Overweight children displayed poorer asthma control than lean children

Lang JE. J Allergy Clin Immunol. 2014;doi:10.1016/j.jaci.2014.08.029.

Overweight and obese children with early-onset asthma had distinct symptoms and experienced poorer asthma control compared with lean children, according to recent study results.

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Researchers conducted a cross-sectional study of 21 lean children (20% to 65% BMI; mean age, 12.8 years; 67% boys) and 35 overweight and obese children (≥85% BMI; mean age, 12.5 years; 57% boys) with persistent, early-onset asthma. Patient history, qualitative and quantitative asthma symptom characterization and lung function were determined during two to three visits. Multivariable linear and logistic regression were used to determine the association between weight status and symptoms.

Similar lung function was displayed by both cohorts. The overweight and obese children reported more than three times frequent rescue treatments compared with lean children (3.7 vs. 1.1 treatments/week; P=.0002), while experiencing lower fraction of exhaled nitric acid (30 vs. 62.6 ppb; P=.037) and reduced methacholine responsiveness (PC20FEV1 1.87 vs. 0.45 mg/mL; P<.012).

“Weight status affected the child’s primary symptom reported with loss of asthma control (Fisher exact test; P=.003),” the researchers wrote.

Shortness of breath was more often reported by the overweight/obese cohort (OR=11.8; 95% CI, 1.41-98.7), while cough was reported less often by those children (OR=0.26; 95% CI, 0.08-0.82). Overweight and obese children had higher gastroesophageal reflux disease scores compared with thin children (9.6 vs. 23.2; P=.003), which appeared to affect asthma symptoms.

“Greater shortness of breath and beta-agonist use appears to be partially mediated via esophageal reflux symptoms,” the researchers concluded. “Overweight children with asthma may falsely attribute exertional dyspnea and esophageal reflux to asthma, leading to excess rescue medication use.

“Until systematic weight loss interventions become more feasible, respiratory physicians may serve their patients better by considering and discussing alternative causes of dyspnea in self-management plans and discussing when [short-acting beta-agonist] use is warranted for obese patients with asthma.”

healio.com

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150 MILLION EUROPEANS ARE ‘TRAPPED’ BY ALLERGY

Raising awareness about allergic diseases: Asthma

Allergy is a public health problem of pandemic proportions that affects more than 150 million people in Europe.

According to experts, 1 out of every 3 children have an allergy and they expect the disease to affect more than 50% of all Europeans in 10 years’ time.

Allergic diseases can limit activities and lower the quality of life, particularly when they coexist in the same individual. Apart from individual suffering allergic diseases present a very high socioeconomic burden to patients and families.

"The European Academy of Allergy and Clinical Immunology (EAACI) has launched an awareness campaign to help the society to better understand how allergy sufferers feel, how profound allergy impacts quality of life, how severe and costly the diseases can become and how important is to diagnose early and better manage this disease." 
- Nikos Papadopoulos, EAACI President 

Allergy and asthma are closely linked

• asthma and other allergic diseases run in families
• many patients are aware of allergic triggers for their asthma (house dust mites, animal dander, molds)
• atopic eczema is often the first sign that the child has an atopic phenotype and may develop rhinitis and asthma when they grow up
• childhood wheeze often persists into asthma if an allergic background is present
• 75% of adults with asthma have allergic rhinitis
• 50% of people with allergic rhinitis have asthma
• treating rhinitis may improve asthma symptoms, especially cough

      A child using an asthma inhaler

Word from EAACI's Asthma Section The reasons behind asthma are not well understood, however people with allergic rhinitis, atopic eczema, food allergy and those who have asthma running in the family are at risk of developing asthma. You may have asthma if you experience recurrent episodes of coughing, wheezing, breathlessness and chest tightness. The complaints may be triggered by colds, exposure to cigarette smoke, air pollution and / or allergens such as house dust mites, grass pollens, cats, etc. The symptoms increase, decrease or disappear from time to time.

Allergic asthma is considered a special phenotype and composes about 80% of cases in children and 40% in adults. Children with allergic asthma may have more severe and persistent disease and both adults and children with allergic asthma may benefit from a specific form of treatment called allergy vaccines. The majority of people with asthma can be controlled by environmental measures and asthma medications. A small percentage, around 5 % of all cases especially in adults, may have severe asthma and can be difficult to control with the traditional approach.

In recent years, there have been important advances in this field and there are now specific medications for people who do not respond to the regular treatment. These treatments are generally aimed at blocking certain substances that may specifically be responsible for severe asthma in selected patients. For the patient this means that asthma can now be controlled even in more severe forms of the disease.

Asthma is a chronic but controllable disease and persons with asthma can have a normal, active life with no restrictions. The important thing is to recognize and treat the disease.

