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PubMed1999

Development and validation of a questionnaire to measure asthma control.

International guidelines on asthma management indicate that the primary goal of treatment should be optimum asthma control. The aim of this study was to develop and validate the Asthma Control Questionnaire (ACQ). The authors generated a list of all symptoms used to assess control and sent it to 100 asthma clinicians who were members of guidelines committees (18 countries). They scored each symptom for its importance in evaluating asthma control. From the 91 responses, the five highest scoring symptoms were selected for the ACQ. In addition, there is one question on beta2-agonist use and another on airway calibre (total questions=7). The ACQ was tested in a 9-week observational study of 50 adults with symptomatic asthma. The ACQ and other measures of asthma health status were assessed at baseline, 1, 5 and 9 weeks. In patients whose asthma was stable between clinic visits, reliability of the ACQ was high (intraclass correlation coefficient (ICC)=0.90). The questionnaire was very responsive to change in asthma control (p<0.0001). Cross-sectional and longitudinal validity were supported by correlations between the ACQ and other measures of asthma health status being close to a priori predictions. In conclusion, the Asthma Control Questionnaire has strong evaluative and discriminative properties and can be used with confidence to measure asthma control.

Adolescent↗
PubMed2000

Steering simulation performance in patients with obstructive sleep apnoea and matched control subjects.

Patients with obstructive pulmonary disease (OSA) have an increased rate of driving accidents, perhaps due to poor vigilance or impaired cognitive skills that influence their driving ability. The authors have assessed whether patients with OSA perform differently to control subjects on a steering simulator which allows the separate assessment of the two visual tasks required for steering a car, immediate positioning on road with reference to the road edges, and assessment of the curve of the oncoming road which allows faster driving. Twelve patients with OSA and 12 control subjects, matched for age, sex and driving experience, performed three 30-min drives with either all the oncoming road visible, only the near part of the road visible, or only the distant part of the road visible. Steering was assessed by measuring the SD around the theoretical perfect path (steering error) and the number of times the driver went "off road". Subjects identified the appearance of target numbers at the four corners of the screen as quickly as possible, thus making the test a divided attention task. Patients with OSA performed significantly less well on the three different road fields as measured by steering error (p<0.001), time to detect the target number (p<0.03), and off road events (p<0.03). The patients appeared to be particularly impaired on the two drives when only part of the road ahead was available to guide steering. This steering simulator, with its more realistic view of the road ahead, identifies impaired performance in patients with obstructive sleep apnoea. In addition it suggests that patients with obstructive sleep apnoea may be more disadvantaged compared to normal subjects when the view of the road ahead is limited (such as in fog).

Adult↗
PubMed2006

Long-term eruptive activity at a submarine arc volcano.

Three-quarters of the Earth's volcanic activity is submarine, located mostly along the mid-ocean ridges, with the remainder along intraoceanic arcs and hotspots at depths varying from greater than 4,000 m to near the sea surface. Most observations and sampling of submarine eruptions have been indirect, made from surface vessels or made after the fact. We describe here direct observations and sampling of an eruption at a submarine arc volcano named NW Rota-1, located 60 km northwest of the island of Rota (Commonwealth of the Northern Mariana Islands). We observed a pulsating plume permeated with droplets of molten sulphur disgorging volcanic ash and lapilli from a 15-m diameter pit in March 2004 and again in October 2005 near the summit of the volcano at a water depth of 555 m (depth in 2004). A turbid layer found on the flanks of the volcano (in 2004) at depths from 700 m to more than 1,400 m was probably formed by mass-wasting events related to the eruption. Long-term eruptive activity has produced an unusual chemical environment and a very unstable benthic habitat exploited by only a few mobile decapod species. Such conditions are perhaps distinctive of active arc and hotspot volcanoes.

Animals↗
PubMed1998

Re-accreditation, re-certification and the postgraduate database.

A consultation paper from the GDC has suggested that there will be a re-accreditation and re-certification procedure for dental practitioners which will require evidence of continuing postgraduate education. There is debate as to how that information should be held and who should hold it.

Accreditation↗
PubMed1998

Rhinitis management: the patient's perspective.

