Differences in parental- and self-report of asthma, rhinitis and eczema among Italian adolescents. SIDRIA collaborative group. Studi Italiani sui Disordini Respiratori dell' Infanzia e l'Ambiente.
(9/967)
Epidemiological and clinical information on respiratory and allergic disorders in adolescents has been collected from the adolescents themselves or from their parents, but little is known about the differences between these two sources of information. This study compared the responses to 10 identically worded questions from the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire on asthma, rhinitis and eczema between written self- and parent-completed questionnaires in a large sample of 21,068 adolescent Italians aged 13-14 yrs. The effects of sex, latitude of residence, urbanization, socioeconomic status, previous diagnosis of asthma, family history of allergic diseases and adolescent's smoking habits on the prevalence estimates obtained with the two questionnaires were analysed using multiple logistic regression. Prevalence of self-reported symptoms was significantly higher in self-reported for all questions except for lifetime eczema, which was higher in parental report. Agreement between the two sources of information was poor, although it was slightly better for questions relative to clinical diagnosis of asthma, hay fever or eczema than for related symptoms, and for respiratory with respect to cutaneous disorders. When compared with self-reported, parent-reported was consistently higher in males and was more affected by socioeconomic level and by a diagnosis of asthma or family history of allergic diseases, whereas self-reported was more sensitive to the effect of the adolescent's smoking habits. It is concluded that, in adolescents, parent- and self-reported respiratory and allergic symptoms differ significantly and are differently affected by several constitutional and environmental factors. Obtaining direct information from adolescents may be essential for a correct evaluation of respiratory symptoms. (+info)
The validity of self-reported diabetes quality of care measures.
(10/967)
OBJECTIVE: First, to test the validity of self-reported quality of care and treatment measures compared with medical records and administrative data for: eye examinations, hemoglobin A1C tests, and use of insulin and oral agents for adult patients with diabetes; and secondly to assess the consistency between medical record information and administrative data for the same measures plus microalbumin testing. DESIGN: Cross-sectional study using data from telephone survey, primary care medical and eye records, and administrative claims. SETTING: Statewide health maintenance organization in Minnesota, USA, 1995. STUDY PARTICIPANTS: Four hundred and forty adults with diabetes, aged 31-64 years. MAIN OUTCOME MEASURES: Validity++ of self-reported diabetes quality of care measures compared with a criterion standard combining information from primary care and eye records with information from administrative data; and reliability of medical record information compared with administrative data. RESULTS: Although the sensitivity of self-reported eye examination was high (89%), the specificity was low (65%). Self-report of hemoglobin A1C also had high sensitivity (99%) and a lower specificity than that of eye examination (28%). The two information sources (medical records and claims) used in the criterion standard each contained complementary and non-overlapping information. Reliability was highest for microalbumin testing (kappa, 0.75) and lowest for eye examination (kappa, 0.37). CONCLUSIONS: Quality of care measures for diabetes are often drawn from a variety of sources. To the extent that data sources are biased, the measures can be misleading. Self-report is likely to lead to an overestimate of eye screening and the measurement of hemoglobin A1C. Reported rates of quality of care should be inspected carefully. The 'same' rate taken from different sources may vary. (+info)
Can peak expiratory flow measurements reliably identify the presence of airway obstruction and bronchodilator response as assessed by FEV(1) in primary care patients presenting with a persistent cough?
