Peer-to-peer education to prevent drug use: A qualitative analysis of the perspectives of student peer educators from Surabaya, Indonesia.

ISSUE ADDRESSED: Adolescence is a transition period between childhood and adulthood during which an individual is more likely to engage in drug use. Peer education is one strategy suggested to discourage adolescents from engaging in negative lifestyle behaviours including drug use. This qualitative research was conducted to understand the perspectives of student peer educators to provide counselling to their peers around drug use. METHODS: Data were gathered at 10 senior high schools in five regions of Surabaya through semi-structured interviews (student peer educators: n = 20; teachers: n = 13) and focus group discussions (three FGDs with student peer educators: n = 25). The data were analysed through thematic analysis following procedures of data reduction, data presentation and conclusion drawing. RESULTS: The peer educators showed readiness (actual or potential) to provide counselling based on the external factor (confidence of ongoing support) and internal factors (motivate healthy lifestyle choices, ready with an open ear, self-development and share knowledge and experience). CONCLUSIONS: The readiness to provide counselling emphasises the preparedness of the students to help their peers and appeared underpinned by their self development and personal experiences. A capacity building program to enable student peer educators to enhance their skills to motivate healthy lifestyle choices would be of benefit. SO WHAT?: The confidence in ongoing support factor recognises the essential role of stakeholders to visibly advocate for the reactivation of the peer educator program for high school students as a clear sign of support.

Non-adherence to antibiotic prescription guidelines in treating urinary tract infection of children: a population-based study in Taiwan.

OBJECTIVES: Inappropriate use of antibiotics may increase antibiotic resistance and health care service load. Few studies have been conducted to investigate physician non-adherence to antibiotic prescription guidelines for treating urinary tract infections (UTIs) in child patients. This study aimed to examine the rates of and factors associated with non-adherence to antibiotic prescription guidelines for treating uncomplicated UTIs in child patients. METHODS: This is a cross-sectional study in which a random sample of 8921 children who received antibiotics prescription for UTIs (ICD-9-CM: 590.1, 595.0, 595.9 or 599.0) at age 17 years or less, between 2000 and 2007, were analysed. Data analysed were retrieved from Taiwan's National Health Insurance database. Non-adherence was determined by antibiotic prescription not recommended by the Infectious Disease Society of Taiwan. Multivariate logistic regression model was employed to assess the potential predictors for non-adherence, including various characteristics of patients, physicians and medical institutions. RESULTS: The overall non-adherence rate was estimated at 20.05%. Older patients, older physicians and physicians from community clinics were associated with higher rates of non-adherence. Compared with pediatricians who had the lowest rate (13.15%) of non-adherence, certain specialties were found to have significantly elevated adjusted odds ratio (AOR) of non-adherence, with the highest one noted for gynecologists (35.11%, AOR = 2.29, 95% confidence interval: 1.89-2.77). We also observed that the most frequently prescribed antibiotics not recommended on guidelines varied with physician specialty. CONCLUSIONS: Special attention should be concentrated on older physicians, gynecologists and physicians who practiced at community clinics to reduce non-adherence of antibiotic prescription for treating UTIs in child patients.

PHF11 is not a major candidate gene for asthma or eczema in Chinese children.

