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Knowledge of asthma guidelines poor among healthcare professionals

By Jeremy Cockerill | July 29, 2010

Source: MedWire News

More needs to be done to increase knowledge of asthma management guidelines among healthcare professionals in the UK, results from an online questionnaire suggest.

The British Thoracic Society and Scottish Intercollegiate Guideline Network (BTS/SIGN) guideline for the management of asthma has been updated regularly since its first publication in 2003, explain Hilary Pinnock (University of Edinburgh, UK) and team.

A summary of the BTS/SIGN guidelines was published on the UK General Practice Airways Group website in 2008, offering “an opportunity to test the knowledge of visitors… using a web-based questionnaire,” they add.

The questionnaire consisted of 11 questions, each reflecting a key point from one of the chapters of the guidelines. Visitors to the site were invited to complete the questions before reading the summary of the guidelines.

In total, 413 people completed the questionnaire, including 96 general practitioners (GPs), 237 primary care nurses, 38 secondary care nurses, and 42 “other” healthcare professionals.

Analysis of the results revealed that the average score was 5.2 out of a possible score of 11, with 24 respondents answering all the questions correctly and three returning no correct answers.

Of the medical professionals, secondary care nurses had the highest mean score, at 5.7, while GPs had the lowest mean score, at 4.6. Primary care nurses had a mean score of 5.5 and “other” medical professionals had a mean score of 4.7.

The difference in mean scores between primary care nurses and GPs was significant, but the difference in scores between primary and secondary care nurses was not significant, the researchers note in the Primary Care Respiratory Journal.

While acknowledging the limitations of an online questionnaire, Pinnock and team conclude: “On average, the respondents to our web-survey answered less than half the questions correctly, suggesting that despite two decades of asthma guideline publication and considerable time and resources devoted to dissemination there is still much to do to ensure that every healthcare professional is familiar with guideline recommendations.”

They add: “Compliance with guidelines is multifactorial, but improving healthcare professionals’ knowledge of asthma is an important prerequisite.”

Tea drinking could prevent coronary artery calcification

By Jeremy Cockerill | July 29, 2010

Source: MedWire News

Drinking tea may help prevent the development and progression of coronary artery calcification (CAC), researchers report.

However, they found no substantial association between coffee or caffeine intake and coronary and carotid atherosclerosis.

The findings come from the Coronary Artery Risk Development in Young Adults (CARDIA) study, which examined the determinants and development of cardiovascular disease over time in 5115 young adults from the USA who were aged 18 to 30 years in 1985 and 1986.

Clinical measurements, dietary information, computed tomography, carotid ultrasonography and questionnaire responses were collected at baseline and 2, 5, 7, 10, 15, and 20 years later.

Average consumption of coffee, decaffeinated coffee, or caffeine during the first 7 years of follow-up was not associated with CAC, defined by an Agatston score of more than 0 at year 15 or 20, after adjusting for multiple variables.

Similarly, it was not associated with the progression of CAC, identified as incident CAC at year 20, or an increase in CAC score of at least 20 Agatston units, or high carotid intima-media thickness, defined as being above the 80th percentile at year 20.

However, tea consumption showed a nonsignificant inverse association with CAC and a significant inverse association with CAC progression, albeit with no association for high carotid intima-media thickness.

Analyzing the coffee data by gender, race, or smoking status revealed similar nonsignificant patterns, report Jared Reis (National Heart, Lung, and blood Institute, Bethesda, Maryland, USA) and colleagues in the journal Arteriosclerosis, Thrombosis, and Vascular Biology.

They conclude: “Our findings suggest that tea consumption may prevent the development and progression of coronary calcification, whereas coffee and caffeine intake at the levels reported in the current study do not appear to be beneficial or harmful.”

High risk criteria validated for bipolar disorder

By Jeremy Cockerill | July 26, 2010

Source: MedWire News

Researchers have developed criteria to identify young people at high risk for developing bipolar disorder, based on detecting a combination of sub-threshold mania, depressive symptoms, cyclothymic features, and genetic risk.

In a sample of young people seeking help, those who met these new criteria were around 40-times more likely to develop full-blown bipolar disorder than those who did not.

“Intervening early in the course of bipolar affective disorder, in the prodromal phase, may reduce this personal and economic burden, as this strategy has the potential to delay, lessen the severity of, or even prevent full-blown disorder,” Andreas Bechdolf (ORYGEN Youth Health Melbourne, Victoria, Australia) and colleagues comment in the Journal of Affective Disorders.

The team previously pioneered ultra-high risk (UHR) criteria for psychosis, now relied upon by mental health teams for help-seeking individuals.

Noting that no such criteria have yet been proposed for bipolar disorder, the researchers devised a “bipolar at-risk” (BAR) tool which relied on surveillance of a combination of sub-threshold mania, depressive symptoms, cyclothymic features, and genetic risk in young people aged between 15 and 24 years.

To validate the BAR tool they recruited 173 young people who sought help at ORYGEN Youth Health (OYH), a public mental health program in Melbourne.

Of the cases assessed, 22 (12.7%) met the BAR criteria for at risk status. Patients in the BAR group were younger than those in the non-BAR group (16.6 versus 18.0 years), 65% were female, and most participants (62%) were students and still living with their families (79%).

After following all 173 participants for an average of 265.5 days, six (22.7%) individuals in the BAR group and one person (0.7%) in the non-BAR group converted to full bipolar disorder, defined in this case as hypomania/mania or initiation of treatment (psychopharmacological medication, admission).

