Effects of rac-albuterol on arterial blood gases in patients with stable hypercapnic chronic obstructive pulmonary disease.

Aims: Many patients with chronic obstructive pulmonary disease (COPD) are treated with high dose beta(2)-adrenoceptor agonists, which can increase ventilation/perfusion mismatching, and tremor and cardiac output, thereby increasing oxygen uptake and carbon dioxide output (VCO(2)). Patients with severe COPD and hypercapnia may be unable to increase ventilation in response to increased VCO(2), in which case arterial carbon dioxide tension (P(a)CO(2)) may rise. Our aim was to determine whether high dose nebulized rac-albuterol could increase P(a)CO(2) in patients with COPD, limited bronchodilator reversibilty and hypercapnia.

Oral and inhaled corticosteroids and adrenal insufficiency: a case-control study.

Background: Adrenal insufficiency, a well recognised complication of treatment with oral corticosteroids, has been described in association with inhaled corticosteroid use in over 60 case reports. The risk of adrenal insufficiency in people prescribed an oral or inhaled corticosteroid in the general population is not known. A study was undertaken to quantify the association between adrenal insufficiency and oral and inhaled corticosteroid exposure.

School-based asthma surveillance: a comparison of student and parental report.

This study addressed the comparability of data obtained from a student-based and parent-based asthma and respiratory health survey. Our goal was to ascertain whether there were meaningful and systematic differences in asthma classification based on symptom and diagnosis reports obtained separately from students and their parents. A brief, written survey, based on the International Study of Asthma and Allergy in Children questionnaire, was administered to 6th through 10th grade students in two schools in Oakland, CA, USA.

Safety of inhaled corticosteroids.

Systemic bioavailability from the gastrointestinal tract is reduced with newer inhaled corticosteroids (ICSs) such as fluticasone, but systemic absorption still occurs via the lung. Observational studies have shown an association between ICS use and several adverse outcomes such as cataracts, glaucoma, and adrenal failure, and prospective controlled studies have confirmed a causal relationship between ICS use and bruising, reduction in bone mineral density, and reduced growth velocity. The evidence suggests that the effect of ICSs on bone mineral density is small in the short term but that patients taking moderate or high doses for long periods will be at increased risk of fractures and that this could be an appreciable public health problem.

Benefit versus risk for oral, inhaled, and nasal glucocorticosteroids.

Many factors affect the benefit-to-risk analysis of the use of the glucocorticosteroids in the treatment of allergic inflammation. For most patients the benefit-to-risk ratio favors topical over oral administration, but in severe disease oral administration may be required. It is clear from pharmacokinetic and pharmacodynamic studies that inhaled glucocorticosteroids in particular are absorbed into the systemic circulation and that they can have clinical adverse effects when given in high doses.

An application of model-fitting procedures for marginal structural models.

Marginal structural models (MSMs) are being used more frequently to obtain causal effect estimates in observational studies. Although the principal estimator of MSM coefficients has been the inverse probability of treatment weight (IPTW) estimator, there are few published examples that illustrate how to apply IPTW or discuss the impact of model selection on effect estimates. The authors applied IPTW estimation of an MSM to observational data from the Fresno Asthmatic Children's Environment Study (2000-2002) to evaluate the effect of asthma rescue medication use on pulmonary function and compared their results with those obtained through traditional regression methods.

Effects of inhaled corticosteroids on bone.

Objective: To discuss the effects of inhaled corticosteroids on bone and their potential public health implications.

Data Sources: The MEDLINE and EMBASE databases were searched to identify articles published between 1966 and January 2004 with the following keywords in the title: inhaled corticosteroid, beclomethasone, budesonide, flunisolide, fluticasone, mometasone, triamcinolone plus bone, fracture, osteoporosis, osteocalcin, growth, or height.

Study Selection: Key studies of adequate size and duration that allowed for potential confounding factors where required were selected.

Shallow marine benthic invertebrates of the Seychelles Plateau: high diversity in a tropical oligotrophic environment.

Soft sedimentary biotopes are extensive in the shallow Western Indian Ocean, especially on the Seychelles Plateau and Mascarene Ridge, yet pro rata compared with coral reefs the research effort devoted to them has been minimal. In this study we examine the benthic mollusc and polychaete worm assemblages of the shallow waters (11-62 m) around Mahe, in the Seychelles, and make direct comparisons with the temperate Irish Sea area and subtropical waters of Hong Kong, China (using identical methodology). Two assemblages were recognized, characterized by depth and sediment type.

Evaluating the use of a portable spirometer in a study of pediatric asthma.

Study Objectives: Laboratory-based spirometry is the "gold standard" for the assessment of lung function, both in clinical and research protocols. These spirometers, however, are neither practical nor affordable for home-based monitoring or studies that collect data in multiple locations. Traditionally, peak flowmeters have been used, but they have important limitations.

The effect of air pollution on inner-city children with asthma.

