Letter from Australia McDonald, Christine F.
Respirology (Carlton, Vic.),
February 2024, 2024-Feb, 2024-02-00, 20240201, Letnik:
29, Številka:
2
Journal Article
Child undernutrition affects millions of children globally. We investigated associations between suboptimal growth and mortality by pooling large studies.
Pooled analysis involving children 1 week to ...59 months old in 10 prospective studies in Africa, Asia and South America. Utilizing most recent measurements, we calculated weight-for-age, height/length-for-age and weight-for-height/length Z scores, applying 2006 WHO Standards and the 1977 NCHS/WHO Reference. We estimated all-cause and cause-specific mortality hazard ratios (HR) using proportional hazards models comparing children with mild (-2≤Z<-1), moderate (-3≤Z<-2), or severe (Z<-3) anthropometric deficits with the reference category (Z≥-1).
53 809 children were eligible for this re-analysis and contributed a total of 55 359 person-years, during which 1315 deaths were observed. All degrees of underweight, stunting and wasting were associated with significantly higher mortality. The strength of association increased monotonically as Z scores decreased. Pooled mortality HR was 1.52 (95% Confidence Interval 1.28, 1.81) for mild underweight; 2.63 (2.20, 3.14) for moderate underweight; and 9.40 (8.02, 11.03) for severe underweight. Wasting was a stronger determinant of mortality than stunting or underweight. Mortality HR for severe wasting was 11.63 (9.84, 13.76) compared with 5.48 (4.62, 6.50) for severe stunting. Using older NCHS standards resulted in larger HRs compared with WHO standards. In cause-specific analyses, all degrees of anthropometric deficits increased the hazards of dying from respiratory tract infections and diarrheal diseases. The study had insufficient power to precisely estimate effects of undernutrition on malaria mortality.
All degrees of anthropometric deficits are associated with increased risk of under-five mortality using the 2006 WHO Standards. Even mild deficits substantially increase mortality, especially from infectious diseases.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
There exists a general consensus in the science education literature around the goal of enhancing learners' views of nature of science (NOS). An extensive body of research in the field has ...highlighted the effectiveness of explicit NOS instructional approaches in improving learners' NOS views. Emerging research has suggested that engaging learners in argumentation may aid in the development of their NOS views, although this claim lacks empirical support. This study assessed the influence of a science content course incorporating explicit NOS and argumentation instruction on five preservice primary teachers' views of NOS using multiple sources of data including questionnaires and surveys, interviews, audio- and video-taped class sessions, and written artifacts. Results indicated that the science content course was effective in enabling four of the five participants' views of NOS to be improved. A critical analysis of the effectiveness of the various course components led to the identification of three factors that mediated the development of participants' NOS views during the intervention: (a) contextual factors (context of argumentation, mode of argumentation), (b) task-specific factors (argumentation scaffolds, epistemological probes, consideration of alternative data and explanations), and (c) personal factors (perceived previous knowledge about NOS, appreciation of the importance and utility value of NOS, durability and persistence of pre-existing beliefs). The results of this study provide evidence to support the inclusion of explicit NOS and argumentation instruction as a context for learning about NOS, and promote consideration of this instructional approach in future studies which aim to enhance learners' views of NOS. Author abstract
To examine the effect of pulmonary rehabilitation (PR) (exercise and education) or exercise training (ET) on exercise capacity, health-related quality of life (HRQOL), symptoms, frequency of ...exacerbations, and mortality compared with no treatment in adults with bronchiectasis.
Computer-based databases were searched from their inception to February 2016.
Randomized controlled trials of PR or ET versus no treatment in adults with bronchiectasis were included.
Two reviewers independently extracted data and assessed methodologic quality using the Cochrane risk-of-bias tool.
Four trials with 164 participants were included, with variable study quality. Supervised outpatient PR or ET of 8 weeks improved incremental shuttle walk distance (weighted mean difference WMD=67m; 95% confidence interval CI, 52-82m) and disease-specific HRQOL (WMD=-4.65; 95% CI, -6.7 to -2.6 units) immediately after intervention, but these benefits were not sustained at 6 months. There was no effect on cough-related quality of life (WMD=1.3; 95% CI, -0.9 to 3.4 units) or psychological symptoms. PR commenced during an acute exacerbation and continued beyond discharge had no effect on exercise capacity or HRQOL. The frequency of exacerbations over 12 months was reduced with outpatient ET (median, 2 vs 1; P=.013), but PR initiated during an exacerbation had no impact on exacerbation frequency or mortality.
Short-term improvements in exercise capacity and HRQOL were achieved with supervised PR and ET programs, but sustaining these benefits is challenging in people with bronchiectasis. The frequency of exacerbations over 12 months was reduced with ET only.
Micronutrient deficiencies compromise immune systems, hinder child growth and development, and affect human potential worldwide. Yet, to our knowledge, the only existing estimate of the global ...prevalence of micronutrient deficiencies is from over 30 years ago and is based only on the prevalence of anaemia. We aimed to estimate the global and regional prevalence of deficiency in at least one of three micronutrients among preschool-aged children (aged 6–59 months) and non-pregnant women of reproductive age (aged 15–49 years).
