Physical activity, sedentary behaviour, and childhood asthma: a European collaborative analysis.

OBJECTIVES: To investigate the associations of physical activity (PA) and sedentary behaviour in early childhood with asthma and reduced lung function in later childhood within a large collaborative study. DESIGN: Pooling of longitudinal data from collaborating birth cohorts using meta-analysis of separate cohort-specific estimates and analysis of individual participant data of all cohorts combined. SETTING: Children aged 0-18 years from 26 European birth cohorts. PARTICIPANTS: 136 071 individual children from 26 cohorts, with information on PA and/or sedentary behaviour in early childhood and asthma assessment in later childhood. MAIN OUTCOME MEASURE: Questionnaire-based current asthma and lung function measured by spirometry (forced expiratory volume in 1 s (FEV1), FEV1/forced vital capacity) at age 6-18 years. RESULTS: Questionnaire-based and accelerometry-based PA and sedentary behaviour at age 3-5 years was not associated with asthma at age 6-18 years (PA in hours/day adjusted OR 1.01, 95% CI 0.98 to 1.04; sedentary behaviour in hours/day adjusted OR 1.03, 95% CI 0.99 to 1.07). PA was not associated with lung function at any age. Analyses of sedentary behaviour and lung function showed inconsistent results. CONCLUSIONS: Reduced PA and increased sedentary behaviour before 6 years of age were not associated with the presence of asthma later in childhood.

Rising Unscheduled Healthcare Utilisation of Children and Young People: How Does the Rise Vary Across Deprivation Quintiles in UK Nations?

This retrospective population-based analysis assessed variations in urgent healthcare use by children and young people (CYP) across UK nations (England, Scotland and Wales) between 2007 and 2017. The study focused on urgent hospital admissions, short stay urgent admissions (SSUA) and Emergency Department (ED) attendances among CYP aged <25 years, stratified by age groups and Index of Multiple Deprivation (IMD) quintile groups. A linear mixed model was used to assess trends in healthcare activity over time and across deprivation quintiles. Urgent admissions, SSUA and ED attendances increased across all deprivation quintiles in all studied nations. Increasing deprivation was consistently associated with higher urgent healthcare utilisation. In England, the rise in urgent admissions and SSUA for CYP was slower for CYP from the quintile of greatest deprivation compared those from the least deprived quintile (respective mean differences 0.69/1000/y [95% CI 0.53, 0.85] and 0.25/1000/y [0.07, 0.42]), leading to a narrowing in health inequality. Conversely, in Scotland, urgent admissions and SSUA increased more rapidly for CYP from all deprivation quintiles, widening health inequality. Understanding the differences we describe here could inform changes to NHS pathways of care across the UK which slow the rise in urgent healthcare use for CYP.

Efficacy of oral corticosteroids for acute preschool wheeze: a systematic review and individual participant data meta-analysis of randomised clinical trials.

BACKGROUND: Oral corticosteroids are commonly used for acute preschool wheeze, although there is conflicting evidence of their benefit. We assessed the clinical efficacy of oral corticosteroids by means of a systematic review and individual participant data (IPD) meta-analysis. METHODS: In this systematic review with IPD meta-analysis, we systematically searched eight databases (PubMed, Ovid Embase, CINAHLplus, CENTRAL, ClinicalTrials.gov, EudraCT, EU Clinical Trials Register, WHO Clinical Trials Registry) for randomised clinical trials published from Jan 1, 1994, to June 30, 2020, comparing oral corticosteroids with placebo in children aged 12 to 71 months with acute preschool wheeze in any setting based on the Population, Intervention, Comparison, Outcomes framework. We contacted principal investigators of eligible studies to obtain deidentified individual patient data. The primary outcome was change in wheezing severity score (WSS). A key secondary outcome length of hospital stay. We also calculated a pooled estimate of six commonly reported adverse events in the follow-up period of IPD datasets. One-stage and two-stage meta-analyses employing a random-effects model were used. This study is registered with PROSPERO, CRD42020193958. FINDINGS: We identified 16 102 studies published between Jan 1, 1994, and June 30, 2020, from which there were 12 eligible trials after deduplication and screening. We obtained individual data from seven trials comprising 2172 children, with 1728 children in the eligible IPD age range; 853 (49·4%) received oral corticosteroids (544 [63·8%] male and 309 [36·2%] female) and 875 (50·6%) received placebo (583 [66·6%] male and 292 [33·4%] female). Compared with placebo, a greater change in WSS at 4 h was seen in the oral corticosteroids group (mean difference -0·31 [95% CI -0·38 to -0·24]; p=0·011) but not 12 h (-0·02 [-0·17 to 0·14]; p=0·68), with low heterogeneity between studies (I2=0%; τ2<0·001). Length of hospital stay was significantly reduced in the oral corticosteroids group (-3·18 h [-4·43 to -1·93]; p=0·0021; I2=0%; τ2<0·001). Subgroup analyses showed that this reduction was greatest in those with a history of wheezing or asthma (-4·54 h [-5·57 to -3·52]; pinteraction=0·0007). Adverse events were infrequently reported (four of seven datasets), but oral corticosteroids were associated with an increased risk of vomiting (odds ratio 2·27 [95% CI 0·87 to 5·88]; τ2<0·001). Most datasets (six of seven) had a low risk of bias. INTERPRETATION: Oral corticosteroids reduce WSS at 4 h and length of hospital stay in children with acute preschool wheeze. In those with a history of previous wheeze or asthma, oral corticosteroids provide a potentially clinically relevant effect on length of hospital stay. FUNDING: Asthma UK Centre for Applied Research.

