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Langan SM, Mulick AR, Rutter CE, Silverwood R, Asher I, García‐Marcos L, Ellwood E, Bissell K, Chiang C, Sony AE, Ellwood P, Marks G, Mortimer K, Martínez‐Torres AE, Morales E, Perez‐Fernandez V, Robertson S, Williams H, Strachan DP, Pearce N. Trends in eczema prevalence in children and adolescents: A Global Asthma Network Phase I Study. Clin Exp Allergy 2023; 53:337-352. [PMCID: PMC10946567 DOI: 10.1111/cea.14276] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 11/12/2022] [Accepted: 11/30/2022] [Indexed: 05/19/2024]
Abstract
Background Eczema (atopic dermatitis) is a major global public health issue with high prevalence and morbidity. Our goal was to evaluate eczema prevalence over time, using standardized methodology. Methods The Global Asthma Network (GAN) Phase I study is an international collaborative study arising from the International Study of Asthma and Allergies in Children (ISAAC). Using surveys, we assessed eczema prevalence, severity, and lifetime prevalence, in global centres participating in GAN Phase I (2015–2020) and one/ both of ISAAC Phase I (1993–1995) and Phase III (2001–2003). We fitted linear mixed models to estimate 10‐yearly prevalence trends, by age group, income, and region. Results We analysed GAN Phase I data from 27 centres in 14 countries involving 74,361 adolescents aged 13–14 and 47,907 children aged 6–7 (response rate 90%, 79%). A median of 6% of children and adolescents had symptoms of current eczema, with 1.1% and 0.6% in adolescents and children, respectively, reporting symptoms of severe eczema. Over 27 years, after adjusting for world region and income, we estimated small overall 10‐year increases in current eczema prevalence (adolescents: 0.98%, 95% CI 0.04%–1.92%; children: 1.21%, 95% CI 0.18%–2.24%), and severe eczema (adolescents: 0.26%, 95% CI 0.06%–0.46%; children: 0.23%, 95% CI 0.02%–0.45%) with larger increases in lifetime prevalence (adolescents: 2.71%, 95% CI 1.10%–4.32%; children: 3.91%, 95% CI 2.07%–5.75%). There was substantial heterogeneity in 10‐year change between centres (standard deviations 2.40%, 0.58%, and 3.04%), and strong evidence that some of this heterogeneity was explained by region and income level, with increases in some outcomes in high‐income children and middle‐income adolescents. Conclusions There is substantial variation in changes in eczema prevalence over time by income and region. Understanding reasons for increases in some regions and decreases in others will help inform prevention strategies.
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Affiliation(s)
| | - Amy R. Mulick
- London School of Hygiene & Tropical MedicineLondonUK
| | | | - Richard J. Silverwood
- London School of Hygiene & Tropical MedicineLondonUK
- Centre for Longitudinal Studies, UCL Social Research InstituteUniversity College LondonLondonUK
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Luis García‐Marcos
- Paediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's HospitalUniversity of MurciaMurciaSpain
- IMIB Bio‐health Research InstituteMurciaSpain
- ARADyAL Allergy NetworkMurciaSpain
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Karen Bissell
- School of Population Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Chen‐Yuan Chiang
- International Union Against Tuberculosis and Lung DiseaseParisFrance
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang HospitalTaipei Medical UniversityTaipeiTaiwan
- Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of MedicineTaipei Medical UniversityTaipeiTaiwan
| | - Asma El Sony
- Epidemiological Laboratory (Epi‐Lab) for Public Health, Research and DevelopmentKhartoumSudan
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, Faculty of Medical and Health SciencesUniversity of AucklandAucklandNew Zealand
| | - Guy B. Marks
- Respiratory & Environmental EpidemiologyUniversity of New South WalesSydneyNew South WalesAustralia
| | - Kevin Mortimer
- Department of MedicineUniversity of CambridgeCambridgeUK
- Department of Respiratory MedicineLiverpool University Hospitals NHS Foundation TrustLiverpoolUK
- Department of Paediatrics and Child Health, College of Health Sciences, School of Clinical MedicineUniversity of KwaZulu‐NatalDurbanSouth Africa
| | - A. Elena Martínez‐Torres
- Paediatric Allergy and Pulmonology Units and Nurse Research GroupVirgen de la Arrixaca University Children's HospitalMurciaSpain
- IMIB Bio‐health Research Institute, Edificio Departamental‐LaibMurciaSpain
| | - Eva Morales
- IMIB Bio‐health Research Institute, Edificio Departamental‐LaibMurciaSpain
- Department of Public Health SciencesUniversity of MurciaMurciaSpain
| | - Virginia Perez‐Fernandez
- IMIB Bio‐health Research Institute, Edificio Departamental‐LaibMurciaSpain
- Department of BiostatisticsUniversity of MurciaMurciaSpain
| | - Steven Robertson
- Centre for Longitudinal Studies, UCL Social Research InstituteUniversity College LondonLondonUK
| | - Hywel C. Williams
- Centre for Evidence‐Based DermatologyUniversity of NottinghamNottingamUK
| | - David P. Strachan
- Population Health Research InstituteSt George's, University of LondonLondonUK
| | - Neil Pearce
- London School of Hygiene & Tropical MedicineLondonUK
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Ellwood P, Asher I, Bissell K, Chiang CY, Ellwood E, Sony AE, García-Marcos L, Marks G, Masekela R, Morales E, Mortimer K, Pearce N, Strachan D. Asthma Network. Int J Tuberc Lung Dis 2022; 26:14-15. [PMID: 36284425] [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: 06/16/2023] Open
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Asher I, Billo N. Preface. Int J Tuberc Lung Dis 2022; 26:5. [PMID: 36284424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023] Open
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Rutter C, Silverwood R, Pérez Fernández V, Pearce N, Strachan D, Mortimer K, Lesosky M, Asher I, Ellwood P, Chiang CY, García-Marcos L. The Global Burden of Asthma. Int J Tuberc Lung Dis 2022; 26:20-23. [PMID: 36284412] [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: 06/16/2023] Open
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Asher I. Asthma in the Western Pacific Region. Int J Tuberc Lung Dis 2022; 26:65-69. [PMID: 36284415] [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: 06/16/2023] Open
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García-Marcos L, Chiang CY, Silverwood R, Asher I, Marks G, Mortimer K, Ellwood P, Morales E, El-Sony A. Global Asthma Management and Control. Int J Tuberc Lung Dis 2022; 26:29-31. [PMID: 36284433] [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: 06/16/2023] Open
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Pearce N, García-Marcos L, Morales E, Strachan D, Marks G, Asher I. Asthma and Factors Affecting it. Int J Tuberc Lung Dis 2022; 26:16-19. [PMID: 36284411] [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: 06/16/2023] Open
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8
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Chiang CY, Ellwood P, Ellwood E, García-Marcos L, Masekela R, Asher I, Badellino H, Sanz AB, Douros K, El Sony A, Diaz CG, Rodríguez MA, Moreno-Salvador A, Pérez-Martini LF, Filho NR, Shpakou A, Sulaimanov S, Tavakol M, Valverde-Molina J, Yousef AA, Pearce N. Infection with SARS-CoV-2 among children with asthma: evidence from Global Asthma Network. Pediatr Allergy Immunol 2022; 33:e13709. [PMID: 34856034 DOI: 10.1111/pai.13709] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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] [Received: 09/27/2021] [Revised: 11/12/2021] [Accepted: 11/30/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Clinical presentations of coronavirus disease 2019 (COVID-19) among children with asthma have rarely been investigated. This study aimed to assess clinical manifestations and outcome of COVID-19 among children with asthma, and whether the use of asthma medications was associated with outcomes of interest. METHODS The Global Asthma Network (GAN) conducted a global survey among GAN centers. Data collection was between November 2020 and April 2021. RESULTS Fourteen GAN centers from 10 countries provided data on 169 children with asthma infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 was asymptomatic in 58 (34.3%), mild in 93 (55.0%), moderate in 14 (8.3%), and severe/critical in 4 (2.4%). Thirty-eight (22.5%) patients had exacerbation of asthma and 21 (12.4%) were hospitalized for a median of 7 days (interquartile range 3-16). Those who had moderate or more severe COVID-19 were significantly more likely to have exacerbation of asthma as compared to those who were asymptomatic or had mild COVID-19 (adjusted odds ratio (adjOR) 3.97, 95% CI 1.23-12.84). Those who used inhaled bronchodilators were significantly more likely to have a change of asthma medications (adjOR 2.39, 95% CI 1.02-5.63) compared to those who did not. Children who used inhaled corticosteroids (ICS) did not differ from those who did not use ICS with regard to being symptomatic, severity of COVID-19, asthma exacerbation, and hospitalization. CONCLUSIONS Over dependence on inhaled bronchodilator may be inappropriate. Use of ICS may be safe and should be continued in children with asthma during the pandemic of COVID-19.
