The effect of medical clowns on performance of spirometry among preschool aged children.

INTRODUCTION: Medical clowns (MCs) are known to assist in reducing pain and alleviating anxiety. The objective of this study is to evaluate the ability of MCs to assist preschoolers in performing spirometry. METHODS: A prospective, randomized controlled trial. Children aged 3-6 years participated. After a first spirometry, children were divided into two groups: the first performed a second spirometry with an MC. The second repeated spirometry with the technician. Primary outcome was second spirometry values compared between the groups. Secondary outcome were change in spirometry values within groups, and difference between the groups. RESULTS: A total of 140 children participated. The groups did not differ in age, sex, mother tongue, or weight. Nor in mean FVC (MC 89.2% ± 16.7, control 89.5% ± 16.3) mean FEV1 (MC 91.3% ± 15.6, control 94.2% ± 16.8), and expiratory time (MC 1.58 ± 0.43, control 1.7 ± 0.44) in first spirometry. In second spirometry the control group had a similar FVC, FEV1, and expiratory time. The MC group had a significant improvement in all parameters: FVC: MC 95.3% ± 15.5, control 89.3% ± 19.1, FEV1: MC 98.0% ± 15.6, control 91.8% ± 19.3, and expiratory time MC 1.96 ± 0.55, control 1.84 ± 0.52. The differences between the groups between first and second attempt were significant (P-value FVC 0.000, FEV1 0.000, expiratory time 0.003). DISCUSSION: MCs improved performance of spirometry among preschoolers. It is possible that laughter and relief of stress had a physiological effect. Further studies are required to better establish the ability of MCs to improve active participation and to better understand whether the mechanism of the improvement is better cooperation or true physiological change.

Adaptation and Validation of the Israeli Version of the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL).

BACKGROUND: Chronic urticaria (CU) is a common disabling disorder. The CU-Q2oL (Chronic Urticaria Quality of Life Questionnaire) is a specific questionnaire for evaluating quality of life in CU patients. It consists of 23 items divided into six quality-of-life dimensions. It was initially developed in Italy and later validated in other countries. OBJECTIVES: To validate and adapt the CU-Q2oL to the Hebrew language in order to make it suitable for use in Israel. METHODS: The CU-Q2oL questionnaire was translated to Hebrew. A group of 119 CU patients were asked to complete this version, in addition to the Dermatology Life Quality Index (DLQI) and Urticaria Activity Score (UAS) questionnaires. A factorial analysis was performed to identify CU-Q2oL subscales, internal consistency and convergent validity assessment, as well as factors determining quality-of-life scores. RESULTS: The factor analysis identified six scales of the Israeli CU-Q2oL: (i) sleep and concentration, (ii) function and mental status, (iii) embarrassment and clothing limitations, (iv) itching, (v) eating behavior and medication side effects, and (vi) swelling, which accounted for 77% of the data variance. Five scales showed good internal consistency over 0.81. The mean ± SD score of CU-Q2oL in our patients with CIU was 41 ± 21.7. We found a strong positive correlation between the overall scores of CU-Q2oL and DLQI questionnaires (r = 0.8, P < 0.01). Additionally, we found a positive correlation between UAS and both CU-Q2oL and DLQI (r = 0.62, P < 0.01, and r = 0.53, P < 0.01, respectively). CONCLUSIONS: This study demonstrates that the Israeli CU-Q2oL questionnaire is suitable for both clinical use and research in Israel.

Interferon-gamma-release assay prevents unnecessary tuberculosis therapy.

BACKGROUND: The mass influx of immigrants from tuberculosis-endemic countries into Israel was followed by a considerable increase in the incidence of tuberculosis (TB). All contacts of active TB patients are obliged to be screened by tuberculin skin tests (TST) and, if found positive, prophylactic treatment is considered. OBJECTIVES: To assess the utility of interferon-gamma (IFNγ)-release assay with a prolonged follow-up in preventing unnecessary anti-TB therapy in individuals with suspected false positive results. METHODS: Between 2008 and 2012 the QuantiFERON TB gold-in-tube test (QFT-G) was performed in 278 sequential individuals who were mostly TST-positive and/or were in contact with an active TB patient. In all, whole blood was examined by the IFNγ-release assay. We correlated the TST diameter with the QFT-G assay and followed those patients with a negative assay. RESULTS: The QFT-G test was positive in only 72 (42%) of all 171 TST-positive individuals. There was no correlation between the diameter of TST and QFT-G positivity. Follow-up over 5 years was available in 128 (62%) of all QFT-G-negative individuals. All remained well and none developed active TB. CONCLUSIONS: A negative QFT-G test may obviate the need for anti-TB therapy in more than half of those with a positive TST.

The significance of allergic contact urticaria to milk in children with cow's milk allergy.

BACKGROUND: Cow's milk allergy (CMA) is the most common food allergy in infancy. Food allergy is generally triggered through ingestion, but can also be triggered through skin contact. We investigated the incidence and the clinical significance of cow's milk protein (CMP)-induced contact urticaria in individuals with CMA with and without atopic dermatitis (AD). METHODS: A total of 157 children of whom 133 were diagnosed with CMA were participated. The study was based on observational data gathered in the course of patient care, including a skin prick test and a 'finger test', in which cow's milk is applied on the cheek by a physician's finger to detect contact urticaria. RESULTS: Eighty nine of 133 patients (66.9%) had IgE-mediated CMA. Forty of these 89 (44.9%) tested positive in the finger test. Family atopy was higher in those with positive contact urticaria [21/40 (52.5%) vs. 14/49 (28.5%), p = 0.029]. Patients with positive vs. negative CMP contact urticaria had higher incidence of multiple food allergies [20 of 40 (50%) vs. 7/49 (14.3%), p < 0.004]. IgE-mediated CMA patients with AD had statistically higher CMP allergic contact urticaria compared to patients without AD [71% (15/21) vs. 37% (25/68), p = 0.0064]. Children with non-IgE milk allergy and healthy control group did not have contact urticaria to CMP. CONCLUSION: CMP contact urticaria exists only in patients with IgE-mediated CMA. A 'finger test' to CMP should be part of the evaluation of CMA patients, and positivity suggests the potential for multiple food allergies, especially to sesame and egg.