About EAACI
The European Academy of Allergy and Clinical Immunology, EAACI, is a non-profit organisation active in the field of allergic and immunologic diseases such as asthma, rhinitis, eczema, occupational allergy, food and drug allergy and anaphylaxis. EAACI was founded in 1956 in Florence and has become the largest medical association in Europe in the field of allergy and clinical immunology. It includes over 8,000 members from 121 countries, as well as 47 National Allergy Societies.

http://www.bewareofallergy.com/

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Energy drinks could cause public health problems, says WHO study

Researchers argue for cap on caffeine levels, citing health risks, particularly when the drinks are consumed with alcohol

• Haroon Siddique
• The Guardian, Tuesday 14 October 2014 21.00 BST
• 

A European study found that over 70% of 18- 29-year olds drink energy drinks like Red Bull with alcohol. Photograph: David Sillitoe for the Guardian

Energy drinks will become a significant public health problem if their use among young people is not addressed through a cap on caffeine levels and restrictions on their sale and marketing, United Nations researchers have warned.

The World Health Organisation (WHO) study said the primary risk was from high caffeine levels, which can cause problems such as palpitations, hypertension, vomiting, convulsions and in extreme cases heart failure leading to death. The paper, published in Frontiers in Public Health on Tuesday, will add to concerns about the harmful effects of excessive energy-drink consumption.

João Breda, from WHO’s Regional Office for Europe, and colleaguesThe researchers wrote that caffeine has a proven negative effect on children.

They said: “The full impact of the rise in popularity of energy drinks has not yet been quantified, but the aggressive marketing of energy drinks targeted at young people, combined with limited and varied regulation have created an environment where energy drinks could pose a significant threat to public health.”

Global sales of energy drinks surged from £2.4bn in 1999 to £17.3bn in 2013, according to Euromonitor. Red Bull is the UK’s third bestselling soft drink. Although some coffees have comparable levels of caffeine, energy drinks can be drunk cold and therefore more quickly.

The WHO study, a review of the literature, said there was also a proliferation of new products containing “extreme” caffeine levels, far higher than mainstream brands. Energy drinks also include other ingredients such as guarana, taurine and B vitamins, which the WHO researchers say require further investigation, including into their interaction with caffeine.

The paper, which does not represent WHO policy, said there was growing evidence of harm due to consumption of energy drinks with alcohol. A European Food Safety Authority study found that over 70% of 18- to 29-year olds who drink energy drinks mix them with alcohol.

The study authors said research has shown this is more risky than drinking alcohol alone, possibly because energy drinks make it harder for people to notice when they are getting drunk even though there is no reduction in intoxication.

They said energy drinks had also been linked to dangers when combined with physical activity – despite often being marketed as boosting sports performance – and to obesity and dental cavities.

The authors did not quantify what cap should be imposed on caffeine levels but stated that it should be evidence based. Other recommendations included making health practitioners aware of the potential dangers of excess caffeine consumption, screening patients with a history of diet problems and substance abuse for heavy consumption of energy drinks, educating the public about the risks of mixing them with alcohol and better labelling.

In the UK, the Food Standards Agency requires high-caffeine energy drinks to be labelled as such and from December they must contain a warning stating: “Not recommended for children or pregnant or breastfeeding women.” A spokesman said: “The FSA advises that people who are sensitive to caffeine should only consume high caffeine drinks ... in moderation.” It is not planning further legislation at present.

Gavin Partington, director general of the British Soft Drinks Association(BSDA), said the review had failed to take into account the conclusions of other scientific articles, adding: “Several of the policy recommendations it makes are already well established through the BSDA’s voluntary code and EU regulation.” An industry code of practice restricts marketing energy drinks to children.

In May, Lithuania become the first EU state to pass legislation banning the sale of such drinks to minors.

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http://www.who.int/topics/chronic_dis...

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Nearly 70% of the world's population dies from non-communicable diseases such as cancer, diabetes, cardiovascular and respiratory disease. Health Sciences student Hannah Burgess asks the Liggins Institute's Professor Sir Peter Gluckman what we can do about the problem.

Find out more about the Liggins Institute: http://www.liggins.auckland.ac.nz
Find out more about LENScience - bringing students and scientists together: http://www.lenscience.auckland.ac.nz

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WHO Nutrition Guidance Expert Advisory Group (NUGAG) subgroup on diet and health

The WHO Nutrition Guidance Expert Advisory Group (NUGAG) subgroup on diet and health has just closed its 6th meeting which was held at the WHO Regional Office for Europe in Copenhagen, Denmark. The NUGAG was established in 2010 to implement the new guideline development process and has met regularly since its establishment.

NUGAG consists of scientists and experts from various areas, representing all WHO regions. The subgroup focuses on updating the dietary goals for the prevention of obesity and noncommunicable diseases (NCDs).

Contributing to the implementation of the political declarations of the United Nations high-level meeting on NCDs and the "WHO Global Action Plan for the Prevention and Control of NCDs 2013-2020", the main objectives of this meeting were:

1. to review the updated systematic reviews and asses the available evidence on saturated fatty acids (SFA) and trans-fatty acids (TFA);
2. to update the recommendations on SFA and TFA for the prevention of NCDs;
3. to review the issues related to replacement of SFA and TFA as public health measures related to diet, nutrition and health.

The meeting and its outcomes are important steps toward the implementation of the WHO agenda on NCDs.