The effect of daily ambient air pollution was examined within a cohort of 846 asthmatic children residing in eight urban areas of the USA, using data from the National Cooperative Inner-City Asthma Study. Daily air pollution concentrations were extracted from the Aerometric Information Retrieval System database from the Environment Protection Agency in the USA. Mixed linear models and generalized estimating equation models were used to evaluate the effects of several air pollutants (ozone, sulphur dioxide (SO2), nitrogen dioxide (NO2) and particles with a 50% cut-off aerodynamic diameter of 10 microm (PM10) on peak expiratory flow rate (PEFR) and symptoms in 846 children with a history of asthma (ages 4-9 yrs).

Are peak flow and symptom measures good predictors of asthma hospitalizations and unscheduled visits?

Epidemiologic studies of pediatric respiratory health often include objective measures such as peak expiratory flow (PEF), and subjective measures such as symptom reports. These measures, however, are poorly correlated with each other, and there is little evidence that PEF is useful in predicting important health outcomes. Within a cohort of 791 inner-city children with asthma, we examined correlations between a series of five peak flow measures and five symptom scores obtained from 2-week diaries.

The effect of ozone on inner-city children with asthma: identification of susceptible subgroups.

Within a cohort of 846 inner-city asthmatic children aged 4 to 9 yr, we looked for subgroups that were more susceptible to the effects of summer ozone. Daily diaries were compared with ambient ozone levels to evaluate effect modification by demographic and environmental characteristics. Children born > 3 wk prematurely or weighing < 5.

Pediatric asthma care in the emergency department: measuring the quality of history-taking and discharge planning.

The National Asthma Education and Prevention Program NAEPP Guidelines include recommendations for history-taking and discharge planning during an asthma visit, but there are no tools to measure performance. The objectives of this study were to define and operationalize key elements of history-taking and discharge planning, to develop a tool for measuring these elements, and to evaluate the quality of history-taking and discharge planning in the emergency department (ED) during visits for asthma using the new tool. Expert opinion and extensive literature review were used to develop a 13-item checklist containing items that should be documented during history-taking and provided during discharge planning for an ED visit for an acute asthma exacerbation by children.

Results of the National Cooperative Inner-City Asthma Study (NCICAS) environmental intervention to reduce cockroach allergen exposure in inner-city homes.

Background: Cockroach allergen is important in asthma. Practical methods to reduce exposure are needed.

Objective: We sought to evaluate the effectiveness of house cleaning and professional extermination on lowering cockroach antigen levels in inner-city dwellings.

Relationship of indoor allergen exposure to skin test sensitivity in inner-city children with asthma.

Background: It is important to understand the relationship between environmental allergen exposure dose and the risk of atopic individuals becoming sensitized to that allergen if we are to change the risk of sensitization and morbidity from allergic disease.

Objective: The objective of these studies was to determine whether there was a dose response between current exposure to mite, cockroach, and cat allergen in inner-city children and to determine the prevalence of sensitization to these allergens.

Methods: A sample of 500 children was selected from the 1528 children enrolled in the National Cooperative Inner City Asthma Study.

Tyrosine phosphorylation of the herpes simplex virus type 1 regulatory protein ICP22 and a cellular protein which shares antigenic determinants with ICP22.

At least eight herpes simplex virus type 1 (HSV-1) and five HSV-2 proteins were tyrosine phosphorylated in infected cells. The first viral tyrosine phosphoprotein identified was the HSV-1 regulatory protein ICP22. Also, two novel phosphotyrosine proteins were bound by anti-ICP22 antibodies.

Clinical research and the culture of collaboration.

This article aims to share some of the strategies and principles that facilitated the completion of an experimental research project undertaken at the Liverpool Health Service (formerly Liverpool Hospital) in the South West of Sydney. The experience demonstrated the interdependence of the academic and clinical nurse practitioners undertaking the project. A collaborative approach to nursing research in which complementarity of participants is recognised and valued is recommended.

Screening alcohol & drug use in a general practice unit: comparison of computerised and traditional methods.

Systematic screening of patients for areas of health risk in their lifestyle has much potential for primary health care clinicians as a cost-effective and time saving means to identify 'at risk' individuals. In the area of alcohol and drug problems, such early identification increases the likelihood of successful intervention. The present study, conducted at a general practice unit, compared the use of a computer to screen for alcohol and drug use with the two more traditional assessment methods of face-to-face interview and paper and pencil questionnaire.

The cloning and over-expression of PABA synthase in E. coli.

Both the genes encoding E. coli p-aminobenzoic acid synthase have been cloned and an overproducing strain has been obtained. The partial purification of the large subunit is described.

Colour television image analysis of carious lesions.

The new technique of colour television image analysis has been used to produce seven-colour contour maps of the radiodensity of micro-radiographs of enamel caries. This method permits the detailed measurement of the mineral content of enamel carious lesions to a sensitivity of +/-3% of the level of complete mineralisation. By selection of appropriate aluminium step-wedges, exposed simultaneously with the tooth section, the whole range of mineral content can be assessed.