(11/967)
BACKGROUND: In general practice airway obstruction and the bronchodilator response are usually assessed using peak expiratory flow (PEF) measurements. A study was carried out in patients presenting with persistent cough to investigate to what extent PEF measurements are reliable when compared with tests using forced expiratory volume in one second (FEV(1)) as the measure of response. METHODS: Data (questionnaire, physical examination, spirometry, PEF) were collected from 240 patients aged 18-75 years, not previously diagnosed with asthma or chronic obstructive pulmonary disease (COPD), who consulted their general practitioner with cough of at least two weeks duration. The relationship between low PEF (PEF < PEFpred - 1.64RSD) and low FEV(1) (FEV(1) < FEV(1)pred - 1.64RSD) was tested. A positive bronchodilator response after inhaling 400 microg salbutamol was defined as an increase in FEV(1) of > or = 9% predicted and was compared with an absolute increase in PEF with cut off values of 40, 60, and 80 l/min and DeltaPEF % baseline with cut off values of 10%, 15%, and 20%. RESULTS: Forty eight patients (20%) had low FEV(1), 86 (35.8%) had low PEF, and 32 (13.3%) had a positive bronchodilator response. Low PEF had a positive predictive value (PPV) for low FEV(1) of 46.5% and a negative predictive value (NPV) of 95%. DeltaPEF of > or = 10%, > or = 15%, or > or = 20% baseline had PPVs of 36%, 52%, and 67%, respectively, and DeltaPEF of > or = 40, > or = 60, and > or = 80 l/min in absolute terms had PPVs of 39%, 45%, and 57%, respectively, for DeltaFEV(1) > or = 9% predicted; NPVs were high (88-93%). CONCLUSIONS: Although PEF measurements can reliably exclude airway obstruction and bronchodilator response, they are not suitable for use in the assessment of the bronchodilator response in the diagnostic work up of primary care patients with persistent cough. The clinical value of PEF measurements in the diagnosis of reversible obstructive airway disease should therefore be re-evaluated. (+info)
Respiratory symptoms in older people and use of domestic gas appliances.
(12/967)
BACKGROUND: Studies in children and young women have indicated an increased risk of respiratory illness in association with the use of domestic gas appliances, possibly caused by oxides of nitrogen generated when gas is burned. It is not known whether risks are similarly increased in older subjects. METHODS: A questionnaire about respiratory symptoms in the past year and potential risk factors for respiratory disease was mailed to 6000 men and women aged 65 years and older who were selected at random from the lists of general practices in North Bristol, UK. Associations between symptoms and the use of gas appliances were examined by logistic regression with adjustment for age, sex, social class, and smoking habits. RESULTS: Questionnaires were completed by 4792 (80%) of those mailed. The most common symptoms were exercise induced breathlessness, wheeze, or chest tightness (51%); wheeze (27%); morning phlegm (20%); and daytime breathlessness at rest (19%). In an analysis that included all subjects only weak associations were found with use of gas appliances, odds ratios all being 1.2 or less. The risks associated with use of a gas hob tended to be higher in women, with odds ratios of 1.36 (95% CI 1.01 to 1.83) for wheeze and 1.33 (95% CI 0.56 to 3.17) for morning chest tightness, but were lower than had been reported previously in younger women. CONCLUSION: The absence of stronger associations cannot readily be explained by bias or confounding. Gas cookers and fires are unlikely to be an important cause of respiratory illness in the elderly. If they do cause such illness, the largest risks are likely to be in women who use gas hobs. (+info)
Generational increase of self-reported first attack of asthma in fifteen industrialized countries. European Community Respiratory Health Study (ECRHS).
(13/967)
The prevalence of asthma has increased worldwide. However, there is only local evidence for changes in incidence. Data from the European Community Respiratory Heath Survey (ECRHS) can be analysed to reconstruct trends in incidence from 1946-1991 in cohorts born between 1946-1971 in 35 areas corresponding to 15 countries. The authors report the time trends in self-reported first occurrence of asthma and its geographical distribution. All centres completed the same cross-sectional study in 1991-92. A total of 17,613 individuals (63% of those randomly selected) were included. Recall of age of first asthma attack was recorded at an interview at one point in time in subjects aged 20-44 yrs. Relative risk of asthma by cohort was estimated using survival methods with age as the time scale. Yearly incidence of asthma increased progressively by birth cohort. The relative risks were 1.12 (0.94-1.34), 1.39 (1.17-1.66), 2.01 (1.60-2.51), and 2.33 (1.81-2.98) for the cohorts born in the years 1951-55, 1956-60, 1961-65, and 1966-71, respectively, in comparison with the cohort born in the years 1946-50. The increase occurred concurrently in most of the countries, in both males and females, and both in childhood and adulthood onset asthma. These results are consistent with a generational increase in asthma incidence during the previous decades (explained by both a period and/or a cohort effect), although some of the findings could be explained by generational increases in asthma diagnosis. (+info)
Self reported health of people in an area contaminated by chromium waste: interview study.
