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PubMed2006

Long-term effects of an educational intervention on self-medication and appropriate drug use in single-sex secondary public schools, Quito, Ecuador.

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT: *Self-medication is extensively practised in both developed and less-developed countries, sometimes inappropriately. *Educational intervention in secondary schools has been proven to be useful. *Most educational interventions in adolescent populations have focused on the reduction of addictive substance abuse. WHAT THIS STUDY ADDS: *Educational intervention can improve knowledge about self-medication and reduce misconceptions about diarrhoea, common cold and vitamins in an adolescent population. *A specific lecture followed by small working-group seminars produces better results than a general lecture alone in terms of 'knowledge' and 'attitude'. *The positive effects of the intervention are detectable even 1 year later. Yearly reinforcing interventions while in secondary school would allow long-lasting effects. AIM: Improving knowledge about rational drug use at an early age may be a good way to increase the population's awareness of health, medicines and self-medication. We set out to evaluate the short- and long-term effects of an educational intervention to promote rational drug use and self-medication in secondary school students. METHODS: A non-randomized, controlled clinical trial. The participants were 367 female students (10-13 years old) from two secondary public schools of the metropolitan district of Quito (Ecuador). The educational campaign had two components [a specific lecture (intervention and control schools) and subsequent small working group seminars (intervention school)] providing short and clear messages of five topics related to rational drug use. The main outcome measures were an increase in 'knowledge' short term (1 month) and long term (up to 1 year) after intervention and the relative risk (RR) reduction in misconceptions or wrong ideas about medicine use. RESULTS: The intervention group showed a significant increase in knowledge both short and long term and in comparison with the control group, mainly regarding oral rehydration salts preparation (+59.4%; P < 0.001), lack of multivitamin energizer action (+57.4%; P < 0.001), healthy growth effects (+53.3%; P < 0.001) and the perception that medicines' promotional activities do not teach how to take care of health (+54.0%; P < 0.001). A RR reduction in misconceptions about drugs was found short term and long term. The intervention group was less predisposed to consume antidiarrhoeals [RR = 0.75, 95% confidence interval (CI) 0.62, 0.92], cough suppressants (0.44, 95% CI 0.35, 0.55) and other medicines for the common cold (0.56, 95% CI 0.45, 0.70). Misconceptions concerning the benefits of multivitamin preparations were reduced in 73%; additionally, the intervention group showed a decrease in their consumption (43.9% basal; 25.3% short term and 25.6% long term; P < 0.001). CONCLUSION: It is possible to achieve a favourable modification of attitudes to appropriate use of medicines in a teenage population and this modification lasts at least 1 year. Continuous reinforcing interventions would allow better and long-lasting effects and could help to fill the gap in health education of the general population.

Adolescent↗
PubMed2002

Biochemical characterization of rhinovirus RNA-dependent RNA polymerase.

Human rhinoviruses (HRV) represent the single most important causative agent of the common cold. The HRV genome encodes an RNA-dependent RNA polymerase (RdRp) designated 3D polymerase that is required for replication of the HRV RNA genome. We have expressed and purified recombinant HRV-16 3D polymerase to near homogeneity from Escherichia coli transformed with an expression plasmid containing the full-length 460 amino acid HRV-16 3D sequence with a methionine at the N-terminus and a glycine-serine linker followed by a 6-histidine affinity tag at the C-terminus. The purified recombinant protein has rifampicin-resistant activity in a poly(A)-dependent poly(U) polymerase assay while corresponding fractions similarly purified from E. coli transformed with an expression plasmid without the HRV-16 3D sequence showed no activity. The optimal conditions for temperature, pH, divalent cations Mg(2+) and Mn(2+), and KCl were determined. The recombinant protein has RNA polymerase activity on homopolymeric templates poly(A) and poly(C) and heteropolymeric RNA templates primed with either RNA or DNA oligonucleotide primers or self-primed by a copy-back mechanism. A unique, secondary structureless heteropolymeric RNA template that is an efficient substrate was developed to facilitate kinetic characterizations of the enzyme. In the presence of Mg(2+), the enzyme displayed strong base and sugar specificity. However, when Mg(2+) was replaced by Mn(2+) specificity for ribonucleotides was lost, utilization of deoxynucleotides became possible and primer-independent activity was observed on the poly(C) template. Zn(2+) was found to inhibit HRV-16 3D polymerase with an IC(50) as low as 0.6 microM by a mechanism distinct from the magnesium ion stimulation. The activity of this 6His-tagged HRV-16 3D polymerase was compared with that of a recombinant HRV-16 3D polymerase expressed without the 6His-tag and was found to be identical. The availability of recombinant rhinovirus RdRp in a purified form will facilitate the structure-function analysis of this enzyme as well as the identification of specific inhibitors to the rhinovirus 3D polymerase that have therapeutic value in the treatment of the common cold.

