Budesonide but not nedocromil sodium reduces exhaled nitric oxide levels in asthmatic children.

Exhaled nitric oxide (ENO) has been proposed as a marker of airway inflammation in asthma and could be useful to evaluate the response to anti-inflammatory treatment. We investigated the effect of budesonide and nedocromil sodium on ENO levels and lung function in asthmatic children. Twenty stable steroid-naïve asthmatic children were randomized in a single blind, cross-over study to receive inhaled budesonide (group A) or nedocromil sodium (group B) for 6 weeks. ENO was measured with a chemiluminescence analyser at baseline and at the end of each treatment period. Repeated-measures ANOVA was carried out. In asthmatic baseline ENO levels [mean 32.5 ppb, 95% confidence interval (CI) 26.4 to 38.7] were significantly higher compared to reference values (8.7 ppb, 95% CI 8.1 to 9.2, P<0.001). There were no treatment-order effect, no carry-over effect and in both groups the response pattern was the same: budesonide significantly lowered ENO levels from 41.0 ppb to 22.8 ppb in group A (mean, P<0.01) and from 22.6 ppb to 13.0 ppb in group B, (mean, P<0.05), while nedocromil did not reduce ENO values (from 24.4 ppb to 22.6 ppb in group B and from 22.8 ppb to 38.0 ppb in group A, mean, P = NS and P<0.01 respectively). After budesonide treatment ENO values of asthmatics were still significantly higher than in healthy children The baseline values of FEV1 and FEF(25-75) were normal in both groups and no significant changes were observed during the study. In conclusion, our study shows that budesonide, but not nedocromil sodium, significantly reduces ENO levels in stable asthmatic children even in absence of changes in the lung function.

Smoking and financial stress.

AIM: Stress relief is commonly provided as a reason for smoking. However, it is plausible that the cost of smoking may create financial stress, particularly among the poor. The aim of the study was to examine the relationship between smoking and financial stress. DESIGN: Cross sectional survey of households from private dwellings conducted by the Australian Bureau of Statistics (ABS), using a stratified multistage area sample design. SETTING: Australia, 1998-99. PARTICIPANTS: Nationally representative sample of households (n = 6892). MAIN OUTCOME MEASURES: The outcome measures of objective financial stress were two dichotomous variables indicating whether the household had experienced any financial stress or severe financial stress in the past 12 months. RESULTS: The odds of experiencing any financial stress were 1.5 (95% confidence interval (CI) 1.3 to 1.7) times greater, and the odds of severe financial stress were twice (95% CI 1.6 to 2.5) as large for smoking households than non-smoking households. The effect of smoking on financial stress did not vary significantly across categories of income. Among smoking households, higher percentage of total household expenditure on tobacco was significantly related to financial stress. CONCLUSIONS: Given data were cross sectional, firm conclusions cannot be drawn about the causal relationship between smoking and financial stress. It is likely that they both affect each other. Undoubtedly, expenditure on tobacco will reduce available funds that could otherwise be used to ameliorate financial stress.

Is household smoking status associated with expenditure on food at restaurants, alcohol, gambling and insurance? Results from the 1998-99 Household Expenditure Survey, Australia.

AIM: To examine how household expenditure on food at restaurants, alcohol, gambling and insurance vary between smoking and non-smoking households. DESIGN: Cross sectional survey of households from private dwellings, conducted by the Australian Bureau of Statistics (ABS), using a stratified multistage area sample design. SETTING: Australia, 1998-99. PARTICIPANTS: Nationally representative sample of households (n = 6892). MAIN OUTCOME MEASURES: Expenditure on meals at restaurants, alcohol, alcoholic beverages at licensed premises, gambling, and insurance. RESULTS: The odds of reporting expenditure on restaurant food and health insurance were 20% and 40% smaller for smoking than non-smoking households, respectively. The odds of reporting expenditure on alcohol (not including expenditure at licensed premises), drinking at licensed premises, and gambling were 100%, 50%, and 40% greater for smoking than for non-smoking households, respectively. CONCLUSIONS: The study suggests that smokers are more likely to engage in risky behaviour. Implementing smoking bans in licensed premises and gambling venues can provide an opportunity to reduce smoking prevalence. Quitting or cutting down smoking can provide opportunities for expenditure on other products or services, and enhance standards of living.