Seasonal allergic rhinitis causes considerable impairment of health-related quality of life (HQRL). Generic quality-of-life questionnaires enable a comparison to be made between patients with different illnesses, but they often have insufficient depth to measure specific problems that are important to an individual with a particular condition. In order to overcome these shortcomings, the Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) was developed. Eighty-nine patients, with a wide range of rhinoconjunctivitis severity, scored a list of 91 problems for importance. The highest-scoring problems were the practical problems: continually having to blow the nose, rub the nose and eyes, and carry tissues. Patients were also bothered by sleep impairments and systemic problems such as tiredness, poor concentration and thirst. Questionnaires have also been developed for adolescents (12-17 years of age)--finding similar results to those for adults--and children (6-12 years of age), who were troubled by their symptoms but did not have the emotional dysfunction experienced by adults and adolescents. All three questionnaires have strong measurement properties and have high reliability and good responsiveness, validity and interpretability. Quality-of-life questionnaires can be used in clinical studies to help elucidate which treatments are preferred by patients and the efficacy of treatment regimens. Disease-specific quality-of-life questionnaires can also be used during routine assessments and may reveal problems not spontaneously volunteered by patients, particularly children. Results can also be compared at each clinic visit to determine whether each intervention has been beneficial.

Adolescent↗
PubMed2000

Development and validation of the mini Rhinoconjunctivitis Quality of Life Questionnaire.

BACKGROUND: The 28-item Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ) has strong measurement properties but for large clinical trials, surveys and practice monitoring, where high efficiency is important, a shorter questionnaire is needed. OBJECTIVE: To develop and validate an abbreviated version of the RQLQ. METHODS: Using five RQLQ databases, items with high item-item correlations were combined and then the highest scoring items were selected for the MiniRQLQ (14 questions). There are five domains: activity limitations (standardized), practical problems and nose symptoms, eye symptoms and other symptoms. The MiniRQLQ, which is self-administered, was tested in a 5-week observational study in 100 adults with symptomatic rhinoconjunctivitis. Patients completed the MiniRQLQ, the RQLQ, and other measures of health status at baseline, 1 and 5 weeks. RESULTS: In patients whose rhinoconjunctivitis was stable between clinic visits, reliability (reproducibility and ability to discriminate between patients of different impairment) was very acceptable for the MiniRQLQ (ICC = 0.93) but not quite as good as for the RQLQ (ICC = 0.97). Responsiveness to change in clinical status was better with the MiniRQLQ than the RQLQ (P = 0. 044). Construct validity (correlation with other indices of health status) was strong for both the MiniRQLQ and the RQLQ. Concordance between the two instruments was high (ICC = 0.87). CONCLUSIONS: The MiniRQLQ has strong measurement properties and measures the same construct as the original RQLQ. The choice of questionnaire should depend on the task at hand.

Adolescent↗
PubMed2000

Comparison of the efficacy, safety and quality of life provided by fexofenadine hydrochloride 120 mg, loratadine 10 mg and placebo administered once daily for the treatment of seasonal allergic rhinitis.

BACKGROUND: As there have been no previously published studies, this multinational, double-blind, randomized, placebo-controlled, parallel group study compared the efficacy, safety and impact on quality of life (QoL) in seasonal allergic rhinitis patients (SAR) of fexofenadine and loratadine (with placebo), when administered once daily. METHODS: Six hundred and eighty-eight SAR patients were randomized to receive fexofenadine HCl 120 mg, loratadine 10 mg or placebo, once daily for 2 weeks. The key parameters were the change from baseline in: mean 24-h reflective total symptom scores (TSS); sum of four individual symptom scores, excluding nasal congestion; instantaneous TSS; individual symptom scores including nasal congestion; and Rhinoconjunctivitis Quality of Life Questionnaire (RQLQ). Adverse events were recorded. RESULTS: Mean 24-h reflective and instantaneous TSS were significantly reduced by both fexofenadine HCl (both P </= 0.0001) and loratadine (P </= 0.001 and P </= 0.005, respectively) compared with placebo (n = 639). Among individual symptom scores, fexofenadine HCl was significantly better than loratadine in improving 24-h reflective itchy, watery, red eyes, as well as relieving nasal congestion (P </= 0.05 for both). Fexofenadine HCl was also significantly better than loratadine (P </= 0.03) and placebo (P </= 0.005) in improving QoL, and the differences were of a magnitude considered to be clinically relevant. Loratadine had no statistically significant effect on QoL compared with placebo. The incidence of adverse events was low and similar across all treatment groups. CONCLUSION: Fexofenadine HCl and loratadine administered once daily are effective and well tolerated in SAR. In this study, fexofenadine HCl was significantly more effective than loratadine in relieving eye symptoms and nasal congestion. Furthermore, fexofenadine was significantly better than loratadine in improving QoL.