Cations, Divalent↗
PubMed2006

Ambroxol for the prevention of acute upper respiratory disease.

Although acute upper respiratory diseases (AURDs) such as common cold and influenza are common, few interventions have been proven to be effective in their prevention and treatment. The aim of this study was to assess the efficacy of ambroxol for preventing AURD. Fifty-four patients were randomly divided into 3 groups: a rebamipide (non-mucoactive drug) group (300 mg/day), carbocisteine group (1500 mg/day) and ambroxol group (45 mg/day). The study was divided into 2 terms, the first half-year (summer season) and the second half-year (winter season). In the preceding winter, only 19.5% of the patients had been vaccinated against influenza viruses (flu). The primary goal of this study was to evaluate the effectiveness of mucoactive drugs in decreasing the frequency of AURD. Treatment with ambroxol, but not carbocisteine, significantly reduced the median number of AURD episodes (P=0.0049 vs. rebamipide). Thirty-three patients without vaccination against flu were assessed especially during the second half-year. Treatment with ambroxol also significantly reduced the median number of AURD episodes in this assessment (P=0.0028 vs. rebamipide in the second half-year). In conclusion, ambroxol may be useful for preventing AURD.

Aged↗
PubMed2000

The role of respiratory viruses in acute and chronic asthma.

Respiratory infections can have dual effects related to asthma. First, there is increasing evidence that severe infections with RSV and PIV in infancy can alter lung development and physiology to increase the risks of subsequent wheezing and asthma. Second, infections with common cold viruses and influenza commonly precipitate wheezing symptoms in children and adults who already have established asthma, and RV appears to be the most important virus in producing exacerbations of the disease. The principal mechanisms by which this occurs appears to be viral replication in epithelial cells, triggering a cascade of inflammation involving granulocytes, macrophages, T cells, and secreted cytokines and mediators. The inflammatory process, although essential to clear the infection, augments pre-existing airway inflammation in asthma, leading to increased airway obstruction and lower respiratory tract symptoms. Greater understanding of virus-induced changes in inflammation and corresponding changes in airway physiology may lead to new therapeutic approaches to the treatment and prevention of virus-induced airway dysfunction.

Acute Disease↗
PubMed1999

Antibiotic prescribing by pediatricians for respiratory tract infection in children.

To examine antimicrobial prescribing rates for viral respiratory tract infections by primary care pediatricians in the greater Toronto area, charts were reviewed for the week of 17-21 February 1997 at 61 pediatricians' offices. Antibiotics were considered appropriate if the diagnosis was compatible with bacterial infection. A total of 3,585 patient visits were reviewed. The common cold was the most common respiratory tract syndrome leading to an office visit (1,317 visits). The overall rate of appropriate antibiotic prescribing was 89.5%. There was no significant difference in prescribing when physicians were compared by year of graduation from medical school, sex, or location of training. Diagnostic codes (ICD-9 [International Classification of Diseases, 9th edition] codes) did not match the chart diagnosis in 41% of cases. Toronto primary care pediatricians appear to have a lower rate of inappropriate antibiotic prescribing than do primary care physicians in other regions of Canada and the United States.

Anti-Bacterial Agents↗
PubMed2004

Proof of the mysterious efficacy of ginseng: basic and clinical trials: clinical effects of medical ginseng, korean red ginseng: specifically, its anti-stress action for prevention of disease.

We are exposed to many external and internal stresses in this day and age. Stress weakens the function of immune systems in living organisms and disturbs homeostasis. As a result, stress induces various psychosomatic diseases. Thus, ways of reducing stress and thus protecting humans from disease must be developed. One such method is called "the prevention of Mibyou" in Kampo, the Chinese traditional medicine. Many studies have reported the direct effects of medical ginseng on damaged target organs and recovery from disease. It also increases immune potential and may maintain homeostasis of living organisms through the autonomic-endocrine systems. It is also thought to prevent the development of disease. We studied and considered the action of medical ginseng on living organisms that were exposed to various stresses such as cold environment and industrial work. Furthermore, we confirmed the preventive effects of medical ginseng on the common cold symptom complex, including flu, by clinical observation. Here, we report our experiences.