SUMMARY: Positional cloning and candidate gene studies in different Caucasian populations identified the gene encoding plant homeodomain zinc finger protein 11 (PHF11) to be associated with asthma and eczema. Microarray analysis also confirmed increased PHF11 expression in type 1 T-helper lymphocytes. However, such disease associations are unclear in Asian subjects. This case-control genetic association study investigated the relationship between asthma and eczema phenotypes and tagging single-nucleotide polymorphisms (SNPs) of PHF11 in Hong Kong Chinese children. Three hundred and nineteen asthmatic children and 236 children with eczema were recruited from hospital clinics and 445 children without any history of allergic disease were recruited as controls from local schools and hospitals. Atopy was defined by the presence of allergen-specific IgE in plasma or positive skin prick tests with wheal >or=3 mm larger than negative control. Lung function of asthmatics was evaluated by pre-bronchodilator spirometry. Ten PHF11 SNPs were genotyped by multiplex SNaPshot assay. Genotyping call rates were 100% for all SNPs, which also followed Hardy-Weinberg equilibrium. These SNPs were tightly linked in one haplotype block (D' >or= 0.95 for nearly all SNP pairs). Physician-diagnosed asthma was weakly associated with PHF11 +20860 and +22818 (P = 0.032 for both). Atopy was also associated with PHF11 +22398 (P = 0.029). However, none of the PHF11 SNPs was associated with eczema diagnosis and plasma total IgE and spirometric parameters in our patients. Our findings do not support PHF11 to be a major candidate gene for asthma, eczema and aeroallergen sensitization in Chinese children.

Predicting changes in clinical status of young asthmatics: clinical scores or objective parameters?

Preventing asthma exacerbation is an important goal of asthma management. The existing clinical tools are not good in predicting asthma exacerbations in young children. Childhood Asthma Control Test (C-ACT) was recently published to be a simple tool for assessing disease control in young children. This study investigated C-ACT and other disease-related factors for indicating longitudinal changes in asthma status and predicting asthma exacerbations. During the same clinic visit, asthma patients aged 4-11 years completed the Chinese version of C-ACT and underwent exhaled nitric oxide and spirometric measurements. Blinded to these results, the same investigator assigned Disease Severity Score (DSS) and rated asthma control according to Global Initiative for Asthma. Asthma exacerbations during the next 6 months were recorded. Ninety-seven patients were recruited, with their mean (standard deviation [SD]) age being 9.2 (2.0) years. Thirty-six (37.1%) patients had uncontrolled asthma at baseline. C-ACT, DSS, and FEV(1) differed among patients with different control status (P < 0.001 for C-ACT and DSS; P = 0.028 for FEV(1)). Thirty-two patients had asthma exacerbations during the 6-month follow-up. Changes in patients' C-ACT scores correlated with changes in asthma control status, DSS, and FEV(1) (P = 0.019, 0.034, and 0.020, respectively). C-ACT score was lower among patients with asthma exacerbations (mean [SD]: 22.9 [4.2] vs. 24.5 [2.1]; P = 0.015). Logistic regression confirmed that the occurrence of asthma exacerbations was associated only with baseline C-ACT (B = -0.203, P = 0.042). In conclusion, C-ACT is better than DSS and objective parameters in reflecting changes in asthma status and predicting asthma exacerbations in young children.

Lack of association between NOS2 pentanucleotide repeat polymorphism and asthma phenotypes or exhaled nitric oxide concentration.

Nitric oxide (NO) plays an immunoregulatory role in balancing cellular immunity. The expression of inducible nitric oxide synthase gene (NOS2) is upregulated upon exposure to proinflammatory cytokines and microbial exposure. The (CCTTT)n polymorphism in NOS2 promoter confers protection against infections and immunological disorders including atopy. We investigated the association between (CCTTT)n and asthma traits in Chinese children. Asthmatic children between 5 and 18 years of age and non-allergic controls were recruited. Plasma total and specific IgEs were measured by immunoassays, and exhaled NO concentration was quantified online by chemiluminescence. NOS2 (CCTTT)n was genotyped by GeneScan analysis. The mean (SD) age of 291 asthmatics and 172 controls were 11.1 (3.8) years and 11.6 (4.0) years, respectively (P = 0.259). NOS2 (CCTTT)n followed Hardy-Weinberg equilibrium in both groups, and its uni-modal allele distribution peaks at 12-repeat. Significant interethnic differences in (CCTTT)n alleles were observed, with our Chinese having less 13-repeat (Pc = 0.022) but more 17-repeat (Pc = 0.033) than Caucasians. The frequency of 14-repeat allele was similar in our Chinese as compared to Japanese (Pc = 0.32). Multivariate regression analyses failed to detect any association between this polymorphic marker and asthma diagnosis (P = 0.949), atopy (P = 0.305), IgE sensitization to aeroallergens (P > 0.2 for all), or FeNO (P = 0.847). These findings do not support NOS2 to be a major candidate gene for asthma or IgE-mediated allergic diseases in Chinese children.