From, WHO

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Equity, education and health

7–9 October, Odense, Denmark

• Health promotion in schools improves learning – what action can we take?
• Equal opportunities – how can schools contribute?
• Policies work – why don’t we use them?
• Interventions are more successful in well-off children – how can we extend the benefits to other children?
• Better education, more equity, better health – what is schools’ role in achieving these?

These are some of the issues to be addressed at the 4th European Conference on Health Promoting Schools, held in Odense, Denmark. The Conference focuses on equity, education and health, and equity’s links with sustainability, social inclusion, innovation and change. It aims to consolidate, strengthen and support the sharing of research, policy and practice related to school-based health promotion across Europe, and outline what can be done to promote equity in health and education.

The 250 Conference participants include decision-makers, researchers and practitioners from the health, education and social sectors; government, nongovernmental, local and youth organizations; and academic institutions.

Research findings on child health and educational achievement

• Overall child health status affects educational performance and attainment.
• Evidence indicates that smoking or poor nutrition has a greater negative effect on educational outcomes than alcohol consumption or drug use.
• Initial research has found that physical exercise has a significant positive impact on academic performance.
• Obesity and overweight are associated negatively with educational outcomes.
• Sleeping disorders can hinder academic performance.

---

Conference website

Press release – Healthy children learn best

7-10-2013

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A new PhD project and scholarship for a suitable candidate from the Eastern Mediterranean Region (EMR) to join the Global Health Research Group at the Centre for Population Health Sciences, University of Edinburgh.

The link to the advertisement is:

http://www.findaphd.com/search/ProjectDetails.aspx?PJID=48736

The candidate must have strong quantitative skills and have worked in a health related area within a key EMR country that has high quality of published epidemiological data in the local language or in English (e.g. Iran, Qatar, UAE).

Attached resources:

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  WCLS_Agenda_9Oct2013.pdf (download, 332.2 KB)

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  Grant_Award_YLI_2013.pdf (download, 574.8 KB)

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Announcement: Global Health Hospitalist position -- Harvard Medical School & Nyaya Health

Nyaya Health and Harvard Medical School are excited to announce that we are now accepting applications for a position that will be divided half-time between the Brigham & Women's Hospital (Boston, USA) and Bayalpata Hospital (Achham, Nepal). This is an ideal position for an Internal Medicine or Medicine/Pediatrics-trained physician interested in launching a career in global health hospital medicine and medical education. While in Boston, the candidate will serve as an associate physician at Brigham & Women's Hospital -- a Harvard University teaching hospital. In Achham, the candidate will be responsible for programmatic development, medical education of Nepali clinical staff, quality improvement initiatives, and implementation research regarding best practices for healthcare in resource-poor settings.

Applications will be accepted from August 26th, 2013 on a rolling basis. The interview and hiring process will be finalized by October, 2013. Start date will be July, 2014, and minimum contractual agreements will be for one year (12 months); however, longer contractual agreements are preferred.

For more information about the position, please see attached, or: http://bit.ly/16vvWf9
For additional information about Nyaya Health and Bayalpata Hospital: http://www.nyayahealth.org
For additional information about the Brigham & Women's Hospital: http://www.brighamandwomens.org/

Interested applicants should send a cover letter and CV to hospitalist@nyayahealth.org

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Global Health Hospitalist Fellowship

Global Health Hospitalist Fellowship

Started by Vince DeGennaro on 13 Aug 2013

University of Florida Global Health-Hospitalist Fellowship

In July 2014, the University of Florida and Project Medishare will begin the Global Health-Hospitalist Fellowship. Project Medishare is a medical service delivery and public health non-profit organization. We are looking for internal or family medicine doctors interested in spending one or two years learning the skills for a career in global health and hospitalist medicine.

Clinical Work: The fellowship will be one or two years in duration, with the fellows spending six months of each year as Hospitalists in the growing and dynamic University of Florida Division of Hospital Medicine at UF Health. The other six months will be spent in Haiti with Project Medishare.

Education: Fellows will receive instruction through the Department of Epidemiology classes and complete a Global Health Certificate by the end of two years. During the optional second year, fellows will attend a two-month course for a Diploma in Tropical Medicine and Hygiene in either Peru or Uganda/Tanzania.

Research: Fellows will work on Project Medishare’s public health grants throughout the fellowship and are expected to present at a conference or publish by the end of the fellowship.

Teaching: The fellows will serve as faculty for residents and medical school students when they are in Haiti, and they will have teaching opportunities while at UF Health as well.

Benefits: Fellows will have Adjunct Clinical Post Doctorate appointments at the University of Florida and commensurate salary.

Requirements
--Internal Medicine or Family Medicine, Board-eligible or Board-certified
--Proficiency in French or Haitian Creole preferred
--Prior global health experience preferred
--Adaptable, flexible, and good communicator
--Strong clinical skills
--Willingness to live in Haiti six months of the year

If you’re interested, please send a CV, a brief personal statement, and a letter of recommendation to the email below. Acceptance is on a rolling basis and the deadline for applications is September 30, 2103.

Vincent DeGennaro, MD, MPH
Medical Director of Global Health-Hospitalist Fellowship, University of Florida
Vincent.DeGennaroJr@medicine.ufl.edu

From, ghdonline.org

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