(14/967)
OBJECTIVES: To compare the self reported health of a group of individuals living in an area contaminated by chromium (chromium group) with a group living in an uncontaminated area (control group), and to assess the effects of perception of risk from exposure to chromium on health. DESIGN: Cross sectional study using the SF-36 validated quality of life questionnaire. Further questions were added to examine the relations between perceptions about living on or near land contaminated with chromium and the effects on self reported health. SETTING: An area contaminated with chromium (Cambuslang, Carmyle, and Rutherglen) and a control area (Barrmulloch and Pollok). PARTICIPANTS: Residents of an area containing chromium landfill and residents of an uncontaminated control area. MAIN OUTCOME MEASURES: Scores on SF-36. RESULTS: Little difference was found in health scores between the two groups, and only for general health was there a significantly higher score in the chromium group. Health scores for the chromium group were significantly worse across all dimensions for those who believed that chromium adversely affected health. Most of the chromium group (68%) would prefer money to be spent on improving amenities rather than on chromium remediation. CONCLUSIONS: Similar self reported health among residents of the chromium and control groups indicates that there is no evidence of harm to health from exposure to chromium in this setting. Noticeably lower scores in participants who believed chromium to be harmful to health point to the potential importance of perception and possible anxiety. Given the overall greater desire for better amenities rather than remedial action, policy makers and planners should discuss with residents how best to spend resources before instigating expensive cleaning up programmes. (+info)
Cross sectional study of reporting of epileptic seizures to general practitioners.
(15/967)
OBJECTIVE: Comparison of reporting of recent epileptic seizures by patients to a doctor and anonymously. DESIGN: Cross sectional study of patients with epilepsy by comparison of paired questionnaires. SETTING: Rural and urban general practices in Norfolk. PARTICIPANTS: 122 patients aged over 16 years and able to self complete a questionnaire who were recruited by 31 general practitioners when attending for review of their epilepsy. MAIN OUTCOME MEASURE: The difference in reported occurrence of seizure to general practitioners and in a linked anonymous questionnaire. RESULTS: 18 patients failed to report a seizure in the past year to their general practitioner (uncontrolled epilepsy). 40% (24/60) of people with epilepsy who anonymously reported a seizure in the past year held a driving licence, but only six revealed this to their general practitioner. The unemployment rate was 34%, substantially higher than the 9% in the general population. Measures of anxiety, depression, and stigmatization were higher in patients with uncontrolled epilepsy. CONCLUSIONS: A significant proportion of patients with epilepsy under-report their seizures. Recognition of underreporting is important if patients are to benefit from adequate and appropriate treatment. General practitioners' ability to treat epilepsy is hampered by their role in regulating the rights of epileptic patients to hold a driving licence or access certain occupations. (+info)
Diet, lung function, and lung function decline in a cohort of 2512 middle aged men.
(16/967)
BACKGROUND: A prospective cohort study of 2512 Welshmen aged 45-59 living in Caerphilly in 1979-1983 was used to investigate associations between diet and lung function. METHODS: At baseline (phase I) and at five year follow up (phase II), forced expiratory volume in one second (FEV(1)) was measured using a McDermott spirometer and dietary data were obtained using a semi-quantitative food frequency questionnaire. RESULTS: Good lung function, indicated by high maximum FEV(1) given age and height, was associated with high intakes of vitamin C, vitamin E, beta-carotene, citrus fruit, apples, and the frequent consumption of fruit juices/squashes. Lung function was inversely associated with magnesium intake but there was no evidence of an association with fatty fish. Following adjustment for confounders including body mass index, smoking history, social class, exercise, and total energy intake, only the associations with vitamin E and apples persisted, with lung function estimated to be 39 ml (95% confidence interval (CI) 9 to 69) higher for vitamin E intakes one standard deviation (SD) apart and 138 ml higher (95% CI 58 to 218) for those eating five or more apples per week compared with non-consumers. Decline in lung function between phases was not significantly associated with the changing intakes of apples or vitamin E. An association between high average apple consumption and slow decline in lung function lost significance after adjustment for confounders. CONCLUSIONS: A strong positive association is seen between lung function and the number of apples eaten per week cross sectionally, consistent with a protective effect of hard fruit rather than soft/citrus fruit. The recent suggestion that such effects are reversible was not supported by our longitudinal analysis. (+info)