Obstructive and restrictive spirometry from school age to adulthood: three birth cohort studies.

Background: Spirometric obstruction and restriction are two patterns of impaired lung function which are predictive of poor health. We investigated the development of these phenotypes and their transitions through childhood to early adulthood. Methods: In this study, we analysed pooled data from three UK population-based birth cohorts established between 1989 and 1995. We applied descriptive statistics, regression modelling and data-driven modelling to data from three population-based birth cohorts with at least three spirometry measures from childhood to adulthood (mid-school: 8-10 years, n = 8404; adolescence: 15-18, n = 5764; and early adulthood: 20-26, n = 4680). Participants were assigned to normal, restrictive, and obstructive spirometry based on adjusted regression residuals. We considered two transitions: from 8-10 to 15-18 and from 15-18 to 20-26 years. Findings: Obstructive phenotype was observed in ∼10%, and restrictive in ∼9%. A substantial proportion of children with impaired lung function in school age (between one third in obstructive and a half in restricted phenotype) improved and achieved normal and stable lung function to early adulthood. Of those with normal lung function in school-age, <5% declined to adulthood. Underweight restrictive and obese obstructive participants were less likely to transit to normal. Maternal smoking during pregnancy and current asthma diagnosis increased the risk of persistent obstruction and worsening. Significant associate of worsening in restrictive phenotypes was lower BMI at the first lung function assessment. Data-driven methodologies identified similar risk factors for obstructive and restrictive clusters. Interpretation: The worsening and improvement in obstructive and restrictive spirometry were observed at all ages. Maintaining optimal weight during childhood and reducing maternal smoking during pregnancy may reduce spirometry obstruction and restriction and improve lung function. Funding: MRC Grant MR/S025340/1.

Use of exhaled nitric oxide in the diagnosis and monitoring of childhood asthma: myth or maxim?

Asthma is a common condition in children. This review describes the evidence from the literature and international asthma guidelines for using fractional exhaled nitric oxide (FENO) in the diagnosis and monitoring of childhood asthma. The accuracy of FENO measuring devices could be further improved, the difference in FENO results between devices are equivalent to what is considered a clinically important difference. For diagnosing asthma no guideline currently recommends FENO is used as the first test, but many recommend FENO as part of a series of tests. A cut-off of 35 ppb is widely recommended as being supportive of an asthma diagnosis, but evidence from children at risk of asthma suggests that a lower threshold of 25 ppb may be more appropriate. Nine randomised clinical trials including 1885 children have added FENO to usual asthma care and find that exacerbations are reduced when care is guided by FENO (OR for exacerbation compared to usual care 0.77, 95% CI 0.62-0.94). What is not clear is what cut-off(s) of FENO should be used to trigger a change in treatment. After 30 years of intensive research there is not sufficient evidence to recommend FENO for routine diagnosing and monitoring asthma in children. Educational aims: To give the reader an overview of literature that supports and does not support the role of FENO in diagnosing asthma in children.To give the reader an overview of literature that supports and does not support the role of FENO in monitoring asthma in children.To give the reader an understanding of the role of FENO in international guidelines for diagnosing and monitoring asthma in children.