Adolescent↗
PubMed2001

Measuring asthma control in group studies: do we need airway calibre and rescue beta2-agonist use?

Collection of airway calibre and beta2-agonist data in large clinical trials and epidemiological surveys is sometimes difficult and may be an inefficient use of resources. The aim of this study was to determine whether the omission of the forced expiratory volume in 1 sec (FEV1) and beta2-agonist questions from the seven-item Asthma Control Questionnaire (ACQ) alters its measurement properties and validity. In an observational study, 50 adults with symptomatic asthma attended the clinic at 0, 1, 5 and 9 weeks to complete the ACQ and other measures of asthma status. All patients completed the study and provided complete data sets. Omission of the FEV1 and beta2-agonist questions from the ACQ made minimal difference to the reliability, responsiveness, and both cross-sectional and longitudinal validity of the instrument. Omission of the FEV1 question significantly lowered the summary score (P<0.001) but omission of the beta2-agonist question did not alter it (P>0.05). In group studies, both the FEV1 and beta2-agonist questions may be omitted from the ACQ without changing the validity or the measurement properties of the instrument. Lowering of the summary score by the omission of the FEV1 question means that data from this abbreviated form cannot be combined with or compared to data collected using the full questionnaire.

Adolescent↗
PubMed1999

Association between paroxysmal trigeminal neuralgia and atypical facial pain.

Paroxysmal trigeminal neuralgia and atypical facial pain are both fairly common conditions that produce pain in the face of different character. Trigeminal neuralgia is sharp and shooting, brought on by facial movement, change of temperature and by touching the face at a specific point (the trigger point). Atypical facial pain is dull and unrelenting and its site is ill-defined. Trigeminal neuralgia is generally more common in older people, and affects women slightly more than men, and atypical facial pain generally affects younger people, with women predominating. The pains should never be confused. We have noticed that many patients with trigeminal neuralgia have additional symptoms of atypical facial pain and so we reviewed the records of the Pain Relief Unit retrospectively. Of the 83 patients identified with trigeminal neuralgia where records were adequate, 35 (42%) also had atypical facial pain. Five of these had developed it before the onset of trigeminal neuralgia and could be examples of pretrigeminal neuralgia. There were eight patients in the series with multiple sclerosis, of whom two also had atypical facial pain. There seemed to be no relationship between the development of atypical facial pain and the interventions used to treat trigeminal neuralgia. It is important that both conditions are identified and treated individually.

Acute Disease↗
PubMed2003

A questionnaire to measure quality of life in adults with nocturnal allergic rhinoconjunctivitis.

BACKGROUND: Many patients with rhinoconjunctivitis experience symptoms at night and these interfere with getting a good night's sleep. OBJECTIVE: The aim of this study was to develop the Nocturnal Rhinoconjunctivitis Quality of Life Questionnaire (NRQLQ) to measure the functional problems that are most troublesome to patients with nocturnal allergic rhinoconjunctivitis (NAR). METHODS: After generating a list of 256 potentially important items, 132 patients with NAR identified the items that were most troublesome. The top scoring 16 items are included in the NRQLQ in four domains (sleep problems, symptoms during sleep time, symptoms on waking and practical problems). The NRQLQ asks patients to recall their experiences during the previous week and score each item on a 7-point scale. RESULTS: One hundred and six patients with NAR participated in a 3 week validation study. This showed the NRQLQ to have good reliability (ICC = 0.87) and responsiveness (responsiveness index = 0.93). For both cross-sectional and longitudinal construct validity correlations between the NRQLQ and other measures of health status were close to a priori predictions. CONCLUSIONS: The NRQLQ has strong evaluative and discriminative measurement properties and can be used with confidence in both clinical practice and clinical trials to measure the functional impairments that are most troublesome to patients with nocturnal allergic rhinoconjunctivitis.

