[Allergic rhinitis and asthma as probable clinical manifestations of the same process].
Explore the source record for details and available documents.
Asthma↗
Biomedical subjects
L Prieto
Publications and source records attributed to L Prieto.
Testing the measurement properties of the Spanish version of the SF-36 Health Survey among male patients with chronic obstructive pulmonary disease. Quality of Life in COPD Study Group.
The aim of this article is to evaluate the measurement properties of the Spanish version of the SF-36 Health Survey (SF-36). In total, 321 male chronic obstructive pulmonary disease (COPD) patients attending hospital outpatient or primary health clinics were cross-sectionally administered the SF-36, the St. George's Respiratory Questionnaire (SGRQ), and a dyspnea scale. A clinical measure of respiratory function, the proportion of the predicted Forced Expiratory Volume in 1 second (%FEV1) was also obtained. Internal consistency, central tendency, and dispersion statistics of scores were calculated, as well as the percentage of respondents with the highest and lowest scores for each scale and correlations between health status and clinical measures. All patients completed the SF-36 questionnaire, and less than 1% of items were missing. The proportion of patients with the worst possible score (floor effect) ranged from 0.9-20.1% among the different scales. The proportion of patients achieving the best possible score (ceiling effect) ranged from 0-61%. Cronbach's alpha coefficients were above 0.75 except for one scale (Social Functioning, alpha = 0.55). SF-36 scores were moderate to highly correlated with SGRQ scores (coefficients ranged from -.41 to -.79). Correlations were moderate to high with dyspnea and lower but statistically significant with %FEV1. A clear gradient of SF-36 scores was found according to dyspnea levels and disease staging based on %FEV1 impairment, the gradient being more marked for the Physical Functioning, Role-Physical, and General Health scales. Data presented suggest that the Spanish version of the SF-36 is acceptable, valid, and reliable in COPD patients. Although more studies are needed, this version is adequate in international comparisons of health outcomes.
Adult↗
The factor structure of the SF-36 Health Survey in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.
Studies of the factor structure of the SF-36 Health Survey are an important step in its construct validation. Its structure is also the psychometric basis for scoring physical and mental health summary scales, which are proving useful in simplifying and interpreting statistical analyses. To test the generalizability of the SF-36 factor structure, product-moment correlations among the eight SF-36 Health Survey scales were estimated for representative samples of general populations in each of 10 countries. Matrices were independently factor analyzed using identical methods to test for hypothesized physical and mental health components, and results were compared with those published for the United States. Following simple orthogonal rotation of two principal components, they were easily interpreted as dimensions of physical and mental health in all countries. These components accounted for 76% to 85% of the reliable variance in scale scores across nine European countries, in comparison with 82% in the United States. Similar patterns of correlations between the eight scales and the components were observed across all countries and across age and gender subgroups within each country. Correlations with the physical component were highest (0.64 to 0.86) for the Physical Functioning, Role Physical, and Bodily Pain scales, whereas the Mental Health, Role Emotional, and Social Functioning scales correlated highest (0.62 to 0.91) with the mental component. Secondary correlations for both clusters of scales were much lower. Scales measuring General Health and Vitality correlated moderately with both physical and mental health components. These results support the construct validity of the SF-36 translations and the scoring of physical and mental health components in all countries studied.
Cross-Cultural Comparison↗
The equivalence of SF-36 summary health scores estimated using standard and country-specific algorithms in 10 countries: results from the IQOLA Project. International Quality of Life Assessment.