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Affiliation(s)
- Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Disease, Paris, France.,Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.,Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Philippa Ellwood
- Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Eamon Ellwood
- Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Luis García-Marcos
- Pediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bioresearch Institute, Murcia, Spain.,ARADyAL Allergy Network, Edificio Departamental-Laib, El Palmar, Murcia, Spain
| | - Refiloe Masekela
- Department of Paediatrics and Child Health, Nelson R Mandela School of Clinical Medicine, College of Health Sciences, University of KwaZulu Natal, Durban, South Africa
| | - Innes Asher
- Department of Paediatrics, Child and Youth Health, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Héctor Badellino
- Pediatric Respiratory Medicine Department, UCES University and Clínica Regional del Este, Corrientes, San Francisco, Argentina
| | - Alberto Bercedo Sanz
- Cantabrian Health Service, Valdecilla Research Institute (IDIVAL), Dobra Health Center, Torrelavega, Cantabria, Spain
| | - Konstantinos Douros
- School of Medicine, 3rd Department of Pediatrics, "Attikon" University Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Asma El Sony
- Epidemiological Laboratory (Epi-Lab) for Public Health, Research and Development, Khartoum, Sudan
| | - Carlos González Diaz
- Department of Pediatrics, University of the Basque Country, Bilbao, Vizcaya, Spain.,UPV/EHU, Basurto University Hospital, Bilbao, Vizcaya, Spain
| | - Ms Albi Rodríguez
- Pediatric Pneumology and Allergy Unit, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Ana Moreno-Salvador
- Pediatric Allergy Unit, Virgen de la Arrixaca University Children's Hospital, University of Murcia, Spain
| | - Luis F Pérez-Martini
- Asociación Guatemalteca de Neumología y Cirugía de Tórax, Guatemala, Ciudad, Guatemala
| | | | - Andrei Shpakou
- Department of Theory of Physical Culture and Sport Medicine, Yanka Kupala State University of Grodno, Grodno, Belarus
| | | | - Marzieh Tavakol
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - José Valverde-Molina
- Department of Pediatrics, Hospital General Universitario Santa Lucia, Cartagena, Murcia, Spain
| | - Abdullah A Yousef
- College of Medicine, Imam Abdulrahman bin Faisal University, Al Khobar, Saudi Arabia.,Department of Pediatrics, King Fahd Hospital of the University Alkhobar, Al Khobar, Saudi Arabia
| | - Neil Pearce
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, UK
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Wallace A, Sinclair O, Shepherd M, Neutze J, Trenholme A, Tan E, Brabyn C, Bonisch M, Grey N, Johnson DW, McNamara D, Thompson JMD, Asher I, Dalziel SR. Impact of oral corticosteroids on respiratory outcomes in acute preschool wheeze: a randomised clinical trial. Arch Dis Child 2021; 106:339-344. [PMID: 33067310 DOI: 10.1136/archdischild-2020-318971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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] [Received: 03/04/2020] [Revised: 07/01/2020] [Accepted: 08/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine if administration of oral prednisolone to preschool children with acute wheeze alters respiratory outcomes. DESIGN Double-blind, randomised, placebo-controlled equivalence trial. SETTING Three hospitals in New Zealand. PATIENTS 477 children aged 24-59 months with acute wheeze associated with respiratory illness. INTERVENTIONS 2 mg/kg (maximum 40 mg) oral prednisolone or similar placebo, once daily for 3 days. MAIN OUTCOME MEASURES Primary outcome was change in Preschool Respiratory Assessment Measure (PRAM) score 24 hours after intervention. Secondary outcomes included PRAM score at 4 hours, length of emergency department and inpatient stays, admission and representation rates, time to return to normal activities and use of additional oral prednisolone or intravenous medications. Analysis was by intention-to-treat. RESULTS There was no difference between groups for change in PRAM score at 24 hours (difference between means -0.39, 95% CI -0.84 to 0.06, p=0.09). Absolute PRAM score was lower in the prednisolone group at 4 hours (median (IQR) 1 (0-2) vs 2 (0-3), p=0.01) and 24 hours (0 (0-1) vs 0 (0-1), p=0.01), when symptoms had resolved for most children regardless of initial treatment. Admission rate, requirement for additional oral prednisolone and use of intravenous medication were lower in the prednisolone group, although there were no differences between groups for time taken to return to normal activities or rates of representation within 7 days. CONCLUSION Oral prednisolone does not alter respiratory outcomes at 24 hours or beyond in preschool children presenting with acute wheeze.
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Affiliation(s)
- Alexandra Wallace
- Department of Paediatrics, Waikato Hospital, Hamilton, New Zealand.,Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Owen Sinclair
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Paediatric Department, Waitakere Hospital, Auckland, New Zealand
| | - Michael Shepherd
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Children's Emergency Department, Starship Children's Health, Auckland, New Zealand
| | - Jocelyn Neutze
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Adrian Trenholme
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Kidz First, Middlemore Hospital, Auckland, New Zealand
| | - Eunicia Tan
- Emergency Department, Middlemore Hospital, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
| | | | - Megan Bonisch
- Children's Emergency Department, Starship Children's Health, Auckland, New Zealand
| | - Naomi Grey
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - David W Johnson
- Departments of Paediatrics, Emergency Medicine, and Pharmacology and Physiology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David McNamara
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Respiratory Medicine, Starship Children's Health, Auckland, New Zealand
| | - John M D Thompson
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand.,Respiratory Medicine, Starship Children's Health, Auckland, New Zealand
| | - Stuart R Dalziel
- Department of Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand .,Children's Emergency Department, Starship Children's Health, Auckland, New Zealand.,Department of Surgery, The University of Auckland, Auckland, New Zealand
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10
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Meghji J, Mortimer K, Agusti A, Allwood BW, Asher I, Bateman ED, Bissell K, Bolton CE, Bush A, Celli B, Chiang CY, Cruz AA, Dinh-Xuan AT, El Sony A, Fong KM, Fujiwara PI, Gaga M, Garcia-Marcos L, Halpin DMG, Hurst JR, Jayasooriya S, Kumar A, Lopez-Varela MV, Masekela R, Mbatchou Ngahane BH, Montes de Oca M, Pearce N, Reddel HK, Salvi S, Singh SJ, Varghese C, Vogelmeier CF, Walker P, Zar HJ, Marks GB. Improving lung health in low-income and middle-income countries: from challenges to solutions. Lancet 2021; 397:928-940. [PMID: 33631128 DOI: 10.1016/s0140-6736(21)00458-x] [Citation(s) in RCA: 122] [Impact Index Per Article: 40.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 01/19/2023]
Abstract
Low-income and middle-income countries (LMICs) bear a disproportionately high burden of the global morbidity and mortality caused by chronic respiratory diseases (CRDs), including asthma, chronic obstructive pulmonary disease, bronchiectasis, and post-tuberculosis lung disease. CRDs are strongly associated with poverty, infectious diseases, and other non-communicable diseases (NCDs), and contribute to complex multi-morbidity, with major consequences for the lives and livelihoods of those affected. The relevance of CRDs to health and socioeconomic wellbeing is expected to increase in the decades ahead, as life expectancies rise and the competing risks of early childhood mortality and infectious diseases plateau. As such, the World Health Organization has identified the prevention and control of NCDs as an urgent development issue and essential to the achievement of the Sustainable Development Goals by 2030. In this Review, we focus on CRDs in LMICs. We discuss the early life origins of CRDs; challenges in their prevention, diagnosis, and management in LMICs; and pathways to solutions to achieve true universal health coverage.
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Affiliation(s)
- Jamilah Meghji
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Kevin Mortimer
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK; Global Initiative for Asthma (GINA), Fontana, WI, USA; Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Global Asthma Network (GAN), Auckland, New Zealand; Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France.
