Risk factor analysis and nomogram for predicting poor symptom control in smoking asthmatics.

BACKGROUND: Smoking induces and modifies the airway immune response, accelerating the decline of asthmatics' lung function and severely affecting asthma symptoms' control level. To assess the prognosis of asthmatics who smoke and to provide reasonable recommendations for treatment, we constructed a nomogram prediction model. METHODS: General and clinical data were collected from April to September 2021 from smoking asthmatics aged ≥14 years attending the People's Hospital of Zhengzhou University. Patients were followed up regularly by telephone or outpatient visits, and their medication and follow-up visits were recorded during the 6-months follow-up visit, as well as their asthma control levels after 6 months (asthma control questionnaire-5, ACQ-5). The study employed R4.2.2 software to conduct univariate and multivariate logistic regression analyses to identify independent risk factors for 'poorly controlled asthma' (ACQ>0.75) as the outcome variable. Subsequently, a nomogram prediction model was constructed. Internal validation was used to test the reproducibility of the model. The model efficacy was evaluated using the consistency index (C-index), receiver operating characteristic (ROC) curve, calibration curve, and decision curve. RESULTS: Invitations were sent to 231 asthmatics who smoked. A total of 202 participants responded, resulting in a final total of 190 participants included in the model development. The nomogram established five independent risk factors (P<0.05): FEV1%pred, smoking index (100), comorbidities situations, medication regimen, and good or poor medication adherence. The area under curve (AUC) of the modeling set was 0.824(95%CI 0.765-0.884), suggesting that the nomogram has a high ability to distinguish poor asthma control in smoking asthmatics after 6 months. The calibration curve showed a C-index of 0.824 for the modeling set and a C-index of 0.792 for the self-validation set formed by 1000 bootstrap sampling, which means that the prediction probability of the model was consistent with reality. Decision curve analysis (DCA) of the nomogram revealed that the net benefit was higher when the risk threshold probability for poor asthma control was 4.5 - 93.9%. CONCLUSIONS: FEV1%pred, smoking index (100), comorbidities situations, medication regimen, and medication adherence were identified as independent risk factors for poor asthma control after 6 months in smoking asthmatics. The nomogram established based on these findings can effectively predict relevant risk and provide clinicians with a reference to identify the poorly controlled population with smoking asthma as early as possible, and to select a better therapeutic regimen. Meanwhile, it can effectively improve the medication adherence and the degree of attention to complications in smoking asthma patients.

[Asthma management and asthma control level in children]. / å„¿ç«¥å“®å–˜ç®¡ç†ä¸Žå“®å–˜æŽ§åˆ¶æ°´å¹³çš„ä¸´åºŠç ”ç©¶.

OBJECTIVES: To investigate the influencing factors for asthma management and asthma control level in children. METHODS: A total of 202 children with a confirmed diagnosis of asthma were enrolled. The questionnaire of asthma control level and family management was used to investigate the influencing factors for asthma control level and the indicators of family management. The awareness of childhood asthma and its management was analyzed among the parents, as well as the influence on asthma control level in children, and the association between them was analyzed. RESULTS: Compared with the non-complete control group, the complete control group had significantly longer course of asthma and treatment time (P<0.05). The proportions of asthma attacks ≥3 times and aerosol treatment for asthma attacks >3 times in one year in the complete control group were significantly lower than those in the non-complete control group (P<0.05). The complete control group had a significantly lower proportion of children with frequent respiratory infection, wheezing during respiratory infection, or a family history of allergic diseases (P<0.05). The parents in the complete control group had significantly stronger awareness of short-term escalation to asthma medication after respiratory infection and significantly enhanced management of maintenance medication (P<0.05). Compared with the complete control group, the non-complete control group had a significantly higher proportion of children with abnormal pulmonary function at the initial stage (P<0.05). The level of asthma control in children was associated with short-term escalation to asthma medication during respiratory infection and initial lung function (P<0.05). CONCLUSIONS: The level of asthma control in children is closely associated with the severity of asthma and the comprehensive management of childhood asthma. Early treatment and family management, especially escalation to asthma medication during the early stage of respiratory infection, are of great importance in asthma control. Citation:Chinese Journal of Contemporary Pediatrics, 2023, 25(1): 73-79.