In this pooled analysis, we reanalysed individual-level biomarker data for micronutrient status from nationally representative, population-based surveys. We used Bayesian hierarchical logistic regression to estimate the prevalence of deficiency in at least one of three micronutrients for preschool-aged children (iron, zinc, and vitamin A) and for non-pregnant women of reproductive age (iron, zinc, and folate), globally and in seven regions using 24 nationally representative surveys done between 2003 and 2019.
We estimated the global prevalence of deficiency in at least one of three micronutrients to be 56% (95% uncertainty interval UI 48–64) among preschool-aged children, and 69% (59–78) among non-pregnant women of reproductive age, equivalent to 372 million (95% UI 319–425) preschool-aged children and 1·2 billion (1·0–1·4) non-pregnant women of reproductive age. Regionally, three-quarters of preschool-aged children with micronutrient deficiencies live in south Asia (99 million, 95% UI 80–118), sub-Saharan Africa (98 million, 83–113), or east Asia and the Pacific (85 million, 61–110). Over half (57%) of non-pregnant women of reproductive age with micronutrient deficiencies live in east Asia and the Pacific (384 million, 279–470) or south Asia (307 million, 255–351).
We estimate that over half of preschool-aged children and two-thirds of non-pregnant women of reproductive age worldwide have micronutrient deficiencies. However, estimates are uncertain due to the scarcity of population-based micronutrient deficiency data.
US Agency for International Development.
Introduction: Chronic obstructive pulmonary disease (COPD) is characterised by persistent respiratory symptoms and chronic airflow limitation, and is associated with exacerbations and comorbidities. ...Advances in the management of COPD are updated quarterly in the national COPD guidelines, the COPD‐X plan, published by Lung Foundation Australia in conjunction with the Thoracic Society of Australia and New Zealand and available at http://copdx.org.au.
Main recommendations:
Spirometry detects persistent airflow limitation (post‐bronchodilator FEV1/FVC < 0.7) and must be used to confirm the diagnosis.
Non‐pharmacological and pharmacological therapies should be considered as they optimise function (ie, improve symptoms and quality of life) and prevent deterioration (ie, prevent exacerbations and reduce decline).
Pulmonary rehabilitation and regular exercise are highly beneficial and should be provided to all symptomatic COPD patients.
Short‐ and long‐acting inhaled bronchodilators and, in more severe disease, anti‐inflammatory agents (inhaled corticosteroids) should be considered in a stepwise approach.
Given the wide range of inhaler devices available, inhaler technique and adherence should be checked regularly.
Smoking cessation is essential, and influenza and pneumococcal vaccinations reduce the risk of exacerbations.
A plan of care should be developed with the multidisciplinary team. COPD action plans reduce hospitalisations and are recommended as part of COPD self‐management.
Exacerbations should be managed promptly with bronchodilators, corticosteroids and antibiotics as appropriate to prevent hospital admission and delay COPD progression.
Comorbidities of COPD require identification and appropriate management.
Supportive, palliative and end‐of‐life care are beneficial for patients with advanced disease.
Education of patients, carers and clinicians, and a strong partnership between primary and tertiary care, facilitate evidence‐based management of COPD.
Changes in management as result of the guideline: Spirometry remains the gold standard for diagnosing airflow obstruction and COPD. Non‐pharmacological and pharmacological treatment should be used in a stepwise fashion to control symptoms and reduce exacerbation risk.
Eosinophil Biology in COPD McDonald, Christine F
The New England journal of medicine,
10/2017, Letnik:
377, Številka:
17
Journal Article
Recenzirano
Chronic obstructive pulmonary disease (COPD) is a lethal disease that is predicted to become the third leading cause of death globally within 3 years.
1
Recent research has highlighted the ...heterogeneity of the pathologic characteristics of COPD, indicating that disease mechanisms are complex. Inflammatory pathways implicating neutrophils have been emphasized,
2
but attention has recently focused on the persistent blood and airway eosinophilia that is found in up to 40% of patients with COPD, even in the absence of a history of asthma; such patients have a higher risk of exacerbations than patients without eosinophilia.
3,4
Guidelines have generally recommended a “one size . . .
Background
Pulmonary rehabilitation is a proven, effective intervention for people with chronic respiratory diseases including chronic obstructive pulmonary disease (COPD), interstitial lung disease ...(ILD) and bronchiectasis. However, relatively few people attend or complete a program, due to factors including a lack of programs, issues associated with travel and transport, and other health issues. Traditionally, pulmonary rehabilitation is delivered in‐person on an outpatient basis at a hospital or other healthcare facility (referred to as centre‐based pulmonary rehabilitation). Newer, alternative modes of pulmonary rehabilitation delivery include home‐based models and the use of telehealth.