Cold Temperature↗
PubMed2001

Audit of management of respiratory infections among children.

OBJECTIVE: To study the pattern of drugs prescribing for acute respiratory infections among young children under 5 years and to establish the first step in auditing acute respiratory infections management in two large Primary Health Care Centers in Abha, Asir region. METHODS: Three hundred and thirteen prescriptions of children less than 5 years old were selected randomly and evaluated for: age, sex, nationality, and drugs prescribed in two large Primary Health Care Centers in Abha city, Asir region, Saudi Arabia. The medical records of children who received antibiotics were further evaluated for: process of recording symptoms and signs and appropriateness with diagnosis. Structures of acute respiratory infections care in both Primary Health Care Centers were evaluated in both centers using checklist and scoring system. RESULTS: Common cold was the most common diagnosis encountered. Antibiotics were the most common prescribed drugs in both Primary Health Care Centers. Less than one third of files revealed appropriate recording of history and physical examination. CONCLUSION: There were inadequate structures in both Primary Health Care Centers which negatively affected the process of acute respiratory infections care in both centers. Urgent providing of those structures and establish continuing medical education for the Primary Health Care Center team and health education of the community about acute respiratory infections are two important priorities at both Primary Health Care Centers.

Community Health Centers↗
PubMed2002

Viral respiratory infection therapy: historical perspectives and current trials.

Attempts to relieve the misery of the common cold have been made since long before current understanding of its viral origin. Although current symptomatic therapies provide some relief, any effective treatment must incorporate an antiviral to address the infection. Symptom production is related not only to viral cytopathic effect but also to the early activation of several inflammatory pathways. Antiviral treatment alone may not be able to prevent these events. Combining an antiviral with selected therapeutic agents that block these inflammatory pathways has been shown to improve the effectiveness of cold treatment. Early diagnosis and initiation of treatment combined with regular dosing until symptoms subside appears to be the most effective treatment strategy to maximize therapeutic outcomes. This strategy reduces viral shedding in nasal fluid, provides treatment for the period of maximum symptom burden, and may reduce the frequency and severity of the sinus disease that accompanies colds.

Antiviral Agents↗
PubMed1978

Diarrhea and school toilet hygiene in Cali, Colombia.

In a 4-week period in early 1976 in a poor, working class area of Cali, Colombia, the prevalences of diarrhea, vomiting, common cold, and head lice in schoolchildren were measured in relation to classroom size and to the condition of the school toilets. The study found that unhygienic toilet conditions were related to diarrhea, and it was estimated that if all schools could reach the modest level of hygiene of the two schools with the relatively best facilities, diarrhea would be reduced by 44% and vomiting by 34%. Toilet hygiene was found to be unrelated to colds or head lice, which have similar social class distributions to diarrhea and vomiting. Crowding was found to be related to a small percentage of the prevalences of vomiting, head lice and colds.

Child↗
PubMed1995

Lower airways inflammation during rhinovirus colds in normal and in asthmatic subjects.

Human rhinoviruses (HRV) cause the majority of common colds and are etiologically linked with changes in lower airways physiology and asthma exacerbations. We hypothesized that changes in bronchial mucosal inflammatory cell populations may be responsible for HRV-induced changes in airway reactivity. We examined bronchial mucosal biopsies during experimental infections with HRV serotype 16 and measured changes in histamine reactivity. Seventeen adult volunteers (six atopic asthmatics) had baseline measurements of histamine reactivity and fiberoptic bronchoscopic biopsies, followed 2 wk later by viral inoculation. Further bronchial biopsies were taken on Day 4 of the infection and 6 to 10 wk later. Mast cells, eosinophils, lymphocytes, and neutrophils were quantified by immunohistochemical techniques. Infection was documented by viral culture, seroconversion, and symptoms. An increase in histamine responsiveness during the cold (p = 0.048) was accompanied by increases in submucosal lymphocytes (p = 0.050). There was a subsequent decrease in submucosal and epithelial lymphocytes in convalescence (p = 0.028; p = 0.030). There was an increase in epithelial eosinophils with the cold (p = 0.042), and in asthmatics this appeared to persist into convalescence. A peripheral blood lymphopenia correlated with increased responsiveness (r = 0.062, p = 0.014). Rhinoviral colds are associated with a bronchial mucosal lymphocytic and eosinophilic infiltrate that may be related to changes in airway responsiveness and asthma exacerbations.