| | - Alvar Agusti
- Global Initiative for COPD (GOLD), Fontana, WI, USA; British Thoracic Society Global Health Group, London, UK; Respiratory Institute, Hospital Clinic, IDIBAPS, University of Barcelona, CIBERES, Barcelona, Spain
| | - Brian W Allwood
- Division of Pulmonology, Department of Medicine, Stellenbosch University, Stellenbosch, South Africa
| | - Innes Asher
- Global Asthma Network (GAN), Auckland, New Zealand; Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Eric D Bateman
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Karen Bissell
- Global Asthma Network (GAN), Auckland, New Zealand; School of Population Health, University of Auckland, Auckland, New Zealand
| | - Charlotte E Bolton
- British Thoracic Society Global Health Group, London, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham UK
| | - Andrew Bush
- British Thoracic Society Global Health Group, London, UK; Imperial College and Royal Brompton Hospital, London, UK
| | - Bartolome Celli
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Harvard Medical School, Boston, MA, USA
| | - Chen-Yuan Chiang
- International Union Against Tuberculosis and Lung Diseases, Paris, France; Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan; Division of Pulmonary Medicine, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Alvaro A Cruz
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Department of Internal Medicine, Federal University of Bahia, Salvador, Brazil
| | - Anh-Tuan Dinh-Xuan
- Cochin Hospital, Université de Paris, Paris, France; European Respiratory Society, Lausanne, Switzerland
| | - Asma El Sony
- Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Epidemiological Laboratory (EPI Lab) for Public Health and Research, Khartoum, Sudan
| | - Kwun M Fong
- The University of Queensland Thoracic Research Centre and The Prince Charles Hospital, Queensland, QLD, Australia; Asian Pacific Society of Respirology, Tokyo, Japan
| | - Paula I Fujiwara
- International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Mina Gaga
- Athens Chest Hospital Sotiria, Athens, Greece; World Health Organization, Geneva, Switzerland
| | - Luis Garcia-Marcos
- Global Asthma Network (GAN), Auckland, New Zealand; Paediatric Pulmonology and Allergy Units, Arrixaca Children's University Hospital, University of Murcia, Murcia, Spain; BioHealth Research Institute of Murcia, Murcia, Spain; ARADyAL network, Madrid, Spain
| | - David M G Halpin
- Global Initiative for COPD (GOLD), Fontana, WI, USA; University of Exeter Medical School, College of Medicine and Health, University of Exeter, Exeter, UK
| | - John R Hurst
- British Thoracic Society Global Health Group, London, UK; UCL Respiratory, University College London, London, UK
| | - Shamanthi Jayasooriya
- British Thoracic Society Global Health Group, London, UK; Academic Unit of Primary Care, University of Sheffield, Sheffield, UK
| | - Ajay Kumar
- International Union Against Tuberculosis and Lung Diseases, Paris, France
| | - Maria V Lopez-Varela
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad de la Republica, Montevideo, Uruguay
| | - Refiloe Masekela
- Pan African Thoracic Society, Durban, South Africa; College of Health Sciences, Nelson R Mandela School of Clinical Medicine, University of KwaZulu Natal, Durban, South Africa
| | - Bertrand H Mbatchou Ngahane
- Pan African Thoracic Society, Durban, South Africa; International Union Against Tuberculosis and Lung Diseases, Paris, France; Douala General Hospital, Douala, Cameroon
| | - Maria Montes de Oca
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmonary Department, Universidad Central de Venezuela, Caracas, Venezuela
| | - Neil Pearce
- Global Asthma Network (GAN), Auckland, New Zealand; London School of Hygiene & Tropical Medicine, London, UK
| | - Helen K Reddel
- Global Initiative for Asthma (GINA), Fontana, WI, USA; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Sundeep Salvi
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Pulmocare Research and Education Foundation, Pune, India
| | - Sally J Singh
- British Thoracic Society Global Health Group, London, UK; Department of Respiratory Sciences, University of Leicester, Leicester, UK
| | - Cherian Varghese
- Department of Noncommunicable Diseases, Disability, Violence and Injury Prevention, World Health Organization, Geneva, Switzerland
| | - Claus F Vogelmeier
- Global Initiative for COPD (GOLD), Fontana, WI, USA; Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-Universität Marburg, Marburg, Germany; German Center for Lung Research (DZL), Giessen, Germany
| | - Paul Walker
- British Thoracic Society Global Health Group, London, UK; Department of Respiratory Medicine, Liverpool Teaching Hospitals, Liverpool, UK
| | - Heather J Zar
- Pan African Thoracic Society, Durban, South Africa; Department of Paediatrics & Child Health, Red Cross Childrens Hospital, Cape Town, South Africa; SA-MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | - Guy B Marks
- Global Asthma Network (GAN), Auckland, New Zealand; International Union Against Tuberculosis and Lung Diseases, Paris, France; Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia; UNSW Medicine, Sydney, NSW, Australia
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Tan E, Braithwaite I, McKinlay C, Riley J, Hoare K, Okesene-Gafa K, Semprini A, Sheridan N, Grant C, Johnson D, Weatherall M, Asher I, Beasley R, Dalziel SR. Randomised controlled trial of paracetamol or ibuprofen, as required for fever and pain in the first year of life, for prevention of asthma at age 6 years: paracetamol or ibuprofen in the primary prevention of asthma in Tamariki (PIPPA Tamariki) protocol. BMJ Open 2020; 10:e038296. [PMID: 33303437 PMCID: PMC7733172 DOI: 10.1136/bmjopen-2020-038296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Asthma is one of the most common diseases in the world and is a global public health burden. There is an urgent need for research that leads to evidenced-based primary prevention strategies to reduce the prevalence of asthma. One novel risk factor that might have a role in the pathogenesis of asthma is the use of paracetamol in early life. This trial aims to determine if paracetamol, compared with ibuprofen use, as required for fever and pain in the first year of life, increases the risk of asthma at age 6 years. METHODS AND ANALYSIS The Paracetamol and Ibuprofen in Primary Prevention of Asthma in Tamariki trial is a multicentre, open-label, two-arm parallel randomised controlled trial. 3922 infants born at ≥32 weeks' gestation will be randomly allocated to receive only paracetamol or only ibuprofen for treatment of fever and pain, if required in the first year of life. The primary outcome is asthma at 6 years of age, defined as the presence of wheeze in the preceding 12 months. Secondary outcomes include hospital admissions for bronchiolitis, wheeze or asthma in the first year of life, and within the first 6 years of life; wheeze at 3 years of age; eczema within the first year and at 3 and 6 years of age; atopy at 3 and 6 years of age. ETHICS AND DISSEMINATION The trial has been approved by the Northern A Health and Disability Ethics Committee of New Zealand (17/NTA/233). Dissemination plans include publication in international peer-reviewed journals, and presentation at national and international scientific meetings, assimilation into national and international guidelines, and presentation of findings to lay audiences through established media links. TRIAL REGISTRATION NUMBER ACTRN12618000303246; Pre-results.
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Affiliation(s)
- Eunicia Tan
- Department of Surgery, University of Auckland, Auckland, New Zealand
- Emergency Department, Middlemore Hospital, Auckland, New Zealand
| | | | - Christopher McKinlay
- Liggins Institute, University of Auckland, Auckland, New Zealand
- Kids First Neonatal Care, Middlemore Hospital, Auckland, New Zealand
| | - Judith Riley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Karen Hoare
- School of Nursing, Massey University, Auckland, New Zealand
| | - Karaponi Okesene-Gafa
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
- Department of Obstetrics and Gynaecology, Middlemore Hospital, Auckland, New Zealand
| | - Alex Semprini
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Cameron Grant
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- General Paediatrics, Starship Children's Health, Auckland, Auckland, New Zealand
| | - David Johnson
- Department of Pediatrics, Physiology and Pharmacology, University of Calgary, Calgary, Alberta, Canada
| | - Mark Weatherall
- Rehabilitation, Teaching and Research Unit, University of Otago, Wellington, New Zealand
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Stuart R Dalziel
- Cure Kids Chair of Child Health Research; Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
- Children's Emergency Department, Starship Children's Health, Auckland, New Zealand
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To T, Viegi G, Cruz A, Taborda-Barata L, Asher I, Behera D, Bennoor K, Boulet LP, Bousquet J, Camargos P, Conceiçao C, Gonzalez Diaz S, El-Sony A, Erhola M, Gaga M, Halpin D, Harding L, Maghlakelidze T, Masjedi MR, Mohammad Y, Nunes E, Pigearias B, Sooronbaev T, Stelmach R, Tsiligianni I, Tuyet Lan LT, Valiulis A, Wang C, Williams S, Yorgancioglu A. A global respiratory perspective on the COVID-19 pandemic: commentary and action proposals. Eur Respir J 2020; 56:2001704. [PMID: 32586874 PMCID: PMC7315811 DOI: 10.1183/13993003.01704-2020] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/05/2020] [Indexed: 12/24/2022]
Abstract
The novel coronavirus disease 2019 (COVID-19) is caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) [1, 2]. The World Health Organization (WHO) declared the COVID-19 outbreak a pandemic on 11 March, 2020, demanding effective national and global mitigation measures, strong public health response and coordination. To date, the SARS-CoV-2 pandemic has affected over 5 million individuals worldwide with an overall 7.02% (median 3.41%, ranges 0.06% to 31.25%) case fatality ratio (European Center for Disease Prevention and Control dashboard: www.ecdc.europa.eu , as of 22 May, 2020) [3]. This ratio may be overstated since it is based primarily on hospitalised or notified cases. This paper offers practical and feasible actions to be implemented at patient, healthcare provider and community level to combat COVID-19 while attending, maintaining and strengthening ongoing health management in people with lung diseases https://bit.ly/30yNyhP
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Affiliation(s)