Adult↗
PubMed2000

Influence of relative size at birth on growth and glucose homeostasis in twin lambs during juvenile life.

The effect of differences in size at birth on growth and glucose homeostasis between female twin lambs during juvenile life was examined. Twenty-six sets of twins were entered into the study, of which ten were used for organ sampling at birth and 16 were studied over the first year of life. Eleven sets were defined as being mismatched for birthweight as the weight difference between twins was >25%, with light lambs weighing 4.1 +/- 0.3 kg and heavy lambs weighing 5.1 +/- 0.1 kg. All remaining twins were matched in bodyweight, weighing 4.6 +/- 0.5 kg. During the rapid period of juvenile growth (i.e. one, three and six months of age) and following stabilization of bodyweight (i.e. 12 months of age) glucose tolerance tests were performed by intravenously injecting 0.8 mg kg(-1) bodyweight glucose. This was followed the next day with an insulin tolerance test, performed by intravenously injecting 0.08 units kg(-1) bodyweight insulin. At birth there were no differences in organ weight as a fraction of total bodyweight between matched and mismatched twins, but the ratio of liver to brain weight was lower in light compared with heavy twins. Light lambs remained lighter than their twins up to six months of age, and crown-rump length was also shorter. At one and three months of age there were no differences in basal plasma glucose concentrations between the groups, but glucose tolerance was greater in light compared with heavy lambs at one and six months of age. Insulin tolerance was greater in light compared with matched lambs at one and six months of age. In conclusion, it has been shown that size at birth of one twin in relation to its co-twin is one factor determining glucose regulation during postnatal life. This not only affects glucose and insulin tolerance but also growth over the first six months of age.

Abdomen↗
PubMed1998

Maternal nutrition in early-mid gestation and placental size in sheep.

We investigated the influence of restricted maternal nutrition between 30 and 80 d gestation on placental growth. Singleton-bearing ewes were fed on either 0.6 (i.e. nutrient restricted) times their energy requirements of 2.25 times this amount (i.e. controls) up to 80 d gestation, when their placentas and fetuses were sampled and analysed. Nutrient-restricted ewes lost body condition score but not body weight and had lower plasma thyroid hormone concentrations than controls, but there were no differences in plasma glucose, non-esterified fatty acids or 3-hydroxybutyrate concentrations between groups. There was no effect of maternal nutrient restriction on fetal weight, conformation or organ weight with the exception of brain weight which was lower nutrient-restricted ewes. Nutrient restriction had no effect on total placental weight, or proportion of inverted placentomes, but was associated with an increased abundance of small placentomes and decreased weight of the fetal but not maternal components of the placenta. Fetal cotyledons form nutrient-restricted ewes also had a lower DNA but higher haemoglobin concentration than those sampled from controls. The plasma concentration of triiodothyronine in umbilical cord plasma was also increased in fetuses from nutrient-restricted ewes. In conclusion, maternal nutrient restriction during early-mid gestation is associated with a smaller placenta.

Animal Nutritional Physiological Phenomena↗
PubMed2006

Eating disorder attitudes and psychopathology in Caucasian Australian, Asian Australian and Thai university students.

OBJECTIVE: To examine eating disorder attitudes and psychopathology among female university students in Australia and Thailand. METHOD: Participants were 110 Caucasian Australians, 130 Asian Australians and 101 Thais in Thailand. The instruments included the Eating Attitudes Test (EAT) and the Eating Disorders Inventory (EDI). RESULTS: Eating disorder attitudes and psychopathology scores in the Thai group were found to be highest. The Asian Australian group did not have significantly higher scores on the EAT-26 than the Caucasian Australian group, but had higher scores in some subscales of the EDI-2. That the Thai group had the highest scores in susceptibility to developing an eating disorder and eating disorder psychopathology may be partially explained in sociocultural terms, with pressure to be thin more extreme in Thailand than in Australia. The evidence suggested that unhealthy eating disorder psychopathology is not limited to Western societies but is already present in Thai and other Asian societies.

Adolescent↗