Data from general population surveys (n = 1771 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to test the algorithms used to score physical and mental component summary measures (PCS-36/MCS-36) based on the SF-36 Health Survey. Scoring coefficients for principal components were estimated independently in each country using identical methods of factor extraction and orthogonal rotation. PCS-36 and MCS-36 scores were also estimated using standard (U.S.-derived) scoring algorithms, and results were compared. Product-moment correlations between scores estimated from standard and country-specific scoring coefficients were very high (0.98 to 1.00) for both physical and mental health components in all countries. As hypothesized for orthogonal components, correlations between physical and mental components within each country were very low (0.00 to 0.12) for both estimation methods. Mean scores for PCS-36 differed by as much as 3.0 points across countries using standard scoring, and mean scores for MCS-36 differed across countries by as much as 6.4 points. In view of the high degree of equivalence observed within each country, using standard and country-specific algorithms, we recommend use of standard scoring algorithms for purposes of multinational studies involving these 10 countries.
Algorithms↗
Cross-validation of item selection and scoring for the SF-12 Health Survey in nine countries: results from the IQOLA Project. International Quality of Life Assessment.
Data from general population surveys (n = 1483 to 9151) in nine European countries (Denmark, France, Germany, Italy, the Netherlands, Norway, Spain, Sweden, and the United Kingdom) were analyzed to cross-validate the selection of questionnaire items for the SF-12 Health Survey and scoring algorithms for 12-item physical and mental component summary measures. In each country, multiple regression methods were used to select 12 SF-36 items that best reproduced the physical and mental health summary scores for the SF-36 Health Survey. Summary scores then were estimated with 12 items in three ways: using standard (U.S.-derived) SF-12 items and scoring algorithms; standard items and country-specific scoring; and country-specific sets of 12 items and scoring. Replication of the 36-item summary measures by the 12-item summary measures was then evaluated through comparison of mean scores and the strength of product-moment correlations. Product-moment correlations between SF-36 summary measures and SF-12 summary measures (standard and country-specific) were very high, ranging from 0.94-0.96 and 0.94-0.97 for the physical and mental summary measures, respectively. Mean 36-item summary measures and comparable 12-item summary measures were within 0.0 to 1.5 points (median = 0.5 points) in each country and were comparable across age groups. Because of the high degree of correspondence between summary physical and mental health measures estimated using the SF-12 and SF-36, it appears that the SF-12 will prove to be a practical alternative to the SF-36 in these countries, for purposes of large group comparisons in which the focus is on overall physical and mental health outcomes.
Cross-Cultural Comparison↗
Differences in sensitivity, maximal response and position of the concentration-response curve to methacholine between asthmatics, patients with allergic rhinitis and healthy subjects.
The aim of this study was to detect differences in maximal response and position of the concentration-response curves to methacholine between asthmatics and subjects with allergic rhinitis. A total of 228 adults (107 mild asthmatics, 96 allergic rhinitics and 25 healthy control subjects) were challenged with methacholine. The test was interrupted when FEV1 dropped by more than 40% or when the highest concentration of methacholine (200 mg ml-1) had been administered. Concentration-response curves were characterized by their PC20 (concentration of methacholine that produced 20% fall in FEV1 = airway sensitivity), and if possible, by their EC50 (concentration of methacholine that produced 50% of the maximal response = position) and level of plateau. The proportion of subjects with plateau was significantly lower in asthmatics (18.7%) than in either allergic rhinitics (57.3%) or healthy subjects (92%). It was also significantly lower in allergic rhinitics than in healthy subjects. The level of plateau for asthmatics was (means +/- SD) 31.5 +/- 5.5%, compared with 20.8 +/- 8.1% in allergic rhinitics and 13.7 +/- 6.7% in healthy subjects (P < 0.01). It was also higher in allergic rhinitics than in healthy subjects (P < 0.01). The EC50 values were decreased in asthmatics when they were compared with either allergic rhinitics or healthy subjects (geometric mean EC50: asthmatics = 2.7 mg ml-1, allergic rhinitics = 6.2 mg ml-1, healthy subjects = 8.7 mg ml-1; P < 0.01), but no significant differences were detected between allergic rhinitics and healthy subjects. These results demonstrate that in subjects with allergic rhinitis, the prevalence and level of the plateau on the methacholine concentration-response curve is intermediate between that of asthmatics and normals. Furthermore, while the asthmatic curves differ from normal in having both an increased maximal response and a leftward shift, the rhinitic curves differ only in terms of plateau level. These results suggest that airway responsiveness in asthma and allergic rhinitis may be a consequence of mechanisms that are at least partially different.