The peripheral blood inflammatory patterns in the control levels of asthma in children.

OBJECTIVE: Asthma is the most common chronic inflammatory disease of childhood, but there are no useful and easily accessible laboratory tests routinely used in the diagnosis and follow-up of this disease in children. Therefore, this study aimed to investigate the roles of white blood cell (WBC) count, platelet count, mean platelet volume (MPV), and eosinophil percentage as full blood count inflammatory markers in evaluating the control level and follow-up of asthma in the pediatric age group. METHODS: A retrospective review of patient records and files of 3,580 patients diagnosed with asthma at the University of Health Sciences in Ankara, Turkey was performed. Patients who met inclusion/exclusion criteria were divided into two groups based on the asthma control level: controlled and uncontrolled. Laboratory data were compared according to the asthma control levels, drug use status, and atopy status of the patients. RESULTS: A total of 348 patients between 4 and 18 years of age, who were followed-up with the diagnosis of asthma, were included in this study. A significant difference was found between the controlled and uncontrolled groups of asthma patients in terms of the eosinophil percentage (mean ± SD, respectively; 3.493 ± 2.24; 4.992 ± 3.43; p = .003). When patients were grouped according to their asthma control levels and atopy status, only the eosinophil percentages were different in the logistic regression analysis (odds ratio = 1.276, 95% confidence interval = 1.113-1.462). CONCLUSION: Our study showed that the percentage of eosinophils can be used as an asthma control parameter, but additional prospective studies would be desirable to confirm our results.

Arterial hypertension in the light of current recommendations.

Arterial hypertension (AH) refers to the most common cardiovascular diseases. The expert community regularly creates recommendations on the definition, diagnostics and treatment of hypertension. The most significant documents are recommendations American Medical Societies and the European Society for Hygiene in association with the European cardiological society. The latter document, as a rule, is fundamental for the creation of Russian recommendations on AH. Similarities are discussed in the article and differences in perceptions of the classification of hypertension, target levels of blood pressure, approaches to non-drug and drug therapy of the disease.

Foreign ownership, subjective willing, and internal control level.

Foreign shareholders are essential in the capital market. The study on A-share listed firms from 2012 to 2021 examines the impact of foreign ownership on internal control and its transmission effect. Using text analysis and machine learning methods, we construct a variable named "internal control willingness" to explore the impact of subjective willingness. The findings indicate that foreign shareholding significantly enhances internal control quality, with a more pronounced effect observed in samples demonstrating a more positive internal control willingness. Moreover, foreign shareholders contribute to the invested firm's sustainable development by enhancing internal control quality. Further research demonstrates that the positive impact of foreign shareholding is more significant in firms with legal foreign shareholders, highly competitive industries, and sound legal environments. These findings can aid host country firms in more efficiently leveraging foreign resources and provide empirical evidence for opening up China's capital market and formulating foreign investment regulations.

Economic burden of type-2 diabetes in Peru: a cost-of-illness study valuing cost differences associated with the level of glycemic control.

OBJECTIVES: Type 2 diabetes mellitus (T2DM) represents an increasing public health problem in Peru. This study aims to estimate the national economic burden of this disease for the public funder, the social security, and private sector insurers. METHODS: Direct healthcare costs were estimated for a cohort of 45-to-75-year-old adults diagnosed with T2DM in 2019, over a 20-year period. Disease progression was modeled using PROSIT Models and literature, including acute and chronic microvascular and macrovascular complications. Three scenarios of glycemic control were considered: current levels of 35.8% of the population controlled (HbA1c < 7%) (S1); 100% controlled (S2) and; 100% uncontrolled (S3). The impact of diabetes prevalence on overall costs was evaluated in sensitivity analysis. RESULTS: Total national economic burden was estimated at $15,405,448,731; an annual average per patient of $2,158. Total costs would decrease to $12,853,113,596 (-16.6%) in S2 and increase to $16,828,713,495 (+9.2%) in S3. Treating patients with complications and risk factors could cost 6.5 times more, being stroke the complication with the highest impact. Up to a 67.6% increase in total costs was found when increasing T2DM prevalence. CONCLUSIONS: T2DM places a heavy burden on the Peruvian healthcare budget that will be even greater if poor glycemic control is maintained.