Telerehabilitation is the delivery of rehabilitation services at a distance, using information and communication technology. To date, there has not been a comprehensive assessment of the clinical efficacy or safety of telerehabilitation, or its ability to improve uptake and access to rehabilitation services, for people with chronic respiratory disease.
Objectives
To determine the effectiveness and safety of telerehabilitation for people with chronic respiratory disease.
Search methods
We searched the Cochrane Airways Trials Register, and the Cochrane Central Register of Controlled Trials; six databases including MEDLINE and Embase; and three trials registries, up to 30 November 2020. We checked reference lists of all included studies for additional references, and handsearched relevant respiratory journals and meeting s.
Selection criteria
All randomised controlled trials and controlled clinical trials of telerehabilitation for the delivery of pulmonary rehabilitation were eligible for inclusion. The telerehabilitation intervention was required to include exercise training, with at least 50% of the rehabilitation intervention being delivered by telerehabilitation.
Data collection and analysis
We used standard methods recommended by Cochrane. We assessed the risk of bias for all studies, and used the ROBINS‐I tool to assess bias in non‐randomised controlled clinical trials. We assessed the certainty of evidence with GRADE. Comparisons were telerehabilitation compared to traditional in‐person (centre‐based) pulmonary rehabilitation, and telerehabilitation compared to no rehabilitation. We analysed studies of telerehabilitation for maintenance rehabilitation separately from trials of telerehabilitation for initial primary pulmonary rehabilitation.
Main results
We included a total of 15 studies (32 reports) with 1904 participants, using five different models of telerehabilitation. Almost all (99%) participants had chronic obstructive pulmonary disease (COPD). Three studies were controlled clinical trials. For primary pulmonary rehabilitation, there was probably little or no difference between telerehabilitation and in‐person pulmonary rehabilitation for exercise capacity measured as 6‐Minute Walking Distance (6MWD) (mean difference (MD) 0.06 metres (m), 95% confidence interval (CI) ‐10.82 m to 10.94 m; 556 participants; four studies; moderate‐certainty evidence). There may also be little or no difference for quality of life measured with the St George's Respiratory Questionnaire (SGRQ) total score (MD ‐1.26, 95% CI ‐3.97 to 1.45; 274 participants; two studies; low‐certainty evidence), or for breathlessness on the Chronic Respiratory Questionnaire (CRQ) dyspnoea domain score (MD 0.13, 95% CI ‐0.13 to 0.40; 426 participants; three studies; low‐certainty evidence). Participants were more likely to complete a program of telerehabilitation, with a 93% completion rate (95% CI 90% to 96%), compared to a 70% completion rate for in‐person rehabilitation. When compared to no rehabilitation control, trials of primary telerehabilitation may increase exercise capacity on 6MWD (MD 22.17 m, 95% CI ‐38.89 m to 83.23 m; 94 participants; two studies; low‐certainty evidence) and may also increase 6MWD when delivered as maintenance rehabilitation (MD 78.1 m, 95% CI 49.6 m to 106.6 m; 209 participants; two studies; low‐certainty evidence). No adverse effects of telerehabilitation were noted over and above any reported for in‐person rehabilitation or no rehabilitation.
Authors' conclusions
This review suggests that primary pulmonary rehabilitation, or maintenance rehabilitation, delivered via telerehabilitation for people with chronic respiratory disease achieves outcomes similar to those of traditional centre‐based pulmonary rehabilitation, with no safety issues identified. However, the certainty of the evidence provided by this review is limited by the small number of studies, of varying telerehabilitation models, with relatively few participants. Future research should consider the clinical effect of telerehabilitation for individuals with chronic respiratory diseases other than COPD, the duration of benefit of telerehabilitation beyond the period of the intervention, and the economic cost of telerehabilitation.
A large body of research has drawn attention to the importance of providing engaging learning experiences in junior secondary science classes, in an attempt to attract more students into post- ...compulsory science courses. The reality of time and resource constraints, and the high proportion of non-specialist science teachers teaching science, has resulted in an overreliance on more transmissive pedagogical tools, such as textbooks. This study sought to evaluate the usage of junior secondary science textbooks in Australian schools. Data were collected via surveys from 486 schools teaching junior secondary (years 7-10), representing all Australian states and territories. Results indicated that most Australian schools use a science textbook in the junior secondary years, and textbooks are used in the majority of science lessons. The most highly cited reason influencing choice of textbook was layout/colour/illustrations, and electronic technologies were found to be the dominant curricula material utilised, in addition to textbooks, in junior secondary science classes. Interestingly, the majority of respondents expressed high levels of satisfaction with their textbooks, although many were keen to stress the subsidiary role of textbooks in the classroom, emphasising the textbook was 'one' component of their teaching repertoire. Importantly, respondents were also keen to stress the benefits of textbooks in supporting substitute teachers, beginning teachers, and non-specialist science teachers; in addition to facilitating continuity of programming and staff support in schools with high staff turnover. Implications from this study highlight the need for high quality textbooks to support teaching and learning in Australian junior secondary science classes. Author abstract
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