Review of the quality of studies on the economic effects of smoke-free policies on the hospitality industry.

OBJECTIVE: To compare the quality and funding source of studies concluding a negative economic impact of smoke-free policies in the hospitality industry to studies concluding no such negative impact. DATA SOURCES: Researchers sought all studies produced before 31 August 2002. Articles published in scientific journals were located with Medline, Science Citation Index, Social Sciences Citation Index, Current Contents, PsychInfo, Econlit, and Healthstar. Unpublished studies were located from tobacco company websites and through internet searches. STUDY SELECTION: 97 studies that made statements about economic impact were included. 93% of the studies located met the selection criteria as determined by consensus between multiple reviewers. DATA EXTRACTION: Findings and characteristics of studies (apart from funding source) were classified independently by two researchers. A third assessor blind to both the objective of the present study and to funding source also classified each study. DATA SYNTHESIS: In studies concluding a negative impact, the odds of using a subjective outcome measure was 4.0 times (95% confidence interval (CI) 1.4 to 9.6; p = 0.007) and the odds of not being peer reviewed was 20 times (95% CI 2.6 to 166.7; p = 0.004) that of studies concluding no such negative impact. All of the studies concluding a negative impact were supported by the tobacco industry. 94% of the tobacco industry supported studies concluded a negative economic impact compared to none of the non-industry supported studies. CONCLUSION: All of the best designed studies report no impact or a positive impact of smoke-free restaurant and bar laws on sales or employment. Policymakers can act to protect workers and patrons from the toxins in secondhand smoke confident in rejecting industry claims that there will be an adverse economic impact.

Impact of tobacco tax reforms on tobacco prices and tobacco use in Australia.

OBJECTIVE: To document the impact of changes to tobacco taxes on the range and price of tobacco sold during the period when the National Tobacco Campaign (NTC) was run. DATA SOURCES: Information about brand availability, pack size, and price was extracted from Australian Retail Tobacconist. A retail observational survey was undertaken to monitor actual retail prices. Data on cigarette prices, brands, packet configurations, and outlets from which they were purchased were obtained from the benchmark and three follow up population telephone surveys conducted to evaluate the NTC. METHOD: Data from the three sources were compared to see the extent to which the impact of tax changes had been offset by greater retail discounting and a more concerted effort by consumers to purchase cheaper products. RESULTS: Smokers were unable to cushion themselves from the sharp price increases that occurred during the third phase of the NTC. Both average recommended retail prices of manufactured cigarettes and average actual cigarette prices paid by smokers increased by 25% in real prices. CONCLUSION: The fall in smoking prevalence over the first two phases of the NTC was substantially greater than would be expected due to tax changes alone. The fall in smoking consumption over the first two phases was slightly less than would be expected and in the third considerably higher than would be expected.

[Assisted labor among non European community pregnant women at the Gynecology and Obstetrics Clinic of the Verona University]. / L'assistenza al parto per le gestanti extracomunitarie presso la Clinica Ginecologica e Ostetrica dell'Università di Verona (1992-1998).

BACKGROUND: The aim of this paper is to evaluate the role and the prevalence of the non-European Community pregnant women in our Institute during the period 1992-1998. The peculiarity of the female immigration in the world and particularly in Italy is stressed from the point of view of the different cultural, ethnic and religious problems of these women. METHODS: During the observed period 8972 women delivered; 434 of them came from non-European Community countries and their individual (age, country) and obstetric (parity, physiological or pathological evaluation of pregnancy, mode of delivery) data were observed. On the basis of the different countries of provenance these women have been subdivided into five groups (East Europe, North Africa and Middle East, Central Africa, Far East and Latin America). RESULTS: The percentages of preterm births (24.2% vs 23.1%), of < or = 1500 g newborns (6.9% vs 5.3%) and of caesarean sections (34.3% vs 27.7%) are higher in the non-European Community women that delivered in our Institute. In 222 (51.1%) cases the women delivered without induction of labour; while in 14.5% of cases it was induced. The length of labour and the genital conditions (episiotomy, tearing) were considered in all ethnic groups of women. CONCLUSIONS: On the basis of the literature and of the analysis of our data, some suggestions about the management of labour and delivery of non-European Community women in Italy are proposed. In particular, the problems of linguistic communication and of the hospital staff preparation in the assistance to labour and delivery are stressed.