The Effects of Combined Respiratory Muscle and Exercise Training in Children with Bronchial Asthma: A Randomised Controlled Study.

Objective: To investigate the effects of combined respiratory muscle and exercise training on inspiratory muscle strength, exercise capacity, spirometry measurements, asthma control the quality-of-life in children with asthma. Methods: Fifty children with asthma, who were treated in children's hospital of Chongqing medical university in Chongqing between May and December 2021, were selected and randomly divided into a rehabilitation group and a control group by using a random number table. The control group was given routine drug treatment and health education while the rehabilitation group received a combination of respiratory muscle and exercise training on the basis of control group. Results: After three months of treatment, the maximum inspiratory pressure, level of asthma control and quality-of-life in the rehabilitation group were significantly improved when compared with those in the control group (P<0.05); there were no significant differences in the 6-minute walking test and spirometry measurements (P>0.05). After three months of treatment, all outcome indicators in the rehabilitation group were significantly improved when compared to those before treatment (P<0.05). The mean value of maximum inspiratory pressure and some indices of spirometry measurements in the control group were significantly improved when compared to those before treatment (P<0.05). Conclusion: Combining respiratory muscle and exercise training on the basis of the routine drug treatment and health education significantly improved inspiratory muscle strength, the level of asthma control and the quality-of-life in children with asthma. More research is needed to explore its role in asthma in the future.

Differential response to the South American rice water weevil (Coleoptera: Curculionidae) damage of rice cultivars with contrasting levels of resistance: implications for field management.

BACKGROUND: Oryzophagus oryzae (Costa Lima) (Coleoptera: Curculionidae) is a major pest of flooded rice paddies throughout South America, and species with very similar life histories are present in many rice-producing regions of the world (collectively rice water weevils, RWWs). The damage caused by RWW larvae on rice cultivars with contrasting levels of resistance ('BRS Pampa CL'= 'Pamp': susceptible, 'BRS Atalanta' = 'Atal': resistant-antibiosis) was evaluated in two consecutive years in the field under seven infestation levels: 0, 2, 4, 6, 8, 10 and 20 adult couples per cage with plants. RESULTS: Higher densities of adults increased the number of leaf-feeding scars and larvae on roots, respectively, at the rate ≤2.14 and 2.75 in Pamp and 2.23 and 2.48 in Atal, with the total number of larvae generated being lower in Atal. Grain yield was negatively impacted with increasing larval density on the roots, mainly by decreasing root volume and the number of grains per panicle. Root injury intensity and yield loss showed a nonlinear relationship. It was found that significant yield losses occurred with 8.37 larvae per plant in Pamp and 9.80 larvae per plant in Atal CONCLUSION: The results provided the first evidence of a tolerance limit for RWW larval damage that, even though similar between cultivars of contrasting resistance, corresponds to twice the current conventional level for larval control in Brazil. We also discuss here the potential of applying tolerance limits to manage the RWW adult population in rice fields. © 2022 Society of Chemical Industry.

Study on the negative effect of internal-control willingness on enterprise risk-taking.

In the traditional cognition, the factors that affect the level of internal control are usually based on the objective factors such as corporate characteristics, financial status, and governance structure. However, the internal control defects of many famous companies expose the phenomenon of subjective manipulation, and this leads us to focus on the subjective factor of internal control, which we call internal-control willingness. We define "internal-control willingness" as the degrees of subjective initiative of the internal-control construction and execution activities. Additionally, we propose a method for measuring internal-control willingness, using text analysis and machine learning. Then, we examine the impact of internal-control willingness on enterprise risk-taking, through the internal-control, financial, and market data of China A-share main board enterprises in 2011-2018. The study found that (1) internal-control willingness has a significant positive impact on internal-control level, which can fairly achieve the measurement of internal-control subjective initiative. (2) It confirms that internal-control willingness lowers corporate risk-taking. (3) Further research finds that state-owned enterprises strengthen internal-control willingness and their risk-taking level is significantly lower than that of non-state-owned enterprises. This paper suggests that the regulatory authorities actively urge the board of directors to strengthen internal-control willingness.