Системы здравоохранения против бедности

Системы здравоохранения многое сделали и продолжают делать для решения сложной и трудной проблемы бедности и здоровья. В данной публикации дается описание 12 инициатив, уже предпринятых в 10 государствах - членах ВОЗ (Венгрия, Германия, Италия, Кыргызстан, Польша, Республика Молдова, Российская Федерация, Соединенное Королевство, Франция, Хорватия). В книге приводятся предварительные результаты исследований ВОЗ, посвященных тому, как системы здравоохранения могут помочь уменьшить проблему бедности. В частности, на основе этих результатов делаются три основных вывода: системы здравоохранения способны предпринять эффективные действия для улучшения здоровья бедных слоев населения; в отдельных случаях они могут стать дополнительной трудностью в жизни малоимущих; в этой области отмечается настоятельная потребность в большем объеме знаний, улучшении подготовки кадровых ресурсов и наращивании потенциала. Хочется надеяться, что информация, приведенная в настоящей публикации, внесет весомый вклад в усилия ВОЗ, нацеленные на то, чтобы помочь всем странам Европейского региона улучшить здоровье населения и обеспечить большую справедливость за счет уменьшения проблемы бедности и ее последствий для здоровья населения.

Les systèmes de santé s’attaquent à la pauvreté

Dans le cadre des systèmes de santé on a beaucoup agi – et l’on continue à le faire – pour tenter de répondre à ce problème lancinant qu’est l’incidence de la pauvreté sur la santé. Le présent ouvrage décrit douze expériences menées sur ce plan dans dix États membres de l’OMS – Allemagne, Croatie, Fédération de Russie, France, Hongrie, Italie, Kirghizistan, Pologne, République de Moldova et Royaume-Uni. Il étaye les premiers constats de l’OMS sur la manière dont les systèmes de santé peuvent contribuer à atténuer la pauvreté. Trois conclusions se dégagent : la première est qu’à travers ces systèmes il est possible de prendre des mesures pour améliorer la santé des personnes démunies, la seconde, c’est que ces systèmes peuvent aussi parfois constituer un obstacle supplémentaire et la troisième, c’est que les connaissances, la formation et le développement des capacités sont encore très lacunaires dans ce domaine. Les informations présentées iront, faut-il espérer, dans le sens des efforts déployés par l’OMS pour contribuer à ce que tous les pays d’Europe tendent à faire progresser la santé et l’équité en s’attaquant au problème posé par les incidences de la pauvreté sur la santé.

Gesundheitssysteme stellen sich der Armut

Die Gesundheitssysteme versuchen seit geraumer Zeit, aktiv gegen das komplexe und erschreckende große Problem von Armut und Gesundheit vorzugehen. In diesem Buch werden zwölf bereits durchgeführte Initiativen aus zehn Mitgliedstaaten der WHO, nämlich aus Deutschland, Frankreich, Italien, Kirgisistan, Kroatien, Polen, der Republik Moldau, der Russischen Föderation, aus Ungarn und dem Vereinigten Königreich vorgestellt. Das Buch enthält erste Erkenntnisse der WHO zu der Frage, wie Gesundheitssysteme zur Linderung der Armutsproblematik beitragen können. Die Autoren gelangen zu drei wesentlichen Schlüssen: Gesundheitssysteme können wirksam dazu beitragen, die Gesundheit der Armen zu verbessern. Manchmal können sie sich jedoch für Arme auch als zusätzliches Hindernis erweisen. Mehr Wissen, Schulung und Kompetenz werden dringend benötigt. Mit dem vorliegenden Material hofft die WHO, die Länder der gesamten Europäischen Region der WHO in ihrem Bemühen zu unterstützen, durch die Bekämpfung von Armut und deren Folgen die Gesundheit und gesundheitliche Chancengleichheit ihrer Bevölkerung zu verbessern.

Health systems confront poverty

Health systems have done and are doing much to tackle the complex and daunting problem of poverty and health. This book describes 12 initiatives already undertaken in 10 WHO Member States: Croatia, France, Germany, Hungary, Italy, Kyrgyzstan, Poland, the Republic of Moldova, the Russian Federation and the United Kingdom. It documents WHO’s preliminary findings on how health systems can help to alleviate poverty and reaches three main conclusions: that these systems can take effective action to improve the health of the poor, that they can sometimes represent an additional barrier for the poor and that more knowledge, training and capacity-building in this area are urgently needed. It is hoped that the information presented in this publication will contribute to WHO’s efforts to help countries across the length and breadth of Europe improve health and increase equity by tackling poverty and its effects on health.