Over one million children have asthma in the UK and a recognised need for support transitioning into adult services. Poor transition with uncoordinated processes risks disengagement from services, and poorer health outcomes. Transition processes are embedded for children with diabetes and transplantation, but less established for severe asthma. We aim to explore the patient experience of transition for young people with severe asthma and evaluate the impact of a transition service in reducing emergency department (ED) presentations with asthma.
Methods
A questionnaire containing Likert scale and free text questions was developed based on the 'ready, steady, go'1 programme. This was given to patients aged 14–15 years attending asthma transition clinic. ED records for the years 2016–2018 were reviewed to identify patients aged 16–19 that presented with asthma symptoms. These data were cross-referenced with the registry of patients known to the transition service and demographic data was analysed.
Results
9 patients completed questionnaires, with two thirds of respondents reporting confidence about the transition process. All respondents reported good knowledge of their condition and treatment. Key themes that emerged were concerns about potential limits asthma may place upon their future achievements and a desire for understanding of management of their asthma during the transition process. During the years analysed for ED attendances, none (0%) of the 17 children who underwent transition through the service presented to the emergency department with asthma. During that time, 131 young people (mean (SD) age 17.5 (0.7) years, 56% female) presented to the emergency department with asthma who were not known to the transition service.
Conclusion
The transition service for young people with severe asthma is successful in preventing emergency department attendances with asthma symptoms. We have identified a need to expand the transition service to young people not already known to the regional severe asthma service.
Reference
Nagra A, McGinnity PM, Davis N, et al. 2015. Implementing transition: ready steady go. Arch Dis Child Educ Pract Ed 2015;0:1–8.
Nymphal Ixodes ricinus ticks collected from woodland areas in South Wales, UK, were tested using the polymerase chain reaction for the presence both of the causative agent of human granulocytic ehrlichiosis (HGE) and Borrelia burgdorferi. Twenty-two of 60 (37%) ticks were found positive in the PCR for B. burgdorferi and 4/60 (7%) for the HGE agent. One tick was found positive both for B. burgdorferi and HGE agent. Our findings imply the presence of the HGE agent in UK ticks and the finding of a tick apparently containing both pathogens underlines the potential for concurrent infection with HGE agent and B. burgdorferi to occur after a single tick-bite. Based on our observations, we conclude that there may be a need to consider a range of pathogens both in laboratory investigation and clinical management of suspected tick-borne disease in the UK, particularly where there is a clinical presentation atypical of Lyme borreliosis alone.
SUMMARY Over 300 cases of acute toxoplasmosis are confirmed by reference testing in England and Wales annually. We conducted a case-control study to identify risk factors for Toxoplasma gondii infection to inform prevention strategies. Twenty-eight cases and 27 seronegative controls participated. We compared their food history and environmental exposures using logistic regression to calculate odds ratios (OR) and 95% confidence intervals in a model controlling for age and sex. Univariable analysis showed that the odds of eating beef (OR 10·7, P < 0·001), poultry (OR 6·4, P = 0·01) or lamb/mutton (OR 4·9, P = 0·01) was higher for cases than controls. After adjustment for potential confounders a strong association between beef and infection remained (OR 5·6, P = 0·01). The small sample size was a significant limitation and larger studies are needed to fully investigate potential risk factors. The study findings emphasize the need to ensure food is thoroughly cooked and handled hygienically, especially for those in vulnerable groups.
In a study involving 14 laboratories supported by the European Community Biomed 2 program, we evaluated immunologic methods for the postnatal diagnosis of congenital toxoplasmosis (CT). Among babies born to mothers who seroconverted to positivity for toxoplasmosis during pregnancy, we analyzed 55 babies with CT on the basis of persistent anti-Toxoplasma immunoglobulin G (IgG) at 1 year of life and 50 control babies without anti-Toxoplasma IgG at 1 year of life in the absence of curative treatment with pyrimethamine-sulfonamides. We tested in-house methods such as the enzyme-linked immunofiltration assay (ELIFA) or Immunoblotting (IB) for the detection of IgG or IgM; these methods allowed comparison of the immunologic profiles of the mothers and the infants. We compared ELIFA and IB with a commercial enzyme immunoassay (EIA) or in-house immunosorbent agglutination assay (ISAGA) for the detection of IgM or IgA. The performances of combinations of methods were also assessed. A cumulative sensitivity of 98% during a 1-year follow-up was obtained with the ELIFA plus ISAGA combination. Only one case of CT was missed by the ELIFA plus ISAGA combination, whereas three cases were missed by the IB plus ISAGA combination, even though 48% of patients with CT were treated with pyrimethamine-sulfonamides, which are known to inhibit antibody neosynthesis. A similar performance was obtained with either ELIFA or IB in combination with EIA. The difference in performance between ELIFA plus ISAGA and IB plus ISAGA was not statistically significant (P = 0.31), and we conclude that both combinations of tests can be used for the diagnosis of CT in newborns.
Over the past ten years, it has been noted that the demand for leafy vegetables in the coastal area of Cameroon is increasing, particularly in the district of Njombe-Penja. Despite this growth in production volumes, there are also more or less severe shortages at certain times of the year. The main causes behind the variations in vegetable production in the Littoral zone are not well known and/or not recorded. In order to sort out the different factors (vegetable varieties, planting period, use of fertilisers and pesticides, soil, etc.) that interact on the production of leafy vegetables in the Littoral zone, it became necessary to conduct a study reviewing the state of leafy vegetable production and marketing activities in the locality of Njombé and its surroundings. This study also aims to better identify the main distribution chains and their vitality related to the markets supplied by vegetable production in the Njombe area. The methodological approach involved random sampling to constitute a population of 100 individuals (farmers, traders, etc.). A survey questionnaire was developed and administered to the target sample. The main results show that 96% of the individuals practising vegetable cropping are uneducated women, aged between 20 and 64 years. The individual areas cultivated are mostly very small to medium (between 64m2 and 870 m2). The vast majority of the cultivated land is rented (80%). The most cultivated leafy vegetable varieties are, in order of importance: "Black nightshade" (100%), "African Eggplant" (84%), "green amaranth" (80%), "bush okra" (80%), "Hibiscus" (40%), and "Water leaf" (32%). The seeds used come mainly from local markets (60%). The use of fertilisers and pesticides (doses and application frequencies) is not mastered by the farmers. The major constraints to production are: the difficulty of obtaining good quality seeds (86%), fungal diseases (80%), and attacks by various pests. This study also highlighted the economic potential of this vegetable activity in the locality.
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