Poor glycemic control might compromise the efficacy of chemotherapy in non-small cell lung cancer patients with diabetes mellitus.

BACKGROUND: Previous studies indicated that type 2 diabetes mellitus (T2DM) is related to an increased lung cancer risk, but its role in the prognosis of NSCLC remains conflicting. This study investigated the impact of blood glucose control on the outcomes in NSCLC patients with T2DM treated with platinum-based doublets. METHODS: Clinicopathological and survival data from 191 T2DM patients with advanced NSCLC, who received platinum-based chemotherapy, were retrospectively analyzed. Based on the blood glucose conditions during chemotherapy, patients were classified into poor (n = 84) and good control (n = 107) groups. Progression-free survival (PFS) was assessed using the Kaplan-Meier method. RESULTS: The median PFS among patients with good glycemic control [197.0 (95% CI: 136.3-257.7) days] was longer than that among those with poor control [132.0 (95% CI: 112.5-151.5) days] (P = .0003). Further subgroup analysis of lung squamous carcinoma and adenocarcinoma patients showed that the median PFS of the good control group was also significantly longer than that of the poor control group [179.0 (95% CI: 78.4-279.6) days vs 125.0 (95% CI: 110.9-139.1) days, P = .0014; 197.0 (95% CI: 124.3-269.7) days vs 154.0 (95% CI: 129.9-178.1) days, P = .0359; respectively]. The incidence rates of side effects were similar among patients with good glycemic control and those with poor glycemic control (all P > .05). CONCLUSIONS: Satisfactory glycemic control during platinum-based chemotherapy might provide a survival benefit to T2DM patients with NSCLC. Further studies are warranted to confirm our findings.

"How Is My Child's Asthma?" Digital Phenotype and Actionable Insights for Pediatric Asthma.

Background: In the traditional asthma management protocol, a child meets with a clinician infrequently, once in 3 to 6 months, and is assessed using the Asthma Control Test questionnaire. This information is inadequate for timely determination of asthma control, compliance, precise diagnosis of the cause, and assessing the effectiveness of the treatment plan. The continuous monitoring and improved tracking of the child's symptoms, activities, sleep, and treatment adherence can allow precise determination of asthma triggers and a reliable assessment of medication compliance and effectiveness. Digital phenotyping refers to moment-by-moment quantification of the individual-level human phenotype in situ using data from personal digital devices, in particular, mobile phones. The kHealth kit consists of a mobile app, provided on an Android tablet, that asks timely and contextually relevant questions related to asthma symptoms, medication intake, reduced activity because of symptoms, and nighttime awakenings; a Fitbit to monitor activity and sleep; a Microlife Peak Flow Meter to monitor the peak expiratory flow and forced exhaled volume in 1 second; and a Foobot to monitor indoor air quality. The kHealth cloud stores personal health data and environmental data collected using Web services. The kHealth Dashboard interactively visualizes the collected data. Objective: The objective of this study was to discuss the usability and feasibility of collecting clinically relevant data to help clinicians diagnose or intervene in a child's care plan by using the kHealth system for continuous and comprehensive monitoring of child's symptoms, activity, sleep pattern, environmental triggers, and compliance. The kHealth system helps in deriving actionable insights to help manage asthma at both the personal and cohort levels. The Digital Phenotype Score and Controller Compliance Score introduced in the study are the basis of ongoing work on addressing personalized asthma care and answer questions such as, "How can I help my child better adhere to care instructions and reduce future exacerbation?" Methods: The Digital Phenotype Score and Controller Compliance Score summarize the child's condition from the data collected using the kHealth kit to provide actionable insights. The Digital Phenotype Score formalizes the asthma control level using data about symptoms, rescue medication usage, activity level, and sleep pattern. The Compliance Score captures how well the child is complying with the treatment protocol. We monitored and analyzed data for 95 children, each recruited for a 1- or 3-month-long study. The Asthma Control Test scores obtained from the medical records of 57 children were used to validate the asthma control levels calculated using the Digital Phenotype Scores. Results: At the cohort level, we found asthma was very poorly controlled in 37% (30/82) of the children, not well controlled in 26% (21/82), and well controlled in 38% (31/82). Among the very poorly controlled children (n=30), we found 30% (9/30) were highly compliant toward their controller medication intake-suggesting a re-evaluation for change in medication or dosage-whereas 50% (15/30) were poorly compliant and candidates for a more timely intervention to improve compliance to mitigate their situation. We observed a negative Kendall Tau correlation between Asthma Control Test scores and Digital Phenotype Score as -0.509 (P<.01). Conclusions: kHealth kit is suitable for the collection of clinically relevant information from pediatric patients. Furthermore, Digital Phenotype Score and Controller Compliance Score, computed based on the continuous digital monitoring, provide the clinician with timely and detailed evidence of a child's asthma-related condition when compared with the Asthma Control Test scores taken infrequently during clinic visits.