- Teresa To
- The Hospital for Sick Children, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Giovanni Viegi
- CNR Institutes of Clinical Physiology, Pisa, and Biomedical Research and Innovation, Palermo, Italy
| | - Alvaro Cruz
- ProAR Foundation and Federal University of Bahia, Salvador, Brazil
| | - Luis Taborda-Barata
- Dept of Allergy and Clinical Immunology, Cova da Beira University Hospital Centre, Covilhã, Portugal
| | - Innes Asher
- Dept of Paediatrics and Child Health, University of Auckland, Auckland, New Zealand
| | - Digambar Behera
- OSD, All India Institutes of Medical Sciences (AIIMS), Raebareli, India
| | - Kazi Bennoor
- Dept of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | | | - Jean Bousquet
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHRU Arnaud de Villeneuve, Montpellier, France
| | - Paulo Camargos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Departamento de Pediatria, Belo Horizonte, Brazil
| | - Claudia Conceiçao
- Instituto de Higiene e Medicina Tropical, Institute of Tropical Medicine and Hygiene, NOVA University of Lisbon, Lisbon, Portugal
| | | | - Asma El-Sony
- Public Health Epidemiological Laboratory [Epi Lab] for Research and Development, Khartoum, Sudan
| | - Marina Erhola
- Division of Health and Social Service, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Mina Gaga
- 7th Respiratory Medicine Dept, Asthma Cen, Athens Chest Hospital, Athens, Greece
| | - David Halpin
- University of Exeter Medical School, College of Medicine and Health, Exeter, UK
| | | | - Tamaz Maghlakelidze
- Ivane Javakhishvili Tbilisi State University, Pulmonology Dept, Chapidze Emergency Cardiology Center, Tbilisi, Georgia
| | | | - Yousser Mohammad
- National Center for Research inn Chronic Respiratory Diseases, Tishreen University, School of Medicine, Latakia, Syria
| | - Elizabete Nunes
- Pulmonology Dept, Maputo Central Hospital, Maputo, Mozambique
| | - Bernard Pigearias
- Espace Francophone de Pneumologie, La Maison du poumon, Paris, France
| | - Talant Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan
| | - Rafael Stelmach
- ProAR Foundation and Heart Institute (InCor) Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Ioanna Tsiligianni
- International Primary Care Respiratory Group; Dept of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Le Thi Tuyet Lan
- Respiratory Care Center, University Medical Center, Ho Chi Minh City, Vietnam
| | - Arunas Valiulis
- Clinic of Children's Diseases, Institute of Clinical Medicine, and Dept of Public Health, Institute of Health Sciences, Vilnius University, Vilnius, Lithuania
| | - Chen Wang
- Peking Union Medical College, Chinese Academy of Medical Science, Beijing, China
| | - Sian Williams
- International Primary Care Respiratory Group, London, UK
| | - Arzu Yorgancioglu
- Dept of Pulmonology, Medical Faculty, Celal Bayar University, Manisa, Turkey
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Rutter CE, Silverwood RJ, Williams HC, Ellwood P, Asher I, Garcia-Marcos L, Strachan DP, Pearce N, Langan SM. Are Environmental Factors for Atopic Eczema in ISAAC Phase Three due to Reverse Causation? J Invest Dermatol 2019; 139:1023-1036. [PMID: 30521836 PMCID: PMC6478380 DOI: 10.1016/j.jid.2018.08.035] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/29/2018] [Accepted: 08/30/2018] [Indexed: 11/26/2022]
Abstract
Some previously described environmental associations for atopic eczema may be due to reverse causation. We explored the role of reverse causation by comparing individual- and school-level results for multiple atopic eczema risk factors. The International Study of Asthma and Allergies in Childhood (i.e, ISAAC) Phase Three surveyed children in schools (the sampling unit) regarding atopic eczema symptoms and potential risk factors. We assessed the effect of these risk factors on atopic eczema symptoms using mixed-effect logistic regression models, first with individual-level exposure data and second with school-level exposure prevalence. Overall, 546,348 children from 53 countries were included. At ages 6-7 years, the strongest individual-level associations were with current paracetamol use (odds ratio [OR] = 1.45, 95% confidence interval [CI] = 1.37-1.54), which persisted at school-level (OR = 1.55, 95% CI = 1.10-2.21), early-life antibiotics (OR = 1.41, 95% CI = 1.34-1.48), and early-life paracetamol use (OR = 1.28, 95% CI = 1.21-1.36), with the former persisting at the school level, whereas the latter was no longer observed (OR = 1.35, 95% CI = 1.00-1.82 and OR = 0.94, 95% CI = 0.69-1.28, respectively). At ages 13-14 years, the strongest associations at the individual level were with current paracetamol use (OR = 1.57, 95% CI = 1.51-1.63) and open-fire cooking (OR = 1.46, 95% CI = 1.33-1.62); both were stronger at the school level (OR = 2.57, 95% CI = 1.84-3.59 and OR = 2.38, 95% CI = 1.52-3.73, respectively). Association with exposure to heavy traffic (OR = 1.31, 95% CI = 1.27-1.36) also persisted at the school level (OR = 1.40, 95% CI = 1.07-1.82). Most individual- and school-level effects were consistent, tending to exclude reverse causation.
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Affiliation(s)
- Charlotte E Rutter
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Richard J Silverwood
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Hywel C Williams
- Centre of Evidence-Based Dermatology, University of Nottingham, Nottingham, UK
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Luis Garcia-Marcos
- Pediatric Allergy and Pulmonology Units, Virgen de la Arrixaca University Children's Hospital, University of Murcia and IMIB Bioresearch Institute, Murcia, Spain
| | - David P Strachan
- Population Health Research Institute, St George's University of London, London, UK
| | - Neil Pearce
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK; Red de Asma, Reacciones Adversas y Alérgicas, Madrid, Spain; Centre for Public Health Research, Massey University, Wellington, New Zealand
| | - Sinéad M Langan
- Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK.
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Morales E, Strachan D, Asher I, Ellwood P, Pearce N, Garcia-Marcos L. Combined impact of healthy lifestyle factors on risk of asthma, rhinoconjunctivitis and eczema in school children: ISAAC phase III. Thorax 2019; 74:531-538. [PMID: 30898896 DOI: 10.1136/thoraxjnl-2018-212668] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/24/2019] [Accepted: 02/11/2019] [Indexed: 11/04/2022]
Abstract
BACKGROUND Asthma is not the key focus of prevention strategies. A Healthy Lifestyle Index (HLI) was developed to examine the combined effect of modifiable lifestyle factors on asthma, rhinoconjunctivitis and eczema using data from the International Study of Asthma and Allergies in Childhood (ISAAC) phase III. METHODS Information on symptoms of asthma, rhinoconjunctivitis, eczema and several lifestyle factors was obtained from children aged 6-7 years through written questionnaires. The HLI combined five lifestyle factors: no parental smoking, child's adherence to Mediterranean diet, child's healthy body mass index, high physical activity and non-sedentary behaviour. The association between the HLI and risk of asthma, rhinoconjunctivitis and eczema was evaluated using multilevel mixed-effects logistic regression models. FINDINGS Data of 70 795 children from 37 centres in 19 countries were analysed. Each additional healthy lifestyle factor was associated with a reduced risk of current wheeze (OR 0.87, 95% CI 0.84 to 0.89), asthma ever (OR 0.89, 95% CI 0.87 to 0.92), current symptoms of rhinoconjunctivitis (OR 0.95, 95% CI 0.92 to 0.97) and current symptoms of eczema (OR 0.92, 95% CI 0.92 to 0.98). Theoretically, if associations were causal, a combination of four or five healthy lifestyle factors would result into a reduction up to 16% of asthma cases (ranging from 2.7% to 26.3 % according to region of the world). CONCLUSIONS These findings should be interpreted with caution given the limitations to infer causality from cross-sectional observational data. Efficacy of interventions to improve multiple modifiable lifestyle factors to reduce the burden asthma and allergy in childhood should be assessed.
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Affiliation(s)
- Eva Morales
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), University of Murcia, Murcia, Spain
| | - David Strachan
- Population Health Research Institute, St George's, University of London, London, UK
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Neil Pearce
- Department of Medical Statistics, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Luis Garcia-Marcos
- Biomedical Research Institute of Murcia (IMIB-Arrixaca), University of Murcia, Murcia, Spain
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Bissell K, Ellwood P, Ellwood E, Chiang CY, Marks GB, El Sony A, Asher I, Billo N, Perrin C. Essential Medicines at the National Level: The Global Asthma Network's Essential Asthma Medicines Survey 2014. Int J Environ Res Public Health 2019; 16:E605. [PMID: 30791442 PMCID: PMC6406388 DOI: 10.3390/ijerph16040605] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/01/2019] [Accepted: 02/02/2019] [Indexed: 12/21/2022]
Abstract
Patients with asthma need uninterrupted supplies of affordable, quality-assured essential medicines. However, access in many low- and middle-income countries (LMICs) is limited. The World Health Organization (WHO) Non-Communicable Disease (NCD) Global Action Plan 2013⁻2020 sets an 80% target for essential NCD medicines' availability. Poor access is partly due to medicines not being included on the national Essential Medicines Lists (EML) and/or National Reimbursement Lists (NRL) which guide the provision of free/subsidised medicines. We aimed to determine how many countries have essential asthma medicines on their EML and NRL, which essential asthma medicines, and whether surveys might monitor progress. A cross-sectional survey in 2013⁻2015 of Global Asthma Network principal investigators generated 111/120 (93%) responses-41 high-income countries and territories (HICs); 70 LMICs. Patients in HICs with NRL are best served (91% HICs included ICS (inhaled corticosteroids) and salbutamol). Patients in the 24 (34%) LMICs with no NRL and the 14 (30%) LMICs with an NRL, however no ICS are likely to have very poor access to affordable, quality-assured ICS. Many LMICs do not have essential asthma medicines on their EML or NRL. Technical guidance and advocacy for policy change is required. Improving access to these medicines will improve the health system's capacity to address NCDs.