Adult↗
PubMed1987

[Temperature changes in the mouth and pharyngeal mucosa during alternating cold and warm footbaths].

Cold and changing (warm/cold) footbaths in a curative dosage, used in physiotherapy, at first have the effect of constantly elevating the temperature of the oral and oropharyngeal mucosa. With longer duration and overdosage of the cold irrigation, a steep decrease of the mucosa temperature ensues. The extent of this reaction is determined by circadian variations. The importance of the elevation of the temperature of the mucosa is discussed with reference to resistance against infections from the common cold.

Adult↗
PubMed1995

Rhinoviruses and cells: molecular aspects.

Recent developments in our understanding of the molecular structure and functioning of the human rhinoviruses are briefly reviewed. The determination of virus structure at near atomic resolution has provided a wealth of information that can be used to help interpret dynamic properties of the virus. The mechanisms involved in capsid assembly, attachment to cell surfaces, uncoating, and the initiation of infection and antibody-mediated neutralization of infectivity can all be examined afresh in the light of the structural data. In addition, molecular techniques for manipulating and analyzing the biological properties of nucleic acids and proteins are providing a wealth of information on details of the replication machinery of the viruses. Probably one of the least understood aspects of viral replication is the precise nature of the interactions between host and viral components during infection. Unfortunately, despite all of these impressive scientific advances the cure for the common cold is still elusive.

Capsid↗
PubMed1976

The cost of upper respiratory tract infections in Canadian children.

We reviewed reports of the incidence, duration, causative organism, sequelae, and cost of upper respiratory tract infections (URI). Using these data, we projected the extent and cost of URI in Canadian children from birth to age 14. We estimated that in 1973, some 6.2 million Canadian children suffered between 23.8 and 42.3 million episodes of URI, of which 5.6 million needed medical attention; approximately 215,300 children were admitted to hospital for treatment of URI-related diseases and utilized 742,800 hospital days. Some direct costs were estimated, including physicians' fees, hospitalization, antibiotics, "cold remedies", and pharmacists' prescription fees; in 1973 these ranged from $141 million to $211 million. The common cold is as common as its name implies, and we need to intensify the search for a solution. Until this is found, both medical profession and the public should be warned of the uselessness, and possible hazards of some of the "remedies" for colds, and made aware of the vast amounts of money expended upon them.

Adolescent↗
PubMed2000

Effect of clarithromycin on experimental rhinovirus-16 colds: a randomized, double-blind, controlled trial.

PURPOSE: Macrolide antibiotics are frequently prescribed to patients with symptoms of a common cold. Despite their lack of proven antiviral activity, macrolide antibiotics may have anti-inflammatory actions, such as inhibition of mucus secretion and production of interleukins 6 and 8 by epithelial cells. Because the symptoms of rhinovirus colds are attributed to the inflammatory response to infection, we studied the effects of treatment with clarithromycin on the symptomatic and inflammatory response to nasal inoculation with rhinovirus. SUBJECTS AND METHODS: We performed a prospective, double-blind, controlled trial in 24 healthy subjects who were seronegative for antibodies to rhinovirus-16. Subjects were randomly assigned to receive either clarithromycin (500 mg) or trimethoprim-sulfamethoxazole (800/160 mg, as a control antibiotic) twice a day for 8 days, beginning 24 hours before inoculation with rhinovirus-16. RESULTS: All 12 subjects in each group were infected and developed symptomatic colds. The groups did not differ in the intensity of cold symptoms (median [25th to 75th percentile] score in the clarithromycin group of 25 [5 to 33] versus 21 [11 to 26] in the trimethoprim-sulfamethoxazole group, P = 0.86), weight of nasal secretions (25 g [8 to 56 g] versus 12 g [5 to 28 g], P = 0.27), or decline in nasal peak flow during the 8 days following viral inoculation. In both groups, similar and significant increases from baseline were observed in the numbers of total cells and neutrophils, and in the concentrations of interleukins 6 and 8, in nasal lavage fluid during the cold. The changes that we observed did not differ from those in an untreated historical control group. CONCLUSIONS: We conclude that clarithromycin treatment has little or no effect on the severity of cold symptoms or the intensity of neutrophilic nasal inflammation in experimental rhinovirus-16 colds.

