Thesis (M.Sc.(Anatomy))--University of Pretoria, 2009. / Includes bibliographical references.

The thesis gives examples of analysing time series data while being employed as statistician at the Industrial and Community Health Research Centre, North Staffordshire Medical Institute, Hartshill Road, Stoke-on-Trent for the period 1988-1997. Topics include:(a) the analysis of asthma data with a view to aid detection and confirmation of occupational asthma. This project highlights possible approaches for modelling regularly and unequally spaced observations (b) modelling bleeding and behavioural patterns of handicapped people using binary valued time series (c) a repeated measures analysis following a surgical intervention (d) a study relating mood scores to progesterone levels

Asthma is a common chronic disease for children and is a leading cause for their hospitalization. Despite its negative health impact, a local survey has shown that children with asthma as well as their parents have a lack of understanding for asthma management (Wong, Wong, Chung & Lau, 2001). However, to help asthmatic children to better cope with their condition, it is important for health care professional such as nurses to enhance their knowledge in asthma management. Recent empirical research has shown that education promoting knowledge of asthma management can improve health outcomes in asthmatic children. Therefore, it is important to develop an evidence-based asthma education guideline for them. This dissertation aims to evaluate the empirical evidence of the education program for asthmatic children, with the age ranging from 5 to 18, and their parents. The goal of the proposed program is to reduce their re-hospitalization rate by enhancing their knowledge of asthma care. A translational nursing research was conducted and 10 studies focusing on asthma education program for children and their parents were identified from electronic databases. Critical appraisal was performed using the recognized assessment tool, named the Scottish Intercollegiate Guidelines Network (SIGN) (2008). Recommendations were developed based on the data extracted from the review. Based on the literatures reviewed, it was found that a 45-to-60 minute one-to-one educational intervention conducted by nurses using self-management plan is the most effective method for improving the health outcomes for asthmatic children. A plan of translating the empirical information extracted from the review into practice was developed and the potential of implementation was assessed. Based on the assessment, it was found that there is high transferability of the findings from the review and the proposed innovation is feasible in the selected clinical setting. In addition, the benefits generated from the proposed innovation also outweigh its cost. An evidence-based guideline was then developed based on the high and medium level of evidence. The grades of the recommendation were stated as well. A comprehensive communication plan targeting on various stakeholders was prepared. A pilot study was designed to examine the feasibility of the proposed innovation before the full-scale implementation. The outcomes of the proposed innovation include the re-hospitalization rate of asthmatic children, the patients’ and nurses’ level of knowledge in asthma care, the satisfactory level of patients and nurses towards the innovation, the competency of nurses in conducting the innovation, and the utilization rate and the cost of the innovation. They would be evaluated using appropriate methodologies. The proposed innovation would be considered as effective if the primary outcome, the re-hospitalization rate of asthmatic children is reduced. / published_or_final_version / Nursing Studies / Master / Master of Nursing

No description available.

Background: Work-related asthma (WRA) is under-recognized and early detection is associated with improved outcomes. The Work-related Asthma Screening Questionnaire (Long-version) (WRASQ(L)) is a 14-item tool designed to increase the detection of WRA in primary care. Purpose: The purpose of this study was to assess whether the WRASQ(L) provided additional and reliable information on a patient’s likelihood of WRA, beyond what is collected in standard care, to explore the relationship of WRASQ(L) responses to clinical actions and to assess the use of the WRASQ(L) in the primary care setting. Methods: This was an intervention study involving two Ontario Primary Care Asthma Program (PCAP) sites assigned the WRASQ(L). Standard care for asthma patients in PCAP sites involved completing the Asthma Care Map (ACM), a clinical pathway which included seven WRA screening items. Consent to participate in this study involved completing an electronic WRASQ(L) at each visit for participants and prompted care providers to record details related to WRA investigations. Results: The study sample (N=37) was predominantly female (73.0%), with a mean age of 46.3 years (SD, 10.9). Use of the WRASQ(L) identified work-related symptoms, exposures and high- risk past occupations in 38% and 60% and 47% of participants, respectively, that were not identified in standard care. Two participants were newly-suspected cases of WRA during this study period. WRASQ(L) items demonstrated fair to moderate reproducibility, but estimates may have been subject to measurement error. Incorporation of the electronic WRASQ(L) in clinical care was limited by time constraints and technical factors, such as ease of use and flexibility of the application. Conclusions: The WRASQ(L) provided added information about possible WRA over standard care. Use of the questionnaire’s results by care providers in this study was limited due to barriers encountered in incorporating the use of the WRASQ(L) in clinical practice. Future directions include the validation of this tool in relation to WRA diagnosis. The WRASQ(L) has the potential to increase recognition of WRA, improving long-term health outcomes for those with WRA. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2012-09-27 21:16:28.59