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Affiliation(s)
- Karen Bissell
- School of Population Health, University of Auckland, Auckland 1023, New Zealand.
| | - Philippa Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Eamon Ellwood
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Chen-Yuan Chiang
- Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 116, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei 110, Taiwan.
| | - Guy B Marks
- South Western Sydney Clinical School, University of New South Wales, Sydney 2085, Australia.
| | - Asma El Sony
- The Epidemiological Laboratory (Epi-Lab), for Public Health and Research, Khartoum, Sudan.
| | - Innes Asher
- Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1023, New Zealand.
| | - Nils Billo
- Independent Consultant, 80220 Joensuu, Finland.
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Asher I, Bissell K, Chiang CY, El Sony A, Ellwood P, García-Marcos L, Marks GB, Mortimer K, Pearce N, Strachan D. Calling time on asthma deaths in tropical regions-how much longer must people wait for essential medicines? Lancet Respir Med 2018; 7:13-15. [PMID: 30553847 DOI: 10.1016/s2213-2600(18)30513-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022]
Affiliation(s)
- Innes Asher
- University of Auckland, Auckland 1142, New Zealand.
| | | | - Chen-Yuan Chiang
- International Union against Tuberculosis and Lung Disease, Paris, France; Department of Internal Medicine, Wanfang Hospital, Taipei Medical University, Taipei, Taiwan; School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | | | | | - Luis García-Marcos
- Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia & Biohealth Research Institute of Murcia, Murcia, Spain
| | - Guy B Marks
- Woolcock Institute of Medical Research, University of New South Wales, Sydney, NSW, Australia
| | - Kevin Mortimer
- International Union against Tuberculosis and Lung Disease, Paris, France; Liverpool School of Tropical Medicine, Liverpool, UK
| | - Neil Pearce
- London School of Hygiene & Tropical Medicine, London, UK
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Woolfenden S, Asher I, Bauert P, De Lore D, Elliott E, Hart B, Matheson V, Nossar V, Roseby R, Scott A, Lynch A, Hardy L, Goldfeld S. The Royal Australasian College of Physicians Paediatic & Child Health Division 145 Macquarie Street, Sydney, NSW, 2000 Summary of position statement on inequities in child health Published by RACP May 2018 and available at: https://www.racp.edu.au/advocacy/policy-and-advocacy-priorities/inequities-in-child-health. J Paediatr Child Health 2018; 54:832-833. [PMID: 30133886 DOI: 10.1111/jpc.14134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 06/19/2018] [Indexed: 12/01/2022]
Affiliation(s)
- Susan Woolfenden
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Innes Asher
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Paul Bauert
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Danny De Lore
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Elizabeth Elliott
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Bret Hart
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Victoria Matheson
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Victor Nossar
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Rob Roseby
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Andrew Scott
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Alex Lynch
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Louise Hardy
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
| | - Sharon Goldfeld
- Paediatric and Child Health Division, The Royal Australasian College of Physicians, Sydney, New South Wales, Australia
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Asher I, McNamara D, Davies C, Demetriou T, Fleming T, Harwood M, Hetaraka-Stevens L, Ingham T, Kristiansen J, Reid J, Rickard D, Ryan D. Asthma and Respiratory Foundation NZ child and adolescent asthma guidelines: a quick reference guide. N Z Med J 2017; 130:10-33. [PMID: 29197898] [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: 06/07/2023]
Abstract
The purpose of the New Zealand Child and adolescent asthma guidelines: a quick reference guide is to provide simple, practical, evidence-based recommendations for the diagnosis, assessment and management of asthma in children and adolescents in New Zealand, with the aim of improving outcomes and reducing inequities. The intended users are health professionals responsible for delivering asthma care in the community and hospital emergency department settings, and those responsible for the training of such health professionals.
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Affiliation(s)
- Innes Asher
- Paediatrics: Child and Youth Health, University of Auckland, Auckland
| | - David McNamara
- Respiratory Service, Starship Children's Health, Auckland District Health Board, Auckland
| | | | | | - Theresa Fleming
- Paediatrics: Child and Youth Health & Psychological Medicine, University of Auckland, Auckland
| | - Matire Harwood
- Te Kupenga Hauora Māori, Faculty of Medical and Health Sciences, Auckland
| | | | | | | | - Jim Reid
- Dept of the Dean, Dunedin School of Medicine, Dunedin
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19
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Vadasz Z, Elbirt D, Radian S, Bezalel-Rosenberg S, Mahlab-Guri K, Toubi E, Asher I, Sthoeger Z. Low levels of the immunoregulator Semaphorin 4D (CD100) in sera of HIV patients. Clin Immunol 2017; 191:88-93. [PMID: 28917721 DOI: 10.1016/j.clim.2017.09.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 09/12/2017] [Accepted: 09/12/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Semaphorin-4D (CD100), generated by CD4/CD8 T-cells and its receptor on B cells - CD72, play a role in immune regulation. Both have soluble forms - sCD100/sCD72. METHODS sCD100 and sCD72 levels were determined by ELISA (MyBioSource, USA). RESULTS 28 chronic HIV patients and 50 matched healthy volunteers participated in our study. Before treatment, CD4 T-cells counts were 267 ± 216 cells/mcl and viral load (VL) was 586,675 ± 1897,431 copies/ml. Two years following HAART, CD4 T-cells counts rose to 475 ± 264 cells/mcl and VL dropped to 2050 ± 10,539 copies/ml. CD8 T-cells counts were stable. sCD72 levels prior (4.13 ± 2.03 ng/ml) and following HAART (3.53 ± 2.01 ng/ml) were similar to control levels (4.51 ± 2.66 ng/ml). sCD100 levels before (40.47 ± 31.4 ng/ml) and following HAART (37.68 ± 29.44 ng/ml) were significantly lower compared to controls (99.67 ± 36.72 ng/ml) despite the significant increase in CD4 T-cells counts. CONCLUSIONS The permanent low levels of the immunoregulator sCD100 suggest a role for CD100 in the immune dysfunction and T cells exhaustion of HIV.
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Affiliation(s)
- Z Vadasz
- Allergy and Clinical Immunology Unit, Bnei-Zion Medical Center, Haifa, Israel
| | - D Elbirt
- Department of Medicine B, Allergy, Clinical Immunology and AIDS Center, Kaplan Medical Center, Rehovot, Israel
| | - S Radian
- Department of Medicine B, Allergy, Clinical Immunology and AIDS Center, Kaplan Medical Center, Rehovot, Israel
| | - S Bezalel-Rosenberg
- Department of Medicine B, Allergy, Clinical Immunology and AIDS Center, Kaplan Medical Center, Rehovot, Israel
| | - K Mahlab-Guri
- Department of Medicine B, Allergy, Clinical Immunology and AIDS Center, Kaplan Medical Center, Rehovot, Israel
| | - E Toubi
- Allergy and Clinical Immunology Unit, Bnei-Zion Medical Center, Haifa, Israel
| | - I Asher
- Department of Medicine B, Allergy, Clinical Immunology and AIDS Center, Kaplan Medical Center, Rehovot, Israel
| | - Z Sthoeger
- Department of Medicine B, Allergy, Clinical Immunology and AIDS Center, Kaplan Medical Center, Rehovot, Israel.
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Wilson R, Burton P, Asher I, Carter K, Castelli A, Cumin D, Evelo C, Stewart L, Tsoi K, White E. Disseminating findings from the Data Analysis with Privacy Protection for Epidemiological Research (DAPPER) workshop. Int J Popul Data Sci 2017. [PMCID: PMC9351008 DOI: 10.23889/ijpds.v1i1.301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
ABSTRACT
ObjectivesThe effective exploitation of what are often called big data is increasingly important. They provide the evidence in evidence-based health care and underpin scientific progress in many domains including social/economic policy. Typically, an optimal analysis involves working directly with microdata; i.e. the detailed data relating to each individual in the dataset. But there are many ethico-legal and other governance restrictions on physically sharing microdata. Furthermore, researchers or institutions may have an extensive intellectual property investment in complex microdata and although keen for other researchers to analyse their data they may not wish to give them a physical copy. These restrictions can discourage the use of optimum approaches to analysing pivotal data and slow scientific progress. Data science groups across the world are exploring privacy-protected approaches to analysing microdata without having to physically share the data.
ApproachA two day international workshop was arranged focussing on privacy protected approaches to data analysis – particularly federated analysis where raw data remain at their original site of collection. The workshop considered the range of approaches that exist, and those that are currently being developed. It explored the strengths, weaknesses, opportunities and challenges associated with these methods and identified situations where specific approaches have a particularly important role. The workshop included a number of practical sessions where potential users could watch demonstrations of the various approaches in action and run analyses themselves.
