Introduction Overweight children with asthma may display impaired response to inhaled corticosteroids (ICS), possibly due to non-eosinophilic inflammation or weight-related lung compression; these mechanisms may differentially affect response to ICS and leukotriene receptor antagonists (LTRAs). We assessed whether weight status modified the response to low-dose ICS and LTRA Step-2 monotherapy. Methods A historical cohort study from clinical data linked to administrative databases was conducted among children aged 2–18 years with specialist-diagnosed asthma who were initiating or continuing a Step-2 monotherapy from 2000 to 2007 at the Montreal Children’s Hospital Asthma Centre. The outcome was time-to-management failure defined as any step-up in therapy, acute care visit, hospitalisation or oral corticosteroids for asthma, whichever occurred first. The independent and joint effects of weight status (body mass index [BMI] percentile) and time-varying treatment on time-to-management failure were estimated with marginal structural Cox models. The likelihood ratio test (LRT) and relative excess risk due to interaction (RERI) were computed to assess treatment effect modification by weight status on the multiplicative and additive scales. Results Of the 433 and 85 visits with a low-dose ICS and LTRA prescription, respectively, 388 management failures occurred over 14 529 visit-weeks of follow-up. Children using LTRA compared with low-dose ICS tended to have an overall higher risk of early management failure (HR 1.52; 95% CI 0.72 to 3.22). Irrespective of treatment, the hazard of management failure increased by 5% (HR 1.05; 95% CI 1.01 to 1.10) for every 10-unit increase in BMI percentile. An additional hazard reduction of 17% (HR 0.83; 95% CI 0.70 to 0.99) was observed for every 10-unit increase in BMI percentile among LTRA users, but not for ICS (HR 0.95; 95% CI 0.86 to 1.04). The LRT indicated a departure from exact multiplicativity (p<0.0001), and the RERIs for ICS and LTRA were −0.05 (95% CI −0.14 to 0.05) and −0.52 (95% CI −1.76 to 0.71). Conclusions Weight status was associated with earlier time-to-management failure in children prescribed Step-2 therapy. This hypothesis-generating study suggests that LTRA response increases in children with higher BMI percentiles, although further research is warranted to confirm findings.
This study sought to explore the perceptions of health care workers about engaging patients as partners on care redesign teams under a program called Transforming Care at the Bedside (TCAB), and to examine the facilitating factors, barriers, and effects of such engagement.This descriptive, qualitative study collected data through focus groups and individual interviews. Participants included health care providers and managers from five units at three hospitals in a university-affiliated health care center in Canada.A total of nine focus groups and 13 individual interviews were conducted in April 2012, 18 months after the TCAB program began in September 2010. Content analysis was used to analyze the qualitative data.Health care providers and managers benefited from engaging patients in the decision-making process because the patients brought a new point of view. Involving the patients exposed team members to valuable information that they hadn't previously thought about during decision making.Health care teams stand to benefit from engaging patients in the change process. Patients contribute a different point of view, and this helps to ensure that the changes proposed and implemented address their needs.
One of the main advantages of the discrete wavelet representation is the near-optimal estimation of signals corrupted with noise. After the seminal work of De Vore and Lucier (1992) and Donoho and Johnstone (1995), new techniques for choosing appropriate threshold and/or shrinkage functions have recently been explored by Bayesian and likelihood methods. This work is motivated by a Bayesian approach and is based on the complex representation of signals by the Symmetric Daubechies Wavelets. Applications for two dimensional signals are discussed.
Background: Multiple animal antigens, spores and pollens were collected and identified from the Kuwaiti atmosphere.The role for these antigens in mediating allergic rhinitis for Kuwaiti residents needs to be evaluated.Objective: To investigate the causes (both indoors and outdoors) of allergic rhinitis for Kuwaiti residents.Method: This is a retrospective study of all positive skin tests that we obtained in our Allergy clinic in Mubarak Alkabeer Hospital in Kuwait, during the period between May 2013 and December 2015, from patients who presented with allergic rhinitis symptoms and/or signs.They underwent skin prick tests to a battery of common allergens (german cockroach, cat dander, dog dander, house dustmites mix, cladosporium, aspergillus mix, penicillium mix, alternaria, grass pollens mix, Russian thistle pollens, mugwort pollens, rough pigweed pollens, sorrel pollens, compositae pollens, olive pollens, and date palm pollens).A wheal of ≥3 mm was considered a positive skin test.Results: A total of 177 patients with rhinitis (90 females and 87 males) had positive test results to at least one allergen and were considered allergic.77.9% of the patients had positive results to Russian thistle pollens, 39.9% to cat dander, 29.9% to grass pollens mix, 22.6% to compositae pollens, 22.6% to mugwort pollens, 22% to house dust mites mix, 21.4% to olive pollens, 20.9% to German cockroach, 20.3% to dog dander, 18.1% to rough pigweed pollens, 15.8% to date palm pollens, and 12.4% to sorrel pollens, 14.7% to penicillium, 10.7% to cladosporium, 10.7% to aspergillus mix, and 4% to alternaria.Conclusion: Russian Thistle pollen is the commonest sensitization for Kuwaiti residents with allergic rhinitis.