Gene-gene interactions for asthma and plasma total IgE concentration in Chinese children.

BACKGROUND: Asthma is a complex disease resulting from interactions between multiple genes and environmental factors. Study of gene-gene interactions could provide insight into asthma pathophysiology. OBJECTIVE: We investigated the interaction among 12 different loci in 8 candidate genes and asthma and increased plasma total IgE concentrations in 240 Chinese asthmatic subjects and 140 control subjects. METHODS: Genotyping was performed by means of RFLP analysis. Multifactor dimensionality reduction and logistic regression were used to analyze gene-gene interactions. RESULTS: A significant interaction was found between R130Q in the IL-13 gene (IL13) and I50V in the IL-4 receptor alpha gene (IL4RA) on the risk of asthma, with a cross-validation consistency of 10 of 10 and a prediction error of 33.7% (P = .014). The odds ratio of the high-risk to low-risk group was 2.6 (95% CI, 1.4-5.0; P = .004). For increased plasma total IgE concentration, the best 2-locus model consisted of R130Q in IL13 and C-431T in the thymus and activation-regulated chemokine gene (TARC). This model showed a maximum cross-validation consistency of 10 and a minimum prediction error of 36.1% (P = .022). The odds ratio of the high-risk to low-risk group was 3.9 (95% CI, 2.0-7.7; P = .0001). Logistic regression revealed significant interactions between IL13 and IL4RA for asthma (P = .042) and IL13 and TARC for increased total IgE concentration (P = .012). CONCLUSIONS: Our data suggest significant interactions between IL13 and IL4RA for asthma and IL13 and TARC for increased plasma total IgE concentrations in Chinese children.

Clinical and technical factors affecting pH and other biomarkers in exhaled breath condensate.

Exhaled breath condensate (EBC) pH appears to be a robust measure of asthma. However, the association between EBC pH and clinical factors and airway inflammatory markers remains unclear. The objectives of this study were to investigate the factors determining EBC pH in asthmatic children, and the reproducibility and effects of collection devices on EBC pH in nine healthy, nonsmoking adults. EBC was collected once from asthmatic children using EcoScreen, and from adults over 3 consecutive days using both RTubes and EcoScreen. EBC pH was measured immediately in non-deaerated samples by microelectrode pH meter. Concentrations of 8-isoprostane, cysteinyl leukotrienes (cys-LT), and leukotriene B4 (LTB4) were measured using enzyme immunoassay. Exhaled nitric oxide concentration (FeNO) was measured by chemiluminescence. Fifty-eight asthmatics (16 intermittent, 12 mild persistent, and 30 moderate-to-severe persistent) were recruited. EBC pH was lower among patients with moderate-to-severe persistent than intermittent asthma (P = 0.046). This marker correlated inversely with disease severity score (rho = -0.276, P = 0.036), but not FeNO or other EBC biomarkers. Bland-Altman analyses found pH but not other EBC biomarkers to be reproducible, which were confirmed by its low coefficient of variation (2.7%; range, 0.4-5.2%). There was poor correlation between pH in EBC collected by RTube and EcoScreen (rho = 0.059, P = 0.784). Factor analysis selected four factors that explained 67.5% of the total variance, and EBC pH clustered with both cys-LT and LTB4. In conclusion, our results suggest that pH in non-deaerated EBC is influenced by asthma severity in children. EBC pH measurement is reproducible, but is dependent on the collection devices used.