ResultsThe Data Analysis with Privacy Protection for Epidemiological Research (DAPPER) workshop was held 22-23rd August 2016, Bristol. We report back to the broader community on the outcomes of this workshop that focussed on exploring current approaches, tools and technical solutions that facilitate sensitive data to be shared and analysed.
ConclusionsThe workshop has helped map out key opportunities and challenges and assisted potential users, developers and other stakeholders (e.g. funders/journals) to recognise the strengths and weaknesses of different privacy protected analytic approaches. The workshop will encourage further methodological work in this field and better informed application of existing methods.
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Asher I, Haahtela T, Selroos O, Ellwood P, Ellwood E. Global Asthma Network survey suggests more national asthma strategies could reduce burden of asthma. Allergol Immunopathol (Madr) 2017; 45:105-114. [PMID: 28161283 DOI: 10.1016/j.aller.2016.10.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Accepted: 10/31/2016] [Indexed: 01/15/2023]
Abstract
BACKGROUND Several countries or regions within countries have an effective national asthma strategy resulting in a reduction of the large burden of asthma to individuals and society. There has been no systematic appraisal of the extent of national asthma strategies in the world. METHODS The Global Asthma Network (GAN) undertook an email survey of 276 Principal Investigators of GAN centres in 120 countries, in 2013-2014. One of the questions was: "Has a national asthma strategy been developed in your country for the next five years? For children? For adults?". RESULTS Investigators in 112 (93.3%) countries answered this question. Of these, 26 (23.2%) reported having a national asthma strategy for children and 24 (21.4%) for adults; 22 (19.6%) countries had a strategy for both children and adults; 28 (25%) had a strategy for at least one age group. In countries with a high prevalence of current wheeze, strategies were significantly more common than in low prevalence countries (11/13 (85%) and 7/31 (22.6%) respectively, p<0.001). INTERPRETATION In 25% countries a national asthma strategy was reported. A large reduction in the global burden of asthma could be potentially achieved if more countries had an effective asthma strategy.
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Pacheco-González R, Ellwood E, Exeter D, Stewart AW, Asher I. Does urban extent from satellite images relate to symptoms of asthma, rhinoconjunctivitis and eczema in children? A cross-sectional study from ISAAC Phase Three. J Asthma 2016; 53:854-61. [PMID: 27211111 DOI: 10.3109/02770903.2016.1156693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The relationship between urbanisation and the symptom prevalence of asthma, rhinoconjunctivitis and eczema is not clear, and varying definitions of urban extent have been used. Furthermore, a global analysis has not been undertaken. This study aimed to determine whether the symptom prevalence of asthma, rhinoconjunctivitis and eczema in centres involved in the International Study of Asthma and Allergies in Childhood (ISAAC) were higher in urban than rural centres, using a definition of urban extent as land cover from satellite data. METHODS A global map of urban extent from satellite images (MOD500 map) was used to define the urban extent criterion. Maps from the ISAAC centres were digitised and merged with the MOD500 map to describe the urban percentage of each centre. We investigated the association between the symptom prevalence of asthma, rhinoconjunctivitis and eczema and the percentage of urban extent by centre. RESULTS A weak negative relationship was found between the percentage of urban extent of each ISAAC centre and current wheeze in the 13-14-year age group. This association was not statistically significant after adjusting for region of the world and gross national income. No other relationship was found between urban extent and symptoms of asthma, rhinoconjunctivitis and eczema. CONCLUSIONS In this study, the prevalence of symptoms of asthma, rhinoconjunctivitis and eczema in children were not associated with urbanisation, according to the land cover definition of urban extent from satellite data. Comparable standardised definitions of urbanisation need to be developed so that global comparisons can be made.
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Affiliation(s)
- Rosa Pacheco-González
- a Paediatric Consultant, Department of Paediatrics , Clinic Hospital Virgen de la Arrixaca , Murcia , Spain
| | - Eamon Ellwood
- b Database Development Manager, Department of Paediatrics: Child and Youth Health , The University of Auckland , Auckland , New Zealand
| | - Daniel Exeter
- c Department of Epidemiology & Biostatistics, School of Population Health , The University of Auckland , Auckland , New Zealand
| | - Alistair W Stewart
- d Department of Epidemiology & Biostatistics, School of Population Health , The University of Auckland , Auckland , New Zealand
| | - Innes Asher
- e Department of Paediatrics: Child and Youth Health , The University of Auckland , Auckland , New Zealand
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Affiliation(s)
- Bhupendrasinh F Chauhan
- University of Manitoba; Faculty of Pharmacy; Winnipeg MB Canada
- University of Manitoba; Knowledge Synthesis, George and Fay Yee Centre for Healthcare Innovation; Winnipeg Regional Health Authority Winnipeg MB Canada
- Sainte-Justine University Hospital Research Center, University of Montreal; Department of Paediatrics; Montreal Canada
| | - Jimmy Chong
- University of Auckland; Auckland New Zealand
| | - Innes Asher
- University of Auckland; Auckland New Zealand
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24
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Abstract
BACKGROUND International guidelines advocate using daily inhaled corticosteroids (ICS) in the management of children and adults with persistent asthma. However, in real world clinical settings, these medicines are often used at irregular intervals by patients. Recent evidence suggests that the use of intermittent ICS, with treatment initiated at the time of early symptoms, may still have benefits for reducing the severity of an asthma exacerbation. OBJECTIVES To compare the efficacy and safety of intermittent ICS versus placebo in the management of children and adults diagnosed with, or suspected to have, symptoms of mild persistent asthma. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials (CAGR), the ClinicalTrials.gov website and the World Health Organization (WHO) trials portal in March 2015. SELECTION CRITERIA We included randomised controlled trials (RCTs) that compared intermittent ICS versus placebo in children and adults with symptoms of persistent asthma. No co-interventions were permitted other than rescue relievers and oral corticosteroids used during exacerbations. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion, methodological quality and extracted data. The primary efficacy outcome was the risk of asthma exacerbations requiring oral corticosteroids and the primary safety outcome was serious adverse health events. Secondary outcomes included exacerbations, lung function tests, asthma control, adverse effects, and withdrawal rates. Quality of the evidence was assessed using the GRADE criteria. MAIN RESULTS Six trials (representing 490 preschool children, 145 school-aged children and 240 adults) met the inclusion criteria. Study durations were 12 to 52 weeks. Results for preschool children were presented in a separate analysis as this represents a distinct clinical condition, not necessarily related to the development of long term asthma.There was a reduction in the risk of patients experiencing one or more exacerbations requiring oral corticosteroids in older children (145 participants, odds ratio (OR) 0.57; 95% confidence interval (CI) 0.29 to 1.12, low quality evidence) and adults with asthma (240 participants, OR 0.10; 95% CI 0.01 to 1.95, low quality evidence). These analyses were each based on the findings of a single study. No group difference was observed in the risk of serious adverse health events (385 participants; OR 1.00; 95% CI 0.14 to 7.25, moderate quality evidence). Compared to the placebo group, there was an insufficient number of participants to make firm conclusions whether the intermittent ICS group displayed any reduction in the rate of hospitalisations, day time and night time symptoms scores, or adverse events. Lung function tests reported by a single study favoured the use of ICS. There was no significant group difference in growth rate of children, or overall withdrawals.In preschool children with frequent wheezing episodes, the use of intermittent ICS at the onset of early symptoms reduced the likelihood of requiring rescue oral corticosteroids by half (490 participants; OR: 0.48; 95% CI 0.31 to 0.73, moderate quality evidence with minimal heterogeneity). Intermittent therapy was associated with fewer serious adverse events (439 participants; OR 0.42; 95% CI 0.17 to 1.02, low quality evidence). There was no significant difference in hospitalisations or in a single study measuring parent perceived quality of life. However, intermittent therapy was associated with improvements in both day time and night time symptoms. There was no increase in the rates of withdrawals, and overall and treatment-specific adverse events. AUTHORS' CONCLUSIONS In children and adults with mild persistent asthma, two studies have shown that the use of intermittent ICS at the time of exacerbation reduced the chances of needing oral corticosteroids by half. This result is statistically significant if we assume that the effect size is the same for each study population (fixed effects model), but is not statistically significant when using a random effects model. However, the paucity of published evidence limits our conclusions towards the 'as-needed' use of this medication. The small number of studies and participants were the major reasons for downgrading the overall quality of the findings. A corresponding result was found in preschool children with wheeze. In this age group, an improvement in day time and night time asthma symptoms score and parental perceived quality of life of children similarly favoured the ICS group. However, there was no statistical difference in hospitalisation rates in any group. This treatment was not associated with any significant increase in adverse events. There was no growth suppression noted with the use of intermittent ICS in either preschool or school-aged children. Considering the limited number of available studies, we emphasise the need for more randomised controlled studies in order to confirm these findings.
