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Background
Asthma education, a key component of long-term asthma management, is challenging in resource-limited settings with shortages of clinical staff. Task-shifting educational roles to lay (non-clinical) staff is a potential solution. We conducted a randomised controlled trial of an enhanced a
...
sthma care intervention for children in Malawi, which included reallocation of asthma education tasks to lay-educators. In this qualitative sub-study, we explored the experiences of asthmatic children, their families and lay-educators, to assess the acceptability, facilitators and barriers, and perceived value of the task-shifting asthma education intervention.
Methods
We conducted six focus group discussions, including 15 children and 28 carers, and individual interviews with four lay-educators and a senior nurse. Translated transcripts were coded independently by three researchers and key themes identified.
Results
Prior to the intervention, participants reported challenges in asthma care including the busy and sometimes hostile clinical environment, lack of access to information and the erratic supply of medication. The education sessions were well received: participants reported greater understanding of asthma and their treatment and confidence to manage symptoms. The lay-educators appreciated pre-intervention training, written guidelines, and access to clinical support. Low education levels among carers presented challenges, requiring an open, non-critical and individualised approach.
Discussion
Asthma education can be successfully delivered by lay-educators with adequate training, supervision and support, with benefits to the patients, their families and the community. Wider implementation could help address human resource shortages and support progress towards Universal Health Coverage.
more
2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group
Cloutier, M. M.; Baptist, A.P.; Teach, S.J.; et al.
The Journal of Allergy and Clinical Immunology
(2020)
CC2
The2020 Focused Updates to the Asthma Management Guidelines: A Report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group was coordinated and supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Healt
...
h. It is designed to improve patient care and support informed decision making about asthma management in the clinical setting. This update addresses six priority topic areas as determined by the state of the science at the time of a needs assessment, and input from multiple stakeholders:
• Fractional Exhaled Nitric Oxide Testing
• Indoor Allergen Mitigation
• Intermittent Inhaled Corticosteroids
• Long-Acting Muscarinic Antagonists
• Immunotherapy in the Treatment of Allergic Asthma
• Bronchial Thermoplasty
more
Asthma is the commonest chronic respiratory tract disease in children. In low-income countries, challenges exist in asthma diagnosis. In surveys done in children, the prevalence of ‘asthma’ defined by symptoms is high compared to ‘doctor diagnosed asthma’. The questions answered by this revi
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ew are What challenges have been experienced in the diagnosis of asthma in children? What solutions will address these challenges?
more
Outcome of illustrated information leaflet on correct usage of asthma-metered dose inhaler
Wrench, W.; van Dyk, L.; Sirinivas, S.; Dowse, R.
African Journal of Primary Health Care & Family Medicine
(2019)
CC2
Research globally has shown that metered dose inhaler (MDI) technique is poor, with patient education and regular demonstration critical in maintaining correct use of inhalers. Patient information containing pictorial aids improves understanding of medicine usage; however, manufacturer leaflets illu
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strating MDI use may not be easily understood by low-literacy asthma patients.
more
The global burden of asthma: executive summary of the GINA Dissemination Committee report
Masoli, M.; Fabian, D.; Holt, S.; Beasley, R.
European Journal of allergy and clinical immunology: Volume59, Issue5 May 2004 Pages 469-478
(2004)
CC2
It is estimated that as many as 300 million people of all ages, and all ethnic backgrounds, suffer from asthma and the burden of this disease to governments, health care systems, families, and patients is increasing worldwide. In 1989 the Global Initiative for Asthma (GINA) program was initiated in
...
an effort to raise awareness among public health and government officials, health care workers, and the general public that asthma was on the increase. The GINA program recommends a management program based on the best available scientific evidence to provide effective medical care for asthma tailored to local health care systems and resources.
more
The European Respiratory Society (ERS)/American Thoracic Society (ATS) Task Force on severe asthma includes an updated definition of severe asthma, a discussion of severe asthma phenotypes in relation to genetics, natural history, pathobiology and physiology, as well as sections on evaluation and tr
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eatment of severe asthma where specific recommendations for practice are made. See the unabridged online version of the document for detailed discussion of the definition of severe asthma, phenotypes and recommendations for practice.
more
Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children. A task force supported by the European Respiratory Society has developed these evidence
...