Asthma phenotypes in Turkey: a multicenter cross-sectional study in adult asthmatics; PHENOTURK study.

BACKGROUND AND AIMS: To evaluate asthma phenotypes in patients with asthma from different regions of Turkey. METHODS: A total of 1400 adult asthmatic patients (mean (SD) age: 44.0 (13.9) years, 75% females) from 14 centers across Turkey were included in this study and a standard questionnaire was applied between the time period of February 2011-January 2012. RESULTS: The disease onset ≥ 40 years of age was higher percentage in obese vs. normal/overweight patients and nonallergic vs. allergic patients (P < 0.01). The percentage of patients who had FEV1 values over 80% was higher in allergic than nonallergic and normal/overweight than obese patients (P < 0.01). Uncontrolled asthmatics have more severe disease (P < 0.01). There were more frequent hospital admissions in nonallergic and uncontrolled asthmatics (P < 0.01). Chronic rhino-sinusitis was the leading comorbid disorder in normal/overweight and allergic asthma, while gastroesophageal reflux disorder was more frequent in nonallergic and uncontrolled asthma (P < 0.01). Asthma control rate was the highest (39.0%) in patients from Marmara region among all geographical regions (P < 0.05). CONCLUSION: In conclusion, our findings revealed existence of clinical/trigger related phenotypes based on BMI, allergic status, control level and geographical region with more frequent respiratory dysfunction and/or adverse health outcomes in uncontrolled, obese and nonallergic phenotypes.

[Knowledge level of hypertensive patients about hypertension. Relationship between knowledge level and hypertension control]. / Estudio Conocimiento: grado de conocimiento sobre hipertensión arterial de nuestros pacientes. Relación con el nivel de control de la misma.

OBJECTIVE: To assess the knowledge of the hypertensive patients about their hypertension and their relation to its control. MATERIAL AND METHODS: Cross-sectional study among 400 hypertensive patients, all over 18 years, selected from 50 primary-care centres, who responded to an hypertension-related survey. Included variables were survey items, age, gender, educational level, professional occupation, blood pressure data and antihypertensive treatment. The obtained differences were analyzed using the chi-square test, Kruskal-Wallis, Wilcoxon, Anova and Bonferroni methods. RESULTS: There were 323 valid surveys. 52.9% of respondents were women, the average age: 65.4 years (SD: 11.2), 54.8% of them had primary education. 39.6% were aware of the objectives of systolic BP control. Only 19.6% having knowledge of those for diastolic BP control, with no differences between controlled and uncontrolled (systolic BP: 39% vs 38.1%, P=.887; diastolic BP: 19.2% vs 21%, P=.721). Over 70% knew about lifestyle changes, without significant differences between controlled and uncontrolled respondents. 82% of controlled respondents, and 79% of those uncontrolled, recognized the chronical nature of the treatment (P=.548), but 15.1% of the controlled respondents and 12.4% of uncontrolled respondents did not see the relation between the treatment and hypertension control (P=.525). 31.1% believed to be well-controlled, but in fact was not. CONCLUSIONS: Our patients doesn't know blood pressure targets of control. There isn't relationship between this knowledge and control of hypertension.

