RESUMEN
BACKGROUND: Refractory chronic cough (RCC) causes significant impairments in the life quality of patients. Further research into the identification of etiologies and development of the treatment schedules for RCC is needed. PATIENTS AND METHODS: We established an multidisciplinary team (MDT) clinic, by integrating respiratory medicine, otorhinolaryngology, and gastroenterology departments, to investigate cough etiologies and the effectiveness of treatment. The therapeutic effect was assessed quantitatively using the Cough Visual Analog Scales (VAS), Leicester Cough Questionnaire (LCQ), and Reflux Symptoms Index (RSI) scores. RESULTS: In total, 213 patients attending the MDT outpatient clinic were examined, and 115 patients with RCC were included for analysis. The RCC diagnosis rate among the outpatient was 88.7%. Common causes of RCC included gastroesophageal reflux cough (63.5%), upper airway cough syndrome (UACS) (43.5%), and cough variant asthma (CVA) (14.8%). After an average treatment period of 2.17 ± 1.06 weeks (wk), 73.9% of the patients had partial cough remission, and 6.1% had complete cough remission. The cough VAS score before and after treatment was 6.11 ± 2.02 vs. 3.66 ± 2.22 (P < 0.05), respectively; LCQ total score before and after treatment was 10.24 ± 3.11 vs. 13.16 ± 3.59 (P < 0.05), respectively; and RSI score before and after treatment was 15.82 ± 7.01 vs. 10.71 ± 6.64 (P < 0.05), respectively. CONCLUSION: The etiologies of most patients with RCC could be identified in the MDT clinic, and the cough-related symptoms of a significant number of patients with RCC improved in a short period.
RESUMEN
Global warming increases the intensity and frequency of extreme weather events, which is harmful to agricultural production. Given that the overuse of fertilizer has been found to be a significant contributor to global warming, it is crucial to analyze the factors affecting farmers' fertilizer use and find appropriate fertilizer reduction measures. Agriculture is inherently risky, but previous studies have ignored the risk factors related to heavy rainfall variability, including fertilizer losses and the possible yield risks, which may lead to income risk. Using the 1995-2018 National Rural Fixed Observation Point Survey Data, this study examines the impact of heavy rainfall variability on maize farmers' fertilizer application rates, aiming to understand farmers' fertilization behavior in response to weather shocks. The results show that heavy rainfall variability significantly increases farmers' fertilizer application rates on maize. Furthermore, we find that heavy rainfall variability has greater effects on fertilizer use in hills and mountainous areas and areas with good irrigation conditions or high economic levels. When examining the potential channels underlying the estimated effects, we find that yield fluctuations are a channel through which heavy rainfall variability affects farmers' fertilizer use on maize. The above results indicate that farmers view applying extra fertilizer as a risk reducing activity in response to rainfall shocks, which helps to prevent low yield and income. Strengthening agricultural infrastructure construction according to local conditions and promoting fertilizer reduction technologies and products to reduce yield risk caused by heavy rainfall can help alleviate the problem of high fertilizer application rates by Chinese farmers.