-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
more
Although asthma is very common, affecting 5–10% of the population, the diagnosis of asthma in adults remains a challenge in the real world, which results in both over- and under-diagnosis. A taskforce was set up by the European Respiratory Society to systematically review the literature on the dia
...
gnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendations for clinical practice.
more
Asthma prevalence is increasing worldwide and surveys indicate that the majority of patients in developed and developing countries do not receive optimal care and are therefore not well controlled. The aim of these guidelines is to promote a better standard of treatment based on advances in the unde
...
rstanding of the pathophysiology and pharmacotherapy of asthma and to encourage uniformity in the management of asthma.
more
Research globally has shown that metered dose inhaler (MDI) technique is poor,
with patient education and regular demonstration critical in maintaining correct use of
inhalers. Patient information containing pictorial aids improves understanding of medicine
usage; however, manufacturer leaflets i
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llustrating MDI use may not be easily understood by
low-literacy asthma patients.
more
Aerosol pollutants are known to raise the risk of development of non-communicable respiratory diseases (NCRDs) such as asthma, chronic bronchitis, chronic obstructive pulmonary disease, and allergic rhinitis. Sub-Saharan Africa’s rapid pace of urb
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anization, economic expansion, and population growth raise concerns of increasing incidence of NCRDs. This research characterizes the state of research on pollution and NCRDs in the 46 countries of Sub-Saharan Africa (SSA). This research systematically reviewed the literature on studies of asthma; chronic bronchitis; allergic rhinitis; and air pollutants such as particulate matter, ozone, NOx, and sulfuric oxide.
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Silica-associated lung disease: An old-world exposure in modern industries
Barnes, H.; Goh, N. S. L.; Leong, T. L.; Hoy, R.
Official Journal of the Asian Pacific Society of Respirology
(2019)
CC2
Silicosis is not a new disease; the impact of silica dust on respiratory function was observed by Hippocrates in 430 B.C. and in the 16th century by Agricol. In 1713, Rammazini described silicotic nodules in post-mortems of stone cutters presenting with respiratory symptoms. In the mid-late 1800s,
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the introduction of mechanized tools in the mining sector rapidly increased levels of silica exposure, resulting in an increase in cases and our understanding of silicosis.
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Стратегия народосбережения в Российской Федерации — один из основных документов государственной социальной политики. Она может быть реализована различными путя
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ми, в частности увеличением продолжительности жизни представителей старшего поколения. Анализ концепций старения и гендерных особенностей процесса старения, дискурс-анализ практики формирования социального и психического здоровья женщин старшего поколения позволили выделить типологию основных социальных проблем этой возрастной группы.
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Globally, there is increased advocacy for community-based health insurance (CBHI) schemes. Like other low and middle-income countries (LMICs), Tanzania officially established the Community Health Fund (CHF) in 2001 for rural areas; and Tiba Kwa Kadi (TIKA) for urban population since 2009. This study
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investigated the implementation of TIKA scheme in urban districts of Tanzania.
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Case Formulation in Young People with Post-Traumatic Stress Disorder and First-Episode Psychosis
Halpin, E., Kugathasan, V., Hulbert, C., Alvarez-Jimenez, M. & Bendall, S
Journal of Clinical Medicine
(2016)
CC
Background: Evidence based treatment interventions for young people with first-episode psychosis (FEP) and trauma histories is lacking. Although case formulation (CF) has been widely regarded in cognitive behavioural therapy manuals as beneficial, there is limited empirical research examining how cl
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ients and therapists experience the process. Aim: This study aimed to explore young people’s reactions to CF in treatment for PTSD (post-traumatic stress disorder) and FEP
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Other disorders
Chapter H.3
Otros trastornos
Capítulo H.3
Edición 2018
Edición: Matías Irarrázaval & Andres Martin
Traducción: Beatriz Ortega & Macarena Espinoza
New Drugs for Human African Trypanosomiasis: A Twenty First Century Success Story
Dickie, E.A.; Giordani, F.; Gould, M.K.; Mäser, P.; Burri, C.; Mottram, J.C.; Rao, S.P.S.; Barrett, M.P.
MDPI Tropical Medicine and Infectious Disease
(2020)
CC2
The twentieth century ended with human African trypanosomiasis (HAT) epidemics raging across many parts of Africa. Resistance to existing drugs was emerging, and many programs aiming to contain the disease had ground to a halt, given previous success against HAT and the competing priorities associat
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ed with other medical crises ravaging the continent. A series of dedicated interventions and the introduction of innovative routes to develop drugs, involving Product Development Partnerships, has led to a dramatic turnaround in the fight against HAT caused by Trypanosoma brucei gambiense. The World Health Organization have been able to optimize the use of existing tools to monitor and intervene in the disease. A promising new oral medication for stage 1 HAT, pafuramidine maleate, ultimately failed due to unforeseen toxicity issues. However, the clinical trials for this compound demonstrated the possibility of conducting such trials in the resource-poor settings of rural Africa.
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The prevalence of asthma and allergic rhinoconjunctivitis is high in western countries, and has been rising throughout the late 20th century. However, relatively little is known about the prevalence of allergic disorders in children in North Africa and the Middle East, and even less is known about t
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he relative importance of socioeconomic factors in its aetiology in these countries, when compared to Europe, the USA and Australia.
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