Historically, the primary belief has been that asthma is an atopic disease with the strongest risk factor for developing asthma being exposure to an allergen. However, researchers have begun to question that long held belief and are beginning to study other postnatal environmental factors such as stress. Research delving into maternal postnatal distress and the subsequent effects seen upon the developing neonatal immune system as it pertains to asthma has gained momentum. With that in mind, the focus of this research was 1) to determine if skin infections are more likely to be seen in young children who have been exposed to maternal distress, 2) to determine if skin infections in children from infancy to age 2 are associated with asthma, independent of atopic dermatitis, and 3) to determine if the association between early life skin infection and asthma was independent of recent stress biomarkers such as cortisol and dehydroepiandrostrone (DHEA). To meet the objectives listed above, the 1995 SAGE (Study of Asthma, Genes and the Environment) Manitoba birth cohort of 13980 children was used. Maternal postnatal distress, skin infection and atopic dermatitis in the infant, asthma at age 11 and other risk factors for asthma were derived from Manitoba’s health care databases. For objective 3, data on stress biomarkers (Cortisol/DHEA ratio) were obtained from the SAGE nested case-control study. Multivariable logistic regression analysis confirmed the first objective that skin infections (adj. OR 1.25, 95% CI 1.13-1.39) and or atopic dermatitis (adj. OR 1.46, 95% CI 1.26-1.70) seen in children from birth to age 2 could be used as indirect markers of stress. The second objective determined that children who exhibited an early skin infection, from birth to age two, were at an increased risk for developing asthma by age 11 independent of atopic dermatitis. However, this finding was dependent upon frequency of health care use. Those children that exhibited an early skin infection and had less than 24 health care visits over 7 years were 1.33 times (95% CI 1.01-1.75) more likely to acquire asthma by age 11 than those who did not have an early skin infection. Children with fewer health care visits were 1.44 times more likely to have asthma. The third objective was not met because the association between early skin infection and asthma was not independent of the Cortisol/DHEA ratio. However, the univariate results for skin infection in the nested case-control study were not significant. The findings of this thesis may be used by family physicians or paediatricians when looking for tangible markers that may indicate infants at risk for developing asthma by school age.

Background and Rationale: Asthma and overweight are public health concerns. Lifestyle, including dietary and activity patterns, is associated with overweight and asthma. Moreover, an association between these two diseases has been described. Yet, few studies have considered these associations longitudinally in youth. Methods: Based on data from the 1995 Manitoba Birth Prospective Cohort (n=723, 404 [55.9%] boys), we designed a series of studies to address the question: “Do obesity and related lifestyle behaviours influence asthma and airway hyperresponsivess (AHR) outcomes in children?” Following protocol for a mixed methods sequential explanatory design study, we first considered this research question using quantitative methods. Exposure variables included weight status (body mass index (BMI); BMI z-scores; normal weight vs. overweight), diet, physical activity and screen time. Outcome variables included asthma and AHR at 8-10 years old and at 12-13 years old. Quantitative findings provided direction for the qualitative investigations. That is, we sought to further explain some of the quantitative findings using qualitative methods. For the qualitative portion of this dissertation, 15-16 year old youth were purposively selected (Winnipeg residency, asthma status, gender) from the 1995 Manitoba Prospective Birth Cohort. Due to recruitment challenges, participation was supplemented with youth from the Canadian Asthma Primary Prevention Study, using the same purposive selection criteria. Quantitative Results: Overweight at 12-13 years old was associated with a two-fold increased odds of persistent asthma in girls. In contrast, boys within the highest BMI quartile at 8-10 years old were nearly twice as likely to have remittent asthma at 12-13 years old. High vegetable intake was protective against allergic asthma and moderate-to-severe AHR by 50% and 42%, respectively. High screen time at 8-10 years old, particularly amongst overweight youth, was associated with an increased odds of asthma, but not AHR at 8-10 years and 12-13 years; there were no associations between physical activity, asthma and AHR. Qualitative Results: Youth spoke of asthma as a condition that neither limits physical activity, nor is an excuse for refraining from physical activity. Conclusions: Modest evidence that some quantitatively-measured weight and related lifestyle behaviours during the pubertal years is associated with asthma. Yet, qualitative data suggest that youth with asthma believe that physical activity is achievable despite their condition, although some describe that asthma interferes with physical activity.

Introduction: People with asthma suffer from lower fitness levels when compared to their peers. The abnormal respiratory response to exercise, known as exercise induced bronchoconstriction (EIB), in the majority of people with asthma is a barrier to improving fitness levels. EIB severity can be increased with airway inflammation, which can be measured by exhaled nitric oxide (eNO). One exercise protocol, high intensity interval exercise (HIIE), may decrease the risk of developing EIB in people with asthma. HIIE warm up studies have demonstrated that HIIE is feasible and reduces the incidence of EIB in subsequent exercise bouts. HIIE may be ideal for people with asthma because it can decrease the duration of high ventilation that can trigger EIB, and improve their fitness levels. The purpose of this study is to compare the acute respiratory effects of traditional constant workrate exercise to a novel HIIE protocol in adults with asthma. Methods: 5 females and 2 males with asthma were recruited to perform two randomly assigned exercise protocols: HIIE (30 seconds of 140% the peak workrate and 90 seconds at 20%) and constant workrate exercise (CWR) (60% peak workrate). Workrates were determined by a peak cardiopulmonary exercise test. Measures of pulmonary function and airway inflammation were done pre and post exercise protocols. During exercise protocols, operational lung volumes, heart rate, rating of perceived exertion (RPE) was obtained. Results: FEV1 decreased significantly in both exercise protocols (HIIE 3.91± 0.65 to 3.33 ± 0.61 vs. CWR 3.90 ±0.50 to 3.09 ± 0.63). eNO measurements decreased after both exercise protocols (HIIE 40.4± 34.8 vs. CWR 42.1 ± 36.3. Conclusion: FEV1 and eNO findings are similar in HIIE and CWR exercise in adults with asthma, therefore, the novel HIIE is a feasible exercise protocol to help improve fitness levels of adults with asthma.

