The efficacy of a mobile phone application to improve adherence to treatment and self-management in people with chronic respiratory disease in Romanian population - a pilot study.

BACKGROUND: Many studies assessed the effect of mobile phone applications on self-management outcomes in patients with asthma, but all of them presented variable results. In this paper. we examined the effect of a mobile phone application on self-management and disease control in Romanian population. METHODS: This study included 93 patients diagnosed with asthma that were recalled every three months for a year for assessment and treatment. Patients were divided into two groups. The first group included patients that received treatment, and the second group received treatment and also used the smartphone application. Number of exacerbations and asthma control test (ACT) were recorded. RESULTS: The ACT score was significantly higher for asthma patients using also the mobile application than for the patients using the treatment alone, for all the evaluation moments (Mann-Whitney U test, p <  0.001). Also, we found significant differences between the ACT score with-in each group, observing a significant improvement of the score between evaluations and baseline (related-samples Friedman's test with Bonferroni correction, p <  0.001). When considering the exacerbations rate, significantly less patients using the application presented exacerbations, 10.30% vs. 46.30% (Pearson Chi-square test, X2 (1) = 13.707, p <  0.001). CONCLUSION: Our study indicates that smartphone applications are an effective way to improve asthma control and self-management when used continually in our population. We found significant positive effects in disease control and exacerbation frequency.

Inhaler technique errors in Romanian patients with asthma - a multicenter study.

BACKGROUND: Non-adherence to treatment is associated with poor asthma control, increased exacerbations, decline in lung function, and decreased quality of life. M-health applications have become increasingly in the last years, but little research regarding the efficiency of the instructional videos for correct inhaler use exist. The aim of this study is to assess and improve the inhalator technique and to establish which types of errors were made more often with the help of a mobile health application. MATERIALS AND METHODS: Seventy-five patients with partially controlled or uncontrolled asthma, using any of turbuhaler, diskus, pressurized metered dose inhaler (pMDI) or soft mist inhaler (SMI), were included in the study. When they first entered the study, the patient's inhaler technique was assessed by a trained medical professional and the technique errors were categorized in handling, respectively inhalation errors. After the first evaluation, the patients downloaded an application on their Smartphone and were encouraged to use the application as much as needed to remind them the correct inhalation technique. The patients were re-called every three months for evaluation, treatment, and assessment of inhalation technique. RESULTS: We analyzed both handling and inhalation errors for each of the four considered inhalers. We observed a significantly reduced number of inhalation technique errors after using the mobile phone application. Turbuhaler median errors were 6.00, and after six months we did not observe errors. Diskus median error was 6.00, and after six months we observed a maximum of one error. pMDI median errors were 7.00, and after six months we observed just one error. Similarly, SMI median error was 7.00, and after six months we observed just one error. CONCLUSION: Although technique inhalation errors are very common among asthma patients, video instructions provided through specific mobile phone applications could improve the inhaler technique in order to achieve a better control of the disease.

Bone Marrow Myeloid Cells Regulate Myeloid-Biased Hematopoietic Stem Cells via a Histamine-Dependent Feedback Loop.

Myeloid-biased hematopoietic stem cells (MB-HSCs) play critical roles in recovery from injury, but little is known about how they are regulated within the bone marrow niche. Here we describe an auto-/paracrine physiologic circuit that controls quiescence of MB-HSCs and hematopoietic progenitors marked by histidine decarboxylase (Hdc). Committed Hdc+ myeloid cells lie in close anatomical proximity to MB-HSCs and produce histamine, which activates the H2 receptor on MB-HSCs to promote their quiescence and self-renewal. Depleting histamine-producing cells enforces cell cycle entry, induces loss of serial transplant capacity, and sensitizes animals to chemotherapeutic injury. Increasing demand for myeloid cells via lipopolysaccharide (LPS) treatment specifically recruits MB-HSCs and progenitors into the cell cycle; cycling MB-HSCs fail to revert into quiescence in the absence of histamine feedback, leading to their depletion, while an H2 agonist protects MB-HSCs from depletion after sepsis. Thus, histamine couples lineage-specific physiological demands to intrinsically primed MB-HSCs to enforce homeostasis.

[Analysis of premature deaths in the Iasi district]. / Analiza deceselor premature din judetul Iasi.

UNLABELLED: Potential years of life lost (PYLL) represent an indicator of premature or untimely death and take into account the age at which deaths occur by giving greater weight to deaths at younger age and lower weight to death at older age. AIM: This study represents a descriptive analysis of PYLL in district of Iasi compared to country-wide level, during 2006 year. MATERIAL AND METHOD: Premature deaths have been assessed using following indicators: PYLL per 1000 population (male, female, total); male : female PYLL ratio; average PYLL per a premature death; average PYLL per death. Confidence interval CI95 has been used for an accurate comparison district of Iasi - Romania. RESULTS: The recorded number of PYLL was 67.65 per 1000 population at national level and 54.02 per 1000 population in district of Iasi (CI95 = 67.55-67.75). The average number of PYLL per a premature death was 18.21 in Iasi compared to 20.71 for Romania (CI95 = 19.75-21.66), whereas the average number of PYLL per death was 5.6 for both levels. The values of PYLL by gender pointed out 74.59 per 1000 male population and 33.99 per 1000 female population in district of Iasi. CONCLUSION: The analysis of the premature deaths in Iasi revealed a lower loss of potential life years compared to values reported at national level. PYLL were twice more frequent among male than women. The favourable findings in Iasi may be related to a decrease of infant mortality rate, with a significant contribution to PYLL values in this district.