Quality of life and control of allergic rhinitis in patients from regions beyond western Europe and the United States.

There is comparatively little information on health-related quality of life (HRQoL) in subjects with allergic rhinitis (AR) or allergic rhinoconjunctivitis (AR/C) in countries beyond western Europe and North America. The primary aim of this investigation was therefore to review and assess the information in the public domain on HRQoL in AR/C patients from diverse regions of the world, represented by different countries, including Argentina, Australia, Brazil, Russia, Singapore, South Africa and Turkey. Second, in view of the absence of a standardized definition for 'AR control', the review aimed to determine whether a working definition of AR/C can be inferred from validated tests or other instruments documented to date. Despite the comparatively low number of studies, this review demonstrated that overall the symptoms of AR/C impair the HRQoL of patients in these regions by adversely impacting sleep, daily activities, physical and mental status and social functioning, similar to that demonstrated in much larger numbers of studies of AR/C patients in Europe and the United States. Furthermore, the findings of the review suggest that 'overall' control of the disease should encompass reduction of nasal and ocular symptoms, as well as improvements in HRQoL, comorbid conditions and cognition. Although some instruments are currently available for measuring control of AR, none are capable of assessing all these aspects, emphasizing the need to develop appropriate new instruments.

Prevalence and diversity of allergic rhinitis in regions of the world beyond Europe and North America.

BACKGROUND: There is comparatively little information in the public domain on the diversity in prevalence and triggers/factors associated with allergic rhinitis (AR) or allergic rhinoconjunctivitis (AR/C) in countries beyond western-Europe and North America. OBJECTIVE: To review the prevalence and the sensitizing agents/triggers and factors associated with AR/C in several countries in Africa, the Asia-Pacific region, Australia, Eastern Europe, Latin America, Middle East and Turkey. METHODS: Articles published in English in peer-reviewed journals were assessed and selected for further review, following an extensive literature search using the Medline database. RESULTS: This review demonstrated that prevalence of AR and AR/C in these regions has predominantly been investigated in children; with studies indicating wide inter- and intra-regional variations ranging from 2.9% AR and 3.8% AR/C in 10-18-years-old children from one region in Turkey to 54.1% AR and 39.2% AR/C in 13-14-years-old children in one region in Nigeria. Moreover, the prevalence of AR and AR/C has increased markedly over the last decade particularly in some of the more affluent African countries, China-Taiwan and several Middle East countries, likely as a consequence of improved living standards leading to increased exposure to multiple traditional and non-traditional sensitizing agents and risk factors similar to those noted in western-Europe and North America. CONCLUSIONS AND CLINICAL RELEVANCE: Our findings suggest that the greater diversity in prevalence of AR or AR/C in populations in these regions is in contrast to the lower diversity of AR or AR/C in the 'western populations (USA and Europe), which tend to be more uniform. This review provides a comprehensive database of the important allergens and triggers which are likely to influence the prevalence of allergic rhinitis in these diverse regions, where the prevalence of allergic rhinitis is increasing and its adverse impact on the quality of life of affected individuals is increasingly recognised.

Cervical retraction of the maxillae in the Macaca mulatta monkey using heavy orthopedic force.

Heavy, interupted orthopedic forces were employed for the cervical retraction of the maxillae in two Macaca mulatta monkeys. The nature, location and magnitude of resultant movements and remodelling were studied with the help of plaster casts, amalgam implants, lateral cephalometric tracings, and of gross and microscopic study of the skulls themselves. The principal effect of the retractive force was a marked downward and backward rotational movement of the maxillae which carried the maxillary teeth into posterior crossbite and a severe Class III molar relationship. Posterior movement of the tuberosity entirely closed the pterygomaxillary fissure so that the tuberosity impinged upon the pterygoid plates. Like the maxillae, the mandible, premaxilla, and nasal boned also moved downward and backward. These changes increased the vertical dimension of the face and diminished it horizontally leaving a flattened facial profile from the nasal opening to the maxillary incisors. Movement of facial elements posteriorly against an unhielding anterior cranial base imposed a number of other compensatory changes. These included generalized resorption at the craniofacial sutures and sliding of the sutures upon each other. They also involved mutual resorption of the maxillary tuberosity and of the pterygoid plates together with remodelling and lateral extension of the malar bones. Tolerance of the animals and of the localized tissues for these intensive forces suggests a significant role for this form of therapy. Clinical application, however, should be tempered by judicious concern for the vital structures of the pterygomaxillary fissure which could be impinged or strangulated by excessive retrusive force.

Adaptive changes in the face of the Macaca mulatta monkey following orthopedic opening of the midpalatal suture.

The classical effects of lateral orthopedic stress on the midpalatal suture were confirmed in this study conducted on ten female Macaca mulatta monkeys in the mixed dentitional period. The suture was opened with consequent expansion of the maxillary arch, of the intranasal space, and of the palatal vault. There was marked buccal displacement of the upper posterior teeth together with a definite broadening of the entire midface. Modest relapse of maxillary expansion and of palatal depth occurred when retention was terminated after four months. Normal angulation of the upper first molars at the end of the experimental period is indicative of a predominantly translatory expansion of the arch or of a rapid restoration of normal tooth alignment and inclination. Subsidiary expansion of the mandibular arch and reclosure of the midpalatal suture also occurred. Of particular importance to this study was confirmation of changes in the bony configuration of the midface manifested by prominence of the canine eminence and the general pug-nosed appearance of treated animals althrough this could not be attributed to retrusion of the premaxilla.