Background Air pollution exposure has been shown to have adverse effects on several health outcomes, and numerous studies have reported associations with cardiovascular morbidity, respiratory disease, and mortality. Over the last decade, an increasing number of studies have investigated possible associations with pregnancy outcomes, including preterm delivery. High levels of vehicle exhaust in residential neighborhoods have been associated with respiratory effects, including childhood asthma, and preterm birth is also associated with childhood asthma. The first aim of this thesis was to investigate possible associations between air pollution exposure and pregnancy outcomes – primarily preterm delivery but also small for gestational age (SGA) and pre-eclampsia – in a large Swedish population (Papers I–III). The second aim was to study any association between exposure to high levels of vehicle exhaust during pregnancy and infancy and prescribed asthma medication in childhood (Paper IV). Methods The study cohorts were constructed by matching other individual data to the Swedish Medical Birth Register. In the first two studies, air pollution data from monitoring stations were used, and in the third and fourth studies traffic intensity and dispersion model data were used.Preterm delivery was defined as giving birth before 37 weeks of gestation. SGA was defined as having a birth weight below the 10th percentile for a given duration of gestation. Pre-eclampsia was defined as having any of the ICD-10 diagnosis codes O11 (pre-existing hypertension with pre-eclampsia), O13 (gestational hypertension without significant proteinuria), O14 (gestational hypertension with significant proteinuria), or O15 (eclampsia). Childhood asthma medication was defined as having been prescribed asthma medication between the ages of five and six years. Results We observed an association between ozone exposure during the first trimester and preterm delivery. First trimester ozone exposure was also associated with pre-eclampsia. The modeled concentration of nitrogen oxides at the home address was associated with pre-eclampsia, but critical time windows were not possible to investigate due to high correlations between time windows. We did not observe any association between air pollution exposure and SGA. High levels of vehicle exhaust at the home address, estimated by nitrogen oxides and traffic intensity, were associated with a lower risk of asthma medication. Conclusion Air pollution exposure during pregnancy was associated with preterm delivery and pre-eclampsia. We did not observe any association between air pollution levels and intrauterine growth measured as SGA. No harmful effect of air pollution exposure during pregnancy or infancy on the risk of being prescribed asthma medication between five and six years of age was observed.

Rationale: The pathophysiologic differences between classic asthma (CA), cough variant asthma (CVA), and methacholine (MCh)-induced cough but normal airway sensitivity (COUGH) are poorly understood and may relate to differences in small airway function. We hypothesized that the bronchodilating and bronchoprotective effects of DIs are: (a) absent or impaired in individuals with CA; (b) impaired in individuals with CVA; and (c) preserved in those with COUGH. Purpose: To compare the effect of DIs in individuals with CA, CVA and COUGH using high-dose methacholine (MCh). Methods: Individuals aged 18-65 years with CA, or suspected CVA attended 3 visits. On visit 1, subjects performed body plethysmography and high-dose MCh testing to a maximum change (Δ) in FEV1 of 50% from baseline (MAX). On visits 2 and 3, subjects performed one of two modified single-dose MCh challenge tests with or without DIs prior to MCh administration. Partial and maximal-flow volume curves (used to calculated a DI index), impulse oscillometry (IOS) measurements and breathlessness (Borg scale) were recorded at baseline and at each dose of MCh. Lung volumes were measured by body plethysmography at baseline and MAX. Responses from baseline to a 20% decline in FEV1 (PC20) or MAX, and between visits with or without DIs were compared using paired t-tests. Between group differences were assessed by analysis of variance. Results: 19 subjects (14 female; 45.1±13.1 years (MEAN±SD)) completed the protocol (n=8 CA, n=7 CVA, and n=4 COUGH). At the dose nearest to PC20, the DI index was positive in all 3 groups, indicating preserved bronchodilation (CA: 0.88±0.67; CVA: 0.33±0.39; COUGH: 0.016±0.46; P=.0.076). There were no significant differences in: the Δs in spirometry, lung volumes, airway resistance, IOS measurements, closing indices, the DI index, or dyspnea when the single dose of MCh was preceded either by five DIs or by DI avoidance in CVA and COUGH. DIs in CA resulted in greater Δs in mid-to-late flows. Conclusion: The bronchodilating effect of DIs is preserved in CA, CVA and COUGH. The bronchoprotective effect may fall along a continuum. A larger study including subjects with more severe CA is required to definitively test the hypotheses. / Thesis (Master, Physiology) -- Queen's University, 2014-06-28 11:23:29.814