Therefore, young people who met the BAR criteria were significantly more likely to develop a full disorder than those who did not, with an odds ratio of 44.

Discussing the findings the researchers note that the BAR-transition rate of 22.8% is “clinically relevant,” being around 100-fold higher than the risk in the general population and around 20 times the risk of patients with unipolar depression.

“Prospective studies in bigger samples and with longer follow-up periods, better controlled antidepressant use and psychometric measures of conversions are warranted to provide further validity of these criteria,” conclude Bechdolf et al.

Western diet linked with increased risk for metabolic syndrome

By Jeremy Cockerill | July 26, 2010

Source: MedWire News

The typical Western diet is associated with an increased risk for the metabolic syndrome compared with other major dietary patterns, a cross-sectional study has found.

Iranian researchers led by Maryam Zare (Isfahan University of Medical Sciences) hypothesized that major dietary patterns would be associated with the prevalence of components of the metabolic syndrome.

To investigate, they enrolled 425 adults aged 35-55 years and studied their diets using food-frequency questionnaires.

Writing in the journal Nutrition, Zare et al say they observed five major dietary patterns, which they labeled “Western,” “prudent,” “vegetarian,” “high-fat dairy,” and “chicken and plant.”

They then used multivariate analysis to look for associations between each dietary pattern and five components of the metabolic syndrome.

The Western diet - high in sweets, butter, soda, mayonnaise, sugar, cookies, lamb, hydrogenated fat, and eggs - was associated with an increased risk for elevated serum triglyceride levels (odds ratio [OR]=1.76) and elevated blood pressure (OR=2.62).

The prudent diet - high in fish, peas, honey, nuts, juice, dry fruits, vegetable oil, liver and organic meat, and coconuts, and low in hydrogenated fat and non-leafy vegetables - was associated with a reduced risk for low levels of high-density lipoprotein cholesterol (OR=0.55).

And finally, the vegetarian diet - high in potatoes, legumes, fruits rich in vitamin C, rice, green leafy vegetables, and fruits rich in vitamin A - was associated with an increased risk for high plasma glucose (OR=2.26).

The remaining two dietary patterns - high-fat dairy (high in high-fat yogurt and high-fat milk and low in low-fat yogurt, peas, and bread), and chicken and plant (high in chicken, fruits rich in vitamin A, green leafy vegetables, and mayonnaise and low in beef, liver, and organic meat) - were not associated with significantly increased or reduced risks for any component of the metabolic syndrome.

In a separate analysis, the team confirmed that the Western diet was associated with an increased risk for the metabolic syndrome (OR=2.32) and the prudent pattern with a reduced risk (OR=0.58), after adjusting for confounders.

“Our findings suggest that consumption of a Western dietary pattern promotes the risk of the metabolic syndrome,” the authors conclude.

“Factors can markedly influence dietary intakes, such as differences in culture, ethnicity, religion, availability of specific foods, and economic development, among others. Therefore, further studies are required to identify major dietary patterns across the country and search for their possible associations with chronic diseases.”

Obesity linked to reduced lung function in asthmatics

By Jeremy Cockerill | July 15, 2010

Source: MedWire News

Obese patients with asthma tend to have poorer lung function and more comorbidities than their normal-weight counterparts, research shows.

Previous studies have shown that overweight and obesity are associated with a significantly increased risk for asthma, and that there is a dose-response effect in the relationship, with increasing body mass index (BMI) associated with an increasing risk for the respiratory condition, explain Smita Pakhale (Ottawa Hospital, Ontario, Canada) and team.

To compare characteristics and severity of disease between obese and normal-weight people with asthma, and to investigate whether obesity increases the risk for asthma misdiagnosis, the researchers studied 496 patients, aged at least 16 years, with reported doctor-diagnosed asthma who were either obese, defined as a BMI of at least 30 kg/m2, or of normal weight, defined as a BMI of 18-25 kg/m2.

Extensive assessments confirmed asthma in 346 patients and ruled-out the condition in 150. Of the 346 patients with confirmed asthma, 165 were obese and 181 were of normal weight.

Analysis revealed that obese asthma patients (mean BMI=35.9 kg/m2) had a significantly lower mean pre- and post-bronchodilation percent of predicted FEV1 values than normal-weight patients (mean BMI=23.2 kg/m2), at 84.7% versus 88.0%, and 90.2% versus 94.3%, respectively.

Obese asthma patients were also significantly more likely to be male than normal-weight asthma patients, and to have a history of hypertension and gastroesophageal reflux disease, at adjusted odds ratios (aORs) of 2.24, 2.92, and 4.11, respectively.

The researchers also found that men, older individuals and those with a higher FEV1 were more likely to have been misdiagnosed with asthma than women, younger individuals, and those with a lower FEV1.

Obesity was not an independent risk factor for misdiagnosis, but obese individuals who had made urgent visits to a healthcare provider for respiratory symptoms in the past year were significantly more likely to be misdiagnosed than normal-weight individuals who had made urgent visits during the past year, at an aOR of 4.08.

Pakhale and team conclude in the journal Chest: “Obese people with asthma have lower lung function and more comorbidities compared with normal-weight people with asthma.”

They add: “Healthcare providers need to order appropriate objective lung function testing in order to avoid falsely labeling patients who are both obese and nonobese as having asthma.”