusion the point prevalence of asthma diagnosed by a physician was 4.0%. In addition at least 3.2% had reproducible significant bronchial hyperreactivity indicating a point prevalence of asthma/clinically significant bronchial hyperreactivity of at least 7.2%. Asthma seems to be underdiagnosed in school children. Furthermore, our results indicate an association between passive smoking and recurrent wheezing.