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Affiliation(s)
| | | | - Bhupendrasinh F Chauhan
- University of ManitobaFaculty of PharmacyWinnipegMBCanada
- University of ManitobaKnowledge Synthesis, George and Fay Yee Centre for Healthcare InnovationWinnipeg Regional Health AuthorityWinnipegMBCanada
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25
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Abstract
About 334 million people worldwide suffer from asthma, and this figure may be an underestimation. It is the most common chronic disease in children. Asthma is among the top 20 chronic conditions for global ranking of disability-adjusted life years in children; in the mid-childhood ages 5-14 years it is among the top 10 causes. Death rates from asthma in children globally range from 0.0 to 0.7 per 100 000. There are striking global variations in the prevalence of asthma symptoms (wheeze in the past 12 months) in children, with up to 13-fold differences between countries. Although asthma symptoms are more common in many high-income countries (HICs), some low- and middle-income countries (LMICs) also have high levels of asthma symptom prevalence. The highest prevalence of symptoms of severe asthma among children with wheeze in the past 12 months is found in LMICs and not HICs. From the 1990s to the 2000s, asthma symptoms became more common in some high-prevalence centres in HICs; in many cases, the prevalence stayed the same or even decreased. At the same time, many LMICs with large populations showed increases in prevalence, suggesting that the overall world burden is increasing, and that therefore global disparities in asthma prevalence are decreasing. The costs of asthma, where they have been estimated, are relatively high. The global burden of asthma in children, including costs, needs ongoing monitoring using standardised methods.
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Affiliation(s)
- I Asher
- Department of Paediatrics: Child and Youth Health, the University of Auckland, Auckland, New Zealand
| | - N Pearce
- Centre for Global NCDs, London School of Hygiene & Tropical Medicine, London, UK
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Pinnock R, Monagle P, Couper J, Wright I, Asher I, Jones P, van Asperen P, Mattes J. Dedicated paediatric teaching remains critical to the undergraduate medical curriculum. J Paediatr Child Health 2014; 50:949-51. [PMID: 25392980 DOI: 10.1111/jpc.12775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/08/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Ralph Pinnock
- Child and Adolescent Health, James Cook University, Townsville, Queensland, Australia
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27
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Asher I. World Asthma Day: reflections on ISAAC. Int J Tuberc Lung Dis 2011; 15:569. [PMID: 21756506 DOI: 10.5588/ijtld.11.0227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Agmon-Levin N, Elbirt D, Asher I, Gradestein S, Werner B, Sthoeger Z. Syphilis and HIV co-infection in an Israeli HIV clinic: incidence and outcome. Int J STD AIDS 2010; 21:249-52. [PMID: 20378895 DOI: 10.1258/ijsa.2009.009011] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The re-emergence of syphilis among HIV-infected patients has been reported in recent years. We evaluated co-infection among heterosexual immigrants in an Israeli AIDS center. The records of 1060 HIV-infected patients were evaluated for positive syphilis serology between the years 2000 and 2005, and all seropositive patients were further evaluated. We found 150 HIV/syphilis co-infected patients (57% men, 93% of African origin), of who 135 were found to have late latent syphilis. Lumbar puncture (LP) was performed in 51 patients, 16 (31%) had abnormal cerebrospinal fluid (CSF) compatible with neurosyphilis. Abnormal CSF correlated with the absence of previous anti-syphilis treatment, but not with CD4 count, viral load or Venereal Disease Research Laboratory titres. Penicillin was recommended to all patients according to their disease stages and 81 patients completed 12 months post-treatment follow-up. Twenty-one of 81 (26%) treatments were successful, 33 (41%) showed 'serofast reaction' and 27 (33%) failed therapy. In conclusion, a high incidence of syphilis with CSF reactivity suggestive of neurosyphilis was observed in heterosexual Ethiopian HIV-infected patients. Thus, repeated serological screening and CSF evaluation seems to be indicated in these patients. Penicillin therapy resulted in 'serofast reaction' or treatment failure for most patients. More, intensive treatment might be needed for HIV/syphilis in co-infected patients, especially those with severe immune-deficiency and prolonged syphilis infection.
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Affiliation(s)
- N Agmon-Levin
- Neve-Or AIDS Center, Kaplan Medical Center, Rehovot, Israel
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29
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Elbirt D, Mahlev-Guri K, Gradstein S, Zung A, Asher I, Werner B, Radain-Sade S, Burke M, Sthoeger Z. Adrenal Suppression And Cushing's Syndrome Due To The Interaction Between Ritonavir And Inhaled Fluticasone. J Allergy Clin Immunol 2010. [DOI: 10.1016/j.jaci.2009.12.309] [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: 11/15/2022]
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Agmon-Levin N, Elbirt D, Asher I, Torten D, Cohen Y, Gradestein S, Werner B, Turner D, Chowers M, Gottesman G, Maayan S, Risenberg K, Levi I, Sthoeger Z. Prevention of human immunodeficiency virus mother-to-child transmission in Israel. Int J STD AIDS 2009; 20:473-6. [PMID: 19541889 DOI: 10.1258/ijsa.2008.008392] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The objective of the study was to investigate the HIV-mother-to-child transmission (MTCT) rate in Israel. This was a retrospective study of HIV-infected pregnant women, mainly immigrants from Ethiopia, in six Israeli AIDS centres, in 2000-2005. Medical records of mothers and newborns were evaluated for HIV status, treatment and MTCT rates. Three hundred pregnancies of 241 HIV-infected women, resulting in 304 live births, were studied. In 86/241(36%) women, HIV diagnosis was made during the current pregnancy or shortly after labour. Thirty others were diagnosed during previous pregnancies. Highly active antiretroviral therapy (HAART) was prescribed in 76% of pregnancies. The mean viral load before labour was 23,000 +/- 100,000 copies/mL with a mean CD4 of 406 +/- 223 (range 4-1277) cells/mm(3). Caesarian sections were preformed in 175/300 pregnancies (103/175 with viral load <1000 copies/mL). During labour, azidothymidine (AZT) was given to 80% and nevirapine to 8% of the women. Eighty-eight percent of the neonates received AZT for six weeks. The overall HIV-MTCT rate was 3.6%. MTCT correlated significantly with delayed HIV diagnosis, low CD4, lack of HAART during pregnancy and lack of perinatal treatment. HIV treatment of mothers and their newborns throughout pregnancy, labour and perinatal period are crucial for effective prevention of MTCT, emphasizing the need for early HIV screening, diagnosis and treatment.
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Asher I. The letter relates to the paper by Ones et al. published in the December 2006 issue of Allergy. Allergy 2008; 63:1249. [PMID: 18699943 DOI: 10.1111/j.1398-9995.2008.01811.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Asher I. The International Study of Asthma and Allergies in Childhood (ISAAC). N Z Med J 2008; 121:117-118. [PMID: 18709058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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34
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Affiliation(s)
- Innes Asher
- Department of Paediatrics, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand.
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35
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Asher I. Salamol and inequalities in New Zealand. N Z Med J 2006; 119:U2275. [PMID: 17072350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
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36
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Krishnan A, Asher I, Davis D, Fuller D, Okunieff P, O'Dell W. TU-C-330A-02: Patterns of Brain Tumor Recurrence Predicted From DTI Tractography. Med Phys 2006. [DOI: 10.1118/1.2241494] [Citation(s) in RCA: 1] [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: 11/07/2022] Open
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37
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Affiliation(s)
- Innes Asher
- Department of Paediatrics, Faculty of Medical and Health Sciences, The University of Auckland, and Starship Children's Health, Auckland, New Zealand.
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38
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Asher I, Baena-Cagnani C, Boner A, Canonica GW, Chuchalin A, Custovic A, Dagli E, Haahtela T, Haus M, Lemmo-Hoten M, Holgate S, Holloway J, Holt P, Host A, Iikura Y, Johansson SGO, Kaplan A, Kowalski ML, Lockey RF, Naspitz C, Odhiambo J, Ring J, Sastre J, Venables K, Vichyanond P, Volovitz B, Wahn U, Warner J, Weiss K, Zhong NS. World Allergy Organization guidelines for prevention of allergy and allergic asthma. Int Arch Allergy Immunol 2004; 135:83-92. [PMID: 15452918 DOI: 10.1159/000080524] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
MESH Headings
- Asthma/diagnosis
- Asthma/economics
- Asthma/genetics
- Asthma/prevention & control
- Dermatitis, Allergic Contact/diagnosis
- Dermatitis, Allergic Contact/genetics
- Dermatitis, Allergic Contact/prevention & control
- Environment
- Humans
- Hypersensitivity/diagnosis
- Hypersensitivity/economics
- Hypersensitivity/genetics
- Hypersensitivity/prevention & control
- Patient Education as Topic
- Rhinitis, Allergic, Perennial/diagnosis
- Rhinitis, Allergic, Perennial/genetics
- Rhinitis, Allergic, Perennial/prevention & control
- Rhinitis, Allergic, Seasonal/diagnosis
- Rhinitis, Allergic, Seasonal/genetics
- Rhinitis, Allergic, Seasonal/prevention & control
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Affiliation(s)
- Innes Asher
- World Allergy Organization Project, 96 Vambrugh Park, Blackheath, London SE3 7AL, UK
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Abstract
Like so much research, the findings from the ISAAC program have raised more questions than they have answered. Despite their limitations, the ISAAC findings provide the basis for further studies to investigate factors that potentially contribute to these international patterns and may lead to novel public health and pharmacologic intervention strategies that reduce the prevalence and severity of asthma worldwide.