Adult↗
PubMed1992

Selective effects of colds and influenza on human performance efficiency: a critical appraisal.

This paper provides an appraisal of the results published from the MRC Common Cold Unit on human performance efficiency during minor upper respiratory tract infection, i.e., colds and influenza. Despite strict controls employed in the methods of data collection, the robustness of the results and some of the conclusions drawn are questioned. In particular, the claim that colds and influenza lead to selective (and different) effects is criticised as being based on incomplete data. The lack of replication, the small sample sizes, possible response biases and use of controls are considered. Overall, it is argued that there are insufficient data to provide conclusive evidence for selective effects and that over-generalisation from such studies can be misleading.

Attention↗
PubMed1998

An epidemiological study of postviral olfactory disorder.

Postviral olfactory disorder develops after infection with the common cold, and is a relatively severe and prolonged disorder without rhino-sinusitis. This epidemiological study aimed to characterize its clinical pathology and determine the causative virus. Postviral olfactory disorder occurs most commonly in middle-aged women and is most prevalent in spring and summer. A comparison of the monthly frequency of the disorder with the incidence of isolation of various viruses suggest that the influenza virus, respiratory syncytial virus, and herpes virus are not causative viruses, while parainfluenza virus type 3 is most likely to be a causative virus. This conclusion is supported by immunological study and analysis of symptoms of the cold. All patients with postviral olfactory disorder had increased serum antibody titre for parainfluenza virus type 3. No prominent or specific symptoms of common cold were identified as a potential trigger of this syndrome in patient questionnaires.

Adult↗
PubMed2000

Transmission of viral respiratory infections in the home.

Respiratory viruses in the home exploit multiple modes of transmission. RSV is transmitted primarily by contact with ill children and contaminated objects in the environment. Influenza appears to be spread mainly by airborne droplet nuclei. Despite many years of study, from the plains of Salisbury, to the hills of Virginia, to the collegiate environment of Madison, WI, the precise routes rhinovirus takes to inflict the misery of the common cold on a susceptible population remain controversial.

Aerosols↗
PubMed2004

Complementary and alternative interventions in asthma, allergy, and immunology.

OBJECTIVE: To review which herbs are most commonly used as complementary and alternative medicine (CAM) for treatment of asthma, allergy, and immunologic conditions. DATA SOURCES: A review of the literature was performed using the PubMed and OVID databases searching the keywords asthma, allergy, and CAM to identify studies published between 1980 and 2003 that focused on Echinacea (Echinacea augustifolia, Echinacea pallida, and Echinacea purpurea); garlic (Allium); angelica; chamomile; ephedra; gingko; grape seed extract; licorice root (Glycyrrhiza); St. John's wort (Hypericum); kava kava (Piper); peppermint oil and leaf (Mentha); stinging nettle (Urtica); and ginseng (Panax) published in the English and German literature. STUDY SELECTION: Studies included in vitro and in vivo clinical trials and case reports selected according to the expert opinion of the author. RESULTS: Echinacea is one of the most common herbs used to treat symptoms of the "common cold" or upper respiratory tract allergies. Although no common drug interactions have been reported, there is a risk of hepatotoxicity, exacerbation of allergies and asthma, and anaphylactic reactions. Garlic is primarily used for cardiovascular health and relief of cough, colds, and rhinitis. Adverse effects commonly include gastrointestinal disturbances, change in body odor through the sweat and breath, and rarely allergic reactions or hypoglycemia. Other CAM agents, including angelica, German chamomile flower, ephedra, gingko, grape seed extract, licorice root, St. John's wort, kava kava rhizome, peppermint, stinging nettle, and ginseng, are also associated with significant adverse effects. CONCLUSION: The specialty of allergy and immunology has seen the second largest increase in the popularity of CAM (second only to practitioners who treat lower back pain). Almost all of the CAM interventions have displayed adverse effects, usually in the form of a hypersensitivity reaction. Allergists and clinical immunologists need to become more knowledgeable about CAM so that they can inform patients about the use and possible abuse of these modalities.

Asthma↗