Randomised trial of three approaches for marketing smoking cessation programmes to Australian general practitioners.

OBJECTIVE: To compare three approaches for marketing a quit smoking intervention kit to general practitioners. DESIGN: Randomised trial of (a) personal delivery and presentation by an educational facilitator with a follow up visit six weeks later; (b) delivery to the receptionist by a friendly volunteer courier with a follow up phone call six weeks later, or (c) postal delivery with a follow up letter six weeks later. SETTING: Melbourne, Australia. SUBJECTS: 264 randomly selected general practitioners. DATA COLLECTION: A research assistant visited each doctor four months after delivery and measured use of components of the kit. A questionnaire measuring perceptions of aspects of the kit and its delivery was completed by doctors. Costs of each approach were calculated. RESULTS: Doctors receiving the educational facilitator approach were significantly more likely than those receiving the other two approaches to have seen the kit, to rate the method of delivery as engendering motivation to try the kit, to have used one of the "intensive intervention" components from the kit, to report that they found the kit less complicated, and to report greater knowledge of how to use the kit. There were no significant differences in use of "minimal intervention" components of the kit, ratings of overall acceptability of delivery, perceptions of cultural and structural barriers to using the kit, and ratings of the overall acceptability of the kit. The cost of the educational facilitator approach ($A142/doctor) was 24 times that of the mailed approach. The volunteer courier approach ($A14) was twice the cost of the mailed approach. CONCLUSION: Educational facilitators and volunteer couriers do not seem to be cost effective strategies for distributing smoking interventions.

[Current role of abdomino-perineal amputation]. / Ruolo attuale dell'amputazione addomino-perineale.

In Italy 6.5% of cancer deaths can be attributed to localized colorectal cancer of which rectal cancer alone accounts for 33%. The introduction of mechanical staplers and new techniques (colo-anal anastomosis) into colon surgery has led to a drastic reduction in indications for Miles' operation in favour of techniques which aim to conserve the sphincter. From October 1987 to March 1991 the Surgical Clinical of the Ospedale Maggiore in Novara operated 75 patients with rectal cancer. Twenty-eight patients underwent APA (abdominoperineal amputation) whereas 47 underwent conservative surgery, referred to as SSR (sphincter-saving resection). Of the 28 APA patients, 19 revealed a localisation in the lower rectum (0-5), 7 in the mid rectum (6-8) and 2 in the upper rectum (9-15). In the latter two cases the considerable size of the tumour mass and the extraparietal diffusion of the tumour led the authors to prefer APA rather than SSR. In SSR the minimum distal safety margin from the tumour was 2 cm, whereas the mean distance of the tumour from the anal margin in APP patients was 4 cm, and that in SSR patients 11 cm. The stage of cancer was not taken into consideration when choosing the type of surgery. Postoperative mortality was 3.5% for APA and 2% for SSR. The overall incidence of recidivation was 20%, equivalent to 11 patients. Recidivation was found to be more frequent in the lower rectum (6 cases) compared to the upper rectum (1 case).(ABSTRACT TRUNCATED AT 250 WORDS)

[Gastric surgery in morbid obesity. Apropos of 101 cases]. / Chirurgie gastrique dans l'obésité morbide. A propos de 101 cas.

The authors analyze the complications and the results of gastric surgery for morbid obesity, on the basis of their personal experience. After abandoning up jejunoileal by-pass because of its severe complications, they started to perform gastric by-pass and vertical banded gastroplasty according to Mason. The number of severe complications was low and the results on the weight loss were good, without any disturbance of metabolic and nutritional tests. Gastric by-passes and gastroplasties had similar results. The authors suggest that gastroplasty could be the technique of choice as it is a simple and quick operation, without anastomosis, which ensures a better respect of gastroduodenal physiology and the possibility of exploration of the distal gastric pouch.

[A rare complication in the suppression of a porto-systemic shunt in disabling encephalopathy]. / Considerazioni su una rara complicanza nella soppressione di shunt porto-sistemico per encefalopatia invalidante.

The authors describe an uncommon complication in a case of side-to-side portacaval shunt which was suppressed due to disabling portal-systemic encephalopathy; the patient was treated by esophageal transection with esophagogastric devascularization and nonoperative secondary occlusion of the shunt by external elastic traction on a Silastic catheter surrounding the anastomosis: a stenosis of the caval vein under traction required another operation in order to close the shunt.