Adult↗
Ventriculo-arterial discordance: switching the morphologically left ventricle into the systemic circulation after 3 months of age.
OBJECTIVE: To retrospectively examine a 4 year policy of restoring the morphologically left ventricle to the systemic circuit in patients presenting after 3 months of age with ventriculo-arterial discordance with or without associated atrio-ventricular discordance. This policy was stimulated by the known tendency of the morphologically right ventricle to develop dysfunction sooner or later when left in the systemic circuit. Such a policy dictates a more complex surgical approach and, at this point, it remains controversial whether or not the increased surgical complexity is warranted. METHODS: From July 1, 1993 to March 31, 1997, a total of 29 patients were entered into a protocol for placement of the morphologically left ventricle into the systemic circuit. Three groups of patients were identified. Group I; congenitally corrected transposition in 14 patients -- were treated with either a Senning plus arterial switch operation or Senning plus Rastelli procedure. Group II; failed atrial switch procedure in 12 patients of which nine proceeded to arterial switch operation with Senning or Mustard takedown and atrial reseptation. Group III; D-transposition of the great vessels presenting more than 1 year after birth in three patients who underwent arterial switch operation alone. A deconditioned morphologically left ventricle required reconditioning by means of preparatory pulmonary artery banding in 17 of 29 patients. In the patients requiring pulmonary artery banding, an average of 2.1 pulmonary artery bandings was required to prepare the morphologically left ventricle for a systemic pressure workload. RESULTS: In those patients with a deconditioned morphologically left ventricle requiring preparatory pulmonary artery banding, the mean ratio between the left ventricular and right ventricular systolic pressure increased from 0.48 to 0.95. The left ventricular mass increased from 46.6 to 81.8 g/m2 in five patients subjected to serial MRI measurement. Three patients failed the preparatory pulmonary artery banding and did not proceed to anatomical correction. Two subsequently died at a later time. In the patients proceeding to complete anatomical correction: group I -- there were no early or late deaths. Two patients required pacemaker implantation post-operatively. Group II -- there were two in-hospital deaths, one early due to intrapulmonary hemorrhage and one late, secondary to postoperative left ventricular failure with a stormy post-operative course requiring successful ECMO placement and weaning. These patients were 18 and 25 years old, respectively. One patient proceeded to cardiac transplantation 3 months after surgery due to ongoing morphologically left and right ventricular dysfunction. Group III -- all patients continue to do well. CONCLUSIONS: Late anatomic correction of ventriculo-arterial discordance with or without atrio-ventricular discordance can be performed at a relatively low risk. Reconditioning of the morphologically left ventricle can be achieved by sequential pulmonary banding but is not without risk. Failure to achieve adequate reconditioning of the morphologically left ventricle by pulmonary artery banding in the older patient probably increases the risk of non-survival and may be offset by timely transplantation. Longer follow-up and an assessment of the functional status of these patients is required to assess whether or not this complex surgical approach is indeed warranted.
Adult↗
Peak flow variability and sputum eosinophilia in allergic rhinitis.