Validation of assay indicating method development of meloxicam in bulk and some of its tablet dosage forms by RP-HPLC.

A novel, simple and economic reverse phase high performance liquid chromatography (RP-HPLC) method has been developed for the quantification of Meloxicam in bulk and tablet dosage form with greater precision and accuracy. Separation was achieved on Develosil ODS HG-5 RP C18, (15 cm × 4.6 mm i.d. 5 µm) column in isocratic mode with mobile phase consisting of acetonitrile: phosphate buffer(pH 3.4) (60:40) with a flow rate of 1 mL/min. The detection was carried out at 268 nm. The retention time of Meloxicam was found to be 2.09 min. The method was validated as per ICH guidelines. Linearity was established for Meloxicam in the range 20 - 120 µg/ml with R(2) value 0.996. The percentage recovery of Meloxicam was found to be in the range 99.99-100.46%. The high recovery and low relative standard deviation confirm the suitability of the proposed method for the estimation of the drug in bulk and tablet dosage forms. Validation studies demonstrated that the proposed RP-HPLC method is simple, specific, rapid, reliable and reproducible for the determination of Meloxicam for Quality Control level.

Sequential sampling of Aphis gossypii Glover (Hemiptera: Aphididae) and Frankliniella schultzei Trybom (Thysanoptera: Thripidae) on cotton crop

The goal of this research was to use the sequential probability ratio test to establish a sequential sampling plan for Aphis gossypii Glover and Frankliniella schultzei Trybom infesting cotton. Field work was conducted at the agricultural experimental station of the Universidade Federal da Grande Dourados during the 2003/2004 and 2004/2005 agricultural years. Aphid colonies and individual thrips in the sampling area were counted and their numbers were recorded. The spatial distribution pattern of A. gossypii and F. schultzei in the cotton culture was aggregated. Sequential sampling plans were developed for aphids and thrips with type I and type II errors set at 0.1, common Kc = 0.6081 (aphids) and = 0. 9449 (thrips), and safety and management levels of 20 percent (aphids) and 40 percent (thrips) of infested plants. The sampling plans resulted in two decision boundaries for each species, as follows: the upper boundary, indicating when management (population control) is recommended: S1 = 4.6546 + 0.2849n (aphids), and S1 = 3.6514 + 0.1435n (thrips); and the lower boundary, indicating when population control is not necessary: S0 = -4.6546 + 0.2849n (aphids) and S0 = - 3.6514 + 0.1435n (thrips). The highest probability of error when making a decision was 3 percent for aphids and 2 percent for thrips, respectively. The maximum number of samples required to reach a decision was 63 for aphids and 95 for thrips.

Factors associated with uncontrolled asthma in Porto Alegre, Brazil

The prevalence of uncontrolled and controlled asthma, and the factors associated with uncontrolled asthma were investigated in a cross-sectional study. Patients aged 11 years with confirmed asthma diagnosis were recruited from the outpatient asthma clinic of Hospital de Clínicas de Porto Alegre, Brazil. Patients were excluded if they had other chronic pulmonary disease. They underwent an evaluation by a general questionnaire, an asthma control questionnaire (based on the 2006 Global Initiative for Asthma guidelines), assessment of inhaled device technique and pulmonary function tests. Asthma was controlled in 48 of 275 patients (17.5 percent), partly controlled in 74 (26.9 percent) and uncontrolled in 153 (55.6 percent). In the univariate analysis, asthma severity was associated with asthma control (P < 0.001). Availability of asthma medications was associated with asthma control (P = 0.01), so that most patients who could purchase medications had controlled asthma, while patients who depend on the public health system for access to medications had lower rates of controlled asthma. The use of inhaled corticosteroid was lower in the uncontrolled group (P < 0.001). Logistic regression analysis identified three factors associated with uncontrolled asthma: severity of asthma (OR = 5.33, P < 0.0001), access to medications (OR = 1.97, P = 0.025) and use of inhaled corticosteroids (OR = 0.17, P = 0.030). This study showed a high rate of uncontrolled asthma in patients who attended an outpatient asthma clinic. Severity of asthma, access to medications and adequate use of inhaled corticosteroids were associated with the degree of asthma control.