The mandibular dental arch: Part I, lower incisor position.

The position of the lower incisor with respect to hard tissue references has been evaluated. Two samples were used for this purpose: one containing 78 patients with posttreatment records having a postretention period of at least 4 years, and the other composed of 82 normal occlusions. The results indicated: 1) There was no significant difference in relapse of lower incisor crowding between cases where the lower incisor had been moved lingually, labially, or held in the same relative position during treatment. 2) The position of the maxilla should be considered when placing the lower incisor. The APo plane adequately serves as a guide to this purpose, whereas other reference lines such as mandibular plane or facial plane do not. 3) The positions of the incisors with respect to popular cephalometric reference lines such as APo, NB, or mandibular plane were not correlated with the relapse of mandibular crowding. Therefore, other clinical guides might be more successful for determining stability.

The mandibular dental arch: part II. Effects of lower incisor position on the soft tissue profile.

It has been demonstrated that there are reliable methods of predicting the ultimate position of the lower incisor and the soft tissue. However, the concept of treating this tooth to any one number for every individual was not supported by the evidence. An optimum system would allow the clinician to select and combine factors from all methods and arrive at a balance of esthetics, function, and stability, obtaining a suitable compromise for his individual patient. This is undoubtedly attempted intuitively by many experienced clinicians.

Lateral expansion of the mandible in the baboon. Following osteotomy at the symphysis.

The mandibles of three baboons are expanded laterally by surgical osteotomy at the symphysis, followed by different regimes of stabilization and orthodontic movement.

Asthma programmes in diverse regions of the world: challenges, successes and lessons learnt.

International surveys have demonstrated that asthma is still underdiagnosed and undertreated in many parts of the world. Despite improvements in the standard of asthma care delivered in many areas, as evidenced by improved global asthma mortality data, much information on projects and programmes undertaken in resource-limited regions of the world is not in the public domain. The aim of this report is to review projects and programmes in diverse regions around the world so that health care providers, planners and consumers may draw on the successes, failures and lessons learnt. Such real world experiences may contribute to achieving Global Initiative for Asthma goals of asthma control. Asthma projects and programmes in Argentina, Australia, Brazil, China, Japan, Mexico, Philippines, Russia, South Africa and Turkey were discussed by a group of experts in asthma care, the Advancing Asthma Care Network, from their respective countries, over a course of three satellite meetings in 2010. Collective analyses consistently identified low rates of dissemination and implementation of national and international treatment guidelines, low levels of continuing medical education and training of primary health care professionals and access and distribution of inhaled corticosteroids to be major barriers that are critical to the overall success of a national asthma management programme. In the less developed asthma programmes, under-recognition and undertreatment further limited the success of the programmes. Evidence from well-established national asthma management programmes suggests that establishment of a successful programme entails a logical progression through specific developmental stages, starting with political/stakeholder endorsement and commitment, followed by epidemiological evaluation, evaluation of disease burden, evaluation of access to care and best therapy, and finally optimisation and maintenance therapy for individual patients.

Update on asthma control in five European countries: results of a 2008 survey.

The 2006 European National Health and Wellness Survey (NHWS) showed that a large proportion of asthmatics had uncontrolled asthma. The current analysis estimated the prevalence of asthma and asthma control (Asthma Control Test™ (ACT); QualityMetric Inc., Lincoln, RI, USA) in five European countries using the 2008 NHWS. Health-related quality of life (HRQoL), using the Short Form-12 (SF-12) health survey, and work productivity/activity impairment were assessed. Of 3,619 respondents aged ≥18 yrs, the prevalence of self-reported physician diagnosis of asthma was 6.1% (15 million people); 56.6% of treated asthmatics were not well-controlled (NWC; ACT score ≤19). Individual components of the ACT showed that, compared with at least well-controlled patients (ALWC; ACT score ≥20), NWC patients had activity limitations at least some of the time (40.8% versus 1.5%, p<0.001), were breathless ≥3 times per week (72.5% versus 5.4%, p<0.001), suffered sleep difficulties due to asthma at least once per week (60.3% versus 4.6%, p<0.001) and required rescue medication ≥2-3 times per week (77.4% versus 15.9%, p<0.001). NWC patients had also received more healthcare contact in the past 6 ;months, including hospitalisation (17.4% versus 9.9%, p<0.001). The SF-12 physical and mental summary scores were 7.46 and 4.73 points higher, respectively, for ALWC patients compared with NWC patients (p<0.001). ALWC patients reported less absenteeism (5.5% versus 12.2%) and work impairment (15.4% versus 30.0%) than NWC patients (both p<0.001). The proportion of asthmatics with NWC asthma has not improved since 2006. ALWC asthma is associated with a significant positive impact on healthcare resource use, HRQoL and work productivity.