BACKGROUND: Although some non-asthmatic subjects with allergic rhinitis exhibit airway hyperresponsiveness and increased diurnal peak expiratory flow (PEF) variation, little is known about the critical features that determine these physiologic alterations. OBJECTIVE: In subjects with allergic rhinitis and methacholine hyperresponsiveness but no asthma symptoms, we examined whether there were features of asthmatic airway inflammation. METHODS: Forty non-asthmatic adults (11 with allergic rhinitis and methacholine hyperresponsiveness, 20 with allergic rhinitis and normal methacholine responsiveness, and 9 healthy control subjects) were studied. Sputum was induced with inhaled hypertonic saline for 5-minute periods for up to 20 minutes. Plugs from the lower respiratory tract were selected for differential counting in cytocentrifuged preparations. For the next 14 days, subjects measured their PEF two times daily. Peak expiratory flow variation was expressed as amplitude % mean. RESULTS: Peak expiratory flow variation was significantly higher in subjects with allergic rhinitis and methacholine hyperresponsiveness than in allergic rhinitis patients with normal methacholine responsiveness and healthy controls. Eosinophil counts in the induced sputum were significantly higher in the subjects with allergic rhinitis and methacholine hyperresponsiveness [median (interquartile range), 7.3 (9.0)%] compared with allergic rhinitis patients with normal methacholine responsiveness [2.5 (3.8)%, P = .03] and healthy controls [1.0 (1.0)%, P = .02]. CONCLUSION: We conclude that eosinophilic inflammation may be present in subjects with allergic rhinitis and airway hyperresponsiveness even when there are no symptoms of asthma. This could indicate that bronchial eosinophilia is insufficient to cause asthmatic symptoms.
Adult↗
Variability of peak expiratory flow rate in allergic rhinitis and mild asthma: relationship to maximal airway narrowing.
BACKGROUND: Previous studies have demonstrated a significant correlation between airway sensitivity to pharmacologic agents and daily peak expiratory flow rate (PEF) variation in asthmatic and nonasthmatic subjects. OBJECTIVE: The aim of this study was to investigate, both in patients with asthma and in subjects with allergic rhinitis, differences in daily PEF variation between subjects with plateau on the concentration-response curves to methacholine and those without plateau. METHODS: A total of 120 adults (50 with mild asthma, 52 with allergic rhinitis, and 18 healthy control subjects) were challenged with methacholine (up to 200 mg/mL) and, for the next 14 days, measured their PEF three times daily. The response to methacholine was measured by the percent decrease in FEV1. A maximal response plateau was considered if three or more of the highest concentrations fell within a 5% response range. Diurnal PEF variation was expressed as the amplitude percent mean. RESULTS: A plateau response was detected in 11 (22%) asthmatic patients, in 33 (63%) subjects with allergic rhinitis, and in 17 (94%) healthy subjects. Diurnal PEF variation was significantly greater (P < .01) in the asthmatic group without a plateau (8.8 +/- 3.7%) compared with the three groups with a plateau (asthma = 5.5 +/- 2.9%; allergic rhinitis = 4.6 +/- 2.1%; healthy = 4.7 +/- 2.3%). Those three groups with a plateau were not significantly different from each other with respect to PEF variability. Diurnal PEF variation was significantly higher in allergic rhinitis patients without plateau (7.6 +/- 3.5%) than in allergic rhinitis patients with plateau (P < .01) and healthy subjects (P < .05). The rhinitic group without a plateau, however, was not significantly different from either the asthmatic group without plateau or the asthmatic group with plateau. CONCLUSIONS: We conclude that in both asthmatic patients and subjects with allergic rhinitis, the shape of the concentration-response curve to methacholine provides new information on the relationship between airway responsiveness and PEF variability. Further, allergic rhinitis subjects without evidence of plateau have a degree of diurnal PEF variation similar to that found in patients with mild asthma. This could indicate that those subjects may have subclinical inflammatory changes in the airways.
Adolescent↗
Increased parental age and number of pregnancies in Klippel-Trenaunay-Weber syndrome.
The Klippel-Trenaunay-Weber syndrome (KTWS) is generally thought to occur sporadically, following a somatic mutation model. However, in some cases, clinical manifestations of the syndrome have been found in family members, suggesting an autosomal dominant inheritance. Here we present an epidemiological analysis of a consecutive series of cases with KTWS identified in the Spanish Collaborative Study of Congenital Malformations (ECEMC). We found an increase in parental age and in the number of pregnancies, as well as familial occurrence of haemangiomas. These observations suggest a genetic contribution to the occurrence of KTWS.