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Affiliation(s)
- Richard Beasley
- Medical Research Institute of New Zealand, 3rd Floor, 99 The Terrace, Wellington, New Zealand.
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Abstract
The prevalence of respiratory symptoms indicative of asthma in children from Latin America has been largely ignored. As part of the International Study of Asthma and Allergies in Childhood (ISAAC), 17 centers in 9 different Latin American countries participated in the study, and data from 52,549 written questionnaires (WQ) in children aged 13-14 years and from 36,264 WQ in 6-7 year olds are described here. In children aged 13-14 years, the prevalence of asthma ever ranged from 5.5-28%, and the prevalence of wheezing in the last 12 months from 6.6-27%. In children aged 6-7 years, the prevalence of asthma ever ranged from 4.1-26.9%, and the prevalence of wheezing in the last 12 months ranged from 8.6-32.1%. The lower prevalence in centers with higher levels of atmospheric pollution suggests that chronic inhalation of polluted air in children does not contribute to asthma. Furthermore, the high figures for asthma in a region with a high level of gastrointestinal parasite infestation, and a high burden of acute respiratory infections occurring early in life, suggest that these factors, considered as protective in other regions, do not have the same effect in this region. The present study indicates that the prevalence of asthma and related symptoms in Latin America is as high and variable as described in industrialized or developed regions of the world.
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Affiliation(s)
- J Mallol
- Department of Pediatric Respiratory Medicine, University of Santiago de Chile, Santiago, Chile
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42
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Asher I, Boner A, Chuchalin A, Custovic A, Dagli E, Haus M, Hemmo-Lotem M, Holgate ST, Holt PG, Høst A, Iikura I, Johansson SG, Kowalski ML, Naspitz CK, Odhiambo J, Vichyanond P, Volovitz B, Wahn U, Warner JO, Weiss K, Zhong NS. Prevention of allergy and asthma: interim report. Allergy 2000; 55:1069-88. [PMID: 11097319 DOI: 10.1034/j.1398-9995.2000.00001-3.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- I Asher
- Management of Noncommunicable Diseases Department, Chronic Respiratory Diseases and Arthritis
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Williams H, Robertson C, Stewart A, Aït-Khaled N, Anabwani G, Anderson R, Asher I, Beasley R, Björkstén B, Burr M, Clayton T, Crane J, Ellwood P, Keil U, Lai C, Mallol J, Martinez F, Mitchell E, Montefort S, Pearce N, Shah J, Sibbald B, Strachan D, von Mutius E, Weiland SK. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999; 103:125-38. [PMID: 9893196 DOI: 10.1016/s0091-6749(99)70536-1] [Citation(s) in RCA: 604] [Impact Index Per Article: 24.2] [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: 10/25/2022]
Abstract
BACKGROUND Little is known about the prevalence of atopic eczema outside Northern Europe. OBJECTIVES We sought to describe the magnitude and variation in the prevalence of atopic eczema symptoms throughout the world. METHODS A cross-sectional questionnaire survey was conducted on random samples of schoolchildren aged 6 to 7 years and 13 to 14 years from centers in 56 countries throughout the world. Those children with a positive response to being questioned about the presence of an itchy relapsing skin rash in the last 12 months that had affected their skin creases were considered to have atopic eczema. Children whose atopic eczema symptoms resulted in sleep disturbance for 1 or more nights per week were considered to have severe atopic eczema. RESULTS Complete data was available for 256,410 children aged 6 to 7 years in 90 centers and 458,623 children aged 13 to 14 years in 153 centers. The prevalence range for symptoms of atopic eczema was from less than 2% in Iran to over 16% in Japan and Sweden in the 6 to 7 year age range and less than 1% in Albania to over 17% in Nigeria for the 13 to 14 year age range. Higher prevalences of atopic eczema symptoms were reported in Australasia and Northern Europe, and lower prevalences were reported in Eastern and Central Europe and Asia. Similar patterns were seen for symptoms of severe atopic eczema. CONCLUSIONS Atopic eczema is a common health problem for children and adolescents throughout the world. Symptoms of atopic eczema exhibit wide variations in prevalence both within and between countries inhabited by similar ethnic groups, suggesting that environmental factors may be critical in determining disease expression. Studies that include objective skin examinations are required to confirm these findings.
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Affiliation(s)
- H Williams
- Queen's Medical Centre, University Hospital, Nottingham, United Kingdom
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Dawson K, Kennedy D, Asher I, Cooper D, Cooper P, Francis P, Henry R, Le Souef P, Martin J, Masters B. The management of acute bronchiolitis. Thoracic Society of Australia and New Zealand. J Paediatr Child Health 1993; 29:335-7. [PMID: 8018135 DOI: 10.1111/j.1440-1754.1993.tb00529.x] [Citation(s) in RCA: 20] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The management of acute bronchiolitis is mainly supportive, but infants require minimal handling. Of those who are hospitalized, less than 3% require intensive care and ventilation but in these children the condition is life threatening. Oxygen, fluid replacement and careful observation remain the cornerstones of management. Bronchodilators should be avoided in young infants and antiviral therapy should only be considered in critically ill infants who have an underlying cardiopulmonary condition.
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Affiliation(s)
- K Dawson
- Department of Paediatrics, Westmead Hospital, NSW, Australia
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46
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Henry RL, Robertson CF, Asher I, Cooper DM, Cooper P, Dawson KP, Francis P, Geelhoed G, Gillies JD, Isles AF. Management of acute asthma. Respiratory paediatricians of Australia and New Zealand. J Paediatr Child Health 1993; 29:101-3. [PMID: 8489787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- R L Henry
- Department of Paediatrics, John Hunter Hospital, NSW, Australia
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47
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Abstract
New Zealand Maoris are one of five ethnic groups in developed countries known to have a high rate of ear disease, including perforation of the eardrum (CSOM). It is a strongly held belief by otolaryngologists whose practice dates back to the 1960's that the prevalence of CSOM in Maori children is gradually falling. Despite the obvious practical implications this change has not yet been documented. The aim of the study was to compare the prevalence of CSOM in two surveys conducted in 1978 and 1987 of children living in a North Island Maori community. A second aim was to examine the natural history of CSOM in these children. The raw data from the 1978 study were reviewed. Of 134 children aged 4-13, 12 had CSOM. In 1987 the same age group yielded 12 children out of 250 with CSOM. The prevalence of CSOM fell from 9 per cent to 4 per cent. The incidence of new perforations in 1987 was 1.3 per cent per child per year. It is concluded there has been a fall in the rate of CSOM, although otitis media remains a significant problem for these children. The probability of a perforation healing was influenced by whether or not the perforation had been observed before: at least 35 per cent of perforations seen for the first time healed, but none of the perforations seen on two occasions healed spontaneously. It was concluded that perforation of the eardrum can be managed conservatively at first.
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Affiliation(s)
- M Giles
- Department of Otolaryngology, Waikato Base Hospital, Hamilton, New Zealand
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48
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Weizman A, Maoz B, Treves I, Asher I, Ben-David M. Sulpiride-induced hyperprolactinemia and impotence in male psychiatric outpatients. Prog Neuropsychopharmacol Biol Psychiatry 1985; 9:193-8. [PMID: 4001434 DOI: 10.1016/0278-5846(85)90082-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The relationship between erectile dysfunction and sulpiride stimulatory effect on prolactin secretion was studied in 13 married male psychiatric outpatients. The patients population was comprised of 2 groups: patients with anxiety disorders resistant to minor tranquilizers who were treated with sulpiride up to 200 mg/day, and schizophrenic patients treated with sulpiride 600 mg/day. All the patients were maintained on maximal dose for a period of 3 weeks. Sexual function and blood prolactin levels were monitored once weekly. The patients who developed impotence were maintained on higher doses of sulpiride and exhibited higher prolactin levels in comparison to the potent patients. Restoration of potency was observed after reduction or discontinuation of sulpiride treatment. It is concluded that sulpiride induced impotence is associated with hyperprolactinemia.
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49
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Greene JS, Asher I. Electronic games. JAMA 1982; 248:1308. [PMID: 7109147] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Abstract
Fluorescence spectra of protoporphyrin bound to its most affinitive site on human serum albumin, bound to human haemopexin and dissolved in human plasma reveal that, when present in plasma, at least 90% of this porphyrin is bound to albumin. Human serum albumin binds protoporphyrin with an affinity KA = 3 X 10(9)M-1 in phosphate-buffered saline. The affinity of haemopexin for protoporphyrin is 4 times smaller. From these data it is concluded that less than 1% of plasma protoporphyrin is bound to haemopexin. Implications of the data for protoporphyrin transport and clearance are discussed.
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