Adolescent↗
Congenital adrenal hyperplasia and early newborn screening: 17 alpha-hydroxyprogesterone (17 alpha-OHP) during the first days of life.
OBJECTIVE: Definition of upper limits for 17 alpha-hydroxyprogesterone (17 alpha-OHP) is important as its measurement is used in screening for congenital adrenal hyperplasia. This study aimed at investigating the cut off concentrations in relation to the day of sample collection. METHODS: 17 alpha-OHP concentration was determined in dried filter paper blood spots taken from cord blood and by heel pricking up to the sixth day of life. A sensitive fluoroimmunoassay (DELFIA) method was used. Samples from 1091 apparently health full term neonates were tested. Samples were separated according to the age of sampling. RESULTS: The 17 alpha-OHP (nmol/l blood) (median and 97.5th centile) concentrations according to the age of sampling were: cord blood (n = 126) 123.7, 265.6; first day 0-6 hours (n = 30) 49.4, 80.3; 6-12 hours (n = 57) 42.7, 79.8; 12-18 hours (n = 58) 38.1, 62.7; 18-24 hours (n = 67) 28.8, 49.7; second day 24-36 hours (n = 51) 23.6, 43.3; 36-48 hours (n = 63) 19.9, 35.4; third day (n = 200) 10.6, 23.5; fourth day (n = 197) 8.8, 20.8; fifth day (n = 76) 6.4, 18.3; sixth day (n = 166) 6.6, 19.4. CONCLUSION: Cord 17 alpha-OHP concentrations were very high as previously described, probably owing to steroid production by fetal adrenal glands. Therefore, cord blood is not useful for screening purposes. Thereafter there is a gradual decline in 17 alpha-OHP median concentrations. A cut off value of 30 nmol/l blood was useful in samples obtained after 48 hours of life. However, cut off values before 48 hours should be adjusted according to the sampling time.
Adrenal Hyperplasia, Congenital↗
Comparison of outcome measures in patients with COPD.
Explore the source record for details and available documents.
Data Collection↗
Rasch measurement for reducing the items of the Nottingham Health Profile.
The present study aimed to develop a short form of the Spanish version of the Nottingham Health Profile (NHP) by means of Rasch analysis. Data from several Spanish studies that included the NHP since 1987 were collected in a common database. Forty-five different studies were included, covering a total of 9,419 subjects both from the general population and with different clinical pathologies. The overall questionnaire (38 items) was simultaneously analyzed using the dichotomous response model. Parameter estimates, model-data fit and separation statistics were computed. The items of the NHP were additionally regrouped into two different scales: Physical (19 items) and Psychological (19 items). Separated Physical and Psychological parameter estimates were produced using the simultaneous item calibrations as anchor values. Misfitting items were deleted, resulting in a 22 item final short form (NHP22)-11 Physical and 11 Psychological-. The evaluation of the item hierarchies confirmed the construct validity of the new questionnaire. To demonstrate the invariance of the NHP22 item calibrations, Rasch analyses were performed separately for each study included in the sample and for several sociodemographic and health status variables. Results confirmed the validity of using the NHP22 item calibrations to measure different groups of people categorized by gender, clinical and health status.
Health Status Indicators↗
Chronic obstructive pulmonary disease stage and health-related quality of life. The Quality of Life of Chronic Obstructive Pulmonary Disease Study Group.
BACKGROUND: The American Thoracic Society recently recommended that chronic obstructive pulmonary disease be staged on the basis of the percentage of predicted FEV1. OBJECTIVE: To examine 1) the relation between the american Thoracic Society system for staging chronic obstructive pulmonary disease and health-related quality of life and 2) the effect of self-reported comorbid conditions on health-related quality of life. DESIGN: Cross-sectional study. SETTING: Outpatient clinics of respiratory departments of four hospitals and one primary health care center in spain. PATIENTS: 321 consecutive male patients with chronic obstructive pulmonary disease. MEASUREMENTS: Functional respiratory impairment, FEV1, respiratory symptoms, and health-related quality of life. Respiratory symptoms and health-related quality of life were measured by using the Spanish version of the St. George's Respiratory Questionnaire and the Nottingham Health Profile. RESULTS: Patient scores on the St. George's Respiratory Questionnaire were moderately to strongly associated with disease staging (r = 0.27 to 0.51). Compared with reference values, values for health-related quality of life for patients with stage I disease were substantially higher on the St. George's Respiratory Questionnaire (6 and 34; p < 0.001) and values for impairment were significantly greater in stage 1 patients with comorbid conditions (19 and 36; P = 0.001). At least one concomitant chronic condition was found in 84% of study patients. Comorbid conditions only partly influenced the observed pattern of deterioration of health-related quality of life with worsening stages of disease. CONCLUSION: Staging criteria for chronic obstructive pulmonary disease based on percentage of predicted FEV1 separated groups of patients with varying degrees of impairment in health-related quality of life. Contrary to expectations, even patients with mild disease showed substantially compromised health-related quality of life. Comorbid conditions influenced the relation between chronic obstructive pulmonary disease and health-related quality of life.
Comorbidity↗
Prevalence of selective IgA deficiency in Spain: more than we thought.
Explore the source record for details and available documents.
Adolescent↗
[Criteria to assess the quality of health measurement tools].
Explore the source record for details and available documents.
Health Status Indicators↗
Prenatal exposure to salicylates and gastroschisis: a case-control study.
Gastroschisis, which is a defect in the abdominal wall, lateral to the umbilical cord, is considered to be a vascular problem, probably due to a disruption of the omphalomesenteric artery [Hoyme et al. (1981) J. Pediatr. 98:228-231]. Recently, Torfs et al. [(1996) Teratology 54:84-92] observed a significantly increased risk for aspirin and ibuprofen, two strong cyclooxygenase inhibitors. Here we present the results of a case-control study conducted by the Spanish Collaborative Study of Congenital Malformations (ECEMC) on the relationship between prenatal exposure to salicylates during the first trimester of pregnancy and gastroschisis. The results show an increased risk (OR = 3.47; P = 0.015) after controlling the possible effect of maternal age and maternal smoking during pregnancy.
Abdominal Muscles↗
Are results of the SF-36 health survey and the Nottingham Health Profile similar? A comparison in COPD patients. Quality of Life in COPD Study Group.
A number of questionnaires have been used to assess the health-related quality of life of patients with chronic obstructive pulmonary disease (COPD). The study compares the performance of the SF-36 and the Nottingham Health Profile (NHP) in a sample of 321 male patients with COPD. Score distributions, reliability estimates, and several item scaling tests, including Rasch analysis were compared. Finally, we assessed the relative ability of the two instruments considered in discriminating different levels of disease severity by comparing: (a) their correlations with dyspnea and %FEV1; the receiver operating characteristic (ROC) curves; and the F-statistics. The SF-36 scores were less skewed and more homogeneously distributed than NHP scores. Item scaling tests and reliability estimates showed a better performance of SF-36 items and scales. Nevertheless, results of Rasch analysis evidenced that both instruments have very similar scaling characteristics. Validity results did not show a consistent pattern of superiority for either of the instruments. For the physical domain, correlations of NHP and SF-36 scores with %FEV1 and dyspnea were very similar and substantial (tau > or = 0.30). F-statistics showed that SF-36 physical scale was more precise (86%) than the NHP counterpart in discriminating among levels of dyspnea and %FEV1 impairment. Nevertheless, the ROC curve and its associated area under the curve did not show a significant difference (p > 0.10). Overall results suggest that both instruments are similar in discriminating among different levels of respiratory impairment.
Data Interpretation, Statistical↗